BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

The political realm has long served as a venue for conflict among individuals and groups with widely different opinions on important public policy issues. A new study indicates that the worksite is not immune to the expression of opposing points of view. As noted in the results of a study published in the August 2019 issue of the journal Stress & Health, the workplace is an environment where individuals have little choice about with whom they interact. As such, employees may find themselves engaged in conversations with co-workers whose political opinions and perspectives are divergent from their own. The investigation examined how co-workers' dissimilarity in political identity is related to the quality of their interpersonal interactions and subsequent well‐being. The authors predicted that political identity dissimilarity is associated with experiences of workplace incivility and, in turn, declines in psychological and occupational well‐being. Hypotheses were tested in a four‐wave survey study conducted during the 2012 U.S. presidential election. The results indicated that political identity dissimilarity was associated with increased reports of incivility experiences instigated by co-workers, which in turn, was associated with increased burnout and turnover intentions and diminished job satisfaction. Several practical implications for organizations are offered in the manuscript.

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index

A small number of hospitals in many U.S. metro areas increasingly are seeing most of the country’s hospital admissions. Some 67% of U.S. metro areas, 75 cities and towns, had high concentrations of hospitals in 2012, but those figures increased by 2016. That year, some 81 metro areas had high concentrations of health care facilities. Rural areas tended to have more patients who sought their care from only a few hospitals. Health care spending in the United States is increasing and accounts for nearly 18% of U.S. economic activity. According to a new report from the Health Care Cost Institute, while policymakers continue to explore the contributors to this phenomenon at the national level, differing local trends add complexity, but critical detail, to the picture of how health care dollars are spent across the country. Investigators analyzed more than 1.8 billion health care claims for individuals with commercial insurance from 2012 to 2016. They computed measures of health care service prices and use, and other measures such as provider market structure for 112 local areas in 43 states. They found that not only did spending trends and drivers vary substantially across metro areas, they varied within metro areas when data were segmented into categories like inpatient, outpatient, and physician services. In summary, each metro had a different experience. The report can be obtained here.

Reducing Inequities In Healthy Life Expectancy

A September 2019 brief from the Urban Institute is one of an eight-part Catalyst series indicating what it would take to advance bold solutions over the next 50 years. Across the country, health care providers and public, private, and nonprofit payers are exploring solutions to help individuals meet their health-related social needs, particularly among Medicaid enrollees. Along the way, they are generating new insights and raising critical questions about what works. The brief highlights five bold approaches that could narrow inequities in health outcomes and healthy life : (1) Assess health-related social needs, (2) Build community resource networks, (3) Incentivize investments in non-medical services with health payoffs, (4) Provide sustainable financing, and (5) Align organizational policies and activities. Based on conversations with innovative thinkers and doers, three areas also were identified where today’s health care payers, plans, and providers need new data and analysis to accelerate promising solutions for improving health equity by better addressing individuals’ health-related social needs. They are: (1) Identify high-priority social needs, (2) Build an actionable evidence base of proven interventions, and (3) Assess strategies for integrating health, social services, and other systems. The brief can be obtained here.

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

On April 26, 2019, the Board on Population Health and Public Health Practice of the National Academies of Science, Engineering, and Medicine held a public workshop to explore the potential effects of addressing non-medical, health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system. The presentations and discussions highlighted in this Proceedings of a Workshop provide a general discussion of the issues, trends, and the opportunities and challenges of investing in interventions that address patients’ non-medical, health-related social needs. The Proceedings can be obtained here.

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

A Data Brief from the National Center for Health Statistics (NCHS) in September 2019 indicates that the average age-adjusted death rate for the five states (AL, KY, MS, OK, WV) with the highest rates (926.8 per 100,000 standard population) was 49% higher than the rate for the five states (CA, CT, HI, MN, NY) with the lowest rates (624.0). Age-specific death rates for all age groups were higher for the states with the highest rates compared with the states with the lowest rates. Age-adjusted death rates were higher for non-Hispanic white and non-Hispanic black populations, but lower for the Hispanic population in states with the highest rates than in states with the lowest rates. The age-adjusted death rates for chronic lower respiratory diseases and unintentional injuries for the states with the highest rates (62.0 and 65.5, respectively) were almost doubled compared with the states with the lowest rates (31.0 and 35.8).

