News Article | February 15, 2017
February 13, 2017 -- A study just released by Columbia University's Mailman School of Public Health reports on the health of American women who were deployed to Vietnam for either military or civilian service. The results show that 48 percent of career military women were very happy compared to 38 percent of women in the general population, and of better than average physical and mental health. The study is the first study to describe the experiences of civilian women deployed to a warzone, compare them to those of military women and match the patterns of general health and happiness for women deployed to Vietnam with a representative sample of their peers. Findings are published online in the journal Social Science & Medicine--Population Health. In addition to positive aspects of service, adverse effects were also noted. Women who served less than 10 years in the military were more likely to report their Vietnam experience as "highly stressful" (28 percent) compared to career military women who served more than 20 years (12 percent) and civilian women (13 percent). They cited such stressors as poor living and working conditions, exposure to the consequences of war, physical threat, negative interpersonal experiences (including rape and sexual harassment), and drug and alcohol problems. About 265,000 women served in the U.S. military during the Vietnam Era, with as many as 11,000 deployed to Vietnam but not formally assigned combat roles. Nonetheless, they were deployed to combat zones where they experienced warzone stressors and hostile fire. "Our results suggest that a military career--which by military rules in force during the Vietnam era, precluded a woman from typical wife and mother roles--afforded women a meaningful experience that continued to positively impact their emotional well-being, even decades after the war," said Jeanne Mager Stellman, PhD, professor emerita of Health Policy and Management and senior author. Career military women who never had children also reported being happier than the average American woman. "Women who volunteered and went to Vietnam in the 1960s may have done so as a way of breaking away from the traditional roles assigned to women in the United States during that time, and they seem to have continued on a different trajectory in post-war years," said Dr. Stellman. Collaborating with the Vietnam Women's Memorial Project, Dr. Stellman and colleagues at the VA National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine also compared civilian women, primarily American Red Cross workers, to military women and studied how warzone experiences, exposure to casualties and sexual harassment, affected their current health. They also compared the deployed women to women of comparable age in the General Social Survey, a widely used representative study of Americans. Both military and civilian women who served in Vietnam, regardless of whether they continued to make the military their career, were less likely to have married or have had children than women from the general population. Deployment to Vietnam for both military and civilian women had other positive aspects. Many women reported satisfaction from their work with the wounded troops and civilians in Vietnam. Those who served as nurses, in particular, commented that they were given much more responsibility in their positions while in Vietnam than they would have had in a similar civilian job in the U. S. An earlier paper by Dr. Stellman and the Boston-VA based group evaluated the psychological well-being of approximately 1,300 female military personnel, Red Cross workers, and others deployed to Vietnam. "Our new study underscores the benefits of a military career for those women who chose it," noted Dr. Stellman. "Entering military service or volunteering for civilian activities in a warzone offered an opportunity for talented women to establish careers, and rise to high ranks and achieve positions that would be impossible in the civilian world. In addition, career military women in general, lived in a supportive community that was knowledgeable and sympathetic to their work. What we learned from this study can help to improve the experiences and well-being of current and future generations of female military personnel," noted Dr. Stellman. Co-authors include Anica Pless Kaiser and Eve H. Davison, Veteran Affairs A National Center for PTSD, Veteran Affairs Boston Healthcare System and Boston University School of Medicine; Avron Spiro III, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System and Boston University Schools of Public Health and Medicine; Daniel H. Kabat, Mailman School of Public Health, now Gold Health Strategies, Inc. The study was supported by the National Academy of Sciences (NAS-VA-5124-98-001), National Institute on Aging (R24-AG039343), and U.S. Department of Veterans Affairs (IK2 RX001832-01A2. Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www. .
