John Colbert

January 24, 2020

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

January 24, 2020

Supplementing the information provided on page three of this issue of the newsletter, it is worth noting that the appropriations portion of the bill for higher education programs provides $2.5 billion, an increase of $163 million above the 2019 enacted level and $941 million above the President’s budget request. For federal student aid programs, the bill provides $24.5 billion, which is $75 million above the 2019 enacted level and $1.5 billion above the President’s budget request. Within this amount, the bill furnishes $865 million for the Supplemental Educational Opportunity Grant (SEOG) program, $1.2 billion for Federal Work Study, and an increase to the maximum Pell grant to $6,345.

A report issued on December 10, 2019 by the Pew Charitable Trusts on how the U.S. has changed in key ways in the past decade indicates that nonwhites now account for the majority of the nation’s newborns, as well as the majority of K-12 students in public schools. More than half of newborn babies in the U.S. are racial or ethnic minorities, a threshold first crossed in 2013. Nonwhite students also account for the majority of the nation’s K-12 public school students. As of fall 2018, children from racial and ethnic minority groups were projected to make up 52.9% of public K-12 students. With the passage of time, these facts will have an enormous impact on higher education in general and on the health professions in particular. Future issues of the ASAHP newsletter TRENDS will serve as a vehicle for discussing how the education sector will be affected by these kinds of societal changes.

Costs Associated With Attending College

Year-over-year increases in college expenses have grown steadily in the U.S. since 1981. Although the Pell Grant Program also has expanded at regular intervals, the maximum does not align well with much higher tuition costs. Consequently, students and their families increasingly find it necessary to take out various kinds of loans. Beyond the day when degrees are awarded, the amount of debt borne by recent college graduates may delay the attainment of milestones associated with adulthood later in life, such as buying a house, getting married, and having children. The situation is even more gloomy for students who have incurred substantial debt, but never ended up graduating from college.

A report made available on December 31, 2019 from the National Center for Education Statistics (NCES) describes four measures of the price of undergraduate education in the 2015–16 academic year: total price of attendance (tuition and living expenses), net price of attendance after all grants, out-of-pocket net price after all financial aid, and out-of-pocket net price after all aid excluding student loans. Estimates are based on the 2015–16 National Postsecondary Student Aid Study, a nationally representative survey of students enrolled in postsecondary institutions in the 50 states, the District of Columbia, and Puerto Rico. The total price of attendance consists of tuition and nontuition expenses (fees, books, supplies, transportation, and living expenses )., For example, full-time students at public two-year institutions had the lowest average total price of attendance at $16,100 in 2015-16. The average total price of attendance was higher at public four-year institutions ($26,900), higher still at for-profit institutions ($32,600), and highest at private non-profit four-year institutions ($48,000). The percentage of students with loans was greatest at private for- profit schools (74%) and lowest at public 2-year institutions (20%).

Opposition To Student Loan Forgiveness Rule

Congressional Democrats aim to prevent implementation of a Department of Education policy that would make it more difficult for federal student loan borrowers to cancel their debt based on misconduct by any college. Set to take effect on July 1 of this year, the Trump administration policy that was finalized last year establishes more stringent rules for when the government will wipe out the debt of students claiming they were misled or deceived by a higher education institution. Democrats are using the Congressional Review Act, a tool that allows Congress to stop recently enacted regulations with a simple majority in both chambers and the president's signature.

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HEALTH REFORM DEVELOPMENTS

John Colbert

January 24, 2020

Trends Archives

Approximately 18% of the U.S. economy, the largest in the world, is represented by the health sector, which suggests that there always will be something occurring within that domain that will prove to be newsworthy. Typical stories in the media and relevant topics in policy discussions revolve around the central issues of cost, quality, and access. The last item is guaranteed to continue to attract significant attention as long as there are any individuals in this country who lack health insurance coverage.

The Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. Usually referred to as either the ACA or Obamacare, this key piece of legislation has been in the news since its various provisions began to unfold. Its enactment was supported wholly in Congress by Democrats in both legislative chambers, without a single Republican vote. That outcome alone essentially assured that the years ahead would be marked by strenuous efforts to repeal and replace its most important features either in whole or in part. Republicans came close to repealing the ACA in 2017 when they were the majority in both the House and the Senate and President Donald Trump occupied the White House, but the attempt did not meet with success, albeit by a close margin. Failure in Congress did not mean that opposition fervor would be diminished, however, as repeal efforts then shifted to the judicial arena.

Repeal Of the Individual Mandate Penalty Set The Stage For Repeal Of The ACA

As part of a successful attempt to overhaul U.S. tax law aimed at energizing the economy, Republicans were able to zero out the individual mandate penalty in 2017. Once that happened, they insisted that a mandate stripped of its penalty for not purchasing health insurance meant the provision no longer was enforceable and could not be considered as being constitutional. Because the mandate is viewed as being such an essential component of the Affordable Care Act, eliminating it led to a claim that the entire law now should be struck down. A federal district court in Texas subsequently declared the ACA invalid in December 2018.

Twenty-one Democratic attorneys general and the House of Representatives then appealed this ruling to to the Fifth Circuit. That court partially affirmed the district court in 2019 in a 2–1 decision, agreeing that the mandate absent a penalty is unconstitutional. Significantly, this narrow majority ruling did not include what should be done with the ACA as a whole. Instead, the case was remanded back to the Texas district court for a more complete severability analysis. A main issue awaiting resolution is whether the mandate can be severed from the ACA, leaving the rest of the law to continue to be constitutional. Meanwhile, the Democratic attorneys general have appealed the ruling by the Fifth Circuit to the U.S. Supreme Court. Whether it will accept the case and deal with it in 2020 is unknown at this juncture.

PCORI Remains In Effect While Some ACA Taxes Are Repealed

The Patient-Centered Outcomes Research Institute (PCORI) was established by the ACA to promote comparative effectiveness research to assist patients, clinicians, purchasers, and policymakers in making informed health decisions. Although it enjoyed widespread support from the time of inception, detractors viewed it as a politically-driven program with attendant dangers associated with central planning. During 2019, there was some opposition to reauthorizing PCORI. Instead, the Institute enjoyed bipartisan support and its funding was reauthorized for 10 years as part of appropriations legislation described on page three of this issue of the newsletter.

