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Blog / en Sat, 26 Apr 2025 07:41:25 -0500 Thu, 03 Apr 25 09:27:58 -0500 Cuts to State Medicaid Finance Methods Would Limit Access to Care for Everyone /news/blog/2025-04-03-cuts-state-medicaid-finance-methods-would-limit-access-care-everyone Paragon Health Institute continues their series of misguided and harmful characterizations of Medicaid financing and provider payment, including through two reports “Addressing Medicaid Money Laundering: The Lack of Integrity with Medicaid Financing and the Need for Reform” and “California’s Insurance-Tax Shuffle: How Federal Money Ends Up Paying for Medicaid for Illegal Immigrants.” The timing of this series of reports aligns with the efforts of some policymakers in Congress to further limit states’ ability to finance their Medicaid programs to fund tax cuts for the wealthy.In their reports, Paragon recommends that Congress pursue several policies that are ultimately harmful to patients and providers, targeting specific state Medicaid programs, such as those in California, North Carolina, Arizona, and Tennessee, without adequate justification. The policies Paragon recommends include:Eliminating or Reducing Provider Taxes. Provider taxes are a legitimate financing method used by 49 states and the District of Columbia to fund a portion of the non-federal share of their Medicaid programs. There are federal limits, overseen by the Centers for Medicare &amp; Medicaid Services (CMS), including a 6% tax safe harbor threshold. Eliminating provider taxes or reducing the safe harbor threshold likely would result in shifting the tax burden to state residents through higher income taxes, property taxes, sales tax or other state tax structures. Specifically:<ul><li>California’s Managed Care Organization (MCO) tax generates general fund revenue, which the state uses to increase already low provider rates and to pay for care to its Medicaid beneficiaries. California’s MCO tax operates under strict federal requirements and oversight of the integrity of its financing arrangement. Even with funds contributed by the federal government, California continues to make state investments in its Medicaid program — at a faster pace than federal spending. California can hardly be accused of taking advantage of the federal government. California pays billions (approximately $83 billion) more in federal taxes than it receives back in federal spending. It’s important to note that a state cannot use federal dollars to pay for undocumented immigrants, and Paragon’s report provides no evidence that federal dollars were used to pay for coverage of undocumented immigrants in the state.</li><li>North Carolina’s provider tax is a financing method the state initiated in 2011 to increase low provider base payments and fund critical Medicaid services, including behavioral health services and postpartum care. Like many states, Medicaid reimbursement without provider taxes and supplemental payments factored in makes it difficult for North Carolina hospitals to continue to serve their communities.</li></ul>Eliminating or Capping State-Directed Payments (SDPs). Medicaid MCOs’ low provider payments have created the need for additional provider support through state-directed payments, particularly for hospitals that serve disproportionately high rates of Medicaid and other public-payer patients and routinely operate with negative margins. Today, as many SDP programs await approval, some hospitals are already making difficult decisions to cut their workforce, struggling to make payroll and fighting to maintain service lines or stay open entirely amid further financial instability. For example:<ul><li>Arizona’s hospital-directed payment program, known as HEALTHII payments, is used to support hospital services, recruit and retain providers in rural communities and keep hospitals open. In Arizona, these payments are a particularly vital source of funding as the state continues to cut inpatient and outpatient Medicaid rates and a significant portion of hospitals face operating losses. Funded in part through provider taxes, if directed payments or finance mechanisms were cut, 69% of hospitals in the state would have a negative operating margin.</li><li>Tennessee’s directed payment program, which is currently awaiting CMS approval, will help sustain the hospital network in a state that has not expanded Medicaid. The directed payment program provides needed funding to improve Medicaid base rates, which cover only half of the cost to provide care to low-income or uninsured residents. Critically, Tennessee has the second highest number of hospital closures in the nation, and without directed payments, that number will only increase.</li></ul>What most people don’t realize is that cutting provider taxes and directed payments wouldn’t just impact Medicaid patients and providers; it would limit access to care for everyone.Cutting provider taxes and supplemental payments would worsen the already significant gap between Medicaid reimbursement and the actual cost of providing care to Medicaid patients. In Florida, for example, with directed payments factored in, which are in part financed through provider taxes, Medicaid pays $0.68 for every dollar spent on care. Without these additional payments, reimbursement would drop to $0.48 for each dollar spent on Medicaid beneficiaries. In California, Medicaid pays $0.80 for every dollar spent on care. Without the additional payments financed by California’s provider tax arrangement, payment would decrease to just $0.70 for each dollar spent on Medicaid patients. In the context of specific services, hospitals experienced a -42% Medicaid margin for inpatient obstetrics care and a -44.9% Medicaid margin for outpatient obstetrics care in 2023. The Medicaid shortfall faced by providers is directly linked to the services and sites of care that they can offer to all patients.Cutting off the financing for a program that is the single largest source of health care coverage in the U.S., while harming providers and patients, is hardly reform. We discourage anyone from trusting attacks on state Medicaid programs that call for unjustifiable federal funding cuts to Medicaid at the