Research Roundup: RUC And Medicare Pay; Rx For Marketplace Patients; Who’s Homebound?

Government Accountability Office: Medicare Physician Payment Rates: Better Data and Greater Transparency Could Improve Accuracy
The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has a process in place to regularly review Medicare physicians' services' work relative values .... Its recommendations to the Centers for Medicare & Medicaid Services (CMS) ... though, may not be accurate .... First, the RUC's process for developing relative value recommendations relies on the input of physicians who may have potential conflicts of interest .... Second, GAO found weaknesses with the RUC's survey data .... [CMS] does not maintain a database to track when a service was last valued or have a documented standardized process for prioritizing its reviews. ... CMS's process is not fully transparent because the agency does not publish the potentially misvalued services identified by the RUC in its rulemaking. (5/21)

Health Affairs: Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk
Medication use may provide an early indicator of the health needs and access to care among Marketplace enrollees. We used data from January–September 2014 on more than one million Marketplace enrollees from Express Scripts, the largest pharmacy benefit management company in the United States. ... Among Marketplace enrollees, we found that those who enrolled earlier (October 2013–February 2014) were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending and were less likely to use most medication classes than the employer-sponsored comparison group. However, Marketplace enrollees were more likely to use medicines for hepatitis C and particularly for HIV. (Donohoe et al., 5/27)

JAMA Internal Medicine: Epidemiology Of The Homebound Population In The United States
It is uncertain how many people who live in the United States are homebound. [Researchers used] cross-sectional data [of Medicare beneficiaries] from the National Health and Aging Trends Study collected in 2011 .... We defined homebound persons as those who never (completely homebound) or rarely (mostly homebound) left the home .... We defined semihomebound persons as those who only left the home with assistance or had difficulty ... leaving the home. ... the prevalence of homebound individuals was 5.6%, including an estimated 395 ,422 people who were completely homebound and 1 ,578, 984 people who were mostly homebound. Among semihomebound individuals, the prevalence of those who never left home without personal assistance was 3.3%, and the prevalence of those who required help or had difficulty was 11.7%. ... Only 11.9% of completely homebound individuals reported receiving primary care services at home. (Ornstein et al., 5/26)

JAMA Internal Medicine/Rand Corp.: Antibiotic Prescribing For Acute Respiratory Infections In Direct-To-Consumer Telemedicine Visits
Direct-to-consumer (DTC) telemedicine companies provide consumers with around-the-clock access to care for common nonemergent conditions through telephone and live video visits via personal computers and mobile phone apps. DTC telemedicine is often more convenient and less expensive than in-person visits. However, concerns about the quality of these services have been expressed .... Using health plan claims, we compared antibiotic prescribing rates for acute respiratory infection (ARI) between Teledoc, a large DTC telemedicine company, and physician offices. ... the fraction of ARI visits at which an antibiotic was prescribed was similar for Teledoc and physician offices. ... For cases in which an antibiotic was prescribed, the adjusted broad-spectrum antibiotic prescribing rate for all ARI visits was 86% for Teladoc vs 56% at physician offices. (Uscher-Pines, 5/26)

The New England Journal of Medicine: Medicaid At 50 — From Welfare Program To Nation’s Largest Health Insurer
Over its 50-year history, the federal–state Medicaid program has evolved from a neglected stepchild of Medicare to the nation’s largest health care program, providing coverage to tens of millions of persons and families of limited means. ... the Affordable Care Act (ACA) essentially completed Medicaid’s transformation from a welfare-style program that served certain categories of low-income persons — namely, those with disabilities, the elderly, pregnant women, parents of dependent children, and children 18 years of age or younger — to one in which any American with a family income at or below 138% of the federal poverty level (just under $28,000 for a family of three) is eligible to enroll. ... In this article, ... we will cover key developments in the program’s history and its current, if unsettled, state as the ACA is implemented. (Iglehart and Sommers, 5/28)