That same appropriations package affected the ACA in other important ways. Members of Congress fully repealed the health insurance tax beginning in 2021, along with the so-called Cadillac tax on beneficiaries who have expensive insurance policies, and the medical device tax beginning in 2020. Repeal of the medical device tax always enjoyed bipartisan support because many states have companies affected by it. A potential downside is that these taxes were intended to cover the costs of expanding health insurance coverage under the law. It is estimated that repealing them will result in the loss of approximately $400 billion in revenue over the next ten years.

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LABOR-HHS FUNDS ALLOCATED FOR FY 2020

John Colbert

January 24, 2020

Trends Archives

It is characteristic in any given year for Congress to be unable to complete work in the area of appropriations in time for necessary funds to be made available for the start of a new fiscal year each October 1. Instead, a series of short-term continuing resolutions (CRs) are implemented so that government functions can continue to operate. The year 2019 was no exception to this sequence of events. Even until late December when a CR was about to expire, there was no firm assurance that another one one would not be necessary.

Nevertheless, the holiday season proved to be a happier one as agreement was reached on how much funding to provide for a wide range of entities that come under the umbrella of the Departments of Labor, Health and Human Services, Education, and Related Agencies, which commonly are referred to as Labor-HHS. That piece of legislation was one of eight large bills that made up one minibus package (four national security bills made up another minibus package). The Labor-HHS bill included $184.9 billion in discretionary funding, an increase of $4.9 billion over the 2019 enacted level and $43 billion over the President’s 2020 budget request.

The Department of Health & Human Services (HHS) was allocated $94.9 billion, an increase of $4.4 billion above the 2019 enacted level and $16.8 billion above the President’s budget request. The largest increase, $2.6 billion, went to the National Institutes of Health. HRSA (the Health Resources & Services Administration) obtained $7.04 billion, a $193 million increase over the FY 2019 level. Within HRSA, Title VII health professions programs received $424.5 million, a $32.3 million increase over the FY 2019 level, and the Health Careers Opportunity Program was funded at $15 million. The Department of Education was awarded a total of $72.8 billion in discretionary appropriations, which was $1.3 billion above the 2019 enacted level and $8.7 billion above the President’s budget request, with the maximum Pell grant increasing to $6,345.

Moving forward, it is unclear to what extent any meaningful legislation involving social determinants of health, surprise billing, drug pricing, and lowering health care costs will be approved by Congress in 2020. One possible impediment to meaningful action is the necessity of having a trial in the Senate now that House officials have transmitted two articles of impeachment. Once the trial begins, its length could depend on whether both impeachment supporters and opponents agree to allow witnesses to testify. Also, a national election next November will contribute to a compression of the legislative calendar. Apart from determining the outcome to elect a U.S. President, all House members and one-third of the Senate who wish to remain in office must face the voters. As the time of the election approaches, campaign activities necessarily must take precedence over legislative business.

A related consideration is that even in the best of times, the nature of certain pieces of legislation will preclude any rapid action. The Higher Education Act (HEA), to cite one key illustration, last was reauthorized in 2008. That authorization expired in 2013. Now that almost seven years have elapsed and several hearings have been conducted, apart from separate bills currently being championed by members of the House and Senate, the prospect of reaching agreement any time soon does not appear to be on the near horizon.

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RESOLVING NETTLESOME HEALTH POLICY DISPUTES

John Colbert

January 24, 2020

Trends Archives

Controversies often are involved when initiatives are undertaken to arrive at the best approach to gaining wide acceptance of proposals involving contentious public policy issues, such as gene editing, euthanasia/assisted dying, and recreational use of marijuana products. A basic question pertains to deciding whom to involve in making decisions that enable these policies to move forward. Three possible groups are: elected public officials; health scientists and other experts in fields, such as ethics; and voters, along with other concerned members of the general public.

To note just one example, President William Clinton, along with British Prime Minister Tony Blair, announced at the White House on June 26, 2000 that the international Human Genome Project and Celera Genomics Corporation both had completed an initial sequencing of the human genome, the genetic blueprint for human beings. This landmark achievement was hailed as promising to bring exciting new approaches to prevent, diagnose, treat, and cure disease. Since that widely heralded occasion, germline gene editing provides a vivid illustration of a current topic that has emerged as a serious concern because of its potentially grave threat to the health of future generations.

Netflix offered a four-episode documentary series in October 2019 entitled “unnatural selection” as a means of furnishing an overview of genetic engineering, with an emphasis on the DNA-editing technology of CRISPR (clustered regularly interspaced short palindromic repeats) from the perspective of scientists, corporations, the public, and biohackers tinkering in garages. Apart from the goal of editing genes to eradicate certain diseases or even to produce so-called designer babies who will possess enhanced abilities (e.g, intellectual, artistic, and athletic), it should be obvious that there are great amounts of money to be made by entrepreneurs able to reach the finish line first with the most effective products.

The problem currently is that: some envisioned new gene therapies may not improve human lives, various species may be at risk of changing in unforeseen ways or perhaps even being eliminated, and assurance still is lacking on whether desired sought after improvements ever will materialize. The Netflix episodes feature discussions with (1) residents of Nantucket Island in Massachusetts who are apprised of a proposal to modify a species of mice affected by ticks that cause disease among humans, (2) inhabitants of New Zealand where rats are killing off many breeds of birds, and (3) villagers in Burkina Faso, Africa where mosquitos continue to cause children to die from malaria.

In all three settings, the notion of Gene Drive to change an entire species to achieve a purported social good encounters resistance. A major concern is that apart from positive outcomes that are touted by proponents of genetic interventions, it remains worrisome that no firm guarantees can be offered regarding possible unanticipated, dangerous outcomes that might occur. While members of the general public may lack the sophisticated knowledge of scientific experts, their basic instincts make them wary of approving proposals that are equivalent to attempting to play God.