expense of Medicaid patients and our communities as a way to finance tax cuts for the wealthy.We urge Congress to reject cuts to vital Medicaid financing methods, including provider taxes and state-directed payments. Thu, 03 Apr 2025 09:27:58 -0500 Blog Can Collaborative Efforts to Improve Device Design Improve Safety? /news/blog/2025-03-28-can-collaborative-efforts-improve-device-design-improve-safety During World War II, the U.S. Army Air Corps depended on its B-17 bombers to inflict incredible damage against the Axis powers in Europe. These “Flying Fortresses” were deemed essential to winning the war in the European theater, but they had one big problem. Despite the plane’s technically advanced design and the provision of effective training for the young pilots responsible for steering them through war zones, too many crashed on landing, destroying the machines and often killing the pilots and crew.Initial investigations into B-17 crashes concluded that the accidents resulted from pilot error, and the Army invested in training and retraining pilots. Yet, the crashes continued. Then Alphonse Chapanis, a young psychologist who joined the Army Air Corps’ aeromedical lab in 1942, noticed that the switches for the plane’s flaps and the landing gear were adjacent on the dash and identical in appearance — but radically different in function.It was far too easy for pilots — stressed and weary after hours of combat flying — to flip the wrong switch when trying to land the B-17. The plane’s design had failed to account for the likelihood of normal human error. Chapanis suggested changing the knobs so that one was triangular and the other was spherical, making it easy for pilots to differentiate. This small change in design led to an immediate and substantial decrease in the number of B-17 crashes. (<a href="https://uxmag.com/articles/pilot-error-chapanis-and-the-shape-of-things-to-come" target="_blank">Read more about Chapanis</a> and his influence on device design).While most health care isn’t delivered in war zones, health care and device company leaders recognize that care is often delivered in high-stress, high-risk situations. Despite elegant efforts to design for safe use, rigorous standards and regulatory requirements from the Food and Drug Administration and standards bodies, and lots of training of health care professionals, many acknowledge that there is still room to ensure clinicians are “flipping the right switch” when using medical devices.<h2>AHA and AAMI Meeting</h2>Earlier this year, the �� Association (AHA) and the Association for Advancement of Medical Instrumentation (AAMI) brought together a small group composed of hospital and health system leaders, device manufacturers and policy leaders to explore how to make devices safer by design. Their energy and commitment were palpable. Participants were invigorated and challenged by the shared goal of creating devices that could be used more easily, effectively and safely.The meeting began with table-setting presentations to make sure all attendees understood each other’s perspectives. Clinical leaders described the stresses and distractions of the busy hospital environment that make it difficult for staff to use devices as the designers had envisioned, including their personal experiences of devices being implicated in near misses or safety events. Manufacturers discussed their rigorous processes for designing, testing and providing instructions to ensure safe use. An AAMI leader described the role of standards in promoting safety, and a former FDA official spoke about the role of regulation, oversight and post-market surveillance in promoting safety. The group then broke into multidisciplinary groups with direction to identify practical, actionable pathways that augment or replace current activities and lead to better safety by design.<h2>3 Key Takeaways from the Conversations</h2><ul><li>Users and manufacturers need better information. Engineers and users need to be able to exchange the right information to make design improvements that address usability issues. Right now, they are not connecting well. Health care providers often discover a design challenge with a piece of equipment when conducting a root cause analysis and then report that information to their patient safety organization, but that information is not readily available to manufacturers. Manufacturers get information from FDA databases, but these may not have sufficient information to understand exactly how the device design may have contributed to the occurrence of patient harm or inform design alterations that could prevent it in the future. Finally, post market surveillance reporting is often slow to reach the manufacturer, limiting their ability to alter design in a timely fashion.</li><li>Work as imagined differs from work as done. In designing each particular product, engineers imagine the clinical environment in which it will be placed, plan for a rigorous training of the health care professionals who will be operating it and create comprehensive instruction manuals. Health care professionals use an expanding and rotating panoply of devices every day, and their ability to be trained on each and every one of those, remember that training and use it in a moment of emergent patient need is radically different from what the designer imagined. Better communication between users and designers is the only way to help designers anticipate how their devices will actually be used.</li><li>There is a natural tension between innovation and the experience that promotes safe use of a device. In a busy clinical environment, it is challenging for clinicians to keep up with all they must learn, but device makers may want to make routine improvements to the software or user interface of their devices to refresh perceptions of the device. Honest discussions about the kind of innovation device manufacturers intend and how the alteration will work in a busy clinical environment are needed to ensure innovation better contributes to safety and ideally decreases the draw on clinicians’ already-stretched mental capacity. Further, the regulatory framework needs to support this balance between innovation and safety by recognizing and creating safe tables and sandboxes within which to drive progress.