The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Tutorial 2.0 on Technical Drawing 3D and Visualization

In recent years, the continuous incorporation of new technologies in the learning process has been an important factor in the educational process [1]. The Technical University of Madrid (UPM) promotes educational innovation processes and develops projects related to the improvement of the education quality. The experience that we present fits into the Educational Innovation Project (EIP) of the E.U. of Agricultural Engineering of Madrid. One of the main objectives of the EIP is to "Take advantage of the new opportunities offered by the Learning and Knowledge Technologies in order to enrich the educational processes and teaching management" [2].

Tutorial 2.0 on Technical Drawing 3D and Visualization

In recent years, the continuous incorporation of new technologies in the learning process has been an important factor in the educational process (1). The Technical University of Madrid (UPM) promotes educational innovation processes and develops projects related to the improvement of the education quality. The experience that we present fits into the Educational Innovation Project (EIP) of the E.U. of Agricultural Engineering of Madrid. One of the main objectives of the EIP is to Take advantage of the new opportunities offered by the Learning and Knowledge Technologies in order to enrich the educational processes and teaching management (2).

Effects of special educator peer coaching on general educator effectiveness in inclusive classroom settings

This dissertation investigated the effects of a peer coaching relationship between a special education teacher and two general education teachers. More specifically, a two-tier multiple baseline design across subjects was used to evaluate the effects of peer coaching on the general education teachers' use of effective instructional practices (EIPs) and subsequent effects on the engagement rate and academic performance of students with and without disabilities. The peer coaching process included modeling, direct support, and feedback on the use of effective instructional practices including getting student attention, giving specific directions, asking specific questions with wait time, contingent positive reinforcement, positive error correction, precorrection, prompting, and proximity control. A 30-second partial interval recording procedure was used to observe the general education teachers' use of effective instructional practices and student engagement rates. Student participants' academic performance was measured using weekly quizzes. ^ Peer coaching resulted in an overall increase in the teachers' use of EIPs. One general education teacher had a 30% increase in average EIP use from 46% during the baseline phase to 76% during intervention. Student engagement for her two student participants with and without disabilities indicated an increase from 54% to 69% and from 47% to 65% respectively. Results for the second general education teacher indicated a 34% increase in average EIP use from 55% during the baseline to 89% during intervention. Student engagement for the two student participants with and without disabilities in her class increased from 48% to 83% and from 29% to 71% respectively. Student academic performance showed a small increase. In follow-up observations, the effects of peer coaching on teacher use of EIPs and student engagement and academic performance were maintained. ^ The results of this study suggest that using peer coaching to support general education teachers can be an effective method to improve the educational outcomes of students with and without disabilities in general education. Further research is needed to investigate the effects of peer coaching with other special and general educator partnerships and other student participants. ^