Research roundup: Pricing and the SHOP exchange; health use in rural vs. urban areas; the health law and AIDS care

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

Health Affairs: Small Employer Perspectives On The Affordable Care Act's Premiums, SHOP Exchanges, And Self-Insurance
Beginning January 1, 2014, small businesses having no more than fifty full-time-equivalent workers will be able to obtain health insurance for their employees through Small Business Health Options Program (SHOP) exchanges in every state. ... Based on a telephone survey of 604 randomly selected private firms having 3–50 employees, we found that both firms that offered health coverage and those that did not rated most features of SHOP exchanges highly but were also very price sensitive. More than 92 percent of nonoffering small firms said that if they were to offer coverage, it would be "very" or "somewhat" important to them that premium costs be less than they are today (Gabel et al., 10/16).

Health Affairs: Rural And Urban Medicare Beneficiaries Use Remarkably Similar Amounts Of Health Care Services
Medicare payment policies for rural health care providers are influenced by the assumption that the limited supply of physicians in rural areas causes rural Medicare beneficiaries to receive fewer health care services than their urban counterparts do. This assumption has contributed to the growth in special payments to rural providers. As a result, Medicare pays rural providers $3 billion more each year in special payments than they would receive under traditional payment rates. ... we analyzed claims data for all Medicare fee-for-service beneficiaries in 2008, stratified by rural/urban status and region. After adjusting for health status, we found no significant differences between rural and urban beneficiaries in either the amount of health care received or satisfaction with access to care (Stensland, 10/30).

Pediatrics: Randomized Controlled Trial Of Universal Postnatal Nurse Home Visiting: Impact On Emergency Care 
The Durham Connects program was developed in collaboration with community leaders as a brief, universal, postnatal nurse home visiting intervention designed to screen for risk, provide brief intervention, and connect families with more intensive evidence-based services as needed. ... Intervention families were offered 3 to 7 contacts between 3 and 12 weeks after birth to assess family needs and connect parents with community resources to improve infant health and well-being. ... families assigned to intervention had 50% less total emergency medical care use across the first 12 months of life. ... This approach offers a novel solution to the paradox of targeting by offering individually tailored intervention while achieving population-level impact (Dodge et al., 11/4). 

Annals of Internal Medicine: A Home Score For Streptococcal Pharyngitis Enabled By Real-Time Biosurveillance: A Cohort Study
Objective: To help patients decide when to visit a clinician for the evaluation of sore throat. ... Patients: 71 776 patients aged 15 years or older with pharyngitis who visited a clinic from September 2006 to December 2008. ... Results: If patients aged 15 years or older with sore throat did not visit a clinician when the new score estimated the likelihood of GAS pharyngitis to be less than 10%, ... 230,000 visits would be avoided in the United States each year and 8500 patients with GAS pharyngitis who would have received antibiotics would not be treated with them. ...  A patient-driven approach to pharyngitis diagnosis that uses this new score could save hundreds of thousands of visits annually by identifying patients at home who are unlikely to require testing or treatment (Fine, Nizet and Mandl, 11/5).

Journal Of The American College Of Radiology: The Increasing Role Of Non-Radiologists In Performing Ultrasound-Guided Invasive Procedures 
Recent proliferation of mobile diagnostic ultrasound (US) units and improved resolution have allowed for widespread use of US by more providers, both for diagnosis and US-guided procedures (USGP). This study aims to document recent trends in utilization for USGP in the Medicare population. Source data were obtained from the CMS Physician Supplier Procedure Summary Master Files from 2004 to 2010. .... The year 2010 represents the first year that nonradiologists performed more USGP than radiologists. From 2004 to 2010, radiologists and surgeons experienced only modest growth in USGP volume, whereas several other provider types experienced more rapid growth. It is likely that many procedures that were previously performed without US guidance are now being performed with US guidance (Sharpe et al., Nov. 2013).

The Kaiser Family Foundation/Topics in Antiviral Medicine: Implications Of The Affordable Care Act For People With HIV Infection And The Ryan White HIV/AIDS Program: What Does The Future Hold?
There are numerous aspects of the Affordable Care Act that will be important for people with HIV in the U.S., including consumer protections and private insurance reforms, establishment of health care marketplaces in every state, new benefit standards, Medicare fixes, prevention enhancements, expansion of Medicaid, and health system improvements. However, it is unlikely that these changes will address all the needs of people with HIV. The Ryan White HIV/AIDS Program will thus remain crucial for the provision of adequate health care to HIV-infected individuals, but it will need to change. Changes in the Ryan White Program's role will depend largely on state decisions on Medicaid expansion and health care marketplaces (Kates, 11/1).

