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Additional Requirements For Charitable Hospitals: Final Rules On Community Health Needs Assessments And Financial Assistance


January 23rd, 2015

On December 29, the Department of the Treasury and the Internal Revenue Service released long-awaited final regulations implementing Affordable Care Act provisions that impose additional obligations on charitable hospital organizations covered by §501(c)(3) of the Internal Revenue Code.  Published in the Federal Register on December 31 2014, the regulations are massive, consolidating a series of prior proposals into a single final body of regulatory law.  The regulations affect more than 80 percent of U.S. hospitals, both the 60 percent that operate as private nonprofit entities and the 23 percent that operate as governmental units.

Because state and local governments typically condition their own sales, property, and corporate income tax exemptions for nonprofit entities to a hospital’s §501(c)(3) status, the final regulations carry broad and deep implications from both a policy and financial perspective.  According to the Congressional Budget Office the 2002 the national value of the federal tax exemption exceeded $12 billion, a figure that undoubtedly has risen considerably.

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CMS Spending Report Leads Health Affairs 2014 Top-Ten List


January 13th, 2015

A report on 2012 health spending by analysts at the Centers for Medicare and Medicaid Services Office of the Actuary was the most-read Health Affairs article in 2014. To celebrate the New Year, Health Affairs is making this piece and all the articles on the journal’s 2014 top-ten list freely available to all readers for two weeks.

Health Affairs publishes annual retrospective analyses of National Health Expenditures by the CMS analysts, as well as their health spending projections for the coming decade. In the latest installment in this series — which also made our 2014 top ten — the analysts reported on 2013 health spending and discussed their findings at a Washington DC briefing. The two reports documented continued slow growth in health spending; the 2013 report featured the slowest rate of health spending growth since CMS began tracking NHE in 1960.

Next on the 2014 Health Affairs most-read list was an article on PepsiCo’s workplace wellnesss program. John Caloyeras and coauthors at RAND and PepsiCo found that the diseases management component of the program saved money, but the lifestyle management component did not. This was followed by two Narrative Matters essays by Charlotte Yeh and Diane Meier; another Narrative Matters piece, by Janice Lynn Schuster, rounded out the list at number ten.

The full top-ten list is below. And check out the 2014 most-read Health Affairs Blog posts and GrantWatch Blog posts.

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The Importance Of Zip Code In Determining One’s Health Tops 2014 GrantWatch Blog Most-Read List


January 9th, 2015

Happy New Year! We have compiled a list of the ten most-read posts on GrantWatch Blog during 2014, in case you missed any of them.

  1. “Zip Code Overrides DNA Code When It Comes to a Healthy Community” (January 30, 2014). This post by Anne Warhover, former president and CEO of the Colorado Health Foundation, was by far the most-read post. She mentions the Robert Wood Johnson Foundation Commission to Build a Healthier America, of which she was a commissioner, and relevant activities in Colorado. We also feel sure that Warhover’s post set a record for the number of re-tweets. Read more about Warhover here.
  2. “A World of Darkness: What If Thomas Edison Had to Write Grant Proposals to Invent the Light Bulb?” (February 18, 2014). This post by Jeffrey Brenner, executive director of the Camden Coalition of Healthcare Providers and a family physician, came in at no. 2. Brenner is also a MacArthur Fellow. This post was published in partnership with Grantmakers In Health.
  3. “Elevating the Role of the Medical Assistant” (March 3, 2014). This post by Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation, in Pittsburgh, was the third most-read post in 2014. Feinstein is also president and CEO of its affiliated organization, the Pittsburgh Regional Health Initiative.
  4. “Foundations Supporting Stewardship of Health Care Resources through Medical Education and Training” (January 22, 2014). Daniel Wolfson and Leslie Tucker of the ABIM Foundation wrote this post about a convening of medical educators, students, residents, and other stakeholders. The ABIM Foundation and the Josiah Macy Jr Foundation held this meeting.
  5. “The Robert Wood Johnson Foundation: Creating Partnerships to Build a Culture of Health” (September 11, 2014). David Colby, who just retired from the RWJF, wrote this popular post about the foundation’s new focus in its work. As Colby notes, “Health actually is a part of everything!”
  6. “Online ACA Marketplaces: the Value of Consumer Experience Assessments” (June 17, 2014). Marian Mulkey of the California HealthCare Foundation (CHCF) and Claudia Page, a consultant to the foundation, wrote this post about people signing up for health insurance under the Affordable Care Act. Page is a former CHCF staffer.
  7. “The Hitachi Foundation Sheds Light on the New Role Frontline Workers Play in Health Care” (April 24, 2014). Tom Strong of the Hitachi Foundation wrote this post. Like no. 3, it mentions the role of medical assistants, which seems to be a popular subject!
  8. “Toxic Stress in Children and the Importance of Listening between the Lines to What Kids Say” (April 29, 2014). I wrote this post about Nadine Burke Harris’s speech at the Grantmakers In Health 2014 annual meeting in Atlanta.
  9. “If You Partner, They Might Just Come: One Foundation’s Effort to Disseminate Data on Quality of Care” (March 13, 2014). Andy Krackov, also of the CHCF, wrote this post about CalQualityCare.org, which it manages.
  10.  “The Rippel Foundation and the RWJF Push Frontiers for Financing and Sustaining Improvements in Health” (February 13, 2014). Laura Landy, who leads the Fannie E. Rippel Foundation, wrote this post about a “project to explore the conditions needed to build a next-generation health system.”

