Category Archives: Hospitals
Richard J. Umbdenstock, American Hospital Association: Opportunities for Collaboration Between Health and Health Care
The intersection of health and health care was an important theme at this year’s Keeneland Conference—during sessions on recent IOM reports, in hallway conversations, in discussions of Public Health Services and Systems Research that explores the most efficient ways to deliver public health services, and, notably, during the keynote address by Richard Umbdenstock, president and CEO of the American Hospital Association.
In his presentation, Umbdenstock talked about hospitals and public health, "collaborating for communities," and said that as health care providers, hospitals had tended to focus on treating the individual, rather than on prevention for the population. Now, he said, the money is gone and the public cares more about health, meaning it makes less and less sense for either hospitals or public health to be concerned with protecting their turf. “We need to incent health and deglamourize consumption.” Quoting a colleague, Umbdenstock said “what we need to do is create an epidemic of health.”
Umbdenstock spoke frankly when he told the attendees, “hospitals want to improve the lives of their patients, and not just their health care. Rather than wait for an [hospital] admission that won’t be paid, they’d rather get upstream on primary care.”
“Public health departments must be funded and supported so that wellness and prevention touches all and there are enough resources to do that,” said Umbdenstock. “And this is where research can play a big part—collaborative health research. We need to know the most effective collaborative models and the most effective ways to advocate for greater personal and community responsibility.”
NewPublicHealth caught up with Richard Umbdenstock following his talk.
NewPublicHealth: What are you hearing from hospitals about the new IRS community benefit requirement?
Richard Umbdenstock: Some hospitals have had similar responsibilities at the state level and many have had to put out accountability reports to their communities, so for many it’s not a new concept. In addition, hospitals have long been under a microscope and they also understand that community benefit is a wonderful community education tool. If they can tell it in a clear and consistent fashion, there’s a real opportunity for the public to better understand what hospitals and public health departments do.
NPH: Do hospitals and public health understand the critical community roles each one plays?
Richard Umbdenstock: I don’t think there’s any question what public health departments do after you’ve see them spring into action after a disaster, just as a lot of people don’t value what hospitals do until after they’ve been a patient. On a day-to-day basis we can all get so deep in our work that we just don’t see what the other person is doing. What we’re learning is that we all serve the same person.
Non-profit hospitals are required to provide a “community benefit” to qualify for tax-exempt status with the Internal Revenue Service. The Patient Protection and Affordable Care Act includes provisions for expanded community benefit opportunities with a focus on improving community and population health.
Massachusetts has had a similar community benefit provision at the state level for decades. NewPublicHealth recently spoke with Massachusetts State Health Commissioner John Auerbach, DPH, about what other states can learn from Massachusetts’ experience, particularly regarding the benefits – and challenges – of critical collaboration between public health departments and hospitals and other health care institutions.
NewPublicHealth:Massachusetts may have a leg up on some states when it comes to community benefit. Can you give us some background on that?
John Auerbach: The state Attorney General has long had community benefit guidelines that direct hospitals to address the non-hospital-based health and social needs of their patients. Consequently every hospital has been accustomed to implementing community benefit projects that follow the Attorney General’s criteria aimed at improving population or community health.
To help public health officials and policy-makers better understand the opportunity around the community benefit requirements for nonprofit hospitals, the Robert Wood Johnson Foundation funded the The Hilltop Institute at UMBC – a research center that focuses on the needs of vulnerable populations – to publish a series of issue briefs on best practices, new laws and regulations, and study findings related to community benefit activities and reporting. The most recent Hilltop Institute brief on community benefit and partnerships between hospitals, public health agencies and the communities they serve includes a discussion of an innovative asthma management program created by Children’s Hospital Boston. Last week, new data was published in the journal Pediatrics showing that this program reduced hospitalizations and emergency room visits, improved patient outcomes and saved $1.46 for every dollar spent.
NewPublicHealth spoke with Laurie Cammisa, Vice President for Child Advocacy at the hospital, about the project and the hospital’s approach to community benefit.
>>Read more on community benefit and the Hilltop issue brief series in a Q&A with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation.
NewPublicHealth: The new IRS regulations on community benefit begin in March, but you are far ahead of the game with some of your community benefit initiatives. How did that come about?
Laurie Cammisa: The State Attorney General called for voluntary community benefit guidelines beginning in the 1990s, so we have been thinking about our initiatives since then. Our community benefit initiatives have included programs on mental health, child development, fitness and asthma. We have programs in each area, in partnership with communities.
NPH: Why is asthma one of the focus programs?
