Research roundup: Less savings needed for retirement health expenses; falls as a predictor of surgical outcomes

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

Employee Benefits Research Institute: Amount Of Savings Needed For Health Expenses For People Eligible For Medicare: More Rare Good News
Individuals should be concerned about saving for health insurance premiums and out-of-pocket expenses in retirement for a number of reasons. Medicare generally covers only about 60 percent of the cost of health care services for Medicare beneficiaries ages 65 and older, while out-of-pocket spending accounts for 12 percent. Furthermore, the percentage of private-sector establishments offering retiree health benefits has been falling, and where benefits are offered, they are becoming less generous. ... This report provides estimates for the savings needed to cover health insurance to supplement Medicare and out-ofpocket expenses for health care services in retirement. ... However, it should be noted that many individuals will need more than the amounts cited in this report because this analysis does not factor in the savings needed to cover long-term care expenses, nor does it take into account the fact that many individuals retire prior to becoming eligible for Medicare (Fronstin, Salisbury and VanDerhei, Oct. 2013).

Health Affairs: Biosimilars
The Affordable Care Act includes several provisions -- collectively referred to as the Biologics Price Competition and Innovation Act (BPCIA) -- which are designed to encourage competition in the market for biologic drugs. The term biologic refers to any therapeutic product derived from a biological source, including vaccines, antitoxins, blood products, proteins, and monoclonal antibodies. These drugs account for a substantial and an increasing share of the pharmaceutical market and a growing share of health systems costs. ... In February 2012 the FDA released draft guidance on this accelerated approval process, but to, date no biosimilar products have been reviewed or licensed in the United States. Numerous scientific, legal, and regulatory issues remain unresolved, and it is not yet clear how the biosimilar market will develop, nor if it will lead to substantially lower drug prices or better access to biologic drugs (Richardson, 10/10).

The Kaiser Family Foundation: Obamacare & You: If You Are A Woman . . .
As a woman, it is especially important for you to understand how the Affordable Care Act (ACA) will change healthcare in 2014. Your health care needs differ from men's and you are often the main healthcare decision maker for your family. Obamacare broadens the range of many services that are important to women that health plans now must cover, some without any co-pay. In addition, it expands access to coverage through Medicaid and the new state health marketplaces. Changes important to women include: no more pre-existing condition limits ..., equitable insurance pricing for men and women ... , preventive services ... , contraceptives (10/16).

The Urban Institute: Reaching And Enrolling The Uninsured: Early Efforts To Implement The Affordable Care Act
With open enrollment now underway, it appears that states and the federal government have taken many of the steps necessary to successfully promote insurance affordability programs, educate the public about new coverage options coming available under health care reform, and create new infrastructures for providing consumers with enrollment assistance. Following the playbook and lessons learned from previous expansions of coverage under Medicaid, CHIP, and other state coverage initiatives, policy-makers are launching multi-pronged campaigns that combine broad marketing with grass-roots outreach. Critically, they are equipping community-based outreach entities with the tools and training to also provide hands-on application assistance to consumers who need help navigating the enrollment process, typically building on existing networks of application assistors that have operated for years within Medicaid and CHIP programs. The most impressive efforts have involved diverse stakeholders from the beginning of the planning process, to gain their early input and buy-in, and to create long-term outreach partners that can help spread the word as expansions are implemented. What is striking, however, is that while state and federal policy-makers are both taking many of the right steps, they are doing so at very different levels of intensity. And these differences are likely to result in state-to-state variation in terms of the ultimate measure of success: consumer enrollment into coverage (Hill, Courtot and Wilkinson, 10/9).

JAMA Surgery: Relationship Between Asking An Older Adult About Falls And Surgical Outcomes
The purpose of this study was to evaluate the relationship of a history of falls to surgical outcomes in older adults undergoing major elective colorectal and cardiac operations. The specific aims were to compare outcomes of patients with and without a fall within the 6 months prior to their operation including 30-day morbidity, the need for discharge to an institutional care facility, and 30-day readmission. ... The main result was that having fallen in the 6 months prior to an operation was related to the occurrence of 1 or more postoperative complications, regardless of what procedure was performed. This finding is independent of advancing age in both groups. Having fallen was also associated with increased 30-day readmission and the need for discharge to an institutional care facility. In addition, a positive correlation between an increased number of falls and an increased number of complications existed for both the colorectal and cardiac groups. ... Given the high volume of surgical care provided for the elderly population, improving preoperative risk assessment for the older adult is becoming increasingly important. Incorporating geriatric-specific variables that reflect physiologic vulnerability of the older adult into large surgical outcomes data sets used to construct preoperative risk calculators has real potential to improve the accuracy of these tools at forecasting risk in older adults (Jones et al., 10/9).

AIDS And Behavior: Outcomes Of HIV-Infected Patients Receiving Care At Multiple Clinics
Receiving care at multiple clinics may compromise the therapeutic patient-provider alliance and adversely affect the treatment of people living with HIV. We evaluated 12,759 HIV-infected adults in Philadelphia, PA between 2008 and 2010 to determine the effects of using multiple clinics for primary HIV care. ... Overall, 986 patients (8%) received care at multiple clinics. The likelihood of attending multiple clinics was greater for younger patients, women, blacks, persons with public insurance, and for individuals in their first year of care. Adjusting for sociodemographic factors, patients receiving care at multiple clinics were less likely to use [antiretroviral therapy] ... and achieve HIV viral suppression ... than individuals using one clinic (Yehia, September 2013).

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

Medscape: Malpractice Premiums Drop For 6th Straight Year
Judging by 3 representative specialties, physicians in 2013 are once again experiencing relief on malpractice insurance premiums. Collective rates for obstetrician-gynecologists, internists, and general surgeons fell on average for the sixth straight year in 2013, according to an annual premium survey released this week by Medical Liability Monitor (MLM) (Loews, 10/10).

Medscape: Higher Nurse Staffing Levels May Mean Fewer CMS Penalties
More nurses mean lower odds of hospital readmission, and that translates into cost savings for hospitals as well as better patient care, a new study suggests. Since October 1, 2012, as part of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) has been reducing payments to hospitals that report excessive 30-day readmission rates among Medicare patients for acute myocardial infarction, heart failure, or pneumonia, note Matthew D. McHugh, RN, PhD, JD, MPH, from the School of Nursing and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, and coauthors (MacReady, 10/10).

Reuters: Medicare Choices Tricky Even For Med Students, Doctors
Even doctors in training have trouble sifting through insurance options to pick the cheapest available plan, a new study shows…An economist at Massachusetts Institute of Technology and director of the Health Care Program at the National Bureau of Economic Research, Gruber was not involved in the new report (Doyle, 10/15).