Research roundup: Health IT and malpractice; Wide variation in hospital rates; Income and insurance offerings

New England Journal of Medicine: Medical Malpractice Liability In The Age Of Electronic Health Records - "Providers can expect a varied and shifting landscape of medical liability risks and benefits as the adoption of [electronic health records] EHRs unfolds," write the authors who explore the ways EHRs may bring about long-term changes in standard of care and affect the course of malpractice litigation. But they note that it is not clear "whether EHRs will lead courts to recognize changes in the legal standard of care — and if so, whether these changes are socially desirable" (Mangalmurti, Murtagh and Mello, 11/18).

Center for Studying Health System Change: Wide Variation In Hospital And Physician Payment Rates Evidence Of Provider Market Power - This brief examines payment rates by private insurers to hospitals and physicians, focusing on variation across and within markets in Cleveland, Indianapolis, Los Angeles, Miami, Milwaukee, Richmond, Va., San Francisco, and what the brief refers to as "rural Wisconsin."

"Average inpatient payment rates in the eight market areas varied widely, ranging from 147 percent of Medicare rates in Miami to 210 percent in San Francisco. Indianapolis, Milwaukee, rural Wisconsin and Richmond stood out as high-priced markets for private insurers relative to Medicare," the author writes. The "price variation within a market indicates some providers have much more leverage than others. Purchasers and policy makers can address weak competitive forces through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain prices through regulation" (Ginsburg, 11/18).

Annals of Internal Medicine: The Epidemiology Of Prescriptions Abandoned At The Pharmacy - When people don't pick up ordered prescriptions, "medication copayment was most strongly associated with abandonment rates.  Compared with prescriptions with no copayment, prescriptions with copayments of $40.01 to $50.00 had a 3.40 times greater probability of being abandoned, and prescriptions costing more than $50.01 had a 4.68 times greater probability of being abandoned" (Shrank et al., 11/16).

U.S. Government Accountability Office: Features of Integrated Systems Support Patient Care Strategies And Access To Care, But Systems Face Challenges - This report examines integrated delivery systems that serve the uninsured or those who are considered to be medically underserved. It finds they use a variety of approaches including, "school-based health centers and federally qualified health centers (FQHC); conducting outreach; helping patients apply for coverage programs such as Medicaid; providing financial assistance; and collaborating with community organizations, including faith-based organizations. ... IDSs in the sample reported facing various operational challenges in providing care, including care for underserved populations. Some reported that not receiving reimbursement from health care insurance companies for the care coordination services they provide to patients is a financial challenge." Other challenges included finding mental health care as well as electronic health record coordination with "providers outside the system"  (11/16).

Health Affairs: How Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries - Researchers asked adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United States, and the United Kingdom about their experiences with "access to health care, financial protection when sick, and the complexity of health insurance" in an attempt to better understand how the coverage designs of the countries affect such experiences. "Overall, across countries, the United Kingdom had the fewest significant differences in access and affordability by income, and the United States had the most. Differences by income, with low-income adults more at risk, also emerged on cost-related measures in several other countries. Strikingly, however, these did not always translate into disparities in waiting times or after-hours use," the authors write (Schoen et al., 11/18).

Annals of Internal Medicine: The Regional Extension Center Program: Helping Physicians Meaningfully Use Health Information Technology - This article examines the role of the 60 Health Information Technology Regional Extension Centers (RECs) funded by the Office of the National Coordinator for Health Information Technology.

"The REC program is designed to address obstacles to adoption and meaningful use by offering physicians expert assistance tailored to practice needs, delivered in physicians' own offices. The RECs will help physicians understand and benefit from the Medicare and Medicaid incentive program, use group purchasing power to negotiate better pricing from vendors, implement their systems successfully and train their staff, institute workflow changes to support the transition from paper to electronic records, and improve the quality and efficiency of care they provide," the authors write. But the offices will likely be necessary beyond the four years for which they have been funded, they note (Maxson et al., 11/16).

Kaiser Family Foundation: Health Benefit Offer Rates And Employee Earnings - This paper examines "how the offer of employer health insurance differs depending on the distribution of worker earnings within an establishment," based on data from the National Compensation Survey (NCS) data. "[O]n average, establishments with lower-wage employees offer health benefits less frequently. For smaller establishments, offer rates are particularly lower when wages are low. Of course, other factors that were not considered here might explain the patterns we show for offer rates and worker earnings. For instance, this analysis did not distinguish between full and part-time workers, or between those that are permanent, temporary, or seasonal. These findings nevertheless suggest that policymakers interested in encouraging employers to offer health benefits may wish to pay particular attention to how the distribution of wages within the establishment are related to whether employees are offered benefits. .... Special subsidies or insurance products may be needed in order to encourage more offering among these businesses, or to help their workers seek out other means of insurance coverage" (Claxton and Damico, 11/16).