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Caution Urged Before Abandoning Employer Health Coverage in Favor of Individual Coverage

In an article published in the May/June Health Affairs, HSC President Paul B. Ginsburg, Ph.D., discusses the advantages and shortcomings of employer-based health coverage, how individual health insurance could be a viable alternative to employer-based coverage, and why care should be taken not to undermine employers’ role in providing coverage.

Safety Net Emergency Departments: Creating Safety Valves for Non-Urgent Care

Faced with more patients seeking care for non-emergencies, safety net hospital emergency departments are working to redirect patients to outpatient clinics, community health centers and private physicians, with varied results, according to a study released today by HSC.

Racial and Ethnic Health Disparities Linked to Physician Practice Resources

Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients and receive lower private insurance payments, according to a national study funded by the Commonwealth Fund and published today as a Web exclusive in the journal Health Affairs.

Public Health Workforce Shortages Imperil the Nation's Health

As the post-9/11 spotlight on shoring up the nation's public health system fades, local health departments face a mounting workforce crisis as they struggle to recruit, train and retain qualified workers ranging from nurses to epidemiologists, according to a study released today by HSC.

Ginsburg Presentation: Health Care Costs 101

HSC President Paul B. Ginsburg, Ph.D., delivered a presentation titled "Health Care Costs 101" at the Association of Health Care Journalists annual meeting in Washington, D.C. Click here to access the slides used in the presentation.

Lots of Window Shopping, But Modest Consumer-Driven Health Plan Adoption

While adoption of high-deductible health plans coupled with spending accounts remains modest, supporters believe consumer-directed health plans will take hold as part of a larger employer strategy to confer more responsibility on workers for health care costs, lifestyle choices and treatment decisions, according to a new study released by HSC.

Demands on Nurses Grow as Hospital Quality Improvement Activities Increase

Hospitals face growing tensions and trade-offs when allocating nurses between the competing priorities of direct patient care and quality improvement efforts, according to a new study by HSC.

Milbank Quarterly Article Examines Decline in Physician Charity Care

Changes in physicians' income, practice ownership and practice size play a large role in their decisions to start or stop treating charity care and Medicaid patients, according to an HSC study published in the March edition of the Milbank Quarterly.

Connecting the Electronic Dots Among Disparate Health Providers

Barriers to sharing patient clinical data electronically among rival hospitals, doctors and health plans remain high as concerns about loss of competitive advantage and data misuse hamper participation in local health information exchanges, according to a new study released by HSC and the National Institute for Health Care Management Foundation.

Rapid Growth Prompts Health Plans to Target Advanced Imaging Services

Faced with double-digit annual increases in the use of advanced imaging services, such as CT and PET scans, health plans are stepping up efforts to slow the proliferation of advanced imaging services, according to a new study by HSC.

Missing Price Information Hampers Usefulness of State Prescription Drug Web Sites

Extensive gaps in price information seriously hamper the effectiveness of state drug price comparison Web sites, according to a study released today by HSC.

State Budget Cycles Hinder Health Care Safety Net Stability

The sensitivity of state budgets to economic cycles contributes to instability in public health insurance eligibility, benefits and provider payments, as well as support for safety net hospitals and community health centers, according to a study released today by HSC.

HSC Researchers Win ACHE Award

HSC Consulting Researchers Robert Berenson, M.D., and Thomas Bodenheimer, M.D., and HSC Senior Researcher Mai Pham, M.D., have been named the winners of the American College of Healthcare Executives 2008 Dean Conley Award for their article "Specialty-Services Lines: Salvos in the New Medical Arms Race," published in the July/August 2006 edition of Health Affairs.

Higher Costs and Stagnant Incomes Increase Financial Burden of Health Care

Rising out-of-pocket expenses and stagnant incomes increased the financial burden of health care for more Americans between 2001 and 2004, especially for the privately insured, according to a national study supported in part by the Commonwealth Fund and published in the January/February edition of Health Affairs.

