Pres Trump

WV Senator says "thanks, but no thanks" to Trump’s nominee for mine safety agency

cmonforton — Fri, 29 Sep 2017 16:22:06 +0000

WV Senator says "thanks, but no thanks" to Trump’s nominee for mine safety agency

West Virginia’s senior U.S. senator will not be supporting President Trump’s nominee to head the Mine Safety and Health Administration (MSHA). Senator Joe Manchin (D-WV) issued a statement on Wednesday which said:

“While I appreciate Mr. Zatezalo’s willingness to serve, I cannot support his confirmation to lead MSHA. After reviewing his qualifications and record of safety during his time in the coal industry, I am not convinced that Mr. Zatezalo is suited to oversee the federal agency that implements and enforces mine safety laws and standards.”

Ken Ward at the Charleston (WV) Gazette was first to report on David Zatezalo’s nomination. It was made public on Saturday, September 2 (Labor Day weekend) on the White House website. The announcement indicated that Zatezalo most recently served as chairman of Rhino Resources. It's a publicly-traded coal mining and oil/gas extraction firm with operations in CO, IL, KY, UT, and WV.

As he does so well, Ward put the nominee’s background in proper context. In his September 2 story, the Gazette reporter described some of the mine safety happenings while Zatezalo was with Rhino Resources.

The company had a “series of run-ins with MSHA” over serious safety violations. In 2010 and 2011, Rhino’s Eagle #1 coal mine in Raleigh County, WV was on track--- not once, but twice---for stepped up enforcement under MSHA’s “pattern of violations” authority.
In the midst of MSHA warnings over a "pattern of violations" at the Eagle #1 mine, Joseph Cassell, 33, was fatally injured while working there.
At the firm's CAM Mine #28 in Pike County, KY, MSHA had evidence of a manager giving miners advance notice that an inspector was at the mine (which is illegal under the Mine Act.) In 2011, MSHA took the matter to court. A federal judge ruled in favor of MSHA and granted an injunction against the mine operator.

Those troubling matters and more appeared in a letter sent last week to Labor Secretary Alex Acosta from three of Senator Manchin’s colleagues. Senators Patty Murray, Sheldon Whitehouse, and Robert Casey requested letters and other documents from MSHA which may help to characterize Zatezalo’s perspective on worker safety and health. The Senators are members of the Committee on Health, Education, Labor and Pension, which is considering Zatezalo’s nomination for MSHA chief.

The lawmakers' inquiry also extends to time periods when the nominee served as vice president for mining operations at AEP (2001 - 2004) and in leadership positions with the Ohio Coal Association (2004 - 2014). The Senators note that the trade group sued MSHA over its "pattern of violations" authority. They asked Labor Secretary Acosta to provide the requested documents at least three days before David Zatezalo's confirmation hearing which is scheduled for Tuesday October 3.

A "smoking gun" document is hard to come by and I doubt MSHA has one. What Senators do have is their West Virginia colleague's "thanks, but no thanks" rejection of President Trump's nominee to lead MSHA. Senator Manchin was Governor of West Virginia during the 2006 disaster at the Sago mine that killed 12 coal miners and the 2010 coal dust explosion at the Upper Big Branch mine that killed 29 men.

“I have comforted too many families who have lost loved ones serving our nation in the mines.

Investigations into those disasters revealed the consequences of lax enforcement and inadequate regulations (here, here.) No one, including Manchin, wants that repeated. No doubt that was on the Senator's mind when he wrote:

"After reviewing his qualifications and record of safety during his time in the coal industry, I am not convinced that Mr. Zatezalo is suited to oversee the federal agency that implements and enforces mine safety laws and standards.”

Will Manchin be able to convince any Republican Senators that Trump’s pick is not right for the job?

Tuesday's confirmation hearing may provide a hint.

cmonforton Fri, 09/29/2017 - 12:22

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government

Mining

MSHA

Occupational Health & Safety

Occupational Health News Roundup

kkrisberg — Wed, 27 Sep 2017 16:31:43 +0000

Occupational Health News Roundup

At the Toronto Star, reporter Sara Mojtehedzadeh went undercover as a temp worker at Fiera Foods, an industrial bakery, to investigate why temp workers are more likely to get hurt on the job. Earlier this year, Canadian occupational health and safety officials brought charges against the company, whose clients include Dunkin’ Donuts, Costco and Walmart, for the death of 23-year-old Amina Diaby, who was strangled to death after her hijab got caught in a machine.

Mojtehedzadeh, along with Brendan Kennedy, write:

I get about five minutes of training in a factory packed with industrial equipment.

I am paid in cash with no deductions or pay stubs. I pick up my wages from a payday lender, a 35-minute bus ride from the factory.

Fiera has been slapped with 191 orders for health and safety violations over the past two decades, for everything from lack of proper guarding on machines to unsafely stored gas cylinders.

At least a dozen of the women I meet on my assembly line at Fiera, a multimillion-dollar company, are hired through temp agencies.

Temp agency workers are changing the face of labour in Ontario.

In workplaces around the province, the use of temp agencies limits companies’ liability for accidents on the job, reduces their responsibility for employees’ rights, and cuts costs.

When I walk into the factory, I see mostly people of colour. Many are new Canadians. Many told me they have taken this job for one reason: to survive.

The story describes the speed of the production line as “crushing” — Mojtehedzadeh reports:

Work that is too slow elicits shouting. Work that is too sloppy elicits more shouting. Our lead hand fires out a salvo of shrill commands to push the tempo.

The pinching continues for seven hours and 15 minutes. We receive one half-hour lunch break, as required by law. It is unpaid. We also receive a paid 15-minute break.

I feel overwhelming relief when it’s finally my turn for lunch. My shoulders are on fire. I shuffle to the break room and look eagerly at the THINK SAFETY clock. Only three hours have passed. A co-worker watches me collapse onto a bench.

“It gets harder,” she calls out.

Read the full story at the Toronto Star.

In other news:

Charleston Gazette-Mail: Ken Ward Jr. reports that Sen. Joe Manchin, D-W.Va., will oppose Trump’s nominee to head the U.S. Mine Safety and Health Administration. Trump has nominated former coal executive David Zatezalo, who served as chairman of Rhino Resources. While Zatezalo was an executive at Rhino, the mining company received more than one letter from MSHA regarding a “pattern of violations”; another Rhino mine was the target of an MSHA lawsuit for undermining inspections. Manchin said in his statement: “I have comforted too many families who have lost loved ones serving our nation in the mines. Strong leadership at the Mine Safety and Health Administration is non-negotiable.”