The Centers for Disease Control and Prevention/Preventing Chronic Disease: The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008–2010
In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. ... In our study uninsured non-Hispanic white women were less likely to receive a Pap test than were uninsured women of other races. Young, uninsured Hispanic women were more likely to receive a Pap test than were young, fully insured Hispanic women. ... Electronic health records enable population-level surveillance in community health centers and can reveal factors influencing use of preventive services (Cowburn et al., 10/24). 

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

Reuters: Black Patients Less Likely To Ask For Lower-Cost Meds
African American patients may feel less comfortable than white patients asking doctors if they can take cheaper drugs, a recent survey from an emergency department shows. White patients in the study were also more likely to be aware of low-cost prescription drug programs, according to lead author Dr. Preeti Dalawari, of Saint Louis University School of Medicine, and her colleagues (Huggins, 11/1).

PBS NewHour: Will Your Specialty Care Be Impacted By The Changing Health Care Landscape?
Take a mental snapshot of the U.S. health care system as it is today, because in 10 years, you might not recognize it. And if something isn't done now to boost the number of doctors in the U.S., you may not like it, either. If current trends hold, the number of physicians -- particularly specialists -- in the pipeline today may not be enough to keep pace with the future needs of a graying population, let alone the challenges of the new health care landscape, according to a study published Monday in the journal Health Affairs (Corapi, 11/4).

Medpage Today: Diabetes Teams With NPs, PAs Mostly Successful
A study comparing care teams with physician assistants (PAs) and nurse practitioners (NPs) with those of just physicians found outcomes were generally the same in 13 of 20 measures for diabetic patients without highly complex conditions. However, patients with care supplemented by PAs and NPs with highly complex conditions experienced worse outcomes in several areas compared with patients receiving physician-only care, Christine Everett, PhD, PA-C, MPH, professor in the physician assistant program at Duke University School of Medicine in Durham, N.C., and colleagues found (Pittman, 11/4).

Reuters: Surgeon All-Nighters Don't Lead To Complications: Study
Sleep-deprived surgeons don't make any more mistakes than usual during gallbladder operations, a new study suggests. Whether doctors had been up doing emergency surgery the previous night did not affect a patient's risk of having complications during or after the procedure (Pittman, 11/5).

Medscape: Colorectal Cancer Screening Rates Remain 'Far Too Low'
About 1 in 3 Americans aged 50 to 75 years, or 23 million people, have not been screened for colorectal cancer as recommended by the US Preventive Services Task Force (USPSTF), according to new data released today by the Centers for Disease Control and Prevention (CDC). This is a "disturbing fact," CDC Director Tom Frieden, MD, MPH, said during a media briefing. "Despite research showing that colorectal cancer screening saves lives, screening rates remain far too low" (Brooks, 11/5).

Medscape: After-Hours Call Centers Over-Refer Children To Emergency
About 1 in 3 children and adolescents referred to the emergency department by an after-hours nurse telephone triage service were considered nonessential referrals, a new study has found. "Although after-hours nurse telephone triage services improve the lifestyle of the outpatient pediatrician -; and have been shown to standardize care -; our research suggests that a large number of nonurgent patients are referred to the emergency department when perhaps they could be managed in the outpatient setting," said Kaynan Doctor, MD, from the Children's National Medical Center in Washington, DC. (McNamara, 11/6).

MedPage Today: Seniors Gain From Fall Prevention Program
A community-based fall prevention program effectively reduced the risk for falls among older adults, researchers said here. The evidence-based program, called Step Up to Stop Falls, includes exercise, home assessment/modification, and community and/or healthcare provider education, according to Mary Gallant, PhD, MPH, at the University of Albany School of Public Health in Rensselaer, N.Y., and colleagues (Buckley, 11/6).

Time: Primary-Care Doctors Don't Have The Best Tools For Treating Depression
Not all doctors are able to treat depression effectively, including those who are most likely to see patients' first symptoms. Even though patients may turn first to their primary-care physicians with any concerns about depression, the tools that those doctors use to evaluate their patients for mental-health disorders aren't necessarily helping to improve their patients' symptoms, according to the latest study published in the Journal of the American Medical Association of some of the most common practices used by these physicians (Sifferlin, 11/6).