Latest Tracking Poll Shows Little Change in Views of Healthcare Reform Law

The Patient Protection and Affordable Care Act was signed into law in March 2010. The latest tracking poll conducted by the Henry J. Kaiser Family Foundation found that despite ongoing efforts by the federal government to educate the American public about the law, more than half of those responding to the poll (52%) still say they do not have enough information about the law to fully understand how it will affect them; 47% say they do understand the impact of healthcare reform on their lives. These percentages are very close to those reported in April 2010 immediately following passage of the law; at that time, 56% of those polled said they did not have enough information to form an opinion. The most recent poll (March 2011) found that 42% of those surveyed have positive opinions about the law, whereas 46% view it unfavorably—a split that has not changed significantly during the year since the law was enacted. Approximately 51% of those with favorable views of the law cite expanded access to insurance and healthcare when asked why they feel the way they do about the law; of those with negative views of the law, 20% are concerned about costs, 19% are concerned about the government’s role, and 19% said they were opposed to the individual mandate. The individual mandate is one of the most unpopular aspects of the law, with 67% of Americans supporting its repeal. However, when told “under the reform law, most Americans would still get coverage from their employers and so would automatically satisfy the requirement without having to buy any new insurance,” support for repealing the mandate fell to 35%. The partisan divide in opinions of the law also has not changed in the year since enactment: 71% of Democrats say they favor the law, while 82% of Republicans oppose it. Opinion is divided among independents: 37% have a favorable opinion and 49% have an unfavorable view. Opinion also remains divided about next steps for healthcare reform. Overall, 21% of Americans favor leaving the law as it is, and an additional 30% favor expanding it; 21% say the law should be repealed, and 18% think it should be repealed and replaced with a Republican-sponsored alternative. Party affiliation changes those numbers significantly: among Democrats, 30% support the law as is and 49% favor expansion; among Republicans, 39% say the law should be repealed and replaced with a Republican-sponsored alternative and 35% favor repealing the law and not replacing it. Just over two thirds of Americans (64%) oppose the idea of using the legislative budgeting process to stop some or all of the reform law from being implemented. Opinions on defunding vary along party lines: 86% of Democrats are against the tactic, 65% of independents also oppose it, while 61% of Republicans approve of stopping funding for the law. MedPAC Recommends Increase in Physician Reimbursement for 2012 The Medicare Payment Advisory Commission (MedPAC) has recommended that the physician reimbursement in the Medicare program be increased in 2012 by 1%. MedPAC, an independent agency charged with providing guidance to the US Congress on issues related to Medicare, sends an annual report to Congress on the fee-for-service payment system in Medicare and makes recommendations on payment updates for the following year. In a story in Medpage Today, the commission noted that, contrary to those who say physicians will stop accepting new Medicare patients, the majority of physicians do accept new patients, including those on Medicare. In the recent report, the commission reiterated its position that Medicare should move away from the fee-for-service system and move to a system that would provide incentives to physicians who provide higher quality of care. The commission also recommended a 1% payment update to hospitals that treat Medicare patients, according to the Medpage Today story. Location and Genetics May Increase Risk of AD Older adults at an increased risk of Alzheimer’s disease (AD) due to a genetic variation (the epsilon-4 allele of the apolipoprotein E gene) who live in low-income, high-crime neighborhoods had poorer scores on standard cognitive tests. According to a story in Medpage Today, researchers found that compared with epsilon-4–negative participants from better neighborhoods, participants in poorer neighborhoods scored significantly (P<.05) lower in 4 categories: processing speed, eye–hand coordination, executive function, and visuoconstruction. The study was reported in the March issue of Archives of Psychiatry. The researchers wrote that “persons with the epsilon-4 allele may be more vulnerable to deleterious effects of nonspecific risk factors,” the Medpage Today article noted. Device Manufacturer Cancels GPO Contracts Medtronic, manufacturer of orthopedic and cardiovascular devices, has canceled contracts with group purchasing organizations (GPOs), according to an article in Medpage Today. Medtronics withdrew from agreements with the largest GPO in the United States, Novation, in February. The canceled agreements covered devices worth a total of $2 billion annually, the article stated. In addition to the Novation cancellation, Medtronic has also canceled a contract for spinal products with Premier, another large GPO, according to an article in the Wall Street Journal. The Health Industry Group Purchasing Association called the cancellations “an attack on American hospitals.” In a statement, the association said that, “Manufacturers compete with one another to win business by offering the best products and services at the best value. Medtronic has simply abdicated this competitive space in an effort to prevent hospitals from banding together to get the best deals.” Recession Cost Healthcare Coverage for Millions A new survey from The Commonwealth Fund found that the economic recession has left millions of Americans without health insurance. In addition, those with healthcare coverage have struggled to pay medical expenses, according to an article on the survey in Medpage Today. In 2001, approximately 38 million people in the United States were without health insurance; in 2010, that number was approximately 52 million. Over the past 2 years, 43 million people (nearly one quarter of working-age adults or their spouses) lost their job; 3 in 5 people who lost a job with health benefits in the past 2 years (approximately 9 million people) became uninsured. The survey’s authors noted that when the Affordable Care Act is fully implemented in 2014, it will provide coverage to nearly all of the 52 million adults uninsured in 2010. Hospital Culture and Patient Outcomes A study published in Annals of Internal Medicine found hospitals that are the most successful at improving patient outcomes do not do so by investing in high-tech equipment or using evidence-based protocols, but by “investing in and focusing on the culture of the organization itself,” according to an article in the New York Times. “It’s how people communicate, the level of support, and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, senior author