ASSESSMENT OF ADULT COMPETENCIES

Apropos of the previous item on patient-provider communication is the issue of adult literacy. The National Center for Education Statistics (NCES) on July 2, 2019 released information about the Program for the International Assessment of Adult Competencies (PIAAC), a large-scale global study of working-age adults (ages 16–65) that assesses adult skills in three domains (literacy, numeracy, and digital problem solving) and collects information on adults’ education, work experience, and other background characteristics. Data summarize the number of U.S. adults with low levels of English literacy and describe how they differ by nativity status and race/ethnicity. PIAAC reports five literacy proficiency levels: from below level 1 to level 4/5. Adults with low levels of literacy are defined, consistent with international reports (OECD 2013), as those performing on PIAAC’s literacy assessment at “level 1 or below” or those who could not participate in the survey.

Four in five U.S. adults (79%) have English literacy skills sufficient to complete tasks that require comparing and contrasting information, paraphrasing, or making low-level inferences, literacy skills at level 2 or above in PIAAC. In contrast, one in five U.S. adults (21%) has difficulty completing these tasks, which translates into 43.0 million U.S. adults who possess low literacy skills: 26.5 million at level 1 and 8.4 million below level 1, while 8.2 million could not participate in PIAAC’s background survey either because of a language barrier or a cognitive or physical inability to be interviewed. Adults classified as below level 1 may be considered functionally illiterate in English.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

An article published in the July 2019 issue of the journal Cambridge Quarterly of Healthcare Ethics discusses how empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements. For example, in the context of a serious illness, a physician might say, “This is a treatable condition,” or “We have treatments for your loved one.” Although in this particular instance, the emphasis is on the doctor-patient relationship, it is not difficult to imagine how interactions of a similar nature occur regularly between members of the allied health professions and the patients whom they treat.

A suitable venue to explore this phenomenon would be a rehabilitation center. Patients arrive there after the occurrence of traumatic brain injuries, various kinds of cancer, heart disease, stroke, and injuries sustained in falls and accidents, to mention just a handful of problems that necessitate long-term treatment. Usually, teams involving physicians and nurses from different specialties and allied health personnel (e.g., physical therapists, occupational therapists, respiratory therapists, and speech-language pathologists) work in sync with one another to address the many ailments that can affect patient well-being. It clearly is in the best interest of patients and their caregivers to begin their interactions on a positive note by recognizing that treatment interventions can produce salubrious outcomes. A key ingredient in achieving success is to foster patients’ resilience by encouraging them to maintain a belief that all the effort and time they must devote to becoming healthier are worth such an investment of personal stamina, combined with a willingness to continue undergoing treatment.

As the journal article points out, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, although this result may not be intended by physicians. A radical divergence in understandings may lead to severe instances of miscommunication, a situation that can arise from the lack of shared experience between practitioners and patients accompanied by differing assumptions that each party makes. Thus, apart from the laying on of professional hands, it is incumbent on the part of caregivers to pay close attention to the quality of communication that occurs with patients. Informed consent and shared decision-making are two aspects of this process that can play a definitive role in improving an agreed-upon understanding of everything that treatment statements actually entail.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Investing In Interventions That Address Non-Medical, Health-Related Social Needs

On April 26, 2019, the Board on Population Health and Public Health Practice of the National Academies of Science, Engineering, and Medicine held a public workshop to explore the potential effects of addressing non-medical, health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system. The presentations and discussions highlighted in a Proceedings of a Workshop were released on August 19. They provide a general discussion of the issues, trends, and opportunities and challenges of investing in interventions that address patients’ non-medical, health-related social needs. While health care services are essential to health, there is growing recognition that social determinants are important influences on population health. Supporting this notion are estimates that while health care accounts for some 10-20% of the determinants of health, socioeconomic factors and factors relating to the physical environment are estimated to account for up to 50%. Challenges at the individual level include housing quality, food insecurity, limitations in access to transportation, and lack of social support. The Proceedings can be obtained here.

Joint Commission Educational Campaign On Preventing Falls

The Joint Commission in July 2019 debuted its new Speak Up to Prevent Falls campaign featuring free, downloadable educational materials in English and Spanish to help educate patients and their health care providers on how to avoid unnecessary falls. Ready-made, easy-to-read resources include: an infographic poster/flyer for patients and their families, an animated video to incorporate in hospital programming, and a distribution guide with recommendations on how health care organizations can use and distribute the materials to patients and their families, caregivers, and advocates. Hundreds of thousands of patients fall in hospitals every year and 30-50% of these patients sustain an injury. Between 50-75% of elder patients suffer from a nursing home fall each year. Of these multiple falls: one out of five cause a serious injury such as broken bones or head injury, with the overall average cost for a fall injury totaling about $14,000. Speak Up to Prevent Falls outlines how to prevent falls and offers four primary areas of direction that patients, their caregivers, and advocates can follow to prevent the risk of falls. More information about the program can be obtained here.

A New Proposed Fix For Long-Term Care

As Americans live longer, more and more families are caring for older adults and facing tough financial circumstances that give rise to a bigger question: How will this nation care for a growing number of older individuals with complex needs once they can no longer take care of themselves? So far, there is not any good answer. With smaller families and half reporting no savings at all, many 60-year-olds simply don’t have the necessary resources to pay for the care they will need during the additional 23 years they are expected to live. Refusing to continue to be stymied by this vexing issue, as a means of answering that important question, Milbank Memorial Fund President Christopher Koller and John A. Hartford Foundation President Terry Fulmer in a paper published on June 25, 2019 highlight an innovation in Washington state that merits national attention. Washington Governor Jay Inslee signed a first-in-the-nation bill to help finance the long- term care needs of all the state’s residents. It’s a solution that may provide a template for other states, and possibly the federal government. New public policies are needed because the private market has failed. Long-term care insurance tends to be highly expensive and has limited benefits. In 2016, of the 89 million individuals in the United States over age 55, only about seven million were covered by long-term care policies and far fewer are buying new policies now than they used to do so previously. The paper can be obtained here.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Aerobic Activity And Time Spent on Sedentary Behavior Among U.S. Adults

The updated 2018 Physical Activity Guidelines (PAG) for Americans reaffirmed key recommendations regarding aerobic activity in the 2008 edition and recently introduced health risks of sedentary behaviors and their association with physical activity. Time spent on sedentary behavior significantly increased over time from a weighted mean (SE) of 5.7 (0.3) hours per day in 2007-2008 to 6.4 (0.2) hours per day in 2015- 2016 (P < .001 for trend). The weighted proportion of individuals not adhering to the PAG for aerobic activity and reporting long sedentary time (>6 hours per day) increased from 16.1% (95% CI, 14.4%- 17.8%) in 2007-2008 to 18.8% (95% CI, 17.7%-20.0%) in 2015-2016. The findings suggest that the adherence rate to the PAG for aerobic activity in US adults has not improved since the release of the first edition in 2008, but that time spent on sedentary behavior has significantly increased over time. Further nationwide efforts appear to be warranted not only to promote physical activity, but also reduce sedentary time in the United States.

Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

A Data Brief from the National Center for Health Statistics (NCHS) in July 2019 indicates that from 1999 through 2017, the age-adjusted unintentional injury death rate increased 40% from 35.3 deaths per 100,000 standard population to 49.4. Motor vehicle traffic death rates increased across all levels of urbanization between 2014 and 2017, with the largest increase in small metropolitan (metro) counties. Unintentional drug overdose death rates increased across all levels of urbanization between 2014 and 2017, with the largest increase in large fringe metro counties. Unintentional fall death rates increased across urbanization levels except for large central metro counties between 2014 and 2017, with the largest increase in rural counties. Unintentional injury is a leading cause of death in the United States. As with many other prominent causes of deaths involving cancer, cardiovascular disease, and suicide, behavior plays a significant role in generating these unfavorable outcomes.

HEALTH TECHNOLOGY CORNER

Achieving Better Health Care Integration Of Radiology

An article published online July 9, 2019 in npd Digital Medicine indicates that although radiology images and reports have long been digitalized, the potential of the more than 3.6 billion radiology examinations performed annually worldwide has largely gone unused in the effort to transform health care. The Bionic Radiologist is a concept that combines humanity and digitalization for better health care integration of radiology. At a practical level, this concept will achieve critical goals: (1) testing decisions being made scientifically on the basis of disease probabilities and patient preferences; (2) image analysis done consistently at any time and at any site; and (3) treatment suggestions that are linked closely to imaging results and are integrated seamlessly with other information. To achieve this potential, barriers that must be overcome include: reluctance to delegate decision making, a possible decrease in image interpretation knowledge, and the perception that patient safety and trust are at stake.

Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications

A study published on August 5, 2019 in the journal ACS Applied Materials and Interfaces describes engineering the first thread-based transistors (TBTs), which can be fashioned into simple, all-thread based logic circuits and integrated circuits. Electronic devices are made entirely of thin threads that could be woven into fabric, worn on the skin, or even (theoretically) implanted surgically for diagnostic monitoring. Fully flexible electronic devices could enable a wide range of applications that conform to different shapes and allow free movement without compromising function. "Soft" electronics are enabling applications for devices that conform and stretch with the biological tissue in which they are embedded, such as skin, heart, or even brain tissue. Compared to electronics based on polymers and other flexible materials, thread-based electronics have superior flexibility, material diversity, and the ability to be manufactured without the need for clean rooms.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Unlike other portions of the higher education sphere, the health sciences are shielded from criticism about the declining value of spending money and devoting the amount of time necessary to obtain a college degree. A steady growth in the U.S. population accompanied by increases both numerically and proportionately of individuals age 65 and older, a group that generates a considerable amount of demand for health care services, means that the nation must continue to address the challenge of producing enough adequately prepared personnel to meet patient needs.

Higher education costs remain high for many students and their families. Some individuals might begin the pursuit of a college degree, but never complete what is necessary and they end up leaving school without that credential, but not without a large amount of debt that must be repaid. Unless their education is linked directly to specific job prospects, such as health care, questions have been raised about the wisdom of pursuing such an educational goal in the first place. An alternative in the form of vocational education has been receiving some attention lately.

As a reflection of that emerging interest, Senator Josh Hawley (R-MO) on July 16 of this year introduced the Break the Higher Education Monopoly Act of 2019 (S. 2123) and the Skin in the Game Act (S. 2124). S. 2123 would amend the Federal Pell Grant program to allow job training and apprenticeship programs to be eligible for Pell Grants. The bill directs the U.S. Department of Education Secretary to devise an alternative certification program that would not require accreditation, state authorization, minimum instructional hours, or minimum classroom time for educational programs to be Pell-eligible. S. 2124 would require colleges and universities to pay off 50% of student loans that are in default and are associated with their institution. The bill would prohibit institutions from raising tuition or creating other fees to cover loan repayments.

Update On The National Advisory Committee On Institutional Quality And Integrity

The National Advisory Committee on Institutional Quality and Integrity (NACIQI) conducted a meeting in Alexandria, Virginia on July 30-31, 2019. The purpose of this entity is to provide recommendations to the U.S. Secretary of Education on recognition of accrediting organizations. Recognition by the Department of Education (USDE) affirms that the standards and processes of accrediting organizations and state accreditation approval agencies demonstrate compliance with criteria. A current effort involves publishing a final rule before November 1, 2019 on proposed regulations regarding accreditation, innovation, and other issues so that the rules will be effective on July 1, 2020. The Department received a total of 198 comments on the proposed regulations that reflect some concerns expressed regarding: retroactive accreditation for institutions and programs, and increasing the time allowed for institutions and programs to come into compliance with accreditor requirements.

Repeal Of The “Gainful Employment” Regulation

During the Obama Administration, a successful attempt was made to crack down on low-performing programs at for-profit schools and other career colleges by implementing a “gainful employment” regulation. The past decade has witnessed an ongoing series of debates and litigation about this matter. Democrats have viewed the rule as an important necessary safeguard for both students and taxpayers while the for-profit sector of the education industry opposed it on the rationale that it unfairly held for-profit colleges to standards that non-profit and public institutions were not required to meet. As published on July 1, 2019 in the Federal Register, the Secretary of the Department of Education amends the regulations on institutional eligibility under the Higher Education Act (HEA) of 1965, as amended, and the Student Assistance General Provisions to rescind the Department’s gainful employment regulations. The repeal of the regulation is scheduled to go into effect on July 1, 2020. As a means of accelerating the process, the Trump Administration announced that it was exercising its authority to permit "early implementation" of the repeal, effectively freeing schools of the regulation immediately.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

HEALTH REFORM DEVELOPMENTS

During a typical session of Congress, elected officials in both chambers work strenuously to pass legislation that can be sent to the President where it is signed into law. The really heavy lifting often takes place, however, in the executive branch agencies that are responsible for developing the rules and regulations that furnish specific guidance on how a law is to be administered. Whatever finally emerges may be challenged by parties that objected to portions of the legislation when it originally was being considered in Congress. Such disputes then make their way into the judicial sphere.

