KHN Morning Briefing

Summaries of health policy coverage from major news organizations

full issue

Research Roundup: Hospital DNR Orders; Medicare Home Visits; Consumer Cost-Sharing

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

JAMA Internal Medicine: Association Of Do-Not-Resuscitate Orders And Hospital Mortality Rate Among Patients With Pneumonia
Hospital quality measures that do not account for patient do-not-resuscitate (DNR) status may penalize hospitals admitting a greater proportion of patients with limits on life-sustaining treatments. ... A retrospective, population-based cohort study was conducted among adults hospitalized with pneumonia in 303 California hospitals between January 1 and December 31, 2011. ... Without accounting for patient DNR status, higher hospital-level DNR rates were associated with increased patient mortality ..., corresponding to worse hospital mortality rankings. In contrast, after accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality ... with reversal of associations between hospital mortality rankings and DNR rates. (Walkey et al., 12/14)

Health Affairs: Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits
Clinical home visit programs for Medicare beneficiaries are a promising approach to supporting aging in place and avoiding high-cost institutional care. ... We evaluated UnitedHealth Group’s HouseCalls program, which has been offered to Medicare Advantage plan members in Arkansas, Georgia, Missouri, South Carolina, and Texas since January 2008. We found that, compared to non-HouseCalls Medicare Advantage plan members and fee-for-service beneficiaries, HouseCalls participants had reductions in admissions to hospitals (1 percent and 14 percent, respectively) and lower risk of nursing home admission (0.67 percent and 1.3 percent, respectively). In addition, participants’ numbers of office visits—chiefly to specialists—increased 2–6 percent (depending on the comparison group). The program’s effects on emergency department use were mixed. (Mattke, Han, Wilks and Sloss, 12/7)

NORC at University of Chicago/Commonwealth Fund: Consumer Cost-Sharing In Marketplace Vs. Employer Health Insurance Plans, 2015
Using data from 49 states and Washington, D.C., we analyzed changes in cost-sharing under health plans offered to individuals and families through state and federal exchanges from 2014 to 2015. ... We found cost-sharing under marketplace plans remained essentially unchanged from 2014 to 2015. Stable premiums during that period do not reflect greater costs borne by enrollees. Further, 56 percent of enrollees in marketplace plans attained cost-sharing reductions in 2015. However, for people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employer-based plans on average, while cost-sharing under gold plans is similar employer-based plans on average. (Gabel et al., 12/22)

Urban Institute/Robert Wood Johnson Foundation: How Much Do Marketplace And Other Nongroup Enrollees Spend On Health Care Relative To Their Incomes?
[W]e examine premiums and out-of-pocket costs, as well as total financial burdens for individuals with different characteristics enrolled in ACA-compliant nongroup coverage. ... individuals across the income distribution who are ineligible for Medicaid can still face very high expenditures. ... As medical care needs increase, however, financial burdens grow appreciably across the income distribution. Even with federal financial assistance, 10 percent of 2016 nongroup marketplace enrollees with incomes below 200 percent of FPL will pay at least 18.5 percent of their income toward premiums and out-of-pocket medical costs. Ten percent of marketplace enrollees with incomes between 200 and 500 percent of FPL will spend more than 21 percent of their income on health care costs. (Blumberg, Holahan and Buettgens, 12/21)

Rand Corp./Commonwealth Fund: Rethinking The Affordable Care Act’s “Cadillac Tax”: A More Equitable Way To Encourage “Chevy” Consumption
Employer spending on premiums is currently excluded from income and payroll taxes. Economists argue that this encourages overconsumption of health care, favors high-income workers, and reduces federal revenue. This issue brief suggests that the Cadillac tax is a “blunt instrument” for addressing these concerns because it will affect workers on a rolling timetable, does relatively little to address the regressive nature of the current exclusion, and may penalize firms and workers for cost variation that is outside their control. Replacing the current exclusion with tax credits for employer coverage that scale inversely with income might allow for regional adjustments in health care costs and eliminate aspects of the tax exclusion that favor high-income over low-income workers. (Nowak and Eibner, 12/18)

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

Reuters: Delayed Prescription Strategy Can Reduce Antibiotic Use
For uncomplicated respiratory infections, strategies that delay the patient’s pick-up or use of antibiotics can result in less antibiotic use with equal satisfaction, according to a new study. Patients who had to go pick up their prescriptions from the primary care office or who delayed taking the antibiotics experienced slightly greater symptoms for a slightly longer time during their illness than people who got antibiotics immediately, but all groups had similar satisfaction levels. (Doyle, 12/22)

Reuters: Even With Advanced Cancer, Many Patients Still Want To Work
Many patients with advanced cancer may still want to work, but symptoms from their disease or related treatment prevent them from doing so, a U.S. study suggests. The study focused on almost 700 adults aged 65 and under with metastatic cancer, meaning tumors had already spread to other parts of the body, and found that more than one-third of them continued to work after their diagnosis. But 58 percent of the patients in the study reported some change in employment due to illness, whether they scaled back hours or stopped working entirely. (Rapaport, 12/21)

Fox4KC (Kansas City, Mo.): Many Teen Girls Who Are Prescribed Medicines That Can Cause Birth Defects May Not Get Birth Control Counseling
Many medications can cause birth defects. That includes medicines that many teen girls take for conditions such as acne, seizures and migraines. Researchers at Children's Mercy Hospital wondered if girls 14 and older who are prescribed medicines that can cause birth defects get counseling from their health care providers about preventing pregnancy and get prescriptions for contraceptives. The researchers found that in many cases, they don't. At least there was no documentation of that. That means these teens could be at higher risk of pregnancy and having babies with birth defects. (McKean, 12/16)

The Philadelphia Inquirer: More With Early-Stage Prostate Cancers Choosing To Wait And See Before Surgery
After Bob Garraty's annual PSA blood test led to the diagnosis of a tiny, slow-growing prostate tumor, he opted to do something almost as stressful as getting treatment. He postponed it. Like a growing number of men, he chose "active surveillance" of his cancer. He had PSA blood tests plus physical exams every three months, and biopsies every year, in hopes that he would never need surgery or radiation -- and never risk treatment-related urinary and sexual problems. It didn't turn out quite that way. In October, after four years of surveillance, his biopsy revealed the cancer was turning more aggressive. To be safe, the 69-year-old workforce training consultant from the Harrisburg suburb of Hummelstown had prostate-removal surgery. (McCullough, 12/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.