Edited by Howard Bauchner, MD
To describe trends in mortality, hospitalizations, and expenditures in the Medicare fee-for-service population between 1999 and 2013, Krumholz and colleagues analyzed data from more than 68 million beneficiaries aged 65 years or older. The authors found that rates of all-cause mortality, hospitalization, and inflation-adjusted inpatient expenditures per beneficiary declined between 1999 and 2013.
Author Video Interview
The second open enrollment period for insurance under the Affordable Care Act (ACA) was completed in February 2015. In an analysis of 2012-2015 national telephone survey data (the Gallup-Healthways Well-Being Index) from 507 055 adults, Sommers and colleagues found that the ACA’s 2 open enrollment periods were associated with significantly improved trends in self-reported insurance coverage, access to primary care and medications, affordability of care, and health status. A comparison of states that expanded Medicaid vs those that did not revealed significant gains in insurance coverage and access to care and medicine among low-income adults in states that expanded.
Continuing Medical Education
The Centers for Medicare & Medicaid Services (CMS) Hospital-Acquired Condition (HAC) Reduction Program, which reduces payments to low-performing hospitals, was instituted in an effort to incentivize high-quality care. In an analysis of data from 3284 hospitals participating in the HAC program, Rajaram and colleagues examined the association between hospital characteristics and HAC program penalization. The authors found that frequently penalized hospitals were accredited by the Joint Commission, offered advanced services, were teaching institutions, and had better performance on 7 publicly reported process and outcome measures.
Medicare and Medicaid provide health coverage to 111 million beneficiaries, and the programs account for 39% of national health spending. Based on an analysis of publicly available and private survey data, Altman and Frist review the 2 programs from the perspectives of beneficiaries and the general public, health care professionals and health care institutions, and policy makers, and they discuss the challenges inherent in reconciling conflicting perspectives and priorities.
Author Audio Interview and Continuing Medical Education
An article in JAMA Internal Medicine reported that in a clinical trial testing the benefit of combined macrolide and β-lactam antibiotic therapy in the empirical treatment of moderately severe community-acquired pneumonia, β-lactam monotherapy was not noninferior to combination therapy. In this From the JAMA Network article, Mandell and Waterer discuss antibiotic choice in community-acquired pneumonia.
This JAMA Clinical Guidelines Synopsis by Elliott and Cifu summarizes the 2014 US Preventive Services Task Force guideline addressing behavioral counseling to promote a healthful diet and physical activity for cardiovascular (CVD) disease prevention in adults with CVD risk factors. The authors review the evidence base for the guideline (74 trials); individual- and population-level benefits that might be achieved; and challenges to guideline implementation.
A man with long-standing human immunodeficiency virus infection—well controlled with antiretroviral therapy—presents for evaluation of new-onset fatigue and malaise. Laboratory findings include elevated liver enzyme levels and negative test results for hepatitis A, B, and C infection. Liver biopsy findings suggest autoimmune hepatitis. Prednisone and azathioprine therapy is initiated, and shortly thereafter, the patient develops fever and a palmar and plantar macular rash. What would you do next?
Highlights. JAMA. 2015;314(4):315-317. doi:10.1001/jama.2014.11879