Posts Tagged ‘Robert Wood Johnson Foundation’

Healthcare Jobs Still the Fastest-Growing Sector

Tuesday, February 7th, 2012

Job growth in the healthcare profession seems to be virtually recession-proof. In Florida, a state with a sizeable percentage of senior citizens, there are about 960,000 healthcare and social assistance jobs, approximately 13 percent of all nonfarm payroll positions in the state.

Some experts are not as optimistic about job growth in the healthcare sector.  “Reform may accelerate the trend toward healthcare’s being the dominant employment sector in the economy,” according to a recent New England Journal of Medicine (now known as NEJM) article.  A significant amount of the growth in healthcare that result from reform might be in support positions, rather than physicians and nurses, several economists said.  “As for jobs for health professionals, I doubt that this will or can increase the number of doctors or nurses.  While there will be greater demand for their services, there will also be offsetting effects as medically unnecessarily procedures are paid less,” said Amitabh Chandra, an economist and public-policy professor at Harvard University.

As the insured population grows under the federal Patient Protection and Affordable Care Act (ACA), healthcare workers will be in high demand.  These gains come on the heels of growth already required to serve an aging population.  In Florida, the aging population’s impact on healthcare employment is more dramatic than in the rest of the country: about 17 percent of the state’s population is older than 65, compared with a 13 percent average in the other states., according to the Census Bureau.

Other experts are far more sanguine about healthcare’s ability to create jobs.  “The big places we waste money is patients who are discharged and there’s not a lot of follow up and they end up in the hospital a month later,” said Leemore Dafny, an economist at Northwestern University whose expertise is competition in healthcare markets.  According to Dafny, reform will create new primary-care physicians and physician “extenders,” such as nurse practitioners; at the same time, it could decelerate growth in spending on medical specialists.  “If the ACA is repealed, it will be business as usual — except that more of the population is now uninsured — so the demand for primary-care professionals will increase much more slowly,” said Dafny.

In fact, according to the Bureau of Labor Statistics (BLS), the healthcare sector for some time has provided about the only bright spot in an otherwise drab report on job growth.  Healthcare employment created 205,100 new jobs in the first eight months of 2011.  Approximately 14.1 million people are employed in the healthcare sector with more than 4.7 million jobs at hospitals; more than 6.1 million jobs in ambulatory services; and more than 2.3 million jobs in physicians’ offices, according to BLS statistics.

According to Risa Lavizzo-Mourey, M.D., CEO of the Robert Wood Johnson Foundation, and Mark Pinsky, president and CEO of the Opportunity Finance Network, “The current economic recovery effort presents an opportunity to build stronger, healthier communities.  That’s a central goal, for example, of the Create Jobs for USA Fund that the OFN and Starbucks launched late last year to support job creation and retention.  Economic growth and job creation provide more than income and the ability to afford health insurance and medical care.  They also enable us to live in safer homes and neighborhoods, buy healthier food, have more leisure time for physical activity, and experience less health-harming stress.  The research clearly shows that health starts in our homes and communities and not in the doctor’s office.  In that way, economic policy is, in fact, health policy.  The end goal?  Create and sustain job growth across the country.  Improve communities.  Improve health.  Give people the opportunities to make smart, healthy decisions so that they can act in the best interests of their communities, themselves, and future generations.”

Healthcare added 17,200 jobs in November of 2011, an increase over the 11,600 jobs reported in October, according to BLS data.  Healthcare accounted for 14.3 percent of 120,000 new jobs created across all sectors in November.  On the whole, healthcare represented 24 percent of the 1.2 million non-farm jobs created this year and is expected to create 321,000 new jobs by year’s end.  That represents a 22 percent increase over the 263,400 healthcare jobs created in 2011.

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Mixed Verdict on Level of RN Staffing and Better Patient Outcomes

Wednesday, April 20th, 2011

Elevated levels of nurse staffing can lead to better patient outcomes, though not necessarily in safety net hospitals – which provide healthcare to low-income, vulnerable and uninsured persons — according to a report published by the American Public Health Association. According to a study funded by the Robert Woods Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, researchers examined discharge records for 1.1 million patients in 872 units — including 285 intensive-care units — at 54 University HealthSystem Consortium hospitals and found relationships between patient outcomes and the length of time that nursing care patients received.

