In today’s world of constant regulation changes, the primary concern for healthcare foodservice operators continues to be centered on achieving higher patient satisfaction scores and outstanding level of service. Following closely behind are efforts to reduce operating costs, improve productivity and implement sustainable practices. All while maintaining a high level of food quality, of course.
Facilities need to be judicious when making decisions to reduce costs to ensure that the patient experience continues to be as positive and as pleasant as possible under the circumstances. One way facilities are achieving this is by incorporating reusable items into their daily operation. Reusable items are an appealing solution because they provide savings, sustainability and efficiency benefits.
An increasingly popular solution is the implementation of reusable lids for meal delivery mugs and bowls. These reusable lids eliminate the need of continuously having to purchase disposable, uneconomical lids that will eventually make their way into our landfills. It is estimated that the total amount of general (non-hazardous) waste generated by health-care activities is about 80% compared to domestic waste; which means sustainability efforts will continue to be top of mind.
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Are you looking for ways to save money on healthcare? Look no further. I worked 7 years as a pharmacist and have seen many people use creative ways to save money on healthcare. At one point I was on over 20 medications and I have used many different strategies to save money on healthcare. Here I share ways to save money on healthcare and medical costs.
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you're here because you want to save money on health care I actually wrote an article seven tips on how to save money on health care for seven years I worked as a pharmacist going to the same place and I saw many patients that came up with creative ways to save money because health care isn't cheap health care seems like it's gone off it was 200 a month and then 400 a month in some cases it's seven hundred or a thousand dollars a month so no wonder folks were having a hard time paying for health care and health care costs too there were a few years where I was on over 20 medications okay I was in and out of doctors offices in and out of pharmacies been through the entire system they grab some water here been through the entire system and found some really creative ways to save money on health care there are like 11 way you can save money on health care is always ask the doctor if you can pay cash and what kind of cash deals are available i have seen instances where a person didn't have insurance and they asked how much the cash price was for a doctor visit it was like a hundred bucks for a doctor visit and normally it would be two hundred bucks if the person had insurance that was really interesting there's other ways to save money too you can ask if a certain test needs to be run or not some tests or ask is it necessary because there's this place that there's hundreds or thousands of tests that can be run because the body can be checked for so many things but which ones actually really need to be run so those are just you know some tips there but I have the entire article on my blog post down below click there and that will bring you to the seven tips to everything they actually shows you much more many more ways how you can save money on health care once again down below is the full article click there and that will bring it to my blog post with that make it a wonderful day
Mid-Atlantic Public Health Training Center, November 18, 2015 – Brenda Roup, PhD, RN, CIC, Robin Decker, RN, BSN, CCM, Office of Infectious Disease Epidemiology and Outbreak Response, Infectious Disease and Envirnmental Health Administration, Maryland Department of Health and Mental Hygiene.
good afternoon and welcome to the public health practice grand rounds for March 2011 my name is Molly Mitchell and I'm the coordinator for the mid-atlantic public health training center and on behalf of the training center and the Maryland Department of Health and Mental Hygiene I'd like to welcome everyone to today's presentation on the health care worker immunizations recommendations and challenges with Robin Decker and Brenda roop just for those watching online if you have questions at any point during today's webcast please just click on the screen to send in an email for the presenters at any time during the today's presentation and before we begin today's presentation I'd like to just draw your attention to some of our trainings that are available online we have archived webcasts of every monthly public health practice grand round that we've ever done you can watch those as well as training for public health nursing and I just want to draw your attention to some of our trainings that are coming up that are face-to-face trainings including our community assessment and formative evaluation training on March 25th investigating environmental Public Health complaints on april six and outbreak investigation fundamentals a team approach on april sixth and seventh and also be sure to join us next month for the april public health practice again grand rounds on syphilis in maryland populations at risk on april twentieth with dr. anne-marie ron polo and with that I'll go ahead and introduce today's speakers we have dr. Brenda Roop who has served since 1999 as the nurse consultant in infection prevention and control for the Maryland State Department of Health and Mental Hygiene she has more than 30 years of experience in infection prevention and control programs has been certified in infection prevention and control since 1984 and has administered infection prevention and control programs in acute care hospitals ranging in size from 80 to 950 beds she's done extensive consultation and continuing education on infection prevention and control issues in acute and long-term care settings has published articles and book chapters relating to infection prevention and control and has presented infection prevention and control research studies at international conferences dr. root is also a retired US Army Nurse Corps officer dr. Roop received her BS in nursing degree from the Medical College of Virginia Virginia Commonwealth University ms in nursing degree from the Catholic University of America and PhD in nursing and epidemiology / infection control from the University of Maryland at Baltimore she also was selected to serve from nineteen ninety five to nineteen ninety seven as a Johnson & Johnson postdoctoral fellow in infection control at the Johns Hopkins University School of Nursing and Robin Decker is also joining us today Robin Decker is currently the nurse consultant in the center for immunization in the infectious disease and environmental health administration at the Maryland Department of Health and Mental Hygiene she has a long-standing interest in immunizations and vaccine preventable diseases and serves on the board of directors of the Maryland partnership for prevention she's a graduate of the University of Maryland School of Nursing and a member of Sigma Theta Tau pi chapter international Honor Society of nursing's since nineteen seventy-four she has worked continuously in both the public private sectors in a variety of settings and service areas with more than 20 years diverse populations in community settings her acute care nursing roles including CCU medicine and ophthalmology she also successfully operated her own company for eight years providing case management services this well that experience gives her an understanding of the benefits and difficulties of implementing national recommendations and with that I'm going to turn the floor over to Robin thanks Molly good afternoon let me put the water wave so I can't reach it and spill it I appreciate the opportunity to speak with you for a few minutes this afternoon about health care worker immunization I'll be talking about recommendations and dr. roof will address challenges this is a mission statement of infectious disease and environmental health administration at the Maryland Department of Health and Mental Hygiene I work there in the center for immunization as Molly said so why do we immunize well you know immunization is an essential part of any infection prevention and control program you're probably aware of the notoriously low immunization rates among healthcare workers in particular for influenza vaccination in one season influenza vaccination rates have not exceeded forty-nine percent which is abysmal really for healthcare providers so it's really not just personal it's important for us to protect patients our family members and our co-workers so we need to be vaccinated immunization has been called the most important public health intervention in but since safe drinking water it saved millions of lives and present prevented hundreds of millions of cases of disease smallpox has been eradicated worldwide the last case occurring in the United States was in 1949 the last naturally occurring case was in Somalia