Investigation into the effect of Y, Yb doping in Ba2In2O5: determination of the solid solution range and co-doping with phosphate

In this paper we examine the effect of Y, Yb doping in Ba2In2O5, examining the solid solution range and effect on the conductivity and CO2 stability. The results showed that up to 35% Y, Yb can be introduced, and this doping leads to an introduction of disorder on the oxygen sublattice, and a corresponding increase in conductivity. Further increases in Y, Yb content could be achieved through co-doping with phosphate. While this co-doping strategy led to a reduction in the conductivity, it did have a beneficial effect on the CO2 stability, and further improvements in the CO2 stability could be achieved through La and P co-doping

Access Transformed: Building a Primary Care Workforce for the 21st Century

Though access to primary care protects health and cuts costs, this report shows there aren\u27t enough primary care doctors and nurses at health centers to meet the need, with some areas having almost none – a situation that cannot be solved just by expanding health insurance coverage. The report indicates the availability of a primary care workforce depends on where you live, and primary care clinicians are not locating in areas that need them most, especially low-income communities. The study includes state-level projections of growing patient needs expected to stretch the health care system in years ahead. It was conducted by the National Association of Community Health Centers (NACHC), the Robert Graham Center and George Washington University Department of Health Policy

The Health Care Access and Cost Consequences of Reducing Health Center Funding

For over four decades, community health centers have served a critical role in providing affordable access to quality care to some of the nation\u27s most vulnerable populations. Health centers have historically enjoyed broad bipartisan support, based on the evidence documenting their high quality care, crucial role in both urban and rural communities, and ability to bend the cost curve. On February 20, 2011, the U.S. House of Representatives voted to reduce discretionary health center funding by $1.3 billion in FY 2011 alone. Although the spending bill was rejected by the U.S. Senate on March 10, 2011, final spending measures for health centers are yet to be determined. If other proposals to reduce health center funding are enacted into law, they would effectively undo health centers\u27 ability to grow, as envisioned under the American Recovery and Reinvestment Act (ARRA) and the Affordable Care Act (ACA). This brief discusses the consequences on access and cost savings of reducing federal funding. Building on our prior analyses of the impact of both ARRA and ACA on improving the ability of health centers to reach medically underserved communities, we conclude that the proposed$1.3 billion reduction in health center funding for FY 2011 would significantly reduce health center capacity, eliminating access for between 10 to 12 million patients. Amid concerns of continuing threats to health center funding, we also find health centers are likely to reconsider some expansion efforts and may be unable to meet the increasing demand for care, particularly as coverage is expanded. Federal investments in health centers under ARRA and ACA were intended to strengthen and expand primary care capacity. The proposed reduction in health center funding would undermine efforts to expand access to quality care for vulnerable populations, reduce health disparities, improve birth outcomes, protect local economies, and save federal and state health care costs. Moreover, we estimate that a $1.3 billion reduction in FY 2011 health center funding would translate into a loss of approximately$15 billion in cost savings; put another way, for every one dollar in health center funding reductions, $11.50 in potential savings is lost as a result of reduced health center capacity to efficiently manage care and reduce avoidable costs

Health Centers Reauthorization: An Overview of Achievements and Challenges

Since the establishment of the first health center in 1965, health centers have evolved into an essential component of the health care safety net. Today, over 1,000 federally funded and look-alike health centers serve 14.3 million people, three-quarters of whom are uninsured or covered by Medicaid. As the nation\u27s largest primary care system, health centers care for one in five low-income uninsured persons and one in nine Medicaid beneficiaries

Health Centers as Safety Net Providers: An Overview and Assessment of Medicaid\u27s Role

In 2001, health centers provided health care services to nearly 12 million people at more than 4,000 sites across the United States. As such, the health center program is a crucial part of the health care safety net for low-income individuals and medically underserved communities. This policy brief looks at health centers in detail in order to illuminate the role they play as providers of care and to document the important nexus between health centers and Medicaid

Medicare\u27s Accountable Care Organization Regulations: How Will Medicare Beneficiaries Who Reside in Medically Underserved Communities Fare?

