Category Archives: Affordable Care Act (ACA)

Aug 21 2014
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RWJF Scholars in the News: Costs for blood tests, dentists testing for hypertension and HIV, fudging medical history, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

A new study uncovers vast variation in pricing for common blood tests by California hospitals, reports the Washington Post. Renee Hsia, MD, MSc, an RWJF Physician Faculty Scholars program alumna, says she was “very surprised” to see such variation among more than 160 hospitals studied. Hsia’s research found that during 2011, some hospitals charged as little as $10 and others as much as $10,169 for a basic cholesterol test. The study found no clear explanation for the price differences for what Hsia categorized as ten “simple and standard” tests in which blood samples are inserted into a machine that performs the analysis. Time magazine, the Boston Globe and Kaiser Health News also cover Hsia’s research.

Dentists could offer a variety of medical tests in the future, including diagnostic tests for health problems such as diabetes, hypertension and HIV, Harold Pollack, PhD, tells Ozy.com. The mouth, Pollack says, “is the gateway to the human body.” He is an RWJF Investigator Award in Health Policy Research recipient.  

“There’s an overabundance of evidence that shows hospitals that have better staffing have better outcomes when we look at things like mortality,” Matthew McHugh, PhD, JD, MPH, FAAN, tells the Santa Fe New Mexican. In an article about nurse staffing ratios, McHugh, an RWJF Nurse Faculty Scholars program alumnus, says hospital readmissions, failure to rescue patients in distress, and patient satisfaction also correlate with increased staffing. “If you compare any two hospitals—one that’s good at staffing and one that has not as good staffing, but are similar in other factors—the hospital with better staffing is much less likely to be penalized” for bad patient outcomes by Medicare and Medicaid, McHugh notes. 

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Aug 7 2014
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RWJF Scholars in the News: The ACA and mental health treatment, HIV training for nurses, the rise of superbugs, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

An Affordable Care Act (ACA) provision that allows parents to keep adult children on their health insurance plans under they reach age 26 has resulted in millions more young people with mental-health and substance-abuse problems getting treatment, according to a study led by Brendan Saloner, PhD. Time reports that over two years, young adults ages 18 to 25 who had screened positive for mental health or substance abuse disorders increased their use of mental-health treatment by 5.3 percent compared to a similar group who were not eligible for their parents’ coverage. Vox and HealthDay were among the outlets to report on the study. Saloner is an RWJF Health & Society Scholar.

Infection Control Today quotes Jason Farley, PhD, MPH, CRNP, on the growing need to train nurses to provide HIV care. An RWJF Nurse Faculty Scholar, Farley developed new HIV curriculum for the John Hopkins School of Nursing, where he is an associate professor. “For many years these specialty training programs in HIV have been available for physicians,” he says. “This is the first time we’re offering them to non-physician providers. It’s quite an important development. When you look at data comparing patient outcomes with physician care and with nurse practitioner care in HIV, whether in the United States or in sub-Saharan Africa, those outcomes are the same.”

Magda Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna, explores the stressors that lead to high numbers of returning National Guard soldiers abusing alcohol, reports Science Codex. Cerda is the lead investigator of the study, which examined 1,095 Ohio National Guard soldiers who served primarily in Iraq or Afghanistan in 2008 and 2009, and found that having just one civilian stressor such as job loss, or legal or financial problems, raised the odds of alcohol use disorders. Medical Daily and Medical Xpress also cover Cerda’s work.

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Aug 5 2014
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Staffing Mattered: Affordable Care Act Enrollment Got a Big Boost from Assister Programs

Healthy enrollment figures from state and federal marketplaces—topping 8 million sign-ups—during the Affordable Care Act’s (ACA) first open enrollment period got a significant helping hand from 28,000 full-time staff and volunteers in 4,400 assister programs, according to a Kaiser Family Foundation survey.

The survey, which is the first nationwide assessment of these programs and their impact, found that navigators and assisters provided in-person help to an estimated 10.6 million people.  Programs in states running their own marketplaces helped people at twice the rate of programs in states that relied on the federal marketplace.

Around one in eight assister programs reported that consumer demand exceeded capacity, and that share grew to one in four during a surge in March as open enrollment neared its deadline. Among the most difficult challenges programs faced were helping consumers with online technical problems, helping consumers understand plan choices, and helping consumers who had a limited understanding of the ACA.