 

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The Value of Workplace Health Promotion (Wellness) Programs


December 22nd, 2014

The recent Health Affairs Blog post by Al Lewis, Vik Khanna, and Shana Montrose titled, “Workplace Wellness Produces No Savings” has triggered much interest and media attention. It highlights the controversy surrounding the value of workplace health promotion programs that 22 authors addressed in an article published in the September 2014 issue of the Journal of Occupational and Environmental Medicine titled, “Do Workplace Health Promotion (Wellness) Programs Work?”  That article also inspired several follow-up discussions and media reports, including one published by New York Times columnists Frakt and Carroll who answered the above question with: “usually not.”

There are certainly many points of contention and areas for continued discussion on this topic. It turns out that Lewis et al. and I agree on many things, and there are other areas where we see things differently.

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How To Succeed At Payment Reform (By Really Trying)


December 18th, 2014

Editor’s note: This is part 2 of a blog post adapted by the author from his recent keynote address at the New York State Health Foundation Conference, “Payment Reform: Expanding the Playing Field.” You can watch his half-hour speech, beginning around the eight-minute mark.

In my previous post, I explained “Why I Oppose Payment Reform.” Despite the reservations I laid out in that post, I do not actually oppose payment reform.

To summarize the case for payment reform, fee-for-service payment has supported a fragmented delivery system with little accountability for cost or quality.  As there is growing consensus that we want to move from our current system toward one that maximizes the health outcomes we achieve relative to the resources we expend, alternative payment models may provide us with a path. We should remember, however, that payment reform is a tool, not an end in itself; and we should be clear about our goals and then deploy the tool where it can help us achieve those goals.

Achieving payment reform is a process.  Here are five elements that are necessary for a successful process.

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Children’s Health: Health Affairs’ December Issue


December 8th, 2014

The December issue of Health Affairs includes a number of studies examining current threats to the health and health care of America’s children, and what can be done to meet their needs within an ever-evolving health care system. Some of the subjects covered: the role of Medicaid in reducing early-term elective deliveries; how pediatric services are covered in the state insurance Marketplaces; Medicaid spending on children with complex medical conditions; and the effect of abuse and neglect on children’s health and school engagement.

This issue of Health Affairs is supported by The W.K. Kellogg Foundation as well as by the Children’s Hospital Association, The David and Lucile Packard Foundation, Nemours, the Annie E. Casey Foundation, and The Child and Adolescent Health Measurement Initiative.

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Health Affairs Event Reminder: Children’s Health


December 4th, 2014

Threats to children’s health have changed dramatically over the past few generations, but America’s health care system has been slow to transform to meet children’s evolving needs. The December 2014 thematic issue of Health Affairs examines the current state of children’s health, health care delivery, and coverage.

