Research Roundup: Effects Of Ending CHIP; Measuring Churn; Kids And Antipsychotic Drugs

Health Affairs: Many Families May Face Sharply Higher Costs If Public Health Insurance For Their Children Is Rolled Back
The potential for a significant rollback of public coverage for children [if the Children's Health Insurance Program is not funded] raises important policy questions regarding alternative pathways to affordable and high-quality coverage for low-income children. For many children at risk of losing eligibility for public coverage, the primary alternative pathway to coverage would be through their parents’ employer-sponsored insurance, yet relatively little is known about the cost and quality of that coverage. Our estimates, based on data from the Insurance Component of the 2012 and 2013 Medical Expenditure Panel Surveys, show that many families would face sharply higher costs of covering their children. In many cases, the only employer-sponsored coverage available would be a high-deductible plan. (Selden et al., 3/25)

Center on Budget and Policy Priorities: Lessons Churned: Measuring The Impact Of Churn In Health And Human Services Programs On Participants And State And Local Agencies
Public benefit programs for low-income individuals and families typically require households to apply, establish eligibility, and then, at subsequent regular intervals, to re-establish eligibility. ... the redetermination process can result in eligible households temporarily losing eligibility, experiencing a short period without benefits, and then reapplying — a phenomenon sometimes called “churn.” Churn entails costs for recipients — in lost benefits, short-term hardship, and effort reapplying — and also for state agencies, because processing a new application usually involves more resources. .... [This paper] defines churn and outlines its consequences, then explores approaches to measuring churn, and finally looks at possible approaches to reducing churn. (Rosenbaum, 3/20)

HHS Office of Inspector General: Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-Of-Care Concerns
Second-generation antipsychotics (SGAs) are a class of drugs used to treat psychiatric disorders, such as schizophrenia, bipolar disorder, and psychotic depression. SGAs are widely used to treat children enrolled in Medicaid who have mental health conditions. However, SGAs can have serious side effects and little clinical research has been conducted on the safety of treating children with these drugs. ... We selected a sample of 687 claims for SGAs prescribed to children in California, Florida, Illinois, New York, and Texas. ... In the five States, 8 percent of SGAs were prescribed for the limited number of medically accepted pediatric indications. There are only five SGAs with medically accepted pediatric indications. It is not uncommon for doctors to prescribe, or Medicaid to pay for, SGAs for children for indications that are not medically accepted. (3/25)

American Journal of Managed Care: Decision Aids For Benign Prostatic Hyperplasia And Prostate Cancer
Our observational study is the largest to date of [using patient decision aids] in the context of quality improvement for elective surgical care. We found that implementing [video-based tools with accompanying booklets] for [benign prostatic hyperplasia patients] in a large, multi-site urology group practice setting was associated with a significant 32% lower rate of transurethral prostate procedures among men who had previously received pharmacological treatment .... Furthermore, we found that [using the video and booklets] for localized [prostate cancer] was associated with a significant 27% reduction in actively treating [the condition] ... Notably, implementing [the videos and booklets] was not associated with changes in healthcare costs. (Arterburn et al., 3/20)

The Kaiser Family Foundation: Medicare’s Income-Related Premiums: A Data Note
As part of this discussion [on replacing Medicare's formula for physician payments], some policymakers have proposed to increase Medicare premiums for higher-income beneficiaries — an idea that also has been raised in the context of proposals to reduce federal spending. ... This data note presents new information to help set a context for understanding the implications of proposed changes to Medicare’s income-related premiums. It describes current-law requirements with respect to the income-related premiums under Medicare Part B and Part D, including the number and share of Medicare beneficiaries who are estimated to pay income-related premiums and revenues raised from the income-related premium. (Cubanski and Neuman, 3/20)

Center for Medicare Advocacy/The Kaiser Family Foundation: Comparison Of Consumer March 2015 Protections In Three Health Insurance Markets
Medicare Advantage plans, QHPs and Medicaid MCOs provide coverage for an increasing number of people .... While many consumer protections between the markets are similar, differences could both cloud consumers’ understanding of their rights in the different programs and fragment oversight by government entities and administration by plan sponsors. Transitioning between types of coverage that have significantly different consumer protections raises issues of not only equity, but ease of administration, oversight and consumer understanding of how to use their insurance and exercise their rights. Whether these differences should be maintained warrants further review by policy makers. (Lipschutz and Pollitz, 3/19)