The survey was designed to capture issues that came up with consumers, assisters’ experiences with the enrollment process, and suggestions for improvements during open enrollment next year.

Read the Kaiser Family Foundation’s Survey of Health Insurance Marketplace Assister Programs.

Jul 24 2014
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RWJF Scholars in the News: Stereotype threat, hand hygiene, misbehaving science, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Anxiety caused by “stereotype threat” could help explain health disparities that persist across race, suggests research co-authored by Cleopatra Abdou, PhD, an RWJF Health & Society Scholars program alumna. News Medical covers the study, describing it as the first of its kind to empirically test, in the context of health sciences, the impact of the “threat of being judged by or confirming a negative stereotype about a group you belong to.” Abdou’s research offers a possible explanation for ethnic and socioeconomic differences in morbidity and mortality between Black and White women because, as Abdou says, the research goes beyond nature vs. nurture, “bringing situation and identity into the equation.” For example, in the study, Black women with a strong connection to their race had the highest anxiety levels when in waiting rooms filled with posters that displayed negative health-related racial stereotypes dealing with such topics as unplanned pregnancy and AIDS.

Having health insurance improves access to medical care for pregnant, low-income women, and results in long-term health benefits for their babies, according to a study by RWJF Scholar in Health Policy Research Sarah Miller, PhD, and RWJF Health & Society Scholar Laura Wherry, PhD, that was reported by Vox. Miller and Wherry found the expansion of Medicaid in the 1980s made prenatal care much more accessible to low-income women, many of whom would otherwise have been without insurance. The result was improvements in obesity, preventable hospitalizations, and preventable, chronic disease-related hospitalizations among children. 

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Jul 21 2014
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Federal Government Sets Aside Funds to Boost Access to Primary Care

The federal government announced on July 7 it had awarded more than $83 million to expand access to care by training hundreds of new primary care providers.

The money will be used to support primary care residency programs in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry at 60 health centers across the country. The expanded residency programs will help train more than 550 residents in coming academic year—about 200 more than were trained in the previous academic year, according to the U.S. Department of Health and Human Services (HHS). The funds will also be used to boost the number of states with teaching health centers from 21 to 24.

“This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Mary K. Wakefield, PhD, RN, head of the Health Resources and Services Administration, a division of HHS. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”

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Jul 10 2014
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Quotable Quotes About Nursing, July 2014

This is part of the July 2014 issue of Sharing Nursing’s Knowledge.

“We can’t just sit back and wait for things to get created, to be made for a bigger market, to be made just for a patient like that, so we have to make and create what we need ...”
--Roxana Reyna, BSN, RNC-NIC, WCC, skin and wound care prevention specialist, Driscoll Children’s Hospital, MacGyver Nurse and Maker Nurse Program, KRISTV (Corpus Christi, TX), June 30, 2014

“Nurses make up the single largest segment of the health care workforce and spend more time delivering patient care than any other health care profession. Nursing’s unique ability to meet patient needs at the bedside and beyond puts us in a critical position to transform health care.”
--Michelle Taylor-Smith, RN, BSN, MSN, chief nursing officer, Greenville Health System, GHS to Require B.S. Degrees for Nurses, Greenville Online, June 28, 2014

“This country won’t succeed in its implementation of health care reform without more of these types of [nurse-led] clinics in underserved communities.”
--Tine Hansen-Turton, MGA, JD, FAAN, CEO, National Nursing Centers Consortium, At Paul’s Place, Partnership with Nursing School Promotes Good Health, Baltimore Sun, June 22, 2014

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Jul 10 2014
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RWJF Scholars in the News: Healthcare.gov, depression and mortality, stress among nurses, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Young adult users of Healthcare.gov, the health insurance marketplace established under the Affordable Care Act, recommend that the site offer better explanations of terminology, more clarity about the benefits various plans offer, and checkboxes and other features that make it easier to compare plans. Those are among the findings of a study conducted by RWJF Clinical Scholar Charlene Wong, MD, along with alumni David Asch, MD, MBA, and Raina Merchant, MD, that looked at the experiences of young adults who used the website. The scholars write about their findings in the Philadelphia Inquirer. Wong told the Leonard Davis Institute of Health Economics blog that these users “may not know what insurance terms mean but they have a lot of expertise and insights about maximizing the usability of the digital platforms that have always been such an integral part of their lives.”

