Advocates for Evidence-Based Health Policy Speakers
Wonk Wednesday
Sometimes there is just too much material to review in the course of 1 month. Here are some important findings from the health policy literature that we had to leave as left-overs. Enjoy!
1. Reductions in Medicare Payments and Patient Outcomes: An Analysis of 5 Leading Medicare Conditions
Results: Mortality trends between hospitals in small and large payment-cut categories were similar between pre-BBA [Balanced Budget Act] and initial-BBA periods, but diverged in the post-BBA period. Relative to the small-cut hospitals, hospitals in the large-cut category experienced smaller decline in 1-year mortality rates in the post-BBA period compared with their pre-BBA trends by 0.8–1.4 percentage points, depending on the condition (P<0.05 for all conditions, except for hip fracture).
Conclusion: We found consistent evidence across multiple conditions that reductions in Medicare payments are associated with slower improvement in mortality outcomes.
{emphasis added}
2. Massachusetts Coverage Expansion Associated with Reduction in Primary Care Utilization among Medicare Beneficiaries
Results: In areas of Massachusetts with the highest uninsurance rates—where insurance expansion had the largest impact—visits per [Medicare] beneficiary fell 6.9 percent (p < .001) relative to areas of Massachusetts with the smallest uninsurance rates.
Conclusion: The expansion of coverage for the nonelderly reduced primary care visits, but it did not reduce the percent of [Medicare] beneficiaries with at least one visit. These results could imply restricted access, increased efficiency, or some blend.
3. Physician Capability to Electronically Exchange Clinical Information, 2011
Results: In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries.
Conclusions: In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians’ capability to exchange varies by vendor and by state.
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