Medicaid Disproportionate Share Hospital Payments (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
The Medicaid statute requires states to make disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. This provision is intended to recognize the disadvantaged financial situation of those hospitals because low-income patients are more likely to be uninsured or Medicaid enrollees. Hospitals often do not receive payment for services rendered to uninsured patients, and Medicaid provider payment rates are generally lower than the rates paid by Medicare and private insurance.
As with most Medicaid expenditures, the federal government reimburses states for a portion of their Medicaid DSH expenditures based on each state’s federal medical assistance percentage (FMAP). While most federal Medicaid funding is provided on an open-ended basis, federal Medicaid DSH funding is capped. Each state receives an annual DSH allotment, which is the maximum amount of federal matching funds that each state is permitted to claim for Medicaid DSH payments. In FY2012, federal DSH allotments totaled $11.4 billion.
The health insurance coverage provisions of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148 as amended) are expected to reduce the number of uninsured individuals in the United States, which means there should be less need for Medicaid DSH payments. As a result, the ACA included a provision directing the Secretary of the Department of Health and Human Services to make aggregate reductions in federal Medicaid DSH allotments for each year from FY2014 to FY2020. The Middle Class Tax Relief and Job Creation Act of 2012 (P.L. 112- 96) and the American Taxpayer Relief Act of 2012 (H.R. 8) extended the DSH reductions to FY2021 and FY2022. The Supreme Court’s decision regarding the ACA Medicaid expansion does not impact these DSH reduction amounts, but states’ decisions about implementing the ACA Medicaid expansion could impact the allocation of the DSH reductions across states starting in FY2016. However, the final rule for the Medicaid DSH reduction methodology for FY2014 and FY2015 does not take into account states’ decisions regarding the ACA Medicaid expansion.
Expand Mental Health Care for Veterans Says CNAS Scholar in New Report
Source: Center for a New American Security
Although the VA will spend nearly $7 billion this year on mental health care for veterans, CNAS Senior Fellow Phillip Carter argues in Expanding the Net: Building Mental Health Care Capacity for Veterans, this is not likely to be enough. The report urges the VA to rely more on the private sector and work more closely with local community and private philanthropic organizations.
Among his specific recommendations, Mr. Carter proposes that the VA develop and share mental health care data, pursue a portfolio approach that invests in the most promising care models, develop a wraparound information environment that integrates with the private and philanthropic sectors, build a human capital pipeline of mental health care personnel, and invest in emerging technologies, such as telemedicine. The additional investment is essential, says Mr. Carter, as “those receiving treatment do better in managing their post-traumatic stress or traumatic brain injury and are less likely to commit suicide.”
Medicare Hospital Readmissions Reduction Program
Source: Robert Wood Johnson Foundation
Policy-makers are constantly searching for ways to improve the quality of patient care and lower Medicare program spending.
One indicator of inadequate quality that results in increased Medicare spending is the rate of readmissions to a hospital.
Readmission refers to a patient being admitted to a hospital within a certain time period from an initial admission. In the context of Medicare, readmissions have been generally defined as a patient being hospitalized within 30 days of an initial hospital stay. If a hospital has a high proportion of patients readmitted within a short time frame, it may be an indication of inadequate quality of care in the hospital or a lack of appropriate coordination of postdischarge care. Although not all readmissions can be prevented, research shows that there are strategies that hospitals can employ to avert many readmissions.
This brief describes the Medicare Hospital Readmissions Reduction Program (HRRP) established in the Affordable Care Act (ACA) that provides a financial incentive to hospitals to lower readmission rates. Although the program has been in operation for only few years, initial results show potential. A number of technical issues in the program design have been identified and are being addressed by the Centers for Medicare and Medicaid Services (CMS) through the administrative process. However, there are also concerns about potential flaws in the program’s methodological approach. Others fear unintended consequences for safety-net hospitals that may threaten care for vulnerable populations.
