Research roundup: Bundled payments, PTSD incidence, cost of treating immigrants

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Feb 15 2010

Health Affairs: Trends In Health Care Spending For Immigrants In The United States -
This paper examines the spending for health care of adult naturalized citizens and immigrant noncitizens (including some undocumented immigrants) compared to U.S. natives, as documented in data from the 1999-2006 Medical Expenditure Panel Surveys (MEPS): "inflation and age-adjusted health care expenditures among noncitizen immigrants were consistently … lower than those of naturalized citizens and U.S. natives during 1999-2006." However, "noncitizen immigrants were more likely than U.S. natives to have a health care visit classified as uncompensated care," the authors note (Stimpson, Wilson and Eschbach, 2/11).

RAND Journal of Economics: Can You Get What You Pay For? Pay-For-Performance And The Quality Of Healthcare Providers - To assess the effectiveness of pay-for-performance (P4P) in improving quality of care, the authors analyzed performance reports from medical groups contracting with a large network HMO, PacifiCare Health Systems, before and after implementation of two P4P programs in California. (Pay-for-performance programs generally offer doctors, hospitals and other healthcare providers bonuses if they score high on defined measures, such as meeting guidelines for chronic disease management or preventive screenings.)

They compare these reports to medical groups that were not affected by either program. "In the end, we fail to find evidence that a large P4P initiative either resulted in major improvement in quality or notable disruption in care," the authors write. "In particular, although some paid measures may have improved in response to the program, we do not find any evidence of positive spillovers to other aspects of care. This result casts doubt on the promise of P4P as a transformative mechanism for improving the general quality of the healthcare system." (Mullen, Frank and Rosenthal, 1/20).

RAND: Increase The Use Of "Bundled" Payment Approaches - This report examines how increased use of bundled payment approaches - such as paying a set fee for specific medical procedures -- affects nine "performance dimensions," including spending, waste, patient experience, coverage, operational feasibility, consumer financial risk, reliability, health and capacity: "Bundled payment approaches create incentives for providers to eliminate unnecessary services and reduce costs. ... From limited evidence in the literature, we would expect that bundled payment approaches involving multiple providers would lead to decreased spending. ... Savings will depend on the design of the payment system, the particular services that are bundled, and the performance of the participating system before implementation" (Bertko and Effros, 2010).

Journal of Traumatic Stress: VA Mental Health Services Utilization In Iraq And Afghanistan Veterans In The First Year Of Receiving New Mental Health Diagnoses - This study examines the use of mental health services by Iraq and Afghanistan veterans with post-traumatic stress disorder (PTSD) who are receiving care at Department of Veterans Affairs facilities: "Of 49,425 veterans with newly diagnosed posttraumatic stress disorder … only a minority of Iraq and Afghanistan veterans … received a recommended number and intensity of VA mental health treatment sessions within the first year of diagnosis" (Seal et al., 2/9). The study also "showed that there are groups of veterans that are less likely to receive adequate care than others, such as male veterans (compared to female veterans), veterans under twenty-five years old, veterans who received their PTSD diagnoses from primary care clinics (requiring referral to a mental health program), and veterans living in rural areas," a press release on the study notes (2/10).

Hormones and Cancer: Trends In Distant-Stage Breast, Colorectal, And Prostate Cancer Incidence Rates From 1992 to 2004: Potential Influences of Screening and Hormonal Factors - This study explores the disparities in specific cancer incidence rates between 1992 and 2004, which the authors note represents "an era when screening tests for each of these cancers were available." Based on data from the Surveillance, Epidemiology, and End Results (SEER) Program, the authors report that "disparities in the incidence of distant-stage breast, colorectal, and prostate cancers experienced by African Americans compared to whites have stayed relatively constant for breast cancer, increased for colorectal cancer, and decreased for prostate cancer from 1990 to 2004 on an absolute scale." The authors conclude, "Ongoing research is needed to determine the causes of these trends and their relative contributions in order to design additional targeted efforts to reduce these cancer disparities" (McDougall and Li, 2/6).

Cancer: The Effect Of Changes In Medicare Reimbursement On The Practice Of Office And Hospital-Based Endoscopic Surgery For Bladder Cancer - An increase in Medicare reimbursement rates for physicians performing outpatient endoscopic bladder procedures, such as biopsies, in 2005 affected the number of such office and hospital-based procedures and overall health care costs (Hemani, Makarov, Huang and Taneja, 2/8). It was expected the change in the reimbursement rates would help move the procedures out of expensive hospital settings and save money, according to a press release on the study. "The investigators found that the number of outpatient bladder surgeries doubled after Medicare reimbursements rose, but the number of hospital-based surgeries did not significantly decline," resulting in "a 50% increase in overall Medicare costs." The authors also found "while the number of outpatient procedures increased, the likelihood that a procedure would lead to a bladder cancer diagnosis declined" (2/8).

Kaiser Health News summarized the news coverage of this study.

Journal of the American Medical Association: Hospital Characteristics Associated With Feeding Tube Placement In Nursing Home Residents With Advanced Cognitive Impairment - After analyzing Medicare claims files, the researchers report: "Among nursing home residents with advanced cognitive impairment admitted to acute care hospitals, for-profit ownership, larger hospital size, and greater ICU use was associated with increased rates of feeding tube insertion, even after adjusting for patient-level characteristics." The authors conclude, "Future research is needed to better understand why this variation occurs and to intervene to ensure that feeding tube insertion reflects informed patient preferences based on discussion of the evidence of risks vs benefits" (Teno et al., 2/10).

Kaiser Health News summarized the news coverage of this study.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.