Health Policy Commons^™

Accountable Care Organizations: Implications For Antitrust Policy, Taylor Burke, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This analysis examines accountable care organizations (ACOs) and assesses their implications for antitrust policy. Consideration of the antitrust implications of ACOs is timely. Both the House and Senate health reform measures contemplate the creation of ACOs as a new class of Medicare provider while providing parallel legal authority under Medicaid.

Can States Pick Up The Health Reform Torch?, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

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.

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.

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 …

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.

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 …

National Health Reform: How Will Medically Underserved Communities Fare?, Sara J. Rosenbaum, Emily Jones, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This brief examines the factors underlying medical underservice. It finds that the number of Americans living in communities at risk for medical underservice is more than double the number of persons who are uninsured. The report notes that even with health insurance reform, these communities and providers that serve them will continue to be affected by elevated numbers of low income uninsured persons, as well as persons who may be seriously under-insured because of poorer health status and lower family income.

Describing health insurance expansion as the single most important strategy to alleviate medical underservice, the Brief also identifies a …

Insurance Discrimination On The Basis Of Health Status: An Overview Of Discrimination Practices, Federal Law, And Federal Reform Options, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term "discrimination" in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products. Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws …

Boosting Health Information Technology In Medicaid: The Potential Effect Of The American Recovery And Reinvestment Act, Brad Finnegan, Leighton C. Ku, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The American Recovery and Reinvestment Act of 2009 (ARRA) will invest approximately $49 billion to expedite health information technology (HIT) adoption through Medicare and Medicaid. Our analysis of 2006 NAMCS data found that approximately 15 percent of the practicing office-based physicians in the country would qualify for up to $63,750 over six years in Medicaid financial incentives for HIT adoption. Included within the 45,000 eligible physicians are about 99 percent of all community health center physicians. If all qualifying physicians apply for the Medicaid incentives and receive the maximum level of payments, the federal government would invest more than $2.8 …

Primary Health Care Access Reform: Community Health Centers And The National Health Service Corps, Fitzhugh Mullan

Health Policy and Management Congressional Testimonies

This testimony by Fitzhugh Mullan, M.D., addresses the following issues:

• Improving access to health care in the United States will require modifications in the U.S. health care workforce, the foremost of which will be the construction of a strong primary care base.
• Two-thirds of the U.S. physician workforce practice as specialists and the number of young physicians entering primary care is declining.
• The distribution of health care providers in the U.S. heavily favors urban areas. Metropolitan areas have 2-5 times as many physicians as non-metropolitan areas and economically disadvantaged areas have significant health care access problems.
• Today's physician-to-population ratio is …

Examining The Experiences Of Puerto Rico's Community Health Centers Under The Government Health Insurance Plan, A. Seiji Hayashi, Brad Finnegan, Peter Shin, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief examines the experiences of Puerto Rico's community health centers under the Commonwealth’s 1994 Government Health Insurance Plan (GHIP) – the Commonwealth's Medicaid program – also known as the Reforma. Of particular interest are the effects of Medicaid under-financing coupled with health centers' continuing obligations to furnish subsidized care for uninsured patients. To finance GHIP, the Commonwealth substantially curtailed its involvement with the direct provision of health care in both community and inpatient settings, transforming the former system of direct care provision into health insurance premium subsidies.

In 2007, the 47 operating sites of Puerto Rico's 19 federally …

Health Care Workforce Issues And Access To Care: Assessing The Present And Preparing For The Future, Fitzhugh Mullan

Health Policy and Management Congressional Testimonies

Summary of Testimony Fitzhugh Mullan, M.D. Before the House Energy and Commerce Subcommittee on Health, March 24, 2009

• Improving access to health care in the United States will require modifications in the structure of the U.S. physician workforce, the foremost of which will be the construction of a strong primary care delivery base.
• There are over 800,000 practicing physicians today or 280 physicians per 100,000 people. This represents a greater physician density than Canada (210) and the United Kingdom (250) but a density less than France (340) and Germany (350).
• The distribution of physicians in the U.S. heavily favors urban …

How Is The Primary Care Safety Net Faring In Massachusetts? Community Health Centers In The Midst Of Health Reform, Leighton C. Ku, Emily Jones, Brad Finnegan, Peter Shin, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Massachusetts' landmark 2006 health reform legislation sets an important precedent for national reform. Initial evaluations have demonstrated the law's success in dramatically expanding health insurance coverage and health care access, but less is known about its effects on community health centers, which serve one of every 13 residents and one in four low-income residents. This analysis evaluates the experiences of health centers with the Massachusetts reforms, using administrative data to examine finances and patient enrollment in addition to the qualitative results of in-depth interviews conducted during site visits in August 2008 and the results of a short survey of health …

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, …

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

Health Policy and Management Faculty Publications

No abstract provided.

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 …

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 …

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 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.

