Blog RSS https://www.vumc.org/health-policy/ en Dusetzina among 9 invited to meet with CMS Administrator on prescription drug prices https://www.vumc.org/health-policy/listening-session-prescription-drugs <span class="field field--name-title field--type-string field--label-hidden">Dusetzina among 9 invited to meet with CMS Administrator on prescription drug prices</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lowaryj" typeof="schema:Person" property="schema:name" datatype="">lowaryj</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 07/11/2019 - 10:02</span> <a href="/health-policy/blog-post-rss/1316" class="feed-icon" title="Subscribe to Dusetzina among 9 invited to meet with CMS Administrator on prescription drug prices"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:.25in"><img alt="Department news header image" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/health-policy/sites/vumc.org.health-policy/files/General%20dept%20news%20header%20image.png" /></p> <p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:.25in"><b>Stacie Dusetzina, PhD</b>, was among nine experts from across the country invited to participate in a listening session July 8 in Washington, D.C. with Seema Verma, administrator for the Centers for Medicare and Medicaid Services on <span style="color:#1F497D">payment strategies for new and innovative high-cost prescription drugs</span>.</p><p></p> <p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:.25in">The administration of President Donald Trump has made the issue of prescription drug prices a public priority in recent weeks as more research is published that illustrates the difficulty many Americans have paying for prescription drugs.</p><p></p> <p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:.25in">Among that research is Dusetzina’s recent study, published July 1 in <a href="https://www.healthaffairs.org/">Health Affairs</a>, that shows how some Medicare beneficiaries are paying more for specialty generic drugs than brand-name counterparts.</p><p></p> <p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:.25in">Read that Health Affairs study <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05476">here</a>.</p><p></p> <p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:.25in">See all the department faculty’s <a href="https://www.vumc.org/health-policy/publication/recent-publications">recent research</a> here. </p><p></p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 11 Jul 2019 15:02:06 +0000 lowaryj 1316 at https://www.vumc.org/health-policy Nursing Home Staffing Shows Wide Fluctuations, New Research Shows https://www.vumc.org/health-policy/nursing-home-nurse-staffing-data-research <span class="field field--name-title field--type-string field--label-hidden">Nursing Home Staffing Shows Wide Fluctuations, New Research Shows</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lowaryj" typeof="schema:Person" property="schema:name" datatype="">lowaryj</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/02/2019 - 11:55</span> <a href="/health-policy/blog-post-rss/1313" class="feed-icon" title="Subscribe to Nursing Home Staffing Shows Wide Fluctuations, New Research Shows"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Jake Lowary</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><img alt="Infographic on nursing home research" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/health-policy/sites/vumc.org.health-policy/files/people/Stevenson-Health%20Affairs-PBJ-July%202019.png" /></p> <p> </p> <p>New research published in July's issue of Health Affairs finds wide variability in nurse staffing at U.S. nursing homes.</p> <p>Across all types and sizes of facilities and all nurse levels, there is variations in the staffing of nursing home facilities. Among the primary findings in the study, in which David Stevenson, PhD, a professor of health policy at VUMC, is low weekend staffing and daily staffing levels that often fall well below the expectations of the Centers for Medicare and Medicaid Services (CMS), all of which can increase the risk of adverse events for residents. </p> <p>The study is among the first to use new payroll-based journal (PBJ) data that CMS began collecting in 2016 as part of requirements in the Affordable Care Act. Prior to 2016, staffing levels at nursing homes were self-reported and unaudited, making the data questionable and at risk for error or bias.</p> <p>"Staffing in the nursing home is one of the most tangible and important elements to ensure high quality care," said study co-author David Stevenson, PhD, a Health Policy professor at Vanderbilt University Medical Center. "Anyone who has ever set foot in a nursing home knows how important it is to have sufficient staffing, something the research literature has affirmed again and again. As soon as these new data became available, researchers and journalists started investigating them, and the government now uses the PBJ data in its quality rating system."</p> <p>Read the study in Health Affairs here: <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05322">https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05322</a></p> <p>Read more about the study here: <a href="https://www.eurekalert.org/pub_releases/2019-07/vumc-ndr070119.php">https://www.eurekalert.org/pub_releases/2019-07/vumc-ndr070119.php</a></p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 02 Jul 2019 16:55:30 +0000 lowaryj 1313 at https://www.vumc.org/health-policy Study: Why Do Some Generics Under Medicare Part D Cost More Than Brands? https://www.vumc.org/health-policy/medicare-part-d-generics-prescription-drugs <span class="field field--name-title field--type-string field--label-hidden">Study: Why Do Some Generics Under Medicare Part D Cost More Than Brands?</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lowaryj" typeof="schema:Person" property="schema:name" datatype="">lowaryj</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/02/2019 - 09:04</span> <a href="/health-policy/blog-post-rss/1312" class="feed-icon" title="Subscribe to Study: Why Do Some Generics Under Medicare Part D Cost More Than Brands?"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Jake Lowary</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><img alt="Infographic" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/health-policy/sites/vumc.org.health-policy/files/Generics_2_0.png" /></p> <p> </p> <p><em>(The following was originally published by the VUMC Communications Office.)</em></p> <p>Medicare Part D enrollees may pay more out of pocket for high-priced specialty generic drugs than their brand-name counterparts, according to <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05476">new research</a> by health policy experts at Vanderbilt University Medical Center and the University of North Carolina at Chapel Hill.</p> <p>Researchers examined differences in brand-name and generic or biosimilar drug prices, formulary coverage and expected out-of-pocket spending across all of the Medicare Part D plans available in the United States in the first quarter of 2018.</p> <p>The study, published in the July issue of <a href="http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05476"><em>Health Affairs</em></a>, found that current Medicare Part D beneficiaries can have higher out-of-pocket spending for generics than their branded counterparts if they use expensive specialty drugs and if the price differences between brands and generics are not large. This can be common for individuals prescribed specialty drugs typically used to treat rare or complex conditions such as cancer, rheumatoid arthritis or multiple sclerosis.</p> <p>“Ironically, even if we assume that generic drugs have lower list prices than brands, for Medicare beneficiaries with $20,000 to $80,000 in annual drug spending, using only brand-name drugs could actually save them money,” said Stacie Dusetzina, PhD, associate professor of Health Policy and Ingram Associate Professor of Cancer Research at VUMC, the study’s lead author.