NewPublicHealth spoke with Eduardo Sanchez, MD, the chief medical officer for Blue Cross Blue Shield of Texas and Chair of the Partnership for Prevention, at the AcademyHealth annual National Health Policy Conference in Washington, D.C. Dr. Sanchez shared his perspective on the intersection and potential opportunities for collaboration between public health and health care.
NewPublicHealth: How do you think public health is being redefined now?
Dr. Sanchez: I think the health system needs to be thought of as being made up of two interdependent components—public health and medical care—that traditionally have been thought of as two different systems. The reason is that a high quality, cost-effective health system that is going to achieve optimal health for all Americans, depends on appreciating that “public health” is important for a truly successful effort to optimize health.
NPH: Where does the responsibility lie for making the critical changes needed for public health?
The holiday message from NewPublicHealth is: stay safe.
A recent report from the University of California at San Francisco finds that emergencies spike during the holidays for a number of reason, including overindulgence and delayed care.
Heart-related deaths increase by 5 percent during the holiday season. Fatal heart attacks peak on Christmas, the day after Christmas, and New Year’s Day, according to a 2004 study in the journal Circulation.
“The holidays are a time when we really increase the amount of salt and fat we eat. Most people don't notice the difference. However, there are certain people -- for example, those with heart failure -- for whom the slight increase in salt intake could result in big problems,” said Ameya Kulkarni, MD, a cardiology fellow with the UCSF Division of Cardiology.
UCSF physicians say another excess that fills the emergency room during the winter holidays involves binge drinking. On New Year’s Eve 2010, the UCSF emergency department saw a 50 percent jump in the number of ER visits from the year before. Of that, 70 percent were for alcohol admissions.
UCSF's Emergency Room Medical Director, Steven Polevoi, MD, says that typically binge drinking patients are so intoxicated that they aren’t able to walk or talk. They can lapse into unconsciousness, have trouble breathing and sometimes even die.
And drunken patients can impede the care of others because no medicine can reverse intoxication. “We must wait until their blood alcohol level decreases and that’s a slow process,” Polevoi said. “Basically we are left with lots of patients in semi-conscious states. They often spend six or eight hours with us until they’re sufficiently sober to go home.”
Bonus to Help Prevent Emergencies: The American College of Emergency Physicians has a good primer on emergency care on its website and gives additional advice on safety for older people, travel and home.
Have a safe, happy and above all healthy holiday.
Extra Bonus from NPH: Here’s a sneak peek at a new portal from the Department of Health and Human Services to help make us all healthier in 2012.
Do you work in a local health department? Please share stories from your departments here with the Robert Wood Johnson Foundation.
Eduardo J. Sanchez, Vice President and Chief Medical Officer for Blue Cross and Blue Shield of Texas, was a key speaker for the Opening General Session of NACCHO's annual conference. Sanchez offered an inspiring, tweet-worthy speech that touted the importance of a revolutionary shift in the way health is organized in the U.S. to focus more on public health. Note-worthy items (paraphrased) of his included:
- Medical ethics says ‘first do no harm’ – we are doing harm by dismantling public health.
- Our nation’s public health system has seen unprecedented divestiture. Resources cannot continue to be dwarfed by investment in medical care system.
- The health and prosperity of nation depends on leadership that bridges public health and medical care.
- We must talk in one loud voice about one health system – public health, the upstream, and medical care, the downstream.
- "We must unify public health and medical care for one health system - the health system!"
Public Health and Community Benefit: A NewPublicHealth Q&A with Abbey Cofsky, Program Officer at the Robert Wood Johnson Foundation
Non-profit hospitals are required to provide a “community benefit” to qualify for tax-exempt status with the Internal Revenue Service. To date, many hospitals have generally fulfilled this requirement by providing charity care to uninsured and underinsured individuals. The Patient Protection and Affordable Care Act (ACA) includes provisions for expanded community benefit opportunities with the assumption that the law will decrease the need for charity care in the future.
To help public health officials and policy-makers better understand the opportunity around the community benefit requirements in ACA, The Robert Wood Johnson Foundation funded the The Hilltop Institute at UMBC – a research center that focuses on the needs of vulnerable populations – to publish a series of issue briefs on best practices, new laws and regulations, and study findings related to community benefit activities and reporting. This week, The Hilltop Institute held a symposium on Responding to Community Health Needs within the Framework of the Affordable Care Act. NewPublicHealth spoke with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation, about community benefit in 2011 and beyond, and about the Foundation’s interest in the opportunities around community benefit created through ACA.
NewPublicHealth: We haven’t talked about community benefit on NewPublicHealth before. Is this a new concept?