Arizona Daily Star: Emily Bregel reports that about 160 members of the Southwest Regional Council of Carpenters showed up at a meeting of the Industrial Commission of Arizona to confront officials about being too lenient with employers who violate health and safety standards. The also confronted the commission for not aggressively going after wage theft allegations and fraud within the construction industry. (An OSHA investigation found the commission arbitrarily reduced penalties for safety violations.) Bregel reported that during the meeting, union President Fabian Sandez said: “In our industry, dishonest businesses commit on a continuing basis acts of wage theft, fraud and willful safety violations, putting the physical safety and financial well-being of our state’s workers at risk. Yet this commission has chosen to side with lawbreakers by reducing fines, watering down violations, rather than taking the appropriate actions demanded by law.”

CNBC: Lauren Thomas reports that Target will be raising its minimum wage from $10 to $11 and is committed to raising it to $15 by 2020. The move comes amid a “quiet wage war” between Target and Walmart, which had previously announced a raise to $10 an hour by 2016. Target said the wage increase will start in October and will apply to the 100,000 temp workers it plans to hire for the holidays. In a commentary, Peter Sonn, general counsel for the National Employment Law Project, writes that Target’s decision “blows up the claims of corporate lobbyists who argue it's simply not possible for industries like retail and restaurants to pay a $15 minimum wage.” He goes on to write: “Target's plan to raise pay to $15 an hour over the next 30 months is smart business strategy, and what our nation's workforce and economy need. There's now a bullseye on the back of employers like Amazon, Walmart and McDonalds. They should follow Target's lead.”

NBC Philadelphia: Alicia Victoria Lozano writes that the Philly-area International Brotherhood of Electrical Workers Local Union 98 is preparing to file suit against pharmaceutical companies that have contributed to the opioid epidemic. The union has lost eight members in 11 months to the drug. The union recently changed its opioid prescription policy to help prevent addiction, with members using the union’s health provider now limited to five days of opioids for injury or pain. The old policy allowed for unlimited opioid prescribing. Lozano quoted John Dougherty, business manager for the union, who said of fellow workers: “They don't want to miss any work time, so they work through injuries, which compounds the pain and leads to the use and abuse of opioids. I'm sick of seeing our members working themselves into an early grave.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Wed, 09/27/2017 - 12:31

Categories

Policy

Graham-Cassidy isn't a health care solution. It's a blueprint for less access, less value and less coverage.

kkrisberg — Mon, 25 Sep 2017 17:35:06 +0000

Graham-Cassidy isn't a health care solution. It's a blueprint for less access, less value and less coverage.

In yet another attempt to repeal and replace the Affordable Care Act, much of the GOP justification boils down to one argument: that the ACA isn’t working. Never mind that we don’t really know what constitutes a “working” health care system for Republicans.

For a while, Republicans said the ACA wasn’t working because some U.S. counties didn’t have an insurer. Today, no county is without an insurer. Then there’s the argument that ACA premiums are too high. However, the research shows that while premiums have gone up, the rise in premiums has been slower under the ACA than it was before the ACA. Other health policy experts have pointed out that average premiums dropped fairly significantly early in the ACA’s implementation, even as many people were receiving much more comprehensive and valuable health coverage.

It's true that premiums did rise — sometimes dramatically and it’s an issue that lawmakers in both parties agree needs to be addressed. But on the other hand, policy experts and lawmakers knew it would take insurers time to adjust to the ACA’s new rules and protections and settle on premium rates that matched the new marketplace. That’s why ACA designers included measures like the “risk corridor” program to protect insurers from too much loss and ensure their continued participation in the ACA. Plus, ACA subsides generally shield marketplace customers from premium hikes.

Now, the GOP argument is that block granting the health care system and handing over (dramatically reduced) funds to states is a magic panacea for all of our health care woes. It's an argument that falls apart once you remember that 19 states chose not to expand their Medicaid programs, even though nearly all of the costs of expansion were picked up by the federal government. That decision — made by state lawmakers — left millions of Americans in a completely preventable health insurance gap.

The Graham-Cassidy bill isn’t a new health care system — it’s the old health care system. (Except likely even worse since it devastates Medicaid funding.) The Graham-Cassidy plan strips American consumers of guaranteed health protections and puts coverage decisions back in the hands of the free market and the political whims of ever-changing state governments. We already did that — before the ACA. That old system delivered higher and higher uninsurance rates every year, higher premiums every year, no guarantee to basic health services, discrimination based on pre-existing conditions and bankruptcy-inducing lifetime limits. Graham-Cassidy threatens to do the same thing. It isn’t innovative; it’s a relic of the past.

The real story is that the ACA isn’t perfect, but it’s ushered in some extremely positive changes that deserve more attention and credit in the health care debate. Premium rates can’t be the only way we define success or failure in a health care system. We should also be focused on how well a health care system is working to broaden access to care, create affordability and improve health metrics. In that vein, let’s take a look at just a few recent studies on the impacts of the ACA — gains we risk losing under the GOP plan as well as under pressure of constant uncertainty coming from the White House.

In a study published this month in Health Affairs, researchers examined data from the Urban Institute’s 2017 Health Reform Monitoring Survey to assess recent gains in coverage, access and affordability under the ACA. They found that the gains made in the early days of ACA implementation have persisted into 2017, with adults in all parts of the country, of all ages and of all income groups benefiting from gains in the U.S. insurance rate. In particular, just 10.2 percent of nonelderly U.S. adults are now uninsured, compared to nearly 41 percent before ACA implementation. Adults with low and moderate incomes experienced the greatest reductions in uninsurance. For example, among adults with family incomes at or below 138 percent of federal poverty, uninsurance decreased by more than 42 percent following ACA implementation; among adults between 139 and 399 percent of poverty, uninsurance decreased by more than 49 percent. The study also found that the share of adults without a usual source of care decreased, the share without a routine check-up in the last year decreased, and fewer adults reported unmet medical needs due to cost.

