The Administration’s new rule making millions of workers eligible for overtime pay is the President’s “most significant action on behalf of middle-class paychecks,” CBPP Senior Fellow Jared Bernstein argues in the Washington Post’s “PostEverything” blog. The rule boosts the threshold salary level under which salaried employees must be paid overtime from $23,660 a year to $47,47
Donald Trump’s real estate background is shining a much-needed spotlight on a major tax loophole that policymakers should close — “like-kind exchange.” It’s an arcane provision in which individuals and corporations can buy and sell assets — like real estate or art — that have grown in value and still avoid capital gains taxes, costing the government bi
Just in time for Infrastructure Week, a new report from the American Society of Civil Engineers highlights the deterioration in our roads, bridges, water treatment systems, and other infrastructure. As our recent report explains, states and localities partners are neglecting investments that are both overdue and economically beneficial.
Years of cuts in state funding for public colleges and universities have driven up tuition and harmed students’ educational experiences by forcing faculty reductions, fewer course offerings, and campus closings. These choices have made college less affordable and less accessible for students who need degrees to succeed in today’s economy.
Today’s interview is with Sara Hoover who works remotely as a volunteer metadata technician with the Digital Resources Division.
Describe your background.
I was born in Salt Lake City, Utah, but grew up in Blacksburg, Virginia. Blacksburg is home to Virginia Tech and growing up in a college town gave me an early appreciation for higher education. Consequently, I have spent most of my adult life living in college towns and working in university systems. In recent years, I have lived in England, Japan, San Francisco, Charlottesville, Baltimore, New Haven and Seattle. In 2015 I moved to Bethesda, Maryland, with my husband and our young daughter.
What is your academic/professional history?
I have always been interested in the humanities and I hold a B.A. in English from Dickinson College, an M.A. in English literature from the University of Virginia, and an M.L.I.S. from the University of Washington. I began my career in academic publishing at Johns Hopkins University Press where I spent three years as a metadata assistant for Project MUSE. I then spent two years at Yale University Press as an editorial assistant on the Science, Technology, and Medicine list. Both of these experiences were fantastic because they gave me an introduction to the different kinds of work that can be done with written materials. Ultimately, my time working with the creation of publications made me realize that I was most interested in areas focused on the preservation and management of written materials. This led me back to graduate school to earn a Master’s degree in Library and Information Science. While in graduate school at the University of Washington, I worked at the Allen Library as an oral history digital technician. This position allowed me to foster my interest in descriptive metadata while helping to preserve oral history interviews that had been collected by the Washington State Jewish Historical Society.
How would you describe your job to other people?
As a remote metadata technician for the Law Library of Congress, I help put together the metadata that allows researchers, scholars, and legislators to more effectively locate digitized content. I examine digitized materials and apply subject headings that help to group similar items together. This metadata allows researchers to quickly search vast amounts of digital materials.
Why did you want to work at the Library of Congress?
Having spent most of my career working in university systems, when I moved to the Washington D.C. area I was eager to try something new and to explore opportunities with the federal government. I have been fascinated by the work done by the Library of Congress ever since I began working with Library of Congress Subject Headings (LCSH) as a metadata assistant with Project MUSE. I was excited about the possibility of working with an institution that has such an incredible breadth and scope of materials. Furthermore, since I sincerely enjoy exploring new disciplines, working with the Law Library of Congress has given me the exciting opportunity to work with a new spectrum of historical content.
What is the most interesting fact you’ve learned about the Law Library of Congress?
What I have enjoyed most about working with the Law Library of Congress is learning how cultural discourse has changed over time within the boundaries of a legal framework. Reading through Civil War era statutes in the United States Statutes at Large Collection, one really gets a sense of how national identity is shaped by the laws that develop and evolve on an historical scale.
What’s something most of your co-workers do not know about you?
I spent a year teaching English in Japan after college and, since that time, I have been fascinated with Japanese food and culture. I adore cooking and I have great ambitions to learn how to make my own tofu and to perfect my ramen broth!
Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.
“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”
The journey lead to the creation of The Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.
“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”
That “thing” is sex reassignment surgery for transgender women. BMC will be the only hospital between Philadelphia and Montreal that performs the procedure. It will be covered by the state’s Medicaid program and commercial insurers in Massachusetts.
“That’s huge for me,” said Nycii Vanderhoff, 43, a transgender woman who lives in western Massachusetts and began reviewing her options for surgery five years ago. “I didn’t think I’d ever be able to get it.”
Vanderhoff said she couldn’t afford the procedure or the travel and recovery time in a city far from home. She put her name on the waiting list at BMC last year. That list has now grown to 100 patients.
Initially, BMC plans to perform one or two genital surgeries a month and then increase to one a week.
“It involves orchiectomy, removing the testicles,” said Dr. Jaromir Slama, a plastic surgeon who will work with a urologist during the typical five-hour procedure. “And we use the skin tube of the penis and some of the skin of the perineum to pretty much turn it outside in and that becomes the new vagina.”
Glands from the penis and tissue from the scrotum are used to create fully functioning female genitalia for transgender women.
The goal is a “fully functional vagina,” Slama said, which “means aesthetically functional and sexually functional as well. They should be able to experience orgasm.”
BMC will not offer female to male genital surgery right now because there are too many complications with the current techniques, Slama said.
The center reflects a shift within mainstream medicine about how to treat transgender patients.
“Up until a decade or so ago, the view among many providers was that this was probably a mental disorder and the fear was that doing hormone therapy or doing surgery might be abetting a mental disorder and the correct intervention would be to counsel people,” Safer said.
