Studies examine health care use, quality

News outlets offered a variety of articles about health care use and quality.

The New York Times: A  new study finds "that more than half of the 354 million doctor visits made each year for acute medical care, like for fevers, stomachaches and coughs, are not with a patient's primary physician, and that more than a quarter take place in hospital emergency rooms. The authors of the study, which was published Tuesday in the journal Health Affairs, said it highlighted a significant question about the new federal health care law: can access to primary care be maintained, much less improved, when an already inadequate and inefficient system takes on an expected 32 million newly insured customers? ... Examining records of acute care visits from 2001 to 2004, the researchers concluded that ... more than half of acute care visits made by patients without health insurance were to emergency rooms" (Sack, 9/7).

Chicago Tribune: "The new federal health care law is bringing additional demands by insurance companies that doctors and hospitals be held to higher quality standards. While this push by insurers on quality implies that consumers will get better care because doctors and hospitals will be measured against the best performers, there may be an unintended consequence: It could leave patients with fewer choices of medical care providers, depending on which health plans they purchase" (Japsen, 9/4). 

The Wall Street Journal reports that a recent survey on employer-provided health care (from the Kaiser Family Foundation and Health Research and Educational Trust) also offered an insight into quality issues. "Just 34% of firms employing at least 200 people and 5% of firms employing between 3 and 199 people reported reviewing performance indicators of plans' clinical and service quality. ... On a conference call with reporters, HRET research director Megan McHugh said that in theory, if more big employers considered quality in their decisions, 'that could create competition and drive quality improvements.' She speculated that firms 'may simply be choosing health plans based on price'" (Hobson, 9/3). 

An August RAND Corp. study says retail health clinics can only expand as part of the national health system if federal policy finds a way to encourage more coordination between such clinics and primary care physicians, American Medical News, a publication of the American Medical Association, reports. "The study said more research is needed to determine how retail clinics fit within the health care system. But the study details policy implications to consider, including a change in reimbursement structures to offer incentives for care coordination among retail clinics, physicians and hospitals." The federal health department commissioned the study (Dolan, 9/6).

Kaiser Health News / The Washington Post reports on the increasing number of claims from hospitals for observation care that "include short-term treatment and tests to help doctors decide if the patient should be admitted for inpatient treatment. Medicare's guidance says it should take no more than 24 to 48 hours to make this determination. … Yet some hospitals keep patients under observation for days, and that decision can have severe consequences. Medicare considers observation services outpatient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when receiving inpatient care. And unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge" (Jaffe, 9/7).

The Boston Globe: "The heart patients at Springfield's Baystate Medical Center almost all thought the stents used to prop open their arteries would prevent a heart attack. But their doctors had told most of them before the procedure that it would do nothing more than relieve chest pain. This yawning disconnect between what doctors say and patients hear was reported in a study published yesterday in the Annals of Internal Medicine. Physicians say the communications gap extends to other types of elective treatments, as well, resulting in patient confusion and perhaps overuse of some procedures" (Cooney, 9/7).

Lexington Herald Leader: "More and more 'concierge' doctors in Central Kentucky are offering these top-flight services for a price — ranging from $1,500 to $4,200 a person annually on top of insurance premiums. Doctors leaving a traditional general practice say decreasing payments from insurance and shrinking Medicaid and Medicare reimbursements mean they have to take on more and more patients to stay afloat. That results, the physicians contend, in stressed doctors and a reduced quality of care" (Meehan, 9/7).