Research Roundup: Medicare Advantage Plan beneficiaries may get more appropriate use of services; CHIP participation grows; College students' flu vaccination rates weak

Dec 7 2012

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Analysis Of Medicare Advantage HMOs Compared With Traditional Medicare Shows Lower Use of Many Services During 2003-09 – Researchers compared the utilization rates of Medicare Advantage health maintenance organizations (HMOs) with those of traditional Medicare beneficiaries, 2003-09, "to ascertain whether the HMO enrollees demonstrated different levels of use of services, which can be a hallmark of more integrated care." They found that Medicare Advantage plans' "utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, were much lower." Some treatments, such as hip and knee replacement surgeries were also lower, "but coronary bypass surgery was more common." The authors concluded: "These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare"  (Landon et al., 12/2012).

Health Affairs: Smoking Bans Linked To Lower Hospitalizations For Heart Attacks And Lung Disease Among Medicare Beneficiaries – Researchers at the University of Iowa analyzed the impact of smoking bans in workplaces, restaurants and bars on hospitalizations involving Medicare beneficiaries for conditions not expected to be linked to smoke exposure. They also studied heart attacks (acute myocardial infarctions) and chronic obstructive pulmonary disease, smoking-related conditions. "We found that smoke-free legislation was associated with a significant reduction in hospitalizations for acute myocardial infarction and that the rate of decline increased over time…" and also "with reductions in hospitalizations for chronic obstructive pulmonary disease." The authors found "very little effect" on admission rates for bleeding in the gastrointestinal tract and hip fractures, which are "largely unrelated" to smoking (Vander Weg, Rosenthal, Sarrazin, 12/2012).

Urban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – "Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options," the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program "may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA" (Kenney et al., 12/3).

Journal Of American College Health: 2009-2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities In North Carolina – Researchers at Wake Forest Baptist Medical Center set out to determine the 2009-2010 seasonal influenza vaccine coverage at eight universities in North Carolina. After surveying more than 4,000 college students between October and November 2009, the researchers found that 20 percent of college students reported receiving the 2009-2010 seasonal flu vaccine. "Self-reported seasonal influenza vaccine coverage among college students in 2009-2010 was one-quarter of the 2020 Healthy People objective of having 80% vaccine coverage for health persons 18 through 64 years of age," they concluded. "This study highlights the opportunity that college campuses have to implement effective strategies and increase influenza vaccine coverage among its diverse student populations" (Poehling, Blocker et al., 12/2012).

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

Medscape: Physician Burnout Decreases With Shorter Trainee Rotations
Shorter, 2-week clinical rotations appear to be similar to 4-week rotations with respect to patient revisits within 30 days (a measure of patient care) and may decrease burnout and stress among attending physicians on the internal medicine wards, who are training house staff and medical students, according to a new trial. Brian P. Lucas, MD, from the Department of Medicine, Cook County Health and Hospitals System and Rush Medical College, Chicago, Illinois, and colleagues report their findings in an article published in the December 5 issue of JAMA (Hitt, 12/5).

Medscape: ACA Offers 'Golden Opportunity' for Mental Illness Prevention
Implementation of the Affordable Care Act (ACA) will create increased opportunity for mental illness prevention and mental health promotion in the primary care setting. Writing in the December issue of Psychiatric Services, members of the Prevention Committee of the Group for the Advancement of Psychiatry, led by Ruth Shim, MD, MPH, note that provisions of the ACA will shift the US healthcare system to address achieving wellness rather than just treating illness by including improved coverage of preventive services and incentives to integrate and coordinate primary care, mental healthcare, and addiction services, and through the establishment of the National Prevention, Health Promotion, and Public Health Council (Harrison, 12/4).

Medpage Today: Preventive Care At Risk With High-Deductible Health Plans?
Nearly 20% of respondents with a high-deductible health insurance plan delayed or avoided a preventive office visit because of cost, even though preventive care was completely covered, a survey found. One possible reason: only 18.1% of respondents understood that their health plan exempted preventive office visits from deductibles and copays, according to a study published in the December issue of Health Affairs (Pittman, 12/6).

Medpage Today: Sentinel Node Surgery Still Less Likely For Black Women
The rate of sentinel lymph node dissection as the standard of care for node-negative breast cancer has persistently lagged for black women, with negative clinical consequences, a national study showed. Use remained roughly 12 to 14 percentage points lower than among white women throughout the period from 2002 through 2007 as the procedure became established as preferred over completion axillary node dissection, Dalliah M. Black MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues found (Phend, 12/6).