About healthcare quality and safety
Safe Ambulatory Care: Strategies for Patient Safety & Risk Reduction: This monograph is a great source for understanding and addressing safety problems in the ambulatory care setting. The four area of focus are: Diagnostic testing errors; Medication safety events; Falls; and Security and safety incidents.
Depression Intervention Flops for Heart Attack Survivors: Depression screening has become an important part of care for heart attack survivors. Some payers even include the process in their quality evaluations. However, this article summaries research that showed mean “quality-adjusted life-years fell by an identical 0.06 over 18 months whether patients were randomized to systematic depression screening plus notification of primary care clinicians and treatment for those with positive results, screening with notification only, or usual care without screening (P=0.98).” This trial is not only important for its specifics, but also highlights why randomized trials are needed, even for measures that seem “obvious.”
Same Day Surgery in the U.S.: Findings of Two Inaugural Leapfrog Surveys: Among the findings of these first Leapfrog surveys of ambulatory surgery centers (ASCs) and hospital out patient departments (HOPDs) are:
—There are gaps in the education, training and national certifications of clinicians in both ASCs and HOPDs.
—ASC and HOPD patients may experience gaps in communication before and after procedures.
—ASCs lag behind HOPD counterparts in implementing best practices for patient safety.
—Patients tend to give higher patient experience ratings to ASCs—but not enough ASCs monitor it.
When Wall Street Took Over This Nursing Company, Profits Grew and Patients Suffered: This in-depth article looks at Aveanna Healthcare, an at-home nursing company that has a dominant market position in caring for “the sick and disabled, mostly children.” It is controlled by two prominent private-equity firms- Bain Capital and J.H. Whitney Capital Partners. The focus of the report is more than “1,000 pages of state health documents, many released under public-records laws, [that] show Aveanna has had a disproportionate number of safety violations.” The implication is that profit motives superseded the desire to provide good patient care.
About health insurance
A group of Republicans has unveiled its healthcare plan. Here is what's new and what isn't: “The Republican Study Committee (RSC), a group of 145 House GOP lawmakers, rolled out a new healthcare plan to counter Democrats’ call for ‘Medicare for All.’
However, the plan itself closely resembles the Affordable Care Act (ACA) repeal bill called the American Health Care Act (AHCA) that the House passed in 2017 and contributed greatly to the loss of the GOP House majority in 2018.” Among the details, is a proposal to retain guaranteed issue of insurance to those with preexisting conditions, but it does not guarantee that the cost are the same for all. Instead, the plan would start high risk pools for individuals who could not afford coverage because of illness.
Given the likelihood of Republicans winning the House in 2020, there is not much chance of this plan going anywhere.
US House Panel Approves Medicare Hearing, Dental And Vision Coverage; Senate Bill Introduced: “Three bills that would supply vision, dental and hearing coverage benefits – including eyeglasses, dental implants and hearing aids – to Medicare recipients was passed by the US House Ways and Means Committee on 22 October. The same troika of bills was approved by the House Energy and Commerce Committee last week, and two Senate committees with health-care jurisdiction are considering similar legislation.” As long as Medicare is so financially solvent, it seems like a good idea to expand benefits when we do not know their future cost.
Trump Birth Control Religious Opt-Out Properly Blocked: Ninth Circuit: “Trump administration rules giving employers with religious or moral objections the right to opt out of Obamacare’s requirement that they provide birth control coverage in employee health plans aren’t enforceable, the Ninth Circuit said…”
75% of Your Employees May Not Plan to Stay for More Than 5 Years: While this article is a business employment piece, the message has profound implications for how employers will look at benefits given this time frame.
About hospitals and healthcare systems
FTC to probe impacts of state antitrust protections for local hospital mergers: Certificates of public advantage (COPAs) are written approvals by state governments that grant state and federal immunity from antitrust actions to merging hospitals. Its aim is to "protect the interests of the public in the region affected and the state." It accomplishes this goal by “replacing competition with state regulation and active supervision.” This exemption was allowed by a 1940s Supreme Court decision. Now the FTC wants to investigate the impact of COPAs.
About the public’s health
FDA grants first-ever modified risk orders to eight smokeless tobacco products: This statement is the epitome of confusion. The FDA says that certain smokeless tobacco products are safer that smoking tobacco. However, in the press release it also said: “All tobacco products are potentially harmful and addictive, and those who do not use tobacco products should continue to refrain from their use.” Why not just try for a tobacco-free society?
FDA recommends new warnings for breast implants: Once again, the harms of breast implants are being highlighted. Today the FDA “recommended that manufacturers use a boxed warning — the FDA’s most serious caution — to identify risks, including that implants are not lifetime devices, that the chances of developing complications increase the longer a woman has an implant, and that they have been associated with a rare form of lymphoma, as well as with symptoms such as fatigue and joint pain.”
Languishing Medicare diabetes program frustrates providers: “A flagship Medicare program that HHS expected to engage up to 110,000 people annually each year in measures to help them avert Type 2 diabetes only managed to enroll about 200 people last year, according to an analysis of CMS data.” This problem is a great case study for social marketing. How can Medicare increase uptake into this program?
23andMe competitor claims direct-to-consumer cancer risk screening produces 'false negatives': “…researchers at medical genetics company Invitae say health reports from limited DTC [direct to consumer] genetic tests can provide consumers with a false sense of security. These tests often miss disease-causing DNA variants, which poses the risk of healthcare decisions based on incomplete information, according to Edward Esplin, M.D., a clinical geneticist at Invitae and lead researcher on the study.”