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Translating Research For Health Policy: Researchers’ Perceptions And Use Of Social Media

June 13, 2014 Comments off

Translating Research For Health Policy: Researchers’ Perceptions And Use Of Social Media
Source: Health Affairs

As the United States moves forward with health reform, the communication gap between researchers and policy makers will need to be narrowed to promote policies informed by evidence. Social media represent an expanding channel for communication. Academic journals, public health agencies, and health care organizations are increasingly using social media to communicate health information. For example, the Centers for Disease Control and Prevention now regularly tweets to 290,000 followers. We conducted a survey of health policy researchers about using social media and two traditional channels (traditional media and direct outreach) to disseminate research findings to policy makers. Researchers rated the efficacy of the three dissemination methods similarly but rated social media lower than the other two in three domains: researchers’ confidence in their ability to use the method, peers’ respect for its use, and how it is perceived in academic promotion. Just 14 percent of our participants reported tweeting, and 21 percent reported blogging about their research or related health policy in the past year. Researchers described social media as being incompatible with research, of high risk professionally, of uncertain efficacy, and an unfamiliar technology that they did not know how to use. Researchers will need evidence-based strategies, training, and institutional resources to use social media to communicate evidence.

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Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

February 4, 2014 Comments off

Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs
Source: Health Affairs

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care. High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins. Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates. Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

How Will Federal Medicaid Payments To States In 2015 Be Affected By New Personal Income Data?

October 10, 2013 Comments off

How Will Federal Medicaid Payments To States In 2015 Be Affected By New Personal Income Data?
Source: Health Affairs

The release of per capita state personal income data by the Bureau of Economic Analysis (BEA) on September 30, 2013, permits the calculation of Federal Medical Assistance Percentages (FMAPs) for federal fiscal year (FY) 2015. These income data are the first state-level data from BEA reflecting its recent comprehensive revisions (“benchmarking”)—adjusting concepts, statistical techniques and presentations—in the National Income and Product Accounts (NIPAs). Such revisions serve BEA’s mandate to track gross domestic product (GDP) and income (GDI). Though the income data revisions have little direct relevance for Medicaid and state government finance, they will drive changes in FMAPs and therefore Medicaid grants to states, both in FY 2015 and beyond.

Twenty-one states will see their FMAPs increase in FY 2015 and seventeen will see them decline. The biggest increases will be for Missouri (+1.42), Nevada (+1.26), Arizona (+1.23), and Colorado and Georgia (each +1.01). The biggest declines will be experienced by Iowa (-2.39), South Dakota (-1.90), Oklahoma (-1.72), Pennsylvania (-1.70) and Delaware (-1.68). These changes reflect the combined impacts of actual economic shifts, annual data adjustments and the comprehensive revisions.

What Types Of Hospitals Have High Charge-To-Reimbursement Ratios?

July 17, 2013 Comments off

What Types Of Hospitals Have High Charge-To-Reimbursement Ratios?
Source: Health Affairs

Recently, the Centers for Medicare & Medicaid Services (CMS) released the average value of hospital billed charges and their corresponding Medicare reimbursed rates for the 100 most common diagnosis related groups (DRGs). The release included data for each Medicare-eligible hospital with eleven or more discharges for the specific DRG in the year 2011. This represents information on 3,337 different hospitals with an average of 48.9 different DRGs (SD=31.3) per institution. On average, hospitals billed Medicare 3.77 times (standard deviation = 1.83) what they were actually reimbursed, with a range of 0.42 to 16.23.

While the difference between charges and reimbursement rates is well known, little has been written about the characteristics of hospitals associated with these factors. This post evaluates hospital characteristics as they relate to higher charged rates compared to actual reimbursed rates for the Medicare population. Hospitals that charge more tend to be affiliated with a hospital system, located in urban areas, and investor-owned, while hospitals that charge less tend to be small, unaffiliated, government-owned entities located in rural areas.

Premium Assistance in Medicaid

June 8, 2013 Comments off

Premium Assistance in Medicaid
Source: Health Affairs

States have proposed using expansion funds to buy private coverage for Medicaid beneficiaries through the new health insurance exchanges.

