Schwitzer health news blog

More health care choices don't mean lower prices

In a study published in the journal Health Affairs (subscription required) and reported in the Star Tribune, there's another challenge to the notion that more choice in health care lowers costs.

Excerpts from the Star Tribune:

Going to a MinuteClinic is cheaper for patients than going to a physician's office or urgent care, but there is no evidence that the advent of the popular retail clinics reduced medical costs overall.

A study published today found prices charged by all providers rose by double digits over the four years tracked, a trend that went against the conventional wisdom that more providers leads to more competition and lower prices. ...

"The data does not support the idea that MinuteClinic or other retail clinics has had any negative impact on rising health-care costs," said the study's author, Dr. Marcus Thygeson, an associate medical director at HealthPartners.

Even if a large number of HealthPartners members switched to retail clinics, the immediate savings would be relatively small, Thygeson said.

What tends to happen, he said, is other providers will raise their charges to make up for lost revenue.

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The Downs side of health info on the Web

Longtime TV celebrity Hugh Downs is apparently promoting cures for just about anything. A website with his name and face on it proclaims "2,618 staggering breakthroughs" from "the greatest medical team ever assembled."

The site offers:

•bypass in a pill
• cure high blood pressure in hours
• Secret Super Vaccines Beat Prostate Cancer...Breast, Lung and Brain Cancer, Too!
• and much more.

The site says, "Hurry! You'll Never See This Offer on TV." Thank God.

Let's hope Downs didn't really lend (or sell) his name to this effort.

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Hospital ads and hospital hype

See Maggie Mahar's entry on the HealthBeat blog.

And for a little wisdom of the crowd, here is one online reader reaction to Maggie's post:

"Our local CBS station has a regular feature called "Breakthroughs Everyday" featuring one healthcare network. I've written to the news director at this station requesting, in the interests of fair and impartial journalism, that they also have a regular feature entitled "Failures Everyday" and start reporting on the stories of patients from the same hospital. No reply. ... The hospital PR has disgusted me for years."

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Big business in snoring and apnea

I've been waiting for someone to do a story on the amount of attention and money that's being spent on snoring and sleep apnea, and a USA Today story comes closest to what I've been waiting for.

The story explains that Medicare approved $571 million in payments for devices called continuous positive airway pressure (CPAP) machines last year, up from $291 million in 2004. The story explains that "Spending could grow even faster under a new federal rule that makes it easier for patients to get the devices by testing for sleep apnea at home rather than in a sleep testing lab."

The story raises some important questions:

Some experts warn there is a potential for unneeded prescriptions for CPAPs. "Are people getting treatment they don't need?" asks Fred Holt of the National Health Care Anti-Fraud Association, composed of health insurers and law enforcement groups.

"Not everyone with a diagnosis of sleep apnea needs CPAP," says Holt, an ear, nose and throat surgeon. "Weight loss, avoiding alcohol and sedatives at bedtime or changing sleep position could eliminate the problem for some."

For others, treatment involves sleeping with a mask connected to the CPAP machine, which blows air into the patient's nose, helping prevent obstruction to breathing.

Until this spring, Medicare would pay for CPAP machines only if a sleep center diagnosed patients with apnea. New rules say a diagnosis can be made with a test taken at home.

Opponents say home testing is less accurate. "To be adequately treated, you have to make sure patients are adequately diagnosed," says Mary Susan Esther, president of the American Academy of Sleep Medicine, a trade group representing sleep labs.

Proponents such as William Abraham, a sleep expert and chief of the division of cardiovascular medicine at Ohio State University, say the change makes it possible for more patients to get tested.

"By allowing home testing, perhaps Medicare is opening the floodgates," he says. Yet given the problems of untreated apnea, "it's not only the right thing to do, but may ultimately prove to be a cost savings."

Still, any time you hear about more testing, and with financial incentives to test and to treat, you should know that the risk for abuse, and for unnecessary testing, treatment and spending is high.

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Would you like first class or second class skin care?

In case you missed it, the New York Times last week reported on how dermatology "is fast becoming a two-tier business in which higher-paying customers often receive greater pampering." Excerpt:

"In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.

In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.

Dr. David M. Pariser, a dermatologist in Norfolk, Va., and the president-elect of the American Academy of Dermatology, said some practices did maintain preferential policies for cosmetic patients.

“The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message,� Dr. Pariser said.

At a time when dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases."

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More MRI & imaging centers - do we ever say "NO"?

