Lunsky Y, Klein-Geltink JE, Yates EA, editors. December 2013
Ontario’s Action Plan for Health Care focuses on becoming healthier, with improved access to integrated family/primary care and a major emphasis on the provision of the right care at the right time and in the right place. These priorities are particularly relevant to individuals with developmental disabilities: research from other jurisdictions would suggest that they have higher rates of preventable diseases, greater challenges obtaining guideline-recommended primary care3 and higher associated health care costs.4 However, the health status and
health care of adults with developmental disabilities have not been well studied in Ontario, due to the absence of population-based data. The work of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program is in direct response to Ontario’s call to action through addressing this data gap. The first H-CARDD project, conducted in partnership with decision makers and clinicians from the health and social services sectors, has focused on primary care.
The Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario provides, for the first time in Canada, descriptive information on the health of adults with developmental disabilities in Ontario and examines the quality of their primary care relative to adults without developmental disabilities. Findings have relevance in Ontario and in other jurisdictions where there is interest in improving health care and the health status of those with developmental disabilities.
Revised ACA Repeal and Replace Bill Likely to Increase the Uninsured Rate and Health Insurance Costs for Many
House Republicans are close to agreeing on an amended version of the American Health Care Act, their proposed repeal and replacement of the Affordable Care Act. David Blumenthal, M.D., and Sara Collins say that, based on the summaries circulated by the media, the revised bill will significantly increase the numbers of uninsured Americans while raising insurance costs for many of the nation’s most vulnerable citizens. At the same time, the bill’s restructuring of the Medicaid program is likely to hurt state economies and enrollees.
News outlets report that House Republicans are close to agreeing on an amended version of the American Health Care Act (AHCA), their proposed repeal and replacement of the Affordable Care Act (ACA). The all-important legislative language for the revised bill is not yet available, nor are Congressional Budget Office (CBO) projections of its effects on coverage and the budget, so any analyses are necessarily tentative.
Nevertheless, the summaries leaked to the media offer insight on the amended bill. If accurate, those summaries suggest that the revised AHCA will significantly increase the numbers of uninsured Americans, raise the cost of insurance for many of the nation’s most vulnerable citizens, and, as originally proposed in the AHCA, cut and reconfigure the Medicaid program. The new amendment specifically allows states to weaken consumer protections by, for example, permitting insurers to charge people with preexisting conditions higher premiums.
CompareMaine shows the average cost of common healthcare procedures at different facilities in Maine. You can also see patient experience ratings and how Maine hospitals compare on patient safety.
more information. better decisions.
The Maine Health Data Organization, in collaboration with the Maine Quality Forum, is required by law to promote the transparency of healthcare cost and quality information via a publicly accessible website. The cost and quality of healthcare procedures can vary widely among providers. You have a choice in where you receive care. CompareMaine shows the average cost of common healthcare procedures at different facilities in Maine. You can also see patient experience ratings and how Maine hospitals compare on patient safety.
The cost estimates on CompareMaine are median payments. They are meant to serve as a reference point for comparison. In order to find out your actual payment, please contact your insurance company. If you do not have insurance, please contact the facility that you are interested in. When contacted directly, facilities often report their charges which may be higher than the actual payments they receive from insurance companies and patients.
Equal access to mainstream healthcare services for people with intellectual disabilities (ID) still requires attention. Although recent studies suggest that health professionals hold positive attitudes towards people with ID, stigmatising attitudes may influence their efforts to serve people with ID in community healthcare practice. To stimulate inclusion in mainstream healthcare services, this systematic review focussed on barriers in attitudes of mainstream health professionals towards people with ID.
Five electronic databases were systematically searched and references in full text articles were checked for studies published in the English language between January 1994 and January 2016. A social–psychological triad of cognitive, affective and behavioural dimensions of stigmatising attitudes is used to structure and discuss the results.
The literature search generated 2190 records with 30 studies that passed our exclusion criteria. Studies were mostly cross-sectional and of moderate quality. With respect to stigma, a lack of familiarity with and knowledge about people with ID was found. ID was considered as a stable condition not under personal control. Moreover, mainstream health professionals had either low or high expectations of the capabilities of people with ID. Professionals reported stress, lack of confidence, fear and anxiety, a tendency to treat people with ID differently and a lack of supporting autonomy.
Stigmatising attitudes towards people with ID appeared to be present among mainstream health professionals. This might affect the ongoing challenges regarding inclusion in mainstream healthcare services. To facilitate inclusion in mainstream healthcare services, it is recommended to include contact and collaboration with experts-by-experience in education programs of health professionals. Future research should progress beyond descriptive accounts of stigma towards exploring relationships between cognitive, affective and behavioural dimensions as pointers for intervention. Finally, inclusion would benefit from an understanding of ‘equal’ treatment that means reasonable adjustments instead of undifferentiated treatment.
Substantial Physician Turnover and Beneficiary “Churn” in a Large Medicare Pioneer ACO
A study of one of the nation’s largest Medicare accountable care organizations (ACOs) found that participating physicians see a relatively small number of patients who are actually part of the ACO population: less than 5 percent of a typical patient panel consists of ACO patients. The ACO also experiences substantial physician turnover. And when physicians leave the ACO, most of their attributed beneficiaries leave as well.
“Physicians play a central role in the delivery of medical care and, not surprisingly, also are critical players in Medicare payment reform.”