</p> <p><strong>READ THE HEALTH AFFAIRS STUDY HERE:</strong> <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05476">https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05476</a></p> <p>“This is happening because branded drug manufacturers now pay a discount in the donut hole, which gets counted as out-of-pocket spending,” she said. “This helps patients reach catastrophic coverage faster, where they pay 5% of the drug’s price instead of 25%. Generic drug makers do not pay these same discounts, so patients have to spend more of their own money to make it to the catastrophic phase of the benefit.”</p> <p>In 2019, this means people using brand-name drugs who reach the donut hole, or coverage gap, have to spend $982 to get to the catastrophic coverage phase. People using generic drugs have to spend $3,730 to reach that point. The study also notes policy changes set to take effect in 2020 will only make the situation worse by increasing patient out-of-pocket spending requirements for the catastrophic phase coverage from $5,100 to $6,350.</p> <p>In response, the administration of President Donald Trump and the Medicare Payment Advisory Commission (MedPAC) have included recommendations to exclude the manufacturer discount from out-of-pocket spending calculations.</p> <p>“While this would level the playing field between generic drugs and brands, it would do so by making brand-name drugs more expensive instead of making generic drugs less expensive,” said Dusetzina. “Congressional committees have signaled interest in addressing this and other issues in Medicare Part D, including placing a cap on out-of-pocket spending.</p> <p>“The Part D benefit needs a redesign so that it works for people needing expensive drugs. I hope Congress will take this opportunity to make changes to Part D, including making sure that generic drug users aren’t overpaying for these drugs.”</p> <p>In addition to Dusetzina, study authors are Shelly Jazowski, a doctoral student in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) and predoctoral fellow in the Department of Population Health Sciences at Duke University; Ashley Cole, a fellow at the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill; and Joel Nguyen, a doctoral student in the UNC Eshelman School of Pharmacy at UNC-Chapel Hill.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 02 Jul 2019 14:04:23 +0000 lowaryj 1312 at https://www.vumc.org/health-policy Study: 'Donut hole' shrinking, but Medicare drug costs rising https://www.vumc.org/health-policy/medicare-drug-prices-part-d-obamacare <span class="field field--name-title field--type-string field--label-hidden">Study: &#039;Donut hole&#039; shrinking, but Medicare drug costs rising</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lowaryj" typeof="schema:Person" property="schema:name" datatype="">lowaryj</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/29/2019 - 11:16</span> <a href="/health-policy/blog-post-rss/1299" class="feed-icon" title="Subscribe to Study: &#039;Donut hole&#039; shrinking, but Medicare drug costs rising"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://consumer.healthday.com/senior-citizen-information-31/medicare-news-422/though-donut-hole-is-shrinking-medicare-drug-costs-are-rising-study-746812.html" target="_blank">https://consumer.healthday.com/senior-citizen-information-31/medicare-news-422/though-donut-hole-is-shrinking-medicare-drug-costs-are-rising-study-746812.html</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><img alt="Infographic about Medicare Part D drug price study." data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/health-policy/sites/vumc.org.health-policy/files/CancerDrugSpending_Image.png" /></p> <p>In a <a href="https://jamanetwork.com/journals/jama/fullarticle/2734308?utm_source=twitter&amp;utm_campaign=content-shareicons&amp;utm_content=article_engagement&amp;utm_medium=social&amp;utm_term=052819#.XO1OnZEVv5c.twitter">research letter</a> published in the Journal of the American Medical Association (JAMA), <strong>Dr. Stacie Dusetzina, PhD</strong>, reviews the rising cost of anticancer drugs under Medicare Part D.</p> <p>Her most recent published study found that although the Affordable Care Act closed the so-called "doughnut hole" and reduced the coinsurance for branded drugs, the rising cost of those drugs has negated any cost savings, and in some cases increasing the cost to patients.</p> <p>Read the news report, published May 29 in HealthDay, here: <a href="https://consumer.healthday.com/senior-citizen-information-31/medicare-news-422/though-donut-hole-is-shrinking-medicare-drug-costs-are-rising-study-746812.html">https://consumer.healthday.com/senior-citizen-information-31/medicare-news-422/though-donut-hole-is-shrinking-medicare-drug-costs-are-rising-study-746812.html</a><br /> <br /> Read the full research letter, published May 28, here: <a href="https://jamanetwork.com/journals/jama/fullarticle/2734308?utm_source=twitter&amp;utm_campaign=content-shareicons&amp;utm_content=article_engagement&amp;utm_medium=social&amp;utm_term=052819#.XO1OnZEVv5c.twitter">https://jamanetwork.com/journals/jama/fullarticle/2734308?utm_source=twitter&amp;utm_campaign=content-shareicons&amp;utm_content=article_engagement&amp;utm_medium=social&amp;utm_term=052819#.XO1OnZEVv5c.twitter</a></p> </div> <div class="field field--name-field-barista-posts-full-image field--type-image field--label-hidden field__item"> <img src="/health-policy/sites/default/files/styles/barista_posts_full_image/public/CancerDrugSpending_Image_0.png?itok=6IeSWagl" width="576" height="288" alt="" typeof="foaf:Image" class="image-style-barista-posts-full-image" /> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 29 May 2019 16:16:54 +0000 lowaryj 1299 at https://www.vumc.org/health-policy Dr. Melissa McPheeters to rejoin primary faculty at VUMC Department of Health Policy https://www.vumc.org/health-policy/melissa-mcpheeters-rejoins-vanderbilt-faculty <span class="field field--name-title field--type-string field--label-hidden">Dr. Melissa McPheeters to rejoin primary faculty at VUMC Department of Health Policy</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lowaryj" typeof="schema:Person" property="schema:name" datatype="">lowaryj</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 05/20/2019 - 13:06</span> <a href="/health-policy/blog-post-rss/1277" class="feed-icon" title="Subscribe to Dr. Melissa McPheeters to rejoin primary faculty at VUMC Department of Health Policy"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p style="margin:0in 0in 0.0001pt"><img alt="Melissa McPheeters portrait" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/health-policy/sites/vumc.org.health-policy/files/public_files/Melissa-McPheeters-2-small.jpg" /></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">NASHVILLE, Tennessee — <strong>Dr. Melissa McPheeters, PhD, MPH</strong>, will return to the permanent faculty of Vanderbilt University’s School of Medicine, beginning July 1.</span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">For the last three years, McPheeters has served the State of Tennessee as Director of Informatics &amp; Analytics</span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"> in the Tennessee Department of Health, where she built a program in informatics and analytics that included key components such as interoperability and data architecture, advanced analytics and data governance. </span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Her program led the state’s data-driven response to the opioid epidemic. </span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">During that time, Dr. McPheeters also served as an adjunct faculty member in the Department of Health Policy.