Research roundup: Barriers to trauma care, immunizations; Small business tax credit; Medicare coverage of preventive care

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Jan 29 2011

Archives of Surgery: Possible Geographical Barriers To Trauma Center Access For Vulnerable Patients In The United States - This study analyzes disparities in geographic access to trauma centers in 2005, drawing from data from the 2005 American Hospital Association annual survey. "In urban areas, 67% of the population had easy access to trauma centers and 12% had difficult access compared with 24% and 31% in rural areas, respectively," the study authors report. They also found that "areas with a higher proportion of certain groups, such as African American and near-poor populations in urban and rural areas and foreign-born population in urban areas, ... were farther away from trauma centers" (Hsia and Shen, January 2011).

Archives of Internal Medicine: Immunization Disparities By Hispanic Ethnicity And Language Preference - This study looks at the percentages of Hispanic seniors (both those preferring to speak Spanish and those preferring English) who receive pneumonia and seasonal flu vaccine compared to non-Hispanic whites. Based on the reports of nearly 250,000 seniors included in a Medicare survey, the authors found: "Three-fourths (76%) of non-Hispanic white seniors reported receiving an influenza immunization in the past year compared with 68% of English-preferring and 64% of Spanish-preferring Hispanic seniors. … Three-fourths (74%) of non-Hispanic white seniors also reported ever receiving a pneumonia vaccine, but considerably fewer Hispanic seniors did so—56% of English-preferring and 40% of Spanish-preferring Hispanics—differences of 18 and 33 percentage points, respectively" (Haviland et al., 1/24).

Annals of Internal Medicine: Lost In Translation: The Unintended Consequences Of Advance Directive Law On Clinical Care - Although advance directives are designed to "allow people to designate a health care agent and specify health care preferences for future medical situations … a fundamental tension exists between advance directive law and clinical practice," write the authors of this study that describes several "unintended consequences of advance directive law that may prevent patients from making or communicating their end-of-life care preferences or having their preferences honored," and the groups most affected by such consequences. The authors report five "overarching legal and content-related barriers: poor readability; health care agent restrictions; execution requirements (steps needed to make forms legally valid); inadequate reciprocity (acceptance of advance directives between states); and religious, cultural, and social inadequacies" (Castillo et al., 1/18). Kaiser Health News summarized coverage of this report (1/18).

Annals of Family Medicine: Comparison Between U.S. Preventive Services Task Force (USPSTF) Recommendations And Medicare Coverage - This study looked at how Medicare coverage aligns with procedures included in the USPSTF recommendations. Though the analysis found that Medicare partially reimbursed 93 percent of the 15 USPSTF-recommended preventive interventions for adults aged 65 years and older, "full reimbursement for the preventive coordination, as well as the service, was available for only 7% of these services." Additionally, Medicare reimbursed clinicians for 7 of the 16 preventive services USPSTF recommends against for Medicare beneficiaries. The conclusion: "Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries" (Lesser et al., January/February 2011).

Health Affairs: Small Business Tax Credits - This brief provides a breakdown of the provision of the new health care law that offers a new federal tax credit for small businesses with fewer than 25 employees. "To qualify for the credit, an employer must pay at least half the premium for each employee. … Since the law was enacted in March 2010, and employers may not have had time to adjust their policies, the Internal Revenue Service (IRS) in 2010 allowed employers who paid at least half the premium to qualify, even if the percentage of premium paid was not uniform across their entire work force." The brief describes arguments of those in favor and opposed to the small business tax credit and notes eligible companies will begin "claiming the credit for 2010 premiums when they file tax returns due in the spring of 2011" (Cassidy, 1/14).

Urban Institute/Robert Wood Johnson Foundation: Employer-Sponsored Insurance Under Health Reform: Reports Of Its Demise Are Premature - The authors of this brief examine the possible effect of the Patient Protection and Affordable Care Act (ACA) on employer-sponsored insurance (ESI) and employer health costs. "Overall ESI coverage under the ACA would not differ significantly from what the coverage was without reform," the authors report. "Total employer spending on premium contributions, assessments and vouchers would be 0.6 percent lower under the ACA than without reform" (Garrett and Buettgens, 1/24).

Kaiser Family Foundation: Building An Information Technology Foundation For Health Reform: A Look At Recent Guidance And Funding Opportunities - The new health law "envisions a streamlined and simplified application process with seamless transitions between coverage in the [health insurance] Exchange and Medicaid," in which consumers will use a Web portal to submit a single application for coverage. This brief "examines new funding opportunities available under the health reform law to help states design and implement the information technology infrastructure necessary"(1/14).

CDC: Complementary And Alternative Therapies In Hospice, National Home And Hospice Care Survey: United States, 2007 - Authors surveyed hospice care providers to determine how many offer complementary and alternative therapies (CAT) and how patients use those therapies. This includes interventions such as "massage, supportive group therapy, music and pet therapy, and guided imagery and relaxation," the authors write. "Results from NHHCS indicate that 41.8% of all hospice care providers offered CAT; however, it was more common for hospice care providers to offer CAT than for discharged patients to receive CAT from the provider. … Of the providers that offered CAT, about one-fifth had at least one discharged patient who used at least one CAT from the provider during an episode of hospice care" (Bercovitz et al., 1/19).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.