Research roundup: Structural concerns in ACOs; public's view of mandated contraception coverage

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

JAMA Internal Medicine: Outpatient Care Patterns And Organizational Accountability In Medicare
[The] Medicare Accountable Care Organization (ACO) programs reward participating health care provider groups that achieve slower spending growth and high quality of care. Concerns have been raised, however, that features of the programs may weaken these incentives and undermine ACO efforts to manage care. ... In this study of 145 organizations participating in the Medicare ACO programs, over one-third of beneficiaries attributed to an ACO in 2010 or 2011 was not assigned to the same ACO in both years. Thus, in any given year, a substantial share of patients for whom an ACO is held accountable may be newly or transiently assigned. ... Much of the outpatient specialty care for patients assigned to ACOs, particularly higher-cost patients with more office visits and chronic conditions, was provided by specialists outside of patients' assigned organizations (McWilliams et al., 4/21).

Journal of General Internal Medicine: Structuring Payment To Medical Homes After The Affordable Care Act
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. ... The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings (Edwards et al., April, 2014).  

The Journal of the American Medical Association: Attitudes About Mandated Coverage Of Birth Control Medication And Other Health Benefits In A US National Sample
The Patient Protection and Affordable Care Act (ACA) requires most private health insurance plans to cover contraception without a shared patient cost to improve access. However, debate continues about applying the contraception coverage mandate to public corporations that object on religious grounds .... We assessed attitudes about mandated coverage of birth control medications. A cross-sectional survey was administered in November 2013. ... Overall, 69% of respondents supported mandated coverage of birth control medications in health plans, with significantly higher odds of support among women, black, and Hispanic respondents (Moniz, Davis and Chang, 4/22).

Health Affairs: Basic Health Program 
[The federal health law] provides an additional means of expanding coverage, by allowing states to run a Basic Health Program. Under such a program, states can offer public health insurance, beginning in 2015, to people whose incomes are too high to qualify for Medicaid but are below 200 percent of the federal poverty level. To help pay for benefits under this program, states are eligible to receive the federal dollars that would otherwise go to subsidizing the purchase of private insurance coverage for those people through exchanges. ... Currently, only a few states have shown an interest in implementing a Basic Health Program (Cassidy, 4/17).

The Gerontologist: Listening to Religious Music And Mental Health In Later Life 
Research has linked several aspects of religion-;including service attendance, prayer, meditation, religious coping strategies, congregational support systems, and relations with God, among others-;with positive mental health outcomes among older U.S. adults. This study examines a neglected dimension of religious life: listening to religious music. ... Findings suggest that the frequency of listening to religious music is associated with a decrease in death anxiety and increases in life satisfaction, self-esteem, and a sense of control (Bradshaw, 4/15).

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

Modern Healthcare: More Patients Chose Specialists Over Primary-Care Docs In 2013
It was probably just a matter of time before it happened, but 2013 may have marked the first year that office visits to specialty physicians outnumbered office visits to primary-care doctors. The development was buried in a report from the IMS Institute for Healthcare Informatics on how healthcare spending had risen after years of "self-rationing." ... "It's the crossing of a threshold, but it's not a dramatic one-year change," Aitken said. "Our expectation is that it will continue to grow." Dr. Atul Grover, chief public policy officer for the Association of American Medical Colleges, observed (Robeznieks, 421).

Bloomberg: Medicare's $5 Billion Ambulance Tab Signals Area Of Abuse
The U.S. Department of Health and Human Services has identified ambulance service as one of the biggest areas of overuse and abuse in Medicare -- companies billing millions for trips by patients who can walk, sit, stand or even drive their own cars. "It's a cash cow," said Assistant U.S. Attorney Beth Leahy, who prosecuted Penn Choice and five other ambulance fraud cases. "It's basically like a taxi service except an extremely expensive one that the taxpayers are financing" (Pettypiece, 4/24).

MedPage Today: Robot Versus Surgeon: No Clear Winner
Robot-assisted radical prostatectomy (RARP) led to complication rates, readmission rates, and rates of additional cancer therapy similar to those of conventional surgical prostatectomy, a review of almost 6,000 cases showed. ... the overall complication rates did not differ. Total hospital reimbursement in the first year after surgery was significantly higher in the RARP patients, as reported online in the Journal of Clinical Oncology (Bankhead, 4/18).

MedPage Today: New Guidelines Address Cancer Survivors' Issues
Acknowledging successes in the war on cancer, three new clinical guidelines address problems frequently encountered by cancer survivors: fatigue, peripheral neuropathy, and anxiety and depression. The recommendations kick off a planned series of 18 clinical practice guidelines on survivorship care from the American Society of Clinical Oncology (ASCO) [which said,] "The release of these guidelines come at a time when the number of people with a history of cancer in the U.S. has increased dramatically, from 3 million in 1971 to about 13.7 million today" (Bankhead, 4/14).

News@JAMA: Reducing Health Disparities With Proven Programs
National and local programs that have succeeded in reducing or eliminating racial or ethnic health disparities are outlined in a new report published as a supplement to today's Morbidity and Mortality Weekly Report. Among the interventions described in the report is the Vaccines for Children program, which was authorized by Congress in 1994. The program provides vaccines at no cost to eligible children nationwide who otherwise might not be immunized (Voelker, 4/18).

Detroit Free Press:  Teaching Seniors To Use The Internet Reduces Risk Of Depression
Depression, a common problem for older adults, might have an easy antidote: The Internet. According to new research by a Michigan State University professor, computer use among retirees reduces the risk of depression by more than 30% ... [The] research was published online last week in the Journal of Gerontology: Social Sciences. ... With other factors held constant -; such as whether the seniors lived with other people -; the authors found that roughly 7 in 100 Internet users were estimated to have depression, whereas 10 in 100 non-computer users were estimated to have depression (Erb, 4/21).

news@JAMA:  Mammography False Positives Briefly Boost Anxiety
Women who receive a false-positive result from mammography screening may briefly experience elevated levels of anxiety, but the effect soon wears off, according to an analysis published today in JAMA Internal Medicine. The relative risks and benefits of routine mammography screening for women have been debated for decades. Last fall, the debate took on renewed urgency as the US Preventive Services Task Force announced it would revisit its existing recommendations regarding mammography. The task force's recommendations are influential and may affect whether health plans cover mammography (Kuehn, 4/21).