</li></ul>One actionable item that drew keen interest was creating an opportunity for the manufacturers’ engineers to participate in a hospital’s response to a patient safety event. Stakeholders across the spectrum agreed that open sharing of how design may have contributed to an event is vital to generating changes needed to promote safer use and reduce patient harm. AHA and AAMI are committed to working to make these conversations a reality as part of our ongoing efforts to make care safer.Nancy Foster is the AHA’s vice president of quality and safety policy. Fri, 28 Mar 2025 11:56:05 -0500 Blog Setting the Record Straight: Beware of Opinions Masquerading as Facts /news/blog/2025-03-27-setting-record-straight-beware-opinions-masquerading-facts For health care organizations that care for the 70 million Medicaid patients in the U.S., provider taxes are a life vest that keep state Medicaid programs afloat and allow them to continue providing critical health care services for their communities. While policymakers in Congress look to finance an extension of the 2017 tax cuts, some are advocating for further limits on states’ ability to use provider taxes to help finance their Medicaid programs.Some new reports have displayed a gross misunderstanding of both the legitimacy of various Medicaid financing arrangements and the consequences of stripping those resources from states trying to provide health care access to their most vulnerable residents. For example, a recent report from the Paragon Health Institute, “Addressing Medicaid Money Laundering: The Lack of Integrity with Medicaid Financing and the Need for Reform” recycles misguided opinions.Medicaid is not a money laundering scheme. Medicaid is a complex program that takes into account state and federal priorities to provide coverage for children, older adults, people with disabilities, and low-income adults. Let’s be clear: Any suggestion that provider taxes are anything but longstanding, legally vetted, state and federally approved tax arrangements, is dishonest and a distraction from what these proposals truly are — a way to cut the Medicaid program.The primary way states generate revenue to pay for state programs, including Medicaid, is through taxes — this includes income tax, sales tax or, in the case of Medicaid, provider taxes. All are legally permissible ways for states to raise money to pay for their portion of the Medicaid program.Provider taxes are a longstanding, legitimate and heavily regulated tax arrangement which states can levy on health care organizations, including hospitals and health systems, nursing facilities, and managed care organizations to pay for their portion of the Medicaid program. Nearly every state (49 states and the District of Columbia) uses some form of provider taxes, and many have done so for decades. In most cases, for a state to implement a provider tax, state legislators are required to first vote on provider tax arrangements. They then must be reviewed and approved by the federal government. Once established, the taxes are then overseen by both state and federal regulators. As an example of the federal oversight, Congress limits these taxes to no more than 6% of net patient revenue. &nbsp;Nearly every state Medicaid program would be hurt by lowering the limit on provider taxes, and state residents would be put in the crosshairs of these cuts. States with strained budgets will need to shore up funding from elsewhere, either by raising taxes on their residents or cutting health care coverage and benefits for some of our most vulnerable people. For many states, a budget gap of this magnitude simply could not be backfilled through other funding sources.For providers, this also could mean steep reimbursement cuts and increased uncompensated care. Even with provider tax financing, state Medicaid programs do not cover the cost of caring for Medicaid patients. Nationally, the Medicaid shortfall — the difference between the hospital's cost of serving Medicaid patients and the payments it receives for services — was $27.5 billion in 2023. These numbers underscore that further strain on hospital revenue would likely require them to reduce or eliminate service offerings, reduce staffing, or — to an entire community’s loss — close altogether.&nbsp; Provider taxes are fundamental to the Medicaid financing structure in nearly every state. The accusation by some that these carefully reviewed, legitimate tax mechanisms are fraudulent is false and a distraction. Just because someone does not like a law, it does not mean that those adhering to the law are committing “money laundering.” Attacks on provider taxes are an attempt to disguise unjustifiable federal funding cuts to Medicaid, which will be devastating to Medicaid patients and our communities. Medicaid provider taxes protect access to care for everyone. We urge Congress to protect Medicaid and reject efforts to mislead and distort the facts about the legitimate use of provider taxes to care for patients.Ashley Thompson is AHA’s Senior Vice President, Public Policy Analysis and Development. Thu, 27 Mar 2025 12:33:27 -0500 Blog Blog: 3 Ways Not Extending the Enhanced Premium Tax Credits Would Hurt Patients in Rural Communities /news/blog/2025-02-27-blog-3-ways-not-extending-enhanced-premium-tax-credits-would-hurt-patients-rural-communities Congress passed into law legislation in 2021 that allowed additional eligibility for enhanced premium tax credits to help certain individuals and families purchase insurance on the health insurance marketplaces. This change has been especially impactful for those in rural areas, who tend to face higher premiums and fewer coverage options, in allowing them to access needed health care coverage.These EPTCs are scheduled to expire at the end of 2025. If they are not extended, millions of Americans will lose coverage or incur significantly higher costs. The largest disruptions will be felt by those who can face some of the highest challenges: the individuals and families living in rural communities.Below are three takeaways about the potential impacts of ending EPTCs on rural patients and communities:Increases in Coverage Disruptions and Uninsured Populations. Analysis by KNG Consulting for the AHA shows the most rural states in America would experience, on average, a 30% decrease in marketplace coverage and a 37% increase in their uninsured populations.Higher Taxes Via Premium Increases. The EPTCs helped millions of rural Americans purchase affordable commercial health care coverage and access necessary health care. The expiration of this policy would both harm the health of entire rural communities and raise individuals’ taxes via premium increases.Exacerbated Health Care Access Challenges. Rural populations have more complex health needs, face longer travel distances to providers and have fewer health care options. The EPTCs are a fundamental support for keeping critical health care access in rural communities and their expiration would exacerbate these existing access challenges.