Research Roundup: 'Pay-for-performance' unintended effects; Lessons from Mass.; End of life treatment

Archives of Internal Medicine: The Quality Of Care Provided To Hospitalized Patients At The End of Life - In this study, researchers used a set of quality indicators to assess the end-of-life care and pain management received by 496 patients who died three or more days after admission at the University of California-Los Angeles Medical Center. The authors found "pain assessments (94%) and treatments for pain (95%) and dyspnea  [breathing problems] (87%) were performed with fidelity." But they noted that "[t]he most striking area in need of quality improvement is communication between physicians and patients (or their families) as they initiate intensive treatments. Even after 48 hours in the ICU or on the ventilator, more than half of patients had no medical record documentation about goals of care or an attempt to pursue the topic," they report (Walling et al., 6/28).

Related KHN story on a separate study: Study Finds Doctors' Orders Help Patients Get Preferred End-Of-Life Treatment (Marcy, 7/2).

PLoS Medicine: Hospital Performance, The Local Economy, And The Local Workforce: Findings From A US National Longitudinal Study - Looking forward to the federal government's plans to implement a "pay-for-performance" system for hospitals, this study examines the association between hospital performance and local economic and human resources. "County-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004-2007" and hospital ratings for treating heart failure and heart attack were and analyzed.

The researchers conclude: "Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare's hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity" (Blustein, Borden and Valentine, 6/29).

More details about the study and related news coverage are in the June 30 Morning Report.

Health Affairs/Robert Wood Johnson Foundation: Paying Physicians For Medicare Services - Following Congress' decision last week to halt the scheduled 21.5 percent cut for physician fees under Medicare and instead give physicians a temporary 2.2 percent increase, this brief examines the history, ongoing challenges presented by Medicare's doctor payment formula and options for congressional action: "A permanent 'doc fix' that would override both pending and expected automatic cuts in future years could add as much as $276 billion to federal spending over the next decade. There is no agreement in Congress on how best to make the fix or on how to pay for it, whether by raising taxes, cutting other federal spending, or simply adding the amount to the federal deficit" (Merlis, 6/29).

Urban Institute: What Is the Evidence On Health Reform In Massachusetts And How Might The Lessons From Massachusetts Apply To National Health Reform? - "As in Massachusetts [the law passed in 2006], national reform includes expansions of public programs, the creation of health insurance subsidies for low- and moderate-income individuals, and requirement for employers, among other provisions." The author writes that "in 2008, 96 percent or more of [Massachusetts'] residents were estimated to have health insurance"; "compliance with the individual mandate is high"; and "the burden of health care costs was reduced under health reform, particularly for lower-income residents."

 "Massachusetts, however, is facing challenges as it moves forward with health reform. In particular, two trends that began prior to health reform continue to put pressure on the health care system in the state: gaps in provider supply, particularly for primary care, and escalating health care costs" (Long, June 2010).

Commonwealth Fund: Measuring the U.S. Health Care System: A Cross-National Comparison - This report compares the U.S. health system to those of 30 industrialized countries, based on more than 1,200 health system measures tracked by the Organization for Economic Cooperation and Development (OECD) in 2006. The authors report, "Health care spending per capita in the U.S. in 2006 ($6,714) was more than twice the median per capita expenditure of the 30 OECD industrialized countries ($2,880), and 50 percent greater than Norway ($4,520), the second-highest spending country."

While "American patients are among the most likely to receive procedures requiring complex technology, [t]he nation now ranks in the bottom quartile in life expectancy among OECD countries and has seen the smallest improvement in this metric over the past 20 years" (Anderson and Squires, 6/29).

More details about the study and related news coverage are in the June 30 Morning Report.