Research Roundup: The Cadillac Tax; Patient-Centered Care; Medicare Advantage
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Physician Compare (Updated)
Measuring physician performance and quality of care is a critical component of the move to greater accountability and improved value in health care. ... The federal government significantly enhanced its presence in this realm with the launch in 2010 of Physician Compare, a website mandated by the Affordable Care Act (ACA). Additionally, in April 2015 a new law--the Medicare Access and CHIP Reauthorization Act (MACRA)--altered the landscape of physician quality measurement and payment beginning in 2019. MACRA accelerates Medicare's shift away from fee-for-service physician payment toward payment based on performance assessment, quality metrics, patient outcomes, and patient experience. ... This brief focuses on the rollout and evolution of Physician Compare .... An earlier version of this brief--pre-MACRA--was published in December 2014. (Findlay, 10/29)
Tax Preparation Services And ACA Enrollment Potential Contributions And Issues
We examine the ACA’s target population of consumers who were uninsured before the law’s main coverage provisions took effect in 2014. In every state, tax returns were filed for 56% or more of those who now qualify for Medicaid and 84% or more of those eligible for health insurance tax credits. The minority of tax preparers who help their clients apply for health coverage have developed several effective models. States could test the impact of measures to increase tax preparation services’ contribution to enrollment while guarding against unethical or incompetent conduct. Federal policy could also play an important role. (Dorn, Buettgens and Dev, 10/29)
Physician And Nurse Nighttime Communication And Parents’ Hospital Experience
We sought to examine relationships between nighttime communication and parents’ inpatient experience. ... [with] a prospective cohort study of parents .... Parents rated their overall experience, understanding of the medical plan, quality of nighttime doctors’ and nurses’ communication with them, and quality of nighttime communication between doctors and nurses. ... A total of 42.5% of parents reported a top overall experience .... top-rated overall experience scores were associated with higher scores for communication and experience with nighttime doctors ..., for communication and experience with nighttime nurses ... and for nighttime doctor–nurse interaction .... As hospitals seek to improve the patient-centeredness of care, improving nighttime communication and teamwork will be valuable to explore. (Khan et al., 10/26)
The ACA's "Cadillac" Tax Versus A Cap On The Tax Exclusion Of Employer-Based Health Benefits: Is This A Battle Worth Fighting?
In recent weeks, prominent business and labor groups and leaders across the political spectrum have called to repeal the “Cadillac tax,” which is an important source of funding for the ACA’s coverage expansion. This excise tax is similar in practical effect to a cap on the current-law tax exclusion of employer contributions to health insurance. ... Our analysis shows that the incidence of the ACA’s excise tax is identical in most circumstances to a cap on the employer exclusion that would raise the same revenue. ... Because capping the exclusion would have the same distributional effects regardless of employer benefit decisions and would be more progressive than the scenario in which employers choose to pay the excise tax, the cap might be the preferred option. (Blumberg, Holahan and Mermin, 10/22)
The Urban Institute:
The Road To Making Patient-Centered Care Real
Although patient-centered care is not new, increasing emphasis on quality measurement as part of health care reform has led to a renewed focus on it. The path to achieving patient-centered care is not always clear, even to those who believe in its importance. This paper informs a discussion of federal policies affecting patient-centered care. The authors recommend that (1) federal efforts toward patient-centered care be catalogued and scrutinized, (2) better measures and information on effective implementation are used, and (3) this intervention’s ability to enhance the doctor-patient bond is emphasized. (Millenson and Berenson, 10/16)
The Kaiser Family Foundation:
Medicare Advantage And Traditional Medicare: Is The Balance Tipping?
A growing share of Medicare beneficiaries have been enrolling in Medicare Advantage plans over the past decade, prompting some to question whether the balance between traditional Medicare and Medicare Advantage could be on the verge of tipping. Since 2006, the share of Medicare beneficiaries enrolled in a Medicare Advantage plan has nearly doubled, from 16 to 31 percent, but in some counties, the percentage is much higher. In this brief, we look beneath national trends to examine Medicare Advantage penetration rates and growth rates in counties across the country to assess the extent to which Medicare Advantage plans are poised to cover more beneficiaries than traditional Medicare across the country. (Neuman, Casillas and Jacobson, 10/20)
The Kaiser Family Foundation:
Medicaid's Role For People With Dementia
Most people with dementia have Medicare, but due to high out-of-pocket costs and lack of long-term services and supports (LTSS) coverage, low-income people with disabilities resulting from dementia may need Medicaid to fill in the coverage gaps. Medicaid plays an important role in providing LTSS and is increasingly focused on efforts to help seniors and people with disabilities remain in the community rather than reside in institutions. Given the expected growth of the elderly population over the coming decades6 and barring medical breakthroughs, a larger share of Americans likely will have dementia, which has implications for Medicaid coverage, delivery system design, financing, and quality monitoring. This fact sheet describes Medicaid’s role for people with dementia who live in the community. (Garfield et al., 10/19)
Here is a selection of news coverage of other recent research:
After Prostate Cancer Surgery, Blacks Have More Complications, Higher Costs
Older black men who have surgery for prostate cancer may have more complications and pay higher out-of-pocket costs than white men, a U.S. study suggests. Researchers focused on men with localized prostate tumors who would be good candidates for removal of the prostate gland, which is recommended for higher-risk cases. They didn’t find a difference in overall or cancer-specific survival based on race. (Rapaport, 10/27)
Do Men's Health Supplements Help Prostate Cancer Patients?
