Research roundup: Benefits of smaller practices; Rx price growth; fixing Medicare claims reviews

Aug 16 2014

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

GAO: Medicare Program Integrity: Increased Oversight And Guidance Could Improve Effectiveness And Efficiency Of Postpayment Claims Reviews
The Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) has taken steps to prevent its contractors from conducting certain duplicative postpayment claims reviews-;reviews of the same claims that are not permitted by the agency-;but CMS neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication. ... GAO recommends that CMS take actions to improve the efficiency and effectiveness of contractors' postpayment review efforts, which include providing additional oversight and guidance regarding data, duplicative reviews, and contractor correspondence. In its comments, the Department of Health and Human Services concurred with the recommendations and noted plans to improve CMS oversight and guidance (King et al, 8/13).

Health Affairs: Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions
It is often assumed that larger practices provide better care, although there is little evidence for or against this assumption. ... We conducted a national survey of 1,045 primary care–based practices with nineteen or fewer physicians to determine practice characteristics. ... Compared to practices with 10–19 physicians, practices with 1–2 physicians had 33 percent fewer preventable admissions, and practices with 3–9 physicians had 27 percent fewer. ... In an era when health care reform appears to be driving physicians into larger organizations, it is important to measure the comparative performance of practices of all sizes (Casalino, 8/13).

Altarum Institute: Health Care Price Growth Moderates
Health care prices in June 2014 were 1.7% higher than in June 2013, a tenth lower than the May year-over-year reading. ... Hospital price growth fell to 1.9% from 2.1% in May, and this was largely responsible for pushing the aggregate HCPI lower despite rapid prescription drug price growth. At 4.1% (up from 3.6% last month), it is the highest drug price growth reading since March 2012, and it follows negative growth as recently as July 2013. Price growth for the other categories showed little movement (8/7).

Health Affairs: More Than Half Of US Hospitals Have At Least A Basic EHR, But Stage 2 Criteria Remain Challenging For Most
The national effort to promote the adoption and meaningful use of electronic health records (EHRs) is well under way. However, 2014 marks an important transition: For many hospitals, penalties will be assessed in fiscal year 2015 for failing to meet federal meaningful-use criteria by the end of fiscal year 2014. We used recent data from the American Hospital Association Annual Survey of Hospitals-;IT Supplement to assess progress and challenges. EHR adoption among US hospitals continues to rise steeply: 59 percent now have at least a basic EHR. Small and rural hospitals continue to lag behind their better resourced counterparts. Most hospitals are able to meet many of the stage 2 meaningful-use criteria, but only 5.8 percent of hospitals are able meet them all (Adler-Milstein et al., 8/7).

Health Affairs: Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings
In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non–primary care specialties lagging behind others. Physicians' electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record (Furukawa, 8/7).

Rand Corp: The 340B Prescription Drug Discount Program
The 340B Drug Pricing Program is a federal program that allows specific categories of safety-net providers-;including some hospitals, clinics, and health centers-;to procure outpatient prescription drugs at discounted prices. ... The discussion surrounding 340B escalated to debate and often disagreement as provisions expanding eligibility for 340B were included in the 2010 Affordable Care Act (ACA). This RAND Perspective describes the purpose, history, and current implementation of the 340B program (Mulcahy, Armstrong, Lewis and Mattke, 8/12).

Employee Benefit Research Institute: Satisfaction With Health Coverage and Care: Findings From The 2013 EBRI/Greenwald & Associates Consumer Engagement In Health Care Survey
The overall satisfaction rate among consumer-driven health plan (CDHP) enrollees increased in most years of the EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS), while it decreased in most years among traditional enrollees. Differences in out-of-pocket costs may explain some of the differences .... In 2013, 44 percent of traditional-plan participants were extremely or very satisfied with out-of-pocket costs (for health care services other than for prescription drugs), while 20 percent of high-deductible health plan (HDHP) enrollees and 31 percent of CDHP participants were extremely or very satisfied. Satisfaction has been trending upward among CDHP enrollees (Fronstin, 8/13).

Kaiser Family Foundation: One Year into Duals Demo Enrollment: Early Expectations Meet Reality
July 2014 marks a year since the first beneficiaries dually eligible for Medicare and Medicaid began receiving services through one of the new financial alignment demonstrations. The demonstrations seek to maintain or decrease health care costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with significant disabilities. ... At this early stage of implementation, some initial insights about the demonstrations are beginning to emerge [including] the work required before the demonstrations were ready to start enrolling and providing services to beneficiaries has taken longer than anticipated (Musumeci, 8/13).

