Digital Commons Network^™

Affirmative Action, Cuban Style, Fitzhugh Mullan

Health Policy and Management Faculty Publications

Twenty-five percent of the U.S. population is black, Hispanic, or Native American, whereas only 6.1 percent of the nation’s physicians come from these backgrounds. Students from these minority groups simply don’t get into medical school as often as their majority peers, which results in a scarcity of minority physicians. This inequity translates into suffering and death, as documented by the Institute of Medicine. Poorer health outcomes in minority populations have been linked to lack of access to care, lower rates of therapeutic procedures, and language barriers. Since physicians from minority groups practice disproportionately in minority communities, they are an important …

Quality Improvement In Maryland: Partnerships And Progress, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This one-and-a-half-day site visit to Easton, Maryland, explored the activities of the Delmarva Foundation, the Quality Improvement Organization (QIO) for Maryland and the District of Columbia. The program reviewed Delmarva’s responsibilities under their Medicare contract and the initiatives they have undertaken with hospitals and other providers to improve health care outcomes and to define, collect, and report quality data. Local hospital officials added their perspective on quality programs and working with Delmarva. Topics of particular interest were health information technology, patient safety, and quality reporting both to government agencies and to consumers.

Integrating Hiv Prevention Services Into The Clinical Care Setting In Medicaid And Ryan White Care Act Programs: Legal, Financial, And Organizational Issues, John Palen, Jeffrey Levi, Sara E. Wilensky, Jennifer Kates

Health Policy and Management Faculty Publications

This policy brief examines the structural-level opportunities and challenges associated with the delivery of HIV prevention services in or closely linked to the clinical care setting. It focuses on two of the major public programs for HIV care in the U.S: Medicaid, the nation's major public health program for low-income Americans, and the largest source of public financing for HIV/AIDS care in the U.S.; and the Ryan White CARE Act, the nation's only HIV-specific care and support services grant program which operates as the payer of last resort at the state and local level. Together, these programs provide care and …

Separate And Concomitant Use Of Lamotrigine, Lithium, And Divalproex In Bipolar Disorders., Daniel Z Lieberman, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

Expert consensus emphasizes the need for better recognition and accurate diagnosis of bipolar disorder. Current research on lithium, divalproex, and lamotrigine provides new insight into the effective management of this illness. Advances in identifying the mechanism of action of mood stabilization has focused on signaling pathways within the cell that are associated with neurotrophic effects. Clinical research has led to confirmatory evidence of the efficacy of lithium in all phases of bipolar disorder, with the greatest effects seen in the treatment and prevention of mania. Compared to divalproex, lithium also has been found to have greater efficacy in the prevention …

The Effects Of Copayments On The Use Of Medical Services And Prescription Drugs In Utah's Medicaid Program, Leighton Ku, Elaine Deschamps, Judi Hilman

Health Policy and Management Faculty Publications

In recent years, a number of states have increased cost-sharing for low-income Medicaid beneficiaries as one approach to Medicaid cost-containment. While copayments have been most commonly applied to prescription drugs, they also have been assessed for other services, such as physician visits, hospital admission, or outpatient clinic use.

Prior research has found that when low-income patients are required to pay more for health care services or for prescription drugs, they use fewer services or medications.[2] In some cases, their health could deteriorate, with the result that they may subsequently require more expensive emergency room or inpatient hospital care. While …

The Provider System For Children's Mental Health: Workforce Capacity And Effective Treatment, Jane Koppelman

National Health Policy Forum

This issue brief examines two issues that are key to meeting children’s unmet needs for mental health care: ensuring that the provider supply is adequate and that the care delivered is effective. It describes the shortage of qualified providers to address children’s mental disorders, as well its possible causes; it describes how managed care, to a certain extent, drives practice patterns; and it discusses the gray areas in deciding which providers are most qualified to deliver what care. In addition, this paper introduces what is known about evidence-based care in children’s mental health, the extent to which it is being …

