Research roundup: New medical coding system; choosing a hospice; revamping Medicare

Mar 21 2014

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

Health Affairs: Transitioning To ICD-10
On October 1, 2014, all health plans, health data clearinghouses, and health care providers that transmit health information electronically must use a new, significantly broader, coding system, called ICD-10, for diagnoses and inpatient procedures. The new system has the potential of improving the health care system, but its costs and complications have caused some to question whether the costs outweigh the benefits. ... Given the political fallout from the data system problems encountered with implementation of the health insurance exchanges, the Obama administration will likely be extremely sensitive to any potential problems with claims processing due to the ICD-10 conversion. Extensive testing, both of the system's connectivity and of coding accuracy, is needed to ascertain readiness for the conversion. As the implementation date approaches, CMS will have to decide if there has been sufficient progress to keep to the deadline (James, 3/20).

American Journal Of Hospice & Palliative Medicine: What Consumers Want To Know About Quality When Choosing a Hospice Provider
Despite the availability of endorsed quality measures and widespread usage of hospice, hospice quality data are rarely available to consumers. ... This study drew on focus group and survey data collected in 5 metropolitan areas. The study found that consumers reported the hospice quality indicators we tested were easy to understand. Participants placed top priority on measures related to pain and symptom management. Relative to consumers with hospice experience, consumers without previous experience tended to place less value on spiritual support for patients and caregivers, emotional support for caregivers, and after-hours availability. The National Quality Forum-approved measures resonate well with consumers. Consumers also appear to be ready for access to data on the quality of hospice providers (Smith et al., 3/4).

Annals of Family Medicine: Staffing Patterns Of Primary Care Practices In The Comprehensive Primary Care Initiative
We undertook a descriptive analysis of [nearly 500 primary care practices involved in the Centers for Medicare & Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative]. ... Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators -; all of these positions are more common in larger practices. ... At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost (Peikes, March/April, 2014).

JAMA Psychiatry: Chronicity Of Posttraumatic Stress Disorder And Risk Of Disability In Older Persons
Little is known about the association between posttraumatic stress disorder (PTSD) and disability into later life. Most studies of late-life psychiatric disorders and function have focused on depression and generalized anxiety disorder. ... This study provides evidence that persistence of PTSD in later life is a prominent predictor of disability in late life above and beyond other psychiatric disorders and medical conditions (Byers et al., 3/19).

The Kaiser Family Foundation: Visualizing Health Policy: What Americans Pay For Health Insurance Under The ACA
The March 2014 Visualizing Health Policy infographic shows examples of what Americans will pay for health insurance under the Affordable Care Act, using different scenarios for 40-year-old individuals living in different parts of the country (Cox et al., 3/19).

Texas A&M University's Private Enterprise Research Center/National Center for Policy Analysis: Framing Medicare Reform
This paper identifies the effects of a reform that relies on two policy levers: raising the Medicare eligibility age (MEA) and means-testing the government's Medicare contribution. ... Raising the MEA and introducing means-testing can achieve the same baseline spending path as forecast under the [Affordable Care Act's] provisions. Admittedly these policy options come with their own concerns, but they must be weighed against the most likely alternatives (Liu et al., March 2014).

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

PBS NewsHour: Study Finds Dramatic Increase In Painkiller Prescriptions For ER Patients
Researchers at George Washington University have found a significant increase in prescriptions for opioid analgesics, such as Percocet, Vicodin, oxycodone and Dilaudid, despite only a modest increase in visits for painful conditions. The report, published Friday in the journal Academic Emergency Medicine, details the growing rate of painkiller prescriptions between 2001 and 2010. The trend concerns co-author Dr. Maryann Mazer-Amirshahi, given the increase in opioid-related overdoses in recent years (Myers, 3/17).

Reuters: Obesity Prevention Programs Might Help Lower Kids' Blood Pressure
Programs designed to prevent obesity in children may help lower kids' blood pressure, according to a new review of past studies. Researchers found that programs targeting both diet and physical activity were more effective than programs that focused on one or the other (Jegtvig, 3/19).

Reuters: You're Not Alone: Medical Conspiracies Believed By Many
About half of American adults believe in at least one medical conspiracy theory, according to new survey results. Some conspiracy theories have much more traction than others, however. For example, three times as many people believe U.S. regulators prevent people from getting natural cures as believe that a U.S. spy agency infected a large number of African Americans with the human immunodeficiency virus (HIV). J. Eric Oliver, the study's lead author from University of Chicago, said people may believe in conspiracy theories because they're easier to understand than complex medical information (Seaman, 3/18).

NPR: Screening Immigrants For TB Pays Dividends In U.S.
Hundreds of people with tuberculosis wishing to come to the U.S. have been stopped before they reached U.S. borders, says a new report from the Centers for Disease Control and Prevention. Physicians overseas picked up more than 1,100 cases in prospective immigrants and refugees prior to their arrival in the U.S. The cases include 14 people with multidrug-resistant TB, the CDC says (Neel, 3/20).

NPR: Flu Drugs Saved Lives During 2009 Pandemic
Drugs used to treat the flu really did save the lives of seriously ill people during the influenza pandemic of 2009-2010, a study in The Lancet Respiratory Medicine suggests. Adults who promptly received doses of Tamiflu, Relenza or related drugs were half as likely to die in the hospital as people who were not treated. The study analyzed 78 different studies from 38 countries to reach this conclusion. ... There's been a simmering controversy, particularly in Britain, over whether the billions of dollars spent on these drugs has been worthwhile. Some independent scientists have challenged the governments' conclusions about the value of these medicines -; in particular, they question whether the drugs actually prevent flu. This latest study is about treatment, not prevention (Harris, 3/18).