Law Commons^™

Strengthening A One Health Approach To Emerging Zoonoses, Samira Mubareka, John Amuasi, Arinjay Banerjee, Hélène Carabin, Joe Copper Jack, Claire Jardine, Bogdan Jaroszewicz, Greg Keefe, Jonathon Kotwa, Susan Kutz, Deborah Mcgregor, Anne Mease, Lily Nicholson, Katarzyna Nowak, Brad Pickering, Maureen Reed, Johanne Saint-Charles, Katarzyna Simonienko, Trevor Smith, J. Scott Weese, E. Jane Parmley

Articles & Book Chapters

Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan …

Path To Publication: A Peer Mentorship Model For Student-Lead Surgical Research, Usama Waqar, Hareem Rauf, Muskaan Abdul Qadir, Hina Inam

Medical College Documents

Early and sustained involvement in research is imperative for medical students to ensure better career prospects in addition to provision of high-quality, evidence-based care to patients. However, involvement of students in surgical research still remains limited, owing to inadequate research training. The current paper was planned to describe the structure of the "Path to Publication" series, incorporating peer mentorship with capacity-building research workshops for medical students. A total of 25 students were grouped into 8 surgical subspecialty groups to conduct research, supervised by experienced student research and faculty mentors. In addition, a series of research workshops were organized in synchronization …

The Role Of The Opioid Crisis In Elder Abuse, Kimberly I. Snow Mhsa, Jennifer Pratt, Stuart Bratesman Mpp

Disability & Aging

As the opioid crisis has deepened over the past twenty years, its effect on individuals and families, including older adults, has grown. To find out how the opioid crisis might be impacting elder abuse, neglect, and exploitation in Maine, we conducted a mixed methods analysis of 2015-2018 Maine Adult Protective Services (APS) investigations to determine: 1) Did opioid-related investigations increase over time? 2) Do investigations involving opioid misuse or abuse differ from investigations that don’t involve opioids? 3) What themes or features of cases involving opioid misuse or abuse by clients and/or perpetrators emerge from the data?

Key Findings: The …

Laws Restricting Access To Abortion Services And Infant Mortality Risk In The United States, Roman Pabayo, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, Sze Yan Liu

Department of Public Health Scholarship and Creative Works

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and …

Association Between Racial Discrimination And Health‐Related Quality Of Life And The Impact Of Social Relationships, Sze Yan Liu, Genevieve Bergeron, Nneka Lundy De La Cruz, L. Hannah Gould, Amber Levanon Seligson

Department of Public Health Scholarship and Creative Works

Purpose: Interpersonal racial discrimination is associated with poor health. Social relationships may moderate the impact of discrimination and represent modifiable behaviors that can be targeted by public health interventions. We described citywide associations between self-reported racial discrimination and health-related quality of life among the overall New York City (NYC) adult residential population and by four main race/ethnicity groups and explored whether social relationships moderated health effects of discrimination.

Methods: We analyzed cross-sectional survey data from 2335 adults weighted to be representative of the NYC population. We measured exposures to lifetime interpersonal racial discrimination in nine domains using a modifed version …

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.

Sexual Assault On College Campuses: An Epidemic And An Alternative Approach, Mark N. Devone

Undergraduate Research

Sexual assault is a major problem that is occurring at staggering rates on college campuses nationwide. Sexual Assault on College Campuses: An Epidemic and An Alternative Approach takes an in depth look at the problem at hand and discusses how the current ways of handling sexual assault cases and their faults. An alternative approach is introduced as a possible way to help fix the current sexual assault problem. The approach is Restorative Justice, which focuses on the rehabilitation of the offender and the healing of the victim through reconciliation techniques that include the victim, offender, and the community.

Evolving Workforce Roles In Medicare Next Generation Acos, Clese E Erikson

Health Workforce Research Center Publications

The purpose of this study was to explore key workforce strategies in Next Generation Accountable Care Organizations (Next Gen ACOs), the latest evolution in Medicare ACOs. We conducted semi-structured interviews with leaders from seven of the initial 18 Next Gen ACOs to better understand their perceptions regarding how workforce roles are changing to support the Next Gen ACO model. Key Questions:

1. What new and expanded roles for existing health workforce members are reported by Next Generation ACO leaders?
2. Has use of the health workforce changed as a result of Next Gen waivers for telehealth, home visits, and use of SNFs? …

Financial Hardship From Purchasing Medications For Senior Citizens Before And After The Medicare Modernization Act Of 2003 And The Patient Protection And Affordable Care Act Of 2010: Findings From 1998, 2001, And 2015, Anthony W. Olson, Jon C. Schommer, David A. Mott, Lawrence M. Brown

Pharmacy Faculty Articles and Research

BACKGROUND: The Medicare Modernization Act of 2003 (Medicare Part D) added prescription drug coverage for senior citizens aged 65 years and older and applied managed care approaches to contain costs. The Patient Protection and Affordable Care Act of 2010 (ACA) had the goals of expanding health care insurance coverage and slowing growth in health care expenditures.

