Hello. I’m here: Globe reports on benefits of keeping #hospitalized #patients in the loop during #rounds.

Liz Kowalczyk reports on a BMJ study out of Boston Children’s Hospital 

Patient “rounds’’ — the crucial daily meetings when doctors and other caregivers determine treatment — often occur in hospital hallways and remote conference rooms.

But a study led by Boston researchers concluded that it’s far safer to do rounds right at the bedside, with the full involvement of patients and families.

Researchers at Boston Children’s Hospital and seven other pediatric hospitals found that harmful medical errors fell by 38 percent when they moved rounds into patients’ rooms and implemented strict protocols to involve patients and families in the discussion. They included limiting medical jargon and providing written summaries of treatment plans.

The story refers to this piece in Catalyst

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KHN: 80 percent of #Massachusetts #nursinghomes penalized for avoidable hospitalizations

Click here to review action at individual homes. 

From Kaiser Health News

Medicare Cuts Payments To Nursing Homes Whose Patients Keep Ending Up In Hospital

The federal government has taken a new step to reduce avoidable hospital readmissions of nursing home patients by lowering a year’s worth of payments to nearly 11,000 nursing homes. It gave bonuses to nearly 4,000 others.

These financial incentives, determined by each home’s readmission rates, significantly expand Medicare’s effort to pay medical providers based on the quality of care instead of just the number or condition of their patients. Until now, Medicare limited these kinds of incentives mostly to hospitals, which have gotten used to facing financial repercussions if too many of their patients are readmitted, suffer infections or other injuries, or die.

“To some nursing homes, it could mean a significant amount of money,” said Thomas Martin, director of post-acute care analytics at CarePort Health, which works for both hospitals and nursing homes. “A lot are operating on very small margins.”

CaptureThe new Medicare program is altering a year’s worth of payments to 14,959 skilled nursing facilities based on how often their residents ended up back in hospitals within 30 days of leaving. Hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been averted with better medical oversight.

These bonuses and penalties are also intended to discourage nursing homes from discharging patients too quickly — something that is financially tempting as Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days.

Over this fiscal year, which began Oct. 1 and goes through the end of September 2019, the best-performing homes will receive 1.6 percent more for each Medicare patient than they would have otherwise. The worst-performing homes will lose nearly 2 percent of each payment. The others will fall in between. (You can see the scores for individual nursing facilities here.)

For-profit nursing homes, which make up two-thirds of the nation’s facilities, face deeper cuts on average than do nonprofit and government-owned homes, a Kaiser Health News analysis of the data found.

In Arkansas, Louisiana and Mississippi, 85 percent of homes will lose money, the analysis found. More than half in Alaska, Hawaii and Washington state will get bonuses.

Overall, 10,976 nursing homes will be penalized, 3,983 will get bonuses, and the remainder will not experience any change in payment, the KHN analysis found.

(Story continues below.)

Medicare is lowering payments to 12 of the 15 nursing homes run by Otterbein SeniorLife, an Ohio faith-based nonprofit. Pamela Richmond, Otterbein’s chief strategy officer, said most of its readmissions occurred with patients after they went home, not while they were in the facilities. Otterbein anticipates losing $99,000 over the year.

“We’re super disappointed,” Richmond said about the penalties. She said Otterbein is starting to follow up with former patients or the home health agencies that send nurses and aides to their houses to care for them. If there are signs of trouble, Otterbein will try to arrange care or bring patients back to the nursing home if necessary.

“This really puts the emphasis on us to go out and coordinate better care after they leave,” Richmond said.

Congress created the Skilled Nursing Facility Value-Based Purchasing Program incentives in the 2014 Protecting Access to Medicare Act. In assigning bonuses and penalties, Medicare judged each facility’s performances in two ways: how its hospitalization rates in calendar year 2017 compared with other facilities and how much those rates changed from calendar year 2015.

Facilities received scores of 0 to 100 for their performances and 0 to 90 for their improvements, and the higher of the two scores was used to determine their overall score. Facilities were then ranked highest to lowest.

