Research Roundup: Cancer Care Expenses; Safety-Net Hospital Funding; Right-To-Try Laws
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Health Affairs:
New Analysis Reexamines The Value Of Cancer Care In The United States Compared To Western Europe
Despite sharp increases in spending on cancer treatment, US cancer mortality rates decreased only modestly .... Our article [compares] the United States to the broad benchmark of all twenty countries in Western Europe between 1982 and 2010. ... Our study has two central findings. First, the number of deaths averted in the United States compared to all of Western Europe from 1982 to 2010 varied substantially by cancer type. The United States averted the largest number of deaths for stomach and colorectal cancer and experienced the largest number of excess deaths for lung cancer and non-Hodgkin’s lymphoma. ... Second, the additional value derived from costlier US cancer care also varied considerably by cancer type. (Soneji and Yang, 3/2)
Health Affairs:
Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare’s Value-Based Purchasing
In 2014, the second year of [Medicare’s value-based purchasing (VBP) program], patient mortality measures were added to the VBP program’s algorithm for assigning penalties and rewards. We examined whether the inclusion ... had a disproportionate impact on safety-net hospitals nationally. We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. ... However, safety-net hospitals’ performance on mortality measures was comparable to that of other hospitals ... Although safety-net hospitals are still more likely than other hospitals to fare poorly under the VBP program, increasing the weight given to mortality in the VBP payment algorithm would reduce this disadvantage. (Gilman et al., 3/2)
Urban Institute:
Special Enrollment Periods In 2014: A Study Of Select States
This study analyzes how five state-based marketplaces
(SBMs)—those of California, the District of Columbia [D.C.],
Kentucky, Minnesota and Washington—addressed and
experienced [special enrollment periods] SEPs in 2014. ... We also studied how these five SBMs coordinated with their state Medicaid programs to enroll people losing Medicaid coverage into marketplace plans. Our study finds that marketplace systems and consumer outreach and enrollment efforts are still in progress and do not yet match the significant potential for SEP enrollment in the five study SBMs. ... we identify four themes related to SEP implementation in 2014 that highlight common challenges. Though some challenges flowed from first-year implementation issues, some will likely recur in future years. (Wishner et al., 2/25)
Health Affairs Blog:
Implementing Health Reform: 2016 Benefit And Payment Final Rule, Consumer & Provider Provisions
On February 20, 2015, the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services published its massive Notice of Benefit and Payment Parameters (BPP) for 2016 final rule, accompanied by a fact sheet. This rule addresses a host of issues involving the continuing implementation of the Affordable Care Act for 2016. A few provisions, however, affect the 2015 year as well and a number of provisions will not be implemented until 2017. (Timothy Jost, 2/22)
Health Affairs/Brookings/Robert Wood Johnson Foundation:
Right-To-Try Laws
In the past four years the FDA has received nearly 6,000 expanded access applications [for experimental drugs] and denied just 33. However, critics of the program argue that the process is too cumbersome and that it discourages many patients and physicians from applying. Since last year, more than 20 states have introduced laws aimed at making experimental therapies more easily accessible to patients with terminal illnesses, five of which have been signed into law. ... Supporters argue that patients have the right to determine what risks they are willing to undertake to save their own lives ... Opponents argue that such laws may introduce new risks for patients while undermining laws meant to protect public safety. The ultimate effects of these state-level efforts are still unclear, and their constitutionality is open to question. (Richardson, 3/5)
JAMA Otolaryngology–Head & Neck Surgery:
Impact Of A New Practice Guideline On Antibiotic Use With Pediatric Tonsillectomy
In 2011, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) published a practice guideline recommending against perioperative antibiotic use for pediatric tonsillectomy. ... [This study sought] to determine the impact of the AAO-HNS guideline ...This was a quasi-experimental study including 9,265 children who underwent routine tonsillectomy from January 2009 through August 2012 ... Immediately after guideline publication, perioperative antibiotic use dropped by 86.5% .... Rates of otolaryngology clinic encounters, emergency department encounters, and hospital admissions did not change significantly over time. There was a small but statistically significant increase in surgical procedures for bleeding. (Milder et al., 2/26)
Preventive Medicine/Rand Corp.:
Prevalence Of Colonoscopy Before Age 50
[Researchers sought to] describe the prevalence of colonoscopy before age 50, when guidelines recommend initiation of colorectal cancer screening for average risk individuals. We assembled administrative health records that captured receipt of colonoscopy between 40 and 49-years of age for a cohort of 204,758 50-year-old members of four US health plans ... We also used self-reported receipt of colonoscopy from 27,157 40- to 49-year-old respondents to the 2010 National Health Interview Survey (NHIS) ... About 5% of the health plan cohort had a record of colonoscopy before age 50. Receipt of early colonoscopy increased significantly from 1999 to 2010, was more likely among women than men and in the east coast health plan compared to west coast and Hawaii plans. (Rutter, 2/24)
The Kaiser Family Foundation:
Insurance Markets In A Post-King World
The Supreme Court is considering a case – King v. Burwell – that challenges the legality of premium and cost-sharing subsidies for low- and middle-income people buying insurance in states where the federal government rather than the state is operating the marketplace under the Affordable Care Act (ACA). ... People receiving subsidies make up 87% of those who have signed up for coverage for 2015 in states using the federal marketplace. For the vast majority of them, coverage would be unaffordable without the subsidies. The subsidies average $268 monthly per person and cover 72% of the premium ... With the subsidies eliminated, those who had been receiving them would face an increase in their out-of-pocket premiums averaging 256%. (Levitt and Claxton, 2/25)
The Kaiser Family Foundation:
Are Premium Subsidies Available In States With A Federally-Run Marketplace? A Guide To The Supreme Court Argument In King V. Burwell
The King v. Burwell petitioners are challenging the legality of the IRS regulation allowing premium subsidies in states with a Federally-run Marketplace as contrary to the language of the ACA. This issue brief examines the major questions raised by the King case, explains the parties’ legal arguments, and considers the potential effects of a Supreme Court decision. (Musumeci, 2/25)
The Heritage Foundation:
King V. Burwell: An Opportunity For Congress And The States To Clear Away Obamacare’s Failed Policies
While a ruling against the Administration would preclude paying those subsidies to individuals who obtain coverage through the federally run exchange, that would merely add one more effect to the ongoing complexity and cascade of adverse effects produced by the law’s complex and flawed design.
