Research Roundup: The Cost Of Bypassing Medicaid Expansion; Shift In RNs' Work Patterns

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

Health Affairs: Opting Out Of Medicaid Expansion: The Health And Financial Impacts
In this post, we estimate the number and demographic characteristics of people likely to remain uninsured as a result of states' opting out of Medicaid expansion. Applying these figures to estimates of the effects of insurance expansion from prior studies, we calculate the likely health and financial impacts of states’ opt-out decisions. ... The Supreme Court’s decision to allow states to opt out of Medicaid expansion will have adverse health and financial consequences. Based on recent data from the Oregon Health Insurance Experiment, we predict that many low-income women will forego recommended breast and cervical cancer screening; diabetics will forego medications, and all low-income adults will face a greater likelihood of depression, catastrophic medical expenses, and death. Disparities in access to care based on state of residence will increase (Dickman, Himmelstein, McCormick and Woolhandler, 1/30).

Rand Corp: Small Ideas for Saving Big Health Care Dollars
A focused review of recent RAND Health research identified small ideas that could save the U.S. health care system $13 to $22 billion per year, in the aggregate, if successfully implemented. In the substituting lower-cost treatments category, ideas are to reduce use of anesthesia providers in routine gastroenterology procedures for low-risk patients, change payment policy for emergency transport, increase use of lower-cost antibiotics for treatment of acute otitis media, shift care from emergency departments to retail clinics when appropriate, eliminate co-payments for higher-risk patients taking cholesterol-lowering drugs, increase use of $4 generic drugs, and reduce Medicare Part D use of brand-name prescription drugs by patients with diabetes. ... Small ideas do not require systemic change; thus, they may be both more feasible to operationalize and less likely to encounter stiff political and organizational resistance. (Liu et al., 1/29).

American Journal of Nursing: Changing Trends In Newly Licensed RNs 
Data were collected from two groups of newly licensed RNs [NLRNs] in 14 states via mailed surveys. The first group consisted of a subset of NLRNs surveyed for a larger study in 2004-05; the second group was surveyed by similar methods in 2010-11. ... The NLRNs in the later cohort were less likely to work in hospitals, special-care units, and direct care and more likely to work as managers, be enrolled in formal education programs, and view their work environments positively, resulting in more commitment to the organization. Also, those in the later cohort reported fewer local job opportunities, and a greater number held a second job. ... These findings indicate a shift from the traditional work patterns of NLRNs, who often began their careers in hospitals (Kovner et al., 1/29).

National Bureau of Economic Research: Challenges To Regulatory Decentralization: Lessons From State Health Technology Regulation
Policymakers often prefer decentralized regulation to central planning because decentralization allows them to better reflect the views of local residents, encourage experimentation, and evaluate various regulatory approaches. These advantages can be undermined, however, when the regulations of one government are affected by those of another. To examine the implications of such externalities, we consider the case of state certificate of need laws (CON), which require providers within the state to obtain licenses before adopting various types of health care technology. In particular, we analyze the cross-border effects of these laws on the number and location of magnetic resonance imaging providers. We find a large effect on the location of providers near borders between unregulated and regulated states (Horwitz and Polsky, 1/28).

The Kaiser Family Foundation/PerryUndem Research: Key Findings From The Field: Early Experience With ACA Enrollment In Maryland And Nevada
To learn more about the early ACA enrollment experience in two states, the Kaiser Commission on Medicaid and the Uninsured and PerryUndem Research and Communication conducted focus groups in Baltimore, Maryland and Reno, Nevada in November 2013 with low- and moderate-income individuals who recently applied for health insurance and consumer assisters trained to help individuals enroll. ... the early ACA enrollment experiences of early applicants and consumer assisters in Maryland and Nevada suggest that, as might be expected, these consumers are highly motivated to obtain health insurance. ... consumer assisters in both states are playing an important role in their communities to help educate consumers and connect them to coverage. As consumers enrolled, they needed and wanted information to understand their health plan options and how to use their coverage. ... These focus groups of early applicants suggest that continued outreach and education about key provisions of the law is needed to ensure consumers understand how the Marketplaces work, and, in particular, the different deadlines for enrolling in coverage (Artigua, Stephens and Perry, 1/27).

Center on Budget and Policy Priorities: How Much Of The Growth In Disability Insurance Stems From Demographic Changes?
The Disability Insurance (DI) program — a vital part of Social Security that pays modest benefits to people who can no longer support themselves by working due to severe medical impairments — has grown rapidly in recent decades. The program's chief actuary has consistently stated that demographic changes account for the bulk of the program's growth .... Our analysis finds that four-fifths of the program's total enrollment in 2013 — and over two-thirds of the growth in enrollment since 1980 — stems from five easily quantifiable factors: growth in the overall working-age population, the aging of that population, growth in women's labor force participation, the rise in Social Security's full retirement age, and the growth in DI receipt among women eligible for benefits to match men's rate of receipt. ... In short, the factors driving DI's growth ... do not depict a program that is "out of control" (Ruffing, 1/27).

