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Health Plans Moving to Pay for Performance, Study Shows
HHS
Creates Task Force to Encourage Medical Technology Innovation
Sen.
Kennedy Introduces Bill to Improve Health Quality
CAQH
Study Finds Decline in Beta Blocker Use After First Year
Patients
of Color Less Likely to Trust Physician Specialists
Consortium
Issues Clinical Practice Guidelines For Quality Palliative Care
Adult
Immunization Week to be Held Sept. 26-Oct. 2
Chronic
Care Saves Money in Heart Patient Study
RAND
Study Finds Patients With Chronic Conditions Cut Use Of Preventive Drugs
When Drug Co-Payments Double
CHCF
Releases Report on Disease Registries
More
Health Plans Moving to Pay for Performance, Study Shows
Health plans
increasingly are dangling a carrot—higher payments—to get
physicians and hospitals to improve patient care, according to a study
released by the Center for Studying Health System Change (HSC).
“Pay-for-performance
initiatives are just getting off the ground in most communities, but they
can provide a springboard for broader acceptance of tying physician and
hospital payments to quality improvement,” said Paul B. Ginsburg,
Ph.D., president of HSC, a nonpartisan policy research organization funded
principally by The Robert Wood Johnson Foundation.
The study’s
findings are detailed in a new HSC issue brief—Paying for Quality:
Health Plans Try Carrots Instead of Sticks. The study is based on
HSC’s 2002-03 site visits to 12 nationally representative communities:
Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little
Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix;
Seattle; and Syracuse, N.Y.
“Health
plan-based quality incentive programs exist in seven of the 12 HSC communities,
and most programs are sponsored by major health plans—those with
large market share and, therefore, significant influence over providers,”
said HSC Research Analyst Bradley C. Strunk, coauthor of the study with
Robert E. Hurley, Ph.D., an HSC consulting researcher from Virginia Commonwealth
University.
A key recommendation
in the Institute of Medicine’s Crossing the Quality Chasm report
was to align payment policies with quality improvement. Quality incentive
programs across the HSC communities varied on three key design features:
quality measurement, incentive payment structure and incentive size:
For more
info, www.hschange.org/CONTENT/675.
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HHS
Creates Task Force to Encourage Medical Technology Innovation
HHS Secretary
Tommy G. Thompson has announced that the department is forming an internal
task force to weigh new ideas and promote new solutions to encourage innovation
in health care and to speed the development of effective new medical technologies,
such as drug and biological products and medical devices
The task
force will involve HHS’ Centers for Disease Control and Prevention
(CDC), Centers for Medicare & Medicaid Services (CMS), Food and Drug
Administration (FDA) and National Institutes of Health (NIH). Secretary
Thompson has charged the task force with issuing a report this year on
appropriate steps that can be taken across the department to speed the
development and availability of new medical technologies.
“This
task force will look for opportunities across the department to promote
speedier access to new innovative medical technologies that can improve
people’s health and save lives,” Secretary Thompson said.
“Often, a new technology must clear several hurdles in different
parts of HHS before it can reach consumers. By better coordinating this
process across HHS, we can streamline the way we do business and make
safe, effective medical technologies more quickly and readily available
to Americans who could benefit from them.”
To assist
the task force’s efforts, HHS is seeking comments from the public
on how to stimulate innovation in medical technologies. HHS will accept
comments until August 23. A notice explaining the comment period and how
to file comments will be published in the Federal Register on Monday,
May 24. Electronic comments will be accepted at www.fda.gov/dockets/ecomments.
The task
force’s efforts will build on similar efforts underway at the FDA
and other agencies, with a goal of improving coordination across agencies.
The task force’s participants will include CDC Director Julie Gerberding,
M.D.; CMS Administrator Mark B. McClellan, M.D., Ph.D.; Acting FDA Commissioner
Lester M. Crawford, D.V.M., Ph.D.; and NIH Director Elias A. Zerhouni,
M.D. Dr. Crawford will serve as the task force’s chair.
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Sen.
Kennedy Introduces Bill to Improve Health Quality
Sen. Edward
M. Kennedy (D-MA) has introduced legislation that seeks to improve quality
through financial incentives, give greater focus to disease prevention,
and boost efforts for modern technology in health care.
The bill,
the “Health Care Modernization, Cost Reduction, And Quality Improvement
Act” would establish a National Quality Council along with initiatives
on diabetes, stroke, arthritis, nutrition, exercise, adult oral health,
adult immunizations, and the provision of culturally and linguistically
appropriate care for patients whose primary language is not English.
“The
legislation we are introducing is an effective way to modernize and improve
the health care system, by using modern information technology, by paying
for value and results and not simply for procedures performed or patients
admitted to hospitals, and by focusing on improving quality and preventing
disease,” Kennedy said in announcing the legislation.
