Research roundup: Compounding pharmacies; marketplace details; changes in insurance coverage

May 5 2014

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

Health Affairs: Regulating Compounding Pharmacies
Outraged over a 2012 fungal meningitis outbreak traced back to Framingham, Massachusetts-based drug compounder New England Compounding Center (NECC) that left sixty-four people dead and more than 700 sickened, Congress passed the Compounding Quality Act .... The law is designed to plug a regulatory gap that existed because drug compounding pharmacies have traditionally been regulated by the states .... The drug compounding community is now waiting for more detailed guidance ... on several questions that the law has left unresolved. For example, under section 503A, a "limited quantity" of so-called anticipatory compounding produced before a patient actually needs the drug can be made up ahead of time based on a patient's prescribing history. But it is unclear how much is a "limited" quantity or how long a prescribing history must be (Goldman, 5/1).

Breakaway Policy/Robert Wood Johnson Foundation: Eight Million And Counting: A Deeper Look At Premiums, Cost Sharing And Benefit Design In The New Health Insurance Marketplaces
[We] analyze data for all 7,027 Silver-level plans and cost sharing data for all 1,208 unique Silver plans in the more than 500 rating areas across all 50 states (plus the District of Columbia), focusing on premiums, deductibles and out-of-pocket maximums. ... Across all 7,027 Silver plans, the national average premium is $265 per month for a 27 year-old individual, $435 per month for a 50 year-old individual, and $878 for a family of four. Under many plans, the family deductible is roughly twice the amount of the individual deductible. ... many Exchange plans subject health care services such as PCP visits and prescription drugs to the deductible, a benefit design feature which is less common in [employer-sponsored plans] plans. ... Of the 1,208 unique Silver plans analyzed, approximately half (641) offer combined deductibles under which medical and prescription drug expenses accumulate to a single deductible (5/1).

The Kaiser Family Foundation: Measuring Changes In Insurance Coverage Under The Affordable Care Act 
[A] key measure of success of the ACA is whether the number of uninsured Americans drops. While that outcome seems like a relatively straightforward metric, it will in fact be surprisingly difficult to evaluate. Early results from polls and surveys by private organizations – Gallup, the Urban Institute, and RAND – show clearly that the number of people uninsured nationally is falling as the ACA goes fully into effect. However, these polls are limited in their ability to precisely estimate the magnitude of the change and discern shifts among different types of coverage. ... Federal surveys also have their limitations, and in many cases these data sources will not be available for quite some time. ... A more complete picture of coverage under the ACA will start to emerge in June 2015, when [National Health Interview Survey] insurance coverage data for all of 2013 and 2014 will be available (Claxton et al., 4/30).

Mathematica Policy Research/The Kaiser Family Foundation: Medicare Advantage 2014 Spotlight: Enrollment Market Update
As of March of 2014, almost one in three (30 percent) people on Medicare (15.7 million beneficiaries) were enrolled in a Medicare Advantage plan, a 10 percent increase since March 2013. During the past year, Medicare Advantage enrollment has increased in virtually all states. ... Average monthly premiums (weighted by enrollment) have remained relatively stable since 2012 ($35 per month in 2014). During this same period, however, average out-of-pocket spending limits have been on the rise, which could expose a subset of enrollees to higher costs – mainly those who have significant medical needs. ... Between 2013 and 2014, the share of Medicare Advantage enrollees in plans with limits above $5,000 almost doubled, from 24 percent in 2013 to 44 percent in 2014. This Data Spotlight reviews national and state-level enrollment trends as of March 2014 and examines variation in enrollment by plan type and firm (Gold, Jacobson et al., 5/1). 

Urban Institute: The Best Evidence Suggests The Effects Of The ACA On Employment Will Be Small
There has been extensive debate over the potential effects of the ACA on the labor market. The recent CBO report has renewed the vigor of the debate and has led to some strong claims that the ACA will harm the economic recovery or even induce another recession. In this brief, we have put this debate in context, first by showing that the ACA is not a new, or a particularly different type of social program, and second by reviewing the most direct evidence of the likely effects of the ACA on the labor market. ... the ACA
is not ... a program with unusually large work disincentives. More importantly, the decline in employment in the ACA will most likely stem from voluntary choices of people not to work because of the access to health insurance benefits makes them better off, and not because employers demand fewer workers (Bowen Garrett and Robert Kaestner, 4/29).