To increase provider accountability for the cost and quality of patient care, health care systems, including the Medicare and Medicaid programs, have begun to move away from fee-for-service and toward ACOs and other alternative payment models that encourage more efficient and effective care delivery. With the ongoing implementation of the Medicare Access and CHIP Reauthorization Act of 2015, the numbers of physicians and provider organizations entering alternative payment models such as ACOs is likely to accelerate rapidly. Evidence to date, however, indicates that ACOs have achieved limited success in attaining their goals. Even though physicians play a decisive role in whether ACOs are able to deliver on their promise, there has been limited research on the physicians who work in ACOs and their experiences with patients. Commonwealth Fund–supported researchers studied a large Medicare Pioneer ACO to learn about the stability of physician participation and beneficiary enrollment.
- The ACO experienced substantial turnover among physicians: only 52 percent were affiliated over the entire three-year contract period.
- Most (88%) physicians had at least some beneficiaries attributed to them, but these patients accounted for just a small part of their panels, which averaged 1,700 patients per panel. Half (50%) of physicians had just 70 or fewer attributed beneficiaries. ACO enrollees accounted for less than 5 percent of the median physician’s patient panel.
- About half (49%) of beneficiaries who joined the ACO in contract year 2 or 3 did so because their physician had joined the ACO. When physicians left the ACO in year 2 or 3, 90 percent of their assigned beneficiaries also left.
The Big Picture
The study’s findings suggest that two factors can dampen an ACO’s potential to hit its financial targets: a relatively low number of enrollees attributed to participating physicians, and the loss of patients when physicians leave the ACO. To the extent that there is patient turnover, the ACO’s incentives also are dampened with respect to investments that require more than a few months to achieve any payoff. The authors conclude that the financial incentives provided by ACOs to provide better, more efficient care may not be sufficient to attract physicians, given the small numbers of ACO beneficiaries they tend to serve. Physicians, they say, might instead repond better to comparable incentives that are linked to having a larger number of patients on their panels. This, however, would require standardizing incentives across payers. Standardization also reduces the potential cacophony associated with having a large number of incentives. Health systems also could reconsider how they link beneficiaries to primary care physicians to concentrate care among a smaller number of physicians, creating a critical mass of patients that might encourage and facilitate practice pattern changes.
The authors also note that having the ability to select participating physicians each year creates a temptation for ACOs to improve their risk profile—and thereby increase their opportunity for shared savings—by dropping the small number of physicians whose patients have the most unfavorable risk mix (e.g., those with very high treatment costs). The Centers for Medicare and Medicaid Services could put policies in place that would reduce the incentive to game the risk pool.
About the Study
The researchers used the following data sources for their analysis: a list of beneficiaries aligned to Partners HealthCare’s ACO; a list of physicians affiliated with the ACO during that period; databases that captured the number of years a physician was affiliated with the ACO, physician specialty, and other factors; and Medicare claims data.
The Bottom Line
A low number of attributed enrollees per physician and substantial physician turnover may help explain the muted impact that accountable care organizations have had thus far.
Improving hospital care of patients with intellectual and developmental disabilities – Disability and Health Journal
People with intellectual disabilities and developmental disabilities (IDD) face poorer care and outcomes when hospitalized than patients without IDD. A panel discussion “Hospital care for individuals with IDD: The Issues and Challenges” was held at the Annual Conference of the American Academy of Developmental Medicine and Dentistry, held in Chicago July 8–10, 2016. Among the panelists were representatives from Rush University Medical Center in Chicago, IL and Saint Barnabas Medical Center in Livingston, NJ who discussed efforts to improve hospital care of patients with IDD at their institutions.
Findings from the National Longitudinal Transition Study 2012. Volume 1: Comparisons with Other Youth (Full Report)
Key Findings: Youth with an IEP are more likely than their peers to be socioeconomically disadvantaged and to face problems with health, communication, and completing typical tasks independently. The vast majority of youth with and without an IEP feel positive about school, but those with an IEP experience bullying and are suspended at higher rates, and are less engaged in school and social activities. Youth with an IEP are more likely than youth without an IEP to struggle academically, yet less likely to
Source: Preparing for Life After High School: The Characteristics and Experiences of Youth in Special Education. Findings from the National Longitudinal Transition Study 2012. Volume 1: Comparisons with Other Youth (Full Report)
Policymakers and educators have long recognized the importance of addressing the needs of youth in special education, who today account for 12 percent of all youth in the United States. Concern that this objective was not being adequately met led Congress to pass landmark legislation in 1975, now known as the Individuals with Disabilities Education Act (IDEA) (U.S. Department of Education, 2010). IDEA mandates that children and youth with disabilities have access to a free appropriate public education.
Got Transition and the American Academy of Pediatrics released a new 2017 Transition Coding and Reimbursement Tipsheet 2017 to support the delivery of recommended transition services in pediatric and adult primary and specialty care settings. The new tip sheet includes a list of updated transition-related CPT codes, including the new code for transition readiness assessment, and current Medicare fees and RVUs for these services. It also includes a new set of seven clinical vignettes with recommended CPT and ICD-10 codes. HERE for the tip sheet.
Developing Culturally Responsive Approaches to Serving Diverse Populations: A Resource Guide for Community-Based Organizations
Michael López, Kerry Hofer, Erin Bumgarner, and Djaniele Taylor
A changing population According to 2013 U.S. Census data: • 48 percent of children under the age of 18 were members of racial/ethnic groups other than nonHispanic white. • Of this group, Hispanics represented the largest racial/ethnic group (24 percent), followed by nonHispanic blacks (14 percent) and non-Hispanic Asians (5 percent). • Hispanics also are a fast-growing racial/ethnic group, almost tripling as a share of the U.S. population between 1980 (9 percent) and 2013 (24 percent). a Across that culturally and linguistically diverse population, however, there is great variability within any given racial/ethnic group. Understanding the variability within and across racial/ethnic subgroups is an important step any organization must take to ensure its services are culturally responsive to the needs of its targeted population.