Safe Nurse-Patient Staffing Legislation Comes in Different Flavors
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Connecticut has become the latest state to pass legislation (here) attempting to require safe nurse-patient ratio staffing in hospitals. The Connecticut effort, according to the State’s AFT Nurses & Health Professionals unit, directs hospitals to “Establish local, nurse-approved patient limits by requiring staffing plans to be voted on by a majority of the facility's staffing committee, which will be made up of 50% + 1 bedside nurses” and will “Empower the Department of Public Health to hold hospital administrators accountable for implementing hospital staffing plans; protect health professionals' ability to exercise their ethical responsibility to object to unsafe assignments; prohibit hospitals from forcing nurses to work more than 12 hours a day or 48 hours a week.”
NurseJournal reports (here) that safe staffing efforts involve legally mandated nurse-to-patient ratios (California, Massachusetts in ICUs), public reporting systems (Illinois, New Jersey, New York, Rhode Island, Vermont and now Connecticut) and hospital-based staffing committees (Connecticut, Illinois, Minnesota, Nevada, New York, Ohio, Oregon, Texas, Washington).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doctors and Unions
More physicians turn to unions (here) to regain autonomy, a reaction to moral injury (here), and to obtain higher wages (BLS report, here).
Surgical Aortic Valve Replacement May Be Superior to TAVR, and to No Operation at All
A Cleveland Clinic study (here) found that “Overall, the mortality rate immediately following SAVR was 0.43%, which is considerably lower than the 1.6% estimated at the time by Society of Thoracic Surgeons (STS) risk models. In addition, researchers noted, mortality steadily declined over time . . . [and] also found that post-SAVR survival was 98% after one year, 91% after five years and 82% after nine years.”
“These survival rates are superior to those for the general U.S. population when matched for age, race and sex.”
Artificial Empathy
A study of A.I. reported in The New York Times (here) found that “Despite the drawbacks of turning to artificial intelligence in medicine, some physicians find that ChatGPT improves their ability to communicate empathetically with patients.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Waiting Times in Hospital EDs: Is Probability Forecasting Superior for Patients and Staff?
Manufacturing & Service Operations Management (here) reports on the “estimation of the probability distribution of individual patient waiting times in an emergency department (ED).”
“Whereas it is known that waiting-time estimates can help improve patients’ overall satisfaction and prevent abandonment, existing methods focus on point forecasts . . . We use the machine learning approach of quantile regression to produce probabilistic forecasts. Using a large patient-level data set, we extract the following categories of predictor variables: (1) calendar effects, (2) demographics, (3) staff count, (4) ED workload resulting from patient volumes, and (5) the severity of the patient condition.”
The authors claim, “By providing personalized probabilistic forecasts, our approach gives low-acuity patients and first responders a more comprehensive picture of the possible waiting trajectory and provides more reliable inputs to inform prescriptive modeling of ED operations . . . [which] could assist in ambulance routing, staff allocation, and managing patient flow, which could facilitate efficient operations and cost savings and aid in better patient care and outcomes.”
Hospital Prices, Continued
Patients’ Rights Advocate reports (here) that “Our latest review of hospital compliance, completed just over two years after the Hospital Price Transparency Rule’s implementation, analyzed the websites of 2,000 U.S. hospitals focusing on the nations’ largest health systems, and found only 24.5% of them (489) to be compliant with all the requirements of the rule. . . the widescale noncompliance of 75.5% of hospitals is due to most hospitals’ files being incomplete, illegible, or not having prices clearly associated with both payer and plan.” New York State (here) and New York City (here) undertake new efforts at transparency, promoted by the union benefit plan of 32BJ.
RAND researchers testify (here) on hospital pricing, and on hospital consolidation (here), a leading factor in price increases. Texas moves to tiering (here), a known factor in allowing referral centers to charge “referral prices” for community hospital services. Rick Louie’s Hospital Pricing Specialists reports (here) on the list price for an MRI of a leg joint without contrast, ranging from $19,000 (six of the most expensive ten prices are found at HCA hospitals) to $210 (eight of the ten least expensive hospitals are in Maryland, with an “all payer” state rate-setting system).
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Preventive Services, Back on Line
The Associated Press reports that the “ACA Preventive Services Mandate Back In Effect For Now After Appeals Court Approves Agreement. The federal government can keep enforcing requirements that health insurance plans cover preventative care – such as HIV prevention, some types of cancer screenings and other illnesses – while a legal battle over the mandates plays out, under a court agreement approved Tuesday.”
Bloomberg Law reports, “The Fifth Circuit order allows the US Health and Human Services Department to continue enforcing the requirement against all but the named plaintiffs.” In exchange for this, “the agency agreed not to seek penalties against these plaintiffs for any actions they’ve taken on the basis of” the Texas judge’s “order while it remains in effect, even if it’s later vacated or reversed.” The Hill also reports. The AMA (and other professional associations) offer(s) an amicus brief in favor of restoring preventive services and screening, here.
MedPAC, MACPAC Report to Congress
The Congressional chartered advisory body MedPAC (for Medicare, report here) and MACPAC (for Medicaid and CHIP, report here) have published their June reports to Congress, recommending adoption of site-neutral payment for certain ambulatory services and amending the Social Security Act to better protect disproportionate share hospital (DSH) payments during economic downturns.
DRUGS & DEVICES
340B Program Grows to $100 Billion Per Year
IQVIA reports (here) that the drug discount program (allowing hospitals to buy drugs low, then sell high), begun for a small number of safety net hospitals in 1992, has now grown to $100 billion in sales per year, an important part of the current financial picture for more than half the nation’s hospitals. The hospitals, however, complain (here) that cutting off the price break for their “affiliated” community clinics and pharmacies has damaged them.
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June 21, 22, 23
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August, no editions
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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