Health Policy Commons^™

Why Policy Matters, D. Richard Mauery

Health Policy and Management Faculty Publications

The Editors and Editorial Board of Women’s Health Issues are pleased to publish in this issue the first article in a new category of peer-reviewed manuscripts for our journal, ‘‘Policy Matters.’’

Diagnosing Death: Why Does It Remain "Well Settled And Persistently Unresolved"?, Melissa M. Goldstein

Health Policy and Management Faculty Publications

For ten days after Motl Brody had been declared dead by physicians, the 12-year-old boy lay in an intensive-care unit of Children's National Medical Center, sustained by drugs and a ventilator. His Orthodox Jewish parents insisted that, according to religious law, Motl remained alive because his heart continued to beat. District of Columbia law said he did not.

Although statutes on the books of every U.S. state allow a determination of death when all functions of the brain, including the brain stem, have irreversibly ceased, there is continued debate, especially in religious, philosophical, and bioethics contexts, about how, or even …

Ready Or Not? Protecting The Public's Health From Diseases, Disasters, And Bioterrorism, Jeffrey Levi, Serena Vinter, Rebecca St. Laurent, Laura M. Segal

Health Policy and Management Faculty Publications

While significant progress has been made to better protect the country from health emergencies, funding for essential programs has been cut, putting these improvements in jeopardy. Additionally, a number of critical areas of preparedness still have significant gaps, including surge capacity and biosurveillance systems, and these problems are less likely to be addressed as funding decreases.

Liability Protections For Emergency Volunteer Health Practitioners And Entities, Jennifer Lee, Orriel L. Richardson, Ross Margulies, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Twenty-four states and D.C. have statutes that extend some level of immunity to groups and/or organizations providing charitable, emergency, or disaster relief services, although these laws varied greatly among states.

Improving Medicaid: Assessment Of District Of Columbia Agencies' Claims Processes And Recommendations For Improvements In Efficiency And Customer Service, George Washington University, School Of Public Health And Health Services, Department Of Health Policy, Health Management Associates

Health Policy and Management Faculty Publications

The District of Columbia Department of Health Care Finance (DHCF), like other state Medicaid agencies, is constantly challenged to improve service delivery and reimbursement for Medicaid services. In the District, several governmental agencies ("Partner Agencies") play an instrumental role in Medicaid – either as a Medicaid provider or in operating a Medicaid program. Today, each Partner Agency may retain its own system and process for claims submission, provider enrollment, and administrative claiming as it relates to Medicaid. For these reasons, the DHCF initiated an assessment of the Medicaid claims processes for Partner Agencies. The purpose of the assessment is to …

Medicare Advantage's Private Fee-For-Service Plans: Paying For Coordinated Care Without The Coordination, Brian Biles, Emily Adrion, Stuart Guterman

Health Policy and Management Faculty Publications

Like the private managed care plans offered under Medicare Advantage, private fee-for-service (PFFS) plans are paid more per beneficiary than those individuals would be expected to cost if they were enrolled in traditional fee-for-service Medicare. However, PFFS plans are not required to provide the same type of coordinated care required of Medicare Advantage plans. Payments to PFFS plans in 2008 average 16.6 percent more than costs in traditional Medicare, or $1,248 for each of the 2 million enrollees in PFFS plans—a total of nearly $2.5 billion in extra payments. Recently, Congress has made significant revisions to policies that will affect …

Assessing The Effects Of Medicaid Documentation Requirements On Health Centers And Their Patients: Results Of A "Second Wave" Survey, Lee Repasch, Brad Finnegan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This report represents a "second wave" follow-up to a "first wave" study whose purpose was to measure the effects of the Deficit Reduction Act's citizenship documentation requirements on health centers and their patients. The earlier study, conducted six months after implementation, found that the law had a widespread impact, including delayed applications, interrupted enrollment, disruptions in care, and at least anecdotal evidence of a growth in the number of uninsured patients as a result of the denial or loss of Medicaid coverage. This "second wave" survey underscores the existence of serious, ongoing problems more than a year after implementation. Specifically, …