Major depression (also known as “clinical depression”) is associated with an elevated risk of death from cardiovascular disease, according to research covered by Kansas City InfoZine. The study, co-authored by Patrick Krueger, PhD, an RWJF Health & Society Scholars program alumnus, also found that the relationship between depression and early non-suicide mortality is independent of such factors as smoking, exercise, body mass, education, income, and employment status. The authors say the findings indicate that the relationship between depression and mortality is not due solely to the interplay between depression and health-compromising risk factors.

Expanding scope of practice for advanced practice nurses and implementing better management practices could alleviate some stress factors for nurses and improve patient care, Matthew McHugh, PhD, JD, MPH, FAAN, tells Healthline News. For example, in some medical facilities, nurses are empowered to decide if a patient’s urinary catheter should be removed without consulting a doctor, thus preventing delays in care. “Lots of things that don’t require policy change” can have an important impact on patient outcomes and nurses’ job satisfaction, said McHugh, an RWJF Nurse Faculty Scholars alumnus.

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Jul 1 2014
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Federal Government Sets Aside Funds for Community Health Centers

The nation’s community health centers are poised for expansion thanks to the availability of new funds authorized under the Affordable Care Act.

In June, the U.S. Department of Health and Human Services announced the availability of up to $300 million to expand community health center services throughout the nation. The funds are intended to help centers expand service hours, hire more medical providers, and add services in areas including oral and behavioral health, pharmacy, and vision.

Community health centers “deliver comprehensive, high-quality preventive and primary care to patients regardless of their ability to pay,” according to the Health Resources and Services Administration (HRSA). Currently, nearly 1,300 such centers provide care to more than 21 million patients across the country.

"These funds will allow health centers to expand health services to better serve newly insured patients,” said HRSA Administrator Mary Wakefield, RN, PhD, FAAN.

Existing grantees of HRSA’s health center program are eligible to apply for funding. Applications demonstrating how funds will be used to expand services are due by July 1.

Learn more about the application process here.

Jun 11 2014
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Emergency Rooms Getting Busier, New Poll Finds

Expanded health care coverage under the Affordable Care Act (ACA) has led to a rise in emergency room (ER) visits this year, according to a survey by the American College of Emergency Physicians (ACEP). Nearly half of the 1,845 ACEP members who responded to an online poll conducted in April report higher ER patient loads since January 1. Additionally, 86 percent anticipate more increases over the next three years, and 77 percent say their ERs are not adequately prepared for significant increases.

“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” ACEP President Alex Rosenau, DO, FACEP, said in a news release. “But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low. When people can't get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care.”

U.S. Department of Health and Human Services spokesperson Erin Shields Britt told the Wall Street Journal that broad conclusions can’t be drawn from the study: “This survey, looking at only the first three months of coverage, cannot speak to the long-term effects of expanded coverage, which will be shaped by our continuing efforts to help people use their new primary care and preventive care benefits and to invest in innovative approaches aimed at improving our nation’s system of primary care.”

Read ACEP’s survey results

May 10 2014
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One Nurse’s Leadership Journey

Cynthia Crone, MNSc, APRN, CPNP, is deputy commissioner of the Arkansas Insurance Department, where she created and now leads the state’s Partnership Health Insurance Marketplace. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program

Cynthia Crone

Being asked to write a post about nurse leadership for National Nurses Week presents a wonderful opportunity to reflect on my nursing journey and express appreciation for the many nurses and other leaders who have played a supportive role in my development. A career in public health with an emphasis on vulnerable populations, including most recently directing efforts in Arkansas to implement the Health Insurance Marketplace, has reinforced with me the critical role nurse leaders play in the politics and policy of health care and how very important it is to foster and support community involvement and interdisciplinary collaboration by younger nurses. 

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I started nursing school in the mid-1970s. Nurse practitioners were just coming on the scene. After graduation I obtained certification as a pediatric nurse practitioner and traveled to 10 rural counties to hold “well child clinics.” I learned a lot from the public health nurses. I loved my job. The work helped me better understand the bio-psycho-social-spiritual art and science of nursing and the social determinants of health. Further, through interaction with nurse and other community leaders, I learned that another element—political–can’t be ignored.

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