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Telemedicine increasingly is being used to enable patients in rural areas to gain access to specialists. At the same time, concerns have arisen about the legality of certain telemedicine applications. To date, the HHS Office of Inspector General (OIG) has issued two advisory opinions stating it would not impose sanctions on two specific telemedicine arrangements, where potential violations of the antikickback statute could exist. These opinions, while applying only to the specific arrangements in question, provide physicians with clues to the OIG's thinking on various arrangements they may wish to initiate.
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There is concern throughout developed countries about how sufficient services can be mounted in this century to care for all older, disabled persons who want to remain at home. With declining availability of family care and high turnover among paid workers, cost, care supply, and quality dilemmas abound. Therefore, how can home care be improved? One suggestion is to revise the care "contract" by simply eliminating the costly bureaucratic and controlling dimensions of agency oversight and management. In consumer-directed or self-managed care, independent workers are hired directly by consumers or their family members. Consumers spend their own private money or government provides authorization for them to "hire" their own workers. Such arrangements may be more responsive to the needs of consumers, more directly accountable to them, and less costly for both individuals and government. This article examines 41 cases of consumer-directed care in Milwaukee. Extended interviews with three "stakeholders" in care--the disabled, older client, the family caregiver, and the personal assistant--were conducted, including both private pay and government subsidized arrangements. This analysis identifies some essential, but disparate interests of the three partners in care.
This Issue Brief examines the 1999 contribution behavior of 1.7 million 401(k) plan participants drawn from the EBRI/ICI Participant-Directed Retirement Plan Data Collection Project. The findings in this paper build on previous academic research examining the contribution activity of 401(k) participants, by using a large sample of participants in a wide range of plan sizes and by examining in detail the factors that influence contribution activity. Eighty-five percent of participants in the sample only made before-tax contributions to their plans, and 97 percent of all dollars contributed by employees were contributed on a before-tax basis. On average, participants contributed 6.8 percent of their salaries on a before-tax basis. Before-tax contribution activity varied among participants. About 61 percent of participants contributed more than 5 percent of their salaries on a before-tax basis and about 21 percent set aside more than 10 percent of their salaries on a before-tax basis. Eleven percent of participants analyzed in this study earning more than $40,000 a year contributed at the $10,000 before-tax IRC limit in 1999. Thirteen percent of participants with salaries between $70,000 and $80,000 contributed at the cap, and 18 percent of those with salaries between $80,000 and $90,000 were at the limit. However, it appears that among participants not contributing at the IRC limit, 52 percent could not have done so because of formal plan-imposed contribution limits below the IRC limit. Older participants tended to contribute a higher percentage of their salaries to plans than did younger participants, even after factoring out differences in salary and job tenure. Participants tended to increase the share of their salary (and amounts) contributed to their 401(k) plan as their salaries rose until salaries reached $80,000. For individuals with salaries above $80,000, before-tax contribution rates (though not the amounts contributed) tended to fall as salaries rose because IRC, and possibly plan sponsor, contribution limits became binding for some participants. Giving employees the option of borrowing from their 401(k) accounts increased participant contribution rates. On average, a participant in a plan offering loans appeared to contribute 0.6 percentage point more of his or her salary to the plan than a participant in a plan with no loan provision. Total contributions--the sum of employee and employer contributions--were higher for participants who received an employer contribution as part of their 401(k) plan than for those who did not. The average total contribution rate was 10 percent of salary for employees in plans offering an employer contribution, compared with 7.4 percent for those in plans not offering an employer contribution.
The dawnings of the age of human cloning and genetics is shaping lives, ideologies, and social structures. How will we--as individuals and as communities--respond to the possibilities, challenges, and changes of the clone age? This essay invites engagement in communal moral deliberation through broadening conversations about serious matters, including human cloning. A framework that includes important moral markers for significant "kitchen table talk" is offered. Clone age justice is also discussed. Attention is paid to the renewed role of religious voices in the public square.
CONFRONTED BY THE MOST SERIOUS ALCOHOLISM PROBLEM IN THE UNITED STATES, CALIFORNIA HAS BEGUN AN EXTENSIVE REHABILITATION PROGRAM IN THREE CATEGORIES: Treatment and rehabilitation services; study and investigation; education, information and training. Treatment clinics operate in seven cities and it is proposed to help finance further facilities in communities interested in their local alcoholic problem. Grants to medical schools for improved personnel training are also proposed. Basic and clinical research and epidemiologic, sociologic and follow-up studies are in progress. Public education to the problems of alcoholism, stressing that it is an illness requiring treatment, is under way. This multi-faceted approach is expected to supply answers to many of the questions surrounding alcoholism.
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Most nonprofits make program decisions based on a mission rather than a strategy. They rally under the banner of a particular cause, be it "fight homelessness" or "end hunger." And since their causes are so worthwhile, they support any programs that are related--even tangentially--to their core missions. It's hard to fault people for trying to improve the state of the world, but that approach to making decisions is misguided. Acting without a clear long-term strategy can stretch an agency's core capabilities and push it in unintended directions. The fundamental problem is that many nonprofits don't have a strategy; instead, they have a mission and a portfolio of programs. But they hardly make deliberate decisions about which programs to run, which to drop, and which to turn down for funding. What most nonprofits call "strategy" is really just an intensive exercise in resource allocation and program management. This article outlines for nonprofits a four-step process for developing strategy. The first step is to create a broad, inspiring mission statement. The second step is to translate that core mission into a smaller, quantifiable operational mission. For instance, an agency whose core mission is to fight homelessness must decide if its focus is rural or urban and if it should concentrate on low-income housing loans or on establishing more shelters. The third step is to create a strategy platform; that is, the nonprofit decides how it will achieve its operational mission. Decisions about funding and about client, program, and organizational development are all made here. Once that platform is established, the nonprofit is ready to move to step four--making reasoned, strategic decisions about which programs to run and how to run them. The agency that follows these steps will improve its focus and its effectiveness at fulfilling its mission.
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