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JAMA article on advantages to early Medicare buy-in; NCQA's new cardiovascular and stroke recognition program; Lewin Group's study of health care outpatient cost drivers




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The near elderly — ages 50 to 64 — who lose work-based health insurance face a double whammy of fearfully expensive premiums in the private market coupled with age-related increases in risk of disease. As a result, they are less likely to use widely accepted preventive measures. That's good reason to offer an affordable early buy-in to Medicare, according to the authors of a study recently published in the Journal of American Medical Association.

Prior to Medicare eligibility, only 41 percent of uninsured adults in this age group sought cholesterol testing vs. 76 percent of insured adults. Similarly, 46 percent of uninsured women sought mammograms vs. 76 percent of those with insurance. The gaps were cut in half once Medicare coverage kicked in. Among the previously uninsured, 65 percent had cholesterol screening and 67 percent had mammographies. The parallel numbers were 83 and 82 percent among the previously insured.

The researchers also noted anomalies in treatment of two conditions that become more common with age. Prior to Medicare eligibility, the uninsured were somewhat less likely to see a doctor about arthritis (35 vs. 39 percent), just as likely to admit that arthritis limited their activities (both 38 percent) and slightly more likely to take medication (41 vs. 37 percent), much of which is available over the counter. Post Medicare, however, physician visits and activity limits jumped to 56 percent for the previously uninsured while staying in the mid 30s for their counterparts. Medication use for both groups inched up to 43 percent.

Among the near elderly with high blood pressure, 67 percent of the uninsured took medication vs. 83 percent of the insured. Numbers for both groups bumped up 6 points after Medicare, leaving the 16-point gap intact.

Almost half of all employees are worried about losing their jobs, reveals a recent poll by ComPsych. When asked about their thoughts on job security, 48 percent were anxious or concerned, 23 percent were neutral, and 29 percent felt safe.


Over 60 million Americans suffer from one or more types of cardiovascular disease, and about 700,000 suffer strokes each year, yet many do not receive the level of care suggested by well-accepted evidence-based guidelines. The National Committee for Quality Assurance (NCQA) and the American Heart Association/American Stroke Association are addressing this failure with a new program that publicly recognizes physicians who provide top-quality care.

The initiative is patterned after an NCQA/American Diabetes Association recognition program that has produced significant improvements in the percentage of diabetic patients who have their blood sugar levels under control. Based on that program, participation will involve approximately 10 hours of paperwork and fees of around $500 per physician.

Applicants to the heart/stroke recognition program must submit records for a sampling of their patients indicating that care consistently incorporates blood pressure control, cholesterol screening and control, aspirin therapy to reduce the risk of blood clots and smoking cessation. Physicians can use an online survey tool to get a detailed assessment of their performance before applying for recognition.

Physicians who meet the performance criteria will be listed on the NCQA and AHA/ASA websites and noted in the national directories of Aetna, CIGNA, United Healthcare and other health plans.

Average annual plan premiums and other out-of-pocket costs for Medicare+Choice enrollees rose 10 percent in 2003, according to a new Commonwealth Fund report. The $1,964 was more than double the costs from 1999. The report also revealed that 2003's out-of-pocket spending for enrollees in Medicare PPO plans is estimated to be almost 50 percent higher than for enrollees of Medicare+Choice.


Hospital outpatient costs were the biggest component of health care spending increases for the past two years (See "DataWatch" from B&H News & Trends 08/12/03), and a study from the Lewin Group explains in detail why this is so.

The biggest driver of outpatient costs — accounting for about 35 percent of the increase —is the structure of the provider market, i.e. the supply and ownership of medical service facilities. Outpatient expenditures rise when larger percentages of hospital beds are in for-profit facilities and also when hospitals are consolidated into medical systems. Hospital outpatient costs also rise in tandem with the proliferation of freestanding surgical, diagnostic imaging and rehab centers. In other words, such facilities complement hospital outpatient care rather than replace it.

General inflation and new technology each contribute about 18 percent of increases in outpatient spending, although Lewin points out that the latter can also save money in the overall picture of health spending.

The total number of physicians is not that big a cost driver in outpatient care, but the percentage of specialist among those physicians has a decided impact on spending. Health care regulation plays only a minor role in outpatient spending trends.

Forty-five percent of adults achieved recommended levels of physical activity in 2001 vs. 26 percent in 2000, according to the Behavioral Risk Factor Surveillance System 2000 and 2001. Physical inactivity was virtually unchanged: 26 percent of adults were couch potatoes in 2001 vs. 27 percent the prior year.


News & Trends.

Business and Health

Aug. 15, 2003;21.

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