Emergency Physicians Urge Policymakers to Remove Obstacles to Treatment for Opioid Use Disorder

WASHINGTON, DC (Sept. 4, 2019) —As the U.S. Department of Health and Human Services (HHS) compiles a report to Congress on treating opioid use disorder, the American College of Emergency Physicians (ACEP) urges policymakers to consider steps to remove obstacles to appropriate care in the emergency department.

Remove the “X-waiver.” Emergency physicians continue to see strong results when they can utilize buprenorphine as part of medication-assisted treatment (MAT) to start patients on the path toward recovery from opioid use disorder. Initiating MAT in the emergency department closes gaps in treatment and helps individuals stay in treatment longer, reduces illicit opioid use and infectious disease transmission, and decreases overdose deaths.

The waiver requires completion of an eight-hour course and license application, and it can take 60 to 90 days for physicians to receive the waiver from the U.S. Drug Enforcement Administration (DEA). The waiver requirement has also resulted in a misperception that buprenorphine is fundamentally different from other medications—including narcotics—that physicians are trained to prescribe. As a result, some physicians have been less willing to pursue the waiver or engage in treatment of patients with opioid use disorder at all. In some cases, there is not an adequate supply of buprenorphine in the emergency department or hospital pharmacy because of the confusion surrounding the X-waiver. ACEP believes Congress should take action to remove the X-waiver.

Modify the “three-day rule.”  This federal regulation requires administration of buprenorphine one day at a time and requires patients to return to the emergency department or other care setting to receive treatment. Emergency departments should be able to dispense a three-day supply of buprenorphine or administer a dose that will last three days.  

Remove pre-authorization requirements. In most states there is a pre-authorization approval requirement by insurers to prescribe buprenorphine. It is estimated that only 25 percent of emergency patients visit during typical office hours. Some states have removed prior authorization for buprenorphine for patients on Medicaid, but the requirement persists in most states for most insurers.

ACEP also supports steps to improve prescription drug monitoring program reporting so that fragmented state-level prescribing data can be meaningfully reported at the federal level.

ACEP and its members would welcome a chance to work with HHS and others to improve and expand education about pain management and addiction treatment, including the benefits of MAT and an effort to correct misperceptions about treating opioid use disorder.

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million Americans they treat on an annual basis. For more information, visit www.acep.org.

Emergency Physicians’ Response to the Shootings in Dayton and El Paso.

WASHINGTON, DC (August 5, 2019) — In response to shootings in Dayton, Ohio and El Paso, Texas, Vidor Friedman, MD, FACEP, president of the American College of Emergency Physician (ACEP) released the following statement:

“The American College of Emergency Physician (ACEP) joins the nation in mourning and offers our heartfelt condolences to the families, friends and communities forever impacted by the tragic shootings in Dayton, Ohio and El Paso, Texas, this weekend. 

News reports are numbing, and even the most well-intentioned thoughts and prayers fall short. As emergency physicians, we are on the frontlines of treating the victims of these senseless, violent acts. The frequency of firearm injuries and fatalities in this country is staggering, and there is no doubt about the threat posed to America’s public health and safety. 

Firearm injuries—accidental or otherwise—should be addressed as a public health epidemic, with investments in research and a sweeping commitment to change that matches or exceeds the level of a number of diseases, outbreaks or disorders that capture the public conscience but have exacted far less of a human toll in recent years.

In addition to our active participation in the American Foundation for Firearm Injury Reduction in Medicine(AFFIRM)—a non-profit organization founded and led by emergency physicians working to end the epidemic of gun violence through research, innovation and evidence-based practice—ACEP supports legislative, regulatory, and public health efforts that:

  • Encourage the change of societal norms that glorify a culture of violence to one of social civility;  
  • Investigate the effect of socioeconomic and other cultural risk factors on firearm injury and provide public and private funding for firearm safety and injury prevention research;  
  • Create a confidential national firearm injury research registry while encouraging states to establish a uniform approach to tracking and recording firearm related injuries;  
  • Promote access to effective, affordable, and sustainable mental health services;  
  • Protect the duty of physicians and encourage health care provider discussions with patients on firearm safety;  
  • Promote the development of technology that increases firearm safety;  
  • Support universal background checks for firearm transactions;  
  • Require the enforcement of existing laws and support new legislation that prevents high risk and prohibited individuals from obtaining firearms by any means; and
  • Restrict the sale and ownership of weapons, munitions, and large-capacity magazines that are designed for military or law enforcement use.

