Research roundup: Confusing high priced for high quality care; Expanding digital records to all hospitals; Veterans and opiod use

Mar 10 2012

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Health Affairs: An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care -- Researchers conducted an experiment with more than 1,400 people to see if the way information on quality and cost of care is displayed affects consumers' decision to choose a high value health care plan. The group was shown different presentations of the same information and was asked to pick their preferred plan. The researchers found that respondents are more interested in quality than cost in health care, but they often associated a high cost with high quality. "It appears that how cost data are presented make more of a difference when those data are not accompanied by quality data or when quality data are difficult to understand," they wrote. (Hibbard, Greene, Sofaer, et. al., March 2012).

Health Affairs: Hospitals Ineligible For Federal Meaningful-Use Incentives Have Dismally Low Rates Of Adoption Of Electronic Health Records -- Researchers used national data to assess the electronic health record (EHR) adoption rates for various inpatient providers that are ineligible for the U.S. government's resources, including long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. The report shows a very low EHR system adoption rate among these hospitals and suggests this delay in implementing technology may hamper the federal government's efforts to increase efficiency in health care through electronic records. "By leaving out ineligible providers, the nation risks building a new digital divide in which key providers, which already have low levels of electronic clinical data may fall further behind" (Wolf, Harveil and Jha, March 2012).

The Kaiser Family Foundation: The Role Of The Basic Health Program In The Coverage Continuum: Opportunities, Risks & Considerations For States -- This issue brief looks at the benefits and drawbacks of the Basic Health Plan (BHP), "an optional coverage program" established in the federal health law "that allows states to use federal tax subsidy dollars to offer subsidized coverage for individuals with incomes between 139-200% of the federal poverty level (FPL) who would otherwise be eligible to purchase coverage through state Health Insurance Exchanges." The BHP could affect the risk pool in the exchanges so states would be allowed to increase premiums if the BHP population is healthier than those enrolled in the exchange, or it may decrease if those in the BHP are sicker than the exchange population. The brief explains that although federal funding will be available for the BHPs, states have not yet been given details about financing. The authors also suggest that states opting to use a BHP program will want to minimize their financial exposure and address impacts on the exchange (Bachrach, Dutton, Tolbert, et. al., 3/5).

Journal of the American Medical Association: Association Of Mental Health Disorders With Prescription Opiods And High-Risk Opiod Use In US Veterans Of Iraq and Afghanistan -- This study looks at a national sample of Iraq and Afghanistan veterans enrolled in the VA health care system and the effect of mental health disorders, especially among those suffering from post-traumatic stress disorder, on the risks of prescription opiod use. The researchers found that veterans with PTSD and those with other mental health issues were more likely to be prescribed opiods for pain than veterans without such conditions. They also found that those with PTSD were likely to get the condition and they were more likely to get a higher dose or have more than one prescription. The medications were "associated with an increased risk of adverse clinical outcomes for all veterans …, which was most pronounced in veterans with PTSD" (Seal, Shi, Cohen, et. al., 3/7).

Government Accountability Office: CMS Should Improve Efforts To Monitor Implementation Of The Quality Indicator Survey -- The Centers for Medicare and Medicaid Services (CMS) aims to implement the Quality Indicator Survey (QIS) -- a survey used to periodically inspect nursing homes -- by 2018. "We examined the extent to which CMS (1) evaluates whether progress is being made in meeting the objectives of the QIS and (2) monitors and facilitates states' implementation of the QIS." CMS conducted three studies to assess the QIS--the last study was finished in 2011 and "identified aspects of the QIS process that could affect the consistency with which surveyors identify quality problems." Overall, the GAO suggests that CMS create a timeline to develop a more systematic process for monitoring states' implementation progress (3/2).