KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Research Roundup: Financial Protections For Medicare Patients; Medicaid Beneficiaries At FQHCs; Prevalence Of Alzheimer’s In African Americans

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: The Availability Of New Patient Appointments For Primary Care At Federally Qualified Health Centers: Findings From An Audit Study
This brief compares the availability of primary care appointments for new patients at Federally Qualified Health Centers (FQHCs) and other non-FQHC providers using data from an experimental simulated patient (audit) study that was conducted in late 2012 and early 2013. ... we find that 80 percent of FQHCs and 56 percent of non-FQHCs scheduled appointments for Medicaid callers—a difference of 24 percentage points. ... FQHCs were more willing than other non-FQHC providers to accommodate new Medicaid patients, but that FQHC wait times were slightly longer. ... even with enhanced funding, it is uncertain how well they will be able to absorb new patient demand caused by the Affordable Care Act’s (ACA) Medicaid expansion and other provisions (Saloner et al., 4/7).

Urban Institute: Financial Burden Of Medical Spending By State And The Implications Of The 2014 Medicaid Expansions
Among the top 25 states with the largest shares of their population attributable to low-income, high burden individuals without Medicaid/CHIP coverage, there is almost an equal divide in the number that have committed to expand or not expand their Medicaid program. ... the choice to participate will affect states differently. States that participate in the expansions have an opportunity to significantly decrease financial burdens for a high-need segment of their population (Caswell, Waidmann and Blumberg, 4/3).

Annals Of Family Medicine: Joint Principles: Integrating Behavioral Health Care Into The Patient-Centered Medical Home
The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. ... The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element ... Principles: Personal physician .... Physician directed medical practice ... Whole person orientation (Baird et al., March/April 2014).

Health Affairs: Alzheimer's Disease In African Americans: Risk Factors And Challenges For The Future
As the US elderly population continues to expand rapidly, Alzheimer’s disease poses a major and increasing public health challenge, and older African Americans may be disproportionately burdened by the disease. Although African Americans were generally underincluded in previous research studies, new and growing evidence suggests that they may be at increased risk of the disease and that they differ from the non-Hispanic white population in risk factors and disease manifestation. This article offers an overview of the challenges of Alzheimer’s disease in African Americans (Barnes and Bennett, 4/7).

Health Affairs: Preparing The Health Care Workforce To Care For Adults With Alzheimer's Disease And Related Dementias
The number of cases of Alzheimer's disease is projected to triple by 2050, from 5.0 million in 2013 to 13.8 million. ... We assessed what is likely to be an increasing shortage of physicians, nurses, and social workers with specialized training in geriatrics and, more specifically, in the care of people with dementia. ... To address these shortfalls, we recommend the dissemination of team-based models of care ...; expansion of education loan forgiveness and faculty development programs ...; inclusion of curricula specific to the disease in all health professions training; expansion of federal programs to train existing workers; and increased compensation for the direct care workforce (Warshaw and Bragg, 4/7).

The Kaiser Family Foundation: Paying A Visit To The Doctor: Current Financial Protections For Medicare Patients When Receiving Physician Services
Congress will likely return within the year to the question of whether and how to replace the widely-criticized formula that Medicare uses to calculate payments for physician services, called the Sustainable Growth Rate (SGR) system. For the most part, recent proposals on reforming the physician payment system leave intact current financial protections ... [which] include the participating provider program, limitations on balance billing, and conditions on private contracting. This issue brief describes these three protections, explains why they were enacted, and analyzes the implications of modifying them for beneficiaries, providers, and the Medicare program (Boccuti, 4/7).

The Kaiser Family Foundation: How Will The Uninsured Fare Under The Affordable Care Act?
Nationally, 4.8 million uninsured adults (10% of the nonelderly uninsured) who would be eligible for Medicaid if their states were to expand, fall into the coverage gap. ... Because they do not gain an affordable coverage option under the ACA, they are most likely to remain uninsured. Two other groups of uninsured individuals are outside the reach of financial assistance for health coverage under the ACA. First, 21% of uninsured people have incomes above the limit for premium tax subsidies or have an affordable offer of coverage through their employer are thus ineligible for financial assistance. ... Second, uninsured undocumented immigrants (about 13% of uninsured) are ineligible for assistance under the ACA and barred from purchasing coverage through the Marketplace. This group is likely to remain uninsured, though they will still have a need for health care services (4/7).