Comparing Retail Clinics With Other Sites Of Care

According to an article published in the September 2019 issue of the journal Medical Care, with primary care transforming from care delivered exclusively in a physician's office to care that can be delivered in multiple sites and through different means, such as virtually and in retail settings, it is important to critique what is being gained from this primary care transformation and what, if anything, is being lost. For instance, entrepreneurs, policymakers, and officials at pharmacy and hospital chains may believe that the retail clinic model of primary care should include complex service delivery. Yet, the current body of research does not furnish enough information about whether this belief is founded in reality. As long as much of what is known for evaluating retail clinic care involves proprietary data controlled by advocates of retail clinics, uses more simplistic assessments of cost and quality, and leaves out the patient experience, there remains much that is unknown about this type of primary care.

HEALTH TECHNOLOGY CORNER

The Use of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

An article published on August 28, 2019 in the journal Science Robotics describes the development by Massachusetts Institute of Technology engineers of a magnetically steerable, thread-like robot that actively can glide through narrow, winding pathways, such as the labrynthine vasculature of the brain. In the future, this robotic thread may be paired with existing endovascular technologies, making it possible to guide the robot remotely through a patient's brain vessels to treat blockages and lesions quickly, such as those that occur in aneurysms and stroke. The latter is the number five cause of death and a leading cause
of disability in the United States. If acute stroke can be treated within the first 90 minutes or so, researchers believe that patients' survival rates could increase significantly. A hope is that designing a device to reverse blood vessel blockage within a so-called “golden hour” potentially could result in the avoidance of permanent brain damage.

The Use Of “Phyjamas” In Health Care

The Ubicomp 2019 Conference on September 11-13, 2019 in London featured a presentation by researchers at the University of Massachusetts, Amherst who developed physiological-sensing textiles that can be woven or stitched into sleep garments they have dubbed "phyjamas." They designed a new fabric-based pressure sensor and combined that with a triboelectric sensor, one activated by a change in physical contact, to develop a distributed sensor suite that could be integrated into loose-fitting clothing like pajamas. They also developed data analytics to fuse signals from many points that took into account the quality of the signal arriving from each location. They report that this combination allowed them to detect physiological signals across many different postures. By performing multiple user studies in both controlled and natural settings, they showed that they can extract heartbeat peaks with high accuracy, breathing rate with less than one beat per minute error, and predict sleep posture perfectly.

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

DEVELOPMENTS IN HIGHER EDUCATION

What transpires in the nation’s capital can have dramatic effects on higher education institutions. An example is the amount of federal funding that is directed to these entities annually. A segment of higher education that is in the spotlight as the government’s current fiscal year ends at the close of September 2019 consists of historically black colleges and other minority-serving institutions. Passed by the U.S. House of Representatives, H.R. 2486 must be taken into consideration by the Senate. The purpose of this legislation is to reauthorize $255 million of mandatory funding each year for programs under Title III of the Higher Education Act, which provides grants to historically black colleges and other institutions that enroll a large share of minority students.

These programs also receive discretionary funding from Congress each year, but the mandatory add-on funding expires on September 30. Officials at the Department of Education have indicated that there are plans to carry over unused mandatory funds from the current fiscal year into future years, so that many existing grants would remain in effect regardless of whether the funding stream expires.

Finalizing Stricter Rules For Student Loan Fraud Claims

An overhaul of rules known as “borrower defense to repayment” is in the process of being officially finalized this month. The purpose of the new policy is to set a more stringent standard for when the government will eliminate the debt of borrowers who claim they were misled or deceived by their institution. A notable example occurred during the Obama Administration when rules were written following the collapse of the for-profit college company Corinthian Colleges in 2015, which resulted in tens of thousands of former students sending requests to the Department of Education for loan forgiveness. Currently, the backlog of existing "borrower defense" claims exceeds 170,000 applications, but the Department has not taken any action on these claims in more than one year.

Education Department Secretary Betsy DeVos has stated that fraud in higher education will not be tolerated by the Trump Administration, adding that the final rules include carefully crafted reforms that hold colleges and universities accountable, and treat students and taxpayers fairly. An expectation is that these newer more strict standards will result in the Department approving fewer borrower defense claims, thereby reducing the amount of loan forgiveness by an estimated $512 million per year. The entire package of regulations, which also curtails loan discharges for students whose schools suddenly close, is projected to save taxpayers more than $11 billion over the next decade.