News Article | November 23, 2016
Beneficiaries of Medicare who develop cancer and don't have supplemental health insurance incur out-of-pocket expenditures for their treatments averaging one-quarter of their income with some paying as high as 63 percent, according to results of a survey-based study published Nov. 23 in JAMA Oncology. Researchers at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center say their study shows that a cancer diagnosis can be a serious financial hardship for many elderly and disabled who receive Medicare, with annual out-of-pocket costs ranging from $2,116 to $8,115, on top of what they pay to have health insurance. The research shows that hospitalizations are a major driver of out-of-pocket costs. Cancer treatment contributes more to health care costs in the United States than treatment for any other disease, say the researchers. "The spending associated with a new cancer diagnosis gets very high quickly, even if you have insurance," says one of the study's authors, Lauren Hersch Nicholas, PhD, MPP, an assistant professor in the Department of Health Policy and Management at the Bloomberg School. "The health shock can be followed by financial toxicity. In many cases, doctors can bring you back to health, but it can be tremendously expensive and a lot of treatments are given without a discussion of the costs or the financial consequences." For their study, Nicholas and Amol K. Narang, MD, an instructor in the Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine and member of the Kimmel Cancer Center, examined data from more than 18,000 Medicare beneficiaries who were interviewed biennially between 2002 and 2012 for the Health and Retirement Survey. The survey is funded by the National Institute on Aging and includes data from seniors in the U.S. with wide geographic, socioeconomic and ethnic representation. Over the course of the study period, more than 1,409 people received a cancer diagnosis. Medicare covers just 80 percent of outpatient health costs and has co-pays of $1,000 for each hospital visit. In the study, 15 percent of participants had Medicare alone. Others had some type of supplemental insurance: 50 percent had a Medigap plan or were still receiving employer or retiree benefits; 20 percent participated in a Medicare HMO; nine percent received Medicaid (the federal plan for the poorest Americans); and six percent got benefits from the Veteran's Administration (VA). Each type of insurance covers a varying amount of the costs that Medicare doesn't cover. The researchers found that the average annual out-of-pocket costs associated with a new cancer diagnosis were $2,116 for Medicaid beneficiaries; $2,367 for the VA; $5,492 for those with employer-sponsored plans; $5,670 for those with Medigap; $5,976 for those with a Medicare HMO; and $8,115 for those without supplemental insurance of any kind. There are no caps on how much Medicare beneficiaries can be asked to pay. Survey respondents without supplemental insurance reported that their average annual out-of-pocket costs were one-quarter of their annual income and, of those, 10 percent reported that those costs were at least 63 percent of annual income. "Cancer costs are high, and a significant segment of our seniors who don't have adequate insurance coverage can be hit hard by this," Narang says. "In addition to efforts aimed at lowering cancer costs, we need to think about how to offer our seniors better insurance coverage." The researchers say one solution, though expensive, would be to cap the amount of out-of-pocket costs a patient can be charged each year. Many private insurance plans have such caps, known as catastrophic coverage. Congress would need to enact such a reform. Narang and Nicholas found that inpatient hospitalizations accounted for between 12 percent and 46 percent of out-of-pocket cancer spending depending on whether and what type of supplemental insurance a patient had. Inpatient care can be necessary for surgical procedures and to handle severe side effects of treatment. Narang says that doctors can help avoid hospitalizations with more intensive outpatient management of common side effects. He also points to the Kimmel Cancer Center's urgent care clinic which has reduced hospitalization rates in patients undergoing cancer therapy. For example, among those undergoing radiation, the average number of patients who were hospitalized during their course of treatment or within 60 days decreased from 35 per month to 18 per month after the clinic opened. Of note, 10 percent of hospitalizations over this time resulted in patient liabilities of more than $2,000; among Medicare patients without supplemental insurance, 10 percent of their hospitalization-associated patient liabilities exceeded $10,000. The researchers say that the study's limitations include the potential for inaccuracies in survey respondents' answers, misclassification of data or incomplete reporting. For the study, the researchers provided ranges within certain survey questions when respondents could not identify a specific value. Because the study did not identify specific information on the type of hospitalizations among survey respondents, Narang says that more research is needed to understand which of these hospitalizations are truly preventable. "We should expect to spend some of our income on health care," Nicholas says. "But many people are unprepared to spend more than a quarter of their income treating a single disease. The physical disease is terrible and then you have to figure out how to deal with the economic fallout associated with paying to treat it." "Out-of-pocket spending and financial burden among Medicare beneficiaries with cancer" was written by Amol K. Narang and Lauren Hersch Nicholas. The study was supported by a grant from the National Institute on Aging (K01AG041763).
