The Robert Wood Johnson Foundation recently issued a study concerning “Demystifying U.S. Health Care Spending.” According this study,

Technology—not demographics or medical malpractice—is the key driver of health spending, accounting for an estimated half to two-thirds of spending growth.

Other important drivers of health care spending include health status (particularly obesity) and low productivity gains in the health care sector.

The Wall Street Journal offered its take on health care technology in today’s paper, suggesting that healthcare technology has been an investment that soon may pay dividends:

IT security will eventually meet the expectations of the health-care industry, just as has happened in other sectors, like banking. And when it does, powerful IT networks crisscrossing the globe will change the way much of health care is delivered: Outsourcing and offshoring of medical and nonmedical services will increase, providing more efficient health care at the most cost-effective rates; systems integrations will allow more medical records to be transferred swiftly and securely; efforts to monitor the safety of medicines will gain global access to data; and professionals and patients will find authoritative and up-to-date information on every specialty online.

The Center for Studying Health Policy Change published a report on patient activation or rather the level of patient involvement in their own health care. According to the Center,

“[b]ecause activation levels are linked to important outcomes, such as seeking care, seeking information and health behaviors, and because it is a changeable attribute, it is a potentially important lever for change. * * * Because activation is changeable and provider support appears to be a factor, incentivizing or holding health care delivery systems and providers accountable for patient gains in activation is a possible policy direction.”

In this regard, it’s worth noting a Kaiser Family Foundation poll surprisingly finding that

three in 10 (30%) Americans say they have seen health care quality comparisons of health insurance plans, hospitals, or doctors in the past year. Not all people make health care choices or decisions in a given year that would call for the use of quality information, but this is a downward trend from surveys in 2006 (36%) and 2004 (35%) and roughly equivalent to the level in 2000 (27%). Further, just one in seven (14%) Americans report that they “saw” and “used” comparative health quality information for health insurance plans, hospitals, or doctors in the past year, again down from roughly one in five in both 2006 (20%) and 2004 (19%).

• Audiologists are licking their chops over the enhanced hearing benefits that FEHB plans are offering in 2009.
• Morpace issued a “study, fielded in September, reveals that 48 percent of American adults
  support creation of a nationwide system of medical records, while 23
  percent oppose such a system.” 29 percent are undecided. The National Health Information Network currently underdevelopment would serve a national electronic patient registry. Unquestionably, privacy protections must be extended to the NHIN and its components. Perhaps a greater issue connected with electronic health records is their longevity. I doubt that anyone could find my childhood medical records but if a child born in the next decade could have cradle to grave medical records accessible through the NHIN. I’m not sure that’s a good idea. Your doctor need to know your relevant medical history. It might be difficult for a doctor to discern that history from all of the records available via the NHIN.
• EBRI issued its 2008 health confidence survey.
• Health Grades issued its 11th annual hospital quality study. “Patients have on average a 70 percent lower chance of dying at the nation’s top-rated hospitals compared with the lowest-rated hospitals across 17 procedures and conditions” analyzed in the study. “The study’s major findings are:
  • The nation’s inhospital risk-adjusted mortality rate improved, on average, 14.17 percent from 2005 to 2007, but the degree of improvement varied widely by procedure and diagnosis studied (range: 6.30% to 20.94%). Five star-rated hospitals’ mortality rates continue to improve at a faster rate (13.18%) than 1- or 3-star hospitals (12.30% and 13.14%, respectively).
  • Large gaps persist between the “best” and the “worst” hospitals across all procedures and
  diagnoses studied. Five star-rated hospitals had significantly lower risk-adjusted mortality across all three years studied. Across all procedures and diagnoses studied, there was an approximate 70 percent lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital. Across all procedures and diagnoses studied, there was an approximate 50 percent lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average.
  • If all hospitals performed at the level of a 5-star rated hospital across the 17 procedures and diagnoses studied, 237,420 Medicare lives could have potentially been saved from 2005 to 2007.
  • Fifty-four percent (128,749) of the potentially preventable deaths were associated with just four diagnoses: Sepsis, heart failure, pneumonia and respiratory failure.
  • Variation in risk-adjusted mortality exists not only at the national level but also at the state and regional levels. The greatest quality differences between states occurred in hospital death rates for heart failure, pulmonary, stroke and cardiac surgery.
  • The region with the lowest overall risk-adjusted mortality rates was the East North Central region (IL, IN, MI, OH, and WI), while the East South Central region (AL, KY, MS, and TN) had the highest mortality rates.
  • The East North Central region (IL, IN, MI, OH, and WI), had the highest percentage of bestperforming hospitals at 26 percent. Less than seven percent of hospitals within the New England region (CT, MA, ME, NH, RI, and VT) were top-performing hospitals.”

