John Colbert

October 29, 2018

IDENTIFICATION OF FITNESS TRENDS FOR 2019

John Colbert

October 29, 2018

While much of the health care domain is characterized by efforts to treat disease, an important portion of it is oriented toward enhancing health promotion and disease prevention. The November 2019 issue of the American College of Sports Medicine’s (ACSM's) Health & Fitness Journal features articles and columns dedicated to several top trends in the 2019 fitness survey, a study in its 13th consecutive year of being conducted. Responses came from more than 2,000 health fitness professionals from around the world and these respondents represented all sectors of the industry: commercial, clinical, community, and corporate. This annual survey is viewed as being useful because it emphasizes the value of appreciating the differences between trends and fads in the fitness industry, helping to make important investment decisions and programming decisions for future growth and development. Despite the inherent difficulty of predicting the future of any industry, the survey helps to track trends that can assist owners, operators, program directors, and health fitness professionals with making important business decisions.

Wearable technology took over the #1 spot for 2019 after dropping to #3 in 2018, which may be the result of manufacturers correcting some monitoring inaccuracies of the past. High Intensity Interval Training (HIIT), the #1 trend in 2014 and 2018, fell to #3 for 2019. Group training made a significant return in 2017 as the #6 trend and has been the #2 trend for the past two years (2018 and 2019). Fitness programs aimed at older adults have regained some popularity after falling out of the top 10 trends in 2017, appearing at #9 in 2018 and becoming #4 for 2019. Bodyweight training first appeared as a fitness trend at #3 in 2013 and has been a top five fitness trend since that time, realizing a peak as the #1 fitness trend in 2015. In 2019, bodyweight training is the #5 fitness trend. A new trend to watch will be the employment of certified fitness professionals, a new potential trend for 2019 (#6) replacing educated, certified, and experienced fitness professionals, which was determined to be too broadly defined for this survey. Other trends to watch are mobile exercise apps, worksite health promotion and workplace well-being programs, outcome measurements, and post-rehabilitation classes.

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GENDER PEER EFFECTS IN DOCTORAL STEM PROGRAMS

John Colbert

October 29, 2018

Trends Archives

The underrepresentation of women in science, technology, engineering, and mathematics (STEM) fields can begin as early as grade school and intensify at each successive career step so that men greatly outnumber women as scientists and engineers at senior levels. This underrepresentation of women in STEM is a topic of great interest in economics and public policy today. Yet, factors affecting persistence in these fields are not well understood and understanding the nature of the situation especially is limited at the graduate education level. A step in the direction of learning more is represented by a paper released by the National Bureau of Economic Research (NBER) last month. It describes an investigation of peer gender composition in the training process of STEM doctoral degrees.

Using year-to-year variation within doctoral programs in the fraction of each cohort that is female, researchers found that women in cohorts with no female peers are less likely to graduate within six years of initial enrollment than men, but an increase in the share of female peers in a cohort increases the probability of on-time graduation for women as compared to their male counterparts. This effect largely is driven by students in typically male programs (less than 38.5% female students in the average cohort) and by dropout behavior in the first year of enrollment. Peer gender composition has a small effect on first term GPA and no effect on the probability of obtaining research funding. The small/null findings for these two channels suggest that the results largely cannot be explained by women learning or competing more successfully in cohorts with more female peers. The findings are consistent, however, with a climate mechanism, through which more female peers create a female friendly environment that encourages women to persist in doctoral programs, despite having no significant effect on learning or financial support. Taken together, the findings indicate that peer gender composition can be a useful proxy for climate and that yearly variations in this measure can provide a useful identification strategy for investigating gender gaps in outcomes.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

October 29, 2018

Trends Archives

2017 National Healthcare Quality And Disparities Report
For the 15th year in a row, the Agency for Healthcare Research and Quality (AHRQ) has reported on progress and opportunities for improving healthcare quality and reducing healthcare disparities. The 2017 National Healthcare Quality and Disparities Report recently was made available. It tracks more than 300 healthcare process, outcome, and access measures, covering a wide variety of conditions and settings. The report and chartbooks are organized around the concept of access to care, quality of care, disparities in care, and six priority areas, including patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. Trends show that about 55% percent of quality measures are improving overall for Blacks, however, most recent data in 2014-2015 show that about 40% of quality measures were worse for Blacks compared with Whites. Trends also show that about 60% of quality measures are improving overall for Hispanics, but in 2014-2015, nearly one-third of quality measures were worse for Hispanics compared with non-Hispanic Whites. The report can be obtained here.

Interoperability Among Health Care Technologies
While health care has made great strides in the proliferation of electronic health records, establishment of regional health information exchanges, and development of data exchange standards and interfaces, interoperability among health care technologies remains quite limited, according to a report from the National Academy of Medicine that recently was made available. Interoperability is the ability to deliver data seamlessly and automatically across time and space from and to multiple devices and organizations. A lack of interoperability results in waste, inefficiency, and clinician burnout, according to the report. The document outlines steps for health systems to establish comprehensive, ongoing procurement strategies with system-wide interoperability by moving away from serial purchases of individual software and hardware with proprietary interfaces toward those that will interoperate with others through a vendor-neutral open platform. The report also contains a technical supplement that details specific approaches. It can be obtained here.

Enhancing High Schools As A Driver Of Individual Mobility And Community Progress
For much of the last century, high schools served as a driver of individual mobility and community progress. Today, however, in too many school districts and communities, high schools are no longer fulfilling that promise. There remain about 1,300 traditional high schools in need of serious improvement and redesign. With an average graduation rate of 49%, these low-graduation-rate high schools are concentrated in 18 states from the inner city to the heartland and sit at the fault lines of race, class, and inequity in America. Yet, clear rays of hope exist. Over the last two decades, the number of low-performing high schools has been cut in half, as high school graduation rates have reached an all-time high. While graduation at the remaining low-performing high schools still is just a 50-50 proposition, these schools make up a small percentage of high schools throughout the country, totaling just 10% of all traditional high schools enrolling 300 or more students. Among its various topics, the Great American High School report includes coverage of progress made and remaining challenges in enabling all students to graduate from high school ready for college or career. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

October 29, 2018

Trends Archives

U.S. Adults Who Should Take Statins For Heart Disease Prevention Fail To Do So
Only 42% of the 26.8 million adults for whom statins are recommended to prevent heart disease actually take the medications, according to an Agency for Healthcare Research and Quality (AHRQ) study. Statin use rates have remained flat in the last decade, despite evidence that they reduce death from heart disease. In 2016, the U.S. Preventive Services Task Force (USPSTF) released new recommendations on statin use to prevent heart disease, the leading cause of death among adults age 40 and older. Using data from AHRQ’s Medical Expenditure Panel Survey to assess the size and characteristics of the population that meets the USPSTF criteria for statin use, researchers found that among adults recommended for statin use, women, Hispanics and individuals living in the South or without health insurance were less likely to receive them. A conclusion reached is that new USPSTF recommendations may result in decreased personal costs and expanded access to statins.

