Research roundup: Role of primary care in reducing readmissions; air transport for wounded soldiers; hospital prices

Jun 27 2014

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

JAMA Surgery: Early Primary Care Provider Follow-up And Readmission After High-Risk Surgery
Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. ... [In this study, early] follow-up with a PCP significantly reduced the risk of readmission among open [thoracic aortic aneurysm] patients who experienced perioperative complications, from 35.0% (without follow-up) to 20.4% (with follow-up). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4% with follow-up vs 21.9% without follow-up). In comparison, early follow-up with a PCP after [ventral hernia repair] did not reduce the risk of readmission, regardless of complications. ... Identifying high-risk surgical patients who will benefit from PCP integration during care transitions may offer a low-cost solution toward limiting readmissions (Brooke et al., 6/25).

JAMA Surgery: A Review Of The First 10 Years Of Critical Care Aeromedical Transport During Operation Iraqi Freedom And Operation Enduring Freedom
One of the unique aspects of the military medical care system that emerged during Operation Iraqi Freedom and Operation Enduring Freedom has been the opportunity to apply existing civilian trauma system standards to the provision of combat casualty care across an evolving theater of operations. [The study sought to] identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and to evaluate the capabilities of the Critical Care Air Transport Team (CCATT) and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. ... Rapid movement of critically injured casualties within hours of wounding appears to be effective, with a minimal mortality incurred during movement and overall 30-day mortality (Ingalls et al., 6/25).

Health Affairs: Risk Corridors
To buffer insurers from high losses in the initial years, keep premiums affordable, encourage insurers to participate in the exchanges, and minimize year-to-year premium fluctuations, the ACA authorized three premium stabilization programs: risk adjustment, reinsurance, and risk corridors. At the time the ACA was passed, risk corridors were noncontroversial. ... So it is perhaps surprising that risk corridors have proven to be a lightning rod for critics of the ACA. Critics claim that risk corridors amount to an insurer bailout. ... bills have been introduced in both chambers of Congress to eliminate the program. ... The changes to the risk corridor program may have an effect on insurers' decisions to participate in the exchanges and their ability to set premiums. Insurers must factor into their rates the possibility that the risk corridor program could incur a shortfall and payments may not be fully made in a given year. This would weaken the protection of the risk corridor program (Goodell, 6/26).

National Insitute for Health Care Reform: Location, Location, Location: Hospital Outpatient Prices Much Higher Than Community Settings For Identical Services
Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price for identical services provided in a physician's office or other community-based setting, according to a study by researchers at the former Center for Studying Health System Change (HSC). Using private insurance claims data for about 590,000 active and retired nonelderly autoworkers and their dependents, researchers found, for example, that the average price for magnetic resonance imaging (MRI) of a knee was about $900 in hospital outpatient departments compared to about $600 in physician offices or freestanding imaging centers. ... Moreover, across and within 18 metropolitan areas with substantial numbers of autoworkers, prices varied considerably between the two sites of care for a variety of services. For some simple laboratory tests, average hospital outpatient department prices were as much as eight to 14 times higher than average community-based lab prices in some metropolitan areas but less than 50 percent higher in other areas (Reschovsky and White, 6/26).

University of Pennsylvania/The Robert Wood Johnson Foundation: Deciphering The Data: Health Insurance Rates And Rate Review
Health insurers participating in the new Marketplaces are filing rates for 2015 during the next few months. A few states have already released data on proposed rates. There is substantial economic, policy, and political interest in the magnitude of proposed rate changes. This brief provides background for understanding the economic drivers of proposed rates, state and federal rate review authority, the effects of rate changes on Marketplace enrollees and federal spending on premium credits, and the economic and political dynamics of the rate review and approval process (Harrington and Weiner, June 2014).

The Kaiser Family Foundation: Visualizing Health Policy: Understanding The Effect Of Medicaid Expansion Decisions In The South
This Visualizing Health Policy infographic examines the effect of decisions by states in the South to implement or forgo the Affordable Care Act Medicaid expansion. It shows that Southerners are more likely than people living in other parts of the United States to be uninsured; that most Southern states have poverty rates above the national average; that without the Medicaid expansion (which most Southern states are not implementing), Medicaid eligibility levels for adults in the South remain low; that nearly 80% of the 4.8 million uninsured US adults who fall into the coverage gap live in the South; and that the coverage gap in the South disproportionately affects people of color (Stephens et al., 6/24). 

The Kaiser Family Foundation: Olmstead's Role In Community Integration For People With Disabilities Under Medicaid
June 2014 marks the 15th anniversary of the United States Supreme Court's landmark civil rights decision in Olmstead v. L.C., finding that the unjustified institutionalization of people with disabilities is illegal discrimination .... The Supreme Court's Olmstead decision has spurred progress toward community integration for people with disabilities, and the Medicaid program plays a key role in Olmstead implementation. Key trends in recent years include a continuing emphasis on deinstitutionalization, as well as efforts to provide services in the most integrated community setting, prevent institutionalization for beneficiaries at risk, increase opportunities for supported employment in the community, and eliminate disability-based discrimination that would otherwise prevent people with disabilities from participating in the community to the greatest extent possible (Musumeci and Claypool, 6/18). 

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

Modern Healthcare: Complicated, Confusing EHRs Pose Serious Patient Safety Threats
Confusing displays, improperly configured software, upgrade glitches and systems failing to speak to one another-;those are just a few electronic health record-related events that put patients in danger, according to a new study. The more complex an EHR system, the more difficult it may be to trace problems, patient safety experts warn. Hospitals planning to add new software or make updates should be strategic about changes and proactively include ways to monitor events (Rice, 6/20).

Modern Healthcare: Long-Term Dementia Care Poses Policy Challenges: RAND
The financial burdens associated with the long-term-care needs of patients with dementia will call for policies that address the heavy toll such demands put on middle-class families, according to a new study. Improving public and private funding mechanisms to aid families with the costs of caring for patients with dementia will be crucial as the prevalence of the illness increases in the coming years with the rise in elderly Americans, according to a RAND Corp. report released Monday (Johnson, 6/23).

Reuters: Death Or Immobility Often Follows Hip Fractures In Nursing Homes
Half of nursing home residents who have a hip fracture either die or lose the ability to walk on their own in the six months after the injury, according to a new study. Residents older than 90 and those who did not have surgery for the fracture were most likely to die or become completely disabled, researchers found (Doyle, 6/24).

The Wall Street Journal: Study: 3-D Scans More Accurate Than Standard Mammograms
Breast-cancer screening with three-dimensional imaging finds more invasive cancers and yields fewer false alarms than standard digital mammograms alone, according to a new study in the Journal of the American Medical Association. The study, funded largely by Hologic Inc., which makes the 3D-imaging equipment, comes amid growing debate about how often women should be screened for breast cancer, when they should start and what technology is best in which cases. While some radiologists hail 3-D mammography as more accurate, other experts say it isn't yet clear that the advantages outweigh the extra cost and the additional radiation exposure (Beck, 6/24).

The New York Times: Pediatrics Group To Recommend Reading Aloud To Children From Birth
In between dispensing advice on breast-feeding and immunizations, doctors will tell parents to read aloud to their infants from birth, under a new policy that the American Academy of Pediatrics will announce ... With the increased recognition that an important part of brain development occurs within the first three years of a child's life, and that reading to children enhances vocabulary and other important communication skills, the group, which represents 62,000 pediatricians across the country, is asking its members to become powerful advocates for reading aloud, every time a baby visits the doctor (Rich, 6/24).