Research Roundup: Surgery and health costs; ACOs and independent doctors; Stroke's long-term effects; Improving low-income care

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Dec 24 2010

Archives of Surgery: Profile Of Inpatient Operating Room Procedures In U.S. Hospitals In 2007 - Understanding operating room (OR) procedures in the hospital "is critical in debates about how to improve the population's health while attempting to constrain growth in health care costs," write the authors of this study that provides an overview of inpatient operating room procedures in the U.S. from 1997 to 2007. Based on data obtained from the Nationwide Inpatient Sample (NIS), the authors report, "[i]n 2007, about 15 million OR procedures were performed in US hospitals at a rate of 495 OR procedures/10,000 population. … OR-related stays had higher resource use than non-OR stays as measured by the mean number of hospital days, mean costs per stay, and mean per diem cost." Additionally, the mean cost of OR-related hospitalizations was more than twice that for non-OR hospital stays," they reported (Elixhauser and Andrews, December 2010).

Health Affairs: A Model For Integrating Independent Physicians Into Accountable Care Organizations - "The current focus for ACO [accountable care organization] development has been on finding ways to build more fully integrated systems that for the most part would employ their own staff physicians. However, few such organizations exist," write the authors of this paper that examines how a physician-hospital organization in Illinois known as Advocate Physician Partners could serve as a "model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results." The paper examines the model, highlights the areas where it's been most successful and describes how such a model might work effectively in other environments (Shields et al., 12/16).

Stroke: Hospital-Level Variation in Mortality and Rehospitalization for Medicare Beneficiaries With Acute Ischemic Stroke - Nearly two-thirds of Medicare patients hospitalized for acute ischemic stroke are rehospitalized or die within one year, according to this study by researchers from UCLA. Their report, in the journal of the American Heart Association, examined the "outcomes for more than 90,000 Medicare patients admitted between 2003 and 2006 to 625 hospitals participating in … a national registry for stroke hospitalizations," according to the UCLA summary of the findings. "Within the first year after hospital discharge among stroke patients who survived and were released from the hospital, the death rate was 26.7 percent, and the readmission rate was 56.2 percent. The overall rate of death or readmission was 61.9 percent" (Fonarow et al., 12/16).

The Commonwealth Fund: Strengthening Primary And Chronic Care: State Innovations To Transform And Link Small Practices - "States can have a significant impact on strengthening primary and chronic care delivery through numerous actions to transform and link small practices," write the authors of this paper that examines several efforts states are making to "produce more efficient and effective care for patients and providers, with an emphasis on small practices." The paper looks at efforts by state health officials and physicians in Colorado, Michigan, North Carolina, Oklahoma, Pennsylvania and Vermont, and it offers "five strategies to organize the state policy levers and actions and include a few examples from states that are using them" (Takach et al., 12/15).

Urban Institute: Swimming Upstream: Improving Access To Indigent Health Care In The Midst Of Major Economic Challenges - This paper examines the effects of a comprehensive health system redesign initiative launched in San Mateo County, California, which aimed to improve health care access to the uninsured and underinsured as well as strengthen the financial viability of the health system itself. Despite "mounting fiscal challenges associated with the economic recession and state budget crisis," the authors report, "the percent of such individuals having a usual source of care rose from 42.5 to 91.2 percent with the initiative. ... The county's efforts offer lessons for local and national policymakers, program administrators, and providers about how progress is possible despite severe financial obstacles" (Benatar, Hughes and Howell, December 2010).

Robert Wood Johnson Foundation: Cost-Sharing: Effects On Spending And Outcomes - This report and accompanying brief (.pdf) explores how cost-sharing impacts individuals' use of health services, affects health outcomes and whether reduced use of services affect some individuals more than others. "Not only are low-income populations disproportionately affected by increased cost-sharing, but they also are more price sensitive than other income groups," the authors of the brief write. "Unless the cost-sharing increases are concentrated on services that are ineffective or unnecessary, low-income groups may avoid necessary medical care as a result. Increased cost-sharing for people with chronic conditions may result in higher expenditures for hospitalizations and other adverse outcomes if necessary care is reduced" (Swartz and Goodell, December 2010).

PwC's Health Research Institute: Top Health Industry Issues Of 2011 - This annual report by the Health Research Institute of consulting firm PwC examines key issues for the health industry in 2011, including technology, changes in benefit design and accountable care organizations. "Accountable care organizations have created buzz in the industry that this is the next big thing for population health management. … 2011 could be a make-it-or-break-it year for ACOs depending on Congressional action," according to a PwC summary of the report. The report also summarizes the findings of its online survey of 1,000 U.S. adults, which examined consumers' understanding of health "reform-related issues," usage and payments. "PwC's research found significant demographic and geographic differences in consumers' willingness to seek all their care within ACO-like organizations, indicating the need for consumer segmentation strategies," the summary's authors write (12/20).

Institute of Medicine: The Digital Infrastructure For A Learning Health System: Foundation For Continuous Improvement In Health And Health Care - Workshop Summary: This report summarizes the discussions that were part of a series of workshops hosted by the Institute of Medicine (IOM) where participants "worked to identify the opportunities, challenges and priorities represented by the application of new information systems to health care and to consider strategy options that could further the development of a learning health system." The "discussions and presentations focused on four important cross-cutting dimensions: promoting technical advances and innovation, generating and using information, engaging patients and the public, and fostering stewardship and governance," according to a IOM summary of the report (12/20).

This article was reprinted from kaiserhealthnews.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.