Research roundup: What older patients really prize; DOD and the ACA

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Government Acountability Office: DOD Health Care: Cost Impact Of Health Care Reform And The Extension Of Dependent Coverage -- This study, mandated by Congress, assesses the financial impact of the federal health law on the Defense Department's budget. Defense provides health care to service members, retirees and dependents through a program called Tricare. Overall, the researchers found that DOD would incure "minimal costs" to implement the 21 provisions mandated by the health law and similar legislation dealing specifically with the Defense Department health programs. In addition, GAO said, the requirement that adults up to the age of 26 be allowed to remain on their parents' health plan would cost Defense about $4.4 million over two years. That will be covered by raising premiums (Draper et al., 9/26).

Journal of the American Medical Association: Operator Experience and Carotid Stenting Outcomes In Medicare Beneficiaries -- Using stents to help open the carotid artery (which leads to the brain) has proved effective but the increasing number raises concerns because it is "a technically demanding procedure and earlier studies have demonstrated a substantial learning curve with it." Authors found that "fewer than 1 in 8 operators had annual operator volumes of 12 procedures or more during the study period. Furthermore, we noted that patients treated by very low-volume operators and those treated early during a new operator's experience had significantly higher 30-day risk-adjusted mortality" (Nallamothu et. al., 9/28).

Archives Of Internal Medicine: Health Outcome Prioritization As A Tool For Decision Making Among Older Persons With Multiple Chronic Conditions -- This study examines how older patients with multiple chronic conditions prioritize their health outcomes. Researchers recruited participants from senior centers and an independent/assisted living facility and conducted face-to-face interviews to determine what older patients were prioritizing in their medical care: keeping you alive, maintaining independence, reducing or eliminating pain, and reducing or eliminating other symptoms (such as dizziness, fatigue, shortness of breath). The authors found that while there was variability in the responses, in general participants said "staying alive" was the most important consideration followed by "maintaining independence" and then "pain relief" (Fried et. al., 9/26).

Institute of Medicine: Geographic Adjustment In Medicare Payment: Phase 1: Improving Accuracy, Second Edition -- The geographic adjustment for Medicare reimbursements to hospitals, doctors and other providers "accounts for differences in the price of doing business that vary between urban and rural areas and by region" but "critics cite inconsistencies in the definitions of payment areas and labor markets, concerns about the appropriateness of data used to calculate adjustments, and lack of transparency of the methods for making the adjustments." The new IOM recommendations call for Medicare to move to a single source of wage and benefits data, change to one set of payment areas and labor markets, expand the range of occupations included in the index calculations, develop new data on the cost of office rent and apply a hospital wage index to facilities other than acute-care hospitals (9/28).

RAND Corporation: The Effects Of Consumer-Directed Health Plans On Episodes Of Health Care -- In these plans, generally, before patients reach their deductible (which can be more than $1,000), consumers pay health costs through a savings account set up by the plan. This study tried to evaluate why the plans save health care costs. Specifically, researchers looked at the number of "health care episodes" consumers encountered and found about two-thirds of the cost savings in such plans come "from reductions in number of episodes and the remaining one-third of the savings are from reductions in costs per episode." The researchers note, however, that "enrollees in plans with generous employer contributions to HSAs have more episodes of care than enrollees in plans where employers make smaller account contributions" (Haviland et. al., 9/29).

Kaiser Family Foundation/UCLA: Medigap Reform: Setting the Context -- This issue brief examines "the characteristics of the one-in-five Medicare beneficiaries with Medigap coverage and the current state of the Medigap market. The brief focuses especially on Medigap plans C and F, which offer first dollar coverage, providing full payment for both Part A and Part B deductibles and other cost-sharing requirements. Many of the proposed Medigap reforms would primarily affect these types of plans." Revising these plans has been suggested as one of the means to reduce Medicare spending. "Striking a balance between maximizing federal savings and protecting Medicare beneficiaries will be critical and challenging as policymakers grapple with the dual issues of rising program costs and the national debt" (Jacobson et al., 9/28).