Research Roundup: U.S. life expectancy ratings; Medicare Advantage outlook; Should advanced cancer patients have routine screening tests?

Oct 25 2010

Health Affairs: What Changes In Survival Rates Tell Us About US Health Care -- Proponents of changes in the U.S. health system have often pointed to studies that find health outcomes in this country are worse than other developed nations, even though the United States "spends well over twice the median expenditure of industrialized nations on health care, and far more than any other country as a percentage of its gross domestic product." Others point to high rates of smoking, obesity and traffic fatalities.

This study, which reviews 15-year survival rates in the U.S. and 12 other developed nations, "found that none of the prevailing excuses for the poor performance of the US health care system are likely to be valid." However, the authors said, "It is possible that rising US health spending is itself responsible for the observed relative decline in survival" because rising health spending increases the number of people who cannot afford insurance, diverts government money from public health and education campaigns and "unregulated fee-for-service reimbursement and an emphasis on specialty care may contribute to high US health spending, while leading to unneeded procedures and fragmentation of care" (Muennig and Glied, 10/7).

Journal of the American Medical Association: Cancer Screening Among Patients With Advanced Cancer - The authors evaluated the use of "common cancer screening tests" in nearly 88,000 fee-for-service Medicare beneficiaries who were diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer: "Notwithstanding their limited life expectancy, a meaningful proportion of patients with advanced cancer continue to undergo routine cancer screening." Of the cancer patients, 9 percent of the women received screening mammograms and 6 percent had Pap smears. For the men, 15 percent got PSA tests.

The authors point out policy implications: "First, greater awareness that screening in the face of limited life expectancy from advanced cancer is of dubious benefit may in and of itself limit use. Second, as electronic medical records and reminder systems are developed to foster screening adherence, they should also include program features that flag when conditions suggest reevaluation or cessation of screening based on competing comorbidities. … Alternatively, the Medicare program might not provide coverage for cancer screening procedures for patients with life expectancy of less than 2 years"  (Sima, Panageas and Schrag, 10/13).

Archives of Surgery Hospital Process Compliance And Surgical Outcomes In Medicare Beneficiaries -- This study looked at whether some of the information that hospitals must submit to Medicare, which is on the public  Hospital Compare website provides consumers with valuable tools to choosing a hospital and prompts hospitals to improve their services. The researchers looked at six high risk surgeries and at two sets of information called the Surgical Care Improvement Project (SCIP), which cover infection and blood clots. They found that "[c]urrently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery. The Centers for Medicare and Medicaid Services needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes to improve public reporting and pay-for-performance efforts" (Nicholas, Osborne, Birkmeyer and Dimick, 10/18).

Mathematica/Kaiser Family Foundation: Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums -- This report (.pdf) looks at  changes planned for the Medicare Advantage program in 2011. While premiums "rose rapidly" in 2010, in 2011 the increase will be smaller and will provide "lower monthly premiums than are generally available in the Medigap market." The number of Advantage plans is "contracting and consolidating. Yet, Medicare beneficiaries will continue to be able to choose from among dozens … in 2011, having, on average, 24 Medicare Advantage plans from which to choose. ... Given wide variations in local market conditions and payment reforms that will vary based on average Medicare costs per county, the effects of these changes are likely to vary across the country" (Gold, Jacobson, Damico, Neuman, 10/15).

The Commonwealth Fund: Realizing Health Reform's Potential: Young Adults And The Affordable Care Act of 2010 -- This report analyzes the effects of provisions in the new federal health law designed to provide coverage to young adults, "one of the largest uninsured segments of the population." The authors say that nearly 15 million young adults without health care now and another 5 million are underinsured. Under the law, they estimate about 1 million will gain access through their parents' plans, more than 7 million will qualify for the expanded Medicaid program in 2014, and nearly 5 million will gain coverage through the exchanges, also beginning in 2014 (Collins and Nicholson, 10/8).

The Commonwealth Fund: Montefiore Medical Center: Integrated Care Delivery For Vulnerable Populations - This case study finds that Montefiore Medical Center, an academic medical center in New York City where more than three-quarters of the revenues come from Medicaid and Medicare, "has been able to achieve financial and organizational sustainability. ... [it] has built an integrated system of high-quality primary, specialty, and inpatient health care for half a million residents of the Bronx." The hospital has redesigned its internal processes to improve care; reached beyond the hospital to partner with government, schools and other providers to improve the health of the community; and created "specialty centers of excellence that extend access to complex care for vulnerable populations and attract high-quality physicians"  (Chase, 10/19).

Kaiser Family Foundation: Medicare Spending And Use Of Medical Services For Beneficiaries In Nursing Homes And Other Long‐Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care - This report found that "Medicare beneficiaries living in long‐term care facilities for at least part of 2006, account for 6 percent of the Medicare population but 17 percent of total Medicare spending. However, nearly half of the Medicare spending for these beneficiaries occurred prior to their admission into a long-term care facility. ... As policymakers look for ways to slow the growth in Medicare spending, our results underscore the potential value in pursuing interventions that focus specifically on Medicare beneficiaries living in long-term care facilities" (Jacobson, Neuman and Damico, 10/12).

Two other reports on long-term care and Medicare were also released at the same time. KHN covered the report: Studies Highlight High Medicare Costs For People In Nursing Homes (Miles, 10/12)