Research Roundup: Lowering Premiums; Basic Health Program Options; Slowdown In Medicare Spending

Journal of General Internal Medicine: CMS Reimbursement Reform and the Incidence of Hospital-Acquired Pulmonary Embolism Or Deep Vein Thrombosis
In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions. ... The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis. At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81 % of all hip or knee replacement surgeries for Medicare patients aged 65–69 years old. CMS payment reform resulted in a 35 % lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). ... Payment reform had the desired direction of effect. (Gidwani and Bhattacharya, 12/18)

The Kaiser Family Foundation: How Much Of The Medicare Spending Slowdown Can Be Explained? Insights And Analysis From 2014
This analysis aims to elaborate on the factors behind the gap between CBO's 2009 projections of what Medicare spending would be in 2014 and actual 2014 spending. Our analysis shows that policy choices make a difference: the ACA and [the Budget Control Act of 2011] BCA, along with various policies adopted by the Administrations, account for most of the $126 billion difference between CBO's 2009 Medicare spending projections for 2014 and actual spending this year. Yet, even after taking into account Medicare spending reductions included in the ACA and BCA, additional savings associated with slower-than-expected growth in drug spending and other changes for which we could find solid evidence of savings, we are still unable to explain what accounts for more than one-third of the gap between projected and actual spending for 2014. (White, Cubanski and Neuman, 12/17)

Health Affairs: State-Based Marketplaces Using ‘Clearinghouse’ Plan Management Models Are Associated With Lower Premiums
There is significant variation in how states have designed and implemented their Marketplaces. ... State-based Marketplaces using “clearinghouse” plan management models had significantly lower adjusted average premiums for all plans within each metal level compared to state-based Marketplaces using “active purchaser” models and the federally facilitated and partnership Marketplaces. Clearinghouse management models are those in which all health plans that meet published criteria are accepted. Active purchaser models are those in which states negotiate premiums, provider networks, number of plans, and benefits. (Krinn, Karaca-Mandic and Blewett, 12/17)

Urban Institute/Kaiser Family Foundation: The ACA’s Basic Health Program Option: Federal Requirements And State Trade-Offs
The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). ... BHP offers the prospect of improved affordability for low-income residents, fiscal gains for some states, and reduced churning. However, it also poses financial risks for states and has implications for state marketplaces. In the coming years, some states may investigate a range of approaches to improving affordability of coverage for their low-income residents. Which approach is best—BHP, state supplementation of marketplace subsidies, or bolder alternatives permitted under state reform waivers that begin in 2017—will depend greatly on the unique circumstances facing each individual state. (Dorn and Tolbert, 11/25)

JAMA Psychiatry: Benzodiazepine Use In The United States
Benzodiazepines are widely used in the treatment of anxiety and sleep problems. ... Despite benzodiazepine-related risks of falls, fractures, and motor vehicle crashes in older people, benzodiazepine use was approximately 3 times more prevalent in older than younger adults. ... Several factors may contribute to the observed high rates of long-term benzodiazepine use in older adults. These factors may include treatment of persistent anxiety disorders; deficits in specialized knowledge concerning benzodiazepine prescribing risks in geriatric care; limited access to alternative effective evidence-based treatments, such as cognitive behavioral therapy for insomnia; an unwillingness of some older people to consider reducing or discontinuing benzodiazepines; and competing clinical demands on physician time related to the other physical health needs of their patients. (Olfson, King and Schoenbaum, 12/17)

Urban Institute: Racial/Ethnic Differences In Uninsurance Rates Under The ACA
According to our projections, the ACA with current Medicaid expansion decisions can substantially narrow differences in uninsurance rates between whites and all racial/ethnic minorities, except blacks, who disproportionately live in nonexpansion states. Dramatic reductions are projected for the American Indian/Alaska Natives uninsurance rate: a decrease from 25.7 percent to 13.0 percent, or a 49.5 percent reduction that translates to 600,000 gaining coverage. Latinos have a projected decrease in the uninsurance rate from 31.2 percent to 19.0 percent: a 39.2 percent reduction that translates to 6.6 million gaining coverage. Both groups’ projections lead to a narrowing of the difference in their uninsurance rates compared with whites. ( Clemans-Cope, Buettgens and Recht, 12/16)