Fast Food Consumption By U.S. Adults
Data from the National Health and Nutrition Examination Survey reveal that during 2013–2016, 36.6% of adults consumed fast food on a given day. The percentage decreased with age: 44.9% aged 20–39, 37.7% aged 40–59, and 24.1% aged 60 and over. A higher percentage of non-Hispanic black adults consumed fast food than non-Hispanic white, non-Hispanic Asian, and Hispanic adults. The percentage of adults who consumed fast food increased with more family income. Among those who consumed fast food, men were more likely than women to eat fast food at lunch, but women were more likely to report eating fast food as a snack. Fast food is a part of the American diet and has been associated with high caloric intake, and poor diet quality. Time, financial resources, price, and availability influence fast food consumption, which was based on 24-hour recall.

HEALTH TECHNOLOGY CORNER

Use Of Biological Swimmers As Cargo Delivery Agents In Blood
Nature presents intriguing biological swimmers with innate energy harvesting abilities from their local environments. Use of natural swimmers as cargo delivery agents presents an alternative strategy to transport therapeutics inside the body to locations otherwise difficult to access by traditional delivery strategies. A manuscript published on September 25, 2018 in the journal Advance Materials describes a biocompatible biohybrid microswimmer powered by a unicellular freshwater green microalga, Chlamydomonas reinhardtii. Nontoxic and biodegradable, it moves by lashing a propeller-like tail. The researchers outfitted individual algal cells with magnetic polymer beads that could hold drugs in small amounts and allowed the researchers to steer the algae by applying a magnetic field to them. In the laboratory, these microswimmers darted through bodily fluids such as blood at more than 100 micrometres per second and successfully deposited payloads onto mammalian cells.

Novel Devices For Studying Acute And Chronic Mechanical Stress In Retinal Pigment Epithelial Cells
Macular degeneration (AMD) is the leading cause of adult blindness in developed countries. Physical changes within the retina are an important factor in its development. As reported in a study published on October 8, 2018 in the journal Lab on a Chip, researchers at Utah State University aimed to mimic changes in cells and find the mechanisms for the initiation and progression of diseases. Their study examines the effects of mechanical stress on elevated protein levels and abnormal development of new blood vessels. They were able to develop new devices to stress human cells in the lab mechanically. One device is designed to mimic slow and continuous stress levels and a second one is used for mimicking high levels of stress. They discovered that mechanical stress results in the expression of vascular endothelial growth factor, a protein that can cause disease initiation and progression. Besides AMD, mechanical stress can occur in other diseases including diabetic retinopathy and even cancer.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

October 29, 2018

Trends Archives

Students and their families view attainment of a baccalaureate degree as an important first step in obtaining a decent paying job upon graduation. Given the fact that the costs of pursuing a college education are beyond the financial reach of many families in the United States today, they especially want their investment to produce favorable outcomes for their offspring in the job market.

Unfortunately, not all academic majors are geared toward producing graduates who will be in high demand by employers seeking workers with that level of formal education. According to a new report from the data analytics firm Burning Glass Technology, some vocationally geared majors, such as fitness studies and criminal justice do not fare as well compared to majors in other areas, such as English and gender studies. All too many students may find jobs after graduation, but in the context of their educational background, they are underemployed.

Health care education programs continue to be an exception. A rapidly growing proportion of the population that is age 65 and older, a group characterized by highly significant numbers of individuals who have one or more chronic conditions, means that the demand for health care services will grow. Shortages of physicians and dentists suggest that there will be increased opportunities for graduates of physician assistant and dental hygiene programs, to cite just two examples, to obtain gainful employment in the health sector following graduation. A challenge will be to ensure that high school graduates are prepared adequately in science and mathematics to thrive academically in health science higher education programs. Just as importantly, it will be essential to attract more students from underrepresented racial and ethnic groups in order to achieve a greater alignment with major demographic changes that the U.S. population is undergoing.

Negotiated Rulemaking For Accreditation And Innovation
The U.S. Department of Education (USDE) announced a negotiated rulemaking on higher education accreditation and innovation, along with three subcommittees to address distance learning and educational innovation, faith-based entities’ participation in Title IV programs and TEACH Grants. A main committee will focus on accreditation while three subcommittees will address these additional issues. The negotiated rulemaking committee will meet three times in 2019: on January 14-16, on February 19-22, and on March 25-28. Each of the three subcommittees also will meet three times, on January 17-18, February 12-13, and March 11-12. The meetings will be held in Washington, DC. Topics to be addressed by the main committee will include:

Requirements for accreditors in their oversight of institutions
Criteria used by the Secretary to recognize accrediting organizations
Simplification of USDE’s recognition of accrediting organizations
Clarification of the responsibilities for each member of the “triad” (accreditors, states and USDE)
Clarification of permissible arrangements between institutions and others providing an education program

Delayed Publication Of New Regulations For Borrower Defense And Gainful Employment
The USDE also announced that final regulations for borrower defense to repayment will not be published by November 1, 2018. The agency received more than 38,000 comments on its proposed borrower defense rules, indicating that additional time is needed to review the comments. Borrower defense regulations focus on the conditions under which students may obtain relief from federal loans. Additionally, final gainful employment regulations also will not be published by November 1, which means that current gainful employment regulations will remain in effect. These regulations address whether or not students who have borrowed federal money complete programs leading to earnings that enable the students to repay the loans. The missed deadlines for publishing new borrower defense and gainful employment regulations mean that the earliest date either could be implemented will be July 2020.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

October 29, 2018

Trends Archives

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 6th of many profiles this year is presented as follows:

Name and Title: Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Professor & Dean, College of Nursing and Health Sciences

Place of birth: Youngstown, OH

University: University of Vermont, Burlington, VT

How long have you been in your position? I am in my 10th year as Dean for the College of Nursing and Health Sciences and I have been a Professor in Communication Sciences and Disorders and in Pediatrics in the Larner College of Medicine for 18 years.

What’s the value of a university education? A university education creates opportunities for our next generation of scholars, leaders and health care professionals to create new knowledge, challenge perspectives, think critically, problem solve, and facilitate innovations in teaching, learning and practice.

What is the value of ASAHP? As a very new member of the organization, our college is experiencing the value of the communications (journal and updates), the opportunities for leadership training, and the potential for networking. We are just getting our feet wet in this new circle of connection with shared values and goals.

If I could teach in another field, which one and why? As a true interdisciplinary professional, I love teaching across the disciplines of medicine, social work, PT, nutrition, nursing, OT, education, psychology, integrative health, early childhood and special education. If I had to select one, it would probably be medicine (e.g., pediatrics, psychiatry, neurology) as I think they would gain significant value in understanding the roles and responsibilities of other health related disciplines.

