September 2010

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Labor Day Post I: A Dangerous Occupation

September 5, 2010 in Nursing Homes | No comments

For Labor Day, I will profile a group of workers who are underappreciated: long-term care workers.  These posts are typically filled by certified nurse’s aids (CNAs).  Despite the importance of their job, their remuneration is far from generous.  In The Politics of Medicaid, Laura Katz Olson reports that CNA hourly wages were only $10.61 in 2008.  This compares to wages of $12.59 for customer service representatives or $11.78 for manufacturing receptionists.

In addition, being a nursing home caregiver is a dangerous job. These workers “…experience an exceedingly high rate of on-the-job injuries, 18.2 per 100 workers, as compared to people engaged in coal mining (6.2) construction (10.6) and warehousing or trucking (13.8).  In fact, nurse’s aides, attendants and orderlies have the third-highest rate of nonfatal occupation-related mishaps in the nation.“

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Does the Ivy League provide a good education?

September 5, 2010 in Current Events | No comments

An Economist editorial wonders whether America’s top universities are doomed to become failures like America’s car companies.  Rising tuition, excess administrative cost, and increased drop-out rates are all causes for concern.  Most troubling, however, is that full-time students are spending only 14 hours per week studying compared to 24 hours/week in 1961.  What is causing this decline?

“The most plausible explanation is that professors are not particularly interested in students’ welfare. Promotion and tenure depend on published research, not good teaching.  Professors strike an implicit bargain with their students: we will give you light workloads and inflated grades so long as you leave us alone to do our research.“

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CMS 2010 Requirements for Medicare Part D Plan MTM Programs

September 2, 2010 in Medicare Part D, Pharmaceuticals | 1 comment

In an effort to standardize the provision of medication therapy management (MTM) within Medicare Part D, CMS has outlined specific requirements for Part D Plan MTM programs in 2010.  The APhA’s Medication Therapy Management Digest (March 2010) reviews these requirements.

MTM programs must:

  • Enroll targeted beneficiaries using an opt-out method only (i.e., beneficiaries are automatically enrolled unless they choose not to be)
  • Target beneficiaries for enrollment at least quarterly.
  • Include the following enrollment criteria for targeted beneficiaries:
    • Does not require more than three chronic disease states.
    • Does not require more than eight medications.
    • In defining multiple chronic diseases, sponsors must target at least four of seven core chronic disease states.
    • Likely to incur annual costs of $3,000 for covered Part D drugs (a reduction from the previous requirement of $4,000).

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Health Wonk Review: In the Here and Now Edition

September 2, 2010 in Carnivals | No comments

The latest edition of the Health Wonk Review is up at Hank Stern’s always interesting InsureBlog.

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Are All Readmissions Bad Readmissions?

September 1, 2010 in Hospitals | 2 comments

Currently, Medicare and private insurers are attempting to put in place incentives to reduce the number of readmissions. Visits to the hospital are costly and reducing the frequency of hospital visits is the best means to reduce medical costs. In particular, if readmissions are the fault of the care the patients receive during the initial admissions, hospitals should be liable for subsequent care.

On the other hand, a recent letter to the New England Journal of Medicine, argues that high readmission rates may in fact indicate high quality care.

“A higher occurrence of readmissions after index admissions for heart failure was associated with lower risk-adjusted 30-day mortality. Our findings suggest that readmissions could be ‘adversely’ affected by a competing risk of death — a patient who dies during the index episode of care can never be readmitted. Hence, if a hospital has a lower mortality rate, then a greater proportion of its discharged patients are eligible for readmission. As such, to some extent, a higher readmission rate may be a consequence of successful care.”

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