News Article | November 15, 2016
November 15, 2016 - New York, NY - Linda P. Fried, Dean and DeLamar Professor at the Columbia University Mailman School of Public Health, will receive the 2016 Inserm International Prize, a scientific honor presented annually by the French National Institute of Health and Medical Research [Inserm], France's equivalent of the U.S. National Institutes of Health. The Prize will be presented along with five other Inserm awards at a December 8 ceremony held at Collège de France in Paris. "Throughout my career, my interest in the science of healthy aging has been guided by a belief that science and society, working in concert, can optimize our innate capacity for good health," Fried said. "I am grateful to Inserm for this honor and for the light it will shine on this body of scientific breakthroughs. My collaborators and I believe that such science can be the basis for the opportunities of our now-longer lives. Science offers enormous potential to build health for older people around the world and create the foundations to benefit all of us. Worldwide, the number of people aged 65 or older will almost triple by 2050, climbing from about 524 million in 2010 to nearly 1.5 billion. Fried, who has actively collaborated with global leaders to help realize the potential of large older populations, recently led an international summit on aging and health in Shanghai. The most populous nation on earth will be home to as many as 330 million people over age 60 by 2050. In designing the summit, Fried included representation from global academia, government, and private industry, all of which will be called upon to meet the demands of this demographic transformation. . John W. Rowe, Julius B. Richmond Professor of Health Policy and Aging Health Policy and Management at Columbia, suggested Inserm's selection marks a milestone for those within public health who study aging. "The importance of the Inserm Prize relates to its truly international scope and its focus not on a particular discovery but on a scholar's systematic body of work in an important area," he said. "Recognition of Linda Fried's research has special significance as it shows that research on aging, long neglected, has come of age." A highly regarded figure in international public health, Fried has dedicated her career to interventions that equip societies to transition to a world in which greater longevity benefits people of all ages. Her research creating the science of frailty, defining frailty as a clinical syndrome and illuminating its causes, consequences and the potential for preventing it has had great impact. Fried's scientific discoveries have transformed science as well as medical care and public health globally, and catalyzed greater interest in helping older populations thrive. Fried was cited by publisher Thompson Reuters in 2014 as among the top one percent of influential scientific minds of the prior decade. She is also the designer and co-founder of Experience Corps, a program that places senior volunteers in public schools in cities in the United States and around the world. Serving in both tutoring and mentoring roles, Experience Corps' older volunteers help enrich students' academic achievements while bolstering their own health through continued activity and community interaction. In a randomized, controlled trial, Fried successfully demonstrated Experience Corps' success preventing physical disability and cognitive decline among older adults, while raising child literacy. Before coming to Columbia in 2008 Fried founded the Johns Hopkins Center on Aging and Health, directed the Division of Geriatric Medicine and Gerontology, and held joint appointments at Hopkins' schools of medicine, nursing, and public health. Prior winners of the International Prize include Chen Zhu, China's former Minister of Health, Nora Volkow, Director of the National Institutes of Drug Abuse, and Harvey Alter, whose work led to the discovery of hepatitis-C. Last year, the Prize was awarded to Peter Piot, who is currently Director of the London School of Hygiene and Tropical Medicine. The 2008 winner, Tomas Lindahl, former Director of Clare Hall Laboratories at Cancer Research in the United Kingdom, went on to win the Nobel Prize in Chemistry in 2015. Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www. .
