Research roundup: Comparing profit and nonprofit hospice care; Hospital mortality and spending; High-deductible insurance plans

Feb 4 2011

Journal of the American Medical Association: Association Of Hospice Agency Profit Status With Patient Diagnosis, Location of Care, and Length of Stay - "The current Medicare Hospice Benefit reimburses hospices at a fixed per diem rate that does not consider the patient's diagnosis, location of care, or hospice LOS [length-of-stay]," and as such, "profit can be maximized by caring for patients with certain diagnoses that require fewer skilled services, patients residing in nursing homes, or patients with longer hospice stays." Based on analysis of a "nationally representative sample of patients discharged from hospice, primarily due to death," the authors report: "For-profit hospices had a disproportionate number of patients with noncancer diagnoses, dementia in particular," and they conclude: "Compared with nonprofit hospice agencies, for-profit hospice agencies had a higher percentage of patients with diagnoses associated with lower-skilled needs and longer lengths of stay"  (Wachterman et al., 2/2).

Health Affairs: Nearly Half Of Families In High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden - "Enrollment in high-deductible plans" is on the rise, yet little is known of "the financial burden experienced by families with children and those with chronic health conditions who participate in high-deductible plans," according to the authors, who analyzed survey and health plan claims data. They found that 48 percent of families in high-deductible plans experienced financial burden compared to 21 percent of families in traditional plans. And, "[a]lmost twice as many lower-income families in high-deductible plans spent more than 3 percent of income on health care expenses as lower-income families in traditional plans (53 percent versus 29 percent)" (Galbraith et al., February 2011).

Annals of Internal Medicine: Hospital Spending And Inpatient Mortality: Evidence From California - Although previous studies have shown "high Medicare spending is not associated with better health outcomes at a regional level," less well known is the association between hospital spending and inpatient mortality, according to this study of 208 California hospitals. "For each of 6 diagnoses at admission—acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia—patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality," the authors write. "Our findings suggest that although greater overall medical spending in the United States is not associated with better quality of care or better health outcomes, specific types of medical spending (for example, acute care hospital spending) may be efficacious," they conclude (Romley, Jena and Goldman, 2/1).

British Medical Journal: Impact Of A Statewide Intensive Care Unit Quality Improvement Initiative On Hospital Mortality And Length Of Stay: Retrospective Comparative Analysis - This study measured the effects of the implementation of Michigan's Keystone ICU program, a statewide initiative to reduce infections, on hospital length of stay and death in patients 65 and older admitted to the intensive care units (ICUs). Analysis of Medicare claims data for these patients revealed: "Implementation of the Keystone ICU project was associated with a significant decrease in hospital mortality in Michigan compared with the surrounding area. The project was not, however, sufficiently powered to show a significant difference in length of stay" (Lipitz-Snyderman et al., 1/31).

Health Affairs: Enrolling More Kids In Medicaid And CHIP - "In 2008, 1.7 million children gained coverage through Medicaid and CHIP. This increased coverage was associated with a reduction in the number of uninsured children, despite reductions in employer-sponsored coverage occurring during the same time. Even with this progress, an estimated 7.3 million children were still uninsured in 2008, and 65 percent of them, close to 5 million, were eligible for public coverage, mostly through Medicaid," according to this policy brief, which highlights some of the challenges parents may face when trying to enroll a child for public health coverage and outlines changes expected with the Medicaid expansion scheduled for 2014 under the new health law. (Cassidy, 1/27).

Institutes of Medicine: HIV Screening And Access To Care: Exploring The Impact Of Policies On Access To And Provision of HIV Care - This consensus report "examine[s] the extent to which federal, state, and private health insurance policies inhibit HIV-positive individuals from initiating or continuing their care," as outlined by the IOM's Committee on HIV Screening and Access to Care during a public workshop in June. "Although the Affordable Care Act will improve access to HIV care in some respects [such as Medicaid] … it may aggravate the situation in other ways," such as reduced or cut funding for the Ryan White programs, according to the report. "Current reimbursement policies, particularly under Medicaid, restrict access to providers with HIV/AIDS expertise. Even under the ACA, infectious disease physicians who provide primary care to HIV/AIDS patients may not be able to benefit from advantageous primary care provider reimbursement policies under Medicaid" (Cleary et al., 1/31).

Commonwealth Fund: Securing A Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011 - "Although federal action to extend insurance to children has made a critical difference in reducing the number of uninsured children across states and maintaining children's coverage during the recent recession … where children live and their parent's incomes significantly affect their access to affordable care, receipt of preventive care and treatment, and opportunities to survive past infancy and thrive," write the authors of this report that examines states' performance on 20 measures assessing "access and affordability, prevention and treatment, and the potential to lead healthy lives." States scoring in the top quartile in overall performance ranking included Iowa, Massachusetts, Vermont, Maine and New Hampshire while Florida, Texas, Arizona, Mississippi and Nevada scored in the bottom quartile (How et al., 2011).