ACEP also supports further research and legislation to address effectiveness and ramifications of Gun Violence Restraining Orders (GVRO) and Extreme Risk Protection Orders (ERPO), which President Trump mentioned in his national response. ACEP will continue to convene public health and injury prevention experts to review the current state of research and legislation regarding firearm violence.”

Trump price transparency proposals take long bet on curbing costs

Requiring hospitals to display their insurer-negotiated prices online likely won’t lower healthcare spending in the near term. But economists and other experts say it’s a worthwhile experiment in bringing transparency to one of the few industries in which patients often don’t know the cost of a service before they buy it. 

The Trump administration earlier this week issued a proposed rule that would force most hospitals in the country to post on their websites the closely guarded rates for certain healthcare services that they work out with insurance companies behind closed doors. The outcry from hospital and insurance trade associations was swift. 

They argued that patients don’t need to see those negotiated rates because they are interested only in an estimate of out-of-pocket costs, which somehospitals are already providing to patients through online cost transparency tools. Hospital lobbying groups and insurers—who are expected to sue to stop the requirement—warned that exposing the rates could undermine their ability to negotiate with each other.

Hospitals and insurance companies are telling the truth. Evidence has shown that many people don’t shop for healthcare, often because they have trouble finding price information, according to Dr. Ateev Mehrotra, an associate professor at Harvard Medical School who has studied price transparency. He agreed with the hospitals that patients care about out-of-pocket costs, not negotiated rates.

Greg Hagood, president at Solic Capital, said exposing the negotiated prices would likely prevent health insurers from securing deep discounts from hospital systems, and that would translate to higher premiums for their customers. Hospitals would be less likely to give insurers a discount on healthcare services because once publicized, other insurers would demand the same rate, he explained.

“Fundamental to insurance companies being able to offer affordable care is getting discounts,” Hagood said.

Although CMS Administrator Seema Verma said the requirement wouldn’t cost hospitals much to comply with, companies that deploy cost-estimator tools for hospitals today say posting negotiated rates for the dozens of insurers they contract with and the dozens of health plans offered by each insurer would be a massively complicated process and difficult for consumers to navigate on the web. 

“It’s going to be nearly impossible for hospitals to comply with this even if there are stiff penalties,” Paul Shorrosh, CEO of revenue-cycle vendor AccuReg, which has created price-estimator tools for hospitals like Mosaic Life Care. “Each of those (insurance) contracts has multiple payment methodologies depending on whether it’s inpatient or outpatient. The only way to do that is computerize it. There’s no other way. If they publish contracted rates, it’s not going to make sense to anybody.”

But most hospital cost-estimator tools don’t show what patients would pay by going to a competitor down the road. Enabling patients to make an apples-to-apples comparison between providers is exactly what the CMS hopes posting the negotiated rates will allow. Verma suggested to reporters this week that the proposal is only a first step toward transparency and that the agency will fulfill President Donald Trump’s June executive order, which included providing access to out-of-pocket cost estimates. 

Most experts—even the ones who warned of disruption—agreed exposing negotiated rates could lead to positive change in the long run. 

Just getting the secret data out in the open and allowing researchers and policy experts to harness it could help lawmakers create better policy, said Benedic Ippolito, an economist with the American Enterprise Institute. “Tomorrow it may not be the most useful data, but who knows in 10 years,” he said. 

Ippolito also doubted that exposing negotiated rates could lead some lower-cost healthcare providers to raise prices to meet those of higher-cost competitors, as some spectators have predicted. That’s because most hospitals in any given market already have a pretty good idea of others’ prices, he said. 

Paul Hughes-Cromwick, co-director of sustainable health spending strategies at consultancy Altarum, said that revealing rates could indeed lead some hospitals to raise prices, but it could also lead high-priced hospitals to lower their prices, “though this would be tempered by their competitive environment,” he explained.

