Tag Archive for Healthcare

2015 Healthcare Workforce Executive Insights Survey Results

To gain a better understanding of how healthcare industry changes have affected talent management practices, HealthcareSource and the American Society for Healthcare Human Resources Administration (ASHHRA) issued the 2015 Healthcare Workforce Executive Insights Survey. 

More than 400 people at healthcare providers across the country offered their views about how their talent management organizations are adapting to industry changes such as aging demographics, population health, accountable care initiatives, and the rapid growth of retail care clinics.

Check out our infographic for a breakdown of a few key data points.

 

2015 Healthcare Workforce Executive Insights Survey - HealthcareSource and ASHHRA

Will Rural Health-Care Providers Pay More for Broadband?

A new order released by the FCC in December will expand broadband access for some health-care providers. But the program may also hamstring the use of telemedicine by doctors who will need to pay more out of pocket to get online.

Called the Healthcare Connect Fund, the program will subsidize 65 percent of broadband costs for participating providers. That’s down significantly from the 85 percent subsidy in the FCC’s existing Rural Health Care pilot program, which was established by the 1996 Telecommunications Act.

In an interview with Government Technology, Eric Brown, president and CEO of the California Telehealth Network (CTN) — an organization that works with stakeholders to establish broadband connectivity for communities to improve the quality of health care — called the change an “obvious concern,” as some providers will not be able to pay the 35 percent contribution as the Healthcare Connect Fund requires.

Brown explained those members of CTN that have a 1.5 Mpbs T1 connection pay roughly $62.50 per month under the Rural Health Care program. If additional subsidies can’t be found, those same health providers will be paying approximately $200 per month for the same connectivity under the Healthcare Connect Fund.

Approximately 50 broadband pilot projects comprising single practices and consortia are currently funded by the Rural Health Care program.

Citing a study conducted by the California Health Care Foundation in 2012, Brown said many rural health clinics and critical access hospitals are not cash flow positive and are in very precarious financial positions. He believed the uptick in broadband expense would make their situations even worse.

“Anything that would require them to come up with more cash for reoccurring broadband expenses and the like, in addition to a lot of the financial demands that they face … makes it a very difficult environment for them,” Brown said.

When contacted by Government Technology about the funding disparity, FCC spokesman Mark Wigfield referred to a statement by FCC Commissioner Mignon Clyburn, who called the order establishing the Healthcare Connect Fund “momentous” and builds on the successes of the Rural Health Care program.

Clyburn’s statement didn’t address the issue of increased costs to be incurred by health-care providers, however. She instead focused on how the Healthcare Connect Fund will avoid wasteful spending and require competitive bids for broadband services and infrastructure.

In addition, the commissioner said both consortia and single sites can apply, and believes the proper balance of rural and urban practices has been struck, as the order requires more than 50 percent of the consortia must be from rural locations.

The FCC order implementing the program reforms includes a $400 million annual cap on the amount of support available through the Healthcare Connect Fund. Funding for existing broadband sites will be available later this year. New entrants to the program can expect funding on Jan. 1, 2014.

Brown emphasized that the expense under the Healthcare Connect Fund is still favorable when compared to the $600-$2,000 per month range for broadband access that some doctors are looking at without the program. But while “still a great deal,” Brown hopes supplementary funding can be found to ease the financial burden.

“It’s going to be a significant increase in what those sites are going to pay,” Brown added. “It’s not coming at the best time when there are all these other competing uses for the few precious financial resources they have.”

Among the expansion elements of the Healthcare Connect Fund is the inclusion of skilled nursing facilities, more commonly known as nursing homes or rest homes. As part of the fund, the pilot project will allow nurses in rural rest homes to have more convenient access to doctors in more urban areas. Up to $50 million over three years will be available out of the fund for the pilot.

In a statement announcing the fund, FCC Chairman Julius Genachowski said enabling broadband access for nurses could help patients and save money through potential earlier discharges from hospitals or to get more focused care closer to their homes.

