Research roundup: Nursing home transitions; the impact of raising Medicare premiums; workers' views of job-based insurance

Published on January 20, 2014 at 1:53 AM · No Comments

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

Journal of the American Geriatrics Society: Hospitalization Of Elderly Medicaid Long-Term Care Users Who Transition From Nursing Homes
To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH. ... Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% over remaining in the NH. NH transitioners had a 58% greater risk of experiencing any type of hospitalization than NH stayers. ... Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community (Wysocki et al., 1/2). 

The George Washington University School of Public Health: Assessing The Potential Impact Of State Policies On Community Health Centers' Outreach And Enrollment Activities 
This nationwide analysis of community health centers' early outreach and enrollment experiences under the Affordable Care Act (ACA) finds that all health centers are engaged in a significant and sustained effort to identify and assist eligible patients and community residents in obtaining health insurance coverage. ... But in states with restrictive policies toward ACA implementation (defined as both opting out of the Medicaid adult expansion and adopting Navigator laws), health centers are confronting significantly greater outreach and enrollment challenges compared to health centers in states that have fully implemented the law through Medicaid expansion and without outreach and enrollment restrictions (Shin et al., 1/14).

JAMA Surgery: Failure To Rescue In Safety-Net Hospitals
While many uninsured persons will obtain coverage under the Patient Protection and Affordable Care Act, historical lack of resources and the introduction of value-based payments may adversely affect some hospitals. We found that hospital safety-net burden was an independent predictor of [the mortality rate among surgical patients with complications] after controlling for hospital and patient factors. Hospitals with a high safety-net burden (HBHs) were more likely to be large teaching facilities with sophisticated internal medicine services and high technology but had lower proportions of RNs among nurses, electronic medical record implementation, and a positron emission tomographic scanner. ... Although we cannot precisely identify the cause of this disparity, it may relate to culture, teamwork, or the way in which resources are mobilized and used to provide care for patients with complications in a timely fashion (Wakeam et al., 1/15).

JAMA Surgery: Association Of High-Volume Hospitals With Greater Likelihood Of Discharge To Home Following Colorectal Surgery
Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals. This study is the first step in a process of identifying which features of high-volume hospitals contribute toward desirable outcomes. Efforts to identify the reasons for improved recovery at high-volume hospitals can help lower-volume hospitals adopt beneficial practices (Balentine, 1/15).

The Kaiser Family Foundation: Raising Medicare Premiums For Higher-Income Beneficiaries: Assessing The Implications
Some recent proposals to address concerns about federal spending have included recommendations to reduce the growth in Medicare spending by increasing beneficiaries' contributions towards their health care costs. ... there is some possibility that such changes could lead some higher-income beneficiaries to drop out of Medicare Part B and instead self-insure, which could result in higher premiums for all others who remain on Medicare if the dropout group is large and relatively healthy. ... given the relatively low incomes of most people on Medicare, a significant amount of savings from this proposal is only possible by going relatively far down the income scale to reach a sizeable share of beneficiaries-;at which point the affordability of these additional costs could be called into question (Cubanski, Neuman, Jacobsen and Smith, 1/13).

Employee Benefit Research Institute/Greenwald & Associates: Views On Employment-Based Health Benefits: Findings From The 2013 Health And Voluntary Workplace Benefits Survey
Enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA) has raised questions about whether employers will continue to offer health coverage to their workers in the future. Yet, the importance of benefits in choosing a job remains high, and health insurance in particular continues to be, by far, the most important employee benefit to workers. Most workers are satisfied with the health benefits they have now and do not prefer to change the mix of benefits and wages. Choice of health plans is important to workers, and they would like more choices, but workers express confidence that their employers or unions have selected the best available health plan (Fronstin and Helman, December 2013).

Journal of Infectious Diseases: Prevalence Of Hepatitis C Virus Infection In US Hispanic/Latino Adults
Prevalence of hepatitis C virus (HCV) antibody has been reported in Mexican Americans, but its prevalence in other US Hispanic/Latino groups is unknown. We studied 2 populations of US Hispanic/Latino adults; 3210 from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 and 11,964 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Age-standardized prevalence ... differed significantly by Hispanic/Latino background in HCHS/SOL (eg, 11.6% in Puerto Rican men vs 0.4% in South American men). These findings suggest that the HCV epidemic among US Hispanics/Latinos is heterogeneous (Kuniholm et al., 1/14).

All-Payer Claims Database Council/Robert Wood Johnson Foundation: The Basics Of All-Payer Claims Databases
Over the past 10 years, a growing number of states have established state-sponsored all-payer claims database (APCD) systems to fill critical information gaps for state agencies, to support health care and payment reform initiatives, and to address the need for transparency in health care ... States working collectively on common issues can leverage solutions more effectively than each state working independently. Areas for continued collective action include development of national standards, both in data and measures. Now and in the future, state APCDs provide the unique data to support the development of comparable information about the cost, effectiveness, and performance of the health care delivery system at the local, state and national levels (Porter et al., 1/14).

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

Examiner: Minorities And The Poor Receive Delayed Thyroid Cancer
A new UCLA study has found that, compared to Caucasian patients and those in higher economic brackets, minority patients and those of lower socioeconomic status are far more likely to have advanced thyroid cancer when they are diagnosed with the disease. The study, which comprised almost 26,000 thyroid cancer patients was published in the January edition of the Journal of Endocrinology and Metabolism (Wulffson, 1/9).

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