Research Roundup: Shifting ER Visits To Urgent Care Centers; Evaluating Doctors; Medicare Advantage Quality Ratings

Health Affairs: Many Emergency Department Visits Could Be Managed At Urgent Care Centers And Retail Clinics – Researchers analyzed samples of patient records and found "13.7 percent of all emergency department visits could take place at a retail clinic" – 7.9 percent when hours are restricted – and "an additional 13.4 percent of emergency department visits could take place at a urgent care center—8.9 percent when hours are restricted. That is, a total of 27.1 percent of all emergency department visits could be managed at a retail clinic or urgent care center—16.8 percent when hours are restricted. ... Assuming the smallest of each of these savings and assuming that 16.8 percent—our midpoint estimate—of the 104 million emergency department visits that did not result in a hospital admission in 2006 could take place in one of these alternative settings, the potential savings to the health care system would be approximately $4.4 billion annually, or 0.2 percent of national health care spending" (Weinick, Burns and Mehrota, September 2010).

Journal of the American Medical Association: Relationship Between Patient Panel Characteristics And Primary Care Physician Clinical Performance Rankings – "An intrinsic assumption underlying physician clinical performance assessment is that the measures represent physician performance. However, the same physician may have higher or lower measured quality scores depending on the panel of patients he or she manages." The authors looked at data from "a large academic primary care network ... 125,303 adult patients who had visited any of the 9 hospital-affiliated practices or 4 community health centers [at Massachusetts General Practice] between January 1, 2003, and December 31, 2005." They report that the primary care doctors who were rated in the top third "of measured quality were more likely to care for older patients with greater comorbidity who made more frequent visits to see a primary care physician. … Because older patients with more comorbidities are often seen more frequently, they may have stronger relationships with their physicians, and physicians caring for such patients may have more opportunities to complete process measures." Those physicians were also "less likely to care for minority, non–English-speaking, Medicaid, and uninsured patients" than the doctors in the bottom third of the rankings (Hong et al., 9.8).

Health Affairs: Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals –The World Health Organization has a Surgical Safety Checklist – "[A] two-minute tool, much like the checklist a pilot uses before takeoff, and is designed to help operating room staff improve teamwork and ensure the consistent use of safety processes to existing practice."  The researchers performed "a decision analysis of implementation and use of the checklist in a U.S. hospital over a one-year period. ... the implementation and use of the checklist would save $103,829 annually for a hospital that performed 4,000 noncardiac operations per year. This equates to a savings of $25.96 per operation performed. The authors conclude that "the adoption and use of the WHO Surgical Safety Checklist is a cost-saving quality improvement strategy. If at least five major complications are prevented within the first year of using the checklist, a hospital will realize a return on its investment within that same year. Since implementation costs make up the majority of the costs associated with the checklist and do not recur, cost savings may occur beyond the first year of use" (Semel et al., September 2010).

Kaiser Family Foundation: Quality Ratings of Medicare Advantage Plans: Key Changes in the Health Reform Law and 2010 Enrollment Data -- This issue brief (pdf.) "examines the key changes in this year's health reform law that will reward bonuses to private Medicare Advantage plans based on quality rating. ... The results indicate that private Medicare Advantage plans with high quality ratings are concentrated in certain states, leaving beneficiaries in some states with few if any options for choosing a highly-rated plan. States with more highly-rated plans, and higher enrollment in those plans, are likely to receive more bonuses and quality-based payments under health reform." The authors recommend that a "careful review of the current rating system is warranted to be sure that the ratings are a valid and meaningful measure of a plan's quality." The also suggest that more information is needed about the quality of special needs plans (SNPs), which "serve the most vulnerable Medicare beneficiaries, including beneficiaries who are dually eligible for Medicare and Medicaid, live in a long-term care facility, or have certain chronic conditions" (Jacobson, Damico, Neuman and Huang, 9/9).

Commonwealth Fund: Systems Of Care Coordination For Children: Lessons Learned Across State Models – "There are few organized systems of referral and care coordination for children and families identified with early developmental delays, complex medical conditions, and difficulties negotiating the medical and related support systems, but some promising models are emerging," write the authors of this issue brief, which examines lessons learned from state models that coordinate such care in Iowa, Rhode Island, Colorado, North Carolina and Connecticut. "Common features of successful programs include: maximizing efficiencies through shared resources, leveraging and partnering with other organizations, in-depth involvement with pediatric practice staff, appropriate training and tools, flexible program design, measurement and evaluation, and a holistic approach to care" (Silow-Carroll and Hagelow, 9/3).

Health Affairs: Who And Where Are The Children Yet To Enroll In Medicaid And The Children’s Health Insurance Program? – "According to our revised coverage estimates, some 7.3 million children were uninsured on an average day in 2008, of whom 4.7 million (65 percent) were eligible for Medicaid or CHIP but not enrolled," the authors report (based on data derived from the 2008 American Community Survey). "The number of uninsured children who were eligible for Medicaid/CHIP but not enrolled was heavily concentrated in a relatively small number of populous states. Just three states combined—California, Texas, and Florida—contained 38.6 percent of all eligible uninsured children in the country" (Kenney et al., 9/3).

Related KHN story: Participation In Children's Health Insurance Program Varies Widely Across Country (Galewitz, 9/7)

Archives of Pediatrics & Adolescent Medicine: Changes In Human Immunodeficiency Virus Testing Rates Among Urban Adolescents After Introduction Of Routine And Rapid Testing – For this study, researchers "examined (1) changes in HIV testing rates that occurred after the release of the 2006 CDC recommendations for routine testing and (2) changes in rates of testing after both rapid and traditional testing" was available in an urban primary care clinic. Based on a review of the computerized billing records of 9,491 sexually experienced 13- to 22-year-olds, the authors report, "HIV testing rates increased significantly following publication of recommendations for routine testing and further increased following introduction of rapid testing." (Mullins et al., September 2010).

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