&nbsp;The AHA urges Congress to continue the EPTCs as they remain an important part of increased access to health care coverage and high-quality care for patients and communities served by hospitals, health systems and other providers. See the <a href="/2025-02-27-fact-sheet-expiration-enhanced-premium-tax-credits" target="_blank" title="AHA Fact Sheet">AHA fact sheet</a> for more details. Thu, 27 Feb 2025 22:58:48 -0600 Blog Elevating the Next Generation of Health Care Leaders to Drive Change and Innovation /news/blog/2025-02-13-elevating-next-generation-health-care-leaders-drive-change-and-innovation I’ve met so many remarkable health care professionals — leaders who wake up each day determined to navigate a shifting landscape of technologies, care models and patient needs. And I know it’s not easy to keep up with constant change. To stay ahead, we have to develop future leaders who are ready to shape the direction of our hospitals and health systems. That’s exactly what the 2025 <a href="/center/next-generation-leaders-fellowship" title="AHA Next Generation Leaders Fellowship">AHA Next Generation Leaders Fellowship</a> sets out to do.Over the course of a year, this competitive program gives high-potential individuals the mentorship, experience and resources they need to become tomorrow’s top executives. Think about what that means for your organization: fresh perspectives, bold strategies and a steady pipeline of talent that can tackle any challenge.<h2>What This Fellowship Can Do for Your Hospital or Health System</h2>Get real solutions for the challenges you’re facing. Each fellow undertakes a project that aligns with their organization’s strategic needs, helping to tackle real issues effectively.Strengthen your organization’s leadership capability. From day one, fellows contribute fresh perspectives and applicable leadership skills that can elevate your team and overall culture.Build valuable connections across the field. Through collaboration with peers and mentors, fellows develop relationships that outlast the program. They return to your organization with new resources and insights that help drive innovation.Retain rising stars. We know how critical it is to keep top talent. When you invest in high-potential employees, you signal you’re committed to their growth, making them more likely to stay and continue contributing to the organization. That boosts retention, fosters innovation and solidifies succession planning.Want more proof? Watch this video on the fellowship’s return on investment to see the measurable impact.<div class="embed-responsive embed-responsive-16by9"></div>You also can check out the <a href="/center/next-generation-leaders-fellowship/fellowship-action#Snapshots" title="AHA Next Generation Leaders Fellowship - capstone project snapshots">capstone project snapshots</a> from our most recent fellows, which highlight how these future leaders are bringing innovative solutions to their hospitals and health systems — and delivering real, tangible results for the communities they serve.<h2>How to Get Involved</h2><ul><li>Nominate rising talent. Identify and support high-potential leaders in your organization who are ready to step up. <a href="/center/next-generation-leaders-fellowship/nomination-form" title="Nomination Form, Next Generation Leaders Fellowship">Nominate a leader</a></li><li>Mentor future fellows. Share your expertise and leave a lasting legacy. Mentors offer coaching, guidance and real-world insight to help fellows succeed. <a href="/center/next-generation-leaders-fellowship/mentor-interest-form" title="Mentor Interest Form for Next Generation Leaders Fellowship">Sign up to be a mentor</a></li><li>Attend an information session. Learn more about the fellowship, the capstone project approach and mentorship opportunities. The fellowship team is hosting a <a href="https://aha-org.zoom.us/webinar/register/WN_OxCNZfgISAWdbmY7gtQIOA#/registration" target="_blank" title="AHA Next Generation Leaders Fellowship Virtual Information Session - Feb. 19">fellows info session</a> Feb. 19 and a <a href="https://aha-org.zoom.us/webinar/register/WN_J2yejO98RqOb-B-xPwmCBQ#/registration" target="_blank" title="Mentor Interest Information Session: AHA Next Generation Leaders Fellowship - Feb. 20">mentors info session</a> Feb. 20.</li></ul><h2>Encourage Your Rising Leaders to Apply</h2>By cultivating emerging leaders, we not only invest in our organizations’ future success but also ensure the entire field continues to innovate and better serve our communities for years to come. Applications for the <a href="/center/next-generation-leaders-fellowship/application" title="Application for Next Generation Leaders Fellowship">2025–2026 cohort</a> are being accepted now through March 31. I hope you’ll join us in championing the next generation of health care leadership.Lindsey Dunn Burgstahler is vice president of programming and market intelligence at the �� Association. Thu, 13 Feb 2025 10:33:56 -0600 Blog Meeting Patients’ Perinatal Mental Health Needs /news/blog/2025-01-23-meeting-patients-perinatal-mental-health-needs When I delivered my first baby in 2016, I did not understand how I would feel postpartum. Though I had many family members who had experienced birth and postpartum before me, they did not share their challenges, fears and emotions. Their stories revolved around the demands of caring for a newborn.I fell into the same pattern. Like so many women before me, my own feelings remained unspoken. It was never about me, Aisha. I did not realize how common my struggles were nor how isolating postpartum would feel.Nine years and a few kids later, I know that I was not alone.