Northeastern physicians lowest paid in US

According to Medscape’s 2016 Physician Compensation Survey, at $266,000 physicians from Northeastern states have the lowest incomes in the US. Medscape reports that uneven distribution between physicians and patients drives compensation levels. Just over half (52%) of US physicians believe that their compensation is fair. Specialists tend to make more than primary care doctors; highest paid are orthopedists while pediatricians make the least. Dermatologists are most satisfied with their career, while nephrologists tend to be least satisfied specialty. In very good news, 77% of self-employed and 84% of employed physicians report that they are taking new and keeping current Medicare and Medicaid patients, up from 64% and 79% respectively last year. Most physicians spend between 13 and 20 minutes with each patient, which has been relatively stable since 2011. Over half of US physicians spend at least ten hours each week on paperwork and administration. Only 30% regularly discuss treatment costs with patients. The survey included 19,200 physicians across 26 specialties.

April web quiz: Medicare disparities in CT

Test your knowledge of Medicare disparities in CT. Take the April CT Health Policy Webquiz.

Approps budget restores many health and human service cuts

The budget approved by the Appropriations Committee yesterday restores many of the health and human services cuts in the Governor’s proposed budget. Long supported by advocates and financial analysts, the Appropriations Committee also proposed de-collapsing the massive Medicaid line item. The Committee’s budget separates out payments to hospitals and community health centers, giving more transparency to significant state spending but also limiting the Governor’s ability to make cuts without legislative approval. Cuts reversed, in part or fully, in the committee’s budget include hospitals, community health centers, school-based health centers, developmental disabilities, the CT Children’s Medicaid Center, Alzheimer’s respite care, and mental health and substance abuse. The bill maintains the Governor’s proposal to privatize 30 DDS group homes, but requires an evaluation of the impact. The bill also restores sorely needed independence to watchdog agencies by de-consolidating functions under the Office of Governmental Accountability. The Governor called the committee’s budget “incomplete” and promised to release a new proposal next week.

CT Health Reform Dashboard update: mixed Medicaid progress, a few good signs elsewhere

Both good and bad news for consumers in planned Medicaid reforms influenced CT Health Reform Dashboard this month. In good news, DSS and SIM agreed to make the well-intentioned but poorly-designed CCIP program optional for Medicaid networks applying to participate in shared savings. A Wall Street Journal article reported on the success of CT’s Medicaid program in improving the Triple Aim. However DSS rejected calls to protect person-centered medical homes in their reform plan, creating incentives for networks to shift the most needy members out of PCMHs. A survey of ACOs in our state found good intentions but mixed views of the future. Members of a taskforce to review CON rules and promote a competitive market were appointed; the first meeting will be next week.

April Health Affairs features CT state employee VBID plan results

An evaluation of CT’s state employee Health Enhancement Program (HEP) published in Health Affairs found improved access to primary care, reductions in ED use, but has not produced savings. HEP is an early adopter of the Value-Based Insurance Design (VBID) model, linking consumer costs to the value of care. Implemented in 2011, HEP encourages preventive care and chronic care disease management with lower premiums and deductibles combined with $35 copays for non-emergency ED visits. Before HEP, per person spending in CT’s program was $7,914, far higher than a matched comparison group from other state employee programs at $4,375, almost three times as many CT state employees had high health costs (over $50,000), and ED use was 56% higher. Over 98% of members enrolled in HEP and utilization of preventive care rose significantly. ED visits dropped by a modest amount while visits in the comparison group rose. Results for members with chronic conditions were mixed and modest. Not unexpectedly, in the first two years costs per person rose – by $730 in the first year and $961 in the second. CT Mirror’s coverage points out that this is due to increases in use of preventive care and reports that the state expects to benefit in the long term from this investment in the health of employees.

CON taskforce members appointed

Governor Malloy has announced the appointments to the Certificate of Need Taskforce. The taskforce was created in a February Executive Order halting mergers and takeovers of large hospital systems for one year to allow a review of CON rules and process. Consolidation in Connecticut’s hospital market has raised significant concerns about the lack of competition, rising prices and reducing consumer choice. A bill to make changes to the CON process is moving through the General Assembly. The taskforce’s first meeting is next Tuesday, April 12^th at 1pm in Room 310 of the State Capitol.

CEPAC meeting affirms the value of outpatient palliative care, but more research is needed

At yesterday’s meeting in Hartford, CEPAC took a deep dive into the clinical and cost effectiveness of palliative care delivered in outpatient settings.

From CEPAC’s report, “Palliative care is a management approach that provides symptom relief and comfort care to patients with serious or life-threatening illnesses, with the goal of improving quality of life for both patients and their families. Unlike hospice care, which is typically restricted to individuals with a prognosis of survival of six months or less, palliative care can begin at diagnosis and is often provided along with treatment aimed at prolonging life, such as chemotherapy or radiation for cancer.  One of the primary objectives of palliative care is to help patients prioritize their goals of care, and may include conversations around advance care planning (e.g., a “living will”) depending the anticipated disease trajectory.”

The group voted unanimously that there is evidence to demonstrate some forms of outpatient palliative care treatment are effective at improving the quality of life and reducing hospitalizations and ED use. The majority also voted that outpatient palliative care is a high value treatment. But members expressed concern that more research is needed to persuade payers to cover it. Other concerns included workforce capacity challenges, time for training busy primary care providers in palliative care, and teasing out which parts of the model are critical to success. Aetna described their successful Compassionate Care program which has an impressive record of improving the quality of life for people and their families facing serious illness, as well as saving money.

Evidence is growing that palliative care can prolong life as well as support patients who choose to remain home. For more on the issue, read CEPAC’s Palliative Care: Barriers, Opportunities and Considerations for Quality Improvement.