Health
The decision by several states not to expand Medicaid health insurance for the poor may create unintended cuts for hospitals that provide uncompensated care, according to a study by John Graves, Ph.D., a Vanderbilt policy expert in the Department of Preventive Medicine.
Graves used financial data from U.S. hospitals and insurance data in each state to predict cuts in Medicare and Medicaid disproportionate share (DSH) funds paid to the nearly three-fourths of U.S. hospitals that serve low-income patients.
The results, published in the Dec. 20 issue of the New England Journal of Medicine, put numbers behind the impact of funding changes and predict what the difference would be if Medicaid is, or is not, expanded in each state.
“Expanded insurance through the exchanges alone will trigger lower DSH payments to hospitals,” Graves said. “The problem comes in states where much of the uncompensated care provided will remain the same if Medicaid is not expanded, yet DSH cuts will still occur. Hospitals will need to recoup these DSH losses either by providing less uncompensated care, or by shifting the costs onto everyone else.”
As planned under the Affordable Care Act (ACA), Medicare DSH cuts will begin with a 75 percent across-the-board reduction in 2014 as new insurance exchanges come on line across the country.
To reduce the impact of the cuts, the government has devised a calculation to add some DSH funds back, based on the proportion of citizens who are uninsured in each state.
But because of the Supreme Court determination that states could not be compelled to expand Medicaid, who becomes covered in each state will vary widely.
Graves found that some states that do not expand Medicaid will be offering coverage to a greater number of people in their insurance exchanges, while continuing to leave most low-income, uninsured people without coverage.
DSH cuts will still move forward in those states, placing a burden on hospitals that provide the most uncompensated care.
On the flip side, Graves found states that are planning to expand Medicaid coverage could end up covering as much as 60 percent of their uninsured citizens, significantly increasing the amount of hospital care covered by public and private insurers and offsetting the reduction in DSH funds.
Graves said of the top five states his calculations show will experience the most unintended DSH reductions, three – Texas, Louisiana and Florida – have already announced they will not expand Medicaid.
The federal government has set no time limit on states opting in or out of Medicaid expansions, but DSH cuts are currently set to begin in 2014.
- Details
- Written by: Editor
Visceral, or deep belly, obesity is a risk factor for bone loss and decreased bone strength in men, according to a new study presented at the recent annual meeting of the Radiological Society of North America (RSNA).
“It is important for men to be aware that excess belly fat is not only a risk factor for heart disease and diabetes, it is also a risk factor for bone loss,” said Miriam Bredella, M.D., radiologist at Massachusetts General Hospital and associate professor of radiology at Harvard Medical School in Boston.
According to the National Center for Health Statistics, more than 37 million American men over age 20 are obese.
Obesity is associated with many health problems, including cardiovascular diseases, diabetes, high cholesterol, asthma, sleep apnea and joint diseases.
Yet despite all the health issues, it was commonly accepted that men with increased body weight were at lower risk for bone loss.
“Most studies on osteoporosis have focused on women. Men were thought to be relatively protected against bone loss, especially obese men,” Dr. Bredella said.
But not all body fat is the same. Subcutaneous fat lies just below the skin, and visceral or intra-abdominal fat is located deep under the muscle tissue in the abdominal cavity.
Genetics, diet and exercise are all contributors to the level of visceral fat that is stored in the body. Excess visceral fat is considered particularly dangerous, because in previous studies it has been associated with increased risk for heart disease.
After the Osteoporotic Fractures in Men Study – a multi-center observational study designed to determine risk factors for osteoporosis – indicated that male obesity was associated with fracture risk, the researchers wanted to quantify belly fat and study its impact on bone strength.
Dr. Bredella and her team evaluated 35 obese men with a mean age of 34 and a mean body mass index (BMI) of 36.5.
The men underwent CT of the abdomen and thigh to assess fat and muscle mass, as well as very high resolution CT of the forearm and a technique called finite element analysis (FEA), in order to assess bone strength and predict fracture risk.
“FEA is a technique that is frequently used in mechanical engineering to determine the strength of materials for the design of bridges or airplanes, among other things,” Dr. Bredella said. “FEA can determine where a structure will bend or break and the amount of force necessary to make the material break. We can now use FEA to determine the strength or force necessary to make a bone break.”
In the study, the FEA analysis showed that men with higher visceral and total abdominal fat had lower failure load and stiffness, two measures of bone strength, compared to those with less visceral and abdominal fat.
There was no association found between age or total BMI and bone mechanical properties.
“We were not surprised by our results that abdominal and visceral fat are detrimental to bone strength in obese men,” Dr. Bredella said. “We were, however, surprised that obese men with a lot of visceral fat had significantly decreased bone strength compared to obese men with low visceral fat but similar BMI.”
The results also showed that muscle mass was positively associated with bone strength.
- Details
- Written by: Editor
How to resolve AdBlock issue?