The new rules are designed to allow borrowers to have their loans forgiven if they can show their institution in a misrepresentation, but they must prove additional elements demonstrating that they relied on the college's misrepresentation and also must document financial harm more extensively. Another major change is a requirement that borrowers apply for loan forgiveness within three years of leaving school. Opponents of the rules are expected to mount legal challenges.

Trends In Ratio Of The Pell Grant To Total Price Of Attendance And Federal Loan Receipt

A new Data Point issued in August 2019 by the U.S. Department of Education is based on figures from four iterations of the National Postsecondary Student Aid Study (NPSAS), a large, nationally representative sample survey of students that focuses on how they finance their postsecondary education. An emphasis is on the percentage of total price of attendance covered by Pell Grants and the percentage of Pell Grant recipients who received federal student loans for academic years 2003–04, 2007–08, 2011–12, and 2015–16. Overall, the percentage of total price of attendance (tuition and fees, plus the cost of room and board, books and supplies, transportation, and personal expenses) covered by Pell Grants has remained consistent for selected years between 2003–04 and 2015–16, with the exception of 2007–08. The percentage of total price of attendance covered by Pell Grants was lower in 2007–08 (20%) compared to the 24% covered in all other years (2003–04, 2011–12, and 2015–16). These grants covered more of the total price of attendance for students at public 2-year institutions compared to public 4-year institutions, private nonprofit 4-year institutions, and private for-profit institutions in all selected academic years be- tween 2003–04 and 2015–16.

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

HEALTH REFORM DEVELOPMENTS

The U.S. Census Bureau on September 10, 2019 released a report on Health Insurance Coverage In The United States: 2018. It revealed that in 2018, 8.5% of individuals, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9% or 25.6 million). The percentage of beneficiaries with health insurance coverage for all or part of 2018 was 91.5%, lower than the rate in 2017 (92.1%). Between 2017 and 2018, the percentage with public coverage decreased 0.4 percentage points, and the percentage with private coverage did not statistically change. In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3% of the population and 34.4% of the population, respectively. Of the subtypes of health insurance coverage, employer-based insurance remained the most common, covering 55.1% of the population for all or part of the calendar year.

Health insurance coverage is related to the highest level of education attained. Individuals with higher levels of educational attainment are more likely to have health insurance coverage than those with less education. In 2018, 96.6% of the population aged 26 to 64 with a graduate or professional degree had health insurance coverage, compared with 93.8% of the population with a bachelor’s degree, 85.1% of high school graduates, and 71.0% of the population with no high school diploma. Income is another contributing factor in coverage differences. In 2018, individuals in households with lower income had lower health insurance coverage rates than residents of households with higher income. In 2018, 86.2% of those in households with an annual income of less than $25,000 had health insurance coverage, compared with 96.8% of individuals in households with income of $150,000 or more. Inhabitants of households with lower income also had lower rates of private coverage and higher rates of public coverage. Children living in the south are more likely than children living in other parts of the nation to be without health insurance, and Hispanic children are more likely than children of other ethnicities to be uninsured.

Questions Pertaining To Enactment Of Proposed Medicare For All Legislation

Democrats competing to be the nominee by their party in the 2020 presidential election have expressed great enthusiasm for the enactment of proposed Medicare For All legislation. If such a law ever becomes a reality, its advantages include free coverage of benefits for all residents of the U.S. Not especially clear at this juncture, however, is how enough revenue will be generated to pay for such an expansion. Another issue worthy of consideration is how the Medicare program as it currently exists might undergo modification.

One aspect in particular is the Medicare Advantage Program. All baby boomers will be older than age 65 by the year 2030. Because one in every five residents will be at retirement age, Medicare enrollment can be expected to grow. By way of background, Medicare Advantage, the public-private health plan option available to Medicare beneficiaries, presently furnishes coverage for more than 22 million individuals, representing greater than one-third of all participants in Medicare. The Congressional Budget Office (CBO) estimates that current enrollment in Medical Advantage will increase to 29 million by the year 2025. A report from the Centers for Medicare & Medicaid Services in September 2018 indicates that 99% of Medicare beneficiaries have access to at least one Medicare Advantage Plan. The firm Avalere Health estimates that Medicare Advantage beneficiaries have higher rates of clinical and social risk factors than Traditional Medicare beneficiaries: 64% are more likely to be enrolled in Medicare due to disability, 57% have a higher rate of mental illness, and 16% have higher rates of alcohol/drug/substance abuse.