This study, recently published in Medical Care Research and Review, analyzed credit bureau data to get a clearer picture of how the ACA Medicaid expansion impacted people’s finances. In states that decided to expand Medicaid, researchers found financial improvements as measured by: improved credit scores; reduced balances past due as a percent of total debt; reduced probability of a medical collection balance of $1,000 or more; reduced probability of having one or more recent medical bills go to a collection agency; reduction in the probability of experiencing a new negative balance of any type; and a reduced probability of a new bankruptcy filing. The study states: “This work demonstrates how the ACA Medicaid expansions have improved economic well-being of low-income Americans, which at the same time has implications for providers and payers of medical services.”

A new study published in the journal Drug and Alcohol Dependence examined the impact of the ACA on opioid addiction treatment. (FYI: Another recent study found that the opioid overdose epidemic has become so bad in the U.S. that it’s contributed to a decline in overall life expectancy.) The ACA study analyzed data from the National Survey on Drug Use and Health on more than 4,000 people with an opioid use disorder between 2008 and 2004. The researcher found that the odds of insurance coverage increased by 72 percent for people with an opioid use disorder between 2008 and 2014. In addition, the odds of not receiving addiction treatment due to financial concerns dropped by 50 percent. After ACA implementation, the study found, the odds of receiving opioid addiction treatment increased by 158 percent, with the odds of a person’s insurance paying for the care going up by 213 percent. (The Graham-Cassidy bill would allow states to waive essential health benefits, such as substance abuse treatment.)

A 2017 study from the Commonwealth Fund, based on data from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System, found that ACA expansions decreased the probability of not receiving medical care by between 21 percent and 25 percent. It also found that gaining insurance coverage increased the probability of having a usual source of care by up to 86 percent. Before the ACA, about 47 percent of uninsured people reported they were unable to get medical care because of cost. Gaining health insurance cut that number by half.

Graham-Cassidy isn’t the future of health care — it’s not a bill informed by evidence-based ways of improving people’s health and lives. It’s a bill based on political calculations, not medical ones.

Yes, the ACA isn’t perfect. But it’s making real progress that lawmakers should be working to improve upon, not tear down. If you’d like to voice your opinion on Graham-Cassidy, the American Public Health Association has an easy-to-use template to help you reach your representatives in Congress.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Mon, 09/25/2017 - 13:35

Doctors, public health workers, patient advocates — even insurers — oppose latest ACA repeal

kkrisberg — Wed, 20 Sep 2017 16:20:00 +0000

Doctors, public health workers, patient advocates — even insurers — oppose latest ACA repeal

Senate Republicans are again trying to ram through an Affordable Care Act replacement that threatens the health and well-being of millions of Americans. It’s shameful. But don’t take my word for it. Let’s look at what people who actually work in health care are saying about the Graham-Cassidy-Heller-Johnson bill.

In this interview, Sen. Bill Cassidy insists that his bill would protect people with pre-existing conditions. Blue Cross Blue Shield Association disagrees. (Cassidy also says in that same interview that his bill would work through the Children’s Health Insurance Program (CHIP), which he said has been reauthorized. That’s totally false — CHIP has not been reauthorized and its funding expires Sept. 30.) But back to pre-existing conditions — here’s what Blue Cross Blue Shield had to say:

Although we support providing states with greater flexibility in shaping health care options for their residents, we share the significant concerns of many health care organizations about the proposed Graham-Cassidy bill. The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.

America’s Health Insurance Plans just released this letter that was sent to Senate leaders Mitch McConnell, R-KY, and Charles Schumer, D-NY. Guess what? They also read the proposed repeal as taking away protections for pre-exiting conditions:

The Graham-Cassidy-Heller-Johnson proposal...would have real consequences on consumers and patients by further destabilizing the individual market; cutting Medicaid; pulling back on protections for pre-existing conditions; not ending taxes on health insurance premiums and benefits; and potentially allowing government-controlled, single-payer health care to grow.

AARP thinks so too:

Overall, the Graham/Cassidy/Heller/Johnson bill would increase health care costs for older Americans with an age tax, decrease coverage, and undermine preexisting condition protections. In addition, this bill would jeopardize the ability of older Americans and people with disabilities to stay in their own homes as they age and threaten coverage for individuals in nursing homes.

Cassidy insists more people will have coverage under his plan. But strangely, people that actually deliver medical care to people disagree. Here’s what the Children’s Hospital Association had to say:

Their legislation would slash funding for Medicaid, the nation’s largest health care program for children, by one-third, reducing access and coverage for more than 30 million children in the program. Furthermore, the legislation weakens important consumer safeguards, and as a result, millions of children in working families would no longer be assured that their private insurance covers the most basic of services without annual and lifetime limits and regardless of any underlying medical condition. This bill would have devastating consequences for children and families.

In a letter to Senate leaders, the American Medical Association writes:

Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care. We are particularly concerned with provisions that repeal the ACA’s premium tax credits, cost-sharing reductions, small business tax credit, and Medicaid expansion, and that provide inadequate and temporary block grant funds (only through 2026) in lieu of the ACA’s spending on marketplace subsidies and the Medicaid expansion.

Not surprisingly, the Republican replacement is bad for women’s health too. According to Planned Parenthood:

The Graham-Cassidy-Heller proposal includes a provision that would block millions of people from going to Planned Parenthood for preventive care, including birth control, cancer screenings, and STD testing and treatment.

And because Cassidy’s bill would allow states to weaken pre-existing condition coverage and the requirement that insurers cover a set of essential health benefits, coverage of maternity care would be at serious risk. According to an analysis from the Center on Budget and Policy Priorities:

While insurers would still be required to offer coverage to people with pre-existing conditions, insurers could charge unaffordable premiums of thousands or tens of thousands of dollars per month, effectively resulting in a coverage denial. Insurers could also offer plans with large benefit gaps. For example, before the ACA introduced the requirement that all plans cover a defined set of basic services, 75 percent of individual market plans excluded maternity coverage, 45 percent excluded substance use treatment, and 38 percent excluded mental health care, according to analysis by the Kaiser Family Foundation. This would leave many people — especially those with pre-existing conditions — without access to the health services they need.

And let’s not forget public health. The ACA’s Prevention and Public Health Fund (PPHF) has become an absolutely critical source of funding for the nation’s public health agencies. Cassidy’s bill would eliminate that fund. Here’s what the Big Cities Health Coalition, a forum for the country’s largest metropolitan health departments, had to say about the fund’s potential elimination:

Among the programs at risk at the CDC are the 317 Immunization Program, Epidemiology and Laboratory Capacity Grants, the Childhood Lead Poisoning Prevention Program, and a host of chronic disease programs. The PPHF provides vital resources to governmental public health at all levels, and its elimination will further erode our fragile health system.