Although staffing levels were similar, outcomes were enhanced in non-safety net facilities, where more registered nurses were associated with lower mortality rates from congestive heart failure, infections and bedsores, as well as shorter stays. There were also fewer “failure to rescue” deaths, where nurses did not note or initiate treatment in life-threatening situations.   “Higher levels of nursing skill and more nurses providing more hours of care, overall, are correlated with better care — shorter hospital stays, fewer infections and lower rates of failure to rescue,” said Mary Blegen, RN, PhD, FAAN, professor in Community Health Systems and director of the Center for Patient Safety at the University of California San Francisco School of Nursing.  “We suspect that the increase in mortality rates due to congestive heart failure in safety-net hospitals are a function of patients’ overall health, rather than staffing rates, but more research needs to be done.  We also need to know more about how non-RNs affect patient care.”

There’s another side to this issue, however.  A study published in the New England Journal of Medicine found that a lack of adequate nurses has a direct correlation to higher patient morality rates.  A study of nearly 200,000 nursing shifts determined that staffing of “RNs below target levels” is linked to increase patient deaths.  Some of the under-staffing is a result of efforts to control costs.  In one finding, when inadequate numbers of nurses were on duty, inappropriate and dangers levels of patient transfers and discharges occurred.  Shortages also lead to higher turnover rates.  According to the study, the risk of death increased two percent for patients cared for by shifts staffed by too few RNs.  The typical patient was exposed to three nursing shifts, which created a six percent increased risk of death.  Elevated levels of shift turnovers resulted in four percent more deaths.  The American Nursing Association believes that policymakers must focus on reimbursement systems that reward hospitals for maintaining adequate nurse staffing.

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New Study Ranks Healthiness in the Nation’s 3,016 Counties

Tuesday, April 19th, 2011

A study led by the Robert Wood Johnson Foundation has ranked the level of healthiness in the more than 3,000 counties that comprise the United States. Conducted with the assistance of the University of Wisconsin’s Population Health Institute, the study entitled “County Health Rankings: Mobilizing Action Toward Community Health,” provides a snapshot of where America’s healthiest people live.

“This is a complicated story about what makes a community healthy and another not so healthy,” said report author Pat Remington, the associate dean for public health at the University of Wisconsin.  For example, researchers point to cities reputed for their top-quality medical centers – most notably Baltimore and Philadelphia — that ranked close to the bottom in their respective states.  “Social, economic and health habits may be at play there,” said James Marks, senior vice president and director of the foundation’s health group.

The researchers examined federal and state health-related data on 3,016 counties, according to Remington.  The information was analyzed by researchers who had created similar reports for the state of Wisconsin over the past six years.  Remington said   his group wanted to “bring it down to the ground level” by learning where strengths and weaknesses lie within individual counties.

Each county is examined in two ways:  “Health Outcomes” and “Health Factors.”  “Health Outcomes” look at a county’s disease and death rates.  The “Health Factors” rating is more complicated and examines such factors as obesity rates, smoking and alcohol use.  Socio-economic factors, such as unemployment, income and safety, also are considered in addition to access to healthcare and the local environmental.  “The ‘Health Outcomes’ rank is about current healthiness factors.  The ‘Health Factors’ rank is about where they are going — predictors of health,” Marks said.

Some of the results are eye-opening. The healthiest of Illinois’s 102 counties is Kendall, which is located next to LaSalle County, which ranked 65th.  LaSalle County, whose smoking rate is twice the national average, is home to twice as many people who can be considered to be in fair to poor health.  The divide between suburban and rural also comes into play here.  Kendall County is close enough to Chicago be almost be considered part of the metropolitan area, while LaSalle County is rural and home to many farms.  According to Dr. Remington, “Affluent suburbs tend to have higher-paying jobs, often in the cities, whereas rural communities often are dealing with loss of business.”  Rural populations also are in decline as younger and healthier people move away from places like LaSalle County to the cities where employment opportunities are more varied.  To improve the health of its citizens, LaSalle County health department officials are giving nicotine patches to smokers and educating school officials about obesity and diabetes.

“It’s hard to lead a healthy life if you don’t live in a healthy community,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.  “The County Health Rankings are an annual check-up for communities to know how healthy they are and where they can improve.  We hope that policymakers, businesses, educators, public health departments and community residents will use the Rankings to develop solutions to help people live healthier lives.”

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Study: U.S. Needs a Comprehensive National Health Strategy

Monday, February 7th, 2011

The United States needs to formulate a consistent national strategy to address life expectancy and overall health, according to recent report from the Institute of Medicine (IOM).  “Although the United States invests over 17 percent of its gross domestic product on medical care – far more than any nation – we lag behind other countries in several measures of health,” said Marthe Goldman, chairwoman of the committee that wrote the report.  “Our understanding of more effective and efficient strategies for improving health is hampered by inadequacies in the current system.”

