Research Roundup: Staying ‘Mentally Sharp’; Meeting The Potential Of ACOs; Drug Shortages

Institutes of Medicine: Cognitive Aging: Progress In Understanding And Opportunities For Action
For most Americans, staying "mentally sharp" as they age is a very high priority. Declines in memory and decision-making abilities may trigger fears of Alzheimer's disease or other neurodegenerative diseases. However, cognitive aging is a natural process that can have both positive and negative effects on cognitive function in older adults -- effects that vary widely among individuals. ... [This report] assesses the public health dimensions of cognitive aging with an emphasis on definitions and terminology, epidemiology and surveillance, prevention and intervention, education of health professionals, and public awareness and education. This report makes specific recommendations for individuals to reduce the risks of cognitive decline with aging. (Blazer, Yaffe and Liverman, 4/14)

Health Affairs: Are Shortages Going Down Or Not? Interpreting Data From The FDA And The University Of Utah Drug Information Service
[M]anufacturers are now required to notify the FDA of impending production disruptions in certain prescription medications. These early notifications give the FDA and manufacturers more time to take actions .... Once companies began to increase reporting of anticipated or in-progress production disruptions, the trend in new shortages reversed. ... the FDA helped prevent almost 80 percent of impending shortages in 2013, up from about 45 percent in 2011. ... But another key data source on drug shortages, the University of Utah Drug Information Service (UUDIS), shows a 47 percent drop in new shortages between 2011 and 2014. ... we discuss how the FDA’s list of shortages represents a subset of a broader list of supply disruptions listed by the UUDIS. (Wosinska, Fox and Jensen, 4/8)

Health Affairs: Changes Needed To Fulfill The Potential Of Medicare’s ACO Program
The Medicare Shared Savings Program (MSSP), Medicare’s main program for accountable care organizations (ACOs), has grown rapidly since it began in 2012. It added 89 new provider organizations earlier this year, bringing the total to over 400 .... however, the potential still mostly remains to be realized. As we noted in a recent post, early results show that the Medicare ACOs have achieved high quality in many areas, while only a quarter of the MSSP ACOs have been able to reduce spending enough to share in savings generated from their efforts so far. ... Given the high expectations and the many startup issues around Medicare ACOs, it is no surprise that the recent proposed rule for reforming the MSSP received a lot of attention. ... we review the major areas of proposed changes along with our views and some notable comments submitted by other groups. (McClellan, Kocot and White, 4/8)

AARP Public Policy Institute: Observation Status: Financial Implications For Medicare Beneficiaries
Doctors who cannot quickly diagnose patients in the emergency room sometimes place them “under observation” .... This report, which uses data from a sample of 2009 Medicare claims, reveals that rules for observation status are having a notable impact on the cost of health care for many Medicare beneficiaries, and perhaps also on their decisions about whether or not to seek additional recommended follow-up care. ... For example, our findings show that 1 in 10 observation patients (about 167,000) spent more for hospital services than they would have spent if they were admitted as inpatients. We found that nearly a third of all those referred to a skilled nursing facility after receiving observation services (50,000) forewent that care, perhaps because of the anticipated costs. (Lind et al., 4/14)

The Kaiser Family Foundation: Medigap Enrollment Among New Medicare Beneficiaries
[The legislation to replace Medicare's payment system for doctors] includes a provision that would prohibit Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare on or after January 1, 2020. This provision is designed to make future Medigap purchasers more price-sensitive when it comes to medical care, which could lead to a reduction in the use of health services and Medicare spending. ... If this policy had been implemented in 2010, it would have affected Medigap coverage for roughly 10 percent of all 65-year old Medicare beneficiaries. Based on declining Medigap enrollment trends among 65-year olds, a smaller share of new Medicare beneficiaries can be expected to be affected by this policy in the future. (Jacobson, Neuman and Damico, 4/13)

Brookings: The Internal Revenue Service Meets The Affordable Care Act
Given the staff limitations of the IRS and the complexity of reporting and reconciling the government subsidies in the law with people’s income there is likely to be confusion, frustration and, most important, a lot of people who find out that their tax refund is a great deal smaller than they anticipated. Massachusetts has had a tax penalty for not having health insurance since the passage of the state’s 2006 health care reform law. ... Massachusetts has had great success in citizens’ compliance with health reform and new tax filing procedures. ... However, one should be cautious before assuming this high-rate of compliance will be easily replicated at the federal level on tax day (Kamarck, 4/10)

Georgetown University Center for Children and Families/Kids Well Florida: Many Working Parents And Families In Florida Would Benefit From Closing The Coverage Gap
In Florida, uninsured parents with children present in the home account for 28 percent of the population potentially eligible for health coverage if the state expands Medicaid. A significant coverage gap exists for parents whose income exceeds Florida’s extremely low eligibility threshold for Medicaid but don’t earn enough to receive tax credits for coverage through the federal health insurance marketplace. A parent in a family of three working more than 18 hours a week in a minimum wage job would earn too much to get Medicaid coverage under Florida’s stringent guidelines. Of those parents that could benefit from extended Medicaid eligibility, 63 percent are employed and many of them are in jobs supporting Florida’s service based, tourist-dependent economy. (Alker and Chester, 4/13)

