Healthcare Reform Poll Returns to Split Opinions

The November 2011 tracking poll conducted by the Henry J. Kaiser Family Foundation found the public in a negative mood about healthcare reform and its perceived impacts. For the 19 months between the March 2010 signing of the Patient Protection and Affordable Care Act (ACA) and September 2011, Americans had been nearly evenly split. The October poll found that 51% of the public held an unfavorable view of the ACA, while 34% viewed the reform favorably. In November, the percentages returned to a more even level, with 44% holding an unfavorable view and 37% feeling positive about the reform effort. The November survey found that the majority of Americans have positive views on individual aspects of the law. The mot popular provision is the requirement for health plans to provide clear and easy-to-understand summaries of benefits; 84% say they view that provision favorably (60% view the provision “very” favorably). Other popular provisions include tax credits for small businesses (80% favorable including 45% very favorable), subsidies to help individuals pay for coverage (75% favorable, including 44% very favorable), gradually closing the coverage gap for Medicare Part D beneficiaries (74% favorable, including 46% very favorable), and the provision that prohibits health plans from denying coverage based on preexisting conditions (67% favorable, including 47% very favorable). The percentage of Americans with favorable opinions of selected provisions is similar across party lines, the survey found. For the provision requiring clear and understandable summaries of benefits, 88% of Democrats, 87% of independents, and 76% of Republicans held favorable views. For providing tax credits to small businesses, the favorable percentages among Democrats, independents and Republicans were 88%, 77%, and 73%, respectively. The individual mandate is the least popular section of the ACA. Sixty-three percent of Americans have an unfavorable view of this provision, including >4 in 10 who have a “very” unfavorable view. Opinions on this provision differ along party lines, with 53% of Democrats in favor of the individual mandate, compared with only 29% of independents and 17% of Republicans. Minorities More Likely to Miss PCP Appointments In a recent study reported in Health Services Research, researchers found that compared with Caucasians, African-American and Latino patients are more likely to miss planned appointments with their primary care provider (PCP). According to an article in Medpage Today, the relative risk for not keeping a PCP appointment for African Americans was 1.6 (compared with Caucasians) P<.0001; for Latinos the relative risk was 1.5 (P=.0001). The analysis adjusted for multiple factors, including age, sex, education, income level, and having an assigned PCP. The researchers defined poor appointment-keeping as missing at least 1 in 3 regularly scheduled appointments. Missing appointments can have an adverse effect on disease control for patients with chronic conditions such as diabetes, the researcher noted. Following adjustment for age and sex, the risk of being a poor appointment-keeper increased by 60% for African Americans and by 80% for Latinos, compared with Caucasians, the study found. Medicare Reform In an editorial in the New York Times, the writers state that the only way to decrease the current deficit must include a way to rein in Medicare costs. The editorial outlines the 3 key drivers of Medicare spending: (1) the spiraling cost of healthcare driven by new technologies and treatments, (2) increased use of medical services by the typical Medicare beneficiary, and (3) the aging population in the United States. The editorial calls for a “judicious approach to policy making” to work toward a Medicare system that will be fiscally sustainable while continuing to provide a lifeline to the 49 million older and disabled Americans who depend on Medicare to pay for care in hospitals, nursing homes, outpatient clinics, physicians’ offices, hospices, and pharmacies. The writers concluded by noting that while the quick Medicare fix in 1997 did not “turn out well…that cautionary tale is in no way an argument for inaction, it is an argument for serious, unhurried analysis in a less polarized climate. That is the only way to fix this vital program.” Readmissions High after Colorectal Surgery Readmissions to the hospital following colorectal surgery are frequent and cost approximately $9000 per admission, according to a recent retrospective study. The study, reported in Diseases of the Colon and Rectum, found that readmissions in <30 days occurred in 11.4% of patients, and patients in an additional 11.9% of cases were readmitted between 31 and 90 days after initial discharge, for a total 90-day readmission rate of 23.3%. According to an article in Medpage Today, the strongest predictors of 30-day readmission were initial hospitalization of >7 days, 3M All Patient Refined Diagnosis-Related Groups score of 4, and development of a postoperative surgical site infection (SSI) at index admission. Readmissions were lower in the group undergoing laparoscopic surgery compared with those in the open surgery group (8.4% vs 18.5%, respectively). The leading diagnoses among all readmitted patients were SSI and gastrointestinal-related. ACA Yields Savings Discounts and other provisions of the Patient Protection and Affordable Care Act (ACA) have contributed to a decrease in costs for Medicare beneficiaries in the prescription coverage gap, known as the doughnut hole, according to the Associated Press. In an article on Yahoo! News, the 50% discount on name drugs for those in the gap has yielded an average savings of $581 per beneficiary. According to data from Medicare’s Office of the Actuary, the average Medicare beneficiary in the coverage gap spent a total of $901 this year on prescription medications; prior to enactment of the ACA, that amount would have been $1504. Under the reform law, the coverage gap will be gradually phased down until 2020. This year, the ACA provides a 7% discount on generic drugs for those in the gap; next year, the discount on generics will be 14%.