Research roundup: Readmission risks after surgery; Assessing Medicaid applicants' eligibility; Satisfaction among health plan types

Aug 31 2012

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

Journal Of the American College Of Surgeons:  General Surgeons Identify Postoperative Complications Posing Strongest Readmission Risks -- Researchers found that about 11 percent of patients in a study of 1,442 individuals who underwent general surgery were readmitted to the hospital within 30 days. Readmissions have become one way that the quality of care is being measured: 19.5 percent of all Medicare beneficiaries between 2003 and 2004 were readmitted within 30 days, leading to a cost of $17.4 billion. The report found several reasons for a patient's return to the hospital, most commonly gastrointestinal problems, surgical infection and the failure to thrive or malnutrition. The results also varied depending on the procedure. The researchers urge hospital officials to hold down readmissions by taking "appropriate steps to minimize postoperative complications" (Kassin, et al, Sept. /2012).

Government Accountability Office: Information Obtained By States About Applicants' Assets Varies And May Be Insufficient -- The Government Accountability Office last year surveyed state and federal Medicaid officials to determine whether states were following the requirements for determining the Medicaid eligibility for long-term care benefits to make sure individuals do not artificially impoverish themselves for eligibility or hide assets. The federal-state program for low-income individuals pays about half of the yearly $263 billion in long-term care costs. The agency found that states varied in their approach and success. Researchers also said that all 50 states and the District of Columbia obtained at least some asset information, but none implemented an electronic Asset Verification System (AVS) that would allow them to contact multiple financial institutions to verify applicants' information (Yocom, et al,  July/2012).

Employee Benefit Research Institute: Satisfaction With Health Coverage And Care: Findings From The 2011 EBRI/MGA Consumer Engagement In Health Care Survey -- Researchers conducted a survey each year since 2005 of employees enrolled in one of three different types of health care plans: a consumer-driven health plan (those that have deductibles of at least $1,000 for an individual or $2,000 for a family and some type of health savings account to help pay for their medical expenses), a high-deductible health plan (which features the same types of deductibles but doesn't have the health savings account) and traditional coverage. They found that survey participants in traditional plans and the consumer driven plans rated the quality of their care similarly in 2011, but ratings for high-deductible plans were lower. There was a significant difference in satisfaction with the health plan, with 57 percent of traditional plan enrollees extremely or very satisfied with their overall health plan in 2011, as compared to 37 percent of those with the high deductible plans and 46 percent of those in consumer-driven plans. The report said out-of-pocket costs played a larger role in consumer satisfaction than the quality of care or access to care (Fronstin, 8/2012).

The Kaiser Family Foundation: Implementing The ACA's Medicaid-Related Health Reform Provisions After The Supreme Court's Decision -- This issue brief examines 10 questions that states may have followiong the Supreme Court decision last June on the federal health care law. The court ruled that the law could not force states to expand their Medicaid programs. Among those questions are: "what parts of the ACA are affected by the decision, whether states can opt in and out of the Medicaid expansion over time, whether federal payments to hospitals for uncompensated care will still be reduced if a state does not expand its Medicaid program, and whether the Court decision affects the ACA's maintenance of effort provisions" (Musumeci, 8/28). A companion brief looks at the court's decision.

The Commonwealth Fund: Choosing the Best Plan In A Health Insurance Exchange: Actuarial Value Tells Only Part Of The Story -- In 2014, up to 23 million Americans will be able to compare health insurance plans through exchanges, or health insurance marketplaces, set up by the states under the 2010 health law. In this issue brief, researchers set out to identify consumers' out-of-pocket costs based on their plan's actuarial value, "the percentage of health care costs that a plan would pay for a standard population." After analyzing 20 plans, they estimated the spending, premiums and affordability by income and age. The researchers conclude that out-of-pocket expenses usually decrease when actuarial value increases, though not consistently. The benefits of each plan also depend on an enrollee's office visits and prescriptions, among other factors. Older people will have up to three times higher health care expenses than young adults.  However, researchers said the health law will "greatly expand consumer protections" and has the ability to give consumers the necessary information to make an educated decision (Lore, et al, 8/2012).

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

Reuters: Midwives, Nurses Can Safely Perform Abortions
Abortions are just as safe when performed by trained nurse practitioners, midwives and physician assistants as when doctors do them, a new review of the evidence suggests. Researchers analyzed five studies that compared first-trimester abortion complications and side effects based on who performed the procedures in close to 9,000 women - and typically found no differences (Pittman, 8/30).

Medpage: Too Early To Make A Call On CKD Screening
Screening for chronic kidney disease (CKD) has insufficient evidence to assess its routine use in asymptomatic patients, the U.S. Preventive Services Task Force (USPSTF) concluded after reviewing available data. Acknowledging undiagnosed early-stage CKD as a common occurrence, the task force found no evidence that routine screening for it improves outcomes. Members of the USPSTF panel also found no generally accepted tool for assessing the risk of CKD or its complications (Bankhead, 8/28).

Medscape Today: Fitness In Middle Age Lowers Risk For Future Chronic Disease
Staying fit during middle age is associated with a decreased risk of developing chronic diseases, such as diabetes, Alzheimer's disease, and heart disease, during the next several years, a new study suggests. Benjamin L. Willis, MD, MPH, from the Cooper Institute at the University of Texas Southwestern Medical Center in Dallas, and colleagues, reported the findings in an article published online August 27 in the Archives of Internal Medicine (Hitt, 8/28).

Reuters: Hormone Therapy Use Among Women Continues To Drop
Years after a large study on hormone replacement therapy revealed health risks among older women using it to prevent chronic disease, the number of women who take hormones continues to decline, according to a new study. The researchers found that in 2009 and 2010, less than five percent of women over age 40, who had already gone through menopause, use either estrogen alone or estrogen and progestin. That compared to about 22 percent in 1999 and 2000 (Grens, 8/30).

Medscape: Well-Baby Dental Checks By Physicians Cut Hospitalizations
Children are less likely to be hospitalized for tooth decay when pediatricians are enlisted to perform dental care during well-baby visits, according to results from a study published online August 27 in the Archives of Pediatric and Adolescent Medicine. ... Sally C. Stearns, PhD, professor, Department of Health Policy and Management, University of North Carolina at Chapel Hill, and colleagues show that infants with 4 or more physician-conducted oral health exams by age 3 years saw a small but statistically significant reduction in hospitalizations for dental caries by their sixth birthday (Laidman, 8/28).

Reuters: Routine Screening Catches Child Abuse In ER
Routinely screening all children seen in the ER for signs of maltreatment seems to have improved child abuse detection in the Netherlands, a new study finds. The progress suggests that such systematic screening helps catch more cases of child abuse, researchers report in the journal Pediatrics (Norton, 8/28).