What works: Healing the healthcare staffing shortage

Source: PricewaterhouseCoopers’ Health Research Institute, 2007

Many nurses and physicians are among the baby boomers who will start to retire in the next three to five years. The federal government is predicting that by 2020, nurse and physician retirements will contribute to a shortage of approximately 24,000 doctors and nearly 1 million nurses. While hospital leaders voice much of the concern over possible shortages, the implications extend throughout the labor-intensive, trillion-dollar United States health system. It’s expensive to educate new nurses and doctors. Taxpayer-funded Medicare spends $8 billion a year for residence training of physicians alone.

While the U.S. has more physicians and nurses today than ever before, they are not distributed or deployed efficiently. Shortage projections tend to be built around today’s often dysfunctional system, which makes them problematic. However, while future shortages are certainly worrisome, the bigger issue for health industry leaders today lies in orchestrating care in an increasingly complex and converging healthcare labor market.

Nursing Faculty Member Explores Factors Effecting Frequency of Non-Intercepted Medication Errors in 17 NJ Hospitals

Source: Rutgers College of Nursing, Press Release, August 15, 2007

From press release:
(NEWARK, N.J., Aug. 14, 2007) – Rutgers College of Nursing faculty member Linda Flynn is conducting a study to explore the effects of nurse staffing, work environment and safety technology on the frequency of non-intercepted medication errors in 17 New Jersey hospitals.

Funded by a two-year $308,254 grant from the Robert Wood Johnson Foundation, the study’s focus is to determine the best practices for reducing non-intercepted medication errors.

Keeping Score: A comparison of pay-for-performance programs among commercial insurers

Source: PricewaterhouseCoopers’ Health Research Institute, 2007

It is impossible to improve what cannot be measured or to measure what hasn’t been defined. Take, for example, the topic of healthcare quality. Everyone wants quality, but everyone’s keeping score differently. This conundrum was described in some detail in The Quality Conundrum, a book developed and distributed in 2007 by PricewaterhouseCoopers’ Health Research Institute (HRI). It explores practical approaches to improving the quality of patient care from the perspective of patients, physicians, payers, and employers.

One of these approaches is pay-for-performance (P4P), which attempts to define, measure, and reward quality. This represents a radical departure from traditional payment methods, which pay providers the same regardless of differences in quality. P4P has gained traction, largely because the Centers for Medicare and Medicaid Services (CMS) has told hospitals and physicians that future increases in payment will be linked to improvements in clinical performance. Commercial health plans are also responding to employers’ demands for quality improvement by developing “scorecards” that use quality metrics to grade care provided by hospitals and physicians. By tying providers’ scores to financial payments, non-financial rewards, and public reporting, both private and public payers intend to incent improvements in quality of care and outcomes.

The most mature P4P programs are more than 10 years old. However, among payers interviewed for this report, P4P programs are still evolving. As they’ve blossomed, providers have faced a host of new and varied reporting requirements-what some call a “virtual soup of different metrics.” This has caused some to question the value of P4P and whether the results are worth the administrative burden.
See also:
Pay-for-Performance: Will the Latest Payment Trend Improve Care?
Source: Meredith B. Rosenthal, R. Adams Dudley, JAMA: Journal of the American Medical Association, Vol. 297 No. 7, February 21, 2007 (subscription required)

Push For Merit-Based Teacher Pay Heats Up

Source: Hays Daily News, 8/26/2007

OKLAHOMA CITY (AP) — A merit-based teacher salary plan proposed by Republican state lawmakers could cause teachers’ paychecks to vary dramatically depending on how well their students perform in the classroom.

Supporters say tying teacher pay to performance will lead to increased accountability and more innovation and effort in the classroom. But opponents say teachers would be forced to compete instead of collaborate. And tying raises or bonuses to student test scores is not the best measure of what constitutes a good teacher, many say.

Recent/Updated CRS Reports: Health Insurance, Medicare and Social Security

Source: Congressional Research Service (via OpenCRS)

American taxpayers spend nearly $100 million a year to fund the Congressional Research Service, a “think tank” that provides reports to members of Congress on a variety of topics relevant to current political events. Yet, these reports are not made available to the public in a way that they can be easily obtained. A project of the Center for Democracy & Technology, Open CRS provides citizens access to CRS Reports that are already in the public domain and encourages Congress to provide public access to all CRS Reports.
Integrating Medicare and Medicaid Services Through Managed Care
Medicare Prescription Drug Benefit: Low-Income Provisions
Primer on Disability Benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)
Social Security Administration: Administrative Budget Issues
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI): Proposed Changes to the Disability Determination and Appeals Processes
Supplemental Security Income (SSI): Accounts Not Counted As Resources
Tax Benefits for Health Insurance and Expenses: Overview of Current Law and Legislation

Post-Election Audits: Restoring Trust In Elections

Source: Lawrence Norden, Aaron Burstein, Joseph Lorenzo Hall
and Margaret Chen, Samuelson Law, Technology, & Public Policy Clinic/Brennan Center for Justice, NYU School of Law, 2007

From press release:
The Samuelson Clinic has co-authored with the Brennan Center for Justice at NYU School of Law the first comprehensive review of state laws and academic research on audits designed to check the integrity of electronic voting systems.