Although the Affordable Care Act of 2010 (ACA) already is almost a decade old, certain features are as lively and combustible in policy circles as when they initially were proposed. As previously reported in past issues of this newsletter, a prominent example is the case of Texas v. United States wherein that state and 17 other states claim that the ACA’s individual mandate is unconstitutional, which in essence also renders the entire law invalid as well. California and 20 other states are in opposition, along with the U.S. House of Representatives. A federal judge ruled for the plaintiffs and the case subsequently proceeded to the Fifth Circuit Court of Appeals. Assuming the decision is upheld, the next step may involve consideration by the U.S. Supreme Court.

Similar ongoing actions represent additional efforts by Republicans to reverse other components of the ACA. New York is one of 12 states contesting a decision by the Trump Administration to extend access to insurance plans that do not comply with the law. That case currently is poised for oral argument at the D.C. Circuit Court of Appeals. Meanwhile on the campaign trail for the 2020 election, several Democrat candidates for the White House advocate enactment of Medicare for All legislation. It is safe to assume that if such a law ever becomes a reality, many law firms and courthouses will be kept busy in efforts to influence its various provisions to their satisfaction.

Enhancement of Quality Care In Hospitals

The Centers for Medicare & Medicaid Services (CMS) is an example of an executive branch agency that on a regular basis develops guiding principles for implementing various health laws. In August 2019, CMS announced plans to update the quality measurement methodology of the Overall Hospital Quality Star Ratings in 2021. As an interim step, the agency will refresh the Star Ratings using the current methodology in early 2020, ensuring patients have timely access to the most up-to-date hospital quality information while a new methodology is being finalized. The effort represents a major step forward in delivering on President Trump’s recent Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First, which seeks to enhance the ability of patients to choose the health care that is best for them.

Potential Impact Of Reimbursing At Medicare Rates On The Health Insurance Exchanges

As the 2020 U.S. election season unfolds, various options for expanding the Medicare program as a way of addressing gaps in health insurance coverage will be discussed. Medicare for All legislation suggests that present commercial insurance and Medicaid could be replaced by having Medicare pay providers using current Medicare rates. According to an analysis released in August 2019 by Navigant Consulting Inc., doing so could place as many as 55% of rural hospitals, or 1,037 hospitals across 46 states, at high risk of closure. It is estimated that 28% of rural hospitals would be at high risk of closure if only uninsured and current individual market participants shifted to the public option, and that more than half of rural hospitals would face high risk of closure if employers shifted 25% to 55% of their covered workers from commercial coverage to the public option.

If nothing else, this analysis reflects the seriousness of the next election and the importance of paying close attention to what is being proposed. The ACA became law in 2010 without a single Republican in the House or Senate voting in favor of it. Important pieces of social legislation demand bipartisan support. Otherwise, to move forward with new health laws that will affect millions of individuals without the incorporation of the best possible thoughts and ideas by members on both sides of the political aisle is destined to result in increased needless litigation and frustration for all concerned parties.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

ACCELERATED PACE ON CAPITOL HILL

Prior to departing Washington, DC for their August recess, legislators adopted a quick pace in July and ASAHP was active in efforts to influence bills under consideration. The House Energy and Commerce Committee attracted noteworthy attention by approving 25 bills, including H.R. 2781, the Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 that contains a provision to provide $5 million annually to support diversity efforts in physical therapy, occupational therapy, and speech- language pathology. Association staff worked with both the Committee and other professional associations in supporting this effort. They also have been working closely with House Ways and Means Committee staff in support of H.R. 3398, the Pathways to Health Careers Act, a measure to reauthorize the Health Profession Opportunity Grant (HPOG program) that is set to expire on September 30.

Budget issues and appropriations are topics that have a tendency to attract significant amounts of attention at this time of year. A major breakthrough occurred when the Senate passed a two-year bipartisan budget deal (H.R. 3877) on a vote of 67-28 to increase budget caps, raise the nation’s borrowing limit, and develop a pathway to fiscal year 2020 government funding, which begins this coming October 1. President Trump signed the arrangement into law (P.L. 116-37) on August 2, 2019. As a result, spending will increase by $320 billion above current levels and the debt ceiling will be lifted for two years. The new law also is expected to add $1.7 trillion to the national deficit over the next 10 years in comparison to automatic spending cuts known as sequestration that otherwise would occur without such an agreement.

The next important piece on the legislative agenda is passage of appropriations bills. Ten of the necessary 12 bills already have been passed by the House. The Senate has not passed a single spending bill, but is expected to direct its attention to this matter when its members return to Capitol Hill on September 9. Senate Majority Leader Mitch McConnell (R-KY) will not allow his chamber to begin marking up and passing appropriations bills without producing a budget caps deal on total spending levels for defense and non-defense domestic programs.

High prices associated with the cost of drugs is a problem that continues to be of concern. Bipartisan leaders of both the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee have initiated discussions on how to integrate their respective activities involving drug pricing and health care costs prior to measures pertaining to these topics being brought for a vote on the Senate floor. Democrats in that chamber have a strong interest in producing legislation that will enable the Medicare program to negotiate drug prices. A parallel effort involves the inclusion of a provision to require manufacturers to disclose the price of drugs in direct-to-consumer (DTC) advertising.

Additionally, the Senate has expressed interest in establishing a national telehealth program by introducing S. 2408 and also by introducing S. 2411 to create a rural health center innovation awards program and a rural health department enhancement program.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

By Susan N. Hanrahan, ASAHP President

Happy start to the ever present fall semester!!! They seem to materialize like the movie “Groundhog Day” ---- a reoccurring event that launches another academic year. Congrats to all of our new deans reading this issue and congrats to all deans who successfully hired all of the faculty they needed to start the fall in good shape---that dean would not be me however. It seems to get more difficult each year to find talented leaders for our high achieving students. But, thanks to our Leadership Committee (Tina Whalen, Chair), they are planning a concurrent session at the Annual Conference on “faculty recruitment” related to best practices—stay tuned.