News Article | November 5, 2016
Roughly 30,000 sports-related eye injuries serious enough to end in a visit to the emergency room occur each year in the United States, and the majority happen to those under the age of 18, new Johns Hopkins Bloomberg School of Public Health-led research suggests. The researchers, publishing Nov. 3 in JAMA Ophthalmology, also found that basketball and cycling were the two sports most likely to cause eye injuries, while 21 percent of baseball and softball injuries resulted in fractures of the bones around the eye, which often require surgery to repair. “These are one-time injuries that can have lifelong impacts on the ability to gain an education, to earn a livelihood, to read or drive a car,” says the study’s leader, R. Sterling Haring, DO, MPH, a DrPH candidate in the Bloomberg School’s Department of Health Policy and Management. “This needs to be recognized on the policy level and on the personal level as something we should be paying attention to.” For the study, Haring and his colleagues analyzed the Nationwide Emergency Department Survey, which contains discharge data on approximately 30 million annual emergency room visits to more than 900 hospitals nationwide. Over the course of the study, from 2010 to 2013, 120,847 patients arrived at the emergency room with sports-related eye injuries, making up roughly three percent of all eye injuries. Sixty percent of the injured males and 67 percent of females were age 18 or younger. “These numbers represent only the injuries coming to the emergency room,” Haring says. “Once you account for the number of people going to urgent care centers, community eye doctors or primary care physicians, the numbers are probably much higher.” Among males, the researchers found, the riskiest sports for eye injuries were basketball (26 percent), baseball or softball (13 percent) and air guns (13 percent). For females, the riskiest sports were baseball or softball (19 percent), cycling (11 percent) and soccer (10 percent). Lacerations were the most common injuries, followed by contusions. The prominent role of cycling and soccer in these injuries was especially surprising, as these have not traditionally been considered high-risk activities, Haring says. The National Eye Institute lists these as low- and moderate-risk sports, respectively. “Thousands of cycling-related eye injuries occur each year,” Haring says. “Many of these could probably be prevented by something as simple as wearing wrap-around sunglasses.” Other sports, however, require more serious eye protection. While visual impairment was generally rare in the sports injuries analyzed, 26 percent of all cases of visual impairment were due to air and paintball guns, even though they made up less than 10 percent of all injuries. It’s unclear what the longer-term consequences will be for those who were injured. Previous research has shown that appropriate protective eyewear can significantly reduce the incidence of sports-related eye injuries. In sports such as hockey, Haring says, the use of visors to protect the eyes has prevented many serious eye injuries that were once common in the sport. Other research, he says, has shown that when appropriate eyewear is available but not mandatory, top-performing athletes frequently choose to wear it. He says he hopes that future research can identify ways to get more athletes of all ages and skill levels to wear appropriate protective eyewear. “While brain injuries such as concussions are getting a lot of attention these days, everyone from Little League coaches to weekend warriors need to understand that there are real risks to the eye when playing sports,” Haring says. “Now that we recognize what sports may be most hazardous to the eye, we need to look for the best ways to prevent these injuries.”
News Article | December 5, 2016
Patients who choose primary care doctors with low office visit prices can rack up considerable savings on overall health care costs, according to new research from Harvard Medical School. The report, published Dec. 5 in the December issue of the journal Health Affairs, suggests that office visit costs may be a reliable indicator of what a patient will pay for a wide range of services and procedures. The analysis shows that a relatively small difference in office visit price -- $26 -- translated into hundreds of dollars in savings over the course of a year. The study found that when patients received care from primary care doctors with lower-than-average office visit prices, they spent, on average, $690 less per year, compared with patients who saw higher-priced physicians. The savings, the researchers note, were not driven by fewer services or less care. Indeed, there was no significant difference in the kind and amount of services received by the two groups of patients. Rather, patients whose physicians charged lower prices for office visits also paid less for almost every other outpatient service they received. In the past decade, patients have had to pay more for health care, due to higher deductibles. Many states and private insurers now offer price transparency tools in the hope that access to such information could help people make better-informed decisions on how much they will pay per visit or for a given procedure. Would picking a provider based on low-priced office visits translate into overall savings including procedures and other follow-up care? The study suggests so. "Because of the tremendous growth in high-deductible health plans, Americans are being forced to think about prices when they choose where to get care," said study lead author Ateev Mehrotra, associate professor of health care policy at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center. "Our data suggest that looking at the price of your doctor's office visit is a good place to start. Choosing a lower-priced primary care doctor could save someone a lot of money." Using the 2010 Ingenix insurance database, which contains data from 27 national employers, the researchers grouped primary care doctors into high, average and low price tiers based on the cost of an office visit. From there, they examined the spending of those doctors' patients, looking at how many services such as drugs and emergency care visits patients used and how much the services cost. Other investigators on the research included Peter Huckfeldt, assistant professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health; Amelia Haviland, Anna Loomis McCandless Professor of Statistics and Public Policy at the H. John Heinz III College of Public Policy and Management at Carnegie Mellon University; Laura Gascue, programmer and quantitative analyst at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Los Angeles; and Neeraj Sood, professor of public policy at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. The work was funded by the Common Fund of the National Institutes of Health (Grant No. R01 AG043850-01). Harvard Medical School has more than 9,500 full-time faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.
