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Summary of Major Health Care Reform Proposals & Other ACA Repeal/Replace Resources

The Kaiser Family Foundation has published a summary outline of HHS Secretary nominee Tom Price’s health plan.  It’s planning comprehensive summaries of other major health reform proposals soon for comparison, with an overview of House Speaker Paul Ryan’s plan scheduled next. The summaries will be updated as changes occur in proposal.

The Foundation has also created a web site compiling other background resources related to the proposed repeal and replacement of the Affordable Care Act: http://kff.org/tag/aca-repeal/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org 


Medicaid and CHIP Data: Findings from a 50-State Survey

The Kaiser Family Foundation has just released its 15th annual 50-state survey on Medicaid and the Children’s Health Insurance Program [CHIP].

The report provides and discusses state data on eligibility, enrollment, renewal and cost-sharing policies and identifies changes over the past year. It also documents the key health coverage role the Medicaid and CHIP programs play for low-income families.

As health coverage policy direction gets debated, this report will provide helpful background information.

Source: Brooks T and others. Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies as of January 2017; findings from a 50-state survey. Kaiser Family Foundation, Jan. 2017. http://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-as-of-Jan-2017


Rosenbaum S and others. Medicaid’s future: what might ACA repeal mean? Commonwealth Fund Issue Brief, Jan. 2017. http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal

State health facts: Medicaid and CHIP. Kaiser Family Foundation, accessed Jan. 12, 2017 at http://kff.org/state-category/medicaid-chip/

Blumberg LJ and others. Implications of partial repeal of the ACA through reconciliation. Urban Institute, Dec. 2016. http://www.urban.org/sites/default/files/publication/86236/2001013-the-implications-of-partial-repeal-of-the-aca-through-reconciliation_0.pdf

Cunningham P and others. Understanding Medicaid hospital payments and the impact of recent policy changes. Kaiser Commission on Medicaid and the Uninsured Issue Brief, June 2016. http://files.kff.org/attachment/issue-brief-understanding-medicaid-hospital-payments-and-the-impact-of-recent-policy-changes

Guy J and others. Repeal of the ACA Medicaid expansion: critical questions for states. State Health Reform Assistance Network, Robert Wood Johnson Foundation Issue Brief, Dec. 2016. http://statenetwork.org/wp-content/uploads/2016/12/State-Network-Manatt-Repeal-of-the-ACA-Medicaid-Expansion-Critical-Questions-for-States-December-2016.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

EMERGENCY DEPARTMENT: Hybrid pediatric inpatient/ED model for lower volume hospitals

Hospitals that do not have enough volume to support 24/7 availability of a pediatric emergency department might consider a hybrid or combination pediatric inpatient/ED unit.  Howard County General Hospital (Columbia, Md.), credited with being the pioneer of this concept nearly 20 years ago, has 6 inpatient beds and 12 emergency beds.  The annual utilization is 18,000 pediatric ED patients.  The recommended minimum volume to make this type of program successful is 10,000 to 12,000 pediatric ED visits per year.

Other hospitals that have established, or are in the process of setting up, a similar unit include Anne Arundel Medical Center (Annapolis, Md.) and Nash General Hospital (Rocky Mount, N.C.).

Why I like this article: It is based on interviews with practitioners and contains pragmatic details about their programs.  Also provided is contact information for each of the interviewees.


Combined pediatric ED/inpatient unit concept catches on with Maryland community hospitals. (2017, January). ED Management, 29(1), 6-11.  Click here https://www.ahcmedia.com/articles/139700-combined-pediatric-edinpatient-unit-concept-catches-on-with-maryland-community-hospitals

See also these hospital websites:

From the Howard County General Hospital website: http://www.hopkinsmedicine.org/howard_county_general_hospital/services/pediatrics/the_childrens_care_center.html

From the Anne Arundel Medical Center website: http://www.aahs.org/peds/er.php

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

COMPENSATION: Nurse leader salary survey with 2015 data

Data from the second compensation survey conducted by the American Organization of Nurse Executives (AONE) – based on 2015 data – are summarized in this article.  The data are reported as the percentage that fall within ranges for different positions.  For example, the most frequently reported range for chief nursing officers in nonsystem hospitals is $250,000 or more (17 percent reported this).  CNOs in system hospitals were much more likely to be in this top salary band – 52 percent reported earning $250,000+.  Not surprisingly, nurse executives working for health systems in the corporate office, those in academic medical centers, and those in consulting firms were more likely to draw higher compensation.

Source: Kittner, A., and Thrall, T.H. (2016, October). AONE 2016 salary survey: Wide ranging compensation, strong satisfaction. Nurse Leader, 14(5), 311-316.  Click here for full text: http://www.nurseleader.com/article/S1541-4612(16)30112-4/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BURNOUT: How managers can prevent it

Yes, another article on burnout, but I like the inclusion (in the magazine version of this article) of pithy bullet-point advice on how a manager can prevent burnout on his or her team.  Example: “Advocate for the resources your team needs to perform.”  Or, “Share what you’re learning and how you’re doing it.”  This is a quick read by a management coach.

Source: Valcour, M. (2016, Nov.). Managing yourself: Beating burnout. Harvard Business Review, 94(11), 98-101.  Click here: https://hbr.org/2016/11/beating-burnout  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Community health workers help reduce

A readmission reduction program established by the University of Maryland St. Joseph Medical Center (Towson, Md.) in partnership with Maxim Healthcare is described in this brief article.  Prior to establishment of this home-based service, the hospital had 30-day readmission rates of 25 percent for high risk patients – which dropped to 10 percent about a year or so later.  It is staffed by nurse practitioners, RNs, and community health workers – who are considered key to the success of the program.

Planning Statistics: Program Experience (based on first 17 months)

  • 1600 assessments of high risk patients
  • 1200 of those patients agreed to participate in the program
  • 5 percent of hospital’s total discharges opt into the program
  • 15 community health workers were employed to care for the 1200 patients

Source: Whitman, E. (2016, Oct. 24). Deploying community health workers to reduce readmission rates. Modern Healthcare, 46(43), 32.  Click here for article published in slightly different version: http://www.modernhealthcare.com/article/20161022/magazine/310229996   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY DEPARTMENT: Front door to hospital brings in 65 percent of admissions through the ED (US 2014 data)

These data are from the Emergency Department Benchmarking Alliance (EDBA) which in 2014 included responses from over 1,100 emergency departments in the United States.

The EDBA data survey over the last five years finds that between 65 and 68 percent of hospital inpatients are processed through the ED.  This reflects the role of the ED as the ‘front door’ of the hospital.

Percent of Patients Processed Through the ED

  • 58 percent (2004)
  • 61 percent (2005)
  • 61 percent (2006)
  • 62 percent (2007)
  • 64 percent (2008)
  • 65 percent (2009)
  • 66 percent (2010)
  • 67 percent (2011)
  • 68 percent (2012)
  • 68 percent (2013)
  • 65 percent (2014)

Source: Augustine, J.J. (2016, Apr. 13). National surveys on emergency department trends bring future improvements into focus. ACEP Now.  Click here:  http://www.acepnow.com/article/national-surveys-emergency-department-trends-bring-future-improvements-focus/?singlepage=1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org