OBJECTIVES: To (a) describe the proportion of senior citizens who had prescription drug insurance coverage and the proportion who experienced financial hardship from purchasing medications in 2015, and (b) compare the findings with those collected in 1998 and 2001.

METHODS: Data were obtained in …

Inequitable Chronic Lead Exposure: A Dual Legacy Of Social And Environmental Injustice, Tamara Leech, Elizabeth A. Adams, Tess D. Weathers, Lisa K. Staten, Gabriel M. Filippelli

Department of Public Health Scholarship and Creative Works

Both historic and contemporary factors contribute to the current unequal distribution of lead in urban environments and the disproportionate impact lead exposure has on the health and well-being of low-income minority communities. We consider the enduring impact of lead through the lens of environmental justice, taking into account well-documented geographic concentrations of lead, legacy sources that produce chronic exposures, and intergenerational transfers of risk. We discuss the most promising type of public health action to address inequitable lead exposure and uptake: primordial prevention efforts that address the most fundamental causes of diseases by intervening in structural and systemic inequalities.

Hospital Discharge Planning In Medicare: Current Requirements And Proposed Changes, Sally Coberly

National Health Policy Forum

Medicare's specific minimum health and safety standards for hospitals, known as conditions of participation, include requirements for discharge planning for patients who need such services. Discharge planning is intended to ensure smooth transitions from hospital to home or other health care facility. This publication reviews the current discharge planning requirements for hospitals as well as changes included in a proposed rule published by the Centers for Medicare & Medicaid Services on November 3, 2015. Key proposed changes include an expanded definition of which patients must receive discharge planning services, a requirement that providers responsible for follow-up care receive timely …

Medicaid Financing, Sally Coberly

National Health Policy Forum

This publication provides an overview of how the Medicaid program is financed. It explains how the federal and state shares of funding are determined, briefly describes disproportionate share hospital payments and how those are affected by the Patient Protection and Affordable Care Act of 2010, and outlines financing mechanisms states have used to maximize federal Medicaid matching funds.

Medicaid Eligibility And Benefits, Sally Coberly

National Health Policy Forum

This publication provides a brief overview of the Medicaid program. It highlights the range of eligibility and benefits requirements and options and it briefly describes the program's financing structure.

Medicare, Sally Coberly

National Health Policy Forum

This publication provides an overview of the Medicare program including eligibility, covered services, cost-sharing requirements, and program financing.

The Medicare Drug Benefit (Part D), Sally Coberly

National Health Policy Forum

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for Medicare beneficiaries that began January 1, 2006. This publication provides an overview of the drug benefit.

Medicare Part B Premiums And Social Security Benefits, Sally Coberly

National Health Policy Forum

This paper describes the annual determination of beneficiaries' premiums for voluntary Medicare Part B coverage and a provision known as "hold harmless." The hold-harmless provision prevents a beneficiary's Social Security payments from being reduced as a result of an increase in the Part B premium. Because there was no cost-of-living increase for Social Security benefits for 2016, the hold-harmless provision will be in effect. This paper discusses what happens to premiums in 2016 for beneficiaries who are not held harmless—new beneficiaries, beneficiaries who do not participate in Social Security, those who are dually eligible for Medicare and Medicaid, and higher-income …

Meaningful Use Of Health Information Technology: Proving Its Worth?, Lisa Sprague

National Health Policy Forum

Health policymakers in recent years have looked to the implementation of health information technology (IT)—electronic health records and the like—as a means to improve quality, reduce costs, and achieve better health outcomes across populations. But implementing health IT in a meaningful way must go beyond purchasing medical records software. The U.S. Department of Health and Human Services (HHS) devised a set of measures and incentives for hospitals and eligible medical professionals within Medicare or Medicaid to mark successive stages of effective IT implementation. This issue brief discusses the history of meaningful use, the measures used to evaluate effectiveness, and the …