What’s The Issue?

Nearly a year after the US Supreme Court’s June 2012 decision declaring the Affordable Care Act’s (ACA’s) Medicaid expansion optional, states continue to grapple with whether or not to pursue the option for newly eligible populations. Although the Medicaid expansion accounted for about half the total number of people projected to gain coverage under the ACA, many states to date have declined to expand Medicaid or are leaning toward rejecting the option because of cost and political concerns. But the long-term consequences of denying the Medicaid expansion, especially large coverage gaps for millions of low-income people, are also prompting some states to consider novel alternatives for extending Medicaid under the ACA.

One approach that has piqued states’ interest is using the additional federal funds as “premium assistance” for eligible Medicaid beneficiaries to purchase private coverage through the law’s new health insurance exchanges.

This middle ground or “private option” appears more politically tenable for states led by conservative lawmakers intent on moving more people into the private market. Proponents of the Medicaid premium assistance option also tout it as a potential path to lowering Medicaid spending, perhaps driving down private exchange costs over time and reducing the cyclical movement of beneficiaries between Medicaid and the exchanges based on their fluctuating incomes.

Skeptics of premium assistance contend the option is less attractive than first thought. States must show that the novel model is cost-effective compared to enrolling people in Medicaid. They must also ensure that the coverage provided through exchange plans is consistent with federal Medicaid requirements, including the scope of benefits provided and cost sharing. Another hurdle is that both states’ legislatures and the federal government have to approve states’ premium assistance plans.

This policy brief examines a range of policy issues surrounding premium assistance using Medicaid expansion funds and next steps for states.

The Aligning Forces For Quality Experience: Lessons On Getting Consumers Involved In Health Care Improvements

June 6, 2013 Comments off

The Aligning Forces For Quality Experience: Lessons On Getting Consumers Involved In Health Care Improvements

Source: Health Affairs

Aligning Forces for Quality is the Robert Wood Johnson Foundation’s signature effort to improve the overall quality of health care in targeted communities, reduce racial and ethnic disparities in care, and provide models for national reform. Activities in each of the sixteen Aligning Forces for Quality alliance communities are guided by a multistakeholder alliance of consumers, providers, and payers. To achieve goals established at the national and local levels, the alliances integrate local consumers into governance and decision making, program design and implementation, and information dissemination efforts. This article describes how the Aligning Forces for Quality investments have evolved since the initiative’s launch in 2006 and offers some early lessons learned. Individual alliances have engaged consumers in numerous capacities, from serving on dedicated consumer advisory boards to representing the consumer’s perspective in the design of public reports of providers’ quality. The alliances’ ongoing and mindful inclusion of consumers provides insights into eliciting and applying their perspectives in the pursuit of improved health care quality, value, and transparency.

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002– 09

May 31, 2013 Comments off

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09 (PDF)

Source: Health Affairs

Many immigrants in the United States are working-age taxpayers; few are elderly beneficiaries of Medicare. This demographic profile suggests that immigrants may be disproportionately subsidizing the Medicare Trust Fund, which supports payments to hospitals and institutions under Medicare Part A. For immigrants and others, we tabulated Trust Fund contributions and withdrawals (that is, Trust Fund expenditures on their behalf) using multiple years of data from the Current Population Survey and the Medical Expenditure Panel Survey. In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.

Immigration Reform: A Long Road to Citizenship and Insurance Coverage

April 17, 2013 Comments off

Immigration Reform: A Long Road to Citizenship and Insurance Coverage

Source: Health Affairs

The 2012 presidential election transformed the national debate regarding unauthorized immigrants and US immigration policy in general. There had long been strong political resistance, especially among Republicans, to legalizing unauthorized immigrants. But on Election Day 2012, Latino voters turned out in large numbers, affecting the results in Florida and several Southwestern states and helping propel President Barack Obama to reelection. Republican losses in key states were attributed in part to voters’ perceptions that the party’s rhetoric on immigration had been too harsh. Almost overnight, immigration reform seemed to rise from the bottom to the top of Washington’s policy agenda.

