Research Roundup: ERs And Surprise Bills; Attrition Of Surgical Residents; Vets And Pain

Health Affairs: One In Five Inpatient Emergency Department Cases May Lead To Surprise Bills
A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. In 2014, 20 percent of hospital inpatient admissions that originated in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bill. (Garmon and Chartock, 12/14)

JAMA Surgery: Prevalence And Causes Of Attrition Among Surgical Residents
This systematic review and meta-analysis found that the pooled estimate of attrition prevalence among general surgery residents was 18%, female residents were more likely to leave than male residents, and residents were most likely to leave after the first postgraduate year owing to an uncontrollable lifestyle. The most common destination of residents who left was relocating to another general surgery program or switch to another specialty. ... Attrition prevalence is relatively high among general surgery residents and future research should focus on developing strategies to limit resident attrition. (Khoushhal et al., 12/14)

JAMA Psychiatry: Women’s Mental Health And Well-Being 5 Years After Receiving Or Being Denied An Abortion
This longitudinal cohort study observed 956 women semiannually for 5 years. Eight days after seeking an abortion, women who were denied an abortion reported significantly more anxiety symptoms and lower self-esteem and life satisfaction, but similar levels of depression, as women receiving abortions; outcomes improved or remained steady over time. (Biggs et al., 12/14)

Journal of Pain: Severe Pain In Veterans: The Impact Of Age And Sex, And Comparisons To The General Population
This study provides national prevalence estimates of US military Veterans with severe pain, and compares Veterans to nonveterans of similar age and sex. Data used are from the 2010-2014 National Health Interview Survey (NHIS) .... It was estimated that 65.5% of US military Veterans reported pain in the previous 3 months, with 9.1% classified as having severe pain. In comparison to Veterans, fewer nonveterans reported any pain (56.4%) or severe pain (6.4%). While Veterans aged 18-39 had significantly higher prevalence rates for severe pain (7.8%) than did similar-aged nonveterans (3.2%), Veterans age 70 or older were less likely to report severe pain (7.1%) than nonveterans (9.6%). (Nahin, 12/13)

Brookings: Why Repealing The ACA Before Replacing It Won’t Work, And What Might
The current situation presents an opportunity to replace the Affordable Care Act with a more sustainable bipartisan law. ... starting with repeal and delay threatens to destabilize the individual market and harm ... everyone who now purchases insurance in the individual market. Estimates show that premiums would jump at least 20 percent and cause 4.3 million to lose health insurance as soon as next year, and that’s nothing compared to the damage that would be inflicted if a replacement plan subsequently failed to emerge. (Rivlin, Adler, and Butler, 12/13)

The Kaiser Family Foundation: What Are The Implications Of Repealing The Affordable Care Act For Medicare Spending And Beneficiaries?
As a result of the Medicare provisions included in the ACA, Medicare spending per beneficiary has grown more slowly than private health insurance spending; premiums and cost-sharing for many Medicare-covered services are lower than they would have been without the ACA; new payment and delivery system reforms are being developed and tested; and the Medicare Part A trust fund has gained additional years of solvency. Full repeal of the Medicare provisions in the ACA would increase payments to hospitals and other health care providers and Medicare Advantage plans, which would likely lead to higher premiums, deductibles, and cost sharing for Medicare-covered services paid by people with Medicare. Full repeal would also reduce premiums for higher-income beneficiaries. (Cubanski et al., 12/13)

Health Affairs: Previous Medicaid Expansion May Have Had Lasting Positive Effects On Oral Health Of Non-Hispanic Black Children
We present new evidence suggesting that a historic public health insurance expansion for pregnant women and children in the United States in the 1980s and 1990s may have had long-lasting effects on the oral health of the children gaining eligibility. ... We found that expanded Medicaid coverage geared toward pregnant women and children during their first year of life was linked to better oral health in adulthood among non-Hispanic blacks. Our results also suggested that there might be a benefit to expanded public health insurance eligibility for children at ages 1–6 among non-Hispanic blacks and Hispanics. (Lipton et al., 12/5)