Before I retire I want to: I don’t have any plans to retire as I love what I do, although I may slow down a bit in the next 10 years.

In college, I was known for: My energy and passion for serving with meaning.

What music is playing in my car/office? Typically, you would hear classical or country-western music. The last book I read for fun was: Throwaway Children by Diney Costeloe

My favorite trip was: A Mediterranean cruise with my husband Billy during which we visited London, Italy, Spain, France, and the Rock of Gibraltar. I have enjoyed, however, several recent professional trips to Hong Kong, Japan, and China.

My hobby is: Walking, boating, snowshoeing, magic, traveling.

My passion is: My grandchildren and serving the needs of children with autism spectrum disorders.

Cats or dogs? We have 2 dogs, Riley (1 year old German Shepherd) and Cocoa (9 year old chocolate lab & a therapy dog).

E-book or hardback? I love the feel and ability to leaf through the pages of a hardback book.

Beach or mountains? We live on a sandy beach on Lake Champlain and can see both the Green Mountains of Vermont and the Adirondacks of NY, so I love the beach, the mountains and the trees of Vermont.

Return to TRENDS October 2018

REFLECTIONS ON AN EXPERIMENT IN DEMOCRACY

John Colbert

October 29, 2018

Trends Archives

The founders of this nation envisioned an arrangement in which the executive, legislative, and judicial branches of government would function effectively to meet the needs of the populace in both domestic and foreign matters. That experiment has endured for some 240 years in times both good and bad. Leaders in all three branches either are elected or appointed while the month of October in each even-numbered year results in a federal election that involves one-third of the Senate and all members of the House of Representatives who aspire to remain in office. These officials return home that month to make their individual appeals to the electorate.

Much of what transpires in government that works beneficially tends to occur without attracting much notice. Social Security checks are mailed or deposited into private accounts every month, payments are made to providers by the Centers for Medicare & Medicaid Services, and members of the military serve in posts throughout the world to safeguard the nation’s interests. As of the end of October 2018, the U.S. Census Bureau estimates that the population is nearly 329 million inhabitants. Given that a typical family consisting of only five individuals can engage in heated disputes regarding, what time to have dinner, what to eat, and whether the meal should consist of home-cooked or carry-out comestibles, it comes as no surprise that a national agglomeration in the hundreds of millions will generate vastly different and especially noisy opinions on the essential roles that government should play in their lives.

Key political factions often are described in binary terms, such as Democrat and Republican or liberal and conservative. Stuck in heavy traffic with no idea of what is happening further up the road and well beyond view, a liberal might conclude that if a police officer was at the main intersection that lies in the distance, traffic would be able to flow more smoothly. A conservative sitting in the next vehicle might just as easily believe that there must be a uniformed official at that same intersection. Otherwise, the situation would not be as messed up as it appears to be. The basic difference between these opposing points of view is that one group believes that government must be more involved as a desirable mechanism to solve various problems while the other group sees that same entity as the cause of a great many difficulties.

Yet, although progress may appear to be too slow at times, constructive action does occur. Presidents propose budgets and Congress acts on them in ways that its members see fit. Ultimately, agreements are reached on spending priorities and the chief executive signs appropriation bills into law. Medicare data show that spending for this program was 15 percent of total federal spending in 2016 and is projected to rise to 17.5 percent by 2027 while the Medicaid program helped provide health care to an estimated 73 million individuals in fiscal 2017 at a cost of about $596 billion. Several congressional committees and sub-committees in both chambers provide valuable oversight of executive branch activities pertaining to these two programs. Moreover, public hearings furnish an opportunity for representatives of a wide range of organizations in the private sector to weigh in with their opinions in ways that accrue to the advantage of program beneficiaries.

As was the case with deciding on the legality of the individual mandate created by the Affordable Care Act, the Supreme Court also sometimes will join a fray to arbitrate jurisdictional controversies. Thus, while it is somewhat less than perfect, the nation’s experiment in democracy endures in meaningful ways.

return to trends october 2018

HEALTH REFORM DEVELOPMENTS

John Colbert

October 29, 2018

Trends Archives

REFLECTIONS ON AN EXPERIMENT IN DEMOCRACY of the newsletter refers to the federal election in November 2018 that will determine the composition of both the House and the Senate, beginning in 2019. As in previous contests that have been conducted since 2010, the Patient Protection and Affordable Care Act (ACA) of 2010 has the potential to influence the outcome. Not a single Republican in either chamber voted in favor of the ACA when it became law. Many candidates of that political party also chose to focus on its negative aspects when vying for office in the elections of 2012, 2014, and 2016. From the time of its inception, multiple attempts also have been made in Congress to repeal and replace this legislation.

Upon assuming the majority in both chambers and taking control of the White House after the 2016 election, Republicans appeared to be in a strong position to achieve their objective of eliminating this law. They came close to doing so in 2017, but the ACA remains in effect and many Democrats are using that fact as a basis for attacking Republicans in the upcoming November 2018 election. A key feature of the ACA is that it eliminated the ability of insurance companies to prohibit patients with preexisting conditions either from obtaining coverage or by requiring them to pay exorbitantly priced premiums for such protection. The Democrat’s message in the present election cycle is: Republicans intend to return to the days when insurers possessed such power and Democrats pledge to prevent them from doing so.

Employers’ Reimbursement Arrangements To Provide Health Coverage For Employees
Meanwhile, the Departments of Labor, Health and Human Services, and the Treasury proposed new rules in the October 29, 2018 issue of the Federal Register pertaining to how employers may use health reimbursement arrangements (HRAs) to provide health coverage to employees. The rule would expand the uses of HRAs to include payment of premiums for individual market coverage in some instances. The Departments estimate that the proposed changes would have an impact on coverage for approximately 10.7 million individuals, decrease the number of uninsured by 800,000, and cost the federal government approximately $30 billion in lost tax revenue from 2020-2028. The proposed rule was issued in compliance with an October 2017 Executive Order on “Promoting Healthcare Choice and Competition Across the United States,” suggesting that these changes would help make coverage more affordable for small to mid-sized employers and provide employees with more coverage options. Public Comments can be submitted for 60 days after publication of the rule.

Access To Health Care For Low-Income Adults With & Without Medicaid Expanded Eligibility
Low-income adults in states that expanded Medicaid under the Affordable Care Act were less likely to report having any unmet medical needs compared with those in non-Medicaid expansion states, according to a Government Accountability Office (GAO) report released on October 15, 2018. Among other findings:

About 26 percent of low-income adults in Medicaid expansion states reported having unmet medical needs compared to 40 percent in non-expansion states.
About 9.4 percent of low-income individuals in Medicaid expansion states said that they passed up needed medical care in the past 12 months because they couldn't afford it compared to 20 percent in non-expansion states.
About 82 percent of low-income adults had a usual place of care in Medicaid expansion states compared to 68 percent in non-expansion states.

