Research roundup: 'Substantial' Medicare savings from avoiding ERs; new ways for primary care; trends in kids' fast food consumption

Dec 9 2013

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Giving EMS Flexibility In Transporting Low-Acuity Patients Could Generate Substantial Medicare Savings
Some Medicare beneficiaries who place 911 calls to request an ambulance might safely be cared for in settings other than the emergency department (ED) at lower cost. Using 2005–09 Medicare claims data and a validated algorithm, we estimated that 12.9–16.2 percent of Medicare-covered 911 emergency medical services (EMS) transports involved conditions that were probably nonemergent or primary care treatable. ... If Medicare had the flexibility to reimburse EMS for managing selected 911 calls in ways other than transport to an ED, we estimate that the federal government could save $283–$560 million or more per year, while improving the continuity of patient care. If private insurance companies followed suit, overall societal savings could be twice as large (Alpert et al., 12/4).

Health Affairs: Health Information Exchange Improves Identification Of Frequent Emergency Department Users
We hypothesized that using communitywide data from a health information exchange (HIE) could improve the ability to identify frequent emergency department (ED) users-;those with four or more ED visits in thirty days-;by allowing ED use to be measured across unaffiliated hospitals. When we analyzed HIE-wide data instead of site-specific data, we identified 20.3 percent more frequent ED users (5,756 versus 4,785) and 16.0 percent more visits by them to the ED (53,031 versus 45,771). Additionally, we found that 28.8 percent of frequent ED users visited multiple EDs during the twelve-month study period, versus 3.0 percent of all ED users (Shapiro et al., 12/4).

Rand Corporation: New Approaches for Delivering Primary Care Could Reduce Predicted Physician Shortage
Numerous forecasts have predicted shortages of physicians in the United States, particularly in light of the expected increase in demand from the Affordable Care Act (ACA). ... RAND researchers analyzed the potential impact of two emerging models of care -; the patient-centered medical home (PCMH) and the nurse-managed health center (NMHC) -; on future shortages of primary care physicians. ... The study found that projected shortages of primary care physicians could be substantially reduced by increasing the prevalence of these new models of care -; without increasing the number of physicians. Researchers also developed an interactive online tool that allows users to change the assumptions used in this research (Auerbach et al., 12/4).

The New England Journal of Medicine: Assessing Participant-Centered Outcomes to Improve Clinical Research
[T]hanks in part to prodding from the newly established Patient-Centered Outcomes Research Institute, patient-centered outcomes are increasingly being incorporated into clinical research. ... [W]e developed and validated a standardized Research Participant Perception Survey ... A majority of participants indicated that they did not feel pressure from research staff to join the study (94%); believed that the consent form covered the study's risks (81%), included study details (80%), and was understandable (78%); and said they had sufficient time to evaluate whether to participate (79%). ... One striking finding was that most participants wanted to receive information about the results of the study (Kost et al., 12/5).

JAMA Pediatrics: The Effects Of Poverty On Childhood Brain Development
Data from a prospective longitudinal study of emotion development in preschool children who participated in neuroimaging at school age were used to investigate the effects of poverty on brain development. Children were assessed annually ... The finding that exposure to poverty in early childhood materially impacts brain development at school age further underscores the importance of attention to the well-established deleterious effects of poverty on child development. Findings that these effects on the hippocampus are mediated by caregiving and stressful life events suggest that attempts to enhance early caregiving should be a focused public health target for prevention and early intervention (Luby et al., 12/2).

JAMA Psychiatry: National Trends In The Mental Health Care of Children, Adolescents, And Adults By Office-Based Physicians
Between 1995-1998 and 2007-2010, visits resulting in mental disorder diagnoses per 100 population increased significantly faster for youths (from 7.78 to 15.30 visits) than for adults (from 23.23 to 28.48 visits). ... Compared with adult mental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use. A great majority of mental health care in office-based medical practice to children, adolescents, and adults is provided by nonpsychiatrist physicians calling for increased consultation and communication between specialties (Olfson et al., 11/27).

