KHN: Kaiser Health News

Insurance brokers won a round in their battle over the future of sales commissions on Thursday when a key committee of state insurance regulators voted to endorse a controversial bill now before Congress.

The task force of the National Association of Insurance Commissioners said they would endorse the bill — sponsored by Rep. Mike Rogers, R-Mich. — which would remove sales agent fees from administrative costs insurers must report under a provision in the federal health law.

The endorsement still needs approval from the full executive committee of the NAIC, which last year recommended to federal officials that broker fees be included in the calculation of the so-called medical loss ratio. That recommendation was accepted.  To remove broker fees from the calculation would take congressional action.

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The government is offering as much as $27 billion in incentives to doctors and hospitals to adopt electronic health records, but the question is whether those incentives will be enough.

A new study published by the Center for Studying Health System Change and the National Institute for Health Care Reform illustrates the difficulty of getting everyone in the health care system to adopt electronic records.

The two organizations found that some physician practices with 25 or fewer doctors who were early adapters of electronic health records are unsure that their investment of time and money has been worth it.

“Despite the widely held belief that HIT adoption ultimately will save costs and improve quality, several respondents suggested the business case – adequate financial incentives and return on investment – remains somewhat unclear, especially in the short term,” said the report.

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This story has been corrected to reflect new information from officials at Trinity Medical Center about isolation procedures and to correct a citation.

In one year, infection specialists saved a Midwest hospital system $110,000 and 2,700 staff hours — by using duct tape.

That effort at Trinity Medical Center, a group of four hospitals in the Quad Cities area of Illinois and Iowa, involved helping staff deal more efficiently with patients who had to be isolated because of serious infection risks. The Infection Prevention Team at Trinity discovered that marking a 3-foot-by-3-foot floor space with duct tape at the entrance of the patient’s room saved nurses and other staff members time and resources because staying in that area meant they didn’t have to wear gowns and gloves each time they came in and out of the room. What’s more, both patients and medical staff reported that they were able to effectively and easily communicate while using the designated space, called the red box.

Janet Nau Franck, a registered nurse and independent consultant at Trinity, recently published a study describing the effort in the American Journal of Infection Control, a  publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

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Most Americans are willing to accept some level of cuts in Medicare spending to keep the program financially sound or to ease the federal budget deficit, but they still balk at major reductions, according to a new survey released Thursday. The poll results show that public opinion on Medicare cuts remains malleable, subject to influence by different arguments and factual assertions.

Forty-two percent of those polled would support minor cuts in Medicare to keep it from “going bankrupt,” according to the poll from the Kaiser Family Foundation. (KHN is an editorially-independent program of the foundation.) Another 32 percent would back major cuts. Only 21 percent opposed any cuts at all.

Support for major Medicare cuts for the purpose of lowering the federal deficit was weaker, at 18 percent, but 45 percent supported minor reductions for this purpose. A majority even backed spending cuts in Medicare to avoid tax increases for the wealthy.

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A study released Thursday on the Health Affairs website documents how far small- and medium-sized physicians’ practices have to go to create patient-centered medical homes. Under this model of care,  primary care doctors manage all of a patient’s care and coordinate with the specialists. The Affordable Care Act encourages model homes as having potential to reduce costs, improve  health and undo much of the fragmented and confusing maze many patients face today.

The new study examined data on 1,344  practices with fewer than 20 doctors each to see how many had adopted processes that are crucial to medical homes, including assignment of nurse managers to severely ill patients, adoption of  electronic medical records and receipt of regular feedback from patients. On average, the practices in the study only followed 21.7 percent of these medical home protocols. The smaller the practice, the fewer were adopted, the study found.

The authors write:

“Medical home advocates may view our findings as a glass one-fifth full, or four-fifths empty. The more optimistic will appreciate that these smaller practices, typically situated in fragmented care systems across the United States, have already implemented some components of the patient-centered medical home. Others will focus on the low mean level of adoption of the medical home processes measured here, placed in context of the complete practice transformation required to realize the full vision of the patient-centered medical home. From this perspective, widespread implementation appears daunting.”

One finding that surprised the authors: practices serving lots of minority or poor patients weren’t less likely to be using medical home practices.

jrau@kff.org

For doctors, pharmacists and other health care experts, it’s a bitter pill to swallow: nearly a quarter of people who get a prescription don’t bother to fill it.

That gap leads to a variety of health issues, according to Marsha Raebel, a researcher for Kaiser Permanente’s Institute for Health Research in Denver. (KHN is not affiliated with Kaiser Permanente.)

“It sounds clichéd but some people simply just don’t realize that they need to finish their dosage—they feel fine so they stop taking their medication,” she said. Although people may avoid the drugs because of the price, Raebel says that the long-term benefits for those who stick to their medications mean, “they will have less health care costs in the future.”

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Democrats must make concessions to reduce spending on Medicare and other entitlement programs, President Obama said in a news briefing Wednesday, but he tempered calls for cuts with promises not to transfer costs to seniors. However, he did not allude specifically to how he would reduce Medicare spending in the short term, and expressed his desire to lower overall health care costs over time. “We’re going to have to look at entitlements, and that’s difficult politically,” he said. “We need to see where we can reduce the cost of health care spending in Medicare and Medicaid in the out years, not by shifting costs to seniors, as some have proposed, but rather by actually reducing those costs.”

Obama urged a balanced approach that included both spending reductions and tax increases. He said he wanted Republicans to abandon their promise not to raise taxes, and he argued that wealthy Americans and corporations should not continue to get generous tax breaks, while funding for medical research and other important programs is at stake.

“The question is, if everybody else is willing to take on sacred cows to achieve the real goal of deficit reduction, it would be hard for Republicans to stand there and say a tax break for corporate jets is sufficiently important that they are not willing to come to the table for a deal.”

View video excerpts from the news conference.

This post was updated at 1:24 p.m.

mserafini@kff.org