Research roundup: Majority of Docs face malpractice claims; colonoscopies in older adults; 'overwhelming' Medicare advantage choices

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

New England Journal Of Medicine: Malpractice Risk According To Physician Specialty -- The authors "analyzed malpractice data from 1991 through 2005 for all physicians who were covered by a large professional liability insurer with a nationwide client base (40,916 physicians and 233,738 physician-years of coverage)" and found that "by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties." Most of those claims did not result in a pyament. "Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk. Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage" (Jena, Seabury, Ladkawalla and Chandra, 8/18).

Government Accountability Office: Medicare Physician Feedback Program: CMS Faces Challenges With Methodology And Distribution Of Physician Reports -- This GAO study examines a 2008 HHS program, the Physicians Feedback Program, which gives "physicians confidential feedback on the resources used to provide care to Medicare beneficiaries."  The GAO found that CMS "had difficulty measuring the resources used by physicians to treat specific episodes of an illness, such as a stroke or a hip fracture" as well as challenges "in distributing feedback reports." The GAO recommended that "CMS use methodological approaches that increase physician eligibility for reports, statistically analyze the impact of its methodological decisions on report reliability, identify and address factors that may have prevented physicians from reading reports, and obtain input from a sample of physicians on the usefulness and credibility of reports. CMS concurred with these recommendations" (Cosgrove et al., 8/12).

Journal of General Internal Medicine: Assessing The Impact Of Screening Colonoscopy On Mortality In The Medicare Population -- Many medical professionals have questioned the need for routine colonoscopies in patients over 75 years old and also have suggested that screenings are more beneficial for older men than for women. By conducting a retrospective study on Medicare beneficiaries between 67-94 years old, researchers found that "increasing age and comorbidity were associated with lower [colorectal cancer]-attributable mortality. Due to shorter life expectancy and [colorectal cancer]-attributable mortality, the benefits associated with [screening colonoscopy] were substantially lower among patients with greater comorbidity." The authors conclude: "Although the effectiveness of SC was equivalent for men and women, there was substantial variation in SC effectiveness within age groups, arguing against screening recommendations based solely on age" (Gross et. al., 8/13).

Health Affairs: Complex Choices In Medicare Advantage Program May Overwhelm Seniors, Study Finds -- This study looks at Medicare data from 2004-2007 "to examine the effects on enrollment of expanded choices and benefits in the Medicare Advantage program. ... The availability of more plan options was associated with increased enrollment in Medicare Advantage when elderly Medicare beneficiaries chose from fewer than fifteen plans. Enrollment in Medicare Advantage remained steady or decreased when beneficiaries had to choose from fifteen to thirty or more than thirty plans, respectively. Elderly adults with low cognitive function were less responsive to the generosity of available benefits than those with high cognitive function when choosing between traditional Medicare and Medicare Advantage. This difference suggests that many beneficiaries are unable to access or process information when making enrollment decisions in the current environment of choices." The researchers conclude that restructuring and simplifying choice "in Medicare Advantage could improve beneficiaries' enrollment decisions, reduce out-of-pocket costs for beneficiaries with cognitive impairments, and help invigorate value-based competition among managed care plans in Medicare" (McWilliams, Afendulis, McGuire and Landon, 8/18).

Robert Wood Johnson Foundation/Urban Institute: Gains For Children: Increased Participation in Medicaid and CHIP in 2009 -- The number and the rate of children enrolled in public health insurance plans increased from 2008 to 2009. While the total number of children not enrolled in either Medicaid or CHIP dropped by 340,000, there were still 4.3 million children who remained uninsured despite meeting elegibility requirements. Researchers suggest that their findings have meaning for the future, because of the Affordable Care Act:  "Under the law, Medicaid enrollment is projected to increase 39 percent overall, but an estimated 38 percent of the uninsured who will become eligible for Medicaid or CHIP are not expected to enroll. Current patterns of participation in Medicaid/CHIP among children can provide insights to state and federal policy-makers who seek to increase coverage for adults under the ACA through higher enrollment in Medicaid" (Kenney et. al., 8/16).

Related KHN coverage from our news blog, Capsules: CHIP Outreach Gets More Kids Covered (Galewitz, 8/18).