Research roundup: Distance from a transplant center; Medicaid prenatal care; metastasis of email; profiting from Medicare Advantage

Mar 29 2014

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

JAMA: Association Of Distance From A Transplant Center With Access To Waitlist Placement, Receipt Of Liver Transplantation, And Survival Among US Veterans 
Centralization of specialized health care services such as organ transplantation and bariatric surgery is advocated to improve quality, increase efficiency, and reduce cost. ... [This was a] retrospective study of veterans meeting liver transplantation eligibility criteria from January 1, 2003, until December 31, 2010, using data from the Veterans Health Administration's integrated, national, electronic medical record linked to Organ Procurement and Transplantation Network data. ... Among VA patients meeting eligibility criteria for liver transplantation, greater distance from a VATC or any transplant center was associated with lower likelihood of being waitlisted, receiving a liver transplant, and greater likelihood of death (Goldberg et al., 3/26).

JAMA Pediatrics: A Statewide Medicaid Enhanced Prenatal Care Program: Impact On Birth Outcomes
Policy makers and practitioners need rigorous evaluations of state-based Medicaid enhanced prenatal care programs that provide home visiting to guide improvements and inform future investments. ... Data, including birth records, Medicaid claims, and monthly program participation, were extracted from the Michigan Department of Community Health warehouse. ... Participation in MIHP reduced the risk for adverse birth outcomes in a diverse, disadvantaged population. The study adds to the evidence base for enhanced prenatal care home visiting programs and informs state and federal investments (Roman et al., March 2014). 

JAMA Pediatrics: Metastasis Of E-mail At An Academic Medical Center
At academic medical centers, e-mail provides a simple way to communicate and serve the multiple missions. ...  Less obvious is how e-mail contributes to a daunting volume of information. ... To call attention to some unintended effects of "cost-free" communication, we quantified the volume and described the content of mass distribution e-mails sent to a single physician over 1 year. ... With 629 employed physicians, the annual institutional cost was between $1,029,419 and $3,088,257 for physicians to read mass distribution e-mails (Paul and Levi, March 2014).

Urban Institute/Robert Wood Johnson Foundation: Health Insurance Coverage And Health Care Access, Use And Affordability In Massachusetts: An Update As Of Fall 2012
In 2012, Massachusetts continued to benefit from the nation's highest level of health insurance coverage following its 2006 health reform initiative. Health insurance coverage for nonelderly adults in the Bay State in 2012 continued at about 95 percent, well above the 79.7 percent that is estimated for the nation overall. ... Massachusetts residents also have continued to enjoy many of the gains in access to health care and health care affordability. ... As of 2012, most nonelderly adults in Massachusetts were connected to the health care system and had a place they usually went when they were sick. ... However, some residents of the state reported problems obtaining the care they needed, including one-third (33.5 percent) who reported going without needed health care. ... Reflecting the level of health care costs in the state, affordability of care was a problem for many nonelderly adults in Massachusetts and their families (Long and Fogel, 3/26).

Employee Benefit Research Institute: Brand-Name And Generic Prescription Drug Use After Adoption Of A Full-Replacement, Consumer-Directed Health Plan With A Health Savings Account
This report looks at the effects of the HSA plan on the absolute and relative use of brand-name and generic drugs. ... Overall, the new plan design was associated with a 4.7 percentage-point rise in GDR [generic dispensing rate] after the first year, and-;before inclining slightly in the second year-;settled to a level that was higher by 3.4 percentage points after four years. ... At the end of the four-year follow-up period, GDR was greater by 4.5 percentage points for hypertension, 15.4 percentage points for dyslipidemia, and 7.8 percentage points for asthma/COPD. No significant effects were detected for diabetes GDR, but the measure for depression was lower by 8.4 percentage points after 2010. ... After one year under the CDHP, 0.43 fewer generic and 0.95 fewer brand-name prescriptions were filled, on average (Fronstin and Roebuck, 3/24).

The National Bureau of Economic Research: Who Benefits When The Government Pays More? Pass-Through In The Medicare Advantage Program
In this paper we examine this issue in the Medicare Advantage (MA) program, through which the federal government contracts with private insurers to coordinate and finance health care for more than 15 million Medicare recipients. To do this, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250 thousand or more relative to MSAs just below this threshold. Our results demonstrate that the additional reimbursement leads more private firms to enter this market and to an increase in the share of Medicare recipients enrolled in MA plans. Our findings also reveal that only about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures (Duggan, Storc and Vabson, 3/26).

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

MedPage Today: USPSTF: No Proven Value in Cognition Screening
Routine screening of all older individuals for cognitive impairment is not supported by the available evidence, the U.S. Preventive Services Task Force (USPSTF) has concluded.  After reviewing 55 studies examining the accuracy of screening instruments, and more than 130 studies of interventions aimed at slowing or stopping cognitive decline in patients who tested positive for cognitive impairment or relieving caregiver burdens, task force members determined that a clear benefit for screening has not been established, relative to the potential for harm (Gever, 3/24).

CBC: Canadians Spend More On Private Health Insurance For Smaller Payouts
Spending by Canadians on private health insurance has more than doubled over the past 20 years, but insurers paid out a rapidly decreasing proportion as benefits, according to a study published today in the CMAJ (Canadian Medical Association Journal). ... Approximately 60 per cent of Canadians have private health insurance. ... Over the past two decades, the gap between what insurers take in and what they pay out has increased threefold. While private insurers paid out 92 per cent of group plan insurance premiums as benefits in 1991, they paid only 74 per cent in 2011 (3/24).

News @JAMA: Report: Medicare Miscalculates Dialysis Drug Costs
Medicare is miscalculating the drug costs it pays to dialysis centers that treat patients with end-stage renal disease, making it difficult to determine whether the federal agency is making appropriate payments, concludes a report released today. ... Since 2011, Medicare began paying these facilities a "bundled" payment for all services, including dialysis-related drugs, creating an incentive for physicians to be more judicious when prescribing medications. Previously, dialysis centers were paid separately for the medications, an unintended incentive to boost profits by overuse of the medications. ... the report by the US Department of Health and Human Services' Office of Inspector General (OIG) found that the bundled payment does not reflect actual cost fluctuations of the individual drugs within the bundle (Mitka, 3/25).

Reuters: Minorities Most Vulnerable To Financial Slide After Breast Cancer
Black and Latina breast cancer patients were more than twice as likely as white women to have lingering medical debt and to skip treatments because of costs, according to a new U.S. study. Based on surveys of 1,500 women diagnosed with mostly early-stage breast cancers, researchers found that up to one quarter were struggling financially as a result of their disease (Doyle, 3/25).