Eliminating public health programs that are now funded by the ACA would seriously undermine the ability of cities and counties to protect and promote health. The loss of hundreds of millions of dollars would hamper efforts to respond to food borne illness outbreaks, prevent emerging infectious diseases like Ebola and Zika, and respond to natural disasters like Hurricanes Irma and Harvey.

And in a letter to senators from the American Public Health Association, Executive Director Georges Benjamin writes:

The Graham-Cassidy plan would also eliminate the Prevention and Public Health Fund, the first and only mandatory funding stream specifically dedicated to public health and prevention activities. The fund has already provided more than $6 billion to support a variety of public health activities in every state including tracking and preventing infectious diseases like the Ebola and Zika viruses, community and clinical prevention programs, preventing childhood lead poisoning and expanding access to childhood immunizations. Eliminating the fund would devastate the budget of the Centers for Disease Control and Prevention. The fund currently makes up 12 percent of CDC’s budget and eliminating this funding stream would force Congress to replace the funding through the regular appropriations process where resources for nondefense discretionary programs are already too low.

Graham-Cassidy-Heller-Johnson is a threat to America’s health. If you’d like to voice your opinion, the American Public Health Association has an easy-to-use template to help you reach your representatives in Congress. For more information on the ACA replacement, NPR has a fantastic explainer.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Wed, 09/20/2017 - 12:20

Categories

Policy

Occupational Health News Roundup

kkrisberg — Tue, 12 Sep 2017 19:30:59 +0000

Occupational Health News Roundup

At the Huffington Post, Dave Jamieson reports that labor unions are stepping up to help protect increasingly vulnerable immigrant workers from deportation. In fact, Jamieson writes that in many instances, labor unions have become “de facto immigrants rights groups,” educating workers on their rights and teaching immigrants how to best handle encounters with immigration officials.

Jamieson’s story begins:

Yahaira Burgos was fearing the worst when her husband, Juan Vivares, reported to the Immigration and Customs Enforcement office in lower Manhattan in March. Vivares, who fled Colombia and entered the U.S. illegally in 2011, had recently been given a deportation order. Rather than hide, he showed up at the ICE office with Burgos and his lawyer to continue to press his case for asylum.

Vivares, 29, was detained for deportation. That’s when Burgos’ union sprang into action.

Prepared for Vivares’ detention, members of the Service Employees International Union Local 32BJ gathered for a rally outside the ICE office that afternoon, demanding his release. Union leadership appealed to New York’s congressional delegation, enlisting Senate Minority Leader Chuck Schumer (D) to reach out to ICE leadership. The union president even disseminated the name and phone number for the ICE officer handling Vivares’ deportation and urged allies to call him directly.

“I was very lucky to have a union,” said Burgos, a 39-year-old native of the Dominican Republic who works as a doorwoman on the Upper East Side. “They moved very fast. They moved every politician and every union member. ... If it were not for the union he would be deported.”

Vivares is now at home with Burgos and their 19-month-old son, having been granted a stay of deportation as the court considers his motion to reopen his asylum case. Although he’s far from being in the clear, his lawyer, Rebecca Press, says the union’s quick response was critical to keeping Vivares in the U.S. for now. “I do believe that their being able to reach the upper echelons of Congress gave us a window of time,” she said.

Vivares’ case provides a vivid example of the gritty work unions are doing to protect immigrant members and their families vulnerable to deportation in the Trump era.

Read the full story at the Huffington Post.

In other news:

Charleston Gazette-Mail: Ken Ward Jr. reports that Trump intends to chose David Zatezalo, the former chief executive of the coal company Rhino Resources, to head up the U.S. Mine Safety and Health Administration. Zatezalo was a top executive at Rhino when MSHA cited the company for a number of health and safety violations, including two “pattern of violations” letters. In 2011, MSHA took the “unusual” action of seeking a court injunction against Rhino after the agency discovered that miners were being tipped off about the timing of MSHA inspections. In a related article in the Huffington Post, Dave Jamieson wrote: “If he’s confirmed by the Republican-controlled Senate, Zatezalo would be just the latest business-friendly official installed in Trump’s deregulation-happy administration. And like many of the appointees before him, Zatezalo has a resume that appears better suited to an industry trade group than a watchdog government agency.”

Sacramento Bee: Marjie Lundstrom reports that a year after 26-year-old Abraham Nicholas Garza was crushed to death at a Sacramento Goodwill outlet store, the nonprofit is facing new lawsuits and heightened scrutiny regarding its worker safety practices. In particular, California’s Division of Occupational Safety and Health opened three more investigations into safety issues at three Goodwill locations in the region. Among the lawsuits is one brought by Dave Goudie, a commercial truck driver who witnessed Garza’s death and had repeatedly warned Goodwill managers about the store’s hazardous work conditions. Goudie is suing Goodwill, his former employer, for defamation and retaliation. In the wake of Garza’s death, Goodwill was issued six violations and more than $106,000 in fines — the highest OSHA penalty ever issued against a Goodwill operation nationwide.

Vox: Alexia Fernandez Campbell reports that in the wake of Hurricane Harvey, unauthorized workers will likely be “desperately needed” to rebuild Houston and the surrounding areas, even as Texas lawmakers are cracking down on undocumented residents and making it harder for them to live and work in the state. Campbell noted that after Hurricane Katrina, undocumented workers did the “dirtiest jobs” during the rebuilding effort, making an average of $10 an hour; overall, undocumented immigrants made up about 25 percent of construction workers after Katrina. However, the post-Katrina situation was also ripe for worker exploitation. Campbell writes: “Federal contractors found themselves in a situation where they could pay workers little money to do dangerous work with little federal oversight. The Department of Labor also temporarily lifted worksite safety enforcement actions against employers in hurricane-affected areas. As a result, undocumented workers were far less likely to get the wages they were promised.”