Assuming that existing Medicare is unaffected by the outcome of the 2020 election, as more beneficiaries switch from Traditional Medicare into Medicare Advantage, plans can be expected to become an increasingly important driver of a quest for high-quality care. If Medicare For All becomes a reality instead, whether private insurance coverage will continue to exist remains an open question. If so, plans, providers, community partners, beneficiaries, and policymakers are going to have to cooperate in figuring out how to support current efforts and build new opportunities to improve beneficiary health and quality of life.

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

AVOIDING A GOVERNMENT SHUTDOWN

In a typical year, legislators find it to be extremely difficult to agree on 12 appropriations bills. The current fiscal year ends on September 30. Assuming that not all of these pieces of legislation have been signed into law by that date, a remedy exists in the form of continuing resolutions (CRs). One possibility could be to produce a CR to avoid a federal government shutdown at the end of the fiscal year (FY) on September 30. Such a short-term spending bill might, for example, extend current government funding into late November or early December.

Having left Capitol Hill for most of August, elected officials returned in September with the Senate Appropriations Committee approving spending allocations for all 12 subcommittees, along with Defense and Energy and Water Development spending bills by a party line vote of 16-15. While appropriators had planned to vote on the Labor, Health and Human Services (Labor-HHS) bill and State-Foreign Operations bills, proceedings had to be postponed because of abortion-related disputes regarding Title X grant funding. Disagreements over the topic of abortion have a long history of serving as a major impediment to reaching agreement.

The 302(b) top-line spending caps for FY 2020 were decided without input from House appropriators, who already have advanced the majority of their panel’s spending bills. Labor-HHS, which includes Education, will receive $187.7 billion, a $200 million amount that constitutes only a 1% increase over FY 2019 levels.

Regardless of party affiliation, it is quite likely that continued efforts will be made to deal with the problem of high pharmaceutical prices. The soaring cost of insulin offers a stark example of exorbitant drug pricing. More than 100 million individuals are either diabetic or pre-diabetic. Although the drug was invented in 1922, its inflated-adjusted per unit price has at least tripled between the 1990s and 2014. In the U.S., insulin costs per patient have nearly doubled from 2012 to 2016 ($2,864 vs $5,075). High prices of this nature are driving up health insurance premiums and creating unaffordable costs for patients.

Proposed solutions vary between Democrats and Republicans. House Speaker Nancy Pelosi (D-CA) is preparing to issue a plan to lower drug prices by directing the U.S. Department of Health and Human Services (HHS) Secretary to negotiate the prices of the 250 drugs that are most expensive to Medicare each year and that lack competition of at least two other generic drugs, biologics, or biosimilars. Pharmaceutical manufacturers that do not negotiate or are unable to reach an agreement with the government would face a 75% penalty of the gross sales of the drug from the previous year. Other purported features include that lower drug prices would apply to both Medicare and private insurers, and that savings resulting from the lower-priced drugs would be directed to the National Institutes of Health (NIH) for the development of new drugs and treatments. The legislation also proposes a $2,000 cap on Medicare beneficiary out-of-pocket spending starting in 2022.

Meanwhile, a more moderate alternative by Republicans has emerged from the Senate Finance Committee that would require manufacturers to issue rebates to the Medicare program if prices rise faster than inflation.

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

By Susan N. Hanrahan, ASAHP President

Time is really going way too fast!!! Our Annual Conference is right around the corner. I sure hope you are able to attend. This should be a good one.

We have continued to highlight Conference plenary speakers and other activities in our newsletters. I would like to point out that four “of our own” will be speaking at plenary sessions this year, including Dr. Randy Lambrecht, who is now President of the Aurora Research Institute and System VP of Advocate Aurora Health, Dr. Lisa Saladin, Provost and EVP for Academic Affairs at Medical University of South Carolina, Dr. Pat Walker, Dean Emeritus at Sacred Heart University, and Dr. Susan Cashin who is the Director of the Office of Performance Analytics at the University of Wisconsin-Milwaukee.

