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West Virginia cities sue Joint Commission over alleged role in opioid crisis

Four West Virginia cities and towns filed a class-action lawsuit against The Joint Commission and Joint Commission Resources on November 2, claiming the accreditor “grossly misrepresented the addictive qualities of opioids” in their pain management standards. The town of Ceredo and cities of Charleston, Huntington, and Kenova claim that those standards forced hospitals to prescribe unsafe amounts of painkillers, fueling addiction and deaths in the state. [Is there any dollar amount named in the lawsuit? What is it asking for?]

“This lawsuit is a critical move toward eliminating the source of opioid addiction and holding one of the most culpable parties responsible,” said Huntington Mayor Steve Williams. “For too long, [The Joint Commission] has operated in concert with opioid producers to establish pain management guidelines that feature the use of opioids virtually without restriction. The [commission’s] standards are based on bad science, if they are based on any science at all.”

West Virginia has the highest drug overdose death rate in the nation, with 41.5 deaths per 100,000 in 2015. Huntington and Cabell County had the highest overdose fatality rate in the state last year.

The lawsuit claims that the pharmaceutical companies like Purdue Pharma (the makers of OxyContin) worked with The Joint Commission to create the pain management standards. These companies stood to gain from the overuse of their drugs, the lawsuit claims.

The Joint Commission accredits at least 10 hospitals and healthcare facilities in Charleston and Huntington, and other cities and towns are expected to join the federal lawsuit.

The Joint Commission updated its pain management standards in June to reduce over prescriptions, which will take effect on January 1. However, the lawsuit says the accreditor waited too long to make those changes.

This isn’t the first time that The Joint Commission has come under fire either. In 2016 more than 60 medical experts and nonprofit organizations signed petitions asking the commission to change its standards. Claiming they “foster dangerous pain control practices, the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families, and communities.”

USP <800> deadline on hazardous drug handling postponed until 2019  

The U.S Pharmacopeial Convention (USP) announced today that it is pushing back the compliance deadline for General Chapter <800> Hazardous Drugs; Handling in Healthcare Settings, from July 1, 2018 to December 1, 2019.

USP <800> covers from the moment a hazardous drug is received at the loading dock all the way through to the medicine’s disposal. Its standards apply to anyone who comes into contact with hazardous drugs: nurses, physicians, pharmacists, pharmacy technicians, loading dock personnel, etc.

“USP encourages early adoption and implementation of General Chapter <800> to help ensure a safe environment and protection of healthcare practitioners and others when handling hazardous drugs.  We will continue to support our stakeholders through education and outreach,” the organization wrote in a press release.

For more on the chapter, please join us for a webinar on October 30 with expert speaker Patricia Kienle.

Mass shooting tests Las Vegas hospitals with surge of more than 500 patients

Moments after shots rang out along the iconic Las Vegas strip Sunday night, sending thousands of concertgoers scrambling for cover, the city’s hospitals sprang into action.

Dignity Health-St. Rose Dominican Hospital treated more than 50 people across its three campuses; the city’s only Level 1 trauma center, University Medical Center, treated another 100 people; and Sunrise Hospital and Medical Center—the trauma center located closest to the strip—treated more than 175 patients, according to a statement from the American Hospital Association (AHA).

“With at least 58 people killed and more than 400 taken to area hospitals with injuries, this tragedy painfully reminds us why violence is now viewed as one of the major public health and safety issues throughout the country,” said AHA Chairman Gene Woods, MBA, MHA, FACHE, president and CEO of Carolinas HealthCare System based in Charlotte, North Carolina, in a statement. “Like all of you, my heart is heavy and my thoughts and prayers are with the victims and their families. My mind is also focused on our colleagues in Las Vegas who are working tirelessly in an overwhelming, mass casualty situation to provide life-saving support to those in need.”

Those colleagues undoubtedly faced a gruesome scene overnight. In its own statement, Sunrise Hospital and Medical Center said 14 of the patients it treated had died. About 30 surgeries had been performed at the site—thus far.

“This has been an unprecedented response to an unprecedented tragedy,” Sunrise CEO Todd Sklamberg, MBA, said in the statement. “Our trauma team and all supporting nursing units, critical care areas and ancillary services are all at work this morning in the aftermath of this tragedy—and most stayed throughout the night—to help the victims and to assist their loved ones.”

 

What providers can do this National Suicide Prevention Week

National Suicide Prevention Week is September 10-16, bringing awareness to the 10th leading cause of death in the United States. This week is a time for physicians, nurses, and other providers to learn more about how their healthcare organizations can help suicidal patients.

Find out how your healthcare organization can help suicide patients

Find out how your healthcare organization can help suicide patients

In 2013, 9.3 million adults had suicidal thoughts, 1.3 million attempted suicide, and 41,149 died. Even more worrying is that the rate of suicides has increased 24% between 1999 and 2014. And as of March 2017, Joint Commission surveyors have been putting special focus on suicide, self-harm, and ligature observations in psychiatric units and hospitals. Surveyors are documenting all observations of self-harm risks, and evaluating whether the facility has:

  • Identified these risks before
  • Has plans to deal with these risks
  • Conducted an effective environmental risk assessment process

 

To learn more about suicide prevention in healthcare, check out the following websites and articles.