On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) released proposed regulations implementing the Medicare Shared Savings Program (MSSP). The thrust of the MSSP is to promote savings to Medicare as well as the greater clinical integration of health care through incentive payments to accountable care organizations (ACOs) that meet Medicare standards for structure, performance, and health care outcomes. The effort to spur greater clinical integration through the MSSP was part of a broader set of reforms contained in the Affordable Care Act (ACA) whose aim was to improve health care quality and efficiency. Among these reforms is an $11 billion investment in community health centers, known as federally qualified health centers (FQHCs) under the Medicare program. In 2009, health centers served nearly 19 million low-income patients, including 1.4 million Medicare beneficiaries. By law, health centers must provide comprehensive primary health care while also serving as gateways to a full range of necessary care, including inpatient and specialty care. Federal data on health center services show that primary care represents 98.2 percent of all health care furnished by FQHCs. Despite the broad aims of the ACA, CMS\u27 proposed rule bars participation by health center-formed ACOs. Furthermore, while the rule permits health centers to be ACO participants, it also prohibits the assignment of Medicare patients to ACOs for shared savings purposes. Despite the absence of any legal barriers to FQHC participation in the statute, CMS bases this exclusionary policy on the fact that the FQHC payment method, which consists of a bundled payment for all primary health care services furnished by FQHC staff, does not allow the agency to identify which procedures are furnished by physicians, whose presence in care provision is a requirement of the ACO statute. In medically underserved communities, however, health care teams are essential because of the severe shortage of physicians; furthermore, FQHCs use health care teams to ensure comprehensive care. CMS policy has the potential to produce a series of downstream consequences, most notably, the systemic exclusion of the poorest and most underserved patients from the benefits of ACOs and the disincentivization of meaningful FQHC affiliation agreements with hospitals and specialty groups participating in ACOs. The exclusion of Medicare FQHC patients comes at a time when health centers have experienced explosive growth in the number of Medicare patients served -- a doubling of patients over the past decade, even as the number of low-income Medicare beneficiaries grew by less than 10% nationwide. The ACO statute provides the Secretary with the discretion to interpret the statute\u27s assignment rule to recognize physicians as providers of health care regardless of whether they furnish health care directly or as part of health care teams. Although technical issues will arise in designing a shared savings methodology for health care team arrangements that rely on bundled payments, this challenge ultimately pales alongside the implications of excluding FQHC Medicare patients from the potential benefits of ACO practice

The Role of Community Health Centers in Addressing the Needs of Uninsured Low-income Workers: Implications of Proposed Federal Funding Reductions

The severe economic downturn over the past few years has demonstrated the heightened importance of strengthening the health care safety net, particularly for working Americans who may have lost their health insurance coverage or do not have access to employer-sponsored benefits. Both historically and most recently during the current recession, health centers have played a critical role in providing services to the working poor, assuring that they continue to receive timely preventive care that obviates the need for, and minimizes use of, more costly services. We estimate that 1 in 4 low income, uninsured working adults depend on health centers for primary care. Our findings underscore the need to strengthen and expand health center capacity and to improve access to care for the working uninsured. Federal budget cuts to health center funding would likely result in significant loss of service capacity for many low income workers, even as states and localities continue to struggle with the deep economic aftereffects of the recession

Community Health Centers and the Economy: Assessing Centers\u27 Role in Immediate Job Creation Efforts

Federal investment in community health centers not only creates health care access but, based on previous studies, generates an estimated 8:1 return for medically underserved communities while creating thousands of jobs. Since our earlier 2008 economic impact study, Congress has made two major program investments: $2 billion under the American Reinvestment and Recovery Act (ARRA) of 2009; and$11 billion under the Affordable Care Act (ACA). This analysis measures the economic and jobs-creation benefits of this cumulative investment in health centers, as well as the impact of legislation enacted in April, 2011, which reduced the first year of new ACA investment by $600 million