Research roundup: 'Early' cost-control lessons from Mass.; Colonoscopy coverage; Impact of PSA recommendations

Sep 21 2012

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

Health Affairs: The New Era Of Payment Reform Spending Targets, And Cost Containment In Massachusetts: Early Lessons For The Nations
On Aug. 8, Massachusetts' third health care cost control bill became law. It "sets annual state spending targets, encourages the formation of accountable care organizations, and establishes an independent commission to oversee health care system performance." The authors write that the state's "experience provides several lessons for state and federal policy makers. First, implementing near-universal coverage, as is planned under the Affordable Care Act for 2014, will increase pressure on government to begin controlling overall health care spending. Second, introduction of cost control measures takes time." They note that the legislation "while lacking strong mechanisms to enforce the new spending goals, creates a framework for increased regulations if spending trends fail to moderate" (Mechanic, Altman and McDonough, 9/19).

Archives of Internal Medicine: Impact Of The 2008 US Preventive Services Task Force Recommendation To Discontinue Prostate Cancer Screening Among Male Medicare Beneficiaries
In 2008, the U.S. Preventive Services Task Force recommended against routine PSA (prostate-specific antigen) screening for men 75 and older because the test did not reduce mortality for prostate cancer. The researcher compared the prevalence of screening tests before and after the recommendations and found that men between the age of 66 and 74 increased their use of the test by 0.5 percent – rising from 33.9 percent to 34.4 percent of the sample. Men older than 75 decreased their use of the screening by 1.6 percentage points, a probable result of the 2008 recommendation (Ross, et al, 9/10).

Kaiser Family Foundation/American Cancer Society/National Colorectal Roundtable: Coverage of Colonoscopies Under The ACA's Prevention Benefit
The health law requires that health insurers cover preventive services, such as screenings, that warrant an A or B recommendation from the U.S. Preventive Services Task Force. Colorectal cancer screening, which received an A, could prevent the third most common cancer in the country. But patients sometimes pay out-of-pocket for the test, which can cost $1,000 to $2,000, when it comes to follow-up or preemptive measures. The authors write: "confusion over whether colon cancer screenings are preventive care or treatment means patients sometimes receive unexpected bills for the procedure," and conclude: "In the absence of federal guidance, the new preventive care benefit may continue to be inconsistently applied for at least some procedures" (Pollitz, Lucia, Keith, Smith, Doroshenk, Wolf and Weber, 9/19).

University of Mass./National Academy of Social Insurance/Robert Wood Johnson Foundation:  Establishing The Technology Infrastructure For Health Insurance Exchanges Under The ACA
Under the health law, federal regulators "have created unprecedented resources" for planning for state-based insurance exchanges. The authors of this analysis call the exchanges a "major technology challenge" for governments who will "need to conduct major updates or complete replacements of their legacy IT systems and create new interfaces to link individual eligibility and enrollment data among Medicaid, CHIP and the state's Exchange." They conclude that "states would be well advised to seek out the 'Early Innovators' and other advanced states for their lessons learned" (Tutty and Himmelstein, 9/2012).

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

Medscape: Best Hospital-to-Primary-Care Procedures Remain Unclear
A systematic review of 36 randomized controlled trials of interventions aimed at improving handovers between hospital and primary care providers at hospital discharge failed to establish any firm conclusions about which interventions have positive effects on quality of care. Gijs Hesselink, MA, MSc, from the Scientific Institute for Quality of Healthcare at Radboud University Nijmegen Medical Centre in the Netherlands, and colleagues published their findings in the September 17 issue of the Annals of Internal Medicine (Hitt, 9/18).

Medscape: Remediation Rate High for Surgical Residents
Almost one third of general surgery residents required remediation to successfully complete their program, according to a retrospective analysis of 11 years of training at 6 US medical schools. The study, published in the September issue of the Archives of Surgery, showed that most of the residents required remediation to fill gaps in medical knowledge, but were not prompted by poor performance to leave surgery. Attrition rates did not differ significantly between remediated and nonremediated residents, and more than 96% of those leaving did so voluntarily for personal reasons (Waknine, 9/17).