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LEARNING ABOUT FIDGETING WHILE FIDGETING

John Colbert

October 22, 2019

Trends Archives

Since it is more than quite likely that the editor of the Association’s newsletter experienced some fidgeting while preparing this edition, it is possible that some readers also could undergo something comparable while reading it. According to an article that was published in the October 2019 issue of the journal Nature Neuroscience, psychologists have ascribed fidgeting to boredom, a form of stress relief, or perhaps as a subconscious way to increase memory. Also, fidgeting may take place even when one seemingly is engaged actively in a task. It is unclear, however, the process by which fidgets go about modulating their neural activity across the brain. Certain brain regions drive actions (such as motor cortex) and many others receive this information (such as sensory areas), in part to distinguish self-generated from movements that are not self-generated. Investigators who participated in the study reported in the aforementioned publication show that in expert mice performing a task, movements that are not task-related dominate the single-trial neural activity. This finding is exciting because it underlines why measuring behavior and other variables are key for exploring the neural code. Apart from whatever value might be associated with this discovery, as an aside it also might be somewhat comforting to know that somewhere out there, a group of expert mice is working on our behalf to enhance a more human-oriented understanding of neural activity.

return to october 2019 trends

PARKINSON’S DISEASE AFFECTS WOMEN AND MEN DIFFERENTLY

John Colbert

October 22, 2019

Trends Archives

Not all demographic groups are affected by disease pathophysiology in the same way as shown in a review published in the August 2019 issue of the Journal of Parkinson's Disease. Growing evidence indicates that Parkinson's disease (PD) affects women and men differently. The article presents the most recent knowledge about these sex-related differences and highlights the significance of estrogens, which play an important role in the sex differences in PD. Although the risk of developing this disease is twice as high in men than women, it is women who experience a more rapid disease progression and a lower survival rate. By drawing attention to sex-related differences and disparities in PD, the investigators hope that recently gained knowledge will further encourage the scientific community and policy makers to foster the development of tailored interventions and the design of innovative programs - for example in care practices - that meet the distinct requirements of women and men with PD.

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EVIDENCE FOR LATINO PREFERENCES FOR METAPHOR AND ANALOGY

John Colbert

October 22, 2019

Trends Archives

It is not too surprising to come to a realization that individuals from different cultures may be inclined to communicate and describe the world differently. A manuscript in the November 2019 issue of the Personality and Social Psychology Bulletin documents one such cultural difference previously unexplored by psychologists: receptiveness to metaphors. Spanish-speaking Latinos were contrasted with Anglo-Americans, Asian Americans, and Latinos who do not habitually speak Spanish. Across four experiments, the investigators showed that relative to these other groups, Spanish-speaking Latinos show stronger preferences for metaphoric definitions, better recall of metaphors, greater trust in both scientific and political arguments that use metaphor, and stronger liking for and desire to connect with persons who use metaphoric speech. Given the substantial representation of Latinos throughout the United States, it definitely is worth considering future directions and implications for improving cross-cultural communication.

Recognizing that Spanish-speaking Latinos display a relatively stronger preference for metaphors in defining abstract constructs and in demonstrating enhanced memory for metaphors in narratives, the findings are particularly relevant in the health care arena. Great emphasis is placed today on how health status is affected by social determinants. Language differences can have a decisive impact on the ability to achieve positive health outcomes. Thus, both from the perspective of patients describing their symptoms to health care practitioners and in their obtaining a greater understanding of diagnostic terminology, the use of metaphors is a tool that can play a highly valuable role.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

October 22, 2019

Trends Archives

Preparing The Current And Future Health Care Workforce For Interprofessional Practice

The Health Resources & Services Administration published a report, "Preparing the Current and Future Health Care Workforce for Interprofessional Practice in Sustainable, Age-Friendly Health Systems." It is the the 17th Annual Report authored by the Advisory Committee on Interdisciplinary Community-Based Linkages (ACICBL) to the Secretary of the United States Department of Health and Human Services and to the Congress. ACICBL is a Federal Advisory Committee that provides advice and recommendations to the Secretary on a broad range of issues dealing with programs and activities authorized under Title VII, Part D of the Public Health Service (PHS) Act. Recommendations provided in this iteration are designed to promote broad changes within the health care system to advance age-friendly practices, train the health care workforce in age-friendly care, and improve the care of older adults, while also facilitating the reduction of burnout and the promotion of wellness and resilience among health care providers. The report can be obtained here.

Integrating Social Care Into The Delivery Of Health Care

How can services that address social needs be integrated into clinical care? What kind of infrastructure will be needed to facilitate that integration? To begin answering such questions, the National Academies of Sciences, Engineering, and Medicine assembled an expert committee to examine the potential for integrating social care services into the delivery of health care with the ultimate goal of achieving better and more equitable health outcomes. The resulting report, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health, identifies and assesses current and emerging approaches and recommends ways to expand and optimize social care in the health care setting. It can be obtained here.

Older Americans’ Views On Navigating The Health Care System

A majority of older Americans who are ages 60+ (79%) are prepared to age well, but nearly 7 in 10 (68%) are at least somewhat concerned about their health as they age, and nearly half (46%) need assistance understanding their health insurance benefits once they have chosen a plan. A survey conducted by The Harris Poll, commissioned by Anthem, Inc. and the National Association of Area Agencies on Aging reveals that while most respondents are confident in some aspects of navigating the health care system, there is opportunity for better understanding of their benefits, bill, diagnosis, and treatment. Among the respondents, which included U.S. adults, 65% reported that they had some type of Medicare insurance coverage. The report can be obtained here.

Survey On State And Local Income, Poverty, And Health Insurance Statistics

The U.S. Census Bureau released its most detailed look at America’s inhabitants, places, and economy. New state and local statistics on income, poverty, and health insurance are available in briefs, detailed tables, data profiles, and more. The American Community Survey (ACS) also produces statistics for more than 40 other topics. Results can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

October 22, 2019

Trends Archives

Death Rates By Marital Status For Adults Age 25 And Older: United States, 2010-2017

A new report from the National Center for Health Statistics (NCHS) presents trends for 2010–2017 in age-adjusted death rates by marital status (married, never married, divorced, or widowed) at the time of death for adults aged 25 and over. The age-adjusted death rate for married persons aged 25 and over was lower than for those who were never married, divorced, or widowed. It declined 7% (839.8 per 100,000 U.S. standard population), while the rate for never-married persons also declined, by 2% (from 1,466.1 to 1,443.6). The rate for widowed persons was the highest of all marital status groups and increased 6% during the period, from 1,567.2 in 2010 to 1,656.9 in 2017. The rate for divorced persons aged 25 and over was stable during the period and was 1,368.8 in 2017. Rates for married men were the lowest of all marital status groups and declined 7% from 2010 (1,012.1) to 2017 (942.9) while for women, rates also declined 7% between 2010 (612.1) and 2017 (569.3).

