Vita Advisors

Deloitte Physician Survey

Kevin Roche — Tue, 21 May 2013 12:00:05 +0000

Physicians remain the linchpin of the American health system, since they control access to many services. How they feel about the health system and their situation is therefore important. A Deloitte Center for Health Solutions survey took stock of current attitudes on a number of subjects. (Deloitte Survey) Most doctors, 70%, are satisfied with practicing medicine, with satisfaction higher among specialists and younger physicians. The most satisfying parts of their work are patient relationships and the promotion of health among patients. The least satisfying are long hours and less time for each patient. Almost 60%, however, express concern about the future of the health system and medicine and think many doctors may retire early. Doctors generally believe ACOs have some ability to improve care and in general find a tradeoff between more economic security working in large organizations and clinical autonomy in smaller practices. Almost half of physicians expect their income to decrease as a result of the reform law. Most expect the reform law to continue to be rolled out as planned, with largely negative consequences. Doctors are concerned about Medicare reimbursement and many would limit seeing Medicare beneficiaries if reimbursement does not improve. Generally they expect the trend toward consolidation with larger health systems to continue. More so than other surveys, this one suggests that most doctors are satisfied with their EHRs, but largely because of improved billing and time savings through e-prescribing, as well as better care coordination. Most doctors believe patient lifestyles have a major effect on health costs, and they think that properly designed incentives can help encourage wellness activities.

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Kevin Roche — Mon, 20 May 2013 15:48:41 +0000

Quest Labs has purchased the lab capabilities of Concentra, owned by Humana, and secured an exclusive contract to provide lab services for its clinics.

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Kevin Roche — Mon, 20 May 2013 14:47:24 +0000

The Wall Street Journal reports that many employers, especially those with large numbers of low-wage workers, are considering bare-bones insurance poli

Implications of a Health Spending Growth Slowdown

Kevin Roche — Mon, 20 May 2013 14:45:01 +0000

The notion that health spending growth in the United States is slowing, perhaps permanently, is becoming an increasing topic among policymakers. The most recent issue of Health Affairs is devoted largely to health costs and one article discusses the possible implications of a longer-lasting reduction of the rate of growth. (HA Article) For government spending, forecasting the rate of growth is critical and CMS and CBO have reduced near-term forecasts for spending increases, largely because of the slowness of economic growth. If the slowing rate of growth extended for longer, the authors believe that spending could be $770 billion lower than currently believed. The authors find a close correlation between income growth, national GDP growth and health spending and suggest that the recession accounted for about 37% of the spending growth slowdown. Other contributors were differences in payers, primarily a shift to more Medicare and Medicaid, which determine prices by fiat or political wrangling, and Medicare reimbursement changes. However, about 55% is unexplained, which leaves everyone wondering if something more permanent has changed in health utilization or pricing. If the economy does return to more robust growth, according to most models, health spending will increase at least proportionately, if not more. Other factors may also be more one-time, as opposed to ongoing changes that permanently lower the growth rate. But maybe Americans are behaving in more healthy ways and are more cautious about running to the doctor. And the effect of cost-shifting in private insurance may not be fully appreciated. And growth in new technologies and treatment methods may have leveled off as well. There certainly are fewer blockbuster drugs. It would be a great boon to public finance if health spending increases are permanently lower, but we simply don’t know that this is the case yet.

The World According to Physicians and Nurse Practitioners

Kevin Roche — Fri, 17 May 2013 14:50:43 +0000

There is concern about the adequacy of primary care provider supply, particularly in light of the impending expansion of coverage, and there is concern about controlling health spending. One approach to addressing each is to expand the number and role of alternative primary care providers, like nurse practitioners and physician assistants. Physicians, however, have typically zealously guarded their turf. A survey of 505 doctors and 467 nurse practitioners reported in the New England Journal of Medicine reveals a wide gulf in the groups view of their value and place in the system. (NEJM Article) Nurse practitioners are significantly more likely to be female and white than doctors and they have a substantially lower annual income. About 81% of nurse practitioners work in physician practices but only 41% of doctors work in practices with nurse practitioners. Nurse practitioners see about 20 fewer patients a week and work around 8 hours a week less. About 25% of nurse practitioners feel they cannot practice to the full extent of their training due to restrictive state laws or other factors. There were very significant differences in views on the role of nurse practitioners, for example, 82% of NPs thought they should be able to lead medical homes and only 17% of doctors agreed. While 64% of NPs think they should be compensated equally to doctors for the same services, only 4% of physicians hold that view. And 66% of physicians think they provide a higher quality of service than NPs for the same type of primary care visit, but only 5% of NPs agree. Physicians hold much less positive views about the effect of expanding the supply of NPs on the quality of health services. All of this suggests that many doctors are as yet unwilling to surrender their opposition to further expansion of the role of NPs. The research, of course, strongly supports the notion that nurse practitioners provide at least equivalent quality, at a lower cost.

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Kevin Roche — Fri, 17 May 2013 14:01:20 +0000

A Congressional Budget Office blog post gives the latest estimate of the net cost of the coverage provisions of the reform act, and examines changes in those projections over time.

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Kevin Roche — Fri, 17 May 2013 13:56:43 +0000

According to the Congressional Budget Office almost any likely fix to the current Medicare physician payment scheme is likely to add significantly to Medicare spending.

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Kevin Roche — Fri, 17 May 2013 12:56:57 +0000

According to Mark Farrah Associates, Medicare supplement enrollment continues to be strong with over 10 million people covered by the policies, which are controversial in some circles because of a perception that they may encourage overuse of services.

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Kevin Roche — Thu, 16 May 2013 14:30:34 +0000

A new report from PWC suggests that employer-based insurance will still be strong after full implementation of the reform law, basing its analysis on the experience of Massachusetts, however different industries had different apparent reactions to the reform law there.

Has the Cost Curve Bent?

Kevin Roche — Thu, 16 May 2013 14:20:17 +0000

It was anticipated that the recent deep recession and weak recovery would impact health spending, since that typically happens in economic downturns. Recent research suggests that perhaps this slowdown will continue and lead to a sustained lower growth rate in coming years. (HA Article) From 2009 to 2011 per capital national health spending grew about 3% annually, compared to 5.9% in the previous 10 years. It should be noted that this is still in excess of GDP growth or general inflation. Looking at a population of ten million members with coverage from large employers over a five year period, the authors attempted to ascertain what factors might account for the lower growth rate. The researchers specifically focused on job loss and benefit changes that shifted costs to employees as potential factors. The authors found that between 2007 and 2009 spending in large firms grew more rapidly than in the country as a whole, but in 2010 this pattern reversed and growth in large firm spending remained low in 2011. It appears that increased out-of-pocket costs for employees was responsible for about 20% of the spending slowdown, which leaves a large part unaccounted for. The authors suggest this is not likely linked to economic factors, which they interpret as meaning that the slowdown is more likely to endure.

The extent to which spending growth will remain relatively low will be confounded this year and next as the health reform law is fully implemented, with general expectations that spending will rise. Provider consolidation has also continued apace which may will not likely have a beneficial effect on costs. On the other side, reform may bring even more people under high-deductible, high co-pay benefit designs, which do appear to have a sustained effect on people’s use of health services, although the effect of the reduced use of services on health outcomes is as yet unclear. One category of health spending, drugs, has sharply lowered its growth rate, largely due to use of generics, but new specialty medications and fewer drugs coming off patent are likely to end that trend. So it likely is premature to declare victory on excessive health spending growth. We’ll know more in 2015.