Research Roundup: Medicare’s Star Ratings; ACO Performance, Texas Medicaid

JAMA Internal Medicine: Association Between The Centers For Medicare And Medicaid Services Hospital Star Rating And Patient Outcomes
[Medicare's 5-star hospital rating system] depends solely on patient experience ... and currently, it does not include measures of quality of care or patients’ health outcomes. ... critics worry that the star rating system may mislead patients into thinking that 5-star hospitals are superior in quality. Therefore, we investigated whether hospitals with more stars have lower risk-adjusted 30-day mortality and readmissions than hospitals with less stars. ... We found that the number of stars was inversely associated with risk-adjusted mortality rate. ... 5-star hospitals [had] the lowest mortality rate of 9.8% ..., followed by 4-star hospitals with a rate of 10.4% .... Higher CMS star ratings were also associated with lower adjusted readmission rates, with 5-star hospitals having the lowest readmissions rate of 18.7%. (Wang et al., 4/10)

The New England Journal of Medicine: Two-Year Costs And Quality In The Comprehensive Primary Care Initiative
The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices .... Support included the ... care-management fees, ... shared savings, and ... data feedback and learning support. ... During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements ... in areas such as management of the care of high-risk patients and enhanced access to care. ... However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Berg Dale et al., 4/13)

The New England Journal of Medicine: Early Performance Of Accountable Care Organizations In Medicare
[W]e compared changes in [Medicare] spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs ... in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group) .... In 2013, the differential change ... in total adjusted annual spending was −$144 per beneficiary in the 2012 ACO cohort as compared with the control group ... consistent with a 1.4% savings, but only −$3 per beneficiary in the 2013 ACO cohort as compared with the control group .... our findings extend evidence of small but meaningful reductions in spending, with unchanged or improved quality of care, early in the Medicare ACO programs and suggest that progress toward net savings ... may be slow. (McWilliams et al., 4/13)

The Urban Institute/Kaiser Family Foundation: Medicaid Spending Growth Compared To Other Payers: A Look At The Evidence
[T]his issue brief examines evidence from over 40 methodologically rigorous studies related to Medicaid program spending. Key findings show: Per capita spending in the Medicaid program is lower compared to private insurers after adjusting for the greater health needs of Medicaid enrollees. ... Medicaid spending growth primarily has been driven by rising Medicaid enrollment .... Lower payment levels in Medicaid have contributed to its relatively low costs. ... Recent federal budget proposals include provisions to reform Medicaid financing .... given Medicaid’s already lower payment rates that contribute to lower per capita spending, such proposals could result in reductions in utilization and/or enrollment as well as additional pressure on states to lower provider payment further. (Clemans-Cope, Holahan and Garfield, 4/13)

The Commonwealth Fund: Medicaid Expansion In Texas: What's At Stake?
Texas is one of nearly 20 states yet to expand its Medicaid program under the Affordable Care Act (ACA), and is home to the largest number of uninsured Americans of any state in the country. For many of the state’s 5 million uninsured, this decision has left them without an option for affordable health insurance. A comparison with other Southern states that have expanded Medicaid shows how this decision has left many low-income Texans less able to afford their medical bills, to pay for needed prescription drugs, and to obtain regular care for chronic conditions. These problems have been compounded by the state’s opposition to outreach and enrollment assistance for many Texans who are eligible for coverage under the ACA. (Sommers, 4/7)

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

MedPage Today: Mixed Results With Readmission Reduction Program
A readmission reduction program for high risk, newly discharged seniors helped lower 30-day hospital readmission rates, but the effect was small and did not reach national goals, researchers reported. Among 10,621 high-risk Medicare fee-for-service patients, ages 64 and older, 30-day readmission rates decreased from 21.5% to 19.5%, compared with a 0.1% reduction in the control group (21.1% to 21.0%), for a relative reduction of 9.3%, after implementation of a transitional care program, according to Leora I. Horwitz, MD, of New York University School of Medicine, and colleagues. (Wickline Wallen, 4/11)

Reuters: Healthcare Providers In Cath Labs May Be Harmed By Radiation
Healthcare workers in labs where patients undergo heart procedures guided by X-rays may be at higher risk for cataracts, skin lesions, bone disorders or cancer than other healthcare workers, according to a new study. Procedures in the “cath lab” -- named for the catheters threaded into the heart -- are done for all forms of cardiac disease, like congenital heart defects, ischemic heart disease or heart arrhythmias, said lead author Maria Grazia Andreassi of the CNR Institute of Clinical Physiology in Pisa, Italy. ... But staff members, too, are exposed to radiation. In particular, for the cardiologists and electrophysiologists who work near the patient and the radiation source, “the cumulative dose in a professional lifetime is not negligible,” Andreassi said. (Doyle, 41/2)

Reuters: Doctors Say Aspirin Lowers Heart Attack Risk For Many Adults
Many adults who have never had a heart attack or stroke should take aspirin every day to keep it that way, new U.S. guidelines say. People in their 50s with risk factors for cardiovascular disease -- including high blood pressure, high cholesterol or a history of smoking -- may benefit from starting a daily aspirin regimen and staying on it for at least a decade, according to the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of independent physicians. (Rapaport, 4/11)

The Washington Post: This Study 40 Years Ago Could Have Reshaped The American Diet. But It Was Never Fully Published.
It was one of the largest, most rigorous experiments ever conducted on an important diet question: How do fatty foods affect our health? Yet it took more than 40 years — that is, until today — for a clear picture of the results to reach the public. The fuller results appeared Tuesday in BMJ, a medical journal, featuring some never-before-published data. Collectively, the fuller results undermine the conventional wisdom regarding dietary fat that has persisted for decades and is still enshrined in influential publications such as the U.S. government's Dietary Guidelines for Americans. (Whoriskey, 4/12)