HEALTH REFORM DEVELOPMENTS

During a typical session of Congress, elected officials in both chambers work strenuously to pass legislation that can be sent to the President where it is signed into law. The really heavy lifting often takes place, however, in the executive branch agencies that are responsible for developing the rules and regulations that furnish specific guidance on how a law is to be administered. Whatever finally emerges may be challenged by parties that objected to portions of the legislation when it originally was being considered in Congress. Such disputes then make their way into the judicial sphere.

Although the Affordable Care Act of 2010 (ACA) already is almost a decade old, certain features are as lively and combustible in policy circles as when they initially were proposed. As previously reported in past issues of this newsletter, a prominent example is the case of Texas v. United States wherein that state and 17 other states claim that the ACA’s individual mandate is unconstitutional, which in essence also renders the entire law invalid as well. California and 20 other states are in opposition, along with the U.S. House of Representatives. A federal judge ruled for the plaintiffs and the case subsequently proceeded to the Fifth Circuit Court of Appeals. Assuming the decision is upheld, the next step may involve consideration by the U.S. Supreme Court.

Similar ongoing actions represent additional efforts by Republicans to reverse other components of the ACA. New York is one of 12 states contesting a decision by the Trump Administration to extend access to insurance plans that do not comply with the law. That case currently is poised for oral argument at the D.C. Circuit Court of Appeals. Meanwhile on the campaign trail for the 2020 election, several Democrat candidates for the White House advocate enactment of Medicare for All legislation. It is safe to assume that if such a law ever becomes a reality, many law firms and courthouses will be kept busy in efforts to influence its various provisions to their satisfaction.

Enhancement of Quality Care In Hospitals

The Centers for Medicare & Medicaid Services (CMS) is an example of an executive branch agency that on a regular basis develops guiding principles for implementing various health laws. In August 2019, CMS announced plans to update the quality measurement methodology of the Overall Hospital Quality Star Ratings in 2021. As an interim step, the agency will refresh the Star Ratings using the current methodology in early 2020, ensuring patients have timely access to the most up-to-date hospital quality information while a new methodology is being finalized. The effort represents a major step forward in delivering on President Trump’s recent Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First, which seeks to enhance the ability of patients to choose the health care that is best for them.

Potential Impact Of Reimbursing At Medicare Rates On The Health Insurance Exchanges

As the 2020 U.S. election season unfolds, various options for expanding the Medicare program as a way of addressing gaps in health insurance coverage will be discussed. Medicare for All legislation suggests that present commercial insurance and Medicaid could be replaced by having Medicare pay providers using current Medicare rates. According to an analysis released in August 2019 by Navigant Consulting Inc., doing so could place as many as 55% of rural hospitals, or 1,037 hospitals across 46 states, at high risk of closure. It is estimated that 28% of rural hospitals would be at high risk of closure if only uninsured and current individual market participants shifted to the public option, and that more than half of rural hospitals would face high risk of closure if employers shifted 25% to 55% of their covered workers from commercial coverage to the public option.

If nothing else, this analysis reflects the seriousness of the next election and the importance of paying close attention to what is being proposed. The ACA became law in 2010 without a single Republican in the House or Senate voting in favor of it. Important pieces of social legislation demand bipartisan support. Otherwise, to move forward with new health laws that will affect millions of individuals without the incorporation of the best possible thoughts and ideas by members on both sides of the political aisle is destined to result in increased needless litigation and frustration for all concerned parties.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

ACCELERATED PACE ON CAPITOL HILL

Prior to departing Washington, DC for their August recess, legislators adopted a quick pace in July and ASAHP was active in efforts to influence bills under consideration. The House Energy and Commerce Committee attracted noteworthy attention by approving 25 bills, including H.R. 2781, the Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 that contains a provision to provide $5 million annually to support diversity efforts in physical therapy, occupational therapy, and speech- language pathology. Association staff worked with both the Committee and other professional associations in supporting this effort. They also have been working closely with House Ways and Means Committee staff in support of H.R. 3398, the Pathways to Health Careers Act, a measure to reauthorize the Health Profession Opportunity Grant (HPOG program) that is set to expire on September 30.

Budget issues and appropriations are topics that have a tendency to attract significant amounts of attention at this time of year. A major breakthrough occurred when the Senate passed a two-year bipartisan budget deal (H.R. 3877) on a vote of 67-28 to increase budget caps, raise the nation’s borrowing limit, and develop a pathway to fiscal year 2020 government funding, which begins this coming October 1. President Trump signed the arrangement into law (P.L. 116-37) on August 2, 2019. As a result, spending will increase by $320 billion above current levels and the debt ceiling will be lifted for two years. The new law also is expected to add $1.7 trillion to the national deficit over the next 10 years in comparison to automatic spending cuts known as sequestration that otherwise would occur without such an agreement.

The next important piece on the legislative agenda is passage of appropriations bills. Ten of the necessary 12 bills already have been passed by the House. The Senate has not passed a single spending bill, but is expected to direct its attention to this matter when its members return to Capitol Hill on September 9. Senate Majority Leader Mitch McConnell (R-KY) will not allow his chamber to begin marking up and passing appropriations bills without producing a budget caps deal on total spending levels for defense and non-defense domestic programs.

High prices associated with the cost of drugs is a problem that continues to be of concern. Bipartisan leaders of both the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee have initiated discussions on how to integrate their respective activities involving drug pricing and health care costs prior to measures pertaining to these topics being brought for a vote on the Senate floor. Democrats in that chamber have a strong interest in producing legislation that will enable the Medicare program to negotiate drug prices. A parallel effort involves the inclusion of a provision to require manufacturers to disclose the price of drugs in direct-to-consumer (DTC) advertising.

Additionally, the Senate has expressed interest in establishing a national telehealth program by introducing S. 2408 and also by introducing S. 2411 to create a rural health center innovation awards program and a rural health department enhancement program.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

By Susan N. Hanrahan, ASAHP President

Happy start to the ever present fall semester!!! They seem to materialize like the movie “Groundhog Day” ---- a reoccurring event that launches another academic year. Congrats to all of our new deans reading this issue and congrats to all deans who successfully hired all of the faculty they needed to start the fall in good shape---that dean would not be me however. It seems to get more difficult each year to find talented leaders for our high achieving students. But, thanks to our Leadership Committee (Tina Whalen, Chair), they are planning a concurrent session at the Annual Conference on “faculty recruitment” related to best practices—stay tuned.