in 1977 polio global eradication efforts are successful the numbers were not 2010 totaled 1292 cases worldwide and as of March 9th 2011 only 51 new cases have been reported diphtheria is essentially a rat well not existed in the US except rarely we had a case reported in 2003 a 63 year old man visited Haiti to work in a rural village and when he returned to pennsylvania he was hospitalized he died 17 days post initial exposure of diphtheria and tetanus ninety-eight percent decrease in tetanus cases in the US since the pre vaccine era most recently in Baltimore County we had a case in September a lady a 95 year old lady was injured when she scratched her arm getting out of her car she died 17 days later this is my herd this addresses herd immunity the vogue term is now community immunity diseases that can spread person-to-person like measles mumps rubella varicella they're the kind impacted by herd immunity tetanus however is one that is spread through contact with contaminated soil or through contract with feces so it's not impacted by how many folks around you are immunized so a critical portion of the population needs to be immunized in order to protect those who are unable to be immunized because they're pregnant immunosuppressed or maybe just too young to get immunizations and it actually depends on the host the environment and the infecting agent some infecting agents require a higher level of immunization than others in order for her to mmunity to be effective so we immunize because vaccines work I'm used to having something in my hand what healthcare workers are we talking about well anyone in a healthcare setting who might expose patients or be exposed to vaccine preventable diseases it's not just employees the doctors the nurses the therapists the AIDS it includes volunteer volunteers and other staff anyone who has dr. group likes to say shares the air with patients why immunize healthcare workers well there are new roop there are reports ongoing of hospital-acquired infections there are always new findings about transmission and lack of immunity against some vaccine-preventable diseases new vaccines we have 2005 tetanus diphtheria and acellular pertussis vaccine was licensed since then we've had zostavax we've had human papillomavirus vaccine there are new recommendations looking at the data recommendations are modified and again I mentioned the low vaccination rates among many healthcare providers for certain recommended vaccines inpatient facilities acute care extended care any residential setting outpatient settings all the clinic settings private physicians offices homes adult day care settings anywhere health department's lab staff first responder certainly nurses and schools if you provide services to patients than as a healthcare person you need to be vaccinated I'll talk a little about the vaccination recommendations specific to healthcare providers in 1981 occupational health administration osha mandated availability of hepatitis B vaccine to all people who might come in contact with blood contaminated body or body fluids but blood contaminated products or body fluids an occupational exposure obviously puts people at great risk for infection the risk has decreased ninety percent with the advent of that recommendation in December 1991 and the implementation of standard precautions still there are approximately thirty percent of healthcare providers who decline hepatitis B vaccination which is I think a pretty high number the numbers in 1983 were seventeen thousand new infections yearly and they dropped by 1995 to 400 cases and that number is believed to remain constant hbv infection is very serious if you have 400 new cases a year approximately 20 of those people will go on to develop cirrhosis liver cancer and possibly need liver transplantation so the recommendation for hepatitis B vaccination is we have three options here two of which are likely to be done with healthcare providers and you'll hear me use health care providers and workers interchangeably so just forgive me follow with me single antigen three doses given at zero one and six months that means day 1 is 0 1 month after the first dose you give the second dose then six months following the first dose you give the third dose the combination vaccine there's one brand that combines a and B you have two dosing options with that you have a three dose option again at 01 and this can be given at six to 12 months or four doses given at 17 21 to 30 days and 12 months in any series that final dose is critical to maximizing immunogenicity the four dose option is generally reserved for people who are at higher risk of contracting hepatitis B that would be people for example in who injection drug users people in instil facilities people that you're not as likely to be able to get to return for those follow-up doses so even with this dosing option with the three-dose on the a and B vaccine a combination you want to take advantage of getting that person back as soon as you can for that third dose that's always important to maximizing your vaccination rates so for healthcare workers specifically well let me just say generally that if a person comes to you as a healthcare worker volunteer if you have a student working for you if they bring with them documentation that they have had the recommended series or you'll see what the other acceptable criteria are here in a few minutes if they bring documentation you don't need to do anything you don't have to do titers just keep the documentation and that's acceptable excuse me if we're hepatitis B if a person comes to you and they have complete documentation as I said that's all you need to worry about if they don't if they have not completed the series you need to either your occupational health group or if you have someone else you enlist to do it complete that series whether they've had one dose ten years ago or two doses 15 years ago you just provide the first or second or third dose whatever they need to complete the series you don't start over again at the end of completion of the series one to two months use that window to test for hepatitis B surface antibody if they are 10 million international units per milliliter or greater than they're considered immune if it's less than you need to repeat the series when you repeat the series you do the entire three-dose series the reason that is recommended versus one booster is that you're likely to get with one booster about twenty percent more of those folks who will respond will have an acceptable add a body rate and if you give a full three-dose series you'll get as much as fifty five percent response rate so that's important if after the second series they don't respond then they're considered susceptible and they should be counseled accordingly it's possible they're already infected they might need to have a hepatitis B surface antibody done and possible treatment initiated recommendations for influenza for everyone six months and older unless it's contraindicated the recommendation as of the current influenza season that's our 2010-11 flu season is that as I said everyone get vaccinated studies have documented the benefits of vaccinating healthcare personnel it reduces transmission of influenza in patient care settings and it decreases dullness and absenteeism rates among your healthcare workers so it's important there was a serious acero survey done at one institution during a mild influenza season and twenty-three percent of the workers tested showed that they had evidence of a menace influenza infection 3059 percent of those could not recall having flu and almost a third didn't even remember having any kind of respiratory infection so that suggests a very very high incidence of asymptomatic illness so if you're one of those folks who says well I don't get the flu shot because I never get the flu then you really could be infecting someone who is it great risk of having problems due to the sequelae of influenza infection recommendations trivalent influenza vaccine TIV or the injectable for everyone ages six months through adulthood who can't get the live attenuated influenza vaccine and for whom flu vaccine is not contraindicated give one dose annually there is situation we're talking about healthcare workers who are adults but for children there is a recommendation for those 2 through 9 who have never been vaccinated before or who had only one dose in the previous season to get two doses but put that aside health care workers are adults live attenuated vaccine is for healthy persons who don't have a medical contraindication that increases their risk for complications of flu it's for healthy non-pregnant persons to through 49 if they have any of the contraindications like chronic respiratory problems or cardiac problems etc if they're in that long list of people for whom flu vaccine is absolutely indicated they need to get the injectable vaccine so la IV is for healthy non-pregnant people to through 49 you give one dose intranasally annually and that to that what I mentioned about the children applies here in this situation the exception is that health care workers who provide