Second-Generation Consumerism: Increasing Consumer Activation To Improve Health Outcomes And Lower Costs For Patients With Chronic Disease, Judith H. Hibbard, Katherine J. Hayes

Health Policy and Management Faculty Publications

With health care costs increasing, some policymakers have sought to make patients better health care consumers through increased cost-sharing linked with greater information on the cost of care. These may be successful cost containment strategies in the short term. But patients are just as likely to forgo necessary as unnecessary care, which ultimately leads to greater demand for more intensive and expensive care in the long term. Patients can, however, play an important role in preventing the onset of chronic conditions or preventing deterioration in health once they have been diagnosed with a chronic condition. In this chapter we discuss …

Slouching Toward Health Reform: Insights From The Battle Over Schip, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

For Asians Only? The Perils Of Ancestry-Based Drug Prescribing, Perry W. Payne

Health Policy and Management Faculty Publications

The article discusses various aspects of ancestry-based drug prescribing and contemporary medical ethics in the U.S. Ancestry has been used by researchers to identify a subgroup of people most likely to have a certain allele linked to an adverse drug response. Also discussed are carbamazepine labeling, the U.S. Food and Drug Administration's (FDA) Alert on drug prescribing based on allele testing and the ethics of genetically categorizing people.

The Continuing Cost Of Privatization: Extra Payments To Medicare Advantage Plans In 2008, Brian Biles, Emily Adrion, Stuart Guterman

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, every MA plan in the nation is paid more for its enrollees than they would have been expected to cost in traditional fee-for-service Medicare. The authors calculate that payments to MA plans in 2008 will be 12.4 percent greater than the corresponding costs in traditional Medicare—an average increase of $986 per MA plan enrollee, for a total of more than $8.5 billion. Over the five-year period 2004–2008, extra payments to MA plans are estimated to have totaled nearly $33 billion. Although …

Designation Of Medically Underserved And Health Professional Shortage Areas: Analysis Of The Public Comments On The Withdrawn Proposed Regulation, Emily Jones, Leighton C. Ku, Joseph Lippi, Ramona Whittington, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In February 2008, the Health Resources and Services Administration (HRSA) proposed new regulations that would have modified and combined the Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designation processes. The comment period was extended twice in response to the large volume of comments, through June 30th. On July 23rd, HRSA effectively withdrew the proposed rule, announcing that in light of its preliminary review of comments, the agency had elected to develop a new proposal. This Research Brief highlights some of the salient issues surrounding the proposed rule, based on an analysis of the public comments by researchers …

Uninsured And Medicaid Patients' Access To Preventive Care: Comparison Of Health Centers And Other Primary Care Providers, Avi Dor, Yuriy Pylypchuck, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This issue of Research Briefs examines health centers' role in reducing disparities in preventive health care access by medically vulnerable and high risk populations. The analysis uses information from several national data sources to examine differences in the provision of preventive health care to Medicaid and uninsured patients between health centers and other primary care providers.

Key Findings:

• Compared to those treated by other primary care providers, Medicaid and uninsured patients treated by health centers are significantly poorer, in significantly worse health, and in the case of uninsured patients, more likely to be members of racial and ethnic minority groups. …

Access Transformed: Building A Primary Care Workforce For The 21st Century, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Though access to primary care protects health and cuts costs, this report shows there aren't enough primary care doctors and nurses at health centers to meet the need, with some areas having almost none – a situation that cannot be solved just by expanding health insurance coverage. The report indicates the availability of a primary care workforce depends on where you live, and primary care clinicians are not locating in areas that need them most, especially low-income communities. The study includes state-level projections of growing patient needs expected to stretch the health care system in years ahead. It was conducted …

Monitoring And Assessing The Use Of External Quality Review Organizations To Improve Services For Young Children: A Toolkit For State Medicaid Agencies, Tara Krissik, Henry T. Ireys, Anne R. Markus, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Federal regulations encourage state Medicaid agencies to use external quality review organizations (EQROs) to help implement strategies for assessing and improving the quality of medical services provided to beneficiaries enrolled in managed care plans. However, many states have not availed themselves of this opportunity and may lack guidance on how to do so. This report provides agencies with specifications for developing a scope of work that will lead to conceptually and methodologically sound studies of the quality of preventive and developmental services for young children enrolled in Medicaid. Among other recommendations, the authors note that states may require EQROs to …