JAMA Internal Medicine: Characteristics Of Medical Professional Liability Claims Against Internists 
From 1985 through 2009, of the 247 073 closed lawsuits reported to the [trade group] PIAA, 33 747 (13.7%) were attributed to internal medicine physicians; 8461 (25.1%) resulted in claims paid. The most common medical misadventure [alleged departures from the appropriate standard of care] causes for claims [are] errors in diagnosis (8925 [26.4%]), which involves alleged errors in diagnosing lung cancer, acute myocardial infarction, colon cancer, and breast cancer; no misadventure (8581 [25.4%]); improper performance of a procedure (3730 [11.1%]); and medication errors (2865 [8.5%]). ... these data confirm that internists are vulnerable to claims related to what they do commonly-;evaluation and management activities (medical histories and physical examinations)-;and for the commonly fatal diseases that they are expected to diagnose (Mangalmurti et al., 4/29).

UCLA Center for Health Policy Research: Asians Below State Average For Timely Mammograms
The large [California Health Interview Survey] sample and diversity of California's population permits calculating separate mammography rates for many Latina and Asian subgroups, revealing potential differences that remain invisible in most national data sets. Rates in routine breast cancer screening among Latina subgroups range from 73% for Latina Europeans to 83% for South American Latinas. ... however, [Latina Europeans'] rate was not statistically different from the state average. Among Asian women, only half of Korean women (52%) reported a mammogram in the past two years – significantly lower than all other Asian subgroups (72%) and significantly lower than all women in California (79.0%). ... These findings point to the need for programmatic interventions and incentives to support routine mammography for Korean women (4/30).

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

Vox: One In Seven Kidney Stone Patients End Up Back In The Hospital
At some point in their life, about 27 million people – 8.8 percent of the population – will have the unpleasant experience of passing a kidney stone. That makes the removal of a kidney stone one of the most basic, most common procedures in the United States – not the type of thing that you'd think would land you in the emergency room a few weeks later. Except it turns out that, after the extremely routine surgery, one in seven patients actually do make an unexpected trip back to the doctor – and that can cost upwards of $30,000. ... That's what [Duke University urologist Charles] Scales' new research, published Monday in the journal Surgery, did. Scales looked at a data set of 93,000 people who had had kidney stones removed or fragmented. He found that 14 percent had an unplanned trip back to the doctor within a month of their kidney stone procedure, where they either turned up at the emergency room or hospital admission (Kliff, 4/29).

Reuters: Caregivers Are Key In Protecting Kids' Dental Health
Many kids on Medicaid are not receiving dental care, and those who do often first show up with a dental emergency, according to a new study. Less than half of a group of four-year-olds the researchers followed had ever visited a dentist, and caregivers who neglected their own oral health tended to neglect that of their children too. "We know that both good oral health and dental problems tend to cluster and co-occur in families," said Kimon Divaris, who led the study at the UNC School of Dentistry at the University of North Carolina at Chapel Hill (Doyle, 4/24). 

Reuters:  One Third Of Americans Mixing Supplements With Meds:  Study
One in three adults in the U.S. is taking both prescription medications and dietary supplements, creating a risk for dangerous interactions, according to a new study. Multivitamins with added ingredients like herbs or fish oil were the most common form of supplement mixed with medications, researchers found (Jegtvig, 4/29).

Time: Nearly Half of US Deaths Can Be Prevented With Lifestyle Changes
Death is inevitable, but premature death can be prevented, say health officials. In its first report calculating the number of these deaths in the U.S. that can be avoided, researchers at the Centers for Disease Control (CDC) found that tens of thousands of lives can be saved, mostly by people making changes to their lifestyle. ... The analysis, published in the agency's Morbidity and Mortality Weekly Report, detailed deaths from the five leading causes -; heart disease, cancer, lower respiratory illnesses, stroke and unintentional injuries -; in each state. These accounted for 63% of deaths in the U.S. between 2008-2010, the latest years for which the data have been studied. When the investigators compared the mortality rates in the three states with the lowest number of deaths by age group to the recorded number of deaths for each of these causes in each state, they determined that up to 40% of them could be avoided (Park, 5/1).

The New York Times: Why Chocolate Is Good For Us
In recent years, large-scale epidemiological studies have found that people whose diets include dark chocolate have a lower risk of heart disease than those whose diets do not. Other research has shown that chocolate includes flavonols, natural substances that can reduce the risk of disease. But it hasn't been clear how these flavonols could be affecting the human body, especially the heart. New findings from Virginia Tech and Louisiana State University, however, suggest an odd explanation for chocolate's goodness: It improves health largely by being indigestible (Reynolds, 4/24).