</span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">At VUMC, Dr. McPheeters will focus on identifying and developing innovative ways to use clinical data to broaden Vanderbilt’s precision medicine translation work in support of public and population health.</span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">“It has been an extraordinary privilege to work in public health for these past three years, building capacity in informatics and data science to support the State’s response to ever evolving public health challenges,” McPheeters said. “I am excited to return to Vanderbilt as we innovate around precision medicine and population health.  Linking healthcare and public health with precision medicine has the potential to change the way we provide healthcare and to improve the public’s health in dramatic ways.”</span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">McPheeters was previously among the faculty at VUMC for 11 years before joining TDOH three years ago.</span></span></p> <p style="margin:0in 0in 0.0001pt"> </p> <p style="margin:0in 0in 0.0001pt"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">McPheeters will serve as a primary faculty member in the Department of Health Policy with a secondary appointment in Department of Biomedical Informatics as a research professor.</span></span></p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 20 May 2019 18:06:41 +0000 lowaryj 1277 at https://www.vumc.org/health-policy Hospitals Stand to Lose Billions Under ‘Medicare for All' https://www.vumc.org/health-policy/press-room/hospitals-stand-lose-billions-under-medicare-all <span class="field field--name-title field--type-string field--label-hidden">Hospitals Stand to Lose Billions Under ‘Medicare for All&#039;</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lovellks-0" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 04/23/2019 - 15:28</span> <a href="/health-policy/blog-post-rss/1268" class="feed-icon" title="Subscribe to Hospitals Stand to Lose Billions Under ‘Medicare for All&#039;"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Reed Abelson</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.nytimes.com/2019/04/21/health/medicare-for-all-hospitals.html?smid=nytcore-ios-share" target="_blank">https://www.nytimes.com/2019/04/21/health/medicare-for-all-hospitals.html?smid=nytcore-ios-share</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><header> <h1 id="link-2df3c937" itemprop="headline">Hospitals Stand to Lose Billions Under ‘Medicare for All’</h1> <p>Proponents held up signs as Senator Bernie Sanders introduced the Medicare for All bill in Washington this month.CreditAaron P. Bernstein/Reuters</p> <p><img alt="" data-entity-type="" data-entity-uuid="" itemid="https://static01.nyt.com/images/2019/04/17/science/17Hospitals-1/merlin_153323283_6ecafb51-3b08-4d0f-9d79-5989f2b3e7a0-articleLarge.jpg?quality=75&amp;auto=webp&amp;disable=upscale" itemprop="url" sizes="((min-width: 600px) and (max-width: 1004px)) 84vw, (min-width: 1005px) 60vw, 100vw" src="https://static01.nyt.com/images/2019/04/17/science/17Hospitals-1/merlin_153323283_6ecafb51-3b08-4d0f-9d79-5989f2b3e7a0-articleLarge.jpg?quality=75&amp;auto=webp&amp;disable=upscale" srcset="https://static01.nyt.com/images/2019/04/17/science/17Hospitals-1/merlin_153323283_6ecafb51-3b08-4d0f-9d79-5989f2b3e7a0-articleLarge.jpg?quality=90&amp;auto=webp 600w,https://static01.nyt.com/images/2019/04/17/science/17Hospitals-1/merlin_153323283_6ecafb51-3b08-4d0f-9d79-5989f2b3e7a0-jumbo.jpg?quality=90&amp;auto=webp 1024w,https://static01.nyt.com/images/2019/04/17/science/17Hospitals-1/merlin_153323283_6ecafb51-3b08-4d0f-9d79-5989f2b3e7a0-superJumbo.jpg?quality=90&amp;auto=webp 2048w" /></p> <figure aria-label="media" itemid="https://static01.nyt.com/images/2019/04/17/science/17Hospitals-1/merlin_153323283_6ecafb51-3b08-4d0f-9d79-5989f2b3e7a0-articleLarge.jpg?quality=90&amp;auto=webp" itemprop="associatedMedia" itemscope="" itemtype="http://schema.org/ImageObject" role="group"> <figcaption itemprop="caption description">Proponents held up signs as Senator Bernie Sanders introduced the Medicare for All bill in Washington this month.CreditCreditAaron P. Bernstein/Reuters</figcaption> </figure> <p itemid="" itemprop="author creator" itemscope="" itemtype="http://schema.org/Person">By <a href="https://www.nytimes.com/by/reed-abelson">Reed Abelson</a></p> <p>For a patient’s knee replacement, Medicare will pay a hospital $17,000. The same hospital can get more than twice as much, or about $37,000, for the same surgery on a patient with private insurance.</p> </header> <section itemprop="articleBody" name="articleBody"> <p>Or take another example: One hospital would get about $4,200 from Medicare for removing someone’s gallbladder. The same hospital would get $7,400 from commercial insurers.</p> <p>The yawning gap between payments to hospitals by Medicare and by private health insurers for the same medical services may prove the biggest obstacle for advocates of “Medicare for all,” a government-run system.</p> <p>If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by <a href="https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf" rel="noopener noreferrer" target="_blank" title="">one estimate</a> — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers.</p> <aside>Some hospitals, especially struggling rural centers, would close virtually overnight, according to policy experts.</aside> <p>Others, they say, would try to offset the steep cuts by laying off hundreds of thousands of workers and abandoning lower-paying services like mental health.</p> <p>The prospect of such violent upheaval for existing institutions has begun to stiffen opposition to Medicare for all proposals and to <a href="https://www.nytimes.com/2019/04/19/business/medicare-for-all-health-care-stocks.html?module=inline" title="">rattle health care stocks</a>. Some officials caution that hospitals providing care should not be penalized in an overhaul.</p> <p>Dr. Adam Gaffney, the president of Physicians for a National Health Program, warned advocates of a single-payer system like Medicare for all not to seize this opportunity to extract huge savings from hospitals. “The line here can’t be and shouldn’t be soak the hospitals,” he said.</p> <p>“You don’t need insurance companies for Medicare for all,” Dr. Gaffney added. “You need hospitals.”</p> <p>Soaring hospital bills and disparities in care, though, have stoked consumer outrage and helped to fuel populist support for proposals that would upend the current system. Many people with insurance cannot afford a knee replacement or care for their diabetes because their insurance has high deductibles.</p> <p>Proponents of overhauling the nation’s health care argue that hospitals are charging too much and could lower their prices without sacrificing the quality of their care. High drug prices, surprise hospital bills and other financial burdens from the overwhelming cost of health care have caught the attention (and drawn the ire) of many in Congress, with a variety of proposals under consideration this year.</p> <p>But those in favor of the most far-reaching changes, including Senator Bernie Sanders, who <a href="https://www.nytimes.com/2019/04/10/us/politics/bernie-sanders-medicare-for-all.html?module=inline" title="">unveiled his latest Medicare for all plan</a> as part of his presidential campaign, have remained largely silent on the question of how the nation’s 5,300 hospitals would be paid for patient care. If they are paid more than Medicare rates, <a href="https://www.nytimes.com/interactive/2019/04/10/upshot/medicare-for-all-bernie-sanders-cost-estimates.html?module=inline" title="">the final price tag for the program could balloon</a> from the already stratospheric estimate of upward of $30 trillion over a decade. Senator Sanders has not said what he thinks his plan will cost, and some proponents of Medicare for all say these plans would cost less than the current system.