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The [federal mental health parity law] of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. ... the law extends parity to out-of-network services. We [used] insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that extending parity to out-of-network services would broaden access to substance use disorder care obtained outside of plan networks. (McGinty et al., 8/3)

We examined county-level rates of ED visits for nontraumatic dental conditions in twenty-nine states in 2010 in relation to dental provider density and Medicaid coverage of nonemergency dental services. Higher density of dental providers was associated with lower rates of dental ED visits by patients with Medicaid in rural counties but not in urban counties, where most dental ED visits occurred. County-level Medicaid-funded dental ED visit rates were lower in states where Medicaid covered nonemergency dental services than in other states, although this difference was not significant after other factors were adjusted for. Providing dental coverage alone might not reduce Medicaid-funded dental ED visits if patients do not have access to dental providers. (Fingar et al., 8/3)

This analysis of clinical data linked to Medicare claims finds the cardiac rehabilitation rate for older patients after acute myocardial infarction [heart attack] is low in the United States and suggests efforts be made for increasing referrals, and addressing attendance barriers, to rehabilitation sessions. ... Cardiac rehabilitation programs are multifaceted outpatient interventions that include individualized exercise regimens, health education, and structured support focused on cardiovascular risk reduction and medication adherence. ... Cardiac rehabilitation improves survival after AMI and is associated with improvements in lifestyle, functional capacity, and quality of life for older adults. (Doll et al., 8/3)

Benefis Medical Group, in Great Falls, Montana, improved identification and treatment of hypertension through multifaceted interventions [including enhanced use of electronic health records]. The interventions included adopting policies for collection of vital signs, enhancing system-level reporting capability, tracking patients for the registry, and conducting patient outreach activities. From baseline to follow-up (December 2012 through September 2013), the percentage of patients with a documented blood pressure increased from 67% to 80%, the percentage diagnosed with hypertension increased from 16% to 36%, and the percentage with blood pressure control increased from 41% to 64%. (Wall et al., 7/30)

As part of its efforts to become a more prudent purchaser of health care services, Medicare has worked to create incentives for hospitals to avoid making patients sicker, instead of healthier, during their inpatient stay. These so-called hospital-acquired conditions (HACs) can lead to poor patient outcomes and higher spending on health care. ... Hospital associations have significant concerns with how Congress designed the program and how CMS is implementing it. ... Under the law, up to 25 percent of hospitals will be subject to the HAC penalty, but which hospitals are affected may change over time for multiple reasons. In future years, CMS is increasing the number of NHSN measures and using measures that a wider array of hospitals may report. (Cassidy, 8/6)

Following several years of slow growth in U.S. national health spending from 2008 to 2013, recent reports suggest such growth has returned to a more typical level of approximately 5.6 percent in 2014, considerably faster than increases in gross domestic product (GDP). Interpreting these new data is difficult, however, because 2014 was the first year of the Affordable Care Act’s (ACA) coverage expansion, under which an estimated 10.6 million individuals gained coverage. In this paper we estimate how the underlying spending growth rate, absent the coverage expansion, compares to GDP growth. ... there does not yet appear to be evidence of an underlying spike in health spending; such a spike may still occur but most of the recent bump can be explained by the ACA coverage expansion. (Holahan and McMorrow, 8/5)

This report is based on findings from the 2015 Kaiser Family Foundation survey of Health Insurance Marketplace Assister Programs and Brokers. ... Seventy-nine percent of Assister Programs this year (and 80% last year) said most or nearly all consumers sought help because they lacked confidence to apply on their own; 82% of Programs this year (83% last year) said most or nearly all consumers needed help understanding their plan choices; 74% of Assister Programs (this year and last year) said most or nearly all consumers needed help understanding basic insurance terms, such as “deductible.” In addition, this year, like last year, most Assister Programs said it took one to two hours, on average, to help each consumer who was new to the Marketplace. (Pollitz, Tolbert and Ma, 8/6)

A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. (Ryan et al., 8/5)

While many initiatives and programs supported by foundations, medical schools, and government have contributed to increasing diversity in the physician pipeline, the number of applicants from one major demographic group—black males—has not increased above the number from 1978. That year, 1,410 black males applied to medical school, and in 2014, just 1,337 applied. A similar trend is observed for firsttime matriculants: in 1978, there were 542 black male matriculants to MD-granting institutions, and in 2014, there were 515. ... This report captures the major themes from ... interviews [with black students, physicians and others] and highlights research and data ... to understand these trends and find broad-based solutions. (8/3)

Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care .... This issue brief provides an overview of what is known about LGBT health status, coverage, and access in the United States, and reviews the implications of the [federal health law], the Supreme Court rulings on marriage equality, and other recent policy developments. (Kates et al., 7/30)

A decades old Medicare rule requiring a three-day hospital stay before patients can transfer to skilled nursing facilities may needlessly prolong hospitalizations, a study suggests. Researchers compared the average time patients were hospitalized between 2006 and 2010 in privately administered Medicare Advantage health plans that either stuck to this rule or allowed people to transfer to skilled nursing facilities sooner. Lengths of hospital stays increased with the rule in place and declined when it was waived, the study found. (Rapaport, 8/4)

Restrictions on U.S. medical residents’ hours implemented in 2011 don’t appear to have significantly lowered the risk of death or serious injury from surgery, a recent study suggests. Researchers compared data on surgical outcomes one year before the duty hour reforms and two years afterwards for five specialties: neurosurgery, obstetrics/gynecology, orthopedics, urology and vascular surgery. While rates of death and injury did decline over the study period, the changes were so small they might have been due to chance. (Rapaport, 7/30)

A cancer diagnosis is devastating for anyone, but for young people it comes with an added concern: the possibility that the disease or its treatment will leave them unable to have children. There are ways to help many young cancer patients preserve their fertility, but a new study finds patients often are not aware of the options. The study, published ... in the journal Cancer, finds young women, especially, may not receive enough information before treatments have already limited their options. (Seidman, 7/27)

The odds are against obese men and women trying to get to a healthy weight, particularly if they are severely obese, a U.K. study suggests. Researchers followed 76,704 obese men and 99,791 obese women for up to nine years. In any given year during the study, the probability that a patient might achieve a normal body weight was 1 in 210 for men and 1 in 124 for women. (Rapaport, 7/30)