Access to care

Study finds fewer post-partum hospitalizations in Medicaid expansion states

States that expanded Medicaid under the Affordable Care Act (ACA) saw a 17% drop in hospitalizations among women during the first 60 days postpartum, new research shows (Source: “Medicaid expansion linked with fewer postpartum hospitalizations: research,” The Hill, Jan. 11).

According to a study published in the journal Health Affairs, states with expanded Medicaid coverage for residents with lower incomes saw a 17% drop in post-partum hospitalization within the first 60 days.

Expansion states included in the study were Iowa, Maryland, New Mexico and Washington. Rates were compared with non-expansion states Florida, Georgia, Mississippi and Utah.

Currently, 40 states (including Ohio) and Washington D.C., have expanded Medicaid under the ACA. Much of the Southeast region of the country continues to hold out on adoption, along with Texas, Kansas, Wyoming and Wisconsin.


Federal study finds racial disparities in access to health data

Research by the federal Office of the National Coordinator for Health IT has found racial and ethnic disparities in patient access to, and usage of, electronic health records (Source: “Report confirms racial disparities in patient access to their health data,” Healthcare IT News, Jan. 5).

Published in the Journal of the American Medical Informatics Association, the ONC study found that in 2019 and 2020, "black and Hispanic individuals were significantly less likely to report being offered and subsequently accessing their portal."

Black and Hispanic people were not offered (5.2 percentage points less likely) and did not access patient portals (7.9 percentage points less likely) nearly as often as white people. 

But when offered access, disparities largely diminished. According to the study, "individuals offered a portal and encouraged to use it by their providers "were 21 percentage points more likely to access it."

"Taken together, our findings point to the important role of healthcare providers in increasing access to EHI by offering portals and encouraging their use," study coauthor Chelsea Richwine, an economist with ONC's Office of Technology, wrote.


Study: Cost of hospital parking overlooked burden for cancer patients

A study released this week found that an often overlooked burden for patients seeking cancer treatment is the ongoing cost of parking (Source: “Cancer patients endure an overlooked financial burden: hospital parking fees,” Stat News, Dec. 7).

new paper in the Journal of Medical Imaging and Radiation Sciences found that the charges are actually eating into patients’ financial well-being, particularly for people who have cancer and have to make frequent visits to the hospital for treatments like radiation and chemotherapy.

Other research in the U.S. has similarly found hospital parking prices contribute to what’s known as “financial toxicity” — the idea that having a serious illness like cancer is stressful and costly on its own, and only made worse when people may have to cope with other expenses like travel while potentially missing work and losing income.

Many community hospitals in rural and suburban areas of the U.S. don’t charge anything for parking. But if people need or want more specialized care in a larger city, where parking is more scarce, they often will encounter some kind of parking fee. And if a loved one is stuck in the hospital for days, weeks, or months, hospitals can saddle families and visitors with hundreds if not thousands of dollars in parking costs.


Doctor shortages loom in rural Ohio

With few medical student showing interest in practicing in rural areas, Ohio is facing a potential workforce shortage in coming years (Source: “Decline of rural doctors may leave parts of Ohio with too few physicians,” Columbus Dispatch, Nov. 14).

Just 1% of medical students in their final year of study in 2019 said they wanted to practice in a rural area, according to a survey from the physician recruiting firm Merritt Hawkins. The survey showed that 2% wanted to practice in a town of 25,000 people or less.

The trend is a reflection of a larger one that could result in too few doctors to meet patient demand in Ohio. By 2025, the U.S. Department of Health and Human services estimates, Ohio will fall 1,200 primary care doctors short of the number needed to treat patients throughout the Buckeye state.

The shortage of rural physicians is a longstanding issue that stems from a decline in the number of independent medical practices, said Todd Baker, chief executive officer of the Ohio State Medical Association, an organization that advocates for physicians and health policy reform.


CDC data shows people of color less likely to receive Paxlovid, other COVID treatments

People of color with a COVID-19 diagnosis were much less likely to receive Paxlovid and other treatments than white patients, according to new data from the Centers for Disease Control and Prevention (CDC) (Source: “CDC data: People of color much less likely to receive Paxlovid, other COVID treatments,” The Hill, Oct. 27).
 
The CDC findings are consistent across all age groups and underscore the persistent disparities surrounding access to COVID-19 treatments, especially the antiviral pill Paxlovid. Paxlovid is the most commonly prescribed medication and the preferred outpatient therapeutic for eligible patients, according to the CDC.
 
During a four-month period from April to July 2022, Paxlovid treatment was 36% lower among Black patients relative to white patients and 30% lower among Hispanic patients relative to non-Hispanic patients, according to the study.