A few days ago, the Star Tribune reported on plans for still another diagnostic imaging center in a Minneapolis suburb that has more MRI machines than in many entire countries. Excerpt:

Along a two-mile stretch of France Avenue in Edina, medical providers have installed so many powerful magnetic resonance imaging (MRI) scanners that radiologists joke that anyone driving through with a pacemaker should beware.

Come September, there'll be a new one. ...

Its opening is likely to reignite a debate on whether Minnesota has too many diagnostic imaging facilities, encouraging doctors to order unnecessary procedures and pushing up medical costs. It's also likely to raise the ethically thorny question of whether doctors should refer patients to a facility in which they have a financial stake.

"Imaging has been an area of concern for a long time," said Julie Sonier, director of the Minnesota Department of Health's health economics program, which does reviews of major medical investments. "Issues about the concentration in Edina have also been a concern for some time."

A 2007 Health Department report said there was anecdotal evidence in Minnesota that physician investments in facilities led to financial conflicts of interest and overuse.

Among the reader responses are these:

• As a patient, how do you know that you really need a test that may be uncomfortable, that might have some risk associated, that might have radiation exposure associated, and that you might have to pay for when you know that the person telling you you need it stands to make up to $1000 just for suggesting it? The answer is you can't. This practice is a pox on medicine.

• There are as many MRI scanners in the Twin Cities as in all of Canada. Is the health of Canadians compromised by fewer imaging studies? Obviously not. There is no relationship between the number of tests and procedures performed in medical care and the health outcomes of the patients. More medical care is not better care. The Health Department should carefully examine the merits of this expansion of imaging services.

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UnitedHealth faces the music

The Associated Press reports:

UnitedHealth Group Inc. will cut at least 4,000 jobs, or 5 percent of its workforce, in a restructuring and warned Wednesday that a weaker environment and higher costs will cut into profits this year. ... The company also said it will pay $895 million to settle lawsuits over stock options backdating, and will pay $17 million into a fund in an agreement to resolve a suit related to the Employee Retirement Income Security Act. ...

The options settlement stems from a 2006 complaint filed in U.S. District Court in Minnesota. The California Public Employees Retirement System (CalPERS) and Alaska Plumbing and Pipefitting Industry Pension Trust, the lead plaintiffs, argued that the backdating cost shareholders money.

The scandal ultimately forced out Bill McGuire, UnitedHealth's chief executive.

Hemsley said the settlement helps the company avoid more costly litigation.

Ramzi Abadou, an attorney representing CalPERS, called it "a significant, epic settlement" that far exceeded previous payouts in options backdating lawsuits. ...

McGuire is not part of the settlement. His attorney, David Brodsky, issued a statement saying McGuire will continue to fight "because he is not liable for any alleged shareholder losses."

Also see reader comments coming in to the Star Tribune website. Some examples:

• This was bound to happen due to their corporate greed. This company is imploding and as a former employee who knew well enough to get the hell out, I am happy to see it. Enough of these CEO's and the like making mulit-million dollar salaries at the expense of the little people, both employees and policy holders.

• How dumb do corporate PR departments think we are? They try to blame market conditions, but don't you think having to pay $895 million due to the backdating scandal has an impact on "rising costs". 4,000 jobs gone because of the illegal actions of a few people at the top. They pay out of their excess, and the rest pay with their jobs. Yeah, United Health!

• Mcguire "not responsible for alleged shareholder losses" - I love that quote! He certainly was willing to take credit (and MAJOR cash - 93m one year?) for shareholder gains! Seems to be a running theme - small groups of people making huge rewards but as soon as the money goes away they bail, leaving the taxpayers and shareholders to cover the loss. Some pundit on the radio said it well - our nation is one where we are capitalists when it comes to rewards but socialist about risk. one more way the average citizen gets shafted.

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Nonprofit hospitals as profit machines

The Wall Street Journal story, "Nonprofit hospitals, once for the poor, strike it rich," should be required reading for anyone who wants to understand the current hospital industry.

Excerpts from the story:
• one nonprofit hospital system has a treasure chest of $7.4 billion - more than many large, publicly traded companies;
• the CEO of Northwestern Memorial Hospital in Chicago recently received a $16.4 million payout while the hospital spent $20.8 million on charity care - less than 2% of its revenues and a fraction of what it received in tax breaks;
• one nonprofit hospital system counts the salaries of its employees as a "community benefit" - including the $1.8 million in CEO compensation;
•"Nonprofit is a misnomer - it's nontaxable," says the president of a small for-profit hospital in a poor neighborhood on Chicago's west side. "When you're making hundred of millions of dollars a year, how can you call yourself a not-for-profit?"

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