Research roundup: The effect of expensive cancer therapies; missed hospital handovers; children's mental health needs

Aug 4 2014

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

Health Affairs: Site-Neutral Payments
Medicare uses more than a dozen different payment systems to set payment rates for the medical items and services the program covers for beneficiaries. The location where a beneficiary receives a service determines which payment system applies. Each system has its own methodology for rate-setting reflecting costs of operating the setting and the different patient populations served in each. ... Recently, the Centers for Medicare and Medicaid Services (CMS) and the Medicare Payment Advisory Commission (MedPAC) have been exploring options to eliminate this differential payment for certain services. This brief explains the origins of these differential payments and the debate over approaches that have been proposed for developing so-called site-neutral payments (Cassidy, 7/24).

JAMA Otolaryngology–Head & Neck Surgery: Unintended Consequences Of Expensive Cancer Therapeutics-;The Pursuit Of Marginal Indications And A Me-Too Mentality That Stifles Innovation And Creativity
The use of expensive therapies with marginal benefits for their approved indications and for unproven indications is contributing to the rising cost of cancer care. We believe that expensive therapies are stifling progress by (1) encouraging enormous expenditures of time, money, and resources on marginal therapeutic indications and (2) promoting a me-too mentality that is stifling innovation and creativity. ... We discuss the economic realities that are driving this process and provide suggestions for radical changes to reengineer our collective cancer ecosystem to achieve better outcomes for society (Fojo, Mailankody and Lo, 7/28).

JAMA Internal Medicine: Morning Handover Of On-Call Issues
Handover is the process of transferring pertinent patient information and clinical responsibility between health care practitioners. Few studies have examined morning handover from the overnight trainee to the daytime team. ... A prospective, point-prevalence study was conducted in the general internal medicine wards of 2 tertiary care academic medical centers in Toronto, Ontario, Canada, in 2012 and 2013. Participants included on-call third-year medical students and first- and second-year residents. ... We identified 141 clinically important overnight issues during 26 days of observation. The on-call trainee omitted 40.4% of clinically important issues during morning handover and did not document any information in the patient's medical record for 85.8% of these issues. ... running the list patient-by-patient (ie, the entire team discusses each patient) and using a dedicated handover location positively correlated with handover of an issue taking place (Devlin et al., 7/21).

Employee Benefit Research Institute: Lifetime Accumulations And Tax Savings From HSA Contributions
In 2013, enrollment in HSA-eligible health plans was estimated to range from 15.5 million to 20.4 million policyholders and their dependents. Nearly 11 million accounts holding $19.3 billion in assets as of Dec. 31, 2013 were also estimated. ... HSAs provide account owners a triple tax advantage. Contributions to an HSA reduce taxable income. Earnings on the assets in the HSA build up tax free. And distributions from the HSA for qualified expenses are not subject to taxation. Because of this triple tax preference, some individuals might find using an HSA as a savings vehicle for health care expenses in retirement more advantageous from a tax perspective than saving in a 401(k) plan or other retirement savings plan. This paper examines the amount of money an individual could accumulate in an HSA over his or her lifetime. It also examines lifetime tax savings from HSA contributions. Limitations of an HSA are also discussed (Fronstin, 7/28).

The Kaiser Family Foundation: Financial And Administrative Alignment Demonstrations For Dual Eligible Beneficiaries Compared: States With Memoranda Of Understanding Approved By CMS
Using new authority in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) is launching demonstrations that seek to improve care and control costs for people who are dually eligible for Medicare and Medicaid. These three year demonstrations, implemented beginning in July 2013, are introducing changes in the care delivery systems through which beneficiaries receive medical and long-term care services. The demonstrations also are changing the financing arrangements among CMS, the states, and providers. As of July 2014, CMS has finalized memoranda of understanding (MOUs) with 12 states to implement 13 demonstrations .... This issue brief compares key provisions of the approved demonstrations (Musumeci, 7/24).

UCLA Center for Health Policy Research: Three Out Of Four Children With Mental Health Needs In California Do Not Receive Treatment Despite Having Health Care Coverage
More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health service use; however, this is not the case for children with mental health needs. This policy brief identifies children at risk for mental health needs and highlights some barriers to their receiving mental health services (Padilla-Frausto et al., 7/24).

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

Reuters: Too Few U.S. Youth Getting Vaccine For Sexually Transmitted Virus: CDC
More U.S. adolescents are receiving vaccines against the sexually transmitted virus that causes cervical and other types of cancer but vaccination rates for the infection remain too low, federal health officials said on [July 24]. In 2013, 37.6 percent of girls ages 13-17 got the recommended three doses of the vaccine against human papillomavirus (HPV), the Centers for Disease Control and Prevention said. That was up from 33.4 percent in 2012 but far short of the CDC's goal of an 80 percent vaccination rate, data showed (Beasley, 7/25).

Reuters: Medication Errors May Be Common After Hospital Discharge
More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them after being discharged from the hospital. Those with the lowest "health literacy" were among the most likely to make the risky errors, highlighting the importance of healthcare professionals making sure their instructions are clear and of patients being sure they understand what they need to do after they get home, the study authors say (Storr, 7/21).

MinnPost: Pre-Diabetes Diagnosis Has Little Value, Experts Say
Millions of people are being needlessly diagnosed with "pre-diabetes," putting them at risk of receiving "unnecessary" medical treatment and creating "unsustainable burdens" for health care systems, according to a commentary published last week in the journal BMJ. Written by Dr. Victor Montori, an endocrinologist who specializes in diabetes at the Mayo Clinic in Rochester, and Dr. John Yudkin, an emeritus professor of medicine at University College London, the commentary describes the dubious origins of the "pre-diabetes" label and its unreliable role as a predictor of who will go on to develop diabetes (Perry, 7/22).

Reuters: Tools For Planning End Of Life Care Are Varied And Untested, Study Says 
Many tools exist to help introduce people to the subject of advanced care planning, but they vary widely in what they offer and how accessible they are, according to a new research review. The authors found the tools that are most readily available often have not been vetted by formal studies, and the ones that have are often not accessible to the public or are specific to certain diseases (Doyle, 7/29).

JAMA: AAP: Toxic Stress Threatens Kids' Long-Term Health
Now, emerging data on how early exposure to adversity can impair long-term health and development have led the American Academy of Pediatrics (AAP) and other thought leaders to call for more effective and aggressive intervention for children in distress. In June, the AAP convened a symposium on the long-term dangers of childhood toxic stress-;early exposure to chronic unmitigated stress-;and urged pediatricians, policy makers, and federal agencies to develop a stronger national response. To facilitate these efforts, the AAP announced it will launch the Center on Healthy, Resilient Children to help pediatricians and others identify toxic stress in children and connect them with appropriate resources (Kuehn, 7/30).