Federation of American Hospitals

Several Centers for Medicare and Medicaid Services (CMS) programs aim to transform how health care is delivered by adjusting Medicare inpatient hospital payments through a system of rewards and penalties based on performance on measures of quality. These programs are the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. We analyzed value-based program penalty results for various groups of hospitals across these three programs and assessed the impact of patient and community health equity risk factors on hospital penalties. We found statistically significant positive relationships between hospital penalties and several factors that affect hospital performance but that hospitals cannot control-namely, medical complexity (as measured by Hierarchical Condition Categories scores), uncompensated care, and the portion of hospital catchment area populations who live alone. Moreover, these environmental conditions can be worse for hospitals that operate in areas with historically underserved populations. This suggests that the CMS programs might not adequately account for health equity factors at the community level. Refinements to these programs (including an explicit incorporation of patient and community health equity risk factors) and continued monitoring will help ensure that the programs work as intended in a fair and equitable fashion.

The International Civil Aviation Organization (ICAO) Manual on Flight and Flow Information for a Collaborative Environment (FF-ICE) outlines the components and requirements to achieve a common picture in global Air Traffic Management (ATM) for implementation readiness in 2020. To prepare for this global implementation by ATM stakeholders and ensure the technical feasibility and interoperability across implementations, the Federal Aviation Administration (FAA) initiated the International Interoperability Harmonization and Validation project (IIH&V) to validate the FF-ICE Planning Provisions [1], FF-ICE Implementation Guidance [2], and message exchanges in a lab environment. This paper explores the technical components of the FAA's IIH&V exercise while the complementary paper “An Operational Approach to FF-ICE Planning and Global Harmonization through IIH&V” explores operational components of the exercises. In order to effectively validate the FF-ICE Planning provisions and implementation guidance, it was required that the exercises focus on two areas. The first focus area was ensuring that future versions of the ICAO exchange models (primarily FIXM) were prepared to support FF-ICE. The second focus area was identifying system-level implementation decisions that could affect international interoperability, critical components to implementation readiness. Thus, the role of the ICAO exchange models, the role of data governance, and the feedback communicated to the FIXM Configuration Control Board (CCB) and the ATM Requirements Performance Panel (ATMRPP) are discussed herein. The FAA split the focus of the IIH&V project into three sequential validation exercises, with each exercise integrating more advanced systems into the lab infrastructure. For each exercise, the paper presents a system architecture diagram as well as an overview of the messages exchanged across systems. Several validation exercises have taken place in the context of a mixed mode environment in which only a subset of actors is FF-ICE capable, thus requiring the use of “bridging” capabilities such as data transformation to allow systems to remain interoperable despite differences in message type, version, etc. Validation 1 included the initial “mixed mode” environment envisioned in 2020 in which FF-ICE capable actors have implemented pre-departure FF-ICE message exchanges for pre-departure trajectory negotiations, while other actors are still using legacy capabilities. Validation 2 expanded trajectory negotiation into the post-departure portion of an active flight using bi-directional Air-to-Ground (A/G) System Wide Information Management (SWIM) data links, and single or bi-directional communications between the Flight Management System (FMS) and Electronic Flight Bag (EFB). Validation 3 further explored post-departure trajectory negotiation leveraging Data Communication (DataComm) messages in addition to A/G SWIM. The outputs and results of the IIH&V project outlined in this paper bring clarity to FF-ICE Planning Provisions and Implementation Guidance, as well as support the authoring organizations refining these documentations through input given to the ATMRPP. The IIH&V project also begins laying the groundwork for the development of FF-ICE Execution for post-departure.

This article tracks recent developments in the law of defamation, exploring United Kingdom cases where journalists have advanced a defence of reportage. This reportage defence is intended to protect the journalist from a defamation action where there has only been neutral reporting of defamatory allegations which are neither adopted nor embellished. The progress of this nascent defence in several United Kingdom cases is traced, including the most extensive development made in the case of Roberts v Gable. This article then proceeds to elucidate the parameters of the new defence, focussing particularly on the tone of the reporting, how the report has to be of the fact that the statement was made, and the particular context in which the defence has so far succeeded. The justifying rationales for the defence are then explored and critiqued. The potential application of such a defence to a New Zealand context is then considered, revealing how such a development is not plausible in the near future.

Payment reforms clearly are an important change agent in our efforts to improve the health care delivery system. For broader health care delivery reform to take root and work, however, payment reform cannot be imposed in a vacuum. To maximize the chances of success and minimize the possibility of unintended consequences, the appropriate culture and structure of our health care institutions first must be in place.

A commonly held view is that system and human vulnerabilities can form links in a chain of events and result in an undesirable outcome. However, this truism has led to only limited success in the development of better techniques to analyze this progression. In this study the evolution of air traffic operational errors (OEs) was of particular interest. While it is generally accepted that OEs evolve over time, the temporal characteristics of OEs have received little attention. By better understanding these temporal characteristics, we will be better able to understand how vulnerabilities become links in a chain so that resources can be allocated effectively to develop mitigation strategies. To better understand how vulnerabilities become links in a chain, two activities were conducted. The first study developed a temporal markers (TMs) definition and sequencing framework. The second study provided an initial assessment of the framework using a small sample of OEs which were readily available in a local archive. Initial results suggest that temporal profiling of OEs may be useful in uncovering trends that are not currently being systematically examined. However, further validation of the framework using a larger set of OEs is required to achieve the goal of developing information that can be routinely used to mitigate OE occurrence.

Issues of physician ownership and referral could cause major shifts in the structure of medical care and make the financing of U.S. hospital services problematic. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 mandated research on this matter and applied an eighteen-month moratorium against self-referral to allow policymakers to consider the issue. Research findings thus far confirm that physicians' ownership and referral present conflicts of interest through medical and economic patient selection and potentially excessive utilization. The policy response must prevent these results and preserve fair competition among hospitals.