Health and Workplace Benefits Survey (WBS) Results
The EBRI/Greenwald & Associates Health and Workplace Benefits Survey (WBS) of 1,025 workers in the United States ages 21–64 was conducted in June 2018. Among its main findings: (1) Workers rank health care as the most critical issue in the nation, (2) One-half of workers describe the health care system as poor (22 percent) or fair (28 percent), (3) Confidence about the health care system is mixed and declines looking into the future, and (4) Thirty-four percent of workers say they are confident that they are able to afford health care without financial hardship today, but this percentage decreases to just 30 percent when they consider the next 10 years.

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MICROBIOME’S OMNIPRESENT UNSEEN GUESTS

John Colbert

October 29, 2018

Trends Archives

Much of health care is delivered at the level of treating acknowledged symptoms, but it is what exists at less visible layers, such as the human microbiome housing several trillion microbial cells, that can be of critical importance. Patients and their caregivers in the clinical setting engage in transactions in which one group arrives with a concatenation of symptoms while the other group is confronted with the task of interpreting these signs correctly in order to develop an effective treatment plan.

An example of the value of comprehending and appreciating layers of increasing complexity is afforded by a painting completed by Salvador Dali in 1956 called Nature Morte Vivante, which in English translates into “Living Still Life.” Influenced by Nobel Laureate physicist Werner Heisenberg’s work in quantum mechanics, the title is a play on words characterized by the basic notion of something being perfectly still, yet continuing to be in motion simultaneously. The seeming paradox is explained by the fact that although an object may not appear to be moving, it is composed of millions of atoms that are in rapid motion.

A closer look at the canvas reveals other features that may not appear to be obvious upon cursory examination. Mathematics did not escape Dali’s attention as evidenced by his employment of the Fibonacci sequence, a generator of spiral images that appear throughout the painting. He associated the spiral with a key element of nature and became even more intrigued by it when he learned of the masterpiece 852-word article, highly unusual for its brevity, by James Watson and Francis Crick that was published in the April 25, 1953 issue of the journal Nature. These researchers suggested a spiral structure (a helix) for the salt of deoxyribose nucleic acid (DNA), one “with novel features of considerable biological interest.”

This helix would revolutionize genetics. Essentially no recognition was given, however, of the work of chemist Rosalind Franklin, whose x-ray diffraction studies in crystallography provided the imagery that inspired Watson and Crick. Assuming that Dali was unaware of her contribution, it is likely that he would have been fascinated to learn about this hidden layer of meaning that subsequently accrued to the enormous advantage of her newly more world famous colleagues.

Allied health clinicians and their patients often interact on the basis of seeking and providing relief from symptoms involving aches, pain, discomfort, and physical immobility. Additional layers that lack such clarity are semiotics (non-language features reflecting patient and caregiver differences based on age, sex, gender, race/ethnicity, and health literacy), genomics, proteomics, metabolomics, and the microbiome. The latter unseen guests continue to attract a significant amount of attention as demonstrated by the following examples of papers in the professional literature: Disruption of maternal gut microbiota during gestation alters offspring microbiota and immunity (Microbiome, July 2018), The gut microbiota and dysbiosis in autism spectrum disorders (Current Neurology and Neuroscience Reports, November 2018), and Researchers link gut bacteria to heart transplant success or failure (Journal of Clinical Investigation Insight, October 4, 2018).

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

September 25, 2018

Trends Archives

Passage of legislation by Congress and enactment into law when signed by the President of the United States are events that attract considerable attention in the media. Equally important in the life of any legislation is what eventually occurs in the regulatory arena. On August 14 of this year, the Secretary of the Department of Education proposed to rescind the gainful employment (GE) regulations, which added to the Student Assistance General Provisions requirements for programs that prepare students for gainful employment in a recognized occupation. The Department plans to update the College Scorecard, or a similar web-based tool, to provide program-level outcomes for all higher education programs at all institutions that participate in the programs authorized by Title IV of the Higher Education Act of 1965, which would improve transparency and inform student enrollment decisions through a market-based accountability system. A key step in the process is to invite comments about such proposals.

Several associations representing college leaders, educators, and professionals responded on September 13, 2018. They advised the Department to revise rather than eliminate the existing rule. A concern is that rescinding the existing rule prior to developing additional alternatives would leave a meaningful gap between oversight of gainful employment programs and the period when additional information could influence prospective students’ decisions. By rescinding the regulations entirely, the Department will forego an opportunity to strengthen and improve them and abandon a meaningful oversight tool. The result, according to the Department’s own estimates, would be $4.5 billion in Pell Grant funding going to programs that otherwise would not be eligible under existing regulations. Considering the importance of Pell Grants and the difficulties involved in providing sufficient funding to meet student needs, it is viewed as troubling that the Department is considering a move that would significantly increase the cost of Pell Grants by directing those additional funds to programs that demonstrate poor returns for students.

Negotiated Rulemaking To Revise Regulations Involving Accreditation
The Department of Education on July 31, 2018 published a notice in the Federal Register announcing its intention to convene a negotiated rulemaking committee to revise regulations regarding accreditation and the recognition of accrediting organizations. The goal is to reduce current compliance requirements, concentrating accreditors’ efforts on educational quality and strengthening commitment to innovation. In preparation, the Department of Education held the first of three public hearings on September 6, 2018. At the hearing, which was held in Washington, DC, testimony was provided by representatives of think tanks, consumer advocacy groups, college presidents, and several accreditation representatives. Comments made on that occasion indicated that: (1) the agenda for the negotiated rulemaking is too large for one committee; (2) the Department needs to strengthen regulations, not reduce them; (3) competency-based education in the context of regular and substantive interaction should be addressed; and (4) institutional mission needs to be protected.

Federal Funding Support For Higher Education In Fiscal Year 2019
Fiscal Year 2019 begins on October 1, 2018. A budget proposal for the new fiscal year released last February signaled an intention by the Trump Administration to consolidate multiple income-contingent repayment plans for student borrowers into a single plan, eliminate Public Service Loan Forgiveness, and end subsidized student loans. It also would expand Pell Grant eligibility to short-term non-degree programs, end the Supplemental Educational Opportunity Grant, and overhaul the Federal Work-Study program. Congress subsequently chose to do otherwise.

A funding agreement reached by House and Senate negotiators reflects an effort to increase spending on student aid, career and technical education, and university-based research. The spending bill for the new fiscal year would increase the Education Department's total budget to $71.5 billion -- a second year in a row Congress has boosted funding, despite efforts by the Administration to reduce spending. The maximum Pell Grant would be raised by $100 to $6,195 in the agreement. Perkins Career and Technical Education grants will receive $1.26 billion, representing a $70 million increase from the previous year. Funding aimed at fixing the Public Service Loan Forgiveness program was extended to an amount of $350 million.