care to people in say a bone marrow transplant unit in Reverse air flow settings should get TIV and not la IV and just an aside we often get the question can pregnant healthcare workers administer la IV yes they can they can administer any vaccine except smallpox MMR vaccine recommendations this is I mentioned the ACIP before these are ACIP presumptive recommendations for presumptive evidence of measles mumps and we address rabello on the next slide these are still provisional meaning they have not been published officially in an MMWR but the D hmh Department of Health and Mental Hygiene does a follow ACIP recommendations whether their final or provisional so for measles and mumps documented administration of two doses of live measles virus or measles should have measles and mumps pardon me the laboratory evidence of immunity or confirmation of disease or birth before 57 and I'll talk about that in a minute for rebello documented administration of one dose and laboratory evidence of immunity or confirmation of disease or birth before 57 except women of childbearing age who could become pregnant notice one dose for rubella two for measles and mumps and I'll point out here that single antigen measles mumps and rubella vaccines are no longer available in the United States they became about mumps has been unavailable for about two years and measles and rubella now for about the past year MMR vaccine recommendations I said I would talk about that asterisk birth before 1957 and itself might not be sufficient evidence of immunity if there's an outbreak they need to have the recommended number of vaccinations there for measles mumps or rubella except for rubella if they have one documented dose they're okay but for measles a month they need to the healthcare facilities even though it's not absolutely recommended should really strongly recommend it in their own staff varicella vaccine recommendations there was a situation documented in 2006 where for medical students were ended up with varicella they were exposed doing an autopsy there was blood that splattered there was no attempt made to wash anyone off or determine their immunity status at that point there is Sela serologic proof of immunity prior vaccination with two doses verified history of varus varicella disease or history of shingles because if they have shingles they've either been vaccinated or they had varicella also you can test again obviously it's one of the acceptable criteria for immunity but it's not recommended that you test after administration of varicella vaccine the tests that are generally available are not consistently sensitive enough to detect vaccine induced immunity Tdap tetanus diphtheria and acellular pertussis this is a recommendation that was made by the ACIP in 2006 healthcare personnel in hospitals or ambulatory care settings who have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously had a pertussis containing dose there was a cow you all are familiar I'm sure you've heard about the California pertussis outbreak the 2010 preliminary data of show they've had the greatest number of cases reported since 1947 they've had almost they had during 2010 almost eighty four hundred cases reported sixty-three percent of those cases were confirmed and the probable and suspect cases were just about an even split among the remaining numbers there were ten reported deaths nine of those were infants under two months of age who were too young to have started their vaccination series this really amplifies the importance of having people around infants immunized not just health care personnel but anyone in fact I'll take a second here to talk about an initiative Department of Health and Mental Hygiene is fortunate to work with the Maryland partnership for a prevention we have the executive executive director Tiffany Tate here in the audience today we work with them many of our initiatives are its far-reaching this one is not specifically targeted to healthcare providers but involves healthcare providers as our partners because the focus is immunizing women postpartum who have not yet been immunized with a pertussis containing vaccine and anyone who's going to be around that infant so if you're interested in this or some of the other initiatives I'll be talking about in a few minutes please contact the Center for immunization at 410 76 76 679 or Google the Maryland partnership for prevention oh by the way that last child the one out of the ten was just I think about three months old and had had only one pertussis dose in the series this is a continuation of the 2006 excuse me MMWR recommendations this describes the CDC definition of who is included physicians etc it's just not limited to all the professional staff involved in caring for patients it's all the people who come into contact with them you can see social workers chaplains clerical people we should include maintenance people vendors anyone who's going to come in contact with that patient the Joint Commission recently released a monograph that addresses Tdap vaccination strategies and they've cited that document that vaccination coverage of healthcare workers in 2008 with tdap was it about sixteen percent so we have a whole lot of work to do tetanus diphtheria pertussis vaccination for adults less than 65 if there is an incomplete series or there's no history of vaccination then you either give a complete series or complete the series that was already started remember you don't have to restart it one dose at 0 1 and 6 to 12 months and again take advantage of that six-month opportunity if you can get someone back quickly you boost every 10 years and the current recommendation is only one Tdap but that may well change as soon as more data is gathered oops sorry adults 65 and older this the FDA has licensed Tdap for use in people in one vaccine brand it's 10 through 64 and another is 11 through 64 so this recommendation is actually an off-label recommendation in California this summer the Department of Health recommended this use because of the pertussis outbreak in Canada it's been used off-label in people 65 and over over and also in a group of children we previously had no recommendations for pertussis containing vaccine for children seven through nine so that created some problems Canada's been doing it for years though and data do not show any increased adverse reactions in these people in the off-label groups so again if you're going to have contact with an infant definitely get it and any other adult over 60 or 65 or over who wants to be immune and protect others timing this is this is critical not just for healthcare workers anymore as the recommendation from 2006 stated but it can be administered regardless of the interval since the last tetanus or diphtheria toxoid containing vaccine I can't stress that enough some physicians are still very uncomfortable with that recommendation so if you have someone who is uncomfortable you can refer them to the CDC they can look at the MMWR that was released in may not may in january of 2011 january 28 which clearly discusses that meningococcal vaccine is recommended for lab workers only and the one of the resources you may have gotten the links that i sent to Mali one of the resources we use often which is a one page healthcare work or vaccination recommendations in brief does not address revaccination of people who remain at risk but that is an important new recommendation that is that F if they remain at risk they should be revaccinated in five years for ages 2 through 54 use meningococcal conjugate and 55 and older use meningococcal polysaccharide I mentioned a couple of other initiatives that we're involved with with MPP this initiative the healthcare work or vaccination initiative is in its sixth year it started out as the healthcare worker influenza vaccination initiative and 29 2009 we began to introduce more information about overall healthcare worker vaccination recommendations and then officially this last season 2010-11 it became we dropped influenza and it became vaccination initiative as you can see the goal is to raise vaccination rates among healthcare workers and support is provided MPP provides resources to support people in their vaccination campaigns there have been lots of creative things that been done could be a provider office it could be an agency can be a health department a hospital any long-term care facility if you have a question just call and find out whether or not you're eligible it's a little late to join for this year but do you think about it next year usually in the late summer the information is sent out and then there is a reward banquet people actually get Awards they're recognized to their efforts it's well received and this is a new initiative the maryland health care worker immunization best practices challenge this is designed to inspire and reward exemplary practices and vaccinating health care workers MPP is providing grants up to fifteen thousand dollars that's huge at least to us it is to start refine and or continue campaigns to vaccinate staff and volunteers against vaccine-preventable diseases this initiative aims primarily