The IOM report, which was sponsored by the Robert Wood Johnson Foundation,  notes that the Department of Health and Human Services (HHS) should take the lead to coordinate and provide pertinent health information and statistics to Americans.  Additionally, HHS should assist in efforts to integrate population health data collection, analysis and reporting, as well as offer guidance on how to develop health indicators and analyze the effects of these over time.  Finally, the nation should adopt a single-summary measure of the population’s health to serve as the GDP equivalent for the health sector.

Typically, the United States and other nations have used death rates as the standard measure of population health.  “However, life expectancy is a blunt tool.  It cannot capture the diminution in life experience and capacities that is associated with the chronic illnesses and injuries that are of increasing prevalence in modern society,” according to the report.

The International Health Partnership, which is dedicated to improving health services and health outcomes, issued a white paper in July, 2009, assessing national health strategies and plans.  According to the paper, “The way a joint assessment is done will be unique to each country, but based on some key principles:  it will be country demand driven; be country led and build on existing processes; be as light as possible without being superficial; include an independent element; and engage civil society and other relevant stakeholders.”

Australia has taken the lead in setting a comprehensive national healthcare strategy.  With the goal of being the world’s healthiest country by 2020, the strategy set in April, 2008, by the National Preventative Health Task Force for the Minister for Health and Ageing focuses on eating healthier foods; reducing obesity; smoking cessation; and addressing the health and social issues associated with heavy drinking.

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Lower-Income Families Often Defer Healthcare Because of Cost

Tuesday, December 7th, 2010

Lower-income families covered by health plans with high deductibles are more likely to defer care than their counterparts who earn more money and have similar coverage.  A survey of 141 families whose income levels were less than 300 percent of the U.S. poverty rate and 273 families with high incomes found that 51 percent of the poorer families deferred healthcare because of the cost, compared with 35 percent of the better off families.  The study, which was led by Jeffrey Kullgren, a clinical scholar at the Robert Wood Johnson Foundation, which is affiliated with the Philadelphia VA Medical Center and the University of Pennsylvania, was published in a recent edition of the Archives of Internal Medicine.  A 22-item questionnaire collected data about health plan characteristics, attitudes towards use, cost and sought information about behavior and demographics.

“One way in which a growing number of families are facing higher levels of cost-shariing for healthcare is enrollment in high-deductible health plans.   These plans, which feature annual deductibles of at least $1,000 per individual and at least $2,000 per family before more services are covered, seek to encourage patients to become more cost-effective consumers of healthcare and frequently offer lower premiums than other types of health insurance.”

Those surveyed were asked how they might respond to three hypothetical scenarios involving services that their plans did not cover – a $100 blood test; a $1,000 colonoscopy; or a $2,000 MRI.  The majority of participants – no matter their income level – would talk with their physician about deferring or making other plans in all three scenarios.  Rather surprisingly, though, the lower-income families were more likely to discuss the $100 blood test of $1,000 colonoscopy than were the higher-income families.

“These findings suggest that physicians have a central role to play in helping their patients navigate the challenges of decision making in high-deductible health plans,” according to the authors.  “Beyond the implications for clinicians, our findings have important implications for federal health reform.  Reform legislation that establishes an individual health insurance mandate could lead more families to enroll in plans with high levels of cost-sharing, as has been seen following the implementation of coverage mandates in Massachusetts.  If more families do enroll in high-deductible health plans, policymakers should consider strategies to support patients facing high levels of cost sharing.”

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Medicaid Expansion Could Insure 20 Million Americans

Thursday, May 27th, 2010

Medicaid expansion could provide healthcare coverage to 20 million lower-income Americans. As healthcare reform is ushered in over the next few years, Medicaid will play a leading role in bringing coverage to as many as 20 million Americans who don’t have the resources to buy insurance on their own.  “Medicaid is finally living up to its role of serving as the healthcare safety net for poor and lower-income individuals and families,” said Jennifer Tolbert, principal policy analyst with the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

Healthy adults under the age of 65 will qualify for Medicaid starting in 2014 if they earn $14,404 in current dollars for a single person or $29,326 for a family of four.  That adds up to 133 percent of the federal poverty level.  Most asset requirements will be abolished, so people who lose their jobs can get health coverage even if they own a home or have money saved for retirement.  Bringing as many as 20 million people into the Medicaid system is a herculean task, even though four years have been set aside to make the changes necessary to make enrollment easier.  Many Americans don’t even know that they will be eligible, and it is the states’ responsibility to inform them.

