Research Roundup: The cost of medical errors; 'Unreasonable rate increases'

Every Friday, Jennifer Evans compiles this selection of recently released health policy studies and briefs:

Health Affairs: The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors - "The estimated total cost of measurable medical errors in the United States was $17.1 billion in 2008, which was 0.72 percent of the $2.391 trillion spent on health care," write the authors of this study that used an "an actuarial approach to measure the frequency and costs of measurable U.S. medical errors, identified through medical claims data." They find that 10 types of errors are responsible "for more than two-thirds of the total cost of errors" and they recommend extra efforts to combat these. In addition, they write: "Although the most frequent medical injuries were adverse events associated with drugs, the most frequent (and nearly the most costly) measurable medical errors were pressure ulcers" (Van Den Bos et al., April 2011).

Health Affairs: The Importance Of Transitional Care In Achieving Health Reform - "Transitions, or 'handoffs,' are vulnerable exchange points [in the health system] that contribute to unnecessarily high rates of health services use and health care spending, and they expose chronically ill people to lapses in quality and safety...," write the authors of this systematic review that examined the outcomes of transitional care interventions in 21 randomized clinical trials targeting chronically ill adults. "Studies of nine interventions demonstrated a positive effect on at least one measure of readmissions" and "eight of the nine reduced all-cause readmissions through at least thirty days after discharge," write the authors of this study. "All nine interventions that showed any positive impact on readmissions relied on nurses as the clinical leader or manager of care" (Naylor et al., April 2011).

Government Accountability Office: Medicaid And CHIP: Reports For Monitoring Children's Health Care Services Need Improvement - This report examines the coordination of health services for children in Medicaid and CHIP and the extent to which annual state reports to the federal Centers for Medicare & Medicaid Services (CMS) detail services to children enrolled in Medicaid and CHIP. It finds: "Although some states are expanding initiatives to help improve children's access to care coordination services, almost one-quarter of families with Medicaid and CHIP children who needed specialty care reported problems accessing that care." Additionally, "[t]he two required summary reports that states provide annually to CMS are of limited use for monitoring the provision of services to children in Medicaid and CHIP due to reporting errors, missing information, and lack of detail." The report lists several recommendations for CMS (4/5).

Kaiser Family Foundation: Comparison Of Medicare Provisions In Deficit-Reduction Proposals - This side-by-side comparison looks changes to Medicare outlined in recent deficit-reduction proposals. The comparison looks at how proposals vary on how to limit growth in Medicare spending, age of Medicare eligibility and physician payments, among others (4/4).

Health Affairs: 'Unreasonable' Insurance Rate Increases - This brief describes how the health law requires the Department of Health and Human Services, together with states, to develop a review process to monitor what the law refers to as "unreasonable" increases in premiums annually. Although the law "did not define what was meant by unreasonable, specify how the review should be conducted, or describe what information would justify a rate increase," in December 2010, HHS proposed a rule that "plans with rate increases filed or effective on or after July 1, 2011, rate increases averaging 10 percent or more in the individual or small-group markets will be considered unreasonable and subject to further review to determine if they are justified." The brief notes the rate increases that will be excluded from the review process, and how after 2011, HHS will "set different percentage thresholds by state that more accurately reflect the particular cost trends in each state." The brief also describes the reactions of several groups to the proposed rule (Cassidy, 3/31).

Commonwealth Fund: A Call for Change: The 2011 Commonwealth Fund Survey of Public Views of the U.S. Health System - This brief describes the results of a recent national survey that found "a large majority of the public would like to see major changes to the health care system: seven of 10 adults believe it needs to be fundamentally changed or completely rebuilt. Support for major health system reform prevailed across different income levels and regions of the country, and among the insured and uninsured alike," the authors write (Stremikis, Schoen and Fryer, 4/6).

RAND: How Will Health Care Reform Affect Costs And Coverage? - This research brief describes estimates of law's impact on insurance coverage and state health spending in California, Connecticut, Illinois, Montana and Texas, according to a model developed by RAND.  The authors found: "The percentage of the state population with health care coverage will increase significantly in all five example states. ... The percentage of employees offered insurance will not change substantially, but a small number of employees in small firms (defined as those with under 100 employees in 2016) will obtain employer-sponsored insurance through the state insurance exchanges." However, the report also noted that state spending on health care would increase in four of the five states (Vaiana, 4/1).  

Urban Institute: The Basic Health Program Option Under Federal Health Reform: Issues for Consumers and States - This paper examines the rules in the federal health law concerning the Basic Health Program (BHP) - an option that offers states the opportunity to provide "low-income residents 'Medicaid look-alike' coverage or 'CHIP [Children's Health Insurance Program] for adults,' with lower consumer costs than will be charged in the exchange and without any risk of beneficiaries incurring year-end tax debts." The paper describes several approaches states could take toward implementing the basic plan and key issues the program would raise. For instance, "[f]rom the consumer's perspective, a serious disadvantage of this 'Medicaid/CHIP lookalike' approach to BHP is that, in most states, provider payment—hence, the breadth of provider networks—would be lower than in the exchange," writes the author. "From the state's perspective, implementing BHP … will have the disadvantage of reducing the size of the exchange. … That said, for state officials interested in improving affordability and continuity of coverage for low-income residents while maximizing state budget savings, using BHP to build on the existing infrastructure of Medicaid and CHIP is an option that deserves serious consideration," the author concludes (Dorn, 3/1).

Commonwealth Fund: St. John's Regional Health Center: Following Heart Failure Patients After Discharge Avoids Readmissions - This case study looks at the strategies taken by St. John's Regional Center in Springfield, Mo., to improve heart attack and heart failure care, and reduce related hospital readmissions.  The study describes patient-focused interventions - such as telephone reminders to schedule follow-up visits with primary care physicians and medical assistance programs - and interventions focused on community providers - such as telephone and electronic notification to a patients' primary care and a patient registry to track all heart failure patients over time. "According to the hospital's reports, its early performance improvement efforts reduced readmissions among heart failure patients by about 50 percent from 1998 to 2001," the article notes (Lashbrook and Edwards, 4/1).

A separate report describes the practices of several other hospitals with low readmission rates following services for heart attack, heart failure and pneumonia (Silow-Carroll, Lashbrook and Edwards, 4/6).