at non flu programs since we have our other now before dr. roof speaks I just want to make two important points just reinforce this you need to be sure that you have documented the immunity status related to vaccine-preventable diseases addressed in these recommendation document that status for all of your staff and for people who decline vaccination who are not immune you want to be sure you revisit that topic on a regular basis so maybe during the year when you have your flu campaign consider that dr. Roop good afternoon everyone please excuse my glasses but I need them to read I'd like to thank the mid-atlantic public health training center for inviting us here today and thank you Robin for that thorough overview of the immunizations that are recommended for health care workers in Maryland from the CDC's Advisory Committee on Immunization Practices now you see on this whoops it would help if i put the next slide up we consider health care worker immunization to be one strategy towards the ultimate goal of patient safety and that is a good way for us to think about it because we're not we are looking at the employees but we're ultimately focusing on the patients and the communities as well now / in my experience and perhaps in yours as well this overview that miss Dekker has given us of immunizations there's an enormous amount of variability in how facilities and agencies of health care in Maryland deal with the challenges of immunizing their healthcare worker workforce now I'm speaking about I am going to talk about the challenges but I'm speaking about all health care settings and agencies not just hospitals or long-term care i'm talking about home health care physicians offices freestanding facilities such as ambulatory surgery dialysis group homes all of these places where healthcare is given our recommendations apply to but before i go into those challenges this afternoon however let me say that in my opinion the success or failure of a healthcare worker immunization program is directly correlated with the amount of emphasis placed upon that program given by the facilities or health systems what infection preventionists like to call the c-suite now when I'm talking about the c-suite I'm talking about that location in a building a headquarters building on a hospital where you have the chief executive officer the chief operating officer the chief finance officer the chief medical officer the chief information officer and so forth and so on so although c is equal to AC sweet and I peas infection preventionists like to refer to that that way and by the human resources human resources must be a part of this process infection prevention and control programs and employee occupational health programs place great emphasis of course and spend enormous amounts of their time and energy on health care worker immunization but without the visible not just tacit but visible support from the folks upstairs these efforts are frequently met with results that are lackluster or mediocre at best I want to put it wanted to put up this disclaimer these opinions and suggestions are mine based upon a literature review and position statements numerous position statements of professional healthcare organizations and these opinions and suggestions do not represent official policy of the Maryland State Department of Health and Mental Hygiene now these suggestions and recommendations again as I said are founded on a substantial body of literature which demonstrates rather conclusively that health care workers who are immunized against or otherwise immune to measles mumps rubella varicella hepatitis B tetanus diphtheria pertussis and influenza not only see their own morbidity decrease but positively affect the patient's they care for by not transmitting those infections to them so let's turn now to challenges and again I'm speaking of all immunizations as being robin said we're not just focusing on influenza here we're talking about all immunizations for healthcare workers in all health care settings so what are these challenges to getting healthcare workers immunized to common vaccine-preventable disease eases now I've distilled the challenges found in the literature down into what I consider to be five overarching concerns that need to be dealt with by the facilities or the health systems CEO Human Resources infection prevention and control and occupational health programs safety and health programs and any employee representation such as unions or collective bargaining units representatives from all of these areas must be at the table to design and enforce these healthcare worker immunization programs so these challenges appear to boil down to vaccine supply challenges related to fears about vaccine safety challenges related to the lack of knowledge regarding the epidemiology of vaccine-preventable diseases that seems that's not usually listed as a challenge but it pervades the literature another challenge is of course the big one health care workers refusal to receive vaccines and finally cost of vaccines to employees is a challenge now I'm only going to offer one or two suggestions for you to think about for each of these challenges but it should give you a framework to direct your thinking about your health care worker immunization program so challenge number one the vaccine supply production issues can usually result in either decreased amounts of doses or decrease delayed a delay delivery of doses or both now unfortunately this is generally something pretty much beyond our control and we can only really react to it so I'll talk in a minute about something you might be able to do about it but two good examples of this were 2003 and I believe 2004 somebody please correct me later if I don't have the dates right a huge influenza vaccine shortage and of course we had come out with all of our recommendations and lo and behold the vaccine was short and late and we had people lined up around the block for all over the place another one in which i found extremely interesting was in 2007 and 2008 shortly after a few months after cdc came out with its rather new recommendation that all healthcare workers should get a Tdap vaccination instead of one of their TD doses there was a Tdap shortage right so we really can't do a lot about that but we can do a little something about it and one of the primary things we can do is to stratify healthcare worker groups according to risk factors that increase the likelihood of their getting the infection the best example I can think of is to say for example Tdap vaccine should go first to emergency department personnel and pediatric staff because those are the persons who would most likely be in contact with a child who would have pertussis challenge number two this is also a big one fears about vaccine safety there are fears about side effects of the vaccine their fears about the vaccine quote causing unquote the disease it is meant to prevent of course we hear this most often with influenza vaccine I can't get the flu vaccine because it'll give me the flu it's interesting because have you ever heard any one say I can't get the hepatitis B vaccine because I'll get hepatitis B have you ever heard anyone say I can't get the measles vaccine because I'll get the measles right I've never heard anyone say that in relation to any immunization except influenza and urban myths and misunderstandings fueled by the internet and of course also certainly by rumor and co-workers and peer pressure and so forth but the internet plays this monstrous role if you go on and Google on urban myths related to influenza immunization or vaccine you get thousands and thousands and thousands of hits it's it's amazing the stuff some times I will just go google and read about some of the stuff that's on the internet about how you should never have a vaccine against anything that it will kill you in the long run it'll give you cancer it'll give you this it'll give you that it's oh it's amazing and yet as an aside I will tell you a few years back the Centers for Disease Control released a list of the 10 most life-saving public health measures in the last 100 years an immunization topped the list okay interestingly enough seat belts were number two but in terms of lives saved but immunizations top the list so what can we do about this continue with education education education education and champions among facility staff you just keep putting the facts out there you know every every vaccine has of as a vis a vaccine information statement that goes with it these are I think by federal regulation or law must be written at a lower level grade level so they're easily understandable you can use those vis is not just a hand of somebody after they've gotten the vaccine but you can use them for education you can anything you can do to to educate people about vaccine preventable diseases in terms of champions champions of course are usually defined as those individuals in a facility or an agency who are in positions of power and authority they can be immunized and agree to serve as role models for others and that can be a really great force for example you can if you can