Speaking of the Annual Conference, thank you for encouraging your faculty and students to submit abstracts for the Oct 16-18 conference in Charleston, SC. We had a record number of submissions so you will see and hear plenty of scholarly work that is always inspiring and very impressive. We also have a great line up of plenary speakers including General George Casey who will be kicking off the conference talking about leadership and one of our own, Lisa Saladin, Executive Vice President for Academic Affairs and Provost at the Medical University of South Carolina. In order to keep “ahead of the curve”, we have added speakers from industry, the federal government and others that I think will supply us with ample “food for thought.” I am very excited about our 2019 conference and appreciate the work of our staff, Barb Wallace (BOD) and Barry Eckert (BOD). In addition, we have a Charleston Harbor Cruise scheduled on Wednesday night that will give us plenty of time to network and enjoy the coastline of Charleston. With our business meeting, awards, committee meetings and the rest, it should be another productive time in the life of our Association.

I do want to mention a couple of things that I am sure you have already read about but I want to reinforce. ASAHP had its 2nd annual Summer Summit, this time in St Louis, MO. It was hosted by Kindred Healthcare and St Louis University. Special thanks to Tony Breitbach (IP subcommittee), Julie O’Sullivan Maillet (Clinical Education Task Force) and Barb Wallace (BOD). The team will be presenting the results of the summit at the conference so if you have interest in ICP, be on the lookout for their work. In addition, we would love to have your ideas for our 3rd Summer Summit---particularly any hot topics that we can organize a diverse group of individuals around to advance the subject.

Our partnership with CGFNS has been a very good one especially with our work around setting standards for global certification of rehab health workers. We have had great buy in from a whole host of countries around this topic. Special thanks to Julia ToDuka (CGFNS) and Rich Oliver (ASAHP) for their leadership to date. They have made great progress on this very exciting project in a short period of time. More to come on this!

Lastly, thanks to all who completed the Institutional Profile Survey. Right now we are tweaking the survey in preparation for the data collection period July 1, 2018 to June 30, 2019 (or whatever is near your fiscal year). Hopefully we can open the survey in September/early October. The data that has already been submitted is being “cleaned” and reviewed by a third party to ensure validity. The salary data is the most difficult to verify as there seem to be some outliers. As we have mentioned before, the first iteration of a new survey is the most difficult for our institutions as well as the people we have collecting, organizing and confirming the data. Be patient. You will have results soon. Let me know if there is anything that the Association can do to assist you.

Here’s to a great fall semester! Susan Hanrahan, President

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Elections in November 2020 are expected to feature health care as a top concern of voters. Already, many Democrat candidates have expressed support for enacting Medicare for All legislation. Apart from the Patient Protection and Affordable Care Act of 2010, which became law to address problems involving access, cost, and quality, since then: Congress passed the 21st Century Cures Act in December 2016, authorizing $1.8 billion in funding for the Cancer Moonshot over seven years; President Donald Trump signed the controversial "right-to-try" bill in May 2018, which bypasses drug regulators to enable gravely ill patients to have access to experimental medicines; and both the Administration and Congress continue to make strenuous efforts to rein in the high costs of many pharmaceutical products.

Assuming that enactment of Medicare for All occurs, resulting in free health care and affordable medications becoming available, what is the likelihood that health policy-related worries will cease to be of concern? An examination within the house of health care itself would suggest a need for caution. The ability to address a health problem successfully is contingent upon being able to identify it properly through an accurate diagnosis. A cursory examination across the professional landscape in domains for both physical and mental health reveals, however, that many deficiencies exist from the perspective of diagnostic capabilities.

According to an article that appeared in the August 2019 issue of JAMA Internal Medicine, in a large proportion of cases, there will be no apparent cause for a given patient’s condition—physical, psychological, or otherwise. Up to one-half of symptoms that present to physicians resist medical diagnosis, and 80% of symptoms resolve on their own within four to 12 weeks of onset. Moreover, ambiguous symptoms currently represent the fastest growing complaint by patients. Meanwhile, the results of a study published online July 11, 2019 in the journal Diagnosis confirm that diagnostic errors remain the most common, most catastrophic, and most costly of serious medical errors in closed malpractice claims. Nearly three-fourths of serious misdiagnosis-related harms are attributable to diseases in just three major categories – vascular events, infections, and cancers (the “Big Three”). A diagnostic error can mean the difference between life and death for patients. While estimates vary, it is likely that more than 100,000 Americans die or are permanently disabled each year due to medical diagnoses that initially miss conditions or are either wrong or delayed.

A paper in the September 2019 issue of the journal Psychiatry Research suggests that diagnostic errors and misclassifications are not confined to the physical realm of conditions. Study findings indicate that psychiatric diagnoses all use different decision-making rules; huge overlap exists in symptoms between diagnoses; almost all diagnoses mask the role of trauma and adverse events; and diagnoses may provide little guidance about patients and the treatment they need. Thus, expanding access to health care by providing adequate health insurance coverage to individuals who lack it is an obvious important policy step in the right direction. Yet, it is reasonably clear that upon their entering the health care system, a major challenge will persist in the form of striving to do the right thing for patients.

CHALLENGES INVOLVED IN DOING THE RIGHT THING

Indicates the importance of providing appropriate health care based on accurate diagnoses. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference, the Institutional Profile Survey, and other relevant activities of the Association. Read More

ACCELERATED PACE ON CAPITOL HILL

Describes legislation involving the budget, appropriations, the health workforce, along with telehealth and rural health proposed initiatives. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to enhance quality care in hospitals and the potential impact of reimbursing at Medicare rates on the health insurance exchanges. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes recent activity by the National Advisory Committee on Institutional Quality and Integrity, and repeal of the “Gainful Employment” regulation. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Aerobic Activity And Time Spent On Sedentary Behavior Among U.S. Adults

• Unintentional Injury And Death Rates In U.S. Rural And Urban Areas

• Achieving Better Health Care Integration Of Radiology

• Manufacture Of Thread-Based Transistors For A Wide Range Of Health Applications Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Investing In Interventions That Address Non-Medical, Health-Related Social Needs

• Joint Commission Educational Campaign On Preventing Falls

• A New Proposed Fix On Long-Term Care Read More

GAP BETWEEN WHAT IS SAID BY PROVIDERS AND HEARD BY PATIENTS

Mentions how health professionals and patients may not always have the same amount of understanding of statements involving treatability. Read More

ASSESSMENT OF ADULT COMPETENCIES

Refers to data from the National Center for Education Statistics on the topic of adult literacy. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Using Herbert Simon’s concept of “bounded rationality,” it is considered highly likely that in complex situations an individual often will pursue a course of action that satisfies the minimal requirements necessary to achieve a particular goal rather than an optimal choice, even when attempting to be rational in decision-making. An article in the June 2019 issue of the journal Nature Human Behavior describes artificial intelligence (AI) as the use of computer algorithms to mimic human cognitive functions, such as learning or problem solving. AI facilitates the analysis of data with a lens that surpasses human capacity through its ability to process data and information, addressing the issue of bounded rationality. AI also is devoid of behavioral limitations, including unsubstantiated deviation from evidence-based guidelines, influence of peers in hierarchical cultural norms, and fatigue.

