5 Imperatives: Addressing Healthcare’s Innovation Challenge

August 19, 2014 Comments off

5 Imperatives: Addressing Healthcare’s Innovation Challenge (PDF)
Source: Harvard Medical School

1. Making value the central objective
In isolation, efforts to either reduce costs or improve outcomes are insufficient; we need to do both through care coordination and shared information.

2. Promoting novel approaches to process improvement
Instead of largely focusing on product innovation, we also must create an environment that encourages process improvement and acknowledges that “failure” represents an important component of experimentation and learning.

3. Making consumerism really work
Today, consumerism remains a strong idea with weak means of execution. We will achieve greater success when providers organize efforts around patient needs and when patients become more active agents in managing their own health.

4.Decentralizing approaches to problem solving
We should facilitate the movement of care delivery and health care innovation from centralized centers of expertise out to the periphery, where more providers, innovators, and patients can engage in collaborative improvement efforts.

5. Integrating new approaches into established organizations
Our future must build on past successes. Existing health care institutions must be reinforced with efforts to integrate new knowledge into established organizations and the communities they serve.

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USPS OIG — Competition Advocate – Audit Report

August 19, 2014 Comments off

Competition Advocate – Audit Report (PDF)
Source: U.S. Postal Service, Office of Inspector General

Background
The U.S. Postal Service established the competition advocate (advocate) on January 28, 2011. The advocate promotes competition by helping contracting officials develop effective ways to obtain best value in contracting and issuing an annual report on noncompetitive purchase activity. The advocate must review noncompetitive requests for contractual actions (steps to create or modify a contract) greater than $1 million. The advocate does not approve or deny noncompetitive purchases but offers feedback to contracting officers (CO) on how to increase competition, including how to transition work to internal resources and research potential suppliers. COs are supposed to consider this feedback when evaluating whether the Postal Service should compete a contract. The advocate does not decide appeals by contractors.

What the OIG Found
We could not determine the advocate’s impact in promoting contract competition because the Postal Service does not have metrics to measure advocate performance. For example, for 35 of the 74 contractual actions, the advocate provided feedback on ways to increase competition, but there are no metrics to determine the impact of this feedback. Without such metrics, the Postal Service cannot accurately gauge the advocate’s success in promoting competition. In addition, the advocate did not review requests for 12 of the 74 contractual actions, totaling about $40 million. This occurred because there is no process to ensure that the advocate reviews all applicable requests. These actions were awarded without an opportunity for the advocate to suggest ways to promote competition.

Further, COs did not document their consideration of the advocate’s comments on requests for two contractual actions, totaling about $2.8 million. This occurred because Postal Service policy does not explicitly state how the CO should document responses to the advocate’s comments.

What the OIG Recommended
We recommended management develop metrics to gauge the impact of the advocate, reiterate the requirement to obtain the advocate’s review of applicable requests, and establish a process to verify that the advocate reviewed all applicable noncompetitive actions. We also recommended management clarify how COs should address the advocate’s feedback.

HHS OIG — Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect

August 19, 2014 Comments off

Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
To protect the well-being of residents, nursing facilities must comply with Federal regulations to develop and implement written policies related to reporting allegations of abuse, neglect, mistreatment, injuries of unknown source, and misappropriation of resident property (allegations of abuse or neglect). Further, allegations of abuse or neglect must be reported to the facility administrator or designee and the State survey agency within 24 hours. Results of investigations of these allegations must be reported to the same authorities within 5 working days. Nursing facilities must also notify owners, operators, employees, managers, agents, or contractors of nursing facilities (covered individuals) annually of their obligation to report reasonable suspicions of crimes.

HOW WE DID THIS STUDY
This study included a: (1) review of sampled nursing facilities’ policies related to reporting allegations of abuse or neglect, (2) review of sampled nursing facilities’ policies related to reasonable suspicions of crimes, and (3) survey of administrators from those sampled facilities. It also included an examination of a random sample of allegations of abuse or neglect identified from the sampled nursing facilities, and a review of documentation related to those sampled allegations of abuse or neglect.

WHAT WE FOUND
It is both required and expected that nursing facilities will report any and all allegations of abuse or neglect to ensure resident safety. We found that 85 percent of nursing facilities reported at least one allegation of abuse or neglect to OIG in 2012. Additionally, 76 percent of nursing facilities maintained policies that address Federal regulations for reporting both allegations of abuse or neglect and investigation results. Further, 61 percent of nursing facilities had documentation supporting the facilities’ compliance with both Federal regulations under Section 1150B of the Social Security Act. Lastly, 53 percent of allegations of abuse or neglect and the subsequent investigation results were reported, as Federally required.