get all of your CEO CFO CMO and all those see people if you can get them down in the facility lobby like the hotel lobby and make it a media event and make sure they all get there safe influenza immunization that can have some impact on folks in terms of seeing okay well this is a top-down effort okay so these folks are getting it another thing that I think is extremely powerful that I don't think people use enough is peer pressure in the work setting you know we all know that in a work area in any work area actually there are individuals that may not have an organizational role that carry authority with it but for some reason they seem to have an enormous amount of influence over the attitudes and the opinions of the people that they work with okay if you can identify those people and get them on your side in terms of immunization then you can probably get a lot more healthcare workers immunized challenge number three healthcare workers lack of knowledge of epidemiology of vaccine-preventable diseases use me while I wet my throat now this may seem surprising but I see it over and over and over again we all do at D hmh and local health departments lack of knowledge of the chain of infection lack of knowledge of the fact that one single thing is not going to cause an infection that it takes a chain of events for that to happen lack of knowledge of roots of transmission lack of knowledge of intubation periods length of infectivity and so forth healthcare workers had a real lack of knowledge about these things why why should this be so probably because we no longer live in a world where we are surrounded by infectious diseases all of the time so education about these common vaccine-preventable diseases is frequently either not done or glossed over or just given very short periods of time and also to along that same black of knowledge about epidemiology healthcare workers are notorious for working when they are sick ok notorious for this most of them either forget or never knew that these vaccine-preventable diseases are by and large most infectious before symptoms appear or when the first day or so of being symptomatic so they've already infected a large number of people this is certainly true of influenza a large number of people by the time they feel sick so what do we do about that innovative education strategies again here we are with the education one thing that I had heard suggested that you'd have to coordinate with your information technology folks on computer terminals throughout the facility or the agency you can have scrolling factoids about did you know and then something about measles something about mumps something about pertussis what's going on pertussis in California and did you know little factoids all the time about vaccine preventable diseases the epidemiology and the vaccine you can offer things with continuing education credit contact hours for nurses continuing medical education credits so forth and so on you give them continuing credits and feed them and they will come and not the same right you can also have teaching rounds you can have short videos that are constantly playing on computer terminals and of course the usual literature and brochure brochures but you need to be as as innovative as you can possibly be when dealing with that lack of education all right number for healthcare worker refusal to receive vaccine now if you as president and or CEO have committed your facility or health system to have a healthcare worker workforce that is as safe as possible for your patience and that one of your strategic goals is to have a workforce that is immune to all common vaccine-preventable diseases then this is the major hurdle you have to overcome and how will you do it well first of all CEO c-suite so forth human resources administration administrative support is absolutely crucial absolutely crucial the refusal to be vaccinated against any of these healthcare worker immunizations should have the quinces the refusal should be have consequences attached to it now there are several ways that you can do this the first of course is declination forms that are placed either in the employees medical or personnel file now most of all of you actually should be used to dealing with this OSHA has required a declination form if you decline the hepatitis B vaccine and work in an area in which you were exposed to blood or body fluids to be placed in the employees medical file for the last 20 years so most places should be used to dealing with declination forms masks or requiring unamused healthcare workers to perform certain actions when around patients such as wearing a mask ok also you can have persons wearing tags on their ID badges or lack of tags on their ID badges to set them apart as it were to say no they have not had these various types of immunizations finally of course is to make the immunizations a condition of employment with its with the exceptions of those with documented and I mean underline that documented medical exemptions we have several health systems in Maryland that have made receiving the influenza immunization mandatory and as a condition of employment as of last fall 2010 generally the implementation of these policies has gone very smoothly for these health systems and only a relatively few employees have had to be terminated the largest of these is medstar medstar health systems has nine hospitals in the Baltimore Washington corridor greater than 25,000 healthcare personnel and 4,000 affiliated physicians they have achieved influenza immunization rates of 99.9 percent of their healthcare workers and ninety-three percent of their affiliated physicians you can read all about it in an article that was just published online the journal is infection control hospital epidemiology which is the official journal of the Society for healthcare epidemiology of America it is in the april 2011 issue it's online it's not out in print yet but it's online the title of the article is champion patient safety through mandatory influenza vaccination for all healthcare personnel and affiliated physicians that is in april 2011 volume 32 by karen fell banner whole fodder and thomas and i'll repeat that for you later if you if you want me to but they go into detail about how that was achieved and all the people they brought to the table so it can be done it can be done and finally challenge number five the cost of vaccine to employees this is a relatively easy one to deal with the body of literature on health care worker immunizations suggests that you meet with the greatest success if the employer offers all testing for immunity and meaning serologies and vaccines free of charge to the employee you end up doing something like putting your money up front okay and if you have decreased employees sickness as a result of your employees being immunized you don't have to call in temps temporary personnel from a temporary agency they always cost more or you don't have to furlough somebody with pay who has been exposed to a patient with a vaccine preventable disease so you save money that way so in the long run of course you do end up saving money so in summary our patients deserve to be cared for by healthcare workers who are immune to common communicable or vaccine preventable diseases to reach the goal of an immunized health care worker workforce a variety of challenges await and the hardiest hardest of these can be overcome with strong consistent support from the administrative c-suite and human resources now thank you and miss Dekker and I are happy to discuss any question you might have thank you very much dr. rube and miss Dekker this is the time in the program for us to take questions and answers both from our live audience as well as those watching online if you are watching online I just want to let you know we have a separate email address for you to send your questions to we're having problems with the training center email so please send any questions too mm I CH AE L at JHS phed you and again that addresses mm I t CH AE L at JH SPH edu and so now we can take questions from our live audience right here especially a comments just interesting information about the pertussis outbreak I was at the National Foundation for infectious diseases clinical vaccinology course back in November and they had dr. Alexander from Chicago who's or pertussis experts speak and one of the points that he brought up which I thought was interesting and I believe he's going to publish it is that about fifteen to twenty percent of adults who have one coughing for more than two weeks where pcr positive or pertussis did not know and that just speaks to the whole thing about vaccinating parents generation and the grandparents generation and healthcare personnel because they don't even know they're exposing susceptible children to pertussis which is much more dangerous to them thank you out I think that dr. Alexander kyt speaking at the National okay do we have any other questions here today comments okay just waiting I wanted to get people a minute to send their emails to this other address if we have no other questions yeah vaccination now I know that is