Specialty Referral Completion Among Primary Care Patients

ICS 614 MEDICAL INFORMATICS I

Dennis Streveler

October 2, 2007

FACTOIDS 2007

1. CLINICAL FACTOIDS

Specialty Referral Completion Among Primary Care Patients

2. HEALTH ECONOMICS FACTOIDS

Average Annual Firm and Worker Premium Contributions and Total Premiums for Covered Workers for Single and Family Coverage, by Plan Type, 2007

Pharmacy Expense and Cost Trends

2007 Health Costs by Geographic Area

3. UTILIZATION FACTOIDS

Race and Primary Reasons for Underuse of Breast Cancer Treatment

Top 10 Most Frequent Specific Conditions Admitted to the Hospital Through the Emergency Department, 2003

State Scorecard on Health System Performance for Selected Quality Indicators

Hospitals Rated Better Than Average for Heart-Attack Mortality

Focus on Diabetes: California

5. TECHNICAL FACTOIDS

Electronic Access to Patient Test Results & Medical Records, by Practice Size, 2006

Top 5 Online Health Destinations in November 2006

1. CLINICAL FACTOIDS

FACTOID

Specialty Referral Completion Among Primary Care Patients

According to a new study published in the Annals of Family Medicine, physicians reported that 79.2% of patients referred had a specialist visit, and 83.0% (644 of 776) of patients reported that they completed the referral.
Of the 132 (17%) referred patients who did not see a specialist, the most common, non-mutually exclusive reasons for choosing not to complete the referral were:
(1) the patient's belief that the health problem had resolved (47.5%);
(2) lack of time (37.3%), and;
(3) the patient disagreed with the physician on the need for referral (26.5%).
Patients who requested the referral were more likely to complete the referral than those who did not (92.4% vs 81.9%).
Source: Specialty Referral Completion Among Primary Care Patients: Results From the ASPN Referral Study, Annals of Family Medicine, Inc., July/August 2007, Volume 5, Issue 4

2. HEALTH ECONOMICS FACTOIDS

Factoid

Average Annual Firm and Worker Premium Contributions and Total Premiums for Covered Workers for Single and Family Coverage, by Plan Type, 2007

Plan Type / Worker Contribution / Firm Contribution / Total
HMO Single / $711 / $3,588 / $4,299
HMO Family / $3,311 / $8,568 / $11,879
PPO Single / $717 / $3,920 / $4,638
PPO Family / $3,236 / $9,207 / $12,443
POS Single / $628 / $3,709 / $4,337
POS Family / $3,659 / $7,929 / $11,588
HDHP/SO Single / $522 / $3,347 / $3,869*
HDHP/SO Family / $2,856 / $7,837 / $10,693*
All Plans - Single / $694 / $3,785 / $4,479
All Plans - Family / $3,281 / $8,824 / $12,106
Notes: HMO = Health Maintenance Organization; PPO = Preferred Provider Organization; POS = Point of Service; HDHP/SO = High Deductible Health Plan with a savings option
*Estimate of total premium is statistically different from All Plans estimate by coverage type (p<.05)
Source: 2007 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2007.

Factoid

Pharmacy Expense and Cost Trends

Pharmacy expenses as a percent of total HMO expenses /

14.3% Commercial
12.3% Medicare

Average HMO ingredient cost per prescription dispensed /

$44.68 Commercial
$42.76 Medicare
$41.76 Medicaid

Average HMO Commercial Premium for Outpatient Rx Benefit /

$28.49 Individual
$72.17 Family

Source: Sanofi Aventis, eManaged Care Trends Digest 2007.
Note: This data is also featured in the Trends section of MCOL's Managed Care Training Kit, Pharmaceutical Edition.
Factoid

2007 Health Costs by Geographic Area

2007 Annual Medical Costs / Percent of National Average
Los Angeles / $14,363 / 99.1%
Seattle / $13,206 / 91.1%
Dallas / $14,447 / 99.6%
Chicago / $15,411 / 106.3%
Atlanta / $14,016 / 96.7%
New York / $16,542 / 114.1%
Washington, DC / $14,685 / 101.3%
National Average / $14,500
Source: Milliman Medical Cost Index 2007 - May 2007.

3. UTILIZATION FACTOIDS

Factoid

Race and Primary Reasons for Underuse of Breast Cancer Treatment

Reason / Total
(N=119) / White
(N=53) / Black
(N=41) / Hispanic
(N=21) / Asian and other
(N=4)
Surgeon Recommended Therapy
Patient Declined / 31% / 32% / 32% / 24% / 75%
System failure / 34% / 21% / 44% / 52% / 25%
Surgeon did not recommend therapy / 34% / 47% / 27% / 25% / 0%
Notes: Percentages may not sum to 100 percent because of rounding.
Source: Adapted from N.A. Bickell, F. LePar, J. J. Wang et al., "Lost Opportunities: Physicians' Reasons and Disparities in Breast Cancer Treatment," Journal of Clinical Oncology, Jone 20, 2007 25(18):2516-21.
For additional information, please visit:
Factoid

Number and Percentage of Visits for Type of Condition
United States, 2005
Type of Condition* / Number of Visits in thousands** / Percent
All visits / 1,169,333 / 100%
Chronic / 343,966 / 29.4%
Preventive / 294,868 / 25.2%
Infectious / 211,654 / 18.1%
Other acute or benign conditions*** / 194,505 / 16.6%
Symptoms and signs / 173,171 / 14.8%
Injury, poisoning, or adverse effects / 141,169 / 12.1%
Mental Health / 88,344 / 7.6%
*Based on any of 3 diagnoses recorded at the visit, coded to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). For related ICD-9-CM codes see
**Sum will not add to total because more than one type of diagnosis may be reported per visit.
***Includes benign neoplasms; problems related to pregnancy, delivery, and reproductive health; and conditions that are not considered infectious or chronic, such as gastroenteritis, glaucoma, and cateracts.
Source: Burt CW, McCaig LF, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2005. Advance data from vital and health statistics; no 388. Hyattsville, MD: National Center for Health Statistics. 2007.
FACTOID

