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California Looks to Build Opportunity, Address Housing Crisis

Center on Budget and Policy Priorities - Mon, 05/23/2016 - 2:14pm

California policymakers have proposed ways to bolster the stock of affordable housing and help voucher holders access higher-opportunity neighborhoods — steps that will help struggling families contribute more fully to the economy and position the state for longer-term, more broadly shared prosperity.

Categories: Benefits, Poverty

On The Shelf: Books in Non-Native Languages

In Custodia Legis - Mon, 05/23/2016 - 11:17am

Josh Darland, an assistant project manager in the Law Library, brought me this book on Minnesota law, written in Danish and published in the United States in 1896.  He thought it would make a good post for our On the Shelf series because it was so unexpected.  And he was correct.

Volume on Minnesota commercial laws, written in Danish. (All photos by Betty Lupinacci)

Though it’s not as unexpected as one might think.

This is a subject I first considered when Nathan Dorn gave our summer interns a look at some early American law books a couple years ago.  Among the treasures he displayed were early New York law books written in Dutch but published in the U.S.

If one thinks about the cultural history of the United States it makes perfect sense that immigrants would need such translations until they learned enough to read these documents in the language of their newly adopted country.

And once I started searching I found many more such items.  For example, when I limited my search to law books published in Louisiana pre-1900 that were written in French, I retrieved six titles, half of which were penned after Louisiana was admitted as a state in 1812.

I thought my focus would be solely on these early U.S. state materials, but my colleagues had loftier ambitions.

Ken Sigmund, for example, brought me two gems that were not written here for our immigrant population but were published abroad for people of other nations interested in our system of laws.

The Federalist Papers in Russian

The U.S. Constitution in Chinese

On the flip side, the Law Library collects relevant material on foreign and international law for the use of our Foreign Law Specialists‘ and the public.  Much of it is in the official language of each jurisdiction, but we also manage to find items written in English.  It is this type of material that many of us are more used to seeing than U.S. material in foreign languages.  Elizabeth Moore, who helped find these items in the Global Legal Resource Room, has remarked more than once that patrons are surprised to see how many of the titles that we have for any given country are not in English.

Published in Germany, but written in English

Chinese laws on AIDS, written in English

A treatise on Cyprus laws, written in English and published in Greece

So while it makes perfect sense that all of these items were published and that we see them on a fairly regular basis when shelving in the Minnesota section of our stacks, it’s still a bit of a surprise to find a volume printed in Danish.

As an added bonus, In Custodia Legis will be adding video content to some of our blog posts.  [You may have already seen a couple of these on the Law Library’s Twitter and Facebook pages.]  See our inaugural video of The Federalist Papers in a variety of languages below.

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Categories: Research & Litigation

First Edition: May 23, 2016

Kaiser Health News - Mon, 05/23/2016 - 6:47am
Categories: Health Care

Doctors’ House Calls Saving Money For Medicare

Kaiser Health News - Mon, 05/23/2016 - 5:00am

Looking for ways to save money and improve care, Medicare officials are returning to an old-fashioned idea: house calls.

But the experiment, called Independence at Home, is more than a nostalgic throwback to the way medicine was practiced decades ago when the doctor arrived at the patient’s door carrying a big black bag. Done right and paid right, house calls could prove to be a better way of treating very sick, elderly patients while they can still live at home.

“House calls go back to the origins of medicine, but in many ways I think this is the next generation,” said Dr. Patrick Conway, who heads the Center for Medicare and Medicaid Innovation, which oversees Independence at Home.    

Use Our Content This KHN story can be republished for free (details).

In the first year of the experiment, Housecall Providers of Portland, Oregon, which had been operating at a loss, saved Medicare an average of almost $13,600 for each patient in the pilot project. Its share of the savings was $1.2 million. The house calls practice at MedStar Washington Hospital in Washington, D.C., cut the cost of care an average of $12,000 per patient.

Medicare reported overall savings of $25 million in the pilot’s first year, officials reported last June. From that money, nine practices earned bonuses totaling nearly $12 million, including a $2.9 million payment to a practice in Flint, Michigan.

After three practices dropped out, there are now 14 around the country participating in the project — including five sites run by the Visiting Physicians Association.

Medicare officials are expected to announce the second round of payments next month.

(Story continues below)

By all accounts, saving any money on these patients is a surprise. Independence at Home targets patients with complicated chronic health problems and disabilities who are among the most expensive Medicare beneficiaries. But a key study, published in 2014 in the Journal of the American Geriatrics Society, found that primary care delivered at home to Medicare patients saved 17 percent in health spending by reducing their need to go to the hospital or nursing home.

In addition to Medicare’s usual house calls payment, doctors in the Independence at Home project get a bonus if patients have at least 5 percent lower total Medicare costs than what is expected for a similar group of beneficiaries. Medicare keeps the first 5 percent of the savings and the house call providers can receive the rest. The doctors must meet at least three of the six performance goals — such as reducing emergency room visits and hospital readmissions, and monitoring patients’ medications for chronic conditions such as diabetes, asthma and high blood pressure.

Under the law creating the program, practices could join only if they make house calls to at least 200 patients with traditional Medicare who have been hospitalized and received rehab or other home health care within the past year. These patients also must have trouble with at least two activities of daily living, such as dressing or eating. The health care providers must be available 24 hours a day, seven days a week. They make visits at least once a month to catch any new problems early, and more often if patients are sick or there’s an emergency.

