A number of articles and resources offer practical advice and
critical information for hospital executives and health care
advocates. Here are Jim Lott’s recommendations for titles with
thought-provoking ideas and simple, but elegant solutions to
improving access, quality and efficiency in health care.
This will be my last post, as I am leaving HASC at the end of
next month. Health is fine, work is great, just moving on
to the next chapter of my life, which will be in health care…what
else would I do?
I have enjoyed writing this blog, and I thank all of you who have
told me that you like reading what I write. I will truly
miss doing this.
Again, I’m still at HASC until May 31, so drop me a line or
call. After I leave, you may reach me on my cell at
213-324-3262 or by email at JLottSr@me.com.
Should California hospitals support a Basic Health Plan (BHP), as provided for by the ACA, to start up in 2015, and/or the creation of a “BHP-like” Bridge Plan to be operated by the state Exchange (Covered California) for low income populations to start up sooner, perhaps in 2014?
Below are my newest recommendations for your reading consideration. I hope you find them to be as thought-provoking and instructive as I did, and, as always, drop me a line to let me know what you think.
Insure the Uninsured Project
(ITUP) is a non-partisan
organization created in 1996 tow rok with state policy makers,
counties health plans, employers, unions, community groups,
providers, and other public and private entities to increase
coverage of California’s 6.6 million uninsured.
The National Institutes of Health (NIH), a part of the U.S.
Department of Health and Human Services, is the nation’s medical
research agency—making important medical discoveries that improve
health and save lives.
National Health Foundation (NHF) has been addressing health care
issues of the underserved for more then 35 years. Throughout its
history, the organization’s mission and direction have evolved in
order to best serve the community, health care providers and
policy makers. Today, NHF is anticipating emerging health care
issues and developing new projects more than before. Over the
next three years, NHF will expand the reach of its projects
across California and throughout the nation, while remaining
grounded in its current mission, vision, and strategic
initiatives.
An independent,
not-for-profit organization, The Joint Commission accredits and
certifies more than 18,000 health care organizations and programs
in the United States. Joint Commission accreditation and
certification is recognized nationwide as a symbol of quality
that reflects an organization’s commitment to meeting certain
performance standards.
The Centers for Medicare & Medicaid Services (CMS) is a branch of
the U.S. Department of Health and Human Services. CMS is the
federal agency that administers the Medicare program and monitors
the Medicaid programs offered by each state.
The Department of Health Care Services’ (DHCS) mission is to
protect and promote the health status of Californians through the
financing and delivery of individual health care services. The
DHCS finances and administers a number of individual health care
service delivery programs, including the California Medical
Assistance Program (Medi-Cal).
CHCF is a nonprofit grantmaking philanthropy based in
Oakland, California. Founded in 1996, the staff of about 50
people issues around $40 million in grants each year from an
endowment of approximately $700 million. CHCF does not
participate in lobbying or fundraising.
The Agency for Healthcare Research and Quality’s (AHRQ) mission
is to improve the quality, safety, efficiency, and effectiveness
of health care for all Americans. As 1 of 12 agencies within the
Department of Health and Human Services, AHRQ supports research
that helps people make more informed decisions and improves the
quality of health care services. AHRQ was formerly known as the
Agency for Health Care Policy and Research.
California Healthline is a free, daily digest of health
care news, policy and opinion. It is designed to meet the
information needs of busy health care professionals and decision
makers. California Healthline is part of the California
HealthCare Foundation’s commitment to important issues affecting
health care policy, delivery, and financing.
Patients who present in the emergency department (ED) with mental
health issues often encounter long delays before being evaluated
and admitted, transferred, or discharged. Arranging appropriate
evaluation for these patients often disproportionately affects
the operation of the ED, particularly in terms of space and
staffing.
Some hospitals are using telemedicine to help evaluate ED
patients. This report examines seven ED telepsychiatry programs
in terms of their operational structure, financial support, and
the challenges they have encountered. It also looks at the
potential value that telepsychiatry could bring to the efficient
operation of the ED and improved patient care.
The major provisions of the federal health care reform law – the
Affordable Care Act (ACA) – including the expansion of coverage
to the uninsured, start in 2014. In the meantime, the feds have
provided states with the ways and means to get an early start on
providing coverage for some uninsured people using the Medicaid
1115 Waiver process. California applied and received approval to
expand coverage to uninsured legal residents under 65 with
incomes between 0-200 percent of the federally defined poverty
level (FPL). With the help of federal matching funds, this
coverage would be provided by counties until 2014 when the 0-133
percent of FPL population converts to Medi-Cal and the 134-200
percent of FPL population converts to subsidized health coverage
purchased through the state Exchange.
This report describes the major provisions of this Waiver with a
focus on Southern California counties.
With hospital emergency departments already taxed enough, the
following isn’t reassuring. A new study concludes that the
proportion of outpatient ED charges paid by both government and
private insurers decreased consistently from 1996 through 2004,
undercutting their ability to subsidize care for the uninsured.
We were asked to measure the impact of the closure of King-Harbor
Hospital on the distribution of uninsured patients admitted to
other public and private hospitals. Accordingly, to help
answer this question we engaged the National Health Foundation
(NHF) to analyze hospital discharge data reported by hospitals to
the Office of Statewide Health Planning and Development (OSHPD)
and available to the public.
California’s emergency rooms are becoming increasingly crowded
with mentally ill and often disruptive patients, partly the
result of inadequate mental health care and sometimes
injudiciously written “5150 holds.” Acute care facilities lacking
psychiatric beds sometimes have to hold these patients for days,
at significant expense. Medi-Cal reimbursement for psychiatric
patients is inadequate; compensation for uninsured patients is
all but non-existent.
Since the 1980s California hospitals have been facing the
increasingly difficult challenge of finding appropriate shelter
settings for increasing numbers of homeless patients who are
discharged from acute-care settings. Hospitals have worked and
will continue to work diligently in their communities to solve
this vexing problem.
Our capacity analysis supports the approach in the department’s
(L.A. County DHS) contingency plan for the closure of King-Harbor
Hospital with two critical caveats: (a) We cannot –and we would
argue that no one can– accurately predict or reasonably estimate
where walk-in patients presenting with both urgent and emergency
medical care needs will go; and (b) Unlike county hospitals,
private sector hospitals are prohibited by law from employing
physicians.
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