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FULFILLING A QUEST FOR PATIENT-CENTERED CARE

Patient-centered care is an important aspect of service delivery, but more efforts are needed to achieve its full potential. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Charles Gulas, Dean of the Walker College of Health Professions at Maryville University of Saint Louis, is featured in this issue of TRENDS. Read More

FISCAL YEAR 2019 FUNDING PICTURE BRIGHTENS

For the first time in 15 years, Congress manages to complete a funding package for health and education prior to the start of the next fiscal year on October 1. Read More

HEALTH REFORM DEVELOPMENTS

Some states seek workforce requirements for certain Medicaid recipients, a challenge is mounted to stop an expansion of short-term health insurance plans, and savings are produced by accountable care organizations. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Prevalence Of Chronic Pain And High-Impact Chronic Pain Among Adults—United States
Daily Use Of Marijuana Among Non-College Young Adults
Micromotor Pills As A Dynamic Oral Delivery Platform
Using Biomimicry To Develop Solutions For Human Health Problems Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Creating A Policy Environment To Address Social Determinants Of Health
Population Health: Translation Of Research To Policy
Achieving Rural Health Equity And Well-Being: Proceedings Of A Workshop Read More

HURRICANE METHUSELAH MOVES STEADILY TOWARD U.S. SHORES

HOW LAWS, REGULATIONS, SELF-REGULATORY PRACTICES, AND FINANCIAL SUBSIDIES AFFECT U.S. HEALTH CARE

John Colbert

September 25, 2018

Trends Archives

Compared to other western nations, the U.S. is assigned low grades based on the amount of money spent on health care and the results that are achieved. A typical analysis shows that lacking a public commitment to universal health care, this nation instead is a product of bio-scientific free enterprise – technologically sophisticated, extremely expensive, but inaccessible to the poor. A contrasting account can be found in a paper in the University of Texas Public Law & Legal Theory, Research Paper Series (#581), which will be a chapter in a book scheduled for publication in 2019. Its author, William Sage, indicates that beginning over 20 years ago, the poor performance of the American health care system has been slowly revealed. For nearly as long, steps that might improve that performance have been identified, but little has changed. The answer to why there has been a lack of significant progress lies in large part to an accumulation of laws, regulations, self-regulatory practices, and financial subsidies which locks U.S. health care into inefficient, unfair patterns and practices. While most of these provisions were well-intentioned when developed, this “deep legal architecture” now serves mainly to prevent meaningful competition in medical markets and to distort or limit collective investment in the nation’s health.

Noting that the United States wastes a vast amount of money each year on ineffective, overpriced, poorly delivered, and inaccessible medical care, the author offers three lessons that seem most important to summarize. First, the various ideological “brands” associated with national health reform must realign themselves to the task of facilitating decentralized, incremental improvement rather than asserting a national political consensus on setting limits. Second, in addition to continuing routine enforcement of the antitrust laws, the U.S. Department of Justice and the Federal Trade Commission should pursue longer-term strategies intended to reverse the distortions currently burdening competition. Third, America’s spendthrift health care system is particularly problematic because it leads the political process to medicalize problems such as poverty, lack of education, and substandard housing while over-investing in medical care and under-investing in non-medical social services that would be less costly, more effective, and more accessible to disadvantaged segments of the population.

Return to September 2018 trends

HURRICANE METHUSELAH MOVES STEADILY TOWARD U.S. SHORES

John Colbert

September 25, 2018

Trends Archives

Just as Hurricane Florence battered the Carolinas in September of this year, a more powerful storm from a quite different perspective continues its steady movement toward the United States and other nations around the globe, with enormous and unprecedented implications for the health sector of the economy. According to the U.S. Census Bureau, the year 2030 marks an important demographic turning point in this country’s history because by that year, all baby boomers will be older than age 65. This transition will expand the size of the older population so that one in every five residents will be retirement age. Moreover, aging of baby boomers (whose members were born between 1946 and 1964) means that in less than two decades, older individuals are projected to outnumber children for the first time in U.S. history. By 2035, there will be 78.0 million persons 65 years and older compared to 76.7 million under the age of 18.

As the population ages, the ratio of older adults to working-age adults, also known as the old-age dependency ratio, is projected to rise. By 2020, there will be just over three-and-a-half working-age adults for every retirement-age person. By 2060, that ratio will fall to just under two-and-a-half working-age adults for every retirement-age person. The non-Hispanic White alone population is projected to shrink over the coming decades, from 199 million in 2020 to 179 million in 2060, even as the U.S. population continues to grow. Their decline is driven by falling birth rates and a rising number of deaths over time among non-Hispanic Whites as that population sub-group ages. The racial and ethnic composition of younger birth cohorts is expected to change more quickly than for older cohorts. In 2060, over 36.4% of children are projected to be non-Hispanic White alone compared with 55.1% of older adults. Key policy issues that must be addressed: meeting the health care needs of an older cohort that disproportionately will be affected by chronic disease, assuring the availability of an adequate supply of competently-prepared health practitioners, and determining how to pay for health and health-related social services.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

September 25, 2018

Trends Archives

Creating A Policy Environment To Address Social Determinants Of Health
The National Alliance To Impact The Social Determinants of Health (NASDOH) in working to build systematically and pragmatically a common understanding of the importance of addressing social needs as part of an overall approach to health improvement has released a new white paper to create a supportive policy environment to address social determinants of health. The document introduces NASDOH’s plans to bring clarity to the current understanding of the issues, challenges, and opportunities for the health care system to address social determinants in concert with communities and the public and private sector. NASDOH encourages public and private sector leaders to support progress by promoting collaboration and innovation around social determinants of health interventions in five areas of focus: (1) Promoting a supportive policy environment at all levels of government and in the private sector, (2) Framing the issue in a way that promotes action, (3) Elevating shared learnings across communities, (4) Leveraging shared approaches to measurement and evaluation, and (5) Encouraging data and technology innovation. The paper can be obtained here.

Population Health: The Translation Of Research To Policy
The Robert Wood Johnson Foundation Health & Society Scholars (HSS) program was designed to build the nation’s capacity for research, leadership, and policy change, while addressing the multiple determinants of population health. One of its goals was to produce a cadre of scientific leaders who could contribute to this research and spearhead action to improve overall population health and eliminate health inequities. A report takes a case study approach using six diverse examples of science to policy translation generated by Scholars in the HSS program from 2003 to 2016. Because the HSS program was discontinued in 2017, the Milbank Memorial Fund published these case studies in the hope that many audiences, including students, would use them to learn about the connection between research, decision making, and policy. The case studies are on the following topics:

Healthy and Unhealthy Food Sources in New York City,
Fragile Health and Fragile Wealth,
Medical Marijuana as a Strategy to Reduce Opioid Overdose Deaths? Lessons from a Study of State Medical Marijuana Laws,
How Practitioners Bring Population Health Ideas Into Other Policy Sectors: Lessons from Transportation,
Forefront Suicide Prevention’s Wheel of Change: Catalyzing a Social Movement to Prevent Suicide, and
Exposure to Heat Waves: Making Film and Policy.

