Health System Review – September 6th, 2012

The Design and Application of Shared Savings Programs: Lessons from Early Adopters

The Design and Application of Shared Savings Programs: Lessons from Early Adopters
Commonwealth Fund – September 4, 2012
Enabling health care providers to share in the savings they generate from the delivery of more efficient, higher-quality care is a promising way to achieve the goals of health reform. Reaching agreement on the methods used to calculate and distribute such savings, however, has been a challenge for payers and providers alike. By following a set of design principles, payers and providers may be able to sidestep some of the pitfalls encountered by early adopters of this payment approach.

Hospitals Expected to Break Even with Value-Based Purchasing
Fierce – September 4, 2012
Under the value-based hospital purchasing program set to launch next month, healthcare economists expect most hospitals will break even, reported Kaiser Health News. A study from Health Affairs examined pilot value-based purchasing programs and found only 2.4 percent of hospitals earned bonuses beyond the break-even point, while a similar percentage is projected to incur significant financial losses from the program.

Bits of Mystery DNA, Far From ‘Junk,’ Play Crucial Role in Our Health
NYT\Nature September 5, 2012
At least four million gene switches that reside in bits of DNA once thought to be inactive turn out to play critical roles in health, researchers reported. The findings, which are the fruit of an immense federal project involving 440 scientists from 32 laboratories around the world, will have immediate applications for understanding how alterations in the non-gene parts of DNA contribute to human diseases, which may in turn lead to new drugs. They can also help explain how the environment can affect disease risk. In the case of identical twins, small changes in environmental exposure can slightly alter gene switches, with the result that one twin gets a disease and the other does not. The discoveries were published on Wednesday in six papers in the journal Nature and in 24 papers in Genome Research and Genome Biology. In addition, The Journal of Biological Chemistry is publishing six review articles, and Science is publishing yet another article.

A Systemic Approach to Containing Health Care Spending
Bending the Cost Curve through Market-Based Incentives
NEJM – September 6, 2012
In this election year, U.S. national spending on health care will reach $2.8 trillion, or about 18% of total spending on all goods and services. This high level of spending reduces our ability to invest in other important parts of the economy and also adds to our unsustainable national debt. There is wide agreement that we must find ways to bend the health care cost curve. Taking different approaches, the two articles on NEJM present a range of options, including reducing both the prices and quantity of services for public and private payers, reducing administrative costs, implementing new market-based incentives, and reforming the tax subsidy for employer-sponsored health insurance.

Can There Be Too Much Breast-Cancer Treatment?
WSJ – September 4, 2012
A study in Norway fuels the debate over whether breast cancer can be overtreated.

Prosthetic Leg Responds to EEG Signals
MIT Technology Review – September 3, 2012
Researchers at the Long Beach Veterans Affairs Medical Center have developed a prosthetic leg controlled by electroencephalogram signals entered into a computer. So far, scientists have tested the device on an able-bodied user and achieved a 100% response rate with no unintended steps.

Incidence of Drug-Resistant TB Rises
NYT – September 3, 2012
Almost 44% of 1,278 tuberculosis patients tested were infected with a strain that resisted at least one second-line drug, a study published in The Lancet found. The nonprofit TB Alliance is testing new drug combinations, and 12 potential vaccine candidates are in clinical trials, according to Aeras, another nonprofit organization.

CDC: Uncontrolled Hypertension is Widespread Among U.S. Patients
InternalMedicineNews – September 4, 2012
Of the 66.9 million adults with hypertension, more than 50% failed to have their condition under control, translating to $131 billion in costs and 1,000 deaths per day, CDC researchers report. “There are obviously a lot of missed opportunities for getting blood pressure under control. We know what to do, there are great medications that work well when taken as prescribed. We have to roll up our sleeves and make blood pressure control a priority at every visit,” CDC Director Thomas Frieden said.