Speaking of the Annual Conference, thank you for encouraging your faculty and students to submit abstracts for the Oct 16-18 conference in Charleston, SC. We had a record number of submissions so you will see and hear plenty of scholarly work that is always inspiring and very impressive. We also have a great line up of plenary speakers including General George Casey who will be kicking off the conference talking about leadership and one of our own, Lisa Saladin, Executive Vice President for Academic Affairs and Provost at the Medical University of South Carolina. In order to keep “ahead of the curve”, we have added speakers from industry, the federal government and others that I think will supply us with ample “food for thought.” I am very excited about our 2019 conference and appreciate the work of our staff, Barb Wallace (BOD) and Barry Eckert (BOD). In addition, we have a Charleston Harbor Cruise scheduled on Wednesday night that will give us plenty of time to network and enjoy the coastline of Charleston. With our business meeting, awards, committee meetings and the rest, it should be another productive time in the life of our Association.

I do want to mention a couple of things that I am sure you have already read about but I want to reinforce. ASAHP had its 2nd annual Summer Summit, this time in St Louis, MO. It was hosted by Kindred Healthcare and St Louis University. Special thanks to Tony Breitbach (IP subcommittee), Julie O’Sullivan Maillet (Clinical Education Task Force) and Barb Wallace (BOD). The team will be presenting the results of the summit at the conference so if you have interest in ICP, be on the lookout for their work. In addition, we would love to have your ideas for our 3rd Summer Summit---particularly any hot topics that we can organize a diverse group of individuals around to advance the subject.

Our partnership with CGFNS has been a very good one especially with our work around setting standards for global certification of rehab health workers. We have had great buy in from a whole host of countries around this topic. Special thanks to Julia ToDuka (CGFNS) and Rich Oliver (ASAHP) for their leadership to date. They have made great progress on this very exciting project in a short period of time. More to come on this!

Lastly, thanks to all who completed the Institutional Profile Survey. Right now we are tweaking the survey in preparation for the data collection period July 1, 2018 to June 30, 2019 (or whatever is near your fiscal year). Hopefully we can open the survey in September/early October. The data that has already been submitted is being “cleaned” and reviewed by a third party to ensure validity. The salary data is the most difficult to verify as there seem to be some outliers. As we have mentioned before, the first iteration of a new survey is the most difficult for our institutions as well as the people we have collecting, organizing and confirming the data. Be patient. You will have results soon. Let me know if there is anything that the Association can do to assist you.

Here’s to a great fall semester! Susan Hanrahan, President

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Elections in November 2020 are expected to feature health care as a top concern of voters. Already, many Democrat candidates have expressed support for enacting Medicare for All legislation. Apart from the Patient Protection and Affordable Care Act of 2010, which became law to address problems involving access, cost, and quality, since then: Congress passed the 21st Century Cures Act in December 2016, authorizing $1.8 billion in funding for the Cancer Moonshot over seven years; President Donald Trump signed the controversial "right-to-try" bill in May 2018, which bypasses drug regulators to enable gravely ill patients to have access to experimental medicines; and both the Administration and Congress continue to make strenuous efforts to rein in the high costs of many pharmaceutical products.

Assuming that enactment of Medicare for All occurs, resulting in free health care and affordable medications becoming available, what is the likelihood that health policy-related worries will cease to be of concern? An examination within the house of health care itself would suggest a need for caution. The ability to address a health problem successfully is contingent upon being able to identify it properly through an accurate diagnosis. A cursory examination across the professional landscape in domains for both physical and mental health reveals, however, that many deficiencies exist from the perspective of diagnostic capabilities.

According to an article that appeared in the August 2019 issue of JAMA Internal Medicine, in a large proportion of cases, there will be no apparent cause for a given patient’s condition—physical, psychological, or otherwise. Up to one-half of symptoms that present to physicians resist medical diagnosis, and 80% of symptoms resolve on their own within four to 12 weeks of onset. Moreover, ambiguous symptoms currently represent the fastest growing complaint by patients. Meanwhile, the results of a study published online July 11, 2019 in the journal Diagnosis confirm that diagnostic errors remain the most common, most catastrophic, and most costly of serious medical errors in closed malpractice claims. Nearly three-fourths of serious misdiagnosis-related harms are attributable to diseases in just three major categories – vascular events, infections, and cancers (the “Big Three”). A diagnostic error can mean the difference between life and death for patients. While estimates vary, it is likely that more than 100,000 Americans die or are permanently disabled each year due to medical diagnoses that initially miss conditions or are either wrong or delayed.

A paper in the September 2019 issue of the journal Psychiatry Research suggests that diagnostic errors and misclassifications are not confined to the physical realm of conditions. Study findings indicate that psychiatric diagnoses all use different decision-making rules; huge overlap exists in symptoms between diagnoses; almost all diagnoses mask the role of trauma and adverse events; and diagnoses may provide little guidance about patients and the treatment they need. Thus, expanding access to health care by providing adequate health insurance coverage to individuals who lack it is an obvious important policy step in the right direction. Yet, it is reasonably clear that upon their entering the health care system, a major challenge will persist in the form of striving to do the right thing for patients.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Using Herbert Simon’s concept of “bounded rationality,” it is considered highly likely that in complex situations an individual often will pursue a course of action that satisfies the minimal requirements necessary to achieve a particular goal rather than an optimal choice, even when attempting to be rational in decision-making. An article in the June 2019 issue of the journal Nature Human Behavior describes artificial intelligence (AI) as the use of computer algorithms to mimic human cognitive functions, such as learning or problem solving. AI facilitates the analysis of data with a lens that surpasses human capacity through its ability to process data and information, addressing the issue of bounded rationality. AI also is devoid of behavioral limitations, including unsubstantiated deviation from evidence-based guidelines, influence of peers in hierarchical cultural norms, and fatigue.

