Research roundup: Malpractice reforms and doctors' practice; Medicaid expansion's effect

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

The New England Journal of Medicine: The Effect of Malpractice Reform On Emergency Department Care
Defensive medicine is considered by many to be a major source of wasteful medical spending in the United States. A widely cited report estimates that $210 billion is spent annually on needless care motivated by fear of malpractice litigation. ... Malpractice reforms in Texas, Georgia, and South Carolina, which changed the liability standard for emergency care from ordinary negligence to gross negligence, provide unusually broad protection for emergency physicians. We did not find evidence that these reforms decreased practice intensity, as measured by the rate of the use of advanced imaging, by the rate of hospital admission, or in two of three cases, by average charges. Although there was a small reduction in charges in one of the three states (Georgia), our results in aggregate suggest that these strongly protective laws caused little (if any) change in practice intensity among physicians caring for Medicare patients in emergency departments (Waxman et al., 10/15).

Urban Institute: In States That Don't Expand Medicaid, Who Gets New Coverage Assistance Under The ACA And Who Doesn't?
In states not expanding Medicaid, 6.3 million uninsured adults who could have qualified for Medicaid are instead ineligible, while 5.9 million other uninsured adults qualify for subsidized, private insurance. We compare these two groups and find the following: Median income for such ineligible adults is 35 percent below poverty. For eligible adults, it is 175 percent of the federal poverty level. In dollars, median incomes are under $800 a month for the ineligible uninsured and over $2,000 a month for eligible adults. As a result: Only 28.0 percent of uninsured black adults qualify for help paying for health coverage while fully 42.7 percent are ineligible because of nonexpansion. By contrast, more uninsured whites qualify (36.0 percent) than not (32.7 percent). ... Uninsured adults who are Hispanic, under age 25, or have at most a high school degree are more likely to be ineligible than eligible (Dorn, Buettgens and Dev, 10/9).

Neurology: Cost Of Informal Caregiving Associated With Stroke Among The Elderly In The United States
We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. ... The economic value of informal caregiving per stroke survivor was $8,211 per year, of which $4,356 (53%) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at $14.2 billion in 2008 (Joo, Dunet, Fang, and Wang, 10/10).

Journal of the American Medical Association: Association Between Skilled Nursing Facility Quality Indicators And Hospital Readmissions
Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available skilled nursing facility (SNF) performance measures and the risk of hospital readmission. ... we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, health deficiencies identified through site inspections, and the percentages of SNF patients with delirium, moderate to severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. ... Among fee-for-service Medicare beneficiaries who received postacute care at a US SNF, better performance on available measures of postacute care quality was not consistently associated with a lower adjusted risk of readmission or death at 30 days (Neuman, Wirtalla and Werner, 10/15).

The Kaiser Family Foundation: What's In and What's Out? Medicare Advantage Market Entries and Exits for 2015
During the debate over the Affordable Care Act (ACA), some questioned whether the Medicare Advantage market would shrink in response to the reductions in payments to Medicare Advantage plans included in the ACA .... The total number of Medicare Advantage plans will be similar to the number in 2014, declining by 3 percent from 2,014 plans in 2014 to 1,945 plans in 2015. ... In most states, the total number of plans offered in 2015 will be similar to the number in 2014. In nine states ... the number of departing plans will exceed the number of new plans by at least 10 plans, while in two states ... the number of new plans will exceed the number of departing plans by at least 10 plans in 2015. ... Plans with relatively low enrollment and plans with average star quality ratings or below comprise the majority of plans exiting the markets (Jacobson, Neuman and Damico, 10/10). 