of the study and faculty director of the Yale Global Health Leadership Institute at Yale University. Study results indicated that factors such as patient economic status hospital affiliation with an academic center, number of beds, and urban setting accounted for <20% of the variation between high- and low-performing hospitals. Instead, it was “the approach to challenging patient care issues that seemed to set institutions apart,” the Times article said. Asthma Drug Effective in Inner City Kids The New England Journal of Medicine has published a study on omalizumab that demonstrated the monoclonal antibody improved asthma symptoms and reduced the need for other controller medications among children living in the inner city. The drug also seemed to significantly reduce seasonal exacerbations, according to an article in Medpage Today. Children who live in inner cities have a higher burden of asthma and are difficult to treat. “This study is extremely important in that it proved, in the most difficult group of patients, that it could significantly reduce symptoms and, more importantly, exacerbations and hospitalizations, thus making it very cost-effective,” said Stephen Pollard, MD, of the University of Louisville. Dr. Pollard was not involved in the study. Gene Therapy for Parkinson’s Disease An investigational therapy for Parkinson’s disease in which genetic material is injected directly into the brain has caused significant improvements in symptoms, according to a recent study. The study, reported in The Lancet, found that the procedure was safe and well tolerated. Adverse events were mild to moderate and resolved without further complication. Six months after the procedure, patients who received the gene therapy had an average 23.1% improvement on a “widely used symptom scale,” according to an article in Medpage Today, compared with an average of 12.7% improvement among patients who received placebo. In addition, half of the gene therapy patients had a “clinically meaningful” improvement, compared with 14.3% of those in the sham surgery arm. Mandate Increases Behavioral Screening Rate A financial incentive coupled with a court-ordered mandate appeared to increase rates of behavioral health screening for children covered by Medicaid, according to a study reported in Archives of Pediatrics & Adolescent Medicine. Just after the mandate was implemented, the screening rate in Massachusetts was 16.6%; a year later, the rate was 53.6%, according to an article in Medpage Today. Karen Kuhlthau, PhD, of the Massachusetts General Hospital Center for Child and Adolescent Health Policy in Boston, said that, “these data suggest that a small payment and a well-supported mandate for use of a formal screening tool can substantially improve the identification of children at behavioral risk.” The researchers noted that they did not have any data on whether the increase in screening and referral resulted in improvements in children’s mental health. MassHealth, the Medicaid program in Massachusetts, includes a court-mandated developmental and behavioral health screening at every well-child visit for MassHealth members <21 years of age; reimbursement is set at $10 for each screening test and $25 for a face-to-face evaluation and management time following a positive screen. Drug Prices Rise Faster than Other Costs A report prepared by the Government Accountability Office (GAO) shows that prices for prescription drugs have risen faster than the cost of other medical goods and services since 2006. Prices for 100 commonly used drugs, including 55 brand-name drugs and 45 generics, increased at an average annual rate of 6.6% from 2006 through early 2010, according to an article on the report in Medpage Today. The increase in drug prices compared with a 3.8% average annual increase in the costs of other consumer medical goods and services. The GAO report was requested from 5 members of Congress. Rep. Pete Stark (D-CA), who was one of the legislators making the request, said in a statement, “This report reminds us that this is an area where we should be looking for savings for taxpayers and beneficiaries.” Revised Car Seat Guidance The American Academy of Pediatrics has issued new guidance for use of car seats, according to an article in Medpage Today. The new recommendations call for all infants and children to ride in rearfacing seats until they are 2 years of age or until they outgrow the height and weight restrictions of the seat; once children outgrow a rear-facing seat, they should be placed in forward-facing seats with harnesses until they exceed the height and weight criteria; once forward-facing seats are no longer suitable, children should be placed in belt-positioning booster seats until the vehicle’s lap-and-shoulder seat belt fits properly; lap-and-shoulder seat belts should be used at all times for children who have outgrown booster seats; and, all children <13 years of age should ride in the back seat at all times. Dennis Durbin, MD, a pediatric emergency physician at the Children’s Hospital of Philadelphia, said that although parents may think of car seat transitions as developmental milestones, “those transitions should be delayed as long as possible, because with each transition you make you give up a little safety in the event of a crash.” Antibiotic Prophylaxis May Reduce Risk of Bacteremia A new study reported in The Lancet Infectious Diseases found that antibiotic prophylaxis for patients who were critically ill reduced the risk of bacteremia from highly drug-resistant organisms. The study, highlighted in Medpage Today, also found that use of preemptive antibiotics reduced colonization of the highly resistant pathogens. Compared with standard care, using 2 forms of prophylaxis (selective digestive tract decontamination and selective oropharyngeal decontamination) improved surgical survival among patients in the intensive care unit. However, reviewers cautioned that the data were relatively unconvincing and added that “the absence of emergence of resistance is counterintuitive” because there is widespread evidence that increased use of antibiotics does lead to resistance, the Medpage Today article noted. CMS Paid $3.1 Million for ED Drugs The US Department of Health and Human Services Office of the Inspector General has released a report on payment by Medicare for drugs to treat erectile dysfunction (ED). Despite a rule that bars Medicare reimbursement for ED drugs, the Centers for Medicare & Medicaid Services (CMS) paid $3.1 million for the drugs in 2007 and 2008. Of the $3.1 million, $3 million went toward payment for sildenafil (Viagra), the report said. According to an article in Medpage Today, the ban, enacted by Congress, went into effect in 2007. The report concluded that, “Part D should not have covered these drugs.” According to the Medicare Modernization Act of 2007, CMS will not pay for “a drug when used for the treatment of sexual or erectile dysfunction, unless such drug were used to treat a condition, other than sexual or erectile dysfunction, for which the drug has been approved by the Food and Drug Administration.”