Research roundup: ACA 'can survive' low enrollment; rural/urban differences in O.B. Care; teaching residents cost consciousness

Dec 23 2013

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

Health Affairs: The Health Reform Monitoring Survey: Addressing Data Gaps To Provide Timely Insights Into The Affordable Care Act
The Health Reform Monitoring Survey (HRMS) was launched in 2013 as a mechanism to obtain timely information on the Affordable Care Act (ACA) ... HRMS data from summer 2013 show that more than 60 percent of those targeted by the health insurance exchanges struggle with understanding key health insurance concepts. This raises concerns about some people's ability to evaluate trade-offs when choosing health insurance plans. Assisting people as they attempt to enroll in health coverage will require targeted education efforts and staff to support those with low health insurance literacy (Long et al., 12/18).

Urban Institute/Robert Wood Johnson Foundation: The Affordable Care Act Can Survive Low Enrollment And Adverse Selection in the First Year
[S]ome adverse selection in the early years of implementation was anticipated by policy-makers. ... Second, ... [c]omponents of the ACA, such as financial assistance for the low-income (who are disproportionately young adults) and lower premiums for young adults than older adults (due to age rating), will tend to increase enrollment among the healthier populations. Third, while insurers may experience some losses in 2014 if adverse selection occurs, market competition will make it difficult for them to recoup those losses in 2015 by increasing premiums substantially (Blumberg and Holahan, Dec. 2013).

JAMA Internal Medicine: Teaching Residents To Provide Cost-Conscious Care
In August 2012, the Association of Program Directors in Internal Medicine (APDIM) electronically surveyed its membership on the state of cost-conscious care curricula as part of an annual survey of residency program directors. ... Despite the national consensus among policy makers and educators on medical education's role in cost conscious care, less than 15% of programs had a formal curriculum, while approximately 50% of programs were working on one. Use of robust teaching and assessment methods linked to practice change was limited. While faculty were the most frequently reported evaluator of resident competence in cost-conscious care, many program directors believed that their faculty did not consistently role model cost-conscious behavior (Patel et al., 12/17).

Medical Care: Rural-Urban Differences In Obstetric Care, 2002-2010, And Implications For The Future
This was a retrospective analysis of hospital discharge records for all births in the 2002–2010 Nationwide Inpatient Sample. ... In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively. ... Between 2002 and 2010, rates of low-risk cesarean and nonindicated cesarean increased, and vaginal birth after cesarean (VBAC) rates decreased in both rural and urban hospitals. ... Nonindicated labor induction rates rose disproportionately faster in rural versus urban settings. Tailored clinical and policy tools are required to address differences between rural and urban hospitals (Kozhimannil et al., Jan. 2014).

California HealthCare Foundation: Monitoring Performance: A Dashboard Of Medi-Cal Managed Care
Medi-Cal managed care performs at or above the national Medicaid median on 17 of 19 quality indicators. On the two measures for which Medi-Cal lags behind the national median -- postpartum care and timeliness of prenatal care -- the gap has persisted over the last four years. On most measures of consumer experience, the program performs below the national Medicaid median. Across all measures of quality, access, and consumer satisfaction, there are considerable differences in performance among participating plans, including significant variation in plan performance within counties. Most plans participating in Medi-Cal appear to be in sound financial health (Dec. 2013).

Health Affairs: Young Adults And The Affordable Care Act
The ACA aims to substantially boost the number of Americans with health care coverage in the United States, and young adults are a prominent part of that goal--three out of ten legal US residents are ages 19-29. This age group has historically been uninsured at far higher rates than any other group. ... Cost, not hubris, appears to be the determining factor. ... It is young adults with low and moderate incomes who continue to suffer from the highest rates of uninsurance (Goldman, 12/16).

BMJ: Following Celebrities' Medical Advice: Meta-Narrative Analysis
Whether motivated by good intentions or financial rewards, celebrities can generate much publicity for health campaigns by virtue of their visibility, public interest, and perceived newsworthiness. ... But the messages espoused by celebrities can also conflict with those recommended by health professionals, public health authorities, and the best available research evidence. ... Health professionals can counter the negative influences of celebrities. ... Those times when patients mention the latest celebrity endorsement should be seen as meaningful opportunities to start important educational conversations rather than as annoyances (Hoffman and Tan, 12/17).

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

Modern Healthcare: Medical Costs, Not ACA, Blamed Most For Big Insurance Hikes So Far
Roughly half of the health plans that filed for premium increases of 10% or more from July 2012 to June 2013 put some of the blame on the Patient Protection and Affordable Care Act. But the vast majority of the hikes were attributed to medical costs and other routine factors, according to a new report by the Commonwealth Fund. "Overall, the Affordable Care Act's benefit mandates and insurer fees had only a minor effect on insurers' larger rate increases prior to 2014," concluded the report (Demko, 12/19).

Medscape: Doctors Who Favor Hospice More Likely To Discuss It
Physicians who would choose hospice care for themselves are more likely to discuss the option in a timely manner with patients than physicians who are less interested in personal hospice care, according to a research letter published online December 16 in JAMA Internal Medicine. Many physicians delay recommending hospice care for terminally ill patients for a variety of reasons. Garrett M. Chinn, MD, from the Division of General Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, and colleagues investigated associations between physicians' personal opinions about if and when to start hospice care and how they present the possibility of hospice care to their patients (Lewis, 12/16).

MedPage Today: Report: States Failing On Public Health Front
Most states scored 50% or lower on a report card assessing their ability to respond to infectious disease threats, according to an analysis released Tuesday. Just 16 states and the District of Columbia scored 60% or better on a set of 10 indicators of public health capability, according to the nonprofit Washington-based Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation, based in Princeton, N.J. (Smith, 12/17).

Reuters: U.S. Hospital Admissions Weakest In A Decade: Citi Analyst
U.S. hospital admissions in November were the weakest in more than a decade, under pressure from a change in reimbursement rules for Medicare patients and confusion tied to the problem-ridden rollout of Obamacare, according to a survey by Citi Research. New billing rules for the Medicare program for the elderly and disabled require hospitals to treat patient stays lasting less than "two midnights" as an outpatient visit (Kelly, 12/17).