An Initial Assessment Of The Effects Of Medicaid Documentation Requirements On Health Centers And Their Patients, Peter Shin, Brad Finnegan, Lauren Hughes, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This policy brief presents the initial effects of recent federal Medicaid reforms on health centers and their patients. Specifically, this report examines the impact of changes in federal Medicaid policy, contained in the Deficit Reduction Act of 2006 (DRA), which requires applicants and recipients to document both their citizenship or legal U.S. residence and proof of their personal identity.

Does Hipaa Preemption Pose A Legal Barrier To Health Information Transparency And Interoperability?, Sara J. Rosenbaum, Phyllis Borzi, Taylor Burke, Sonia W. Nath

Health Policy and Management Faculty Publications

This paper summarizes the results of a review of nearly 500 judicial opinions decided as of fall 2006, involving access to protected health information (PHI) and privacy of medical information under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). This review was undertaken to determine whether HIPAA, which permits application of state privacy laws that are more stringent than the federal privacy standard, acts as a legal barrier to the creation of interoperable health information systems that permit transparency of health information. The availability of transparent and complete information regarding health system performance has been recognized as …

Health Information Technology In The United States: The Information Base For Progress, David Blumenthal, Catherine M. Desroches, Karen Donelan, Sara J. Rosenbaum, Timothy Ferris

Health Policy and Management Faculty Publications

Health information technology (HIT) has the potential to advance health care quality by helping patients with acute and chronic conditions receive recommended care, diminishing disparities in treatment and reducing medical errors. Nevertheless, HIT dissemination has not occurred rapidly, due in part to the high costs of electronic health record (EHR) systems for providers of care—including the upfront capital investment, ongoing maintenance and short-term productivity loss. Also, many observers are concerned that, if HIT follows patterns observed with other new medical technologies, HIT and EHRs may diffuse in ways that systematically disadvantage vulnerable patient populations, thus increasing or maintaining existing disparities …

Update On The Status Of The Medicaid Prospective Payment System In The States, Roger Schwartz, Peter Shin, Megan Reilly

Health Policy and Management Faculty Publications

The Benefits Improvement and Protection Act of 2000 replaced the traditional cost-based reimbursement system for federally-qualified health centers (FQHCs) with a new prospective payment system. States were also allowed to implement an alternative payment methodology (APM) as long as it did not pay less than what FQHCs would have received under PPS and the affected FQHC agreed to the APM. Although changes in payment policies were to take effect in 2001, states were slow to implement them and most only did so after one or two years. With little or no oversight by the federal government, the National Association of …

Laying The Foundation: Health System Reform In New York State And The Primary Care Imperative, Sara J. Rosenbaum, Peter Shin, Ramona Whittington

Health Policy and Management Faculty Publications

New York State has embarked on a substantial effort to restructure its health care system as a result of rapidly escalating health care expenditures, especially with respect to Medicaid expenditures for institutional health care. But it is impossible to alter these high cost health expenditures without strengthening and expanding the primary care foundation on which New York's health system rests.

Health Centers Reauthorization: An Overview Of Achievements And Challenges, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Since the establishment of the first health center in 1965, health centers have evolved into an essential component of the health care safety net. Today, over 1,000 federally funded and "look-alike" health centers serve 14.3 million people, three-quarters of whom are uninsured or covered by Medicaid. As the nation's largest primary care system, health centers care for one in five low-income uninsured persons and one in nine Medicaid beneficiaries.

Achieving "Readiness" In Medi-Cal's Managed Care Expansion For Persons With Disabilities: Issues And Process, Sara J. Rosenbaum, Sara E. Wilensky, Peter Shin

Health Policy and Management Faculty Publications

This Policy Brief examines issues that can be expected to arise as California moves to significantly expand the use of mandatory managed care arrangements for Medi-Cal enrollees with disabilities. This analysis is based on information gleaned from more than a decade of Medicaid managed care specification analyses for the federal government and private funders, focusing on both the general beneficiary population and persons with chronic illnesses and disabilities. This Policy Brief also reflects experiences in furnishing technical assistance to state purchasers and in developing model managed care purchasing specifications for both general and special needs managed care populations for both …

Migrant And Seasonal Farmworkers: Health Insurance Coverage And Access To Care, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Migrant and seasonal farmworkers are an integral support to the nation's agricultural industry. Nearly three million workers earn their living through migrant or seasonal farm labor. Migrant and seasonal farmworkers and their families confront health challenges stemming from the nature of their work, their extreme poverty and mobility, and living and working arrangements that impede access to health coverage and care. This brief provides an overview of migrant and seasonal farmworkers and the health challenges they face and considers options for improving their health coverage and access to care.

A Nation's Health At Risk Iii: Growing Uninsured, Budget Cutbacks Challenge President's Initiative To Put A Health Center In Every Poor County, Michelle Proser, Peter Shin, Dan Hawkins

Health Policy and Management Faculty Publications

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 …