Research Roundup: funding for safety net hospitals; competition from insurance -
Each week, KHN compiles a selection of studies and health policy briefs published recently
Health Affairs: . disproportionate-share payment may Hospital cuts threaten payments The financial stability of Safety-net hospitals
Safety-net hospitals rely on disproportionate share of the hospital (DSH) to help cover the costs and insufficient care not compensated by Medicaid .... the affordable care Act (ACA) provides that insurance expansion will increase the income of hospital safety net and reduce DSH payments accordingly. We examined the impact of Medicaid DSH cuts ACA Financial Stability California public hospitals .... decreases the costs of uncompensated care resulting from the expansion of the ACA insurance may not match the DSH reductions due to the high number of people who remain insured of the law, low Medicaid reimbursement rates, and inflation of medical costs. ... We estimate that the total cost DSH California public hospitals will increase from $ 2.044 billion in 2010 to $ 2.363- $ 2.503 billion in 2019, with costs of unmet DSH billions of $ 1.381- $ 1.537 (Neuhausen et al. , 6/2).
Annals of Internal Medicine: Medical Patient-Centered Home, electronic health records, and quality of care
The medical home (PCMH) model of primary care patient-centered is implemented widely although its effects on quality are not clear. The PCMH usually involves electronic health records (EHR), the change of organizational practice and payment reform. [The researchers sought to] compare the quality of care provided by physicians in PCMHs with those provided by physicians using paper medical records and, separately, with those provided by physicians using EHRs without PCMH .... The group PCMH improved significantly over time than either the group of paper or DSE group for 4 of the 10 measures (from 1 to 9 points percentage measure): eye exams and A1c hemoglobin testing in patients with diabetes, chlamydia screening and screening for colorectal cancer (adjusted P <0.05 for each). The chances of improving overall quality within the PCMH group were 7% higher than in the paper group and 6% higher than in the group of EHR (Kern, 6/3)
National Bureau economic research. More insurers lower premiums: evidence of initial pricing in health insurance markets
participation freshman insurer in the health insurance market (HIM) established by the Affordable Care Act is limited in many parts of the country. ... We study the impact of competition on premiums. We use the change of competition area-rating level induced by the decision of United Healthcare not to participate in one of [federally facilitated marketplaces] VPCM. We believe that the money bonus second lowest price (which is directly related to federal subsidies) would have decreased by 5.4 percent, on average, had participated United. If all insurers active on the market for individual insurance in each state in 2011 had participated in all evaluation areas in IT this state, we believe this key premium would be 11.1 percent less and 2014 grants federal would be reduced by $ 1.7 billion (Dafny, Gruber and Ody, 6/4)
National Bureau of economic research. ACA: Some Unpleasant Arithmetic Welfare
under the Affordable Care Act, between six and eleven million workers increase their disposable income by reducing their weekly working hours. About half of them would mostly do so by making eligible for federal aid ACA with Medicare premiums and out-of-pocket health costs, despite the fact that subsidized workers are not able to pay health premiums with pre-tax dollars. The rest would mainly by relieving employers of sanctions, or the threat of sanctions, as mandated by the employer of the ACA. Women, especially those who are not married, are more likely than men to have their short-term financial reward to a full-time job eliminated by the ACA. additional workers, beyond 6-11000000 could increase their disposable income using reduced hours to assemble one of the "cliff" that are part of the mapping of the ACA of household income for federal assistance ( Mulligan, March 2014).
Avalere Health: design delivery Analysis of Variations of money regime
both federal ease trade based on the state and offer financial assistance for registrants with lower incomes. The aid takes two forms: tax credits of advanced premium and cost sharing reductions (CSRS). This report focuses on CSR schemes that are available for individuals and families earning between 100% of the federal poverty level (FPL) to 250% FPL; ... The health insurers have great flexibility on how to adjust the sharing of costs for other services ... in fact, the plans vary greatly in how they affect cost sharing for each of the benefits examined in this analysis. ... For example, there is a tendency among issuers to systematically reduce medical franchises, while at the same time a little more than half of the plans to modify cost sharing for level four prescription drugs in CSR plans AV 94%. Given the continued flexibility granted issuers the design of CSR plans and the high proportion of registrants eligible for financial aid, stakeholders may wish to identify trends in the design of benefit plans and evaluate CSR accessibility of consumers heading into the plan year 2015 (. Brantley, Bray and Pearson, June 2014)
This is a selection of news coverage of other recent research:
the New York Times: study may change the approach to prostate cancer
many men with prostate cancer put off using chemotherapy as long as possible, fearing side effects. But a new study has found that men given chemotherapy early in treatment for advanced disease experienced a median of nearly 14 months longer than those who do not receive early chemotherapy. The result could upset the established management practice, researchers said here Sunday [at the annual meeting of the American Society of Clinical Oncology]. ... Another study presented Sunday found that drugs called aromatase inhibitors may be better than standard drug tamoxifen to prevent a recurrence of the disease in premenopausal women with early breast cancer (Pollack, 6/1).
The Associated Press: Doctors Use immune therapy against cancer of the cervix ago
Two years Arrica Wallace was riddled with tumors widespread cervical cancer chemotherapy and radiation the stronger could not fight back. Today, Kansas mother shows no signs of illness, and it was his own immune system which removed. The experimental approach that helped her was one of the last frontiers in the field of rapid advancement of cancer immunotherapy, which stimulates the natural pathways of the body to attack tumors. At a conference in Chicago on Monday, doctors have also reported gains ranging achieved recently with immune therapies against leukemia and skin cancer melanoma, bladder, lung and other tumor types (Marchione, 6/2).
Reuters: young Insured cancer patients do better, live longer: study
Young adults with cancer are much more likely to recover or live longer if they have health insurance, a new study on the potential impact of the Affordable Care Act shows. The study published Monday reported benefits for young people who were uninsured before the act, also known as Obamacare, entered into force this year (Steenhuysen, 6/2)
Reuters :. In the treatment of some patients with cancer, Less Is More: American studies
doctors can scale back treatment for some cancer patients, based on evidence that some drugs can be used less frequently, according to new information that opens the way for doctors to limit the risks of care. Several studies support the strategy "less-is-more", which can also reduce the cost of care, were presented Friday at the American Society of Clinical Oncology meeting in Chicago (Beasley, 5/30).
Modern Healthcare: Move to ICD-10 Will Hurt low-margin practice, a study
Pediatricians and other practices with low margins could take a significant financial hit during the transition to the procedural codes and ICD-10 diagnosis, according to a study in Pediatrics, the journal of the American Academy of Pediatrics. 68000 ICD-10 code system is intended to replace ICD-9 code system 14,000 1 October 2015. researchers from the University of Illinois at Chicago used the general equivalent mapping tool or CMS Gems, to "translate" ICD -9 codes ICD-10 in their most granular counterparts. They calculated that, for meetings of pediatric patients, payment and clinical data may be lost in about 8% of these translations (Robeznieks, 6/2)
Reuters :. Telemedicine Detects eye problems, doctors must prepare for other patients
Setting up a telemedicine screening option for patients in primary care clinics can catch a lot of potential eye problems early. But sending more patients to eye doctors, who need to be prepared for the influx, according to a new study of the administration of former Health Affairs. Researchers at the Atlanta VA Medical Center used two years of medical records to analyze what happened when retinal cameras were placed in primary care clinics to monitor eye problems related to diabetes. nurses trained abroad have used specialized cameras to take pictures of patients with diabetes retinas, which were then sent to an eye specialist or medical image analysis for readers (Doyle, 6 / 4).
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