Medicare is not measuring readmission rates of patients who are insured through private Medicare Advantage plans, even though in some regions the majority of Medicare beneficiaries rely on those to afford their care.

Through the incentives, Medicare will redistribute $316 million from poorer-performing to better-performing nursing homes. Medicare expects it will keep another $211 million that it would have otherwise paid to nursing homes if the program did not exist.

The new payments augment other pressures nursing homes face from Medicare and state Medicaid programs to lower readmissions to hospitals.

“Skilled facilities have been working toward this and knew it was coming,” said Nicole Fallon, vice president of health policy and integrated services at LeadingAge, an association of nonprofit providers of aging services.

The American Health Care Association, a trade group of nursing homes, said in a statement that it had supported the program and was gratified to see that more than a quarter of facilities received bonuses.

While most researchers believe that readmissions can be reduced, some consumer advocates fear that nursing homes will be reluctant to admit very infirm residents or to re-hospitalize patients even when they need medical care.

“It may end up causing great pain to residents who actually need to be hospitalized,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, which is based in San Francisco.

Fallon said Medicare eventually may penalize homes that have done all they can to prevent return trips to the hospital. But because of the program’s design by Congress, Medicare still will need to punish large numbers of homes.

“There’s always going to be winners and losers, even if you make good progress,” Fallon said. “At what point have we achieved all we can achieve?”

Meanwhile, Medicare is looking to expand financial incentives to other kinds of providers. Since 2016, it has been testing quality bonuses and penalties for home health agencies in nine states. Richmond, the nursing home executive, applauded that kind of expansion.

‘There’s a whole bunch of people in this chain” of institutions caring for patients at different stages, she said, “and we all need to be working in a common direction.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN’s coverage related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

How many #marijuana puns can you fit in a lead? Find out as #Massachusetts opens its first recreational #pot shops.

Hey bud. It’s a green day in Massachusetts. Not to be blunt, but it’s a stone-cold fact –  marijuana /weed/ kush/grass goes on sale legally at two stores today. Medical marijuana has been on sale for a more than a year. Now, leaf peepers can score over the counter.

Recreational operations  with names like Commonwealth Cultivation and Caroline’s CanCapturenabis need state approval to grow, sell, transport, process and test pot

What does this mean for the state’s medical marijuana industry? Some medical sites will switch to or add recreational elements; some will remain dispensaries. Medical cardholders buy their supplies tax free.

For those without a medical marijuana card who want to see if pot can ease their pain, nausea or seizures, they now have a chance.

The Globe has a marijuana page, where it will  employ “robust high-standards journalism, hold industry and government accountable — all while writing with clarity, urgency, and style.”

Sounds a little like the description of some of the strains. Like Tangerine Haze, which one seller promises ” can help start your day with energy and euphoria. Many patients are using this strain to stimulate appetite and elevate their mood. This strain may be best for those with high-stress lifestyles.”

The state is asking people to be cool.  So, before you hit the baked sale to satisfy your stimulated appetite, read the rules. 

BOSTON—Upon issuing notices today for two retail marijuana establishments to commence adult-use operations in Massachusetts, the Cannabis Control Commission (Commission) is urging adults who will enter stores for the first time to know the law and consume responsibly.Capture

More on Massachusetts marijuana:

Globe: Hundreds of people wait for hours in long lines to purchase recreational marijuana in Massachusetts

 

 

In Boston, docs to use direct action to #protest the #price of #insulin

11/19 update: Audio from the event.

Activist docs argue that people are dying for lack of access to insulin. Tomorrow — Friday — the Right Care Alliance will take that complaint to the Sanofi offices in Cambridge.

More here from STAT, including a company statement noting that it provides free IMG_6677medications for some low-income, uninsured patients and will  “continue to explore innovative ways to find long-term solutions to help eliminate or significantly reduce the out-of-pocket expenses for patients.”

