Is the blogosphere really the best place to address health policy issues?

The findings of a recent study reported in the February issue of Current Directions in Psychological Science, suggests that complex problems may be best addressed in small social networks rather than large ones.

Wray Herbert, who pens the We're Only Human blog, discussed the results of the study in Got an Original Idea? Not Likely:

A team of psychologists at Indiana University has been . . . gaining some insights into the collective mind. Robert Goldstone and his colleagues created a virtual environment, an Internet-based “world” in which groups of people—from 20 to about 200-- simultaneously “forage” for ideas. They use the word “forage” to make the point that ideas are really just abstract resources, food for the brain. As we solve life’s various problems, we observe others’ ideas in action, invent a few of our own, trade off ours against theirs—and succeed or fail. The psychologists have been studying these virtual successes and failures to see what lessons they can draw. When the problems were easy, the global networks did best. This makes sense because such richly connected groups can spread information rapidly, and basically speed is all that’s needed to spread a simple notion efficiently. But as the problems became trickier, the small-world networks tended to perform better. In other words, the truism that more information is always better proved untrue when life got a little messy. And as the problems became even more complex, the small local networks proved most clever.

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No one of us can navigate this complicated world by ourselves. It’s too arduous and time-consuming, like designing all your own clothes instead of trusting the Gap. But there is also a hazard in connectivity. If everyone ends up knowing exactly the same thing, you have a world of like-minded people, and this homogenous group ends up acting like a single explorer rather than a federation of ideas. People pile on to the well-known “bandwagon,” even if it’s a really bad idea. It happens in politics, in musical taste and, yes, in the world of fashion. How else can you explain the popularity of crocs?

Does this mean that blogging and reading blogs about health policy issues could simply result in more of us piling on the bandwagons of tired, rehashed or just plain bad ideas?

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The Supreme Court is asked to take action on the San Francisco pay or play law

About a month ago I wrote about San Francisco’s so-called “Pay or Play” ordinance and the Ninth Circuit’s decision to allow the ordinance to remain in effect while under appeal. The Ninth Circuit’s decision, by a three-judge panel, said San Francisco "has a strong likelihood of success on the merits," meaning that the panel found that the city is likely to successfully defend an ERISA challenge to its health plan. Under the San Francisco ordinance, employers with 100 employees must spend a certain amount on health care for their employees or risk substantial penalties.

Last week, the SCOTUSblog folks reported that the Supreme Court has been asked to temporarily block the city of San Francisco from requiring employers to spend specific amounts on health care for their employees, arguing that the city's ordinance is preempted by ERISA. The application was filed with Justice Anthony M. Kennedy as Circuit Justice for the Ninth Circuit. Justice Kennedy has the option of acting on the plea alone, or of referring it to his colleagues for action.

Yesterday, SCOTUSblog reported that Justice Kennedy asked the city of San Francisco to respond, by 5 p.m. next Wednesday, to the application by a restaurant association to block a local ordinance.

The association argued in its application:

This matter lies at the center of a national debate over universal healthcare: may various local governments require employers to pay different minimum amounts toward employee health benefits, or is that authority reserved to the federal government? More than half the states have considered this type of legislation in the past three years, setting up an inevitable collision with more than three decades of uniform benefit regulation under ERISA.

Here is a copy of the restaurant association’s brief courtesy of SCOTUSblog.

I'll keep you posted as to further developments.

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The Cavalcade of Risk #45 is up at Paid Twice

Paid Twice hosts the 45th edition of the Cavalcade of Risk #45: Is Love a Risk?. Check out the best posts from the past two weeks on risk, insurance and financial matters.

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RHI Health Blog of the Week

The RHI Health Blog of the Week is awarded to an exceptional health-related post appearing during the previous week (Wednesday to Tuesday).

This week's award goes to: Shelved in the W's February 11 post "Are shy people mentally ill?: the DSM and SAD"

The post is typical for Mark Rabnett: thoughtful, visually pleasing and exceptionally well written. Also, be sure to check out the video at the very bottom of the blog.

The award is presented every Wednesday. If you would like to be considered for the RHI Health Blog of the Week, please contact me.

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Haven Health Center of Pawtucket makes the federal government’s list of worst nursing homes

Haven Health Center of Pawtucket, on Gill Avenue in Pawtucket, was just fingered by the feds as one of the worst nursing homes in the nation. See the report here.

My former employer, the United States Department of Health & Human Services, and its component agency, the Centers for Medicare & Medicaid Services (CMS), are responsible, along with state agencies, for monitoring nursing homes to ensure that they are providing the quality of care that the Medicare and Medicaid programs require. This list came about as a result of inspections by CMS and state officials.

To make the list, a nursing home must have more problems than other nursing homes, more serious problems than most other nursing homes (including harm or injury experienced by residents), and a pattern of serious problems that has persisted over a long period of time (as measured over the three years before the date the nursing home was first put on the list). The problems can include drug errors, failure to protect residents from falls or from wandering off facility grounds while incapacitated, and failure to provide proper care.

To make matters worse, Haven Health Center is currently in bankruptcy.

For more information about nursing homes, check out the CMS Nursing Home Compare tool.

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Health care costs and medical imaging: are payers beginning to show some spine?

Recent research suggests that physicians who have a financial interest in imaging technologies, such as CT, MRI and PET scans, are more likely to order those services. See Jean M. Mitchell, “The Prevalence of Physician Self-Referral Arrangements After Stark II: Evidence From Advanced Diagnostic Imaging,” Health Affairs, May/June 2007; 26(3): w415-w424 (subscription required). Despite the fact that such “self-referrals” are illegal, the Health Affairs article suggests that physician involvement in self-referrals may be widespread. Using 2004 data from a large insurer in California, the study found that nearly 33% of providers who submitted bills for MRI scans, 22 % of those who submitted bills for CT scans, and 17% of those who submitted bills for PET scans were self-referrals. These self-referrals result in over utilization of imaging technologies, drive up health insurance costs and increase a patient’s risk of harm—for example, unnecessary radiation exposure. See D. J. Brenner and E. J. Hall, “Computed Tomography—An Increasing Source of Radiation Exposure,” The New England Journal of Medicine, Nov. 29, 2007; 357:2277-2284.

But it isn’t the alleged illegal activities or health risks that may result in a slowdown in the imaging tests, it’s the cost. Forbes.com reports that while imaging tests account for only 5% of the $2 trillion in U.S. medical spending, such tests have been the fastest-growing component of recent health care cost inflation, climbing 20% annually until last year. The result: Medicare pays 15% to 50% less for such tests and some health insurers started imposing a 48-hour review on imaging orders. This has led to a decrease in imaging tests and radiologist revenues, which in turn, have led to a decrease in scanning equipment orders from imaging technology giants GE, Siemens and Philips.

How big is the problem? As the Forbes article notes, "Pittsburgh has more MRI machines than Canada."

Hat tip: The WSJ's Health Blog

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