• Reading list (it’s back!)

    There was enough lament about the movement of the weekly reading list from the blog to Twitter that I found a way, with help from a coworker, to keep it going on TIE. I will also tweet out items that are destined for the list with the #AFread hashtag. You’ll see them on Twitter first and then on Fridays here.

    Also, not everything I read makes it to the reading list. If I blog or intend to blog on a paper, I will sometimes leave it off, presuming you follow the blog anyway. If a paper has received attention from another prominent health policy blogger, I will often leave it off too, presuming you follow other blogs. But maybe I should not do those things. Tell me in the comments!

    Here’s everything I tweeted with the #AFread hashtag since Nov. 1.

    Mayo Clinic Employees Responded To New Requirements For Cost Sharing By Reducing Possibly Unneeded Health Services Use, by Nilay D. Shah, et al. (Health Affairs)

    Some health plans have experimented with increasing consumer cost sharing, on the theory that consumers will use less unnecessary health care if they are expected to bear some of the financial responsibility for it. However, it is unclear whether the resulting decrease in use is sustained beyond one or two years. In 2004 Mayo Clinic’s self-funded health plan increased cost sharing for its employees and their dependents for specialty care visits (adding a $25 copayment to the high-premium option) and other services such as imaging, testing, and outpatient procedures (adding 10 or 20 percent coinsurance, depending on the option). The plan also removed all cost sharing for visits to primary care providers and for preventive services such as colorectal screening and mammography. The result was large decreases in the use of diagnostic testing and outpatient procedures that were sustained for four years, and an immediate decrease in the use of imaging that later rebounded (possibly to levels below the expected trend). Beneficiaries decreased visits to specialists but did not make greater use of primary care services. These results suggest that implementing relatively low levels of cost sharing can lead to a long-term decrease in utilization.

    Medicare Payments to Physicians (Health Affairs)

    A problematic formula for paying physicians under Medicare has been in place for years and, since 2003, has been stipulating that there should be mandatory cuts in payments to doctors. However, Congress has consistently postponed those cuts and instead raised Medicare physician fees slightly or held them constant.

    Unless Congress acts again soon, payment rates for physician services will be reduced by 27.4 percent starting January 1, 2012, according to a new administration calculation.

    Congress could simply pass another short-term “doc fix,” as it did most recently in December 2010. But there is growing agreement among lawmakers and policy makers that it would be preferable to find a multiyear plan to stabilize payment rates coupled with a general redesign of the physician payment system.

    The challenge is that the Congressional Budget Office has estimated that such a doc fix would increase the federal deficit by about $300 billion or more from 2012 to 2021. Many analysts suggest that the Joint Select Committee on Deficit Reduction–the so-called Super Committee that is charged with identifying $1.5 trillion in budget cuts over 10 years–should include a permanent payment rate solution, and a way of paying for it, in its recommendations due in November 2011.

    This policy brief examines the various proposals and their possible effects on federal spending and on health care providers.

    Health Reform and the Individual Insurance Market, by Deloitte Issue Brief

    As a direct outcome of the Affordable Care Act (ACA), an estimated 32 million individuals will no longer be uninsured by 2014. Starting January 1 of that year, ACA introduces incentives and penalties to encourage individuals to maintain a required minimum level of health insurance coverage, defined as a government-sponsored plan, employer-sponsored insurance (ESI), or a plan offered through the individual market.

    Changes in the individual insurance market could ripple across every sector of the U.S. health care delivery system. The potential for rapid expansion of this market is strong; forces impacting employer-sponsored coverage and a shifting workforce suggest the market will be robust. Also, the implementation of health care reform initiatives such as health insurance exchanges and subsidies for insurance purchases by those under qualified income thresholds could make individual coverage more prevalent than employer-sponsored group coverage.

    The Impact of Health Reform on the Individual Insurance Market: A strategic assessment, a new Issue Brief by the Deloitte Center for Health Solutions:

    • Examines the individual or non-group insurance market and outlines factors that are likely to drive changes
    • Details ACA provisions that introduce levers at the individual, employer, and system level which are anticipated to shift individuals throughout the insurance market
    • Introduces “The Impact of Health Reform on Health Insurance Coverage: Projection Scenarios Over 10 Years,” Deloitte’s actuarial-based tool that models change scenarios
    • Explores several possible scenarios that could have major impacts on enrollment in the individual market
    • Discusses potential implications for industry stakeholders, including state and federal government, commercial health insurance plans, health care providers, employers, supply chain members, and consumers

    Accountable Care Organizations in Medicare and the Private Sector (RWJF)

    This policy paper examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations on ACOs issued in October 2011 by the Centers for Medicare & Medicaid Services (CMS). The paper, written by the Urban Institute, provides an overview of ACOs, the key complaints about CMS’ proposed regulations and their resolution in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans.

    The paper notes that so far, the reception to CMS’ final regulations has been positive, but how many organizations will actually apply to CMS to be ACOs is another question. By the end of 2012, the authors explain that we should know how successful CMS’ program was in attracting provider interest in the ACO model in Medicare, and how extensively the private sector plans to experiment with this payment model.

    Trends in Retail Clinic Use Among the Commercially Insured, by Ashwood, J.S. et al. (American Journal of Managed Care)

    Objectives: To describe trends in retail clinic use among commercially insured patients and to identify which patient characteristics predict retail clinic use.

    Study Design: Retrospective cohort analysis of commercial insurance claims sampled from a population of 13.3 million patients in 22 markets in 2007 to 2009.

    Methods: We identified 11 simple acute conditions that can be managed at a retail clinic and described trends in retail clinic utilization for these conditions. We used multiple logistic regressions to identify predictors of retail clinic versus another care site for these conditions and assessed whether those predictors changed over time.

    Results: Retail clinic use increased 10-fold from 2007 to 2009. By 2009, 6.9% of all visits for the 11 conditions were to a retail clinic. Proximity to a retail clinic was the strongest predictor of use. Patients living within 1 mile of a retail clinic were 7.5% more likely to use one than those living 10 to 20 miles away (P <.001). Women ( 0.9%, P<.001), young adults ( 1.6%, P <.001), patients without a chronic condition ( 0.9%, P <.001), and patients with high incomes ( 2.6%, P <.001) were more likely to use retail clinics. All these associations became stronger over time. There was no association between primary care physician availability and retail clinic use.

    Conclusions: If these trends continue, health plans will see a dramatic increase in retail clinic utilization. While use is increasing on average, it is particularly increasing among young, healthy, and higher income patients living close to retail clinics.

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