“We’re pretty busy, I can tell you that,” said Ann Kohler, director of health services with the American Public Human Services Association, which administers the National Association of State Medicaid Directors.  “Many of my members opposed the bill and still do, frankly.  But it is the law, and we’re working hard to get it implemented.”  The most frequently cited obstacles include the fact that many doctors refuse to accept Medicaid payments because it doesn’t reimburse as much as private plans or Medicare.  Additionally, filing claims involves significant paperwork and lengthy payment delays.

The federal government is sweetening the pot for physicians by increasing Medicaid payments for primary care to Medicare levels in 2013 and 2014.  That may not be enough, though.  Physicians prefer to avoid Medicaid patients because they tend to be sicker than insured patients, miss appointments and do not cooperate with treatment plans.

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Standardized Medical Billing Could Save $7 Billion a Year

Wednesday, May 19th, 2010

Physicians could save $7 billion a year if insurers standardized medical billing procedures. If healthcare insurance companies created a standardized billing system, it could cut physician office administrative costs by $7 billion a year, according to a study published in Health Affairs. Standardizing medical billing would assure transparency, as well as create a single claim submission deadline and payment posting rules.

That estimate is based on a 2006 analysis of the labor and overhead costs required to process health insurance benefits and claims at one large academic physician group practice.  According to the study, the physician group could hypothetically save $44 million if it processed all benefits and claims using Medicare payment rules.  Paperwork and follow-up with insurers totaled $33.1 million, while office labor and overhead ate up an additional $5.6 million that could be saved with standardized billing procedures.

According to the study’s authors, “The U.S. system of billing third parties for healthcare services is complex, expensive, and inefficient.  Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity.  A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations.  On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services.  Four hours of professional time per physician and five hours of practice support staff time could be saved each week.”

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“Barely Hanging On”

Tuesday, May 11th, 2010

Study finds that middle-class Americans are losing their healthcare coverage. Middle-class Americans are losing their healthcare insurance at a faster rate than other income earners. This finding was reported in “Barely Hanging On”, prepared by the University of Minnesota’s State Health Access Data Assistance Center.  The report was commissioned by the Robert Wood Johnson Foundation as part of its yearly Cover the Uninsured Week and analyzed data from the U.S. Census Bureau and the Department of Health and Human Services.

According to the study, three million fewer middle-income Americans had healthcare insurance provided by their employers in 2008 when compared with 2000.  Two-thirds of families earning between $45,000 and $85,000 a year were insured by their employers in 2008, a seven percent drop from 2000.

The study also found that costs had risen 81 percent between 2000 and 2008.  During the same timeframe, household incomes fell 2.5 percent.  Additionally, fewer workers were offered or could afford employer-provided coverage.

“America’s uninsured crisis means that hard-working people with average incomes are being squeezed,” said Risa Lavizzo-Mourey, the Robert Wood Johnson Foundation’s president and CEO.  “The fallout from rising health insurance costs hits everyone.”

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America Losing War on Obesity

Tuesday, July 14th, 2009

A new report — “F” as in Fat:  How Obesity Policies are Failing in America 2009 – gives America a failing grade on its efforts to control obesity among children and adults.

The report, released by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, found that obeseobesity rates rose in 23 states during 2008, with no states showing decreases.  The number of overweight children is at or above 30 percent in 30 states.

Mississippi came in dead last for the fifth year in a row, with an adult obesity rate of 32.5 percent.  Three states were close runners up:  West Virginia reported a 31.2 percent obesity rate; Alabama had 31.1 percent; and Tennessee had 30.2 percent.  On the opposite side, the states reporting the lowest obesity rates were Colorado with 18.9 percent; Massachusetts with 21.2 percent; Connecticut with 21.3 percent; Rhode Island with 21.7 percent and Hawaii with 21.9 percent.

“Our healthcare costs have grown along with our waistlines,” according to Jeff Levi, PhD, TFAH’s executive director.  “The obesity epidemic is a big contributor to the skyrocketing healthcare costs in the United States.  How are we going to compete with the rest of the world if our economy and workforce are weighed down by bad health?”

Fully two thirds of American adults are now overweight or obese.  Adult obesity rates are higher than 25 percent in 31 states, and above 20 percent in 49 states and Washington, D.C.  Compare this with 1991, when no state reported an obesity rate higher than 20 percent.

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