Health Policy Commons^™

Abortion Provisions In The Senate Managers Amendment, Sara J. Rosenbaum

Health Policy and Management Informal Communications

An assessment on the potential industry effects of the abortion provisions in the Senate Managers Amendment made available on December 18, 2009.

Challenges In Language Services: Identifying And Responding To Patients' Needs, Marsha Regenstein, Holly Mead, Kathryn E. Muessig, Jennifer Huang

Health Policy and Management Faculty Publications

Objective: Identify characteristics of hospitalbased language services (LS), and describe practices of identifying patients with limited English proficiency (LEP) and interpreter training.

Participants: Seventy-one hospitals applied to participate in a national initiative. Applicants were non-federal, acute care hospitals with substantial LEP populations, at least 10,000 discharges, and in-person interpreters.

Methods: Descriptive statistics were generated on language, collection of language data, LEP volume and service utilization, staffing and training requirements and organizational structure. The relationship between admissions and encounters was analyzed.

Results Ninety percent of hospitals collect primary language data. Spanish is the most common language (93% of hospitals). …

Leveling The Field--Ensuring Equity Through National Health Care Reform, Bruce Siegel, Lea Nolan

Health Policy and Management Faculty Publications

Members of minority groups have higher rates of disease, poorer health, and more limited access to care than their white counterparts. They account for half of the uninsured population and 58% of the low-income uninsured population. Even when they have coverage, minority patients are at risk for receiving lower-quality medical and surgical care than white patients. The factors underlying these inequities are complex and go far beyond the health care system,but any meaningful reform must, at a minimum, confront disparities in care. Health care reform provides a unique opportunity to reversea legacy of inequality in health and health care. This …

Racial/Ethnic Disparities In Access To Care Among Children: How Does Medicaid Do In Closing The Gaps?, Marsha Lillie-Blanton, Julia Paradise, Megan Thomas, Paul D. Jacobs, Bianca Dijulio

Health Policy and Management Faculty Publications

While Medicaid and the Children's Health Insurance Program (CHIP) have become increasingly important sources of health coverage for low-income children in all racial and ethnic groups, the program plays an especially large role for children of color, who are more likely than white children to be low-income. In 2007, Medicaid and CHIP covered nearly one in five white children, but roughly two in five African American and Hispanic children.

As policymakers engaged in health reform consider the merits of public and private approaches to expanding coverage, this report provides an assessment of Medicaid's relative impact on racial and ethnic disparities …

Analysis Of State Medicaid Agency Performance In Relation To Incentivizing The Provision Of H1n1 Immunizations To Eligible Populations, Nancy Lopez, Ross Margulies, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This analysis examines the extent to which state Medicaid agencies have translated a recent CMS guidance on vaccine coverage into clear information for participating providers clarifying payment for costs associated with the administration of H1N1 vaccines. This clarification may be particularly important in states that do not otherwise cover and pay for recommended immunizations as part of treating adult patients.

Mandatory Vaccination Of Health Care Workers, Alexandra M. Stewart

Health Policy and Management Faculty Publications

New York State’s regulations require health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza. Courts must take into account Constitutional guarantees of personal autonomy, freedom of contract, and freedom of religion when reviewing the current lawsuits. These rights, however, have been constrained when they conflict with government measures that are intended to protect the community’s health and safety. Health care workers have a profound effect on patients’ health. Although they have the same rights as all private citizens, it is likely that courts will continue …

An Analysis Of The Implications Of The Stupak/Pitts Amendment For Coverage Of Medically Indicated Abortions, Sara J. Rosenbaum, Lara Cartwright-Smith, Ross Margulies, Susan F. Wood, D. Richard Mauery

Health Policy and Management Faculty Publications

This analysis examines the implications for coverage of medically indicated abortions under the Stupak/Pitts Amendment (Stupak/Pitts) to H.R. 3962, the Affordable Health Care for America Act. In this analysis we focus on the Amendment's implications for the health benefit services industry as a whole. We also consider the Amendment's implications for the growth of a market for public or private supplemental coverage of medically indicated abortions. Finally, we examine the issues that may arise as insurers attempt to implement coverage determinations in which abortion may be a consequence of a condition, rather than the primary basis of treatment.