&nbsp;<a href="https://www.cdc.gov/reproductive-health/depression/index.html">1 in 8 women</a> report symptoms of postpartum depression after birth, and&nbsp;<a href="https://www.acog.org/womens-health/faqs/anxiety-and-pregnancy">1 in 5</a> pregnant or postpartum women experience anxiety. The most startling statistic:&nbsp;<a href="https://www.cdc.gov/maternal-mortality/php/data-research/index.html">65%</a> of pregnancy-associated morbidity and mortality happens during the postpartum period and are primarily caused by mental health conditions.Through my role at the �� Association, I have witnessed the transformative changes hospitals and health systems are implementing to improve maternal mental health. They are offering access to resources and creating unique and tailored approaches for postpartum support to best meet the needs of their patients and communities. And at the AHA, we will continue to elevate the importance of postpartum mental health so that no mom feels alone.<h2>The Role of Hospitals in Optimizing Postpartum Mental Health <a>Support</a></h2>Hospitals can play a key role in building holistic treatment and support for perinatal mental health disorders during this critical period. Last year, the&nbsp;<a href="https://policycentermmh.org/">Policy Center for Maternal Mental Health</a> and the AHA cohosted a&nbsp;<a href="https://www.youtube.com/watch?v=4Zl_e-ZnASM">panel discussion</a> with leaders from Woman’s Hospital in Baton Rouge, La., and the University of Colorado Hospital on providing maternal mental health care. The panelists discussed the clinical and operational considerations of their programs as well as topics ranging from respectful maternity care and multidisciplinary team-based care to peer support and integration with community-based partners. &nbsp;<h2>Programming and Practice</h2><a href="https://www.womans.org/inpatient-behavioral-health-care" target="_blank">Woman’s Hospital Inpatient Program</a>Woman’s Hospital is the newest of a handful of inpatient perinatal mental health treatment programs.&nbsp;Their 10-bed perinatal mental health unit opened in September 2024 and had served 43 patients by mid-October. Their team specializes in caring for high-risk pregnant women and those who have experienced a pregnancy loss, supporting women up to one year postpartum.Patients receive team-based care from psychiatrists, psychologists, social workers, nurse practitioners, nurses skilled in both obstetrical and psychiatric care, specialty-trained mental health technicians, maternal fetal medicine specialists, onsite OBGYNs and lactation consultants. The unit also provides group therapy, which helps patients feel a sense of support in shared experiences.&nbsp; &nbsp; &nbsp;&nbsp;Woman’s Hospital has built partnerships with nearby clinics and community-based organizations to expand reach, raise awareness and gather resources to better support women when they are admitted. The aim is for this integrated approach to help women build trust with the inpatient hospital program and ensure they can access the support they need.<a href="https://medschool.cuanschutz.edu/psychiatry/Healthyexpectationsiop" target="_blank">The University of Colorado Hospital Anschutz Medical Campus, Intensive Outpatient Program</a>The University of Colorado’s Healthy Expectations Perinatal Mental Health Intensive Outpatient Program (IOP) provides care for individuals with moderate to severe perinatal mood and anxiety disorders or related conditions. The program provides a higher level of treatment than traditional outpatient therapy. The IOP runs nine hours weekly over an eight-week curriculum, focusing on three key components: skill-building and coping strategies for managing mental health symptoms, promoting secure parent-child attachment, and developing wellness strategies and routines.The program prioritizes connecting families to community-based resources that reduce isolation, foster connection and validate the challenges of parenthood. Collaborations with local organizations, such as doula programs for individuals with substance use behaviors, as well as community parenting interventions, provide support beyond traditional maternal mental health support. The hospital also provides home visits, parenting workshops and peer-led groups to ensure families receive care that meets their unique needs and empowers them to thrive.<h2>Key Takeaways</h2>Both hospitals emphasized the need to partner with front-line providers to build their awareness of perinatal mental health needs and services. They need training to identify mental health conditions and establish systems for referrals and follow-ups with specialists and community resources as appropriate. Hospitals also can play a role in providing clinicians with additional trainings, such as&nbsp;<a href="https://www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/get-trained">behavioral health integration training through the American Psychiatric Association.</a>&nbsp;Clinicians and mental health professionals in hospitals can register for the Policy Center for Maternal Mental Health’s&nbsp;<a href="https://policycentermmh.org/certificate-training/">Maternal Mental Health Certificate Training for Mental Health and Clinical Professionals</a> to gain knowledge and insights on&nbsp;strategies and interventions to increase awareness, screening and treatment of perinatal mental health conditions. Hospitals also can connect patients and their families to the&nbsp;<a href="https://mchb.hrsa.gov/programs-impact/national-maternal-mental-health-hotline" target="_blank" title="(opens in a new window)">National Maternal Mental Health Hotline</a>, 1-833-TLC-MAMA, which offers 24/7 support and resources via call or text to pregnant women and new mothers and their families. These resources help ensure front-line providers have the tools necessary to respond to mental health needs.