The report can be obtained here.

Achieving Rural Health Equity And Well-Being: Proceedings Of A Workshop
Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. A publication that summarizes the presentations and discussions from the workshop can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

September 25, 2018

Trends Archives

Use Of Yoga, Meditation, And Chiropractors Among U.S. Adults: 2012-2017
A report from the National Center for Health Statistics (NCHS) in November 2018 examines changes over time in the percentage of adults who used yoga, meditation, and chiropractors in the past 12 months, as well as variation by sex, age, race, and Hispanic origin. Among adults aged 18 and over, increases were seen from 2012 to 2017 in the use of yoga, meditation, and chiropractors. Yoga was the most commonly used complementary health approach among U.S. adults in 2012 (9.5%) and 2017 (14.3%). In 2017, women were more likely to use yoga, meditation, and chiropractors in the past 12 months compared with men. Non-Hispanic white adults were more likely to use yoga, meditation, and chiropractors compared with Hispanic and non-Hispanic black adults. In 2012, seeing a chiropractor was as popular as yoga, followed by meditation, but in 2017, meditation became the 2nd most-used approach ahead of chiropractic.

Increasing Medication Adherence Could Improve Care And Save Health Care Costs
Non-adherence to medication represents a major problem that limits the effectiveness of treatment and adds to the burden of illness and cost of health care. About half of all patients do not take their medication as prescribed, according to a September 2018 report from the National Council for Behavioral Health’s Medical Director Institute. Estimates indicate that medication non-adherence costs the health care delivery system $100 billion to $300 billion annually due to more frequent use of high-cost services, additional prescriptions to offset non-adherence, and interventions to address relapses. The report discusses medication non-adherence in chronic conditions, mental health, and substance use disorders, and offers some possible solutions. If many of these solutions were to be adopted by 2025, a projection is made that the health system would save $2 billion a year from reduced hospital costs alone. Apart from improving communication between patients and providers, some more high-tech solutions include apps and robots.

HEALTH TECHNOLOGY CORNER

Robotic Arm May Help To Rehabilitate Chronic Stroke Victims’ Communication Deficits
Apropos of the article about silos in Health Silo Disruption and Eradication of this issue of TRENDS, treatment in one domain (motor function) may benefit performance in another untreated domain (communication) in individuals with acquired aphasia, the loss of ability to understand or express speech. Research published in Frontiers in Neurology on October 22, 2018 shows that robotic arm rehabilitation in chronic stroke patients with aphasia may promote speech and language function recovery. The rehabilitation in this study targeted the right arm since study participants each had suffered a left hemisphere stroke leading to a deficit in motor function on their right side. The research team observed small, but consistent improvement on measures assessing speech articulation and overall language processing in aphasia. It is believed some treatment approaches may encourage plasticity and reorganization that can span multiple domains. Although this initial finding should be interpreted cautiously, it remains exciting to consider the possibility that stroke rehabilitation in one domain would improve performance in another domain.

Obesity Provides Unexpected Enhancement Of Anticancer Medications
Obesity is associated with increased mortality and reduced longevity, but counter-intuitive findings occasionally suggest evidence of an obesity paradox. An article published in the journal Nature Medicine on November 16, 2018 indicates that overweight patients sometimes respond better than other patients to powerful drugs that harness the immune system to fight tumors. Called checkpoint inhibitors, the drugs block the activation of PD-1, a protein on the surface of immune sentinels called T cells. The body naturally triggers PD-1 to dampen immune responses, but tumors also can stimulate PD-1 to protect themselves. Lifting this molecular “brake” allows the T cells to attack the cancer cells. PD-1 inhibitors have caused untreatable tumors to vanish for years in patients with melanoma, lung cancer, and some other cancer types. Although there is heightened immune dysfunction and tumor progression, there also is greater anti-tumor efficacy and survival after checkpoint blockade that targets some pathways activated in obesity.

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HEALTH REFORM DEVELOPMENTS

John Colbert

September 25, 2018

Trends Archives

Efforts have been made over the past several decades to achieve meaningful health reform. The number “three” figures prominently in such attempts. One version focuses on: increasing access to health care, improving quality, and reducing costs. Pursuing any one of these aims often has the unwanted outcome of making it difficult to realize the other two. Another version based on the number three is known as the Triple Aim, which consists of improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care.

Worth noting is that it occasionally proves challenging at times to obtain a clear picture of what is transpiring when reports from different sources present conflicting information. As an illustration, the U.S. Census Bureau earlier this month indicated that the uninsured rate from 2016-2017 remained statistically unchanged, while private polling data suggest an increased uninsured rate of 1-2 percent. Meanwhile, the most recent attempt of a comprehensive nature to make improvements in the realm of health care is represented by the Patient Protection and Affordable Care Act (usually referred to as the ACA or Obamacare) that became law in 2010. Since then, several policy initiatives of a more incremental nature have been proposed. Recent examples are described on this page of each issue of TRENDS, along with updates as they occur. Some developments that continue to materialize are discussed below.

Medicaid Work Requirements
Many individuals who previously did not have health insurance were able to obtain coverage when the federal-state Medicaid program was expanded to include them. Some states currently are planning to add work requirements for able-bodied adults who receive coverage. Michigan recently submitted a waiver application that would require enrollees in the age bracket 19-62 either to work, attend job-training, or volunteer at least 80 hours per month to retain coverage. If approved, the proposal will become effective in 2020 and may affect as many as 540,000 beneficiaries. Because of 12 possible exemptions that would apply to particular groups, such as family caretakers and pregnant women, the actual number may prove to be lower. If the waiver application is approved, Michigan is in line to become the fifth state to be able to impose work requirements. Utah and Wisconsin are among some other states that also are seeking waiver approvals.

Exploring The Fate Of Short-Term, Limited-Duration Health Insurance Plans
The Trump Administration was successful in having a final rule issued on August 1, 2018 to help individuals struggling to afford health coverage find new, more affordable options. The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage now can cover an initial period of less than 12 months, and taking into account any extensions, a maximum duration of no longer than 36 months in total. A case filed in mid-September 2018 in Washington, DC is aimed at stopping the expansion of short-term health plans because opponents view them as not requiring provision of the same essential health benefits as ACA-compliant plans and possibly jeopardizing the ability of individuals with pre-existing conditions to find coverage. In contrast, proponents believe that short-term, limited-duration insurance will benefit: individuals who are between jobs, students taking time off from school, and middle-class families without access to subsidized ACA plans. Compared to the federal final rule, Oklahoma released guidance on September 7, 2018 to limit the sale of short-term, limited-duration plans to six months.

