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On February 10, the U.S. Senate voted 52 to 47 confirming Rep. Tom Price, MD (R-GA) as the new head of the Department of Health and Human Services (HHS). Price is an orthopedic surgeon and the first physician to head the HHS since the George H.W. Bush administration. He’s known for his opposition to the Affordable Care Act.
Price’s appointment has been highly controversial, in part due to his investments in healthcare companies that could potentially benefit or be harmed by his actions as HHS secretary.
A recent survey of nearly 1,100 physicians revealed a sharp divide in opinions on Price’s appointment; with 46% feeling positive and 42% leaned negative. The survey also revealed that 47% of respondents believe that Price will diminish patients’ ability to access quality care, with 42% who believed the opposite.
On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for executive departments or agencies, including healthcare. Under the executive order, for a new healthcare regulation to be implemented, two older regulations will have to be eliminated.
“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”
The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.
While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.
Efforts to improve patient safety are paying off, according to a new Health and Human Services (HHS) department report. Between 2010 and 2015, increased patient safety efforts have:
• prevented 3.1 million hospital-acquired conditions (HAC), a 21% decline
• saved 125,000 lives
• saved $28 billion in healthcare costs
In the announcement, HHS Secretary Sylvia Burwell cited the Affordable Care Act as a major cause of the improvement in patient safety.
“The Affordable Care Act gave us tools to build a better healthcare system that protects patients, improves quality, and makes the most of our healthcare dollars and those tools are generating results,” said HHS Secretary Sylvia M. Burwell. “Today’s report shows us hundreds of thousands of Americans have been spared from deadly hospital-acquired conditions, resulting in thousands of lives saved and billions of dollars saved.”
There are other federal patient safety efforts mentioned in the report as aiding in patient safety improvement. Among those cited were the Partnership for Patients initiative, a public-private partnership launched in 2011 though CMS Innovation to target a specific HACs. CMS also worked with hospital networks and aligned payment incentives to improve focus on making care safer.
“These achievements demonstrate the commitment across many public and [more]
On December 2, the American Hospital Association (AHA) sent a letter to president-elect Donald Trump asking him to reform CMS regulatory requirements. This is the second letter the group sent the president-elect in the space of three days.
The AHA has 43,000 individual members and nearly 5,000 member hospitals in its ranks. AHA CEO and President Rick Pollack wrote that the balance between flexibility in patient care and regulatory burden was at a tipping point. He continues to say that reducing administrative complexity would save billions annually and allow providers to spend more time on patients, not paperwork.
“[CMS] and other agencies of the Department of Health and Human Services (HHS) released 43 hospital-related proposed and final rules in the first 10 months of the year alone, comprising almost 21,000 pages of text,” he wrote. “In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them. Moreover, this does not include the increasing use of sub-regulatory guidance (FAQs, blogs, etc.) to implement new administrative policies.”
The letter includes a list of 33 changes the AHA wants to be made, including
• Suspend hospital star ratings
• Suspend electronic clinical quality measure (eCQM) reporting requirements
• Delete faulty hospital quality measures
• Have readmission measures reflect socioeconomic factors
• Cancel stage 3 of “meaningful use” program.
• Stop federal agencies (HHS, CMS) from forcing private sector accreditors (Joint Commission, DNV, HFAP) to conform with government accreditation standards
• Refocus the Office of the National Coordinator (ONC) on certifying electronic health records
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The high rate of burnout and unengaged physicians and nurses is an increasing concern for the healthcare industry. Burnout is characterized by exhaustion, cynicism, and reduced effectiveness. It’s also a proven influence on care quality, patient safety, physician turnover, and patient satisfaction. However, industry attempts to engage with physicians have been haphazard at best. The Mayo Clinic recently released a new paper on preventing burnout, emphasizing the need for individual physicians and hospital leaders to work together on this problem.
“The reality is that an engaged physician workforce is requisite to achieving institutional objectives, that small investments can have a large impact, and that many effective interventions are cost neutral,” wrote John Noseworthy, MD, president and CEO of the Mayo Clinic, and Tait D. Shanafelt, the Mayo Clinic’s director of the program on physician well-being, in the report.
1. Admit there is a problem and then assess it: Provide your medical staff with many opportunities to talk about the problems they face. These discussions can be done in many different formats: town halls, radio broadcasts, face-to-face meetings and video interviews. Use these discussions to measure engagement and satisfaction with work-life integration each year.
2. Identify physician leaders: Healthcare leaders must look for physicians with the ability to listen to, engage, develop, and lead physicians. But then the organization must help develop and train these leaders. Staff should also be given a chance to evaluate their physician leaders. [more]
During a recent meeting, the American Medical Association (AMA) released new guidance for clinicians on mobile health (mHealth) apps. With the number of health apps growing exponentially, the guidance is meant to help clinicians determine coverage and payment policies for apps providing useful care quality data. The guidance specifically looks at apps that support patient-centered care delivery, care-coordination, and team-based communication.