Antibiotic prescribing, whether appropriate or inappropriate, is a driver of antimicrobial resistance, a complex social and biological challenge that reflects many problems Simon set out when describing the boundary of rationality. It also is an ideal example of when caring for an individual has immediate and far reaching externalities. A decision made to prescribe an antibiotic affects not only the individual patient, but also an individual’s microbiome and society as a whole, through the selection of drug-resistant organisms. Decision-making during infection management is a dynamic and often inconsistent process. The development of AI systems in the field of infection still is in its infancy. Nonetheless, a range of supervised and unsupervised AI tools have been developed, including causal probabilistic networks and support vector machine classifiers. These tools have shown high accuracy in predicting infection and recommending appropriate antibiotic therapy. AI provides the potential to integrate these complex processes and support optimal use of data for evidence-based decision-making.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

The Association of Schools of Allied Health Professions hosted its 2nd Annual ASAHP Summit on May 31, 2019 at Saint Louis University in St. Louis, MO. The theme of this year’s event, co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences, was “Connecting Academic Programs and Clinical Practice Together to Inform System Improvement.” The Summit was a first-ever collaboration between ASAHP’s Professional Education Committee and Clinical Education Task Force (CETF), bringing multiple interested parties together in a convenient venue to discuss important factors in the connection between academia and the healthcare industry.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Financial Burden Of Paid Home Care On Older Adults

According to an article in the June 2019 issue of the journal Health Affairs, paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. Researchers simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults aged sixty-five and older. Researchers found that 74% could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58% could fund at least two years of an extensive amount of paid home care. Among older adults with significant disabilities, however, only 57% could fund at least two years of moderate paid home care by liquidating all of their assets, and 40% could fund at least two years of extensive paid home care. This form of care could become less affordable if growing labor shortages raise future costs. The article can be obtained here.

Faith-Health Collaboration To Improve Community And Population Health

On March 22, 2018, an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine planned and convened a one-day public workshop that explored challenges and opportunities for health sector actors that engage with faith-based health assets. The workshop provided an overview of faith-based assets in communities and their relationship to population health and the work of health improvement; highlighted areas where faith-based health assets are using evidence to inform their work and demonstrating effectiveness in improving health outcomes; provided examples of effective partnerships involving faith-based health assets; and shared lessons learned from working with faith-based assets that could contribute toward principles for engagement for health care organizations and public health agencies. The workshop proceedings can be obtained here.

Family Care-Giving Roles In Medical Product Development

For the first time, a newly-released report, resulting from a one-day summit, “Paving the Path for Family-Centered Design: A National Report on Family Caregiver Roles in Medical Product Development,” explores the vital roles that family caregivers can play in shaping biomedical research and development, regulatory decision-making, and healthcare delivery. Specifically, the report begins a dialogue on how to incorporate the critical knowledge of caregivers in developing pharmaceutical products, biotechnology therapies, and medical devices. It presents recommendations for leveraging the enormous and largely untapped reservoir of information and observations of caregivers about the conditions their care recipients experience and health outcomes. Approximately 43.5 million individuals provide unpaid caregiving services to Americans of all ages, 60% of whom have a long-term health condition. The report can be obtained here.

2018 National Health Interview Survey Selected Estimates

Early released measures based on selected estimates in the 2018 National Health Survey provide valuable information on a wide range of topics, including health insurance coverage, places to go for health care, obesity, and personal care needs. The measures can be obtained here.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Prescriptions Filled By Americans In 2018

Americans filled 5.8 billion 30-day equivalent prescriptions in 2018 (17.6 prescriptions per person), an increase of 2.7% from the prior year, according to the IQVIA Institute for Human Data Science’s report, Medicine Use and Spending in the U.S. More than two-thirds of prescriptions are for chronic conditions, which increasingly are filled with 90-day prescriptions and are thought to result in better adherence to prescribed regimens. Retail and mail pharmacies dispensed 127 million specialty prescriptions last year, an increase of 15 million since 2014. While specialty drug prescriptions increased more than 5% between 2017 and 2018, these drugs make up just 2.2% of all prescriptions. The report also notes that patient out-of-pocket costs increased in 2018 to an estimated $61 billion, with Medicare patients facing higher annual out-of-pocket costs than patients in commercial plans or those enrolled in Medicaid.

Dental Care Among Adults Aged 65 And Older

Dental care often is an overlooked aspect of overall health care among older adults. In 2017, slightly less than one-third (29.2%) of adults aged 65 and over had dental insurance. National Center for Health Statistics (NCHS) data show that overall, approximately two-thirds of adults aged 65 and over had a dental visit in the past 12 months. Older adults who were poor (42.7%) or near poor (42.8%) were less likely to have had a dental visit compared with non-poor (74.4%) older adults. Non-Hispanic black (11.2%) and Hispanic (12.3%) adults aged 65 and over were more likely to have unmet need for dental care due to cost compared with non-Hispanic white (6.8%) and non-Hispanic Asian (5.9%) older adults. The percentage with dental insurance was higher among those aged 65–74 (34.3%) compared with older age groups and lower among Hispanic adults (17.5%) compared with other race and Hispanic-origin groups.

HEALTH TECHNOLOGY CORNER

3-D Print Flexible Mesh For Knee And Ankle Braces

Limb prosthetics are medical devices that can be digitally designed and customized for individual patients, as a result of 3-D printing. Typically, they are designed to replace or support bones and other rigid parts of the body, and often are printed from solid, relatively inflexible material. According to an article published on June 19, 2019 in the journal Advanced Functional Materials, engineers at the Massachusetts Institute of Technology have designed pliable, 3-D-printed mesh materials with flexibility and toughness they can tune to emulate and support softer tissues such as muscles and tendons. Additive manufacturing (AM) of medical devices such as orthopedic implants and hearing aids is highly attractive because of its potential to match the complex form and mechanics of individual human bodies. Externally worn and implantable tissue‐support devices, such as ankle or knee braces, and hernia repair mesh, offer a new opportunity for AM to mimic tissue‐like mechanics and improve both patient outcomes and comfort.