Analysis Of The Extent To Which State Insurance Laws Mandate Coverage And Payment Of Vaccines And Vaccine Administration Fees During Periods Of Declared Public Health Emergencies, Sara J. Rosenbaum, Nancy Lopez, Ross Margulies

Health Policy and Management Faculty Publications

This analysis examines whether state insurance laws require health insurers, as a condition of doing business, to pay the costs associated with the administration of immunizations during declared public health emergencies. As is the case with the current H1N1 emergency, a public health emergency triggers nationwide distribution of free vaccine. But even when vaccine is distributed free of charge, its administration poses costs to private physicians and charges can be significant. As a result, the Institute of Medicine has identified vaccine administration as a potential financial barrier to care. Most communities have limited numbers of public health workers and professional …

State Medicaid Coverage Of Perinatal Services: Summary Of State Survey Findings, Usha Ranji, Alina Salganicoff, Alexandra M. Stewart, Marisa A Cox, Lauren Doamekpor

Health Policy and Management Faculty Publications

No abstract provided.

Paying Medicare Advantage Plans By A Blend-Based System: Where Are The Gains And Losses?, Brian Biles, Jonah Pozen, Grace Arnold

Health Policy and Management Issue Briefs

Medicare Advantage (MA) plans are now paid $11 billion a year and $150 billion over 10 years more than costs in fee-for-service (FFS) Medicare. In the past two years there have been discussions about reducing MA payments to the level of FFS costs and using the savings to offset the costs of new Federal initiatives such as health care reform. These discussions have included a number of options on the specific new approach to pay plans including: average FFS costs in each county; a blend of local county FFS costs and national FFS average costs; and a regional system based …

Health Insurance Patterns Among Latinos In Comparative Perspective 2004 — 2007, Rachael Varra

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report examines the rates at which the four major racial/ethnic groups in the United States — Latinos, non-Hispanic Whites, non-Hispanic Blacks and Asians — lacked health insurance from 2004- 2006 in the U.S. overall and in the ten states with the largest Latino populations: California, Texas, Florida, New York, Illinois, Arizona, New Jersey, Colorado, New Mexico and Georgia.

Methods: The “lack of insurance data” in this report were derived from Health Statistics Data obtained by the Center for Disease Control from 2004 to 2006. In September 2008 these data became available by race, age and ethnicity/race on a …

Health Care Fraud, Sara J. Rosenbaum, Nancy Lopez, Scott Stifler

Health Policy and Management Faculty Publications

Adequate safeguards against health care fraud are essential to the proper functioning of any health care system. This analysis examines health care fraud in the U.S., and its findings underscore the importance to national health reform of comprehensive anti-fraud protections covering both public and private health insurance industry. This analysis, funded by the Robert Wood Johnson Foundation, examines health care fraud in a national policy context.

Using Primary Care To Bend The Cost Curve: The Potential Impact Of Health Center Expansion In Senate Reforms, Leighton C. Ku, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including $105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases …

Estimating The Economic Gains For States As A Result Of Medicaid Coverage Expansions For Adults, Peter Shin, Leighton C. Ku, D. Richard Mauery, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This policy research brief examines the Medicaid eligibility expansions under the pending legislative proposals, including the House Tri-Committee bill, the Senate Health, Education, Labor and Pensions Committee bill and the Senate Finance Committee bill. Using new Census Bureau data, the researchers find that under both the House and Senate Finance Committee proposals, about 9.6 million nonelderly adults would gain Medicaid eligibility by 2014. Furthermore, the federal and state expenditures are less than Medicaid's positive impact on the economy amounting in a return of three dollars in new business activities for every dollar of state Medicaid investment. Because Medicaid is designed …

A Community Benefit Reporting Toolkit For Critical Access Hospitals, John A. Gale Ms, Melanie Race Ms

Rural Hospitals (Flex Program)

No abstract provided.