Active Shooter in a House of Worship (PDF)
Source: National Disaster Interfaiths Network
Recent shootings at houses of worship and religious schools have led religious leaders to question wha t they can do to protect their congregations. This emerging need poses a challenge to religious leaders who want to provide safety without sacrificing the welcoming atmosphere of their houses of worship. These incidents may occur at any time, during virtually any size gathering or age range of people on the premises; they may be hate crimes, terrorist acts, acts of retribution, or simply random violence. Nevertheless, religious leaders can take steps to reduce the likelihood and the impact of an active shooter in a house of worship, religious school or other religious events, sites or facilities.
Previously, we demonstrated the possibility of fMRI in two awake and unrestrained dogs. Here, we determined the replicability and heterogeneity of these results in an additional 11 dogs for a total of 13 subjects. Based on an anatomically placed region-of-interest, we compared the caudate response to a hand signal indicating the imminent availability of a food reward to a hand signal indicating no reward. 8 of 13 dogs had a positive differential caudate response to the signal indicating reward. The mean differential caudate response was 0.09%, which was similar to a comparable human study. These results show that canine fMRI is reliable and can be done with minimal stress to the dogs.
Improvements Needed to ACA Health Care Premium Tax Credit Project
Source: Treasury Inspector General for Tax Administration
The Internal Revenue Service (IRS) needs to strengthen systems development controls for the Premium Tax Credit (PTC) Project, the Treasury Inspector General for Tax Administration (TIGTA) concludes in a new report publicly released today.
The PTC is part of the Affordable Care Act (ACA). Beginning January 2014, eligible taxpayers who purchase health insurance through the Health Insurance Marketplace (an Exchange) may qualify for and request a refundable tax credit (the PTC) to assist with paying their health insurance premium. The credit is claimed on the taxpayer’s Federal tax return at the end of each coverage year. Because it is a refundable credit, taxpayers who have little or no income tax liability can still benefit. The PTC can also be paid in advance to a taxpayer’s health insurance provider to help cover the cost of premiums. This credit is referred to as the Advanced Premium Tax Credit (APTC).
The IRS’s implementation plan for ACA Exchange provisions includes providing information that will support the Department of Health and Human Services and the Exchanges in three main areas: eligibility and enrollment; developing calculations for the maximum APTC; and reconciling PTCs with reported taxable income.
TIGTA reviewed whether the IRS is adequately managing systems development risks for the PTC Project. TIGTA evaluated the IRS’s key management controls and processes for risk management, requirements and change management, testing, security, and fraud detection for the PTC Project.
TIGTA found that the IRS has completed development and testing of the software used to calculate the Advanced Premium Tax Credit and the Remainder Benchmark Household Contribution (RBHC) which is the household’s contribution towards the monthly insurance premium.
In addition, the IRS developed a process to verify the accuracy of the PTC calculations. Based on an analysis of IRS test cases for the software, TIGTA was able to replicate the IRS’s results showing that the software accurately calculated the maximum APTC and RBHC amounts for eight specific test cases within the IRS test environment. While the IRS was able to accurately calculate the maximum APTC amounts within the software testing environment, TIGTA was unable to assess the software’s full operational capabilities based on the test cases.
Critical Issues in the Identification of Gifted Students With Co-Existing Disabilities: The Twice-Exceptional
Federal law ensures all students with disabilities the right to a Free, Appropriate Public Education (FAPE). However, current policies governing a student’s eligibility for services may contribute to the underidentification of gifted children with co-existing disabilities—the Twice-Exceptional. The emphasis on below-grade-level (or lower) performance, without regard to ability or potential weaknesses, misses twice-exceptional students. Those who perform at grade level, by using advanced conceptual abilities and hard work to compensate, may still require interventions and accommodations to manage increasing educational demands. Otherwise, college and even high school graduation may be out of reach. This article reviews changing laws and policies, explores case studies of twice-exceptional students missed, and examines the diagnosis of twice-exceptionality through comprehensive assessment. Appropriate best practices for the identification of twice-exceptional learners, maintenance of their civil rights, and provision of FAPE are offered for educators, parents, advocates, and legislators as federal, state, and district laws/policies evolve.
