Research Roundup: Price Transparency; Cost Of Not Expanding Medicaid; Coverage In Rural Areas

JAMA Internal Medicine:
Effect Of A Price Transparency Intervention In The Electronic Health Record On Clinician Ordering Of Inpatient Laboratory Tests

Question: Does increasing price transparency for inpatient laboratory tests in the electronic health record at the time of order entry influence clinician ordering behavior? Finding: In this year-long randomized clinical trial including 98 529 patients at 3 hospitals, displaying Medicare allowable fees in the electronic health record at the time of order entry did not lead to a significant change in overall clinician ordering behavior. Meaning: These findings suggest that price transparency alone may not lead to significant changes in clinician behavior, and future price transparency interventions may need to be better targeted, framed, or combined with other approaches. (Sedrak et al., 4/21)

Urban Institute/Robert Wood Johnson Foundation:
The Cost Of Not Expanding Medicaid

Nineteen states have not expanded Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA). We estimate that from 2018 through 2027, expansion in these states would increase nominal state costs and federal spending by $59.9 billion and $427.5 billion, respectively, if enrollment is moderate and by $62.9 billion and $487.0 billion if enrollment is high. Each state dollar would thus draw down between $7.14 and $7.75 in net federal funding. (Dorn and Buettgens, 4/27)

Kaiser Family Foundation:
The Role Of Medicaid In Rural America

This brief describes Medicaid’s role for 52 million nonelderly children and adults living in the most rural areas in the United States and discusses how expansions or reductions in Medicaid could affect rural areas. … Although private insurance accounts for the largest share of health coverage in rural areas, nonelderly individuals in rural areas are less likely to have private coverage compared to those in urban and other areas (61% vs. 64% and 66%, respectively). Medicaid helps fill this gap in private coverage, covering nearly one in four (24%) nonelderly individuals in rural areas. Further, in many states, Medicaid coverage rates are higher in rural areas than in urban or other areas of the state. (Foutz, Artiga and Garfield, 4/25)

JAMA Internal Medicine:
Association Of Donor Age And Sex With Survival Of Patients Receiving Transfusions

In this binational cohort study, which included 968 264 patients who received transfusions, there was no association between age and/or sex of blood donors and survival of patients. Even among the patients who received multiple units of blood from very young or very old donors, absolute mortality differences compared with patients who received no such units of blood were consistently below 0.5%. (Edgren et al., 4/24)

Urban Institute:
Shared Decisions In Cancer Care: Is Medicare Providing A Model?

Medicare’s Oncology Care Model (OCM) is designed to incentivize providers to reduce unnecessary spending, improve care, and involve patients more closely in decisions about
the use of chemotherapy. The model includes a 13-point care plan recommended by the Institute of Medicine (IOM) that represents a significant step toward making patients partners in their own care; in particular, it aims the volume of OCM episodes by reducing overly aggressive use of chemotherapy and underuse of hospice services among patients who are close to death. However, IOM recommendations since 1999 and recent medical literature suggest that a formal shared decision-making process (SDM) remains vitally important. This paper discusses the rationale for and barriers to adopting a more formal SDM. (Millenson and Berenson, 4/23)

Preventing Chronic Disease/CDC:
Quit Methods Used by US Adult Cigarette Smokers, 2014–2016

To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014–2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. (Caraballo et al., 4/13)

Morbidity and Mortality Weekly Report/CDC:
Trends In Repeat Births And Use Of Postpartum Contraception Among Teens — United States, 2004–2015

From 2004 to 2015, the number and percentage of teen births that were repeat births decreased 53.8% and 16.9%, respectively; in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among teens with a recent live birth, use of the most effective contraceptive methods postpartum increased substantially, from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three teens with a recent live birth reported using a least effective contraceptive method or no method postpartum. (Dee et al., 4/27)