Research Roundup: Observation Care At VA; Meeting Charity Standards; Medicare Drug Plans

Health Affairs: Observation Rates At Veterans’ Hospitals More Than Doubled During 2005–13, Similar To Medicare Trends
When neither inpatient admission nor prompt discharge is clearly indicated for a patient in the emergency department, physicians place the patient under observation in a hospital for diagnosis and treatment. The increasing prevalence of observation stays at hospitals reimbursed by Medicare is receiving considerable attention, but the prevalence remains unexplored in Veterans Health Administration (VHA) hospitals, which are subject to different payment policies. Using VHA data for fiscal years 2005–13, we identified trends and variations in observation rates across twenty-one Veteran Integrated Service Networks and 128 VHA hospitals nationwide. We found that observation rates across VHA hospitals more than doubled, from 6.5 percent to 13.8 percent, and that there was substantial variation across both Veteran Integrated Service Networks and hospitals. (Wright et al., 10/5)

Health Affairs: Connecticut’s ‘Money Follows The Person’ Yields Positive Results For Transitioning People Out Of Institutions
[T]he federal Money Follows the Person Rebalancing Demonstration helps qualified individuals living in institutions make the transition to life in the community. The Connecticut Money Follows the Person program is an unusually rich source of data, with information on the 2,262 people who transitioned to the community under that state’s program during 2008–14. ... for the majority of respondents who remained in the community, quality of life and life satisfaction improved significantly after transition, and they stayed high. About half of the participants visited hospitals or emergency departments after transition; however, only 14 percent had returned to an institution one year after transition. Predictors of reinstitutionalization included some not previously observed: mental health disability, difficulties with family members before transition, and not exercising choice and control in daily life. (Robison et al., 10/5)

Brookings: A Floor-And-Trade Proposal To Improve The Delivery Of Charity-Care Services By U.S. Nonprofit Hospitals
Many uninsured Americans rely on charity care provided by nonprofit hospitals, which receive substantial tax benefits in exchange for providing community benefits. In this discussion paper we show that the hospitals that receive the largest tax benefits tend to be located in wealthier communities, whereas the demand for uncompensated care is highest in poorer communities. To ameliorate this geographic mismatch between the supply of charity care and the demand for charity care, we propose a floor-and-trade system whereby nonprofit hospitals would be required to meet charity-care standards, either by providing care to local patients or by purchasing credits from other hospitals. (Ody, Dranove and Garthwaite, 10/7)

The Kaiser Family Foundation: Medicare Part D At Ten Years: The 2015 Marketplace And Key Trends, 2006-2015
This report presents findings from an analysis of the Medicare Part D marketplace in 2015 and changes in features of the drug benefit offered by Part D plans since 2006. ... In 2015, more than 39 million Medicare beneficiaries are enrolled in Medicare drug plans. Since 2006, the share of Medicare beneficiaries enrolled in a Part D plan has increased from 53 percent to 72 percent of all eligible Medicare beneficiaries. ... The average Part D enrollee had a choice of 30 PDPs and 15 MA-PD plans in 2015. ... In 2015, most plans use five cost-sharing tiers: preferred and non-preferred tiers for generic drugs, preferred and non-preferred tiers for brand drugs, and a tier for specialty drugs. ... Cost sharing for brand-name drugs has been relatively stable in recent years. (Hoadley, Cubanski and Neuman, 10/5)

The Commonwealth Fund: U.S. Health Care From A Global Perspective: Spending, Use Of Services, Prices, And Health In 13 Countries
This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries .... These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions. (Squires and Anderson, 10/8)

CDC's Preventing Chronic Disease Journal: Health Status of Older US Workers and Nonworkers, National Health Interview Survey, 1997–2011
Many US workers are increasingly delaying retirement from work .... We examined the association of older adults’ health status with their employment/occupation and other characteristics. National Health Interview Survey data from 1997 through 2011 were pooled for adults aged 65 or older .... Employed older adults had better health outcomes than unemployed older adults. Physically demanding occupations had the lowest risk of poor health outcomes, suggesting a stronger healthy worker effect: service workers were at lowest risk of multiple functional limitations ... and blue-collar workers were at lowest risk of multimorbidity ... and multiple functional limitation .... A strong association exists between employment and health status in older adults beyond what can be explained by socioeconomic factors (eg, education, income) or health behaviors (eg, smoking). (Kachan et al., 9/24)