&nbsp; &nbsp; &nbsp;By normalizing conversations about mental health across the perinatal care continuum, bringing awareness of its impact, supporting obstetric providers to screen and educate, and creating new hospital treatment programs, we can create a culture where new moms feel empowered to seek help and are supported when they do.Aisha Syeda, MPH, senior program manager for AHA’s Strategic InitiativesRegan Moss, MPH, policy and programs analyst with the Policy Center for Maternal Mental Health&nbsp; Thu, 23 Jan 2025 10:08:22 -0600 Blog Building Emergency Readiness to Meet the Needs of Children /news/blog/2024-12-05-building-emergency-readiness-meet-needs-children In 2024, the U.S. suffered<a href="https://www.ncei.noaa.gov/access/billions"> 24 weather and climate disasters</a>. In October alone, two major hurricanes devastated communities in North Carolina and Florida, leaving residents struggling with scarce resources. In these challenging times, hospitals and health care systems are safe havens, providing communities essential health care services, coordinating with emergency response teams, and supporting those affected. Hospitals and health care systems must be prepared to handle the unexpected and ready to meet the health care needs of everyone – young and old – in the community.Children often receive care in general acute care hospitals rather than at dedicated pediatric facilities. This means every hospital – not just specialized pediatric centers – needs to be equipped and prepared to manage and treat pediatric emergencies. In 2019, the Department of Health and Human Services’ Administration for Strategic Preparedness and Response funded the&nbsp;<a href="https://www.pediatricdisaster.org/">Pediatric Disaster Care Centers of Excellence</a>, an initiative to design and share evidence-based practices and protocols emergency departments can implement to address the needs of children day to day and in disasters.University Hospitals Rainbow Babies &amp; Children’s Hospital and Corewell Health Children’s are among the hospitals on this journey. In a recent AHA&nbsp;<a href="https://www.youtube.com/watch?v=BXN8PzkW3Zg">webinar</a>, they shared five action steps hospitals can take to establish pediatric disaster readiness, as well as day-to-day readiness.<ol><li>Build awareness and conduct asset mapping. Hospitals recognize that their EDs are required by law to screen, and either stabilize or transfer patients, both adult and pediatric, to a higher level of care. Use the&nbsp;<a href="https://emscimprovement.center/domains/pediatric-readiness-project/readiness-toolkit/readiness-ED-checklist/">ED Checklist</a> to assess if your hospital’s ED has the critical components to serve pediatric-specific health care needs. Take the&nbsp;<a href="https://pedsready.org/">National Pediatric Readiness Project assessment</a> and receive a pediatric readiness score for your ED and a gap report to understand where to make improvements in pediatric readiness.</li><li>Review your current disaster preparedness plan.&nbsp;Children’s unique vulnerabilities are often magnified during disasters. Use the&nbsp;<a href="https://emscimprovement.center/domains/preparedness/disaster-plan-prepare/disaster-checklist/">Essential Pediatric Considerations for Every Hospital’s Disaster Policies checklist</a> to examine if your current disaster preparedness plan contains essential tools, resources, policies, partnerships and workforce to address the diverse needs of children that arise in disasters.</li><li>Connect and coordinate with your state and region. Develop a clear picture of existing resources locally, in the state and across the region, and work to coordinate and streamline response and recovery efforts for pediatric readiness. Partner with nearby states to network, learn and build a collective repository of resources and workforce. These partnerships are crucial for potentially establishing transfer agreements amongst hospitals for high-risk or trauma patients.</li><li>Build capacity and competencies. Enhance your hospital’s capabilities and capacity by expanding educational competencies and trainings focused on responding to surges and increased patient volumes. Hospitals can offer&nbsp;<a href="https://emscimprovement.center/domains/pecc/">Pediatric Emergency Care Coordinator</a> training to empower pediatric care coordinators and emergency medical services to be properly equipped to manage pediatric emergencies.&nbsp;<a href="https://emscimprovement.center/domains/pediatric-readiness-project/readiness-toolkit/readiness-toolkit-checklist/">Use the National Pediatric Readiness Project toolkit</a>&nbsp;to find recommendations and tools hospitals can use to address gaps in their pediatric disaster care, along with services hospitals can implement to build operational readiness to manage pediatric needs daily. Disaster situations can be distressing, and hospitals also should be prepared with trained mental health professionals who understand pediatric trauma.</li><li>Engage with the community for practical solutions. Work with community stakeholders and families to hear their first-hand experiences to design support that will meet their children’s health care needs.</li></ol>Hospitals and their health care professionals understand that children are not little adults. These action steps serve as a guide to building pediatric readiness in emergency situations. When effectively implemented, they can help ensure that hospitals and emergency responders are even better prepared to address the unique needs of children. America’s hospitals and health systems are committed to continually improving the care we provide for our communities, and that includes caring for kids.Aisha Syeda, MPH, serves as senior program manager for AHA’s Strategic Initiatives. Thu, 05 Dec 2024 11:31:41 -0600 Blog Creating a Culture of Connection: Combating Isolation and Loneliness in the Health Care Workforce /news/blog/2024-11-22-creating-culture-connection-combating-isolation-and-loneliness-health-care-workforce No one goes into the health care field unless they want to care for people, but often we care for others so much that accepting care for ourselves is difficult. Add to that the fact that