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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.”

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:

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.

AHA asks Trump to change CMS regulations

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.The White House

“[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.”

CMS LogoThe 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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Congress proposes delaying CMS star ratings for a year

Congress introduced a new bill yesterday that would force CMS to delay the release of its hospital star rating system by a year. The bill, the Hospital Quality Rating Transparency Act of 2016, would also require that a third party analyze CMS’ methodology and data and provide a 60-day comment period for interested parties.

The star ratings are determined by 62 quality measurements and are meant to be a simple, comprehensive look at hospital quality to help consumers make their medical choices. The ratings have come under fire by several hospital organizations who say that the ratings don’t show true quality and that the methodology CMS uses is flawed. One of these groups, the American Hospital Association, applauded Congress’s efforts to delay the ratings.

“Hospitals and members of Congress are in agreement: CMS can do better,” they wrote. “The majority of Congress—60 members of the Senate and more than 225 members of the House—asked CMS to delay and improve upon the star ratings. Our own analysis of preliminary data continues to raise questions and concerns about the methodology, which may unfairly penalize teaching hospitals and those serving the poor.

“We continue to urge CMS to work with hospitals and health systems to provide patients with a rating system that accurately reflects the quality of care provided at their facilities, and will work with Reps. [James] Renacci [R-OH] and [Kathleen] Rice [D-NY] to move this legislation forward.”

U.S. House passes mental health bill

On June 6, the House of Representatives passed the “Helping Families in Mental Health Crisis Act” by a 442-2 vote. The bill would allow CMS to reimburse providers for treating Medicaid patients’ mental health and physical health on the same day, increase the number of psychiatric hospital beds, and cut CMS spending by $5 million over 10 years. The bill was created and led by Rep. Tim Murphy, a licensed child psychologist, in response to the Sandy Hook shootings.

“This historic vote closes a tragic chapter in our nation’s treatment of serious mental illness and welcomes a new dawn of help and hope,” he said in a press release. “We are ending the era of stigma. Mental illness is no longer a joke, considered a moral defect and a reason to throw people in jail.”

The Senate is expected to vote on the bill by the end of the year.