You are invited to join us on Monday, December 8, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.  Panels will cover financing, delivery, access, and the social determinants of children’s health, and spotlight innovative programs that are making a difference.

WHEN: 
Monday, December 8, 2014
9:00 a.m. – 12:30 p.m.

WHERE: 
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live tweets from the briefing @Health_Affairs, and join in the conversation with #HA_ChildHealth. 

See the full agenda. Among the confirmed speakers are:

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Collaborating On A Culture Of Health: Buncombe County, North Carolina


December 2nd, 2014

Editor’s note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change.

Located in the Blue Ridge Mountains, at the junction of the Swannanoa and French Broad Rivers, Asheville, N.C. is graced with natural beauty and an abundance of health and economic resources. But in 2012, many residents of Asheville and the surrounding Buncombe County area were struggling with poverty and chronic illness. So the community responded as advocates, public health experts, community leaders, and business leaders came together to establish a culture of health.

As County Health Director Gibbie Harris explained, “the thing that is really driving us forward is an interest in being the healthiest community in the country… We have people who are interested in social justice, and a desire to improve the lives of our friends and neighbors.”

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Exhibit Of The Month: Maps Tell Powerful Stories About Children, Neighborhoods, And Possible Policy Solutions


November 25th, 2014

Editor’s note: This post is part of an ongoing “Exhibit of the Month” series. Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below.

Maps and health have been powerfully intertwined since nineteenth-century British physician John Snow produced a hand-drawn map that famously showed a correlation between the locations where cholera was killing hundreds of Londoners during an 1854 epidemic and the Broad Street pump where locals unknowingly drew water contaminated with the deadly bacterium.

Fast-forward to the twenty-first century, and maps that tell compelling stories about health, policy, and place are ubiquitous. If Snow were alive today, no doubt his stethoscope would be spinning.

The power and art of mapping, geospatial analysis, and health policy research are regularly featured in Health Affairs, but never before to the extent in the journal’s November issue. Four research papers give readers five maps that depict meaningful findings about children, low-income neighborhoods, and other local characteristics that affect health and offer valuable insights for policy makers.

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Workplace Wellness Produces No Savings


November 25th, 2014

During the last decade, workplace wellness programs have become commonplace in corporate America. The majority of US employers with 50 or more employees now offer the programs. A 2010 meta-analysis that was favorable to workplace wellness programs, published in Health Affairs, provided support for their uptake. This meta-analysis, plus a well-publicized “success” story from Safeway, coalesced into the so-called Safeway Amendment in the Affordable Care Act (ACA). That provision allows employers to tie a substantial and increasing share of employee insurance premiums to health status/behaviors, and subsidizes such program implementation by smaller employers. The assumption was that improved employee health would reduce the employer burden of health care costs.

Subsequently, however, Safeway’s story has been discredited. And the lead author of the 2010 meta-analysis, Harvard School of Public Health Professor Katherine Baicker, has cautioned on several occasions that more research is needed to draw any definitive conclusions. Now, more than four years into the ACA, we conclude that these programs increase, rather than decrease employer spending on health care with no net health benefit. The programs also cause overutilization of screening and check-ups in generally healthy working age adult populations, put undue stress on employees, and incentivize unhealthy forms of weight-loss.

Through a review of the research literature and primary sources, we have found that wellness programs produce a return-on-investment (ROI) of less than 1-to-1 savings to cost. This blog post will consider the results of two compelling study designs — population-based wellness-sensitive medical event analysis, and randomized controlled trials (RCTs). Then it will look at the popular, although weaker, participant vs. non-participant study design. (It is beyond the scope of this posting to question non-peer-reviewed vendor savings claims that do not use any recognized study design, though those claims are commonplace.)

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What Is The Future For Community Health Workers?


November 25th, 2014

I recently attended a symposium entitled “Community Health Workers: Getting the Job Done in Health Care Delivery.” (My concluding remarks begin at the 6:00:40 mark in the video.) Speakers examined the evolving role of Community Health Workers (CHWs) in the current era of delivery system reform. Health Affairs has published work documenting the importance of this part of the workforce, and our November issue is dedicated to the topic of “Collaborating for Community Health.”

