Dartmouth Atlas: Little Progress on Reducing Readmissions
A Sept. 28 report from the Dartmouth Atlas of Health Care found persistent variation in 30-day readmission rates, with the rates at some hospitals and in certain regions worsening over the 2004 to 2009 period examined. About one of six Medicare beneficiaries treated for a medical condition ended up back in the hospital within a month. The analysis also found that more than half of those discharged do not see a primary care clinician within two weeks of leaving the hospital—indicating widespread failures to coordinate care across settings and an overreliance on inpatient, rather than outpatient, care in some areas.
The report comes at a time when the federal government has begun keeping score of hospitals' readmission rates, with plans to impose new penalties under the Medicare program. Starting in 2013, hospitals stand to be penalized—first at 1 percent of their total Medicare billings—if they readmit an excessive number of patients. The penalty will rise to 3 percent of their total Medicare billings by 2015.
WellPoint Hires Watson to Provide Decision Support
Last month the health insurer WellPoint made a deal with IBM to use the Watson technology—the supercomputer that made headlines for beating two human contestants on “Jeopardy!”—to help clinicians evaluate treatment options and make diagnoses. This is the first time that Watson will be used in a real-world health care setting. The computer, which is capable of processing millions of pages of content in seconds, will initially be used by WellPoint nurses who help manage complex patient cases and review treatment requests from providers. It also will be used in a pilot program to assist oncology providers in reviewing treatment options.
Study: U.S. Lags Other Nations in Preventing Deaths
The United States placed last among 16 high-income, industrialized nations in terms of deaths that could potentially have been prevented by timely access to health care, according to a Commonwealth Fund–supported study in the journal Health Policy. According to the study, other nations lowered their preventable death rates an average of 31 percent between 1997–98 and 2006–07, while the U.S. rate declined by only 20 percent, from 120 to 96 per 100,000. At the end of the decade, the preventable mortality rate in the U.S. was almost twice that in France, which had the lowest rate—55 per 100,000.
The researchers analyzed deaths that occurred before age 75 from causes such as treatable cancer, diabetes, childhood infections/respiratory diseases, and complications from surgeries.
IoM Panel Recommends Cost Be Considered in Defining "Essential Health Benefits"
In an October 6 report, an Institute of Medicine (IoM) panel advised the federal government to explicitly consider costs as one of the factors in mandating what benefits must be covered by insurance plans.
The Affordable Care Act tasked the U. S. Department of Health and Human Services (HHS) with outlining the minimum diagnostic, preventive, and therapeutic services that insurers must cover. These "essential health benefits" will provide a guaranteed level of protection and help consumers compare plans across insurers, particularly in the new state insurance exchanges. To help in this task, HHS asked an IoM panel to propose criteria and methods that should be used to define the essential benefits.
According to the New York Times, the panel's recommendation to consider cost in choosing benefits was unexpected—but something it said was necessary to keep the plans affordable. The panel also recommended that, in general, insurers should not be required to cover new treatments unless they are shown to have "meaningful improvement in outcomes over current effective services."
