Research roundup: Eye care disparities; more complications for Medicaid patients after spine surgery; the cost to states opting against Medicaid expansion

Jul 20 2013

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

Spine: Medicaid Status Is Associated With Higher Complications Rates After Spine Surgery – After analyzing 2003-2004 data of patients who underwent spinal surgery at two medical institutions, they found that Medicaid beneficiaries were at much higher risk of experiencing any type of complication than patients who are privately insured. "The results of our study further support the growing body of literature that Medicaid patients have higher rates of complications," the authors write. When evaluating patients and considering the likelihood of complications, "Medicaid status should be considered as well," they concluded (Hacquebord et al., 7/15).

Annals Of Family Medicine: Care From Family Physicians Reported By Pregnant Women – With national survey data from 2000 to 2009, researchers looked at how family physician use for maternity-related care varied by geographic region. "Even though provision of maternity care by family physicians has decreased during the past decade, a substantial and steady proportion of pregnant women (34.4%) received care from a family physician, underscoring the importance of family physicians as providers of clinical services for childbearing women, before and during pregnancy," the authors write, concluding: "Trends in family medicine care for pregnant women have remained steady for the nation as a whole, but they differ by region of the United States. Most pregnant women reported care from multiple clinicians, highlighting the importance of care coordination for this patient population" (Kozhimannil and Fontaine, 7/15).

JAMA Ophthalmology: Socioeconomic Disparity In Use Of Eye Care Services Among US Adults With Age-Related Eye Diseases: National Health Survey, 2002 And 2008 – Among U.S. adults, age-related eye diseases, such as glaucoma and cataracts, are the leading causes of vision impairment. Early detection and treatment can prevent permanent damage. Researchers analyzed 2002 and 2008 survey data of adults ages 40 years and older and found that: "Many issues affect the use of eye care services, including an individual's ability to pay for the services, accessibility of eye care professionals and facilities, vision and eye care insurance coverage, high insurance deductibles, provider and patient education, and beliefs about health. However, we found that eye care in the United States is suboptimal, especially among [groups with low socioeconomic status]. This calls for continued efforts to improve access to and use of eye care services among socioeconomically disadvantaged groups" (Zhang et al., 7/18).

Urban Institute and The Kaiser Family Foundation: The Cost Of Not Expanding Medicaid – "As of July 2013, 24 states were moving forward with the Medicaid expansion, 21 states were not moving forward with the expansion and debate was on-going in the remaining 6 states. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave many more uninsured; these states would also forgo billions in federal funds," the authors write. They add that 64 percent "of all consumers who were originally slated to receive coverage under Medicaid expansion live in states that are not moving forward or are still debating the expansion – 6.3 million and 2.1 million, respectively. Texas, Florida and Georgia account for half of the enrollees in the states not moving forward" (Holahan, Buettgens and Dorn, 7/17).

In a related report, researchers highlight "five key ways that state decisions will shape the outcome of Medicaid expansion" (Rudowitz and Stephens, 7/17).

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

Medscape: Urgent Care Centers Divert Patients From PCPs, EDs Alike
Urgent care centers (UCCs) save money by treating patients who otherwise may land in a more costly hospital emergency department (ED), but they also boost healthcare spending by diverting patients from primary care practices (PCPs), according to a new study published online today by the Center for Studying Health System Change (HSC). Given these findings, UCC executives, ED directors, and health plan network managers interviewed in the study are uncertain about the overall effect of UCCs on cost, write lead author Tracy Yee, PhD, and coauthors (Lowes, 7/12).

Reuters: Half Of Parents Aware Of CT Scan Risks
Just under half of parents in a recent survey understood that radiation from a computed tomography (CT) scan is tied to an increased risk of cancer for their child. There has been a growing understanding among the medical community in the past decade that children who have had a CT scan are slightly more likely to develop cancer later in life, researchers said. ... About 47 percent of parents correctly believed that undergoing a CT scan is tied to a greater cancer risk over a child's lifetime, according to findings published in Pediatrics (Grens, 7/17).

MedPage Today: Dementia Screening Gets Thumbs Down
Population screening to detect Alzheimer's disease or other dementia can't currently be recommended because there isn't enough evidence to show it offers practical benefits, researchers reported here at the annual Alzheimer's Association International Conference. In addition to this "gap in evidence," even when the screening programs identify possible dementia patients, only about half those people undergo follow-up testing, according to Carol Brayne, MD, professor of public health medicine at the Cambridge University Institute of Public Health in England (Susman, 7/18).

MedPage Today: Misdiagnosed Dementia Adds $$$ To Healthcare Bill
When patients with vascular or Parkinson's disease-related dementias are initially misdiagnosed as having Alzheimer's disease, their cost of care rises dramatically, a researcher said here. In an analysis of anonymous Medicare beneficiary records, about one in eight individuals receiving diagnoses of vascular dementia had previously been diagnosed with Alzheimer's disease, incurring average Medicare claims of about $12,000 to $14,000 during the year of diagnosis change over and above the costs recorded for individuals with unchanged vascular dementia diagnoses, said Noam Kirson, PhD, of Analysis Group (Gever, 7/17). 

Boston Globe: Small Number Of Doctor Shoppers Have Big Impact
They make up a very small percentage of people filling prescriptions but the amount of opioids they buy, feeding their own addiction or others', is alarming. "Doctor shoppers," or people who visit multiple physicians' offices and pharmacies soliciting the highly-addictive drugs, accounted for about 7 of every 1,000 people who filled a prescription for narcotic painkillers in 2008. But they purchased nearly 4 percent sold that year, according to a study by Cambridge researchers published Wednesday evening on PLOS ONE (Conaboy, 7/18).

Oregonian: Oregon Elderly Live Healthier, Longer Lives Than In Other States
Because they stay physically active and eat smart, Oregon's seniors have more healthy years ahead of them than folks in most other states. The Centers for Disease Control released a report Thursday that put Oregon's healthy-life expectancy after 65 -- the length of the time after retirement-age that one can expect to stay healthy -- at 15 years, ranking it with the top quarter of U.S. states (Karlamangla, 7/18).