Congress and the states should therefore seize the opportunity and clear the way for patient-centered, market-based reforms to take root in the states. To start, Congress should devolve the regulatory authority over insurance back to the states. In anticipation of such an exemption, states should use their authority now to put in place their own policies governing insurance. (Owcharenko and Haislmaier, 2/27)
Here is a selection of news coverage of other recent research:
Reuters:
Treatment For Prostate Cancer Varies By Area Of U.S.
A new study of Medicare and private insurance claims confirms that treatment trends for localized prostate cancer differ by U.S. region, by state and even from county to county. Overall, though, researchers found that newer, less invasive technologies, like laparoscopic prostate removal, have supplanted older treatment methods like open surgery over time. (Doyle, 3/4)
The Wall Street Journal:
Up To 27,000 Americans Didn’t Die Of Cardiovascular Disease Thanks To Medicare Drug Coverage
The Medicare prescription-drug benefit introduced in 2006 saved an estimated 19,000 to 27,000 lives in its first year by expanding access to medications that treat cardiovascular killers like strokes and heart disease, according to new research from the Federal Reserve Bank of San Francisco. “While the exact magnitude of the number of lives saved depends on the particular specification, the basic result of a decline in cardiovascular-related deaths is shown to hold up across a multitude of robustness tests,” economists Abe Dunn and Adam Hale Shapiro wrote this month in a working paper, “Does Medicare Part D Save Lives?” The Part D benefit, enacted by Congress in 2003 and introduced in 2006, subsidized drug coverage for elderly and disabled Americans through the Medicare program. (Leubsdorf, 2/20)
The Associated Press:
IUDs, Hormone Implants Growing More Popular Among US Women
Long-acting but reversible methods of birth control are becoming increasingly popular among U.S. women, with IUDs redesigned after safety scares and the development of under-the-skin hormone implants, a government report shows. Birth control pills remain the most popular contraceptive method nationwide, but intrauterine devices and implants are more effective at preventing pregnancy and they last for several years. (2/24)
Reuters:
Providers, Patients Differ On Birth Control Choices
When women who are family planning experts need to pick a birth control method for themselves, what do they generally choose? Not the same thing the average woman chooses, a new study found. About 42 percent of the family planning experts in the study used long-acting reversible contraceptives (LARCs) – a choice made by only about 12 percent of women in the general population. (Seaman, 2/24)
Reuters:
Doctors With Bad News Seen As Less Compassionate
Regardless of how they frame the discussion, doctors who deliver bad news may be seen as less compassionate by their patients, a new study suggests. Patients who watched videos of fictional interactions between doctors and patients felt the doctors delivering bad news were less compassionate than those giving good news, researchers found. Until recently, doctors and researchers believed that doctors who delivered bad news in an empathetic tone would be seen as sincere, said Dr. Eduardo Bruera, the study’s lead author from the University of Texas MD Anderson Cancer Center in Houston. But it seems the news itself has an impact on the way patients see doctors. (Seaman, 2/27)
The New York Times:
Most Doctors Give In To Requests By Parents To Alter Vaccine Schedules
A wide majority of pediatricians and family physicians acquiesce to parents who wish to delay vaccinating their children, even though the doctors feel these decisions put children at risk for measles, whooping cough and other ailments, a new survey has found. Physicians who reluctantly agreed said they did so to build trust with families and to avoid losing them as patients. The survey, published Monday in the journal Pediatrics, asked a nationally representative sample of 534 primary care physicians in 2012 how often parents in their practices postponed one or more vaccinations for children younger than age 2. (Saint Louis, 3/2)
Forbes:
Obamacare Jobs Grow Faster In Medicaid Expansion States
States that agreed to expand coverage of Medicaid to more Americans under the Affordable Care Act have created more jobs than other areas of the country, according to a new report. Fitch Ratings said “healthcare and social assistance jobs grew over 30% faster between December 2013 and December 2014 for 24 states that implemented ACA expansion on Jan. 1, 2014 than those that did not.” (Japsen, 2/20)
CQ Healthbeat:
Health Law To Drive Up Demand For Primary Care, Study Finds
The health care law may result in roughly 20.3 million additional primary care visits nationally, about a 3.8 percent increase, according to a new state-by-state analysis by the Commonwealth Fund. Primary care visits are expected to grow more than hospital inpatient visits, which are likely to increase by 3.1 percent, or hospital outpatient visits, which may rise roughly 2.6 percent, the study said. (Adams, 2/25)
CQ Healthbeat:
Heroin-Related Deaths Surged 40 Percent In 2013, CDC Reports
The number of heroin-related deaths rose by nearly 40 percent in 2013, according to data from the Centers for Disease Control and Prevention. CDC reported that about 8,257 people died in 2013 of causes related to heroin use, including unintentional fatalities and suicides linked to the drug. That's a marked increase from the 5,925 fatalities reported for the previous year. And the 2013 figure also marks a more than doubling in the number of heroin-related deaths from the 3,036 reported for 2010. (Young, 3/3)