Also representing one of our member institutions will be Dr. Mitchell Scheiman who is the Dean of Research at Salus University who will be delivering the Switzer Lecture. Provost Lori Gonzalez of the University of Tennessee Health Science Center will be back to serve on a leadership panel entitled Recruiting Strategies and Challenges that will be held Friday morning so we will be excited to see her again. There are MANY other esteemed speakers plus all of the poster and concurrent session presentations. It will be a great time.

The Business Meeting will actually host the Association Awards this year since we are “boating” on our usual awards evening. Please plan to attend because you will get updates on a number of activities and also be able to bring new business items at the end of the meeting when we will open it up for a “town hall” discussion. Be thinking of things you might want to chat about. Phyllis King, our President Elect, will also be sharing some highlights for her two-year term as president.

The Institutional Profile Survey has gotten some new “enhancements” based on your feedback and is about ready for its second data collection release. The first aggregated data report from our new survey is ready for its “reveal” and will be appearing in the boxes of those that completed the survey. So, if you did not fill out the survey and want the data next time, please take time to fill out the IPS when it is released to our member institutions. If you have questions on this, please ask myself or Kristen in the ASAHP office.

Lastly, you have received a Bylaws notice for a name change of our association. This has been a topic of conversation over the 25 years I have been an ASAHP member. The BOD discussed this in their summer 2018 meeting and in summer 2019 made a decision to offer you a name change. We will keep the ASAHP acronym and literally replace the word “allied” with “advancing.” Since we are educating the health workforce for the 21st Century, it is a very appropriate and timely change. I hope you will vote yes.

My last note to you as President will come after the Annual Conference. See you there!! Susan Hanrahan, President

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Now that debates are well underway involving candidates who seek to be the Presidential nominee in the 2020 election, the word existential has been associated with a claim that climate change poses such a threat. One view of existentialism is that it represents an effort by individuals to construct meaning out of a world characterized by chaos and uncertainty. The realm of health care may be viewed as offering a suitable template for a cursory exploration of how it happens to be influenced by the term uncertainty.

Attention was drawn to this matter in a paper appearing in the October 2019 issue of the Journal of Patient Education and Counseling. The authors’ contention is that uncertainty in health care is an extremely important, but incompletely understood phenomenon. They argue that improving an understanding of the many important aspects of uncertainty in health care will require a more systematic program of research based upon shared, integrative conceptual models and active, collaborative engagement of the broader research community.

Uncertainty not only may be considered an essential facet of human life and an integral problem of health care. It is the single, common challenge faced by every patient who receives health care and every clinician who provides it, along with administrators, payers, policymakers, and researchers who deliver, finance, regulate, and study it. In every one of these diverse activities undertaken by different actors, uncertainty of one form or another—arising from various sources, pertaining to any number of relevant issues, and formed and reformed through communication—provides the call to action, and provokes a variety of different responses.

At the level of patient-provider interactions, diagnostic misclassifications and errors can result in treatment that is inappropriate and harmful. Moreover, patients may be plagued by doubts and uncertainties about their ability to remain employed, have satisfactory health insurance coverage, and be able to meet out-of-pocket costs for health care. Medicare for All proposals by political candidates raise concerns regarding whether reimbursement policies will suffice to meet the costs experienced by clinicians and facilities, such as rural hospitals. Policymakers also are faced with the quandary of coping with the task of figuring out how to provide free health care without simultaneously necessitating a huge spike in taxation.

Studies that focus explicitly on uncertainty have grown in number and diversity, but the growth is not systematic because the research has developed organically, in an uncoordinated, piecemeal fashion. Developing a more systematic approach to uncertainty in health care has the potential to improve the clinical communication of uncertainty by providing health professionals with a coherent, comprehensive understanding of the uncertainties that arise in different circumstances, the diversity of responses to these uncertainties, the various approaches to communicating uncertainty, and the many competing goals of doing so. A positive end product of enhancing this field of research could be a more comprehensive, rational, deliberate approach to communicating and managing uncertainties.

