Research Roundup: Medicare Benefits And Glaucoma; Weekend Hospital Discharges; Insurers’ Health
Each week, KHN compiles a selection of recently released health policy studies and briefs.
JAMA Ophthalmology:
Cost-Related Medication Nonadherence And Cost-Saving Behaviors Among Patients With Glaucoma Before And After The Implementation Of Medicare Part D
[Researchers sought to] determine whether the implementation of the Medicare Part D prescription drug benefit [in 2006] affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma ... using 2004 to 2009 Medicare Current Beneficiary Survey data. ... the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% ... and 2.8%, respectively .... However, reports of failure to obtain prescriptions owing to cost did not improve in the same period .... This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization. (Blumberg et al., 6/4)
JAMA Internal Medicine:
Effects Of A Medical Home And Shared Savings Intervention On Quality And Utilization Of Care
The northeast region of the Pennsylvania Chronic Care Initiative began in October 2009, included 2 commercial health plans and 27 volunteering small primary care practice sites, and was designed to run for 36 months. ... We analyzed medical claims for 17 363 patients attributed to 27 pilot and 29 comparison practices .... All pilot practices received recognition as medical homes during the intervention. By intervention year 3, relative to comparison practices, pilot practices had statistically significantly better performance on 4 process measures of diabetes care and breast cancer screening; lower rates of all-cause hospitalization ... lower rates of all-cause emergency department visits ... lower rates of ambulatory care–sensitive emergency department visits ... lower rates of ambulatory visits to specialists ... and higher rates of ambulatory primary care visits. (Friedberg, 6/1)
JAMA Surgery:
Association Between Weekend Discharge And Hospital Readmission Rates Following Major Surgery
Although evidence suggests worse outcomes for patients admitted to the hospital on a weekend, to our knowledge, no previous studies have investigated the effects of weekend discharge. ... [Researchers reviewed] discharge abstracts from the California Office of State Health Planning and Development from 2012 identifying all patients who underwent abdominal aortic aneurysm (AAA) repair, colectomy, total hip arthroplasty, and pancreatectomy. ... Hospital readmission rates were similar for those discharged on a weekend vs weekday after AAA repair (8.8% vs 9.3%) and pancreatectomy (17.5% vs 15.9%). However, weekend discharge was associated with a lower 30-day readmission rate for patients undergoing colectomy (12.1% vs 14.1%) and hip replacement (6.9% vs 7.7%). ... Similar results were seen for 90-day readmissions. (Cloyd, 6/3)
Health Affairs blog:
The Post-Launch Problem: The Affordable Care Act’s Persistently High Administrative Costs
The roughly $6 billion in exchange start-up costs pale in comparison to the ongoing insurance overhead that the ACA has added to our health care system — more than a quarter of a trillion dollars through 2022. We calculated these new overhead costs from the official National Health Expenditure Projections for 2012-2022 .... Most of this soaring private insurance overhead is attributable to rising enrollment in private plans which carry high costs for administration and profits. The rest reflects the costs of running the exchanges .... Government programs—primarily Medicaid—account for the remaining $101.4 billion increase in overhead. But even the added dollars to administer Medicaid will flow mostly to private Medicaid HMOs, which will account for 59 percent of total Medicaid administrative costs in 2022. (Himmelstein and Woolhandler, 5/27)
The Kaiser Family Foundation:
How Have Insurers Fared Under The Affordable Care Act?