Antibiotic prescribing, whether appropriate or inappropriate, is a driver of antimicrobial resistance, a complex social and biological challenge that reflects many problems Simon set out when describing the boundary of rationality. It also is an ideal example of when caring for an individual has immediate and far reaching externalities. A decision made to prescribe an antibiotic affects not only the individual patient, but also an individual’s microbiome and society as a whole, through the selection of drug-resistant organisms. Decision-making during infection management is a dynamic and often inconsistent process. The development of AI systems in the field of infection still is in its infancy. Nonetheless, a range of supervised and unsupervised AI tools have been developed, including causal probabilistic networks and support vector machine classifiers. These tools have shown high accuracy in predicting infection and recommending appropriate antibiotic therapy. AI provides the potential to integrate these complex processes and support optimal use of data for evidence-based decision-making.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

The Association of Schools of Allied Health Professions hosted its 2nd Annual ASAHP Summit on May 31, 2019 at Saint Louis University in St. Louis, MO. The theme of this year’s event, co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences, was “Connecting Academic Programs and Clinical Practice Together to Inform System Improvement.” The Summit was a first-ever collaboration between ASAHP’s Professional Education Committee and Clinical Education Task Force (CETF), bringing multiple interested parties together in a convenient venue to discuss important factors in the connection between academia and the healthcare industry.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Financial Burden Of Paid Home Care On Older Adults

According to an article in the June 2019 issue of the journal Health Affairs, paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. Researchers simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults aged sixty-five and older. Researchers found that 74% could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58% could fund at least two years of an extensive amount of paid home care. Among older adults with significant disabilities, however, only 57% could fund at least two years of moderate paid home care by liquidating all of their assets, and 40% could fund at least two years of extensive paid home care. This form of care could become less affordable if growing labor shortages raise future costs. The article can be obtained here.

Faith-Health Collaboration To Improve Community And Population Health

On March 22, 2018, an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine planned and convened a one-day public workshop that explored challenges and opportunities for health sector actors that engage with faith-based health assets. The workshop provided an overview of faith-based assets in communities and their relationship to population health and the work of health improvement; highlighted areas where faith-based health assets are using evidence to inform their work and demonstrating effectiveness in improving health outcomes; provided examples of effective partnerships involving faith-based health assets; and shared lessons learned from working with faith-based assets that could contribute toward principles for engagement for health care organizations and public health agencies. The workshop proceedings can be obtained here.

Family Care-Giving Roles In Medical Product Development

For the first time, a newly-released report, resulting from a one-day summit, “Paving the Path for Family-Centered Design: A National Report on Family Caregiver Roles in Medical Product Development,” explores the vital roles that family caregivers can play in shaping biomedical research and development, regulatory decision-making, and healthcare delivery. Specifically, the report begins a dialogue on how to incorporate the critical knowledge of caregivers in developing pharmaceutical products, biotechnology therapies, and medical devices. It presents recommendations for leveraging the enormous and largely untapped reservoir of information and observations of caregivers about the conditions their care recipients experience and health outcomes. Approximately 43.5 million individuals provide unpaid caregiving services to Americans of all ages, 60% of whom have a long-term health condition. The report can be obtained here.

2018 National Health Interview Survey Selected Estimates

Early released measures based on selected estimates in the 2018 National Health Survey provide valuable information on a wide range of topics, including health insurance coverage, places to go for health care, obesity, and personal care needs. The measures can be obtained here.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Prescriptions Filled By Americans In 2018

Americans filled 5.8 billion 30-day equivalent prescriptions in 2018 (17.6 prescriptions per person), an increase of 2.7% from the prior year, according to the IQVIA Institute for Human Data Science’s report, Medicine Use and Spending in the U.S. More than two-thirds of prescriptions are for chronic conditions, which increasingly are filled with 90-day prescriptions and are thought to result in better adherence to prescribed regimens. Retail and mail pharmacies dispensed 127 million specialty prescriptions last year, an increase of 15 million since 2014. While specialty drug prescriptions increased more than 5% between 2017 and 2018, these drugs make up just 2.2% of all prescriptions. The report also notes that patient out-of-pocket costs increased in 2018 to an estimated $61 billion, with Medicare patients facing higher annual out-of-pocket costs than patients in commercial plans or those enrolled in Medicaid.

Dental Care Among Adults Aged 65 And Older

Dental care often is an overlooked aspect of overall health care among older adults. In 2017, slightly less than one-third (29.2%) of adults aged 65 and over had dental insurance. National Center for Health Statistics (NCHS) data show that overall, approximately two-thirds of adults aged 65 and over had a dental visit in the past 12 months. Older adults who were poor (42.7%) or near poor (42.8%) were less likely to have had a dental visit compared with non-poor (74.4%) older adults. Non-Hispanic black (11.2%) and Hispanic (12.3%) adults aged 65 and over were more likely to have unmet need for dental care due to cost compared with non-Hispanic white (6.8%) and non-Hispanic Asian (5.9%) older adults. The percentage with dental insurance was higher among those aged 65–74 (34.3%) compared with older age groups and lower among Hispanic adults (17.5%) compared with other race and Hispanic-origin groups.

HEALTH TECHNOLOGY CORNER

3-D Print Flexible Mesh For Knee And Ankle Braces

Limb prosthetics are medical devices that can be digitally designed and customized for individual patients, as a result of 3-D printing. Typically, they are designed to replace or support bones and other rigid parts of the body, and often are printed from solid, relatively inflexible material. According to an article published on June 19, 2019 in the journal Advanced Functional Materials, engineers at the Massachusetts Institute of Technology have designed pliable, 3-D-printed mesh materials with flexibility and toughness they can tune to emulate and support softer tissues such as muscles and tendons. Additive manufacturing (AM) of medical devices such as orthopedic implants and hearing aids is highly attractive because of its potential to match the complex form and mechanics of individual human bodies. Externally worn and implantable tissue‐support devices, such as ankle or knee braces, and hernia repair mesh, offer a new opportunity for AM to mimic tissue‐like mechanics and improve both patient outcomes and comfort.

Using Pig Brains To Understand Human Brain Functions

An article published on May 22, 2019 in the journal Brain Connections by researchers at the University of Georgia’s Regenerative Bioscience Center reports on a study that shows that as a translational, large animal model, pigs demonstrate great potential for mapping connectome-scale functional connectivity in experimental modeling of human brain disorders. The investigators used an imaging method normally reserved for humans to analyze brain activity in live agricultural swine models, discovering that pig brains are even better platforms than previously thought for the study of human neurological conditions such as Alzheimer’s and Parkinson’s diseases. An immediate potential application is in the study and diagnosis of chronic traumatic encephalopathy (CTE), a progressive brain disease caused by a series of blunt trauma usually seen in military veterans and National Football League players. Currently, CTE can be diagnosed only through an autopsy.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

DEVELOPMENTS IN HIGHER EDUCATION

The 1st Session of the 116th Congress began in January 2019 with an expectation among legislators that this year would be the one to resolve issues for a most important piece of legislation know as the Higher Education Act. Last reauthorized in 2008, since 2013 it has been sustained by a series of short-term continuing resolutions (CRs). As of June 2019, some doubt continues to exist regarding whether the task can be completed by the end of this year. Teams consisting of staff members for Senators Lamar Alexander (R-TN), Chairman of the Committee on Health, Education Labor & Pensions (HELP), and Ranking Member Patty Murray (D-WA) have been working to produce a bill that can achieve bipartisan agreement. An inability to meet their self-imposed deadline of having a bipartisan proposal finished by the end of May would appear to render it unlikely that a bill can be brought to the Senate floor any time soon.

