Research Roundup: Patient Costs And Medicaid; ER Co-Payments

JAMA Internal Medicine: The Effect Of Emergency Department Copayments For Medicaid Beneficiaries Following The Deficit Reduction Act Of 2005
To provide states with flexibility in administering [Medicaid] while containing costs, the Deficit Reduction Act of 2005 (DRA) gave states the authority to impose cost-sharing strategies, including emergency department (ED) copayments for nonurgent visits. ... [The researchers compared] trends in ED use among Medicaid beneficiaries from January 2001 to December 2010. Eight states with ED copayments for nonurgent ED visits (copayment states) were compared with 10 states with zero ED copayments (control states). ... [They] detected no statistically significant change in annual ED admissions per Medicaid enrollee in copayment states compared with control states following the DRA. There was also no change in the rate of outpatient medical provider visits or in annual inpatient days per Medicaid enrollee. (Siddiqui, Roberts and Pollack, 1/26)

Health Affairs: The Two-Midnight Rule
Medicare pays for inpatient services and outpatient services under separate and very different payment systems, which can produce substantially different payment amounts for similar patients receiving similar services. The cost-sharing implications for beneficiaries under the two systems can also vary significantly. ... In 2013 CMS announced the so-called two-midnight rule to clarify when it expected a patient to be designated to inpatient status. Under this rule, only patients that the doctor expects will need to spend two nights in the hospital would be considered as hospital inpatients. This brief describes the perceived need by CMS for the two-midnight rule, how it would work, and the implications for Medicare payment. It also reviews the heated response to the rule. (Cassidy, 1/22)

The New England Journal of Medicine: Cost-Effectiveness Of Hypertension Therapy According To 2014 Guidelines
We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines. ... The full implementation ... would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. ... treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. (Moran et al., 1/29)

The Kaiser Family Foundation: Federal And State Standards For "Essential Community Providers" Under The ACA And Implications For Women's Health
Congress established general requirements to assure that [safety-net providers, such as community health centers and family planning clinics] have the opportunity to participate in the health plans that are offered through the [health law's] Marketplaces. These safety net clinics and hospitals are referred to as Essential Community Providers (ECPs) .... there is considerable variation across the country in both the categories of providers included as ECPs as well as the standards required for inclusion in plan networks. This brief reviews the definition of ECP, examines the federal and state rules..., identifies the variation from state to state, and discusses the particular importance of these rules and providers for women’s access to care. (Jade Peña, Sobel, and Salganicoff, 1/23)

Brookings: Medicare Physician Payment Reform: Securing The Connection Between Value And Payment
Last year, Congress reached agreement in principle on legislation that would move Medicare’s payment of physicians and other clinicians away from fee-for-service (FFS), which pays based on the volume and intensity of services they provide. Instead, Medicare would begin paying clinicians for providing better care, keeping patients healthy, and lowering overall costs – a “pay for value” approach. ... we believe that some specific modifications to the legislation would enable it to do more to support better care and more value in Medicare. (McClellan, Berenson et al., 1/27)

The Robert Wood Johnson Foundation: State-Level Trends In Employer-Sponsored Health Insurance
[C]oncerns have been raised that the ACA could have unintended consequences that would cause declines in ESI [employer sponsored insurance]. To provide a baseline for understanding the impacts of the ACA on ESI, this report examines and compares trends during two time periods: a period before and including the recession (2004/2005 to 2008/2009), and a period including and since the recession (2008/2009 to 2012/2013). While the majority of nonelderly Americans with health insurance are covered by employer-sponsored insurance (ESI), the percentage of the U.S. population with ESI has been declining for more than a decade. (Planalp, Sonier and Fried, 1/29)

The Kaiser Family Foundation: The HPV Vaccine: Access And Use In The U.S.
Vaccination rates have remained mostly static for the two vaccines that protect young people against infection by certain strains of the human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States. The vaccines were originally recommended only for girls and young women and were subsequently broadened to include boys and young men. This factsheet discusses HPV and related cancers, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines. (1/26)

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

Medscape: Headache-Related Imaging, Referrals Almost Doubled
Contrary to practice guidelines, clinicians treating patients with headache are increasingly ordering costly imaging tests and referring patients to other physicians, and they're doing less counseling on lifestyle changes, authors of a new review suggest. The researchers found an almost doubling of the use of computed tomography (CT) and MRI in a recent 10-year period. Although given the nature of the study they couldn't determine which referrals or imaging studies weren't appropriate, the trend toward a doubling of these tests is concerning, said lead study author, John Mafi, MD, fellow, general internal medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. (Anderson, 1/26)

Medscape: To Meet Demand For Pediatric NPs, System Must Change
Pediatric nurse practitioner (PNP) programs in the United States will need to increase in number and size, promote the pediatric specialization better, and better prepare students to pass the certification exam to meet the coming demand, a new study finds. Without changes, the shortage, based on a prediction model for admissions into PNP programs, is expected to last 13 years or more. (Putre, 1/26)

The Washington Post: An ‘Expensive’ Placebo Is More Effective Than A ‘Cheap’ One, Study Shows
Parkinson's Disease patients secretly treated with a placebo instead of their regular medication performed better when told they were receiving a more expensive version of the "drug," researchers reported Wednesday in an unprecedented study that involved real patients. (Bernstein, 1/28)

Medscape: Tiered Care Centers Proposed For High-Risk Pregnancies
A new consensus document proposing the establishment of levels of care for perinatal and postnatal women has been developed by the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine. The document was published in the February issue of Obstetrics & Gynecology. (Brown, 1/29)

Medscape: PCPs Should Be Consultants On Hospitalists' Team, Experts Say
To better coordinate primary care and hospitalists' care in the inpatient setting, internal medicine researchers from Massachusetts General Hospital in Boston have proposed a collaborative model. Allan Goroll, MD, and Daniel Hunt, MD, say that under their plan, the primary care provider (PCP) would become a consultant to the hospitalists' team. The PCP would visit patients within 12 to 18 hours of admission to give support and counseling and recommend a care plan. (Frellick, 1/26)