[W]e analyzed 2014 financial performance for insurers in the individual market (using data compiled by Mark Farrah Associates). We examined the trend in the medical loss ratio (MLR) .... For 2014, financial results depend heavily on how much insurers will receive in reinsurance payments under the ACA, which will not be known until June 30, 2015. Insurers submit requests for reinsurance payments to the federal government based on expenses for high-cost patients. ... We estimate that the MLR in 2014 for the individual market ... will range from 81% to 87%. The high end of the range assumes that reinsurance payments to insurers will total (as a share of claims) what carriers with available data reported to state insurance departments. The low end of the range assumes that the full estimated amount of $9.7 billion will be paid out. This would suggest insurers overall had roughly comparable financial performance as in recent years. (Levitt, Claxton and Cox, 6/1)
Urban Institute/Robert Wood Johnson Foundation:
Employer-Sponsored Insurance Continues To Remain Stable Under The ACA: Findings From June 2013 Through March 2015
[B]etween 2000 and 2012, [employer-sponsored insurance] ESI coverage rates for nonelderly workers (ages 18 to 64) fell 11 percent .... Among workers in firms with fewer than 50 employees, coverage rates fell 17 percent, from 61.1 percent to 52.4 percent. ... The subsidies provided by the ACA, along with the availability of Medicaid for most adults up to 138 percent of the federal poverty level (FPL) in states that expanded Medicaid, may lead to changes in employer decisions to offer coverage and employee decisions to take up those offers. If ESI erodes ... the government cost of the ACA will increase .... Though it is too soon to know the long-term course of ESI, we are now 18 months into the implementation of the ACA. ... Similar to [earlier] findings published in Health Affairs, we continue to find no change in ESI offer rates, take-up rates, or overall ESI coverage under the ACA. (Blavin, Shartzer, Long and Holahan, 6/3)
Health Affairs Policy Brief:
The FDA's Sentinel Initiative
Until recently ... the FDA had primarily relied on passive collection of adverse events obtained from manufacturers or through voluntary physician and consumer reporting to track emerging safety issues after drugs received FDA approval. ... the FDA's Sentinel Initiative ... aims to use big data and broad networks to proactively and systematically detect and respond to emerging risks associated with prescription medicines. ... The Sentinel network consists primarily of eighteen organizations that include some of the nation's largest health insurers ... and various disease registries. ... the FDA says that it has access to selected data from eighty-eight hospitals and other inpatient facilities. ... Sentinel has not yet become a tool for the rapid assessment of potential drug safety problems .... That's in large part because of persistent technical and methodological challenges. (Findlay, 6/4)
The Urban Institute:
The Challenge Of Financing Long-Term Care
Although insurance is ... essential to assuring access and financial protection for long-term care ... insurance protection is lacking. Private health insurance doesn’t cover long-term care, and few Americans have private long-term care insurance, which typically costs a lot, offers limited value, and is subject to premium increases that can cause purchasers to lose coverage they have paid into for years. ... Medicare—which older people and some younger people with disabilities rely on for health insurance—does not cover long-term care. The federal-state Medicaid program does serve as a valuable last resort for people who need long-term care, but its protections (especially for care at home) vary considerably from state to state and become available only when people are, or have become, impoverished .... As a result, families bear enormous responsibility for caregiving. (Feder, 6/3)
The Kaiser Family Foundation:
Medicare’s Income-Related Premiums: A Data Note
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—a new law to repeal and replace Medicare’s ... formula for physician payments—includes a provision to increase Medicare premiums for some higher-income beneficiaries .... This data note describes current requirements with respect to Medicare’s Part B and Part D income-related premiums, including the number and share of Medicare beneficiaries who are estimated to pay these premiums in 2015, the amount they pay, and the revenues raised from these premiums, based on data from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. ... Based on our estimates, the recently enacted provisions ... would affect around 2 percent of beneficiaries if it were implemented this year. (Cubanski and Neuman, 6/3)
Here is a selection of news coverage of other recent research:
JAMA:
Novel Programs And Discoveries Aim To Combat Antibiotic Resistance
The perception that the commercial potential of antibiotics is much lower than that of drugs used to treat conditions such as cancer, heart disease, or mental illness has historically stalled investments and advances in novel antibiotic development. However, the annual effect of antibiotic-resistant infections on the US economy may be as high as $20 billion in excess direct health care costs and as much as $35 billion in lost productivity from hospitalizations and sick days. (Hampton, 6/3)
Reuters:
U.S. Policies To Encourage Organ Donation Largely Ineffective
State policies meant to encourage people throughout the U.S. to donate organs over the past few decades have been largely ineffective, a new study suggests. Creating a state fund to promote organ donations was the only policy linked to any increase in transplants, the researchers reported June 1 in JAMA Internal Medicine. (Seaman, 6/2)
Medscape:
Return Visits To ED Twice As Frequent As Thought
Nearly 1 in 12 patients who visited an emergency department (ED) in six states returned to an acute care setting within 3 days, and 30 days after that first emergency visit, the revisit rate to acute care settings rose to nearly 1 in 5 patients, according to a longitudinal and population-based study. This return rate is twice as frequent as was previously reported. Reena Duseja, MD, from the Department of Emergency Medicine, University of California, San Francisco, and coauthors report their findings in an article published in the June 2 issue of the Annals of Internal Medicine. (Henderson, 6/2)
Reuters:
Early Diabetes Detection Tied To Fewer Heart Problems
Earlier screening, diagnosis and treatment of type 2 diabetes may decrease the risk of cardiovascular problems, hint results from a computer model. The timing of the diagnosis and the start of treatment appeared more important than the actual intensity of treatment, the researchers reported online May 18 in Diabetes Care. (Doyle, 6/2)
The New York Times:
Teenagers Seek Health Information Online, But Don’t Always Trust It
Four out of five teenagers turn to the Internet for health information, but they don’t always put much stock in what they find, according to a national survey released on Tuesday. The source they really trust with questions about health? Surprise: their parents. The new report, “Teens, Health and Technology,” is an expansive look at how teenagers use technology to learn about health by researchers at Northwestern University. The findings are based on a nationally representative sample of 1,156 adolescents aged 13 to 18. (Hoffman, 6/2)