Research Roundup: Surgeons And Supply Costs; Medicaid And Dental Needs; HIV Diagnosis

JAMA Surgery: Association Between Surgeon Scorecard Use And Operating Room Costs
Question: What is the association between providing surgeons with individualized cost feedback and surgical supply costs? Findings: In this case-control study, surgeons in the intervention group received cost feedback scorecards during the study period, while those in the control group did not. The median surgical supply direct costs per case decreased 6.54% in the intervention group compared with a 7.42% increase in the control group. (Zygourakis et al., 12/7)

Health Affairs: After Medicaid Expansion In Kentucky, Use Of Hospital Emergency Departments For Dental Conditions Increased
Following the 2014 expansion of Medicaid eligibility in Kentucky, millions of adults became eligible to receive dental benefits. ... Based on our analysis of data for Kentucky from the State Emergency Department Databases, we found that the rate of discharges for these conditions from the [emergency departments] ED increased significantly, from 1,833 per 100,000 population in 2013 to 5,635 in 2014. Adults covered by Medicaid who used the ED for treatment of oral health conditions in 2014 had high levels of chronic comorbidities and were more likely to be male and nonwhite than those in earlier years. To avoid costly and inappropriate use of the ED, states considering adding an adult Medicaid dental benefit should consider also making changes to assist beneficiaries in obtaining access to the dental health care delivery system. (Chalmers, Grover and Compton, 12/5)

Health Affairs: Dental Care And Medicare Beneficiaries: Access Gaps, Cost Burdens, And Policy Options
Despite the wealth of evidence that oral health is related to physical health, Medicare explicitly excludes dental care from coverage, leaving beneficiaries at risk for tooth decay and periodontal disease and exposed to high out-of-pocket spending. To profile these risks, we examined access to dental care across income groups and types of insurance coverage in 2012. High-income beneficiaries were almost three times as likely to have received dental care in the previous twelve months, compared to low-income beneficiaries—74 percent of whom received no dental care. We also describe two illustrative policies that would expand access, in part by providing income-related subsidies. (Willink, Schoen and Davis, 12/5)

Preventing Chronic Disease/CDC: Understanding Barriers To Cervical Cancer Screening In Women With Access To Care, Behavioral Risk Factor Surveillance System, 2014
Cervical cancer screening can save lives when abnormal cervical lesions and early cancers are detected and treated; however, many women are not screened as recommended. We used the Behavioral Risk Factor Surveillance System survey to examine nonfinancial barriers to cervical cancer screening among women who reported having insurance and a personal doctor or health care provider. Among these women, a higher proportion who were never or rarely screened reported having multiple chronic conditions. The results of this study underscore the importance of incorporating preventive clinical services into the management of one or more chronic conditions. (Crawford et al., 11/10)

Morbidity and Mortality Weekly/CDC: Vital Signs: Trends In HIV Diagnoses, Risk Behaviors, And Prevention Among Persons Who Inject Drugs — United States
Persons who inject drugs (PWID) are at increased risk for poor health outcomes and bloodborne infections, including human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus infections. ... During 2008–2014, HIV diagnoses among PWID declined in urban and nonurban areas, but have leveled off in recent years. Among PWID in 22 cities, during 2005–2015, syringe sharing decreased by 34% among blacks/African Americans (blacks) and by 12% among Hispanics/Latinos (Hispanics), but remained unchanged among whites. The racial composition of new PWID changed during 2005–2015: the percentage who were black decreased from 38% to 19%, the percentage who were white increased from 38% to 54%, and the percentage who were Hispanic remained stable. Among new PWID interviewed in 2015, whites engaged in riskier injection behaviors than blacks. (Wejnert et al., 11/29)

Kaiser Family Foundation: Key Medicaid Questions Post-Election
President-elect Trump supports repeal and replacement of the Affordable Care Act (ACA) and a Medicaid block grant. The GOP plan would allow states to choose between block grant and a per capita cap financing for Medicaid. The new Administration could also make changes to Medicaid without new legislation. ... The full implications of repeal will depend on whether the ACA is repealed in whole or in part, whether there is an alternative to the ACA put in place and what other simultaneous changes to Medicaid occur. However, examining the effects of the ACA on Medicaid provide insight into what might be at stake under a repeal. (11/23)

The Kaiser Family Foundation: What Coverage And Financing Is At Risk Under A Repeal Of The ACA Medicaid Expansion?
[T]his issue brief examines the changes in coverage and financing that have occurred under the Medicaid expansion to provide insight into the potential scope of coverage and funding that may be at risk under a repeal. It finds: In 2015, an estimated 11 million enrollees were adults made newly eligible by the expansion who could be at risk for losing Medicaid coverage. ... Loss of Medicaid coverage could reverse the progress in reducing the uninsured. ... As a result of the enhanced federal funding for expansion, expansion states have received $79 billion in federal funding from January 2014 through June 2015. (Rudowitz, Artiga and Young, 12/6)

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

Reuters: In Dementia, Care From Multiple Health Systems Poses Drug Safety Risks
Dementia patients who get prescriptions from multiple health systems may face a higher risk of drug mix-ups or unsafe interactions than people with cognitive problems who get all their medications from one place, a study of U.S. veterans suggests. Researchers examined data on more than 75,000 veterans with dementia and found that among patients who received all of their care at Department of Veterans Affairs (VA) facilities, 39 percent had potential safety issues with prescribed medications. Among those who got some care at the VA and some treatment elsewhere, however, 59 percent had possible drug safety issues, the study found. (Rapaport, 12/6)

Reuters: Generic Heart Failure Drug Costs Too High For Many Uninsured: Study
The cost of generic drugs that treat heart failure can vary so wildly, even among pharmacies within one area, that uninsured patients may not be able to afford them, according to research reported at the American Heart Association medical meeting in New Orleans on Tuesday. Researchers found that the combined cost for a month's supply of three commonly prescribed generic heart failure drugs ranged from $12 to $400, with an average price of about $70 in the greater St. Louis area, putting them out of reach for some patients who desperately need them. (Berkrot, 11/15)