Here’s what the Right Care Alliance will do Friday:

 The mothers of two young adults with diabetes who died while rationing insulin last year will deliver the ashes of their children to Cambridge pharma corporation Sanofi. The mothers will be joined by activists from at least five local groups that are demanding a reduction in insulin prices so that no more people die.

Here’s what Dr. Saini has to say about the campaign:

More news about the price of insulin:

Minnesota Attorney General Lori Swanson today filed a lawsuit against the nation’s three major manufacturers of insulin used to treat diabetes after prices more than doubled in recent years.

Press release: Sanofi has expanded its access program for people living with diabetes to include all Sanofi insulins*, helping patients get the insulin they need at a significantly reduced price.

 

 

Have you ever read the #nutrition label on a muffin? If you want one with less sugar and fat, try one of these recipes.

Read the nutrition label on that muffin. It might look healthy, but it is likely heavy on sugar and fat.

For an alternative,try these recipes from the Harvard School of Public Health.

Harvard Business Review on sexual harassment in health care

From HBR,  which has a three story pay-wall:

Many factors make an organization prone to sexual harassment: a hierarchicalstructure, a male-dominated environment, and a climate that tolerates transgressions — particularly when they are committed by those with power. Medicinehas all three of these elements. And academic medicine, compared to other scientific fields, has the highest incidence of gender and sexual harassment. Thirty to seventypercent of female physicians and as many as half of female medical students report being sexually harassed.

As we wrote in a recent New England Journal of Medicine article, “Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: ‘Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician’.”

The NEJM

nci-vol-1884-150
National Cancer Institute archives

 piece is not:

The declaration of “Time’s Up” for medicine feels at once urgent and aspirational. Putting an end to the culture of gender-based harassment is key to recruiting, retaining, and realizing the full potential of the female-majority health care workforce, including 1 in 3 physicians, and feels long overdue. Actually running down the clock on harassment, however, will depend on our willingness to undergo a complete transformation in how we conceive of, approach, and prioritize this problem.

11/7 Live streamed Harvard event: “Addressing Adolescent Mental Health Beyond the Clinic: Lessons from the Global South”

Live streamed Harvard event on adolescent mental health beyond the clinic.  The Child Mental Health Forum talks run through May.

10 AM- 11:15 a.m.  at the Judge Baker Children’s Center
53 Parker Hill Avenue, Boston,
Limited free parking available

November 7th, 2018 “Addressing Adolescent Mental Health Beyond the Clinic: Lessons from the Global South”

Vikram Patel, MBBS, PhD

The Pershing Square Professor of Global Health and Wellcome Trust Research Fellow,
Department of Global Health and Social Medicine,
Harvard Medical School and Harvard TH Chan School of Public Health

Series runs through May ;

December 5th, 2018 “Genetics of Autism Spectrum Disorder”
Catalina Betancur, MD, PhD
Director of Research, INSERM Division,
Sorbonne University, Paris, France
January 9th, 2019 “Why do People Hurt Themselves? Using New Technologies to Better Understand, Predict, and Prevent Suicidal Behavior”
Matthew K. Nock, PhD
Edgar Pierce Professor of Psychology,
Harvard University
February 6th, 2019 “Gender Identity Development in Children and Adolescents”
Elizabeth Freidin Baumann, PhD
Instructor, Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School
Cynthia Telingator, MD
Assistant Professor of Psychiatry, Cambridge Health Alliance and Harvard Medical School
March 6th, 2019 “Exploring the Unique Needs of Adopted Teens: Four Essential Tasks for Parents and Providers”
Katie Naftzger, LICSW
Author of “Parenting in the Eye of the Storm: The Adoptive Parent’s Guide to Navigating the Teen Years.”
April 3rd, 2019 “Boys’ Friendships and the Crisis of Connection”
Niobe Way, PhD
Professor of Developmental Psychology,
New York University
May 1st, 2019 “Treatment Strategies for Sleep Disorders in Children and Adolescents”
Jess Shatkin, MD, MPH
Professor, Department of Child and Adolescent Psychiatry
Professor, Department of Pediatrics
New York University School of Medicine