Research roundup: Nursing home transitions; the impact of raising Medicare premiums; workers' views of job-based insurance

Jan 20 2014

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

Journal of the American Geriatrics Society: Hospitalization Of Elderly Medicaid Long-Term Care Users Who Transition From Nursing Homes
To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH. ... Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% over remaining in the NH. NH transitioners had a 58% greater risk of experiencing any type of hospitalization than NH stayers. ... Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community (Wysocki et al., 1/2). 

The George Washington University School of Public Health: Assessing The Potential Impact Of State Policies On Community Health Centers' Outreach And Enrollment Activities 
This nationwide analysis of community health centers' early outreach and enrollment experiences under the Affordable Care Act (ACA) finds that all health centers are engaged in a significant and sustained effort to identify and assist eligible patients and community residents in obtaining health insurance coverage. ... But in states with restrictive policies toward ACA implementation (defined as both opting out of the Medicaid adult expansion and adopting Navigator laws), health centers are confronting significantly greater outreach and enrollment challenges compared to health centers in states that have fully implemented the law through Medicaid expansion and without outreach and enrollment restrictions (Shin et al., 1/14).

JAMA Surgery: Failure To Rescue In Safety-Net Hospitals
While many uninsured persons will obtain coverage under the Patient Protection and Affordable Care Act, historical lack of resources and the introduction of value-based payments may adversely affect some hospitals. We found that hospital safety-net burden was an independent predictor of [the mortality rate among surgical patients with complications] after controlling for hospital and patient factors. Hospitals with a high safety-net burden (HBHs) were more likely to be large teaching facilities with sophisticated internal medicine services and high technology but had lower proportions of RNs among nurses, electronic medical record implementation, and a positron emission tomographic scanner. ... Although we cannot precisely identify the cause of this disparity, it may relate to culture, teamwork, or the way in which resources are mobilized and used to provide care for patients with complications in a timely fashion (Wakeam et al., 1/15).

JAMA Surgery: Association Of High-Volume Hospitals With Greater Likelihood Of Discharge To Home Following Colorectal Surgery
Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices (Balentine, 1/15).

The Kaiser Family Foundation: Raising Medicare Premiums For Higher-Income Beneficiaries: Assessing The Implications
Some recent proposals to address concerns about federal spending have included recommendations to reduce the growth in Medicare spending by increasing beneficiaries' contributions towards their health care costs. ... there is some possibility that such changes could lead some higher-income beneficiaries to drop out of Medicare Part B and instead self-insure, which could result in higher premiums for all others who remain on Medicare if the dropout group is large and relatively healthy. ... given the relatively low incomes of most people on Medicare, a significant amount of savings from this proposal is only possible by going relatively far down the income scale to reach a sizeable share of beneficiaries-;at which point the affordability of these additional costs could be called into question (Cubanski, Neuman, Jacobsen and Smith, 1/13).

Employee Benefit Research Institute/Greenwald & Associates: Views On Employment-Based Health Benefits: Findings From The 2013 Health And Voluntary Workplace Benefits Survey
Enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA) has raised questions about whether employers will continue to offer health coverage to their workers in the future. Yet, the importance of benefits in choosing a job remains high, and health insurance in particular continues to be, by far, the most important employee benefit to workers. Most workers are satisfied with the health benefits they have now and do not prefer to change the mix of benefits and wages. Choice of health plans is important to workers, and they would like more choices, but workers express confidence that their employers or unions have selected the best available health plan (Fronstin and Helman, December 2013).

Journal of Infectious Diseases: Prevalence Of Hepatitis C Virus Infection In US Hispanic/Latino Adults
Prevalence of hepatitis C virus (HCV) antibody has been reported in Mexican Americans, but its prevalence in other US Hispanic/Latino groups is unknown. We studied 2 populations of US Hispanic/Latino adults; 3210 from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 and 11,964 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Age-standardized prevalence ... differed significantly by Hispanic/Latino background in HCHS/SOL (eg, 11.6% in Puerto Rican men vs 0.4% in South American men). These findings suggest that the HCV epidemic among US Hispanics/Latinos is heterogeneous (Kuniholm et al., 1/14).

All-Payer Claims Database Council/Robert Wood Johnson Foundation: The Basics Of All-Payer Claims Databases
Over the past 10 years, a growing number of states have established state-sponsored all-payer claims database (APCD) systems to fill critical information gaps for state agencies, to support health care and payment reform initiatives, and to address the need for transparency in health care ... States working collectively on common issues can leverage solutions more effectively than each state working independently. Areas for continued collective action include development of national standards, both in data and measures. Now and in the future, state APCDs provide the unique data to support the development of comparable information about the cost, effectiveness, and performance of the health care delivery system at the local, state and national levels (Porter et al., 1/14).

