Morning Briefing
Summaries of health policy coverage from major news organizations
Research Roundup: Burdens On Safety Net Hospitals; Rural Hospitals' Unpaid Care; Covering The Uninsured
JAMA Surgery: Effect Of Hospital Safety-Net Burden On Cost And Outcomes After Surgery
[Researchers sought to] determine the effect of patient and hospital factors on surgical outcomes and cost at safety-net hospitals ... [using analysis of statistics from the] University HealthSystem Consortium database .... After adjusting for patient characteristics and center volume, [hospitals with high safety-net burden] HBHs still had higher odds of mortality for 3 procedures ..., readmission for 2 procedures ... and the highest cost of care associated with 7 of 9 procedures ....Analysis of Hospital Compare data found that HBHs had inferior performance on Surgical Care Improvement Project measures, higher rates of surgical complications .... These data suggest that intrinsic qualities of safety-net hospitals lead to inferior surgical outcomes and increased cost .... In addition, impending changes to reimbursement may have a negative effect on the surgical care at these centers. (Hoehn et al., 10/15)
Health Affairs: Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals In States That Did Not Expand Medicaid
We compared rural hospitals in Medicaid expansion and nonexpansion states in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013. We found that rural hospitals in expansion states provided more dollars of uncompensated care than those in nonexpansion states and that the difference was at least partly driven by greater uncompensated costs associated with public programs such as Medicaid. We found higher dollar values of unrecoverable debt and charity care among non–critical access rural hospitals in nonexpansion states than among those in expansion states. Compared to hospitals in expansion states, those in nonexpansion states provided greater amounts of uncompensated care as a percentage of revenues and appeared to be more financially vulnerable. (Reiter, Noles and Pink, 10/5)
Health Affairs: High-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining Traditional Medicare
We examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. We found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care (17 percent versus 3 percent), short-term nursing home care (9 percent versus 4 percent), and home health care (8 percent versus 3 percent). These results were magnified among people who were enrolled in both Medicare and Medicaid. Our findings raise questions about the role of Medicare Advantage plans in serving high-cost patients with complex care needs, who account for a disproportionately high amount of total health care spending. (Rahman et al., 10/5)
The Kaiser Family Foundation: New Estimates Of Eligibility For ACA Coverage Among The Uninsured
This analysis provides national and state-by-state estimates of eligibility for ACA coverage options among those who remained uninsured. It is based on Kaiser Family Foundation analysis of the 2015 Current Population Survey, combined with other data sources. ... As of the beginning of 2015, 32.3 million nonelderly people lacked health coverage in the U.S. Nationally, we estimate that nearly half (15.7 million, or 49%) of this population is eligible for financial assistance to gain coverage through either Medicaid or subsidized Marketplace coverage .... One in ten uninsured people (3.1 million) fall into the coverage gap due to their state’s decision not to expand Medicaid, and 15% of the uninsured (4.9 million) are undocumented immigrants who are ineligible for ACA coverage under federal law. (Garfield et al., 10/13)
The Kaiser Family Foundation/Health Policy Institute at Georgetown University: Medicare Part D: A First Look At Plan Offerings In 2016
This issue brief provides an overview of the 2016 [Medicare prescription drug plan] PDP marketplace .... In 2016, beneficiaries in each region will have a choice of 26 PDPs, on average, down by 4 from 2015. The average PDP premium (weighted by 2015 plan enrollment) is projected to increase by 13 percent from 2015 to 2016, from $36.68 to $41.46 per month. Even if a number of beneficiaries switch or are reassigned to lower-premium plans, the average premium increase for 2016 is likely to be the largest since 2009. More than one-third of the 11.2 million PDP enrollees who do not receive Low-Income Subsidies (LIS) would pay premiums of $60 or more per month in 2016 if they stay in the same plan. (Hoadley, Cubanski and Neumann, 10/13)
Here is a selection of news coverage of other recent research:
The New York Times: Dietary Supplements Lead to 20,000 E.R. Visits Yearly, Study Finds
A large new study by the federal government found that injuries caused by dietary supplements lead to more than 20,000 emergency room visits a year, many involving young adults with cardiovascular problems after taking supplements marketed for weight loss and energy enhancement. The study is the first to document the extent of severe injuries and hospitalizations tied to dietary supplements, a rapidly growing $32 billion a year industry that has attracted increased scrutiny in the past year and prompted calls for tougher regulation of herbal products. (O'Connor, 10/14)
The Baltimore Sun: Study Reveals Why Gowns And Gloves Can Be So Dangerous For Hospital Workers
A hospital ought to be the last place to get a life-threatening infection, but it happens. A new study helps explain why. Researchers asked real hospital workers to remove gowns and gloves smeared with fake bacteria. When they did, the fake bacteria wound up on their skin or clothes 46% of the time, according to their report published Monday in JAMA Internal Medicine. (Kaplan, 10/12)
Reuters: Women Less Likely To Be Taking Post-Heart Attack Meds
Women appear less likely than men to take all the medications needed after a heart attack to help prevent repeat episodes, a Canadian study suggests. Researchers analyzed data on more than 12,000 patients who survived for at least a year after a heart attack between 2007 and 2009. ... While the study can’t determine the exact reason for the gender gap – doctors might not have prescribed the drugs or women might not have filled the prescriptions – the findings highlight the need to offer women more aggressive treatment, said lead study author Kate Smolina. (Rapaport, 10/15)
JAMA Medical News: Transgender Care Moves Into The Mainstream
A 2011 survey by the Williams Institute, a think tank based at the University of California, Los Angeles, School of Law that conducts research on sexual orientation and gender identity law and public policy, estimated the US transgender population to be about 700 000—nearly 0.3% of the population. Many have faced difficulties ... when trying to access quality health care or, in some cases, any health care at all. According to the 2011 National Center for Transgender Equality/National Gay and Lesbian Task Force report “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey,” of the 6456 transgender and gender-nonconforming people polled, 19% of respondents had been refused medical care, 28% had experienced verbal harassment in a medical setting, and 2% had been physically assaulted in a physician’s office. (Buchholz, 10/14)
JAMA Medical News: Working Late, Courting Stroke
According to a recent review and meta-analysis in The Lancet, [for people] working more than 55 hours a week, their stroke risk will climb .... The analysis included 25 prospective cohort studies involving a total of 603 838 men and women with no history of coronary heart disease who were followed up for a mean of 8.5 years and 528 908 men and women with no history of stroke who were followed up for 7.2 years. The investigators found that working 55 hours a week or more was linked with a 33% increased risk of stroke and a 13% increased risk of coronary heart disease. ... According to the US Bureau of Labor Statistics, the average full-time worker in 2014 worked 42.5 hours .... Nearly 10% of nonagricultural workers worked between 49 and 59 hours a week, and among agricultural workers, 20.7% worked more than 60 hours per week .... Hidden in those numbers are a lot of workers at risk for stroke. The question, then, is what to do about it. (Buchholz, 10/9)
Reuters: U.S. Prescription Opioid Misuse And Deaths Increase
The proportion of people reporting use of prescription opioids for reasons other than medical necessity fell between 2003 and 2013, but use disorders and overdose deaths increased, according to a new study. “The results underscore the importance of addressing the prescription opioid crisis,” said lead author Dr. Beth Han of the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Maryland. (Doyle, 10/13)