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

• Comparing Retail Clinics With Other Sites Of Care

• The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

• The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Hospital Concentration Index

• Reducing Inequities In Healthy Life Expectancy

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

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

ASSESSMENT OF ADULT COMPETENCIES

Apropos of the previous item on patient-provider communication is the issue of adult literacy. The National Center for Education Statistics (NCES) on July 2, 2019 released information about the Program for the International Assessment of Adult Competencies (PIAAC), a large-scale global study of working-age adults (ages 16–65) that assesses adult skills in three domains (literacy, numeracy, and digital problem solving) and collects information on adults’ education, work experience, and other background characteristics. Data summarize the number of U.S. adults with low levels of English literacy and describe how they differ by nativity status and race/ethnicity. PIAAC reports five literacy proficiency levels: from below level 1 to level 4/5. Adults with low levels of literacy are defined, consistent with international reports (OECD 2013), as those performing on PIAAC’s literacy assessment at “level 1 or below” or those who could not participate in the survey.

Four in five U.S. adults (79%) have English literacy skills sufficient to complete tasks that require comparing and contrasting information, paraphrasing, or making low-level inferences, literacy skills at level 2 or above in PIAAC. In contrast, one in five U.S. adults (21%) has difficulty completing these tasks, which translates into 43.0 million U.S. adults who possess low literacy skills: 26.5 million at level 1 and 8.4 million below level 1, while 8.2 million could not participate in PIAAC’s background survey either because of a language barrier or a cognitive or physical inability to be interviewed. Adults classified as below level 1 may be considered functionally illiterate in English.

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

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

An article published in the July 2019 issue of the journal Cambridge Quarterly of Healthcare Ethics discusses how empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements. For example, in the context of a serious illness, a physician might say, “This is a treatable condition,” or “We have treatments for your loved one.” Although in this particular instance, the emphasis is on the doctor-patient relationship, it is not difficult to imagine how interactions of a similar nature occur regularly between members of the allied health professions and the patients whom they treat.

A suitable venue to explore this phenomenon would be a rehabilitation center. Patients arrive there after the occurrence of traumatic brain injuries, various kinds of cancer, heart disease, stroke, and injuries sustained in falls and accidents, to mention just a handful of problems that necessitate long-term treatment. Usually, teams involving physicians and nurses from different specialties and allied health personnel (e.g., physical therapists, occupational therapists, respiratory therapists, and speech-language pathologists) work in sync with one another to address the many ailments that can affect patient well-being. It clearly is in the best interest of patients and their caregivers to begin their interactions on a positive note by recognizing that treatment interventions can produce salubrious outcomes. A key ingredient in achieving success is to foster patients’ resilience by encouraging them to maintain a belief that all the effort and time they must devote to becoming healthier are worth such an investment of personal stamina, combined with a willingness to continue undergoing treatment.

As the journal article points out, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, although this result may not be intended by physicians. A radical divergence in understandings may lead to severe instances of miscommunication, a situation that can arise from the lack of shared experience between practitioners and patients accompanied by differing assumptions that each party makes. Thus, apart from the laying on of professional hands, it is incumbent on the part of caregivers to pay close attention to the quality of communication that occurs with patients. Informed consent and shared decision-making are two aspects of this process that can play a definitive role in improving an agreed-upon understanding of everything that treatment statements actually entail.

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

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

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

On April 26, 2019, the Board on Population Health and Public Health Practice of the National Academies of Science, Engineering, and Medicine held a public workshop to explore the potential effects of addressing non-medical, health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system. The presentations and discussions highlighted in a Proceedings of a Workshop were released on August 19. They provide a general discussion of the issues, trends, and opportunities and challenges of investing in interventions that address patients’ non-medical, health-related social needs. While health care services are essential to health, there is growing recognition that social determinants are important influences on population health. Supporting this notion are estimates that while health care accounts for some 10-20% of the determinants of health, socioeconomic factors and factors relating to the physical environment are estimated to account for up to 50%. Challenges at the individual level include housing quality, food insecurity, limitations in access to transportation, and lack of social support. The Proceedings can be obtained here.

