Research roundup: Medicaid peer support; doctor Jokes; ACA's asset rules for coverage

Mar 3 2014

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

National Academy for State Health Policy/Robert Wood Johnson Foundation: Paving The Way To Simpler: Experience From Maximizing Enrollment States In Streamlining Eligibility And Enrollment
Since 2009, the eight states (Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia, and Wisconsin) participating in the Robert Wood Johnson Foundation's Maximizing Enrollment program have worked to streamline and simplify enrollment systems, policies, and processes for children and those eligible for coverage in 2014. ... States [focused] on five key areas: 1) applications, 2) eligibility determinations, 3) renewals and transfers, 4) notices, and 5) business processes.  ... The following report shares the experiences of these states (Baudouin, Weiss and Hensley-Quinn, 2/21).

Health Affairs: Implementing Health Reform: Medicaid Asset Rules And The Affordable Care Act
Medicaid law has ... permitted the states to impose liens on homes or other retained assets, and to recover Medicaid long-term care payments against a recipient's estate upon the death of a recipient. ... The Affordable Care Act creates a new category of Medicaid recipients -; adults with incomes under 133 percent of the poverty level. It also changes income and asset eligibility rules for parents, children, and pregnant women, who were already eligible for Medicaid. Eligibility for these categories of recipients is now calculated based on "modified adjusted gross income," or MAGI. There are no asset requirements for persons who become eligible for Medicaid under MAGI rules. ... CMS intends, however, to take steps to avoid applying estate-recovery rules to MAGI-eligible individuals who do not receive [long-term care services] to keep this from becoming a barrier to Medicaid expansion eligibility (Jost, 2/24).

National Institute for Health Care Reform/Center for Studying Health System Change: Inpatient Hospital Prices Drive Spending Variation For Episodes Of Care For Privately Insured Patients
[This] analysis focuses on private health plans' spending on episodes of care beginning with a hospitalization, ... and up to 30 days after discharge, and payments for any readmission within 30 days of the initial discharge. .... hospital payments for initial inpatient stays accounted for two-thirds of total episode spending while related services accounted for a third. ... This study's findings-;inpatient prices drive the bulk of episode-spending variation and hospitals with high spending for one service line tend to have high spending for other service lines-;indicate that private purchasers can focus on hospitals' overall inpatient price levels rather than pursue bundled payments for episodes of care (White, Reschovsky and Bond, 2/27).

Medicare & Medicaid Research Review: The Impact Of Medicaid Peer Support Utilization On Cost
Peer support programs have proliferated over the past decade, building on recovery oriented programming, yet relationships between peer support services and the costs to public programs have not been well described in literature. ... Peer support was associated with $5,991 higher total Medicaid cost. Peer support was also associated with higher crisis stabilization cost and lower psychiatric hospitalization cost, but the relationships were not statistically significant. Peer support was associated with $2,100 higher prescription drug cost, $5,116 higher professional services cost, and $1,225 lower facility cost.  State policy makers must weigh the potential higher cost associated with peer support programs with efforts to redesign the delivery of mental health services (Landers and Zhou, 2/18).

JAMA/Kaiser Family Foundation: Physicians and Medicare
This month's Visualizing Health Policy [infographic] takes a look at physicians and Medicare, including information about Medicare's payment formula for physicians and about access to health care for people covered by Medicare. (Boccuti, Huang, Neuman, Jankiewicz, and Rousseau, 2/25). 

Kaiser Family Foundation: Kaiser Health Policy News Index: February 2014 
This month's Index finds that the implementation of the Affordable Care Act (ACA) was the most-closely followed health policy news story this month, ranking behind news of the U.S. economy, but ahead of news about the Winter Olympics and President Obama's State of the Union address in late January. The survey also finds that the news media is by far the public's top source of information on the ACA, and that more say their impression of the law is based on what they've heard in the media than on their own experiences or those of their family and friends. The public continues to say that the media's coverage of the law has focused more on politics and controversies than the impact on people. A plurality feel coverage is balanced but more feel it is biased against the law than for it (Hamel, Firth and Brodie, 2/27).

Journal Of Medical Internet Research/Dartmouth Institute: Did You Hear The One About The Doctor? An Examination Of Doctor Jokes Posted On Facebook 
We performed a cross-sectional study of 33,326 monitored Facebook users, 263 (0.79%) of whom posted a joke that referenced doctors on their Facebook wall during a 6-month observation period ... Jokers told 156 unique doctor jokes and were the same age as nonjokers but had larger social networks (median Facebook friends 227 vs 132, P<.001) and were more likely to be divorced, separated, or widowed (P<.01). In 39.7% (62/156) of unique jokes, the joke was at the expense of doctors (Davis et al., 2/21).

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

MinnPost: Getting Opioid Painkillers From Multiple Doctors Is Common Among Medicare Patients, U Of M Study Finds
More than 30 percent of Medicare beneficiaries who have been prescribed opioid painkillers get those prescriptions from multiple health-care providers -; a practice that significantly raises the risk of being hospitalized for opioid-related injuries and medical conditions, according to a study published last week in the British Medical Journal (BMJ). That 1-in-3 number was unexpectedly high, said Pinar Karaca-Mandic, one of the authors of the study and an assistant professor of health policy and management at the University of Minnesota (Perry, 2/24).

Modern Healthcare: For-Profit Hospices Incur Medicare Penalties Over Longer Stays, Study Finds
Investor-owned hospice operators were far more likely than not-for-profit operators to incur Medicare penalties for admitting patients whose stay exceeded six months, a study has found. Terminally ill patients in for-profit hospices were more likely to leave alive, the new research also found (Evans, 2/24).

Reuters: Partner's Death Tied To More Heart Attacks, Strokes
Older men and women whose partners died within the past month are at an increased risk of heart attacks and strokes, according to a new study from the UK. Researchers found the chance of having a heart attack or stroke doubled within the 30 days after people lost their significant other (Seaman, 2/24).

Reuters: Elderly Profit From Group Meetings And Home Visits
Group meetings and preventive home visits helped octogenarians maintain their health, independence and a positive outlook, according to a first-of-its-kind study in Sweden. Gerontologist Gwen Yeo told Reuters Health she was "amazed" that researchers at the Sahlgrenska Academy at the University of Gothenburg successfully documented what she has long suspected -- health-promotion programs can postpone disease progression in older adults and keep them in relatively good shape ... [the study was] published in the Archives of Gerontology and Geriatrics (Cohen, 2/21).

Modern Healthcare: Hip, Knee Replacement Cost-Variation For Insured Patients Driven By Hospitals: Study
The cost of new hips and knees for privately insured patients varied widely across three dozen hospitals in six states, with hospitals themselves the primary reason, a study shows (Evans, 2/26).

NPR: Scant Evidence To Support Vitamins Against Cancer, Heart Disease
Nearly half of American adults take a vitamin of some kind each a day. About a third take a multivitamin. But are they worth it? For people in good health and without any special nutritional deficiencies, there isn't enough evidence to say it's a good idea -; at least when it comes to preventing cardiovascular disease and cancer. That's the verdict from the U.S. Preventive Services Task Force, ... The group published new guidelines on vitamins Monday in Annals of Internal Medicine (Hensley, 2/25).

The New York Times: Test Is Improved Predictor Of Fetal Disorders
A test that analyzes fetal DNA found in a pregnant woman's blood proved much more accurate in screening for Down syndrome and another chromosomal disorder than the now-standard blood test, a new study has found. The promising results may change how prenatal screening for genetic diseases is done, though the test is costly and generally not yet covered by insurance for women at low risk (Belluck, 2/26).