Research roundup: Use of high-deductible plans limits some E.R. visits; older folks not as sick as they used to be

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

Health Affairs: Low-Socioeconomic-Status Enrollees In High-Deductible Plans Reduced High-Severity Emergency Care
One-third of US workers now have high-deductible health plans, and those numbers are expected to grow in 2014 as implementation of the Affordable Care Act continues. There is concern that high-deductible health plans might cause enrollees of low socioeconomic status to forgo emergency care as a result of burdensome out-of-pocket costs. We analyzed emergency department (ED) visits and hospitalizations over two years among enrollees insured in high-deductible plans through small employers in Massachusetts. We found that plan members of low socioeconomic status experienced 25–30 percent reductions in high-severity ED visits over both years, while hospitalizations declined by 23 percent in year 1 but rose again in year 2 (Wharam et al., Aug. 2013).

Health Affairs: Premium Rate Variation In Exchanges Is An Eye Opener
Like a burlesque strip tease for health policy wonks, the slow motion unveiling of premiums for state health insurance exchanges has generated a lot of attention, unease, and, yes, excitement. The 2014 premiums, the first for Obamacare's centerpiece feature of health insurance marketplaces, represent nothing short of a referendum on the &quotaffordable&quot in the Affordable Care Act. ... We took a look at the rates for silver plans, the ones most closely watched as they form the basis for computing the premium subsidies. ... While it is not surprising that rates would vary among states and regions within a large state, it is surprising to see the large variance of rates within the same regional market at the same metal level. ... What does all this rate variation portend for the future of the ACA? The news is likely good. The marketplace will present potential plan members with clear choices within metal levels. Plans with relatively high premiums may choose to reduce premiums, or risk being eliminated by market forces. Alternatively, these plans may find a successful niche offering premium products to a segment of the population. Both outcomes would indicate success in market-based competition (Ario, Block and Spatz, 8/7).

National Bureau of Economic Research: Evidence For Significant Compression Of Morbidity In The Elderly U.S. Population
Using nearly 20 years of data from the Medicare Current Beneficiary Survey, we examine how health is changing by time period until death. ... Our results show clearly that over the 1991-2009 period, disability has been compressed into the period just before death. Disability-free life expectancy rose, and disabled life expectancy declined. Thus, by either measure of compression of morbidity, morbidity is being compressed into the period just before death. Disease-free survival increased as well, although so did survival with a major disease. The major question raised by our results is why this has occurred. How much of this trend is a result of medical care versus other social and environmental factors? Our results do not speak to this issue, but they give us a metric for analyzing the impact of changes that have occurred (Cutler, Ghosh and Landrum, 8/2013).

Journal of the American Society of Nephrology: Medical Costs of CKD [Chronic Kidney Disease] in the Medicare Population
We combined laboratory data from the National Health and Nutrition Examination Survey with expenditure data from Medicare claims to estimate the Medicare program's annual costs that were attributable to CKD stage 1–4. The Medicare costs for persons who have stage 1 kidney disease were not significantly different from zero. Per person annual Medicare expenses attributable to CKD were $1700 for stage 2, $3500 for stage 3, and $12,700 for stage 4, adjusted to 2010 dollars. Our findings suggest that the medical costs attributable to CKD are substantial among Medicare beneficiaries, even during the early stages (Honeycutt et al., 8/1).

Health Care Incentives Improvement Institute/Robert Wood Johnson Foundation: Improving Incentives To Free Motivation
The challenge we face in health care is to figure out how to reverse the incentives that currently encourage doctors, nurses and others to make inefficient and potentially harmful health care choices. ... Changing incentives for providers and patients requires an understanding that modifying either will have an effect on the other, and that, wherever possible, we must reduce the potential for conflict between the two. ... To start solving these problems, we suggest that incentives be redesigned .... consider that neither the carrot nor the stick is particularly effective at creating a lasting incentive, or "charge" (Painter, de Brantes and Eccleston, 8/7).

The Heritage Foundation: Medicare's Sustainable Growth Rate: Principles For Reform
Congress may soon revisit the issue of Medicare physician reimbursement. Much of the discussion will focus on the sustainable growth rate (SGR), enacted in 1997 as a mechanism to update yearly Medicare physician payments. ... Since 2003, Congress has blocked the SGR formula from going into effect because the applicable cuts would threaten seniors' access to care. For 2014, the formula calls for a reimbursement cut of almost 25 percent. Many policymakers have concluded that the SGR must be reformed. They are right, but Congress must ensure that any fundamental reform of the SGR is accompanied by fundamental Medicare reform (Jacobs, 7/18).

Public Citizen: No Correlation: Continued Decrease In Medical Malpractice Payments Debunks Theory That Litigation Is To Blame For Soaring Medical Costs
Since 2003, both the frequency of medical malpractice payments on behalf of doctors and the amount of money paid out have fallen every single year, according to the government's National Practitioner Data Bank (NPDB), which tracks such payments. In 2012, the number of payments fell to the lowest level on record, setting a new record low for the sixth consecutive year. ... Meanwhile, the dividends promised by those pushing litigation restrictions, such as cheaper overall health care, have not remotely been realized. Since 2003, medical malpractice payments have fallen 28.8 percent. If medical malpractice litigation were truly the "biggest cost driver" in medicine, then declining payments should have pulled overall health care costs down. But the nation's health care bill has risen 58.3 percent since 2003 (Lincoln, 8/6).

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

MedPage Today: EMRs Lower Odds of Heart Failure Readmission
When electronic medical record (EMR) data was used to assess of risks of 30-day readmission for hospitalized heart failure patients, there was a significant reduction in readmission rates, researchers found. The EMR-based intervention allowed healthcare professionals to allocate intensive evidence-based interventions to those at greatest risk. ... However, there was no difference in readmission rates before and after the intervention period among those admitted with acute myocardial infarction (MI) or pneumonia, [the authors] wrote online in BMJ Quality and Safety (Petrochko, 8/7).

Modern Healthcare: ACOs Could Hurt Competition, Health Affairs Authors Say
Fledgling accountable care organizations have faced plenty of challenges. Now a group of economists and lawyers are calling for a close look at issues involving insurance, antitrust and other regulation to avoid "unintended consequences." Health policy experts Gary Bacher, Michael Chernew, Daniel Kessler and Stephen Weiner write in the latest issue of the policy journal Health Affairs that ACOs could stifle competition among insurers and providers and potentially drive up prices (Evans, 8/6).

FierceEMR: Hospital Electronic Health Data Exchange On The Rise
Data sharing by hospitals is rising, but varies by the type of clinical information exchanged and recipient, according to a new study published in the August issue of Health Affairs. The researchers--including National Coordinator for Health IT Farzad Mostashari--analyzed over 2,800 hospitals from 2008 through 2012. ... in 2012 more than half of the hospitals analyzed (51 percent) exchanged clinical information with unaffiliated ambulatory care providers, but only about one-third (36 percent) exchanged information with unaffiliated hospitals (Hirsch, 8/5).

Health Data Management: Study: Critical Access & Small Hospitals Falling Behind In Meaningful Use
A study from Mathematica Policy Research and the American Hospital Association, published in Health Affairs, finds many critical access hospitals and other smaller hospitals are at risk to fail achieving meaningful use and face Medicare payment penalties in 2015. With fewer than half of all hospitals having a basic EHR in 2012, smaller and rural hospitals "appear to be less likely than other hospitals to have met the Stage 1 criteria, and very few hospitals had all of the computerized systems necessary to achieve Stage 2 meaningful use," [the] authors contend (Goedert, 8/6).