Research roundup: For-profit hospitals' readmission rate, containing self-referrals, children's dental health, revisiting McAllen

Annals of Internal Medicine: For-Profit Hospital Status And Rehospitalizations At Different Hospitals: An Analysis of Medicare Data - "Rehospitalization within the first 30 days of discharge affects 1 in 5 hospitalized Medicare fee-for-service patients and costs approximately $17.4 billion in payments annually ... the top 4 factors most related to the risk for rehospitalization at a different facility were initial admission to a for-profit index hospital … lower-volume index hospital (hospitals with <1000 annual discharges) … hospital with a major medical school affiliation … and being disabled." Additionally, the author write, "Rehospitalization at a different hospital was associated with a statistically significant increase in adjusted total 30-day payments at the 50% and 90% payment spectrum levels. The increase in adjusted 30-day payments at the median for rehospitalization at a different hospital was $1308 per patient. This pattern of significantly increased adjusted 30-day payments was maintained regardless of whether a patient was initially hospitalized at a for-profit or a nonprofit or public hospital" (Kind et al., 12/7).

Health Affairs: The 2007-09 Recession And Health Insurance Coverage - "Those who became unemployed or underemployed moved into income strata in which they were less likely to have employer coverage, and more likely to be uninsured. … The proportion of children covered through employer-sponsored insurance also declined sharply, but this change was offset by increases in Medicaid and CHIP coverage. Adults accounted for all of the increases in the uninsured population between 2007 and 2009," the author reports. "All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance"  (Holahan, 12/6).

Health Affairs: McAllen And El Paso Revisited: Medicare Variations Not Always Reflected In The Under-Sixty-Five Population - This study compares the "use of and spending per capita for medical services" by patients younger than 65 insured by Blue Cross and Blue Shield of Texas in McAllen and El Paso, Texas, to Medicare recipients in the same areas. Although "[t]otal price-adjusted Medicare spending was 86 percent higher in McAllen than in El Paso, and was 75 percent above the national average in 2007 …, for the population insured by Blue Cross Blue Shield of Texas, total spending per member per year in McAllen was 7 percent lower than in El Paso. Although spending for professional and inpatient services were similar in the two regions, spending for outpatient services in McAllen was 31 percent less" (Franzini et al., December 2010).

Kaiser Health News featured coverage of the Health Affairs study by staff writer Jordan Rau (12/7).

Health Affairs: Imaging: The Self-Referral Boom And The Ongoing Search For Effective Policies To Contain It - This article examines the issues surrounding imaging self-referral (when a physician refers patients for diagnostic procedures on imaging machines that the doctor owns or has an ownership interest in) and reviews several efforts to control such practice in recent years, including those taken by private insurers and the Centers for Medicare and Medicaid Services (CMS) and in the passage of the Deficit Reduction Act and the Affordable Care Act. "It will take several years to evaluate the effect on self-referral of the sizable payment reductions implemented in the Deficit Reduction Act and the Affordable Care Act," the authors write. "In the interim, it behooves Congress to ensure that Medicare beneficiaries, to the maximum extent possible, receive only medically necessary imaging studies, regardless of who owns or operates the equipment" (Hillman and Goldsmith, December 2010).

Related, earlier KHN story: Health Law Changes Rules For Docs With In-House Imaging Machines (Galewitz, 8/23)

Archives of Pediatrics & Adolescent Medicine: Electronic Health Record Adoption By Children's Hospitals In The United States - "Only 2.8% of hospitals had hospital-wide use of all functionalities needed for a comprehensive EHR system" and 17.9% have a basic EHR, the authors report. "Among hospitals with no EHR system, the most commonly reported barriers to adoption were inadequate capital for purchase (56.8%), maintenance cost (37.6%), lack of interoperability (35.9%), physician resistance (33.2%), and difficulty meeting organizational needs (29.4%)  … The policy changes identified by these hospitals as most likely to have a positive effect on EHR adoption were additional reimbursement for EHR use (85.8%) and financial incentives for implementation (68.6%)" (Nakamura et al., December 2010).

Health Affairs: How A North Carolina Program Boosted Preventive Oral Health Services For Low-Income Children - "Implementation of a preventive oral health program in North Carolina medical offices led to a net statewide increase in the provision of preventive oral health services to young Medicaid-enrolled children, who historically have had very limited access to dentists," write the authors of this study that examined physician and dentist Medicaid claims between 2000-2006. The article details how the program, initiated in 2000, reimburses "providers for up to six visits for preventive oral health services in primary care medical settings for children during their first three years of life" and subsequent trends in use (Rozier et al., December 2010).