Deficiency History and Recertification of Medicare Home Health Agencies (PDF; 1.1 MB)
Source: U.S. Department of Health and Human Services, Office of Inspector General

Findings

+ Fifteen percent of HHAs repeated the same deficiency citation on three consecutive surveys. These cyclically deficient HHAs’ most frequently repeated deficiency citation is related to patient plans of care. On the three most recent surveys, these HHAs received, on average, twice as many deficiency citations per survey compared to HHAs that did not repeat citations. Among cyclically deficient HHAs, most are located in six States and tend to be concentrated in highly populated areas.

+ CMS oversight of HHAs could be improved. Currently, CMS does not use all available deficiency history information in its oversight of HHAs. We found that deficiency history beyond the most recent survey can be an important indicator of performance on the next survey and can improve CMS’s identification of at-risk HHAs. For HHAs with one or more condition-level deficiencies, CMS has no sanction other than initiating a termination track.

Adoption Experiences of Women and Men and Demand for Children to Adopt by Women 18-44 Years of Age in the United States, 2002
Source: National Center for Health Statistics

U.S. men aged 18-44 years are more than twice as likely as women of the same age group to have adopted a child, according to a new report released today by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

The data come from the 2002 National Survey of Family Growth, conducted by NCHS. Some of the findings in the report includes:

• Among ever-married persons, men were more than 2.5 times as likely as women to have adopted — 3.8 percent compared with 1.4 percent.
• Overall, 2.3 percent of all men had ever adopted a child, compared with 1.1 percent of women. This equates to nearly 1.3 million men and 613,000 women. Though the new report does not provide conclusive data as to why more men adopt than women, the author of the study points out that the reasons are likely related to the fact that there are greater opportunities for men to adopt their stepchildren than for women, mainly because of post-divorce living arrangements.
• Over one in four women aged 40-44 years who had ever used infertility services had adopted a child.
• Though never-married adults aged 18-44 years were significantly less likely to have adopted a child compared with those who were currently married, approximately 100,000 never-married women and 73,000 never-married men had adopted a child.
• Hispanic and non-Hispanic black women were more likely to be currently seeking to adopt a child, compared with non-Hispanic white women.

Epilepsy Surveillance Among Adults — 19 States, Behavioral Risk Factor Surveillance System, 2005
Source: Morbidity and Mortality Weekly Report (CDC)
From press release:

A multi-state study by the Centers for Disease Control and Prevention has found that about one out of 100 adults have active epilepsy, and more than one-third are not getting sufficient treatment. The study, which examined the prevalence of epilepsy or seizure disorder in 19 states, was published in today?s Morbidity and Mortality Weekly Report.

Epilepsy affects an estimated 2.7 million people in the United States and costs about $15.5 billion in medical costs and lost or reduced earnings and productivity each year.

Fatal Fires Associated with Smoking During Long-Term Oxygen Therapy — Maine, Massachusetts, New Hampshire, and Oklahoma, 2000–2007
Source: Morbidity and Mortality Weekly Report (CDC)

Approximately 1 million persons in the United States receive long-term oxygen therapy (LTOT) annually through the Medicare program, most often for smoking-related lung disease. At 2:10 a.m. on December 14, 2007, a fire occurred in a public housing project for the elderly in Westbrook, Maine. Approximately 60 residents were evacuated; six were transported to a hospital for smoke inhalation. The fire was caused unintentionally by a woman aged 57 years who was an overnight guest of a relative who lived in the housing project. The visitor had ignited the fire while simultaneously smoking and using an oxygen concentrator. After this incident, the Maine Department of Health and Human Services, in collaboration with three other states, attempted to determine 1) how often this type of event results in fatalities and 2) factors common to these incidents that might be amenable to prevention. This report describes the results of that study, which found that, during 2000–2007, of the 38 deaths identified in the four states, 37 occurred in private residences, and the median age of the decedents was 67 years. Prevention of this type of fatality is dependent on smoking cessation, careful assessment of the need for LTOT, and strategies to prevent injuries from fires, such as smoke alarms and sprinklers.