Prevalence Of Screening For Social Determinants Of Health

Social needs are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening. Most hospitals and physician practices don’t screen patients for social determinants of health such as food insecurity, housing instability, utility and transportation needs, and interpersonal violence, according to a study described in the journal JAMA Network Open on September 18, 2019. Surveys administered from June 2017 to August 2018 to 2,190 physician practices and 739 hospitals found that about 16% of practices and 24% of hospitals reported screening for all five factors, while 8% of hospitals and 33% of practices screened for none. The most commonly screened-for factor was interpersonal violence, occurring at 75% of hospitals and 56% of practices. Almost 50% of academic hospitals reported screening, compared with 23% of hospitals overall. Facilities that serve economically disadvantaged patients were more likely to screen.

HEALTH TECHNOLOGY CORNER

Hierarchical Encoding Of Attended Auditory Objects In Multi-Talker Speech Perception

Humans easily can focus on one speaker in a multi-talker acoustic environment, but how different areas of the human auditory cortex (AC) represent the acoustic components of mixed speech is unknown. A team of Columbia University neuroengineers has uncovered the steps that take place in the brain to make this feat of picking out a single voice possible, according to an online article that became available in the journal Neuron on October 21, 2019. The discovery helps to solve a long-standing scientific question as to how the auditory cortex, the brain's listening center, can decode and amplify one voice over others -- at lightning-fast speeds. This new-found knowledge also stands to spur development of hearing-aid technologies and brain-computer interfaces that more closely resemble the brain. An end goal is to understand better how the brain enables individuals to hear so well, plus to create technologies so that stroke survivors can speak to loved ones, or to enable the hearing-impaired to converse more easily in a crowded setting.

Exergaming And Virtual Reality For Health: Implications For Cardiac Rehabilitation

According to an article published online September 12, 2019 in the journal Current Problems in Cardiology, cardiac rehabilitation (CR) programs focused on improving the health trajectory of patients with cardiovascular disease strive to increase physical activity (PA) and cardiorespiratory fitness. However, historically low compliance with recommended PA has prompted exploration of alternatives to traditional courses of exercise therapy. One alternative, exergaming, or the requirement of physical exercise inherent to a video game's activities, has shown to have a promising impact in improving patient self-efficacy for exercise training using digital hardware (e.g., the Wii or the Xbox Kinect). Moreover, novel technologies in virtual reality can provide an engaging, immersive environment for exergaming techniques, maximizing goal-oriented training, and building self-efficacy for patients during CR. The concept of a “Clinical Arcade” is introduced as a new approach to integration of these techniques in CR care.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

October 22, 2019

Trends Archives

Apart from legislation that emerges on Capitol Hill, the regulatory arena plays a key role in determining how policies are implemented. A recent example occurred during the week of October 14, 2019 when the federal Office of Management and Budget (OMB) gave the necessary go-ahead signal to the Department of Education’s final proposal to overhaul college accreditation. This approval means the final regulation likely will be published soon. The proposed rule is intended to ease some requirements that college accreditors must meet to obtain federal recognition, an important status that enables the institutions they accredit to be eligible for federal student aid. An ongoing criticism by the Trump Administration is that the existing college accreditation system is too costly and burdensome.

Protecting Students From Sudden College Closures

Throughout 2019, administrators at some small institutions have announced that their doors soon will be closed. Declining student enrollment and an inability to finance rising costs often are cited as reasons for this decision. In response, on October 3, 2019, Representatives Donna Shalala (D-FL), Peter King (R-NY) and Sean Casten (D-IL) introduced a bill aimed at protecting students in the event of the sudden closure of a higher education institution. As of October 22, the measure had 11 co-sponsors. Among its various provisions, the Stop College Act of 2019 (H.R. 4615) would require accrediting organizations to:

Review teach-out plans and agreements when the accreditor is notified by the U.S. Department of Education (USDE) of problems pointing to the potential closure of a college or university, a state removes an institution’s license to operate, or accrediting organizations place an institution on probation, show-cause, or equivalent status.
Monitor institutions whose ability to meet accreditation standards has declined, particularly related to financial responsibility requirements, as identified by USDE, an auditor or the accrediting organization, which may indicate that a closure is imminent.
Respond to complaints, monitor, and assess an institution’s records of student complaints within 30 days and submit such complaints to USDE and state agencies when appropriate.

Reauthorization Of The Higher Education Act

This important piece of legislation last was reauthorized in 2008. Early in 2019, there were hopes that reauthorization would occur by the end of this year. Hearings were held, key issues were identified, and legislators in both political parties have attempted to bring a comprehensive bill to fruition. On October 15, 2019 the House Committee on Education and Labor introduced the College Affordability Act (H.R. 4674), which is designed to achieve: a comprehensive overhaul of the higher education system that lowers the cost of college for students and families, improves the quality of higher education through stronger accountability, and expands opportunities by providing students the support and flexibility they need to succeed. Some of the main provisions under Title 1 of this proposed legislation are:

Ensures programs lead to gainful employment
Protects the integrity of non-profit institutions of higher education
Improves available post-secondary data
Improves the Federal Student Aid (FSA) office
Establishes an enforcement unit

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HEALTH REFORM DEVELOPMENTS

John Colbert

October 22, 2019

Trends Archives

Earlier this month, President Trump announced an Executive Order charging the Centers for Medicare & Medicaid Services (CMS) to propose annual changes to combat waste, fraud, and abuse in the Medicare program. From its inception in 1966, there have been policy concerns about installing program integrity methods to better protect taxpayers from fraud, waste, and abuse in Medicare. The challenge is to “pay it right,” which translates into paying the right amount, to legitimate providers, for covered, reasonable and necessary services made available to eligible beneficiaries while taking aggressive actions to eliminate fraud, waste, and abuse.