No one has more at stake in this development than the estimated 11 million unauthorized immigrants in the United States.1 As of 2007 almost 60 percent of unauthorized immigrants lacked health insurance, and they accounted for about one-seventh of the country’s uninsured population.2,3

Yet as the Affordable Care Act is fully implemented, and millions of people gain access to coverage through new private insurance options or an expanded Medicaid program, under the law unauthorized immigrants will still be frozen out. Legally present immigrants without permanent resident status, such as students and temporary workers, will also be excluded from Medicaid, as will adults and, in some states, children who have been permanent residents for fewer than five years.

Adapting Standards: Ethical Oversight of Participant-Led Health Research

March 18, 2013 Comments off

Adapting Standards: Ethical Oversight of Participant-Led Health Research

Source: PLoS Medicine

Summary Points

  • Online social media and digital technologies have facilitated formation of communities of individuals engaged in establishing and conducting health research projects. The results of such participant-led research (PLR) have already appeared in leading biomedical journals.
  • These projects involve research with human participants. Hence, what are the requirements for ethical oversight? To what extent is standard ethics review also suitable for PLR?
  • A comparison of PLR with standard research reveals six areas that are of potential relevance to ethical oversight: institutionalization, state recognition and support, incentive structures, openness, bottom-up approach, and self-experimentation.
  • The distinctive nature of PLR requires adaptation of ethical oversight standards to the character of such research. These should strike a balance between protecting interests of research participants and achieving promised benefits of PLR.
  • The appropriate form of ethical oversight for PLR projects depends on which of three categories they fall into. If they meet the “institution-plus” criterion, standard ethics review applies. If not, then the appropriate form of oversight depends on the application of a minimal risk criterion.

National Athletic Trainers’ Association Position Statement: Anabolic-Androgenic Steroids

December 13, 2012 Comments off

National Athletic Trainers’ Association Position Statement: Anabolic-Androgenic Steroids

Source: Journal of Athletic Training

Objective:

This manuscript summarizes the best available scholarly evidence related to anabolic-androgenic steroids (AAS) as a reference for health care professionals, including athletic trainers, educators, and interested others.

Background:

Health care professionals associated with sports or exercise should understand and be prepared to educate others about AAS. These synthetic, testosterone-based derivatives are widely abused by athletes and nonathletes to gain athletic performance advantages, develop their physiques, and improve their body image. Although AAS can be ergogenic, their abuse may lead to numerous negative health effects.

Recommendations:

Abusers of AAS often rely on questionable information sources. Sports medicine professionals can therefore serve an important role by providing accurate, reliable information. The recommendations provide health care professionals with a current and accurate synopsis of the AAS-related research.

Essential Health Benefits: States will determine the minimum set of benefits to be included in individual and small group insurance plans. What lies ahead?

May 11, 2012 Comments off
What’s the issue?

The Affordable Care Act of 2010 requires that health insurance plans sold to individuals and small businesses provide a minimum package of services in 10 categories called “essential health benefits.” These include hospitalization, maternity and newborn care, ambulatory care, and prescription drugs.

But rather than establishing a national standard for these benefits, the Department of Health and Human Services (HHS) has decided to allow each state to choose from a set of plans to serve as the benchmark plan in their state. Whatever benefits that plan covers in the 10 categories will be deemed the essential benefits for plans in the state.

This approach has drawn criticism from health care providers, consumer groups, and patient advocates, who would prefer a national standard. But it has been more welcomed by states and the business community, who appreciate the flexibility the arrangement will afford states to tailor benefits to local circumstances. This policy brief explores the background of the debate and the policy implications surrounding essential health benefits.

