Research roundup: Rural hospitals have poorer quality; Cost-effective migraine relief; Doctors still take Medicare

Jul 8 2011

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Journal of the American Medical Association: Quality Of Care And Patient Outcomes In Critical Access Rural Hospitals -- This study looks at the quality of care provided by patterns of care at "critical access hospitals," a federal designation for hospitals that serve rural populations and thus have been granted special incentives under Medicare. The authors looked at care for Medicare patients with three conditions -- heart attack, congestive heart failure and pneumonia -- at 4,000 hospitals including nearly 1,300 critical access hospitals. They found that the critical access hospitals "had fewer clinical capabilities, worse measured processes of care, and higher mortality rates" (Joynt et. al., 7/6).

Health Affairs: Differences In The Volume Of Services And In Prices Drive Big Variations In Medicaid Spending Among U.S. States And Regions -- After accounting for differences in the type of people allowed into the Medicaid program in various states, researchers found that the differences in spending per Medicaid beneficiary "is due to variation in the volume of services and the prices paid per unit of service." They write: "Overall, per capita spending in the ten highest-spending states was $1,650 above the average national per capita spending, of which $1,186, or 72 percent, was due to the volume of services delivered. Spending in the ten lowest-spending states was $1,161 below the national average, of which $672, or 58 percent, was due to volume." The authors found that the most money spent per beneficiary was in New York, New Jersey and Pennsylvania, while Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and Texas spent the least per person (Gilmer and Kronick, 7/7). 

National Bureau Of Economic Research: The Oregon Health Insurance Experiment: Evidence From The First Year -- This study analyzes the effects of Medicaid coverage by looking at a group of low-income Oregon residents randomly selected for the program in 2008 and compares their circumstances to low-income residents who were not selected in the lottery. "About one year after enrollment, we find that those selected by the lottery have substantial and statistically significantly higher health care utilization, lower out-of-pocket medical expenditures and medical debt, and better self-reported health than the control group that was not given the opportunity to apply for Medicaid" (Finkelstein, et. al., 7/7).

See related news coverage and blog coverage of this study on Kaiser Health News.

Archives Of Internal Medicine: Declines In Physician Acceptance Of Medicare And Private Coverage -- This study examines whether there is a decline in the number of physicians accepting Medicare patients. Using data from a federal survey of doctors, the authors found more than 90 percent of physicians continue to accept Medicare patients and there was "only a small decline in physician acceptance of Medicare patients between 2005 and 2008." They identified a "more pronounced decline," however, in the number of physicians accepting patients with traditional private, non-HMO insurance. The study notes that the decrease in privately insured patients could be a result of administrative "burdens" as well as lower reimbursements (Bishop, Federman and Keyhani, 6/27).

Headache: The Journal of Head and Face Pain: Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches - The authors examined treatments for migraine headaches by tracking the total cost of prescription medicines and a number of behavioral treatments, such as biofeedback and relaxation techniques. They found that through the first year, "inexpensive" preventive medications "(such as generically available beta-blocker or tricyclic antidepressant medications) and behavioral interventions … are the least costly of the empirically validated interventions. This analysis suggests that, relative to pharmacologic options, limited format behavioral interventions are cost-competitive in the early phases of treatment and become more cost-efficient as the years of treatment accrue." According to a press release from The University of Mississippi, one of the participating institutions, "the researchers didn't compare the effectiveness of methods, nor did they calculate the costs over time of individual drugs, since dosages and prices vary widely. Rather, they figured the per-day costs of each method based on fees of physicians and psychologists" (Schafer et al., June 2011).

Archives of Pediatric & Adolescent Medicine: School-Based Body Mass Index Screening And Parent Notification -- Nearly all school districts in California conduct weight screenings of students in the fifth, seventh and ninth grades and some notify parents if their child exceeds health standards. The researchers analyzed the program to see if it had an impact on children's weight. The author "did not find that notifying parents of school-based BMI screening results for fifth- and seventh-grade students had an effect on pediatric obesity" (Madsen, 7/4).