Genachowski gave a number of potential examples of how broadband connectivity will aid skilled nursing facilities. He said from patients recovering from open heart surgery in rural Virginia who could get evaluated from afar, to a small town resident that can have chest x-rays sent to a doctor in another location, consultations through technology can save ambulance trips or emergency room visits.

Brown said the addition of skilled nursing facilities as a pilot project was a “big deal” for many of the CTN’s members that have those facilities in close proximity, but up until now, were not able to serve them. He said that will change as various nursing homes and similar facilities are enrolled in the pilot.

Clyburn added that if the skilled nursing facilities program is supported and becomes a permanent to the Healthcare Connect Fund, it will give patients that are too sick to stay home, but not ill enough to be admitted to a hospital, more diverse choices in care.

“Broadband is especially useful for these facilities, as it permits a doctor to be virtually present, and offers patients and their families’ increased peace of mind,” Clyburn said in a statement.

Photo from Shutterstock

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http://www.govtech.com/health/Will-Rural-Healthcare-Providers-Pay-More-for-Broadband.html

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GovTech Innovators: Jon Rosenberg, Chief of California’s Healthcare Infections Map

Our latest GovTech Innovator is Jonathan Rosenberg, chief of the Healthcare Associated Infections Program at the California Department of Public Health. 

His program, established in 2009, tracks the surgical infection rates in the state’s hospitals and reports the data publicly. This means that Californians can check the program’s website if they’re curious about the infection rates associated with local hospitals.

But medical information can be complicated, and sometimes people have trouble deciphering large blocks of texts and detailed tables, so Rosenberg and his colleagues are trying an extra method to simplify the process. 

They’ve created an interactive map (snapshot shown above) that charts California hospitals and assigns them symbols based on how their infection rates compare with state and national averages. They hope this will help people make better healthcare choices.

Rosenberg spoke to us about the map and his program’s role is assisting Californians.


You may use or reference this story with attribution and a link to
http://www.govtech.com/health/GovTech-Innovators-Jon-Rosenberg-Chief-of-Californias-Healthcare-Infections-Map.html

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Obama Win Means Big Health-Care Decisions for States

Since the day it was enacted, many of the Affordable Care Act’s opponents have preferred to treat it as provisional. First, they argued, the Supreme Court might overturn the whole law. When that didn’t happen in June, opponents turned to the hope that maybe Mitt Romney would win the presidency and repeal it.

Now, there are no more maybes. “With an Obama victory one has to come to terms that the Affordable Care Act is the law of the land,” says Henry Aaron, a senior fellow at the Brookings Institution. “Maybe it’s time to start living in reality rather than fantasy.”

Still, in the new reality, there remain some significant uncertainties in the immediate future of the ACA, particularly in how Republican governors, who have vociferously opposed the law until now, will react in the wake of President Obama’s victory. The ACA is indeed the law of the land and will remain so for the foreseeable future, but that doesn’t mean that Republican governors have to be full participants.

If they decline to be involved, however, they have to be willing to forego billions of federal dollars while at the same time inviting more federal involvement in their state health policies.

At issue is whether states will be willing and able to run their own health insurance exchanges — the ACA’s envisioned online marketplaces where some 30 million Americans will be able to comparison shop for private insurance plans and apply for Medicaid and federal tax credits. If states choose not to run their own exchanges, the law requires the federal government to do it for them.

States must also decide whether they want to accept generous federal funding to expand their Medicaid programs to cover millions more people. In addition to the political liability that may represent for Republicans, the expansion also comes with a future price tag some states are taking very seriously.

The initial decision on establishing exchanges must be made by November 16, although the administration is expected to be lenient if some states need more time to complete their proposals. There is no deadline for states in considering whether to participate in the ACA’s expanded Medicaid program, but it is a decision many of them will want to make sooner rather than later. Choices made on both health exchanges and Medicaid expansion will have major effects on consumers and the entire health care industry, as well as state budgets, for years to come.

From here on out, states will be the primary drivers of the health law’s implementation. To achieve its intended goal of covering 30 million uninsured people with affordable health care, the Obama administration will have to engage in some give-and-take in order to ensure the cooperation of as many states as possible.

