Research Roundup: Local Health Resources; Plan Losses; Medicare Advantage Networks
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Morbidity and Mortality Weekly (CDC):
Assessment Of Staffing, Services, And Partnerships Of Local Health Departments — United States, 2015
Beginning in 2008, the National Association of County and City Health Officials (NACCHO) periodically surveyed local health departments (LHDs) to assess the impact of the economic recession on jobs and budgets .... Overall [in 2015], LHDs reported 3,400 jobs lost; 25% of LHDs reported budget decreases; 36% reported a reduction in at least one service area; and 35% reported serving fewer patients in clinics [compared to 2014]. In addition, up to 24% of LHDs reported expanding population-based prevention services, and LHDs reported exploring new collaborations with nonprofit hospitals and primary care providers (PCPs). ... Since 2008, LHDs have collectively lost 51,700 jobs because of layoffs and attrition. For many LHDs, the cumulative effects of budget cuts and job losses experienced during and after the recession have not been reversed as the economy recovered. (Newman et al., 7/1)
Association Between Trauma Center Type And Mortality Among Injured Adolescent Patients
Although data obtained from regional trauma systems demonstrate improved outcomes for children treated at pediatric trauma centers (PTCs) compared with those treated at adult trauma centers (ATCs), differences in mortality have not been consistently observed for adolescents. ... Among 29 613 injured adolescents ..., most were treated at ATCs (20 402 [68.9%]), with the remainder at MTCs [mixed trauma centers] (7572 [25.6%]) or PTCs (1639 [5.5%]). ... Mortality among injured adolescents was lower among those treated at PTCs, compared with those treated at ATCs and MTCs. (Webman et al., 6/27)
George Mason University Mercatus Center:
Affordable Care Act Turmoil
This study presents data from the 174 insurers that offered qualified health plans (QHPs)—plans that satisfy the ACA requirements and are certified to be sold on exchanges—in both the individual and small group markets in 2014. QHPs in both markets are essentially the same and are governed by nearly identical regulations, making possible a better-controlled analysis of the performance of insurers participating in the two markets. Average medical claims for individual QHP enrollees were 24 percent higher than average medical claims for group QHP enrollees. Moreover, average medical claims for individual QHP enrollees were 93 percent higher than average medical claims for individual non-QHP enrollees. As a result, insurers made large losses on individual QHPs despite receiving premium income that was 45 percent higher for individual QHP enrollees than for individual non-QHP enrollees. (Blase et al., 6/28)
The Kaiser Family Foundation:
Modifying Medicare's Benefit Design: What's The Impact On Beneficiaries And Spending?
Proposals to modify the benefit design of traditional Medicare have been frequently raised in federal budget and Medicare reform discussions .... Typically, benefit design proposals include a single deductible for Medicare Part A and B services, modified cost-sharing requirements, and a new annual cost-sharing limit, combined with restrictions on “first-dollar” Medigap coverage. ... This report examines the expected effects of four options to modify Medicare’s benefit design and restrict Medigap coverage .... Proposals to modify the benefit design of traditional Medicare have the potential to decrease—or increase—federal spending and beneficiaries’ out-of-pocket spending, depending upon the specific features of each option. These options can be designed to maximize federal savings, limit the financial exposure of beneficiaries, or target relief to beneficiaries with low-incomes, but not simultaneously. (Cubanski et al., 6/29)
The Kaiser Family Foundation:
Medicare Advantage Hospital Networks: How Much Do They Vary?
This report, the first broad-based study of Medicare Advantage networks, takes an in-depth look at plans’ hospital networks, examining their size and composition. The analysis draws upon data from 409 plans, including 307 HMOs and 102 local PPOs, serving beneficiaries in 20 diverse counties that together accounted for about one in seven (14%) Medicare Advantage enrollees nationwide in 2015. Key findings include: On average, Medicare Advantage plan networks included about half (51%) of all hospitals in their county. Most plans (80%) included an Academic Medical Center in their network, but one in five did not. Two in five plans in areas with an NCI-designated cancer center did not include the center in their networks. Almost one-quarter (23%) of Medicare Advantage plans in our study had broad hospital networks in 2015. About one in six plans (16%) had narrow or ultra-narrow networks. (Jacobson et al., 6/20)
Here is a selection of news coverage of other recent research:
Doctors Less Satisfied, More Burned Out With Electronic Records
Most doctors who use electronic health records and order entry software tend to be less satisfied with how much time they spend on clerical tasks and are at higher risk of burnout than others, according to a new study. Electronic health records – EHR for short - are “focused on documentation for billing as opposed to efficient and effective documentation of clinical care,” said Dr. Ann O’Malley of Mathematica Policy Research in Washington, D.C., who was not part of the new study. This makes the EHR less useful for actual patient care, which can be frustrating for doctors, she told Reuters Health by email. (Doyle, 6/28)
As Walking Movement Grows, Neighborhood Walkability Gains Attention
[T]oday there are almost 250 Walk with a Doc chapters around the country, with roughly 3000 physicians and other health professionals and more than 200 000 community members participating in regular group walks. “We look at it almost like a bonfire on a beach that has continued to grow,” said [Dr. David] Sabgir, who today sees heart patients at Mount Carmel St Ann’s Hospital outside Columbus. Many of the group’s doctors and community members are starting to advocate for “walkability” improvements in their neighborhoods, Sabgir said. (Abbasi, 6/29)
Racially Biased Cancer Doctors Spend Less Time With Black Patients
Racial bias on the part of a doctor can lead to poor communication and medical treatment for black cancer patients, a U.S. study suggests. Researchers who analyzed video-recorded discussions between oncologists and African-American patients found that biased doctors spent less time with patients, and patients had a harder time remembering the contents of the conversation. (Doyle, 6/24)