KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Research Roundup: Long-Term Care Needs; Publishing All Research Results; Surprise Bills

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

The New England Journal of Medicine: Future Of Long-Term Care And The Expanding Role Of Medicaid Managed Care
America faces a complex policy challenge that lies at the intersection of social welfare and health care: the 12 million people who cope with one or more chronic disabling conditions requiring them to use long-term services and supports (LTSS) (also called long-term care) must negotiate a patchwork of services to find assistance. Most of the care is provided by some 40 million unpaid family members or friends, 60% of whom hold jobs while also giving care, according to recent survey research. Of that number, about 11% (2.6 million workers) reported leaving their jobs by resigning, retiring, or taking a leave of absence because they could not afford paid care for their care recipient. This report is an overview of the major issues that surround LTSS, a complex sphere with an array of stakeholders. (Iglehart, 1/14)

Health Affairs: Transparency In Clinical Research
Reporting biases in the published literature -- whereby the results of research are inconsistently or selectively reported -- is a well-known phenomenon and has been a source of concern in the health care field since at least the 1980s, particularly in the realm of therapeutic drug trials. Despite several efforts over the ensuing decades to address this issue, it is estimated that up to half of all clinical trials conducted and completed have never had their results published. ... An oft-cited concern is how to ensure that patients' rights are adequately protected--in particular, how to share patient-level data without compromising privacy. ... Another key concern relates to the risk that trial data will be misused or improperly analyzed. (Richardson, 1/14)

Rand Corp./Journal of General Internal Medicine: Cost Of Transformation Among Primary Care Practices Participating In A Medical Home Pilot
We interviewed practice leaders in order to identify changes practices had undertaken due to medical home transformation. ... Practices incurred median one-time transformation-associated costs of $30,991 per practice (range, $7694 to $117,810), equivalent to $9814 per clinician ($1497 to $57,476) and $8 per patient ($1 to $30). Median ongoing yearly costs associated with transformation were $147,573 per practice (range, $83,829 to $346,603), equivalent to $64,768 per clinician ($18,585 to $93,856) and $30 per patient ($8 to $136). Care management activities accounted for over 60% of practices’ transformation-associated costs. ... The costs of medical home transformation vary widely, creating potential financial challenges for primary care practices—especially those that are small and independent. Tailored subsidies from payers may help practices make these investments. (Martsolf, 12/29)

The Kaiser Family Foundation: Medicaid Expansion Spending And Enrollment In Context: An Early Look At CMS Claims Data For 2014
CMS released preliminary spending and enrollment data from the [Medicaid Budget and Expenditure System] MBES that covers the period from January 2014 through December 2014. This period is of particular interest because these are the first quarters that the Medicaid expansion was in effect. ... Key findings from this data show: The new adult group represented a relatively small share (10%) of total Medicaid spending across all states in CY 2014. Looking at just expansion states, spending for the new adult group made up a slightly larger share (16%) total spending. ... Spending per enrollee for the new adult group is notably lower than spending per enrollee across all groups ($4,513 vs. $7,150.) (Snyder et al., 1/11)

The Kaiser Family Foundation: Surprise Medical Bills
“Surprise medical bill” is a term commonly used to describe charges arising when an insured individual inadvertently receives care from an out-of-network provider. ... Federal authority to track the incidence and impact of surprise medical bills exists but has not yet been implemented. Policy makers have considered and adopted various responses, yet tradeoffs are involved in protecting consumers from surprise bills. There is concern among some as to whether or how new consumer protections might affect insurance premiums. Establishing requirements both on what health plans must cover and on amounts that out-of-network providers can bill can limit the impact on premiums, though providers may balk at restrictions on how much they can charge. (Pollitz, 1/6)

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

Stat: Doctors Are Biased Against Patients. Is That A Problem?
Forty percent of physicians report that they’re biased against certain groups of patients, finds a new national survey from Medscape out Wednesday. Some of the factors that were reported to trigger bias: emotional problems, weight, language disparities, and insurance coverage. (Thielking, 1/13)

NBC News: Saving Lives: 2015 Was A Record Year For Organ Donations In The U.S.
More than 30,000 organs were transplanted in 2015 in the United States, the United Network for Organ Sharing reported Wednesday. And more than 15,000 people donated organs. Both numbers are records, UNOS says. "These trends are encouraging, and they make a huge difference not only for transplant recipients, but for many more people whose lives they touch," UNOS CEO Brian Shepard said. (Fox, 1/13)

Reuters: New U.S. Cancer Cases Holding Steady, Deaths Declining
The number of new cancer diagnoses in the U.S. is largely steady while the number of cancer deaths continues to decline, according to a new report from the nation's leading cancer advocacy group. This year, the U.S. will see nearly 1.7 million new cancer cases and nearly 600,000 cancer deaths, according to American Cancer Society projections published in CA: A Cancer Journal for Clinicians. (Seaman, 1/8)

NPR: Forget The Gizmos: Exercise Works Best For Lower-Back Pain
[Chris Maher, a physical therapist turned health researcher at the University of Sydney in Australia,] and his colleagues in Australia and Brazil wanted to know if there were approaches that would reduce people's risk of getting an episode of acute low-back pain. So they rounded up 21 studies done around the world, involving over 30,000 participants in total, on how to treat and prevent lower-back pain. While back belts and shoe insoles didn't seem to offer a benefit, they determined, exercise reduced the risk of repeated low-back pain in the year following an episode between 25 and 40 percent. It didn't really matter what kind of exercise — core strengthening, aerobic exercise, or flexibility and stretching. Their review was published Monday in JAMA Internal Medicine. (Bichell, 1/11)

Reuters: Delayed Deaths Declining Among Pediatric Cancer Survivors
It's long been known that cancer survivors -- people alive five years after diagnosis -- face a higher risk of premature death, and doctors have made efforts over the decades to reduce those deaths. A new study of childhood cancer cases suggests that the effort has been successful, at least to some degree. Most people "kind of assume that if you hit the five-year time point, you've beaten your cancer and the story's over," chief author Dr. Gregory Armstrong of St. Jude Children's Research Hospital in Memphis told Reuters Health by phone. "I think the first thing this paper does is show on a national scale that beyond five years there's a very significant risk of mortality. That should be a big wakeup call for most of the primary physicians who are taking care of these patients." (Emery, 1/14)

Reuters: Study Yields Clues To Explosions' Effect On Brain
Damage to the filter that protects the brain from toxins may partly explain why explosions have been leaving soldiers with lasting brain injuries, researchers say. In a study of U.S. veterans after hazardous tours in Iraq and Afghanistan, the researchers found that the higher the exposure to blasts, the lower the activity in a brain region called the cerebellum. The cerebellum is important for motor skills and also for emotions. Problems with irritability, mood and impulsivity are very common in veterans who suffer the kinds of mild traumatic brain injury that a blast can inflict, said study coauthor Dr. Elaine Peskind. (Seaman, 1/14)

Reuters: U.S. Girls, Women At Risk Of Genital Mutilation Has Tripled: Study
More than half a million women and girls in the United States live at risk of female genital mutilation, a threefold increase in recent years due to the rise in immigrants from countries where it is practiced, a government study said on Thursday. The number of U.S. women and girls who have undergone the actual procedures is unknown, however, due to a lack of reliable data, said the study by the U.S. Centers for Disease Control and Prevention (CDC). (Wulfhorst, 1/14)

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