Research roundup: Lowering health costs of the poorest sick; Local variations in health spending

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Archives Of Internal Medicine: Myocardial Infarction And Sudden Cardiac Death In Olmsted County, Minnesota, Before And After Smoke-Free Workplace Laws – Olmstead County, Minn., which earlier required just restaurants to be smoke-free, enacted a law in 2007 that banned smoking in all workplaces. Researchers reported "a substantial decline in the incidence of MI from 18 months before the smoke-free restaurant law was implemented to 18 months after the comprehensive smoke-free workplace law was implemented 5 years later. ... The implementation of smoke-free workplace ordinances was associated with a substantial decrease in MI ... Secondhand smoke exposure should be considered a modifiable risk factor for MI" (Hurt et al., 10/29).

CDC's Mortality and Morbidity Weekly Report : Assisted Reproductive Technology Services-United States, 2009 -- Compared to women who conceive naturally, women who undergo Assisted Reproductive Technology (ART) procedures have a higher likelihood of delivering multiple-birth infants, which pose substantial health risks ranging from pregnancy complications to low preterm delivery, according to this study. "Promotion of single-embryo transfer, where feasible, is needed to reduce multiple births and related adverse consequences of ART. Nevertheless, because ART accounts for a relatively small fraction of total births in most states and territories, the overall prevalence of low birthweight and preterm births cannot be explained solely by the use of ART, and therefore non-ART causes of these adverse outcomes must be examined," the authors concluded (Sunderam et al., 11/2).

Mathematica and The Kaiser Family Foundation: Best Bets For Reducing Medicare Costs For Dual Eligible Beneficiaries: Assessing The Evidence – Nine million Medicare beneficiaries also receive Medicaid. This group, known as dual eligible beneficiaries, is "on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost." Federal and state officials are seeking ways to coordinate care, "with some estimates projecting hundreds of billions of dollars in savings over the next decade." This study looks at some of the pilot projects and demonstrations "and finds support for modest Medicare savings through well-targeted interventions, including "a small number of fully integrated, capitated managed care programs and fee-for-service based interventions for dual eligible beneficiaries that succeeded in reducing hospitalizations, although few of these programs were able to demonstrate net savings for Medicare" (Brown and Mann, 10/30).

New England Journal Of Medicine: Comparing Local And Regional Variation In Health Care Spending – The wide variation in health care spending has raised concerns about geographic-based Medicare payment reform. This study looked at local variations of a sample of Medicare beneficiaries within hospital referral regions (HRRs), which include local hospital service areas, from 2006 to 2009. "We found that there was substantial location variation in utilization and spending for pharmaceutical and medical services and that there was substantial dispersion with respect to the level of location spending within HRRs .... Policies that aim to reduce spending in high-cost areas by targeting high-spending HRRs may fail with respect to both sensitivity and specificity ... This analysis suggests that policies focused exclusively on the HRR may be too blunt to promote the best use of health care resources" (Zhang et al., 11/1).

Here is a selection of news coverage of other recent research:

Politico Pro: Heritage: Actually Obama Makes Seniors Pay More
Democrats have repeatedly hit GOP Medicare reform ideas as draconian plots to shift more costs onto seniors. But health care experts at the Heritage Foundation essentially threw that attack line back at Democrats yesterday, writing in a new analysis that the Obama plan makes seniors dig deeper into their pockets. "Under the Obama plan, seniors will pay more -; a lot more -; and they will pay this steep price in many different ways, including a loss of access to care from demoralized doctors and other medical professionals," they write, citing new fees, cuts to providers and new drug costs. Their analysis: http://herit.ag/U1E1Z7 (Millman, 11/2).

Reuters: Cancer Docs Often Delay Referrals To Hospice Care
Cancer doctors often refer their patients to palliative care very late in the course of disease, according to a new survey from Canada. About a third of oncologists said they refer patients to palliative care, or hospice, when they diagnose a cancer that has spread and therefore usually is incurable. Another third, however, said they wait until chemotherapy has been stopped, which is often just a few months or even weeks away from death (Joelving, 10/30).

Medpage Today: Debate On Independent NPs Continues
State legislatures will continue to debate the role advanced-practice nurses should play in the delivery of primary care as physician groups push for greater oversight of their work, a policy brief stated. About 50 of 245 bills recently filed at the state level relating to changing scopes of practice dealt in some way with how much freedom nurses -- including nurse practitioners (NPs) -- can operate with, according to data from the National Conference of State Legislatures, wrote Amanda Cassidy, principal at Meitheal Health Policy in Richmond, Va., in a recent Health Affairs brief (Pittman, 10/31).

Medscape: Breast Screening Saves Lives, But At A Cost, UK Panel Concludes
Routine screening can lead to a 20% reduction in the relative risk for breast cancer death, although it can also lead to overdiagnosis, according to a review conducted by an independent panel in the United Kingdom and published online October 30 in the Lancet. ... [The panel] would like to see an ongoing meta-analysis of centrally collated individual patient data from all the randomized trials, randomized trials looking at risks and benefits of screening women younger than 50 years and older than 70 years (Nelson, 10/30).

Medscape: Stressed Med Students At High Risk For Later Depression
Young, female medical students with specific personality traits and baseline depressive symptoms face a high risk for severe depression 15 years after graduating, new research shows.  ... Unpublished work by [Dr. Reidar Tyssen, a psychiatrist and professor at the University of Oslo, in Norway] comparing nonmedical students with medical students shows that although more women report mental distress than men overall, the sex difference is not statistically significant in nonmedical students (25% of women vs 17% of men), but it is significant in medical students (34% vs 20%, P = .006) (Johnson, 10/31).