Government Health IT reports today on yesterday’s HHS-sponsored medical ID theft town hall meeting:

Emboldened by the lure of easy money, medical identity thieves have adopted sophisticated ruses, said Gary Cantrell, director of computer forensics investigations in the Health and Human Services Department’s Office of Inspector General.

One scam involves collecting information about health care providers from sources such as the National Provider Identifier registry. Thieves use the data to bill for services never delivered at health care facilities that never existed. In recent years, investigators have recovered several billion dollars in restitution.

That amount is “probably the tip of the iceberg,” Cantrell said.

According to HHS, a “report and roadmap summarizing health IT and medical identity theft issues raised at the town hall will be released in Winter 2008 – 2009 and will set forth possible next steps for the Federal government and other stakeholders in order to work toward prevention, detection, and remediation of medical identify theft.”

HHS has proposed requiring HIPAA covered entities to implement the new X12 5010 transaction standards on April 1, 2010 and the ICD-10 code sets on October 1, 2011. The comment period ends next Tuesday April 21. A broad coalition of industry members advocate adoption of the stretched out timeline recommended by two HHS advisors, NCVHS and WEDI.

The ICD-10 Coalition which is composed of the AMA and other health care provider associations has released a Nachimson Advisors report that finds that

• For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $83,290.
• For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $285,195
• For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as more than $2.7 million.

Accelerating the change will only increase the impact of the cost burden on providers and payors and could lead to a systemic meltdown as BCBSA has warned.

Healthcare IT News reports today that the CMS administrator gave Zen-like advice on this major issue:

“Be serious about the date.”
That’s the advice of Centers for Medicare and Medicaid Service Acting Administrator Kerry Weems, when asked Tuesday about how CMS could help drive the conversion of healthcare diagnostic and billing codes from ICD-9 to ICD-10 code sets.

• Last week, according to Business Insurance, the Internal Revenue Service issued guidance to employers (IRS Notice 2008-82) that interprets a new law permitting employers to allow reservist employees called to active duty for 180 days or more to withdraw their health care flexible spending account balances as taxable cash distributions. Prior to enactment of this law, such employees often forfeited their balances because they became eligible for Tricare with no premium contribution obligation. The IRS Notice explains that
  

  Notwithstanding the general rule that amendments to cafeteria plans and health FSAs may only be effective prospectively from the date of the plan amendment and that a QRD may not be made before the cafeteria plan is first amended to provide for QRDs, a plan may be amended retroactively to permit QRDs requested on or before December 31, 2009, provided that the QRD satisfies the other requirements in this notice. The retroactive amendment must be made by December 31, 2009, and be effective retroactively to the date of the first QRD paid under the plan, but not prior to June 18, 2008.

• CMS announced on Friday that Medicare beneficiaries, their caregivers, and family members can begin to review 2009 Medicare prescription drug plan and health plan information online through the Medicare Prescription Drug Plan Finder and Medicare Options Compare at www.medicare.gov.
• HHS’s Office of the National HIT Coordinator is holding a Medical Identify Theft Townhall this coming week. The all day meeting will be held on October 15th at the FTC Conference Center at 601 New Jersey Ave., NW, Washington, DC. RSVP: MedIDTheftTownHall@hhs.gov and indicate that you are planning to attend in person or by webcast.
• In an interesting development, Healthcare IT News reports that
  

  Microsoft, Scripps Health, Affymetrix and Navigenics will launch what the companies say is ground-breaking research to evaluate the impact of personal genetic testing on the health and psyche of a patient. The study will offer genetic scans to up to 10,000 employees, family and friends of Scripps Health system and will measure changes in participants’ behaviors over a 20-year period. Researchers will use healthcare IT to study genetic variations linked to many diseases.

Govexec.com provides advice on the upcoming FEHBP Open Season here.