Medicare Competitive Acquisition: Implications For Persons With Diabetes, Sara J. Rosenbaum, Avi Dor, Brad Finnegan, Emily Jones

Health Policy and Management Faculty Publications

Nearly one in five Medicare beneficiaries has diabetes and these patients face major challenges in managing their health. The high diabetes rate among beneficiaries also means that the Medicare program itself is highly vulnerable to the high costs of uncontrolled diabetes. As a result, great care must be taken when implementing any new cost containment strategy that has the potential to disrupt access to preventive health care. This is particularly in the case of the Medicare Competitive Acquisition Program for Durable Medical Equipment and Supplies (DMEPOS), because of its potential impact on access to products needed for a basic preventive …

Baseline Evaluation Of The Dc Emergency Healthcare Coalition, Melissa A. Higdon, Peter Shin, Michael A. Stoto

Health Policy and Management Faculty Publications

The DC Healthcare Facilities Emergency Care Coalition, funded by a grant by the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR), was designed to significantly improve the state of emergency preparedness in health care facilities in the District of Columbia (DC), and to create a model for emergency preparedness that can be used by other large cities or regions of care across the nation. Its goal is to provide a comprehensive, uniform, and consistent framework and infrastructure for emergency preparedness across the full continuum of patient care. Devised to address the inconsistencies, shortcomings, fragmentations, …

Addressing Disparities In Health And Health Care: Issues For Reform, Marsha Lillie-Blanton

Health Policy and Management Congressional Testimonies

The testimony focuses on the role of health insurance in reducing disparities in health care and in health status, two distinct but related challenges. Disparities in health care – whether in insurance coverage, access, or quality of care – are one of many factors producing inequalities in health status in the U.S. Eliminating disparities in health among segments of the population (e.g., by race/ethnicity, education, income, gender, geographic location) was one of two overarching goals of Healthy People 2010, the federal government’s blueprint for what it wanted to achieve in health by the end of this decade.

Primer On Medicare Advantage Payments In 2008, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) included provision intended to increase the role of private health plans in Medicare. These provisions, building on policies adopted earlier in 1997 and 2000, set Medicare Advantage (MA) plan benchmark rates at levels higher than average costs in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these policies total over $8.5 billion in 2008 and over $82 billion over the five year period between 2009 and 2013.

This briefing paper outlines the three major Medicare policies that generate these extra …

Grantee-Level Estimates Show That 31 Percent Of All Health Centers Would Fail To Meet Tier Two Status Under Hrsa's Proposed Mua/Mup/Hpsa Designation Regulations, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In April of 2008, we issued a research brief which analyzed the impact on various federal programs of a February 29, 2008 Notice of Proposed Rulemaking (NPRM) regarding the designation of Medically Underserved Populations and Health Professional Shortage Areas. Among its findings, the report estimated that resources for one-third of community health center sites would be jeopardized by this rule change because they could not attain a sufficiently high priority status, even under the newly-proposed, higher-scoring Tier 2 methodology. On May 1, 2008, we issued a revision in response to an April 21, 2008 clarification notice from the Health Resources …

Building A High-Quality Language Services Program Toolkit, Jennifer Trott, Catherine West, Priti Shah, Marsha Regenstein

Health Policy and Management Faculty Publications

Ten hospitals with racially and ethnically diverse patient populations participated in the Robert Wood Johnson Foundation's "Speaking Together: National Language Services Network," a program aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP). This toolkit provides advice to hospitals on improving quality and accessibility of language services.

Harnessing Knowledge To Ensure Food Safety: Opportunities To Improve The Nation's Food Safety Information Infrastructure, Michael R. Taylor, Michael B. Batz

Health Policy and Management Faculty Publications

Those working in the food industry face an abundance of information generated by diverse institutions and individuals.

Ensuring the safety of food is critically important to the public's health and a challenge for policy-makers seeking to enhance the government's role in this arena. Although the food industry has an inherent duty to make food safe, the effectiveness of what they do is highly dependent on the quality of the information they receive on potential hazards and good practices.