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …

The Star Rating System And Medicare Advantage Plans, Lisa Sprague

National Health Policy Forum

With nearly 30 percent of Medicare beneficiaries opting to enroll in Medicare Advantage (MA) plans instead of fee-for-service Medicare, it’s safe to say the MA program is quite popular. The Centers for Medicare & Medicaid Services (CMS) administers a Star Ratings program for MA plans, which offers measures of quality and service among the plans that are used not only to help beneficiaries choose plans but also to award additional payments to plans that meet high standards. These additional payments, in turn, are used by plans to provide additional benefits to beneficiaries or to reduce cost sharing—added features that are …

Improving Rhode Island’S Health Care System: Lessons From The Cuban Model, Sarah R. Moffitt

Senior Honors Projects

Improving Rhode Island’s health care system: lessons from the Cuban model

Cuba is world renowned for its health care system. In regards to international health crises, Cuba is a leader in sending workers abroad and training doctors from all over the world. Within its own borders, the Cuban model provides free access to all citizens in which every individual has a primary care provider. Cuba boasts high vaccination rates, a long life expectancy, low infant mortality rate, and a population that is one of the healthiest in the western hemisphere.

The purpose of this research project is to evaluate the …

Annual Report 2014, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2014 calendar year, and provides a snapshot of our audience and resources.

The Public Health Service, Jennifer Jenson

National Health Policy Forum

This document provides an overview of the Public Health Service (PHS) within the U.S. Department of Health and Human Services, including a brief history and discussion of the agencies and offices that constitute the PHS today. Information on the mission, key programs, and budgets of PHS agencies and offices is also included.

Health Policy Essentials: Common Health Care Acronyms, National Health Policy Forum

National Health Policy Forum

No abstract provided.

Relative Value Units (Rvus), Sally Coberly

National Health Policy Forum

This publication reviews Medicare's relative value units (RVUs), which are assigned to each physician service to represent the resources required to provide the service relative to all other physician services. Three types of resources are included: physician work, that is, the physician time and effort; practice expenses, such as clinical staff and equipment; and professional liability insurance. Each service's RVUs are multiplied by a common dollar conversion factor to determine the Medicare payment.

Just Compensation: A No-Fault Proposal For Research-Related Injuries, Leslie Meltzer Henry, Megan E. Larkin, Elizabeth R. Pike

Faculty Scholarship

Biomedical research, no matter how well designed and ethically conducted, carries uncertainties and exposes participants to risk of injury. Research injuries can range from the relatively minor to those that result in hospitalization, permanent disability, or even death. Participants might also suffer a range of economic harms related to their injuries. Unlike the vast majority of developed countries, which have implemented no-fault compensation systems, the United States continues to rely on the tort system to compensate injured research participants—an approach that is no longer morally defensible. Despite decades of US advisory panels advocating for no-fault compensation, little progress has been …

Bundled Payments For Care Improvement Initiative – Insights From The Test Pilots Of Payment Reform, Jason M. Sutherland, William B. Borden

Medicine Faculty Publications

Background: The Medicare Bundled Payments for Care Improvement (BPCI) pilot program aims to reward high-value providers by setting a global payment target for particular episodes of care. The representativeness of BPCI participants will influence the ability of this pilot to inform policy decisions. Methods: We linked the Medicare lists of participants in the risk-bearing portion of BPCI Model 2, encompassing acute and post-acute care, to the American Hospital Association resource file and the 2013 Hospital Value-Based Purchasing quality performance data. We classified episode-initiating hospitals by the number of bundles in which they were participating into “narrow”, “medium” and “comprehensive”. The …

Consumer Assessment Of Healthcare Providers And Systems (Cahps) Surveys: Assessing Patient Experience, Lisa Sprague

National Health Policy Forum

This publication provides an overview of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys, which are widely used by both public and private health plans and providers to assess the patient's experience of health care. Included is information on survey contents, how surveys are tailored to different users, and how the resulting information is collected, reported, and used to help consumers make choices and providers carry out quality improvement, as well as its role in pay-for-performance reimbursement.

Health Care In The Motor City: Thriving Or Surviving?, Sally Coberly, William J. Scanlon

National Health Policy Forum

This site visit explored the forces shaping the delivery of health care in Detroit. Health care providers in Detroit face the twin challenges of controlling costs and serving a bifurcated metropolitan area that includes large numbers of uninsured, low-income, and vulnerable residents as well as more prosperous residents of a reviving inner core and the surrounding suburbs and counties. The program looked at the underlying economic, social, and physical conditions that make improving the health of the city's residents extremely challenging. Efforts to contain costs through payment innovations such as the Blue Cross Blue Shield of Michigan's Physician Group Incentive …

Annual Report 2013, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2013 calendar year, and provides a snapshot of our participants and resources.