Research Roundup: The Effects Of ACOs; Declines In Medical Liability Payments

The New England Journal of Medicine: Changes In Patients' Experiences In Medicare Accountable Care Organizations
[W]e compared experiences of care reported by Medicare beneficiaries served by provider organizations entering the [accountable care organization] programs in 2012 with the experiences reported by beneficiaries served by other providers, before versus after the start of ACO contracts. ... incentives for participating provider organizations to limit health care utilization and improve quality of care were associated with meaningful improvements in some measures of patients' experiences and with unchanged performance in others. ... patients served by ACOs reported improvements in domains more easily affected by organizations (access to care and care coordination) but not in domains in which changes in physicians' interpersonal skills may be required to achieve gains .... In addition, medically complex patients ... reported significantly better overall care after the start of ACO contracts. (McWilliams, Landon, Chernew and Zaslavsky, 10/30)

The Journal of the American Medical Association: The Medical Liability Climate And Prospects For Reform
For many physicians, the prospect of being sued for medical malpractice is a singularly disturbing aspect of modern clinical practice. State legislatures have enacted tort reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice litigation. ... In this Special Communication, we review recent national trends in medical liability claims and costs, which indicate a sharp reduction in the rate of paid claims and flat or declining levels in compensation payments and liability insurance costs over the last 7 to 10 years. ... Rates of paid claims against physicians have decreased since the early 2000s. For MDs, the rate decreased from 18.6 to 9.9 paid claims per 1000 physicians between 2002 and 2013. Regression analyses estimate an annual average decrease of 6.3% for MDs and 5.3% for DOs over this 12-year period. (Mello, Studdert and Kachalia, 10/30)

Journal of the American Medical Association: Association Between Hospital Conversions To For-Profit Status And Clinical And Economic Outcomes
We found that between 2002 and 2010, 237 US hospitals switched from nonprofit to for-profit status. This conversion was associated with better subsequent financial health but had no relationship to the quality of care delivered or to mortality rates at the converting hospitals. We also found no evidence that for-profit conversion was associated with any increase in Medicare payments or annual Medicare case volume or decrease in the provision of care to poor patients or to racial or ethnic minorities. Prior to conversion, we found that hospitals that would eventually become for-profit institutions were struggling financially, with negative total margins; this is in keeping with prior research2 and is likely why these hospitals were targeted for conversion. (Joynt, Orav and Jha, 10/22)

Journal of the American Medical Association: Physician Practice Competition And Prices Paid By Private Insurers For Office Visits
Less competition among physician practices is statistically significantly associated with substantially higher prices paid by private PPOs to physicians in 10 large specialties for office visits. ... Examining changes in prices between 2003 and 2010, we found that prices increased more rapidly in areas where practices were initially less competitive than in other areas. In some specialties, declining competition was also associated with larger increases in prices in areas that were initially more competitive. This pattern suggests the possibility that the results we observe in 2010 may be related to the ability of practices in low-competition areas to negotiate larger price increases over time as well as related to changes in competition over time. (Baker et al., 10/22)

JAMA Pediatrics: Improvement In Preventive Care Of Young Adults After The Affordable Care Act
Objective: To examine the ACA’s initial effects on young adults’ receipt of preventive care. ... After ACA, young adults had significantly higher rates of receiving a routine examination (47.8% vs 44.1%), blood pressure screening (68.3% vs 65.2%), cholesterol screening (29.1% vs 24.3%), and annual dental visit (60.9% vs 55.2%) but not an influenza vaccination (22.1% vs 21.5%). Full-year private insurance coverage increased (50.1% vs 43.4%), and rates of lacking insurance decreased (partial-year uninsured, 18.4% vs 20.7%; and full-year uninsured, 22.2% vs 27.1%). Full-year public insurance rates remained stable (9.4% vs 8.8%; P = .53). Insurance status fully accounted for the pre- and post-ACA differences in routine examination and blood pressure screening and partially accounted for year differences for cholesterol screening and annual dental visits. Covariate adjustment did not affect year differences. (Lau et al., 10/27)

JAMA Surgery: Variation In Readmission By Hospital After Colorectal Cancer Surgery
Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. ... but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment. ... We studied 44 822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002. ... Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2% (IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals (Lucas et al., 10/22)

Georgetown University Health Policy Institute/Robert Wood Johnson Foundation/Urban Institute: Federal And State Policy Toward Association Health Plans In Oregon
Before the Affordable Care Act (ACA), some state regulatory approaches created powerful incentives for health insurers to sell through associations to individuals and small employers, largely because they were exempt from key state consumer protections and requirements .... Some experts suggested these regulatory differences allowed for insurers to segment the market by separating healthier individuals and small groups from the less healthy .... Though many believed that the newly level playing field created by the ACA would effectively eliminate the incentive to market and sell health insurance through associations, this paper finds that associations in Oregon offering health insurance are claiming single large-group health plan status under ERISA, thus sidestepping the requirements under the ACA for the small-group market. (Lucia, Ahn and Corlette, 10/28)

