Research Roundup: Doctors’ Financial Incentives When Ordering Stress Tests
Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.
New England Journal Of Medicine: Full Coverage For Preventive Medications After Myocardial Infarction – The researchers examined whether drug costs for heart attack patients affects health. Half of a group of more than 5,000 patients were given prescription coverage that eliminated co-payments and expanded drug choices. The others had "usual prescription coverage." The study found that while the patients in the complete coverage group had fewer heart attacks, strokes and hospitalizations, they were no less likely to die from a second heart attack or to need bypass surgery. Importantly, researchers noted that even though patients were somewhat more likely to take medicine if they didn't have to pay for it, "less than half of patients in the full-coverage group were fully adherent to their prescribed therapies" (Choudhry et. al, 11/14).
Journal of the American Medical Association: Association Between Physician Billing And Cardiac Stress Testing Patterns Following Coronary Revascularization -- The American College of Cardiology recommends that bypass patients wait five years after surgery for routine stress tests and that angioplasty patients wait two years. However, the researchers examined insurance billing information for more than 17,000 patients and found that 12 percent of patients who had a cardiac follow-up outpatient visit at least three months after the procedure had a stress test within 30 days. They found that "patients treated by practices who billed for the technical and professional fees were significantly more likely to order nuclear stress imaging after revascularization relative to those who did not directly bill for these tests" (Shah et. al, 11/9).
Kaiser Family Foundation/Actuarial Research Corporation: Restructuring Medicare's Benefit Design: Implications for Beneficiaries And Spending -- The authors examined several deficit-reduction plans and projected "what would happen if Medicare's current benefit design were replaced with a unified deductible of $550; 20 percent coinsurance on most Medicare-covered services; and a $5,500 annual limit on out-of-pocket spending." They found that "restructuring Medicare's cost sharing is expected to raise costs for most beneficiaries but reduce spending for some of the sickest. The study also illustrates how changes in out-of-pocket spending are greatly influenced by beneficiaries' medical needs and supplemental coverage" (Cubanski, Brenner et. al, 11/15).
Annals Of Internal Medicine: The Cost-Effectiveness Of Birth-Cohort Screenings For Hepatitis C Antibody In U.S. Primary Care Settings – Experts estimate that more than 4 million Americans test positive for the hepatitis C virus but most don't know they are infected. The infection is most common among adults born from 1945 through 1965, and generally doctors test only those people who engaged in behaviors that could have led to infection, such as intervenous drug use. Researchers found that if everyone in that age group were tested as part of primary care, and treated if they tested positive, lives would be saved and it would be cost-effective (Rein et. al, 11/4).
The Commonwealth Fund: Realizing Health Reform’s Potential: State Trends In Premiums And Deductibles, 2003-2010: The Need For Action To Address Rising Costs -- The rate of employer-based insurance premiums and deductibles increased by 50 percent across all states from 2003 to 2010. This issue brief looks at the impact of these increases on employers, the uninsured, families and individuals. It also determines what kind of impact the Affordable Care Act will have on premiums and deductibles (Schoen et. al., 11/17).
Related, from KHN: Health Insurance Premiums Soar In All 50 States (Gold, 11/17)
Urban Institute: How Human Services Programs And Their Clients Can Benefit From National Health Reform Legislation -- The author of this brief writes that the health law can "(a) help health programs efficiently reach eligible consumers; (b) access unprecedented, time-limited federal funding for modernizing eligibility computer systems while limiting risks to current funding; (c) keep social services offices available as an avenue for seeking health coverage; and (d) use a forthcoming Medicaid expansion to accomplish core human services goals related to employment and child development" (Dorn, 11/10).
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.