Briefly Noted

The Centers for Medicare & Medicaid Services (CMS) has expanded Medicare beneficiaries' access to telehealth, allowing payment for individual psychotherapy, patient education and group psychotherapy that are delivered in “temporary expansion locations, including patients' homes.” In addition, it will consider adding more services if providers show they are interested in doing this. The April 30 decision will temporarily allow Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in their homes. The CMS previously announced that Medicare would pay for certain services conducted by audio‐only telephone between beneficiaries and their doctors, but has broadened that list to include many behavioral health and patient education services. The payments for telephone visits now match payments for similar office and outpatient visits, retroactive to March 1, 2020. Instead of using a rulemaking process to add Medicare services that may be furnished via telehealth, the CMS will continue to add these during the COVID‐19 emergency on a subregulatory basis, taking into consideration “requests by practitioners now learning to use telehealth as broadly as possible.” And the CMS is waiving the video requirement for certain “evaluation and management services” — the office visits with the doctor — and now these can be provided by telephone only. Some beneficiaries don't have access to the technology for video, or don't want to use it. For more information, go to https://www.cms.gov/newsroom/press‐releases/trump‐administration‐issues‐second‐round‐sweeping‐changes‐support‐us‐healthcare‐system‐during‐covid .     

H.R. 6: SUPPORT for Patients and Communities Act: The Substance Use‐Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act

Section 2005. Medicare coverage of certain services furnished by opioid treatment programs. This provision expands Medicare coverage to include Opioid Treatment Programs (OTPs) for the purposes of delivering Medication‐Assisted Treatment (MAT) to expand access to treatment options for Medicare beneficiaries. Currently, OTPs are not recognized as Medicare providers, meaning that beneficiaries receiving MAT at OTPs for their opioid use disorders must pay out‐of‐pocket. In 13 states, the highest rate of opioid‐related inpatient stays is among the over 65 population. Under the provision Medicare will pay the outpatient OTPs through bundled payments made for wholistic services, including necessary medications, counseling, and testing.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.     

Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change

Components of nursing home (NH) culture change include resident-centeredness, empowerment, and home likeness, but practices reflective of these components may be found in both traditional and “culture change” NHs. We use mixed methods to examine the presence of culture change practices in the context of an NH’s payer sources. Qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation. Findings indicate that heightened coordination of Medicare and Medicaid could influence NH implementation of reform practices.     

A federal survey deficiency citation is needed for resident-to-resident aggression in U.S. nursing homes

Resident-to-resident aggression (RRA) in nursing homes is a prevalent and concerning public health problem. A rapid growth in the number of research studies has led to advancements in understanding and awareness of these incidents. However, no state survey deficiency citation (F-Tag) currently exists to capture RRA in a structured way in the Centers for Medicare & Medicaid Services’ (CMS) nursing homes F-Tags Coding System. This omission represents a major barrier to State Survey Agencies, CMS, consumers, and care advocacy organizations’ efforts to keep vulnerable and frail residents safe and free from psychological harm. The commentary makes the case for development and implementation of a new RRA-specific F-Tag by identifying 20 problem areas and the ways in which this F-Tag could address them. The new F-Tags Coding System (part of the new Federal Nursing Home regulations) represents a rare and time-sensitive opportunity to bridge this major gap in practice, research, and policy.     

Do high rates of OSCAR deficiencies prompt improved nursing facility processes and outcomes?

Recently, some researchers have argued that high state rates of Centers for Medicare and Medicaid Services (CMS) Online Survey, Certification and Reporting (OSCAR) nursing facility deficiencies indicate stringent enforcement, leaving the impression of better-quality care soon to follow; others maintain that the rank ordering of states' quality of nursing facility care remains fairly constant, resting on deep-seated state characteristics that change slowly, so that short-term improvement in poor-quality care is unlikely. The authors examine change in the process and outcome quality of states' Medicare nursing facility long-term care programs across 1999 to 2005, using linear and two-stage least squares regression. They find that (1) nationally, process quality generally falls across this period while outcome quality generally increases; (2) neither a prominent enforcement stringency index nor state culture, a relatively stable state characteristic, exerts much influence on state process and outcome quality scores over time, but (3) the relative costs and benefits for CMS compliance appear to contribute to explaining change in states' quality of resident outcomes over time; and (4) states' process quality is much less stable than outcome quality, and outcome indices distinct from OSCAR deficiency data provide more reliable and possibly more valid measures of care quality.     

