Research Roundup: ‘Family Glitch’ And Subsidies; Depression Care By Home Health Aides

Health Affairs: The Family Glitch
The Affordable Care Act's (ACA's) "family glitch" ... refers to how some low-to-moderate-income families may be locked out of receiving financial assistance to purchase health coverage through the new health insurance Marketplaces. Eligibility ... is also subject to whether a family has access to affordable employer-sponsored insurance. The problem is that the definition of "affordable"--for both an individual employee and a family--is based only on the cost of individual-only coverage and does not take into consideration the often significantly higher cost of a family plan. ... Families caught up in this glitch, however, cannot qualify for premium tax credits to reduce the cost of a Marketplace plan or for cost-sharing reductions to lower their out-of-pocket payments for health services, even if the family cannot afford coverage otherwise. ... Estimates of the number of dependents (spouses and children) affected vary widely from two to four million. (Brooks, 11/10)

JAMA Internal Medicine: Clinical Effectiveness Of Integrating Depression Care Management Into Medicare Home Health
Among older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes. ... Objective [of the study is to] determine whether, among older Medicare Home Health recipients who screen positive for depression, patients of nurses receiving randomization to an intervention have greater improvement in depressive symptoms during 1 year than patients receiving enhanced usual care. ... The principal finding in this study is that, among medical home health care patients who screen positive for depression, a home health nursing intervention did not improve depression scores overall. However, among the subgroup with more significant depression, the intervention was associated with greater decrease in depressive symptoms than enhanced usual care. (Bruce et al., 11/10)

Urban Institute/Robert Wood Johnson Foundation: Analyzing Different Enrollment Outcomes In Select States That Used The Federally Facilitated Marketplace In 2014
This report analyzes two pairs of states that achieved very different enrollment rates in the federally facilitated Marketplace (FFM) during the 2014 open enrollment period. We compare North Carolina with South Carolina and Wisconsin with Ohio. ... All four states were also home to significant anti-Affordable Care Act (ACA) political activity. ... Demographic factors do not appear to explain the different enrollment outcomes in the four states, nor does the amount of federal funding. We find, however, that development of a strong collaborative infrastructure between and among diverse groups engaging in outreach and enrollment assistance was an important factor in both North Carolina and Wisconsin, the states with the higher enrollment rates of the pairs. (Wishner, Spencer and Wengle, 11/13)

The Kaiser Family Foundation: Visualizing Health Policy: Recent Trends In Employer-Sponsored Insurance
This Visualizing Health Policy infographic takes a look at recent trends in employer-sponsored insurance, including average premium increases for workers with family coverage, the average yearly cost of premiums for single and family coverage and how those costs have increased in the past decade, along with the prevalence of health promotion programs (such as wellness programs) offered by large firms. It also looks at differences in premium and worker contributions at firms with many lower-wage workers and firms with many higher-wage workers; the average general annual deductible for workers who face a deductible for single coverage; and the percentage of workers covered by employers’ health benefits at offering and non-offering firms, from 2000 to 2014. (11/11)

The Kaiser Family Foundation: Assessing Americans' Familiarity With Health Insurance Terms And Concepts
[T]he Kaiser Family Foundation conducted a nationally representative survey of 1,292 U.S. adults to shed light on Americans’ understanding of basic health insurance terms and concepts .... When asked a series of questions about health insurance terms and concepts, including some that require calculating out-of-pocket costs, over half of the public (52 percent) scored an impressive grade of at least 7 out of 10 right answers, but only 4 percent answered all 10 questions correctly. On the other side of the spectrum, nearly three in ten (28 percent) gave correct answers to 4 or fewer questions, with 8 percent giving no correct answers at all. (Norton, Hamel and Brodie, 11/11)

American Health Policy Institute: The Impact Of The Health Care Excise Tax On U.S. Employees And Employers
Under the Affordable Care Act (ACA), in 2018, an excise tax on high-cost health plans, the so-called “Cadillac tax,” takes effect. The potential impact of this tax is driving employers to fundamentally reassess their health care plans and reconsider what their role and approach to providing health care benefits should be in the future. At the moment, the tax is acting as a catalyst for change. In the future, however, continued medical inflation and regional differences in health care costs will make it very difficult for employers to continue reducing benefit costs to avoid the tax. (Troy and Wilson, 11/10)

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

Medscape: Minorities With Cancer Not Using High-Volume Hospitals
Cancer patients from an ethnic minority don't use high-volume hospitals in the United States as much as white patients, even though they live just as close, a new study shows. Socioeconomic factors, such as poverty and education level, could contribute to this difference. This is important because ethnic minorities fare worse after diagnosis with many diseases, said first author Lyen Huang, MD, a research fellow at Stanford University in California. For example, 65.6% of white patients live 5 years after a diagnosis of colorectal cancer, compared with 55.5% of black patients. "We know that high-volume hospitals are associated with decreased mortality rates after cancer, but minorities are less likely to use these hospitals," Dr Huang said here at the American College of Surgeons 2014 Clinical Congress. (Harrison, 11/11)