In this context, the Robert Wood Johnson Foundation funded a project under the auspices of the Food Safety Research Consortium to examine …

Highlights: Analysis Of The Proposed Rule On Designation Of Medically Underserved Populations And Health Professional Shortage Areas, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

For decades, the federal government has targeted health care funding, resources and staff to meet the health care needs of areas designated as "medically underserved areas" and "health professional shortage areas." Areas that qualify may, for example, receive federal funding to support the establishment and operation of community health centers, or receive National Health Service Corps (NHSC) physicians and clinicians. In addition, physicians who practice in these health shortage areas may receive higher payments under Medicare. These designations thus affect the availability of health care in thousands of urban and rural areas all across the United States. Community health centers …

Analysis Of The Proposed Rule On Designation Of Medically Underserved Populations And Health Professional Shortage Areas, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Numerous safety net programs and health care providers depend on Medically Underserved Area and Population (MUA/P) and Health Professional Shortage (HPSA) designations to qualify for federal funding, physician subsidies and placement, and health-related investments to improve access to care for communities and populations at high risk of poor health. These resources are particularly critical for federally-qualified health centers at a time when the number of uninsured is growing and the capacity of the safety net shrinking. On February 29, 2008, the Department of Health and Human Services (HHS) released a proposed regulation to alter the way these designations are made. …

Cms' Medicaid Regulations: Implications For Children With Special Health Care Needs, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Centers for Medicare and Medicaid Services (CMS) is currently engaged in a policy initiative that should serve as a reminder of the power of a single federal administrative agency to change the course of national health policy. Through a virtual deluge of regulations and policy issuances, CMS has sought to redirect the course of Medicaid; in a number of respects, the course that CMS has sought to chart for the program is not only poorly thought out and ill-considered, but would actually propel the program in a direction directly contrary to both longstanding federal statutory provisions and recent decisions …

How Does Investment In Community Health Centers Affect The Economy?, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The economic slowdown that began in 2007 has prompted policymakers to focus on investments that can produce rapid economic gains in communities. Building on a previous analysis, this Research Brief estimates that a $250 million appropriations increase in the community health centers program would yield health care for an additional 1.8 million patients and a nationwide four-to-one return on investment:

• nearly $1 billion in direct community economic benefits, and
• over $1.1 billion in indirect benefits in jobs and other community investments.

On a state-by-state basis, each $1 million in federal appropriations would assure care for an additional 8,400 patients and …

Health Information Privacy, Patient Safety, And Health Care Quality: Issues And Challenges In The Context Of Treatment For Mental Health And Substance Use, J. Zoe Beckerman, Joy Pritts, Eric Goplerud, Jacqueline C. Leifer, Phyllis Borzi, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Vision Exams For Children Prior To Entering School, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

Children's vision problems are very common, affecting nearly 15 million children. Early screening and detection are essential in treating eye disorders in children. This fact sheet discusses statistical data associated with Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of vision/eye conditions, and provides recommendations from the National Commission on Vision and Health.

Access To Comprehensive Vision Care Services Under Schip, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

Vision services are generally classified as optional benefits in Medicaid and SCHIP, and access to vision care services may vary due to lack of uniform coverage and benefit design across states. Although children enrolled in Medicaid are generally able to obtain access to vision care services through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit, states that operate separate SCHIP programs are not mandated to cover EPSDT benefits. A GAO report found that states tend to place more limits on vision benefits in SCHIP than in Medicaid and in ten states limit the number of exams and corrective …

Health Centers: An Overview And Analysis Of Their Experiences With Private Health Insurance, Peter Shin, Brad Finnegan, Jessica Sharac, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Steady growth in the number of uninsured and under-insured has sparked health reform proposals at the national and state levels. With many proposals emphasizing expanded access to private health insurance among the low-income population through the use of tax credits and an emphasis on stable and continuous primary care as a key to improving health care access, the interaction between health centers and private health insurance becomes an important aspect of national health policy. This policy brief provides an overview of health centers, with a special focus on the relationship between health centers and private health insurance.