Nearly a quarter of all Californians could soon have their medical histories accessible to doctors and emergency rooms all over the state with just a few strokes on the keyboard. Two of the state's largest insurers are launching perhaps the biggest health information network anywhere in the country, putting California at the center of the decade-long push to digitize medical records. Supporters say the project could mean faster and better healthcare, with less spending on unneeded tests — if it can clear a thicket of technical challenges and privacy concerns. Dubbed Cal Index, the system is set to launch by the end of the year, connecting the nearly 9 million patients of Anthem Blue Cross and Blue Shield of California with doctors, hospitals and other healthcare providers.
The good news about health-care spending continues. In the first nine months of this fiscal year, Medicare spending increased only 1.2 percent in nominal terms, and for 2014, it's now projected to be $1,000 lower per beneficiary than the Congressional Budget Office said it would be as recently as 2010. Even the Medicare trustees are starting to recognize that something big may be happening. In evaluating the recent deceleration, however, a crucial question remains: Can slower cost growth continue without harming the quality of outcomes? Jack Wennberg, emeritus professor of the Dartmouth Institute for Health Policy and Clinical Practice, has spent his career suggesting the answer is yes, because costs vary substantially across the U.S. in ways not correlated with quality.
When St. Joseph's Hospital unveiled its new emergency room in July, officials touted its modern additions, from bedside ultrasound machines to cellphone charging stations. But the new feature that says even more about American health care? A treatment room for obese patients, complete with a larger bed, floor-mounted commodes and scales and a lift that can hoist a person weighing nearly 1,000 pounds. It's the latest example of how hospitals here and elsewhere are investing in design and equipment that can better serve the increasing number of severely obese patients while also protecting health care workers from injury due to lifting these patients.
When Dartmouth economics professor Jonathan Skinner was speaking recently at the University of Texas about the "cowboy doctor" problem, an audience member objected: "You have a problem with cowboys?" Well, actually, we all have a problem with cowboys — when they're doctors. Including the Texans. New research written up in a National Bureau of Economic Research paper finds that "cowboy" doctors — who deviate from professional guidelines, often providing more aggressive care than is recommended — are responsible for a surprisingly big portion of America's skyrocketing health costs. The paper concludes that "36 percent of end-of-life spending, and 17 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence."
Franklin-based hospital company Community Health Systems will pay a total of more than $98 million to settle a Department of Justice investigation into the company's billing practices. About $88 million of the settlement will go to resolve claims made by the federal government that between January 2005 and December 2010, 119 of the company's hospitals billed the government for inpatient admissions when, in the government's view, those services should have been billed as outpatient cases. Those types of patients tend to less expensive than those that need hospitalization.
Analysts who fear health spending is accelerating got plenty of evidence in Wall Street's second-quarter results to support their thesis. But so did folks who hope spending is still under control. Now everybody's trying to sort out the mixed message. The answer matters because deficit debates and affordability concerns revolve around forecasts that health spending will speed up as the economy revives. If it doesn't, the future looks better for consumers, employers and taxpayers. To hear hospitals tell it -- based on earning reports issued over the last two weeks -- we might be heading back toward the painful, 8 percent spending increases of the early 2000s.