</p> <p>The nation’s major health insurers are sounding the alarms, and pointing to the potential impact on hospitals and doctors. David Wichmann, the chief executive of UnitedHealth Group, the giant insurer, told investors that these proposals would “destabilize the nation’s health system and limit the ability of clinicians to practice medicine at their best.”</p> <p>Hospitals could lose as much as $151 billion in annual revenues, a 16 percent decline, under Medicare for all, according to Dr. Kevin Schulman, a professor of medicine at Stanford University and <a href="https://jamanetwork.com/journals/jama/fullarticle/2730485" rel="noopener noreferrer" target="_blank" title="">one of the authors of a recent article in JAMA looking at the possible effects on hospitals</a>.</p> <p>“There’s a hospital in every congressional district,” he said. Passing a Medicare for all proposal in which hospitals are paid Medicare rates “is going to be a really hard proposition.”</p> <p>Richard Anderson, the chief executive of St. Luke’s University Health Network, called the proposals “naïve.” Hospitals depend on insurers’ higher payments to deliver top-quality care because government programs pay so little, he said. </p> <p>“I have no time for all the politicians who use the health care system as a crash-test dummy for their election goals,” Mr. Anderson said.</p> <p>The American Hospital Association, an industry trade group, is <a href="https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html?module=inline" title="">starting to lobby against the Medicare for all proposals</a>. Unlike the doctors’ groups, hospitals are not divided. “There is total unanimity,” said Tom Nickels, an executive vice president for the association.</p> <p>“We agree with their intent to expand coverage to more people,” he said. “We don’t think this is the way to do it. It would have a devastating effect on hospitals and on the system over all.”</p> <aside> </aside> <p><iframe frameborder="0" height="540" scrolling="no" src="https://www.nytimes.com/interactive/2019/admin/100000006459019.embedded.html?" width="100%"></iframe></p> <p>Rural hospitals, which have been closing around the country as patient numbers dwindle, would be hit hard, he said, because they lack the financial cushion of larger systems.</p> <p>Big hospital systems haggle constantly with Medicare over what they are paid, and often battle the government over charges of overbilling. On average, the government program pays hospitals about 87 cents for every dollar of their costs, compared with private insurers that pay $1.45.</p> <p>Some hospitals make money on Medicare, but most rely on higher private payments to cover their overall costs.</p> <p>Medicare, which accounts for about 40 percent of hospital costs compared with 33 percent for private insurers, is the biggest source of hospital reimbursements. The majority of hospitals are nonprofit or government-owned.</p> <p>The profit margins on Medicare are “razor thin,” said Laura Kaiser, the chief executive of SSM Health, a Catholic health system. In some markets, her hospitals lose money providing care under the program.</p> <p>She says the industry is working to bring costs down. “We’re all uber-responsible and very fixated on managing our costs and not being wasteful,” Ms. Kaiser said.</p> <p>Over the years, as <a href="https://www.nytimes.com/2018/11/14/health/hospital-mergers-health-care-spending.html?module=inline" title="">hospitals have merged, many have raised the prices they charge to private insurers.</a></p> <p>“If you’re in a consolidated market, you are a monopolist and are setting the price,” said Mark Miller, a former executive director for the group that advises Congress on Medicare payments. He describes the prices paid by private insurers as “completely unjustified and out of control.”</p> <p>Many hospitals have invested heavily in amenities like single rooms for patients and sophisticated medical equipment to attract privately insured patients. They are also major employers.</p> <p>“You would have to have a very different cost structure to survive,” said Melinda Buntin, the chairwoman for health policy at the Vanderbilt University School of Medicine. “Everyone being on Medicare would have a large impact on their bottom line.”</p> <p>People who have Medicare, mainly those over 65 years old, can enjoy those private rooms or better care because the hospitals believed it was worth making the investments to attract private patients, said Craig Garthwaite, a health economist at the Kellogg School of Management at Northwestern University. If all hospitals were paid the same Medicare rate, the industry “should really collapse down to a similar set of hospitals,” he said.</p> <aside>Whether hospitals would be able to adapt to sharply lower payments is unclear.</aside> <p>“It would force health care systems to go on a very serious diet,” said Stuart Altman, a health policy professor at Brandeis University. “I have no idea what would happen. Nor does anyone else.”</p> <p>But proponents should not expect to save as much money as they hope if they cut hospital payments. Some hospitals could replace their missing revenue by charging more for the same care or by ordering more billable tests and procedures, said Dr. Stephen Klasko, the chief executive of Jefferson Health. “You’d be amazed,’ he said.</p> <p>While both the Medicare-for-all bill introduced by Representative Pramila Jayapal, Democrat of Washington, and the Sanders bill call for a government-run insurance program, the Jayapal proposal would replace existing Medicare payments with a whole new system of regional budgets.</p> <p>“We need to change not just who pays the bill but how we pay the bill,” said Dr. Gaffney, who advised Ms. Jayapal on her proposal.</p> <p>Hospitals would be able to achieve substantial savings by scaling back administrative costs, the byproduct of a system that deals with multiple insurance carriers, Dr. Gaffney said. Under the Jayapal bill, hospitals would no longer be paid above their costs, and the money for new equipment and other investments would come from a separate pool of money.</p> <p>But the Sanders bill, which is supported by some Democratic presidential candidates including Senators Kirsten Gillibrand of New York, Cory Booker of New Jersey, Elizabeth Warren of Massachusetts and Kamala Harris of California, does not envision a whole new payment system but an expansion of the existing Medicare program. Payments would largely be based on what Medicare currently pays hospitals.</p> <p>Some Democrats have also proposed more incremental plans. Some would expand Medicare to cover people over the age of 50, while others wouldn’t do away with private health insurers, including those that now offer Medicare plans.</p> <aside>Even under Medicare for all, lawmakers could decide to pay hospitals a new government rate that equals what they are being paid now from both private and public insurers, said Dr. David Blumenthal, a former Obama official and the president of the Commonwealth Fund.</aside> <p>“It would greatly reduce the opposition,” he said. “The general rule is the more you leave things alone, the easier it is.”