Centers for Disease Control and Prevention: Assessment Of Epidemiology Capacity In State Health Departments
Data on state-level epidemiology capacity from surveys conducted by the Council of State and Territorial Epidemiologists (CSTE) since 2001 indicate that capacity in many areas previously peaked in 2004, a time of peak federal funding for public health preparedness, and then diminished to especially low levels by 2009. ... Data from the most recent CSTE survey indicate that overall state-level epidemiology capacity and the epidemiology capacity in many program areas has increased markedly since 2009. The number of epidemiologists, the percentage of state health departments with substantial-to-full capacity for three essential public health services, and the percentage with substantial-to-full epidemiology capacity for eight of 10 program areas were at their highest level since assessments began in 2001. However, >50% of states reported minimal-to-no epidemiology capacity in occupational health, oral health, substance abuse, and mental health. Most health departments still lack critical technology capacity. (Hadler et al., 4/17)

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

Medscape: USPSTF Evidence Review Supports Prediabetes Screening
Screening asymptomatic people for type 2 diabetes does not improve mortality after 10 years of follow-up, but detection and treatment of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) could delay progression to diabetes. Those were among the conclusions from a systematic literature review performed by an independent panel to inform upcoming guidelines from the United States Preventive Services Task Force (USPSTF). (Tucker, 4/13)

Reuters: U.S. Emergency Rooms Getting Better-Prepared For Kids
U.S. emergency departments are better prepared these days to care for young patients, a new study shows. The average readiness score for emergency departments responding to a survey in 2013 was about 69 percent, compared to an average score of about 55 percent in 2003, researchers say. (Seaman, 4/13)

Reuters: Detecting Diabetes In Children Before Symptoms Appear
Doctors may be able to detect type 1 diabetes in children before they exhibit any symptoms of the disease, new research from Sweden shows. Type 1 diabetes is an autoimmune disease that often appears in childhood and is the result of the body being unable to produce the hormone insulin. (4/9)

The New York Times: Report Questions Whether Health Apps Benefit Healthy People
Consumers looking to use their mobile devices to improve their health — or at least maintain their well-being — have tens of thousands of choices. But if those consumers are already healthy, the apps won’t necessarily do them any good, according to a new report in The BMJ, a British medical journal. (Singer, 4/14)

Medscape: Postacute Care Important In Medicare Spending Imbalance
Differences in Medicare spending for episodes of hospital and postacute care are driven by both hospital-based and regional factors, a new study concludes. Peter S. Hussey, PhD, from RAND Corporation, Boston, Massachusetts, and colleagues used claims for all Medicare fee-for-service beneficiaries in 2008 and compared hospital vs regional variation in Medicare payments for hospital and postacute care (nursing homes, home health, and inpatient rehabilitation) for 10 common conditions. Results were published online April 13 in a JAMA Internal Medicine research letter. (Frellick, 4/14)

The New York Times: The Right Dose Of Exercise For A Longer Life
Exercise has had a Goldilocks problem, with experts debating just how much exercise is too little, too much or just the right amount to improve health and longevity. Two new, impressively large-scale, studies provide some clarity, suggesting that the ideal dose of exercise for a long life is a bit more than many of us currently believe we should get, but less than many of us might expect. The studies also found that prolonged or intense exercise is unlikely to be harmful and could add years to people’s lives. (Reynolds, 4/15)

NPR: Is That Corporate Wellness Program Doing Your Heart Any Good?
Odds are your employer has a wellness program that prods you to exercise and eat healthy. But that program may not be doing all that much for your health, according to the American Heart Association, and attempts to measure the benefits of wellness programs often fail. When it comes to improving cardiovascular health, "most of the programs appear to be falling short," says Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and lead author of the scientific statement, which was published Monday in the journal Circulation. (Shute, 4/14)

St. Louis Public Radio: Length Of Cigarette Addiction Linked To Common Gene Marker, But Treatments Available
Can’t stop smoking? Your genes might be part of the problem. After a case review of 24 studies involving 29,000 participants, researchers at Washington University in St. Louis determined that smokers who carried a relatively common genetic marker tend quit smoking four years later on average than those without. The genetic variation was also linked to earlier diagnoses for lung cancer. (Bouscaren, 4/15)

Reuters: Mid-Pregnancy Maternal Diabetes Tied To Child's Autism Risk
When mothers develop diabetes during the first 26 weeks of pregnancy, the child they’re carrying may be at increased risk of autism, according to a new study. Kids exposed to so-called gestational diabetes before the third trimester were at higher risk compared to those whose mothers did not develop diabetes during pregnancy, developed it later in pregnancy or had type 2 diabetes before pregnancy, researchers found. (Doyle, 4/14)