Research Roundup: Insurer Payments To Doctors Vary Across U.S.

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

Health Affairs: Private Insurers' Payments For Routine Physician Office Visits Vary Substantially Across The United States
Anecdotal reports suggest that substantial variation exists in private insurers' payments for physician services, but systematic evidence is lacking. Using a retrospective analysis of insurance claims for routine office visits, consultations, and preventive visits from more than forty million physician claims in 2007, we examined variations in private payments to physicians ... Physicians at the high end of the payment distribution were generally paid more than twice what physicians at the low end were paid for the same service. Little variation was explained by patients' age or sex, physicians' specialty, place of service, whether the physician was a "network provider," or type of plan, although about one-third of the variation was associated with the geographic area of the practice (Baker, Bundorf and Royalty, 9/9).

Health Affairs: No Evidence That Primary Care Physicians Offer Less Care To Medicaid, Community Health Center, Or Uninsured Patients 
Using data from more than 31,000 visits to primary care physicians in the period 2006–10, we examined whether the length or content of a visit was different for safety-net patients—those insured by Medicaid, those who are uninsured, and those seen in a community health center—compared to patients with private insurance. We found no significant differences in the average length of a primary care visit or in the likelihood of a patient's receiving preventive health counseling. Medicaid patients received more diagnostic and treatment services, and uninsured patients received fewer services, compared to privately insured patients, but the differences were small (Bruen, Ku, Lu and Shin, 9/9).

Health Affairs: Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care
Considerable attention is being paid to hospital readmission as a marker of poor postdischarge care coordination. However, little is known about another potential marker: emergency department (ED) use. We examined ED visits for Medicare patients within thirty days of discharge for six common inpatient surgeries. We found that these visits were widespread and showed extensive variation across facilities. ... There was substantial variation—as much as fourfold—in hospital-level ED use for these patients across all six procedures. The variation might signify a failure in upstream coordination of care and therefore might represent a novel hospital quality indicator (Kocher, Nallamothu, Birkmeyer and Dimick, 9/9). 

The New England Journal of Medicine: The Public And The Conflict Over Future Medicare Spending
As we reported in the Journal in 2011, there has been little public support for major policy changes aimed at reducing Medicare spending to lower the federal deficit. This article goes further and seeks to document the underlying beliefs that may shape the public response to future efforts to substantially slow projected Medicare spending. Our thesis is that there exists today a wide gap in beliefs between experts on the financial state of Medicare and the public at large. ... We examine this thesis by analyzing data from six public opinion polls conducted in 2013 ... Although Medicare is popular, it is not seen as better run than private insurance plans, nor is it seen as particularly different from private coverage with respect to quality of care or access to physician care (Blendon and Benson, 9/12).

JAMA Pediatrics: Healthy Habits, Happy Homes: Randomized Trial to Improve Household Routines for Obesity Prevention Among Preschool-Aged Children
In this 6-month follow-up of a home-based randomized trial, we found that a multicomponent intervention that uses individually tailored counseling focused on improving household routines increased children’s sleep duration and reduced children’s TV viewing on weekends. We found that, compared with control subjects, children who participated in the intervention decreased their BMI. To our knowledge, the Healthy Habits, Happy Homes study is the first home-based randomized trial to address key household routines related to obesity risk among young children. Recent reviews of obesity prevention interventions among young children have identified the paucity of home-based interventions and have called for interventions that are appropriately tailored for families (Haines et al, 9/9).

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

Medscape: Statewide Medical Home Pilot Reduces ED Visits
A patient-centered medical home pilot program in Rhode Island showed significant improvements in medical home recognition scores and in ambulatory emergency department (ED) visits, according to an article published online September 9 in JAMA Internal Medicine. Meredith B. Rosenthal, PhD, from the Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, and colleagues analyzed multipayer claims data from 2 years before the pilot program and/or 2 years after the program began (Hand, 9/9).

Reuters: 'Futile Treatment' Common In ICUs: Study
More than one in ten patients being treated in intensive care units (ICUs) was at some point receiving what doctors deemed to be futile care, in a new study. In those cases, critical care doctors believed people would never survive outside an ICU or that the burdens of their care "grossly outweighed" any benefits. And, researchers found, treating each of those patients cost about $4,000 every day (Pittman, 9/9).

Medscape: Small Clinics: Pay-for-Performance Improved Outcomes
In small practices using electronic health records (EHRs), a pay-for-performance (P4P) program was associated with modest improvements in cardiovascular care processes and outcomes, according to findings of a cluster-randomized trial published in the September 11 issue of JAMA (Barclay, 9/11).

Medscape: Most NEJM Readers Oppose Physician-Assisted Suicide
Roughly 2 in 3 readers of the New England Journal of Medicine (NEJM) oppose physician-assisted suicide, according to survey results published online today in the journal. That level of opposition to physicians administering a lethal dose of narcotic to a terminally ill patient who requests it held true for 2356 readers in 74 countries (64.6%) as well as a subset of 1712 US readers from 49 states (67.3%) (Lowes, 9/11).

NPR's SHOTS blog: What To Avoid At The Orthopedist's Office
In a perfect world, data gleaned from clinical trials would get distilled into guidelines about which treatments work best. Doctors would follow the guidelines, making allowance for a person's particular circumstances. Patients would get high-quality, cost-effective care. ... The five not-so-great orthopedic treatments posted today are part of a coalition effort by dozens of medical specialties to change that, called "Choosing Wisely" (Shute, 9/11). 

Reuters: Hospital Infections Cost U.S. $10 Billion A Year
Infections acquired in the hospital cost the U.S. health care system $10 billion a year, new findings show. Past studies have pegged the annual cost of treating those infections at $20 billion to $40 billion, so the new numbers show progress is being made, Dr. Eyal Zimlichman of The Center for Patient Safety Research and Practice at Brigham and Women's Hospital in Boston, one of the new study's authors, told Reuters Health (Harding, 9/12).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from major news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.