</p> </section> <p>A version of this article appears in print on <time datetime="2019-04-22T04:00:00.000Z">April 21, 2019</time>, on Page B1 of the New York edition with the headline: Medicare Plans Vex Hospitals. <a href="http://www.nytreprints.com/">Order Reprints</a> | <a href="http://www.nytimes.com/pages/todayspaper/index.html">Today’s Paper</a> | <a href="https://www.nytimes.com/subscriptions/Multiproduct/lp8HYKU.html?campaignId=48JQY">Subscribe</a></p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 23 Apr 2019 20:28:56 +0000 lovellks 1268 at https://www.vumc.org/health-policy “Crushing” medical debt leaves Tennesseans with few options https://www.vumc.org/health-policy/press-room/crushing-medical-debt-leaves-tennesseans-few-options <span class="field field--name-title field--type-string field--label-hidden">“Crushing” medical debt leaves Tennesseans with few options</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lovellks-0" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 04/09/2019 - 09:57</span> <a href="/health-policy/blog-post-rss/1265" class="feed-icon" title="Subscribe to “Crushing” medical debt leaves Tennesseans with few options"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Chris Conte</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.newschannel5.com/news/medical-news/medical-debt-rescue/crushing-medical-debt-leaves-tennesseans-with-few-options" target="_blank">https://www.newschannel5.com/news/medical-news/medical-debt-rescue/crushing-medical-debt-leaves-tennesseans-with-few-options</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><blockquote><i>This story is part of NewsChannel 5’s community initiative known as “Medical Debt Rescue." The goal of the project is to shed light on a lopsided medical debt system that has left thousands of Tennesseans with crippling debt and forced many into foreclosure, while also wiping $1.8 million dollars of medical debt in Middle Tennessee. <a href="https://www.newschannel5.com/medicaldebtrescue">Learn more about the initiative here.</a></i></blockquote> <p>NASHVILLE, Tenn. (WTVF) -- The asphalt county road Gary Brown walked down seemed to stretch on for eternity, yet all he could focus on was putting one foot delicately in front of the other.</p> <p>His breaths were labored, his eyes focused on the pavement, his movements methodical. As he took a step forward, Gary Brown’s hands came out to his sides to steady his unsure body.</p> <p>This is what it takes for Gary Brown to walk to his mailbox.</p> <p>It wasn’t always like this for Brown. There was a time just two years ago when the 48-year-old had a full-time job as a welder. Simple tasks like walking his dog didn’t require this tall, husky man with a pulled back ponytail to take a break from walking simply because he ran out of breath. But that was before the accident.</p> <p> </p> <figure>"I dream about it. I think about it all the time. I want to pay my debt, but I don’t know what else to do. I’ve run out of options."</figure> <p> </p> <p>Brown’s story is one thousands of Tennesseans share, one of a medical debt he can’t afford. Brown estimates he owes $500,000 dollars. He can’t work and his only form of income is through disability, which means most of his debt is in the hands of collection agencies.</p> <p>There are days Brown sees no way out.</p> <p>An avid motorcycle rider, Gary had left dinner with some friends back in May 2016. He was less than five miles from his home in Unionville when he suddenly went off the road. Gary’s motorcycle hit two driveway culverts, Gary was thrown off the bike.</p> <p>He landed a few feet away from a sign in a homeowner’s front yard which read, “Prepare to meet thy God.”</p> <figure><img alt="" data-entity-type="" data-entity-uuid="" src="https://ewscripps.brightspotcdn.com/2b/b1/87d7d49d4ae6b6d474c1795315d8/gary-brown-walking.JPG" /></figure> <p>“I landed in the middle of the road, head first. I broke my neck and had trauma to my brain,” Brown said.</p> <p>Brown was airlifted to Vanderbilt University Medical Center after the crash, where he spent months learning to walk, talk and even swallow again. Every day, he said, was a painful struggle to try and overcome his injuries.</p> <p>Then, Brown lost his job. “They terminated me because I couldn’t perform my job, so there went my health insurance, I had no coverage,” he said.</p> <p>“It’s mentally draining. It’s devastated me. I worked so hard for everything. Why didn’t I die right there on the road that day?” Brown said.</p> <p>Once the bills started piling up, they didn’t stop. Two years after the crash, the 48-year-old still can’t work. There’s a lien on his home. And there are days when he sees no way out.</p> <p>"I dream about it. I think about it all the time. I want to pay my debt, but I don’t know what else to do. I’ve run out of options,” he said.</p> <p>“The system is broken and people don’t even know about,” Gary said as his eyes glances down at a pile of medical bills.</p> <h2>Rising costs, shrinking coverage</h2> <p>In 2018, a majority of Americans said they wouldn’t be able to afford a $400 medical bill. For decades those with insurance thought they could depend on employer-paid coverage to help offset everything from hospital visits to a simple trip to the pediatrician. But rising health care costs have meant more and more employers shifting to higher deductible health insurance plans, a change that has left consumers to pick up a rising portion of health coverage costs.</p> <p>Studies show that those in this country who carry the most amount of medical debt are people who have insurance.</p> <p>“Healthcare costs are growing greater and greater over time,” said Melinda Buntin, a Health Economist at Vanderbilt University Medical Center in Nashville. “Healthcare coverage has gotten skinnier. With auto insurance or home insurance, we know those are there for the unforeseen, but with health insurance we get lulled into this false sense of security. And we may not pay attention to what’s actually covered until we need it most.”</p> <p>One in four adults say they’ve had trouble paying medical bills in the last year Buntin said. In most instances, like Brown’s case, folks have typically lost their jobs due to injuries or illness. Once that happens the downward spiral into medical debt typically begins. With no insurance, the bills continue to pile up.</p> <figure>"It’s almost impossible to figure out what things cost in advance."</figure> <p>“It’s this avalanche of things that can happen when you get ill, and that’s very scary for people. We developed this system to the point where it’s unaffordable for a growing part of our society,” Buntin said.</p> <p>By some estimates, health costs for Americans exceeded $450 billion dollars last year alone.</p> <p>With shrinking or no coverage, many Americans and Tennesseans end up relying on Emergency Rooms for their medical needs. In Tennessee alone, at least nine hospitals have shutdown over the last few years because they have been overburdened with costs from patients who never pay their bills.</p> <p>And that is where the medical debt system becomes more complex for thousands Tennesseans, stuck in a crippling maze of debt.</p> <p>“Health care is complex, and it’s almost impossible to figure out what things cost in advance, and when you’re sick, that’s when you least want to deal with figuring out what things cost,” Buntin said.</p> <h2>A lopsided system</h2> <p>For decades, hospitals and doctors have focused on billing insurance companies, and most experts say they got pretty good at it. Unfortunately for patients, though, the process of billing insurance companies isn’t the same as billing patients.</p> <p>For example, if you go out to a nice restaurant, the server brings you an itemized bill. The bill shows the cost of the appetizer, the main course, the dessert – maybe even the coffee.</p> <p>But when a patient leaves the hospital, it’s more like an expensive five-course meal with no menu, and not getting the bill for 60 days.</p> <p>“The patient has no idea what they owe when they leave the hospital,” said David Frederiksen, CEO of Patient Focus, a medical billing assistance group based in Nashville.</p> <p>Nearly one in every four Tennessans has medical debt, according to the Finra Investor Education Foundation. That debt often means patients are forced to make impossible choices.