Research Roundup: Drug Costs In Medicare; Impact Of Anticancer Drugs; Doctors’ Time
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Health Affairs:
Medicare Beneficiaries Face Growing Out-Of-Pocket Burden For Specialty Drugs While In Catastrophic Coverage Phase
The Affordable Care Act (ACA) includes provisions to reduce Medicare beneficiaries’ out-of-pocket spending for prescription drugs by gradually closing the coverage gap between the initial coverage limit and the catastrophic coverage threshold (known as the doughnut hole) .... However, Medicare beneficiaries who take specialty pharmaceuticals could still face a large out-of-pocket burden because of uncapped cost sharing in the catastrophic coverage phase. ... we analyzed trends in total and out-of-pocket spending among Medicare beneficiaries who take at least one high-cost specialty drug .... Annual total drug spending per specialty drug user studied increased considerably ... from $18,335 to $33,301, and the proportion of expenditures incurred while in the catastrophic coverage phase increased from 70 percent to 80 percent. (Trish, Xu and Joyce, 9/7)
Health Affairs:
New Anticancer Drugs Associated With Large Increases In Costs And Life Expectancy
Spending on anticancer drugs has risen rapidly over the past two decades. A key policy question is whether new anticancer drugs offer value, given their high cost. Using data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, we assessed the value of new cancer treatments in routine clinical practice for patients with metastatic breast, lung, or kidney cancer or chronic myeloid leukemia in the periods 1996–2000 and 2007–11. We found that there were large increases in medical costs, but also large gains in life expectancy. (Howard et al., 9/7)
Annals of Internal Medicine:
Allocation Of Physician Time In Ambulatory Practice: A Time And Motion Study In 4 Specialties
[This was a] direct observational time and motion study ... [of] 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries. ... During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks. ... For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. (Sinsky et al., 9/6)
JAMA Pediatrics:
Effects Of Social Needs Screening And In-Person Service Navigation On Child Health
Social determinants of health shape both children’s immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. ... Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers’ reports of social needs and child health status. ... The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items .... At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm .... In addition, caregivers in the intervention arm reported significantly greater improvement in their child’s health. (Gottlieb et al., 9/6)
Commonwealth Fund:
A “Volatile Marketplace”: Second Quarter Earnings Calls Offer Glimpse Of How Insurers Are Faring On ACA Marketplaces—And What 2017 Might Bring
As they did in Q1, several companies reported losses on their individual market business, both on and off the marketplaces. Not surprisingly, United, which announced its departure from most ACA marketplaces earlier this year, reported continued losses. ... Centene and Molina attributed their financial success in this market in part to their strategy of targeting the lowest-income marketplace enrollees, some of whom may experience fluctuations in income that move them above or below the income threshold for Medicaid eligibility. Both companies have considerable experience in the Medicaid markets. ... Further, their targeted enrollees are the most heavily subsidized, making them more likely to enroll and less likely to drop their plans than those who must pay a higher proportion of the premium and cost-sharing. (Corlette, Lucia and Curran, 9/6)
The Kaiser Family Foundation:
The Status Of Funding For Zika: The President’s Request And Congressional Proposals
As Congress returns from recess this September and is expected to once again consider funding for Zika, this brief compares funding in the President’s emergency Zika request to the Congressional bills that have been proposed thus far. Specifically, it looks at the President’s February 22nd request compared to House and Senate bills that passed each chamber in May and a Conference Agreement that was approved by the House in June but blocked in the Senate and opposed by the Administration. (Wexler, Oum and Kates, 9/6)
Here is a selection of news coverage of other recent research:
Reuters:
Gluten-Free Diet Becoming More Common Even If Celiac Disease Isn't
More people in the U.S. are on gluten-free diets even though the proportion of Americans with celiac disease held steady from 2009 to 2014, according to a new study. Despite the fact that gluten-free diets are not known to provide any health benefits for the general population, some people believe they benefit from going gluten-free, said lead author Dr. Hyunseok Kim, of Rutgers New Jersey Medical School in Newark. (Seaman, 9/6)
Reuters:
Perceptions Of Pregnancy During Medical Training Are Changing
Trainee doctors are finding a more supportive attitude from superiors and colleagues toward their pregnancies, a small study suggests. In the U.S., women entering medicine face many barriers to childbearing, including a persistent negative stigma surrounding pregnancy during years-long training programs, said senior author Dr. Marissa Tenenbaum of Washington University School of Medicine in St. Louis, Missouri. (Doyle, 9/5)
Reuters:
Hospice Care Improves Patient Experience
A new study adds to evidence that hospice care during the last six months of life is associated with better overall experiences for patients and a lower likelihood of dying in a hospital. “Consistent with other studies demonstrating benefit, the use of hospice care is associated with better quality-of-care outcomes, including patient-centered care metrics,” study leader Ruth Kleinpell and colleagues write in the journal BMJ Supportive and Palliative Care, online August 16. (Thrasybule, 9/2)