The federal health law originally required states to expand their Medicaid programs, starting in 2014, to people with incomes at or below 133 percent of the federal poverty level, about $31,000 for a family of four and $15,000 for an individual. That expansion by itself was expected to take in some 16 million uninsured people nationwide, about half of the total population the law aimed to cover.

But this year’s Supreme Court decision, which largely upheld the law, made the Medicaid expansion optional for the states. That spawned a series of refusals to participate by GOP governors who opposed the law. Most Democratic governors are expected eventually to agree to implement the provision.

For states that take up the Medicaid option, the federal government will pay 100 percent of the costs for the first three years; after that states are responsible for up to 10 percent of the costs. Although the offer seems generous, some states genuinely worry that the increased expenses in the fourth year and beyond will strain their already costly Medicaid programs.

But the real decision will come early next year when state legislatures weigh in on the issue. In the meantime, many analysts expect the objections by GOP governors to fade away. Aaron, for example, maintains that the offer “is so hugely attractive to each state financially that refusal to expand coverage … [would be] an act of fiscal self-mutilation.”

Even so, all states are expected to weigh carefully the federal government’s deficit reduction agreements this January as they make a decision on expanding Medicaid. In deficit talks last year, the Obama administration recommended substantial cuts to the overall Medicaid program under a proposal known as the “blended rate.” The extent of those cuts in a final budget agreement is expected to factor heavily into states’ decisions on whether to expand Medicaid.

“State Medicaid programs are already unsustainable,” says Matt Salo, director of the National Association of Medicaid Directors. “That is not going to change.” No matter what states decide on the Medicaid expansion, simultaneous efforts will have to be made to cut overall costs by making fundamental changes to the program. For that to happen, the Obama administration will need to make the process of change much more flexible, Salo says.

Questions have also come up about whether states that accept the expansion will be permanently required to maintain the broader Medicaid coverage. So far, the administration has said that states may join the expansion now, then opt out later if the costs are too burdensome. But states have not been given an answer on whether they will be allowed to strike a middle ground by expanding coverage to a smaller number of people — those with incomes at or below the federal poverty line, rather than the broader population with incomes below 133 percent.

As for the absence of a deadline on the expansion, experts say states could conceivably hold out indefinitely because making a technical change to their enrollment systems to include the expanded population would not require a huge effort. Some may wait until after 2014 to expand Medicaid.

“The goal of expanding Medicaid in every state may take years,” says Chris Whatley, deputy director of the Council of State Governments. “Even if you have half the states not doing it in the beginning, they may eventually come along.” The 1965 Medicaid amendment to the Social Security Act made the program optional and many states took up the offer in the first couple of years. But there were stragglers. Arizona did not sign on until 1982.

The issue of whether to participate in health insurance exchanges confronts Republican governors with a difficult decision: either create your own state insurance exchange, a central element of the Affordable Care Act they oppose, or stand by and watch the federal government come in and dictate changes in your state’s health insurance market.

“They are faced with a difficult choice politically because Obamacare is so bitterly unpopular among Republican voters,” says Mike Tuffin of APCO Worldwide, a health care consulting firm. “That said, if they don’t pursue a state exchange they leave themselves open to having Washington come in and do it themselves, which is antithetical to Republican philosophy.”

A third option is for states to join in a partnership with the federal government to create and run an exchange. In future years, those states could opt to take over their exchanges entirely if they wanted to.

As of late October as many as 30 states had not yet committed to creating their own insurance exchanges, according to the Center on Budget and Policy Priorities. That does not mean that all of those states will refuse to do it. Some states, while resisting Obamacare publicly, have quietly taken steps to launch their own exchanges or join in partnership with the federal government, even while they hoped that a Romney victory would ultimately allow them to shelve those plans.

The exchanges are supposed to be up and running in less than a year (October 1, 2013) so that people can sign up for insurance that would take effect in January 2014. Given the complexity of the technical, design and insurance market issues that must be addressed to create an exchange, a number of states will be hard-pressed to create one on their own at this point. For those that have laid adequate groundwork, however, there is still time.