VA OIG — Healthcare Inspection: Alleged Improper Opioid Prescription Renewal Practices, San Francisco VA Medical Center
Healthcare Inspection: Alleged Improper Opioid Prescription Renewal Practices, San Francisco VA Medical Center
Source: U.S. Department of Veterans Affairs, Office of Inspector General
The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection in response to complaints concerning improper opioid prescription renewal practices in the Medical Practice Clinic at the San Francisco VA Medical Center (facility), San Francisco, CA. We reviewed the following allegations: (1) attendings on-duty are tasked with evaluating numerous opioid renewal requests for patients with whom they are unfamiliar, (2) providers do not routinely document patients’ opioid prescription renewal problems in the electronic health record, and (3) there have been patient hospitalizations and deaths related to opioid misuse.
We substantiated that attendings on-duty are tasked with evaluating numerous opioid renewal requests for patients with whom they are unfamiliar; however, Veterans Health Administration regulations and local policy do not prohibit such practice.
We partially substantiated that providers do not routinely document patients’ opioid prescription renewal problems in the electronic health record. The providers did not consistently document an assessment for adherence with appropriate use of opioids and monitor patients for misuse, abuse, or addiction. The primary care providers did not consistently complete the templated Narcotic Instructions Note for patients with opioid prescription renewal problems.
We partially substantiated that there have been hospitalizations and deaths of patients related to opioid misuse. Seven patients were hospitalized for opioid overdose; however, the primary care provider, Psychiatry Service, and/or the facility’s Substance Abuse Program assessed and appropriately monitored the patients for misuse. There were no deaths related to opioid overdose.
We recommended that the Facility Director (1) ensure that providers comply with all elements of the management of opioid therapy for chronic pain, as required by Veterans Health Administration and the VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, and (2) ensure that the Narcotic Instructions Note is reevaluated for appropriate use in the Medical Practice Clinic and that providers comply with established protocol.
The Veterans Integrated Service Network and Facility Directors concurred with our recommendations and provided an acceptable action plan. (See Appendixes A and B, pages 6–9 for the Director’s comments.) We will follow up on the planned actions until they are completed.
Bayesian Analysis of Epidemics – Zombies, Influenza, and other Diseases
Mathematical models of epidemic dynamics offer significant insight into predicting and controlling infectious diseases. The dynamics of a disease model generally follow a susceptible, infected, and recovered (SIR) model, with some standard modifications. In this paper, we extend the work of Munz et.al (2009) on the application of disease dynamics to the so-called “zombie apocalypse”, and then apply the identical methods to influenza dynamics. Unlike Munz et.al (2009), we include data taken from specific depictions of zombies in popular culture films and apply Markov Chain Monte Carlo (MCMC) methods on improved dynamical representations of the system. To demonstrate the usefulness of this approach, beyond the entertaining example, we apply the identical methodology to Google Trend data on influenza to establish infection and recovery rates. Finally, we discuss the use of the methods to explore hypothetical intervention policies regarding disease outbreaks.
CMS Finalizes Physician Payment Rates for 2014
Source: U.S. Department of Health and Human Services (Centers for Medicare and Medicaid Services)
In a rule issued today, the Centers for Medicare & Medicaid Services (CMS) finalized payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare. CMS’ care coordination policy is a milestone, and demonstrates Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015. The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.
As part of CMS’ continuing effort to recognize the critical role primary care plays in providing care to beneficiaries with multiple chronic conditions, beginning in 2015, the agency is establishing separate payments for managing a patient’s care outside of a face-to-face visit for practices equipped to provide these services.
National Action Alliance for Suicide Prevention Releases Life-Saving Juvenile Justice System Resources
National Action Alliance for Suicide Prevention Releases Life-Saving Juvenile Justice System Resources (PDF)
Source: National Action Alliance for Suicide Prevention
The National Action Alliance for Suicide Prevention ( Action Alliance) today released a set of comprehensive suicide prevention resources to support professionals who work with youth in the juvenile justice system. The newly developed educational tools advance the National Strategy for Suicide Prevention, which guides efforts to prevent suicide across the nation. Online versions of the nine resources are now available to the juvenile justice workforce and the general public…
Jet Lag in Military and Civil Aviation: A Review Study
Source: Journal of Archives in Military Medicine
Physiological or behavioral cycles are generated by an internal pacemaker with an oscillatory frequency of approximately 24.2 hours which are named as circadian rhythm. This internal pacemaker is located at hypothalamus as suprachiasmatic nucleus and control sleep-wake cycle, with wakefulness commonly promoted during daylight hours and sleep promoted during evening hours.