Joint Commission Educational Campaign On Preventing Falls

The Joint Commission in July 2019 debuted its new Speak Up to Prevent Falls campaign featuring free, downloadable educational materials in English and Spanish to help educate patients and their health care providers on how to avoid unnecessary falls. Ready-made, easy-to-read resources include: an infographic poster/flyer for patients and their families, an animated video to incorporate in hospital programming, and a distribution guide with recommendations on how health care organizations can use and distribute the materials to patients and their families, caregivers, and advocates. Hundreds of thousands of patients fall in hospitals every year and 30-50% of these patients sustain an injury. Between 50-75% of elder patients suffer from a nursing home fall each year. Of these multiple falls: one out of five cause a serious injury such as broken bones or head injury, with the overall average cost for a fall injury totaling about $14,000. Speak Up to Prevent Falls outlines how to prevent falls and offers four primary areas of direction that patients, their caregivers, and advocates can follow to prevent the risk of falls. More information about the program can be obtained here.

A New Proposed Fix For Long-Term Care

As Americans live longer, more and more families are caring for older adults and facing tough financial circumstances that give rise to a bigger question: How will this nation care for a growing number of older individuals with complex needs once they can no longer take care of themselves? So far, there is not any good answer. With smaller families and half reporting no savings at all, many 60-year-olds simply don’t have the necessary resources to pay for the care they will need during the additional 23 years they are expected to live. Refusing to continue to be stymied by this vexing issue, as a means of answering that important question, Milbank Memorial Fund President Christopher Koller and John A. Hartford Foundation President Terry Fulmer in a paper published on June 25, 2019 highlight an innovation in Washington state that merits national attention. Washington Governor Jay Inslee signed a first-in-the-nation bill to help finance the long- term care needs of all the state’s residents. It’s a solution that may provide a template for other states, and possibly the federal government. New public policies are needed because the private market has failed. Long-term care insurance tends to be highly expensive and has limited benefits. In 2016, of the 89 million individuals in the United States over age 55, only about seven million were covered by long-term care policies and far fewer are buying new policies now than they used to do so previously. The paper can be obtained here.

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

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

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

The updated 2018 Physical Activity Guidelines (PAG) for Americans reaffirmed key recommendations regarding aerobic activity in the 2008 edition and recently introduced health risks of sedentary behaviors and their association with physical activity. Time spent on sedentary behavior significantly increased over time from a weighted mean (SE) of 5.7 (0.3) hours per day in 2007-2008 to 6.4 (0.2) hours per day in 2015- 2016 (P < .001 for trend). The weighted proportion of individuals not adhering to the PAG for aerobic activity and reporting long sedentary time (>6 hours per day) increased from 16.1% (95% CI, 14.4%- 17.8%) in 2007-2008 to 18.8% (95% CI, 17.7%-20.0%) in 2015-2016. The findings suggest that the adherence rate to the PAG for aerobic activity in US adults has not improved since the release of the first edition in 2008, but that time spent on sedentary behavior has significantly increased over time. Further nationwide efforts appear to be warranted not only to promote physical activity, but also reduce sedentary time in the United States.

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

A Data Brief from the National Center for Health Statistics (NCHS) in July 2019 indicates that from 1999 through 2017, the age-adjusted unintentional injury death rate increased 40% from 35.3 deaths per 100,000 standard population to 49.4. Motor vehicle traffic death rates increased across all levels of urbanization between 2014 and 2017, with the largest increase in small metropolitan (metro) counties. Unintentional drug overdose death rates increased across all levels of urbanization between 2014 and 2017, with the largest increase in large fringe metro counties. Unintentional fall death rates increased across urbanization levels except for large central metro counties between 2014 and 2017, with the largest increase in rural counties. Unintentional injury is a leading cause of death in the United States. As with many other prominent causes of deaths involving cancer, cardiovascular disease, and suicide, behavior plays a significant role in generating these unfavorable outcomes.

HEALTH TECHNOLOGY CORNER

Achieving Better Health Care Integration Of Radiology

An article published online July 9, 2019 in npd Digital Medicine indicates that although radiology images and reports have long been digitalized, the potential of the more than 3.6 billion radiology examinations performed annually worldwide has largely gone unused in the effort to transform health care. The Bionic Radiologist is a concept that combines humanity and digitalization for better health care integration of radiology. At a practical level, this concept will achieve critical goals: (1) testing decisions being made scientifically on the basis of disease probabilities and patient preferences; (2) image analysis done consistently at any time and at any site; and (3) treatment suggestions that are linked closely to imaging results and are integrated seamlessly with other information. To achieve this potential, barriers that must be overcome include: reluctance to delegate decision making, a possible decrease in image interpretation knowledge, and the perception that patient safety and trust are at stake.