It's Your Life: Building Connections Through Work - Project Summary Report, Sherrie Winton Med

Disability & Aging

This report gives a detailed description of It's Your Life: Building Connections Through Work project from design, to implementation and evaluation of the workshop sessions. It is our hope that you enjoy learning about this project and that professionals working in the rehabilitation field continue to seek out opportunities to provide co-training models, partnering with adults with disabilities to train their peers.

Profiling Maine’S Long Term Support System [Project Brief], Eileen Griffin Jd

Disability & Aging

A recent report by the Muskie School and the Maine Department of Health and Human Services provides a new way of looking at the state’s long term support system. With an emphasis on developing a common approach for description and analysis across programs, the profile reveals that users of long term services and supports in Maine span all age groups and types of service users. In fact, 28% are ages 17 or younger and 29% are between the age of 35 and 64. Long term service users include people with physical impairments, cognitive and intellectual disabilities, and people who need …

Strengthening Security And Oversight At Biological Research Laboratories, Michael Greenberger

Congressional Testimony

With the advent of the Anthrax attacks in the fall of 2001, this Nation has been confronted with a serious policy conundrum. On the one hand, we have strengthened programs that encourage the use of our best scientific resources to develop countermeasures to the weaponization of highly dangerous biopathogens. On the other hand, research on those countermeasures requires the use of the very biopathogens we seek to defeat. There have been many mishaps in the handling of those pathogens, which raises the frightening prospect that the research may be as (or more) dangerous than the potential bioterrorist acts themselves. Indeed, …

Revitalisation, Rigour And Relevance: The Citizen-Client And Planning In The Health Services., Vivienne Byers

Conference Papers

Whereas, in many OECD countries strategic planning in health care has been in evidence since the 1970s, in Ireland the emergence of strategic management processes in health care planning didn’t occur until the 1990s.

This paper reports on part of a comparative study of health services planning in Ireland and in Canada. How can the strategic management of the Irish health services in the form of service planning be implemented? The focus of this paper is the identification of two key stumbling blocks to success in this endeavour. These include the limitations of the control mechanism, the legislation, underpinning service …

Quality Of Life Estimation With Structural Equation Modeling In School Aged Children With Asthma, Sheniz Moonie, Xuan Huang, David A. Sterling

Environmental & Occupational Health Faculty Publications

Significant increases in childhood asthma prevalence and mortality has prompted federal and regulatory agencies to work towards a national framework to address childhood asthma. Quality of life is an important component of chronic disease, and the evaluation of healthcare outcomes. There is little discussion in the literature regarding the implications of QoL as a theoretical construct. This study determined the effect of asthma on the QoL of our study population and caregiver’s missed workdays on the child’s QoL scores. A negative relationship was found between the child’s QoL and the caregiver’s missed workdays due to their child’s asthma. The use …

Using Primary Care To Bend The Curve: Estimating The Impact Of A Health Center Expansion On Health Care Costs, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform. Key findings include:

Increasing health center capacity by another 20 million patients by 2019 (to 39 million patients) under health reform can be expected to generate an additional $35.6 billion savings in 2019 and $212 billion in additional savings over the 2010-2019 ten-year time period.

Were the Medicaid prospective payment rate system to be applied to exchange …

Talking With Patients: How Hospitals Use Bilingual Clinicians And Staff To Care For Patients With Language Needs, Jennifer Huang, Karen C. Jones, Marsha Regenstein, Christal Ramos

Health Policy and Management Issue Briefs

Improving access to language services in health care settings has become a focal point for health reform and disparities-focused legislation, in recognition of the increasing linguistic and cultural diversity of individuals across the nation. Bilingual staff and clinicians can serve as enormously valuable resources to hospitals and other health care organizations, offering a critical set of skills to interact with individuals who require care in a language other than English. Bilingual clinicians can serve a vital need for hospitals by providing high-quality health care, improving patient safety, and meeting organizational priorities to provide linguistically and culturally appropriate care for patients. …

The Economic Burden Of Health Inequalities In The United States, Thomas A. Laveist, Darrell J. Gaskin, Patrick Richard

Health Policy and Management Faculty Publications

This study, commissioned by the Joint Center for Political and Economic Studies and carried out by leading researchers from Johns Hopkins University and the University of Maryland, provides important insight into how much of a financial burden racial disparities are putting on our health care system and society at large. The researchers examined the direct costs associated with the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity, lost wages, absenteeism, family leave, and premature death.