News Article | December 5, 2016
Only 12 percent of older Americans have some form of dental insurance and fewer than half visited a dentist in the previous year, suggests new Johns Hopkins Bloomberg School of Public Health research on Medicare beneficiaries. Insurance status appeared to be the biggest predictor of whether a person received oral health care: For those with incomes just over the federal poverty level, 27 percent of those without dental insurance had a dental visit in the previous year, compared to 65 percent with dental insurance, according to an analysis of 2012 Medicare data. Income also played a role: High-income beneficiaries were almost three times as likely to have received dental care in the previous 12 months as compared to low-income beneficiaries, 74 percent of whom reported receiving no dental care. Many high-income beneficiaries - even those with dental insurance - paid a sizable portion of their bills out of pocket. The findings, published in the December issue of the journal Health Affairs, suggest an enormous unmet need for dental insurance among those 65 and older in the United States, putting older adults at risk for oral health problems that could be prevented or treated with timely dental care, including tooth decay, gum disease and loss of teeth. It also highlights the financial burden associated with dental visits, among both the insured and uninsured. "Medicare is focused specifically on physical health needs and not oral health needs and, as a result, a staggering 49 million Medicare beneficiaries in this country do not have dental insurance," says study author Amber Willink, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School. "With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem." Eighty percent of Americans under the age of 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare. The vast majority of Medicare beneficiaries who have dental insurance are those who are still covered by employer-sponsored insurance, either because they are still working or because they are part of an ever-dwindling group of people with very generous retiree medical and dental benefits. For the new study, the researchers analyzed data provided by 11,299 respondents to the 2012 Cost and Use Files of the Medicare Current Beneficiary Survey. The data included information collected on income, dental insurance status, dental health access and out-of-pocket expenditures. Among the findings: On average, Medicare beneficiaries reported spending $427 on dental care over the previous year, 77 percent of which was out-of-pocket spending. An estimated seven percent reported spending more than $1,500. Dental expenses, on average, accounted for 14 percent of Medicare beneficiaries' out-of-pocket health spending. Poor dental hygiene not only contributes to gum disease, but the same bacteria linked to gum disease has also been linked to pneumonia, a serious illness that increases the risk of hospitalization and death. It can also contribute to difficulty eating, swallowing or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn't have any of his or her original teeth left, according to the Centers for Disease Control and Prevention. The researchers took the research a step further. They analyzed two separate proposals for adding dental benefits to Medicare, estimating how much each would cost. One was similar to the premium-financed, voluntary Medicare Part D benefit that was added to Medicare a decade ago to help cover prescription drugs for seniors. The other was similar to a proposal that has been introduced in Congress that would embed dental care into Medicare as a core benefit for all of the program's 56 million beneficiaries, which is not expected to pass before Congress recesses. The first proposal, which would cost an average premium of $29-a-month and would come with a subsidy for low-income seniors who couldn't afford that, would run an estimated $4.4 to $5.9 billion annually depending on the number of low-income beneficiaries who participate. The second, with a $7 monthly premium and subsidies for low-income people, would cost between $12.8 and $16.2 billion annually. The packages would cover the full cost of one preventive care visit a year and 50 percent of allowable costs for necessary care up to a $1,500 limit per year to cover additional preventive care and treatment of acute gum disease or tooth decay. "It's hard to tell in this current political climate whether this is something that will be addressed by lawmakers, but regardless this is affecting the lives of many older adults," Willink says. She cautions that if the costs become too high for Medicare beneficiaries, they could lose whatever wealth they have and end up on Medicaid, the insurance for the very poor which the government pays for fully. "Older adults are struggling and the current benefits structure of Medicare is not meeting their needs. We need to find the right solution," she says. "Otherwise, it's going to end up being so much more expensive for everyone." "Dental Care and Medicare Beneficiaries: Access Gaps, Cost Burdens and Policy Options" was written by Amber Willink, Cathy Schoen and Karen Davis. The work was supported by the Commonwealth Fund.