Bob Berenson, healthcare policy expert at the Urban Institute think tank, along with several other sources, said the proposal could lead to lower prices if the public or policymakers uses the price information to shame high-cost hospitals into bringing their prices down.


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Rattled by Cyberattacks, Hospitals Push Device Makers to Improve Security

Exposed

More than 150 million personal health records have been breached in health-care company hacks since 2009.

In stepping up their efforts, hospitals have gone beyond building firewalls and taking other actions to shield their own networks—they have moved into demanding information like the software running devices that manufacturers have long considered proprietary. The requests have generated tensions between the sides.

Medical-device manufacturers including Royal Philips NV and Boston Scientific Corp. have begun adding new features and disclosing more about products—such as which third-party software they contain—to help hospitals protect devices against attacks, health-care and security experts said.

The interconnectivity has given rise to new headaches for hospital executives, worried about the consequences of a hack. Their fears were brought home two years ago, when the WannaCry and NotPetya cyberattacks disrupted operations at some hospitals, forcing the cancellation of some surgeries.

Hospital-technology officials say gaining access to the software running inside devices—and knowledge of its vulnerabilities—would help them build firewalls and other defenses against attacks. The Food and Drug Administration recommended in guidance proposed last October that manufacturers provide software disclosures to hospitals. Partners HealthCare, based in Boston, this year required for the first time that an unnamed device maker reveal its device software as part of their contract, said Julian Goldman, Partners’ medical director of biomedical engineering.

NewYork-Presbyterian, meanwhile, is seeking contracts with device makers that allow independent tests of device cybersecurity, called “penetration tests,” said Jennings Aske, the hospital network’s chief information security officer.

Last year, NewYork-Presbyterian began working with outside consultants to assess the cyberdefenses of the corporate networks of suppliers, including medical-device makers, Mr. Aske said. In 2017, the hospital dropped plans to buy infusion pumps manufactured by Smiths Group PLC after the Department of Homeland Security warned that hackers could take control of the pumps, 

Smiths said it released a fix in 2017. “While we were disappointed with the NYP decision to purchase another system, we are confident in the firmware update and that the pump is safe for patients,” the spokesman said.

Vizient Inc., which negotiates contracts for products and services on behalf of 3,100 health systems in the U.S., added cybersecurity questions for the first time to requests now under consideration for bids across 10 medical-device categories, said Ross Carevic, Vizient’s director of technology sourcing. The questions included whether device data are encrypted and what password procedures are used. Vizient plans to factor the answers into contract-award decisions. 

Philips, a major supplier of imaging, respiratory and other gear to hospitals, often receives such cybersecurity questionnaires, said Michael McNeil, the company’s global product security officer. He said it would be helpful if the requests were standardized in order to make answering them more routine.

Boston Scientific, which supplies products like lasers and catheters used by hospitals in surgeries and heart procedures, said it is facing requests for more stringent password features like automatic time-outs, said Ken Hoyme, director of product security. But password timeouts could interfere during time-sensitive surgical procedures, he said.

The health-care companies, including hospitals, reported 148 hacks exposing personal-health information last year, up from five hacks in 2009. The Department of Homeland Security last year issued 30 advisories about cybersecurity vulnerabilities in medical devices, up from 16 the year before, according to MedCrypt, which makes security software for medical devices.

Device makers say hospitals’ cybersecurity demands can be complicated and bog down sales negotiations. “These contracts are taking more time to negotiate,” said James Kinkela, corporate counsel at Boston Scientific. “The contracting has definitely gotten more complex.”

The attention to cybersecurity follows health-care’s embrace in recent years of digital technologies, from electronic medical records to mobile lab tests. For hospitals, internet-connected devices offer the potential to monitor patients more continuously and closely, and use the data to guide—and improve—care.

“There are struggles right now about who owns which piece of cybersecurity,” said Stephanie Domas, vice president of research and development at cybersecurity consultant MedSec. Hospitals don’t know enough about the security of devices on their networks, and manufacturers don’t always provide software updates to fix vulnerabilities quickly, she said.

Hospitals are pushing medical-device makers to improve cyber defenses of their internet-connected infusion pumps, biopsy imaging tables and other health-care products as reports of attacks rise.

