Safety net hospitals prepare for changes from health law; Patients hesitant to challenge doctors

KHN reporter Ankita Rao compiles a weekly selection of recently released health policy studies and briefs.

Health Affairs/Urban Institute/Kaiser Family Foundation: How Five Leading Safety-Net Hospitals Are Preparing For The Challenges And Opportunities Of Health Care Reform – Safety-net hospitals – which often provide care to low-income and uninsured populations – are facing reduced federal and state support for uncompensated care under the Affordable Care Act. However, this study points out that 23 million people will remain uninsured and continue to need care from the hospitals. Researchers studied five leading safety-net hospitals: Bellevue Hospital Center in New York City, Denver Health Medical Center, Parkland Health and Hospital System in Dallas, San Francisco General Hospital and Virginia Commonwealth University Health System in Richmond, Va., to examine their strategies for surviving under health reform. They found that the hospitals were focusing on adding health information technology, improving efficiency in delivering care and integrating systems so that they can retain and attract new patients who have coverage and position themselves for the new health care models advocated by the overhaul law (Coughlin, et al, 8/2012).

Archives of Internal Medicine: Communicating With Physicians About Medical Decisions: A Reluctance To Disagree –Researchers found that patients are hesitant to disagree with their physicians or make choices about their health care through a shared decision process. Most survey participants were white, educated and between 40 and 60 years old, but the study said that socioeconomic backgrounds did not play a role in a patient's fear to voice opposition when relevant or share their preferences with their doctor. Of the participants, 89.6 percent were currently insured, and 38 percent had a chronic ailment such as heart disease. The researchers, who presented their results in a letter in the journal, commented that the findings point to a need to test interventions "that explicitly allow patients to voice disagreement with their physicians" (Adams, et al, 8/13).

Urban Institute: Opting In To The Medicaid Expansion Under The ACA: Who Are The Uninsured Adults Who Could Gain Health Insurance Coverage? – This study examines who would be eligible to gain health coverage under the 2010 health law's expansion of Medicaid to low-income people. Researchers suggest that if states adopt the measure, 15.1 million uninsured adults could gain coverage. Of this group, less than one-fifth are parents living with dependent children – about 2.7 million adults in total. The majority are white, single and under 35 years old, although the demographics vary among states (Kenney, et all, 8/10).

Health Affairs: Graduate Medical Education -- Residency programs, the training regimens that young doctors go through after graduating from medical school, are largely financed by the federal government. These young doctors are a key part of the staffing at many teaching hospitals and proponents of this funding say it is imperative to maintain a supply of doctors that will be needed as more people get health insurance when the federal health overhaul takes effect. Although some members of Congress and hospital officials are pushing to expand that spending, the Obama administration has called for cuts. This issue paper looks at the background of the current system and the arguments for change (Dower, 8/16).

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

MedPage Today: New Data Confirm 'Fat Belt'
States in the Southeast and Midwest had the highest rates of obesity in 2011, the CDC reported, with almost the same pattern as that found in 2010 from the same data source. The 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) showed that the 12 states with obesity rates of 30% or more were the same as in the 2010 edition, except that Indiana joined the list and and Tennessee -- at 29.2% in 2011 -- had dropped off (Gever, 8/13).

Slate: Most People Who Take Blood Pressure Medication Possibly Shouldn't
A new study is turning decades of medical dogma on its head. A panel of independent experts reports this week that drugs used to treat mild cases of high blood pressure have not been shown to reduce heart attacks, strokes, or overall deaths. Most of the 68 million patients in the United States with high blood pressure have mild, or Stage 1, hypertension, defined as a systolic (top number) value of 140-159 or a diastolic (bottom number) value of 90-99. The new review suggests that many patients with hypertension are overtreated-;they are subjected to the possible harms of drug treatment without any benefit. The study was conducted by the widely respected Cochrane Collaboration, which provides independent analyses of medical data (Lenzer, 8/14).

Medscape: Study 'Shows The Way' To Resolving PSA Controversy
A new approach to evaluating the benefits and harms of prostate-specific antigen (PSA) testing "shows the way to a resolution of the long-standing problem about screening for prostate cancer," according to an editorial in the August 16th edition of The New England Journal of Medicine. … A big part of the problem has been that any recommendation about testing, like that recently from the US Preventive Services Task Force, is based on an "apples-and-oranges" comparison, says Dr. [Harold] Sox, who is from the Dartmouth Institute for Health Policy & Clinical Practice, in Hanover, New Hampshire. A new study, published in tandem with the editorial, now addresses the "apples-and-oranges problem" by using the same measure -; quality-adjusted life-years -; to quantify the harms and benefits of screening, Dr. Sox explains (Mulcahy, 8/15).