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Monitoring the compliance of the academic enterprise with the Fair Labor Standards Act.

ABSTRACT: Background: On December 1, 2016, the Fair Labor Standards Act (FLSA) was due to be updated by the U.S. Department of Labor. Key changes included an increase in the salary threshold for exemption from overtime for working more than 40 hours per week, and indexing the salary level so that it is updated automatically every 3 years. This was predicted to have a profound effect on academe as postdoctoral researchers were mostly paid at a salary below the new threshold. On November 22, 2016, an injunction was granted nationwide, delaying implementation of the updates, which were finally struck down entirely on August 31, 2017. Here we review the key changes to the FLSA, how they came about, and how the postdoctoral population was affected. Methods: We describe recent data collection efforts to uncover what institutions with postdocs were doing to comply with the FLSA. Results: Our data showed that 57% of institutions checked (containing 41% of the estimated postdoctoral workforce in science, engineering and health) had not decided or had no public decision available one month prior to implementation, and only 35.5% of institutions were planning to raise salaries to the new minimum. After the injunction, a number of institutions and the NIH continued with their plans to raise salaries. Overall, despite the removal of a federal mandate, approximately 60% of postdocs are at institutions whose policy is to raise salaries. Conclusions: Our data show uncertainty in postdoctoral salaries in the U.S. prior to implementation of the FLSA ruling. In addition, while some institutions did suspend plans to raise postdoctoral salaries after the injunction, many continued with the raise. The implementation of postdoctoral salary raises may be inconsistent, however, as the legal minimum is still $23,660.

SUBMITTER: Bankston A

PROVIDER: S-EPMC5130071 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Monitoring the compliance of the academic enterprise with the Fair Labor Standards Act.

Bankston Adriana A McDowell Gary S GS

F1000Research 20161117

<b>Background</b>: On December 1, 2016, the Fair Labor Standards Act (FLSA) was due to be updated by the U.S. Department of Labor. Key changes included an increase in the salary threshold for exemption from overtime for working more than 40 hours per week, and indexing the salary level so that it is updated automatically every 3 years. This was predicted to have a profound effect on academe as postdoctoral researchers were mostly paid at a salary below the new threshold. On November 22, 2016, an ...[more]

PMID: 27990268

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Project description:A recent comprehensive report on healthcare quality in Italy published by the Organization of Economic Co-operation and Development (OECD) recommended that regular monitoring of quality of primary care by means of compliance with standards of care for chronic diseases is performed. A previous ecological study demonstrated that compliance with standards of care could be reliably estimated on regional level using administrative databases. This study compares estimates based on administrative data with estimates based on GP records for the same persons, to understand whether ecological fallacy played a role in the results of the previous study.We compared estimates of compliance with diagnostic and therapeutic standards of care for type 2 diabetes (T2DM), hypertension and ischaemic heart disease (IHD) from administrative data (IAD) with estimates from medical records (MR) for the same persons registered with 24 GP's in 2012. Data were linked at an individual level.32,688 persons entered the study, 12,673 having at least one of the three diseases according to at least one data source. Patients not detected by IAD were many, for all three conditions: adding MR increased the number of cases of T2DM, hypertension, and IHD by +40%, +42%, and +104%, respectively. IAD had imperfect sensitivity in detecting population compliance with therapies (adding MR increased the estimate, from +11.5% for statins to +14.7% for antithrombotics), and, more substantially, with diagnostic recommendations (adding MR increased the estimate, from +23.7% in glycated hemoglobin tests, to +50.5% in electrocardiogram). Patients not detected by IAD were less compliant with respect to those that IAD correctly identified (from -4.8 percentage points in proportion of IHD patients compliant with a yearly glycated hemoglobin test, to -40.1 points in the proportion of T2DM patients compliant with the same recommendation). IAD overestimated indicators of compliance with therapeutic standards (significant differences ranged from 3.3. to 3.6 percentage points) and underestimated indicators of compliance with diagnostic standards (significant differences ranged from -2.3 to -14.1 percentage points).IAD overestimated the percentage of patients compliant with therapeutic standards by less than 6 percentage points, and underestimated the percentage of patients compliant with diagnostic standards by a maximum of 14 percentage points. Therefore, both discussions at local level between GP's and local health unit managers and discussions at central level between national and regional policy makers can be informed by indicators of compliance estimated by IAD, which, based on those results, have the ability of signalling critical or excellent clusters. However, this study found that estimates are partly flawed, because a high number of patients with chronic diseases are not detected by IAD, patients detected are not representative of the whole population of patients, and some categories of diagnostic tests are markedly underrecorded in IAD (up to 50% in the case of electrocardiograms). Those results call to caution when interpreting IAD estimates. Audits based on medical records, on the local level, and an interpretation taking into account information external to IAD, on the central level, are needed to assess a more comprehensive compliance with standards.

Project description:INTRODUCTION:The Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition - labor - specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care. METHODS:We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements. RESULTS:Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle. CONCLUSION:Despite inclusion of the term "labor" in the law's title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated.

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Dataset Information

Monitoring the compliance of the academic enterprise with the Fair Labor Standards Act.

Publications

Monitoring the compliance of the academic enterprise with the Fair Labor Standards Act.

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