Research Roundup: Medicaid Doctor Pay; Malpractice Settlements; Nursing Home Quality

Health Affairs: Medicaid Primary Care Parity
[T]he Affordable Care Act (ACA) required states to raise Medicaid primary care payment rates to Medicare levels in 2013 and 2014 .... Federal lawmakers failed to reauthorize the fee bump during the 113th Congress, ending in December 2014. ... As of January 1, 2015, sixteen states and the District of Columbia had decided to continue paying enhanced rates, while thirty-four states had declined. Although the program is over, the debate about whether it worked--and should, therefore, be reinstated in some form--continues. Evaluators have been challenged by the program's later-than-planned start and short duration, which many believe made it impossible to detect program impacts. Another challenge to measuring the program's impact is that it was intended to improve access to care--a variable that is difficult to measure directly. (Tollen, 5/11)

JAMA Internal Medicine: Use Of Nondisclosure Agreements In Medical Malpractice Settlements By A Large Academic Health Care System
We performed a retrospective review ... for [medical malpractice] claims closed before (fiscal year 2001-2002), during (fiscal year 2006-2007), and after (fiscal years 2009-2012) the implementation of tort reform in Texas. We studied The University of Texas System .... During the 5 study years, The University of Texas System closed 715 malpractice claims and made 150 settlement payments. For the 124 cases that met our selection criteria, the median compensation paid by the university was $100 000 .... A total of 110 settlement agreements (88.7%) included nondisclosure provisions. All the nondisclosure clauses prohibited disclosure of the settlement terms and amount, 61 (55.5%) prohibited disclosure that the settlement had been reached, 51 (46.4%) prohibited disclosure of the facts of the claim, 29 (26.4%) prohibited reporting to regulatory agencies. (Sage, Jablonski and Thomas, 5/11)

JAMA Surgery: Hospital-Level Factors Associated With Mortality After Endovascular And Open Abdominal Aortic Aneurysm Repair
Endovascular technology [which threads a catheter through blood vessels] has become ubiquitous in the modern care of abdominal aortic aneurysm (AAA), yet broad estimates of its efficacy among variable hospital and regional settings is not known. [Researchers sought to] perform a preliminary analysis of hospital [size and type] on mortality following open AAA repair (OAR) and endovascular AAA repair (EVAR). ... Our data demonstrate that outcomes for both OAR and EVAR appear to depend greatly on hospital-level effects. Academic institutions appear to have better outcomes after elective AAA repair overall, and in particular after EVAR. In contrast, hospital size appears to have a more significant effect on 30-day mortality for OAR cases than for EVAR cases. These data make a preliminary argument in favor of AAA centers of excellence that deserves further investigation. (Hicks et al., 5/13)

The Kaiser Family Foundation: Reading The Stars: Nursing Home Quality Star Ratings, Nationally And By State
In 2008, the Centers for Medicare and Medicaid Services (CMS) launched the Five-Star Quality Rating System on its Nursing Home Compare website .... This issue brief presents national and state-level analysis of nursing homes quality scores based on these five-star ratings and discusses relevant policy considerations.... More than one-third of nursing homes certified by Medicare or Medicaid have relatively low overall star ratings of 1 or 2 stars, accounting for 39 percent of all nursing home residents. Conversely, 45 percent of nursing homes have overall ratings of 4 or 5 stars, accounting for 41 percent of all nursing home residents. For-profit nursing homes, which are more prevalent, tend to have lower star ratings than non-profit nursing homes. Smaller nursing homes (with fewer beds) tend to have higher star ratings than larger nursing homes. (Boccuti, Casillas and Neuman, 5/14)

Urban Institute: Health Insurer Responses To Medical Loss Ratio Regulation
One of the Affordable Care Act’s early market reforms, starting in 2011, required health insurers to spend 80 percent or more of premiums on medical claims or quality improvement in aggregate. Using data submitted by insurers from 2010 to 2012, we found that the new regulations on medical loss ratios (MLRs) led to substantially higher MLRs in the individual market overall, driven by increases among insurers who started with MLRs less than 80 percent in 2010. The increase in MLR occurred in part through increasing the amount of claims paid for health care, while holding premium growth in check, and represented increased value for consumers. In addition, the MLR rule created an incentive for insurers to reduce their administrative overhead costs as a share of premiums. We find evidence suggesting insurers did indeed become more efficient, with minimal disruption to the market.(Clemans-Cope, Garrett and Wissoker, 5/13)

Brookings Institution/Leavitt Partners/Robert Wood Johnson Foundation: Origins And Future Of Accountable Care Organizations
The fragmented and misaligned state of the U.S. health care system has become a catalyst for payment and delivery system reforms. Traditional fee-for service (FFS) payment structures incentivize high volume rather than high quality care, and lead to the suboptimal provision of medical services across the disjointed provider landscape. Despite various attempts to improve care delivery, health care costs continue to rise. The Accountable Care Organization (ACO) model seeks to reverse these trends by promoting a simultaneous restructure of the payment and delivery systems to incentivize higher quality, lower cost care. This paper provides an overview of the accountable care movement; describes the structural classification of ACOs and various accountable care payment contracts; and provides a high-level trend analysis of where the ACO movement is heading. (Tu et al., 5/12)

