Research roundup: Doctors' training; expanding FEHBP; the ACA and part-time work

Sep 8 2014

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

JAMA Internal Medicine: The Association Between Residency Training And Internists' Ability To Practice Conservatively
Growing concern about rising costs and potential harms of medical care has stimulated interest in assessing physicians' ability to minimize the provision of unnecessary care. Objective: To assess whether graduates of residency programs characterized by low-intensity practice patterns are more capable of managing patients' care conservatively ... Intensity of practice, [was] measured using the End-of-Life Visit Index, which is the mean number of physician visits within the last 6 months of life among Medicare beneficiaries 65 years and older … Regardless of overall medical knowledge, internists trained at programs in hospital referral regions with lower-intensity medical practice are more likely to recognize when conservative management is appropriate (Sirovich, Lipner, Johnston and Holmboe, 9/1).

Center for Health and Economy: Expanding FEHBP Plan Options
[T]he Obama Administration included in the President's FY2015 Budget a proposal ... to allow [the Office of Personnel Management] to contract with a fourth category of insurance [for federal workers] that includes any "additional health plan types." ... [This study] examines the impact of including preferred provider organization (PPO) plans. ... Under current law, the federal government pays 72 percent of the weighted average FEHBP plan cost, up to a maximum of 75 percent of the plan premium. ... if OPM focuses on adding lower-cost PPO plans to the program, the federal budget will see savings both through lower payments to insurance plans and diversion to less expensive health insurance plans (9/2).

Urban Institute: Little Evidence Of The ACA Increasing Part-Time Work So Far
There has been considerable public policy debate and media attention over the employment effects of the Affordable Care Act (ACA), and one of the most contentious issues has been whether the ACA has, or will, increase part-time work at the expense of full-time employment. ... We find a small increase in part-time work in 2014 ... however, [it] is not specific to the category of part-time work defined by the ACA (i.e., less than 30 hours per week), but applies to part-time work more broadly (also between 30 and 34 hours per week) .... These findings suggest that the increase in part-time work in 2014 is not ACA related, but more likely due to a slower than normal recovery of full-time jobs following the Great Recession (Garrett and Kaestner, 9/3).

American Health Policy Institute: The Health Care Employment Squeeze: Labor Day 2014 
The recent persistent lag in the U.S. labor force participation rate suggests that the U.S. economy must make additional strides in order to create sufficient levels of both supply and demand for labor. Unfortunately, the Health Care Employment Squeeze-;the pressures health care imposes on both the supply and the demand for labor – is making it difficult to get the U.S. labor force participation rate back on track .... The labor [force] participation rate problem has a number of causes. As this paper shows, though, health care policy is a key and often overlooked component of that challenge (Troy, Czekai and Wilson, 9/1).

JAMA Internal Medicine: Use Of Medical Consultants For Hospitalized Surgical Patients
As payers move toward bundled payments, understanding sources of variation, including use of medical consultants, is important. ... Observational retrospective cohort study [examined] fee-for-service Medicare patients undergoing colectomy or total hip replacement (THR) between January 1, 2007, and December 31, 2010, at US acute care hospitals. ... More than half of patients undergoing colectomy (91 684) or THR (339 319) received at least 1 medical consultation while hospitalized ....The likelihood of having at least 1 medical consultation varied widely among hospitals .... For colectomy, settings associated with greater use included nonteaching ... and for-profit .... Variation in use of medical consultations was greater for colectomy patients without complications ... compared with those with complications (Chen et al., 9/1).

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

Bloomberg: Medicaid Expansion Is A Windfall For Hospitals
Hospitals in states that expanded Medicaid have more paying customers, bolstering the bottom lines of for-profit hospital chains, a new analysis published on Wednesday shows. "For-profit health systems, operating more than 500 hospitals in the U.S., report far better financial returns through the first half of the year than expected," the report (PDF) from PricewaterhouseCoopers Health Research Institute found. One chain, LifePoint Hospitals (LPNT), reported a 30 percent drop in "self-pay" patients, whose care hospitals often write off as a loss (Tozzi, 9/4).

Reuters: Switching To 'Adult Doctor' Sometimes Hard For Kids With Chronic Illness
Chronically ill kids who "graduate" from their pediatrician to an "adult" doctor often feel dissatisfied with the transition, says a new study. Young patients who believed their "adult" doctors were "patient-centered" seemed to feel the most positive about their experience (Lehman, 9/2).

Reuters: Uninformed Breast Cancer Patients More Apt To Consider Removing The Other Breast, Too
More than half of women newly diagnosed with breast cancer consider removal of the second, unaffected breast to prevent cancer spread, and according to a new survey, they tend to have more anxiety and less knowledge about breast cancer than women who don't consider [contralateral prophylactic mastectomy] (Brooks, 9/3).

Reuters: Obesity Rates Reach Historic Highs In More U.S. States
Rates of adult obesity increased in six U.S. states and fell in none last year, and in more states than ever -- 20 -- at least 30 percent of adults are obese, according to an analysis released on Thursday. The conclusions were reported by the Trust for America's Health and the Robert Wood Johnson Foundation and were based on federal government data (Begley, 9/4).

The New York Times: Childhood Diet Habits Set In Infancy, Studies Suggest
Efforts to improve what children eat should begin before they even learn to walk, a series of nutritional studies published on Tuesday has found. Taken together, the data indicate that infant feeding patterns persist far longer than has been appreciated. ... The package of 11 studies was published in the journal Pediatrics and was funded by the Centers for Disease Control and Prevention and the Food and Drug Administration, among others. Investigators tracked the diets of roughly 1,500 6-year-olds, comparing their eating patterns to those observed in a study that followed them until age 1 (Saint Louis, 9/2).

The Associated Press: U.S. Eating Habits Improve, Except Among Poor, Study Shows
Americans' eating habits have improved-;except among the poor, evidence of a widening wealth gap when it comes to diet. Yet even among wealthier adults, food choices remain far from ideal, a 12-year study found. On an index of healthy eating where a perfect score is 110, U.S. adults averaged just 40 points in 1999-2000, climbing steadily to 47 points in 2009-10, the study found (9/1).