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

Examiner: Minorities And The Poor Receive Delayed Thyroid Cancer
A new UCLA study has found that, compared to Caucasian patients and those in higher economic brackets, minority patients and those of lower socioeconomic status are far more likely to have advanced thyroid cancer when they are diagnosed with the disease. The study, which comprised almost 26,000 thyroid cancer patients was published in the January edition of the Journal of Endocrinology and Metabolism (Wulffson, 1/9).

MedPage Today: Results Mixed For Patient-Centered Medical Homes
An analysis of patient-centered medical home (PCMH) studies showed sparse levels of improvement in overutilization and patient satisfaction, but stakeholders say the delivery model is still the right direction to move in. A review of 20 peer-reviewed and industry reports about the effect of PCMHs found eight studies (40%) reported fewer hospital admissions and three (15%) showed fewer 30-day readmissions. Only five (25%) reported improved access to care, the Patient-Centered Primary Care Collaborative (PCPCC) said. Meanwhile, four (20%) showed increase in patient satisfaction and six (30%) showed an increase in preventive services, the PCPCC, a Washington-based advocacy group for PCMHs, said in an analysis of the model's costs and quality. The report looked at studies released or published between August 2012 and December 2013 (Pittman, 1/14).

Medscape: Mental Disorders Substantially Underestimated In Adults
The number of middle-aged and older adults who have psychiatric disorders is substantially and consistently under-reported, especially when compared with physical disorders, new research suggests. An analysis of more than 1000 adult participants from the Baltimore Epidemiologic Catchment Area (ECA) study, which included interviews going back 24 years, showed that those who had reported a mental disorder in previous assessments under-reported by 2- to 12-fold this information at later recall (Brauser, 1/14).

Medscape: Five Things To Stop Doing In The ICU To Limit Waste
Four critical care provider groups have announced a list of measures to limit wasteful procedures in the intensive care unit (ICU) in an attempt to control spiraling healthcare costs. "It should be clear to everyone in the audience that rationing is unavoidable," said committee chair Scott Halpern, MD, assistant professor of internal medicine at the University of Pennsylvania in Philadelphia. "You cannot reconcile boundless needs to bounded funds." Dr. Halpern presented the list here at the Society of Critical Care Medicine 43rd Critical Care Congress (Harrison, 1/13).

Medscape: Grocery Store Coupons Encourage Unhealthy Eating
Grocery stores in the United States could be doing a better job of promoting healthful eating by changing the types of online coupons they offer their customers, a new study suggests. An analysis of over 1000 online coupons from 6 national grocery chains finds that the vast majority of the coupons were for discounts on snack foods, candies, desserts, prepared meals, cereals, and beverages, and very few were for fruits or vegetables (Tucker, 1/13).

Reuters: Many Younger U.S. Adults Skipping Flu Shots: Report
Just over a third of U.S. adults ages 18 to 65 got the flu shot during the 2012-2013 flu season, according to an analysis released on Tuesday, and if that trend holds for the current flu season, many adults may be at risk (Steenhuysen, 1/14).

Reuters: Minority Children Use Appropriate Car Seats Less Often
Many kids are not put in car seats and booster seats as recommended, studies have shown. A new report suggests use may be particularly low among non-white children. "We expected that differences in family income, parental education, and sources of information would explain the racial disparities in age-appropriate restraint use and they did not," lead author Dr. Michelle L. Macy told Reuters Health by email (Doyle, 1/13).

Los Angeles Times: Survivors Of Traumatic Brain Injuries More Likely To Die Young
People who suffer traumatic brain injuries face an elevated risk of death from suicide or accidents for years to come, according to a new study based on four decades of data on hundreds of thousand of patients in Sweden. Those who survived the immediate aftermath of moderate and severe traumatic brain injuries were three times more likely than people without such injuries to die prematurely, defined by the researchers as before age 56. Experts said the study was likely to spur calls for long-term monitoring of some brain injury patients. By virtue of its size and scope, the analysis, published Wednesday in JAMA Psychiatry, puts an authoritative stamp on a growing body of evidence that impacts to the brain can be deadly in ways that are not easily apparent (Zarembo, 1/15).