What’s going on in Pennsylvania?

It’s 2008. There are thousands of really smart people working to change the delivery of health care, reduce inappropriate use, and improve outcomes.
But in one state, things aren’t getting better – they are getting worse. (I’m not picking on Pennsylvania; they just have the misfortune of being in the news more than other states lately)
A study of admission rates in Pennsylvania found that patients with chronic conditions are being admitted to the hospital more often. The analysis focused on HMO members with diabetes, asthma, and/or hypertension and the result is particularly troubling as these conditions are responsible for a large percentage of US health care costs.
Notably, these HMOs have also been lauded for their effectiveness in delivering preventive care, care that should help reduce the number of admissions for these conditions.
Previous studies indicate that effective primary care can dramatically reduce the number of admissions for these conditions. And further reductions can be achieved by implementing quality improvement programs, programs that have well-documented results.
So we’re left with the conclusion that despite the fact that we know how to keep patients with chronic conditions out of the hospital, admission rates are going up. And Pennsylvania is not particularly bad – there are a dozen other states that spend a lot more money on inpatient chronic care than the national average.
Can you sense the frustration?


Wasted dollars

Alex Swedlow and the good folks at CWCI have published a study that clearly demonstrates the amount of waste in the US health care system, waste generated by nothing other than greed and lousy medicine. While the analysis focused on workers comp, the lessons cross all coverage.
The great thing about workers comp is that unlike health insurance, payers are actually concerned about and financially motivated to ensure claimants get the amount and type of care needed to help them recover and get back to work. And there is a wealth of data to evaluate the effects of medical treatment on RTW.
California changed its workers comp rules a few years ago to limit the number of physical or occupational therapy or chiropractic visits a claimant would get covered by workers comp. The limit was 24 (for each, not together), which all the data suggest is more than adequate to take care of 90%+ of WC medical conditions – surgical or non.
So, what happened?
The average number of PT, OT, or chiro visits per patient dropped by almost half, and the number of patients with more than 24 visits dropped from 30.4% to 9.7% (a decline of 68%). Costs declined dramatically as well.
But did this lead to poorer outcomes?
The results, while encouraging, are not as clear.
While there are data from California that appear to show reductions in the length of disability, the results are muddled by a cap on benefit payments that was also part of the WC reforms. The duration of disability (the length of time claimants were out of work) did decline post-reform. Comparing disability duration two years post-injury, the median length of disability declined by 21.4% (average was down 17.4%).
My sense is the reduction in physical medicine visits contributed to the drop in disability duration – without endless visits to PTs and Chiros to receive ‘care’ that was not helping them recover but merely extending the process, claimants were more likely to be released to return to work.
There’s a lesson here for the non-workers comp world, and policy wonks in particular. It is this – providers overtreat, to the detriment of the patient and the payer. Draconian measures such as flat limits on the amount of treatment do work.
With health reform on the horizon, here’s a great example of the waste in our health care ‘system’, waste that benefits the provider.


How does Oregon do it?

Oregon’s workers comp system is a success.
It is 42nd lowest in insurance rates and among the highest benefits for injured workers in the nation.
Premium rates have not gone up for eighteen (18) years.
Costs have declined 50% during that time.
Here are some of the factors behind that success.

Continue reading How does Oregon do it?


The VA’s been cooking the books

Richard Eskow of Sentinel Effect reports on the latest revelations about a bit of book-cooking at the VA. Seems the VA has been a bit, or perhaps more than a bit, overly positive about its record.
More troubling than boosterism is the allegation that the VA selectively reported results, and even fabricated conclusions to make the system appear better than it actually is.
As a fan of the VA, I’m concerned about two things.

Continue reading The VA’s been cooking the books