I was asked to summarize some key points from the day-long conversation. In this post I highlight some of the themes covered.

Over the course of the day I heard the elements of two very different paths forward for community health workers. Each path was coherent and compelling, but they lead in very different directions.

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Health Affairs December Briefing: Children’s Health


November 24th, 2014

Threats to children’s health have changed dramatically over the past few generations, but America’s health care system has been slow to transform to meet children’s evolving needs. The December 2014 thematic issue of Health Affairs examines the current state of children’s health, health care delivery, and coverage.

You are invited to join us on Monday, December 8, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.  Panels will cover financing, delivery, access, and the social determinants of children’s health, and spotlight innovative programs that are making a difference.

WHEN: 
Monday, December 8, 2014
9:00 a.m. – 12:30 p.m.

WHERE: 
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live tweets from the briefing @Health_Affairs, and join in the conversation with #HA_ChildHealth. 

Read the rest of this entry »

Adverse Events In Older Adults: The Need For Better Long-Term Care Financing And Delivery Innovation


November 20th, 2014

Evidence mounts that a major disconnect exists between the services most frail older adults need and what they get. The vast majority of frail older adults (around 75 percent) who face challenges in taking care of themselves live at home. According to new research from Vicki Freedman and Brenda Stillman, published in the most recent issue of The Milbank Quarterly, almost a third of these older adults report having an adverse consequence as a result of not getting the help they need. These consequences are pretty grim – the most frequently reported event being wet clothes associated with an unmet need around toileting.

But the most shocking statistic from this research is that hiring a paid helper appears to do little to protect against these consequences. Among those who hired help, nearly 60 percent reported adverse consequences. No doubt this reflects a higher level of need: paid helpers are brought in when the risk is quite high. But, it also reflects an inadequacy in support — an analogous group living in supportive housing (i.e., residential care or assisted living facilities) reported these events at a much lower rate (36 percent).

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Risk And Reform Of Long-Term Care


November 14th, 2014

Editor’s note: This post is part of a series of several posts stemming from presentations given at “The Law of Medicare and Medicaid at Fifty,” a conference held at Yale Law School on November 6 and 7.

The 50th Anniversary of Medicare and Medicaid offers an opportunity to reflect on how U.S. social policy has conceived of the problem of long-term care.

Social insurance programs aim to create greater security—typically financial security—for American families (See Note 1). Programs for long-term care, however, have had mixed results. The most recent attempt at reform, which Ted Kennedy ushered through as a part of the Patient Protection and Affordable Care Act (ACA), called the CLASS Act, was actuarially unsound and later repealed. Medicare and especially Medicaid, the two primary government programs to address long-term care needs, are criticized for failing to meet the needs of people with a disability or illness, who need long-term services or supports. These critiques are valid.

Even more troublesome, however, long-term care policy, especially in its most recent evolution toward home-based care, has intensified a second type of insecurity for Americans. This insecurity arises when someone becomes responsible for the long-term care of a loved one. In a longer forthcoming article, I argue that this insecurity—which I call “next-friend risk”—poses a serious threat to Americans and needs to be addressed. (I borrow the phrase next friend from a legal term for a person who in litigation represents someone with a disability who is otherwise unable to represent him or herself. Although not a legal guardian, the next friend protects the interests of an incompetent person.)

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Health Affairs Event Reminder: Collaborating For Community Health


November 4th, 2014

Policymakers are paying increasing attention to the relationship between the characteristics of communities and the health of the people living in them. The November 2014 issue of Health Affairs, “Collaborating For Community Health,” examines new possibilities created by alignment of the fields of health and community development.

These possibilities come from both sides, including recent changes in the community development field that have set the stage for the new focus on improving health, as well as new approaches to health care financing that create incentives for improving health outcomes.

You are invited to join us on Wednesday, November 5, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.

WHEN:
Wednesday, November 5, 2014
9:00 a.m. – 12:00 p.m.

WHERE:
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live Tweets from the briefing @Health_Affairs, and join in the conversation with #HA_CommunityHealth.