For more
info, kennedy.senate.gov.
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CAQH
Study Finds Decline in Beta Blocker Use After First Year
Less than
half of heart attack survivors continue taking beta-blockers during the
first year after the attack, sacrificing the lifesaving benefits of the
drug, according to a study conducted by the Council for Affordable Quality
Healthcare (CAQH). Researchers further found that continued patient-doctor
communication was key to adherence.
The findings
were presented this past week at the American Heart Association’s
Second Annual Scientific Conference on Compliance in Healthcare and Research.
CAQH said it was one of the largest studies of long-term beta-blocker
adherence to date,
Researchers
performed a retrospective analysis of one-year survivors of myocardial
infarction and measured adherence during the first year post-MI. The study
surveyed 17,035 patients in 46 states and the District of Columbia. Data
was collected through calendar year 2002.
Duke Clinical
Research Institute independently analyzed and presented the results. The
finding is significant because of the proven benefits of beta-blockers
to heart attack survivors. According to guidelines published by the American
Heart Association and the American College of Cardiology, the long-term
use of beta-blockers after a heart attack can reduce the risk of another
heart attack and increase the probability of long-term survival by up
to 40%.
More than
90% of heart attack patients are prescribed beta-blockers within seven
days of leaving the hospital, according to the National Committee for
Quality Assurance (NCQA). However, the new CAQH data showed that only
69% of patients took beta-blockers regularly during the first 30 days
after their hospital discharge.
Subsequently,
the study found that the rate continued to decrease. Over the six month
period after the heart attack, only 52 percent of patients had regularly
taken beta-blockers. Looking at the first year after a heart attack, only
45 percent of heart attack survivors had continued taking the therapy
regularly.
“This
finding raises great concern,” said Judith Kramer, MD, the lead
author of the study and principal investigator of the Duke Center for
Education and Research on Therapeutics (CERTS) at the Duke Clinical Research
Institute. “While we have made significant progress in the frequency
of doctors prescribing beta-blockers at discharge after MI, we have not
been successful at getting the patients to stay on this life-saving therapy.”
Notably,
all the patients surveyed had prescription coverage. Researchers found
that 80% of the patients were covered by commercial insurance plans, and
20% by a Medicare+Choice plan.
If CAQH
findings are extrapolated to the whole U.S. population, it would mean
that more than half of approximately 7.5 million heart attack survivors
in the U.S. do not take a beta-blocker regularly, skipping an effective
step to decrease the risk of another heart attack and death from cardiovascular
disease. Of the approximately 1.1 million heart attack cases reported
in the U.S. each year, 450,000 are recurrences.
To better
understand why patients stop taking beta-blockers, CAQH conducted additional
qualitative research among patients and physicians. The findings revealed
a substantial gap in doctor-patient communication, which appeared to significantly
contribute to the survivors’ failure to maintain their beta-blocker
regimens long-term.
The research
showed that many heart attack survivors are not aware of the life-saving
benefits of beta-blockers or do not realize that in order to achieve these
benefits they must continue to take the medicine indefinitely.
While most
physicians believe beta-blocker use is an essential part of recovery and
say they would not discontinue beta-blocker treatment except in extreme
cases, patients do not seem to appreciate the importance of staying on
beta- blockers. At the same time, patients are often concerned about taking
a medication for life, but their concerns may not be raised in discussions
with their doctors.
“It
appears that at some point in treatment patients begin to mistakenly believe
they no longer need the drug. Heart attack survivors are much more open
to maintaining beta-blocker therapy indefinitely if they understand how
the medication works and the benefits of the drug,” commented John
Charde, M.D., co-author, and vice president of Health Improvement for
Health Net.
For more
info, www.caqh.org.
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Patients
of Color Less Likely to Trust Physician Specialists
Black patients
are less likely than white patients to trust physician specialists, according
to a study published in the May 10 edition of the Archives of Internal
Medicine.
Researchers at Brigham and Women’s Hospital and Harvard Medical
School, for the first time, analyzed patient care experiences and levels
of patient trust after visits with medical specialists. The study found
that almost 80% trusted their specialist, but less than two-thirds of
black American patients reported complete trust in the specialist physician
after the initial visit.
To date,
research on patient trust has been limited to primary care providers.
This research finds that levels of trust in specialist physicians are
similar to that of primary care physicians, and identifies elements of
the patient-physician interaction associated with increased trust in specialists.
The data suggest that improving communication during the visit may help
medical specialists form trusting bonds with new patients thereby enhancing
patient outcomes through continued care. However, this research also exposes
a population that is not responding to current practices, which indicates
that physician communication needs to be evaluated in this context.