European Union Policy on Older Adult Learning: A Critical Commentary

Recently, some researchers have argued that high state rates of Centers for Medicare and Medicaid Services (CMS) Online Survey, Certification and Reporting (OSCAR) nursing facility deficiencies indicate stringent enforcement, leaving the impression of better-quality care soon to follow; others maintain that the rank ordering of states' quality of nursing facility care remains fairly constant, resting on deep-seated state characteristics that change slowly, so that short-term improvement in poor-quality care is unlikely. The authors examine change in the process and outcome quality of states' Medicare nursing facility long-term care programs across 1999 to 2005, using linear and two-stage least squares regression. They find that (1) nationally, process quality generally falls across this period while outcome quality generally increases; (2) neither a prominent enforcement stringency index nor state culture, a relatively stable state characteristic, exerts much influence on state process and outcome quality scores over time, but (3) the relative costs and benefits for CMS compliance appear to contribute to explaining change in states' quality of resident outcomes over time; and (4) states' process quality is much less stable than outcome quality, and outcome indices distinct from OSCAR deficiency data provide more reliable and possibly more valid measures of care quality.     

Between sociology and the business school: critical studies of work,employment and organization in the UK

This is a paper about what happens when a form of knowledge moves to another part of the university. The author, identifying himself as an ‘ex‐sociologist’, investigates the relationship between the sociology of work, employment and organization and various ‘critical’ traditions within the business school. I argue that the contemporary divide between sociologies of work and employment, and Critical Management Studies (CMS) within the business school rests in part on developments in UK sociology in the 1960s and 70s. This means that divergent understandings of the role of sociology and its relevant theoretical resources provided the deep structure for the current tension between CMS on the one hand and research on work and employment on the other. The movement of sociologists and industrial relations academics to the business school provided the preconditions for two very different critical traditions. The paper concludes with thoughts on what it means to be an outsider inside an institution, and on the future prospects for Burawoy's ‘critical’ or ‘public’ sociologies in UK business schools.     

Table of Contents

CMS Proposes Free SBI for Medicare Patients, but Barriers Still Exist for PCPs Small Wis. Facility Redefines Itself After Shock of County Funding Loss The Medicare SBI Counseling Interventions for Positive Screens Louisiana Budget Passes Without Welfare Drug‐Test Provision National Council to Poll Substance Abuse Providers on Primary Care How Substance Abuse Fits in to Federal Integration Initiatives NIAAA Study Finds Low Response to Alcohol is Main Cause of Alcohol Problems Briefly Noted Business News Coming up     

Twenty‐first century dis‐ease? Habitual reflexivity or the reflexive habitus

While certain theorists have suggested that identity is increasingly reflexive, such accounts are arguably problematised by Bourdieu's concept of habitus, which – in pointing to the ‘embeddedness’ of our dispositions and tastes – suggests that identity may be less susceptible to reflexive intervention than theorists such as Giddens have implied. This paper does not dispute this so much as suggest that, for increasing numbers of contemporary individuals, reflexivity itself may have become habitual, and that for those possessing a flexible or reflexive habitus, processes of self‐refashioning may be ‘second nature’ rather than difficult to achieve. The paper concludes by examining some of the wider implications of this argument, in relation not only to identity projects, but also to fashion and consumption, patterns of exclusion, and forms of alienation or estrangement, the latter part of this section suggesting that those displaying a reflexive habitus, whilst at a potential advantage in certain respects, may also face considerable difficulties simply ‘being themselves’. ‘I noticed how people played at being executives while actually holding executive positions. Did I do this myself? You maintain a shifting distance between yourself and your job. There's a self‐conscious space, a sense of formal play that is a sort of arrested panic, and maybe you show it in a forced gesture or a ritual clearing of the throat. Something out of childhood whistles through this space, a sense of games and half‐made selves, but it's not that you’re pretending to be someone else. You’re pretending to be exactly who you are. That's the curious thing.’ ( DeLillo, 1997 : 103)     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Table of Contents

CMS Announces Dollar Values for New SBI Codes, and New Codes for Medicare States Focus on Equipping Workforce to Treat Gambling Problems CRAFFT Screen Finds 14.8% Positive Results Reality of Relapse Requires Changing to a Chronic Care Approach Veto Looms for Health Spending Bill, Including the Block Grant Letter to the Editor Briefly Noted Resources State Watch Coming up     

The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Demand for decision autonomy and the desire to avoid responsibility in risky environments: Experimental evidence

