Category Archives: Health Care

Wisconsin: Round 1 – State-Level Field Network Study of the Implementation of the Affordable Care Act

Source: Donna Friedsam, Thomas Kaplan, Sara Eskrich, Rockefeller Institute of Government, Brookings Institution, Fels Institute of Government, ACA Implementation Research Network, August 2014

Wisconsin’s implementation of the Affordable Care Act has set it apart from its neighboring states and put it on a unique path among states nationally. This approach has been referred to as “Obamacare with a twist.” A new study by the University of Wisconsin Population Health Institute reviews Wisconsin’s implementation process and milestones to date.
Press Release

2014 Employer Health Benefits Survey

Source: Kaiser Family Foundation and Health Research & Educational Trust (Kaiser/HRET), September 10, 2014

From the abstract:
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and employer opinions. The 2014 survey included almost three thousand interviews with non-federal public and private firms.
Annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, with workers on average paying $4,823 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2014 Employer Health Benefits Survey. Survey results are released here in a variety of ways, including a full report with downloadable tables, summary of findings, and an article published in the journal Health Affairs.
Press Release
Summary of Findings
Technical Supplement
Premiums and Worker Contributions Among Workers Covered by Employer-Sponsored Coverage, 1999-2014

Health Benefits In 2014: Stability In Premiums And Coverage For Employer-Sponsored Plans
Source: Gary Claxton, Matthew Rae, Nirmita Panchal, Heidi Whitmore, Anthony Damico and Kevin Kenward, Health Affairs, Web First, September 10, 2014
(subscription required)

From the abstract:
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2014 the average annual premium (employer and worker contributions combined) for single coverage was $6,025, similar to 2013. The premium for family coverage was $16,834—3 percent higher than a year ago. Average deductibles and most other cost-sharing amounts were similar to those in 2013. On average, in 2014 covered workers paid nearly $5,000 per year for family health insurance premiums, and 18 percent of covered workers were in a plan with an annual single coverage deductible of $2,000 or more. Fifty-five percent of employers offered health benefits in 2014, similar to 2013. The Affordable Care Act has not yet led to substantial changes in the employer-based market. However, the next few years could present a different picture as delayed provisions and other changes take effect. This year’s survey included new questions on firms’ policies related to enrolling spouses and dependents, enrollment in private exchanges, and the use of narrow networks and financial incentives for wellness programs.

Reducing Variation In Hospital Admissions From The Emergency Department For Low-Mortality Conditions May Produce Savings

Source: Amber K. Sabbatini, Brahmajee K. Nallamothu and Keith E. Kocher, Health Affairs, Vol. 33 no. 9, September 2014
(subscription required)

From the abstract:
The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions.

2014 Employee Healthcare and Other Benefits in Higher Education Survey

Source: College and University Professional Association for Human Resources, 2014

The Employee Healthcare and Other Benefits Survey collects data on the most representative healthcare and non-healthcare benefits offered to faculty and staff employed in a cross-section of the nation’s colleges and universities. Healthcare data is collected annually and non-healthcare data every two years. The latter includes basic life insurance, short- and long-term disability, paid time-off, tuition assistance and retirement benefits.

As a result of changes to healthcare benefits stemming from the implementation of the Affordable Care Act (ACA), and in an effort to better control costs, many higher education institutions are passing more of the cost of healthcare along to their employees. According to findings from CUPA-HR’s 2014 Employee Healthcare and Other Benefits in Higher Education Survey, 41 percent of respondents have increased the employee share of premium costs since the ACA went into effect. Additionally, 26 percent have increased in-network deductibles, 27 percent have increased out-of-pocket limits, 20 percent have increased the employee share of prescription drug costs, and 24 percent have increased the employee share of dependent coverage costs. Many institutions are also ramping up their efforts to encourage healthy living among employees, with 36 percent of respondents indicating they have adopted or expanded a wellness program and 21 percent saying they have adopted or expanded the use of financial incentives to encourage healthy behaviors. …

Other Findings of Note:
Other findings from this year’s benefits survey:
PPO plans continue to be the plan of choice for a majority of institutions – 82 percent of respondents offer PPO plans. However, HDHPs continue to increase in popularity, with 44 percent of respondents offering this type of plan (up from 17 percent in 2009).
Sixty percent of institutions offer healthcare benefits to same sex domestic partners or spouses (up from 46 percent five years ago).
A substantial percentage of institutions offer healthcare benefits to part-time staff and faculty (42 percent and 36 percent, respectively), and most of those also pay part of the premium.
None of the institutions not offering healthcare benefits for part-time employees provide financial support for enrollment in a public exchange, and only 2 percent are considering doing so next year.
Almost all institutions provide basic life insurance, long-term disability, paid time-off, tuition assistance and retirement benefits. Short-term disability, however, is only offered by 64 percent of the respondents.
Press Release
Fact Sheet
3 Trends in Employee Benefits in Higher Ed

Little Evidence of the ACA Increasing Part-Time Work So Far

Source: Bowen Garrett and Robert Kaestner, Robert Wood Johnson Foundation & the Urban Institute, Timely Analysis of Immediate Health Policy Issues, September 2014

From the Robert Wood Johnson Foundation summary:
Some reports have suggested that the Affordable Care Act (ACA) is already triggering an increase in part-time workers. Is this true?