Hearing Their Voices: Lessons From The Breast And Cervical Cancer Prevention And Treatment Act (Bccpta), Kyle Kenney, Sarah C. Blake, Kathleen A. Maloy, Usha Ranji, Alina Salganicoff

Health Policy and Management Faculty Publications

This brief provides: 1) an overview of California breast and cervical cancer screening programs for low-income women, 2) description of California's implementation of the BCCPTA and state-funded treatment coverage, and 3) findings from a series of 15 focus groups with low-income women in San Diego and San Francisco discussions conducted to learn more about BCCPTA coverage and its implementation in California. The purpose of the study was to hear directly from women in California about their experiences, knowledge, and opinions of breast and cervical cancer screening and treatment services after the implementation of the BCCPTA.

Skyrockets 24/7: A Response To Flat Budgets, Skyrocketing Serials Costs, And Patron Pressure For Increased Access To Electronic Journals, Cynthia Swope, Kathe Obrig, Laura E. Abate, Anne Linton

Himmelfarb Library Faculty Posters and Presentations

This poster represents the culmination of a year’s work by the Journals@Himmelfarb committee. This intra-library committee was formed to discuss the critical issues surrounding transitioning print journal subscriptions to electronic access only. In response to these discussions, collection development policies were created to reflect both print and electronic resources, a model electronic license was created, and faculty department heads were surveyed as to the usefulness and format preference for titles in their subject area. This resulted in improved understanding of the existing collection and assisted in developing the first steps for migrating from a print to an electronic collection.

Electronic Health Records: How Close? How Far To Go?, Lisa Sprague

National Health Policy Forum

This paper looks at the central role of the electronic health record (EHR) in health information technology. It considers the extent to which EHRs are in use and initiatives designed to increase their prevalence, as well as barriers to the widespread adoption of EHRs and efforts to surmount them. Particular attention is given to such obstacles as cost, the professional culture of physicians, standardization, and legal questions.

Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments, Robert E. Mechanic

National Health Policy Forum

This background paper describes the history and political evolution of Medicaid’s disproportionate share hospital (DSH) program and examines DSH as it exists today. It highlights the importance of DSH payments for the viability of safety net hospitals and considers the consequences of states’ creative financing strategies for maximizing federal Medicaid matching funds. Finally, this paper reviews several options for improving the structure and effectiveness of the DSH program.

Bursting At The Seams: Improving Patient Flow To Help America's Emergency Departments, Marcia J. Wilson, Khoa Nguyen

Health Policy and Management Faculty Publications

From 1992 to 2002, the number of annual ED visits increased 23 percent in the U.S., while the number of EDs decreased by 15 percent. Many EDs are overwhelmed by the number of patients needing their services, with 62 percent of the nation's EDs reporting being "at" or "over" operating capacity. Almost daily, newspaper headlines across the country relay stories about patients waiting for hours in the ED before being seen and tales of ambulances being diverted from one hospital to the next due to overcrowding. But while much of the blame for this situation has been placed on broader …

Fundamentals Of Community Health Centers, Jessamyn Taylor

National Health Policy Forum

This background paper examines the dominant model of federal grant funding for primary care in the health care safety net: the community health center. It describes the history of the health center program and highlights key policy issues influencing health centers, such as Medicaid payment policies and medically underserved area designations. The paper also examines the recent presidential initiative to expand health centers, including a review of the process used to identify new grantees, an assessment of remaining gaps in capacity, an exploration of continuing challenges, and a discussion of unresolved policy questions.

