Research Roundup: Mass. medical bankruptcies; Palliative care teams work; Innovative health IT

Mar 11 2011

Every Friday, Jennifer Evans compiles this selection of recently released health policy studies and analyses.

The theme for the current issue of Health Affairs Is "Profiles of Innovation in Health Care Delivery."

Health Affairs: Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries - This authors examined palliative care teams at four New York State hospitals and found: "On average, patients who received palliative care in this study incurred $6,900 less in hospital costs during a given admission than patients who received usual care. ... Patients who received palliative care also had lower costs for intensive care and higher rates of referral to outpatient hospice programs. ... We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team" (Morrison et al., March 2011).

Health Affairs: The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices - This study estimates the costs of implementing an electronic health record system at a large fee-for-service physician network in north Texas, including the purchase of hardware and software and licenses, maintenance costs and technical support for a year and "costs to be related to the time spent by many parties to bring the system online." The authors estimate the cost through the first 60 days "was $162,047 for a five-physician practice, with an average per physician total cost of $32,409. Adding maintenance costs for the whole first year after launch, we estimated the total costs through the first year to be $233,297, with an average per physician cost of $46,659" (Fleming et al., March 2011).

Health Affairs: More Than Four In Five Office-Based Physicians Could Qualify For Federal Electronic Health Record Incentives - This study analyzed data from 2007 and 2008 and found "that more than four in five office-based physicians could qualify for new federal incentive payments to encourage the adoption and 'meaningful use' of electronic health records, based on the numbers of Medicare or Medicaid patients they see." But those results would "likely vary by specialty: 90.6 percent of physicians working in general or family practice or internal medicine could qualify for incentives, but fewer than two-thirds of pediatricians, obstetrician-gynecologists, and psychiatrists may qualify. Eligibility and use will also vary by factors such as size and type of practice; physicians in solo practice are much less likely to use electronic health records than physicians in other practice settings" (Bruen et al., March 2011).

The Children's Partnership/Kaiser Family Foundation: Mobile Technology: Smart Tools To Increase Participation In Health Coverage - "Mobile technology, which is rapidly expanding to a growing number of users and purposes, offers a set of new, as yet untapped, tools that can be used to promote robust participation and stability in health coverage, both in the immediate term and as coverage is expanded" under the new health law, write the authors of this brief. "Potential uses include text reminders, smartphone apps that allow submission of a completed application/renewal form, and electronic payment of premiums, among others," they add, and also note several policy initiatives that could help integrate such innovations into health insurance programs (Han, Morrow and Paradise, 3/2).

Archives of Pediatrics & Adolescent Medicine: Increases In Behavioral Health Screening In Pediatric Care For Massachusetts Medicaid Patients - Following regulations requiring that providers "use validated, standardized screening tools" combined with reimbursements of "approximately $10 for each screening test performed and an additional $25 for face-to-face evaluation and management time for a positive screen," the authors analyzed "pediatric well-child visits of Medicaid-enrolled children" between January 2008 to December 2009. They report visits "coded for behavior screens" rose from 16.6 percent of all well-child visits in the first quarter of 2008 to 53.6 percent in the first quarter of 2009. "Additionally, the children identified as at risk increased substantially from about 1,600 in the first quarter of 2008 to nearly 5,000 in quarter 1 of 2009. ... The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services" (Kuhlthau et al., 3/7).

American Journal of Medicine: Medical Bankruptcy In Massachusetts: Has Health Reform Made a Difference? - The authors compared the survey responses of Massachusetts' bankruptcy filers in July 2009 to those in a national sample in 2007 and a sample of Massachusetts debtors in 2007 and write: "Despite a marked declined in the uninsurance rate in Massachusetts since the implementation of health reform, the proportion of bankruptcies that occurred in the wake of medical problems has not decreased significantly, and the absolute number of medical bankruptcies has actually increased by one third." They note the economic recession likely had a role in that increase and that "the medical bankruptcy rate in the state was lower than the national rate both before and after the reform" (Himmelstein, Thorne and Woolhandler, March 2011).

Health Affairs/Robert Wood Johnson Foundation: Employers And Health Care Reform - This brief examines the requirements in the federal health law that, by 2014, employers with at least 50 full-time employees either offer health insurance that meets certain requirements or pay the federal government if they do not. "Supporters say the employer requirement will encourage companies that already offer insurance programs to continue providing coverage, and will encourage companies without such programs to start offering them. But critics of the requirement worry that it will be harmful," holding back companies who currently have just under 50 full-time employees from hiring more. Additionally, some critics "worry that the law might erode the employment-sponsored insurance model should employers cease to offer coverage once state-run insurance exchanges open in 2014" (Haberkorn, 3/9).

Kaiser Family Foundation: The HIV/AIDS Epidemic In The United States - This updated fact sheet provides an overview of the current impact of HIV/AIDS on Americans, particularly racial/ethnic minorities, women and gay and bisexual men. "In FY 2010, U.S. federal funding to combat HIV totaled $26 billion. Of this, 50% is for care, 10% for research, 10% for cash and housing assistance, 3% for prevention, and 25% for the international epidemic." The fact sheet names federal programs that provide health insurance coverage, care and support to people with HIV/AIDS and highlights the aims of the National AIDS Strategy, released in July 2010 by President Barack Obama (3/9).