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[The study sought to] examine the proportions of patients admitted to the intensive care unit (ICU) with limitations on life-sustaining treatments and the proportions of such patients who receive aggressive care across individual ICUs. ... [It used a] database (from April 1, 2001, to December 31, 2008) including 141 ICUs in 105 hospitals in the United States and 277 693 ICU patient visits. ... Of the ICU admissions evaluated, 4.8% had previously established treatment limitations. ... Intensive care units vary dramatically in how they manage care for patients admitted with treatment limitations. Among patients who survive, escalations in the aggressiveness of care are more common during the ICU stay than are de-escalations in aggressiveness. (Hart et al., 3/30)

People may purchase subsidized health insurance through the ACA exchanges with premiums based on projected future income. However, if actual income is higher than estimated, they may be required to repay part or all of the subsidy when they file tax returns. This “reconciliation” process could raise taxes substantially for many ACA participants. However, analysis of income tax return data suggests that for most lower-income filers, the reconciliation will reduce the refund they receive rather than require them to remit additional tax because their refunds exceed the reconciliation amount. We conclude by making suggestions to improve the reconciliation process. (Burman, Mermin and Ramirez, 4/1)

The individual responsibility requirement, most often referred to as the individual mandate, included in the Affordable Care Act (ACA) has perhaps been the most controversial feature of the law since its passage. ... Although those opposing the ACA have decried the burdensome nature of such a mandate, a recent proposal (the Patient Choice, Affordability, Responsibility, and Empowerment Act, or PCARE) developed by [congressional Republicans] ... would impose strong penalties on the uninsured. ... Medicare Parts B and D also have provisions that penalize individuals for failing to promptly enroll in coverage .... With the PCARE proposal, there now seems to be at least some agreement across the political spectrum that insurance markets cannot effectively operate while simultaneously treating individuals equitably regardless of health status (e.g., covering pre-existing conditions, no medical underwriting) if the healthy can obtain coverage whenever they choose. (Blumberg and Holahan, 4/1)

[The researchers sought to] examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics) from Massachusetts and three control states. ... we found no evidence of a change in the admission rate for overall composite ACSC or for subgroup composites of acute and chronic ACSCs. Nor did we find a change in disparities in admission rates between black and white people or white and Hispanic people for overall composite ACSC that existed in Massachusetts before reform. (McCormick et al., 4/1)

This interactive tool provides up-to-date information on U.S. health spending by federal and local governments, private companies, and individuals. It was developed by analysts at the Kaiser Family Foundation using data from the National Health Expenditure Account. (3/31)

This brief provides an overview of recent trends in Medicaid and CHIP enrollment .... In sum, the data show: As of January 2015, 70.0 million people were enrolled in Medicaid or CHIP. Nearly two-thirds of enrollees resided in states that have implemented the ACA Medicaid expansion. Between Summer 2013 and January 2015, there was a net increase of nearly 11.2 million people enrolled in Medicaid and CHIP among the 49 states reporting data for both periods. ... States that expanded Medicaid experienced significantly greater net Medicaid and CHIP enrollment growth between Summer 2013 and January 2015 than states that have not expanded. ... Children account for a greater share of total Medicaid and CHIP enrollment in nearly all states that have not expanded Medicaid compared to states that have expanded. (Artiga et al., 3/31)

Should the Court reject the Obama Administration’s regulatory interpretation of the provisions of the Affordable Care Act (ACA) at issue in the King case, the Treasury would be barred from paying premium subsidies to individuals who, while meeting all other eligibility criteria, live in any of the 34 states that have not established their own exchanges. Thus, the “insurance subsidies” would not be available to such individuals. However, that does not mean that those individuals would automatically lose their “insurance coverage.” (Haislmaier, 3/30)

[A] visual timeline of Medicare’s history, including the debate that led to its creation in 1965 and subsequent changes, such as: the passage and repeal of the Medicare Catastrophic Coverage Act in the late 1980s, the Medicare Modernization Act in 2003, and the Affordable Care Act in 2010. The video also highlights the program’s impact on the 55 million elderly and disabled Americans it covers today, as well as the fiscal challenges it faces in ensuring its long-term sustainability. (3/27)

The largest study to date of recent military and veteran suicides has identified two high-risk groups of former troops who are generally ineligible for the psychiatric care afforded to all others who served: those forced out of the military for misconduct and those who enlisted but were quickly discharged for other problems. In each of those groups, an average of 46 of every 100,000 former service members committed suicide each year — more than double the rate for veterans with honorable discharges. ... Traditionally, the military suicide rate has been about half that in the civilian world. But it surged and caught up over the course of the recent wars and has remained elevated. The explanation that once seemed obvious — the stress of combat — is no longer seen as a primary cause. (Zarembo, 4/1)

An apple a day doesn't necessarily keep the doctor away. That's according to proverb-busting research that found daily apple eaters had just as many doctor visits as those who ate fewer or no apples. The findings don't mean apples aren't good for you but they do underscore that it takes more than just one kind of food to make a healthy diet and avoid illness. (3/30)

Patient preference has shifted in terms of the way they want to hear skin biopsy results: most patients now say they would rather get the news faster by telephone than wait for a face-to-face clinic visit. In a study by Aditi Choudhry, MD, from the Dermatology Service, Veterans Affairs Medical Center in San Francisco, California, and colleagues, most (67.1%) of the 301 patients who responded to a survey preferred to speak directly with their physician by telephone to get results. (Frellick, 4/2)

A Roche blood test to screen fetuses for Down syndrome worked far better than standard prenatal screening tests in younger, low-risk women, U.S. researchers said on Wednesday, setting the stage for more widespread use. The new study, published in the New England Journal of Medicine, is the largest to show the tests are accurate in even low-risk women. But experts warned that women who test positive still need to confirm the result through more invasive diagnostic testing such as amniocentesis, especially if they would consider terminating a pregnancy. (Steenhuysen, 4/1)

Schools should not be using random drug tests to catch or deter drug abusers, the American Academy of Pediatrics advises in an updated policy statement. The Academy recommends against school-based “suspicionless” drug testing in the new issue of the journal Pediatrics. Identifying kids who use drugs and entering them into treatment programs should be a top priority, but there is little evidence that random drug testing helps accomplish this, said Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children’s Hospital and lead author of the new policy statement. (Doyle, 3/30)

Hospitals are discovering that it's nearly impossible to clean endoscopes blamed for spreading deadly bacteria that have sparked lawsuits from patients and sent device regulators scrambling for a fix. The Seattle hospital where a fatal drug-resistant superbug was spread by contaminated scopes is still finding germs on the instruments even after heightening its cleaning procedures, researchers reported in a journal article Monday. (Tozzi, 4/1)

Hospitals may want to devote more attention to the power of social media, according to a recent study looking at the correlation between hospitals' Facebook ratings and how well they performed on 30-day readmission rates. Hospitals with fewer patients readmitted to the hospital within 30 days—an outcome measure used to evaluate quality—also had higher ratings on the social media site's five-star rating scale, the report found. (Rice, 4/1)

Lawmakers are responding to recent concerns from researchers who collaborate with the Centers for Disease Control and Prevention that the agency's process for approving the release of scientific papers is “censoring, duplicative, and an impediment to timely dissemination of science.” Two researchers who have partnered with the CDC, University of Pennsylvania professors Michael Blank and John B. Jemmott III, argued in an editorial published last month in the American Journal of Public Health that the CDC has such a difficult and slow process for releasing scientific findings that “there are serious ethical questions regarding delays in dissemination of scientific information.” (Adams, 4/1)