Government watchdogs routinely identify concerns about waste and abuse. The Government Accountability Office (GAO) has designated Medicare as a High Risk program since 1990 because of its size, complexity, and susceptibility to improper payments. In 2018, improper payments accounted for 5% of the total $616.8 billion of Medicare's net costs. As programs, such as Medicare and Medicaid become more complex, program integrity risks become increasingly difficult to recognize. New provider types have entered the program, including hospices, home health agencies, and federally qualified health centers. More challenging cross-ownership issues have emerged, such as one corporate parent owning various providers and provider types. Increasingly complex webs of affiliations can allow unscrupulous providers to simply appear, disappear if they come under scrutiny, and then re-appear as “new” entities.

When enacted into law, Medicare had 19 million beneficiaries. Today, there are almost 61 million of them and 10,000 new enrollees are added every day. When the programs began, Medicare and Medicaid accounted for only 2.3% of federal spending. That paltry amount has grown to 23.5% of federal outlays today. Some candidates hoping to be elected president of the U.S. are in favor of expanding Medicare, including making it a program that covers everyone in the U.S. even to the extent of eliminating private insurance coverage obtained through employment. Yet, rarely is it clearly stated how this expansion will be paid for without raising taxes nor is there any recognition of what mechanisms will be installed to combat chronic problems involving waste, fraud, and abuse.

Reducing Healthcare Administrative Costs

Following the success of enacting Medicare and Medicaid legislation in 1965 and making these programs available the next year, a steady drumbeat occurred throughout the remaining 1960s and much of the 1970s to expand the scope of coverage. The emphasis back then was to enact health insurance legislation to benefit a wider segment of the U.S. population. Health spending in the year 1960 was 5.2% of Gross Domestic Product (GDP). By 1970, it had increased to 6.9% while it currently is approaching nearly 20% of the world’s largest economy. The average cost of a stay in a hospital was $68 per day in 1970, but there were predictions that it could rise to $98 per day by 1973. Those figures seem risible in light of current health care spending patterns.

In late September 2019, the Omnibus Burden Reduction (Conditions of Participation) Final Rule came into effect in an effort to strengthen patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. This rule is intended to advance CMS’s “Patients over Paperwork” initiative by saving providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years, giving physicians more time to spend with their patients.

Thousands upon thousands of regulations affect Medicare and Medicaid. CMS officials need to stay on the alert to determine where changes to obsolete, duplicative, or unnecessary requirements can be made to improve healthcare delivery and reduce unnecessary spending. An overall aim should be to improve patient care, jettison burdensome rules, and eliminate duplicative regulations. Voters would benefit from learning how political candidates for high public office would perform to achieve such objectives.

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THE DANCE OF LEGISLATION

John Colbert

October 22, 2019

Trends Archives

A book published in 1973 with the title, “The Dance of Legislation” by Eric Redman provided a thorough, credible account of the legislative process involving an effort to pass S.4106, the National Health Service Bill. The essence of the book’s material enables readers to appreciate the various forms of bureaucratic infighting that occurred, political prerogatives, and Congressional courtesies required to achieve a favorable outcome.

While the assortment of lions and lionesses on Capitol Hill back then has long since departed the legislative scene, a strong case may be made that nothing significant has changed over the past several decades. The current political scene includes talk of impeaching President Trump, but that distraction is just one of many factors contributing to a general sense of paralysis affecting the ability to pass needed forms of legislation. A case in point is the necessity of reauthorizing the Higher Education Act (HEA).

Last reauthorized in 2008 for a five-year period, the six years since then have enabled the contents of this legislation to continue to be implemented. Fortunately, although technically it could be declared null and void at any time, its provisions are too important to be placed on the chopping bock. A downside, however, is that changes need to be made in order to achieve a more perfect accommodation with changing times and situations since 2008.

This piece of legislation, along with other important considerations such as immigration policy, constitute bottlenecks that can erupt at many different points. Apart from partisan disagreements that can lead to delays, even when both chambers are ruled by the same party, important differences may exist. The fact that in 2019 Democrats are the majority in the House of Representatives while Republicans have more favorable numbers in the Senate adds to the challenge of overcoming certain impediments that result in legislation being stalled.

Even within the two parties, disagreements may arise. A member from a state with strong agricultural interests may not always share the same outlook of a colleague whose constituents may have a stronger maritime focus. The same holds true when a member of Congress represents predominantly urban rather than rural interests. Ultimately, each Representative and Senator is beholden to addressing the needs and interests of voters back home. If perceived as failing to do so, there is a risk of not being reelected.

Strenuous efforts continue to be exerted to pass appropriations legislation. The 2020 fiscal year began on October 1 of this year without funding bills being signed into law. One or more continuing resolutions (CRs) enable the government to continue operating until such time that a more permanent agreement can be reached. It will not be long until the end of the calendar year is reached and a new Congressional session will begin next January.

The year 2020 will involve a national election, including who will occupy the White House in 2021. Republicans campaigning will blame Democrats for blocking legislative achievements. Democrats will point to their do-nothing Republican opponents and insist on voting them out of office. Some things never change, thus ensuring that the dance of legislation will continue uninterrupted for the forseeable future.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

October 22, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

Well, I am ‘fresh off” the Annual Conference and what a week it was. I am not sure I have a favorite time, place or event but all of the speakers and activities had significance and seemed to resonate with one or more aspects of my life. Thanks to everyone who was able to attend. For those that did not, you can check out our website and access some of the plenary and concurrent session presentations----it was a very inspirational week.

Here are a couple of things you might have missed. We did approve to change the name of our organization to “Association of Schools Advancing Health Professions”. The logo “appears” the same but is a little more dynamic to fit the nature of our ever evolving world. People seemed excited about it and we are ready to move forward. The name change is also a perfect segue to our Strategic Planning Initiative announced by your new President, Phyllis King. This will happen in January and I am sure there will be opportunities for you to provide input.