The report, “Post Elections Audits: Restoring Trust in Elections,” finds that most states are not doing enough to use post-election audits of paper trails to ensure that electronic voting is secure and accurate. Taking account of the wide variations in the organization of election jurisdictions around the country, “Restoring Trust in Elections” outlines goals and methods for conducting cost-effective, rigorous audits that will help guard against programming errors as well as malicious attacks against electronic voting systems.

See also:
Clinic’s Electronic Voting Research Helps To Advance Election Integrity
Legal Issues Facing Election Officials in an Electronic-Voting World

Pathways to the Middle Class: Ensuring Greater Upward Mobility for All Americans

Source: Hugh Price, Amy Liu, Rebecca Sohmer, Brookings Institution, Opportunity 08, August 2007

Middle-class prosperity is the cornerstone of the American Dream. Americans believe that through hard work and education families can enter the middle class and keep on climbing. However, recent evidence shows that, even with a rebounding U.S. economy, working and middle-class families are struggling more than in decades past, and upward economic mobility may not be continuing, even for those who work hard and play by society’s rules. Moreover, the road to middle-class prosperity is even rockier for minorities. Several time-honored pathways that lead to the middle class are postsecondary education, good jobs, living in viable neighborhoods, personal financial prudence, and entrepreneurship. This paper focuses on all but the last of these pathways of opportunity.

See also:
Fact Sheet

EAC Issues Poll Worker Best Practices

Source: U.S. Election Assistance Commission, August 2007

From news release:
The United States Election Assistance Commission (EAC) has released two best practices guidebooks to help election officials recruit, train, and retain poll workers. The two guidebooks are: “Successful Practices for Poll Worker Recruitment, Training and Retention” and “A Guidebook for Recruiting College Poll Workers.”

“Elections are becoming more complicated because of new federal and state laws, new procedures and new technical and security requirements for voting equipment,” said EAC Chair Donetta Davidson. “The need for trained poll workers is more urgent than ever, and we hope these guidebooks will help election officials find and keep good poll workers as well as recruit a new generation of poll workers.”

The guidebooks entailed a fifteen month development process involving two working groups and dozens of interviews and focus groups with election officials, voters and veteran poll workers. Draft versions of each guidebook were field-tested at six sites during the 2006 elections. The guidebooks were reviewed by the EAC’s Standards Board and Board of Advisors during a virtual public meeting last month.

See also:
Compendium of State Poll Worker Requirements

Wrong-Way Reforms for Allocating Electoral College Votes

Source: Monideepa Talukdar, Rob Richie, and Ryan O’Donnell, FairVote,
August 9, 2007

From abstract:
This paper analyzes two of the three major options available to state leaders interested in taking action to reform how their state allocates its Electoral College votes: the whole number proportional and congressional district systems. It evaluates them on the basis of whether they promote majority rule, make elections more nationally competitive, reduce incentives for partisan machinations, and make all votes count equally. We use vote returns from a number of previous elections to analyze what the outcomes would have been if Electoral College votes had been allocated according to the whole number proportional and the congressional district systems.

Our analysis reveals that both of these methods fail to meet our criteria. Neither reform option promotes majority rule, greater competitiveness, or voter equality. Pursued at a state level, both reforms dramatically increase incentives for partisan machinations. If done nationally, the congressional district system has a sharp partisan tilt toward the Republican Party. The whole number proportional system sharply increases the odds of contingent elections (the selection of president by Congress).

Historical Averages Not A Meaningful Benchmark For Future Revenues

Source: Matt Fiedler and Richard Kogan, Center on Budget and Policy Priorities, August 22, 2007

The “Mid-Session Review” that the Office of Management and Budget issued last month projects that revenues will be slightly above their 30-year average in 2007, measured as a share of the economy. The Administration and many of its supporters have cited this fact as evidence that current tax policies are generating an appropriate level of revenue and the Administration’s tax cuts therefore should be made permanent without the costs being offset. Similarly, Senator Charles Grassley, the ranking Republican on the Senate Finance Committee, has cited this fact as a reason for repealing the Alternative Minimum Tax without offsetting the large costs involved.

The simple fact that the government collected a particular level of revenue in the past says little, however, about what level of revenues is appropriate today, will be appropriate or necessary in the future, or even was appropriate in the past.