Using Pig Brains To Understand Human Brain Functions

An article published on May 22, 2019 in the journal Brain Connections by researchers at the University of Georgia’s Regenerative Bioscience Center reports on a study that shows that as a translational, large animal model, pigs demonstrate great potential for mapping connectome-scale functional connectivity in experimental modeling of human brain disorders. The investigators used an imaging method normally reserved for humans to analyze brain activity in live agricultural swine models, discovering that pig brains are even better platforms than previously thought for the study of human neurological conditions such as Alzheimer’s and Parkinson’s diseases. An immediate potential application is in the study and diagnosis of chronic traumatic encephalopathy (CTE), a progressive brain disease caused by a series of blunt trauma usually seen in military veterans and National Football League players. Currently, CTE can be diagnosed only through an autopsy.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

DEVELOPMENTS IN HIGHER EDUCATION

The 1st Session of the 116th Congress began in January 2019 with an expectation among legislators that this year would be the one to resolve issues for a most important piece of legislation know as the Higher Education Act. Last reauthorized in 2008, since 2013 it has been sustained by a series of short-term continuing resolutions (CRs). As of June 2019, some doubt continues to exist regarding whether the task can be completed by the end of this year. Teams consisting of staff members for Senators Lamar Alexander (R-TN), Chairman of the Committee on Health, Education Labor & Pensions (HELP), and Ranking Member Patty Murray (D-WA) have been working to produce a bill that can achieve bipartisan agreement. An inability to meet their self-imposed deadline of having a bipartisan proposal finished by the end of May would appear to render it unlikely that a bill can be brought to the Senate floor any time soon.

This massive piece of legislation consists of many components, any one of which has the potential to create more delay. Examples are: simplifying the federal student aid application, creating a new income-based repayment plan for borrowers, building a new accountability system for colleges based on whether borrowers actually are repaying their loans, expanding competency-based education programs, requiring colleges to use clearer language in letters telling students about the aid they are receiving, Title IX campus sexual assault incidents, and collecting better data on how much students borrow and how much they earn after graduation. Other aspects include allowing incarcerated individuals to access Pell Grants and making grants available for shorter academic programs. Worth noting is that some current issues not easily resolved are accountability as it relates to the for-profit sector and student loan repayments.

Federal Work-Study (FWS) Experiment Launched

U.S. Secretary of Education Secretary Betsy DeVos announced a new Federal Work-Study (FWS) Experiment to provide institutions with increased flexibilities that will enable students to earn work-study benefits while participating in apprenticeships, internships, and work-based learning programs, as well as earn work-study wages while completing required clinical rotations, externships, and student teaching. “For decades, the Federal Work-Study program has allowed students to support themselves while earning a college degree, but for too long, the majority of the work options students have had access to have been irrelevant to their chosen field of study,” she stated. Under the current FWS program, nearly 92% of all funds are spent to support students in on-campus employment, while just over 8% support students working for non-profit organizations. Less than one-tenth of 1%, or just $726,000 of the billion-dollar FWS program, are spent to support students in private-sector employment, where many students are likely to seek permanent employment. The experiment is aimed at eliminating barriers that made engagement with private-sector employers undesirable for many colleges and universities.

Proposed Regulations On Accreditation, Innovation And Other Topics

The U.S. Department of Education (USDE) on June 12, 2019 published proposed regulations on accreditation, innovation, and other topics, reflecting the draft consensus language approved by the negotiated rulemaking committee that met earlier this year and reached consensus on April 3. The proposed regulations would affect several areas involving accreditation, including: increase expectations by USDE concerning student achievement; provide more flexibility for innovation for institutions and accrediting organizations; and increase the time for institutions and programs to come into compliance with accreditation requirements.

Two aspects of interest for institutions belonging to ASAHP are: (1) Establish that the Department recognizes an institution’s legal authorization to operate postsecondary educational programs when it is exempt from State authorization under the State constitution or by State law as a religious institution with a religious mission, and (2) Revise the State authorization requirements for institutions offering distance education or correspondence courses.

A public comment period began on June 12, 2019 and is in effect until July 12, 2019. Comments can be submitted electronically here.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

HEALTH REFORM DEVELOPMENTS

Chronicity is a term frequently employed to describe the kinds of health problems that affect patients aged 65 and older. It also can be applied to health workforce challenges that steadily prove difficult to overcome. Rural sections of the United States represent areas that often suffer the effects of being inadequately served as a result of severe shortages of various kinds of health professionals. Mental health offers a good example of where considerably more effort is needed to address the health care needs of residents of rural areas. Compared to urban locales, for example, suicide rates are higher in rural parts of the nation.

Unfortunately, no single magic bullet is available to remedy the fact that as many as one-half of U.S. counties, predominantly located in rural areas, do not have a single psychiatrist to respond to the needs of residents. As an illustration of a recently proposed legislative remedy, the “VA Mission Telehealth Clarification Act” was introduced in the U.S. House of Representatives on June 12, 2019. It has seven co-sponsors for the purpose of authorizing health professional trainees to provide treatment via telemedicine. Proposals of a broader nature would involve allowing Medicare beneficiaries to access mental health services through telemedicine regardless of where they live and without having to leave home.

A different kind of approach would entail helping mental health professionals pay off their educational debt if they agree to work in an area with a shortage of workers. Inadequate reimbursement levels may be a major disincentive for mental health professionals to live and work in rural areas, especially in sections of the country that are remote. A way of addressing the situation would be to consider using peer support specialists who could work with doctors who treat patients using telemedicine. These individuals are neither physicians nor other kinds of health professionals. Instead, they are characterized by having knowledge derived from their own personal recovery process in combination with some formal training to enable them to support patients confronting similar challenges.

Obtaining More Savings From Accountable Care Organizations

The Medicare Shared Savings Program (MSSP) has produced modest savings for Medicare and been popular among health care providers, with 561 participating accountable care organizations (ACOs) covering nearly a third of the fee-for-service Medicare population in 2018. According to a paper in the June 6, 2019 issue of the New England Journal of Medicine, the savings pace has not proven to be commensurate with Medicare’s fiscal challenges, however, prompting calls for reform. The Centers for Medicare and Medicaid Services (CMS) responded in December 2018, with “Pathways to Success.” Strengthening incentives for ACOs to reduce spending is challenging because the program is voluntary. Some approaches, such as requiring ACOs to bear downside risk for excess spending, may make the program unattractive to some providers, potentially lowering program-wide savings by reducing participation. The involvement of providers with high spending that isn’t explained by patient risk factors is particularly critical to MSSP success, because the care their patients receive (including care from other providers) presents the greatest opportunities for savings. So far, ACOs with high risk-adjusted spending have lowered spending more than ACOs that began with low spending.