one way to certain when we approach it up I'm guessing now when I say this but from my interactions with Maryland's QPR infection preventionists all of the hospitals require an immunization review when that person is hired and I believe that most of them to require an entry to at least MMR and varicella but IM pertussis not yet not yet that still considered to be a relatively new requirement I think most of them are fine to get their orbits department of pediatrics pass any ties but as for everyone else I don't think so but you know again I don't have that yo collecting today I don't but the immunization Action Coalition I think in their mother to their I AC express newsletter does offer out the number two now and grow them to our requiring hospital staff requiring innovation if you probably have a breakdown we're saying when they come in but probably an increasing number are probably going to add it this is really increasing them probably going to add it this is becoming you know now that we do have now that we do have published experiences showing that it can be done you just bring all the right people to the table I mean they didn't accomplish this so MedStar didn't accomplish this overnight they started working on this years ago okay but they brought all the elements together and lots and lots of Education lots and lots of advanced notice that type of thing so it's Adventist Health System is also another system in Maryland that started to require it last fall of course they're not as large as MedStar but they are the other big one there are other big facilities in Maryland that stopped just short of making it mandatory and do that second thing that I mentioned on the slide is if you have turned down the influenza immunization you must wear a mask within six feet of a patient so I think the general trend is we are moving in that direction so uh is there any reason I can't name a hospital institution I don't know of any reason why are you asking me I don't know you're here with me pick your partner in crime one of our large healthcare facilities in Baltimore County the Greater Baltimore Medical Center had a one hundred percent vaccination rate for influenza this year and I believe not absolutely sure I believe that they they lost only I'm thinking seven people either through termination or a resignation so we really are seeing more and more of this people jumping on the bandwagon right some hospitals are still reluctant to require it but more and more saying this is it one of that one of the things that MedStar discovered you which you'll read in the article when you when you look it up is you know you hear a lot of people say that they are allergic to the influenza immunization or other kinds of things out of 25,000 there were I think 125 documented medical reasons exemptions out of a 25,000 people only a hundred and twenty-five could bring a note from their doctor saying that they couldn't have it so the condition is not nearly as widespread as they people think it is so it will move ahead I can cite something I meant to speak about I was talking a measles outbreak in Arizona in 2008 at three hospitals almost 8,000 healthcare personnel were exposed 25% had no documentation of immunity so they were serologically tested and thirty percent were born before fifty seven and five percent were susceptible seventy percent were born after nineteen fifty seven and eleven percent were susceptible so obviously there was a big gap there and knowledge of their immune status so hopefully we'll begin to see one of the things it's on the to-do list addy hmh or rather in the center for immunization I shouldn't commit everyone is to work more closely with our institutions of higher learning here in Maryland and any programs where healthcare staff are trained so that they can be sure that they know what the immunes immune status is and not over tests not do more than they need to do I think I briefly mentioned that but we do have places who call us saying we have a student or a parent my call and say my daughter had documentation of her hepatitis B vaccine series she's in this nursing school and they're requiring her to start the series again because when they tested her she showed no immunity so we want to educate people about that so that we have a nice balance of what's happening out there first of all the epidemiologists in center for immunization closely monitor any imported pertussis cases and work very closely with the local health department's Maryland has not seen an increase in in pertussis cases I believe there's been a slight increase in Pennsylvania I believe there has but we're watching things very closely with regard to the immunization rates certainly we were number one in the u.s. two years ago Tiffany regarding our immunization rates for children up to 36 months ok so hi hi immunization rates it's easier of course to make sure those rates are high once children are entered into daycare or school because of state requirements that are in place but we really continue the Maryland partnership for prevention is always you know working on initiatives to try to put that out there the importance of immunization how can we educate people our local health department's do a wonderful job the private providers involved in the vaccines for children program do a great job immunizing those kids so we have high vaccination rates among our children in Maryland if I can emphasize again I in kind of alluding to what Robin just said in my experience and I mentioned this at the beginning of my remarks the variability in immunization rates especially influenza immunization rates among say for example acute care hospitals in Maryland okay it truly is directly correlated with the emphasis on immunization of their healthcare worker workforce by the administration it really is if the administration has decided that immunization is one strategy towards the goal of patient safety and our number one goal in this business is to keep our patients safe then immunization plays an enormous role and everybody is aware of it everybody knows they have to go and be tested or get their immunizations and that kind of thing and in other acute care facilities in Maryland it's not a priority at all and you can see that when you see their immunization rates you know you can see that it's not a priority at all so it definitely depends you know infection Preventionist and occupational health nurses can only do so much they have to have administrative support so okay we do have some questions from our online audience and this is a question from Portland Oregon how have non-western myths of immunization been addressed when they view research based education with suspicion say that again how have non-western myths of immunization been addressed when they view research based education with suspicion no I think that that you can be sometimes very very innovative in terms of Education and that's really all I can suggest at this point that sounds like the kind of thing if you have someone who simply is is not going to believe what you say regardless of what you say you just try to be as innovative as you can that's that's the only way i can think of answer that okay and then we also have a question about pertussis if a fifty-year-old healthcare worker had pertussis infection about two years ago do they need a dtap vaccine and if yes when or how often I do believe it is recommended even if you have had documented pertussis dr. Wilson please correct me if I'm wrong that does not necessarily confer lifelong immunity is that correct okay yeah so timing wise if the person had it 50 year two years ago rather I would say now is the time to get that Tdap vaccination okay and then we also have a question about TB skin testing please shed light on TB skin testing for staff if this is appropriate for the viewing audience at this time well I would say our a TB staff would need to address that question I thought it was going to relate to vaccinations but it's not really no relevant okay okay do we have any other questions from our live audience if not then I think that ends our presentation for today I really want to give a big hand and thank you to dr. roop and miss Dekker for joining us today and again we hope that you all will join us again next month on april twentieth for our presentation on syphilis in maryland thank you very much you
Senate Republicans have released their version of a health care bill to replace the Affordable Care Act. Title IX was signed into law by President Nixon on June 23, 1972. Since it was passed, it has swung open the doors to women in school sports. Becca Longo, has signed a letter of intent to play for Adams State in Colorado, the first female on a football scholarship at a Division I or II school.