WHAT WE RECOMMEND
We recommend that CMS ensure that nursing facilities: (1) maintain policies related to reporting allegations of abuse or neglect; (2) notify covered individuals of their obligation to report reasonable suspicions of crimes; and (3) report allegations of abuse or neglect and investigation results in a timely manner and to the appropriate individuals, as required. CMS concurred with all three of our recommendations.

E-Health Interventions for Suicide Prevention

August 19, 2014 Comments off

E-Health Interventions for Suicide Prevention
Source: International Journal of Environmental Research and Public Health

Many people at risk of suicide do not seek help before an attempt, and do not remain connected to health services following an attempt. E-health interventions are now being considered as a means to identify at-risk individuals, offer self-help through web interventions or to deliver proactive interventions in response to individuals’ posts on social media. In this article, we examine research studies which focus on these three aspects of suicide and the internet: the use of online screening for suicide, the effectiveness of e-health interventions aimed to manage suicidal thoughts, and newer studies which aim to proactively intervene when individuals at risk of suicide are identified by their social media postings. We conclude that online screening may have a role, although there is a need for additional robust controlled research to establish whether suicide screening can effectively reduce suicide-related outcomes, and in what settings online screening might be most effective. The effectiveness of Internet interventions may be increased if these interventions are designed to specifically target suicidal thoughts, rather than associated conditions such as depression. The evidence for the use of intervention practices using social media is possible, although validity, feasibility and implementation remains highly uncertain.

AU — Crime and law enforcement: a quick guide to key Internet links

August 19, 2014 Comments off

Crime and law enforcement: a quick guide to key Internet links
Source: Parliamentary Library of Australia

This Quick Guide provides key Internet links to websites with information on crime and law enforcement arrangements and issues. Australian Government Attorney-General’s Department —the lead Commonwealth agency for criminal law, law enforcement policy, crime prevention and anti-corruption. Key pages include:
– crime and corruption—overview and links to more specific information including legislation and policy on organised crime, money laundering, people smuggling, human trafficking, cybercrime, foreign bribery, anti-corruption, illicit drugs and federal offenders
– crime prevention—information on the government’s crime prevention initiatives, including grants programs and
– international crime cooperation arrangements—information on extradition, mutual assistance and international transfer of prisoners processes and arrangements with other countries.

Interactive Map: Where Can Renters Afford to Own?

August 19, 2014 Comments off

Interactive Map: Where Can Renters Afford to Own?
Source: Joint Center for Housing Studies of Harvard University

Homebuyer affordability remains near an all-time high, so where are all the first-time homebuyers? According to indexes that incorporate gross measures of house prices, interest rates, and household incomes, affordability remains at unprecedented levels. The National Association of Realtors® index, for instance, shows that the median-income household can afford to buy a home in all but 7 percent of the largest metros. Given that affordability looks good on paper, the lack of first-time homebuyers in all metros has been surprising. In 2013, first-time homebuyers made up 38 percent of home purchases, below the historical average of 40 percent, dating back to 1981. The most recent American Housing Survey shows that 3.3 million households were first-time buyers in 2009-2011, a 22 percent drop from the 2001 survey, which covered 1999-2001. This decline in first-time buyers comes in spite of real mortgage payments for the median home that remain below $800 (levels unprecedented before the recession) and a 7 percentage point decline in the mortgage payment-to-income ratio since 2001.

Historically, the majority of first-time buyers are households aged 25-34. Looking at renters in this age group, most would find the monthly costs of homeownership affordable in many metros across the country. Indeed, in 42 of the 85 metros studied, more than half of renters can afford the monthly costs of homeownership. Nearly 30 percent of the 25-34 year old renters in our sample lived in these affordable metros. Only in six metros, concentrated almost exclusively in California, are renter incomes so low compared to house prices that less than 30 percent of renters aged 25-34 can afford the costs of owning.

So why, given that so many metros are affordable to potential 25-34 year old first-time buyers, has the first-time buyer share remained low? Many demographic and economic forces are constraining the transition to homeownership for renters in their 20s and 30s.

Reasons for Emergency Room Use Among U.S. Children: National Health Interview Survey, 2012

August 19, 2014 Comments off

Reasons for Emergency Room Use Among U.S. Children: National Health Interview Survey, 2012
Source: National Center for Health Statistics

Key findings
Data from the National Health Interview Survey, 2012

  • In 2012, children with Medicaid coverage were more likely than uninsured children and those with private coverage to have visited the emergency room (ER) at least once in the past year.
  • About 75% of children’s most recent visits to an ER in the past 12 months took place at night or on a weekend, regardless of health insurance coverage status.
  • The seriousness of the medical problem was less likely to be the reason that children with Medicaid visited the ER at their most recent visit compared with children with private insurance.
  • Among children whose most recent visit to the ER was for reasons other than the seriousness of the medical problem, the majority visited the ER because the doctor’s office was not open.
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