Health Care Safety-Net Programs After The Affordable Care Act
Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.
Health Care Safety-Net Programs Continue to Serve Most Vulnerable
[cross-posted from the United States of Care blog]
Beyond Physicians: Interdisciplinary Teams in Integrated Care
In our recent blog post, we explore barriers to behavioral health care in the United States and discuss an alternate strategy: integrated care. Traditionally, integrated care has entailed behavioral health care delivered by a primary care provider.
Fast-tracking Behavioral Health Care
Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.
Organization Theory Research and the Future of U.S. Health Care
When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers
Dan Treglia, Eileen L. Johns, Maryanne Schretzman, Jacob Berman, Dennis P. Culhane, David C. Lee, and Kelly M. Doran
Abstract [from journal]
People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases
...Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital
Amy Trowbridge, Tara Bamat, Heather Griffis, Eric McConathey, Chris Feudtner, Jennifer K. Walter
Abstract [from journal]
Objectives: Pediatric residents are expected to be competent in end of life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures.
Methods: Retrospective chart review of all deceased patients at one children's hospital over three years collected patient demographics, time and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within
...Causes, Risk Factors, and Costs of 30-day Readmissions after Mitral Valve Repair and Replacement
Nicholas J. Goel, Amit Iyengar, John J. Kelly, Chase R. Brown, Fabliha Kurshan, Pavan Atluri, Michael A. Acker, Zehang Chen, Nimesh D. Desai
Abstract [from journal]
Background: Postsurgical readmissions are an increasingly scrutinized marker of healthcare quality. We sought to estimate the risk factors and costs associated with readmissions following mitral valve surgery in a large, nationally-representative cohort.
Methods: Adult patients undergoing mitral valve repair or replacement were queried from the National Readmissions Database from 2010 to 2014. Data was collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure
...Capacity Pooling in Hospitals: The Hidden Consequences of Off-Service Placement
Hummy Song, Anita L. Tucker, Ryan Graue, Sarah Moravick, Julius J. Yang
Abstract [from journal]
Hospital managers struggle with the day-to-day variability in patient admissions to different clinical services, each of which typically has a fixed allocation of hospital beds. In response, many hospitals engage in capacity pooling by assigning patients from a service whose designated beds are fully occupied to an available bed in a unit designated for a different service. This “off-service placement” occurs frequently, yet
...Should Health Systems Recognize Gun Violence as a Disease?
How Do Non-profit Hospitals Give Back?
Hospitals designated as non-profits received tax-benefits valued at over $24 billion annually in 2011. Non-profit hospitals justify their tax-exempt status by providing “community benefits” in the form of free and subsidized care, investments in public health, and community-based initiatives intended to address the social determinants of health, such as food or housing insecurity.
Penn's Karen Lasater Wins AcademyHealth IRGNI New Investigator Award
Do Cardiac Centers of Excellence Really Excel?
If I needed a cardiac procedure, I might look for a hospital designated as a cardiac “center of excellence” (COE) by my insurer. I might assume that the hospital delivers higher quality care and achieves better outcomes than other hospitals. But that assumption might be wrong, according to a new study by LDI Associate Fellow Sameed Khatana and colleagues in JAMA Internal Medicine.
Linda Aiken Honored by Ireland's Royal College of Surgeons
Prompt Primary Care Linked to Fewer Rehospitalizations in Medicaid Patients
The Camden Coalition of Healthcare Providers (of hotspotting fame) has published some intriguing findings from a city-wide program to reduce rehospitalizations by linking hospitalized Medicaid patients to primary care follow-up within seven days of discharge.