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Of 2.6 million total deaths in the United States in 2014, 2.1 million were among Medicare beneficiaries. Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34 529 per person) than for other beneficiaries that year ($9121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014. Medicare spending for people at the end of life also decreased with age. Hospice use among Medicare beneficiaries at the end of life increased between 2000 and 2014 to nearly half (46%) of all beneficiaries. Medicare spending on hospice also increased during that period, from $2.3 billion to $10.4 billion. (Griffin et al., 11/1)

In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014. ... Of 111 patients included ... 81 (73%) were emergent vs 30 (27%) elective admissions. Only 15 (14%) had an advance directive. Of the 81 (73%) patients placed on comfort care, 31 (38%) had care withheld or withdrawn despite available medical options, 15 (19%) had an advance directive, and 28 (25%) had a palliative care consultation. ... Palliative care consultations may be underused at the end of life. A large percentage of patients were transitioned to comfort measures despite available treatment, yet few presented with advance directives. (Wilson et al., 11/2)

Even after full implementation of the ACA coverage expansions, an estimated 28 million to 31 million people will remain uninsured and will continue to rely on the safety net for care. Hence, for some safety-net providers, the expansion in coverage may not be sufficient to offset reductions in federal payments for uncompensated care. ... The concentration of uninsured or high-risk patients with costly or complex conditions who are cared for by safety-net providers could increase as newly insured persons seek other sites of care. ... In addition to expanding health coverage, the ACA included a variety of provisions to advance health care payment reform. ... studies of all three programs have shown that safety-net hospitals face a higher risk of being penalized through reductions in payments than other hospitals. (Chokshi, Chang and Wilson, 11/3)

In March 2016, the American Academy of Pediatrics (AAP) released the first-ever policy statement on poverty, calling for pediatricians to screen and address poverty and related social determinants of health (SDH). ... Notably, poverty has grown by 66% in suburban communities over the past decade, double the rate in cities. ... Low-income suburbanites confront challenges distinct to this setting. The first is the lack of access to safety net services. Food pantries and other resources are often less available .... Second is the relative lack of public transportation. ... The AAP recommends that pediatricians identify families in need, connect families to resources, and coordinate with community partners. Doing so in suburban practices may require approaches that differ from urban practices. (Palakshappa and Fiks, 11/1)

[M]illions of people — 28 million nonelderly people as of the end of 2015 — remain without coverage. ... Over half (57%) of the ... uninsured are outside the reach of the ACA either because their state did not expand Medicaid, they are subject to immigrant eligibility restrictions, or their income makes them ineligible for financial assistance. The remainder are eligible for assistance under the law but may still struggle with affordability and knowledge of options and require targeted outreach to help them gain coverage. For both eligible and ineligible remaining uninsured people, health care needs persist regardless of insurance status, underscoring the importance of safety net providers and community health clinics to serve this population. (Garfield et al., 11/1)

Fewer U.S. men got prostate biopsies and surgery after new recommendations steered most men away from routine prostate cancer screening, researchers reported Wednesday. Their findings add to a growing body of research that's adding to the debate about prostate cancer screening and often leaving men and their doctors more confused than informed. ... The latest report, published in the Journal of the American Medical Association's JAMA Surgery, shows the new guidelines have indeed cut back on the number of procedures that men are undergoing. (Fox, 11/2)

Did you not get enough sleep last night? You may find yourself overeating today. That’s the conclusion investigators came to after reviewing data on 172 participants in 11 sleep studies. (Bakalar, 11/2)

A risk-based gun removal law enacted in Connecticut in 1999, which allows police to temporarily seize firearms from people thought to be at risk of harming themselves or others, has prevented an estimated 72 suicide deaths, a new analysis suggests. (King, 11/2)