Women's Health Issues/Kaiser Family Foundation: Medicaid At 50: Marking A Milestone For Women’s Health
When Medicaid was enacted 50 years ago, no one could have imagined that this relatively modest program would become the backbone of coverage for millions of low-income women. Today, Medicaid provides health and long-term coverage to more than 1 in 10 women. For women in particular, the program has served as a critical safety net by providing coverage for a wide spectrum of services that other government programs and private insurance did not, from contraceptives and pregnancy-related care to longterm care services and supports. Medicaid’s 50th anniversary is an opportune time to look back at some of the program’s achievements as they have affected women and to take stock of the challenges the program will continue to face in the coming years. (Salganicoff, Ranji and Sobel, 5/8)

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

Reuters: Inhaler Ban Boosts Costs For People With Asthma
A 2008 ban on chlorofluorocarbons (CFCs) has ended up being particularly costly for people with asthma. The ban changed the type of albuterol inhaler available in the U.S., and since then costs have gone up and inhaler use has gone down, according to a new study. Albuterol inhalers prevent and treat wheezing, shortness of breath, coughing, and chest tightness due to asthma or chronic obstructive pulmonary disease. Generic albuterol inhalers using CFCs were banned and were replaced by more expensive inhalers using hydrofluoroalkane (HFA). (Doyle, 5/11)

Reuters: Number Of Americans Using $100,000 In Medicines Triples: Express Scripts
More than a half-million U.S. patients had medication costs in excess of $50,000 in 2014, an increase of 63 percent from the prior year, as doctors prescribed more expensive specialty drugs for diseases such as cancer and hepatitis C, according to an Express Scripts report released on Wednesday. Of the estimated 575,000 Americans who used at least $50,000 in prescription medicines last year, about 139,000 used at least $100,000 worth of medication, nearly triple the 47,000 who hit that mark in 2013, the report said. (Berkrot, 5/13)

NBC News: Can A Weak Grip Predict Heart Disease?
Here's a surprisingly easy and low-tech way to predict who's most likely to have a heart attack or stroke: measure their grip. A large study of nearly 140,000 people from 17 different countries found a clear and consistent link between grip strength and death from any cause, but especially from heart attack and stroke. It is a better predictor than blood pressure and could be a cheap, quick way for doctors to screen out who needs the most attention. (Fox and Silverman, 5/13)

Time: More Than A Quarter Of American Adults Have Untreated Tooth Decay
New data on tooth decay and cavities among American adults reveal the sad state of our pearly whites. More than 25% of American adults ages 20 to 64 have untreated tooth decay, and 91% have one tooth — or more — that has been treated for tooth decay or needs to be. The latest findings published Wednesday from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics show that while tooth decay and complete tooth loss have dropped among Americans since the 1960s, disparities still remain, and there’s room for improvement in our oral health. (Sifferlin, 5/13)

Reuters: Waiting To Call Ambulance Delays Heart Attack Treatment
Half of heart attack patients fail to immediately call an ambulance for help, delaying diagnosis and potentially worsening their survival odds, a Swedish study suggests. Researchers studied treatment timelines from symptom onset to diagnosis for about 450 people hospitalized for the deadliest type of heart attacks, known as ST-elevation myocardial infarction (STEMI), which are caused by prolonged blockage of blood supply to the heart. (Rapaport, 5/7)

Medscape: Patients Commonly Stop Antidepressants, Don't Tell Docs
About 20% of patients who are prescribed antidepressants stop taking them without telling their doctor, new research shows. Characteristics of those most likely to discontinue these medications include younger age, being diagnosed with anxiety or substance use disorder in addition to depression, and being treated in a general medical setting rather than by a psychiatrist or other mental health specialist. The findings are published in the May issue of Psychiatric Services. (Lowry, 5/11)

Medscape: Addiction Programs Need Help To Maximize ACA Benefits
Addiction treatment centers need help to fully realize the Affordable Care Act's (ACA's) promise of improved access to high-quality addiction treatment, new research suggests. The ACA "dramatically" expands health insurance for addiction treatment and provides "unprecedented" opportunities for service growth and delivery model reform, investigators led by Christina Andrews, PhD, MSW, assistant professor of social work, University of South Carolina, in Columbia, write. "Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change." (Brooks, 5/11)

Reuters: Children Of Depressed Mothers At Risk For Behavior Problems
Children are more likely to develop behavioral or emotional problems if their mothers are chronically depressed, even if symptoms aren't severe, a French study finds. While previous research has linked clinical depression in mothers to mood disorders and other health problems in their children, the current study is among the first to make this connection even when mothers have milder symptoms that might not be diagnosed or treated by clinicians, said lead author Judith van der Waerden. (Rapaport, 4/24)