A Report From The Forum Session "Implementing The New Medicare Drug Benefit: Challenges And Opportunities For States", Judith D. Moore

National Health Policy Forum

The National Health Policy Forum convened a meeting on July 22, 2004 to discuss state-based challenges associated with implementing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The meeting brought together an extremely insightful and experienced group of current and former state officials and other experts to discuss key issues. In keeping with its tradition of promoting a frank, off-the-record exchange on health policy issues, NHPF does not normally prepare written summaries or reports of meetings. However, because this meeting provided vivid illustrations of the importance of state-federal collaboration for the successful implementation of the new Medicare drug benefit, …

Tick-Tock: Preparing For The Next Influenza Pandemic, Eileen Salinsky

National Health Policy Forum

This paper describes the nature of pandemic influenza and highlights key challenges for responding to this disease threat. It explains how an influenza pandemic would differ from annual influenza outbreaks and examines how a pandemic virus could emerge. It also explores important issues involved in pandemic preparedness capabilities, including disease surveillance, vaccine production and distribution, antiviral stockpiling, health care system readiness, and public health containment measures. The national pandemic preparedness plan is briefly reviewed, and unresolved policy issues related to the plan’s implementation are identified.

Fundamentals Of The Prescription Drug Market, Christie Provost Peters

National Health Policy Forum

This background paper is a primer on the prescription drug market. It provides information on the fundamentals of the pharmaceutical industry and various marketplace stakeholders, including manufacturers, retailers, consumers, regulators, researchers, and purchasers. This paper also examines the various ways the federal government interacts with the pharmaceutical market. Due to the breadth of material addressed, some complex issues and relationships are presented in broad conceptual terms without extensive technical detail.

Information Interface - Volume 32, Issue 3 - August/September 2004, George Washington University, Himmelfarb Health Sciences Library

Information Interface (1976 - 2009)

News and information about Himmelfarb Health Sciences Library of interest to users. Includes articles on digital microscopes, Ovid OpenLinks and PubMed Linkout, library liaisons, and database search tips.

The Promise And The Reality Of Long-Term Care Insurance, Randy Desonia

National Health Policy Forum

The aging of the nation’s population will create a surge in the need for long-term care services, putting pressure on existing funding sources and fueling demand for more. This paper examines one financing option—private long-term care insurance—and summarizes its brief history and the several critical precedents that have influenced the products as currently sold. Other topics discussed include the challenges to encouraging sales growth as well as increasing the role of this type of insurance in paying for long-term care.

Medicare Advantage: Déjà Vu All Over Again?, Brian Biles, Geraldine Dallek, Lauren Hersch Nicholas

Health Policy and Management Faculty Publications

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expands the role of private health plans in Medicare through prescription drug plans and a revised Medicare+Choice (M+C), renamed Medicare Advantage, program. This paper discusses the factors responsible for the failure of M+C to develop as intended in 1997 and analyzes the challenges for MMA implementation in light of these factors. They include making a complex program understandable to beneficiaries; addressing plans? efforts to avoid enrolling high-cost beneficiaries; ensuring stability of benefits, providers, and plans; dealing with beneficiaries enrolled in unsuitable plans; providing equity of health benefits throughout the …

Teaching Medicaid: A Tool For Health Law Teachers (2004 Update), Sara J. Rosenbaum, David Rousseau

Health Policy and Management Faculty Posters and Presentations

A teaching guide examining: (1) Medicaid's role as a health insurer: major themes; (2) Eligibility and services; (3) Where do Medicaid expenditures go and how; (4) Important are they to the health care system?; (5) Medicaid as health care payer and its role in supporting the health care safety net; (6) Medicaid's role in state financing; (7) Medicaid's role as a legal entitlement; (8) Does Medicaid need reform and if so, what should reform accomplish?

Medicaid Prescription Drug Spending And Use, Brian Bruen, Arunabh Ghosh

Health Policy and Management Issue Briefs

No abstract provided.