For those that participated in the Institutional Profile Survey, you received your copy of the report prior to the Annual Conference. It is broken out into three sections---all institutions, academic health centers and 4-year institutions. Our contract group, Altegra Tech, has been instrumental in almost all aspects of the development of the survey and its reporting. The more all of us work on it, the more everyone understands the intricacies of the data and the questions themselves. We still have some minor tweaks for the 2018-2019 data collection instrument (i.e., survey) but it will be available soon for your university numbers. If you want to get the final survey report for 2018-2019, you have to participate in this year’s reporting so check your inbox in the next few weeks for a request to participate.

For the current data set, we will be working to share some additional reports as we continue to refine the data. If there are particular questions you would like for us to answer or tables you would like to see, please let Kristen Truong know. By the way, she received the President’s Award at the conference and deserved every accolade she received. She has been a tremendous asset for ASAHP and I want to thank her, Kate Aultman (former member who validated our data), all of the subcommittees, task forces members that helped prepare questions and edit the survey and Chris Yokely and his team at Altegra Tech for their work on the IPS. Thanks to all of you again for your patience.

Since this will be my last note to you (except for the Annual Report synopsis), let me just say I hope you feel more connected to each other. The Member Q&As were meant to “share secrets” about some of us that we often never “learn” in our associations with one another. In addition, the dedicated list serve (was a member request) was deployed so I hope you will increase your utilization of it with information you might want to share with members or for questions that need to be answered. I want to thank my BOD for their support over my 2-year presidency, the committee and task force chairs and their members that worked to get even more accomplished on our behalf and to the ASAHP staff (including Tom Elwood who produces this letter). I hope each of you will take some time to personally invest in ASAHP—it is a rewarding effort. Phyllis King will be awaiting your volunteerism call. I will serve one more year as past president so please continue to reach out to me for “anything” the Association can help you with.

A new decade—a new Association name—a new President --- a new strategic plan (in progress). Here we go!!!! Let’s have more fun!!

Susan Hanrahan, President/Past President

return to october 2019 trends

THE VALUE OF GLANCING IN THE REARVIEW MIRROR

John Colbert

October 22, 2019

Trends Archives

Characteristically, many readers of periodicals look forward to each new issue to obtain valuable insights. Yet, there also may be considerable value in exploring professional literature archives as a means of obtaining an enhanced understanding of current challenges and perceived dilemmas. During the October 2019 conference of the Association of Schools of Allied Health Professions, it was announced that as of that day the new name would be the Association of Schools Advancing Health Professions, a term that represents the third occasion such a change has occurred since the organization was founded in 1967.

Allied health has a rich history. The federal government provided $276,495,000 between 1967 and 1979 after the Allied Health Professions Personnel Act became law in 1966. While that amount may not sound like much, as measured by its value in purchasing power in dollars in the year 2019, it equates to more than $1.498 billion. Significantly, a portion of that money was directed to the Association and many institutions that belonged to it during that time period.

The Journal of Allied Health was founded in 1972. During its second year of existence, ASAHP’s first President—Darrel Mase—penned an article, “Allied Health-Today and Tomorrow” (reprinted in the Winter 2010 issue). In it, he discussed: interprofessional education; how professional territoriality can impede effective utilization of health manpower; the difficulty of obtaining hard data regarding manpower needs to determine numbers and kinds of allied health personnel needed; the proper ratio of auxiliary to primary personnel; and evaluation of the effects of expanded functions of auxiliary personnel on patient dynamics or practice economics.

That particular manuscript was preceded by an article in the New England Journal of Medicine on April 27, 1972 with the title, “Allied Health Manpower-Solution or Problem?” It contained a discussion of how health manpower analysis and inventories have produced an inappropriate concern with numbers rather than with actual job content, flexibility, and development. Moreover, if non-physician medical manpower is to improve the health system, tasks rather than numbers must be studied, management must be given more authority, and professionalism must be curtailed. Apart from the fact that the term manpower has been replaced by the expression workforce, much of the contents of both papers have relevance today.

To cite work in another field where it may be valuable to glance occasionally in the rearview mirror, it is worth noting that developments in genomics are anticipated to exert meaningful impacts on patient care. Issue 2 in 2006 of the journal Epigenetics furnishes a brief historical account of genetics and developmental biology, and how they diverged for a major part of the 20th century. Epigenetics is the field that attempted to unite them and provide new insights into the mechanisms for unfolding the genetic program for development. That achievement has the potential to affect the ability to continue experimenting with genome editing technologies, such as CRISPR (clustered regularly interspaced short palindromic repeats) to go beyond only tweaking what already exists in a genome.

return to october 2019 trends

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

John Colbert

September 19, 2019

Trends Archives

As the third leading cause of death in the U.S., accidents involve all age groups. Adoption of prevention measures has enormous potential to avoid such outcomes, but producing an accident-free environment continues to be a major uphill struggle. Motor vehicle crashes are the leading cause of injury and death for adolescents in this country. A possible developmental source of crash risk is working memory (WM). Results of a study published on September 13, 2019 in JAMA Network Open suggest that a relatively slower WM growth trajectory is associated with young driver crashes. Routine assessment of WM across adolescence may help to identify opportunities for providing adaptive interventions. Meanwhile, a correspondent who occasionally provides information proved useful for inclusion among views expressed in ASAHP’s newsletter TRENDS confessed earlier this month to incurring a severe wound by attempting to remove an avocado pit with a knife. The injury occurs frequently enough that it is referred to as “avocado hand,” a condition that results in making a dash to an emergency room for treatment. More precisely, the expression “post-brunch surge” of avocado-related injuries is being used to describe hand wounds sustained on Saturdays. A suggested remedy is to post safety labels on this fruit.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

John Colbert

September 19, 2019

Trends Archives

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

John Colbert

September 19, 2019

Trends Archives

Professional health literature is replete with examples of how clinicians are adversely affected by burnout, a term applied to a variety of imprecise symptoms associated with the onset of conditions involving stress, fatigue, and depression. A question worth pondering is whether burnout is the equivalent terminologically of old wine in a new bottle? A paper appearing in the September 2019 issue of the periodical The Journal of Nervous and Mental Disease rephases the questions as follows: Is today's 21st century burnout an earlier century's neurasthenia? Viewed in this light, the author advances a proposition that "stress" of all kinds (itself a fuzzy concept), including overwork, discouragement, disillusionment, demoralization, and even suicide, have been known as an accompaniment of training and practice for decades. Is something catastrophic happening or are practitioners merely being swept along in a profound, but ill-defined contagious tide of discontent? Is burnout merely this era's zeitgeist, the remnant of "compassion fatigue" of "wounded warriors" of years past, or neurasthenia of the 1900s? In an effort to conclude on a positive note, an observation is made that hysteria, neurasthenia, hypochondriasis, and other conditions all have had their day and cultish followers. With better definition of the problem(s) comes more effective interventions. The author considers the possibility that burnout most likely will experience the same historical reality of earlier variants.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