As for those states, such as Texas, that have done nothing thus far, it’s probably too late. “They have not taken enough steps even if they change their minds,” says Alan Weil, executive director of the National Academy for State Health Policy.

In those states, the federal government will create and operate the exchange. “What they lose is being able to define the structure of the insurance choices in their own states and overseeing the health insurance plans that are offered,” says Weil. Many believe that every state knows its own insurance marketplace and consumers best and is therefore best-suited to design its own exchange.

An irony is that during the congressional debate over the Affordable Care Act, the initial favored position of Democrats was that there be only a federally administered exchange. Ultimately, those in favor of decentralized control won out, giving states the opportunity to create their own exchanges. Now it is a group of Republican-controlled states that will likely have to submit to a federal exchange.

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Photo from spirit of america / Shutterstock.com

You may use or reference this story with attribution and a link to
http://www.govtech.com/pcio/articles/Obama-Win-Means-Big-Health-Care-Decisions-for-States.html

View the original article here

Obama Win Means Big Health-Care Decisions for States

Since the day it was enacted, many of the Affordable Care Act’s opponents have preferred to treat it as provisional. First, they argued, the Supreme Court might overturn the whole law. When that didn’t happen in June, opponents turned to the hope that maybe Mitt Romney would win the presidency and repeal it.

Now, there are no more maybes. “With an Obama victory one has to come to terms that the Affordable Care Act is the law of the land,” says Henry Aaron, a senior fellow at the Brookings Institution. “Maybe it’s time to start living in reality rather than fantasy.”

Still, in the new reality, there remain some significant uncertainties in the immediate future of the ACA, particularly in how Republican governors, who have vociferously opposed the law until now, will react in the wake of President Obama’s victory. The ACA is indeed the law of the land and will remain so for the foreseeable future, but that doesn’t mean that Republican governors have to be full participants.

If they decline to be involved, however, they have to be willing to forego billions of federal dollars while at the same time inviting more federal involvement in their state health policies.

At issue is whether states will be willing and able to run their own health insurance exchanges — the ACA’s envisioned online marketplaces where some 30 million Americans will be able to comparison shop for private insurance plans and apply for Medicaid and federal tax credits. If states choose not to run their own exchanges, the law requires the federal government to do it for them.

States must also decide whether they want to accept generous federal funding to expand their Medicaid programs to cover millions more people. In addition to the political liability that may represent for Republicans, the expansion also comes with a future price tag some states are taking very seriously.

The initial decision on establishing exchanges must be made by November 16, although the administration is expected to be lenient if some states need more time to complete their proposals. There is no deadline for states in considering whether to participate in the ACA’s expanded Medicaid program, but it is a decision many of them will want to make sooner rather than later. Choices made on both health exchanges and Medicaid expansion will have major effects on consumers and the entire health care industry, as well as state budgets, for years to come.

From here on out, states will be the primary drivers of the health law’s implementation. To achieve its intended goal of covering 30 million uninsured people with affordable health care, the Obama administration will have to engage in some give-and-take in order to ensure the cooperation of as many states as possible.

The federal health law originally required states to expand their Medicaid programs, starting in 2014, to people with incomes at or below 133 percent of the federal poverty level, about $31,000 for a family of four and $15,000 for an individual. That expansion by itself was expected to take in some 16 million uninsured people nationwide, about half of the total population the law aimed to cover.

But this year’s Supreme Court decision, which largely upheld the law, made the Medicaid expansion optional for the states. That spawned a series of refusals to participate by GOP governors who opposed the law. Most Democratic governors are expected eventually to agree to implement the provision.

For states that take up the Medicaid option, the federal government will pay 100 percent of the costs for the first three years; after that states are responsible for up to 10 percent of the costs. Although the offer seems generous, some states genuinely worry that the increased expenses in the fourth year and beyond will strain their already costly Medicaid programs.

But the real decision will come early next year when state legislatures weigh in on the issue. In the meantime, many analysts expect the objections by GOP governors to fade away. Aaron, for example, maintains that the offer “is so hugely attractive to each state financially that refusal to expand coverage … [would be] an act of fiscal self-mutilation.”

