Â鶹ŮÓÅ

MACRA creates a payment system for physicians that will accelerate Medicare's transition from fee-for-service to payment based on performance metrics, patient experience, and patient outcomes. But three years of complex MACRA rulemaking lie ahead amid a still-entrenched fee-for-service system, continued political rancor over the ACA, and a change in administrations and a new Congress. The trajectory of health care spending over the next few years could also affect the urgency and design components of MACRA implementation. The hundreds of comments on CMS's request for information signal many areas of tension but also areas of agreement. The major question is whether MACRA will succeed at improving quality, reducing unnecessary care, and lowering cost growth where past efforts have lagged or failed outright. (Findlay, 4/21)

This review focuses on our current knowledge about workplace violence in various health care settings, including the prevalence across professions, potential risk factors, and the use of metal detectors in preventing violence. It also highlights the difficulty researchers have encountered in developing experimental models and the need for further evidence-based research. Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored. According to the Joint Commission, a major accrediting body for health care organizations, institutions that were once considered to be safe havens are now confronting “steadily increasing rates of crime, including violent crimes such as assault, rape, and homicide." (Phillips, 4/28)

This study presents an overview of insurers’ performance selling [Qualified Health Plans] in the individual market and discusses how insurer performance varied across carriers and states. In sum, it finds that insurers incurred sizeable losses on a per-enrollee basis—despite much higher government support through the law’s reinsurance program than they expected when they set premiums. It also finds that insurers would have needed to increase premiums by at least 26 percent, on average, to have avoided losses in 2014 without the reinsurance program. (Blase, Badger and Haislmaier, 4/22)

Focus groups with low-income individuals who have Medicaid or Marketplace coverage in California, Florida, Maryland, Missouri, Ohio, and Virginia reveal that many are struggling financially—they have difficulty paying their bills each month and many are burdened by debt (including medical debt). Their new coverage did not change these underlying financial struggles. However, gaining coverage enabled many to access care they needed to treat ongoing conditions giving them peace of mind. Participants with Medicaid were generally able to access care with few out-of-pocket costs. (Tolbert, Rudowitz and Majerol, 4/21)

This brief shows that low- and moderate-income adults with Marketplace coverage seem to be doing as well as might be expected. They fared as well as those with [employer-sponsored insurance] ESI, Medicaid, or non-Marketplace nongroup coverage on having a usual source of care and having had a routine checkup, and they did considerably better than the uninsured on those measures. Their ability to get a timely doctor’s appointment and find a doctor as a new patient over the past 12 months was comparable to those with ESI and non-Marketplace nongroup coverage. ... [Marketplace enrollees] do however report more unmet need because of affordability for medical tests, treatments, or follow-up care than those groups. (Holahan, Karpman and Zuckerman, 4/21)

Potential effects of climate change on human health include higher rates of respiratory and heat-related illness, increased prevalence of vector-borne and waterborne diseases, food and water insecurity, and malnutrition. Persons who are elderly, sick, or poor are especially vulnerable to these potential consequences. ... In this position paper, the American College of Physicians (ACP) recommends that physicians and the broader health care community throughout the world engage in environmentally sustainable practices that reduce carbon emissions; support efforts to mitigate and adapt to the effects of climate change; and educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change. (Crowley, 4/19)

Seventy-six percent of California veterans in need of mental health care from 2011 to 2013 either didn’t receive treatment or received inadequate care, according to a new study by the UCLA Center for Health Policy Research. But the share of veterans who needed mental health care was no greater than that of the general population, despite common perceptions that veterans are more likely than others to need care. (Lai, 4/27)

Rates of antibiotic prophylaxis in pediatric surgery vary greatly among children's hospitals and by procedure, according to a retrospective cohort study published online April 18 in JAMA Pediatrics. From 1% to 4% of children undergoing surgical procedures in the United States each year develop a surgical site infection (SSI). Whereas appropriate use of antibiotic prophylaxis reduces the incidence of SSI, inappropriate administration can result in Clostridium difficile infection at the patient level, antibiotic resistance, adverse drug events, and increased healthcare costs at the population level. (Lewis, 4/18)

E-cigarette use continued to rise among young teenagers and preteens in the United States last year, according to new federal data, but cigarette smoking overall did not increase, suggesting that, at least so far, fears that the devices would hook a new generation on traditional cigarettes have not come to pass. (Tavernise, 4/14)

A new study published this week in Pediatrics found that food-allergic children from households that earn less than $50,000 a year incur 2.5 times the cost of emergency room visits and hospital stays compared with their peers from families that are in a higher-income bracket. (Netburn, 4/27)

Chronic conditions appear to be causing a poorer quality of life for childhood cancer survivors, according to a new study. Young adults who survived cancer as children had health and wellbeing comparable to that of people nearly two decades older than them, researchers found. (Seaman, 4/25)

Patients in the emergency room who don't speak English well are slightly more likely to return within days, suggesting their care the first time was not as good as it could have been, researchers say. (Doyle, 4/28)

Looking to avoid a profession where the risk of assault is high? You might want to stay away from police work, the military and . . . healthcare. A new report that reviews research on assaults against doctors, nurses and other medical personnel concludes that healthcare workers often experience physical and verbal attacks, and, all too often, little is done to address it. (Emery, 4/28)