“Other
studies have shown that patients with greater trust in their physicians
are more likely to adhere to clinical recommendations. Establishing a
trusting bond during the initial visit is imperative for specialists to
provide optimal treatment for his or her patient,” said lead author
Nancy L. Keating, MD, MPH of BWH and Harvard Medical School. “This
study suggests that by listening and communicating effectively with patients,
physicians may promote more trust. This may be particularly important
during visits with black American patients, who were less trusting overall
than whites.”
Researchers
reviewed survey information from 424 patients who visited a specific cardiologist,
neurologist, nephrologist, gastroenterologist or a rheumatologist for
the first time. Two weeks after the initial visit, the patients were surveyed
about their experiences during that visit. Of the patients surveyed, 79%
indicated that they completely trusted their medical specialist. Within
this population, 81% of white Americans indicated that they had complete
trust in their medical specialist while only 63 % of black Americans reported
similar levels of trust.
Patients
who reported the following positive experiences during their visit with
the specialist were more likely to report complete trust in that specialist
if:
- The
specialist listened
- Patient
received as much information as he or she wanted
- Patient
was told what to do if problems or symptoms continued, got worse, or
returned
- Patient
was involved in decisions as much as he or she wanted
- Patient
spent as much time as he or she wanted with the specialist
For more
info, http://archinte.ama-assn.org/cgi/content/abstract/164/9/1015.
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Consortium
Issues Clinical Practice Guidelines For Quality Palliative Care
The National
Consensus Project for Quality Palliative Care, a consortium of five palliative
care organizations, has released a set of clinical practice guidelines
to promote quality palliative care in the U.S.
The “Clinical
Practice Guidelines for Quality Palliative Care” seek to support
quality and reduce variation in new and existing programs; develop and
encourage continuity of care across settings; and facilitate collaborative
partnerships among palliative care programs, community hospices and a
wide range of other health care delivery settings. The project is an initiative
of the American Academy of Hospice and Palliative Medicine, Center to
Advance Palliative Care, Hospice and Palliative Nurses Association, Last
Acts Partnership, and National Hospice and Palliative Care Organization.
For more
info, www.nationalconsensusproject.org/guidelines.html
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Adult
Immunization Week to be Held Sept. 26-Oct. 2
The National
Foundation for Infectious Diseases (NFID) and the National Coalition for
Adult Immunization have set the date for National Adult Immunization Awareness
Week this year as September 26 to October 2. This year’s theme is
“Immunization: Building a Pathway to a Healthy Tomorrow.”
Organizers
hope the new, earlier date will allow immunizers and the general public
to better prepare for the start of influenza season, which typically begins
in October.
For more
info, www.nfid.org.
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Chronic
Care Saves Money in Heart Patient Study
A study
of chronically-ill elderly heart patients showed that those who received
specialized nursing care during their hospital visits and at home had
fewer hospital readmissions.
While the
specialized care initially costs more money, it ultimately resulted in
a 38% savings for Medicare, the study showed, because of the reduction
in hospital visits.
The study,
conducted by the University of Pennsylvania and funded by the National
Institutes of Health’s nursing research unit, appears in the May
2004 issue of the “Journal of American Geriatrics Society.”
The research
focused on elderly heart patients, who typically have the highest rates
of hospitalization at a cost of about $24 billion annually.
The research,
led by Mary Naylor, a nursing professor at the University of Pennsylvania,
compared two groups of elderly heart patients in the Philadelphia area.
One group received traditional medical care while an advanced practice
nurse followed the other group for a year. That nurse coordinated the
care received by patients and visited the patient in the hospital and
at home.
The costs
of being followed by an advanced practice nurse was almost double that
of the patients in the “routine” care group. Those costs,
however, were more than offset by a drop in hospital admissions among
the group receiving the higher level of coordinated care. On average taxpayers
were saved $4,845 per patient annually.
Heart patients
often suffer from other illnesses such as depression and diabetes that
can land them back in the hospital after originally being admitted for
their heart conditions. When patients are discharged they are often left
to handle their own care, which can include taking multiple prescription
drugs and visiting several doctors.
The potential
savings demonstrated as part of the study is so great that a large health
insurance company is looking to adopt Penn’s model of care for a
test program that is expected to be launched this summer in the Mid-Atlantic
region.
“We
are trying to translate this body of research into practice,” she
said. Naylor was also recently in Washington to brief federal officials
on her work.
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RAND
Study Finds Patients With Chronic Conditions Cut Use Of Preventive Drugs
When Drug Co-Payments Double
When the
amount patients pay for prescription drugs doubles, patients cut their
use of common drugs for chronic diseases such as diabetes, asthma and
gastric acid ailments by as much as 23%, according to a study issued by
RAND Corp. researchers.