</p> <p>“If a patient is so concerned about the cost, they’re going to skip treatment, then they’re going to get sicker and that doesn’t help anybody,” Frederiksen said.</p> <h2>How NewsChannel 5 is helping</h2> <p>Over time, if you can't pay a hospital they will send that bill to a collection agency. This is happening so often that most hospitals and collection agencies are just happy to get any kind of money. But then something else happens. Collection agencies will try to make money off your debt.</p> <p>In order to do that, those debt collection agencies will then sell your debt for pennies on the dollar to other debt collectors. To make a profit off the debt, a collection agency only has to collect about 1.5% of the debt. If a collection agency collects $1.5 million for $100 million in debt, that company would essentially come out on top.</p> <p>The system is so lopsided that through the non-profit group RIP Medical Debt, NewsChannel 5 was able to help hundreds of Tennesseans eliminate some or all of their medical debt.</p> <p>With a $15,000 donation, NewsChannel 5 wiped out $1.8 million in medical debt for 604 people across Middle Tennessee. There are no strings attached.</p> <p><b><i><a href="https://www.newschannel5.com/news/medical-news/medical-debt-rescue/newschannel-5-wipes-1-8-million-in-medical-debt-for-middle-tennesseans">Read a county-by-county breakdown of where NewsChannel 5 erased medical debt in Middle Tennessee</a></i></b></p> <p>Because the chances of collecting any kind of money from those who owe are so low, debt buyer are willing to accept pennies on the dollar. Or in this case, $15,000 to erase $1.8 million in debt.</p> <p>“You’re not looking at a real market here. And unfortunately, it’s putting a lot of people into bankruptcy,” Frederiksen said.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 09 Apr 2019 14:57:36 +0000 lovellks 1265 at https://www.vumc.org/health-policy Senate hearing examines 'devastating' nursing home abuse https://www.vumc.org/health-policy/press-room/senate-hearing-examines-devastating-nursing-home-abuse <span class="field field--name-title field--type-string field--label-hidden">Senate hearing examines &#039;devastating&#039; nursing home abuse</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/health-policy/users/lovellks-0" typeof="schema:Person" property="schema:name" datatype="">lovellks</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 03/06/2019 - 15:05</span> <a href="/health-policy/blog-post-rss/1262" class="feed-icon" title="Subscribe to Senate hearing examines &#039;devastating&#039; nursing home abuse"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">Jacqueline Howard, Blake Ellis and Melanie Hicken</div> <div class="field field--name-field-barista-posts-external-url field--type-link field--label-hidden field__item"><a href="https://www.cnn.com/2019/03/06/health/nursing-home-abuse-senate-hearing-bn/index.html" target="_blank">https://www.cnn.com/2019/03/06/health/nursing-home-abuse-senate-hearing-bn/index.html</a></div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The phone rang shortly before Christmas in 2014.</p> <p>When Maya Fischer answered, a nurse from the nursing home where her mother had been staying for more than a decade was on the other end of the line. In her Minnesota home, Fischer braced herself for difficult news.</p> <p>"When you receive a phone call from the nursing home, your first thought is that ... my mother has passed," Fischer said.</p> <p>The news was indeed troubling, but it was not what she expected.</p> <p>Content by Realtor.com</p> <p>What makes a neighborhood so special?</p> <p>Looking for that perfect home? We just asked people what they love most about their neighborhood</p> <ul data-layout="list-hierarchical-xs"> </ul> <p>"I was not at all prepared for the call that I received. ... The call that my mother had been a victim of a sexual assault in her nursing home," Fischer said. "For me and my family, it's been devastating."</p> <p>Fischer testified in front of lawmakers in the nation's capital on Wednesday. The <a href="https://www.finance.senate.gov/hearings/not-forgotten-protecting-americans-from-abuse-and-neglect-in-nursing-homes" target="_blank">US Senate Committee on Finance held a hearing</a> to discuss reports of abuse and neglect in some nursing homes nationwide and what can be done to protect those of all ages at risk of abuse.</p> <p>"My final memories of my mother's life now include watching her bang uncontrollably on her private parts for days after the rape, with tears rolling down her eyes, apparently trying to tell me what had been done to her but unable to speak due to her disease," Fischer said in the hearing, referring to her mother's Alzheimer's disease.</p> <p>Along with Fischer, Iowa resident Patricia Blank testified about how she is the daughter of a nursing home neglect victim, Virginia Olthoff. In a news release on Tuesday, <a href="https://www.grassley.senate.gov/news/news-releases/iowan-recount-story-mother-s-death-delinquent-nursing-home-finance-committee" target="_blank">Iowa Sen. Chuck Grassley's office noted</a> how the nursing home where Blank's mother resided and died "received the highest possible ranking from the Centers for Medicare and Medicaid Services (CMS) for quality of resident care, though it had been fined for physical and verbal abuse a year before Olthoff's death."</p> <p>"How a place with the highest possible rating could yield such a tragic incident is just outrageous," he said in the news release. "Things need to change, both for the standards at care facilities and for how CMS rates them. When American families consider where their loved ones can get the care they need, they should be able to rely on CMS information. That's clearly not the case right now."</p> <p>After the hearing, Grassley said in a statement that Fischer's and Blank's stories were "troubling."</p> <p>"Today I heard troubling accounts, which lead me to believe continued oversight is needed in this area. There are two government watchdog agencies currently working on reports for Congress. One is the Inspector General of Health and Human Services and the other is the Government Accountability Office. I plan to convene another hearing on this topic after these agencies release their reports. I also intend to submit follow-up questions to each of the witnesses as we work toward reforms," he said.</p> <p>On Tuesday, <a href="https://www.cms.gov/newsroom/press-releases/cms-improving-nursing-home-compare-april-2019" target="_blank">CMS announced that updates will be made</a> next month to the online tools for consumers to research nursing home quality: the <a href="https://www.medicare.gov/nursinghomecompare/search.html?" target="_blank">Nursing Home Compare database</a>, which allows users to compare nursing homes, and the <a href="https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html" target="_blank">Five-Star Quality Rating System</a>, which rates nursing homes based on inspections, staffing and quality measures.</p> <p>CMS also <a href="https://www.cms.gov/blog/protecting-health-and-safety-all-americans" target="_blank">issued new guidance</a> Tuesday that "clarifies what information is needed to identify immediate jeopardy cases across all healthcare provider types, which we believe will result in quickly identifying and ultimately preventing these situations," such as abuse or neglect cases.</p> <p>"Every nursing home serving Medicare and Medicaid beneficiaries is required to keep its residents safe and provide high quality care. We have focused on strengthening requirements for nursing homes, working with states to enforce statutory and regulatory requirements, increasing transparency of nursing home performance, and promoting improved health outcomes for nursing home residents," Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality at the Centers for Medicare &amp; Medicaid Services, said in a statement Tuesday.