Practice strategies don’t affect diabetes care

A Harvard Medical School study has found that current practice management strategies and financial arrangements have a limited impact on the quality of care for patients with diabetes. Led by Nancy L. Keating, MD, researchers reviewed medical records of 652 diabetes patients enrolled in three health plans in Minnesota along with the 399 physicians in 135 practices who cared for them.

Researchers defined the main outcome measures by a quality score indicating receipt of care in accordance with six accepted quality indicators.

Only 5% of the variation in quality was attributed to characteristics of physicians’ practices. Quality scores tended to be higher for patients whose physicians received quality performance reports or utilization profiles from more than one source, routinely enrolled diabetic patients in disease-management programs, or received diabetes-specific reports.

The study, The Influence of Physicians’ Practice Management Strategies and Financial Arrangements on Quality of Care Among Patients With Diabetes, is available in the September issue of Medical Care, the journal of the American Public Health Association.

Survey reveals hospital outpatient surgery decline

In a continuation of a trend of outpatient surgical procedures moving from hospitals to surgery centers and physician offices, hospitals reported a 1.1% decline in the percentage of outpatient surgeries performed at hospitals in 2003, the first drop in more than two decades, according to the latest annual survey from the American Hospital Association (AHA).

"In 1980, more than 90% of outpatient surgeries were performed in hospitals," says Caroline Steinberg, vice president for trends analysis for the AHA in Washington, DC. "By 2003, 47% were performed in hospital outpatient departments, 37% were in freestanding centers, and 16% were in physician offices."

Kathy Bryant, executive vice president of the Federated Ambulatory Surgery Association, says some large-volume procedures such as endoscopies and pain management may be moving to physician offices. "Physicians have long complained that they have difficulty scheduling these procedures in hospitals due to poor reimbursement," Bryant says.

The future movement of outpatient surgery is uncertain, Steinberg says. "Technology will continue to probably allow more patient surgeries to be provided in an outpatient setting," she says.

Bryant agrees. "As technology continues to improve, procedures will move to outpatient settings, and some projections suggest huge growth in surgical demand," she says.

Where that surgery will be scheduled remains to be seen. "In some areas, we have heard of hospitals scheduling outpatient surgery at 10 p.m. due to limited capacity," Bryant says. "If outpatient operating rooms are full, then I would expect to see movement to other sites."

CBO: Jury still out on disease management

Insufficient evidence exists to prove that disease management programs can lower overall health care costs, concluded the Congressional Budget Office (CBO) in an Oct. 13, 2004, press release.

The CBO based its analysis, conducted at the request of Senate Budget Chairman Don Nickels (R-OK), on a review of medical journal studies on disease management programs for congestive heart failure, coronary artery disease, and diabetes.

The CBO found that few studies directly addressed the costs of such programs, and those that did failed to capture all forms of health care spending, excluded administrative costs, did not consider the unintended consequences of intervention and were conducted in limited, controlled settings.

If applied to a broader population, the programs actually could increase health costs, the report said.

The CBO also found little evidence to address obstacles in translating disease management into savings for Medicare, including an older, sicker population and the current fee-for-service system.