This massive piece of legislation consists of many components, any one of which has the potential to create more delay. Examples are: simplifying the federal student aid application, creating a new income-based repayment plan for borrowers, building a new accountability system for colleges based on whether borrowers actually are repaying their loans, expanding competency-based education programs, requiring colleges to use clearer language in letters telling students about the aid they are receiving, Title IX campus sexual assault incidents, and collecting better data on how much students borrow and how much they earn after graduation. Other aspects include allowing incarcerated individuals to access Pell Grants and making grants available for shorter academic programs. Worth noting is that some current issues not easily resolved are accountability as it relates to the for-profit sector and student loan repayments.

Federal Work-Study (FWS) Experiment Launched

U.S. Secretary of Education Secretary Betsy DeVos announced a new Federal Work-Study (FWS) Experiment to provide institutions with increased flexibilities that will enable students to earn work-study benefits while participating in apprenticeships, internships, and work-based learning programs, as well as earn work-study wages while completing required clinical rotations, externships, and student teaching. “For decades, the Federal Work-Study program has allowed students to support themselves while earning a college degree, but for too long, the majority of the work options students have had access to have been irrelevant to their chosen field of study,” she stated. Under the current FWS program, nearly 92% of all funds are spent to support students in on-campus employment, while just over 8% support students working for non-profit organizations. Less than one-tenth of 1%, or just $726,000 of the billion-dollar FWS program, are spent to support students in private-sector employment, where many students are likely to seek permanent employment. The experiment is aimed at eliminating barriers that made engagement with private-sector employers undesirable for many colleges and universities.

Proposed Regulations On Accreditation, Innovation And Other Topics

The U.S. Department of Education (USDE) on June 12, 2019 published proposed regulations on accreditation, innovation, and other topics, reflecting the draft consensus language approved by the negotiated rulemaking committee that met earlier this year and reached consensus on April 3. The proposed regulations would affect several areas involving accreditation, including: increase expectations by USDE concerning student achievement; provide more flexibility for innovation for institutions and accrediting organizations; and increase the time for institutions and programs to come into compliance with accreditation requirements.

Two aspects of interest for institutions belonging to ASAHP are: (1) Establish that the Department recognizes an institution’s legal authorization to operate postsecondary educational programs when it is exempt from State authorization under the State constitution or by State law as a religious institution with a religious mission, and (2) Revise the State authorization requirements for institutions offering distance education or correspondence courses.

A public comment period began on June 12, 2019 and is in effect until July 12, 2019. Comments can be submitted electronically here.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

HEALTH REFORM DEVELOPMENTS

Chronicity is a term frequently employed to describe the kinds of health problems that affect patients aged 65 and older. It also can be applied to health workforce challenges that steadily prove difficult to overcome. Rural sections of the United States represent areas that often suffer the effects of being inadequately served as a result of severe shortages of various kinds of health professionals. Mental health offers a good example of where considerably more effort is needed to address the health care needs of residents of rural areas. Compared to urban locales, for example, suicide rates are higher in rural parts of the nation.

Unfortunately, no single magic bullet is available to remedy the fact that as many as one-half of U.S. counties, predominantly located in rural areas, do not have a single psychiatrist to respond to the needs of residents. As an illustration of a recently proposed legislative remedy, the “VA Mission Telehealth Clarification Act” was introduced in the U.S. House of Representatives on June 12, 2019. It has seven co-sponsors for the purpose of authorizing health professional trainees to provide treatment via telemedicine. Proposals of a broader nature would involve allowing Medicare beneficiaries to access mental health services through telemedicine regardless of where they live and without having to leave home.

A different kind of approach would entail helping mental health professionals pay off their educational debt if they agree to work in an area with a shortage of workers. Inadequate reimbursement levels may be a major disincentive for mental health professionals to live and work in rural areas, especially in sections of the country that are remote. A way of addressing the situation would be to consider using peer support specialists who could work with doctors who treat patients using telemedicine. These individuals are neither physicians nor other kinds of health professionals. Instead, they are characterized by having knowledge derived from their own personal recovery process in combination with some formal training to enable them to support patients confronting similar challenges.

Obtaining More Savings From Accountable Care Organizations

The Medicare Shared Savings Program (MSSP) has produced modest savings for Medicare and been popular among health care providers, with 561 participating accountable care organizations (ACOs) covering nearly a third of the fee-for-service Medicare population in 2018. According to a paper in the June 6, 2019 issue of the New England Journal of Medicine, the savings pace has not proven to be commensurate with Medicare’s fiscal challenges, however, prompting calls for reform. The Centers for Medicare and Medicaid Services (CMS) responded in December 2018, with “Pathways to Success.” Strengthening incentives for ACOs to reduce spending is challenging because the program is voluntary. Some approaches, such as requiring ACOs to bear downside risk for excess spending, may make the program unattractive to some providers, potentially lowering program-wide savings by reducing participation. The involvement of providers with high spending that isn’t explained by patient risk factors is particularly critical to MSSP success, because the care their patients receive (including care from other providers) presents the greatest opportunities for savings. So far, ACOs with high risk-adjusted spending have lowered spending more than ACOs that began with low spending.