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

The Wall Street Journal: How Economic Downturns May Be Good For Your Health
Economic downturns, it turns out, appear to be good for health, according to a study released this week by the National Bureau of Economic Research. The research by Christopher Ruhm, a professor at the University of Virginia, builds upon earlier studies looking at the impact of economic downturns on health. “There is considerable evidence that harmful behaviors–like heavy drinking and smoking–decrease in bad economic times, whereas health-enhancing activities such as exercise and social interactions increase,” Mr. Ruhm said. (Sparshott, 10/7)

Reuters: Women Are Missing From HIV Drug Trials
Although women make up roughly half of the world’s HIV cases, they remain largely excluded from clinical trials testing drugs, vaccines and potential cures for the virus, a research review confirms. In an analysis spanning several decades that included work done as recently as 2012, researchers found that women typically comprised about 11 percent of participants in trials investigating cures for HIV. Similarly, drug studies were only about 19 percent female and just 38 percent of vaccine trial subjects were women. (Rapaport, 10/2)

Reuters: Caring For Loved One With Alzheimer's May Be Most Stressful For Spouse
Caring for a loved one with Alzheimer’s disease isn’t easy under the best of circumstances, but it may be much more stressful for spouses and people who suffer from depression, a Finnish study suggests. Researchers followed 236 family caregivers of Alzheimer’s patients for three years after the diagnosis. Caregiving appeared to be much more stressful for people who were married to the patients or who suffered from depression when the study began. (Rapaport, 10/2)

Reuters: Perceived Discrimination Linked To Smoking And Poor Diet
Feeling like the target of discrimination may increase a person’s odds of harmful behaviors like smoking, eating fatty foods and getting less sleep, a study of African-Americans suggests. Researchers examined the connection between discrimination and these unhealthy habits among almost 5,000 African-American residents of the Jackson, Mississippi metropolitan area. (Rapaport, 10/8)

The Oregonian: Oregonians Billed By Out-Of-Network Health Providers At High Rates, Insurer Group Says
Patients who use health providers outside of their insurer's network can expect bills to be as much as 1,200 percent more than what those services would cost under Medicare, according to a new study from an insurer lobbying group. In Oregon, for instance, a session of computer-targeted radiation therapy to treat tumors costs, on average, $2,409. That's about six times the average Medicare reimbursement rate of $397 — a key benchmark for health care costs. (Budnick, 10/5)

The Wall Street Journal: Study: Attempted Suicide Rises After Weight-Loss Surgery
People who undergo surgery for weight loss are 50% more likely to attempt suicide after the operation than before it, according to a large Canadian study published Wednesday in the journal JAMA Surgery. The popular procedures, which were performed nearly 200,000 times in the U.S. last year, result in significant weight loss for most patients and often bring about reductions in Type 2 diabetes, hypertension and sleep apnea as well. Many patients also report improved mood and self-esteem. But a small group experience a worsening of depression, substance abuse and eating disorders, past studies have found. (Beck, 10/7)

Reuters: Type Of Weight Loss Surgery Matters For Diabetes Remission
Diabetics considering weight-loss surgery to help send their disease into remission should opt for the most popular procedure, a gastric bypass, researchers suggest. In their study of different types of so-called bariatric surgeries, the biggest impact on diabetes remission was seen with gastric bypass, which can reduce the size of the stomach from about three pints to roughly the size of a shot glass. (Rapaport, 10/6)

The Associated Press: Gene Test Finds Which Breast Cancer Patients Can Skip Chemotherapy
Many women with early-stage breast cancer can skip chemotherapy without hurting their chances of beating the disease, a major new study has found. The 21-gene test accurately identified a group of women whose cancers are so likely to respond to hormone-blocking drugs that adding chemo would do little, if any, good while also exposing them to side effects and other risks, the researchers found. “You can’t do better than that,” says the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. (Marchione, 10/3)

The New York Times: Heart Scan Can Fine-Tune Risk Estimate For Patients Considering Statins
Treatment guidelines suggest that nearly half of those over age 40 — nearly 50 million people in the United States — at least consider a cholesterol-lowering statin to reduce heart attack risk. But a new large study of people who had an inexpensive heart scan found that half of those who were statin candidates had no signs of plaque in their heart and very little chance of having a heart attack in the next decade. (Kolata, 10/5)

The Associated Press: Report: More US Hospitals Are Encouraging Breast-Feeding
Health officials say more hospitals are encouraging new mothers to breast-feed. A new report found more than two-thirds of hospitals in 2013 helped women start breast-feeding within an hour after birth. That's up from 44 percent six years earlier. Roughly 90 percent of hospitals teach moms breast-feeding techniques and how to recognize and respond to infant feeding cues. But only about a quarter refrain from giving infants breast milk alternatives — like formula or water — unless medically necessary. (Stobbe, 10/6)