So far, the available evidence suggests those claims are false. This Quick Strike analysis by the Urban Institute suggests that there is “no evidence that the ACA had already started increasing part-time work before 2014.”

If the ACA was likely to have increased part-time work, how might it have happened?
Primarily in two ways:
∙ Employers with 50 or more employees will be subject to penalties under the ACA if they fail to comply with the act’s employer mandate—the requirement that they provide adequate and affordable coverage for their full-time employees. In anticipation of the mandate, some suggest, employers are seeking to avoid or reduce penalties either by cutting employee hours to below 30—the threshold at which an employee is considered full-time—or hiring more part-time workers.
∙ Employees, offered access to health insurance under the ACA—including subsidies for those with family incomes below 400 percent of the federal poverty level—might be voluntarily choosing part-time employment because they no longer need the employer-sponsored health insurance available only to full-time employees.

Urban Institute researchers say their analysis offers more likely explanations. Their research indicates transitions between full-time and part-time work are consistent with historical patterns. Moreover, “These findings suggest that the increase in part-time work in 2014 is not ACA-related, but more likely due to a slower than normal recovery of full-time jobs following the great recession.”

Learning About Medical Student Mistreatment From Responses to the Medical School Graduation Questionnaire

Source: Brian Mavis, Aron Sousa, Wanda Lipscomb, and Marsha D. Rappley, Academic Medicine, Volume 89 no. 5, May 2014

From the abstract:
Although evidence of medical student mistreatment has accumulated for more than 20 years, only recently have professional organizations like the Association of American Medical Colleges (AAMC) and the American Medical Association truly acknowledged it as an issue. Since 1991, the AAMC’s annual Medical School Graduation Questionnaire (GQ) has included questions about mistreatment. Responses to the GQ have become the major source of evidence of the prevalence and types of mistreatment. This article reviews national mistreatment data, using responses to the GQ from 2000 through 2012; examines how students’ experiences have changed over time; and highlights the implications of this information for the broader medical education system. The authors discuss what mistreatment is, including the changing definitions from the GQ; the prevalence, types, and sources of mistreatment; and evidence of students reporting incidents. In addition, they discuss next steps, including better defining mistreatment, specifically public humiliation and belittling, taking into account students’ subjective evaluations; understanding and addressing the influence of institutional culture and what institutions can learn from current approaches at other institutions; and developing better systems to report and respond to reports of mistreatment. They conclude with a discussion of how mistreatment currently is conceptualized within the medical education system and the implications of that conceptualization for eradicating mistreatment in the future.

Human Rights and Immigrants’ Access to Care

Source: Wendy E. Parmet, Simon Fischer, Northeastern University School of Law Research Paper No. 183-2014

From the abstract:
This article first examines the international framework for the right to health, and how it applies to non-citizens within a state. It then looks specifically at the case of the United States of America, which does not recognize a general right to health, but does have numerous particularized health programs, each with their own criteria and exclusions. The resulting hodgepodge is especially difficult for non-citizens, who face a number of exclusions based on their immigration status. This results in non-citizens being insured at low rates, and being put at greater risk for certain preventable or treatable diseases. Finally, the article looks at an example of using state rather than federal law in the United States to secure better health care for immigrant populations. Particular attention is paid to Finch v. Commonwealth Health Insurance Connector Authority, which established under Massachusetts law that legal immigrants could not be discriminated against in a state-funded broad-based health insurance program.