This paper experimentally studies individuals’ willingness to pay for the authority to make risky decisions for themselves, and the willingness to take responsibility for others, as primary determinants of leadership willingness. We consider a setup involving a pair of individuals, where one individual is designated to make both parties’ decisions by default. Depending on treatment, either party can express a willingness to pay to change this situation. If one’s willingness to pay to make her own decision herself is positive (negative), we interpret it as a demand for autonomy (a desire to delegate). On the flip side, if one’s willingness to pay to avoid making a decision on behalf of another person is positive (negative), we interpret it as a desire to avoid responsibility (a demand for authority). We find that on average, individuals are willing to pay positive amounts of money to make their decisions themselves, and incur positive but smaller opportunity costs for the right to make decisions for others. Certain individual and contextual characteristics emerge as important predictors. Notably, (1) men are more likely to demand both autonomy and authority at the same time, (2) individuals with other regarding preferences are more likely to pay to avoid taking responsibility for others’ decisions when the probability of loss is high. Exploring differences between individuals’ own decisions and the decisions they make on behalf of others, we find that subjects with other-regarding preferences tend to “cautious-shift” when making decisions on behalf of others. Also, we find that individuals who would like to avoid responsibility also tend to “shift” their decisions when put in a decision-making role. The results have implications for the allocation of decision-making authority in pairs and leadership.     

Could hemogram parameters be predictors of dementia in elderly patients?

Objective: To study red cell distribution width (RDW), RDW to platelet ratio (RPR) and mean platelet volume to platelet ratio (MPR), novel inflammatory markers of routine hemogram, of patients with or without dementia, according to the grade of the disease established by Fazekas’s score in magnetic resonance imaging (MRI).

Methods: A total of 1342 cases that undergone cranial MRI study were retrospectively analyzed. Patients without a previous stroke and over 45 years were enrolled in the study. Demographic and laboratory characteristics of the participants were obtained from institutional computerized database. Subcortical and periventricular white matter were evaluated in axial FLAIR images according to Fazekas’s grading scale. Univariate and multivariate analysis were performed for assessing the predictors of Fazekas’s grading scale.

Results: MPR of Fazekas 0, Fazekas 1, Fazekas 2 and Fazekas 3 groups were 3, 3, 4 and 3%, respectively. MPR difference between study groups was not significant (p?=?.32). RPR of Fazekas 0, Fazekas 1, Fazekas 2 and Fazekas 3 groups were 6, 7, 7 and 7%, respectively. RPR difference between study groups was significant (p?Conclusion: We suggest that increased RDW and RPR values may indicate higher Fazekas’s score and dementia in cranial imaging studies. The radiologist should pay particular attention in interpretation of cranial MRI of these patients.     

Zur Effektivität des Gordon-Eltern-Trainings (PET) — eine Meta-Evaluation

The article shows how meta-evaluation leads to evidence about the differential effectiveness of the parent effectiveness training (PET) by Thomas Gordon. It shows that the training has a high general effectiveness. There are large effects for the directly trained communication skills, medium effects for the change of parental attitudes toward child-rearing and the parent-child-communication and small effects in parental behavior and the children’s self-concept. The training also shows long-term effects. Moreover, PET seems to be better suited for gender homogenous parent groups and for parents of older children.     

Learning and the Form of Compensation

Using data from the PSID and an empirical setup similar to the one used in Altonji and Pierret (Q J Econ 116(1):313–350, 2001)’s paper on wages and employer learning, we find that the coefficient of a hard-to-observe correlate of productivity—parents’ educational attainment—in a wage regression increases more rapidly with experience in performance pay jobs than in nonperformance pay jobs. This result is driven entirely by bonus pay jobs as opposed to commission/piece rate jobs. In the latter, there is no evidence that the importance of parental education in the wage determination process increases over time. This is consistent with the notion that explicit pay-for-performance compensation schemes are, by design, revealing workers’ productivities and that employers need not infer anything about worker productivity when the payment is ex post as is the case for commissions and piece rates as opposed to having to set pay ex ante.     

Marrying the social and the biological? A rejoinder to Newton

Marrying the biological and the social raises a complex series of issues that defy easy answer or simple resolution. In this brief rejoinder to Newton's (2003 ) recent paper in this journal –‘Truly embodied sociology: marrying the social and the biological?’– I take up some of these issues through: (i) a restatement of my own position in these debates and the broader sociological context within which it is located; (ii) a discussion of various problems and tensions within Newton's own critique of this ‘nascent material‐corporeal’ project to date. Newton's paper, it is concluded, is a welcome, timely and topical contribution to these (evolving) debates, though any such ‘dispute’ is probably more apparent than real: a case, in short, of reinforcing arguments about the complexity of these relations and the consequent need to ‘tread warily’.