Lots of New England in the NE Journal of Medicine

The latest NEJM includes lot of New Englanders:

Researchers from Harvard asked – What motivates “whistleblowers” who report health care fraud?

This study identified several commonalities in whistle-blowers’ experiences. Generally, whistle-blowers’ first move was to try to address problems internally; they became litigators either accidentally (while pursuing other claims) or as a last resort. The most prevalent motivations reported were personal values and self-preservation rather than financial incentives. These findings provide a number of useful insights into the qui tam mechanism as a tool for addressing health care fraud.

MIT’s Jonathan Gruber comments on costs.

In summary, analysis by both the Congressional Budget Office and the CMS actuary show that the ACA (Affordable Care Act) will substantially reduce the federal deficit, only slightly increase national medical spending (despite an enormous expansion in insurance coverage), begin to reduce the growth rate of medical spending, and introduce various new initiatives that may lead to more fundamental reductions in the long-term rate of health care cost growth. The ACA will not solve our health care cost problems, but it is a historic and cost-effective step in the right direction.

Jon Kingsdale from the Commonwealth Connector  on health insurance exchanges.

I believe in exchanges’ potential to help manage competition. But I’m a realist: I know that controversies will arise over their proper function and mission. The opponents of change will try to hobble exchanges, market skeptics will try to convert them into purely regulatory schemes, and even when exchanges succeed in increasing transparency and demand for value, other critical links must be forged in the supply chain of managed competition. After all, an accessible, customer-friendly, easy-to-use market is still only as good as the products it offers. Whether an insurance exchange looks more like a Walmart than a flea market will depend on whether doctors organize themselves into efficient, patient-responsive systems of care. In the United States, reforming the organization and delivery of medical care has always been the biggest challenge in the struggle to produce better care at sustainable cost.

 

A team led by folks from the Dartmouth Institute for Health Policy and Clinical Practice asks – in places where patient receive much more care that usual, are the patients sicker or are they being overtreated?

To address this question, we followed Medicare beneficiaries for 2 years before and 3 years after a move and found that a move to a region with a higher intensity of practice as compared with a move to a region with a lower intensity of practice was associated with greater increases in diagnostic testing, the number of recorded chronic conditions, and HCC risk scores, with no apparent survival benefit.”

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