UCLA Center for Health Policy Research: Majority Of Young Children In California Eat Fast Food Regularly But Drink Less Soda
This policy brief examines the eating habits of children ages two to five years. Despite steady declines in soda consumption, 60 percent of children in this age group continue to eat fast food at least once a week. Among young Latino children, the rate is 70 percent; overall, one in ten young children eats three or more fast food meals per week. The majority of children also fall short of the state standard on fruit and vegetable consumption, ... Asian children have the lowest levels of fruit and vegetable consumption (Holtby, Zahnd and Grant, 11/21).

The Kaiser Family Foundation: Medicare Advantage 2014 Spotlight: Plan Availability And Premiums
Beneficiaries will see limited changes in the number of plans offered in 2014. Our analysis finds that beneficiaries will be able to choose from 18 plans, on average, in 2014, down from an average of 20 plans in 2013. While some plans will leave the market in 2014, others are coming in or expanding. ... Almost all will be able to stay in a similar type plan, often with the same company. Beneficiaries will continue to have access to plans with relatively low premiums. ... Of note, out-of-pocket limits are expected to be higher in 2014 than in 2013, on average, providing less financial protection to enrollees (Gold, Jacobson, Damico and Neuman, 11/25). 

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

Medscape: Study Dispels 'Urban Legends' About Frequent ED Users
Contrary to "urban legend," frequent users of emergency care actually have high rates of primary care use and only a small proportion of their emergency department (ED) visits are for substance abuse and mental health problems, a new study of Medicaid ED users in New York City shows. ... Moreover, the study also found that visits for substance abuse and mental health comprised just 5% of total visits in a single year. ... [in] the journal Health Affairs (Tucker, 12/5). 

MedPage Today: Hospital Error Rates Cut With Better Handoffs
Rates of medical errors detected at a large children's hospital declined 45% after a program to improve patient handoff procedures was implemented, researchers said. Medical errors of all types occurred at a rate of 33.8 per 100 admissions at Boston Children's Hospital during a baseline period, which then declined to 18.3 per 100 admissions  following implementation of a program targeted to interns and residents that emphasized communication and a standardized approach to handoffs, according to Amy J. Starmer, MD, MPH, of Boston Children's, and colleagues. ... in the Dec. 4 issue of the Journal of the American Medical Association (Gever, 12/3).

Reuters: Hospitals Will Quote Prices For Parking, Not Procedures
People usually don't know what their medical procedures cost until after they leave the hospital, and a new study suggests they would have a hard time finding out in advance. Inspired by an earlier study looking at hip replacement surgery costs, researchers tried to see if consumers could get price quotes for a much simpler diagnostic test from Philadelphia area hospitals. They found that parking prices were readily available by calling the hospital and asking, but only three out of 20 hospitals could provide the cost of an electrocardiogram test (Jegtvig, 12/2).

Medscape: Shingles Vaccine Uptake Disappointing
Although most adults 40 years and older are at risk for herpes zoster infection, also known as shingles, uptake of the vaccine (Zostavax) to prevent infection is disappointing, researchers say. "The risk of herpes zoster is increasing faster than the aging population," said Elizabeth Cohen, MD, from the NYU Langone Medical Center in New York City. ... As renowned bioethicist Arthur Caplan said, 'We have a moral obligation to do the right thing to change behavior'," she said (Goodman, 11/27).

MedPage Today: Kids' Psychiatric Visits a Growing Concern
Sixteen years of data from a large federal survey indicated that outpatient visits resulting in mental health diagnoses increased significantly in the U.S., especially in children and adolescents. Rates of such visits for individuals younger than 21 nearly doubled from 1995 to 2010 (from 7.78 to 15.30 per 100 population), while those for adults 21 and older rose from 23.23 to 28.48 per 100, according to Mark Olfson, MD, MPH, of Columbia University in New York City, and colleagues. .... reported online in JAMA Psychiatry  (Gever, 11/27).