Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

About two-thirds of primary care physicians (PCPs) reported in 2004–05 that they could not get outpatient mental health services for patients — a rate that was at least twice as high as that for other services. Shortages of mental health care providers, health plan barriers, and lack of coverage or inadequate coverage were all cited by PCPs as important barriers to mental health care access. According to the study, the probability of having mental health access problems for patients varied by physician practice, health system, and policy factors. The results suggest that implementing mental health parity nationally will reduce some but not all of the barriers to mental health care.

The Current Recession and Healthcare Consumers

The current recession has caused concern for  hospitals. This study examines how it may be impacting consumer healthcare behaviors, attitudes, and use. the study is an analysis of data from the Thomson Reuters PULSE Healthcare Survey. To analyze the effect the recession is having on healthcare consumers, the researchers asked questions regarding:

• Household employment status
• Primary household insurance coverage
• Reasons for lack of insurance
• Impact of the recession on paying for care
• Postponement or delays in receiving care

The survey or 12,000 people, nationwide, found that approximately 20% of Americans say they have delayed or postponed medical care-particularly physician visits-because of related costs.

Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage

This study reports, once people reached age 65 — the qualifying age for Medicare — the gaps in health indicators narrowed across race, economic status and ethnicity. By analyzing data describing measures of blood pressure, cholesterol and blood sugar collected between 1999 and 2006 in individuals by the National Health and Nutrition Examination Survey, the researchers were able to determine that disparities in healthcare were large and persistent except among those 65 and older. The findings suggest that one potential benefit of universal health coverage could be fewer racial, ethnic and socio-economic disparities in care.

Costly Hospital Readmissions and Complex Chronic Illness

People with multiple chronic conditions account for a large and disproportionate share of total health care costs. One aspect of the high cost for such patients is a
relatively high number of hospital admissions per year. This study aims to clarify how the rate of hospital readmissions and hospital cost per person in a year depend on a patient's number of different chronic conditions (‘‘complexity''), severity of illness, principal diagnosis at discharge, payer group, and other variables. The researchers used a database of all hospital discharges for adults in six states. The number of different chronic conditions has a smoothly increasing effect on readmissions and cost per year, and there are notable differences by payer group. The study provides examples of the potential savings from reducing total inpatient cost and readmissions in narrowly targeted populations with the most complex problems. The study's methods and descriptive data potentially could be useful for health plans and their sponsors (employers, government) when they design strategies to address the high cost of complex chronic illness.

Fourteen Areas Join Program Targeting Readmissions

The following areas have been selected to participate in Care Transitions, a CMS pilot project that seeks to eliminate unnecessary hospital readmissions —promoting seamless transition from the hospital to home, skilled-nursing care or home healthcare: Upper Capital Region around Albany, N.Y.; east metropolitan Atlanta; Baton Rouge, La.; Evansville, Ind.; northwest Denver; Harlingen, Texas; the greater Lansing, Mich., area; Miami; Southwestern New Jersey; Omaha, Neb.; Western Pennsylvania; Providence, R.I.; Tuscaloosa, Ala.; and Whatcom County, Wash.  Each of the pilot communities will be led by a state quality improvement organization, (in Michigan, this is organized through MPRO, and includes BCBSM's Medical Director, Dr. Tom Simmer) which will work with healthcare providers, consumers and stakeholder groups to implement hospital and community interventions.  The CMS will monitor the rates at which patients in these communities are readmitted. This project addresses the recently reported findings (see March CHRTWatch)  that reveal, nationwide, nearly one in five patients who leave the hospital will be readmitted within the next month, and that more than three-quarters of these readmissions are potentially preventable.

Groups release guidelines on medical home demos

Four primary-care organizations have released guidelines designed to help shape the growing number of tests around patient-centered medical homes. The organizations include the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association. Collectively, the groups represent 350,000 physicians. The groups made 16 recommendations that outline what they believe to be the necessary elements of any medical home demonstration project, including what practices should be involved, what kind of support they should have, how reimbursement should be structured, and how the projects should analyze and distribute the results. The timing of the guideline releases coincides with a CMS announcement that it will do a three-year medical home demonstration project, expected to include eight sites. The project has yet to be cleared by HHS and the White House Office of Management and Budget.