“The new AMA principles aim to foster the integration of digital health innovations into clinical practice by promoting coverage and payment policies that are contingent upon whether mHealth apps and related devices are evidence-based, validated, interoperable and actionable,” said Steven Stack, MD, AMA’s immediate past president in a press release.
While addressing mHealth apps coverage and payment issues, the guidance addressed the need for apps to:
• Support the patient-physician relationship
• Have a clinical evidence base validating their safety and effectiveness
• Follow evidence-based practice guidelines to ensure patient safety, quality of care, and positive health outcomes
• Ensure that the delivery of any services via the app conform to state practice laws
The AMA is currently working with several health IT companies and organizations to develop technologies and applications that better serve patient care. In its announcement, the association warned that the liability issues for mHealth apps are unclear and physicians should work with their legal teams before promoting or using an app.
These guidelines come several months after The Joint Commission announced that it had reversed its ban on texting medical orders. The accreditor and CMS said they are collaborating on a set of FAQs and had originally hoped to publish their additional guidance by September. http://blogs.hcpro.com/acc/?p=2781
The Government Accountability Office (GAO) sent a report on October 13 to the Department of Health and Human Services (HHS) urging for better alignment of healthcare quality measures. The conclusion of the 42-page document is that payers haven’t agreed on what quality measures to track, which puts a burden on healthcare organizations.
“For example, a physician may participate in Medicare and a private health plan that each use different measures for assessing the care of diabetic patients,” the GAO wrote. “In another example, a physician may report similar measures to multiple payers that assess blood sugar levels among diabetic patients, but each measure may use a different threshold to determine which patients have their blood sugar levels under control.”
The GAO says there are three main drivers of these misalignments:
- Dispersed decision-making:Each public and private payer decides which quality measures they want to use and which specifications apply. This is done without regard to the measures that other payers are using.
- Variation in data collection and reporting systems:The electronic health record (EHR) systems, paper records, or clinical data registries that physicians use all differ in how they collect and report quality data. Without standard measures, there’s little incentive for EHR vendors to create systems to facilitate data collection and reporting.
- Few meaningful measures:Of the hundreds of quality measures currently used, only a few are seen as leading to meaningful quality improvements.
“What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serve no one,” said Kathleen Ciccone, RN, introducing a Healthcare Association of New York State report calling for streamlined measures.
The GAO report recommends that HHS, CMS, and the Office of the National Coordinator for Health Information Technology develop a comprehensive plan, including timelines, for more meaningful quality measures and electronic quality measures. The GAO particularly wants to see the creation of standardized data elements to report on core electronic quality measures.
The fight against antimicrobial-resistant (AMR) infections has become a hot topic in 2016, and the United Nations (UN) has now joined the fray. This year, The Joint Commission and CMS making antimicrobial stewardship programs (ASP) mandatory for all healthcare facilities. At the World Economic Forum in Davos, 74 drug makers, 11 diagnostic test manufacturers, and nine industry groups signed “The “Declaration on Combating Antimicrobial Resistance.” Two different disease strains were found to be resistant to the “last-resort” antibiotic colistin.
During the 71st session of the UN General Assembly in New York City last week, the world’s governments discussed the increasing dangers posed by AMR infections and doubled down on the need for national and international AMR action plans. This makes AMR infections the fourth health issue in history to be taken up by the U.N. General Assembly after HIV, noncommunicable diseases, and Ebola.
“Antimicrobial resistance threatens the achievement of the Sustainable Development Goals and requires a global response,” said H.E. Peter Thomson, president of the 71st session of the UN General Assembly, in an address to delegates. “Member states have today agreed upon a strong political declaration that provides a good basis for the international community to move forward. No one country, sector, or organization can address this issue alone.” [more]
CMS announced yesterday that it had finalized new emergency response requirements for healthcare providers participating in the Medicare or Medicaid system. The new rule comes as a response to a string of disasters, natural and mad-made, including the recent flooding in Louisiana. The rule requires that healthcare providers meet the following four standards:
- Emergency plan: Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier.
- Policies and procedures: Develop and implement policies and procedures based on the plan and risk assessment.
- Communication plan: Develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well-coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems.
- Training and testing program: Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan.
“As people with medical needs are cared for in increasingly diverse settings, disaster preparedness is not only a responsibility of hospitals, but of many other providers and suppliers of healthcare services. Whether it’s trauma care or long-term nursing care or a home health service, patients’ needs for health care don’t stop when disasters strike; in fact, their needs often increase in the immediate aftermath of a disaster,” said Dr. Nicole Lurie, Health and Human Services assistant secretary for preparedness and response, in a press release. “All parts of the healthcare system must be able to keep providing care through a disaster, both to save lives and to ensure that people can continue to function in their usual setting. Disasters tend to stress the entire health care system, and that’s not good for anyone.”