Research Roundup: Teen Suicides; Medicare Pay For Doctors; Out-Of-Pocket Costs
Each week, KHN compiles a selection of recently released health policy studies and briefs.
JAMA Pediatrics:
Widening Rural-Urban Disparities In Youth Suicides, United States, 1996-2010
[Researchers sought to] examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum. ... Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States .... Across the study period, 66 595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100 000, respectively) and females (4.40 and 2.39 per 100 000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males. (Fontanella et al., 3/9)
Health Affairs:
Solving The Sustainable Growth Rate Formula Conundrum Continues Steps Toward Cost Savings And Care Improvements
Congress is again attempting to repeal the Sustainable Growth Rate (SGR) formula. The formula is a failed mechanism intended to constrain Medicare Part B physician spending by adjusting annual physician fee updates. ... Current congressional deliberations appear focused on how to pay for the fix, with wide consensus that the 2014 legislation should remain the basic model for reform. We describe key features of the 2014 SGR fix, place it in the context of both past and ongoing Medicare health policy, assess its strengths and weaknesses as a mechanism to foster improved care and lower costs in Medicare, and suggest further actions to ensure success in meeting these goals. (Reschovsky, Converse and Rich, 3/11)
The Kaiser Family Foundation:
How Much (More) Will Seniors Pay For A Doc Fix?
Last year, Members of Congress ... came to consensus on a long-term alternative system for setting [Medicare's] physician fees. ... But, as in prior years, lawmakers have yet to come to agreement on the vexing issue of financing .... Among the more contentious issues is whether beneficiaries should pay more ... to help offset this cost to the federal government. ... Often overlooked in these discussions is the fact that, under current law, beneficiaries would automatically absorb their share of Part B costs associated with replacing the SGR. Take the Part B premium, for example .... We estimate that Medicare beneficiaries would automatically contribute $58 billion over the next ten years in Part B premiums to replace the SGR along the lines of the leading bipartisan proposal. (Boccuti and Neuman, 3/10)
Rand Corp.:
Borrowing For The Cure
Recent market entries of breakthrough pharmaceutical products have reignited the debate about the affordability of high-priced drugs for public and private payers worldwide. ... medical professionals and government ministers have complained that this "blank check" might not be sustainable. Concerns about short-term budget impact have led countries to restrict access to expensive drugs, even when they met cost-effectiveness criteria and could lead to long-term savings. This paper offers a research-grounded perspective on innovative financing mechanisms to facilitate access to expensive yet highly effective breakthrough medical treatments. The authors outline the scope of the problem; describe several policy and market options, including bond financing and linking repayment to real-world value generation; and describe real-world applications. (Mattke and Hoch, 3/11)
The Kaiser Family Foundation:
Consumer Assets And Patient Cost Sharing
Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs .... For families with limited resources, however, high cost sharing can be a potential barrier to care and may lead ... to significant financial difficulties. ... We use information from the 2013 Survey of Consumer Finances to look at how household resources match up against potential cost-sharing requirements. ... we compare household resources against two deductible levels: $1,200 single/$2,400 family ... and $2,500 single/$5,000 family .... Overall, three in five (63%) households have enough liquid financial assets to meet the lower deductible amounts while one-half (51%) can meet the higher deductible amounts. ... Only 32% of households with incomes between 100% and 250% of poverty can meet the lower deductible amounts, while one-in-five can meet the higher deductible. (Claxton, Rae and Pancha, 3/11)
Journal of General Internal Medicine/Rand Corp.:
Impact Of Out-Of-Pocket Spending Caps On Financial Burden Of Those With Group Health Insurance
The Affordable Care Act (ACA) mandates that all private health insurance include out-of-pocket spending caps. Insurance purchased through the ACA's Health Insurance Marketplace may qualify for income-based caps, whereas group insurance will not have income-based caps. ... We applied the expected uniform spending caps, hypothetical reduced uniform spending caps (reduced by one-third), and hypothetical income-based spending caps ... to nationally representative data .... With the uniform caps, 1.2 % of individuals had lower out-of-pocket spending, compared with 3.8 % with reduced uniform caps and 2.1 % with income-based caps. ... Mandated uniform out-of-pocket caps for those with group insurance will benefit very few individuals. (Riggs, Buttorff and Alexander, 3/9)
Here is a selection of news coverage of other recent research:
NPR:
Results Of Many Clinical Trials Not Being Reported
