Tag Archives: Vulnerable Populations

CMS finalizes 340B drug program cut

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https://www.healthcaredive.com/news/cms-finalizes-340b-drug-program-cut/509892/

Dive Brief:

  • The CMS on Wednesday released a final rule that will significantly cut drug payments to hospitals that use the 340B Drug Pricing Program. The changes to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Program take effect Jan. 1, 2018.
  • The rule also puts a moratorium on enforcement of the direct supervision policy in certain cases, increases outpatient payments by 1.35%, removes six measures from the Outcome Reporting Program and removes total knee arthroplasty from the inpatient only list.
  • The American Hospital Association released a statement blasting the 340B cut, saying it “will dramatically threaten access to healthcare for many patients, including uninsured and other vulnerable populations.” AHA, America’s Essential Hospitals and the Association of American Medical Colleges plan to sue the administration over the change.

Dive Insight:

The cut to drug payments in the 340B program, which is mostly used by safety net hospitals, is dramatic. Instead of being paid the average sales price plus 6%, they will now be paid 22.5% less than the average price. Children’s hospitals and community hospitals in rural areas are exempt from the reduction.

Hospitals that use the program say it is necessary to helping them care for vulnerable populations, and have cautioned the cut will jeopardize that. There is little oversight, however, over how hospitals track and use the savings generating through 340B. Some lawmakers have said hospitals should be required to make this information readily available.

A controversial study released last month showed hospitals participating in 340B had more of a decline in charity care than other hospitals. AHA said the report is misleading and doesn’t take into account other community benefits hospitals provide.

Hospitals will also be angered by the CMS decision to allow total knee replacement surgeries to take place in outpatient settings. The agency is following the lead of commercial payers, who are pushing for care to move away from more expensive inpatient settings. CMS has said the change will let Medicare beneficiaries get a knee replacement at lower cost, but hospitals say the quality of care for those procedures could decrease.

 

The surprising link between air pollution and Alzheimer’s disease

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http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=41764605&_hsenc=p2ANqtz-9DiZmgGHX54LqTpQGsAm4ohgFFyJHWy6ijRJ-3gxyi-aPS9QNViqc7K33BgIAVc43xoyt9TPB1HdtN7c-F__ONriUMMQ&_hsmi=41764605

Image result for The surprising link between air pollution and Alzheimer’s disease

With environmental regulations expected to come under heavy fire from the Trump administration, new research offers powerful evidence of a link between air pollution and dementia risk.

For older women, breathing air that is heavily polluted by vehicle exhaust and other sources of fine particulates nearly doubles the likelihood of developing dementia, finds a study published Tuesday. And the cognitive effects of air pollution are dramatically more pronounced in women who carry a genetic variant, known as APOE-e4, which puts them at higher risk for developing Alzheimer’s disease.

In a nationwide study that tracked the cognitive health of women between the ages of 65 and 79 for 10 years, those who had the APOE-e4 variant were nearly three times more likely to develop dementia if they were exposed to high levels of air pollution than APOE-e4 carriers who were not.

Among carriers of that gene, older women exposed to heavy air pollution were close to four times likelier than those who breathed mostly clean air to develop “global cognitive decline” — a measurable loss of memory and reasoning skills short of dementia.

While scientists have long tallied the health costs of air pollution in asthma, lung disease and cardiovascular disease, the impact of air pollutants on brain health has only begun to come to light. This study gleans new insights into how, and how powerfully, a key component of urban smog scrambles the aging brain.

Published Tuesday in the journal Translational Psychiatry, the research looks at a large population of American women, at lab mice, and at brain tissue in petri dishes to establish a link between serious cognitive decline and the very fine particles of pollution emitted by motor vehicles, power plants and the burning of biomass products such as wood.

All three of these biomedical research methods suggest that exposure to high levels of fine air pollutants increases both dementia’s classic behavioral signs of disorientation and memory loss as well as its less obvious hallmarks. These include amyloid beta protein clumps in the brain and the die-off of cells in the brain’s hippocampus, a key center for memory formation.

 

California Reforms Target Workers’ Compensation Fraud

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California Reforms Target Workers’ Compensation Fraud

Image result for Workers’ Compensation Fraud

California is cracking down on graft in the state’s system of medical care for injured workers with two bills recently signed into law by Gov. Jerry Brown.

The reforms will prohibit medical providers who are felons from billing for workers’ compensation care and rein in a court-governed payment system that gave rise to hundreds of millions of dollars in unsanctioned treatment.

Lawmakers who introduced the bills cited an investigation by Reveal from The Center for Investigative Reporting that examined more than $1 billion in alleged fraud in the medical system for injured workers.

Reviewing more than a dozen prosecutions and analyzing state data, the investigation found that alleged scams affected more than 100,000 injured workers. Many were monolingual Latinos who were targeted in aggressive marketing efforts in Southern California. They encountered everything from kickback-fueled spinal surgeries to fraudulent providers to $1,600 tubes of pain cream.