Health Affairs/RWJF: The Ninety-Day Grace Period
From October 2013 through March 2014 more than eight million Americans enrolled in a new health plan through the Affordable Care Act's (ACA's) insurance Marketplaces. The law recognizes that for some enrollees this represents a significant period of transition, with many gaining regular health coverage for the first time in their lives. To help enrollees new to the system keep their insurance, the ACA provides a ninety-day grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium. .. Most criticism about the ninety-day grace period has come from provider organizations, such as hospital and physician groups. ... Insurers, on the other hand, were concerned about the effect on plan premiums if they were required to pay claims for the entire ninety days (Pradhan, 10/16).
 

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

Reuters: Report Shows Disparities In U.S. Diabetes Prevention, Amputation
Differences in amputation rates for diabetes complications are a sign that disparities in care by region and race start much earlier, according to a new report. U.S. blacks are less likely to get routine preventive care for diabetes than other patients and three times more likely to lose a leg to amputation because of the disease, according to a new report from the Dartmouth Atlas Project, which analyzes Medicare data to see how well the healthcare system is working. ... Diabetic amputation rates in the U.S. are lower now than they were 10 or 15 years ago, but for some groups the rates are actually on the rise, he said. Amputation rates are highest in the Southeast, in rural areas and among black Americans (Doyle, 10/14).

MinnPost: Unneeded Stress Tests Cost $500M Annually, Study Finds
Inappropriate use of cardiac stress testing -; particularly testing done with imaging -; is costing the U.S. health care system more than half a billion dollars a year, according to a study published last week in the Annals of Internal Medicine. The study also estimates that the radiation exposure associated with inappropriate cardiac stress testing with imaging leads each year to almost 500 future cases of cancer (Perry, 10/15). 

The Washington Post's Wonkblog: How Family Planning Programs Save Taxpayers Billions Of Dollars Each Year
Publicly-funded family planning services help low-income Americans avoid serious health conditions while saving billions of dollars each year, according to a new analysis -- benefits that go beyond providing contraception that can prevent unintended pregnancies. Past research from the Guttmacher Institute, a research organization that supports publicly funded family programs , already found that family planning services such helped prevent an estimated 2.2 million unintended pregnancies in 2010, which would have resulted in about 1.1 million unplanned births (Millman, 10/14).

Philadelphia Inquirer: More Kids Using ERs For Medical Care, Researchers Say
More children are going to the emergency room for health care, a new California study reveals. Children's visits to the emergency room in California hospitals increased 11 percent between 2005 and 2010. At the start of the study, 2.5 million children were seen in the ER. By 2010, 2.8 million children visited the ER each year, according to the study released Oct. 14 in the Journal of the American Medical Association. Children on Medicaid made up 44 percent of the visits overall, according to the study. The proportion of Medicaid-insured patients increased over the five-year period, likely due to the economic recession (Haelle, 10/14).

NPR's SHOTS blog: Sloppy Splinting Can Make A Child's Broken Arm Much Worse
About half of all boys and a quarter of all girls will break an arm or leg before they turn 16, ... In more than 90 percent of the children and teens studied [by Dr. Josh Abzug, who directs pediatric orthopedics at the University of Maryland School of Medicine in Baltimore], the fractures weren't splinted properly by the doctors or other health workers who first treated the kids in the emergency room of a community hospital or urgent care center. ... He's alerting doctors to his findings this week at the San Diego meeting of the American Academy of Pediatrics. ... with increasing specialization within medicine, and a proliferation of urgent care centers, it's more common for the doctor, nurse or other health care worker who splints the break to instruct the parent to follow up with a call to an orthopedist (Franklin, 10/10).

Reuters: Americans Have 14M Smoking-Related Ailments, Study Finds
About 14 million major medical conditions in the U.S. can be blamed on smoking, according to a study by health officials. Using surveys, the researchers found that in 2009 roughly seven million Americans reported almost 11 million major medical conditions caused by smoking. Including ailments people don't know they have or didn't report, that number climbs to 14 million medical conditions. ... These numbers are up from the 12.7 million medical conditions estimated 10 years ago by the U.S. Centers for Disease Control and Prevention (CDC) (Doyle, 10/13).