Here is a selection of news coverage of other recent research:

Reuters: Lack Of Insurance Bars Some From Hepatitis C Treatment
Survey data from 2001 to 2010 show that lack of insurance kept some people with hepatitis C virus from getting treatment. Recently, more effective and well-tolerated drugs have been developed to treat hepatitis C, removing many of the discouraging side effects of older drugs. The infection is curable and transmission can be prevented, researchers write in the American Journal of Gastroenterology. (Doyle, 3/24)

Reuters: Path To Breast Cancer Care Differs By Race, Ethnicity
Breast cancer patients of different races and ethnicities may not pick surgeons and hospitals in the same way, a new study suggests. For example, black and Hispanic women with breast cancer were less likely than white women to select surgeons and hospitals based on reputation, researchers found. The differences in how people select healthcare providers may help explain racial differences in use, delivery and quality of medical care, the researchers write in JAMA Oncology. (Seaman, 3/20)

Medscape: Reimbursement Key To Improving End-Of-Life Care
Giving physicians incentives — and compensating them appropriately — will be key to helping the nation improve end-of-life planning and care, said experts gathered at an Institute of Medicine (IOM) forum today. The National Action Conference on Policies and Payment Systems to Improve End-of-Life Care was held to discuss how to implement the recommendations in IOM's September report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. (Ault, 3/20)

Reuters: Resuscitation Outcomes No Worse When Families Watch Doctors Work
Letting family members watch while doctors work to bring a loved one back from the brink of death may not hurt patients' odds of survival, a new study suggests. "Hospitals that have been hesitant to set policies that allow families to be in the room during resuscitation should be encouraged that this didn't lead to worse outcomes or errors," said Dr. Zachary Goldberger, the study’s lead author from the University of Washington Harborview Medical Center in Seattle. (Rapaport, 3/24)

Reuters: Cancer Patients Want More Info About CT Risks
Some cancer patients would like more information on the health risks of their radiology tests, a new study found. Most of the 30 patients questioned for the study said they looked online for information about the radiation hazards of tests like computed tomography (CT) scans, since their doctors did not explain the risks. (Doyle, 3/24)

Medscape: Most New Pediatricians Happy With First Job Choice
Most general pediatricians said lifestyle and family considerations influenced their first job choice, and 83% said the time allocated for specific duties in their current position was compatible with their career goals, according to a survey. ... Amid concerns about a mismatch between young general pediatricians' short- and long-term career goals and desired work responsibilities and the available jobs, the research team surveyed all 5210 clinicians who sat for the General Pediatrics Certifying Examination in 2012. ... 1190 (87%) were engaged in direct or consultative pediatric care. Within this group, 66% said lifestyle and family considerations were the most important factors in choosing their first position after completing training. Eighty-three percent said they spent their work time in the way they wanted. (Henderson, 3/23)

Time: This Map Shows The Deadliest Counties In The United States
Oglala Lakota County, South Dakota is the deadliest county in America, at least by one measure: It is the place where residents are most likely to die before the age of 75, which health experts consider premature death. The new edition of County Health Rankings from the University of Wisconsin Population Health Institute, places the county–which until very recently was called Shannon County–at the bottom of the class in the number of people who died before age 75, a common measure of public health. (Wilson, 3/25)

MinnPost: Antipsychotic Drugs Are Riskier For Older Dementia Patients Than Previously Thought
Physicians often prescribe antipsychotic drugs to older people with dementia to control non-memory related behavioral symptoms, including agitation, aggressiveness, delusions and hallucinations. But officials at the U.S. Food and Drug Administration (FDA) have never approved antipsychotic medications — such as haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel) — for that purpose. Indeed, these medicines come with a “black box” FDA warning that their use to control behavioral disturbances in people with dementia is associated with an increased risk of premature death. (Perry, 3/19)