Alleged scammers included felons and doctors banned from billing Medicare for malfeasance. Many fraud defendants exploited a feature of California’s workers’ compensations system that let them file a “lien,” or a demand for payment, for services after insurers refused to pay. They included therapies like shock wave pain treatments or unwanted drugs, such as the pricey pain creams.

The new laws would ban certain medical providers with troubled pasts from treating injured workers and also aim to limit the avalanche of liens that clog the docket in two dozen workers’ compensation courts throughout the state.

Christine Baker, director of the Department of Industrial Relations, which administers workers’ compensation, said she hopes the laws improve care for people who seek help for an on-the-job injury.

“I think both abuses and fraudulent activities prey on the most vulnerable populations and we’re hopeful that appropriate treatment will be provided to workers when needed,” Baker said. The laws “should reduce costs, because a lot of costs are tied to fraudulent activity, and that frees up dollars for the injured workers.”

Uncovered California: What’s Holding Back Nurse Practitioners?

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Uncovered California: What’s Holding Back Nurse Practitioners?

NPnurses4

Nurse practitioners, or NPs, are registered nurses with “advanced clinical training at the master’s and doctoral levels, providingprimary, acute and specialty health care services,” according to the American Association of Nurse Practitioners. Most NPs (55 percent) specialize in family care and in adult gerontology (nearly 21 percent). A significant number provide acute, pediatric, neonatal, women’s and psychiatric health care services.

According to a 2014 study published in Nursing Outlook, nurse practitioners are significantly more likely than primary care physicians to “practice in urban and rural areas, provide care in a wider range of community settings and treat Medicaid recipients and other vulnerable populations.”

“Uncovered California”is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

 

Uncovered California: Community College Students’ Quest for Mental Health Services

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Uncovered California: Community College Students’ Quest for Mental Health Services

Mental Health infographic

On April 19, 35-year-old Sacramento City College student Rachel Wilson testified before the state Assembly’s higher education committee. A survivor of sexual assault and multiple suicide attempts, she described the lack of mental health support services available to her at school. Wilson was followed by an American River College professor, whose own son had killed himself while studying at a community college. The professor talked about three students who had recently committed suicide at her school, and of the lack of mental health services to help troubled individuals. When faculty members saw someone in crisis, she said, they were instructed to call campus police and have them take the student away.

“Mental illness is not a crime,” she told legislators. Then she repeated it: “Mental illness is not a crime.”

 Both women wanted the legislators to support Kevin McCarty’s (D-Sacramento) Assembly Bill 2017, which would significantly expand mental health services across California’s vast community college system.

Roughly two million Californians attend classes in one or another of the 113 community campuses dotted around the state. Surveys suggest that somewhere in the region of one in four of these students will experience a diagnosable mental health problem at some point, but approximately 40 percent of them won’t seek timely help. And too often, the institutions at which they study won’t be proactive in linking them up with vital services. As a result, they go untreated.

“Uncovered California” is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

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http://www.commonwealthfund.org/publications/in-the-literature/2016/june/association-between-medicare-accountable-care-organization?omnicid=CFC1066901&mid=henrykotula@yahoo.com

“Medicare ACO programs are associated with modest savings on average across all beneficiaries, with savings concentrated in clinically vulnerable beneficiaries and use of institutional settings.”

Physician group: High cost-sharing undermines insurance protections

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http://www.fiercehealthcare.com/payer/physician-group-high-cost-sharing-undermines-insurance-protections?mkt_tok=eyJpIjoiTXpVMk1HRm1NRE5pWW1JMSIsInQiOiIrM3BwTVBRRXorTzl3NjQxOWNPOUh1UUxUT0ZcL2xNTGdleWQzKzRFRzIwZzhHYTg2T0c3TWlZV1BjUEsxd0JBRmNJaGk0WU9NMTRvWmFyZndPVit2SzZmUDFxM1dWSm1OV2l4Rnd1YlBMWTQ9In0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

closeup of a person holding a credit card

Increased cost-sharing, particularly high deductibles, lead patients to neglect necessary healthcare, according to a position paper from the American College of Physicians (ACP).

“The effects are particularly pronounced among those with low incomes and the very sick,” said Nitin S. Damle, M.D., president of the ACP in an announcement that accompanied the paper.

By exposing individuals to the full cost of certain expenses, cost-sharing undermines the primary function of insurance, says the ACP, noting that underinsurance may be a more challenging problem than lack of insurance.

More than 40 percent of marketplace plan enrollees and more than 20 percent of those insured through employers who report being in fair or poor health or having a chronic condition express confidence that they can afford necessary care, the paper says. But those with high-deductible plans have less confidence in their ability to afford a serious illness than those with low-deductible plans.

The ACP notes that rising premiums have led many employers to shift costs to employees in the form of higher average deductibles, which more than doubled between 2005 and 2015, even as wages remained largely flat.

CMS’ 6 health equity problems: What execs should know

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/cms-6-health-equity-problems-what-execs-should-know-slideshow

health equity priorities