According
to the study in the May 19 edition of the Journal of the American Medical
Association, people being treated for diabetes cut back on drugs to treat
diabetes (except insulin) by 23 percent when their out-of-pocket payments
doubled, while those treated for asthma cut use of drugs to treat asthma
by 22 percent. People with gastric disorders cut use of related drugs
by 17%.
RAND Health
researchers found preliminary evidence that patient health suffers as
patients with some chronic illnesses cut back on their medicines. For
example, as the use of prescription drugs dropped, visits to hospital
emergency rooms increased 17% and hospital stays rose by 10% among patients
with diabetes, asthma and gastric acid diseases, according to the study.
The study
was sponsored by the California HealthCare Foundation (CHCF), with additional
funding from Merck & Co. and the U.S. Agency for Healthcare Research
and Quality.
In a previous
report, RAND researchers found that increasing co-payments for prescription
drugs caused patients to reduce their use of medications and switch to
lower-cost drugs. But they wanted to know whether the changes cut use
of drugs that are necessary for controlling symptoms and preventing complications
of common diseases.
Goldman
and his colleagues studied the experiences of nearly 530,000 privately
insured non-elderly adults from 1997 to 2000 who were covered by one of
52 health insurance plans provided by 30 different employers. They examined
how the use of eight therapeutic classes of drugs changed when co-payments
for prescription medicines doubled. Most other studies on the effects
of rising drug plan co-payments have focused on elderly patients or older
plan arrangements.
The drugs
they studied are used to treat high blood pressure, elevated cholesterol,
depression, arthritis, asthma, allergies, diabetes and gastric acid disorders,
including ulcers. The drugs studied account for about half of all the
drugs used by the group over the study period.
Use of all
of the drugs dropped, particularly for medications where there are close
over-the-counter substitutes such as antihistamines used to treat allergies
and pain medicine used to treat arthritis, each of which dropped by about
45%.
Patients
generally were less likely to reduce use of a drug if they were receiving
ongoing care from a physician for the disorder. For example, patients
who had seen a physician two or more times over the previous year for
high blood pressure reduced their use of anti-hypertension drugs by just
10 percent when co-payments doubled, while their use of other drugs dropped
27%.
Spending
on outpatient prescription drugs has increased at double-digit rates for
the past decade and now is the third-largest component of health care
costs, after hospital care and physician services.
In an attempt
to control those costs, many insurance plans have increased co-payments
or adopted incentive-based programs where drugs are placed in different
tiers. Co-payments depend on the tier where a drug is placed. Generics
typically have the lowest co-payments, with the co-payments higher for
name-brand drugs. An increasing number of plans have added a third tier
by creating a list of preferred name-brand drugs.
Collaborating
on the study were Jose J. Escarce, Jennifer E. Pace and Matthew D. Solomon,
all of RAND; Marianne Laouri of the California HealthCare Foundation (now
with Genentech); and Pamela B. Landsman and Steven M. Teutsch of Merck
& Co.
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CHCF
Releases Report on Disease Registries
To inform
decision-making related to choosing a disease registry product, the California
HealthCare Foundation (CHCF) released its latest iHealth Report, Chronic
Disease Registries: A Product Review on May 20.
Chronic
diseases are placing a growing burden on the health care system in the
United States. As a result, provider organizations are seeking new strategies
for effectively managing individuals and populations with one or more
chronic disease. One such strategy is to implement computerized disease
registries, systems that capture and track key patient information to
assist care team members in proactively managing patients with chronic
diseases such as asthma and diabetes.
“By
tracking key patient information, a disease registry helps physicians
and other members of their team provide the right care at the right time.
It is an important tool in better preparing for visits and assuring follow-up,”
said Sophia Chang, M.D., M.P.H., director of CHCF’s Chronic Disease
Program.
The report,
prepared for CHCF by NAS Consulting Services, helps physicians, medical
groups, and other organizations considering the purchase or adoption of
an electronic registry application. It provides an overview of stand-alone
electronic registry products that are publicly and commercially available
and describes 16 of those products in detail. Important decision criteria
are outlined to help providers choose the most appropriate product. The
report helps providers identify the best options by offering details on
functionality strengths, weaknesses, and cost.
For background
information on disease registries, see CHCF’s recently published
Using Computerized Registries in Chronic Disease Care. The report
provides an overview of the function and use of computerized disease registries
and outlines issues for consideration in obtaining registry software and
integrating registry products into the routine work of the physician practice.
Both reports
may be found at www.chcf.org.
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