JAMA Surgery: Colorectal Cancer Resections In The Aging US Population
In this extensive review of national trends of CRS, we observed that, despite the improvements in mortality and a decrease in the incidence of CRS, older patients continue to have worse risk-adjusted outcomes compared with those who are younger. A clear association between worse outcomes and age was established. Even patients aged 65 to 69 years have poorer outcomes than those younger than 65 years. Since most (63.8%) procedures in the United States are performed on patients 65 years and older, measures to improve outcomes need to be implemented in all settings. The higher percentage of patients requiring nursing facilities for rehabilitation postoperatively reiterates the importance of outcomes as well as the social impact of age (Jafari et al., 4/9).

American Journal Of Medicine: Treat Or Eat: Food Insecurity, Cost-Related Medication Underuse, And Unmet Needs
[N]o study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. ... There were 9696 adult 2011 National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. ... Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic, non-Hispanic black, and have more chronic conditions than patients reporting neither. ... WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse (Berkowitz, Seligman and Choudhry, April 2014).

Rand Corp.: How Will The Patient Protection And Affordable Care Act Affect Liability Insurance Costs?
The Patient Protection and Affordable Care Act (ACA) will greatly expand private coverage and Medicaid while making major changes to payment rates and the health care delivery system. These changes will affect traditional health insurers, individuals, and government payers. In addition, a considerable amount of health care is paid for directly by or is indirectly paid for via legal settlements after the care occurs, by liability insurers. This report identifies potential mechanisms through which the ACA might affect claim costs for several major types of liability coverage, especially auto insurance, workers' compensation coverage, and medical malpractice (Auerbach, Heaton and Bradley, 4/9).

University of Minnesota State Health Access Data Assistance Center/RWJF: For Kids' Sake: State-Level Trends in Children's Health Insurance
This 50-state analysis shows that the U.S. has made significant progress toward ensuring all kids have health insurance. The report finds that the percentage of children without insurance fell from 9.7 percent in 2008 to 7.5 percent in 2012 (Sonier and Fried, 4/3).

Here is a selection of news coverage of other recent research:

Medscape: Choosing Wisely Lists Dominated By Cost Considerations
Healthcare costs figured highly in specialty medical societies' decision-making processes in determining what to include in their Choosing Wisely Top 5 lists, according to a research letter published in the April 9 issue of JAMA. Choosing Wisely is an initiative of the American Board of Internal Medicine Foundation to get specialty societies to develop lists of medical services that do not provide broad overall patient benefits but that still may be performed often. The goal is to phase out unnecessary use of these procedures or tests (Hand, 4/9).

The New York Times: Many Drug Prescriptions Go Unfilled
A Canadian study has found that almost one-third of patients never fill the prescriptions for the medicines they are told to take. The analysis, published online in The Annals of Internal Medicine, was conducted in Quebec, where all residents are covered by health and drug insurance. There were 15,961 patients in the study. Over all, 31.3 percent of prescriptions were never filled. But some types were filled more often than others. Prescriptions for headaches and migraines were filled more than half the time, but only 20 percent for bronchitis, and 25 percent for skin irritations. The more often a patient saw the doctor, the more likely the prescriptions would be filled, but medicines with high co-pays were less likely to be bought (Bakalar, 4/7).

MedPage Today: Fewer Americans Struggling With Medical Debt
The percentage of people in families having problems paying their medical bills continues to tick downward, according to a CDC report. The percentage of people under age 65 who were in families having problems paying medical bills fell to 19.8% in the first 6 months of 2013, Robin A. Cohen, PhD, and Whitney K. Kirzinger, MPH, of the National Center for Health Statistics in Hyattsville, Md., wrote in a report released Wednesday (Pittman, 4/9).

NPR SHOTS blog: Avoiding The Nursing Home Ups The Risk Of Unwanted Medical Care
Most older people suffer from cognitive impairment or dementia in the year before death, making it more likely that they will get aggressive medical treatments that they don't want. And people with dementia who are cared for at home are more likely to get unwanted treatment than if they are in a nursing home, a study finds. That could be because medical personnel are less likely to know a person's end-of-life wishes of someone who isn't in a facility ... Among patients with normal or less impaired cognitive function, having an advanced directive did not limit the treatment that they needed, according to results published Monday in the journal Health Affairs (Poon, 4/8).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.