The aim of this article is to provide a framework for understanding the biological basis of jet lag and recommend management strategies. Understanding jet lag can help us to address the broader problem of circadian misalignment, which has increasingly been associated with increased risk of cancer (colorectal and breast), metabolic diseases, cardiovascular dysfunction, mood disorders (depression), and cognitive decline.
Materials and Methods:
The current study is a review article based on literatures in the field of aerospace medicine. It is hoped that this presentation will be useful for those who are interested in aviation medicine.
Jet Lag usually experienced by individuals who cross at least 2 time zones by intercontinental flights. Symptoms and signs usually reveal after 1-2 days of arrival in relation with circadian system complication and cause insomnia, sleepiness, general malaise, gastrointestinal upset (anorexia, indigestion and defecation disorders), neural (fatigue, headaches, and irritability) and cognitive impairments (concentration, judgment and memory disturbance), etc.
Eastward travel requires an advance phase and these persons often complain about initiating sleep at early evening and being awake at early morning. Thus, eastbound travelers have difficult adaptation and worsen features rather than westbound travelers. The incidence of jet lag often has not been reported, so the accurate prevalence is uncertain.
Due to the progressive development of aviation and intercontinental travels, the awareness about jet lag and its complications, prevention and treatment for all population especially aviators and medical groups are necessary.
New GAO Reports
Source: Government Accountability Office
1. National Mediation Board: Strengthening Planning and Controls Could Better Facilitate Rail and Air Labor Relations. GAO-14-5, December 3.
Highlights - http://www.gao.gov/assets/660/659361.pdf
2. VA Health Care: Improvements Needed in Processes Used to Address Providers’ Actions That Contribute to Adverse Events. GAO-14-55, December 3.
Highlights - http://www.gao.gov/assets/660/659379.pdf
The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid
Source: Kaiser Family Foundation
The expansion of Medicaid eligibility to nearly all low-income adults is a core component of the coverage provisions in the 2010 Affordable Care Act (ACA). The ACA Medicaid expansion provides a link between new private coverage options available through either Health Insurance Marketplaces or employers and the existing Medicaid program, which previously had many gaps in coverage for adults. Historically, Medicaid eligibility generally was restricted to low income individuals in a specified category, such as children, their parents, the aged, or individuals with disabilities. In most states, adults without dependent children were not eligible for Medicaid. Further, eligibility levels for parents were generally set very low and varied greatly across states. As a result, only 30% of poor nonelderly adults had Medicaid coverage in 2012, compared to 70% of poor children, and uninsured rates for poor adults (42%) were well over twice the national average (18%).
The expansion of Medicaid, effective in January 2014, fills in historical gaps in Medicaid eligibility for low-income adults and has the potential to extend health coverage to millions of currently uninsured individuals. This expansion essentially sets a national Medicaid income eligibility level of 138% of poverty (about $27,000 for a family of three) for adults. The expansion was intended to be national and to be the vehicle for covering low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with higher incomes. However, the June 2012 Supreme Court ruling made the expansion of Medicaid optional for states, and as of October 2013, 25 states did not plan to implement the expansion.
In states that do not expand Medicaid, nearly five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Most of these people have very limited coverage options and are likely to remain uninsured. This brief describes the coverage gap and presents estimates of the population that falls into this situation. An overview of the methodology underlying the analysis can be found in the Methods box at the end of the report, and more detail is available in the accompanying Technical Appendices.
Canaries in the coal mine: a cross-species analysis of the plurality of obesity epidemics
Source: Proceedings of the Royal Society
A dramatic rise in obesity has occurred among humans within the last several decades. Little is known about whether similar increases in obesity have occurred in animals inhabiting human-influenced environments. We examined samples collectively consisting of over 20 000 animals from 24 populations (12 divided separately into males and females) of animals representing eight species living with or around humans in industrialized societies. In all populations, the estimated coefficient for the trend of body weight over time was positive (i.e. increasing). The probability of all trends being in the same direction by chance is 1.2 × 10−7. Surprisingly, we find that over the past several decades, average mid-life body weights have risen among primates and rodents living in research colonies, as well as among feral rodents and domestic dogs and cats. The consistency of these findings among animals living in varying environments, suggests the intriguing possibility that the aetiology of increasing body weight may involve several as-of-yet unidentified and/or poorly understood factors (e.g. viral pathogens, epigenetic factors). This finding may eventually enhance the discovery and fuller elucidation of other factors that have contributed to the recent rise in obesity rates.