Smoking Prevalence Among Women of Reproductive Age — United States, 2006
Source: Morbidity and Mortality Weekly Report (CDC)

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Women of reproductive age (18–44 years) who smoke risk adverse pregnancy outcomes and adverse health consequences for themselves. They also are exposing their children to secondhand smoke and modeling behavior that will increase the likelihood that their children will become smokers. CDC analyzed state-specific prevalence of smoking and attempts to quit among women of reproductive age, using 2006 data from the Behavioral Risk Factor Surveillance System (BRFSS). The data indicated a six-fold difference between the state and territory with the highest and lowest prevalence (range: 5.8% [U.S. Virgin Islands (USVI)]–34.7% [Kentucky]). Among women of reproductive age, those aged 18–24 years were most likely to have attempted to quit (68.4%), but least likely to have quit smoking (26.3%). Successful prevention and cessation interventions for this group of women can protect their own and their children’s health.

Persons Tested for HIV — United States, 2006
Source: Morbidity and Mortality Weekly Report (CDC)

During 2001–2006, HIV testing rates among adults remained nearly flat. The percentage of persons who reported ever being tested for HIV was approximately 40%. The number of persons being tested during each 12-month period also remained stable. These results suggest that, during 2001–2006, some persons were tested repeatedly while the majority of persons remained untested. The proportion of persons who are tested repeatedly is unknown. However, in 2005, 67% of persons tested at sites that are primarily publicly funded reported having had a previous HIV test (CDC, unpublished data, 2005).

After several years of steady increases in overall testing associated with targeted strategies, the data in this report suggest that progress in HIV testing stalled in the mid- to late- 1990s and new strategies such as expanded screening in health-care settings appear to be warranted. However, barriers to promoting expanded screening in health-care settings exist, including lack of coverage for HIV screening by some health insurance carriers, laws or regulations requiring pretest counseling and written consent in several states, competing priorities in busy clinical settings, and limited resources for care of persons with an HIV-positive test result. In addition, 77.0% of persons with HIV risk factors were not tested in the preceding 12 months; annual testing of persons with HIV risk factors has been recommended by CDC since 2006. Additional testing strategies also are needed in the community to reach persons without access to health care.

Personal Income for Metropolitan Areas, 2007
Source: Bureau of Economic Analysis

Personal income growth slowed in 2007 in most of the nation’s metropolitan statistical areas (MSAs), according to estimates released today by the U.S. Bureau of Economic Analysis. On average, MSA personal income grew 6.2% in 2007, down from 6.8% in 2006. Personal income growth slowed in 208 MSAs, increased in 144, and remained unchanged in 11 MSAs.

Americans Divided on Airplane Cell Phone Use, According to New BTS Special Report
Source: Bureau of Transportation Statistics

Americans are divided on whether cell phones should be allowed during flights, with people age 65 and older more likely to oppose their use than those between 18 and 34, according to a new Bureau of Transportation Statistics (BTS) special report using survey data on opinions about the transportation system.

BTS, a part of the U.S. Department of Transportation’s Research and Innovative Technology Administration, reported that four out of 10 U.S. residents (39.7 percent) responded in November 2007 that passengers should definitely or probably be allowed to use cell phones if there were no interference issues with aircraft communications systems. Slightly less than half (45.2 percent) said they definitely or probably should not be used. The remaining 15 percent said they weren’t sure.

The report uses data from BTS’ annual Omnibus Household Survey conducted in November 2006 and November 2007. The margin of error for the 2007 cell phone questions is 3.1 percent.