News Article | December 21, 2016
Elderly people treated by female doctors in hospital had significantly better survival rates and fewer readmissions than those treated by male doctors (AFP Photo/Pascal Lachenaud) Miami (AFP) - Elderly people who were treated by female doctors in the hospital had significantly better survival rates and fewer readmissions than those treated by male doctors, said a US study Monday. The findings in the Journal of the American Medical Association (JAMA) Internal Medicine were based on a sample of more than one million people whose records were analyzed from 2011 to 2014. Those with female doctors were significantly less likely to die within 30 days of admission, or to be readmitted within 30 days of discharge. If men could achieve the same success as women in this realm, researchers estimated that there would be 32,000 fewer deaths each year among Medicare patients alone, a group that includes people over 65. The number is about the same as the death toll across the United States from car accidents in a given year, the report said. "The difference in mortality rates surprised us," said lead author Yusuke Tsugawa, research associate in the Department of Health Policy and Management at Harvard University's T.H. Chan School of Public Health. "The gender of the physician appears to be particularly significant for the sickest patients." The study was described as the first national assessment of its kind to compare outcomes among patients of female and male doctors. It found that patients treated by a female physician had a four percent lower relative risk of dying prematurely compared to those treated by men. Patients cared for by women doctors had a five percent lower relative risk of being readmitted to a hospital within 30 days. "The association was seen across a wide variety of clinical conditions and variations in severity of illness," said the report. The study did not delve into the reasons for the differences. However, previous research has shown that female doctors tend to follow clinical guidelines more closely than men, and that women provide more patient-centered communication. A better understanding of the different approaches is now more important than ever, said senior author Ashish Jha, professor of health policy and director of the Harvard Global Health Institute. "There was ample evidence that male and female physicians practice medicine differently. Our findings suggest that those differences matter and are important to patient health," said Jha. "We need to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician." Female physicians now account for approximately one third of doctors in the United States, and about half of all US medical school graduates.
News Article | December 1, 2016
Acting under existing legislative authority and without new funding, the new administration can give hospitals greater flexibility over tax-exempt spending while strengthening their role in building healthy communities WASHINGTON, DC (December 1, 2016)-- A new report recommends that the Trump Administration take action to revise existing Internal Revenue Service (IRS) policies governing community benefit spending by tax-exempt hospitals in order to encourage greater hospital involvement in activities that can improve health on a community-wide basis. Research increasingly shows the outsize importance of healthy communities to population health. Affordable and safe housing, safe and welcoming neighborhoods, access to nutritious food, strong child development programs, and quality education together can lead to better health outcomes. Hospitals themselves have recognized the health impact of these broader social, economic and environmental conditions as well as the value of their involvement in activities aimed at improving social conditions. Building on longstanding policies regarding tax exempt hospitals and community benefit spending, the report shows the Trump Administration can encourage greater hospital involvement in community-wide health by adopting a more flexible regulatory standard on what constitutes a community benefit. Produced by researchers at the George Washington University's Milken Institute School of Public Health (Milken Institute SPH), the report identifies a series of steps that the IRS can take, working in collaboration with public health experts drawn from across government and private institutions and organizations, to modify existing community benefit policies to encourage greater population health activities. Such a change would be wholly consistent with hospitals' own community health needs assessments (CHNAs), which focus on high priority community health needs that extend beyond clinical health care. Nonprofit hospitals qualify for a tax exemption under the U.S. tax code as long as they provide a public benefit, known as a community benefit. In 1969 the IRS used its broad authority to establish a "community benefit" standard that permits hospitals to undertake activities that improve the health of communities as a whole, not just residents who are patients. Hospitals today still devote the vast majority of community benefit spending to patient services, including charity care. Yet, increasingly hospitals are looking outside their walls to provide activities that improve health more generally, such as improvements to housing and the environment, economic development, child development, and efforts to reduce food insecurity. These efforts to move beyond the four walls of the hospital also align with hospitals' increasing focus on achieving greater health care quality and efficiency that can promote overall patient health while reducing costs. However, existing IRS policies create uncertainty for hospitals regarding the conditions under which many types of expenditures that can improve overall community health will count as a community benefit activity. This uncertainty may, in turn, make institutions potentially more