A new study finds no evidence that men's health supplements help prostate cancer patients. Although popular, such supplements do not appear to lower the risk for experiencing radiation treatment side effects; the risk that localized cancer will spread; or the risk that prostate cancer patients will die from their disease, researchers found. The study focused on supplement use among more than 2,200 men newly diagnosed with localized prostate cancer. (Mozes, 10/19)
Most E-Cigarette Users Are Current And Ex-Smokers, Not Newbies
It's become an emotional debate: Do e-cigarettes help people get off regular cigarettes or are they a new avenue for addiction? Until now, there has been little solid evidence to back up either side. But a new study from the Centers for Disease Control and Prevention could help fill that void. E-cigarettes work by heating up a fluid that contains the drug nicotine, producing a vapor that users inhale. The CDC found that nearly 48 percent of current tobacco smokers said they had tried e-cigarettes at least once. Among those who recently quit smoking, more than 55 percent said they'd tried the devices. (Stein, 10/28)
Doctors, Not Parents, Are The Biggest Obstacle To The HPV Vaccine
Vaccination rates against human papillomavirus have remained far lower than rates for other routine childhood and teen immunizations. But a big reason for those low rates comes from a surprising source. It's not hesitant parents refusing the vaccine. Rather, primary care doctors treat the HPV vaccine differently from other routinely recommended immunizations, hesitating to recommend it fully and on time and approaching their discussions with parents differently, a study finds. (Haelle, 10/22)
Even Doctors And Nurses Don’t Always Have Healthy Lifestyles
Even doctors and nurses don’t always follow the healthy lifestyle choices they recommend for patients to reduce the risk of medical problems like obesity, heart disease and diabetes, a U.S. study suggests. Although rates of these conditions appeared lower among health care workers than other people, the diseases were still common. They also rose over time at rates similar to increases in the general population, researchers reported in Mayo Clinic Proceedings. (Rapaport, 10/22)
Kaiser Reduces Complications After Surgery For Patients With Diabetes, Study Says
A study by Kaiser Permanente at its Sunnyside Medical Center in Clackamas found that monitored patients were more than twice as likely to have their blood sugar under control the day after surgery. They were also less likely to be readmitted to the hospital or be rushed to the emergency department with complications. (Terry, 10/27)
The Washington Post:
Sleep Study On Modern-Day Hunter-Gatherers Dispels Notion That We’re Wired To Need 8 Hours A Day
Modern life's sleep troubles — the chronic bleary-eyed state that many of us live in — have long been blamed on our industrial society. The city lights, long work hours, commutes, caffeine, the Internet. When talking about the miserable state of our ability to get enough rest, sleep researchers have had a tendency to hark back to a simpler time when humans were able to fully recharge by sleeping and waking to the rhythms of the sun. It turns out that may not be quite right. In fact, it now appears that our ancestors may not have been getting the doctor-recommended eight hours of sleep, either. (Cha, 10/16)
Regular Staph Kills More Babies Than 'Superbugs', Study Finds
Ordinary staph infections are just as likely to kill newborn babies as infections caused by a superbug, researchers reported Monday. ... They surveyed 48 neonatal intensive care units around the United States from 1997 through 2012 and found most staph infections — 72 percent of them — caused by ordinary Staphylococcus aureus germs. Just 28 percent were caused by the headline-generating methicillin-resistant Staphylococcus aureus or MRSA. In fact, more babies die from drug-susceptible staph than from MRSA. (Fox, 10/19)
Is Any Amount Of Alcohol Safe During Pregnancy?
While some research suggests that small amounts of alcohol may be harmless during pregnancy, a new report from a leading U.S. pediatricians' group warns that drinking is never a good idea for expectant moms. ... According to the paper, published online today in the journal Pediatrics, "there is no safe trimester to drink alcohol" and "all forms of alcohol, such as beer, wine, and liquor pose similar risk." (Welch, 10/19)
Got Back Pain? Narcotic Painkillers Won't Help, Study Says
Naproxen -- a drug available over-the-counter and by prescription -- appears to provide as much relief for low back pain as a narcotic painkiller or a muscle relaxant, a new study suggests. The study compared the use of prescription-strength naproxen (Naprosyn) alone to the use of naproxen with the narcotic painkiller oxycodone with acetaminophen (Percocet), or the muscle relaxant cyclobenzaprine (Amrix). Patients who took a combination of drugs fared no better than when they took naproxen alone, the researchers said. (Reinberg, 10/20)
Milwaukee Journal Sentinel:
Study: Two-Thirds Of New Cancer Drugs Not Found To Extend Life
Two-thirds of new cancer drugs in the past five years were approved not because they extended or improved life but based on so-called surrogate measures of effectiveness, such as scans showing tumor shrinkage, according to a paper published Monday in JAMA Internal Medicine. What's more, even four years after being allowed on the market by the U.S. Food and Drug Administration, many of the drugs still had not showed they were making people live longer, according to the paper, which closely echoes findings from a Journal Sentinel/MedPage Today investigation from last October. (Fauber, 10/19)
Can Infertility Point To Ovarian Cancer Risk?
A woman's need for fertility treatments may point to a higher risk of ovarian cancer, researchers reported Tuesday. A large study of women getting fertility help in Britain shows that those women had a 60 percent higher risk of developing the hard-to-treat cancer. (Fox, 10/20)