Even so, all states are expected to weigh carefully the federal government’s deficit reduction agreements this January as they make a decision on expanding Medicaid. In deficit talks last year, the Obama administration recommended substantial cuts to the overall Medicaid program under a proposal known as the “blended rate.” The extent of those cuts in a final budget agreement is expected to factor heavily into states’ decisions on whether to expand Medicaid.

“State Medicaid programs are already unsustainable,” says Matt Salo, director of the National Association of Medicaid Directors. “That is not going to change.” No matter what states decide on the Medicaid expansion, simultaneous efforts will have to be made to cut overall costs by making fundamental changes to the program. For that to happen, the Obama administration will need to make the process of change much more flexible, Salo says.

Questions have also come up about whether states that accept the expansion will be permanently required to maintain the broader Medicaid coverage. So far, the administration has said that states may join the expansion now, then opt out later if the costs are too burdensome. But states have not been given an answer on whether they will be allowed to strike a middle ground by expanding coverage to a smaller number of people — those with incomes at or below the federal poverty line, rather than the broader population with incomes below 133 percent.

As for the absence of a deadline on the expansion, experts say states could conceivably hold out indefinitely because making a technical change to their enrollment systems to include the expanded population would not require a huge effort. Some may wait until after 2014 to expand Medicaid.

“The goal of expanding Medicaid in every state may take years,” says Chris Whatley, deputy director of the Council of State Governments. “Even if you have half the states not doing it in the beginning, they may eventually come along.” The 1965 Medicaid amendment to the Social Security Act made the program optional and many states took up the offer in the first couple of years. But there were stragglers. Arizona did not sign on until 1982.

The issue of whether to participate in health insurance exchanges confronts Republican governors with a difficult decision: either create your own state insurance exchange, a central element of the Affordable Care Act they oppose, or stand by and watch the federal government come in and dictate changes in your state’s health insurance market.

“They are faced with a difficult choice politically because Obamacare is so bitterly unpopular among Republican voters,” says Mike Tuffin of APCO Worldwide, a health care consulting firm. “That said, if they don’t pursue a state exchange they leave themselves open to having Washington come in and do it themselves, which is antithetical to Republican philosophy.”

A third option is for states to join in a partnership with the federal government to create and run an exchange. In future years, those states could opt to take over their exchanges entirely if they wanted to.

As of late October as many as 30 states had not yet committed to creating their own insurance exchanges, according to the Center on Budget and Policy Priorities. That does not mean that all of those states will refuse to do it. Some states, while resisting Obamacare publicly, have quietly taken steps to launch their own exchanges or join in partnership with the federal government, even while they hoped that a Romney victory would ultimately allow them to shelve those plans.

The exchanges are supposed to be up and running in less than a year (October 1, 2013) so that people can sign up for insurance that would take effect in January 2014. Given the complexity of the technical, design and insurance market issues that must be addressed to create an exchange, a number of states will be hard-pressed to create one on their own at this point. For those that have laid adequate groundwork, however, there is still time.

As for those states, such as Texas, that have done nothing thus far, it’s probably too late. “They have not taken enough steps even if they change their minds,” says Alan Weil, executive director of the National Academy for State Health Policy.

In those states, the federal government will create and operate the exchange. “What they lose is being able to define the structure of the insurance choices in their own states and overseeing the health insurance plans that are offered,” says Weil. Many believe that every state knows its own insurance marketplace and consumers best and is therefore best-suited to design its own exchange.

An irony is that during the congressional debate over the Affordable Care Act, the initial favored position of Democrats was that there be only a federally administered exchange. Ultimately, those in favor of decentralized control won out, giving states the opportunity to create their own exchanges. Now it is a group of Republican-controlled states that will likely have to submit to a federal exchange.

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Photo from spirit of america / Shutterstock.com

You may use or reference this story with attribution and a link to
http://www.govtech.com/pcio/articles/Obama-Win-Means-Big-Health-Care-Decisions-for-States.html

View the original article here