Thanks to Fred Hapgood and his thorough list of lectures. As always, double check times, locations and access.
This morning’s Globe quotes Donald Berwick, MD, on the potential impact of last week’s court ruling declaring the ACA unconstitutional in Massachusetts. Readers not yet eligible for Medicare take note.
…Massachusetts relies on billions of dollars in federal funding every year to provide coverage to lower-income residents, and the state’s health care system is deeply entwined with the federal system. So major disruptions to the federal law would extend here, several health care experts said Monday.
If the decision issued Friday were to stand, “it would be a disaster” said Dr. Donald M. Berwick, senior fellow at the Institute for Healthcare Improvement in Boston and a former administrator of Medicare and Medicaid under President Obama.
For more, see Kaiser Health News coverage of the ACA.
Some stats from the Massachusetts Health Insurance Survey.
When Liz Tidyman’s elderly parents moved across the country to be closer to their children and grandchildren years ago, they carried their medical records with them in a couple of brown cardboard folders tied with string.
Two days after their arrival, Tidyman’s father fell, which hadn’t happened before, and went to a hospital for an evaluation.
In the waiting room, Tidyman opened the folder. “Very soon I saw that there were pages and pages of notes that referred to a different person with the same name — a person whose medical conditions were much more complicated and numerous than my father’s,” she said.
Tidyman pulled out sheets with mistaken information and made a mental note to always check records in the future. “That was a wake-up call,” she said.
Older adults have cause to be careful about what’s in their medical records. Although definitive data aren’t available, the Office of the National Coordinator for Health Information Technology estimates that nearly 1 in 10 people who access records online end up requesting that they be corrected for a variety of reasons.
In the worst-case scenario, an incorrect diagnosis, scan or lab result may have been inserted into a record, raising the possibility of inappropriate medical evaluation or treatment. This, too, is something that Tidyman’s father encountered soon after moving from Massachusetts to Washington. (Her parents have since passed away.)
When both his new primary care physician and cardiologist asked about kidney cancer — a condition he didn’t have — Tidyman reviewed materials from her father’s emergency room visit. There, she saw that “renal cell carcinoma” (kidney cancer) was listed instead of “basal cell carcinoma” (skin cancer) — an illness her father had mentioned while describing his medical history.
“It was a transcription error; something we clearly had to fix,” Tidyman said.
Omissions from medical records — allergies that aren’t noted, lab results that aren’t recorded, medications that aren’t listed — can be equally devastating.
Susan Sheridan discovered this nearly 20 years ago after her husband, Pat, had surgery to remove a mass in his neck. A hospital pathology report identified synovial cell sarcoma, a type of cancer, but somehow the report didn’t reach his neurosurgeon. Instead, the surgeon reassured the couple that the tumor was benign.
Six months later, when Pat returned to the hospital in distress, this error of omission was discovered. By then, Pat’s untreated cancer had metastasized to his spinal canal. He died 2½ years later.
“I tell people, ‘Collect all your medical records, no matter what’ so you can ask all kinds of questions and be on the alert for errors,” said Sheridan, director of patient engagement with the Society to Improve Diagnosis in Medicine.
In less dire scenarios, a patient’s name, address, phone number or personal contacts may be incorrect, making it difficult to reach someone in the event of an emergency or causing a bill to be sent to the wrong location. Or, your family history may not be conveyed accurately. Or, you may not have received a service recorded in your record — for instance, a stress test — and want to contest the bill.
Dave deBronkart, a 68-year-old cancer survivor and patient activist, recounts mistakes he and his family have experienced. Once, he checked a radiology report through a Boston hospital’s patient portal. It had his name on it but identified him as a 53-year-old woman.
In another instance, the records that accompanied deBronkart’s mother to a rehabilitation center after a hip replacement incorrectly identified her as having an underactive thyroid when in fact she had an overactive thyroid. DeBronkart’s sisters, who asked to look at their mother’s chart, discovered the mistake and had it fixed on the spot, so she wouldn’t get potentially harmful medications.
“It’s important for people to realize how easy it is for mistakes to get into the system and for nobody to know it. And that can cause downstream harm,” deBronkart said.
The law that guarantees your right to review your medical record, the Health Insurance Portability and Accountability Act of 1996, offers some recourse: If you think you’ve discovered an error in your medical record, you have the right to ask for a correction. (For more information about how to obtain your record, see my earlier column here.)
Start by asking your doctor or hospital if they have a form (either a paper or electronic version) you should use to submit a suggested change.
A simple error such as a wrong phone number can be corrected by drawing a thin line through the material and writing a suggested change in the margins or making an electronic note. A more complicated error such as incorrect description of your symptoms or a diagnosis that you’re contesting may require a brief statement from you explaining what material in the record is wrong, why and how it should be altered.
Physicians and hospitals are required to respond in writing within 60 days, with the possibility of a 30-day extension. (Some states set shorter deadlines.) But medical providers are not obligated to accept your request. If you receive a rejection, you have the right to add another statement contesting this decision to your medical record. You can also file a complaint with the government office that oversees HIPAA or a state agency that licenses physicians.
Devin O’Brien, senior counsel with The Doctors Company, the largest physician-owned medical malpractice firm in the U.S., notes that rejections can be warranted when facts or medical judgments are in question. An example might be a patient who wants a doctor’s notes about potentially excessive opioid use eliminated from the record. “The patient may say I don’t have a problem, I don’t know what you’re talking about, but the physician may think the patient has an issue,” O’Brien said.
Another example might be a patient who wants a diagnosis eliminated from a medical record, because it might compromise her ability to get insurance coverage. That wouldn’t be an acceptable reason for making a change, experts said.
For more information about correcting errors in medical records, see this guide to getting and using your medical record from the Office of the National Coordinator for Health Information Technology, this explainer from patient advocate Trisha Torrey, and these descriptions of your HIPAA rights from the Privacy Rights Clearinghouse and the Center for Democracy & Technology.
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
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
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.”
The 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.
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 Cannabis 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.”
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.
More on Massachusetts marijuana:
Globe: Hundreds of people wait for hours in long lines to purchase recreational marijuana in Massachusetts
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 medications 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.