+ Opinions on Cell Phone Use on Airplanes, Congestion, and Telecommuting—from the 2006 and 2007 Omnibus Household Survey

Behavioral Economics: Lessons from Retirement Research for Health Care and Beyond
Source: Congressional Budget Office
From CBO Director’s Blog:

Many of the most dramatic behavioral economics success stories come from work done in retirement research. Researchers have found, for example, that more workers participate in a 401(k) retirement plan if they are automatically enrolled (with the ability to opt out of the plan) than if they have to make an affirmative decision to participate. Researchers have also found that the number of investment options offered changes how participants allocate their assets, and that cues embedded in employer-based retirement plans as well as entitlement programs like Social Security and Medicare shape people’s decision about when to retire. This work has emphasized the power that defaults, framing of decisions, and perceptions of social norms have on how individuals make decisions.

I’ll be giving a speech today at the Retirement Research Consortium conference that highlights the important work done in this arena and explores how some of these behavioral economics lessons could potentially be applied to another crucial policy issue– health care costs and the large portion of those resources that do not result in improved health. The hope is that behavioral researchers will help uncover the same type of policy-relevant insights into improving people’s health — perhaps especially among those on the lowest rungs of the socioeconomic ladder — as has occurred in retirement saving.

The top 10 risks for business
Source: Ernst & Young

The greatest strategic challenge facing leading global businesses in 2008 will continue to be regulatory and compliance risks, according to “Strategic business risk: 2008 — the top 10 risks for global business” (pdf, 3.1mb). This is closely followed by global financial shocks, workforce and consumer aging, and the rise of emerging markets.

The new Ernst & Young report identifies the top 10 strategic risks for global business by analyzing the top risks identified for some of the world’s most important industry sectors. It also highlights the five fastest-rising threats that could also have a significant impact over the next three to five years.

The top ten risks identified in “Strategic business risk” are:

• Regulatory and compliance risk
• Global financial shocks
• Aging consumers and workforce
• The inability to capitalize on emerging markets
• Industry consolidation/transition
• Energy shocks
• Execution of strategic transactions
• Cost inflation
• Radical greening
• Consumer demand shifts

The report was produced by Ernst & Young in collaboration with Oxford Analytica, and sought the views of more than 70 analysts from around the world and more than 20 disciplines.

+ Full Report (PDF: 3.1 MB)

401(k) Benchmarking Survey: 2008 Edition
Source: Deloitte LLP

Against the challenging backdrop of today’s workplace, employers are diligently seeking better ways to leverage their investment in 401(k) plans to attract, motivate and retain workers. They are doing so with a relatively consistent set of beliefs about the key elements of plan “effectiveness.” Yet employers also are expressing some doubts and disappointments with their 401(k) plans as they experiment with designs and policies to achieve their business goals – sentiments that point to the need for additional fine-tuning, or perhaps, in some cases, even a radical overhaul.

The 2008 edition of the 401(k) Benchmarking Survey results offer a detailed snapshot of the 401(k) policies, features, objectives and expectations of hundreds of diverse employers. A total of 436 companies were surveyed, representing a wide distribution of employers in terms of geography, size, industry and ownership structure (publicly or privately held).

The survey revealed fewer than one in five employers believe “most employees” will be financially prepared for retirement. In addition, employers today worry more about attracting and retaining qualified workers than about the ever-rising costs of compensation and benefits. Against this challenging backdrop, employers are jumping in with more ways to help employees get involved in investing and preparing for retirement with less effort. Employers are catering to the needs of employees to make 401(k) participation as easy as possible by diligently seeking better ways to leverage plans to attract, motivate, financially prepare and retain workers. Yet, many companies also express doubts and disappointments as they experiment with 401(k) policies to achieve business goals. The survey results highlight a strong need for fine-tuning compensation and benefits strategies, and, in some cases, even a radical overhaul.

In addition to the full report, industry data is also available for the following sectors:

• Manufacturing
• Wholesale/Retail
• Financial Services
• Health Care
• Media & Telecommunications

+ Full Report (PDF; 2 MB)

Free registration required.