But Safer’s research traces the increasing evidence that gender identity is rooted in biology, “which makes it so logical that an option for people in 2016 is to change the external appearance to meet that gender identity,” he said.
That point of view may be gaining acceptance in mainstream medicine, but the debate is not settled.
Andrew Beckwith, president of the Massachusetts Family Institute, points out that the American Psychiatric Association still uses a mental health diagnosis to describe “people whose gender at birth is contrary to the one they identify with.”
“We believe that the proper treatment would be in the realm of mental health therapies and treatments, again not amputating otherwise healthy organs,” Beckwith said. “I mean in what other scenario would you amputate a healthy organ to conform to a troubled mind.”
“There is still a lot of opposition to the recognition of transgender medicine,” said Jamison Green, president of the World Professional Association for Transgender Health.
With a growing demand for transgender care in Boston, “it’s really important that a comprehensive center exists,” Green said, “to show others that it is possible to do this, to train more professionals and to inspire the other facilities in the region.”
At BMC, patients seeking male to female gender surgery must be at least 18 years old, have been on hormone therapy for a year and be approved by a panel of physicians.
For Vanderhoff, who says she doesn’t leave the house much to avoid harassment and threats, the surgery can’t happen fast enough.
“If my body, when I look in the mirror, is what I’m feeling on the inside, then I don’t have to worry about those issues as much,” Vanderhoff said. “I can just be just a person.”
Over the past decade, the federal government has publicized 115 different ways to measure medical quality in hospitals, from assessing wait times in emergency rooms and noise levels outside hospital rooms to tracking blood clots in surgical patients. But the latest effort, to combine dozens of metrics into one patient-friendly quality indicator, has proven the most contentious.
The Centers for Medicare & Medicaid Services recently postponed its plan to release the new rating system, which would award one star to the worst-quality facilities and five stars to those with the best marks. The delay came after a majority of members of Congress signed a letter supporting the hospital industry’s concerns.
Hospital leaders who previewed the preliminary rating system say the formula seems skewed against institutions that treat the poorest or toughest patients, meaning those with complex illnesses. The number of stars would be based on 64 different measures, which are posted on Medicare’s Hospital Compare website. The metrics on mortality, readmission, patient experience and patient safety are the most influential, each representing 22 percent of a facility’s rating.
If you come out with a rating that says Cleveland Clinic is terrible but podunk hospital in North Carolina, they’re the bomb, there’s a disconnect.Ashish K. Jha
Steven Lipstein, president of BJC HealthCare, a St. Louis-based nonprofit that runs 14 hospitals, said the ones in his organization that earned five stars were smaller, located in affluent areas and handled less complicated cases. “They don’t have comprehensive cancer centers, they don’t have major cardiovascular disease, they don’t have neuro-specialties,” he said.
BJC’s more advanced hospitals did worse, he said. “That’s not surprising when you look inside the ratings and see how they’re built,” he added.
Consumer advocates defend the rating system, saying that while not perfect, it correctly reflects higher rates of problems in some big institutions despite their lofty reputations. They worry that delay and congressional resistance are undermining Medicare’s attempt to help consumers select a hospital based on something more substantive.
“The star ratings hopefully will get quality into that decision-making process,” said Andrew Scholnick, a lobbyist for AARP, the advocacy group for seniors.
Medicare officials initially said they hoped to release the ratings to the public in July. But in a presentation to hospitals and other interested parties last Thursday, they did not set a firm date.
Medicare already has made minor tweaks in the formula to calculate the stars, but it remains a tough grader, the presentation shows. If Medicare releases the star ratings in July, nearly half of the 3,658 hospitals being evaluated would be getting three stars, according to Medicare’s preliminary calculations. Just 100 hospitals would receive five stars, while 135 would receive a single star.This KHN story also ran in The Washington Post. It can be republished for free (details).
Officials indicated they were standing firm in their intention to eventually release the scores. “The Overall Star Rating represents a performance summary designed to facilitate patient and consumer use of Hospital Compare,” the presentation said. Officials plan to update the scores every three months through the end of this year and then twice thereafter.
The broader debate about the government judging hospitals has been going on since Medicare began publishing quality ratings in 2005. But it has intensified since passage of the Affordable Care Act, which instructed Medicare to use quality metrics in setting payments.
Teaching hospitals as a group have tended to fare poorly from some of these financial incentives. This year, for instance, nearly half of major teaching hospitals are losing 1 percent of their Medicare payments because of high rates of infections and surgical complications. Facilities with more low-income patients, who often face difficulties affording medication, following complicated recovery instructions and getting to doctors regularly, typically have higher readmission rates.
Some health care researchers are also skeptical. “If you come out with a rating that says Cleveland Clinic is terrible but podunk hospital in North Carolina, they’re the bomb, there’s a disconnect,” said Ashish K. Jha, a professor at Harvard’s public health school. “If it completely contradicts everything you’ve known, you need to ask yourself, ‘Did I not understand the way hospital care works, or is there a problem with the metric?’”
Medicare’s move toward using star ratings is part of a greater focus on easy-to-grasp composite judgments of hospital quality. The Leapfrog Group, a nonprofit patient safety group, uses report-card letter grades to characterize hospital safety based on many of the same individual measures as Medicare. Healthgrades, a Denver-based company, judges hospital quality with one, three or five stars. Consumer Reports calculates a safety score on a 100-point scale.
Medicare hopes a star rating from the government will carry even more credibility.
“People need this information now,” Scholnick said. “Trying to wait until everyone’s 100 percent happy with everything just delays it further than it needs to be.”