Research roundup: New hips, Medicare & hospital stays; Medicaid update

Apr 22 2011

Jennifer Evans and Shefali Kulkarni compiled this selection of recently released health policy studies and briefs:

JAMA: Clinical Characteristics and Outcomes of Medicare Patients Undergoing Total Hip Arthroplasty, 1991-2008 - "Total hip arthroplasty is a common surgical procedure but little is known about longitudinal trends," according to this study which found that "Between 1991 and 2008, the mean age for patients undergoing primary total hip arthroplasty increased from 74.1 to 75.1 years and for revision total hip arthroplasty from 75.8 to 77.3 years (P < .001)." While the average hospital length of stay decreased over that time,  there was a significant "increase in the rates of discharge to postacute care and readmission" (Cram et al., 4/20).

Geiger Gibson/RCHN Community Health Foundation/ George Washington University School of Public Health: Medicare's Accountable Care Organization Regulations: How Will Medicare Beneficiaries Who Reside In Medically Underserved Communities Fare? -- This report "examines the impact on medically underserved Medicare beneficiaries of CMS' proposed rule implementing the Medicare Shared Savings Program for Accountable Care Organizations (ACOs)" and "finds that the regulation excludes from the anticipated benefits of ACO growth over 1.4 million Medicare beneficiaries who receive their primary care from federally qualified health centers (FQHCs). The exclusion arises from an interpretation of the law by the Centers for Medicare and Medicaid Services (CMS) that excludes patients whose physicians practice as part of health care teams that bill globally for their care," according to a press release from GWU.  This "policy has the potential to produce ... the systemic exclusion of the poorest and most underserved patients from the benefits of ACOs and the disincentivization of meaningful FQHC affiliation agreements with hospitals and specialty groups participating in ACOs," the authors write (Rosenbaum and Shin, 4/20).

RAND Corp.: Does Employer-Based Health Insurance Discourage Entrepreneurship And New Business Creation? -- In this fact sheet based on their Journal of Economics study, researchers examined if concern about securing health insurance is creating an "entrepeneurship lock." The researchers found that workers with "access to a spouse's health insurance plan are much more likely to become self-employed. The study found consistent evidence that men and women with poor family health and no access to spouse health insurance were significantly less likely to give up an employer plan and start a new business." The study also found that when workers reach the age of 65 and qualifies for Medicare, there was a significant increase in business ownership (Leuschner, Fairlie, Kapur and Gates, 2011).

Health Affairs: Health Policy Brief: Improving Quality And Safety -- Despite a number of high-profile initiatives, the authors note, "quality improvement throughout much of the US health care system is still proceeding at a glacial pace, if at all. ... Several quality measures relating to cancer screening and diabetes management actually worsened ... And according to the Joint Commission, approximately 40 surgeries are performed on the wrong patient or on the wrong site of a patient's body every week." The brief concludes that "health care providers must take a page from such high-reliability systems as the flight decks of aircraft carriers and other complex organizations that 'establish and maintain extremely high levels of safety.'" that quality care can be attained when patients are able to participate in their care and be medically informed (Bielaszka-DuVernay, 4/15).

The Kaiser Commission on Medicaid and the Uninsured: Comparison Of Medicaid Provisions In Deficit-Reduction Proposals -- To combat the massive U.S. budget deficit, several proposals -- including ones by President Barack Obama and the House Budget Committee Chairman Paul Ryan (R-Wis.) -- have been offered. "These proposals include both tax increases and spending reductions in discretionary programs, including defense, and in mandatory programs, such as Social Security, Medicare, and Medicaid."  The authors of this brief write that some proposals "would fundamentally alter the current structure and financing of the Medicaid program which could have significant implications for the populations served as well as the states" (4/14).

The Kaiser Commission on Medicaid and the Uninsured: Implications Of A Federal Block Grant Program For Medicaid-- This issue paper examines the House GOP's 2012 budget plan to convert Medicaid into a block grant program, gives an overview of the current program and examines results of past block grant efforts. The authors write: "Medicaid currently plays a significant role in providing care to many low-income individuals including children, the elderly and individuals with disabilities, financing long-term services and supports not covered by Medicare or private insurance. ... However, these current and future roles that Medicaid plays, particularly for low-income, vulnerable and currently uninsured Americans, are at risk under a federal block grant" (4/14).

Pricewaterhouse Coopers LLP: From Courtship To Marriage: How Physicians And Hospitals Are Creating Sustainable Relationships -- This report, the second of two, focuses on how physicians and hospitals can work together through shared governance, aligned compensation and altering the practice patterns of physicians. Hospital executives and physicians surveyed for the report were excited about the concept of partnering to implement the new Accountable Care Organizations championed in the new health law. Both hospitals and physicians were eager to have more physicians in hospital governance roles and leadership roles. "More than 90% of physicians surveyed said they should be involved in hospital governance activities such as serving on boards, being in management, and taking part in performance improvement." In addition, physicians recognized the need to change their practice patterns to emphasize quality rather than patient volume (March 2011).

Alliance for Health Reform/Robert Wood Johnson Foundation: Health Care Workforce: Future Supply vs. Demand -- This issue brief assesses the reports of a shortage of health care workers, which workers are most needed and how to deal with the problem. It notes that one-third of physicians and half of all nurses could retire in the next 10 years. The concerns about worker shortages come as health care is undergoing strains caused by a major transformation with the new health law and its guarantee of coverage to millions of uninsured people, and by the booming Medicare population (Okrent, April, 2011)