New From the GAO

May 10, 2012 Comments off

New GAO Reports and TestimonySource: Government Accountability Office

+ Reports

1. Defense Management: Actions Needed to Evaluate the Impact of Efforts to Estimate Costs of Reports and Studies. GAO-12-480R, May 10.
http://www.gao.gov/products/GAO-12-480R

2. Patient-Centered Outcomes Research Institute: Review of the Audit of the Financial Statements for 2011 and 2010. GAO-12-663R, May 10.
http://www.gao.gov/products/GAO-12-663R

3. Security Force Assistance: Additional Actions Needed to Guide Geographic Combatant Command and Service Efforts. GAO-12-556, May 10.
http://www.gao.gov/products/GAO-12-556
Highlights – http://www.gao.gov/assets/600/590769.pdf

4. Homelessness: Fragmentation and Overlap in Programs Highlight the Need to Identify, Assess, and Reduce Inefficiencies. GAO-12-491, May 10.
http://www.gao.gov/products/GAO-12-491
Highlights – http://www.gao.gov/assets/600/590781.pdf

+ Testimony

1. Unconventional Oil and Gas Production: Opportunities and Challenges of Oil Shale Development, by Anu K. Mittal, director, natural resources and environment, before the Subcommittee on Energy and Environment, House Committee on Science, Space, and Technology. GAO-12-740T, May 10.
http://www.gao.gov/products/GAO-12-740T
Highlights – http://www.gao.gov/assets/600/590763.pdf

Consumers’ And Providers’ Responses To Public Cost Reports, And How To Raise The Likelihood Of Achieving Desired Results

April 13, 2012 Comments off

Consumers’ And Providers’ Responses To Public Cost Reports, And How To Raise The Likelihood Of Achieving Desired Results
Source: Health Affairs

There is tremendous interest in different approaches to slowing the rise in US per capita health spending. One approach is to publicly report on a provider’s costs—also called efficiency, resource use, or value measures—with the hope that consumers will select lower-cost providers and providers will be encouraged to decrease spending. In this paper we explain why we believe that many current cost-profiling efforts are unlikely to have this intended effect. One of the reasons is that many consumers believe that more care is better and that higher-cost providers are higher-quality providers, so giving them information that some providers are lower cost may have the perverse effect of deterring them from accessing these providers. We suggest changes that can be made to content and design of public cost reports to increase the intended consumer and provider response.

Red Meat Consumption and Mortality

March 13, 2012 Comments off

Red Meat Consumption and Mortality
Source: Archives of Internal Medicine

Background
Red meat consumption has been associated with an increased risk of chronic diseases. However, its relationship with mortality remains uncertain.

Methods
We prospectively observed 37 698 men from the Health Professionals Follow-up Study (1986-2008) and 83 644 women from the Nurses’ Health Study (1980-2008) who were free of cardiovascular disease (CVD) and cancer at baseline. Diet was assessed by validated food frequency questionnaires and updated every 4 years.

Results
We documented 23 926 deaths (including 5910 CVD and 9464 cancer deaths) during 2.96 million person-years of follow-up. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95% CI) of total mortality for a 1-serving-per-day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat. The corresponding HRs (95% CIs) were 1.18 (1.13-1.23) and 1.21 (1.13-1.31) for CVD mortality and 1.10 (1.06-1.14) and 1.16 (1.09-1.23) for cancer mortality. We estimated that substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat.

Conclusions
Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.

New From the GAO

January 25, 2012 Comments off

New GAO Reports and TestimonySource: Government Accountability Office

+ Reports

1. Chemical, Biological, Radiological, and Nuclear Risk Assessments: DHS Should Establish More Specific Guidance for Their Use. GAO-12-272, January 25.
http://www.gao.gov/products/GAO-12-272
http://www.gao.gov/assets/590/587673.pdf

2. Capitol Police: Retirement Benefits, Pay, Duties, and Attrition Compared to Other Federal Police Forces. GAO-12-58, January 24.
http://www.gao.gov/products/GAO-12-58
http://www.gao.gov/assets/590/587910.pdf

3. Defense Health: Coordinating Authority Needed for Psychological Health and Traumatic Brain Injury Activities. GAO-12-154, January 25.
http://www.gao.gov/products/GAO-12-154
http://www.gao.gov/assets/590/587920.pdf

4. Federal Employees’ Compensation Act: Preliminary Observations on Fraud-Prevention Controls. GAO-12-402, January 25.
http://www.gao.gov/products/GAO-12-402