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Social Services And Community Health: Health Affairs’ November Issue


November 3rd, 2014

The November issue of Health Affairs includes a number of studies looking at how social services and community support programs can improve the health of local residents. Other subjects covered: the potential for pay-for-performance payment models to create a market that values health, not just health care; how one safety-net accountable care organization is uniquely improving care coordination; a three-year progress report on a regional health collaborative; and more.

This issue of Health Affairs is supported by The Kresge Foundation, the Robert Wood Johnson Foundation, and the Annie E. Casey Foundation. It will be discussed at a Wednesday, November 5 briefing at the National Press Club in Washington, DC.

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Bringing Health, Wellness, And Opportunity To Coal Country


October 31st, 2014

Editor’s Note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change.

A small Appalachian coal mining town might seem like an unlikely place for a contemporary community health revolution, but Williamson, WV can proudly claim that achievement. As a city of 3,098 people along the banks of the Tug Fork River, Williamson has a long history of defying expectations. In the late 19th and early 20th century, it became the center of a cultural renaissance that began when the Norfolk and Western Railway brought people from all over the United States to Mingo County (Williamson is the county seat).

This diverse group of entrepreneurs and miners turned Williamson into a sophisticated urban center that became the “heart” of America’s billion-dollar-coal-field. They created an infrastructure that survived three great floods and today is part of a network of facilities that are being used for renewed development through the Sustainable Williamson project — a six-part initiative designed to bring better health and economic opportunity to a region faced with daunting financial and public health challenges.

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Poverty’s Association With Poor Health Outcomes and Health Disparities


October 30th, 2014

A recent ecological study by Carl Stevens, David Schriger, Brian Raffetto, Anna Davis, David Zingmond, and Dylan H. Roby, published in the August issue of Health Affairs, showed significant associations between neighborhood poverty and diabetes-related lower extremity amputations (LEA) in the state of California, which adds to the growing evidence that where you live (not just how you live) may directly impact your health.

The authors linked data from multiple sources (i.e. California Health Information Survey, Census Bureau’s American Community Survey, health facility discharge data) and used geographic information system (GIS) analyses and regression analyses to identify amputation “hot spots” and uncovered a 10-fold variation in LEA rates between low-income and high-income neighborhoods.

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Health Affairs Briefing: Collaborating For Community Health


October 29th, 2014

Policymakers are paying increasing attention to the relationship between the characteristics of communities and the health of the people living in them. The November 2014 issue of Health Affairs, “Collaborating For Community Health,” examines new possibilities created by alignment of the fields of health and community development.

These possibilities come from both sides, including recent changes in the community development field that have set the stage for the new focus on improving health, as well as new approaches to health care financing that create incentives for improving health outcomes.

You are invited to join us on Wednesday, November 5, at a forum featuring authors from the new issue at the National Press Club in Washington, DC.

WHEN:
Wednesday, November 5, 2014
9:00 a.m. – 12:00 p.m.

WHERE:
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW!

Follow live Tweets from the briefing @Health_Affairs, and join in the conversation with #HA_CommunityHealth.

Read the rest of this entry »

Tax-Exempt Status For Nonprofit Hospitals Under The ACA: Where Are The Final Treasury/IRS Rules?


October 23rd, 2014

Months have now stretched into years, and there still remains no sign of final Treasury/IRS regulations interpreting the Affordable Care Act (ACA)’s provisions covering the expanded obligations of nonprofit hospitals that seek tax-exempt status under §501(c)(3) of the Internal Revenue Code.

The ACA amendments do not depend on formal agency policy to take effect. Nonetheless, Congress directed the Treasury Secretary to issue regulations and guidance necessary to carry out the reforms (26 U.S.C. §501(r)(7)). To this end, two important sets of proposed rules were issued: the first in June, 2012; and the second, in April 2013. While an informative IRS website lists various proposed rules and guidelines important to nonprofit hospitals, final rules seem to have performed a disappearing act.

Apparently recognizing the problems created by its delays, the agency has gone so far as to issue a special Notice letting nonprofit hospitals (and presumably the public) know that they can rely on its proposed rules. But this assurance overlooks the fact that the proposed rules themselves contained crucial areas in which final agency policy has not yet been adopted.

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