Research Roundup: Evidence-Based Medicine Consumer/Expert Divide; Pay For Performance Limitations; Improving Community Health Centers

Health Affairs: Evidence That Consumers Are Skeptical About Evidence-Based Health Care – This survey of more than 1,500 patients with employer-based insurance found "there is a fundamental disconnect between the central tenets of evidence-based health care and the knowledge, values, and beliefs held by many consumers." For instance, "only 34 percent of participants ever recalled having a physician discuss what scientific research had shown about the best way to manage their care" and "33 percent of [the] survey respondents agreed or strongly agreed with the statement that 'medical treatments that work the best usually cost more than treatments that don't work as well.' … 40 percent reported that they were not sure about this" (Carman et al., 6/3).

Journal Of The American College Of Radiology: Medicare's Physician Quality Reporting Initiative: Incentives, Physician Work, And Perceived Impact On Patient Care – "In recent years, P4P [pay-for-performance] has gained considerable traction as a likely pillar of ongoing health care payment system reform. ... From the physician perspective, however, it is unclear whether voluntary participation in current P4P programs such as [Medicare's ] PQRI [Physician Quality Reporting Initiative] are worth the time, effort, or expenses involved."

Based on Medicare PQRI bonus data from 29 radiologists from a single practice over the program's first two cycles, the authors conclude: "Even when aggressively pursued, Medicare's pay-for-performance program, PQRI, yields actual physician bonuses far less than those expected, more than an order of magnitude less than requisite incremental radiologist work, with little reported impact on quality. For such programs to engender ongoing physician participation, fundamental changes will be necessary to address discordantly low incentives and perceived lack of benefit to patient care" Duszak Jr. and Saunders, June 2010).

Mathematica Policy Research: Financial Incentives For Health Care Providers And Consumers – This brief (.pdf)  details the effect cost sharing, value-based purchasing and pay-for-performance systems have on providers and consumers. "Incentives that improve care and reduce cost present challenges. For plan administrators, designing and using effective incentives can be technically demanding and administratively expensive. For providers, performance reporting can be time consuming. For consumers, choosing among plan options, providers, and treatments can be difficult. … If not carefully designed, financial incentives can have unintended adverse consequences, including poorer health outcomes and higher long-term costs" (Bernstein, Chollet and Peterson, 5/25).

Journal Of The American Medical Association: Trends In Length Of Stay And Short-Term Outcomes Among Medicare Patients Hospitalized For Heart Failure, 1993-2006 – "During the last decade, the most prominent change in the acute care of patients with heart failure (HF) was a decreasing length of stay in hospitals," write the authors of this observational study that examined how a reduction in patient stay affected patient outcomes. Based on an analysis of Medicare data on patients with heart failure from 1993 through 2006, the authors report, "30-day mortality decreased but post-hospital readmission and mortality risk increased. .... The current model of care for older patients with HF in the United States may benefit from more attention to the care and outcomes in the early transition period after hospital discharge and routine surveillance of how changes in practice affect patient outcomes" (Bueno, Krumholz et al., 6/2).

More details about the study and related news coverage are in the June 2 Morning Report.

Commonwealth Fund: Enhancing The Capacity Of Community Health Centers To Achieve High Performance: Findings From The 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers – This survey of more than 1,000 Federally Qualified Health Centers (FQHCs), which provide primary care "regardless of ability to pay"  found that "many health centers can provide timely access to on-site care," although "[m]any centers face barriers … providing off-site specialty care services for their patients, even if these patients have insurance." Off-site speciality services include referrals to physician specialists. The survey "highlights methods for strengthening FQHCs' ability to provide care," such as "formalizing partnerships with hospitals, improving office systems, adopting the medical home model, and increasing use" of health information technology (Doty et al., 5/27).

Commonwealth Fund/University of British Columbia: Prescription Drug Accessibility And Affordability In The United States And Abroad – This issue brief compares prescription drug accessibility and cost in the U.S. to Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom. Drawing data from a 2007 survey, the researchers found "younger and healthier Americans use prescription drugs more often than do their counterparts in the six countries." However, "[d]espite higher rates of prescription drug use in the U.S., Americans are more likely than residents of the other countries to report having left prescriptions unfilled or skipped because of cost, and Americans with low income report the highest rates of such financial barriers. … Even with their higher rate of unfulfilled prescriptions, Americans are much more likely than residents of the other countries to report out-of-pocket spending in excess of $1,000 in the previous year" (Morgan and Kennedy, 6/1).

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