there is still stigma in seeking mental support; and in rural hospitals it can be especially difficult, as resources are limited. Even in the rare occasions that there are multiple locations available, health insurance may require those suffering to ask for help from the co-workers they see every day.As a leader in health care, I support 14 facilities across six states. The majority are in rural locations, many of which are critical access hospitals (CAHs). As I visited many of the facilities in 2023, I observed amazing clinical work. However, both my human resource partner and I heard endless stories of how many team members were struggling with issues at home. Multiple members of the team were caring for aging parents and children, and many were struggling with their own mental health for other reasons. Even though they were surrounded by people all day, the common theme was they felt entirely alone.I started to do some research and learned that Surgeon General Vivek Murthy, M.D., has stated that loneliness is an epidemic in our country. In his 2023 study “Our Epidemic of Loneliness and Isolation,” he found approximately 50% of adults experience loneliness. At the time, I supervised 6,000 employees, meaning it was more than probable that 3,000 people felt alone, even though they were surrounded by people who may have been going through similar issues. I realized that, as a leader, I needed to intentionally focus on creating cultures of connection.In March 2024, the human resource leader for the region and I hosted a panel discussion for Women’s History Month focusing on life’s struggles. We thought if 10 people showed up, we would have a success on our hands. Over 200 people participated virtually, and the conversation was engaging and extremely emotional. In the 30-minute session, my co-coordinator and I shared our personal stories, creating a safe space for those attending to share their own, in addition to sharing helpful resources and strategies. Comments received after the session included:<ul><li>“Thank you so much for sharing. It is tremendous to hear the real journeys some of our strongest leaders have walked through.”</li><li>“Thank you for your honesty and vulnerability in bringing to light such an important conversation. I feel connected and so hopeful for where this helps lead us all.”</li><li>“Those who are the most sad are the best at being happy on the outside.”</li></ul>We have continued with these 30-minute sessions, which have a different focus (suggested by the participants) each month. Team members have found a place to be vulnerable, to share what help they need and to see where their colleagues are struggling.We’ve also found that three things are necessary for the work to be worthwhile:<ul><li>High-level leaders need to kick things off by sharing their own stories. It can seem strange for a leader to show vulnerability, but it was and is my responsibility as a leader to demonstrate that we all have struggles.</li><li>Be clear on the why. Keeping meetings short and focused means busy people know that these meetings are worth their time.</li><li>Allow others to participate in and even adapt the program as they see fit, whether that’s suggesting topics; starting small, in-person groups; or contributing any other ideas that will best serve their team. Leadership cannot do it all, so find people who have the same passion and trust them to lead.</li></ul>Just as in our society at large, it’s clear that in the microcosms of our health care facilities there is a real need for connection. Helping people feel seen and connected to others is a critical step in reaching our ultimate goal: not one more suicide in the health care workforce. Creating a culture where team members know that colleagues — whether the high-level executive or the co-worker next to them in the lunchroom&nbsp;— truly care for them is the key to sharing the burden that no one can bear alone.Margo Karsten is the president of Banner Health’s Western Region and sits on AHA’s Policy Board for Region 8.&nbsp; Fri, 22 Nov 2024 11:13:24 -0600 Blog AHA Committee Chairs Come Together for Increasing Access to Behavioral Health Services in Rural Communities /news/blog/2024-11-04-aha-committee-chairs-come-together-increasing-access-behavioral-health-services-rural-communities Sean Fadale, FACHE&nbsp; President and CEO, Nathan Littauer Hospital and Nursing Home&nbsp; Gloversville, N.Y.&nbsp; Chair, AHA Rural Health Services CommitteeFrom the beginning of my health care career through the present day, there has been one constant challenge that my organizations have had to deal with: access to consistent and quality behavioral health services. The bulk of my work in health care has been in rural areas and the lack of access to behavioral health services has negatively impacted three major areas of need: &nbsp;<ul><li>Lack of step-down levels of care from inpatient units</li><li>Decreased volumes and challenges throughout (especially in emergency departments)</li><li>Lack of integration of behavioral health services</li></ul>Thankfully, AHA has champions like Jill Howard, who has spent her career providing organizations with solutions and initiatives that can help us mitigate our challenges. &nbsp;&nbsp;Jill Howard, RN &nbsp; Senior Consultant, Sheppard Pratt Solutions Towson, Md. Chair, AHA Committee on Behavioral HealthImproving the continuum of care in behavioral health involves ensuring that patients receive seamless, coordinated and comprehensive care across different stages and settings. This is especially important in rural markets, where access is often the most challenging. &nbsp;Below are approaches that I have leveraged to enhance that continuum:<ul><li>Integrate care models that incorporate behavioral health care services into primary care settings. This helps to improve access and facilitate communication and coordination between primary care providers and behavioral health specialists.</li><li>Coordinate care through the employment of care managers who perform roles such as tracking patient progress and ensuring that follow-up appointments are kept. This can help bridge gaps in communication among providers.</li><li>Leverage telehealth services that increase access to behavioral health care.