The Kaiser Family Foundation: The ACA Primary Care Increase: State Plans For SFY 2015
To increase support for physicians providing primary care for Medicaid beneficiaries, and to improve access to primary care as Medicaid coverage expands, the Affordable Care Act (ACA) increased Medicaid payment rates for many primary care services to Medicare fee levels in 2013 and 2014. ... Fifteen states indicated that they will continue the primary care fee increase in 2015, at least in part. The 100% federal funding for rate increase ends on December 31, 2014, so these states will continue the increase at their regular federal matching rate. For states that were paying primary care physicians close to 100% of Medicare rates even before the ACA (such as Alaska, whose rates were 124% of Medicare rates), extending the ACA increase does not impose significant new costs. However, most states noted a sizable increase in state funds required to continue the primary care increase. (Snyder, Paradise and Rudowitz, 10/28)

The Kaiser Family Foundation: Preventive Services Covered By Private Health Plans Under The Affordable Care Act
A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. ... However, costs do prevent some individuals from obtaining preventive services. ... While the number of individuals who have gained coverage for no-cost preventive services is large, public awareness of the preventive services requirement is relatively low. In March 2014, three and half years after the rule took effect, less than half the population (43%) reported they were aware that the ACA eliminated out-of-pocket expenses for preventive services. (10/28)

Urban Institute: Monitoring The Impact Of The Affordable Care Act On Employers
In this report, we analyze recent trends in the employer health insurance market and the anticipated effects of the Affordable Care Act on employers, with a particular focus on small firms with fewer than 50 workers. ... we find the following: Employers have a strong economic incentive to offer health insurance .... Before the Affordable Care Act, most of the nonelderly population had health coverage through an employer, but rates of employer-sponsored insurance (ESI) decreased nearly every year since 2000. The decline in ESI was even more drastic among small-firm workers .... While nearly all larger firms offered ESI in 2012—99.5 percent of employers with 1,000 or more employees and 94.1 percent of those with 100–999 employees—only 35 percent of small firms with fewer than 50 workers offered coverage to their employees. Small firms have lower offer rates than larger firms because of the additional costs and challenges they face. (Blavin et al., 10/23)

Brookings: Pharma Pays $825 Million To Doctors And Hospitals, ACA’s Sunshine Act Reveals
The purpose of [the Sunshine Act] is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. ... Teaching hospitals and physicians together received $669,561,563 in general payments from 949 different medical manufacturers. Interestingly, close to 70 percent ($460,369,403) of this amount was paid to individual physicians and the rest was paid to teaching hospitals. More than half of the total general payments were made by only 20 companies led by Genentech .... Two hundred and ninety-four manufacturers awarded 23,225 research grants to teaching hospitals and physicians. The total value of these grants was $155,815,828. About 70 percent ($107,969,961) of these grants were awarded to teaching hospitals and the rest were awarded to physicians (Yaraghi, 10/23)

Other news sources also reported:

Medscape: Reminders May Trigger Advance Care Conversations Earlier
A simple trigger reminder to oncologists at key times during the course of care of a seriously ill cancer patient may prompt earlier discussions regarding advance care planning (ACP) for the end-of-life phase, according to preliminary research presented at the inaugural Palliative Care in Oncology Symposium, held in Boston, Massachusetts, October 24-25. (Hand, 10/28)

Reuters: Knowing Prices Tied To Lower Healthcare Spending
People who search and compare the prices of common healthcare services tend to spend a bit less than people who don’t, according to a new study. The overall amount of money people and their employers spent on office visits, laboratory services and imaging tests was between $1 and $125 less than normal when they looked up the prices ahead of time, researchers found. (Seaman, 10/23)

Medscape: No Drop In Malpractice Payments When Caps Rise To $500K
Putting in place noneconomic damage caps appears to reduce payouts more than not having caps, but when caps increased to $500,000, the effect on payments was neutralized, new research shows. Specifically, any cap trimmed average payments by 15% ($42,980) compared with no cap, and a $250,000 cap reduced average payments by 20% ($59,331), researchers report in an article published online October 22 in Health Affairs. However, when caps reached $500,000, they no longer had a significant effect, compared with no cap. (Frellick, 10/24)

Politico Pro: Study: Not All Assumptions About Narrow Networks Hold True
A narrow network plan isn’t the only way to get lower premiums yet still have access to highly ranked hospitals, according to a study released Thursday. Research from the Urban Institute found that the relationship between network size and cost does not always hold. In the six cities examined, some broad networks have low premiums and some narrow networks have high premiums — an inverse relationship that runs counter to most people’s assumptions in picking a health plan. (Villacorta, 10/30)