Rattled by recent global cyberattacks, U.S. hospitals are conducting tests to detect weaknesses in specific devices, and asking manufacturers to reveal the proprietary software running the products in order to identify vulnerabilities. In some cases, hospitals have canceled orders and rejected bids for devices that lacked safety features.

Hospitals, after a decade of racing to wire up their medical records and an explosion of internet-connected medical devices, are growing more aggressive with technology suppliers amid pressure to better defend against incursions that could threaten patients and cause costly disruptions. Credit-rating agency Moody’s Investors Service in February ranked hospitals as one of the sectors most vulnerable to cyberattacks.

4 Things Seniors Should Know About Treating Depression

Author: Teresa Greenhill

When we feel physical pain, we reach for ibuprofen or call our doctors for advice. So, why shouldn’t seniors do the same when they are experiencing the physical and mental pain of depression? You don’t need to suffer due to stigma, and you don’t need to take on this battle alone. Here’s what you need to know about getting help for your depression. 

Medicare Can Help with Mental Health Too 

Most seniors know they can rely on Medicare for their annual check-ups and physical health needs. For seniors struggling with depression and other mental health issues, however, Medicare can offer coveragethat can help as well. For example, Medicare Part B offers some coverage for outpatient services, but it may not be enough. So, stay informed about your Medicare plan options and any changes that could impact your ability to seek care for your depression. You may want to research supplemental Medicare plansthat could offer even more benefits for your mental health so you can get the help that you need to feel like yourself again. These plans can also help out with prescription drug costs, which can come in handy if you need medication to alleviate your depression symptoms. 

Asking for Help Is Often the Hardest Step 

Depression is common among adults in America, and yet there is still so much stigmaaround getting treatment. As a society, we have a long history of treating mental illness differently than other health conditions, but that really shouldn’t be the case. The truth is, millions of Americansare dealing with mental health issues every single day, but less than half of those people seek out the help they need. You can reduce the voice of stigma in yourself by knowing that you are not alone and that you are not weak for wanting to get better. Start by searching for a therapistwho can help you get on the road to recovery and develop ways to cope along the way. You can also check to see if your therapist will accept Medicare or if you will need to find another way to pay for your treatment or another therapist that fits your Medicare coverage. 

Social Connection Can Ease Symptoms of Depression 

There are so many things you can do to find relief from depression. You may need to make a self-care checklistto remind yourself to practice basic healthy habits, like taking a shower and eating healthfully. Those efforts can help you stay afloat when you are feeling down, but one of the most impactful ways seniors can ease feelings of depression is to stay socially connected. When you feel isolated, research shows you are more likely to feel depressed, which can cause you to isolate yourself even more. You can prevent isolation and depression by reaching out to loved ones for support or by taking up a new hobby that allows you to meet new people, such as volunteering at a local charity or taking a yoga class. Plus, staying physically active can ease feelings of depression as well, so you will be reaping more benefits for your mental health. 

Addiction Often Occurs With Depression in Older Adults 

Getting help for your depression is a good first step towards taking back control of your life. It’s also important to note that depression and addictionoften occur together. Which comes first is hard to pinpoint, but what matters is that those suffering from addiction address mental health issues during their treatment. Going through treatment can make depressive symptoms worse, so it’s also important to take this into account as well. For seniors, alcohol abuseis very common when there is an untreated mental health issue, such as depression. Since drinking can make depression worse, it’s crucial to recognize whether you have an unhealthy relationship with alcohol or other substances and seek out comprehensive treatment to help. 

If you’re a senior who is struggling with depression, you shouldn’t have to suffer alone. There are professionals who can help you feel like yourself again and help you see your way out of the darkness. You just have to reach out and get that help for yourself. 

Author: Teresa Greenhill

Ascension’s CEO Anthony Tersigni announced a series of leadership changes

St. Louis-based Ascension revealed changes to its operational structure and leadership amid the departure of three longtime executives in a Jan. 22 announcement.

The changes include the dissolution of Ascension’s solutions and healthcare divisions. The solutions and healthcare divisions were created in 2012 to improve focus and growth for the system’s subsidiaries.

