Physicians In Medicare ACOs Offer Mixed Views Of Model For Health Care Cost And Quality.

Physicians' willingness to change how care is delivered is a key component of the ability of accountable care organizations (ACOs) to transform patient care. Yet physicians participating in Medicare ACOs are only moderately convinced that ACOs are an effective model for delivering cost-effective care.

The home health workforce: a distinction between worker categories.

The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes.

Understanding and enhancing the value of hospital discharge data.

This work summarizes how hospital discharge data are used, identifies strengths and shortcomings, and presents suggestions for enhancing usefulness of the data. Results demonstrate that discharge data are used in a wide range of applications by diverse users. Uses include public health and population-based applications, as well as quality assessment, informed purchasing, strategic planning, and policy making.

Primary care experiences of people with psychiatric disabilities: barriers to care and potential solutions.

This study examined the barriers that 16 focus group participants with psychiatric disabilities confront in obtaining primary care services and their recommendations on improving quality of care. They cited a) difficulty identifying a primary care physician with good empathic and communication skills, b) physicians' misunderstanding of the nature of psychiatric disability, c) inadequate information about the side effects of psychotropic medications, and d) costs due to inadequate insurance coverage. In addition to suggestions for improving patient-physician communication and expanding physician knowledge, participants emphasized strategies to become empowered in their relationships with physicians and to obtain personal support.

A rural perspective regarding regulations implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

A Joint Publication of The Walsh Center for Rural Health Analysis, National Opinion Research Center, University of Chicago, W Series, No. 6 and the RUPRI Center for Rural Health Policy Analysis, University of Nebraska Medical Center, P2004-6.

Promoting accountability: hospital charity care in California, Washington state, and Texas.

Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state.

Achieving equity in Medicare disproportionate share payments to rural hospitals: an assessment of the financial impact of recent and proposed changes to the disproportionate share hospital payment formula.

Historically, the Medicare Disproportionate Share Hospital (DSH) payment program has been less favorable to rural hospitals: eligibility thresholds were higher and the payment adjustment was smaller for rural than for urban hospitals. Although the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act (BIPA) of 2000 established a uniform low-income threshold and increased the magnitude of the adjustment for certain small and rural hospitals as a means to promote payment equity, the DSH distribution formula continues to vary by location. This study examines how the DSH revisions mandated under BIPA are likely to affect rural hospitals' financial performance and simulates the financial impact of implementing a uniform DSH payment adjustment.

Hospital charity care policies and the California health care safety net.

Estimates of charity care expenditures provide a quantitative measure of hospitals' commitment to expanding access to the medically uninsured in their communities but fail to provide information about the subset of uninsured who benefit or the gaps in public insurance programs' coverage that are filled by these charity care programs. This brief provides an overview of a study, conducted for the California HealthCare Foundation, that gathered information on California hospitals' charity care policies. The objective of the study was to identify the eligibility criteria hospitals use for free care and to understand the gaps in Medi-Cal, California's version of Medicaid, and county indigent program coverage that these providers are capable of filling.