Research Roundup: Opioid Abuse; Profiling The Uninsured; Surprise Medical Bills

New England Journal of Medicine: Opioid Abuse In Chronic Pain — Misconceptions And Mitigation Strategies
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction. Given the lack of clinical consensus and research-supported guidance, physicians understandably have questions about whether, when, and how to prescribe opioid analgesics .... Here, we draw on recent research to address common misconceptions regarding the abuse-related risks of opioid analgesics and highlight strategies to minimize those risks. (Volkow and McLellan, 3/31)

Health Affairs: Final 2015-20 Dietary Guidelines For Americans
The Dietary Guidelines for Americans: 2015-2020, eighth edition, was released on January 7, 2016. The guidelines were heavily informed by the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC), which was charged with analyzing the latest in nutrition science since the 2010 guidelines were published and coming up with food-based recommendations of public health importance. ... The 2015-20 guidelines have, at the very least, resuscitated a vigorous debate about nutrition health policy, especially the role of saturated fat in one's diet and the influence of dietary cholesterol on cardiovascular disease. ... It may never be possible to definitively determine the extent to which, if at all, the past decades of dietary guidelines have helped create the country's obesity and chronic disease crisis. After all, most people ignore them. (Goldman, 3/31)

Urban Institute: Who Are The Remaining Uninsured, And What Do Their Characteristics Tell Us About How To Reach Them?
[T]his analysis presents estimates of the characteristics of those remaining uninsured after implementation of the Affordable Care Act’s coverage provisions. The researchers also analyze the characteristics of two subpopulations that they posit are those for whom additional outreach and enrollment efforts are likely to be most successful: those eligible for Medicaid/CHIP but not enrolled and those who are both eligible for Marketplace tax credits and have incomes below 200 percent of the federal poverty level. ... Together, these subgroups account for 37.5 percent of the remaining uninsured, or approximately 12.4 million people. Focusing on the characteristics of these individuals, we find high rates of school age children in the household, household receipt of other non-health public benefits, firm-based employment, and single parent households. (Blumberg et al., 3/30)

Urban Institute: Health Insurance Coverage And Health Care Access And Affordability In Massachusetts: 2015 Update
The 2015 Massachusetts Health Reform Survey (MHRS) highlights sustained gains in health insurance coverage since the passage of Massachusetts’ 2006 health care reform law, as well as persistent gaps in health care access and affordability for many of those with insurance coverage. Low-income adults and those with health problems tend to be disproportionately impacted by these gaps. The survey findings are a reminder that the goals of health care reform are not fully achieved by simply reducing the number of people who are uninsured. (Long and Dimmock, 3/23)

The Kaiser Family Foundation: Surprise Medical Bills
Surprise medical bills can contribute significantly to financial burden and medical debt among insured individuals, though data on the incidence and impact of this problem are limited. Federal authority to track the incidence and impact of surprise medical bills exists but has not yet been implemented. Policy makers have considered and adopted various responses, yet tradeoffs are involved in protecting consumers from surprise bills. There is concern among some as to whether or how new consumer protections might affect insurance premiums. Establishing requirements both on what health plans must cover and on amounts that out-of-network providers can bill can limit the impact on premiums, though providers may balk at restrictions on how much they can charge. (Pollitz, 3/17)

Brookings/Clinical Gastroenterology and Hepatology: Shifting Away From Fee-For-Service: Alternative Approaches To Payment In Gastroenterology
Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. (Patel et al., 3/22)

Avalere: Evolving The Risk-Adjustment Model To Improve Payment Accuracy In The Individual & Small Group Market
The ACA created risk adjustment for the commercial population in order to transfer funds appropriately between plans based on their relative healthcare costs. To accomplish this goal, CMS built a model using a similar framework to the model used for the Medicare Advantage population. However, although the commercial model is more accurate in predicting the costs of a sample population, it is unclear how well the model predicts actual costs. (March 2016)

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

Medscape: Study Suggests Bringing Back Whole-Cell Pertussis Vaccine
Switching to a whole-cell pertussis priming strategy could reduce incidence of whooping cough by up to 95%, new research indicates. Studies have widely agreed that pertussis protection from the current vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), is limited, and a new vaccine is not imminent. Meanwhile, cases are climbing. In 2012, there were 48,277 whooping cough diagnoses in the United States, a record high since 1955, and that number included 16 infant deaths. (Frellick, 3/29)

Reuters: Out-Of-Hospital Births On The Rise In U.S.
Giving birth outside of a hospital has become more common in the U.S., especially for white women, with almost 60,000 out-of-hospital births in 2014, according to a new study. “I think it speaks to some women’s growing discomfort with the standard hospital-based system of childbirth in the U.S,” said lead author Marian F. MacDorman of the Maryland Population Research Center at the University of Maryland in College Park. (Doyle, 3/28)

KQED: Study: Mandatory Waiting Period Stopped Few Abortions
Most women seeking an abortion were not deterred by a Utah law requiring a 72-hour waiting period before having the procedure, according to a recent study by the University of California, San Francisco. The 2012 law requires a 72-hour waiting period and at least two medical visits before an abortion. It was the first such law in the nation, and researchers found that it added financial costs and increased logistical hassles and anxiety for the women. (Fine, 3/30)

HealthDay News: Medicare Spends Billions On Chronic Kidney Disease
Chronic kidney disease affects nearly 14 percent of Americans and costs Medicare billions of dollars a year, a new study reveals. In 2013, Medicare spent $50 billion on chronic kidney disease among people 65 and older, and $31 billion on those with kidney failure, the researchers found. "This report is a one-stop shop to try to understand the prevalence of kidney disease, how it's being treated and how the burden affects various populations," researcher Rajesh Balkrishnan, a professor of public health sciences at the University of Virginia School of Medicine, said in a university news release. (3/30)

MedPage Today: Hip Fracture Slightly Lower With Mediterranean Diet
Women who ate a Mediterranean diet had a slightly lower risk for hip fracture, compared with women who ate other healthy diets, a post hoc analysis of the Women's Health Initiative (WHI) found. (Wickline Wallen, 3/28)