JAMA Internal Medicine: Nudging Guideline-Concordant Antibiotic Prescribing
Despite published clinical guidelines for diagnosis and treatment of acute respiratory infections (ARIs) and decades of admonitions and clinical interventions, inappropriate antibiotic prescribing for ARIs persists. Each year, adults in the United States receive 41.2 million antibiotic prescriptions for ARIs at a cost of $1.1 billion. Half of these prescriptions are inappropriate. ... We developed a simple, low-cost behavioral "nudge" in the form of a public commitment device: a poster-sized letter signed by clinicians and posted in their examination rooms indicating their commitment to reducing inappropriate antibiotic use for ARIs. ... Relative to standard-practice control, we found a significant decrease in unnecessary antibiotic prescribing rates for patients treated by clinicians who signed and posted a letter in their examination rooms emphasizing a commitment to avoid inappropriate antibiotic prescribing for ARIs (Meeker et al., 1/27).

Accreditation Council for Graduate Medical Education: CLER Pathways To Excellence 
A survey of hospital leaders conducted by the American Hospital Association (AHA) found that newly trained physicians were deficient in the areas of communication, use of systems-based practices, and interprofessional teamwork, and highlighted the need to educate US physicians, residents, and fellows to address quality improvement. ... The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public's need for a physician workforce capable of meeting the requirements of a rapidly evolving health care environment. ... The Clinical Learning Environment Review (CLER) program is ... designed to provide US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited institutions with periodic feedback that addresses the following six areas: patient safety; health care quality; care transitions; supervision; duty hours and fatigue management and mitigation; and professionalism (1/27).

The Heritage Foundation: Replacing The Medicare SGR: Getting The Policy And The Financing Right
This year, Medicare physicians face a 24 percent pay cut. The reason: Congress updates Medicare doctors' payments by a formula called the Sustainable Growth Rate (SGR). ... Congressional leaders want to repeal the SGR entirely and replace it with an alternative payment program. The House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee have developed alternative payment proposals. They are structured to provide payment stability over the next few years and increase physician payment based on quality measures or performance standards (Robert E. Moffit, 1/24).

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

MedPage Today: PAs Switch Specialties With Ease 
Physician assistants (PAs) who have practiced for more than 10 years tend to have switched specialties at least twice, making them more nimble than physicians in easing provider shortages, new data show. "It is common, very common, for PAs to change their specialty multiple times during their careers," Larry Herman, RPA-C, MPA, president of the American Academy of Physician Assistants (AAPA), told MedPage Today (Pittman, 1/27).

MedPage Today: USPSTF: Screen Older Male Smokers For AAA
Routine, one-time screening for abdominal aortic aneurysm (AAA) with an ultrasound should be confined to men ages 65 to 75 who have ever smoked, updated draft guidelines from the U.S. Preventive Services Task Force (USPSTF) reiterated. For men in that age group who have never smoked, however, clinicians should offer selective screening on a case-by-case basis, stated the guidance. ... Screening is not recommended for women or nonsmoking men (Neale, 1/28).

Medscape: Medical Care A Financial Hardship For 1 In 4 US Families
In 2012, more than 1 in 4 families (26.8%) in the United States felt the financial burden of medical care, according to the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention. In addition, nearly 1 in 6 families (16.5%) had problems paying medical bills in the last 12 months, 1 in 10 (8.9%) had medical bills they were unable to pay at all (a subgroup of those having problems paying medical bills), and 1 in 5 (21.4%) were paying medical bills over time, according to a NCHS data brief released January 28 (Brooks, 1/28).

Reuters: Many Chronically Ill Americans Unable To Afford Food, Medicine
One in three Americans with a chronic disease such as diabetes, arthritis or high blood pressure has difficulty paying for food, medications or both, according to a new study. People who had trouble affording food were four times more likely to skip some of their medications due to cost than those who got plenty to eat, researchers found (Bond, 1/30).

Reuters: Being Overweight In Kindergarten Sets Stage For Later Obesity
Children who are overweight when they start school are far more likely to be obese by the time they become teenagers, according to a new study of nearly 8,000 children. Overweight five-year-olds were four times more likely to be obese by age 14 than children who started kindergarten at a healthy weight. Overall, 27 percent of kids in the study were overweight or obese (Emery, 1/29).

Reuters: Detailed Exams Might Benefit Older Cancer Patients
Older people with cancer who seem to be coping well with the disease might still earn poor health scores when examined by a geriatrician, according to a new analysis of past studies. The review focused on older people with leukemia and lymphoma. The findings suggest detailed examinations of those patients provide a better, more nuanced picture of their health for oncologists making treatment decisions, researchers said (Raven, 1/24).

Reuters: Seeing Ultrasound Rarely Changes Abortion Plans: Study
Nearly 99 percent of women went ahead with an abortion after voluntarily viewing an ultrasound image of the fetus beforehand, according to a large new U.S. study. Based on medical records for more than 15,000 women seeking abortion at Los Angeles Planned Parenthood clinics, researchers found that only a small fraction of the women changed their minds after seeing the image (Jegtiv, 1/30).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 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.