Research Roundup: Ads And Testosterone Use; Home Monitoring With Apps; Per Capita Caps
Each week, KHN compiles a selection of recently released health policy studies and briefs.
JAMA:
Association Between Direct-To-Consumer Advertising And Testosterone Testing And Initiation In The United States, 2009-2013
Question: Is there an association between televised direct-to-consumer testosterone advertising and testosterone testing and initiation in the United States? Findings: In this ecological study of 75 US designated market areas, each exposure to a testosterone advertisement was associated with monthly relative increases in rates of new testosterone testing of 0.6%, new initiation of 0.7%, and initiation without a recent baseline test of 0.8%. (Layton et al., 3/21)
JAMA Surgery:
Effect Of Home Monitoring Via Mobile App On The Number Of In-Person Visits Following Ambulatory Surgery
Question: For patients undergoing ambulatory surgery, can follow-up care via a mobile app avert in-person visits compared with conventional, in-person follow-up care during the first 30 days after the operation? Findings: In this randomized clinical trial of 65 patients, those who used the mobile app attended fewer in-person visits for follow-up care during the first 30 days after the operation than patients in the in-person follow-up care group. This difference was statistically significant. (Armstrong et al., 3/22)
JAMA Surgery:
Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Question: Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? Findings: In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 3/22)
JAMA Internal Medicine:
Patient Mortality During Unannounced Accreditation Surveys At US Hospitals
Question: What is the effect of heightened vigilance during unannounced hospital accreditation surveys on the quality and safety of inpatient care? Findings: In an observational analysis of 1984 unannounced hospital surveys by The Joint Commission, patients admitted during the week of a survey had significantly lower 30-day mortality than did patients admitted in the 3 weeks before or after the survey. This change was particularly pronounced among major teaching hospitals; no change in secondary safety outcomes was observed. (Barnett, Olenski and Jena, 3/20)
The Kaiser Family Foundation:
Health Insurance Premiums Under The ACA Vs. AHCA: County-Level Data
These maps compare county-level estimates of premiums and tax credits under the Affordable Care Act (ACA) in 2020 with what they’d receive under the American Health Care Act as unveiled March 6 by Republican leaders in Congress. The maps were updated on March 21, 2017 to show estimates of how much a person buying their own insurance would have to pay under both the ACA and the House replacement bill. The maps include premium tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $75,000, or $100,000. (3/22)
Urban Institute:
The Impact Of Per Capita Caps On Federal And State Medicaid Spending
In this paper, we analyze the effect of two per capita cap approaches: that in the AHCA and that in Speaker of the House Paul Ryan’s “Better Way” health care plan, released in June 2016. We estimate the effect of each of these per capita caps on federal and state spending from 2019 to 2028. We estimate that between 2019 and 2028, the Better Way proposal would reduce federal Medicaid spending by $841 billion, or 18.1 percent. The AHCA would reduce federal spending by $457 billion, or 9.8 percent. Assuming the bulk of states that expanded coverage under the ACA dropped eligibility for their expansion populations, we estimate that 8 million enrollees would lose Medicaid coverage, and federal savings would increase to $735 billion between 2019 and 2028. (Holahan, Buettgens and Wang Pan, 3/20)
The Kaiser Family Foundation:
What Could A Medicaid Per Capita Cap Mean For Low-Income People On Medicare?
Policymakers are giving serious consideration to proposals, such as the American Health Care Act (AHCA), that would fundamentally change the structure and financing of Medicaid – the federal-state program that provides health coverage for 70 million low-income Americans, including one in five people on Medicare. Federal financing for Medicaid would be converted to a per capita cap model (such as under the AHCA) or block grant, both of which aim to limit and make more predictable federal spending on Medicaid and provide states more flexibility in their management of Medicaid spending. Such a change could affect low-income people on Medicare because Medicaid help cover Medicare’s premiums and cost-sharing, and pays for services not covered by Medicare, such as nursing home care. (Jacobson, Neuman and Musumeci, 3/20)
