Research Roundup: Mastectomies; Hospital Drug Discounts; Homeless Coverage
Each week, KHN compiles a selection of recently released health policy studies and briefs.
JAMA Surgery:
Nationwide Trends In Mastectomy For Early-Stage Breast Cancer
Accredited breast centers in the United States are measured on performance of breast conservation surgery (BCS) in the majority of women with early-stage breast cancer. Prior research in regional and limited national cohorts suggests a recent shift toward increasing performance of mastectomy in patients eligible for BCS. ... We performed a retrospective cohort study of ... more than 1.2 million adult women treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer ... In the past decade, there have been marked trends toward higher proportions of BCS-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease. (Kummerow et al., 11/19)
Health Affairs/Robert Wood Johnson Foundation:
Health Policy Brief: The 340B Drug Discount Program
The 340B program is a federal program established in 1992 that allows safety-net health care organizations serving vulnerable populations to buy outpatient prescription drugs at a discount. ... Since 2010, 340B has become a higher-profile issue as a result of growth of the program via two actions: the Affordable Care Act's (ACA's) addition of more eligible hospitals and new Health Resources and Services Administration (HRSA) guidance allowing covered entities to contract with multiple pharmacies. Government reports documenting deficiencies in oversight and management of 340B have also brought attention to the program. ... the debates regarding the program are not particularly unique. Among the most persistent questions are: Is the scope of the program justified considering the current health care system? Is there sufficient, and sufficiently-funded, government oversight? (Stencel, 11/17)
The Kaiser Family Foundation:
Early Impacts Of The Medicaid Expansion For The Homeless Population
This analysis provides an early look at the impact of the expansion for homeless providers and the patients they serve .... Medicaid expansion has already contributed to key benefits for individuals and providers within the homeless community. Sites in states that expanded Medicaid
have experienced significant gains in coverage among their homeless patients. Participants report that these coverage gains have led to improved access to care and other broader benefits, including improved ability to work and maintain housing. Providers feel they have a wider array of treatment options available and that they are better able to provide care based on the best courses of treatment rather than on the availability of charity or discounted services. (DiPietro, Artiga and Gates, 11/13)
UCLA Center for Health Policy Research:
More Than Half A Million Older Californians Fell Repeatedly In The Past Year
Falls are the leading injury-related cause of death and of medical care use among Californians ages 65 and over. In 2012, there were 1,819 deaths due to falls among older Californians. More than 72,000 hospitalizations were caused by fall injuries among older adults during that year, along with more than 185,000 emergency department (ED) visits. ... Fewer than half of those experiencing multiple falls discussed how to reduce their risk with a health professional. This policy brief details the characteristics of older Californians who have repeated falls, their health care use, and the actions they can take to reduce the risk of future falls. It also provides policy suggestions for reducing
the risk of falls. (Wallace, 11/20)
JAMA Internal Medicine:
Use Of Cardiac Biomarker Testing In The Emergency Department
Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. ... Retrospective study of ED visits by adults ... selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey, ... Cardiac biomarker testing in the ED is common even among those without symptoms suggestive of [acute coronary syndrome]. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers.
(Makam and Nguyen, 11/17)
Urban Institute:
Immigrant Access To Health And Human Services Final Report
Eligibility policies limit immigrants’ access to some parts of the safety net supporting low-income and
poor families in the United States. The ACA opens public health insurance and affordable private health
insurance to some immigrant families who were previously uninsured, but not all. And even immigrants who are eligible for safety-net programs face a number of administrative, logistical, and cultural barriers to accessing benefits. Our research found that complicated eligibility criteria combined with existing data systems and eligibility screening forms and processes made enrollment difficult for both agency staff and immigrant families. ... Our research in California, Maryland, Massachusetts, North Carolina, and Texas uncovered a number of promising practices that can help bridge the gap between available public supports and immigrants’ needs. (Gelatt and Koball, 11/12)
Heritage Foundation:
Medicare’s SGR: Fixing It The Right Way, Not In A Lame Duck Session
Congress needs to junk the sustainable growth rate (SGR) formula that governs Medicare physician payment. Under the formula, if Medicare physicians’ payments in any given year increase by more than the economy’s growth, an automatic and proportionate reduction in their reimbursements is imposed the following year. ... Congress routinely circumvents the SGR—its own handiwork—by making a series of temporary adjustments preventing the SGR’s reductions from taking effect, a practice known as the “doc fix.” ... Congress must also make sure that it does not impose hundreds of billions of costs on already overburdened American taxpayers by ignoring the accumulation of the costs of the fix outside the CBO’s normal 10-year budget window. ... Any permanent Medicare “doc fix” must be financed with permanent Medicare savings. (Robert Moffitt, 11/20)
Here is a selection of news coverage of other recent research:
Medscape:
Low-Dose Aspirin Fails In Primary Prevention
A new trial shows no benefit of low-dose, once-daily aspirin in the primary prevention of cardiovascular events in patients with multiple risk factors, including hypertension, diabetes, and dyslipidemia. ... There were significant reductions in MI and in transient ischemic attack (TIA), but a significant increase in serious extracranial hemorrhage meant the net benefit was questionable. ... The results of the Japanese Primary Prevention Project (JPPP) were published online November 17 in JAMA . (Jeffrey, 11/18)
Reuters:
U.S. States Get More, Spend More On Medicaid Under Obamacare: Report
One part of the Affordable Care Act is going according to plan, with U.S. states receiving and spending more money on the Medicaid health insurance program, a report released by the National Association of State Budget Officers on Thursday showed. (Lambert, 11/20)
