DCMedical News: Wednesday, March 6, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, March 6, 2019
The publication schedule and subscription information for DCMedical News will be found below.
THE BIG STORY IN HEALTH CARE:
Do “Gag Clauses” Prevent Doctors from Reporting EHR Problems?
Mass. General cardiologist John Levinson says “Yes,” and describes the challenges in the Wall Street Journal, here. Levinson notes that “Now nearly every clinician in the U.S. uses EHRs—and many don’t like it. For an EHR to comply with the Hitech Act, it must be used for the collection of very specific diagnosis and treatment data. These data are irrelevant to the care of individual patients but helpful to the government as it manages the health-care system as a whole. That’s one new task EHRs created for doctors. But there are plenty more: Each hospital or hospital group customizes its EHR to meet local corporate and legal goals.” Levinson describes how electronic information systems make clinical care slower, more costly and sometimes more hazardous to patients.
Levinson’s essay references work from the MedStar National Center for Human Factors in Healthcare, here (in JAMA, 3-27-2018) and here (in Health Affairs, 11-2018, referencing pediatric populations). The MedStar group studied EHRs primarily through review of three years of IT-safety related reports to the Pennsylvania Patient Safety Authority, a resource unique among the states. Interoperability, for example, or its absence, is often discussed as a phenomenon hindering communication from one hospital to another, from a hospital to a physician practice, etc. This MedStar work makes clear that “EHR interoperability is inadequate within components of the same EHR,” for example “Patient was admitted as a trauma; the lab value did not flow into the EHR when the patient identification was confirmed.” Visual display: “The orders in the EHR still showed the medication from the previous 2 administrations at the correct dose (unchanged), but dated for the previous day, which is subtle to notice in a long list of medications.” Information becomes “unavailable”: “I placed post operation orders in EHR; they were initiated and I signed them; the perianesthesia nurse called and said they had ‘failed’; on the orders menu, all orders had failed; I was unable to place new orders, the nurse was unable to initiate old orders,” and “A physician put his orders in the EHR (patient was in the recovery room post-surgery) 15 min after physician left the hospital the orders should have been active; unable to pull the medications to administer to the recovery room patient; but the orders appeared to be completed; on the Medication Administration Record everything was shadowed grey; I spoke to the medical-surgical charge nurse to see if the floor discontinued the orders, and she stated this has happened several times on the night shift regarding physician orders being discontinued and or disappearing.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES:
Sepsis and Death:
A review of hospital deaths (JAMA Network, here) found that sepsis was present in 53% of the cases, that 35% of hospital mortality was due to sepsis, but that only 3.7% of sepsis-related deaths were judged to be partially or completely avoidable.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Five Star Call-In:
CMS is hosting a call-in session today (1:00 p.m., Eastern, dial in 1-800-837-1935, conference ID=3934159) on the Hospital 5-Star Rating system. A press release announcing the call is here, a 48-page description of how inputs might be made to revise the system is found here. By way of background, the input-invitation document notes that “The Overall Hospital Quality Star Ratings have been reported since July 2016 and were most recently refreshed in December 2017. While ratings were recalculated in July 2018 using updated data on Hospital Compare and were shared with hospitals during the Preview Period in May 2018, they were not publicly reported in July.” The purpose of this effort, in sum, is to reevaluate the measures used for consistency and reliability. Comments are due March 29.
No Country for Rural Citizens with Incomes Over 400% of FPL
The Kaiser Family Foundation reports (here) that the number of unsubsidized enrollees in “ACA-compliant” plans fell between 2015 and 2018 from 6.4 million to 3.9 million, primarily those with incomes over 400% of the Federal Poverty Line ($48,560 for an individual, $100,400 for a family of four), and that (here) middle-class older adults in rural areas face the highest premiums as a percentage of their income.
Medicaid Drug Rebates Explained, Imperiled:
The National Association of Medicaid Directors explains (here) the peril to its State Medicaid drug programs from “value-based purchasing” initiatives. “Unlike commercial payers, the Medicare Part D program, and plans on the Exchanges, Medicaid must cover all drugs approved by the Food and Drug Administration (FDA). States may create prior authorization and utilization management criteria for products, but may not exclude products from coverage entirely. In exchange for this mandatory coverage, states are guaranteed a number of rebates from manufacturers, including mandatory rebates off of a product’s list price which vary based on whether the drug is branded or generic, mandatory rebates if price increases outpace inflation in a given year, and a guarantee that Medicaid is offered the same price paid by another payer” (the best-price provision). NAMD thinks the “value-based” drug purchase proposals would undermine both favorable pricing and rebates.
DRUGS & DEVICES
Is PhRMA Weakened Politically?
A report in Bloomberg Businessweek (here) says “Yes,” that well-organized patient advocacy groups mean that “Drug manufacturers are facing an invigorated price-fighting lobby, plus a bipartisan consensus in Congress and the White House that prices are too high.”
READING AND REFERENCE
U.S. House of Representatives:
Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
March publication dates: 7, 8, 11, 12, 13, 14, 25, 26, 27, 28
April publication dates: 1, 2, 3, 4, 9, 10, 11, 12, 29, 30
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.