The Kaiser Family Foundation: Medicaid Financing: How Does It Work And What Are The Implications?
Medicaid represents $1 out of every $6 spent on health care in the US and is the major source of financing for states to provide coverage to meet the health and long-term needs of their low-income residents. The Medicaid program is jointly funded by states and the federal government. ... This brief reviews how the Medicaid program is financed as well as the implications for budgets, responsiveness to state policy choices and need, the links between Medicaid spending and state economies. Key conclusions include: ... The federal government guarantees matching funds to states for qualifying Medicaid expenditures .... In some instances, Medicaid provides a higher matching rate for select services or populations, the most notable being the ACA Medicaid expansion enhanced match rate. (Snyder and Rudowitz, 5/20)

The Urban Institute/Robert Wood Johnson Foundation: Medicaid Expansion, The Private Option And Personal Responsibility Requirements
Ever since the Supreme Court effectively ruled in June 2012 that states could choose whether or not to expand Medicaid to nonelderly adults under the Affordable Care, that choice has been one of the most prominent and often one of the most contentious issues for states. In this report, we describe the six states (Arkansas, New Hampshire, Indiana, Iowa, Michigan and Pennsylvania) that requested and received approval from the federal government to experiment with coverage approaches that are modelled on private insurance concepts .... The bottom line is that some state initiatives under [Medicaid's waiver] Section 1115 may be effective, while others are unlikely to achieve their stated objectives. But regardless of their ultimate effectiveness, all of them have extended health coverage to large numbers of people. (Wishner et al., 5/27)

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

MedPage Today: Docs 'Missing The Mark' On Shared Medical Decisions
Patients trying to decide between two surgical options for the treatment of ulcerative colitis found information supplied by doctors to be "believable" but not very "useful," according to a small pilot study at the University of California San Francisco. The study was based on responses from 25 patients who were questioned about the research they did before meeting with a surgeon and the sources of information they considered most useful. An abstract of the study was presented at Digestive Disease Week in Washington. (Ready, 5/24)

Reuters Health: Younger Cancer Patients More Open To Alternative Therapies
Cancer patients under age 65 are much more likely than older people to explore alternative and complementary medicine for easing their symptoms and side effects of treatment, a new study suggests. (Rapaport, 5/26)

Reuters: Gender And Family Relationships Affect Caregiver Strain
For both men and women, caring for a sick or disabled spouse or child is more stressful than caring for a parent, according to a new study from Canada. Caregiving can be difficult, but little is known about whether it's harder on women or men, or depends on the nature of the relationship between the recipient and the giver of care, the researchers wrote in The Gerontologist, online April 17. (Doyle, 5/26)

Reuters Health: To Promote Breastfeeding, Fewer Hospitals Hand Out Formula
Fewer U.S. hospitals are giving away free infant formula, a new study finds, a shift that may help encourage more new mothers to breastfeed. Pediatricians recommend that mothers exclusively breastfeed infants until at least six months of age because it can reduce babies’ risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes. Formula provides nutrients needed for growth and development, but doesn’t offer added protection against illness or infection. (Rapaport, 5/26)

The Associated Press: Study Reveals Flaws In Gene Testing; Results Often Conflict
The first report from a big public-private project to improve genetic testing reveals it is not as rock solid as many people believe, with flaws that result in some people wrongly advised to worry about a disease risk and others wrongly told they can relax. Researchers say the study shows the need for consumers to be careful about choosing where to have a gene test done and acting on the results, such as having or forgoing a preventive surgery. (Marchione, 5/28)

Reuters: Fitness In Middle Age Linked To Healthier Brain In Later Years
People who have better aerobic fitness in middle age may ward off decreases in brain volume later in life, potentially preserving memory and other functions, a U.S. study suggests. “The current findings suggest that maintaining high fitness in midlife may boost brain health on average 20 years later in adults who have not yet experienced cognitive impairment,” lead study author Qu Tian, a gerontology researcher at the U.S. National Institute on Aging, said by email. (Rapaport, 5/28)