Research roundup: Managing nursing home patients, streamlining medical billing, financial disclosures

May 3 2010

Health Affairs: Saving Billions Of Dollars--And Physicians' Time--By Streamlining Billing Practices - "The U.S. system of billing third parties for health care services is complex, expensive, and inefficient," write the authors, who analyzed Massachusetts General Physicians Organization staffing and cost data in fiscal year 2006. "In fiscal year 2006, the cost of excessive administrative complexity, including both expense and lost revenue, was nearly $45 million for this organization, or 11.9 percent of net patient revenue."

"A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations. On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services. Four hours of professional time per physician and five hours of practice support staff time could be saved each week" (Blanchfield et al., 4/29).

Journal Of The American Medical Association: Changes In The Use And Costs Of Diagnostic Imaging Among Medicare Beneficiaries With Cancer, 1999-2006 - Between 1999 and 2006, imaging costs among Medicare beneficiaries with cancer rose at a higher rate than did overall costs for those beneficiaries. The greatest increase was in positron emission tomography (PET), according to this study. The findings were based on "a nationally representative 5% sample of claims from the US Centers for Medicare & Medicaid Services from 1999 through 2008," of patients who had at breast cancer, colorectal cancer, leukemia, lung cancer, non-Hodgkin lymphoma, or prostate cancer. "[T]he cost of cancer care increased 1.8% to 4.6% per year, with imaging growing at 5.1% to 10.3% per year. Thus, imaging represented a larger share of total costs in 2006 than in 1999" (Dinan et al., 4/28).

KHN summarized news coverage of the JAMA study (4/28).  

Urban Institute: The Effects Of Large Premium Increases On Individuals, Families, And Small Businesses - This report (.pdf), following on recent publicity about large premium increases, examines the impact of premium increases "much higher than the rate of health care cost growth on coverage, costs and the decisions by small firms to offer ESI [employer-sponsored insurance]." Based on a simulation of scenarios in which premiums rise at a significantly faster rate than baseline premium growth (4.8 percent), the authors find an "ESI premiums increase 6 percent for large firms, 10 percent for small firms, and 20 percent in the individual market" would result in 1.9 million Americans becoming uninsured. "ESI premiums rising 9 percent for large firms, 20 percent for small firms, and 30 percent in the individual market would lead 3.3 million to become uninsured."

And, over health care spending would go up "by $18.1 billion with intermediate premium increases and by $38.6 billion with the highest increases" (Buettgens, Garrett and Holahan, 4/23).

Mathematica Policy Research: How Does Insurance Coverage Improve Health Outcomes? - This brief compares the health outcomes of populations who lack health insurance to those who are insured - including outcomes from severe illness or injury, and chronic illness. 

During the implementation of the Patient Protection and Affordable Care Act, "federal and state policymakers should consider lessons learned about continuous coverage and affordable care. For example, cost sharing, especially for mental health and drug benefits, can create financial barriers that jeopardize the appropriate and efficient use of care," the authors write. "Policymakers might also consider ways to make it easier for populations enrolled in public programs and coverage through the exchanges, particularly populations with serious conditions or special needs, to maintain relationships with their primary care providers over time" (Bernstein, Chollet and Peterson, April 2010).

The Kaiser Family Foundation released two briefs "to help answer common questions" about provisions in the health law: "Questions About Health Insurance Exchanges examines the exchanges that will be set up in states to create a more organized and competitive market for health insurance by offering a choice of health plans, establishing common rules regarding the offering and pricing of insurance, and providing information to help consumers better understand the options available to them."  The second brief, "Questions About Health Insurance Subsidies describes the subsidies available in the law, including premium subsidies that would be provided in the form of tax credits, as well as other subsidies that would lower cost sharing to eligible Americans. It explains the sliding scale of subsidies available to Americans in 2014 with annual incomes between 133 and 400 percent of the federal poverty level, and describes the cost-sharing assistance and the impact of the subsidies on reform's overall cost" (April 2010).

Centers for Disease Control and Prevention: Potentially Preventable Emergency Department Visits By Nursing Home Residents: United States, 2004 - This report (.pdf) looks at emergency department (ED) visits among nursing home residents, including "potentially preventable" visits, as documented in the 2004 National Nursing Home Survey. "Eight percent of nursing home residents in 2004 had at least one ED visit in the past 90 days, representing 123,600 residents nationally. … Among nursing home residents with an ED visit in the past 90 days, 40 percent had potentially preventable ED visits," the author writes and includes a breakdown of the common causes of preventable ED visits, noting injuries from falls accounted for over one-third of the potentially preventable ED visits (Caffrey, April 2010).

Centers for Disease Control and Prevention: Prevalence and Management of Pain, by Race and Dementia Among Nursing Home Residents: United States, 2004 - The key findings of this examination of nursing home data found that: "About one-quarter of all nursing home residents reported or showed signs of pain. Nonwhite residents and residents with dementia were less likely to report or show signs of pain compared with white residents and residents without dementia. ... Forty-four percent of nursing home residents with pain received neither standing orders for pain medication nor special services for pain management (i.e., appropriate pain management). Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management" (Sengupta, Bercovitz and Harris-Kojetin, March 2010).

Archives of Internal Medicine: Medicare Part D's Exclusion of Benzodiazepines and Fracture Risk in Nursing Homes - "Medicare Part D excludes benzodiazepine medications [such as Valium] from coverage, and some state Medicaid programs also limit coverage. We assessed whether such policies decrease the risk of fractures in elderly individuals living in nursing homes. ... we found that the Medicare Part D's reimbursement exclusion of benzodiazepines was associated with a significant and abrupt decrease in prescribing of these agents in [nursing homes], if the state did not mitigate the effect by providing partial or complete supplemental coverage with state funds. The reimbursement restriction was not associated with any advantage in patient safety by reducing falls and fracture risk" (Briesacher et al., 4/26).

Journal of General Internal Medicine: Changes In Health Care Costs Over Time Following The Cessation Of Intimate Partner Violence - This study found that, even after domestic violence ends, it takes four years for the health care costs among abused women to return to the levels of women who have not been abused. Based on an a telephone survey with a sample of 2,026 women enrolled in Group Health Cooperative and an analysis of health costs from 1992-2002, the authors report, "Lifetime exposure to IPV [intimate partner violence] resulted in $585 greater annual total health care costs during the period of abuse … and these greater health care costs remained significantly …  higher for 3 years following the end of exposure." Mean costs attributed to the violence ranged from $785 to $1,200.

"Our findings highlight the need for policy makers to consider the ongoing needs of women after abuse ends. In this regard, IPV may be more similar to a chronic health condition, in which the diagnostic and treatment phase must be followed by long-term management. … Interventions designed to positively impact women's health have the potential to reduce the rate of growth of health care costs if these interventions are successful in effectively responding to women's health care needs during and following their exposure to IPV" (Fishman et al., 4/23).

Archives of Internal Medicine: The Impact Of Disclosing Financial Ties In Research And Clinical Care - This review of 20 published articles examines the perspectives of patients, research participants and medical journal readers on physicians' and researchers' financial ties (FTs) to pharmaceutical and medical device companies. "This review indicates that disclosure recipients—patients, research participants, and physicians evaluating evidence—want FTs to be disclosed and are able to discriminate between different types of ties. Nevertheless, these disclosures appear to have a limited effect on behavioral outcomes, such as willingness to participate in research," the authors write. "Patients, physicians, and research participants believe FTs decrease the quality of research evidence, and, for some, knowledge of FTs would affect willingness to participate in research" (Licurse et al., 4/27).