Brookings: Five-Star Ratings For Sub-Par Service: Evidence Of Inflation In Nursing Home Ratings
This paper systematically analyzes CMS’s nursing home rating system, demonstrates the existence of inflation, and presents a model to detect likely inflators. We show that nursing homes have strong financial incentives directly related to higher star ratings, which may in turn drive the inflating behaviors. We then develop a systematical method which uses the independent third-party measure of patient complaints to demonstrate the existence of rating inflation. An inflation prediction model is then developed, which provides an estimate of the proportion of inflating nursing homes in the current system, and gives a quantifiable evaluation of the system performance. (Han, Yaraghi and Gopal, 12/15)

Urban Institute/Brookings Institution: The Pros And Cons Of Taxing Sweetened Beverages Based On Sugar Content
In this report, we analyze the potential policy benefits of taxing sugar content; document how content-based taxes have been used to discourage consumption of sugar, alcohol, and tobacco; and examine the legal and practical challenges of implementing such taxes at the federal, state, and local level. We conclude that taxing based on the amount of added sugar a drink contains, either by taxing sugar content directly or by levying higher volume taxes on drinks with more sugar, is feasible in many jurisdictions and reduces sugar consumption more effectively than comparable taxes on drink volume. Broad-based volume or sales taxes on all soft drinks, however, raise revenue more efficiently. (Francis, Marron and Rueben, 12/12)

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

MedPage Today: Patient Volumes Affect Quality Of Diabetes Care
Varying levels of patient volume and diabetes management experience influenced the quality of diabetes care provided by primary care physicians in the Canadian province of Ontario, researchers said. The cohort study found that patients of primary care physicians with higher ambulatory volumes tended to receive significantly lower-quality diabetes management, wrote Andrew Cheung, MD, of McMaster University, and colleagues in Annals of Internal Medicine. (Monaco, 12/12)

Stat: 'Pokemon Go' Players Really Got Going, Researchers Find
Annoyed business owners and frightened neighbors weren’t the only ones who noticed that the “Pokemon Go” craze sent a lot of people walking. Scientists took note too, and in a new study they confirmed that many of the mobile game’s players walked farther than before, to places they hadn’t previously visited, in search of elusive imaginary creatures visible in its augmented reality display. But, the findings published in BMJ indicate, that effect did not last long: Within six weeks they were back to their normal activity habits. (Samuel, 12/13)

The Washington Post: ‘Everybody Outside Of The Top Is Suffering’: How Stress Is Harming America’s Health
The stresses of poverty in the United States have grown so intense that they are harming the health of lower-income Americans — even prematurely leading to their death. A report published Monday by the Hamilton Project at the Brookings Institution finds that stress levels have greatly increased for Americans at all income levels since the 1970s, but especially for low-income groups, as the chart below shows. (Swanson, 12/13)

The New York Times: One In 6 American Adults Say They Have Taken Psychiatric Drugs, Report Says
About one in six American adults reported taking at least one psychiatric drug, usually an antidepressant or an anti-anxiety medication, and most had been doing so for a year or more, according to a new analysis. The report is based on 2013 government survey data on some 242 million adults and provides the most fine-grained snapshot of prescription drug use for psychological and sleep problems to date. (Carey, 12/12)

WBUR: Health Innovator: Patients Who Are Asked About Food, Heat See Medical Benefits
New research out Monday shows that when primary care patients get help attaining basic resources — like food, housing, heat and access to affordable medicines — it leads to improvements in their blood pressure and cholesterol levels. The findings, published in JAMA Internal Medicine, may be intuitive. But they provide further evidence that a Boston-based nonprofit founded 20 years ago by a Harvard undergraduate is on the right track by focusing on patients' "unmet social needs" as a critical pathway toward true health. (Zimmerman, 12/12)