Don't Break Out the Champagne: Slowdown in Health Spending Growth Unlikely to Last

The continued slowdown in personal health care spending growth in 2006 reported by government economists is unlikely to last, according to a perspective by HSC President Paul B. Ginsburg, Ph.D., published in the January/February Health Affairs.

Community Health Centers Adapt to Increased Demand for Care

Despite significant federal funding increases, community health centers—the backbone of the nation's safety net—are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to a new study released by HSC.

Communities Struggle with High Medical Cost Burdens

The number of people with high medical cost burdens varies widely across the nation, reflecting differences in the number of both uninsured and underinsured people. Those states with the largest numbers of individuals with high medical expense face numerous difficulties in achieving affordable coverage, and lack of action at the federal level has driven many to undertake their own heath care reform efforts. Reliance on state efforts alone, however, is unlikely to lead to major national expansions in coverage and will not alleviate persistently high degrees of medical cost variation across the country, according to a report by an HSC researcher released today by The Commonwealth Fund.

Hospital Emergency On-Call Coverage: Is There a Doctor in the House?

As emergency departments face ever-rising demands, hospitals are confronting greater problems obtaining emergency on-call coverage from specialist physicians, according to study released today by HSC.

Why Do Hispanics Have So Little Employer-Sponsored Health Insurance

Poor education, lack of citizenship and the inability to speak English—all more common among Spanish-speaking Hispanics—result in lower wages and fewer jobs that offer health insurance, according to an article by HSC researchers in the fall edition of the journal Inquiry.

Unhealthy Trends: The Future of Physician Services

Left unchecked, most trends in how physicians organize and practice medicine are likely to lead to higher spending and declining access to care for lower-income people, according to an article by HSC researchers in the November/December edition of Health Affairs

Health Care Cost and Access Challenges Persist Across the Country

Little has changed in local health care markets since 2005 to break the cycle of rising costs, declining insurance coverage and widening access inequities, according to initial findings from HSC's 2007 site visits to 12 nationally representative metropolitan communities.

A conference was held today for the release of this Issue Brief. A webcast and transcript of the conference are now available. Links to both are available below.

Variation in Clinical IT Across Physician Specialties

While practice setting and size are the strongest predictors of physicians' access to clinical information technology (IT) in their practices, significant variation in IT adoption exists across specialties, according to a national study released today by HSC.

Insurance-Related and Racial/Ethnic Disparities in Access to Care

Health surveys have shown that the uninsured and racial/ethnic minorities are more likely than privately insured and whites to report unmet medical needs. Among 15 symptoms that medical doctors believe should prompt people to seek care—such as shortness of breath, chest pain, persistent headache or loss of consciousness—80 percent of uninsured did not obtain care, compared to 52 percent of privately insured and 39 percent of Medicare beneficiaries, according to a study by HSC researchers in the September edition of the journal Medical Care. In addition, Hispanics were less likely than whites to get the care they need. Findings also show that differences in perceived need for care among insured and racial/ethnic groups did not explain access disparities.

Proportion of Physicians in Solo/Two-Physician Practices Drops

The proportion of physicians in solo and two-physician practices decreased significantly from 40.7 percent in 1996-97 to 32.5 percent in 2004-05, according to a new national study released today by HSC.

Despite the shift away from the smallest practices, physicians are not moving to multispecialty practices, the study found. The proportion of physicians in multispecialty practices decreased from 30.9 percent to 27.5 percent between 1998-99 and 2004-05. Some experts believe that large, multispecialty practices, which combine primary care physicians and a range of specialists in the same practice, are the organizational structure with the greatest potential to provide consistently high-quality care.

Affordability Remains a Key Concern in Massachusetts Health Reform

As Massachusetts' landmark effort to reach nearly universal health coverage continues, affordability of coverage remains a key concern for individuals and small employers, according to a study released today by HSC.