Hearty Perennials Of The Affordable Care Act Battles

For several years, supporters of the ACA have attempted to force the Little Sisters of the Poor to provide free-of-charge abortion-inducing contraceptives to their employees under this law. A 2011 HHS mandate requiring employers to provide certain health care, including birth control and emergency contraception, generated a lawsuit by the nuns. They sued in 2013 to be exempt from the rule, but lengthy court battles later, the case still is ongoing. New HHS rules created in 2017 allowed for religious exemptions for employers, including the group run by the Little Sisters of the Poor, but 13 states and the District of Columbia sued to block the rules. Two judges in January temporarily blocked the rules from going into effect, but a hearing presided over by a federal judge in California in June 2019 helps to guarantee that the dispute will continue to be ongoing regardless of any ruling that emerges.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

SPENDING LEGISLATION TAKES SHAPE

The U.S. House of Representatives on a vote of 226-203 on June 19, 2019 approved a four-bill spending package (H.R. 2740). The Minibus included the fiscal year (FY) 2020 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill, along with spending for Defense; Energy and Water; and State and Foreign Operations. This legislation specifies all the particulars regarding amounts of money to allocate for a wide range of programs. A prime example is the National Institutes of Health, which stand to benefit by an increase of more than two billion dollars in the upcoming fiscal year that begins this October 1, which is a larger increase than what has been provided in three of the previous four fiscal years.

The Agency for Healthcare Research and Quality (AHRQ) has been slated on several occasions for extinction, including in the current Administration’s budget proposal for FY 2020. Based on action by the House, however, the Agency will continue to exist. Its eventual fate will be determined once the Senate takes action by approving its own spending legislation. Members of that chamber have not yet officially established a timeline for consideration of its FY 2020 appropriation levels.

An ongoing concern in Congress is the steady rise in health care costs. A growing overall population in the U.S. and increases in the number of individuals aged 65 and older, many of whom have multiple chronic health problems, provide assurance that unless some constructive action is taken, costs will increase rather than stabilize or decrease any time soon. Apart from providing appropriations for necessary programs in the health and education spheres, Congress plays a valuable role by conducting hearings to obtain information and guidance on steps that can be taken to respond effectively to various social challenges. An example is that the Senate Health, Education, Labor, and Pensions (HELP) Committee on June 18, 2019 held a hearing on the Lower Health Care Costs Act of 2019 (S. 1895) to examine matters involving a benchmark payment rate for providers. At issue is a concern by representatives from the hospital industry that arbitrary, government-dictated reimbursement could result in significant unintended consequences for patients and create a disincentive for insurers to maintain adequate provider networks.

Except for major figures in Congress, such as House Speaker Nancy Pelosi (D-CA), and Senate Majority Leader Mitch McConnell (R-KY), the 535 elected members of the two chambers may be the equivalent of a giant blur to anyone who does not work for a living as a lobbyist. A fascinating group with a wide range of personal experience and ideological beliefs, legislators are confronted with the challenge of doing their best to represent the constituents who sent them to the nation’s capital as well as act effectively on behalf of the interests of the nation as a whole. An unintended consequence of this duality is that meeting the needs of the voters back home may not always correspond exactly with how the nation itself would benefit.

Members of Congress come from all walks of life, including as health professionals. A head count indicates that four Senators are from the following professions (surgery, optometry, gastroenterology, and ophthalmology). In the House, 26 Representatives are from several professions, including a rehabilitation therapist from Pennsylvania, 13 physicians, and five dentists.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 14th of many profiles and the fifth in 2019 is presented as follows:

Name and Title: Gwendolyn Mahon, Dean and Professor

Place of birth: Tullamore, Ireland

University: Rutgers, The State University of New Jersey

How long have you been in your position? 4 years

What’s the value of a university education? Opens up your mind to other worlds.

What is the value of ASAHP? ASAHP provides the opportunity to network with educators, administrators and clinicians from other schools across the country.

Your philosophy on education in seven words: A lifelong endeavor for growth and improvement

If I could teach in another field, which one and why? Architectural Engineering, I love the idea of developing ways to build structures that fulfill real world needs.

Before I retire I want to: Walk the entire Camino de Santiago.

In college, I was known for: Studying and working hard.

What music is playing in my car/office?  Spanish guitar, Folk, Alternative Rock

The last book I read for fun was: Born to Run, Christopher McDougall

My favorite trip was: We go to Acadia National Park in Maine every summer and it is always my favorite trip.

If I could travel anywhere it would be: A 6 month driving trip across America in an RV hitting every national park.

Four people I’d take to coffee or have a glass of wine with: Leo Varadkar (current Taoiseach of Ireland), Barack Obama, Jane Goodall, My Mom

The best advice I ever received was: If you have nothing good to say about someone then best to say nothing at all.

My hobby is: Gardening, walking, cooking

My passion is: My family

My pet peeve is: People saying they are bored.

A perfect day is: A foggy day on the coast of Maine with family

Cats or dogs? Like both but allergic to cats.

E-book or hardback? Hardback

Beach or mountains? Mountains

I wish I could: Spend more time outdoors.

Only my friends know I: Love to decorate my home.

My favorite saying is: If you are not going to do your best then do not do it at all.

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

TENTATIVE VS. DEFINING CRITERIA

The June 2019 issue of the journal Astrobiology features an essay on extraterrestrial life that may have some applicability for health matters here on earth. It does so by presenting a contrast between tentative versus defining criteria, by indicating that the function of tentative criteria is not, like that of defining criteria, to provide an estimate (via a decision procedure) of the likelihood that an extraterrestrial phenomenon is the product of life. Instead, it is to identify phenomena that resist classification as living or nonliving as worthy of further investigation for novel life.

The physicist and philosopher of science Thomas Kuhn argued that a recognition that a puzzling empirical phenomenon is anomalous is a driving force behind scientific revolutions. An anomaly is a violation of a paradigm-induced expectation about a domain of natural phenomena. He characterized scientific paradigms broadly as including laws, theories, and other widely accepted scientific beliefs, as well as sanctioned methods and instruments, concerning a domain of phenomena. Paradigms play vital roles in scientific practice, facilitating the construction of hypotheses, design of experiments, and interpretations of results, but they also may hinder the exploration of nature, discouraging certain lines of research and biasing the interpretation of data. Essentially, a paradigm literally may blind researchers to the presence of anomalies. They either are not perceived as puzzling or alternatively, are interpreted as puzzles that eventually will be solved using the resources (concepts, laws, methods, etc.) provided by the paradigm.