♪ ♪ >> COMING UP NEXT ON ARIZONA HORIZON: WE'LL TAKE A CLOSE LOOK AT THE HEALTHCARE PLAN RELEASED TODAY BY SENATE REPUBLICANS. ALSO TONIGHT: A LAW THAT OPENED UP COLLEGE SPORTS PROGRAMS TO WOMEN IS TURNING 45 YEAR OLD. AND WE'LL HEAR ABOUT THE FIRST WOMAN TO EARN A FOOTBALL SCHOLARSHIP AT A DIVISION-2 OR HIGHER SCHOOL. THOSE STORIES NEXT, ON ARIZONA HORIZON. ARIZONA "HORIZON" IS MADE POSSIBLE BY CONTRIBUTIONS FROM THE FRIENDS OF ARIZONA PBS, MEMBERS OF YOUR PBS STATION. THANK YOU! >> GOOD EVENING AND WELCOME TO ARIZONA HORIZON. I'M TED SIMONS. LEGENDARY ASU FOOTBALL COACH FRANK KUSH PASSED AWAY THIS MORNING AT THE AGE OF 88. KUSH'S HAD BEEN IN DECLINING HEALTH OVER THE PAST 2-YEARS. FRANK KUSH WAS MORE THAN A FOOTBALL COACH, HE HELPED WITH ASU'S TRANSITION FROM A COLLEGE TO A UNIVERSITY, AND WAS INSTRUMENTAL IN PUTTING ARIZONA SPORTS AND ARIZONA ITSELF ON THE MAP. KUSH COACHED ASU'S FOOTBALL TEAM FROM 1958 TO 1979, A RUN THAT INCLUDED A SCHOOL-RECORD 176 GAMES. IN 1975, HIS TEAM FINISHED WITH A PERFECT RECORD, WHICH INCLUDED A WIN OVER NEBRESKA IN THE FIESTA BOWL AND A NUMBER-2 FINISH IN THE COLLEGE FOOTBALL RANKINGS. >> THE NEBRASKA GAME, OUR QUARTERBACK GOT HIM AND WE SENT FRED IN AND HE DID A COMMENDABLE JOB. MY SON DAN KICKED THREE FIELD GOALS AND FINALLY KICKED THE WINNING FIELD GOAL. >> DANNY WHITE, WHO WAS QUARTERBACK UNDER KUSH IN THE EARLY 70S, REACTED TO HIS DEATH BY SAYING, QUOTE: "IF YOU KNOW FRANK KUSH AND THE KIND OF MAN HE WAS, HIS (RECENT) LIFE HAS NOT BEEN A LIFE YOU WOULD HAVE WISHED ON ANYBODY. THAT MORTAL BODY THAT WAS HOLDING HIM BACK AND GIVING HIM SO MUCH PAIN IS GONE. HE'S A HAPPY MAN ONCE AGAIN. ASU VICE PRESIDENT FOR UNIVERSITY ATHLETICS RAY ANDERSON ALSO REACTED TO KUSH'S DEATH. HE SAID "FRANK KUSH IS SUN DEVIL FOOTBALL. FRANK WAS THE ARCHITECT OF SUN DEVIL FOOTBALL AND IS REVERED BY ALL SUN DEVILS EVERYWHERE. HE'S A COLLEGE FOOTBALL HALL OF FAMER, HE'S IN OUR HALL OF DISTINCTION AND THE FIELD AT SUN DEVIL STADIUM IS NAMED AFTER HIM. TODAY, HE AND HIS FAMILY ARE IN OUR HEARTS. KUSH'S CAREER FAMOUSLY ENDED IN CONTROVERSY WHEN A PLAYER SAID KUSH PUNCHED HIM DURING A 1978 GAME. AFTER LEAVING ASU, KUSH WENT ON TO COACH IN THE NFL, THE CANADIAN FOOTBALL LEAGUE AND THE SHORT-LIVED USFL. HE CAME BACK TO ASU IN 2000 AS A SPECIAL ASSISTANT TO THE ASU ATHLETIC DIRECTOR, AND REMAINED A PART OF THE ASU ATHLETIC DEPARTMENT FOR THE REST OF HIS LIFE. AGAIN, ASU FOOTBALL COACH FRANK KUSH PASSED AWAY TODAY AT THE AGE OF 88. SENATE REPUBLICANS TODAY RELEASED THEIR VERSION OF HEALTH CARE LEGISLATION DESIGNED TO REPLACE AND REPEAL THE AFFORDABLE CARE ACT, OR OBAMA-CARE. HERE TO BREAK DOWN THE SENATE PLAN IS DR. DANIEL DERKSEN, A HEALTH POLICY EXPERT WITH THE UNIVERSITY OF ARIZONA. >> THIS SENATE BILL IS HOW SIMILAR TO THE HOUSE BILL? >> VERY SIMILAR IN SOME WAYS IT IS WORSE. THE CUTS TO MEDICAID ARE WORSE THAN THE HOUSE VERSION. THE HOUSE VERSION WAS ESTIMATED TO REMOVE 834 MILLION FOR MEDICAID AND THAT MEANS 200 MILLION A YEAR IN ARIZONA. IN THE COUNTRY, IT IS ESTIMATED THOSE CUTS WOULD FORCE 14 MILLION OFF MEDICAID AND 23 MILLION WOULD BECOME UNINSURED. THE TOTAL IN ARIZONA UNINSURED WOULD TURN TO 1.2 MILLION. THESE ARE CUTS IN THE FUNDING AND MANY ARIZONA RESIDENTS LOSE COVERAGE. >> Ted: AND AS FAR AS MEDICAID IS CONCERNED BECAUSE THAT IS THE BIG ONE AS FAR AS ARIZONA IS CONCERNED, STATES THAT EXPANDED LIKE ARIZONA GET TO KEEP FUNDING THROUGH 2023 EVEN THOUGH THE FUNDING CUTS START IN 2021. >> THE SENATE VERSION THAT CAME OUT, THE BETTER CARE RECONCILATION ACT IS WHAT THEY ARE CALLING IT, DELAYS IT FOR A YEAR. THE WAY THEY DESCRIBED IT IN THE SENATE IS THIS WOULD BE A SOFTER LANDING FOR STATES BUT IN MY VIEW IT IS A CRASH LANDING. IT WOULD SERIOUSLY DAMAGE THE STATE'S MEDICAID INFRASTRUCTURE. IT IS VERY HARD FOR ANY STATE TO ABSORB THE KIND OF CUTS WE ARE TALKING ABOUT OVER THE NEXT TEN YEARS IN MEDICAID FUNDING. >> Ted: IT CAPS FUTURE FEDERAL FUNDING PER ENROLLEE BUT THE STATES HAVE OPTIONS FOR THE LUMP SUM BLOCK GRANTS. WHAT ARE THOSE? ARE THOSE ENOUGH TO COVER WHAT WILL NEED TO BE COVERED? >> THIS IS SOCIAL SECURITY ACT THAT CREATED MEDICAID AS AN AMENDMENT BACK IN 1965. FROM THAT POINT, THE FEDERAL GOVERNMENT HAS TO PAY 50%. IN ARIZONA, 70% IS THE FEDERAL SHARE. THIS BILL REPEALS NOT OBAMACARE BUT THE SOCIAL SECURITY ACT THAT REQUIRES FEDERAL FUNDING. IT CONVERTS IT TO THIS PER PERSON AMOUNT BASED ON PREVIOUS YEARS EXPERIENCE. NO LONGER CAN THE STATE COUNT ON THIS BEING PART OF ENTIGHTMENT FUNDING BUT INSTEAD SHIFTED TO DISCRETIONARY FUNDINGS AND THE YEAR TO YEAR BATTLE IN APPROPRIATION RATHER THAN BEING GUARANTEED A CERTAIN AMOUNT BASED ON UTILIZATION. >> ARE THE BLOCK GRANTS YEAR TO YEAR? >> THEY ARE. THIS SHIFTS IT FROM ENTITLEMENT FUNDING TO DISCRETIONARY FUNDING. THE CUTS OF 800 BILLION TO MEDICAID OVER THE TEN YEARS BUT IN ADDITION THEY COULD COME BACK AND CUT EVERY YEAR BECAUSE IT IS THE YEARLY BATTLE. THAT IS A REAL CONCERN. >> Ted: IF THE CUTS START IN 2021 OUT OF HERE BY 2023, HOW DO HOSPITALS RESPOND? >> WE HAVE BEEN THROUGH THIS IN ARIZONA DURING THE GREAT RECESSION. WE WERE UNFORTUNATELY ONE OF THE BOTTOM FIVE STATES AS FAR AS JOB LOSS. WE LOST MORE JOBS THAN ALL BUT FOUR OTHER STATES. IN THE LAST FIVE YEARS, WE HAVE BEEN ONE OF THE TOP FIVE IN JOB GROWTH AND THE BIGGEST GROWTH IS THE HEALTH SECTOR. THIS WOULD REVERSE US TO 2008-2009 WHERE EVERY HOSPITAL WAS ON THE BRINK OF EXTINCTION. >> WHEN YOU BRING UP THOSE IDEAS TO THOSE WHO SAY THIS IS A BETTER IDEA THAN THE OBAMACARE WHAT ARE THE ARGUMENTS ON THE OTHER SIDE? >> I DON'T SEE HOW THIS IS A BETTER DEAL. CERTAINLY NOT FOR THE 75 MILLION ON MEDICARE. TWO MILLION OF OUR POPULATION ARE ON MEDICARE OR CHIP. THIS IS NOT A BETTER DEAL. THIS IS NOT MORE CHOICES AND IT WILL MAKE IT ALMOST IMPOSSIBLE FOR THE STATES TO BALANCE THE BENEFITS THEY OFFER THROUGH THE ACCESS PROGRAM. WHAT PEOPLE DON'T REALIZE IN THE MEDICAID PROGRAM AND OUR STATE AND OTHER STATE IS TWO THIRDS OF THE EXPENSES RELATE TO TWO ELIGIBILITY CATEGORIES AND THOSE ARE THE FRAIL ELDERLY AND THE BLIND AND DISABLED. HOW CAN A STATE MAKE UP $2 BILLION A YEAR DIFFERENCE IN THE BUDGET TO TAKE CARE OF A GROUP THAT IS VERY EXPENSIVE TO TAKE CARE OF? WHAT ARE YOU GOING TO DO IF YOU HAVE A DISABLED CHILD AND YOU CAN'T GET HELP WITH THE COST OF CARE? THIS IS A REAL ISSUE WE ARE FACING. >> Ted: ANOTHER ISSUE IS THE AFFORDABLE CARE ACT SAID YOU COULD NOT CHARGE MORE THAN THREE TIMES MORE FOR OLDER FOLKS THAN YOU DID FOR YOUNGER FOLKS. THIS PLAN SAYS FIVE TIMES OR MAYBE MORE COULD BE CHARGED TO OLDER FOLKS. I KNOW KAISER CAME OUT SAYING THE 60-YEAR-OLD IN PHOENIX WOULD PAY $9,000 MORE PER YEAR IF THEY HAD $40,000. OLDER FOLKS ARE PAYING MORE UNDER THIS PLAN. >> SOME PEOPLE ARE CALLING THIS THE AGE TAX AND THAT IS GETTING PUSH BACK RIGHT NOW. WE ARE IN THE TOP FIVE STATES AS FAR AS GROWTH OF POPULATION IN LOW INCOME ELDERLY. THE FIVE STATES IN THAT CATEGORY ARE GOING TO BE UNDUALLY PUNISHED BY THE CHANGES. WE HAVE THAT PLUS WE HAVE BEEN COST EFFICIENT. WE HAVE THE EIGHTH LOWEST PER CAPITA EXPENSE FOR MEDICAID PATIENT. WE HAVE BEEN ONE OF THE MOST COST EFFICIENT STATES AND WILL BE PEGGED TO THAT. THE STATES THAT HAVE BEEN LESS COST EFFICIENT WILL BE REWARDED FOR THAT INEFFICIENCY. THAT IS A LOT OF THE POLICY DISCUSSION GOING ON. >> Ted: COVERAGE UNTIL THE AGE OF 26 ON PARENTS DOESN'T CHANGE. >> THAT IS A VERY POPLAR PROVISION. FROM THE GET-GO THAT HAS BEEN PROTECTED. >> THE TAXES TO HELP PAY FOR COVERAGE WHETHER IT IS PRESCRIPTION DRUGS, MEDICAL DEVICES, INDOOR TANNING, WHATEVER IT IS. THEY ARE ALL GONE. >> YEAH, SO THE REVENUE SIDE GOES AWAY. YOU HAVE LESS INCOME COMING IN. THOSE WERE THE PAY-FORS FOR HAD YOU EXPAND COVERAGE TO THE NUMBERS. WE ARE AT THE LOWEST RATE OF PEOPLE UNINSURED HISTORICALLY IN THE COUNTRY AND THE WAY YOU PAY THROUGH THESE IS THE REVENUE SIDE OF THINGS. ALL THOSE ARE REMOVED SO LESS REVENUE COMING IN AND IN ADDITION TO THAT ALMOST A TRILLION OVER THE NEXT TEN YEARS IN CUTS TO MEDICAID. >> Ted: BOTTOM LINE, LAST QUESTION HERE, HOW WOULD THIS CHANGE THE NATURE OF HEALTH CARE? BECAUSE RIGHT NOW REPUBLICANS ARE SAYING OBAMACARE IS FAILING AND FAILING FAST. SOMETHING HAS TO BE DONE. THIS IS WHAT THEY ARE DOING WHAT DOES IT MEAN? >> THIS IS REPEAL THE AFFORDABLE CARE ACT AND SOCIAL SECURITY. THE PROBLEM IS YOU GO BACKYARDS AND BACK TO THE DAYS OF 50 MILLION AND 1.2 MILLION UNINSURED. YOU DON'T SAVE MONEY THROWING PEOPLE OFF COVERAGE. YOU ARE JUST SHIFTING THE COST TO PHYSICIANS AND NURSES AND OTHERS WHO ARE TAKING CARE OF THEM. YOU ARE SHIFTING THAT IN THE FORM OF UNCOMPENSATED CARE. >> THANK YOU SO MUCH FOR JOINING US. THIS IS ARIZONA HORIZON. UP NEXT, WE TALK ABOUT A LAW THAT OPENED UP COLLEGE SPORTS TO WOMEN. >> TOMORROW MARKS THE 45TH ANNIVERSARY OF TITLE-9, WHICH WAS SIGNED INTO LAW BY PRESIDENT NIXON. TITLE-9 PROHIBITS EDUCATIONAL FACILITIES THAT RECEIVE FEDERAL FUNDS FROM BANNING PARTICIPATION IN SPORTS PROGRAMS AND OTHER EDUCATIONAL ACTIVITIES, A MOVE THAT'S MADE A SIGNIFICANT IMPACT ON WOMEN'S SPORTS. HERE TO TALK ABOUT TITLE-9 IS DEANA GARNER SMITH, THE SENIOR ASSOCIATE ATHLETIC DIRECTOR FOR ASU AND BIANCA ARELLANO, A MEMBER OF THE ASU VOLLEYBALL TEAM. GOOD TO HAVE YOU BOTH HERE. WHAT IS TITLE NINE? >> TITLE NINE IS ACTUALLY IS THE EDUCATIONAL LAW ALLOWING FOR WOMEN TO PARTICIPATE IN EDUCATION AND BECAUSE IN THE UNITED STATES EDUCATIONAL OPPORTUNITIES AND PARTICIPATING IN SPORTS ARE CO-ACTIVITIES TITLE NINE FORGED THEM INTO DOING THAT. >> Ted: THE EDUCATION ASPECT WAS THE FIRST THAT WENT THROUGH AND THEN ATHLETICS FOLLOWED; CORRECT? >> FROM WHAT YOU ARE SEEING, HOW