Medical Tourism: Emerging Phenomenon in Health Care Industry
Source: Deloitte LLP

The impact of dramatically rising U.S. health care costs is prompting increasing numbers of consumers to consider outbound medical tourism as a viable care option. In 2007, an estimated 750,000 Americans traveled abroad for medical care; this number is anticipated to increase to 6 million by 2010. Concurrently, inbound medical tourism and medical tourism across state lines continue to present opportunities for specialty hubs offering treatments unavailable elsewhere in the world or in a community setting.

Medical Tourism: Consumers in Search of Value, a new paper from the Deloitte Center for Health Solutions, part of Deloitte LLP, examines the growth of medical tourism: the hot spots for outbound and inbound programs and factors important to the attractiveness of both.

Deloitte’s 2008 Survey of Health Care Consumers explored the consumer’s outlook on medical tourism. The survey discovered medical tourism is set to explode in growth over the next three to five years.

As patients are exposed to greater financial burdens resulting from higher copayments and price transparency efforts, they are likely to seek low-cost treatment alternatives such as medical tourism. This, in turn, has major implications for health care providers, health plans, employers, regulators and policymakers.

+ Full Report (PDF; 3.3 MB)

Free registration required.

Retail Medical Clinics: Disrupting Models of Primary Care
Source: Deloitte LLP

Retail medical clinics are disrupting existing models of primary care by shifting delivery of health care services from traditional clinical settings to consumer-friendly locations such as “big-box” discount stores, grocery stores and retail pharmacies.

More than 800 retail medical clinics were in operation at the end of 2007, and the Convenient Care Association (CCA) is forecasting retail clinic totals to reach 5,000 by the end of the decade. Why the boom? According to Deloitte’s 2008 Survey of Health Care Consumers, almost half of all consumers report being receptive to retail clinics. They do not appear concerned about safety issues or staffing by nurse practitioners, and they like the convenience.

Retail Clinics: Facts, Trends and Implications, a new paper from the Deloitte Center for Health Solutions, part of Deloitte LLP, addresses four key questions:

• What are retail medical clinics and how are they different from traditional primary care delivery?
• What are the current trends in the growth of retail clinics and their use, and what are the characteristics of their users?
• What forces will drive or impact retail clinics going forward?
• How will retail clinics affect key stakeholders in the health care system?

+ Full Report (PDF; 514 KB)

Free registration required.

NOAA: 2008 Atlantic Hurricane Season Outlook Update
Source: National Oceanic and Atmospheric Administration
From press release:

In the August update to the Atlantic hurricane season outlook, NOAA’s Climate Prediction Center has increased the likelihood of an above-normal hurricane season and has raised the total number of named storms and hurricanes that may form. Forecasters attribute this adjustment to atmospheric and oceanic conditions across the Atlantic Basin that favor storm development - combined with the strong early season activity.

NOAA now projects an 85 percent probability of an above-normal season – up from 65 percent in May. The updated outlook includes a 67 percent chance of 14 to 18 named storms, of which seven to 10 are expected to become hurricanes, including three to six major hurricanes of Category 3 strength or higher on the Saffir-Simpson Scale. These ranges encompass the entire season, which ends November 30, and include the five storms that have formed thus far.

In May, the outlook called for 12 to 16 named storms, including six to nine hurricanes and two to five major hurricanes. An average Atlantic hurricane season has 11 named storms, including six hurricanes and two major hurricanes.

New GAO Reports (PDFs)
Source: Government Accountability Office
7 August 2008
+ Reports
1. Medicare and Medicaid: CMS and State Efforts to Interact with the Indian Health Service and Indian Tribes
2. DOD Business Systems Modernization: Key Navy Programs’ Compliance with DOD’s Federated Business Enterprise Architecture Needs to Be Adequately Demonstrated
–
+ Presentation By The Acting Comptroller General
1. “The Role of the U.S. Government Accountability Office,” a presentation by Gene L. Dodaro, acting comptroller general of the United States, before the House Democracy Assistance Commission, in Washington, D.C.