</p> <p>At Wednesday's hearing, lawmakers pressed Goodrich on what has been done and what more could be done to ensure quality at facilities.</p> <p>There were several factors mentioned about why a nursing home might fall behind certain quality standards, including being unable to retain qualified staff and conduct comprehensive background checks on staff.</p> <p>"We do have expectations for nursing facilities for having the appropriate staffing for their patient population, and we survey for that on a regular basis," Goodrich said in the hearing.</p> <p>At the hearing, New Jersey Sen. Bob Menendez said in response, "I think there's a gulf between the expectations and the reality in several of these instances and we look forward to working with you to bridge the gulf."</p> <h3>'The most vulnerable people in our society'</h3> <p>Wednesday's hearing came just weeks after a <a href="https://www.cnn.com/2019/01/09/health/vegetative-state-pregnancies/index.html" target="_blank">sexual assault case at an Arizona health care facility</a> involving a 29-year-old woman who has been in a <a href="https://www.cnn.com/2019/01/11/us/arizona-vegetative-state-birth-911-call/index.html" target="_blank">vegetative state for years and gave birth</a> in December. She has been a patient at the facility since 1992, according to court records. In January, a <a href="https://www.cnn.com/2019/01/23/health/arizona-woman-birth-vegetative-state/index.html" target="_blank">36-year-old nurse was arrested</a> on suspicion of impregnating the woman.</p> <p>Among nursing homes, an <a href="https://www.cnn.com/interactive/2017/02/health/nursing-home-sex-abuse-investigation/" target="_blank">exclusive CNN investigation in 2017</a> found that the federal government has cited more than 1,000 for mishandling or failing to prevent alleged cases of sex abuse, including rape and assault, at their facilities between 2013 and 2016 -- before <a href="https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/nursing-homes.html" target="_blank">revisions were made in November 2016</a> relating to how CMS surveys and inspects long-term care facilities. Fischer's mother's case was one of several in CNN's 2017 investigation. Her mother has since died.</p> <p>"My goal by attending the hearing is simply to be my mom's voice and to put a face with her name. I don't want her to go down as being just another horrible statistic," Fischer said. "Stronger legislation needs to be enacted to protect the elderly. These are some of the most vulnerable people in our society, and I don't think that we're doing enough to ensure their safety."</p> <p>Anyone -- a nurse, family member or resident -- can report nursing home abuse or neglect to CMS through state groups or a state's long-term care ombudsman program, whose information is <a href="https://www.medicare.gov/Contacts/" target="_blank">provided on the Medicare website</a>.</p> <p>State health investigators examine all types of abuse reported at nursing homes and assisted living facilities. In the case of nursing homes, state officials typically conduct these investigations on behalf of the Centers for Medicare &amp; Medicaid Services, which regulates the more than 15,000 facilities that receive government reimbursements that pay for many residents' care.</p> <p>Additionally, <a href="https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/nhs.html" target="_blank">states conduct standard survey inspections</a> of nursing homes that are unannounced and can come at any time. Both state health agencies and the federal government use the information from routine surveys to rate facilities.</p> <p>If abuse or neglect is found in a nursing home, penalties are enforced, ranging from monetary penalties to termination from the Medicare and Medicaid program.</p> <p>A database of nursing home penalties in the United States can be <a href="https://data.medicare.gov/Nursing-Home-Compare/All-US-Nursing-Home-Penalties/2shu-hjj2" target="_blank">found on the Medicare website</a>, and there is a <a href="https://www.medicare.gov/nursinghomecompare/search.html" target="_blank">national registry of Medicare-funded nursing homes</a> where you can find out how the facility ranks and whether it has any recent citations.</p> <p>The American Health Care Association represents nursing centers, assisted living communities and centers and homes for individuals with disabilities.</p> <p>Dr. David Gifford, senior vice president of quality and regulatory affairs at the association, who testified at the hearing, said in a statement after the hearing that the group "remains committed to reducing any future cases of abuse and neglect."</p> <p>"AHCA stands ready to work with Congress, members of the Senate Finance Committee, CMS, and other providers to keep residents safe and continue improving the quality of care provided. There are robust regulatory requirements and penalties already in place to ensure patients are protected and corrective measures are implemented after a case of abuse or neglect occurs. But we can -- and must -- do more," Gifford said in the statement.</p> <p>"We should expand federal programs that attract health care workers to the nursing home profession. We should strengthen federal regulations around reporting and sharing of information about employees who have engaged in abuse through the creation of a national background check registry. And we should make resident and family satisfaction ratings of nursing homes publicly available."</p> <p>This isn't the first time lawmakers looked into nursing home safety. In September, the <a href="https://energycommerce.house.gov/committee-activity/hearings/hearing-on-examining-federal-efforts-to-ensure-quality-of-care-and" target="_blank">House Committee on Energy and Commerce held a subcommittee hearing</a>on "examining federal efforts to ensure quality of care and resident safety in nursing homes."</p> <p>In a response at that time, Mark Parkinson, president and CEO of the American Health Care Association, <a href="https://www.ahcancal.org/News/news_releases/Pages/AHCA-Statement-on-Congressional-Hearing-.aspx" target="_blank">said in a statement</a> that long-term care providers have made improvements in quality of care, such as by reducing rehospitalization rates and increasing staffing.</p> <p>"Instead of praise for this progress, we have been subjected to additional scrutiny and criticism," Parkinson said.</p> <p>"The reality is that nursing homes are a convenient political punching bag. Over the years, Congress has turned to us to pay for everything from student loan debt relief to Medicare physician payments," he said. "At a time when Congress faces public criticism for its failure to work together and accomplish shared goals, this hearing seems like a misguided effort to find more ways to regulate an already overburdened sector. Long term care is one of the most regulated industries in the country, yet we've shown some of the most dramatic improvement on both self-reported and government quality measures."</p> <h3>'I find it hard to believe that the time he was caught was the first time'</h3> <p>George Kpingbah, the 76-year-old nursing assistant accused of assaulting Fischer's mother, Sonja Fischer, had a history of sexual assault allegations.</p> <p>How safe are your elderly loved ones?</p> <p>There is no way to know about abuse that goes unreported or isn't flagged by regulators. But you can look up the name of a nursing home in federal inspection data and see whether it has been cited for sexual abuse, neglect and other issues in the past three years or so. Here's how:</p> <ol> <li>Go to <a href="https://www.medicare.gov/nursinghomecompare/search.html" target="_blank"><strong>this site on the federal Nursing Home Compare website</strong></a><strong> </strong>to look up facilities by name or location.