Health Center Data Warehouses: Opportunities And Challenges For Quality Improvement, A. Seiji Hayashi, Emily Jones, David M. Stevens, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This Policy Research Brief reports on a pilot effort to leverage the growing presence of health center data warehouses to advance health care quality improvement through data sharing and exchange. This project builds on a partnership between the Michigan Primary Care Association and The George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative that centers on developing approaches to using existing health center data for quality improvement.

Do Medicaid And Chip Measure Errors Correctly?, Leighton C. Ku

Health Policy and Management Issue Briefs

Measuring and reducing errors in Medicaid and CHIP is important, but the current program and the proposed regulatory provisions are flawed and misleading. Reducing errors should involve not only reducing payments that are issued in error, but reducing the rate at which eligible applicants are erroneously denied Medicaid coverage. CMS should give develop a better, more valid approach to error determination when there are cases of missing or insufficient provider or eligibility data and issue a new proposed rule that offers a new approach or approaches.

Network Governance And Health Care Policy, M. Ernita Joaquin, Nathan Meyers

Public Policy and Leadership Faculty Publications

As a paradigm, network governance is trumping “public administration” or traditional models of government. Policies taking a network governance approach seem to have a greater chance of goal
attainment. Is network governance in health care policy a means of bridging the ideological divide, what with national health policy initiatives tripping on partisan hurdles? One example of network governance (as expounded by Stephen Goldsmith and William Eggers in their 2004 book) at the state level is high-risk health insurance programs (HRPs).

Use Of Revised International Health Regulations During Influenza A (H1n1) Epidemic, 2009, Rebecca L. Katz

Health Policy and Management Faculty Publications

Strong international health agreements and good planning created a structure and common procedure for nations involved in detection and evaluation of the emergence of influenza A (H1N1). This report describes a timeline of events that led to the determination of the epidemic as a public health emergency of international concern, following the agreed-upon procedures of the International Health Regulations. These events illustrate the need for sound international health agreements and should be a call to action for all nations to implement these agreements to the best of their abilities.

Emergency Department Operations In Top-Performing Safety-Net Hospitals, Lea Nolan, Marsha Regenstein, Donna Anthony, Bruce Siegel

Health Policy and Management Faculty Publications

This report profiles five safety-net hospitals—Boston Medical Center, Denver Health, Memorial Regional Hospital, Memorial Hospital West, and Virginia Commonwealth University Health System—that made improvements to curb emergency department (ED) crowding, reduce long waits, and lower the number of hours spent on ambulance diversion. Hospitals used a combination of interventions, including: reconfiguring the ED to maximize efficiency; devising a pre-diversion system to alert staff of ED crowding; installing an electronic tracking system; designating staff members to be responsible for tracking patients; and developing meaningful performance metrics. To be successful, such interventions need to take place within a broader improvement strategy that …

Community Health Centers In Indiana: State Investments And Returns, Avi Dor, Patrick Richard, Ellen Tan, Sara J. Rosenbaum, Peter Shin, Lee Repasch

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Indiana Community Health Centers (I-CHC), including Federally Qualified Health Centers (FQHCs) and State Funded Health Centers (SFHCs), play a vital role in caring for the state's most vulnerable populations. Although their patient base tends to be poorer and experience greater health challenges than the general population, these health centers have generated substantial health care savings while providing high quality, low cost care. In this brief, key findings are presented from a recent study, conducted for the Indiana State Department of Health by GWU faculty and staff that was designed to estimate the cost savings and benefits generated by the state's …

Fair Process In Physician Performance Rating Systems: Overview And Analysis Of Colorado's Physician Designation Disclosure Act, Lara Cartwright-Smith, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Programs to rate, grade, rank, or tier physicians based on quality or other measures are becoming more commonplace as the demand for greater transparency and accountability in the nation’s health care system intensifies. For many years, the preferred provider organization (PPO) reflected the most basic form of tiering—physicians were either included or excluded from the PPO network. However, this approach has become more refined as the tools for evaluating physician performance have evolved.