Hospitals often ignore policies on using qualified medical interpreters

Source: Sabriya Rice, Modern Healthcare, Vol. 44 no. 35, September 1, 2014
(subscription required)

As the U.S. grows increasingly more linguistically and culturally diverse, some safety experts worry that healthcare providers too often are not making professional interpreter and translator services available to patients and families, increasing the risk of adverse events.
Identifying and Preventing Medical Errors in Patients With Limited English Proficiency: Key Findings and Tools for the Field
Source: Melanie Wasserman, Megan R. Renfrew, Alexander R. Green, Lenny Lopez, Aswita Tan-McGrory, Cindy Brach and Joseph R. Betancourt, Journal for Healthcare Quality, Volume 36 Issue 3, May/June 2014
(subscription required)

From the abstract:
Since the 1999 Institute of Medicine (IOM) report To Err is Human, progress has been made in patient safety, but few efforts have focused on safety in patients with limited English proficiency (LEP). This article describes the development, content, and testing of two new evidence-based Agency for Healthcare Research and Quality (AHRQ) tools for LEP patient safety. In the content development phase, a comprehensive mixed-methods approach was used to identify common causes of errors for LEP patients, high-risk scenarios, and evidence-based strategies to address them. Based on our findings, Improving Patient Safety Systems for Limited English Proficient Patients: A Guide for Hospitals contains recommendations to improve detection and prevention of medical errors across diverse populations, and TeamSTEPPS Enhancing Safety for Patients with Limited English Proficiency Module trains staff to improve safety through team communication and incorporating interpreters in the care process. The Hospital Guide was validated with leaders in quality and safety at diverse hospitals, and the TeamSTEPPS LEP module was field-tested in varied settings within three hospitals. Both tools were found to be implementable, acceptable to their audiences, and conducive to learning. Further research on the impact of the combined use of the guide and module would shed light on their value as a multifaceted intervention.

Fair Hospital Prices are Not Charity: Decoupling Hospital Pricing and Collection Rules from Tax Status

Source: Erin Fuse Brown, Georgia State University College of Law, Legal Studies Research Paper No. 2014-24, June 16, 2014

From the abstract:
The Patient Protection and Affordable Care Act created a new set of rules for nonprofit hospitals to maintain their federal tax-exemption, codified at Section 501(r) of the Internal Revenue Code. The 501(r) rules attempt to address the problem of hospitals’ excessive prices and onerous debt collection actions against self-pay patients by imposing fair pricing and debt collection requirements for patients eligible for financial assistance. Nevertheless, the 501(r) rules leave many financially vulnerable patients unprotected: those who receive care at for-profit hospitals and those who find themselves ineligible under a hospital’s self-defined criteria for financial assistance. Protection by the 501(r) rules is not only uneven, it is also opaque, based on circumstances and information the patient cannot easily discover or control, creating a kind of fairness roulette. The ramifications of losing the fairness roulette for the patient can mean the difference between a manageable medical bill and financial ruin. There is no good reason to limit fair pricing and collection requirements to tax-exempt hospitals. Fairness is not charity because requiring a hospital to charge a fair price does not require it to give services away for free or at a loss. This article proposes to decouple the fair pricing and collection rules from a hospital’s tax status, and instead make compliance with these rules a condition of participation in Medicare. Under this proposal, all hospitals that participate in Medicare would have to limit charges and collection activities for uninsured and underinsured self-pay patients who fall within certain income limits or whose medical bills exceed a defined percentage of income. Because fair hospital pricing and collection requirements are not charity, we should be treated fairly by any hospital regardless of its tax status.

Employee Benefits: Today, Tomorrow, and Yesterday

Source: Nevin Adams and Dallas Salisbury, Employee Benefit Research Institute, Issue Brief, no. 401, July 2014

From the summary:
In 2013, the nonpartisan Employee Benefit Research Institute (EBRI) commemorated its 35th anniversary. While much has changed with health and retirement benefits during the past three decades—the first generation of the Employee Retirement Income Security Act (ERISA)—many of the issues that were present at EBRI’s beginning remain today.

But even if core issues endure, the historic shift away from “traditional” defined benefit pension plans and toward 401(k)-type defined contribution retirement plans, along with the recent enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA), and the demographic shifts attendant with the retirement of the Baby Boomers and the workplace ascendency of the Generation X and Millennial cohorts, employee benefits are certain to continue to change and evolve in the future.
Each year EBRI holds two policy forums which bring together a cross-section of national experts in the benefits field, congressional and executive branch staff, and representatives from academia, interest groups, and labor to examine public policy issues affecting health and retirement benefits.

This Issue Brief summarizes the presentations and discussions at EBRI’s 73rd policy forum held in Washington, DC, on Dec. 12, 2013. Titled “Employee Benefits: Today, Tomorrow and Yesterday,” the symposium offered expert perspectives on not only the workplace and work force of the past, but the challenges of today’s multi-generational workplace, and the difficulties and opportunities that lie ahead. Following a review of the benefits landscape by EBRI’s research team, panels discussed:
• 1978 to 2013: The Changing Role of Employers in Employee Benefits.
• Employee Benefits from 2013 to 2048: The Road to Tomorrow.
• 2013 to 2048: Work Force Trends and Preferences, Today and Tomorrow.