Los Angeles Times: Matt Hansen writes that years after the Sept. 11 terrorist attacks, “the list of the fallen continues to grow as police officers, firefighters, first responders and recovery workers succumb to illnesses linked to their work in the aftermath of the attacks.” Yesterday, he reported, a memorial on Long Island, New York, was dedicated to those who died on Sept. 11 as well as to those who’ve died from response-related illnesses. As of June, the World Trade Center Health Program had more than 67,000 responders and 12,000 attack survivors enrolled; since the program began in 2011, more than 1,300 enrollees have died, though not all deaths were related to the attack. Hansen writes: "John Feal, who heads the FealGood Foundation, a nonprofit that advocates for first responders, worries that there are still too many responders and survivors who aren’t aware of the federal programs. ‘The reality is that more and more people are getting sick and dying,’ he said. He is particularly concerned about the coming emergence of asbestos cases, which he noted can take up to 20 years to appear.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 09/12/2017 - 15:30

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Occup Health News Roundup

occupational fatalities

Occupational Health & Safety

OSHA

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Public Health - General

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Labor Day yearbook: All workers deserve safety, dignity, respect and justice on the job

kkrisberg — Fri, 08 Sep 2017 15:55:44 +0000

Labor Day yearbook: All workers deserve safety, dignity, respect and justice on the job

Typically, we like to end the annual “The Year in U.S. Occupational Health & Safety” on an uplifting note. But this time around — to be honest — that was a hard sell.

Take a quick look through the 2017 yearbook and you’ll quickly glean that worker health and safety is very much at risk under the new administration and from lawmakers in the states. From the attempted rollback of a new federal beryllium exposure standard to state efforts to weaken workers’ compensation systems, the view from 2017 does not seem terribly promising. On the other hand, the fight for workers’ rights has never been easy — it’s always been a movement defined by taking on the powerful by giving voice to the powerless. In that way, organizers and advocates are well prepared for the fight ahead — and they have a long history of labor accomplishments from which to draw strength.

On that note, we leave you with an excerpt from the 2017 yearbook — a section called “The Year Ahead”:

Let’s be frank, the year ahead does not look great. It looks hard and disappointing and upsetting. Beyond the politics and talking points and arguments, the cold, hard fact on the ground is that weakening key mechanisms that create safe and fair working conditions — like data collection, transparency, research and enforcement — emboldens unscrupulous employers and puts workers in harm’s way. This is a fact.

Just as this yearbook was going to press in August, worker safety advocates noticed that OSHA has scrubbed its worker fatality list from its home page and buried the link on an internal page. Now, the list only contains incidents for which a citation was issued and removes the names of deceased workers. A Department of Labor spokesperson told reporters the change was meant to protect the privacy of workers’ families. The truth is that OSHA leadership decided to weaken one its most useful enforcement tools. The truth is that removing workers’ names only protects the privacy of employers who may have needlessly put them at mortal risk. A decision like this dehumanizes workplace fatalities, erasing from the raw data the real people and families behind the numbers.

Word of OSHA’s website change began circulating around worker advocate listservs and on occupational safety and health sites. By that afternoon, the news had popped up in Politico. Just as quickly as advocates had spread word about the problem, they began discussing ways to ensure that the names and stories of fallen workers would not be washed from public view.

No one is surprised that the Trump administration is hostile toward OSHA, an agency whose mission is to hold employers accountable to the law. After all, it’s also a fact that private citizen Trump had a sizeable history of ﬂouting labor laws and practicing ethically questionable behaviors in his own business ventures. Still, watching those inclinations manifest into public policy is hard to stomach.

All that said, we know worker advocates in communities across the country won’t be deterred. They’ll just work harder. They face anti-worker sentiment every day, working hand in hand with some of the most powerless people in the U.S. They know that the collective power of informed workers is greater than those who conspire to deny workers their rights and erase their names from view. Labor history is full of such stories. For example, just this year, farm workers in Washington state ofﬁcially formed America’s ﬁrst new farm worker union in 25 years. The union is aptly named Familias Unidas por la Justicia — or Families United for Justice.

With the future so uncertain and federal commitment to worker safety so unclear, it seems like a critical moment to support organizers on the ground and stand with workers in the streets. Let next year’s Workers’ Memorial Week be a forceful reminder that all workers, regardless of immigration status, deserve safety, dignity, respect, and justice on the job. To borrow a phrase from another social justice movement, workers’ lives matter. Keep telling their stories.

Like we wrote earlier this week, we also hope you’ll help share the 2017 yearbook far and wide — not only is the yearbook a call to action, it’s a source of inspiration and motivation. Download the 2017 yearbook here and find previous editions here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 09/08/2017 - 11:55

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Occupational Health & Safety

OHS Yearbook

OSHA

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Public Health - General

The Year in US Occupational Health and Safety

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A Labor Day tradition: Sixth annual yearbook on worker health and safety released today

kkrisberg — Mon, 04 Sep 2017 12:42:41 +0000

A Labor Day tradition: Sixth annual yearbook on worker health and safety released today

For the sixth year in a row, we present “The Year in U.S. Occupational Health & Safety,” our attempt to document the year’s highs and lows as well as the challenges ahead.

Like previous editions, the 2017 yearbook highlights policies, appointments and activities at the federal, state and local levels; outstanding news reporting on workers’ rights, safety and health; and the latest research from public health agencies and worker groups on the ground. Of course, you can’t ignore the giant elephant (no pun intended) in the room in 2017 — a new president and a Republican-controlled Congress that seem intent on rolling back worker protections and making it harder to access the very information that’s used to prevent future injuries and illnesses in the workplace.

To give you a better sense of our 2017 yearbook, released appropriately on Labor Day, below is a passage from its “Introduction and Overview”:

Protecting worker health and safety is always a challenge, no matter the administration in charge. OSHA is and has always been the little agency that could — there is perhaps no other federal agency whose mission is more stacked against the odds. And yet OSHA has made huge gains in its more than four-decade history.

Today, after eight years of steady and hard-fought progress, advocates are watching in dismay as the Trump administration’s anti-regulatory agenda goes to work inside OSHA. Just a couple of examples from the first eight months: elimination of the Fair Pay and Safe Workplaces rule, which required those bidding for federal contracts to disclose prior labor violations; proposed elimination of OSHA’s new beryllium exposure standards for the maritime and construction industries; and moves to roll back an Obama-era rule expanding overtime eligibility to millions more workers.

Beyond the regulatory rollbacks, OSHA under Trump has quietly made itself less transparent, changing its everyday practices to make  it harder for advocates to access worker safety data and easier for negligent employers to break the law with little public notice. For instance, in the first four months of the Trump administration, OSHA issued just two enforcement-related news releases, even though the agency had issued more than 200 citations exceeding $40,000. The shift was a big deal, as the resource-strapped agency has typically used public notices as a low-cost, but potentially persuasive, enforcement tool.