Health Affairs Article Details Care Redesign at Seattle Medical Center

The tale of one Seattle medical center's quest to improve care and reduce costs illustrates the obstacles physicians face in practicing more efficiently under a fee-for-service payment system that overpays for some medical services and underpays for others, according to a study by researchers at HSC published today as a Web Exclusive in the journal Health Affairs. An accompanying HSC Issue Brief on this topic was also releasaed today.

Exodus of Men from Primary Care Drives Shift To Medical-Specialty Practice

An exodus of men from primary care practice is driving a marked shift in the physician workforce toward such specialties as cardiology and dermatology, reinforcing concerns about a looming shortage of primary care physicians, according to a new national study released today by HSC.

HSC's Wall Street Comes to Washington Conference

HSC's 12th annual Wall Street Comes to Washington conference was held on Thursday, June 14. A transcript of the conference is now available, as well as a webcast, courtesy of Kaisernetwork.org.

Potentially Avoidable Hospitalizations of Medicare Patients

Elderly Medicare patients at high risk for hospitalization for two common conditions—bacterial pneumonia and chronic obstructive pulmonary disease (COPD)—were more likely to stay out of the hospital if treated by experienced physicians, according to a study by researchers at HSC and Memorial Sloan-Kettering Cancer Center (MSKCC) in the June edition of the journal Medical Care.

But patients of physicians reporting more difficulty accessing ancillary services for patients—for example, home oxygen or respiratory therapy—and physicians treating more poor patients were at higher risk of hospitalization for both conditions, the study found.

High-Performance Health Plan Networks: Early Experiences

Despite broad interest among employers and health plans, a nascent move to steer patients to physician specialists who score well on efficiency and quality measures is off to a slow start, according to a study by HSC.

HSC Researcher Testifies on Health Plan Care Management Activities

HSC Associate Director Debra Draper, Ph.D., testified on commercial health plans' care management activities and the impact on costs, quality and outcomes at a Senate Finance Committee hearing on the Medicare Advantage program.

Many Physicians Don't Routinely Consider Insured Patients' Out-of-Pocket Costs

Increased patient cost sharing is likely to miss the mark in safely reducing health care spending because many physicians do not routinely consider insured patients’ out-of-pocket costs when recommending expensive medical care, according to a study by researchers at HSC and the University of Chicago Hospitals in the April 9 Archives of Internal Medicine.

Wide Gap Between Vision for E-Prescribing and Reality in Physician Offices

While physicians who have embraced e-prescribing wouldn't go back to paper prescriptions, they report major barriers to using advanced e-prescribing features that many advocates believe offer the greatest potential to improve the safety and quality of health care, according to a study by HSC researchers published today as a Web exclusive in the journal Health Affairs.

Consumer Tolerance for Inaccuracy in Physician Performance Ratings

While consumer tolerance for inaccurate physician performance ratings varies widely, more than one-third of Americans believe such ratings should be no more than 5 percent inaccurate, according to a national study released today by HSC.

Use of Clinical Practice Guidelines by Physicians Grows

The proportion of primary care physicians reporting that clinical practice guidelines had a very large or large effect on their practice increased significantly from 1997 to 2005, from 16.4 percent to 38.7 percent, according to a study by HSC ressearchers published in the Journal of General Internal Medicine.

Revising Medicare's Physician Fee Schedule—Much Activity, Little Change

Without an effective way to track changes in medical practice and physician productivity, the underlying structure of Medicare’s physician fee schedule has defied gravity, generally rewarding specialty procedures at the expense of primary care services, according to a perspective by economist Paul B. Ginsburg, Ph.D., and Robert Berenson, M.D. in the March 22 New England Journal of Medicine.

Care Patterns in Medicare and Their Implications for Pay for Performance

Medicare beneficiaries' care is spread over so many physicians that determining which physician should qualify for additional payment is a moving target under current pay-for-performance (P4P) designs, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center in the March 15 New England Journal of Medicine.

