California Saves $7 Million on Colonoscopies by Limiting Reimbursements to High-Cost Facilities

AHRQ Stats: Health Care Coverage

The percentage of people without health insurance decreased from 22 percent in 2010 to 20 percent in 2013. The percentage of uninsured fell further, to 16 percent, in the first half of 2014. (Source: Agency for Healthcare Research and Quality, 2014 National Healthcare Quality and Disparities Report Chartbook on Access to Health Care.)

Today's Headlines

1. California Saves $7 Million on Colonoscopies by Limiting Reimbursements to High-Cost Facilities.
2. New AHRQ Study: Women at Risk for Osteoporosis Often Not Screened.
3. Healthcare Cost and Utilization Project Issues Three Methods Reports.
4. AHRQ Web M&M Spotlights Abdominal Pain in Early Pregnancy.
5. Register Now: 2015 AHRQ Research Conference.
6. Register Now: 3rd International Conference on Academic Detailing November 9-10 in Boston.
7. Featured Impact Case Study: AHRQ Toolkit Helps Lower Readmissions in San Francisco Hospital System.
8. AHRQ in the Professional Literature.

1. California Saves $7 Million on Colonoscopies by Limiting Reimbursements to High-Cost Facilities

A new payment model known as “reference pricing” saved the California Public Employees' Retirement System (CalPERS) $7 million on colonoscopies since its introduction in 2012, according to an AHRQ-funded study. Under reference pricing, CalPERS covered the full cost of a colonoscopy if a member chose to have it at a facility that cost less than the 80th percentile of prices in the market ($1,500), but covered only the first $1,500 for the same procedure at higher-priced facilities, with the patient responsible for the remaining cost. The authors found that implementation of reference payments greatly increased the percentage of patients choosing lower-priced facilities. This led to a substantial reduction in the mean price paid for the procedure (21 percent less on average), without any observed reduction in safety. In the first two years after implementation, CalPERS saved 28 percent compared with what it would have spent in the absence of reference payments. The study was published online September 8 by the journal JAMA Internal Medicine.

2. New AHRQ Study: Women at Risk for Osteoporosis Often Not Screened

There is both underuse and overuse of screening for osteoporosis among various groups of women, according to a new AHRQ-funded study. Researchers studied more than 50,000 women between the ages of 40 and 85 who received primary care at the University of California Davis Health System clinics from 2006 to 2012. They found underuse of screening among those for whom the U.S. Preventive Services Task Force (USPSTF) recommends screening. The USPSTF recommends examining for osteoporosis with dual-energy X-ray absorptiometry (DXA) screening for women over the age of 65 and for younger women with increased risk. Investigators found that more than 40 percent of eligible women between the ages of 65 and 74 did not receive recommended DXA screening. Meanwhile,  about  half of women younger than 65 years old without risk factors received a screening. Researchers also found that DXA screening was significantly less common among black women compared with white women, as well as among current smokers. The study and abstract were published in the May 19 issue of the Journal of General Internal Medicine.

3. Healthcare Cost and Utilization Project Issues Three Methods Reports

The Healthcare Cost and Utilization Project (HCUP) has released three new reports on methodological issues concerning administrative databases:

• Report #2015-05: Identifying Observation Services in the Healthcare Cost and Utilization Project (HCUP) State Databases.
• Report #2015-06: Examination of the Coding of Present-on-Admission Indicators in Healthcare Cost and Utilization Project(HCUP) State Inpatient Databases (SID).
• Report #2015-07: Population Denominator Data for Use with the HCUP Databases (Updated with 2014 Population Data).

HCUP is a family of health care databases and related software tools and products made possible by a federal/state/industry partnership sponsored by AHRQ. It is the most comprehensive source of hospital data in the U.S., featuring information on inpatient care, ambulatory care and emergency department visits.