Solar Eclipse: Prepare for eye injuries

Healthcare providers should be on the lookout (no pun intended) for patients complaining of eye trouble over the next few days. 

Monday, August 21, a total solar eclipse will occur over the continental United States, the first one to do so since 1918. Over 12 million of people will be able to see the sun completely blocked out by the moon, with more able to see a partial eclipse.

While there have been plenty of PSAs and warnings about not looking directly at the sun (even when it’s partially obscured) healthcare organizations should be ready to deal with patients coming in complaining of eye pain or damaged vision.

CMS withdraws proposal to have AOs post survey reports online

A proposal by CMS to have accrediting organizations (AOs) post the details of survey reports online was withdrawn by the agency, not because of negative comments — although there were plenty — but because, well, it might be prohibited under federal law.

CMS first made the proposal in April, tucking it into the latter pages of the always-long proposed on changes to the Inpatient Prospective Payment System (IPPS) for the upcoming fiscal year.

The proposal was to have AOs post final survey reports online within 90 days that the same information is available to the hospital or other health care organization, including details of all initial and recertification surveys at that provider in the prior three years, as well as the accepted plans of correction (PoCs).

AOs now post only whether an organization is accredited or not, and do not make details of findings public.

CMS argued its proposal was to promote transparency in health care, and noted that it posts its own  survey reports online. But critics responded that the CMS reports are made available in a hard-to-read spreadsheet and that the federal agency was responsible for far fewer surveys at health care organizations that were often surveyed only after a complaint (IJC 5/1/17).

In public comments to CMS concerning the proposal, The Joint Commission said that requiring survey details be made public would have “chilling effect” on efforts to raise standards of quality. Dr. Mark R. Chassin, president and CEO of The Joint Commission, wrote: “There will be a race to the bottom on quality as health care organizations seek out oversight bodies that will report on the least number of standards comparable to the Medicare requirements. This may also lead to a growth in non-accredited facilities that will then be surveyed at taxpayer expense and with fewer oversight visits.”

Other groups similarly weighed in against the proposal, and offered alternatives. In the end though, it was shot down because it might potentially be prohibited.

In the IPPS final rule published Aug. 2, CMS noted that its proposal included revising the federal regulations overseeing Medicare to incorporate the requirement for AOs to post report details publically.

“Section 1865(b) of the Act prohibits CMS from disclosing survey reports or compelling the AOs to disclose their reports themselves. The suggestion by CMS to have the AOs post their survey reports may appear as if CMS was attempting to circumvent the provision of section 1865(b) of the Act. Therefore, this provision is effectively being withdrawn.” — A.J. Plunkett (aplunkett@h3.group)

Resource:

NQF launches opioid stewardship initiative

The National Quality Forum earlier this month announced the creation of an Opioid Stewardship Action Team. The team will summon experts together to develop new best practices, strategies, and tactics to curb the opioid epidemic in America.

“As an emergency medicine doctor, I’ve seen first-hand the devastating effects of opioid misuse on our nation’s health, and it is imperative that we all work together to address it,” said Shantanu Agrawal, MD, NQF’s president and CEO, in a press release. “This new initiative will provide those on the frontlines with essential guidance for better, safer management of patients’ pain.”

Nearly 2 million people suffer from prescription opioid disorder and the number of opioid prescriptions written annually has quadrupled in under two decades.

Along with the NQF team, there are several ongoing efforts to stop the problem, including controversial guidelines released by the Centers for Disease Control and Prevention in 2016.

The team will consist of nurses, physicians, consumers, and others to build upon on current efforts to address the opioid epidemic, with a focus on improving prescribing practices. The team is being modeled after successful NQF action plans, such as NQF’s playbook on antibiotic stewardship.

Those interested in joining or supporting the Opioid Stewardship Action Team should contact the National Quality Partners at nationalqualitypartners@qualityforum.org.

Caucus pushes for telemedicine expansion in Congress

When it comes to healthcare and congress, finding bipartisan support on anything is a daunting task. That said, politicians from both sides are coming together in support of new bills aimed at improving and expanding telemedicine services in the United States.

The U.S. House of Representatives and Senate are considering both the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 and the Medicare Telehealth Parity Act (MTPA). The two bills are aimed at lowering CMS restrictions on telemedicine coverage and test the efficacy of telehealth services in Medicare healthcare delivery reform models. The Senate Finance Committee is also considering a bill called the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which includes a section that would allow greater use of telehealth.

Both CONNECT and MTPA had failed to advance during previous sessions of Congress, and were re-launched by members of the newly formed bipartisan Congressional Telehealth Caucus on May 19. The four founding members of that caucus are Representatives Mike Thompson (D-Calif.), Gregg Harper (R-Mass.), Diane Black (R-Tenn.), and Peter Welch (D-Vt.)

