Managed Care - August 2012 - (Page 7)

N E W S & C O M M E N TA R Y Informal Physician Ties Forge Stealth ‘Networks’ T he age of health reform places increased emphasis on providers, and it might behoove insurers to find the informal ways that some physicians are connected. Often doctors have “a history of working with each other, and likely have evolved natural communication channels,” says “Variation in Patient-Sharing Networks of Physicians Across the United States,” which was published in the July 18 edition of the Journal of the American Medical Association. One of the things the study looks at is how best to form accountable care organizations (ACOs), a bulwark of health reform. “Insurers and policymakers who want to influence physician behavior might find it more efficient to identify candidate accountable care organizations in this fashion.” The study adds, “These informal information-sharing networks of physicians differ from formal organizational structures (such as a physician group associated with a health plan, hospital, or independent practice association) in that they do not necessarily conform to the boundaries established by formal structures. Informal information-sharing networks among physicians may be seen as organic or natural rather than as artificial or deliberate.” That’s not to say that formal organizations do not influence relationships among physicians. They clearly do. “Formal networks are important, as evidenced by the unsurprising finding that physicians associated with the same hospital are far more likely than other physicians to be connected. Yet this is not always the case.” For instance, although hospital affiliation appears to be the reason physicians connect in Albuquerque, that’s not the case in Minneapolis/ St. Paul. The study looks at administrative data for nearly 4.6 million Medicare beneficiaries in 2006. The patients were seen by about 68,000 doctors in 51 urban and rural hospital referral regions (HRRs). The number of physicians per HRR ranged from 135 in Minot, N.D., to 8,197 in Boston. “There was substantial variation in network characteristics across HRRs,” the study notes, adding that connected physicians had “more similar patient panels in terms of the race or illness burden than unconnected physicians.” The study adds that “physicians tend to share patients with colleagues who have similar personal traits, practice styles, and patient panels, although the influence of some of these traits is small in magnitude.” Mortality Rates Drop For Cardiac Arrest The chances of surviving cardiac arrest in the hospital have improved nearly 12 percent in the last decade, possibly because of the introduction of new treatment approaches and guidelines, including therapeutic hypothermia. “Post Cardiac-Arrest Mortality Is Declining: A Study of the U.S. National Inpatient Sample 2001–2009,” which was published in Circulation, adds that the lowered mortality rate for cardiac arrest is a fact that sneaked up on us. Researchers used the 2001–2009 U.S. National Inpatient Sample (NIS), a national hospital discharge database, to determine the mortality rates. In that time, nearly 1.2 million people were hospitalized with the condition. The in-hospital mortality rate decreased from 69.6 percent to 57.8 percent. “The mortality rate declined across all analyzed subgroups, including gender, age, race, and stratification by comorbidity,” the study states. Researchers stress that the numbers are for people who survive long enough to make it to the hospital. Many aren’t so fortunate. The study cites new guidelines by the American Heart Association that stress CPR without mouth contact and easy-touse automated external defibrillators for shockable arrhythmias. They also cite randomized trials that “showed that induced hypothermia reduces mortality and improves neurologic outcomes in patients with out-ofhospital ventricular fibrillation cardiac arrest.” The idea is to cool the body by IV saline, cooling blankets, or ice packs. That helps protect the brain until the patients can be slowly re-warmed. Alejandro Rabinstein, MD, of the Mayo Clinic, lead researcher, tells Managed Care, “Our analysis … cannot discriminate between the various factors that may have contributed to the decline (better access to defibrillators, early coronary interventions, and therapeutic hypothermia, among others), thus providing indirect data to justify their application and expense. The improvement in mortality correlated with the gradual implementation of therapeutic hypothermia, but we cannot prove that this treatment was a major determinant for the improved outcomes.” Still, changes in the care of these patients, rather than a change in the population itself, probably led to this decline in mortality. “The improve- AUGUST 2012 / MANAGED CARE 7

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine

Managed Care - August 2012