Economic Stress And The Safety Net: A Health Center Update, Sara J. Rosenbaum, Peter Shin, Julie S. Darnell

Health Policy and Management Faculty Publications

Federally funded health centers provided care to 11.3 million patients in 2002, the vast majority of whom were either uninsured (39%) or covered by Medicaid (34%). This paper provides new information on the demographic profile of health center patients and the revenue sources available for financing their care, including recent increases in federal discretionary funding. It examines the impact of the recent economic downturn on health centers in selected communities, exploring the effect of elevated unemployment levels among lower wage workers, declining private health insurance coverage, and widespread state cutbacks in Medicaid – the single most important source of health …

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

Consumer Cost Sharing In Private Health Insurance: On The Threshold Of Change, Veronica V. Goff

National Health Policy Forum

Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, copays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?, Nora Super

National Health Policy Forum

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician’s role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

Seize The Power: Librarian Roles In Developing And Implementing Enterprise-Wide Hipaa Training, Shelley Bader, Alexandra Gomes

Himmelfarb Library Faculty Posters and Presentations

Himmelfarb Health Sciences Library librarians collaborated to develop a web-based HIPAA training module for the medical center. Content was based on materials from an outside legal expert. Special attention was given to clinical scenarios illustrating key issues in HIPAA regulations. Librarians drafted the module which was then reviewed by legal consul, the George Washington University School of Medicine and Health Sciences, and the Graduate Medical Office. The final module was disseminated via the university's course management system. A corresponding module was developed for CME credit.

Walking A Tightrope: The State Of The Safety Net In Ten U.S. Communities, Marsha Regenstein, Lea Nolan, Marcia J. Wilson, Holly Mead, Bruce Siegel

Health Policy and Management Faculty Publications

This report presents the findings from the Urgent Matters safety net assessments and identifies common characteristics, opportunities and challenges for communities that wish to better serve the health care needs of uninsured and underserved individuals. It also illustrates differences across many of the communities, especially in terms of the structure and financing of their safety nets. It is a companion report to the individual safety net assessments and provides an overarching perspective of problems that affect safety nets across the country.

Information Interface - Volume 32, Issue 2 - May/June 2004, George Washington University, Himmelfarb Health Sciences Library

Information Interface (1976 - 2009)

News and information about Himmelfarb Health Sciences Library of interest to users. Includes articles on medical publishing, AHEC summer program, a journals shift project, and database search tips.

Olmstead V. L.C. And The Americans With Disabilities Act: Implications For Public Health Policy And Practice, Joel B. Teitelbaum, Taylor Burke, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This installment of Law and the Public’s Health examines the meaning of Olmstead v. L.C. for public health agencies administering personal health care programs. Handed down by the U.S. Supreme Court in 1999, Olmstead was a landmark decision that interpreted the Americans with Disabilities Act (ADA or the Act) as it applies to public programs and thus is of great relevance to many public health agencies. Following an overview of the decision and its interpretation by lower federal courts, this column concludes with a discussion of the implications of Olmstead and its progeny for public health policy and practice.

Integration Of Medical Informatics Curriculum Into Problem-Based Learning (Pbl) Course For 1st Year Medical Students, Laura E. Abate, Anne Linton, Patricia Wilson

Himmelfarb Library Faculty Posters and Presentations

Himmelfarb Health Sciences Library librarians developed and taught "Introduction to Medical Informatics" to first-year medical students through the 2002/03 school year. In 2003/04, this course was restructured and integrated into the "Problem-Based Learning" (PBL) course taken by all first-year medical students. The goal was to improve resource selection and search skills, provide point-of-use learning and instruction, and to enhance the student experience. Librarians were assigned to individual PBL groups to act as advisors and guided the students through the informatics-related curriculum.

Empowering Faculty To Choose: Open Access And Alternative Publishing, Laura E. Abate, Leah Pellegrino, Anne Linton, Patricia Wilson

Himmelfarb Library Faculty Posters and Presentations

Himmelfarb Health Sciences Library librarians initiated an effort to increase awareness of alternative publishing venues which exist outside the commercial arena; to encourage faculty to investigate electronic publishing alternatives; and to provide a connection to open access initiatives. George Washington University now participates in four open access initiatives and interest is growing among GWU faculty.