Research roundup: Racial disparities in hospital readmissions; evaluating home oxygen costs; Medicare funding hurdles

Journal of the American Medical Association: Thirty-Day Readmission Rates For Medicare Beneficiaries By Race And Site of Care - Using national Medicare data on 30-day readmissions after hospitalizations for heart attack, congestive heart failure and pneumonia, the authors report that "black patients had 13% higher odds of all-cause 30-day readmission than white patients. ... These disparities were related to race itself as well as to the site where care was provided," and patients "discharged from minority-serving hospitals had a 23% higher odds of readmission than patients discharged from non-minority-serving hospitals" (Joynt et al., 2/16).

Health Services Research: Following The Money: Factors Associated With The Cost Of Treating High-Cost Medicare Beneficiaries - "The 2006 average standardized medical cost for predicted high-cost beneficiaries was nearly U.S.$48,000, compared with about U.S.$7,000 for predicted low-cost patients," the authors report, adding: "Among high-cost beneficiaries, health was the predominant predictor of costs, with most physician and practice and many market factors (including provider supply) insignificant or weakly related to cost." The study suggests that new policies in the federal health law designed to cut costs may not have a big effect. "Instead, developing interventions tailored to improve care and lowering cost for specific types of complex and costly patients may hold greater potential for 'bending the cost curve'" (Reschovsky, Hadley, Saiontz-Martinez and Boukus, 2/9).

Health Policy Alternatives/Kaiser Family Foundation: Medicare Spending And Financing - A Primer - "Policymakers are always challenged to balance the interests of Medicare beneficiaries, taxpayers, health care providers and manufacturers, but national economic and fiscal constraints in the near term will make the task more difficult than ever," write the authors of this primer (.pdf) that examines trends in Medicare spending, the factors contributing to its growth, and how the rising costs of Medicare will affect beneficiaries. the authors note: "Medicare now covers 47 million seniors and younger people with disabilities, with total expenditures of $524 billion in fiscal year 2010, representing 15 percent of federal outlays." The primer also looks at the health law's effects on Medicare spending (Potetz, Cubanski and Neuman, 2/14).

GAO: Medicare Home Oxygen: Refining Payment Methodology Has Potential To Lower Program And Beneficiary Spending - After studies showed Medicare payment rates for home oxygen exceeded the amount offered by other payers, "Congress reduced home oxygen payment rates, capped rental payments after 36 months, and directed the Centers for Medicare & Medicaid Services (CMS), which administers Medicare, to use competitive bidding," according to this review of the Medicare oxygen policy. "Utilization trends show overall beneficiary access to home oxygen has not diminished, despite reductions in payment rates and in the number of suppliers from 2001 through 2008." The report has a recommendation: "To establish rates that more accurately reflect the distinct costs of providing each type of home oxygen equipment, the Administrator of CMS should restructure Medicare's home oxygen payment methodology. This should include removing the payment for portable oxygen refills from that for stationary equipment and paying for refills only for the equipment types that require them" (1/21).

Kaiser Family Foundation: Reaching For The Stars: Quality Ratings Of Medicare Advantage Plans, 2011 - "For the first time, the Medicare Advantage quality ratings will be used to identify and reward highly‐rated plans in 2012," as required by the health law, write the authors of this issue brief (.pdf) that examines differences between the plans that received higher quality ratings. The brief also details how a demonstration proposed by CMS "would modify the rating system and provide additional quality‐based payments to the Medicare Advantage plans for 2012 to 2014" (Jacobson, Damico, Huang and Neuman, 2/17).

Health Affairs: The 1099 Provision - This policy brief examines the provision in the new health law which requires "that businesses file Form 1099 with the Internal Revenue Service (IRS) for all purchases made from any vendor totaling $600 or more per year." While it doesn't "have anything directly to do with health care per se, [it] was designed to capture tax revenues that may be lost if businesses fail to report income. However, lawmakers from both parties and the Obama administration now support repealing the measure on the ground that it would place an undue burden on business, especially small businesses. ... both parties and both houses of Congress have struggled to find a viable alternative for replacing the $19 billion that would be lost," the brief notes. Since the provision is "only one of many financing measures" in the health law, "its repeal is not likely to have any direct impact on health reform's implementation" (Haberkorn, 2/14).