Research Roundup: Safety-Net Hospitals, Spending Implications Of BCRA, End-Of-Life Care
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The Commonwealth Fund:
Financial Impact AHCA Medicaid On Safety-Net Hospitals
Safety-net hospitals play a vital role in our health care system, delivering significant care to Medicaid, uninsured, and other vulnerable patients. The American Health Care Act (AHCA) would make changes to Medicaid that would substantially reduce federal funding, resulting in potential adverse effects on safety-net hospitals and the populations they serve. ... Beginning in 2020 the financial status of safety-net hospitals will deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. By 2026 total margins will drop to 0.5 percent compared with estimates under current law of 2.9 percent—representing an 83 percent reduction in net income for safety-net hospitals. Small rural safety-net hospitals and safety-net hospitals treating the largest proportion of low-income patients would be hurt the most. (Allen Dobson, Joan DaVanzo and Randy Haught, 6/28)
Urban Institute:
State-By-State Coverage And Government Spending Implications Of The Better Care Reconciliation Act
The Better Care Reconciliation Act (BCRA) was introduced in the Senate on June 22, 2017, and is now under debate. The bill would eliminate much of the Affordable Care Act. In this report, we present state-by-state estimates of the impact of the BCRA on health care coverage and costs. Nationwide, we find that there would be 24.7 million more uninsured people under the BCRA by 2022. Federal funding for Medicaid, premium tax credits, and cost sharing reductions would be $140.4 billion lower under the BCRA in 2022, while state Medicaid spending would increase by $565 million. (Blumberg et al, 6/28)
Health Affairs:
Epidemiology And Patterns Of Care At The End Of Life: Rising Complexity, Shifts In Care Patterns And Sites Of Death
In 2015 an estimated 2.7 million people in the United States (1 percent of the population) died. Although decedents’ illness experience varies substantially, important trends in care at the end of life are evident. To identify the most pressing health care policy issues related to end-of-life care, we present a comprehensive picture of the epidemiology and care patterns of people in the last stage of life. We identify three key trends in end-of-life care: increasing diversity in the primary diagnoses of decedents, increases in multimorbidity and illness complexity among people with terminal illnesses, and shifts in patterns of care at the end of life and in sites of death. (Aldridge and Bradley, 7/5)
Health Affairs:
End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported
Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. (French et al., 7/5)
Annals Of Internal Medicine:
Generic Drug Prices And Market Competition
Market competition levels were associated with a change in generic drug prices. Such measurements may be helpful in identifying older prescription drugs at higher risk for price change in the future. (Dave et al., 7/4)
AJMC:
How Do Medicare Advantage Beneficiary Payments Vary With Tenure?
Objectives: To compare how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. ... We found average spending on premiums and OOPC in enrolled plans exceeded such costs in the lowest-cost plan by $697 in 2013. Beneficiaries who remained in their plans for 6 or more years were most at risk of spending these higher amounts, paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment. For each year a beneficiary remained in their same plan, their additional spending in excess of the minimum cost choice increased by roughly $50. (Jacobs and Molloy, 6/29)
AJMC:
Patient Ratings Of Veterans Affairs And Affiliated Hospitals
Objectives: Hospital Compare, a website maintained by CMS, allows comparisons of outcomes and processes of care but not of patient satisfaction for hospitals within the Veteran Affairs (VA) Healthcare System. Therefore, we sought to compare online hospital ratings between VA hospitals and their local affiliated hospitals. ... VA hospitals had higher patient ratings than their non-VA affiliated hospitals, a finding not explained by bed size or teaching status. (Heidenreich et al., 6/28)
