One nation, indivisible

Richard J. Umbdenstock has served as president and CEO of the American Hospital Association (AHA) since January 1, 2007, and is stepping down from this role at the end of 2015. In 2006, he was elected AHA board chair. Mr. Umbdenstock's career includes experience in hospital administration; health system governance, management, and integration; association governance and management; health maintenance organization (HMO) governance; and healthcare governance consulting. He has written several books and articles for the healthcare board audience and national survey reports for AHA, Health Research & Educational Trust, and ACHE. Mr. Umbdenstock has served as vice chair of the National Quality IH'orum, on the board of Enroll America, and on the National Priorities Partnership. Mr. Umbdenstock recently received ACHE's 2015 Gold Medal Award, the American Organization of Nurse Executives 2015 Honorary Member Award, and the Federation of American Hospitals Inaugural Health Care leadership Award.Dr. Kash: As a servant leader, what do you see as your legacy? How can emerging healthcare leaders, such as students and early careerists, learn from your experience?Mr. Umbdenstock: I am proud of having played a role in extending coverage to about 17 million Americans who did not have it before the Affordable Care Act (ACA)-to be part of something that has provided better access to care for millions of Americans. I am proud that it has happened without increased utilization busting the banks. Dire predictions that physicians' offices and emergency departments would be swamped because of the new coverage haven't happened. 1 think this shows that major change is possible without completely upsetting the existing system. We are, of course, in only the second year of this extended coverage, so we can't declare total victory-but so far, so good.I also hope I have left some mark on the system, and something for early careerists to be thinking about is in the area of performance improvement. As a trade association, AHA has become much more focused on helping members improve their performance. We embraced public reporting a long time ago, and when you do that, you hope that your members will look as good as possible. At the same time, I believe that our public policy credibility hinges on the height of the bar that AHA set for quality and safety. In a more transparent advocacy world, you want to eliminate your vulnerabilities, which means you have to get better faster and address any performance issues you may have.Performance improvement is the right thing for patients. None of us wants to see anybody harmed. There was a time in my career when people thought that they were doing extremely well if they achieved a 90% safety rate in some areas. Our thinking has changed. Many organizations reach a 100% rate-orzero harm-on certain measures because nothing less than that is satisfactory. I feel good about having promoted performance improvement, quality, and transparency.Finally, I hope I have helped our field see the value of moving on the path toward a more integrated system of care. 1 have spent time in such systems as both a board member and a patient, and those experiences have helped me chart a course for members interested in moving in this direction. Thirty years ago, many believed that HMOs were evil-they seemed so counter-cultural! Today, people want to see that kind of integration in healthcare.Dr. Kash: Tell us about the most challenging aspect of your term as CEO of AHA.Mr. Umbdenstock: The greatest challenge is how to reform the healthcare system in the long term. The AHA does three big things. First, we advocate for our members in the public policy realm. Second, we try to shape the long-term direction of the health system, which means creating a shared vision of where it should go, determining where forces are taking it, and then helping our members get from here to there. Third, we support our members in performance improvement. …

The Staffing Challenges Older Nurses Face Now, and in the Future

Impact of the American Organization of Nurse Executives' Development Programs

The American Organization of Nurse Executives (AONE) strives to provide its members with timely and useful information. In this article, the author describes AONE's work to guide the policy process about nurse shortages. The results of this survey will help you practice in your position and in your state, regional, and national policy work. AONE's policy agenda is driven by its mission and commitment to patient care. One of the most current, compelling policy issues is ensuring an adequate supply of nurses to meet the patient care demand. In response to the increasing reports of nurse shortages, AONE engaged the HSM Group, Ltd. to conduct a survey to determine if hospitals were experiencing a shortage. The survey questions were developed with the Health Resources and Services Administration (HRSA), Division of Nursing, the American Nurses Association, and the American Society for Healthcare Human Resources of the American Hospital Association. The Research on Nursing Staff Shortage was published in 1999.