New Approaches for Delivering Primary Care Could Reduce Predicted Physician Shortage
Source: RAND Corporation
If the prevalence of two innovative care delivery models — the patient-centered medical home and the nurse-managed health center — increases, projected U.S. physician shortages can be cut in half by 2025 without training a single additional physician.
Early Stage Animal Hoarders: Are These Owners of Large Numbers of Adequately Cared for Cats?
Source: Human-Animal Interaction Bulletin
Animal hoarding is a spectrum-based condition in which hoarders are often reported to have had normal and appropriate pet-keeping habits in childhood and early adulthood. Historically, research has focused largely on well-established clinical animal hoarders with little work targeted towards the onset and development of animal hoarding. This study investigated whether a Brazilian population of owners of what might typically be considered an excessive number (20 or more) of cats were more likely to share the commonly reported psychological and demographic profile of animal hoarders than owners of 1-2 cats drawn from the same population. Psychological traits measured were attachment to pets (Lexington Pet Attachment Scale, LAPS), anxiety and depression (Hospitalized Anxiety and Depression Scale, HADS), and hoarding behavior (Saving Inventory-Revised, SI-R). Owners of 20 or more cats were significantly older, scored significantly higher pet attachment scores, and displayed significant positive relationships between hoarding behavior and anxiety. Such a profile demonstrates greater similarities to clinical animal hoarders than to typical cat owners on these particular measures, although additional disparities with clinical animal hoarders exist in the areas of functioning, veterinary care and home organization. Taking this information together, the studied population may represent the understudied group of early stage animal hoarders. However, external factors such as culture and societal animal control policies should not be overlooked as alternative explanations for pet keeping at levels that might be considered excessive.
Free registration required.
Connecting Grassroots and Government for Disaster Response
Source: Woodrow Wilson International Center for Scholars
Leaders in disaster response are finding it necessary to adapt to a new reality. Although community actions have always been the core of the recovery process, collective action from the grassroots has changed response operations in ways that few would have predicted. Using new tools that interconnect over expanding mobile networks, citizens can exchange information via maps and social media, then mobilize thousands of people to collect, analyze, and act on that information. Sometimes, community-sourced intelligence may be fresher and more accurate than the information given to the responders who provide aid. This report explores approaches to the questions that commonly emerge when building an interface between the grassroots and government agencies, with a particular focus on the accompanying legal, policy, and technology challenges.
Active shooters: is law enforcement ready for a Mumbai style attack? (PDF)
Source: Naval Postgraduate School
Between April 16, 2007, and December 14, 20 12, the United States has seen 25 mass shootings, seven of which occurred in 2012. A report by United States Department of Homeland Security, in 2009, suggested that the United States will be the target of a terrorist act that could cause a high number of casualties.
The November 26, 2008, attack on Mumbai is a transparent example of how determined terrorists, trained to die fighting, can bring a large metropolitan city to its knees. It is entirely probable that Mumbai – type attacks could occur in the United States. Since the local law enforcement respond to attacks in progress, any active shooter event would be handled by the local jurisdiction. Many law enforcement agencies have begun to incorporate tactical plans to respond to Mumbai – type terrorist a ttacks.
This thesis focused on police preparedness of select large metropolitan law enforcement agencies for potential Mumbai – type terrorist attacks. A comparative analysis of these police agencies was conducted, which showed that the frequency of trainin g was found to be varying and inadequate by these agencies. A similar concern was that none of the agencies had equipped all the police officers with rifles, which were deemed critical to engage well – equipped active shooters.
It is the conclusion of the thesis that gaps in preparedness exist and law enforcement organizations have room for improvement. It was also concluded that agencies need to enhance communication capability between neighboring jurisdictions and focus on triage of the victims during t he early stages of attacks when medical personnel would be unable to approach.