Restoring Fiscal Sanity 2007: The Health Spending Challenge

HSC President Paul B. Ginsburg explores the role of private payers in moving toward more efficient health spending in a chapter in the just-released Brookings Institution book, Restoring Fiscal Sanity 2007: The Health Spending Challenge, edited by Alice Rivlin and Joseph Antos.

Ginsburg to Serve on CBO Panel of Health Advisers

HSC President Paul B. Ginsburg will serve as a member of the Congressional Budget Office's newly formed Panel of Health Advisers. Panel members will meet periodically to examine research in health policy and advise the agency on its analyses of health care issues.

Benefit Design Innovations: Implications for Consumer-Directed Health Care

Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool, according to a study released today by HSC.

Self-Pay Markets in Health Care: Consumer Nirvana or Caveat Emptor?

Even when patients must pay the full cost of medical care out of pocket, there's limited comparison shopping for the lowest-price, highest-quality care, according to a study by HSC researchers published as a Web exclusive in the journal Health Affairs. In an accompanying article, HSC President Paul Ginsburg, Ph.D., points out that current efforts to increase price transparency for health care services often downplay complex decisions about medical care, patients' dependence on physicians for guidance and the need for information on quality.

Quality-Based Physician Incentives Up Slightly, but Productivity Incentives Still Dominate

While the proportion of physicians in group practice whose compensation is based in part on quality measures increased from 17.6 percent in 2000-01 to 20.2 percent in 2004-05, far more physicians face financial incentives tied to individual productivity, according to a national study released today by HSC.

GAO Analyst Joins HSC as Health Researcher

Ann C. Tynan, M.P.H., previously a senior health policy analyst at the U.S. Government Accountability Office (GAO), has joined the Center for Studying Health System Change (HSC) as a health researcher.

Hospital-Physician Rift Leads to Medical Arms Race

Deteriorating relations between hospitals and physicians are imperiling a wide range of health care objectives—including adoption of information technology, the implementation of pay-for-performance programs and care for the uninsured—HSC researchers reported in a Health Affairs Web exclusive published today.

4 in 10 Workers in Consumer-Directed Health Plans Lack Choice

While consumer-directed health plan proponents often assert that the high-deductible plans linked to savings accounts offer enrollees greater choice and autonomy in the health care marketplace, 39 percent of the estimated 2.7 million workers enrolled in employer-sponsored CDHPs had no choice of another type of health plan in 2006, according to a national study released HSC.

Recalibrating Medicare Payments for Inpatient Care

Small but important steps to improve the accuracy of Medicare inpatient hospital payment rates could help stem a growing medical arms race, but policy makers will need to follow through in the coming years with more comprehensive reforms, according to a perspective by economist Paul B. Ginsburg, Ph.D., in the Nov. 16 New England Journal of Medicine.

Employers View Health Benefits as an Important Recruitment and Retention Tool

Despite intense health care cost pressures, firms covering more than 90 percent of the nation's workforce view health benefits as an important tool to attract and retain qualified workers, according to a national study by researchers at HSC and the Commonwealth Fund published in the November/December edition of Health Affairs.

The Role of Competition in Driving Clinical Data Exchange

Recent policy efforts to encourage the use of health information technology are emphasizing development of communitywide health information exchanges to share clinical data across patient care settings. The study—published in the November/December edition of Health Affairs—found that most large hospitals have or are developing physician portals to provide admitting physicians with remote access to patient records, but there is little data sharing among unaffiliated organizations. Competition among hospitals for physicians is a key factor driving adoption of these proprietary systems. In contrast, provider and health plan competition and adversarial relationships between providers and plans are viewed as major barriers to communitywide clinical data sharing.

Safety Net Expansions and Racial/Ethnic Disparities

This study—published in the November/December edition of Health Affairs—explores whether increased community health center (CHC) funding under the Bush administration narrowed racial/ethnic gaps in access to care among low-income people.