The invention of a nurse leader

Purpose: The general objective of this study was to explore investment in health care and its impact on poverty reduction. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to investment in health care and its impact on poverty reduction. Preliminary empirical review revealed that investments in health care significantly contributed to poverty reduction by improving overall health and economic productivity. Healthier individuals were more capable of pursuing education and employment, creating a positive cycle of health and economic growth. The study emphasized the importance of health care accessibility and affordability, noting that targeted investments addressing health disparities and providing preventive care were essential. It highlighted the need for a holistic approach to health care that includes preventive measures, primary care, and addressing social determinants of health to sustain poverty reduction efforts. Unique Contribution to Theory, Practice and Policy: The Human Capital Theory, Capability Approach and Structural Functionalism may be used to anchor future studies on health care and its impact on poverty reduction. The study recommended that policymakers adopt a comprehensive approach to health care investment, ensuring strategic targeting of funds to address pressing health needs. It suggested that health care systems prioritize accessibility and affordability, expand infrastructure in underserved areas, and implement inclusive health insurance schemes. The study advocated for increased government commitment to equitable health care funding and the integration of health services with other social support programs. It also called for international cooperation to strengthen health care systems in developing countries and emphasized recognizing health care investment as a strategic economic priority to mobilize resources and political support for sustainable development.

Who pays for health care-and who owns it-determine what care is delivered, who receives it, and who profits from it. We examined trends in health care ownership and financing over a century. We used multiple historical and current data sources (including data from the American Medical Association, the American Hospital Association, government publications and surveys, and analyses of Medicare Provider of Services files) to classify health care provider ownership as: public, private (for-profit), and private (not-for-profit). We used US Census data to classify physicians' employers as public, not-for-profit, or for-profit entities or "self-employed." We combined estimates from the official National Health Expenditures Accounts with other data sources to determine the public vs. private share of health care spending since 1923; we calculated a "comprehensive" public share metric that accounted for public subsidization of private health expenditures, mostly via the tax exemption for employer-sponsored insurance plans or government purchase of such plans for public employees. For-profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not-for-profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer-financed share of health care spending has increased dramatically from 9% in 1923 to 69% in 2020, with taxpayer-financed subsidies to private expenditures accounting for much of the recent growth. American health care is increasingly publicly financed yet investor owned, a trend accompanied by rising costs and, recently, worsening population health. A reassessment of the US mode of health care financing and ownership appears warranted.

Roxane Spitzer, PhD, RN, MBA, MA, FAAN

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Independent foundations' primary focus is grant making.In general, their assets come from the gift of an individual or family.Community foundations' assets usually come from many donors rather than a single source, and grant making is limited to a particular region.Community foundations are usually classified as private charities under the tax law and are subject to different rules and regulations than are other private foundations. Access To CareAccording to 1988 Census Bureau estimates, over thirty-one million Americans are without health insurance.The demographics of these people are diverse, and their ranks continue to grow as the service industry burgeons and as competition in health care increases.Regional disparities in access also exist.Foundation funding in this area ranges from economic analyses of the problem to direct provision of care.

A Rose by Any Other Name: A Brief Review of <i>ICD-9-CM</i> Diagnosis Coding

Talking the Talk: Financial Skills for Nurse Leaders

This article studies the efficacy of the public investment in human capital and physical capital to raise income in Bangladesh over the period 1980–2016. This article also assesses whether the investment in human capital and income have raised life expectancy of the country. The Johansen cointegration test identifies a long-run relation of income with investment on education, health care and physical capital. The error correction mechanism (ECM) based on the cointegrating relation followed by the Wald test of Granger causality has found that these investments have caused income to rise with some lag periods. Robustness of these findings is confirmed by involving an autoregressive distributed lag (ARDL) model of cointegration followed by its ECM representation. On the other hand, the Johansen and ARDL methods of cointegration followed by their ECMs have also found a long-run relation of life expectancy with the investment in education, health care and income. A decisive role of the investment in health care and income on life expectancy is observed, while an unusual negative role of the investment in education is also found. However, positive value of the long-run coefficients of the education and health-care investments of the ECM-ARDL model indicate some long-run favourable impact of these investments on life expectancy in Bangladesh. JEL: I26, I15, C32

Patient Dumping: The Physician's Dilemma

The Times They are a Changing!