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

Medscape: Only 10% of Medicaid Enrollees' ED Use Is Unnecessary
Medicaid enrollees use emergency departments (EDs) more often than privately insured and uninsured people, but that use accounts for just 4% of total Medicaid spending, a literature review by the Medicaid and CHIP Payment and Access Commission (MACPAC) indicates. The review also found that only 10% of ED visits by nonelderly patients are for nonurgent reasons, which compares with the rate of use by privately insured patients. MACPAC researchers reviewed recent studies on ED use and did not find consistent links between Medicaid status and disproportionate ED use for nonemergency situations (Frellick, 8/11).

MedPage Today: Readmission Rates High In Lupus
One in six patients with lupus discharged from the hospital was readmitted within a month, with underserved minority populations being most vulnerable, researchers found. ... Compared with whites, the adjusted odds ratios for readmission were 1.18 for blacks and 1.12 for Hispanics, the researchers reported online in Arthritis & Rheumatology (Walsh, 8/11).

Medscape: Racial Disparity In CRC Screening Despite Similar Access
Colorectal cancer screening (CRC), particularly colonoscopy, is low in blacks, despite similar access to care across races, according to a Veterans Affairs (VA) healthcare system study published online March 25 and in the August issue of Gastrointestinal Endoscopy. "African Americans have the highest incidence and mortality from [CRC]," write Folasade P. May, MD, Mphil, from the Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, California, and colleagues. "Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, the CRC incidence remains high in this group" (Barclay, 8/11).

Reuters: Nonprofit Hospitals At A Tipping Point From Mounting Challenges
Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor's Rating Services. The rating agency warned the healthcare sector was at "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate (Respaut, 8/13).

Reuters: Many Meds Taken By Seniors Can Raise Risk Of Falls
Half of the 20 most commonly prescribed medications taken by older adults may raise the risk of falls, according to new research. Painkillers and antidepressants were most strongly tied to a greater likelihood of being injured in a fall, the study of 64,000 Swedes over age 65 found. Severe injuries were significantly more common with 11 out of the 20 medications studied (Kennedy, 8/12).

Medscape: 2 In 5 American Adults Will Develop Diabetes
About 40% of US adults will develop diabetes, primarily type 2, in their lifetime, and over 50% of some ethnic minorities will be affected, according to new research from the Centers for Disease Control and Prevention (CDC) and Emory University, Atlanta, Georgia, published online August 13 in Lancet Diabetes & Endocrinology. This is substantially higher than previous estimates that were based on incidence and mortality from the 1990s, say the researchers (Hackethal, 8/13).

Medscape: Physician Assistants More Than Double In A Decade
The number of certified physician assistants (PAs) grew 219% from 2003 to 2013, almost 6% alone during the last year of that decade, according to the 2013 Statistical Profile of Certified Physician Assistants published online by the National Commission on Certification of Physician Assistants (NCCPA). The number of certified PAs stood at 95,583 across the United States at the end of 2013, compared with 90,227 in 2012 and 43,500 in 2003. PAs practice in all 50 states and the District of Columbia, according to the NCCPA, the only certifying organization for PAs in the country (Hand, 8/12). 

Reuters: Dentists Miss Chances To Urge Patients To Quit Smoking 
Healthcare providers, particularly dentists, frequently miss opportunities to advise patients about ways to stop smoking cigarettes, a new study shows. Since 1996, the U.S. Public Health Service has been urging all healthcare workers to ask every one of their patients if they smoke and to counsel smokers to quit, said senior author Amy Ferketich, a professor at the Ohio State University College of Public Health in Columbus. But when she and her colleagues analyzed survey data from 2010, they found that less than 12 percent of smokers who visited a dental worker and only half of smokers who saw a doctor reported receiving guidance about how to break the habit (Cohen, 8/8).

Medscape: 'Vanished' In US, Sigmoidoscopy Saves Lives In Norway 
Screening with flexible sigmoidoscopy significantly reduces colorectal cancer (CRC) incidence and mortality, compared with no screening, a large randomized trial has found. The study results were published in the August 13 issue of JAMA. The findings from the Norwegian Colorectal Cancer Prevention Trial are not surprising. Three previous randomized clinical trials have reported similar results with sigmoidoscopy. The sum total of evidence is, however, "ironic" for clinicians in the United States, according to an accompanying editorial. "Screening by sigmoidoscopy has all but vanished" in the United States, writes editorialist Allan Brett, MD, professor of clinical internal medicine at the University of South Carolina in Columbia (Mulcahy, 8/12).