Clinical IT Gaps Persist Between Small and Large Physician Practices

Physicians in smaller practices continue to lag well behind physicians in larger practices in reporting the availability of clinical information technology (IT) in their offices. The proportion of physicians reporting access to IT for each of five clinical activities increased across all practice settings between 2000-01 and 2004-05. However, adoption gaps between small and large practices persisted for two of the clinical activities—obtaining treatment guidelines and exchanging clinical data with other physicians—and widened for the other three—accessing patient notes, generating preventive care reminders and writing prescriptions

University of Michigan Physician Joins HSC as Senior Researcher

Matthew M. Davis, M.D., M.A.P.P., associate professor of pediatrics, internal medicine and public policy at the University of Michigan, has joined HSC as a part-time senior health researcher.

Health Care Spending Growth Stays High in 2005

Health care spending growth stayed in a high-altitude holding pattern in 2005 as costs per privately insured American grew 7.4 percent -—virtually the same rate of increase as the previous two years, according to anHSC published today as a Web Exclusive in Health Affairs.

Physician-Patient E-mail Disconnect

Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01, according to a national study released today by HSC.

Health Plan Pay-for-Performance Strategies

In a quest to reduce costs, improve quality and increase hospital and physician efficiency, most health plans in 12 communities across the country are adopting pay-for-performance (P4P) programs that tie financial incentives to improved provider performance, according to a study by HSC researchers in the September edition of The American Journal of Managed Care.

The Impact of Quality-Reporting Programs on Hospital Operations

While reporting programs have raised the profile of hospital quality measurement and improvement in 12 communities across the country, lack of coordination among reporting programs and inadequate resources hinder efforts to improve patient care, according to a study by HSC researchers published in Health Affairs.

CTSonline Updated with 2004-05 Physician Survey Results

Want to find out how many hours of charity care physicians typically provide? Or whether doctors believe they can spend enough time with their patients? How about the percentage of physicians earning more than $300,000 a year? Answers to these questions and many others are available through HSC's CTSonline, which was recently updated with results from the 2004-05 Community Tracking Study (CTS) Physician Survey.

Debra Draper Joins HSC as Director of Site Visits and Senior Researcher

Debra A. Draper, Ph.D., M.S.H.A., assistant director of the health care team at the U.S. Government Accountability Office (GAO), has joined HSC as director of site visits and senior researcher.

Medicaid Patients Increasingly Concentrated Among Physicians

Despite increases in Medicaid payment rates and enrollment, the proportion of U.S. physicians accepting Medicaid patients has decreased slightly over the past decade, according to a national study released today by HSC.

Immunization Disparities in Older Americans

Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive vaccinations, according to an HSC study published in the August edition of the American Journal of Preventive Medicine.

Specialty-Service Lines: Salvos in the New Medical Arms Race

The proliferation of heart institutes, cancer centers, orthopedic hospitals and other niche specialty centers signals an escalation in a new medical arms race as hospitals and physicians develop and market profitable specialty-service lines, according to a study by Center for Studying Health System Change (HSC) researchers published today as a Web Exclusive in the journal Health Affairs.

Hospital Emergency Department Use Varies Greatly Across the U.S.

Contrary to popular belief, communities with high levels of uninsured, Hispanic or immigrant residents generally have much lower rates of per person hospital emergency department use than other communities, according to a study by HSC published today as a Web exclusive in the journal Health Affairs.

Bioterrorism Preparedness Efforts Strengthen Public Health Capabilities

National initiatives to improve bioterrorism preparedness have strengthened communities' overall public health readiness, but concerns remain about hospitals' ability to handle a sudden surge of patients during an emergency, according to a study by HSC researchers in the July/August edition of the journal Health Affairs.

Hospital Steps Ease Nurse Shortage in Near Term but Long-Term Worries Persist

While many hospitals in 12 communities across the country report that short-term measures, such as higher pay and temporary staff, have helped ease nurse staffing shortages, serious doubts remain about hospitals’ ability to meet future nursing needs, according to a study by Center for Studying Health System Change researchers (HSC) published today as a Web Exclusive in the journal Health Affairs.

