�鶹Ů��

The 21-member IOM Committee on the Governance and Financing of Graduate Medical Education, two thirds of whose members are or previously were academic medical and nursing leaders, asserted that GME programs that are supported by Medicare do not train adequate numbers of physicians who are prepared to work in needed specialties or underserved geographic areas. The report recommends the creation of a new GME financing system “with greater transparency, accountability, strategic direction, and capacity to innovate.” ... This article will cover the key recommendations of the IOM committee, strong objections to them voiced by recipients of Medicare GME payments, and disagreements over whether there is a shortage of physicians. (John K. Iglehart, 1/22)

Diagnostic errors contribute substantially to preventable medical error. ... Our aim was to investigate the effect of working in pairs as opposed to alone on diagnostic performance. ... Volunteer fourth-year medical students recruited via mailing lists at Charité Medical School, Berlin, Germany, participated in the study during June 2013 and gave written informed consent. Their main task was to evaluate 6 simulated cases of respiratory distress on a computer .... Working collaboratively reduced diagnostic errors among medical students. As in previous research, neither differences in knowledge nor in amount and relevance of acquired information explained the superior accuracy of the pairs .... Similar to other studies, collaboration may have helped correct errors, fill knowledge gaps, and counteract reasoning flaws. (Hautz et al., 1/20)

Over 58 million Americans reside in geographic areas or belong to population groups that are considered primary care shortage areas. ... This brief focuses on the untapped potential of one type of advanced-practice nurses – nurse practitioners – to increase access to primary care. In 2012, about 127,000 NPs were providing patient care in the U.S., roughly half of whom – around 60,400 – were practicing in primary care settings. ... optimizing our existing primary care capacity by removing barriers to NPs’ full deployment is a step that states, public and private health insurance programs, and managed care plans are in a position to take in the immediate term. Fuller participation of NPs in primary care might help, in particular, to increase access in underserved rural and urban areas. (Van Vleet and Paradise, 1/20)

In a recent brief, we examined the broad coverage and premium implications of a ruling that would end federal tax credits for marketplace-based private health insurance coverage in states in which the federal government operates the marketplaces. Here, we provide the characteristics of those affected by such a ruling. Of the 9.3 million people estimated to lose tax credits under a finding for King, two-thirds would become uninsured. Most of these are adults with incomes between 138 and 400 percent of the federal poverty level (FPL). Over 60 percent of those who would become uninsured are white, non-Hispanic and over 60 percent would reside in the South. More than half of adults have a high school education or less, and 80 percent are working. (Blumberg, Buettgens and Holahan, 1/22)

The Affordable Care Act requires health insurers to justify rate increases that are 10 percent or more for nongrandfathered plans in the individual and small-group markets. Analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the Affordable Care Act. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program. On average, insurers that quantified any ACA impact attributed about a third to these new ACA assessments. (McCue and Hall, 1/20)

In the years following the passage of the ACA, ... the availability of abortion coverage varies considerably. In states that have not banned abortion coverage, plans sold on the Marketplace electing to include abortion coverage must segregate funds consumers pay for abortion coverage from those paid for all other care. By 2017, at least one Multi-State plan that excludes abortion coverage must be available in each Marketplace, so that consumers have an option to enroll in a plan that does not cover abortion. ... As the debate on abortion continues, both sides remain dissatisfied with how the law is being implemented with regard to abortion coverage. Given the polarized nature of the abortion debate in this country, the issue of access to abortion coverage will continue to be a focus of policy at both the state and national level. (Salganicoff and Sobel, 1/21)

As of January 1, 2015, 28 states set their Medicaid income eligibility levels for parents and other adults to at least 138 percent of the federal poverty level (FPL), reflecting their implementation of the ACA Medicaid expansion. ... There is no deadline for states to expand Medicaid, and debate over the adult expansion will continue in some states in 2015. Medicaid and CHIP coverage for children and pregnant women remains strong across states, but without Congressional action there will not be continued funding for CHIP beyond September 2015. If CHIP funding expires, some children may lose coverage and some may face higher premiums and cost-sharing .... On the operational and systems side, many states have achieved significant progress toward realizing the ACA’s vision of a modernized, streamlined enrollment system, but work continues in many areas. (Brooks, Artiga et al., 1/20)

[The Affordable Care Act] does not let people continue Medicaid expansion coverage once they are eligible for Medicare. As a result, many individuals will transition from the Medicaid-expansion program, where they face very low out of-pocket costs, to Medicare, where their basic costs will start at $1,495.80 per year in 2014 and 2015. This amount does not include the thousands of dollars in potential additional cost sharing associated with service use, including inpatient hospital services and prescription drugs. These costs place a tremendous burden on low-income people ... However, there are programs that can help low-income people with these new costs as they move from the Medicaid expansion to Medicare. (Flowers, Buettgens and Dev, 1/21)

Well-documented shortcomings in Medicare's payment system for skilled nursing facilities (SNFs) have prompted many revisions to the system. This study finds that Medicare's payments to SNFs for therapy and non-therapy ancillary (NTA) services are the least accurate they have been since 2006. Payments are less reflective of cost differences across both stays and facilities and payments are less proportional to costs. An alternative design that would base payments on patient characteristics and establish separate payments for NTA services would increase payment accuracy and dampen the incentives to furnish excessive therapy and avoid patients with complex medical needs for financial gain. (Carter, Garrett and Wissoker, 1/15)

Replacing the current SGR with a more rational Medicare physician payment system will increase Medicare spending. The Congressional Budget Office (CBO) estimates that the cost of the policy embodied in the compromise bill would be $144 billion over 10 years. If Congress were to base payment updates on medical inflation, it would cost $204 billion over the initial decade of implementation. ... There are at least four major structural changes that have attracted bipartisan support and would improve the functioning of the program and guarantee permanent savings in the future. These reforms are: benefit modernization, means-testing expansion, increasing eligibility age, and new competitive bidding in Medicare Advantage. (Moffit and Senger, 1/21)

About three-quarters of Americans search the Internet for medical information within any 12-month period, and almost half of them do so to find out information about a specific medical treatment or procedure. What many consumers do not understand, however, is that much of that “educational” information is really a form of advertising — even on the websites of many large, reputable, nonprofit teaching hospitals. (Perry, 1/6)

Being physically inactive is associated with twice the risk of dying prematurely than being obese, according to a study published last week in the American Journal of Clinical Nutrition by a multinational team of researchers. Furthermore, even a small increase in physical activity among individuals who are currently sedentary — the equivalent of, say, a 20-minute brisk walk daily — may help lower their risk of premature death, whether they are obese or not, the study suggests. (Perry, 1/19)

Prescription opioid abuse in the United States has plateaued, with early indicators suggesting it may finally be declining, new research suggests. A study examining opioid abuse trends between 2002 and 2013 showed that prescriptions for opioid analgesics, rates of opioid diversion and abuse, and opioid-related deaths increased significantly from 2002 through 2010. However, all three measures flattened or decreased from 2011 through 2013. (Brauser, 1/22)

Since the late 1990s, almost 30 percent more adults age 65 and older are likely to say they have had a recent fall, according to a new study. The rise – from 28 percent of seniors reporting a fall in 1998, to 36 percent in 2010 – may be due in part to increased awareness of fall risks, but it is not just a result of the population aging, study authors say. (Lehman, 1/21)