Hearty Perennials Of The Affordable Care Act Battles

For several years, supporters of the ACA have attempted to force the Little Sisters of the Poor to provide free-of-charge abortion-inducing contraceptives to their employees under this law. A 2011 HHS mandate requiring employers to provide certain health care, including birth control and emergency contraception, generated a lawsuit by the nuns. They sued in 2013 to be exempt from the rule, but lengthy court battles later, the case still is ongoing. New HHS rules created in 2017 allowed for religious exemptions for employers, including the group run by the Little Sisters of the Poor, but 13 states and the District of Columbia sued to block the rules. Two judges in January temporarily blocked the rules from going into effect, but a hearing presided over by a federal judge in California in June 2019 helps to guarantee that the dispute will continue to be ongoing regardless of any ruling that emerges.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

SPENDING LEGISLATION TAKES SHAPE

The U.S. House of Representatives on a vote of 226-203 on June 19, 2019 approved a four-bill spending package (H.R. 2740). The Minibus included the fiscal year (FY) 2020 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill, along with spending for Defense; Energy and Water; and State and Foreign Operations. This legislation specifies all the particulars regarding amounts of money to allocate for a wide range of programs. A prime example is the National Institutes of Health, which stand to benefit by an increase of more than two billion dollars in the upcoming fiscal year that begins this October 1, which is a larger increase than what has been provided in three of the previous four fiscal years.

The Agency for Healthcare Research and Quality (AHRQ) has been slated on several occasions for extinction, including in the current Administration’s budget proposal for FY 2020. Based on action by the House, however, the Agency will continue to exist. Its eventual fate will be determined once the Senate takes action by approving its own spending legislation. Members of that chamber have not yet officially established a timeline for consideration of its FY 2020 appropriation levels.

An ongoing concern in Congress is the steady rise in health care costs. A growing overall population in the U.S. and increases in the number of individuals aged 65 and older, many of whom have multiple chronic health problems, provide assurance that unless some constructive action is taken, costs will increase rather than stabilize or decrease any time soon. Apart from providing appropriations for necessary programs in the health and education spheres, Congress plays a valuable role by conducting hearings to obtain information and guidance on steps that can be taken to respond effectively to various social challenges. An example is that the Senate Health, Education, Labor, and Pensions (HELP) Committee on June 18, 2019 held a hearing on the Lower Health Care Costs Act of 2019 (S. 1895) to examine matters involving a benchmark payment rate for providers. At issue is a concern by representatives from the hospital industry that arbitrary, government-dictated reimbursement could result in significant unintended consequences for patients and create a disincentive for insurers to maintain adequate provider networks.

Except for major figures in Congress, such as House Speaker Nancy Pelosi (D-CA), and Senate Majority Leader Mitch McConnell (R-KY), the 535 elected members of the two chambers may be the equivalent of a giant blur to anyone who does not work for a living as a lobbyist. A fascinating group with a wide range of personal experience and ideological beliefs, legislators are confronted with the challenge of doing their best to represent the constituents who sent them to the nation’s capital as well as act effectively on behalf of the interests of the nation as a whole. An unintended consequence of this duality is that meeting the needs of the voters back home may not always correspond exactly with how the nation itself would benefit.

Members of Congress come from all walks of life, including as health professionals. A head count indicates that four Senators are from the following professions (surgery, optometry, gastroenterology, and ophthalmology). In the House, 26 Representatives are from several professions, including a rehabilitation therapist from Pennsylvania, 13 physicians, and five dentists.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 14th of many profiles and the fifth in 2019 is presented as follows:

Name and Title: Gwendolyn Mahon, Dean and Professor

Place of birth: Tullamore, Ireland

University: Rutgers, The State University of New Jersey

How long have you been in your position? 4 years

What’s the value of a university education? Opens up your mind to other worlds.

What is the value of ASAHP? ASAHP provides the opportunity to network with educators, administrators and clinicians from other schools across the country.

Your philosophy on education in seven words: A lifelong endeavor for growth and improvement

If I could teach in another field, which one and why? Architectural Engineering, I love the idea of developing ways to build structures that fulfill real world needs.

Before I retire I want to: Walk the entire Camino de Santiago.

In college, I was known for: Studying and working hard.

What music is playing in my car/office?  Spanish guitar, Folk, Alternative Rock

The last book I read for fun was: Born to Run, Christopher McDougall

My favorite trip was: We go to Acadia National Park in Maine every summer and it is always my favorite trip.

If I could travel anywhere it would be: A 6 month driving trip across America in an RV hitting every national park.

Four people I’d take to coffee or have a glass of wine with: Leo Varadkar (current Taoiseach of Ireland), Barack Obama, Jane Goodall, My Mom

The best advice I ever received was: If you have nothing good to say about someone then best to say nothing at all.

My hobby is: Gardening, walking, cooking

My passion is: My family

My pet peeve is: People saying they are bored.

A perfect day is: A foggy day on the coast of Maine with family

Cats or dogs? Like both but allergic to cats.

E-book or hardback? Hardback

Beach or mountains? Mountains

I wish I could: Spend more time outdoors.

Only my friends know I: Love to decorate my home.

My favorite saying is: If you are not going to do your best then do not do it at all.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

TENTATIVE VS. DEFINING CRITERIA

The June 2019 issue of the journal Astrobiology features an essay on extraterrestrial life that may have some applicability for health matters here on earth. It does so by presenting a contrast between tentative versus defining criteria, by indicating that the function of tentative criteria is not, like that of defining criteria, to provide an estimate (via a decision procedure) of the likelihood that an extraterrestrial phenomenon is the product of life. Instead, it is to identify phenomena that resist classification as living or nonliving as worthy of further investigation for novel life.

The physicist and philosopher of science Thomas Kuhn argued that a recognition that a puzzling empirical phenomenon is anomalous is a driving force behind scientific revolutions. An anomaly is a violation of a paradigm-induced expectation about a domain of natural phenomena. He characterized scientific paradigms broadly as including laws, theories, and other widely accepted scientific beliefs, as well as sanctioned methods and instruments, concerning a domain of phenomena. Paradigms play vital roles in scientific practice, facilitating the construction of hypotheses, design of experiments, and interpretations of results, but they also may hinder the exploration of nature, discouraging certain lines of research and biasing the interpretation of data. Essentially, a paradigm literally may blind researchers to the presence of anomalies. They either are not perceived as puzzling or alternatively, are interpreted as puzzles that eventually will be solved using the resources (concepts, laws, methods, etc.) provided by the paradigm.

Many key initiatives continue to be undertaken in the health sphere with the intention of improving individual and community health status. The Patient Protection and Affordable Care Act of 2010 was the most ambitious and comprehensive effort in that regard in several decades. Some of its provisions represented the best forms of conventional wisdom, but other portions of the law’s components lacked evidence and may have entailed nothing more substantial than a leap of faith that they would produce desired outcomes. A notable example may be the Hospital Readmissions Reduction Program (HRRP), which was designed to reduce costs and prevent deaths by imposing financial penalties on hospitals if their rate of readmissions within 30 days exceeds an arbitrary threshold.