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

CQ Healthbeat: Enrollment In Medicaid Managed Care Grows Faster Than Fee-For-Service
The number of Medicaid beneficiaries enrolled through private managed care plans is growing faster than the number of people entering the traditional program, according to an analysis released Wednesday by a trade group representing health plans. The study, done by the PricewaterhouseCoopers accounting firm for the Medicaid Health Plans of America, found that 9.3 million more Medicaid beneficiaries were in managed care plans in 2014. The number in Medicaid fee-for-service programs fell for the first time, dropping by 300,000 enrollees. (Adams, 12/17)

Politico Pro: Study: Hospitals Penalized Despite Lower Readmissions
Hospitals that do a good job in reducing readmissions can still end up getting penalized under the Affordable Care Act — if they are also lowering overall admissions, according to research released Tuesday by the Altarum Institute. The findings raise questions about whether Medicare is using the right measurements, the researchers say. (Kenen, 12/16)

Reuters: California Study Finds Abortion Complications Very Rare
Less than one quarter of one percent of abortion procedures result in major complications, a very low rate that is comparable to minor outpatient procedures in the U.S., according to a study of more than 50,000 women. [in the journal Obstetrics and Gynecology.] ... Abortion is actually as safe as, or safer than, colonoscopy, said Dr. Elizabeth Raymond, and has complication rates similar to outpatient plastic surgery or dental surgery. (Doyle, 12/11)

Medscape: Maternal Mortality Ratio Has Doubled In 23 Years
The US pregnancy-related mortality ratio has continued to increase, rising to 16.0 deaths per 100,000 live births. The latest epidemiologic data from 2006 to 2010 suggest that cardiovascular conditions and infection contributed to the increase in pregnancy-related mortality. The fact that chronic diseases are playing a larger role in pregnancy-related mortality suggests there has been a change in the risk profile of the birthing population. (Pullen, 12/9)

Medscape: First-Episode Psychosis Treatment: Lots Of Room For Improvement
Almost two fifths of all first-episode psychosis (FEP) patients are prescribed drug treatment that does not meet current recommendations, new research shows. In an examination of first prescriptions among FEP patients entering a study of specialized treatment for the disorder, investigators found that prescriptions could have been improved in almost 40% of cases. (Davenport, 12/9)

Medscape: Pediatric Coverage A "Patchwork" Under Affordable Care Act
The approach used to establish the Affordable Care Act's pediatric essential health benefit has resulted in a state-by-state patchwork of coverage with inconsistent exclusions, particularly of services for children with mental or developmental disabilities, a new study finds. The results were published in the December children's health-themed issue of Health Affairs, and presented in a briefing by Aimee M. Grace, MD, a fellow in general academic paediatrics at Children's National Health System (Washington, DC). (Tucker, 12/8)

Medscape: Pharmacist Phone Call Before Physician Visit Enhances Care
Clinical pharmacists who perform medication reconciliation with new patients by telephone before their first visit to a primary care physician (PCP) can improve quality of care, researchers have found. ... They can prioritize medication concerns for the PCP so that important issues are addressed during appointments. Results of the study were presented in a poster at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting (Frellick, 12/8)

Reuters: Problems At Home After Surgery? Study Says Go Back To Same Hospital
When patients have complications after surgery, it’s best to go back to the hospital where the operation was done, a new study suggests. Patients who go instead to a hospital that didn’t do the original operation have a higher risk of death, the researchers found. ... Generally, patients readmitted to a different hospital lived farther from the original facility than the one where they went for follow-up care, the researchers wrote in JAMA Surgery. (Rapaport, 12/8)