“You never know what you’re walking into,” said Terri Hobbs, Housecall Providers’ executive director. “This is a very sick group of people, with multiple chronic conditions, taking multiple medications and [they] have a very long problem list.” About half the Portland patients have some degree of dementia.

Yet the Medicare reimbursement for house calls is about the same as an office visit and doesn’t cover travel time or the extra time needed to take care of complex patients. It’s not enough to convince most doctors “to leave the relatively comfortable controlled environment of an office or hospital to do this sort of work,” said Dr. William Zafirau, medical director for Cleveland Clinic’s house calls program in Ohio, which has 200 patients in the Medicare pilot and plans to add 150 more.

A house calls doctor can see only five to seven patients a day. One reason is that a house call visit can take longer than an office visit, even after taking travel time into account. After Zafirau examines his patients, he also takes a look around the home. He may open their refrigerators to make sure they have enough food or see if medicine bottles are running low. He may arrange home-delivered meals or other social services.

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“How people are functioning is often the best indicator of their overall health,” he said.

The care can also extend to other professional services. Portland’s Housecalls Providers hired a nurse and a social worker to serve as an advocate for patients who enter the hospital. When the patient returns home, they visit. “They make sure if patients are supposed to get an antibiotic, a hospital bed or oxygen, that they get them,” said Hobbs.

Hospital admissions dropped so significantly that Hobbs expanded the transition team to serve house calls patients who were not part of the pilot program when they were hospitalized.

A similar team serves MedStar Washington Hospital Center’s house calls patients, said Dr. Eric De Jonge, director of geriatrics at the hospital and president-elect of the American Academy of Home Care Medicine. “When patients go to the hospital, there is very little contact from the primary care doctor with the hospital care,” he said. Independence at Home “is actually pushing back to reverse that trend.”

Ironically, Medicare doesn’t pay for the transition team even though Hobbs said it saves Medicare “a tremendous amount of money.”

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Categories: Health Care

A Tender Steak Could Be A Little Dangerous

Kaiser Health News - Mon, 05/23/2016 - 5:00am

A new label on some of the steaks in your grocery store highlights a production process you may have never heard of: mechanical tenderizing.

This means the beef has been punctured with blades or needles to break down the muscle fibers and make it easier to chew. But it also means the meat has a greater chance of being contaminated and making you sick.

The labels are a requirement from the U.S. Department of Agriculture that went into effect this week.

“Blade tenderized,” that label might read, followed by safe cooking instructions: “Cook until steak reaches an internal temperature of 145°F as measured by a food thermometer and allow to rest for 3 minutes.”

Here’s how it can make you sick: If pathogens like E. coli or salmonella happen to be on the surface of the steak, tenderizing transfers those bacteria from the surface to the inside. Since the inside takes longer to cook and is more likely to be undercooked, bacteria have a higher chance for survival there.

And without a label, you can’t tell if you need to be especially careful your steak.

This story also ran on NPR. It can be republished for free (details).

“It doesn’t look any different,” said a spokesperson for USDA’s Food Safety and Inspection Service. “It’s not filled with holes from the needle piercings.”

Mechanical tenderizing is not an unusual occurrence. FSIS estimates that 2.7 billion pounds or about 11 percent of the beef labeled for sale has been mechanically tenderized. The new labels will affect an estimated 6.2 billion servings of steaks and roasts every year, according to FSIS.

The U.S. Centers for Disease Control and Prevention has tracked six outbreaks of foodborne illness since 2000 that were attributable to mechanically tenderized beef products prepared in restaurants and consumers’ homes.

In 2009, 21 people in 16 states were infected with the most common strain of dangerous E. coli called O157. Nine had to be hospitalized, and one victim developed hemolytic uremic syndrome, a potentially fatal kidney disease. USDA food safety officials connected the illnesses to blade-tenderized steaks from National Steak and Poultry, and the company recalled 248,000 pounds of beef products.

“We need to improve how we tell consumers and the food service workers about the particular risks that would be involved in cooking it so that they can reduce the risk of illness,” said Patricia Buck, co-founder and executive director of the Center for Foodborne Illness Research & Prevention, a nonprofit advocacy group.

Buck, who has been pushing for the labeling rule since 2009 said she’s “very excited” to see it happening. “I think it’s an important step in the direction we need to go.”

The label on blade tenderized beef sold at Costco recommends 160 degrees as the minimum internal temperature, which doesn’t require a 3-minute rest time. (Lydia Zuraw/KHN)

The National Cattlemen’s Beef Association “worked closely” with USDA on the label, said spokesman Chase Adams. “We will continue to work with them to provide helpful guidance for our members.”

Before the label became a requirement, Costco had been voluntarily labeling its meat. According to Consumer Reports, the grocery giant began labeling its mechanically tenderized beef in 2012 after an E. coli outbreak in Canada was linked to their blade-tenderized steaks.

Consumer advocate Buck lost her toddler grandson to an E. coli O157 infection in 2001. “I don’t like scaring people,” she said, “but on the other hand, people don’t really know that these can be really deadly pathogens.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Proposal to Reduce Medicare Drug Payments Is Widely Criticized

Medicare -- New York Times - Sun, 05/22/2016 - 9:00pm
Patients’ advocates have joined doctors and drug companies in warning that the Obama administration plan could jeopardize access to medications.
Categories: Elder, Medicare

In Case You Missed It . . .

Center on Budget and Policy Priorities - Fri, 05/20/2016 - 4:03pm

This week at CBPP, we focused on state budgets and taxes, the federal budget and taxes, food assistance, housing, family income support, and the economy.

Categories: Benefits, Poverty

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