Category Archives: Health Care

California’s Behavioral Health Services Workforce Is Inadequate for Older Adults

Source: Janet C. Frank, Kathryn G. Kietzman, and Alina Palimaru, UCLA Center for Health Policy Research, Health Policy Brief, January 2019

The Workforce Education and Training component of California’s Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers…..

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions

Source: Carolyn C. Foster, Rishi K. Agrawal, and Matthew M. Davis, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Property Tax Exemptions for Nonprofit Hospitals: What Are They Worth? Do They Earn Them? Evidence From New York City

Source: Geoffrey Propheter, Public Budgeting and Finance, Early View, First published: March 25, 2019
(subscription required)

From the abstract:
This study estimates the property tax expenditure for nonprofit hospitals (NPHs) in New York City using Medicare and IRS data from 2011 through 2013. After comparing the estimates to various definitions of community benefits, it is concluded that NPHs generally earn their property tax break. Evidence is also presented that using book values is a reasonably accurate method for estimating the property tax expenditure nationwide. Finally, econometric analyses reveals that net income is negatively associated with community benefits, suggesting justification for taxing higher net income hospitals and reallocating the funds to similarly sized but lower net income hospitals.

Robotic health care is coming to a hospital near you

Source: Mattie Milner, Stephen Rice, The Conversation, May 7, 2019

Medical robots are helping doctors and other professionals save time, lower costs and shorten patient recovery times, but patients may not be ready. Our research into human perceptions of automated health care finds that people are wary of getting their health care from an automated system, but that they can adjust to the idea – especially if it saves them money.

Hospitals and medical practices are already using a fair amount of automation. For instance, in one San Francisco hospital and other places, delivery robots – about the size of a mini-fridge – zip through the hallways delivering pills, bringing lunch to patients and ferrying specimens and medical equipment to different labs. Some hospitals are set up for delivery robots to open remote-control doors and even use elevators to get around the building.

Not-for-profit and public healthcare – US – Preliminary medians – Profitability holds steady as revenues and expenses converge

Source: Rita Sverdlik, Nansis Hayek, Lisa Goldstein, Kendra M. Smith, Moody’s, Not-for-profit and public healthcare – US, Sector Profile, April 25, 2019
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Not-for-profit and public hospitals are showing signs of stability with profitability margins holding relatively steady and leverage metrics slightly improving, per our preliminary 2018 medians. The revenue growth rate edged ahead of expenses for the first time since 2015,driven by M&A, steady patient volumes and revenue cycle improvements. Cost-cutting initiatives and lower increases in drug prices contributed to a slower expense growth rate. A weak equity market in 2018 contributed to a slowdown in absolute cash growth while days cash on hand declined.

Related:
U.S. Not-For-Profit Health Care Rating And Outlook Change Drivers, First-Quarter 2019
Source: S&P Global Ratings, April 30, 2019
(subscription required)

S&P Global Ratings performed a review of factors and how they influenced, positively or negatively, the credit profile of the U.S. not-for-profit health care providers it reviewed in the first quarter of 2019. From Jan. 1 to March 31, operating performance was a driver in 57% of the total 35 rating actions, followed by affiliations or deepened integration of already-affiliated organizations (23%), business position and utilization trends (17%), and balance sheet metrics (17%).

Status of State Medicaid Expansion Decisions: Interactive Map

Source: Kaiser Family Foundation, April 26, 2019

To date, 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

To view this data in a table format, click here. To download a Powerpoint slide of the expansion status map, click here.

Pensions and retiree healthcare challenge some of the largest mass transit enterprises

Source: Thomas Aaron, Timothy Blake, Moody’s, Sector In-Depth, April 11, 2019
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Pensions and retiree healthcare pose a credit risk for some of the largest mass transit enterprises. Transit enterprises with material unfunded liabilities face budget challenges that can limit capital reinvestment, contribute to rising debt loads and/or lead to lower service levels.

2019 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds

Source: Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds, April 22, 2019

From the press release:
Today, the Medicare Board of Trustees released their annual report for Medicare’s two separate trust funds — the Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, and the Supplementary Medical Insurance (SMI) Trust Fund, which funds Medicare Part B and D. The report found that the HI Trust Fund will be able to pay full benefits until 2026, the same as last year’s report.  For the 75-year projection period, the HI actuarial deficit has increased to 0.91 percent of taxable payroll from 0.82 percent in last year’s report. The change in the actuarial deficit is due to several factors, most notably lower assumed productivity growth, as well as effects from slower projected growth in the utilization of skilled nursing facility services, higher costs and lower income in 2018 than expected, lower real discount rates, and a shift in the valuation period.

Related:
Medicare’s fiscal outlook deteriorates as 2026 funding cliff looms, Trump administration says
Source: Jeff Stein, Washington Post, April 22, 2019

Medicare, Social Security face shaky fiscal futures
Source: Andrew Taylor, Associated Press, April 22, 2019

Lower Nurse-to-Patient Ratio: Higher Patient Satisfaction

Source: Teresa Dousay, Bailey Childers, Madison Cole, Tara Hill and Charles Rogers, Morehead State University, (undated)

Objectives
• Determine if lower nurse to patient ratio improved patient satisfaction
• To assess how nurse-to patient ratios and nurse work hours affect the patients hospital stay.
• To determine whether nurse staffing in California hospitals, where state mandated minimum nurse to patient ratios are in effect, differs from Kentucky with no mandated ratio

Abstract:
The issue of nursing care and patient staffing ratios is not new to medical-surgical nurses. It took national importance in 1996 with the release of an Institute of Medicine (IOM) report that evaluated nursing and patient safety. Patient’s conditions have become complex and require more nursing attention than before, yet, hospitals have become more economically focused and business oriented. Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as “variable patient or family caregiver state, condition, or perception responsive to nursing intervention”. Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are more likely documented in the medical record (Stanton, 2004, p. 2). This project focuses on positive nursing sensitive outcomes such as patient satisfaction, shortened inpatient length of stay and decreased hospital readmissions. The purpose of this paper is to reinforce the hypothesis that lower nurse-to-patient ratio results to higher patient satisfaction…..

Related:
Mandated Nurse-to-Patient Staffing Ratios: Benefits at the Bedside and Beyond
Source: Advanced Medical Reviews, February 28, 2019
….Adequate nurse staffing can reduce medical errors, patient mortality, length of stay, preventable events such as patient falls, healthcare-associated infections (HAIs), pressure ulcers and central line infections. It also may reduce patient care costs by avoiding readmissions. ….

The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

Source: Johanna Catherine Maclean, Brendan Saloner, Journal of Policy Analysis and Management, Volume 38, Issue 2, Spring 2019
(subscription required)

From the abstract:
We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid‐reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event‐study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post‐expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.