4. AHRQ Web M&M Spotlights Abdominal Pain in Early Pregnancy

The current issue of AHRQ Web M&M features a case involving a pregnant women who visited the emergency department after experiencing abdominal pain, nausea and vomiting, and was discharged with antibiotics for treating a urinary tract infection. She returned the next day with unchanged abdominal pain and more nausea and vomiting. Apart from a focused ultrasound to document her pregnancy, no further testing was done. When the patient returned on the third day appearing more ill, magnetic resonance imaging was done, revealing a ruptured appendix. The Perspectives on Safety section includes two interviews about electronic tools for patient safety. An interview with Vineet Arora, M.D., M.A.P.P., director of GME Clinical Learning Environment Innovation and assistant dean for scholarship and discovery at the University of Chicago Pritzker School of Medicine, focuses on the intersection of health information technology and patient safety. Eric J. Topol, M.D., director of the Scripps Translational Science Institute and editor-in-chief of Medscape, talks about his new book, "The Patient Will See You Now: The Future of Medicine Is in Your Hands."

5. Register Now: 2015 AHRQ Research Conference

There is still time to register for the 2015 AHRQ Research Conference October 4-6 at the Crystal Gateway Marriott Hotel and Convention Center in Crystal City, Virginia. The agenda is available on the conference Web site. The keynote speakers for the opening plenary October 5 are Bruce Siegel, M.D., America’s Essential Hospitals; Alice Rivlin, Brookings Institution; and Beverley Johnson, Institute for Patient- and Family-Centered Care. Other featured speakers include Nadine Gracia, M.D., director of the HHS Office of Minority Health, for the October 6 session titled, "Making Good Sense Out Of Good Science." Attendees will also learn about results and impacts of AHRQ-sponsored research, data and tools that have helped to improve care in a changing health care environment. Join hosts AHRQ and AcademyHealth as they partner with the Patient-Centered Outcomes Research Institute (PCORI) for joint sessions on October 6 to address key issues in dissemination and implementation of patient-centered outcomes research, launching PCORI's first annual meeting October 6-8 at the same location. Registration is open.

6. Register Now: 3rd International Conference on Academic Detailing November 9-10 in Boston

The National Resource Center for Academic Detailing's 3nd International Conference on Academic Detailing will be held November 9-10 in Boston. The conference is supported by an AHRQ grant and will explore how educational outreach to physicians, nurses and other professionals can improve patient care and outcomes.

7. Featured Impact Case Study: AHRQ Toolkit Helps Lower Readmissions in San Francisco Hospital System

Three California hospitals are among those in the San Francisco-based Dignity Health system using AHRQ's Re-Engineered Discharge (RED) Toolkit to reduce hospital readmissions and improve care transitions. One of the hospitals cut its 30-day Medicare readmission rate by more than half within months of implementing elements in the toolkit.

8. AHRQ in the Professional Literature

Lau B, Overby CL, Wirtz HS, et al. The association between use of a clinical decision support tool and adherence to monitoring for medication-laboratory guidelines in the ambulatory setting. Appl Clin Inform 2013 Oct 16;4(4):476-98. Select to access the abstract on PubMed®.

Sharifi M, Adams WG, Winickoff JP, et al. Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke. Acad Pediatr 2014 Sep-Oct;14(5):478-84. Select to access the abstract on PubMed®.

Butler M, Ratner E, McCreedy E, et al. Decision aids for advance care planning: an overview of the state of the science. Ann Intern Med 2014 Sep 16;161(6):408-18. Select to access the abstract on PubMed®.

Gidengil C, Mangione-Smith R, Bailey LC, et al. Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development. Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S76-81. Select to access the abstract on PubMed®.

Martin SK, Farnan JM, Flores A, et al. Exploring entrustment: housestaff autonomy and patient readmission. Am J Med 2014 Aug;127(8):791-7. Epub 2014 May 4. Select to access the abstract on PubMed®.

Adams WG, Phillips BD, Bacic JD, et al. Automated conversation system before pediatric primary care visits: a randomized trial. Pediatrics 2014 Sep;134(3):e691-9. Epub 2014 Aug 4. Select to access the abstract on PubMed®.

Black JT, Romano PS, Sadeghi B, et al. A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition—Heart Failure (BEAT-HF) randomized controlled trial. Trials 2014 Apr 13;15:124. Select to access the abstract on PubMed®.

Lazarus G, Valle MF, Malas M, et al. Chronic venous leg ulcer treatment: future research needs. Wound Repair Regen 2014 Jan-Feb; 22(1):34-42. Epub 2013 Oct 17. Select to access the abstract on PubMed®.