HAS IT CHANGED WOMEN'S SPORTS? PARTICIPATION ESPECIALLY. >> IN ARIZONA, ASU STATE DID SO MANY THINGS FOR WOMEN. ALMOST 20-21 YEARS PRIOR TO THE TITLE NINE ACT BEING IN PLACE IN 1972. WHEN IT WAS ENACTED, IT ALLOWED FOR MORE OPPORTUNITY FOR WOMEN SO THEY DIDN'T HAVE TO WORK AND PLAY THE SPORT. IT ALLOWED FOR THEM TO FULLY PARTICIPATE IN A SPORT. >> IS THAT THE MATTER IT USUALLY HAPPENED? >> YEAH. >> HOW FAMILIAR ARE YOU WITH TITLE NINE? >> RECENTLY WE HAD A CELEBRATION AND PARTY TO MAKE THE PUBLIC MORE FAMILIAR AND ESPECIALLY THE STUDENT ATHLETES MORE FAMILIAR WITH THE EDUCATIONAL LAW. FROM A SPORTS PERSPECTIVE WE ARE BLESSED TO HAVE SUCH AN IMPACT ON US. >> KIND OF HARD TO BELIEVE? >> IT IS HARD TO BELIEVE. >> HOW ARE YOU ENCOURAGED WERE YOU WERE YOUNGER? BIG TIME VOLLEYBALL PLAYER HERE. DID ANYONE EVER SAY NO? >> WELL, LUCKILY I GREW UP IN A FAMILY WHERE MY PARENTS INSTILLED ACADEMIC EXCELLENCE. I WAS SENT TO AN ALL-GIRLS CATHOLIC SCHOOL WHERE THEY FORCE ACADEMIC EXCELLENCE ON YOU AND THAT CORRELATES WITH ATHLETIC DOMINANCE SO WE WERE BLESSED TO HAVE BOTH EXPERIENCE. >> AND NEVER OCCURRED TO YOU THIS IS SOMETHING I SHOULD NOT BE DOING OR IS ODD FOR ME TO DO? >> ABSOLUTELY. IT WAS INHERENT. >> IT IS INTERESTING TO HEAR THAT BECAUSE THAT WASN'T ALWAYS THE CASE. >> NO, IT WAS DEFINITELY NOT. AND TALKING WITH SO MANY LEGENDS WHO HAVE BEEN TRAILBLAZERS HERE AT ARIZONA AND PARTICULARLY ARIZONA STATE TALK ABOUT THE EVOLUTION OF PARTICIPATING AS A STUDENT ATHLETE AND BEING GIVEN THE OPPORTUNITY AT 23 YEARS OF AGE IS AMAZING. >> WE ARE WATCHING A LOT OF WOMEN ATHLETICS HERE. IT IS AGAIN I THINK FOR FOLKS OF A CONCERN AGE THE IDEA WOMEN COULDN'T COMPETE IN ALL THE THINGS THEY WANT TO COMPETE IN OR VOLUNTEER OR WORK. IT JUST SOUNDS ODD. >> YES. AND AGAIN ATHLETICS FOR WOMEN, HOW IMPORTANT IS THAT? >> EXTREMELY IMPORTANT. FOR EMPLOYERS, YOU LOOK AT ANOTHER STATISTIC DR. VICTORIA JACKSON COMMUNICATES AND DR. NICOLE LEVOY AT THE UNIVERSITY OF MINNESOTA THAT A LOT OF YOUR TOP WOMEN THAT ARE IN BUSINESS AND FORTUNE 500 COMPANIES MANY OF THEM WERE ATHLETES IN COLLEGE. IT PROMOTES LEADERSHIP SKILLS, CONFIDENCE, THE ABILITY TO WORK THROUGH ADVERSITY WITH A TEAM THAT THERE MAY BE PEOPLE ON YOUR TEAM THAT YOU DON'T REALLY HAVE MUCH AN AFFINITY WITH. BUT THROUGH THE SPORT YOU WORK TOGETHER. IT CREATES INTEGRITY BECAUSE YOU CAN WIN BUT IF YOU DON'T HAVE THE ASPECTS OF THE INTEGRITY YOU MAY ONLY WIN A FEW TIMES. >> VOLLEYBALL VERY MUCH A TEAM SPORT. EVEN BEACH VOLLEYBALL YOU HAVE TO HAVE A FEW PEOPLE AROUND. THE TEAM THEME COMES THROUGH DOESN'T IT? >> THERE ARE SO MANY INFLUENCES SPORTS HAS ON YOU IN TERMS OF CHARACTER AND LEADERSHIP BUILDING. IT IS JUST COINCIDES WITH EDUCATION SO WE ARE THANKFUL TO HAVE THIS EDUCATION LAW. >> DOES IT FEEL WOMEN'S SPORTS IS ON EQUAL FOOTING? >> I THINK SO. I KNOW THERE IS THE TITLE NINE MYTH AND DISCREPANCY BUT IT IS PUSHING TOWARD EQUALITY. AND EQUAL REPRESENTATION ESPECIALLY WITH STUDENT ATHLETES. >> DOES IT FEEL LIKE THAT TO YOU AS WELL? >> I WOULD SAY THE ONE THINK THAT IS INTERESTING AFTER TITLE NINE WAS PASSED IS THE NCAA CREATED A DESIGNATION WHICH IS PART OF MY ROLE AS ARIZONA STATE. I AM THE PERSON IN THE ATHLETIC DIRECTOR AND WE MAKE SURE ALL OUR TEAMS ARE APPROPRIATELY SOURCED. I WORKED WITH THE BUSINESS DEPARTMENT, HR DEPARTMENT, AND SUPPORT ADMINISTRATORS TO MAKE SURE THE ROSTER IS MANAGED PROPERLY. THANK YOU FOR BEING HERE. >> WE WANT TO HEAR FROM YOU. SUBMIT YOUR QUESTIONS AND COMMENTS VIA E-MAIL AT OUR E-MAIL ADDRESS. >> A TEENAGER IS MAKING HISTORY FOR ROVING AN NCAA FOOTBALL SCHOLARSHIP TO PLAY FOR FOOTBALL. THAT IS BECAUSE THE KICKER IS BELIEVED TO BE THE FIRST WOMAN TO RECEIVE SUCH AN AWARD. ROCKY MOUNTAIN CORRESPONDENT REPORTS AT THIS MOMENT IN TIME IS INSPIRING MANY TO FOLLOW THEIR DREAMS. >> Reporter: THIS ARIZONA TEENAGER SEEMS LIKE A NORMAL TEENAGER AT GLANCE TRYING TO CAPTURE THE PERFECT PICTURE ONLINE. BUT THOOES THESE FINAL THREE — BUT THESE FINAL FLEEING MOMENTS ARE HISTORICAL. >> ALL THESE HUGE ORGANIZATIONS ARE DOING INTERVIEWS ON ME. MY PHONE IS CONSTANTLY GOING OFF. >> Reporter: SHE IS ATTRACTING INTERNATIONAL ATTENTION BECAUSE SHE IS BELIEVED TO BE THE FIRST FEMALE TO RECEIVE AN NCAA SCHOLARSHIP AND SIGN A NATIONAL LETTER OF INTENT. SHE IS GOING TO BE A KICKER AT ADAM STATE UNIVERSITY IN COLORADO THIS FALL. >> I FEEL LIKE IT MEANS I AM DOING SOMETHING. TO BE GETTING THIS KIND OF ATTENTION, I FEEL LIKE I AM HAVING MY STORY HEARD AND LETTING PEOPLE KNOW YOU CAN DO ANYTHING YOU PUT YOUR MIND TO. >> GREAT STORIES BEGIN HERE ACCORDING TO THE CAMPUS SLOGAN AT ADAM STATE UNIVERSITY AND FOR THE HEAD FOOTBALL COACH: >> IT DOES FIT THIS. >> ONE OF THOSE STORIES IS BECKA AND HOW SHE MADE IT ON HIS TEAM. >> IT IS A REALLY GREAT STORY. WE WILL HAVE TO WORK OUR TAILS OFF. ME, HER AND THE REST OF THE TEAM TO MAKE IT A GREAT STORY. >> I AM STILL PINCHING MYSELF BECAUSE OF EVERYTHING GOING ON. IT DOESN'T FEEL REAL. I AM ALWAYS NERVOUS THE FIRST KICK OF EVERY GAMER >> SHE FIRST PUT FOOT ON THE FIELD AS A HIGH SCHOOL SOPHOMORE INSPIRED BY A GIRL ON HER OLDER BROTHER'S FOOTBALL TEAM. >> I SPENT ALL OF MY CHILDHOOD WATCHING HER PLAY ON THE FIELD AND THAT IS WHEN I REALIZED GIRLS COULD PLAY FOOTBALL. >> SHE KNEW SHE HAD A LEG UP WHEN IT CAME TO KICKING AFTER BEING A SOCCER PLAYER. >> WHY NOT CONTINUE WITH SOCCER AND DO THE GIRLS SPORTS? >> I WANTED TO BE DIFFERENT. I HAVE DONE EVERYTHING ELSE. >> Reporter: SHE HAD TO BE GOOD ENOUGH TO SECURE A SPOT ON VARSITY TEAM AND THAT MEANT GETTING A DOCTORS NOTE TO PLAY AFTER STRAINING HER BACK AND CONVINCING THE BOY'S FOOTBALL COACH TO GIVE HER A CHANCE. >> YOUR HONEST FIRST IMPRESSIONS. DID YOU THINK SHE WAS GOING TO END UP BEING YOUR KICKER? >> HONESTLY, I IMAGINE, NO. BUT I WANTED TO SEE IF SHE COULD KICK. SHE CAME OUT, KICKED AND IT WAS IMPRESSIVE. SHE HAD A STRONG LEG AND HIT FROM ABOUT 25 YARDS. >> IT WAS COUNTLESS HOURS OF JUST TRAINING AND KICKING AND MORE SPEED TRAINING AND THEN JUST GETTING MY HIPS READY. I SPENT A LOT OF TIME. SHE IS AMAZING. SHE IS AMAZING. >> ANDREA LONGO HAS ALWAYS KNOWN HERE DAUGHTERS WOULD ACHIEVE GREAT THINGS. >> EVEN FROM THE MOMENT SHE WAS BORN SHE WAS DEFYING THE ODDS. >> SHE SUFFERED SEVERAL MISCARRIAGES AFTER THEIR SON WAS BORN. AND MORE THAN A DECADE LATER BECCA BECAME THEIR MIRACLE. DURING HIS DAUGHTERS EARLY GAME — >> SHE IS RIGHT HERE. >> Reporter: STRESS WOULD OVERCOME BOB IN THE STANDS. >> I WAS SITTING THERE SHAKING AND COULDN'T HOLD THE CAMERA TO VIDEO TAPE HER. BECCA'S KICK PROVE TO BE IMPORTANT TO THE 36 POINTS SHE SCORED DURING HER SENIOR YEAR. SHE WAS BLAZING A PATH THAT EARNED HER A PLACE IN SPORTS HISTORY. >> I KNOW FOR A GIRL DOING THIS, THE COACHES SAYING SHE CAN NOT DO THIS AND SHE WENT OUT THERE AND PROVED THEM ALL WRONG. >> I AM PROUD OF HER. SHE HAS ACCOMPLISHED EVERYTHING. EXCEPT FOR PRE-CAL EVERYTHING SHE HAS ATTEMPTED TO DO SHE SUCCEEDED OUT. SHE IS AN AMAZING GIRL. >> THIS IS MY FAVORITE SPOT TO KICK FROM BECAUSE HIGH PARENTS SIT HERE. >> HOW DO YOU MAKE SURE YOU ARE ACCURATE? >> YOU DON'T AIM. YOU KEEP YOUR HEAD DOWN, FOLLOW THROUGH AND IT WILL GO. >> HER ADVICE TO KICKING A FIELD GOAL TO FOLLOW THROUGH IS WHAT HELPED HER REACH OR PERSONAL GOAL TO PLAY COLLEGE FOOTBALL. >> I HAVE A TON OF VIDEO HERE. >> SHE PUT HERSELF OUT THERE. WHEN SOMEBODY DOES THAT, IT SAYS SOMETHING ABOUT THEM AS A PERSON. IF THEY ARE DETERMINED TO DO SOMETHING AND BE MAYBE IN A NOT SO POPLAR SITUATION YOU HAVE TO REALLY WANT TO DO IT. THAT IS WHAT CAUGHT MY EYE. >> HER PERSISTANCE PAID OFF WITH A FATHER OF A FORMAL NFL QUARTERBACK AND THE FATHER OF TWO YOUNG GIRLS. >> HE HAS SEEN OTHER WOMEN KICK FOR COLLEGE TEAMS BUT NEVER KNEW HE WAS MAKING HISTORY. >> HOW MUCH PRESSURE DO YOU THINK SHE IS FEELING? >> FROM THE PERSPECTIVE OF A PERSON THAT PLAYED QUARTERBACK, ALTHOUGH A LOT OF PRESSURE CAME FROM INSIDE, I THINK SHE WEARS THAT A LITTLE BIT INSIDE BUT I THINK SHE IS PRETTY ROCK SOLID ON THE OUTSIDE. >> I KNOW I CAN BE ON THE FIELD. IF THERE IS ANY PRESSURE, I LOVE IT. I LOVE PRESSURE. I THRIVE IN IT. I AM THAT PERSON THAT IF WE ARE ON 4TH DOWN AND COACH IS THINKING ABOUT GOING FOR IT I AM JUMPING ON THE SIDELINES HOPING HE IS PUTTING ME IN. >> LOOKING FORWARD TO A CHANCE TO KICKING IN A COLLEGE GAME, SHE IS HOPING LITTLE GIRLS AROUND THE COUNTRY LOOK FORWARD TO NEW POSSIBILITIES IN THEIR FUTURES, TOO. >> I THINK ALL THESE LITTLE GIRLS OUT HERE EVERYBODY IS SAYING I AM INSPIRING THEM BUT I FEEL LIKE THEY ARE INSPIRING ME TO BECOME A BETTER PERSON BECAUSE I KNOW THEY ARE ALL WATCHING ME. >> WHETHER OR NOT LONGO MAKES ANY PLAYS IN A COLLEGE GAME, SHE KNOWS THE BIGGEST IMPACT SHE WILL MAKE MAY NOT BE ON THE FIELD. >> THERE YOU GO. NICE. GO AHEAD. >> I AM TRYING TO GET PEOPLE TO DO WHAT THEY LOVE. I AM TRYING TO SET AN EXAMPLE, BE A ROLE MODEL IN A SENSE FOR A BUNCH OF PEOPLE OUT THERE THINKING THEY CANNOT DO SOMETHING AND SHOWING THEM THAT ANYTHING IS POSSIBLE. >> RUN THROUGH, KEEP GOING. >> AND AS WE MENTIONED AT THE TOP OF THE SHOW, ASU LEGENDARY FOOTBALL COACH FRANK KUSH PASSED AWAY THIS MORNING AT THE AGE OF 88. >> ARIZONA "HORIZON" IS MADE POSSIBLE BY CONTRIBUTIONS FROM THE FRIENDS OF ARIZONA PBS, MEMBERS OF YOUR PBS STATION. THANK YOU.