reluctant to engage in community-wide health improvement efforts. The public interest in the adoption of a more inclusive community benefit policy is high. In 2011, U.S. taxpayers invested nearly $25 billion nationwide to support tax-exempt hospitals, and across all states, hospital community benefit spending is considerable. "The public has an enormous stake in policies that broaden and clarify the scope of permissible community benefit activities," says Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH and the lead author of the new report. "This interest can be measured in the tens of billions of taxpayer dollars that support tax-exempt hospitals." At a time when the future of affordable insurance is uncertain, hospitals will continue to invest the great majority of their community benefit obligations in financial assistance for those in need. But with relatively minor adjustments, the IRS can considerably strengthen hospitals' potential role as community health improvement actors, Rosenbaum said. Rosenbaum and her co-authors assessed the current status of community benefit policy in the United States and analyzed the most up-to-date hospital CHNAs, which under existing law non-profit hospitals must conduct every three years. The researchers found that 72 percent of hospitals identified obesity, 68 percent identified mental health and 62 percent identified diabetes as the top health challenges of their communities. The report, which was funded by The Kresge Foundation and the Robert Wood Johnson Foundation, suggests that hospitals could be encouraged to take steps to actively address these top health problems in their communities. To that end, the authors outline three policy opportunities that would help align U.S. tax policy with the growing focus on community-wide health improvement. First, the IRS could issue guidance to hospitals stating that activities now designated as community building efforts but that promote population health on a community-wide basis will be treated as community benefit spending. Such activities may include partnering with farmers markets to address obesity, or providing support to community organizations that develop safe and affordable housing. Existing IRS policy leaves hospitals uncertain about the range of "community building" efforts that go beyond their walls and that qualify as community health improvement spending. Second, the IRS could bring greater transparency to community benefit reporting by creating a link between community health priorities documented through the community health needs assessment process and their community-benefit spending allocations. IRS policy could require hospitals to report on the percentage of their community benefit spending that is linked to community-wide health needs identified through the CHNA process. For example, if a CHNA identifies childhood asthma as a major community health problem, a hospital could help support programs whose purpose is to reduce asthma triggers in homes and schools. Third, working with experts drawn across the federal government the IRS could issue tax guidance on effective community-wide health improvement activities. The IRS could receive guidance and support from a federal interagency group that includes experts not only in health, but in areas such as nutrition, education, the environment, transportation, the work force, and housing. The policy opportunities outlined in this report would not require new legislation, says Maureen Byrnes, one of the study's co-authors and a Lead Research Scientist at Milken Institute SPH. Instead, the IRS could use its broad authority to define community benefit to encourage hospitals to grow as leaders in the area of population health. Such a reform would require no additional appropriations and could be a major win for public health, Byrnes adds. The report, "Improving Community Health through Hospital Community Benefit Spending: Charting a Path to Reform," was authored by Rosenbaum, Byrnes, Sara Rothenberg and Rachel Gunsalus--all from Milken Institute School of Public Health Department of Health Policy and Management at the George Washington University. A blog by Rosenbaum and colleagues on the same topic appears today in the journal Health Affairs.
News Article | December 19, 2016
Boston, MA - Elderly hospitalized patients treated by female physicians are less likely to die within 30 days of admission, or to be readmitted within 30 days of discharge, than those cared for by male physicians, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. It is the first research to document differences in how male and female physicians treat patients result in different outcomes for hospitalized patients in the U.S. The researchers estimated that if male physicians could achieve the same outcomes as their female colleagues, there would be 32,000 fewer deaths each year among Medicare patients alone--a number comparable to the annual number of motor vehicle accident deaths nationally. The study will be published online December 19, 2016 in JAMA Internal Medicine. "The difference in mortality rates surprised us," said lead author Yusuke Tsugawa, research associate in the Department of Health Policy and Management. "The gender of the physician appears to be particularly significant for the sickest patients. These findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications." Previous studies have found differences in the way female and male physicians practice -- for example, female physicians are more likely to adhere to clinical guidelines and provide more patient-centered communication--but this is the first national study to look at whether the differences in the way male and female physicians practice affect clinical outcomes. The researchers analyzed data from more than 1 million Medicare beneficiaries age 65 years or older hospitalized with a medical condition and treated by general internists between 2011 and 2014. They adjusted for