Officials said the decision to eliminate the divisions stems from the health system’s goal to become a unified organization, One Ascension.

In addition to the organizational changes, Ascension President and CEO Anthony Tersigni announced the departure of three longtime executives, and the creation of a new position.

Patricia A. Maryland, DrPH, will leave the organization after a 15-year tenure. She will continue in her role as CEO of Ascension Healthcare through June 30. After her departure, the position will be eliminated.

Executives John Doyle and David Pryor, MD, will retire at the end of the health system’s fiscal year, June 30.

To support Ascension’s integrated health ministry, Joseph R. Impicciche will assume the newly created role of Ascension president and COO. He will oversee Ascension’s healthcare operations and services and report to Mr. Tersigni.

Mr. Impicciche has served as executive vice president and general counsel since 2004.

Johns Hopkins Reaches Settlement with Registered Nurses Affirming Nurses’ Guaranteed Right to Unionize

Nurses at Johns Hopkins Hospital in Baltimore are hailing as a critical victory a settlement reached with the hospital which reaffirms the nurses’ guaranteed legal right to unionize, said the National Nurses Organizing Committee/National Nurses United (NNOC/NNU) today.  

“This settlement makes clear that nurses have the right to form a union, we have a right to speak with our coworkers about a union, and Johns Hopkins does not have the legal right to target and intimidate nurses who engage in union activity,” said Alex Laslett, RN. “We are organizing at Johns Hopkins because we know a union affords nurses the protection we need to advocate freely for the best care for our patients.”

The settlement resolves unfair labor practices charges filed with the Baltimore-based National Labor Relations Board (NLRB) on behalf of the Johns Hopkins nurses by NNOC/NNU. The NLRB found merit to charges that the hospital broke the law by:

  • The creation of the impression of surveillance and unlawful interrogation in regards to protected union activity,
  • Promulgating and/or enforcing a rule barring off-duty RNs access to break rooms, outside patient care areas, in connection with union activity, and
  • Prohibiting Hopkins RNs from talking about the union at work, while permitting other non-work conversations.

The settlement requires that Johns Hopkins Hospital management post signs throughout the facility affirming the nurses’ right to form a union. The signs declare that Johns Hopkins Hospital will not prohibit nurses from talking about the union, will not create the impression that hospital management is watching out for union activities, will not ask nurses about their union sympathies, and will not discriminatorily enforce its policies on nurses accessing break rooms.

Diverting patients from emergency departments with telemedicine can save more than $1,500 per visit.

Telemedicine visits generate cost savings mainly by diverting patients away from more costly care settings, new research shows.

The primary market opportunity for telemedicine visits is the value proposition that they can both expand access to patients while also reducing costs compared to alternative care settings.

The new study is based on data collected from 650 patients who used the JeffConnect telemedicine platform at Philadelphia-based Jefferson Health.

“In our on-demand telemedicine program, we found the majority of health concerns could be resolved in a single consultation and new utilization was infrequent. Synchronous audio-video telemedicine consults resulted in short-term cost savings by diverting patients from more expensive care settings.”

The cost of a JeffConnect visit was a $49 flat fee.

The bulk of the cost savings from the telemedicine program was generated in diverting patients from emergency departments. Each avoided emergency department visit garnered cost savings ranging from $309 to more than $1,500. Cost savings from other alternate care types was below $114 average savings per visit.

“The net cost savings to the patient or payer per telemedicine visit of $19 to $121 represents a meaningful cost savings when compared with the $49 cost of an on-demand visit. The primary source of the generated savings is from avoidance of the emergency department, as this is by far the most expensive of the alternative care options provided,” the researchers wrote.

OFFSETTING INCREASED UTILIZATION
 

About 16% of the JeffConnect patients surveyed said they would have “done nothing” as an alternative to a telemedicine visit—representing potential increased utilization of services. But cost savings outweigh possible higher utilization of services due to telemedicine’s easy access, the researchers found.

“A substantial shift would be necessary to outpace the savings from diversion. Conversely, this population of patients who would have done nothing may represent improved access and incorporation of patients into the healthcare system that might not have participated previously. This might actually prevent more costly care further down the line.”