</li><li>Develop Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP). These can be financially viable options in behavioral health care and are often greatly needed. Without the option of step-down services, inpatient length of stay can be driven up due to provider concerns surrounding safe discharge options. In addition, the lack of adequate step-down services can result in an increase in readmission rates.</li><li>Advocate for increased funding for behavioral health services to improve access and quality of care. &nbsp;</li><li>Collaborate with community mental health agencies and local providers.</li></ul>Improving behavioral health care access, volume, and ED throughput requires strategic planning, efficient processes and leveraging technology. There are several approaches to achieve this:<ul><li>Implement uniform processes such as standardized admission algorithm and criteria; metrics for response times to referrals; referral and deflection logging; and a designated MD or RN accountable for admission deflections. &nbsp;</li><li>Implement a system for capturing system referrals to decrease outmigration. </li><li>Add ED crisis assessment staff and case managers to include potential billing for assessments; this can also be achieved virtually.</li><li>Ensure provider and staff productivity and staff-to-patient ratios are in line with industry standards. Review inpatient admission and exclusionary criteria for opportunities to increase access and to include monitoring of adherence to set criteria and deflection tracking.</li><li>Leverage telehealth to expand access to behavioral health services.</li></ul>All of the above can improve access to care for individuals living in rural areas. In taking even one of these steps, hospitals and health systems can move towards the ultimate goal: To provide the best of physical and mental health care for everyone, regardless of where they live. &nbsp;&nbsp; Mon, 04 Nov 2024 15:52:50 -0600 Blog Open enrollment is a chance to choose affordable, comprehensive coverage /news/blog/2022-11-01-open-enrollment-chance-choose-affordable-comprehensive-coverage Starting today and going through Jan. 15, 2025, individuals and families may buy or change their health insurance through the Affordable Care Act marketplaces.For Americans who do not yet have comprehensive insurance through their employer, Medicare, Medicaid, or another existing program, now is the time to enroll in a plan that offers strong patient protections. The plans sold through the marketplaces must cover medically necessary care, without regard for pre-existing conditions and without arbitrary limits on that coverage. Eligible individuals and families also may be able to enroll for free or at very low cost as a result of subsidies that can reduce premiums and cost-sharing.Enrolling in coverage is critical because we don’t know where our lives or health will take us, and choosing the right coverage matters too. It’s important that those shopping for coverage during this open enrollment period look beyond the cost of the premium to ensure that their doctors and medications are covered and that their deductible and cost-sharing amounts won’t stand in the way of being able to access care.Thankfully, the ACA put in place important consumer protections, including out-of-pocket limits that ensure coverage kicks in for costly and unanticipated treatments and essential health benefit requirements that ban insurers from refusing to cover things like behavioral health or maternal care. Comprehensive, affordable health insurance helps people receive care for chronic illness, treat life-threatening diseases and receive preventive care like vaccines. It also helps to lower financial stress and keep people in the workforce and able to provide for themselves and their families.Unfortunately, some gaps remain even under the ACA. This is especially true when it comes to high deductible amounts, which enrollees must pay before coverage kicks in for many services. This is why the AHA urges enrollees to research all aspects of their coverage options before making a final selection.It also is important to be aware of other health insurance plans offered outside of the marketplaces that are not subject to any consumer protections and are very likely to have significant gaps in coverage. These plans can be appealing because of their lower upfront premiums. What these plans often fail to clearly explain to those shopping for coverage is just how costly they can be when something goes wrong. Indeed, the only reason these plans can have such low premiums is because they do not cover very much. Some do not cover emergency care or hospitalizations. They often exclude the prescription drugs that are needed to help manage a chronic condition. The rules about what is covered can change, and these plans can decline coverage for anything deemed a “pre-existing” condition. They also can impose limits on coverage.The risks to patients of these inadequate health plans are exactly why hospitals and health systems have long been strong advocates for ensuring everyone is enrolled in comprehensive, affordable health coverage. This includes working with the Administration and Congress to enact and later strengthen the ACA coverage provisions, including instituting important patient protections, establishing the health insurance marketplaces and reducing the cost of coverage through federal subsidies. The hospital field also continues to advocate for the government to prohibit the sale of products that provide substandard coverage except in very limited circumstances, such as when the plan is a temporary bridge between enrollment in comprehensive plans.Open enrollment makes it easy to pick the health plan that best fits an individual or household’s needs. Enrollees also can count on the help of local hospitals to help review coverage options and find a plan that is the best fit for them.For more information, visit <a href="http://aha.org/getcovered" target="_blank">aha.org/getcovered</a> or <a href="https://www.healthcare.gov/" target="_blank">healthcare.gov</a>.Ariel Levin is the AHA’s director of coverage policy. Fri, 01 Nov 2024 06:00:00 -0500 Blog