John Colbert

September 19, 2019

Trends Archives

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

John Colbert

September 19, 2019

Trends Archives

The political realm has long served as a venue for conflict among individuals and groups with widely different opinions on important public policy issues. A new study indicates that the worksite is not immune to the expression of opposing points of view. As noted in the results of a study published in the August 2019 issue of the journal Stress & Health, the workplace is an environment where individuals have little choice about with whom they interact. As such, employees may find themselves engaged in conversations with co-workers whose political opinions and perspectives are divergent from their own. The investigation examined how co-workers' dissimilarity in political identity is related to the quality of their interpersonal interactions and subsequent well‐being. The authors predicted that political identity dissimilarity is associated with experiences of workplace incivility and, in turn, declines in psychological and occupational well‐being. Hypotheses were tested in a four‐wave survey study conducted during the 2012 U.S. presidential election. The results indicated that political identity dissimilarity was associated with increased reports of incivility experiences instigated by co-workers, which in turn, was associated with increased burnout and turnover intentions and diminished job satisfaction. Several practical implications for organizations are offered in the manuscript.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

John Colbert

September 19, 2019

Trends Archives

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

September 19, 2019

Trends Archives

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates

A Data Brief from the National Center for Health Statistics (NCHS) in September 2019 indicates that the average age-adjusted death rate for the five states (AL, KY, MS, OK, WV) with the highest rates (926.8 per 100,000 standard population) was 49% higher than the rate for the five states (CA, CT, HI, MN, NY) with the lowest rates (624.0). Age-specific death rates for all age groups were higher for the states with the highest rates compared with the states with the lowest rates. Age-adjusted death rates were higher for non-Hispanic white and non-Hispanic black populations, but lower for the Hispanic population in states with the highest rates than in states with the lowest rates. The age-adjusted death rates for chronic lower respiratory diseases and unintentional injuries for the states with the highest rates (62.0 and 65.5, respectively) were almost doubled compared with the states with the lowest rates (31.0 and 35.8).

Comparing Retail Clinics With Other Sites Of Care

According to an article published in the September 2019 issue of the journal Medical Care, with primary care transforming from care delivered exclusively in a physician's office to care that can be delivered in multiple sites and through different means, such as virtually and in retail settings, it is important to critique what is being gained from this primary care transformation and what, if anything, is being lost. For instance, entrepreneurs, policymakers, and officials at pharmacy and hospital chains may believe that the retail clinic model of primary care should include complex service delivery. Yet, the current body of research does not furnish enough information about whether this belief is founded in reality. As long as much of what is known for evaluating retail clinic care involves proprietary data controlled by advocates of retail clinics, uses more simplistic assessments of cost and quality, and leaves out the patient experience, there remains much that is unknown about this type of primary care.

HEALTH TECHNOLOGY CORNER

The Use of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas

An article published on August 28, 2019 in the journal Science Robotics describes the development by Massachusetts Institute of Technology engineers of a magnetically steerable, thread-like robot that actively can glide through narrow, winding pathways, such as the labrynthine vasculature of the brain. In the future, this robotic thread may be paired with existing endovascular technologies, making it possible to guide the robot remotely through a patient's brain vessels to treat blockages and lesions quickly, such as those that occur in aneurysms and stroke. The latter is the number five cause of death and a leading cause
of disability in the United States. If acute stroke can be treated within the first 90 minutes or so, researchers believe that patients' survival rates could increase significantly. A hope is that designing a device to reverse blood vessel blockage within a so-called “golden hour” potentially could result in the avoidance of permanent brain damage.

The Use Of “Phyjamas” In Health Care

The Ubicomp 2019 Conference on September 11-13, 2019 in London featured a presentation by researchers at the University of Massachusetts, Amherst who developed physiological-sensing textiles that can be woven or stitched into sleep garments they have dubbed "phyjamas." They designed a new fabric-based pressure sensor and combined that with a triboelectric sensor, one activated by a change in physical contact, to develop a distributed sensor suite that could be integrated into loose-fitting clothing like pajamas. They also developed data analytics to fuse signals from many points that took into account the quality of the signal arriving from each location. They report that this combination allowed them to detect physiological signals across many different postures. By performing multiple user studies in both controlled and natural settings, they showed that they can extract heartbeat peaks with high accuracy, breathing rate with less than one beat per minute error, and predict sleep posture perfectly.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

John Colbert

September 19, 2019

Trends Archives

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

September 19, 2019

Trends Archives

What transpires in the nation’s capital can have dramatic effects on higher education institutions. An example is the amount of federal funding that is directed to these entities annually. A segment of higher education that is in the spotlight as the government’s current fiscal year ends at the close of September 2019 consists of historically black colleges and other minority-serving institutions. Passed by the U.S. House of Representatives, H.R. 2486 must be taken into consideration by the Senate. The purpose of this legislation is to reauthorize $255 million of mandatory funding each year for programs under Title III of the Higher Education Act, which provides grants to historically black colleges and other institutions that enroll a large share of minority students.

These programs also receive discretionary funding from Congress each year, but the mandatory add-on funding expires on September 30. Officials at the Department of Education have indicated that there are plans to carry over unused mandatory funds from the current fiscal year into future years, so that many existing grants would remain in effect regardless of whether the funding stream expires.

Finalizing Stricter Rules For Student Loan Fraud Claims

An overhaul of rules known as “borrower defense to repayment” is in the process of being officially finalized this month. The purpose of the new policy is to set a more stringent standard for when the government will eliminate the debt of borrowers who claim they were misled or deceived by their institution. A notable example occurred during the Obama Administration when rules were written following the collapse of the for-profit college company Corinthian Colleges in 2015, which resulted in tens of thousands of former students sending requests to the Department of Education for loan forgiveness. Currently, the backlog of existing "borrower defense" claims exceeds 170,000 applications, but the Department has not taken any action on these claims in more than one year.