Many scientists are failing to live up to a 2007 law that requires them to report the results of their clinical trials to a public website, according to a study in Thursday's New England Journal of Medicine. The website is clinicaltrials.gov, which draws 57,000 visitors a day, including people who are confronting serious diseases and looking for experimental treatments. A study from Duke University finds that five years after the reporting law took effect, only 13 percent of scientists running clinical trials had reported their results. (Harris, 3/11)
Reuters:
Seeing Medical Records Might Ease Hospital Patients’ Confusion
Letting patients see their medical records while they’re in the hospital might ease worry and confusion without extra work for doctors and nurses, a small study suggests. "The hope is that increased transparency achieved by sharing electronic medical records with patients while they're in the hospital would make them more engaged in their care, more satisfied, and more likely to ask questions and catch errors," said lead study author Dr. Jonathan Pell, an assistant professor at the University of Colorado in Denver. (Rapaport, 3/9)
The Philadelphia Inquirer:
Privately Insured Brain Tumor Patients May Fare Better
Brain tumor patients with private health insurance do better than those who have Medicaid coverage or are uninsured, a new study finds. Researchers analyzed data from more than a half-million brain tumor-related hospitalizations in the United States between 2002 and 2011. (3/9)
Modern Healthcare:
PCORI Is Meeting Its Mission Under Affordable Care Act, GAO Says
The Patient-Centered Outcomes Research Institute awarded 360 contracts totaling $670.8 million as of October 2014, according to a report (PDF) issued Monday by the Government Accountability Office. The not-for-profit organization is operating in accordance with the requirements of the Affordable Care Act, the government watchdog agency concluded. PCORI was established under the federal healthcare law to promote research into how conditions and diseases can be most effectively diagnosed and treated. The ACA established five research priorities for the institute, including improving dissemination of research and addressing healthcare disparities. (Demko, 3/9)
Medscape:
Study Spots Patients Who Benefit From Early Postdischarge Care
Hospital readmissions were significantly reduced when patients with multiple chronic conditions and a greater than 20% baseline risk for readmission received follow-up within 7 days of discharge, according to a study of 44,473 Medicaid recipients in North Carolina with 65,085 qualifying discharges. The main findings, published in the March/April issue of the Annals of Family Medicine, showed that the one quarter of patients having the highest risk had a clinically meaningful reduction in the rate of readmission if they had an outpatient visit within 7 days of discharge. Others saw little, if any, reduction. (London, 3/10)
Reuters:
Survival Rates For Risky Surgeries In U.S. Vary Widely
The chance of surviving any of four high-risk surgeries can vary by as much as 23 percent depending on what hospital patients use, according to an analysis released on Thursday. The report - by the nonprofit Leapfrog Group, a patient-safety organization supported by large employers, and Castlight Health Inc, which sells software for employers to manage healthcare spending - shows that choice of hospital "can mean the difference between life and death," said Leapfrog's Erica Mobley. (Begley, 3/12)
McKnight's:
OIG Says Critical Access Swing Beds Should Be Paid At SNF Rates
New legislation should be introduced to significantly change the way rural-based hospitals are reimbursed for care provided in post-acute care swing beds, the Department of Health and Human Services' Office of Inspector General told the Centers for Medicare & Medicaid Services this week. In its report to Congress, the OIG found that the agency could have saved more than $4 billion over a six-year period by reimbursing critical access hospitals (CAHs) under the conventional skilled nursing facility prospective payment rate. The OIG recommended that the agency switch CAH reimbursement to the SNF prospective payment rate as soon as possible. (Hall, 3/11)
MedPage Today:
Male Med Students: More Resolute, More Fallible
Female medical students answered medical questions correctly more often than their male counterparts, but expressed less certainty about their answers, researchers reported. Recognizing the association -- or lack thereof -- between accuracy and confidence in medical trainees may help reduce diagnostic errors caused by overconfidence, wrote three male medical students in a letter published in Annals of Internal Medicine. (Yurkiewicz, 3/3)
Marketplace:
In Surgery, Practice Makes Perfect
From today's file of statistics that will scare you, a patient-safety organization called The Leapfrog Group finds survival rates for some high-risk surgeries can swing by as much as 23 percent depending on the hospital a patient visits. In all, The Leapfrog Group looked at four risky surgeries including esophagectomy, replacing the aortic valve in the heart and removing some or all of the pancreas. (Gorenstein, 3/12)