Based on assessments that have appeared recently in prominent journals (e.g., June 13, 2019 issue of New England Journal of Medicine), the HRRP has assumed the coloration of a debatable proposition rather than a proven fact. Key considerations, such as that a HRRP defines only inpatient hospitalizations, not observation stays or emergency department (ED) visits, as readmissions, and social factors involving poverty cloud the picture quite significantly. The Affordable Care Act was a good faith effort to increase access, lower costs, and improve quality. An implicit assumption involving some aspects of the law was that defining criteria rather than tentative criteria existed, which has the potential to blind advocates of some interventions to the actual worth of what is being proposed. Moving forward in health care, rather than define all proposed actions as valid programs, it would be advisable to consider some of them as experiments awaiting proof of effectiveness.

More Articles from TRENDS June 2019

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

According to an article published on May 13, 2019 in the journal npj Digital Medicine, despite the growth in the number and capabilities of digital health solutions, the confidence of patients, clinicians, payers, and representatives from industry and the regulatory sphere in medicine remains quite low. A need exists for objective, transparent, and standards-based evaluation of digital health products that can bring greater clarity to the digital health marketplace. Investment in the digital health sector is enormous, with nearly $6 billion in funding in 2017, compared to $4.4 billion in the previous year. For mobile health applications alone, there exist more than 3,000,000 of them, with another 200 added daily.

Currently, no reliable mechanism exists to identify validated digital health solutions. Payers also cannot easily identify quality in this crowded field. Regulatory guidance and oversight are limited, with enforcement restricted to companies that make claims out of proportion to the evidence or where application failures might lead to risks to patient safety. For example, a recent evaluation of 280 diabetes mobile applications found only five associated with clinically meaningful improvement and none were of high methodological quality. A more standardized, objective, rigorous, and transparent process for validation is warranted. Specifically, the validation domains would be: technical validation (e.g., how accurately does the solution measure what it claims?), clinical validation (e.g., does the solution have any support for improving condition-specific outcomes?), and system validation (e.g., does the solution integrate into patients’ lives, provider workflows, and healthcare systems?).

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Randomized clinical trials (RCTs) are considered to be the preferred criterion standard in research for assessing the effectiveness of clinical interventions. Yet, a level that lofty has not always prevailed in experimental work. At the turn of the 20th century, a physician from Haverhill, Massachusetts by the name of Duncan MacDougall conducted an experiment that involved weighing six terminally ill patients immediately before and after being pronounced dead. Upon recording a reduction in a single patient’s weight of 21 grams, he believed the loss represented that individual’s departed soul, while excluding data from the other patients. His findings were reported in both a 1907 issue of the Journal of the American Society for Psychical Research and the periodical American Medicine. A reference to the study also was mentioned in the New York Times.

Progress has been made since then as evidenced by the fact that a lot more rigor characterizes clinical investigations conducted today. Nonetheless, as noted in an article that appeared in the May 2019 issue of the journal JAMA Network Open, scientific lapses committed by MacDougall, such as excluding potentially eligible patients, using unreliable measures, and selectively reporting results that are favorable to the investigator’s hypothesis remain distressingly common. A possible explanation is that confirmation bias may lead to accepting data that support a researcher’s preconceptions and to rejecting data that do not.

Another manuscript in the same issue of that journal entails a systematic review of the level and prevalence of spin in published cardiovascular randomized clinical trial reports with statistically nonsignificant primary outcomes. Spin in this instance is defined as the use of specific reporting strategies, from whatever motive, to highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome (i.e., inappropriate use of causal language), or to distract the reader from statistically nonsignificant results (i.e., to focus on a statistically significant secondary result). The authors of the review found that RCTs with statistically nonsignificant primary outcomes were published in high-impact cardiovascular journals and that considerable manipulation of language occurred in both the abstracts and full texts of the reports. Their observations have significant implications for the integrity of clinical science, the translation of clinical evidence at the bedside, peer review, and the rate of medical progress. Indeed, manipulation of language to distort findings also may contribute to further public distrust in science.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

As part of a series of blog posts from leaders of the Agency for Healthcare Research and Quality (AHRQ), a posting on May 10, 2019 discusses how every day many patients and their caregivers struggle to find care that effectively addresses their needs. Clinicians also are frustrated, experiencing epidemic levels of burnout while working in systems often ill-designed to support them in addressing these fundamental objectives of healthcare delivery. This challenge is particularly pronounced for the nearly one of three American adults, and four of five Medicare beneficiaries, who are living with multiple chronic conditions (MCC). Patients with MCC account for 64% of all clinician visits, 70% of all in-patient hospital stays, 83% of all prescriptions, and 71% of all healthcare spending. Alarmingly, the number of children and adolescents with MCCs is growing as well. Currently, there is a critical mismatch between the way care is delivered (disease-specific) and the needs of patients with MCC, who require whole-person (patient-centered) care. This disconnect too often results in care that is fragmented and of suboptimal quality, leading to poor outcomes and increased costs. Furthermore, practice guidelines that help clinicians make testing and treatment decisions tend to guide the care of each of the patients’ conditions in isolation. One consequence of this narrow scope is that recommended treatments for one condition may interact harmfully with recommended treatments for another one. As a first step towards realizing this vision, AHRQ needs to have a well-conceived and effectively executed research agenda. The Care-and-Learn Model, developed by AHRQ researchers to map the work of the Agency and its research portfolio, will help identify areas of unmet need and prioritize research questions with the most value for advancing the care of individuals with MCC. The blog can be obtained here.

Effects of Early Care And Education On Children’s Health

The journal Health Affairs released a Health Policy Brief as part of an ongoing series on the social determinants of health. In “The Effects of Early Care and Education on Children’s Health,” an overview is provided of the landscape of nonparental early care and education (ECE). The focus primarily is on center-based care, including public and private preschool, child care centers, and Head Start. While the impact of ECE on children’s educational, social-emotional, and behavioral outcomes is well studied, its impact on health has become a subject of significant research interest mainly in the last 10 to 15 years. Challenges in studying the health impacts of ECE are identified and an extended summary of key studies in this area is provided. In short, while such programs are not necessarily designed to improve child health, a growing body of research indicates that they may lead to short- and long-term improvements in health-related outcomes. Additional research needs are discussed and the Brief notes that, moving forward, ECE policy must attend to promoting parental employment and improving children’s outcomes, including health outcomes. The Brief can be obtained here.

