Research roundup: Slowdown in medical imaging; Hospitals' efforts mixed on reducing readmissions

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Health Affairs: The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause -- Recent research showed a slowdown in the use of medical imaging for people enrolled in Medicare. This article follows up and finds that annual imaging growth slowed down from an average of 14 percent between 2000 and 2005 to 2.6 percent between 2006 and 2009. An analysis of commercial insurance claims shows a similar trend outside of Medicare. Based on interviews and other evidence, the researchers suggest "that prior authorization policies, higher deductibles, and lower reimbursements worked to offset strong nonmedical incentives, such as physicians' fear of malpractice litigation or a desire to generate revenue" when providers considered imaging tests (Lee and Levy, 7/25).

Journal of the American College of Cardiology: Contemporary Evidence About Hospital Strategies For Reducing 30-Day Readmissions -- Hospitals across the country are looking into how best to prevent readmissions, which could impact their Medicare reimbursements under the health law. In this study, researchers surveyed a group of hospitals to see how successful they have been in setting out and implementing policies to prevent readmission after heart failure and heart attack. Nearly all of the more than 500 hospitals reported having a written objective for reducing readmissions, but their strategies -- such as providing physician follow-up or medication management -- varied. "Although some practices were implemented by many hospitals," the authors write, "most hospitals did not report having a comprehensive set of recommended practices in place" (Bradley et al, 7/20).

Center for Studying Health System Change: Small Employers And Self-Insured Health Benefits: Too Small To Succeed? -- Changes in the insurance market, along with requirements from the health law, are expected to drive small employers toward self-funding their employee health plans. This brief looks at how self-funding could lead to market disruptions and how "certain health reform goals, such as strengthening consumer protections and making the small-group health insurance market more viable, may be undermined." For example, self-funded plans will not fall under the law's requirement for covering essential health benefits. Also, if healthier individuals go on self-funded plans, sicker and older individuals might end up burdening the small-group market, which could then lead to higher premiums (Yee, Christianson and Ginsburg, 7/19).

The Kaiser Family Foundation: How Will The Medicaid Expansion For Adults Impact Eligibility And Coverage? -- The Supreme Court ruling on the health law has opened the door for states to refuse, without punishment, the expansion of Medicaid. This brief gives a state-by-state breakdown of current Medicaid eligibility, as well as data on uninsured adults. If the whole country pursues the expansion, 40 states would increase their Medicaid eligibility for parents, and nearly all the states would increase coverage for childless adults. The report also notes that, as of 2010, there were 16 million uninsured adults below the federal poverty level. Without the expansion, these adults could end up without Medicaid and without access to the subsidies available on state insurance exchanges (7/25).

Here is a selection of excerpts from news coverage of other recent research:

Medscape: Subspecialist Shortages At Children's Hospitals Delay Care
Families wait on average almost 15 weeks to see a developmental-behavioral pediatrician at children's hospitals, and almost 11 weeks to see a geneticist, all because of shortages in these and other pediatric subspecialties, according to a survey released yesterday by the Children's Hospital Association (CHA) (Lowes, 7/24).

Reuters: Drop In Prostate Cancers Seen After New U.S. Advice
The rate of early prostate cancers among older Americans dropped suddenly following a change in screening advice from government-backed experts in 2008, new research shows. The findings are another sign that the tide could be turning against routine prostate cancer screening, which a growing number of medical groups worry could do more harm than good (Joelving, 7/23).

Medpage Today: Wide Variation In ICU Admits In VA System
Intensive care admission practices varied widely at Veterans Affairs hospitals, suggesting a lack of consensus about high- and low-risk patients, investigators concluded. Out of 31,555 patients admitted directly to 118 acute-care hospitals included in the analysis, more than 50% had a 30-day predicted mortality of 2% or less, reported Lena Chen, MD, of the University of Michigan in Ann Arbor, and colleagues in Archives of Internal Medicine online (Bankhead, 7/24).

Reuters: Hospitals Hype Robot Surgery For Women: Study
Consumers shouldn't expect straight talk about robot surgery from hospital websites, but rather vague claims and marketing mantras, according to a new U.S. study. Researchers sifted through online information from 432 hospitals across the country and found nearly half marketed robotic surgery for gynecologic conditions such as endometriosis or cervical cancer (Joelving, 7/20).