Research Roundup: Health law's under-26 coverage 'significantly increased' access to care; Thousands of surgical 'never events' occur each year

Dec 21 2012

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

Health Affairs: The Affordable Care Act Has Led To Significant Gains In Health Insurance And Access To Care For Young Adults
The health law allows young adults to remain under their parents' health insurance plans until age 26, raising questions about the law's overall impact on access to care. Researchers used data from two nationally representative surveys to compare young adults who've gained access to dependent coverage to a control group of individuals (ages 26-34) unaffected by the new policy. "We found that the policy significantly increased private health insurance for people ages 19-25 and also resulted in a significant improvement in access to care," the authors write, adding that the policy "was particularly beneficial for young men, unmarried people, and nonstudents." They conclude that there were "significant reductions in the number of young adults who delayed getting care and in those who did not receive needed care because of cost" (Sommers, Buchmueller, Decker, Carey and Kronick (12/19). 

Archives Of Surgery: The Employed Surgeon
"[S]urgeons are increasingly choosing hospital or large group employment as their practice environment," the authors write. They analyzed data (2001-2009) from the American Medical Association, and found that the number of self-employed surgeons decreased from 48 percent in 2001 to 33 percent in 2009: "During this period, there was a corresponding increase in the number of surgeon employees. ... 67.9 percent of all surgeons and 66.1 percent of general surgeons can be described as employed as of 2009." They conclude: "General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance" (Charles et al., 12/17).  

Urban Institute/Kaiser Commission On Medicaid and the Uninsured: How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees
This issue paper "estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent [on average] when the primary care fee increase takes effect on January 1, 2013." The other key findings are: "Medicaid physician fees vary widely by state....  Medicaid pays 66% of Medicare fees on average. ... The Medicaid-to-Medicare fee gap has widened." The authors conclude: "This 2012 data on primary care fees provides a baseline for assessing the impact of the Medicaid primary care fee increase" (12/17).  

Related: Kaiser Family Foundation brief: Increasing Medicaid Payments for Certain Primary Care Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule (12/17).  

Academic Medicine: Can Medical Students Afford To Choose Primary Care? An Economic Analysis Of Physician Education Debt Repayment
Researchers write: "Among medical school graduates in 2011, 86 percent had education debt at graduation, averaging $161,290 -- the highest total to date." Researchers created economic models to examine loan repayment for a fictional physician's household and found that: "Our economic modeling of a physician's household income and expenses across a range of medical school borrowing levels in high- and moderate-cost living areas shows that physicians in all specialties, including primary care, can repay the current median level of education debt," though "Graduates pursuing primary care with higher debt levels need to consider additional strategies to support repayment such as extended repayment terms, use of a federal loan forgiveness/repayment program, or not living in the highest-cost areas" (Youngclaus, Koehler, Kotlikoff, and Wiecha, 1/2012).

Surgery: Surgical Never Events In The United States
Using the National Practitioner Data Bank, a federal database of medical malpractice claims, researchers identified a total of 9,744 paid malpractice settlement and judgments for surgical "never events," which include "retained foreign bodies, wrong-site, wrong-patient, and wrong-procedure surgery. They write: "Based on literature rates of surgical adverse events resulting in paid malpractice claims, we estimated that 4,082 surgical never event claims occur each year in the United States. Increased payments were associated with severe patient outcomes and claims involving a physician with multiple malpractice reports. ... Surgical never events are costly to the health care system and are associated with serious harm to patients. Patient and provider characteristics may help to guide prevention strategies" (Mehtsun et al., 12/22).

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

Medscape: Surgical Interns On Home Call Do Not Decrease Patient Safety
Having interns on call at home rather than at the hospital was not linked to postoperative morbidity or mortality among patients who underwent general, vascular, urologic, or cardiac surgery, according to a new report presented by Zachary J. Kastenberg, MD, from the Stanford University School of Medicine in California, and colleagues in an article published online December 17 in the Archives of Surgery (Hitt, 12/18).

Reuters: Shorter Hospital Stays Don't Mean Worse Care: Study
U.S. Veterans Affairs hospitals were able to reduce their patients' length of stay without increasing the number of people who needed to be readmitted later on, according to a new study. According to the researchers, who published their findings in the Annals of Internal Medicine, hospitals are under pressure to cut the amount of time their patients spend there (Seaman, 12/18).

Politico Pro: Study: Most Workers To Keep Employer Insurance
It's a key worry when it comes to health reform: After health exchanges kick in, will businesses find that covering workers no longer makes economic sense and drop their insurance plans? A new study for the National Institute for Health Care Reform says there's no need to worry -- for the most part. It finds that businesses covering a big majority of workers with health insurance -- 81 percent -- will still find it financially advantageous to keep offering it after the health law is implemented in 2014. But the health law will hit small businesses harder when it comes to the economic benefits of offering insurance (Smith, 12/19).

CQ HealthBeat: GAO Finds Some Duplication In Innovation Center Testing
A new Government Accountability Office report found three examples of overlap in some Centers for Medicare and Medicaid Services programs and 17 models of health care delivery its innovation center is testing. "The efforts share similar goals, engage in similar activities or strategies to achieve these goals, or target similar populations," the study said. ... The areas of duplication involved programs for accountable care organizations, Medicaid pilot programs and existing demonstration programs, and the Partnership for Patients effort to reduce medical errors (Reichard, 12/18).

Reuters: Medical Abortions Are Safe: Study
Less than one percent of women getting a medication-induced abortion at Planned Parenthood had a serious side effect or a failed abortion, according to a new study. Researchers found the rate of abortion-related complications sending women to the emergency room or requiring a blood transfusion, for example, was one in 625 during 2009 and 2010 (Pittman, 12/20).

Reuters: Poor Children Have Highest In-Hospital Death Rate
Children from poorer neighborhoods who are hospitalized are more likely to die before discharge than kids from wealthier areas, according to a new study. These differences persisted even though the number of deaths for all kids at the hospitals studied was lower than expected (Grens, 12/20).

Reuters: HIV Cases Decline For Black Women, Increase For Gay Men: CDC
Fewer black women in the United States are being infected with HIV, but the number of young gay and bisexual men infected is rising, the Centers for Disease Control and Prevention said on Wednesday. Between 2008 and 2010, the number of newly infected black women dropped 21 percent, according to the CDC report (Beasley, 12/19).