Medscape: New Tool Aims To Identify Soldiers At Highest Suicide Risk
A new "risk algorithm" may help identify US soldiers at highest risk for suicide following psychiatric hospitalization and offer an effective opportunity to curb this growing problem in the US military, new research suggests. The latest results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) showed that 5% of the soldiers classified as being at highest risk for suicide accounted for 53% of all suicides that occurred within 12 months of inpatient discharge. (Brauser, 11/13)

Medscape: Fewer Gun Injuries In States With Tighter Controls
States with tight regulations on the purchase and control of guns have fewer injuries and deaths from firearms, a new study shows. "Strict firearm legislation may help to reduce firearm-related injuries and mortalities, and help to reduce the years of life lost," Viraj Pandit, MD, a researcher at the University of Arizona in Tucson, said here at the American College of Surgeons 2014 Clinical Congress. (Harrison, 11/13)

Reuters: Elderly Kidney Patients May Not Understand Treatment Choices
Talking through treatment choices and what will happen in the future with health providers is important for elderly patients with chronic kidney disease, a new study finds. Based on interviews with older late-stage kidney patients, researchers found differences in their understanding of what conservative management means, and of the pros and cons of choosing that route over dialysis. (Lehman, 11/12)

Medscape: Hospice Care Lowers Cost And ICU Use In Cancer Patients
Hospice care at the end of life can significantly lower rates of hospitalization, intensive care unit (ICU) admission, and invasive procedures for cancer patients, according to a new study. Not surprisingly, it can also significantly lower healthcare costs. The study, which was published in the November 12 issue of JAMA, adds further evidence to research that has shown that hospice care can reduce aggressive medical interventions and healthcare costs. (Nelson, 11/11)

Reuters: Diabetes Test Strips Likely Overused Among Dual VA, Medicare Patients
Millions of blood sugar testing strips may be unneeded by the U.S. veterans who receive the strips through two government insurance programs each year, suggests a new study. There was potential waste in the two insurance programs, researchers found, but the most waste occurred among veterans who received strips through both programs. “There’s nothing illegal going on,” said Dr. Walid Gellad, the study’s lead author from the Pittsburgh VA Medical Center. “These individuals have benefits from both, but when you look at overall health spending it’s a matter of what’s efficient.” (Seaman, 11/10)

The Philadelphia Inquirer: Many Dialysis Patients Ill-prepared For Emergencies, Study Says
Although their health depends on working technology, many kidney-failure patients on dialysis are not prepared for natural disasters or other emergencies, new research finds. But the study from Mount Sinai Beth Israel Hospital in New York City found that giving dialysis patients detailed information about their medical history and treatment schedule could help improve their emergency preparedness. (11/13)

Reuters: Insurance, Income, Education Tied To Survival After Lung Cancer Surgery
How long patients survive after surgery to remove lung cancer may depend on factors like insurance, income and education, according to a new study. While the stage of the cancer is a more important influence on patient outcomes, the study’s senior author said understanding all of the factors tied to survival can identify groups of people who need more attention for quality improvement. (Doyle, 11/7)

The MiddletownPress: Medicare Costs For Breast Cancer Screenings Soar, But Benefits Remain Unclear
The cost of Medicare-funded breast cancer screenings jumped 44 percent from $666 million to $962 million from 2001 to 2009, yet those added millions did not improve early detection rates among the 65 and older Medicare population, according to a Yale School of Medicine study published recently in the Journal of the National Cancer Institute. The increase was due mostly to the use of costlier digital mammography ($115 per screening) compared to film mammography ($73 per screening), along with newer and expensive screening and adjunct technologies, including breast ultrasound, magnetic resonance imaging — or MRI — and biopsy. The study is the second from Yale since January 2013 to conclude that increased Medicare spending for breast cancer screening does not necessarily translate into better outcomes. (Olivero, 11/9)

MinnPost: Economic Barriers Keep Millions From Cervical Screenings, CDC Finds
Cervical cancer screening is one of the great medical success stories of the 20th century. Since the Pap test (which can detect changes in cells in the cervix that may indicate early signs of cancer) was developed in the 1940s, the U.S. death rate from cervical cancer has plummeted by more than 70 percent. Yet, as a new study published last week by the Centers for Disease Control and Prevention (CDC) makes clear, a substantial number of women continue to develop — and die from — cervical cancer in the United States. Each year, according to the latest CDC statistics, about 12,000 women are diagnosed with the disease and 4,100 die from it. (Perry, 11/10)

MinnPost: Risk Of Hospital Infections Increases At End Of Work Shifts
Here’s some disquieting news to keep in the mind the next time you or someone you know is hospitalized: Nurses, physicians and other hospital workers who interact closely with patients tend to wash their hands less frequently as their work shift progresses, according to a study published earlier this week in the Journal of Applied Psychology. Specifically, the study found that the hospital workers’ compliance rate with hand-washing protocols fell almost 9 percent from the beginning to the end of a normal 12-hour shift. (Perry, 11/13)