Wall Street Comes to Washington Conference

HSC held its eleventh annual Wall Street Comes to Washington conference in Washington, D.C., on June 21. A transcript of the meeting is now available, as well as a webcast at kaisernetwork.org.

Physicians Lose Ground in Real Income Between 1995 and 2003

In sharp contrast to other professionals, physicians' net income from the practice of medicine declined about 7 percent between 1995 and 2003 after adjusting for inflation, according to a new national study by HSC.

Physician Access to Clinical Information Technology Grows

Physician access to practice-based clinical information technology (IT) grew significantly between 2000-01 and 2004-05, according to a national study released today by HSC.

HSC's Cunningham Wins NIHCM Research Award

HSC Senior Researcher Peter Cunningham, Ph.D., has won the National Institute for Health Care Management Foundation's (NIHCM) 2006 research award for excellence in original and creative health care research. Cunningham and coauthor Len Nichols, Ph.D., formerly HSC's vice president and now with the New America Foundation, were recognized for an article published in the December 2005 edition of Medical Care Research & Review—"The Effects of Medicaid Reimbursement on Access to Care of Medicaid Enrollees: A Community Perspective."

Congressional Testimony: Consumer Information on Health Care Cost and Quality

Better consumer information about health care costs, quality and treatment alternatives could help stem rapidly rising health costs, but some are overselling the potential of consumer empowerment to reshape the health care system, economist Paul Ginsburg, Ph.D., HSC president, told a congressional committee today.

Five HSC Studies Appear in May/June Health Affairs

Five studies from the Center for Studying Health System Change (HSC) appear in the May/June edition of Health Affairs, on topics ranging from the hospital building boom to care for the seriously mentally ill to local market perspectives on consumer-driven health plans.

Proportion of U.S. Physicians Without Managed Care Contracts Ticks Up

After remaining stable since the mid-1990s, the proportion of U.S. physicians without any managed care contracts rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study released today by HSC.

Community Safety Nets and Prescription Drug Access for Uninsured People

As the number of uninsured Americans increases, community safety net providers are stretching limited resources to meet growing prescription drug needs for low-income, uninsured people under age 65, according to a new HSC study.

Public Employee Health Benefits Weather Rising Costs and Tight Budgets

Generous public employee health benefits have survived major threats so far, but the growing gap between public- and private-sector benefits, coupled with new accounting rules for government agencies, could force public officials to make more far-reaching benefit changes, according to a HSC study published today as a Web exclusive in the journal Health Affairs.

Community Approaches to Caring for Uninsured People

Faced with rising uninsurance rates and little response from state and federal governments, local communities have developed a range of approaches to provide care to uninsured people, according to a study by HSC published today as a Web-exclusive in the journal Health Affairs.

Population Aging Plays Small Role in Growing Demand for Hospital Services

While the aging of the baby boomers is an oft-cited justification for the sharp increase in U.S. hospital construction, population aging will play a relatively small role in rising demand for inpatient hospital care over the next decade, according to an HSC study published today as a Web exclusive in the journal Health Affairs.

U.S. Physician Charity Care Continues Decade-Long Decline

The proportion of U.S. physicians providing charity care dropped 8 percentage points in the last decade, falling to 68 percent of physicians in 2004-05 from 76 percent in 1996-97, according to a national study released today by HSC.

Reflections on a Decade of Tracking Health System Change

Despite a decade of tumultuous change, the perennial problems of high costs, uneven quality and inequitable access continue to plague the U.S. health care system, according to a commentary published today by HSC.

Testimony: Consumer Price Shopping

HSC President Paul Ginsburg testified today before the House Committee on Energy and Commerce Subcommittee on Health on consumer price shopping in health care. Ginsburg testified that fostering consumer price shopping for health services can potentially help contain costs but cautioned that some are overselling the magnitude this potential.

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