Addressing Social Determinants Of Health Through Housing Improvements

Improving the health of individuals and their neighborhoods and communities as a whole is one of the most complex and pressing challenges in health care today. Given the inextricable link between affordable quality housing and good health, housing is one area that hospitals and health systems are starting to focus on more resolutely. A new American Hospital Association (AHA) issue brief describes how hospitals are investing in affordable housing. The brief can be obtained here.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Pregnancy-Related Deaths, United States, 2011-2015

According to a Morbidity and Mortality Weekly Report posted online May 10, 2019 by the CDC, approximately 700 women die annually in the United States from pregnancy-related complications. Among such deaths for which timing was known, 31.3% deaths occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days 1–6 postpartum, 21.4% on days 7–42 postpartum, and 11.7% on days 43–365 postpartum. Leading causes of death varied by timing relative to the end of pregnancy. Approximately three in five pregnancy-related deaths were preventable. Contributing factors can be categorized at the community, health facility, patient, provider, and system levels. The national pregnancy-related mortality ratios (PRMRs) was 17.2 per 100,000 live births. Non-Hispanic black women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white women (13.0).

Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis. Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations. According to an analysis of 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, the median age-standardized state prevalence of arthritis among adults aged ≥18 years was 22.8% (range = 15.7% [District of Columbia] to 34.6% [West Virginia]) and was generally highest in Appalachia and Lower Mississippi Valley regions. Among adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3%; range = 20.8% [Colorado] to 45.2% [Mississippi]) and physical inactivity (median = 33.7%; range = 23.2% [Colorado] to 44.4% [Kentucky]) were highest in southeastern states. Maintaining a healthy weight or being physically active can reduce arthritis pain and prevent or delay arthritis-related disability.

HEALTH TECHNOLOGY CORNER

Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

According to an April 30, 2019 report from Deloitte, approximately 300,000 premature babies are delivered each year in the US. Multiple wires and adhesive patches can damage fragile skin and prevent parents from holding and nurturing their babies. A team from the Northwestern University Feinberg School of Medicine has been working for five years to develop a wireless sensor system that uses Bluetooth technology to monitor babies in the neonatal intensive care unit (NICU). The new system appears to be as precise and accurate as traditional monitors. Two lightweight wireless patches are attached to the baby's chest and foot to collect a wide range of data, including temperature, respiratory rate, EKG, oxygen saturation, and blood pressure. The patches are flexible and gentle on a newborn's skin. The wireless device allows for more physical contact between baby and parents. Researchers note that the sensor system could be sent home with a patient, so monitoring can continue beyond the hospital if necessary.

Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing

Bacterial biofilms are thin, slimy accretions that form on some wounds, including burns or post-surgical infections, as well as after a medical device, such as a catheter, is placed in the body. These bacteria generate their own electricity, using their own electric fields to communicate and form the biofilm, which makes them more hostile and difficult to treat. Researchers at Indiana University School of Medicine have found a way to advance the fight against bacterial infections using electricity. Work has led to the development of a dressing that uses an electric field to disrupt biofilm infection. Findings were published in the April 2019 issue of the journal Annals of Surgery. As an alternative to pharmacological intervention, this effort is the first pre-clinical porcine mechanistic study to recognize the potential of electroceuticals as an effective platform technology to combat wound biofilm infection.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More

DEVELOPMENTS IN HIGHER EDUCATION

American Council Education (ACE) President Ted Mitchell sent a letter on May 9, 2019 to members of the House Ways and Means and Senate Finance Committees, urging swift action to correct a mistake made in the Tax Cuts and Jobs Act (TCJA) of 2017 that inadvertently has resulted in harm to many low- and middle-income students who rely on scholarship aid to pay for their college education. The letter notes that the TCJA made changes to the so-called “kiddie tax” that sharply increased the tax levied on the portion of scholarships set aside for expenses, such as room and board that colleges and universities award to students from families of little or modest means. A consequence is that many low- and middle-income students are being taxed at the same rates as wealthy individuals.

Academic, need-based scholarship students are not the only ones who will feel the impact of the amended kiddie tax. College athletes on full scholarships, which include money for housing and other non-tuition expenses, also are affected by kiddie tax changes, many of whom come from economically disadvantaged families. Based on Department of Education data, the increased tax on scholarship/grant aid could exert an effect on nearly 1.4 million students and their families. A related concern is that problems caused by the change to the kiddie tax extend beyond higher education. For example, “Gold Star” Families (immediate family survivors who receive benefits resulting from a fallen service member who died while serving in a time of conflict) also may be affected negatively.

Student Loan Borrower Bill Of Rights Act Of 2019 Re-Introduced

Senators Dick Durbin (D-IL), Elizabeth Warren (D-MA), and Jack Reed (D-RI) on May 8, 2019, re-introduced the Student Loan Borrower Bill of Rights Act of 2019, which would amend the Truth-in-Lending Act, to create consistent disclosure and servicing standards across federal and private student loan programs. Its provisions include:

• Requiring various disclosures to borrowers when a loan is sold or transferred,

• Standardizing the application of payments and the allocation of payments among multiple loans in a

  manner that is most beneficial to a borrower, and

• Limiting when borrowers are subject to late fees and other consequences.
  

Trump Administration Proposes To Reduce Pell Grant Surplus

An effort by the Trump administration that was announced in May 2019 to make a deep reduction in the Pell Grant surplus was criticized by several groups representing colleges, universities, and student aid advocates. A concern is that the proposal, which is in the form of a revised budget request for FY 2020 that would shift $3.9 billion from the Pell surplus to aid in funding a National Aeronautics and Space Administration (NASA) mission to the moon, not only will hurt students, but also make attending college more expensive. Previously, White Office officials sought to take $1.3 billion from left-over Pell funding in 2017. Fiscal year 2018 and 2019 budgets also proposed multibillion-dollar cancellations, but these proposals eventually were withdrawn.