Medicare Savings Achieved By Accountable Care Organizations (ACOs)
An estimate from the Center for Medicare & Medicaid Services (CMS) indicates that Medicare ACOs underperformed during the first few years of implementation, generating a gross savings of $954 million. This estimate is contested by a report commissioned by the National Association of Accountable Care Organizations (NAACOS), which claims that the Medicare Shared Savings Program (MSSP) produced more than $1.84 billion in gross savings between 2013 and 2015. According to NAACOS, as of January 2018, there are 561 Medicare ACOs serving more than 12.3 million beneficiaries with hundreds more commercial and Medicaid ACOs serving millions of additional patients.

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FISCAL YEAR 2019 FUNDING PICTURE BRIGHTENS

John Colbert

September 25, 2018

Trends Archives

A principal function of Congress is to provide funds to support a broad array of government activities in time for the start of a new fiscal year each October 1. Except for 2018, that particular task has proven to be exceptionally challenging. During the past 15 years, two kinds of obstacles have stood in the path of appropriating money in a timely manner. The first is differences between Democrats and Republicans, while the second is a basic disagreement that proves difficult to reconcile between the Senate and the House of Representatives.

Some candidates in elections of yesteryear were fond of using a campaign theme song called “Sunny Days Are Here Again.” Unlike those earlier funding cycles, 2018 truly represents a most welcome departure from more cloudy times to a present sunny day. Especially gratifying is that this turn of events affects one of the largest of the 12 categories of funding, the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The House Appropriations Committee on September 13, 2018 filed a two-bill Appropriations “minibus” funding bill, which was approved by a joint House and Senate Conference Committee. The Conference Report includes the Department of Defense and the Labor- HHS Appropriations bills for fiscal year 2019. This package also includes a short-term “Continuing Resolution (CR),” which will provide continued funding to keep the federal government operating until all yearly funding bills can be signed into law. The CR merely extends current levels of funding for federal agencies until December 7, 2018.

Some appropriation highlights that await being finalized by having bills signed into law are:

Includes vital funding for the National Institutes of Health – $39 billion, an increase of $2 billion.
Funds programs to protect against health threats such as pandemics and bio-threats, providing $7.9 billion for the Centers for Disease Control and Prevention (CDC) and $2 billion to prepare for and prevent public health and social services emergencies with programs such as biomedical research, acquisition of medical supplies and vaccines, and hospital preparedness grants.
Saves taxpayers $50 million in future appropriations by creating the first Infectious Diseases Rapid Response Reserve Fund, where funds only become available for use in the event of a future public health emergency.
Helps to combat the opioid epidemic by providing $6.7 billion, a historic level of funding, for programs that fight, treat, and stop substance abuse and support access to mental health services. Includes $5.7 billion for the Substance Abuse and Mental Health Services Administration, a $584 million increase. Funds activities authorized under the 21st Century Cures Act and other addiction and recovery programs.
As described on page five of this issue of TRENDS, furnishes support for students who are studying for careers in the health professions.

return to trends september 2018

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

September 25, 2018

Trends Archives

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 6th of many profiles this year is presented as follows:

Name and Title: Charles J Gulas, Dean, Walker College of Health Professions, Professor of Physical Therapy

Place of Birth: Cleveland Ohio

University: Maryville University of Saint Louis

How long have you been in your position? Started at Maryville as an adjunct in 1999, Director of Clinical Education, and Director of Physical Therapy Program, 2000 and 2001, Dean in 2004.

What’s the value of a university education? Teaches students to be critical thinkers, reflective learners, be creative and ignite passions.

What is the value of ASAHP? Updated information, and Networking, Networking and Networking!!

Your philosophy on education in seven words: Facilitating Thinking to Expand Creativity and Passion.

If I could teach in another field, which one and why? Botany/landscaping because I love plants, or Cyber- security because I am fascinated by how our information is tracked.

Before I retire I want to: Teach abroad.

In college, I was known for: Undergraduate days organizing protests.

What music is playing in my car/office? No music in office... in car Sirius On Broadway or 80’s hits

The last book I read for fun was: “small great things” by Jodi Picoult

My favorite trip was: Greek Islands

If I could travel anywhere it would be: Africa safari

Four people I’d take to coffee or have a glass of wine with: Gertrude Stein, Abraham Lincoln, Claude Monet, Ignatius de Loyola

The best advice I ever received was: Always Be Present.

My hobby is: Gardening, Travel

My passion is: Experiencing life with fascinating people.

My pet peeve is: Having to wait for coffee to be brewed at Starbuck’s.

A perfect day is: When I am challenged to learn something new.

Cats or dogs? Either are nice to visit.

E-book or hardback? Depends on the day, but loving my Kindle more.

Beach or mountains? Beach

I wish I could: Have more time to be outdoors.

Only my friends know: How much I love chocolate, and do need time to be alone.

My favorite saying is: No good deed goes unpunished!

Return to TRENDS September 2018

FULFILLING A QUEST FOR PATIENT-CENTERED CARE

John Colbert

September 25, 2018

Trends Archives

Much emphasis is placed today on the importance of putting patients first as exemplified by the common use of related terms, such as patient-centered care and shared decision-making. Application of these terms represents worthy objectives. Repeated often enough, however, such language may be equivalent to the reification of a metaphor, with the implication that objectives are being fulfilled satisfactorily, while the reality of the actual situation may suggest otherwise.

Patient-centered care is a term highlighted when the Patient Protection and Affordable Care Act (PPACA), more popularly known as Obamacare, became law in March 2010. A new care model in the form of Patient-Centered Medical Homes (PCMH) and establishment of a Patient-Centered Outcomes Research Institute (PCORI) were created by that landmark piece of legislation. Regarding the former, a declared outcome by the American Academy of Pediatrics in 2002 for the 21st century was that “every child deserves a medical home.” Although for more than a decade efforts to improve the health care experiences and outcomes of high-risk pediatric populations have centered on the redesign of health care settings to deliver PCMH care, results show that more work is needed to reach fruition.

According to an article published in the October 2018 issue of the journal Medical Care, just over one-third of children with special health care needs reported experiencing PCMH concordant care and there was high variation across components. Disparities in access to PCMH care also were significant from the perspective of children’s demographic characteristics, with minority children faring worse in access to this care compared with their white counterparts.

Although they do not always agree on bracketed years, demographers find utility in generating population categories based on age, producing the following kinds of groups by birth year: Post-War Cohort (1928-1945), Baby Boomers (1946-1964), Generation X (1965-1979), Millennials (1980-1994), and Generation Z (1995- 2015). Health professionals also may benefit to some degree as a result of this taxonomy by seeking and acquiring greater knowledge about and increased sensitivity toward members of these groups from the standpoint of being able to provide more appropriate, targeted kinds of care for them.