Most recently in late August, worker safety advocates noticed and quickly spread word about changes on OSHA’s website, where a link to “Workplace Fatalities” had disappeared from the agency’s home page. The fatality list had also been scaled back to only include workplace deaths in which a citation was issued. Both changes make it more burdensome to access health and safety data, which in turn makes it harder to protect workers and hold employers accountable. On top of all that, the Trump administration is proposing elimination of the Chemical Safety Board and big funding cuts to the Department of Labor and the National Institute for Occupational Safety and Health.

At the end of the day, it’s worrisome, but oddly familiar territory for safeguarding workers’ rights, safety, and health.

We’ll be providing brief snapshots of the 2017 yearbook here at The Pump Handle every day this week. We hope you’ll write to us in the comments section detailing your own experiences from the past year and letting us know what we might have missed. We also hope you’ll help share the 2017 yearbook far and wide — not only is the yearbook a call to action, it’s a source of inspiration and motivation. Something we could all use this Labor Day.

Download the 2017 yearbook here and find previous editions here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Mon, 09/04/2017 - 08:42

Terrific work as always, Celeste and Kim! It's a grimmer picture this year, but great to see important progress in some states and in research.

Public health officials call on HHS to restore grant funding for preventing teen pregnancies

kkrisberg — Tue, 22 Aug 2017 16:19:42 +0000

Public health officials call on HHS to restore grant funding for preventing teen pregnancies

In July, public health departments across the country got a letter from the Trump administration abruptly cutting off funding for teen pregnancy prevention efforts in the middle of the program’s grant cycle. The move means that many teens will miss out on receiving an education that could — quite literally — change the trajectory of their lives.

The abrupt funding cut — which came down without reason or explanation, according to grantees — also cuts off research efforts right at the evaluation stage. That’s the stage when public health practitioners rigorously assess a program’s outcomes, gather evidence of its effectiveness, and determine what works and what doesn’t. That’s exactly what we should want from our public investments — evidence, not anecdotes — and it’s exactly how you tackle a problem as complex and as costly as teen pregnancy. Teasing out the evidence is how we sort the aspirational from the effectual.

And determining what works to prevent and reduce teen pregnancy is a worthy endeavor. According to the Centers for Disease Control and Prevention, while the U.S. teen birth rate recently hit a record low — the birth rate among young women ages 15 to 19 dropped 8 percent between 2014 and 2015 — the U.S. is still home to one of the highest teen pregnancy rates in the industrialized world. And that rate comes with impacts, including upping the risk that teen girls won’t graduate from high school, which has a generational domino effect in and of itself, as well as racking up billions in societal costs related to health care, foster care and lost tax revenue. Plus, nearly all teen pregnancies are unplanned, which makes investing in their prevention sound public policy.

At a news conference held earlier this month and hosted by the Big Cities Health Coalition (BCHC), health officials from cities on opposite coasts — Baltimore and Seattle — spoke about the importance of preventing teen pregnancy in their communities and the on-the-ground impact of abruptly losing federal funding that had already been awarded and appropriated. Both the Baltimore City Health Department as well as Public Health — Seattle & King County are among the 81 grantees who received a letter from the U.S. Department of Health and Human Services (HHS) in July saying the five-year grant they’d already been awarded through the agency’s Teen Pregnancy Prevention Program would be ending two years early, in 2018 instead of 2020.

Both Leana Wen, Baltimore’s health commissioner, and Patty Hayes, director of Public Health — Seattle & King County, said there was no dialogue, discussion or explanation for the funding cut. The announcement didn’t even come in a special notice. Instead, both health officials found out about the cut when they received their usual, yearly notice-of-award letter in which the end date had been pushed up by two years. Hayes said Seattle’s program manager quickly reached out to HHS for an explanation and was basically told the agency was moving on to implement the cuts.

“It’s just an arbitrary decision that we’re trying to appeal,” Hayes said during the BCHC news conference.

Hayes and Wen are among 20 public health officials from around the country who signed onto a BCHC letter to HHS Secretary Tom Price asking him to reconsider the cuts. Also, in July, Democratic senators wrote to Price asking him to explain his plan to “unilaterally” cut the teen pregnancy prevention grants short. The letter states:

Since the start of the grant projects and prior to the recent notification of early termination, (the HHS Office of Adolescent Health) has ensured the program includes high quality implementation, rigorous evaluation, innovation and learning from results. The pace of progress has accelerated dramatically since the federal investments in evidence-based teen pregnancy prevention began. Since 2010, pregnancy rates among 15- to 19-year-olds has declined by 41 percent nationwide — more than double the decline in any other six-year period since rates peaked in 1991 — and is at a historic low. Seventy-five percent of pregnancies among this population remain unintended. The (Teen Pregnancy Prevention) Program has been proven to support young people in delaying sexual initiation and adopting sexual health behaviors that help them avoid unintended pregnancy.

In Baltimore, the grant termination means a cut of $3.5 million, which means 20,000 students in grades seven through nine will lose access to comprehensive reproductive health education, Wen said. The funding cut also means the agency won’t have the resources to continue training teachers or members of a local youth advisory council that does peer-to-peer education.

Wen said Baltimore has made huge progress in reducing its teen birth rate — it fell by 44 percent between 2009 and 2015. She’s worried that losing any ground on that front will only lead to fewer educational and economic opportunities for Baltimore youth, fewer young women graduating from high school and greater public costs to the community.

“We should be doing everything we can to empower youth to succeed and thrive,” Wen said during the BCHC news conference. “We see the impact in our cities, and we urge the federal government and HHS to reconsider this drastic cut, taking into account the future of all of our youth across the country.”

In Seattle and King County, where teen pregnancy rates have gone down by more than half since 2008, public health officials were using their $5 million Teen Pregnancy Prevention grant to evaluate the effectiveness of a sexual health curriculum they recently updated called FLASH, which includes a variety of strategies to help reduce teen pregnancy, sexually transmitted diseases and sexual violence. During the BCHC news conference, Hayes said FLASH has been used all over the U.S. and the world, with about 80,000 FLASH lessons downloaded in the span of just one year. She noted that the curriculum is designed to be inclusive of LGBT students and is just as relevant for young people who decide to abstain from sex as it is for those who don’t.

However, Public Health — Seattle & King County hadn’t had the chance to rigorously evaluate the curriculum to tease out its exact impacts, such as whether it increased the number of students who delay sex or the number of young people who practice safe sex. That’s what it was using its HHS grant funding for – to measure the effectiveness of the curriculum. The public health agency had already recruited more than two-dozen schools in multiple states to take part in the evaluation; thousands of students participated in the FLASH curriculum and an independent evaluator was hired to analyze the outcomes.

