About 8 million children currently receive health insurance through CHIP, created in 1997 to bring coverage to children whose families earn too much to qualify for Medicaid but not enough to buy private insurance. States administer the program and receive federal matching funds to cover costs. In 2009, Congress reauthorized funding for CHIP through 2015.
What will happen to CHIP beyond 2015 is uncertain, not just because of the funding deadline but also because of changes brought on by the 2010 Affordable Care Act (ACA). Many believe that the ACA’s Medicaid enrollment incentives and expanded tax credits will add so many lower-income kids to the insurance rolls that CHIP will become unnecessary and simply go away. Others, however, say that the plans sold through the ACA’s insurance exchanges could produce gaps in coverage for children, making it crucial to keep CHIP funded.
A growing number of health care professionals are looking at their patients not just as individuals with unique concerns but also as members of larger groups with common problems and needs. This broader, population-based framework could lead to better health outcomes for more people, according to Jonathan Finkelstein, MD, MPH of Boston Children’s Hospital.
“The health care system is changing from one that’s more reactive to illness—you come see the doctor when you’re not well—to one that’s more responsible for the promotion of health for defined groups of people,” he explains. While individual patients will always be treated as, well, individuals, the concept of population health can help providers “figure out the most appropriate services within a set of limited resources for specific groups.”
With appendicitis readmissions rates at some hospitals as high as 30 percent for children with severe disease, a group of children’s hospitals has started handing out comparative performance report cards to grade the way they diagnose and treat the condition. The quarterly reports are tools for hospitals to examine their performance across the entire scope of appendicitis care, prioritize quality improvement efforts and establish best practices.
According to Shawn Rangel, MD, a surgeon at Boston Children’s Hospital, the report cards grew out an effort to “understand high rates of preventable readmissions for complicated appendicitis.” A few years ago, Rangel and his colleagues began comparing appendicitis readmission rates at hospitals in the Children’s Hospital Association. The researchers found that the rate of kids readmitted within 30 days ranged from a low of 5 percent to a high of 30 percent for children with severe (ruptured) appendicitis.
It’s been a few months since the Affordable Care Act (ACA) health exchanges opened for business, and there’s still a lot of speculation on how the bill will affect children, hospitals and insurers.
One thing that’s clear is that ACA is having some success in bringing more people into the system. In his recent State of the Union address, President Obama reported that since the federal and state health insurance exchanges opened for business on Oct. 1, 2013, 3 million citizens have enrolled in private plans and 6.3 million have been deemed eligible for Medicaid. Moreover, some health care experts believe that the Obama Administration may meet its goal of adding 7 million Americans to private insurance rolls by the March 31 enrollment deadline.
Who’s signing up for insurance through the exchanges? According to an analysis by PricewaterhouseCoopers (PwC), individual exchange members have a median age of 33 and a median income of $21,716, or 186 percent of the Federal Poverty Level. Some 91 percent are expected to be in relatively good health.
Apologizing for a mistake is always a good idea. With a sincere “I’m sorry,” you acknowledge that harm’s been done, take responsibility for your actions and start to move forward. But for medical professionals, apologizing—something avoided in the past—can have an added benefit: it can discourage malpractice lawsuits.
According to Konstantinos Papadakis, MD, a surgeon at Boston Children’s Hospital, there has been a large movement across the country to pass “apology laws,” which encourage clinicians to “apologize to patients and families if there’s been a medical mistake and to have a conversation in which they disclose the details.” Under these statutes, he says, medical professionals are granted legal protections when having these conversations.
Scaffolds made of silk could give doctors a simple, more effective material for performing bladder augmentation in people with urinary tract defects—to relieve incontinence and prevent kidney damage in children born with small bladders, for example. Rather than using cells to augment the bladder, a complicated process, silk could provide an “off the shelf” option, says Carlos Estrada, MD, a urologist at Boston Children’s Hospital.
Recent research by Estrada and Joshua Mauney, PhD, shows that scaffolds made of fibroin (the protein that makes up raw silk) have worked well in augmenting bladders in animal models—without the need for cells.
Estrada and Mauney built on the work of Anthony Atala, MD, who became head of the Institute for Regenerative Medicine at Wake Forest after undertaking pioneer work in tissue engineering in Boston Children’s Urology Department.
The Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.
According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals.
For Eric Fleegler, MD, MPH, good legislation is good medicine. Just as the right diagnosis and treatment can make the difference in a child’s health, laws and regulations that address public health issues can reduce the incidence of injuries or disease. Fleegler, an emergency medicine physician at Boston Children’s Hospital, believes that doctors, nurses and other medical professionals can—and should—get involved in public policy debates.
“They are not only looked at as experts, they are also respected as people who represent the rights of children,” Fleegler says.
Health policy experts
For years, Fleegler has represented the rights of children by offering expert testimony to legislators and committees, and by advocating for laws and regulations that address issues like gun violence, food insecurity and asthma in inner-city school children.
“We can lose sight of the value we have in the legislative world,” he says. “In my experience, legislators ask questions of physicians because they want to interact with a doctor and understand what’s really happening. We can bring insight.”
Because unplanned hospital readmissions put patients at risk, burden families and add to the cost of health care, many medical professionals are taking steps to reduce them. To push the effort, new Centers for Medicare & Medicaid Services (CMS) rules impose escalating penalties that decrease a hospital’s Medicare payments if patients are readmitted within 30 days of discharge.
One step, highlighted here last week, is making post-discharge communications much simpler with texts and emails. But how can hospitals make sure their patients are ready to go home? A new study published in the International Journal for Quality in Health Care finds that in pediatric settings, the answers may be found in parents’ perceptions, which turn out to be good predictors of an unplanned readmission.
Signed into law by President Obama in 2010 and upheld as constitutional by the Supreme Court in 2012, the Affordable Care Act (ACA) is withstanding yet another assault. Efforts to repeal or at least delay implementation of the complex, multi-part ACA are entangled with the current government shutdown. However, because many parts of the ACA rely on mandatory spending, the act is moving forward as planned. In fact, the health insurance exchanges called for under the bill opened last week.
John McDonough, DPH, MPA, of the Harvard School of Public Health, briefing clinicians at Boston Children’s Hospital just before the shutdown, maintained that Americans are “just three months away from a fundamental turning point in U.S. health care policy.” Efforts to derail the ACA, he said, are the “death throes” of the anti-Obamacare movement.