Research roundup: 'Cadillac' plan taxes; 'chronic care management' for substance abusers; long-term care services

Sep 21 2013

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

Health Affairs: Excise Tax On 'Cadillac' Plans
As health coverage expands to tens of millions of Americans--through Medicaid expansion in states and the new state health insurance exchanges that will soon begin selling individual health coverage--some Americans with employer-sponsored health coverage are seeing their benefits decrease. One of the most significant, and controversial, provisions of the Affordable Care Act is the new excise tax on high-cost health plans proposed to both slow the rate of growth of health costs and finance the expansion of health coverage. The provision is often called the "Cadillac" tax because it targets so-called Cadillac health plans that provide workers the most generous level of health benefits. These high-end health plans' premiums are paid for mostly by employers. ... It's not yet clear how widely the excise tax will be felt by both employers and consumers (Piotrowski, 9/12).

Journal of the American Medical Association: Chronic Care Management For Dependence On Alcohol And Other Drugs
People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes. ... Chronic care management is multidisciplinary patient-centered proactive care, a way to organize services that provides coordination and expertise, and has been effective for depression, medical illnesses, and tobacco dependence (a substance use disorder). ... Participants were randomized to receive CCM>

Commonwealth Fund: Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013
Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp health care disparities among states. Between leading and lagging states, up to a fourfold disparity in performance exists on a range of key health care indicators for low-income populations. There are also wide differences within states by income. If all states could reach the benchmarks set by leading states, an estimated 86,000 fewer people would die prematurely and tens of millions more adults and children would receive timely preventive care. Moreover, many benchmarks for low-income populations in the top states were better than average and better than those for higher-income or more-educated individuals in the lagging states (Schoen et al., 9/18).

The Kaiser Family Foundation: Five Key Facts About the Delivery and Financing of Long-Term Services and Supports
Fact #1: People of All Ages Require Long-Term Services and Supports. As a result of physical limitations, cognitive impairments, mental illness, and/or a disabling chronic condition, an individual may need long-term assistance for several months or years. ... Fact #2: Many People Who Need Long-Term Services and Supports Rely on Unpaid, Informal Care. Family caregivers have traditionally provided informal assistance with personal care and household chores, but in many cases informal caregiving now includes skilled medical/nursing care tasks such as meal preparation for a special diet, wound care, and care coordination (9/13).

The Urban Institute/Connecticut Health Foundation: No Wrong Door: Improving Health Equity and the Health Coverage Consumer Experience in Connecticut
"No Wrong Door" (NWD): A system that allows consumers to apply for health insurance through different agencies, and then seamlessly routes them to the program for which they qualify. Full implementation is critical in order for the Affordable Care Act (ACA) to accomplish its goals. Even without NWD, the ACA would increase the number of state residents with health insurance. However, adding NWD would increase that enrollment figure by 13 percent, with the greatest advantage accruing to children and people of color. With full implementation of NWD, over the course of a year, 36,000 people who would otherwise experience periods without coverage will instead be continuously insured (Buettgens and Dorn, 9/6).

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

Medscape: Self-Referring Physicians Have Lower Threshold for Knee MRI
When physicians have a financial interest in imaging equipment, they are much more likely to order knee magnetic resonance imaging (MRI), according to a study published online September 17 in Radiology. The practice is called self-referral, meaning physicians who are not radiologists refer patients to imaging facilities in which they or their partners have a financial interest (Frellick, 9/17).

Los Angeles Times: Colon Cancer Screening Works Over The Long Term, Studies Confirm
Getting a colonoscopy is not something most people look forward to -- but a new analysis suggests that it's worth it to follow screening recommendations and have the test done every 10 years (or every five for those at high risk.) Writing in the New England Journal of Medicine on Wednesday, Harvard researcher Reiko Nishihara and co-authors assessed colonoscopy use, colorectal cancer cases and colorectal cancer deaths among participants in the multidecade Nurses' Health Study and Health Professionals Follow-up Study (Brown, 9/18).

HealthDay: Medicaid Patients Behind Jump In California ER Visits, Study Finds 
Difficulty finding primary care may explain a large rise in emergency department visits by adults in California with Medicaid coverage, according to researchers. Emergency department visits made by adults aged 19 to 64 increased 13 percent between 2005 and 2010, according to their analysis. ... The largest increase in visits occurred in 2009, likely because of the H1N1 swine flu pandemic and the effects of the economic downturn, the authors suggested in a research letter published in the Sept. 18 issue of the Journal of the American Medical Association (Preidt, 9/17).

Medscape: Dental Care in Exchange for Community Service, Program Works
Requiring indigent patients to do community service in exchange for their dental care can reduce their reliance on emergency rooms, a new study shows. Emergency room visits for dental pain in Calhoun County, Michigan, have dropped by 70% since the start of a new program called the Calhoun County Dentists' Partnership, researchers report in the September issue of Health Affairs (Harrison, 9/17).

Medscape: Delivery Room Guidelines Improve Outcomes for Preemies
Use of new evidence-based delivery room guidelines was associated with significantly improved outcomes for very low birth weight infants, according to the results of a single-institution study published online September 16 in Pediatrics. The authors, led by Sara B. DeMauro, MD, MSCE, from the Department of Pediatrics, the Children's Hospital of Philadelphia, Pennsylvania, note that events during the first moments of an infant's life can have lasting effect, especially for those born very prematurely. "Specifically, 3 aspects of newborn care that require prompt attention in the delivery room are thermoregulation, respiratory management, and oxygen delivery," they write (Fox, 9/16).

MedPage Today: Majority of Docs Still Own Their Own Practices
Despite perceptions of corporatization of American medicine, more than half of surveyed physicians (53.2%) were self-employed in 2012, according to by the American Medical Association. An even larger majority -- 60% -- worked in practices that were fully owned by physicians (Bankhead, 9/17).