Top 10 Most Frequent Specific Conditions Admitted to the Hospital Through the Emergency Department, 2003

Rank / Condition (CCS Code) / Number of admissions through the ED / Percentage of all cases admitted through the ED
1 / Pneumonia / 935,000 / 5.7
2 / Congestive heart failure / 807,000 / 5.0
3 / Chest Pain / 702,400 / 4.3
4 / Hardening of the arteries (coronary atherosclerosis) / 521,000 / 3.2
5 / Heart attack (acute myocardial infarction) / 485,900 / 3.0
6 / Chronic obstructive lung disease / 445,200 / 2.7
7 / Stroke (acute cerebrovascular disease) / 436,100 / 2.7
8 / Irregular heartbeat (cardiac dysrhythmias) / 425,800 / 2.6
9 / Complications of procedures, devices, implants and grafts / 412,700 / 2.5
10 / Mood disorders (depression and bipolar disorder) / 387,500 / 2.4
Note: The number of admissions through the ED have been rounded to the nearest hundred.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003. Admissions for pregnancy, childbirth, and newborns are excluded.
Publication: Healthcare Cost and Utilization Project, Statistical Brief #2, February 2006.

4. QUALITY FACTOIDS

Factoid

State Scorecard on Health System Performance for Selected Quality Indicators

Year / All States Median / Range of State Performance (Bottom-Top) / Top State
Adults age 50 and older received recommended screening and preventive care / 2004 / 39.7% / 32.6% - 50.1% / MN
Adult diabetics received recommended preventive care / 2004 / 42.4% / 28.7% - 65.4% / HI
Children ages 19-35 months received all recommended doses of five key vaccines / 2005 / 81.6% / 66.7% - 93.5% / MA
Heart failure patients given written instructions at discharge / 2004-2005 / 49% / 14% - 67% / NJ
Nursing home residents who were physically restrained / 2004 / 6.2% / 15.9% - 1.9 / NE
Source: Aiming Higher: Results from a State Scorecard on Health System Performance, The Commonwealth Fund Commission on a High Performance Health System, June 2007.

Factoid

Hospitals Rated Better Than Average for Heart-Attack Mortality

The Center for Medicare and Medicaid Services released data on its Hospital Compare web site on hospitals' Death (Mortality) Rates for heart attack and heart failure. Over 4,000 hospitals across the country are ranked. Hospitals that were better than the national average for patient heart-attack mortality:

Hartford Hospital, Hartford, Conn.
St. Vincent's Medical Center, Bridgeport, Conn.
Advocate Lutheran General Hospital, Park Ridge, Ill.
St. Vincent Heart Center of Indiana, Indianapolis
Cape Cod Hospital, Hyannis, Mass.
Suburban Hospital Association, Bethesda, Md.
Maine Medical Center, Portland, Maine
Abbott-Northwestern Hospital Inc., Minneapolis
Barnes Jewish Hospital, St. Louis
Rex Hospital, Raleigh, N.C.
New York-Presbyterian Hospital, New York City
Maimonides Medical Center, New York City
Trumbull Memorial Hospital, Warren, Ohio
Hillcrest Hospital, Mayfield Heights, Ohio
Avera Heart Hospital of South Dakota, Sioux Falls
Evergreen Hospital Medical Center, Kirkland, Wash.
Aurora St. Luke's Medical Center, Milwaukee

Data Source: Centers for Medicare and Medicaid Services
Publication: USA Today, June 22, 2007

Factoid

Focus on Diabetes: California

States are significant purchasers of health care. An estimated 30,500 California government employees and their dependents likely had a diagnosis of diabetes in 2004, and California is estimated to have spent $219,000,000 or 12.9% of State government employee health dollars on diabetes care. An additional 13,000 covered lives are estimated to have undiagnosed diabetes or are at high risk for diabetes.
2004 Estimated Share of Health Expenditures on State Government Employees that Relates to Diabetes Care, Compared to Pacific States and All States:
California: 12.9%
Pacific States: 9.6%
All States: 6.4%
Source: AHRQ's Annual State Snapshots Highlight States' Gains and Lags in Health Care Quality, Agency for Healthcare Research and Quality, June 11, 2007.

5. TECHNICAL FACTOIDS

FACTOID

Electronic Access to Patient Test Results & Medical Records, by Practice Size, 2006

Electronic Access to Test Results / Electronic Medical Records
1 Physician / 36% / 13%
2-9 Physicians / 61% / 23%
10-49 Physicians / 66% / 35%
50+ Physicians / 87% / 57%
Data Source: The Commonwealth Fund (2006) A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency.
Publication: 2007 Medical Cost Reference Guide, Blue Cross and Blue Shield Association.
FACTOID

Top 5 Online Health Destinations in November 2006

Rank / Destination / Unique Visitors (Millions)
1 / WebMD.com / 9.5
2 / NIH.gov / 9.4
3 / MSN Health / 6.7
4 / About.com Health / 5.5
5 / Yahoo Health / 4.1
Source: comScore Media Metrix
Publication: The Wall Street Journal, January 22, 2007.