+ Testimony

1. Arlington National Cemetery: Actions Taken and Steps Remaining to Address Contracting and Management Challenges, by Brian J. Lepore, director, defense capabilities and management, and Belva M. Martin, director, acquisition and sourcing management, before the Ad Hoc Subcommittee on Contracting Oversight, Senate Committee on Homeland Security and Governmental Affairs, GAO-12-374T, January 25.
http://www.gao.gov/products/GAO-12-374T
http://www.gao.gov/assets/590/587928.pdf

Achieving Equity in Health

October 18, 2011 Comments off

Achieving Equity in Health (PDF)
Source: Health Affairs

America’s racial and ethnic minorities have worse health than whites do, and they often receive a lesser standard of health care. People who have limited education or income or who live in poor neighborhoods have worse health and health care compared to those who are better educated or financially better off. People with disabilities are also in worse health, and receive worse health care, compared to people without disabilities.

Narrowing these disparities in health and health care has been the goal of many public and private efforts since the early 1990s. Although some progress has been made—particularly in closing the quality gap in the care that minorities and whites receive—much more remains to be done.

The multiple causes of health and health care disparities are complex, and some are only beginning to be explored deeply. This policy brief summarizes what is known about health and health care disparities, discusses recent efforts to close the gaps, and enumerates some policy recommendations for making further progress.

U.S. Physician Practices Spend Nearly Four Times as Much Money Interacting with Health Plans and Payers Than Do Their Canadian Counterparts

August 10, 2011 Comments off

U.S. Physician Practices Spend Nearly Four Times as Much Money Interacting with Health Plans and Payers Than Do Their Canadian Counterparts
Source: Health Affairs (via Commonwealth Fund)

Synopsis
Survey research reveals that physician practices in the United States incur nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts. The U.S. could save almost $27.6 billion in annual health spending if administrative costs were similar to those in Canada.

The Issue
Per capita health spending in the United States is 87 percent higher than in Canada—$7,290 versus $3,895 annually. Many factors contribute to the high cost of health care in the U.S., but there is broad consensus that administrative costs stemming from interactions between physician offices and health insurance plans are a leading culprit. In contrast to physicians in Canada, which has a single-payer, predominantly public health insurance system, most U.S. practices must interact with many health plans, each with its own insurance products and rules regarding formularies, prior authorization, billing, and claims submission. For this Commonwealth Fund–supported study published in Health Affairs, researchers surveyed physicians and administrators in Ontario, Canada, about the time they spend interacting with payers. Results were compared with a national companion survey in the United States.

Key Findings

  • Physician practices in the United States spent $82,975 per physician per year interacting with payers, compared with $22,205 in Ontario.
  • If U.S. physicians had administrative costs similar to those of Ontario physicians, their total savings would be approximately $27.6 billion per year.
  • In the U.S., nurses and medical assistants spent 20.6 hours per physician per week on administrative tasks related to health plans, nearly 10 times the 2.5 hours spent by Canadian nursing staff. U.S. nursing staff spent more time in every category of interactions, most notably obtaining prior authorizations, which accounted for 13.1 hours per physician per week.
  • Very little time was spent submitting quality data in either the United States or Ontario.

+ Full Paper (PDF)

Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths

July 22, 2011 Comments off

Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths
Source: Health Affairs

Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well.

Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008

May 9, 2011 Comments off

Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008
Source: Health Affairs

A 2002 analysis documented $54.9 billion in annual costs of environmentally mediated diseases in US children. However, few important changes in federal policy have been implemented to prevent exposures to toxic chemicals. We therefore updated and expanded the previous analysis and found that the costs of lead poisoning, prenatal methylmercury exposure, childhood cancer, asthma, intellectual disability, autism, and attention deficit hyperactivity disorder were $76.6 billion in 2008. To prevent further increases in these costs, efforts are needed to institute premarket testing of new chemicals; conduct toxicity testing on chemicals already in use; reduce lead-based paint hazards; and curb mercury emissions from coal-fired power plants.

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