Many key initiatives continue to be undertaken in the health sphere with the intention of improving individual and community health status. The Patient Protection and Affordable Care Act of 2010 was the most ambitious and comprehensive effort in that regard in several decades. Some of its provisions represented the best forms of conventional wisdom, but other portions of the law’s components lacked evidence and may have entailed nothing more substantial than a leap of faith that they would produce desired outcomes. A notable example may be the Hospital Readmissions Reduction Program (HRRP), which was designed to reduce costs and prevent deaths by imposing financial penalties on hospitals if their rate of readmissions within 30 days exceeds an arbitrary threshold.

Based on assessments that have appeared recently in prominent journals (e.g., June 13, 2019 issue of New England Journal of Medicine), the HRRP has assumed the coloration of a debatable proposition rather than a proven fact. Key considerations, such as that a HRRP defines only inpatient hospitalizations, not observation stays or emergency department (ED) visits, as readmissions, and social factors involving poverty cloud the picture quite significantly. The Affordable Care Act was a good faith effort to increase access, lower costs, and improve quality. An implicit assumption involving some aspects of the law was that defining criteria rather than tentative criteria existed, which has the potential to blind advocates of some interventions to the actual worth of what is being proposed. Moving forward in health care, rather than define all proposed actions as valid programs, it would be advisable to consider some of them as experiments awaiting proof of effectiveness.

More Articles from TRENDS June 2019

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More

SPENDING LEGISLATION TAKES SHAPE

Describes a bill passed in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Prescriptions Filled By Americans in 2018

• Dental Care Among Adults Aged 65 Years And Older

• 3-D Print Flexible Mesh For Knee And Ankle Braces

• Using Pig Brains To Understand Human Brain Function Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Financial Burden Of Paid Home Care On Older Adults

• Faith-Health Collaboration To Improve Community And Population Health

• Family Care-Giving Roles In Medical Product Development

• 2018 National Health Interview Survey Selected Estimates Read More

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

According to an article published on May 13, 2019 in the journal npj Digital Medicine, despite the growth in the number and capabilities of digital health solutions, the confidence of patients, clinicians, payers, and representatives from industry and the regulatory sphere in medicine remains quite low. A need exists for objective, transparent, and standards-based evaluation of digital health products that can bring greater clarity to the digital health marketplace. Investment in the digital health sector is enormous, with nearly $6 billion in funding in 2017, compared to $4.4 billion in the previous year. For mobile health applications alone, there exist more than 3,000,000 of them, with another 200 added daily.

Currently, no reliable mechanism exists to identify validated digital health solutions. Payers also cannot easily identify quality in this crowded field. Regulatory guidance and oversight are limited, with enforcement restricted to companies that make claims out of proportion to the evidence or where application failures might lead to risks to patient safety. For example, a recent evaluation of 280 diabetes mobile applications found only five associated with clinically meaningful improvement and none were of high methodological quality. A more standardized, objective, rigorous, and transparent process for validation is warranted. Specifically, the validation domains would be: technical validation (e.g., how accurately does the solution measure what it claims?), clinical validation (e.g., does the solution have any support for improving condition-specific outcomes?), and system validation (e.g., does the solution integrate into patients’ lives, provider workflows, and healthcare systems?).

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Although progress has been made in research to measure the effectiveness of clinical interventions, similar lapses found in a study from the early 20th century can be observed in studies conducted today. Read More

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

Randomized clinical trials (RCTs) are considered to be the preferred criterion standard in research for assessing the effectiveness of clinical interventions. Yet, a level that lofty has not always prevailed in experimental work. At the turn of the 20th century, a physician from Haverhill, Massachusetts by the name of Duncan MacDougall conducted an experiment that involved weighing six terminally ill patients immediately before and after being pronounced dead. Upon recording a reduction in a single patient’s weight of 21 grams, he believed the loss represented that individual’s departed soul, while excluding data from the other patients. His findings were reported in both a 1907 issue of the Journal of the American Society for Psychical Research and the periodical American Medicine. A reference to the study also was mentioned in the New York Times.

Progress has been made since then as evidenced by the fact that a lot more rigor characterizes clinical investigations conducted today. Nonetheless, as noted in an article that appeared in the May 2019 issue of the journal JAMA Network Open, scientific lapses committed by MacDougall, such as excluding potentially eligible patients, using unreliable measures, and selectively reporting results that are favorable to the investigator’s hypothesis remain distressingly common. A possible explanation is that confirmation bias may lead to accepting data that support a researcher’s preconceptions and to rejecting data that do not.

Another manuscript in the same issue of that journal entails a systematic review of the level and prevalence of spin in published cardiovascular randomized clinical trial reports with statistically nonsignificant primary outcomes. Spin in this instance is defined as the use of specific reporting strategies, from whatever motive, to highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome (i.e., inappropriate use of causal language), or to distract the reader from statistically nonsignificant results (i.e., to focus on a statistically significant secondary result). The authors of the review found that RCTs with statistically nonsignificant primary outcomes were published in high-impact cardiovascular journals and that considerable manipulation of language occurred in both the abstracts and full texts of the reports. Their observations have significant implications for the integrity of clinical science, the translation of clinical evidence at the bedside, peer review, and the rate of medical progress. Indeed, manipulation of language to distort findings also may contribute to further public distrust in science.

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

Examples are provided of how terminological inexactitudes and differences in language can influence understanding and quality of patient care. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Ken Johnson from Weber State University is featured in this issue of TRENDS. Read More

BIPARTISAN HEALTH LEGISLATION

Describes a bipartisan bill in Congress to reauthorize workforce programs under Title VII of the Public Health Service Act and action in the House of Representatives to fund the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). Read More

HEALTH REFORM DEVELOPMENTS

Discusses health challenges in rural areas, Medicare for All legislation, and predictive analytics to address social determinants of health. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Describes an attempt to correct a mistake in the Tax Cuts and Jobs Act of 2017; re-introduction of the Student Loan Borrower Bill of Rights Act of 2019; a Trump administration proposal to reduce the Pell Grant surplus; and laws passed by states involving student loan companies. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

• Pregnancy-Related Deaths, United States, 2011-2015 

• Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

• Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

• Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

• Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

• Effects Of Early Care And Education On Children’s Health

• Addressing Social Determinants Of Health Through Housing Improvements Read More

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Refers to how confidence remains low in the production of validated digital health solutions and how more standardized and transparent kinds of validation are needed. Read More