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

A study published on August 5, 2019 in the journal ACS Applied Materials and Interfaces describes engineering the first thread-based transistors (TBTs), which can be fashioned into simple, all-thread based logic circuits and integrated circuits. Electronic devices are made entirely of thin threads that could be woven into fabric, worn on the skin, or even (theoretically) implanted surgically for diagnostic monitoring. Fully flexible electronic devices could enable a wide range of applications that conform to different shapes and allow free movement without compromising function. "Soft" electronics are enabling applications for devices that conform and stretch with the biological tissue in which they are embedded, such as skin, heart, or even brain tissue. Compared to electronics based on polymers and other flexible materials, thread-based electronics have superior flexibility, material diversity, and the ability to be manufactured without the need for clean rooms.

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

DEVELOPMENTS IN HIGHER EDUCATION

Unlike other portions of the higher education sphere, the health sciences are shielded from criticism about the declining value of spending money and devoting the amount of time necessary to obtain a college degree. A steady growth in the U.S. population accompanied by increases both numerically and proportionately of individuals age 65 and older, a group that generates a considerable amount of demand for health care services, means that the nation must continue to address the challenge of producing enough adequately prepared personnel to meet patient needs.

Higher education costs remain high for many students and their families. Some individuals might begin the pursuit of a college degree, but never complete what is necessary and they end up leaving school without that credential, but not without a large amount of debt that must be repaid. Unless their education is linked directly to specific job prospects, such as health care, questions have been raised about the wisdom of pursuing such an educational goal in the first place. An alternative in the form of vocational education has been receiving some attention lately.

As a reflection of that emerging interest, Senator Josh Hawley (R-MO) on July 16 of this year introduced the Break the Higher Education Monopoly Act of 2019 (S. 2123) and the Skin in the Game Act (S. 2124). S. 2123 would amend the Federal Pell Grant program to allow job training and apprenticeship programs to be eligible for Pell Grants. The bill directs the U.S. Department of Education Secretary to devise an alternative certification program that would not require accreditation, state authorization, minimum instructional hours, or minimum classroom time for educational programs to be Pell-eligible. S. 2124 would require colleges and universities to pay off 50% of student loans that are in default and are associated with their institution. The bill would prohibit institutions from raising tuition or creating other fees to cover loan repayments.

Update On The National Advisory Committee On Institutional Quality And Integrity

The National Advisory Committee on Institutional Quality and Integrity (NACIQI) conducted a meeting in Alexandria, Virginia on July 30-31, 2019. The purpose of this entity is to provide recommendations to the U.S. Secretary of Education on recognition of accrediting organizations. Recognition by the Department of Education (USDE) affirms that the standards and processes of accrediting organizations and state accreditation approval agencies demonstrate compliance with criteria. A current effort involves publishing a final rule before November 1, 2019 on proposed regulations regarding accreditation, innovation, and other issues so that the rules will be effective on July 1, 2020. The Department received a total of 198 comments on the proposed regulations that reflect some concerns expressed regarding: retroactive accreditation for institutions and programs, and increasing the time allowed for institutions and programs to come into compliance with accreditor requirements.

Repeal Of The “Gainful Employment” Regulation

During the Obama Administration, a successful attempt was made to crack down on low-performing programs at for-profit schools and other career colleges by implementing a “gainful employment” regulation. The past decade has witnessed an ongoing series of debates and litigation about this matter. Democrats have viewed the rule as an important necessary safeguard for both students and taxpayers while the for-profit sector of the education industry opposed it on the rationale that it unfairly held for-profit colleges to standards that non-profit and public institutions were not required to meet. As published on July 1, 2019 in the Federal Register, the Secretary of the Department of Education amends the regulations on institutional eligibility under the Higher Education Act (HEA) of 1965, as amended, and the Student Assistance General Provisions to rescind the Department’s gainful employment regulations. The repeal of the regulation is scheduled to go into effect on July 1, 2020. As a means of accelerating the process, the Trump Administration announced that it was exercising its authority to permit "early implementation" of the repeal, effectively freeing schools of the regulation immediately.

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

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