On a Scale of Pass to Fail, Many Medical Schools Fail Students on Health Policy

The U.S. Capitol is a site of health policy discussion and legislative action.

We are in a time when physicians are increasingly speaking the language of health policy and public health — “value-based care,” “co-payment,” “social determinants of health,” “accountable care organization” — and are increasingly asked by patients to ensure that a particular treatment or procedure is covered by their insurance before moving forward. This dizzying list of health policy terms (and the responsibility of a physician to understand the lingo) just keeps growing. And there is no better time to introduce students to this world than in medical school, when they are primed for learning and not yet overwhelmed with patient care.

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Reductions in Medicare Hospital Readmissions: Real or Illusory?

Source: Lehigh Valley Hospital-Muhlenberg

Hospital readmissions pose serious risks to patients, especially to Medicare patients who are older and typically sicker than other patients. Hospital stays increase the risk of infection and medication error, put patients through physical and psychological stress (i.e. being woken up multiple times a night, falls on the way to the bathroom), and increase Medicare expenditures. Under the Hospital Readmission Reduction Program (HRRP) created by the Affordable Care Act, hospitals are penalized by Medicare if beneficiaries are readmitted (to any hospital) within 30 days of discharge. The goals of the HRRP are to:

  1. Improve care transitions
  2. Reduce the burden of readmission for Medicare beneficiaries
  3. Reduce the cost of readmissions to the taxpayer
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Thank U, Next: The 116th Congress Gets to Work

Image Source: Getty Images

The 116th Congress was sworn in at noon on Wednesday, January 3, 2019. The Senate remains under Republican control but the House of Representatives is now firmly in the grasp of the Democratic Party. How the business of legislating flows between the two houses remains to be seen, but it is fair to assume that health policy will be a focus for the new Congress. A Kaiser Family Foundation poll taken before the 2018 midterm election reported that seven in ten voters (71%) indicated healthcare as “very important” in making their voting decision. In comparison, 64% said the same about the economy and jobs, 55% about immigration, and 53% about tax cuts and tax reform.

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The Slow Rise of Telehealth

One of the reasons I wake up early each day is to have (hopefully) around 30 minutes to catch up on the news or some health policy research. Today I hit the snooze button a few too many times, but still managed to sneak in a glance through the December issue of Health Affairs. This month is all about telehealth — the practice of medicine utilizing a range to technologies to connect health professionals to each other and their patients.

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The ACA & Medicare

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Medicare provides health insurance to nearly 57 million individuals (17% of the U.S. population) in three categories: those who are over the age of 65; those under 65 who receive social security disability insurance; and those under 65 with end-stage renal disease (ESRD). As described by the Commonwealth Fund’s Medicare at 50 Years series, Medicare beneficiaries are “the nation’s oldest, sickest, and most disabled citizens.” In 2013, 30% of Medicare beneficiaries were either over 85 or disabled and under 65. Seventy-five percent of beneficiaries have one or more chronic condition and 25% rate their health status as fair or poor.

Before the Medicare program, 48% of adults over the age of 65 did not have health insurance; that figure has fallen to 2%. The intentions of the Medicare program were and are two-fold: (1) ensure that beneficiaries have access to health care; and (2) protect beneficiaries from health care-related financial hardship. By the numbers, Medicare has been an immense success. Only 13% of older Americans now pay out of pocket for their health care costs (versus 56% in 1966). Medicare has also increased life expectancy at 65 by five years.

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Legal Timeline of the ACA

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On March 23, 2010, the ACA was enacted into law and quickly plunged into seemingly never-ending, ever-evolving litigation. If you’ve found our site, you’re most likely not a lawyer, which makes it a bit more challenging to understand how we’ve gotten to this point in health law as it regards the ACA. 

Two key points that every individual should know: (1) the requirement that every state expand Medicaid was deemed unconstitutional however, the U.S. Supreme Court (SCOTUS) ruled that states could opt-in to the expansion [34 states including D.C. have expanded Medicaid]; and (2) the individual mandate is constitutional and still the law of the land [the Tax Cuts and Jobs Act repeals the financial penalty for not having insurance, but does not repeal the language of the mandate].

Below are some of the big milestones in the ACA’s legal history.

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The Triple Aim

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The singular best assertion of the connections between health policy, clinical medicine, and public health comes from none other than Dr. Donald Berwick. As the former Administrator of the Centers for Medicare and Medicaid Services (CMS), former Vice Chair of the U.S. Preventive Services Task Force (USPSTF), a pediatrician by training, and dozens of other accolades, there is hardly anyone better versed in the interwoven web of medicine and policy. His expertise, coupled with experts in health care quality improvement and patient safety, resulted in The Triple Aim, a set of interconnected goals aimed at improving U.S. health care through political, rather than technological or biomedical, avenues.

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