Medicare mulls adding limited dental benefits

Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated (Source: “After Congress fails to add dental coverage, Medicare weighs limited benefit expansion,” Kaiser Health News via Ohio Capital Journal, Oct. 18, 2022).

Under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January.

The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. Sen. Bernie Sanders (I-Vt.) sought in vain to add that to the Democrats’ last major piece of legislation, the Inflation Reduction Act, which passed in August. As defeat appeared imminent, consumer and seniors’ advocacy groups along with dozens of lawmakers urged CMS to take independent action.


Ohio bill aims to boost mental health workforce

As the demand for mental health services grows — and with many psychologists aging and near retirement — Ohio lawmakers are sponsoring a bill aimed at increasing the number of mental health care providers (Source: “Ohio lawmakers propose a new way to increase the number of mental health providers,” Statehouse News Bureau, Oct. 13).

State Senator Theresa Gavarone (R-Bowling Green) said her bill would create more access to mental health professionals by allowing colleges to offer specialized master's degrees.

"It creates a new licensed professional in the state of Ohio who has the ability to prescribe and work under the supervision of a medical professional and just creates greater access for individuals in need of mental health services," Gavarone said.

The National Alliance on Mental Illness in Ohio estimates one in five people experience mental illness each year. Many times, people who need help for a mental health problem cannot get in to see a provider because there aren’t enough of them. The Ohio Department of Mental Health and Addiction Services shows between 2013 and 2019, there was a 353% increase in demand for mental health services.

Gavarone said she doesn’t expect this bill to be taken up before the end of this year but added she wants lawmakers to start considering the proposal soon.


Disparities in vision health linked to access challenges, study finds

A new study shows significant disparities in vision function among Black, Hispanic and poorer adolescents (Source: “Lack of Access Appears Tied to Disparities in Vision Health,” U.S. News, Sept. 16).

New research suggests a lack of access to vision care services has contributed to racial, ethnic and socioeconomic disparities in visual function among Black, Hispanic and poorer adolescents.

Findings of a new study published last month in JAMA Ophthalmology reveals approximately 16% of Black and 18% of Mexican American adolescents had worse than 20/40 vision in their better-seeing eye compared to 7% of white adolescents. After correcting for visual impairment, 3% of Black and 3% of Mexican American adolescents still had worse than 20/40 vision compared to 1% of white adolescents.

Study co-author Dr. Idsin Oke, a clinical scientist and pediatric ophthalmologist at Boston Children’s Hospital, said the findings highlight the importance of addressing barriers that could hinder access to vision care services for racial and ethnic minority youth.


Feds increase ACA tax credits through fix to the ‘family glitch’

The Treasury Department on Tuesday announced new rules that determine the tax breaks for certain families when they buy private health insurance plans through the Affordable Care Act (ACA) (Source: “New rules fix ‘flaw’ for families seeking Obamacare coverage,” Associated Press, Oct. 11).

The new interpretation of the health law aims to fix the “family glitch,” which determines a family’s eligibility for ACA tax credits based on the cost of an individual’s work-sponsored health insurance plan rather than the cost of the plan for the whole family.

Since the law was enacted more than a decade ago, people who have access to health insurance plans through their employers are supposed to get price breaks on the Affordable Care Act marketplace if they pay more than 9.5% of their income toward monthly premiums.

But for years, the Internal Revenue Service arrived at that calculation based on the cost of a work-sponsored health insurance plan for a single individual, instead of a more expensive family plan. That meant many families didn’t qualify for the tax breaks offered through the ACA.

“Given the complexity of the policy, we encourage families to work with a certified and licensed Navigator organization by calling 833-628-4467 or visiting getcoveredohio.org,” said Zach Reat, Director of Health Initiatives for the Ohio Association of Foodbanks.  


Congress temporarily extends Medicare programs that boost pay to rural hospitals

Congress has cleared a short-term spending bill that includes extensions of two programs aimed at helping rural hospitals, punting the issue and others into December (Source: “Congress passes short-term spending bill that extends 2 key rural hospital programs,” Fierce Healthcare, Sept. 30). 

The House voted 230 to 201 to advance to President Biden’s desk a continuing resolution that funds the federal government through Dec. 16. Biden is expected to sign the legislation.
 
The legislation also extends through Dec. 16 the hospital payment adjustment for certain low-volume hospitals (LVH) and the Medicare-Dependent Hospital (MDH) program, which have helped shore up finances for rural hospitals that have been vulnerable to closures in recent years and strained further due to the COVID-19 pandemic. 
 
Both programs were set to expire after September.