“Telehealth saves lives and reduces costs; it’s a win-win for both patients and providers,” said Thompson in a press release. “We’ve all seen how technology has made us more connected in our daily lives. These same advances allow physicians to provide more patients with better healthcare—especially patients in rural, difficult-to-access, and underserved communities. Unfortunately, regulations haven’t kept pace with the times. These commonsense, bipartisan policies will allow us to make sure every American gets the best care and the best treatment—no matter where they live. The Caucus will give us a venue to collaborate with our interested colleagues to advance the delivery of care via telemedicine.”

“My many years as a nurse, especially my time spent working in long-term care, taught me that if Medicare is to provide real benefit to seniors while ensuring real efficiency for taxpayers, it must embrace the advances in technology and innovation that are already taking place across the health care sector,” said Black. “That is what telehealth is all about—promoting cost savings and quality care through the use of technology like remote patient monitoring services. Harnessing the power of telemedicine is a win for seniors, a win for providers, a win for taxpayers, and a win for rural Tennessee.”

If passed, the Medicare Telehealth Parity Act would:

•    Allow for the provision of telehealth services in rural, underserved, and metropolitan areas, rather than just rural areas
•    Expand the types of providers who can be reimbursed for telehealth services to include several kinds of allied health professionals
•    Expand access to telestroke services
•    Allow remote patient monitoring for patients with chronic conditions
•    Allow a Medicare beneficiary’s home to serve as a site of care for remote dialysis, hospice care, outpatient mental health services, and home health services

If passed, the CONNECT for Health Act of 2017 would:

•    Expand originating sites for telehealth care
•    Create a Medicare remote patient monitoring benefit for certain high-risk, high-cost patients;
•    Lift restrictions on the use of telehealth in ACOs and Medicare Advantage plans;
•    Urge the Secretary of Health and Human Services to have CMMI evaluate the applicability of telehealth in demonstration projects;
•    Authorize a study on the use of telehealth services after restrictions on coverage have been lifted.
•    Save Medicare around $1.8 billion over the course of 10 years 

It’s important to remember that even if these bills become law, providers will still have to be licensed in whatever state their patient is physically located.

For example, if you’re in New York and one of your patients is on vacation in California, you have to be licensed by the California medical board to treat him via telemedicine. And you still have to meet the standard of care required under California law. That won’t change under these proposed laws.

AHA offering free cybersecurity training for hospitals

For years, security experts have tried to warn hospitals and clinics about the dangers of hackers and computer viruses. And as the recent Wanna Cry ransomware attack on the UK’s National Health Service (along with thousands of others) shows, many still haven’t taken the steps needed. The American Hospital Association (AHA) is now offering free cybersecurity training programs for hospital and health system leaders to help educate people on how to prevent and limit the effects of a cyberattack.

5ntkpxqt54y-sai-kiran-anagani“Every organization, no matter what its size, can do a great deal to reduce their risk and prevent attacks,” said Lawrence Hughes, AHA assistant general counsel, in a press release.

The remaining programs are scheduled for July 20 in San Francisco and October 26 in Chicago. To learn more and see the AHA’s library of cybersecurity tools, resources, click here.

Easily preventable ransomware attack hits hospitals worldwide

Wanna Cry map, Screenshot, Sunday 14

A map of all computer systems struck by the Wanna Cry virus as of May 14. Courtesy of Malwaretech.com

As of Monday, May 15, , forcing them to pay $300 in untraceable currency to regain access to their files. One of the most notable victims of Wanna Cry was the United Kingdom’s National Health Service (NHS). At least 25 NHS hospitals had to reroute patients and cancel appointments while trying to save their medical records from the virus.

Ransomware is a new twist on an old crime. The virus locks down all your computer files so you can’t access them. Then a screen appears telling you that you have a certain number of days to pay the hacker in untraceable currency. Pay and you get all your files back. Refuse and your computer remains locked and your files, documents, photos, and videos are lost forever.

This type of attack particularly devastating for hospitals, where the locked medical records and computer system are critical for patient care and treatment. Nor is Wanna Cry the first ransomware attack to affect hospitals. Here’s a quick list of 12 that happened in 2016,  with many more cases occurring that same year.

Barts Health NHS Trust, which runs four hospitals in London, had its files locked on May 13. The hospital noted the attack had forced it to cancel some appointments, send incoming patients to other hospitals, and slowed down the facilities’ pathology and diagnostic services.

“Barts Health staff are working tirelessly, using tried and tested processes to keep patients safe and well cared for,” the system wrote on Monday. “We are no longer diverting ambulances from any of our hospitals. Trauma and stroke care is also now fully operational. However, we continue to experience IT disruption, and we are very sorry for any delays and cancellations that patients experience. In these circumstances, we would ask the public to use other NHS services wherever possible.”

Microsoft had already created a software patch in mid-March that closed the Wanna Cry vulnerability. However, many facilities didn’t update their security systems.