Research roundup: Hospitalists & health costs; treating substance abuse

Aug 6 2011

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

The Annals Of Internal Medicine: Association of Hospitalist Care With Medical Utilization After Discharge: Evidence Of Cost Shift From A Cohort Study -- This study looks at the effects hospitalists -- or physicians who specialize in hospital medicine and health care -- have on patient care, costs and use of medical services. Researchers examined the length of stay, spending, hospital charges and discharge location for Medicare patients. They found that patients who were treated by a hospitalist stayed in the hospital less time and had lower hospital charges but they had significantly higher health costs and were more likely to go to the emergency department in the 30 days after discharge than patients treated by their regular doctor. The study concludes that "decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge" (Kuo and Goodwin, 8/2).

The Journal Of Cancer Survivorship: Cost-Related Medication Nonadherence And Cost-Saving Strategies Used By Elderly Medicare Cancer Survivors --  This study looks at how the cost of medication for elderly Medicare patients is a hindrance to effective treatment. "Cancer costs in particular have grown substantially and patients with cancer are faced with significant out-of-pocket expenses during diagnosis, treatment and follow-up care." By analyzing data from 2005 Medicare Current Beneficiary Survey Claims, researchers found: "Six percent of cancer survivors and nine percent of those without cancer also said they spent less on basic needs (such as food and heat) so that they could afford medicines. In addition, more than half of all enrollees used other cost-saving measures, including taking generic medications, requesting free samples and comparing pharmacy prices before buying drugs." Cancer survivors who didn't take their medication were more likely to be African-American and less likely to have employer-based prescription drug insurance (Nekhlyudov et al., 8/1).

Health Affairs: U.S. Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers -- This study found that U.S. private-practice doctors and their staffs spend, on average, 10 times more hours and $60,000 more per year than Canadian physicians do on paperwork.  The authors concluded: "if U.S. physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year," and the health care system would run more efficiently (Morra et al., 8/3).

Health Affairs: Following Federal Guidelines To Increase Nutrient Consumption May Lead To Higher Food Costs For Consumers -- The authors note that the "federal 'Dietary Guidelines for Americans, 2010' emphasized the need for Americans to consume more potassium, dietary fiber, vitamin D, and calcium, and to get fewer calories from saturated fat and added sugar." However, this would cost the average American consumer $380 more per year in potassium costs alone. The authors write: "each time consumers obtained 1 percent more of their daily calories from saturated fat and added sugar, their food costs significantly declined. These findings suggest that improving the American diet will require additional guidance for consumers, especially those with little budget flexibility, and new policies to increase the availability and reduce the cost of healthful foods" (Monsivais, Aggarwal and Drewnowski, August 2011).

Health Affairs: The Looming Expansion And Transformation Of Public Substance Abuse Treatment Under The Affordable Care Act - Unlike mental health treatment, most substance abuse treatment is done outside the medical system by stand-alone or government-operated facilities and generally consists of abstinence-oriented counseling and education. Currently, a large number of providers do not accept any private insurance or Medicaid. "Transforming the public substance abuse treatment system was never one of the explicit goals of health reform," the author writes. "But policies expanding health insurance coverage and providing substance abuse treatment benefits at parity with medical and surgical benefits are likely to have that effect. The result will be a different system of treatment, with a greater variety of larger providers in the mainstream of general health care. This will be a more ambulatory-based, medically oriented, and physician-directed system" (Buck, 8/4).

The Journal Of General Internal Medicine: Doctors And Patients Susceptibility To Framing Bias: A Randomized Trial --  This study looked at how doctors and patients analyzed risk of a hypothetical clinical drug trial comparing a new and old drug. Some of the more than 1,400 doctors and 1,000 patients were told about the absolute survival rates for the drugs (new drug: 96% versus old drug: 94%), others were told about the absolute mortality rates (4% versus 6%), others were given statistics showing that the new drug reduced mortality by a third and the final group was given all three sets of data. There were significant differences in how all surveyed judged whether the new drug was better, based on what "framing format" they heard, with "relative mortality reduction" information most likely to cause respondents to think the new drug was better. The authors conclude: "Presenting several risk formats (on both absolute and relative scales) should be encouraged" (Perneger and Agoritsas, 7/27).