Research Roundup: Lack Of Psychiatrists; ACOs And Mental Health Care; Medicaid And Asthma
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Health Affairs:
Population Of US Practicing Psychiatrists Declined, 2003–13, Which May Help Explain Poor Access To Mental Health Care
We studied changes in the supply of psychiatrists from 2003 to 2013, compared to changes in the supply of primary care physicians and neurologists. During this period the number of practicing psychiatrists declined from 37,968 to 37,889, which represented a 10.2 percent reduction in the median number of psychiatrists per 100,000 residents in hospital referral regions. In contrast, the numbers of primary care physicians and neurologists grew during the study period. These findings may help explain why patients report poor access to mental health care. (Bishop et al., 7/6)
Health Affairs:
Early Efforts By Medicare Accountable Care Organizations Have Limited Effect On Mental Illness Care And Management
People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008–13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. (Busch et al., 7/6)
Pediatrics:
Practice Patterns In Medicaid And Non-Medicaid Asthma Admissions
With American children experiencing increased Medicaid coverage, it has become especially important to determine if practice patterns differ between Medicaid and non-Medicaid patients. ... [Researchers studied] 17 739 matched pairs of children (Medicaid to non-Medicaid) admitted for asthma in the same hospital between April 1, 2011 and March 31, 2014 in 40 Children’s Hospital Association hospitals .... Medicaid patient median cost was $4263 versus $4160 for non-Medicaid patients .... Additionally, the median cost difference (Medicaid minus non-Medicaid) between individual pairs was only $84 ... and the mean cost difference was only $49 .... Length of stay (LOS) was also very similar; both groups had a median stay of 1 day. (Silber et al., 7/6)
JAMA:
Effect Of Palliative Care–Led Meetings For Families Of Patients With Chronic Critical Illness
[Researchers sought to] determine whether family informational and emotional support meetings led by palliative care clinicians improve family anxiety and depression .... [in a] randomized clinical trial conducted from October 2010 through November 2014 in 4 medical intensive care units. ... At 3 months, there was no significant difference in anxiety and depression symptoms between surrogate decision makers in the intervention group and the control group. ... Posttraumatic stress disorder symptoms were higher in the intervention group .... These findings do not support routine or mandatory palliative care–led discussion of goals of care for all families of patients with chronic critical illness. (Carson et al., 7/5)
American Journal of Managed Care:
Primary Care Appointment Availability And Nonphysician Providers One Year After Medicaid Expansion
We examined primary care appointment availability and wait times for new Medicaid and privately insured patients before and after Medicaid expansion in Michigan. ... During the study period, approximately 600,000 adults enrolled in Michigan’s Medicaid expansion program .... One year after expansion, we found that appointment availability remained increased by 6 percentage points for new Medicaid patients ... and decreased by 2 percentage points for new privately insured patients .... Over the same period, the proportion of appointments scheduled with nonphysician providers (nurse practitioners or physician assistants) increased from 8% to 21% of Medicaid appointments ... and from 11% to 19% of private-insurance appointments .... Median wait times remained stable for new Medicaid patients and increased slightly for new privately insured patients, both remaining within 2 weeks. (Tipirneni et al., 6/17)
The Kaiser Family Foundation:
Overview Of Medicaid Per Capita Cap Proposals
The House Republican Plan (“A Better Way”) released on June 22, 2016, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant (based on a state choice). ... Proponents of per capita cap proposals argue that this structure could reduce federal spending and promote flexibility for
states. However, such policies may be difficult to implement and may result in cost shifts .... Pre-set growth rates cannot account for changes in medical costs or health care epidemics or emergencies. With limited federal financing states may turn to restrictions in provider rates and benefits, and with changes to federal requirements states could impose eligibility restrictions or policies to shift costs to beneficiaries. (Rudowitz, Garfield and Young, 6/22)
The Kaiser Family Foundation:
Children’s Health Coverage: The Role Of Medicaid And CHIP And Issues For The Future
This brief summarizes the role Medicaid and CHIP play in providing coverage to children ... and raises issues impacting the future of children’s coverage. It shows: Medicaid and CHIP are central sources of coverage for the nation’s children, covering nearly four in ten children nationwide. ... Despite consistent coverage gains for children, which have reduced their uninsured rate to a record low of 6%, an estimated 5 million children remain uninsured. ... Going forward, sustaining and advancing coverage gains for children will hinge in part on the future of CHIP as well as outreach and enrollment efforts and state adoption of policy options. (Cornachione, Rudowitz and Artiga, 6/27)
Urban Institute:
Sales Of Insurance Across State Lines: ACA Protections And The Substantial Risks Of Eliminating Them
This analysis delineates the reasons why proposals to sell nongroup health insurance coverage across state lines, outside the consumer protections provided by the Affordable Care Act, cannot solve problems with the health care system. Like other policies that would increase segmentation of health care risks, such sales would reduce premiums for those who are healthy at a given time but would increase premiums and reduce access to coverage for those with health problems. Such an approach would also reduce the likelihood that insurers would continue to sell comprehensive benefits and moderate cost-sharing options to any nongroup consumers. (Blumberg, 6/29)