Education Department Secretary Betsy DeVos has stated that fraud in higher education will not be tolerated by the Trump Administration, adding that the final rules include carefully crafted reforms that hold colleges and universities accountable, and treat students and taxpayers fairly. An expectation is that these newer more strict standards will result in the Department approving fewer borrower defense claims, thereby reducing the amount of loan forgiveness by an estimated $512 million per year. The entire package of regulations, which also curtails loan discharges for students whose schools suddenly close, is projected to save taxpayers more than $11 billion over the next decade.

The new rules are designed to allow borrowers to have their loans forgiven if they can show their institution in a misrepresentation, but they must prove additional elements demonstrating that they relied on the college's misrepresentation and also must document financial harm more extensively. Another major change is a requirement that borrowers apply for loan forgiveness within three years of leaving school. Opponents of the rules are expected to mount legal challenges.

Trends In Ratio Of The Pell Grant To Total Price Of Attendance And Federal Loan Receipt

A new Data Point issued in August 2019 by the U.S. Department of Education is based on figures from four iterations of the National Postsecondary Student Aid Study (NPSAS), a large, nationally representative sample survey of students that focuses on how they finance their postsecondary education. An emphasis is on the percentage of total price of attendance covered by Pell Grants and the percentage of Pell Grant recipients who received federal student loans for academic years 2003–04, 2007–08, 2011–12, and 2015–16. Overall, the percentage of total price of attendance (tuition and fees, plus the cost of room and board, books and supplies, transportation, and personal expenses) covered by Pell Grants has remained consistent for selected years between 2003–04 and 2015–16, with the exception of 2007–08. The percentage of total price of attendance covered by Pell Grants was lower in 2007–08 (20%) compared to the 24% covered in all other years (2003–04, 2011–12, and 2015–16). These grants covered more of the total price of attendance for students at public 2-year institutions compared to public 4-year institutions, private nonprofit 4-year institutions, and private for-profit institutions in all selected academic years be- tween 2003–04 and 2015–16.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

John Colbert

September 19, 2019

Trends Archives

HEALTH REFORM DEVELOPMENTS

John Colbert

September 19, 2019

Trends Archives

The U.S. Census Bureau on September 10, 2019 released a report on Health Insurance Coverage In The United States: 2018. It revealed that in 2018, 8.5% of individuals, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9% or 25.6 million). The percentage of beneficiaries with health insurance coverage for all or part of 2018 was 91.5%, lower than the rate in 2017 (92.1%). Between 2017 and 2018, the percentage with public coverage decreased 0.4 percentage points, and the percentage with private coverage did not statistically change. In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3% of the population and 34.4% of the population, respectively. Of the subtypes of health insurance coverage, employer-based insurance remained the most common, covering 55.1% of the population for all or part of the calendar year.

Health insurance coverage is related to the highest level of education attained. Individuals with higher levels of educational attainment are more likely to have health insurance coverage than those with less education. In 2018, 96.6% of the population aged 26 to 64 with a graduate or professional degree had health insurance coverage, compared with 93.8% of the population with a bachelor’s degree, 85.1% of high school graduates, and 71.0% of the population with no high school diploma. Income is another contributing factor in coverage differences. In 2018, individuals in households with lower income had lower health insurance coverage rates than residents of households with higher income. In 2018, 86.2% of those in households with an annual income of less than $25,000 had health insurance coverage, compared with 96.8% of individuals in households with income of $150,000 or more. Inhabitants of households with lower income also had lower rates of private coverage and higher rates of public coverage. Children living in the south are more likely than children living in other parts of the nation to be without health insurance, and Hispanic children are more likely than children of other ethnicities to be uninsured.

Questions Pertaining To Enactment Of Proposed Medicare For All Legislation

Democrats competing to be the nominee by their party in the 2020 presidential election have expressed great enthusiasm for the enactment of proposed Medicare For All legislation. If such a law ever becomes a reality, its advantages include free coverage of benefits for all residents of the U.S. Not especially clear at this juncture, however, is how enough revenue will be generated to pay for such an expansion. Another issue worthy of consideration is how the Medicare program as it currently exists might undergo modification.

One aspect in particular is the Medicare Advantage Program. All baby boomers will be older than age 65 by the year 2030. Because one in every five residents will be at retirement age, Medicare enrollment can be expected to grow. By way of background, Medicare Advantage, the public-private health plan option available to Medicare beneficiaries, presently furnishes coverage for more than 22 million individuals, representing greater than one-third of all participants in Medicare. The Congressional Budget Office (CBO) estimates that current enrollment in Medical Advantage will increase to 29 million by the year 2025. A report from the Centers for Medicare & Medicaid Services in September 2018 indicates that 99% of Medicare beneficiaries have access to at least one Medicare Advantage Plan. The firm Avalere Health estimates that Medicare Advantage beneficiaries have higher rates of clinical and social risk factors than Traditional Medicare beneficiaries: 64% are more likely to be enrolled in Medicare due to disability, 57% have a higher rate of mental illness, and 16% have higher rates of alcohol/drug/substance abuse.

Assuming that existing Medicare is unaffected by the outcome of the 2020 election, as more beneficiaries switch from Traditional Medicare into Medicare Advantage, plans can be expected to become an increasingly important driver of a quest for high-quality care. If Medicare For All becomes a reality instead, whether private insurance coverage will continue to exist remains an open question. If so, plans, providers, community partners, beneficiaries, and policymakers are going to have to cooperate in figuring out how to support current efforts and build new opportunities to improve beneficiary health and quality of life.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

Costs Associated With Attending College

Opposition To Student Loan Forgiveness Rule

More Articles from Dec 2019 - Jan 2020 TRENDS

RESOLVING NETTLESOME HEALTH POLICY DISPUTES

PRESIDENT’S CORNER

LABOR-HHS FUNDS ALLOCATED FOR FY 2020

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

A CONCEPTUAL ANALYSIS OF DECISION FATIGUE

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