States Pass Laws Aimed At Student Loan Companies

Stimulated to some extent by Democratic gains in state houses around the nation in the November 2018 election, coalitions involving liberal groups, consumer advocacy organizations, and labor unions have launched efforts to regulate student loan companies operating in their respective states. For example, a new law in New York places student loan servicers under the jurisdiction of the state's financial services regulator as a means of protecting student loan borrowers and reducing their financial loan burden by cracking down on unscrupulous lending practices. Both the Trump administration and student loan industry groups oppose these initiatives on the grounds that states don’t have the power to regulate companies collecting federal student loans. Such issues await further resolution in the courts.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More

HEALTH REFORM DEVELOPMENTS

A chronic health workforce challenge facing nations throughout the world is a maldistribution of personnel. Approximately 60 million inhabitants of the United States, roughly one of every five individuals, live in rural areas. Significant obstacles face patients and providers in rural communities where rates for the five leading causes of death are higher, poverty is more common, higher rates of uninsurance or underinsurance prevail, greater transportation difficulties exist in going to a hospital or to the offices of health professionals, and residents lack access to high-speed Internet, which limits their access to information. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 individuals, compared to 53.3 physicians per 100,000 in urban areas, to cite just one example of a health professions workforce shortage. A worrisome trend according to the Centers for Medicare & Medicaid Services (CMS) is that since 2010, more than 100 rural hospitals have closed and nearly 40% of rural hospitals currently running are operating with negative margins, limiting the ability of providers to compete based on high value care and leading to fewer choices for beneficiaries.

Similar to other U.S. presidential administrations, the Trump administration has launched initiatives aimed at ensuring improved access to health care services in rural areas. A Rural Health Strategy has been undertaken to increase access to telehealth and other virtual services across the Medicare program. One way of doing so is to pay for virtual check-ins that allow a patient to check in with his or her clinician by telephone or other telecommunication system, along with remote evaluations of recorded videos or images that a patient submits to a clinician to help in making a joint decision whether a trip needs to be made by this individual to be seen in-person. An example of coping with the threat of hospital closures is a proposal to enhance their stability by transforming the way CMS pays certain rural hospitals and facilities in other low wage areas. A related action is a proposed change in the way Medicare factors local labor costs into hospital payments by increasing the wage index of rural and other low wage index hospitals to address payment disparities.

Provision Of Health Coverage For The Uninsured: Medicare For All

The Affordable Care Act of 2010 has been instrumental in reducing the proportion of the U.S. population lacking health insurance coverage. Despite many impressive gains that have been made, an estimated 9.4% of U.S. residents, or 30.4 million individuals, lacked health insurance when surveyed in 2018, according to a report released by the Centers for Disease Control and Prevention (CDC) on May 9 of this year, a rate not significantly different from the survey’s uninsured rate in 2017, but 18.2 million persons fewer than in 2010. The uninsured rate for adults under age 65 was 9.9% in Medicaid expansion states, compared with 18.7% in non-expansion states.

An effort gaining momentum in Congress is a proposal by Democrats called Medicare for All legislation. Generally, this universal health care program would include coverage of primary care, hospital stays, mental health treatment, prescription drugs, along with dental, vision, hearing, and home and community-based long-term care services. Meanwhile, an annual report from the Medicare Board of Trustees that was released last month indicates that the Hospital Insurance (HI) Trust Fund is expected to be depleted in 2026. Also, a report from the RAND Corporation on May 19, 2019 states that the prices paid to hospitals by private health plans averaged 241% of what Medicare would have paid. Since Medicare for All has the prospect of terminating private health plans, an interesting question is what rate will an expanded Medicare program pay and how will these costs be financed?

Predictive Analytics And Social Determinants Of Health (SDoH)

A report from Deloitte on April 30, 2019 discusses how addressing the housing, nutrition, and other social needs of Medicaid members could result in fewer ambulance rides, fewer emergency room visits, and fewer hospitalizations. Predictive analytics could help Medicaid departments and managed care organizations more accurately target these services by using a state’s resources more efficiently and effectively. Officials of SDoH programs also might want to determine how to ensure that spending is aimed at individuals who are most at risk of a decline in health status so that they can leverage the lessons learned from the experience of Medicaid home and community-based service programs.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More

BIPARTISAN HEALTH LEGISLATION

Even under ordinary circumstances, it is common for competition between Democrats and Republicans and also between the two legislative chambers to serve as obstacles to passing important bills. Given that a presidential election occurs next year, it can be expected that partisanship will play a role in complicating attempts to pass legislation that would be perceived as accruing to the advantage of one political party over the other party’s fortunes. So, it always is refreshing that at a time of potential conflict, there is evidence that opponents can join forces to advance the common good.

The introduction of H.R. 2781, a bipartisan bill to amend Title VII of the Public Health Service Act to reauthorize certain programs relating to the health professions workforce, and for other purposes, is an example of one such effort. The proposed legislation would increase the authorization for most Title VII programs by 5% over the fiscal year 2019 appropriated levels, 7.2% for Area Health Education Centers (AHECs), and 25% for Geriatric Programs. The legislation also provides flat funding authorization for the Pediatric Loan Repayment program, which has yet to receive an appropriation.

Title VII programs are under the direction of the Health Resources and Services Administration (HRSA). They have been created to enhance the health professions pipeline through a wide variety of education and training programs that play a critical role in addressing major health problems in rural and underserved communities. One aim of H.R. 2781 is to respond to the problem of an emerging shortage of physicians in the United States. It is anticipated that the House Energy and Commerce Committee will conduct a hearing on Title VII reauthorization in June 2019.

Meanwhile, despite partisan differences on important funding legislation for the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS), the House Appropriations Committee on May 8, 2019 approved its FY 2020 spending bill by a party line vote of 30-23. The committee also approved 302(b) allocations for all twelve appropriations subcommittees. Among the various provisions are the following:

• The approved legislation provides a program level of $41.084 billion for the National Institutes of Health (NIH), which amounts to a $2 billion or 5.12% increase over the comparable FY 2019 level. The bill provides an across-the-board increase of approximately 5% for all Institutes and Centers to maximize the across-the-board increase for all these entities in order to ensure a significant boost for the best peer-reviewed research across all scientific disciplines.

• Other funding allocations include $734.9 million for HRSA’s Title VII health professions and Title VIII nursing workforce development programs, a $93.25 million (14.5%) increase over FY 2019 enacted levels. The amounts include increases for diversity pipeline programs, such as the Health Careers Opportunity Program, which received $20 million in funding for FY 2020, a $5.8 million (41%) increase over FY 2019 levels. Other kinds of programs, such as Children’s Hospital Graduate Medical Education would benefit by an allocation of $350 million, which is a $25 million (7.6%) increase over FY 2019 levels.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More
 

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More