Families spent an average of 14 percent less on their healthcare when they shifted into health insurance plans with high deductibles compared to families in health plans with lower deductibles, according to a new RAND Corporation study published in the American Journal of Managed Care. Studying more than 800,000 families, the study found that spending was lower on both inpatient and outpatient medical services, as well as prescription drugs for those with high-deductible health plans. Spending for emergency care did not differ when compared with those in traditional plans. And while childhood vaccination rates increased among families in traditional health plans, they fell among families in high-deductible health plans. Rates of mammography, cervical cancer screening and colorectal cancer screening also fell among those with high-deductible health plans relative to those in other plans.

By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in high-deductible plans, and a 2010 survey found that more than 54 percent of large employers offered at least one high-deductible health plan to their employees. High-deductible health plans are expected to be a key offering in the insurance exchanges being established by states to help the uninsured find health coverage.

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Medical groups face significant challenges as they seek to transition to the new HIPAA Version 5010 electronic standards, according to a new survey by the Medical Group Management Association. A majority of respondents stated that critical software upgrades have not been made and testing with health plans has not been scheduled. Groups face potential interruption of claims processing and other essential administrative transactions if they don’t successfully implement Version 5010 by the Jan. 1, 2012, compliance date.

Only 22.3 percent of respondents believed their current software would permit them to use Version 5010, with 48.6 percent stating that their software would require an upgrade and 5.8 percent indicating that their software would need replacement. Almost a quarter of respondents (22.6 percent) stated that they did not know what needed to be done with their software. More than half of respondents (56.3 percent) indicated that internal testing had not yet been scheduled, and 61.4 percent reported that testing had yet to be scheduled with major health plans. Only 3.6 percent said that external testing had already been initiated with some of their major health plans.

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In a study of more than 1 million adult patients cared for in 54 hospitals, researchers found that nurse staffing levels were similar in safety-net and non-safety net hospitals, yet patients’ outcomes were worse in safety-net hospitals. The study, published in Medical Care, found that in non-safety net hospitals, higher nurse staffing rates and a larger number of registered nurses (RNs) were associated with fewer deaths due to congestive health failure; fewer incidents in which nurses did not note or initiate treatment in life-threatening situations (failure to rescue); lower rates of infection, including postoperative sepsis; and fewer patients who were required to stay in the hospital for longer than expected. In ICUs, higher total hours of nursing care per day was associated with fewer infections and decubitus ulcers, while RN skill mix was associated with fewer cases of sepsis.

With the same nurse staffing levels, safety-net hospitals had higher rates of congestive heart failure mortality, decubitus ulcers, and failure to rescue. The authors hypothesize that the worse outcomes in safety-net hospitals are likely a function of patients’ poorer health rather than staffing ratios.

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