Regardless of age bracket, shared characteristics cut across each classification, such as religiosity, adherence to prescribed treatment, and patient resilience. Also, within each group, members can be differentiated on the basis of their individual outlook, how they experience pain, reliance on family support, and desire to return to a pre-health problem stage involving employment or leisure activities.

A particularly important attribute is affective behavior consisting of verbal and non-verbal displays of emotion, mood, and other feeling states that contribute to impression formation when patients and their health care givers interact with one another. Differences stemming from age, gender, and race/ethnicity may play a decisive role in determining just how effective that interaction will prove to be.

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SOCIAL SECURITY AND PAYING FOR HEALTH CARE

John Colbert

August 27, 2018

Trends Archives

As guaranteed pension plans continue to disappear in the lives of most workers, many retirees will rely heavily on Social Security monthly payments. Numerically, the ranks of the so-called “Baby Boomer” generation reaching the age of 65 increase by an average 10,000 individuals every day, a growth spurt that will continue over a 19-year period that began on January 1, 2011. The Social Security program assumes great importance in the lives of patients who rely on Medicare to address their health care wants and needs.

Participation in Medicare can entail high out-of-pocket costs for some beneficiaries that relate to the nature of their health problems. Approximately one in five Medicare beneficiaries has serious physical or cognitive limitations that require personal care services and supports. A March 2017 report from the National Center for Health Statistics (NCHS) examines health care access and utilization among adults with multiple chronic conditions (MCC). As the number of these conditions increases, the health care costs for those so diagnosed also will grow. The program is expensive and money is spent unevenly: 10% of enrollees represent 63% of expenditures. The 5% who die each year account for 30% of costs, often involving intensive care that prolongs life with no hope of recovery.

The adequacy of retirement income – from Social Security benefits and other sources – can be reduced quite substantially by personal health care expenditures. As reported in a study published in October 2017 by the Center for Retirement Research at Boston College, data for the period 2002-2014 were used to calculate post-out-of-pocket benefit ratios, defined as the share of either Social Security benefits or total income available for non-medical spending. The results show that average out-of-pocket spending (excluding long-term care) was $4,274 per year in 2014, with approximately two-thirds ($2,965) spent on premiums.

In 2014, the average retiree had only 65.7 percent of Social Security benefits remaining after this spending and only 82.2 percent of total income. Nearly one-fifth (18 percent) of retirees had less than 50 percent of their 2014 Social Security income remaining after out-of-pocket spending, with six percent of retirees falling below 50 percent of total income. A conclusion drawn from this analysis is that with less than two -thirds of Social Security benefits available for non-medical consumption, and limited income outside of Social Security for much of the aged population, many retirees likely feel that making ends meet is difficult. Meanwhile, Medicare spending per beneficiary is expected to resume its decades-long rise by the end of the present decade, which will exert even more pressure on retirees’ budgets.

A shortfall in Social Security financing poses a significant challenge for policymakers. The Medicare program also is on a short financial leash since its trust fund rapidly is running dry. Alternatives for shoring up these two sets of accounts are not pleasant to contemplate because they entail some mixture of either lowering annual benefit levels or imposing higher tax rates. Finding remedies for certain problems can be deferred for only so long. Eventually, Congress will be compelled to tackle them. No option exists in shifting a portion of the burden to the states. Many of them have crises in the form of significantly underfunded pension and health benefit systems for current and future retired public service employees.

return to trends july - august 2018

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

August 27, 2018

Trends Archives

Matching Patients And Their Records
Despite widespread adoption of electronic health records and increasing exchange of health care data, the benefits of interoperability and health information technology have been hampered by the inability to match patients and their records reliably. The Pew Charitable Trusts contracted with the RAND Corporation to investigate "patient-empowered" approaches to record matching — solutions that have some additional, voluntary role for patients beyond simply furnishing demographics to their health care providers — and to select a promising solution for further development and pilot testing. A report recommends adopting a three-stage approach that aims to: improve the quality of identity information; establish new smartphone app functionality to facilitate bidirectional exchange of identity information and health care data between patients and providers; and create advanced functionality to improve value further. The report also suggests that because the solution contains multiple components involving diverse stakeholders, a governance mechanism likely will be needed to provide leadership, track pilot tests, and evaluation, along with convening key parties to build consensus where consensus is needed. The report can be obtained at https://www.rand.org/pubs/research_reports/RR2275.html.

Reasonable Patient Care Under Uncertainty
An article published on August 2, 2018 in the journal Health Economics discusses how limited ability to predict illness and treatment response may affect the welfare achieved in patient care. The discussion covers both decentralized clinical decision-making and care that adheres to clinical practice guidelines. The author explains why predictive ability has been limited, calling attention to questionable methodological practices in the research that supports evidence‐based medicine. Research is summarized on identification whose objective is to yield credible prediction of patient outcomes. Recognizing that uncertainty will continue to afflict medical decision making, basic decision theory is applied to suggest reasonable decision criteria with well‐understood welfare properties. The article can be obtained at https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.3803.

Patient-Centered Medical Homes And Accountable Care Organizations
Patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) often were considered to be competing models for reforming health care delivery. It increasingly has become apparent, however, that one helps the other, according to the main finding from the new Patient- Centered Primary Care Collaborative (PCPCC) 2018 evidence report, “Advanced Primary Care: A Key Contributor to Successful ACOs,” the first study of its kind to look at how the role of advanced primary care, such as the PCMH, may contribute to the success or failure of ACOs. While these two leading models are transforming health care delivery and payment, little research has been done on how these models interact to promote lower costs and better quality for populations. Using qualitative and quantitative methods, researchers at the Robert Graham Center and IBM Watson Health found that: The attributes of successful ACO’s are necessary to transform the practice of primary care, successful ACO’s are more likely to be built on the basis of high- quality primary care, Medicare ACOs with a higher proportion of PCMH primary care physicians were more likely to generate savings, and Medicare ACOs with a higher proportion of PCMH primary care physicians demonstrated higher quality scores, including on a significant number of process and outcome measures. The report was published with support from the Milbank Memorial Fund for the fifth time. The document can be obtained at https://www.milbank.org/wp-content/uploads/2018/08/advanced_primary_care_report_080118.pdf.

return to trends july - august 2018

More Articles from TRENDS October 2018

MICROBIOME’S OMNIPRESENT UNSEEN GUESTS

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

REFLECTIONS ON AN EXPERIMENT IN DEMOCRACY

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

GENDER PEER EFFECTS IN DOCTORAL STEM PROGRAMS

More Articles from TRENDS October 2018

MICROBIOME’S OMNIPRESENT UNSEEN GUESTS

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

REFLECTIONS ON AN EXPERIMENT IN DEMOCRACY

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY