Author Archives: afscme

Rethinking the Role of the Profession on Public Sector Compensation

Source: Thom Reilly, Public Administration Review, Volume 73 Issue 1, January/February 2013
(subscription required)

…Instead of constantly defending postretirement benefits and arguing that public sector employees are paid less than their private sector counterparts, I would like to suggest that the public administration profession take the lead in reforming public pay and benefits. If public managers, along with elected officials and employee and union groups, do not comprehensively address this issue, fed-up citizens will head to the ballot box, and their remedies will likely be much more punitive and draconian than any legislation or policy changes. Our field has been slow to lead in this area.

The field of public administration should be at the forefront, driving the reform agenda and discussion. I suggest four areas in which we could move in this direction.

-Transparency. Our field must insist on transparency in the adoption of public pay and benefits, including an independent analysis of the current cost of any pay or benefit increase, as well as how future costs will be paid for and managed.

-Shared pension (and retiree health care) costs. Similar to Social Society and defined contribution plans, there should be equal employee/employer contribution. Allowing public employees to take reduced pay increases in lieu of sharing in the cost of pensions is problematic and allows for a good deal of gamesmanship. If the pension rate goes up 2 percent and the employee gets a 3 percent cost-of-living adjustment, does that mean he or she would otherwise have gotten 5 percent? The reality is that in many jurisdictions, the public employer has largely picked up employee contributions. Courts have generally held that existing pension benefits are protected, but increasing existing employees’ contributions is generally permissible, which can significantly address a portion of the current underfunding.

-Hybrid and cash-balance pension plans. Our field should take the lead in designing hybrid plans that combine elements of existing defined-benefit plans with a new 401(k)-style system in which money is invested on behalf of the retiree. The Federal Employee Retirement System has adopted such a model. Under cash-balance plans, workers get an individual retirement account to which both the employee and the employer contribute while the employer guarantees a minimum return. These plans have the potential to increase active participation of public employees in retirement planning while transferring some of the risk away from the taxpayer. Moving public employees to these type systems will also allow portability of these benefits so that they can follow workers if they choose to switch jobs and move to the private or nonprofit sector or to another public sector job.

-Retirement security for all. Our field can use the increased national attention on public employee benefits to expand the conversation on the need for retirement security for all Americans. According to data from the Federal Reserve, U.S. Census Bureau, and Internal Revenue Service, 25 percent of American families have no savings at all, and the average amount saved for retirement is $35,000. Our nation is not adequately prepared to deal with this retirement security crisis….

Compensation Matters: The Case of Teachers

Source: Alicia H. Munnell and Rebecca Cannon Fraenkel, Center for Retirement Research at Boston College, State and Local Pension Plans, SLP#28, January 2013

From the key findings:
• Many public sector pension plans have recently cut pension benefits for new hires, thereby reducing compensation.
• The analysis looks at how such cutbacks could affect the quality of teachers.
• One proxy for teacher quality is the average SAT score at a teacher’s undergraduate institution.
• The analysis finds that school districts with higher wages and/or higher pensions are able to hire teachers from institutions with higher SAT scores.
• These results suggest that cutting compensation for new teachers is not costless, as it will likely reduce applicant quality.

State Trends and Innovations in Medicaid Long-Term Services and Supports

Source: Sarah Barth, Brianna Ensslin and Nancy Archibald, Center for Health Care Strategies, Policy Brief, December 2012

From the abstract:
States continue to work on rebalancing their Medicaid long-term services and supports (LTSS) systems away from institutional settings and toward community-based care. They are using opportunities provided by the Affordable Care Act to develop their LTSS eligibility and delivery systems in a way that strengthens both access to and availability of community-based services. States also are migrating from fee-for-service delivery systems to managed care to better integrate LTSS with primary and acute care and behavioral health care.

This brief highlights states’ continued progress in: 1) rebalancing Medicaid LTSS options toward home- and community-based services; and 2) developing and implementing managed LTSS programs to better integrate care. It also describes states’ progress in improving quality of care for LTSS and the decision by some states to change program authority for LTSS services from 1915(c) waivers to comprehensive Section 1115(a) demonstration waivers.

Statewide Law Enforcement/Mental Health Efforts: Strategies to Support and Sustain Local Initiatives

Source: Melissa Reuland, Laura Draper, Blake Norton, Council of State Governments Justice Center, December 2012

From the abstract:
Statewide Law Enforcement/Mental Health Efforts: Strategies to Support and Sustain Local Initiatives is the product of a project supported by the Bureau of Justice Assistance. It examines how states have developed structures and standards to make police encounters with people with mental illnesses safer for all involved and to produce better mental health and criminal justice system outcomes. The report offers a starting point for policymakers, practitioners, and others interested in planning or enhancing a statewide initiative that will support local-level specialized policing responses (SPRs) such as crisis intervention and law enforcement/mental health co-response teams.

State ‘Accountable Care’ Activity Map

Source: National Academy for State Health Policy, 2013

With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid and Children’s Health Insurance Program populations. Accountable care models aim to address lack of care coordination and wide disparities in cost and quality of care in the U.S. health care system, perpetuated by the prevailing fee-for-service payment method, through shared incentives to manage utilization, improve quality, and curb cost growth.

State efforts to advance accountable care models vary considerably. However, for the purposes of this map, a set of three core characteristics and capabilities, consistent across designs, is needed:
-Organizations or structures should assume responsibility for a defined population of patients across a continuum of care, including across different institutional settings.
-Participants should be held accountable through payments linked to value, emphasizing dual goals of improving quality and containing costs.
-Accountability should be facilitated by reliable performance measurements that demonstrate savings are achieved in conjunction with improvements in care.

The Increase in Unemployment Since 2007: Is It Cyclical or Structural?

Source: Linda Levine Congressional Research Service, CRS Report for Congress, R41785, January 24, 2013

…This report assesses the relative magnitudes of cyclical and structural unemployment as they respond to different policy measures. An analysis of changes since 2007 in a variety of labor market indicators across industries and areas finds patterns that strongly suggest most of the increase in the U.S. unemployment rate is cyclical (i.e., due to depressed aggregate demand). Empirical studies suggest that, although structural unemployment has temporarily increased, it accounted for a minority of the rise in the unemployment rate in recent years…

The Federal Prison Population Buildup: Overview, Policy Changes, Issues, and Options

Source: Nathan James, Congressional Research Service, CRS Report for Congress, R42937, January 22, 2013

Since the early 1980s, there has been a historically unprecedented increase in the federal prison population. Some of the growth is attributable to changes in federal criminal justice policy during the previous three decades. An issue before Congress is whether policymakers consider the rate of growth in the federal prison population sustainable, and if not, what changes could be made to federal criminal justice policy to reduce the prison population while maintaining public safety. This report explores the issues related to the growing federal prison population….Changes in federal sentencing and correctional policy since the early 1980s have contributed to the rapid growth in the federal prison population. These changes include increasing the number of federal offenses subject to mandatory minimum sentences; changes to the federal criminal code that have made more crimes federal offenses; and eliminating parole….

Healthcare Facility Public Safety-Related Deaths Reached All-Time High in 2012

Source: Campus Safety Magazine, January 28, 2013

….According to Dr. Victoria Mikow-Porto, the principal researcher and writer on the recently-released 2012 Crime and Security Trends Survey underwritten by the Foundation of the IAHSS, healthcare facility crime increased in nearly every category since the most recent survey in 2010, with a significant rise in the number of simple assaults, larceny and thefts, vandalism, and rape and sexual assaults. It’s also the highest number of crimes ever recorded in the history of the IAHSS Crime Survey, with 20,515 crimes reported: an increase of 5,524 compared to 2010.

Additionally, 98% of healthcare facilities now experience violence and criminal incidents. Porto attributes the surge to a number of factors, among them:
-Greater access to weapons, particularly guns
-Generally 24/7, open access to an expanding number of large and small healthcare complexes
-long, frustrating waits in emergency rooms
-Increased size and violence of gangs, and carry over of gang warfare into HCFs
-Deinstitutionalization of psychiatric patients who are unable or unwilling to take meds
-Increasing treatment of forensics patients who are at high risk for violence
-Rise in substance abuse and easily-accessed hospital pharmacies

Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists

Source: Henry J. Michtalik, Hsin-Chieh Yeh, Peter J. Pronovost, Daniel J. Brotman, JAMA Internal Mededicine, Published online January 28, 2013
(subscription required)

From the preview:
Up to 98 000 patients die each year in the hospital as a result of preventable medical errors. Most errors are caused by well-intentioned individuals working within faulty systems, processes, or conditions. One such condition is excess clinical workload. For resident physicians, workload so heavy as to result in physician fatigue is associated with increased medical errors and has led to the implementation of work-hour restrictions. For nurses, a recent cross-sectional analysis showed a significant association between patient mortality and low staffing. Fourteen states have enacted legislation and/or adopted regulations to address nurse staffing.

An Incentive-Based Approach to Regulating Workplace Chemicals

Source: Jason R. Bent, Ohio State Law Journal, Vol. 73 no. 6, 2013

From the abstract:
The United States’ system for regulating employee exposures to hazardous chemicals is broken. Absent regulation, the labor market fails to produce efficient levels of precaution against chemical exposures. Information asymmetries, long disease latency periods, and other characteristics of chemical exposures thwart the market’s ability to produce efficient risk/wage tradeoffs. These same characteristics permit employers and chemical manufacturers to externalize the costs of injuries caused by chemical exposures. The current U.S. regulatory system, including a combination of OSHA regulations and state workers’ compensation programs, is not correcting the labor market’s failure. The result is a level of workplace chemical exposure risk that is systematically too high, and a level of precaution that is systematically too low.

The reforms proposed in the literature to date do not harness the financial incentives of the least-cost information providers and least-cost risk avoiders: chemical manufacturers and employers. This Article takes the search for a solution in a new direction by using state workers’ compensation laws to capitalize on the incentives of chemical manufacturers and employers. The Article argues that state workers’ compensation laws should be amended in two ways: (1) shift the default burden of proof on causation to the respondents, but only in cases where there is no applicable OSHA exposure limit, and (2) allow employers to include chemical manufacturers as respondents in workers’ compensation proceedings for purposes of apportioning liability. These amendments could be implemented by convening a new National Commission on State Workers’ Compensation Laws. The result would be a new push for OSHA chemical exposure limits by chemical manufacturers and employers – the entities in the best position to provide the toxicity and precaution information necessary to support OSHA regulations.