Medicine and Health Sciences Commons^™

Clinical Support Personnel In The U.S. Hospitals: Job Trends From 2010-2014, Patricia Pittman, Suhui Li, Xinxin Han

Health Workforce Research Center Publications

The use of various forms of Clinical Support Personnel (CSP), who perform healthcare tasks under the supervision of registered nurses and other licensed healthcare providers has been used as a primary strategy for managing professional shortages (Huston, 1996; Zimmerman, 2000), while at the same time reducing costs (Orne, Garland, O’Hara, Perfetto, & Stielau, 1998; Keenan, 2003). The purpose of this analysis is to better understand how hospitals are using CSP, and to explore changes that may have occurred since the 2010 passage of the Affordable Care Act. We use the term CSP to refer to a portion of the allied …

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 …

Workforce Planning & Development In Times Of Delivery System Transformation: The Stories Of Kaiser Permanente And Montefiore Health System, Patricia Pittman, Ellen Scully-Russ

Health Workforce Research Center Publications

As the implementation of the Affordable Care Act (ACA) advances, many health systems are taking bold measures to reorganize how they deliver care, and finding that in order to do so; they need to make major changes in how their healthcare workforces are organized.

Understanding what workforce changes are occurring and how they are being managed is important not just for healthcare leaders, but for policymakers as well. Traditional methods of projecting provider shortages and justifying the allocation of public funding to expand various professional pipelines are giving way to the notion that there are many models of care delivery …

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 …

Community Health Workers: Health System Integration, Financing Opportunities, And The Evolving Role Of The Community Health Worker In A Post-Health Reform Landsacape, Mary-Beth Malcarney, Patricia Pittman, Leo Quigley, Naomi Seiler, Katie B. Horton

Health Workforce Research Center Publications

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

The purpose of this report is to better understand the varied landscape; to offer categories of analysis that may help inform policy, management, and research; …

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 …

Longitudinal Analysis Of Electronic Health Records On Staffing Mix In Community Health Centers, Bianca K. Frogner, Xiaoli Wu, Jeongyoung Park, Patricia Pittman

Health Workforce Research Center Publications

Community health centers (CHCs) have long faced clinical staffing challenges especially in rural areas of the US due to providers perceiving a lack of socioeconomic opportunities. A recent study found that CHCs are adaptable and manage to maintain productivity levels across different staffing configurations by leveraging the clinical staff available. What is unknown is how two major changes in the health care landscape—adoption of an electronic health record (EHR) system and recognition of being a patient-centered medical home (PCMH)—have impacted staffing in CHCs, which may in turn have productivity implications.

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 …

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.

Alternate Payment Models For Ryan White Hiv/Aids Program Funded Services: Strategies Used By Nine Grantees, Naomi Seiler, Scott Dafflitto, Rosalind Fennell, Julia Hidalgo, Katie Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. …

Teaching Health Centers: A Promising Approach For Building Primary Care Work Force For The 21 St Century, Leighton Ku, Fitzhugh Mullan, Christine Cerrano, Zoe Barber, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Community Health Centers: A 2013 Profile And Prospects As Aca Implementation Proceeds, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2013, more than 1,200 federally funded community health centers provided access to care for low-income populations living in medically underserved communities throughout the country. The Affordable Care Act made expansion of health centers a key part of its strategy for ensuring that these communities would realize the benefits of increased health insurance coverage for their residents. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase. A key question going forward is whether health centers’ expanded capacity, developed over the past five …

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.

Impact Of Condition Specific Camps On Resiliency And Adaptive Behavior In Children With Heart Conditions, Jeanette Fong, Sandra Cushner-Weinstein

GW Research Days 2015

Objectives: Resilience is the ability to adapt in stressful situations and overcome adversity through the use of effective coping strategies. Previous studies have demonstrated that condition-specific camps designed for children with epilepsy can increase adaptive coping skills including social interactions, cooperation, initiative, and communication in participants over a three-year period ^[1,2]. Additionally, research indicates that as a group, individuals who live with chronic health disorders exhibit less hope and have worse health outcomes when compared to their normative peers. The aim of this study was to determine the impact of condition-specific camps on children with heart conditions.

Methods: 39 …

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 …