But now that HHS has shut down the grant funding early, that data will be lost. Hayes said she believed there was a “good chance” the evaluation would have shown that FLASH does, indeed, make a positive difference in young people’s lives. Without such evidence, however, it may become more difficult to persuade schools to adopt the curriculum. Hayes said her agency has filed an administrative appeal with the HHS Office of Adolescent Health in the hopes of getting the funding restored.

Hayes said she believes the funding cut is due to both across-the-board budget cuts, but also to an ideological shift on how to address teen pregnancy.

Beyond the particular efforts that the HHS grants were supporting, the abrupt funding cuts also impact both agencies’ overall capacity to prevent teen pregnancy in their communities. In Baltimore, Wen said the funding gap will “create a huge hole in our ability to deliver services.” At Public Health — Seattle & King County, Hayes said the grant supported a significant portion of the agency’s teen pregnancy prevention efforts.

“It does shrink our program,” Hayes said, “and so it’s not without great implications.”

Visit CDC to learn more about the benefits of investing in teen pregnancy prevention.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 08/22/2017 - 12:19

Tags

government

Pres Trump

Public Health - General

teen pregnancy prevention

Everyday I read a heartbreaking report from this Whitehouse. The ignorance is dumbfounding and down right scary.

Report: U.S. funding for global health research saves lives and creates American jobs

kkrisberg — Wed, 02 Aug 2017 12:19:14 +0000

Report: U.S. funding for global health research saves lives and creates American jobs

U.S. investments in global health research have saved millions of lives and prevented immeasurable suffering. And by working to detect, treat and eventually eliminate infectious diseases worldwide, we’re protecting our own country too. That cliché about diseases knowing no borders is unfortunately very true. All that alone should be enough to remain committed to the cause.

But a couple weeks ago, a new report from the Global Health Technologies Coalition (GHTC) offered another persuasive reason: U.S. funding for global health research and development (R&D) is good for the American economy. The report, “Return on Innovation,” found that in 2015, 89 cents of every U.S. public dollar directed to global health R&D was invested right here at home. Between 2007 and 2015, that investment injected $12 billion into the U.S. economy, creating an estimated 200,000 new jobs and generating an additional $33 billion in economic output. Every $1 that the National Institutes of Health spends on basic research is estimated to generate more than $8 of industry investments over the next eight years.

“We want policymakers to know that (global health funding) affects their constituents,” Jamie Bay Nishi, director of GHTC, told me. “Part of the interesting story here is the catalytic power of U.S. government investment in terms of incentivizing private investment.”

Nishi said work on the new report began last fall — before the presidential election — and wasn’t initially intended as a response to global health cuts now being proposed by the Trump administration. With U.S. funding for global health R&D either stagnant or declining since 2009 (with the exception of emergency funds for Ebola and Zika), Nishi said the report was written to help “change that trend line regardless of administration.” According to the report, the U.S. invested $1.7 billion in global health R&D in 2015, which represented less than one-tenth of 1 percent of U.S. gross domestic product. The 2015 budget for global health R&D was already a quarter-billion dollars less than 2012 funding levels.

President Trump’s fiscal year 2018 proposal doesn’t look much better. Among its many recommended cuts to global health: A 50 percent cut to USAID global health programs, including a zeroing out of its HIV programs; a $25 million cut to neglected tropical diseases; a $65 million cut to maternal and child health; a $1.1 billion cut to the National Institute of Allergy and Infectious Diseases, which leads critical infectious disease research; and a $70 million cut to the CDC’s National Center for Emerging and Zoonotic Infectious Diseases. There’s more than that, but fortunately no one — including Nishi — thinks Trump’s budget will make it out of Congress in one piece. Like many other advocates working in Washington, D.C., she called it “dead on arrival.”

The budget proposal from House looks better for global health — it increases the NIH budget and saves its global health center, though it still recommends sizeable cuts to USAID and CDC. The House proposal may be an improvement over Trump’s, but Nishi said “there’s still too many variables out there for us to feel that global health funding for R&D is safe.”

Enter the new GHTC report, which provides a trove of information on the benefits and returns we yield with investments in global health R&D. Its authors write:

Not only does U.S. government investment play an essential and catalytic role in developing new drugs, vaccines, diagnostics, and other urgently-needed tools for neglected diseases and health conditions, but it also delivers tangible economic and security returns for Americans. This is a win-win from a humanitarian and strategic perspective – these investments save and improve lives in vulnerable populations around the world, while at the same time advancing American leadership in science and innovation, creating jobs and economic growth at home, supporting public-private partnerships, and protecting American and health security.

First, the lives saved. According to the GHTC report, all 42 new drugs, diagnostics, vaccines and reproductive health technologies created since 2000 with U.S. investment have made a positive difference. For instance, a 50-cent meningitis A vaccine, developed with U.S. global health R&D funding support, prevented 673,000 cases of disease, 378,000 deaths and 63,000 cases of lifelong disability. By the end of this decade, this one vaccine will have saved $9 billion in health care spending. Other examples include a new pediatric malaria treatment estimated to have saved 750,000 children, and a late-stage HIV vaccine candidate now being tested that could cut the number of new HIV infections in half in just 10 years.

Global health R&D is good for America’s health and economy too. Since 2007, global health R&D investment has created about 200,000 U.S. jobs and generated more than $30 billion in economic output as it cycles its way through the American economy. For example, the U.S. invested $192 million in global health R&D monies into U.S.-based pharmaceutical companies in 2015. That investment, according to the report, encouraged those companies to invest another $294 million, with the majority of that money spent domestically. In other words, “US government investment in global health R&D has a stimulative effect” that not only encourages additional private investment in the U.S. economy, but investment in disease research that benefits the world’s poorest people.

Plus, upfront investments now could help avert much higher spending in the future. For example, the growing problem of antimicrobial resistance — a problem often described as a looming public health crisis — is expected to cause 10 million deaths by 2050 and cost the global economy upwards of $100 trillion. However, according to the GHTC report, investing $2 billion annually in anti-microbial R&D could lead to the kinds of tools needed to combat the problem. Global R&D investments also prepare us for the next novel disease outbreak. The report notes:

The US government spent nearly $600 million to improve domestic preparedness for Ebola within the United States during the recent outbreak, and an additional $2.4 billion on efforts to combat and contain the Ebola outbreak at its source. If a point-of-care diagnostic and vaccine against Ebola had been available at the start, the 2014 West African Ebola outbreak would never have grown into the global health emergency it became. Not only would thousands of deaths have been prevented, but the US government would also have saved billions of dollars.