differences in patient and physician characteristics, and considered whether differences in patient outcomes varied by specific condition or by severity of illness. The researchers found that the patients, if treated by a female physician, had a 4% lower relative risk of dying prematurely and a 5% lower relative risk of being readmitted to a hospital within 30 days. The association was seen across a wide variety of clinical conditions and variations in severity of illness. When the researchers restricted their analysis to hospitalists -- physicians focused on hospital care, to whom patients are randomly assigned based on work schedule--the results remained consistent, suggesting that patient selection, in which healthier patients might choose certain types of doctors, didn't explain the results. Female physicians now account for approximately one third of the U.S. physician workforce and comprise half of all U.S. medical school graduates. There are important gender differences in how women physicians are treated--they are less likely to be promoted and are generally paid less, said senior author Ashish Jha, K.T. Li Professor of Health Policy and director of the Harvard Global Health Institute. "There was ample evidence that male and female physicians practice medicine differently. Our findings suggest that those differences matter and are important to patient health. We need to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician," said Jha. Jena was supported by NIH Early Independence Award, Grant 1DP5OD017897-01 and reports receiving consulting fees unrelated to this work from Pfizer, Inc., Hill Rom Services, Inc., Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry. Tsugawa was supported in part by St. Luke's International University, Tokyo, Japan. "Physician Gender and Outcomes of Hospitalized Medicare Beneficiaries in the U.S.," Yusuke Tsugawa, Anupam B. Jena, Jose F. Figueroa, E. John Orav, Daniel M. Blumenthal, Ashish K. Jha, MD, MPH1,2,8, JAMA Internal Medicine, online December 19, 2016, doi: 10.1001/jamainternmed.2016.7875 Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings. Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives -- not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.
News Article | October 28, 2016
Client Solution Architects (CSA) announced that David J Hickey, previously CSA’s Chief Branding Officer, has been selected as CSA’s new Chief Executive Officer. Hickey assumed the new role on 1 October 2016, the start of CSA’s new fiscal year. CSA has four offices across the U.S. and employs more than 360 employees. “I am honored to have been selected to lead and serve as CSA’s next CEO,” said David Hickey. “This is a critical time for CSA as we begin our transformation from a solid midsized firm into a large consulting firm competing in the full and open market. I look forward to working with the entire leadership team as we continue to fulfill our corporate vision of creating a great company, that attracts great people, to Do Great Things. I’m confident we have developed a true industry differentiator in our Guidance Consulting approach, and will be working with the entire CSA organization to operationalize and deploy this concept to our existing and future clients.” David succeeds Brian K Lebeau, Sr, who will remain with CSA as President of Strategic Management and will work closely with David to seamlessly transition the CEO position. David’s selection was part of a decision made by both Lee Arroyo and Brian, both founders and previous CEOs of CSA. “David has been with CSA for virtually all of our history, joining just two months after inception,” said Brian. “He was the first employee hired by CSA and has been a steadfast and loyal proponent of the culture and ideologies that have emerged over the years, and has guided CSA’s growth to more than doubling in the past three years. I can think of no one better to lead CSA through one of the company’s most challenging times, as we transition from a successful mid-sized company to a large business.” “I have had the pleasure of working alongside David for over fifteen years,” said Lee Arroyo, CSA’s President and Chairman of the Board. “He has continuously shown a propensity for applying innovative methods and a desire to achieve the mission at hand in an exceptional manner. I am excited to work with David as we continue to achieve efficient client delivery, build the CSA brand and provide services that will help differentiate CSA by employing the principles of Guidance Consulting.” Mr. Hickey brings more than 20 years of experience in process improvement driven management consulting, working for firms such as Manugistics (now JDA Software) and Price WaterhouseCooper. He has worked numerous projects in both the commercial and government sectors that have required specialized experience in strategic planning, business continuity planning, supply chain management, logistics, procurement, best practices investigation and business case analysis. Hickey grew up in Massachusetts and holds a bachelor’s degree in Health Policy and Management from Providence College. He is a U.S. Army veteran and received his ROTC commission into the Army Medical Service Corps from Providence College. Visit http://www.csaassociates.com for a full bio. About CSA CSA is a professional services firm providing strategic guidance and operational solutions to government and commercial clients. CSA helps clients achieve their goals by enhancing organizational performance and maximizing return on investments. CSA helps clients plan and execute processes associated with Project and Portfolio Management, Acquisition and Program Management, Contracts Management, Business and Financial Management, Logistics and Supply Chain Optimization and Business Improvement and Analytic Services. CSA delivers services by combining deep process expertise with strong program management disciplines, analytics and a focus on performance results.