Nishi said the coalition hopes to follow its new report with one that breaks down the impact of global health R&D at the state level — “we really want to connect those dots for policymakers so they understand why they should care about this,” she said.

“First and foremost, it’s about saving millions of lives,” Nishi said. “The U.S. has an incredible history of being a leader in technology and innovation and that should hold true when it comes to (global health R&D) as well.”

She added: “Sometimes it does seem like these are distant problems and it’s hard to see the connections. …But it can’t be U.S. health versus global health — U.S. health is global health.”

For a copy of the “Return on Innovation” report, visit GHTC.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Wed, 08/02/2017 - 08:19

Tags

Public Health - General

global health funding

global health research and development

Anything that saves lives is ok with me.

Study: ACA-backed efforts to reduce hospital readmissions also reduced mortality

kkrisberg — Sat, 22 Jul 2017 12:36:11 +0000

Study: ACA-backed efforts to reduce hospital readmissions also reduced mortality

With the future of the Affordable Care Act still up in the air, most of the news coverage has gone to insurance coverage, premiums and Medicaid. And rightly so. But also included in the massive health reform law were a number of innovative measures to improve the quality and value of the medical care we actually get in the doctor’s office. With repeal still on the table, those measures are at risk too.

One of those ACA efforts is the Hospital Readmissions Reduction Program, which reduces Medicare payments to hospitals with relatively high rates of often-preventable hospital readmissions. The program is focused on readmissions after an initial hospitalization for a select group of conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, elective hip or knee replacement, and coronary artery bypass graft.

The idea is to incentivize hospitals to adopt protocols that improve the quality and coordination of care so that patients can avoid costly and stressful readmissions to the hospital. Luckily, there are a number of protocols shown to work, such as providing patients and caregivers with better discharge instructions, coordinating post-hospital care with a patient’s primary care doctor, and improving efforts to prevent surgical site infections.

So far, research shows such readmission rates have been falling since 2012, when the ACA financial penalties kicked in (though it’s important to note that hospitals began receiving and reviewing their Medicare readmission data back in 2009). Federal officials estimate hundreds of thousands fewer readmissions between 2010 and 2015. Still, every new initiative comes with concerns, as did this one: Would financially penalizing hospitals for readmissions encourage them to deny patients needed care? Does reducing readmissions among Medicare patients increase death rates after discharge?

Kumar Dharmarajan set out to examine that question in a study published this month in JAMA. He and co-authors not only found no increase in death rates; they actually detected a slight decrease in death rates associated with heart attack, heart failure and pneumonia.

“It was an important question because the financial penalties for readmissions have been one of the biggest changes in payment policies in recent years,” Dharmarajan, chief scientific officer at Clover Health, a Medicare Advantage insurer, told me. “Honestly, I wasn’t surprised at the results. Strategies that hospitals take to lower readmissions are generally very patient-centered and they should really be standard patient care. …Plus, the idea that hospitals would keep sick patients out isn’t in the DNA of doctors.”

But it’s still important to look for any unintended consequences of such a big policy change — one that essentially changed a key hospital revenue stream from paying based on quantity to paying based on quality.

To conduct the study, Dharmarajan and colleagues analyzed Medicare data on patients ages 65 and older who were hospitalized for heart failure, heart attack and pneumonia between 2008 and 2014. During that same time period, 30-day readmission rates declined across hospitals for the three conditions. The study found that the decrease in readmission rates for the three health conditions did not coincide with an increase in death among patients. Instead, they actually found a slight decrease in death for the three conditions. To quote the study directly: “Reductions in 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge.” In fact, researchers found an even stronger link between reduced readmissions and reduced mortality at 90 days after initial discharge from the hospital.

Dharmarajan and co-authors Yongfei Wang, Zhenqiu Lin, Sharon-Lise Normand, Joseph Ross, Leora Horwitz, Nihar Desai, Lisa Suter, Elizabeth Drye, Susannah Bernheim and Harlan Krumholz write:

Researchers and policymakers have also expressed concern that penalizing hospitals caring for patients with low socioeconomic status could worsen disparities for this vulnerable group of patients. However, recent national declines in readmission rates have been greater at hospitals caring for patients with low socioeconomic status and have therefore reduced disparities in readmission across hospitals. In this context, this study has shown that hospitals with greater readmission reductions have had greater improvements in mortality. Hospitals nationally have made significant efforts to lower readmissions through improved transitional and postacute care.

“Hospitals really pushed to increase responsibility and accountability for patient outcomes after discharge,” said Dharmarajan, also an adjunct faculty member of Yale School of Medicine. “It’s a win for patients and for the health care system. This policy really did lead to physicians breaking down the siloes that had separated the inpatient and outpatient world.

“And it’s an example of a win that didn’t occur because of an expensive new technology or new drug, but because of very purposeful collaborations between patients, providers, hospitals and providers out in the community,” he said.

Dharmarajan noted that while some hospitals were aware of and even working on their readmission rates before the ACA, the law certainly motivated hospitals to further invest in the kinds of care coordination strategies shown to improve patient outcomes. In other words, the ACA aligned payment incentives in way that put long-term patient health outcomes front and center.

“Initially, I think hospitals were very uncomfortable with the idea of being held accountable for patients after discharge because so much is out of a hospital’s control,” Dharmarajan said. “But there are times that readmission is the result of suboptimal care, like not setting up adequate supports for a patient after discharge. …Now, this idea of reducing readmission is becoming a common part of clinical practice.”

Of course, the future of the Hospital Readmissions Reduction Program, which is overseen by the Centers for Medicare & Medicaid Services, is uncertain if the GOP succeeds at repealing the ACA. It’s yet another example of the significant, often life-saving, health gains made under the ACA that are now at risk.

“Even if the financial penalties were taken away (under an ACA repeal), I’d like to believe the effort would continue because it’s the right thing to do,” Dharmarajan told me. “It would be an interesting national experiment, but I really hope we don’t go there.”

To request a full copy of the new study, visit JAMA.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Sat, 07/22/2017 - 08:36

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Medicine