</li> <li>On the first page of results, you will see a government star rating for the facility based on factors such as staffing levels or use of anti-psychotic drugs. A history of abuse or other problems will typically be reflected in the "health inspection" rating.</li> <li>Click on the health inspection rating to see a summary of the facility's most recent visit by state health inspectors.</li> <li>From here, click on "View all health inspections." For details, go to a specific date and click "View full report."</li> <li>From the main profile page for the facility, click on "Penalties" to see if an inspection resulted in fines or payment denials.</li> <li>To view older citations, download archived reports <a href="https://data.medicare.gov/data/archives/nursing-home-compare" target="_blank"><strong>here</strong> </a>or file a public records request <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/FOIA/filehow.html" target="_blank"><strong>here.</strong></a> Some states may also offer detailed information. A list of state websites is <a href="https://www.medicare.gov/NursingHomeCompare/Resources/State-Websites.html" target="_blank"><strong>here.</strong></a></li> </ol> <p>Personnel records obtained by prosecutors during the investigation into Sonja Fischer's case and reviewed by CNN showed that Kpingbah was suspended three times as officials at Walker Methodist Health Center in Minneapolis investigated accusations of sexual abuse at the facility, including at least two in which he was the main suspect.</p> <p>The earliest complaint was in 2008, when police investigated allegations that he had engaged in sexual intercourse with a 65-year-old with multiple sclerosis. In another case, an 83-year-old blind and deaf woman who lived on the same wing as Maya Fischer's mother said she was raped multiple times -- always at midnight.</p> <p>Police investigated her report just seven months before Fischer's mother was assaulted. Though the woman could not identify her assailant, Kpingbah was suspended, along with several other male staffers who were on duty during the nights of the alleged assaults.</p> <p>None of these allegations was found to be substantiated by the facility or the state. For years, Walker Methodist kept Kpingbah on the overnight shift -- until one early morning in December 2014, when someone caught him in the act.</p> <p>It was 4:30 a.m. December 18, 2014, when a fellow caregiver saw Kpingbah in 83-year-old Sonja Fischer's room at Walker Methodist. The witness noticed the aide thrusting back and forth, which is when she said she knew that a sexual assault was occurring.</p> <p>Kpingbah ultimately pleaded guilty to third-degree criminal sexual conduct with a mentally impaired or helpless victim and was sentenced to eight years in prison.</p> <p>In a court statement in 2015, Maya Fischer said that her mother, who had Alzheimer's disease, was "unable to speak" and "unable to fight back" against her assailant.</p> <p>Fischer detailed her mother's story, recounting how she had fled Indonesia with her family to escape the rape and killing of young girls by Japanese soldiers, only to fall victim decades later to a man whose job was to care for her.</p> <p>"I find it hard to believe that the time he was caught was the first time he assaulted her, and that will always haunt me," Fischer said Monday.</p> <p>Abuse cases typically get reported to state departments of health, and Fischer hopes nursing homes and state agencies will be more transparent when there are future cases of abuse.</p> <p>"The Department of Health needs to take these accusations and investigations more seriously," she said. "It's my understanding that Mr. Kpingbah was a suspect in prior investigations before he was caught raping my mother, and my mother lived there for 12 years."</p> <p>Regarding Sonja Fischer's case, the Minnesota Department of Health found that the facility acted immediately to ensure the resident's safety and promptly removed Kpingbah. The state also noted that the facility had provided Kpingbah with required abuse training. As a result, the facility was not cited for any wrongdoing; only Kpingbah was held accountable for the assault.</p> <p>Maya Fischer had no way of knowing about the previous allegations against Kpingbah uncovered by CNN. But she sued Kpingbah, who agreed to an unusual arrangement in which, as of 2017, he is on the hook for a $15 million judgment only if he abuses again.</p> <p>Walker Methodist refused to comment on the previous allegations against Kpingbah, who worked at the facility for nearly eight years, but said in a statement that it fully cooperated with authorities and that "the care and well-being of all of our residents and patients is our primary focus."</p> <p>Mark Kosieradzki, a <a href="https://koslawfirm.com/the-attorneys/mark-r-kosieradzki/" target="_blank">Minnesota attorney</a> who has represented a number of victims and their families, including the Fischer family, said he has seen the number of nursing home abuse cases rise within his own practice.</p> <p>"The number of calls we get are increasing. The severity of some of the problems we're seeing is increasing. Whether more people are calling because there's a greater awareness in the community or whether there's more problems, I guess it would be nice if we had information from [the Centers for Medicare and Medicaid Services] about that, but the fact of the matter is, we'll get six to eight calls a day in our law firm," Kosieradzki said.</p> <p>"Certainly, there's good nursing homes out there, but there's also nursing homes that are focused on their profits as opposed to the care they're giving, and that's what we try to focus on to change," he said.</p> <p>Our analysis</p> <p>CNN began its in-depth analysis by obtaining federal inspection reports filed between 2013 and 2016. These reports are filed by state health inspectors working in conjunction with the federal government for the more than 15,000 nursing homes that receive Medicare and Medicaid reimbursements. They include complaints and allegations where state inspectors have cited a facility for failing to meet a wide variety of federal standards, whether it is storing food improperly or serious allegations of abuse or neglect.</p> <p>For CNN's analysis, these reports were narrowed down using a specific set of sex-related keywords. But because many citations included information about intimate medical care and not abuse, CNN reporters read <strong>more than 6,000 citations </strong>to identify only those related to allegations of sexual assault or abuse. During this analysis, the reporters also categorized allegations based on the severity of abuse and the kind of perpetrator (whether a caregiver, resident or visitor), among other data points. At the end of this weeks-long analysis, CNN concluded that more than 1,000 nursing homes across the country have been cited for somehow mishandling or failing to prevent alleged cases of sexual assault at their facilities in recent years.</p> <p>Although laws require abuses to be reported and investigated, these laws may not always be followed by some nursing homes. Then there are concerns that if an incident gets reported, some experts say, investigations<strong> </strong>should<strong> </strong>be conducted more aggressively.</p> <p>Many nursing home employees promptly report abusers to authorities, as required by federal law, and assist in the investigations, but in numerous examples of abuse uncovered by CNN in 2017, some facilities made it possible for violent rapes and sexual assaults to go unchecked.</p> <p>In those facilities, allegations were routinely questioned or dismissed because victims had cognitive conditions such as Alzheimer's. Workers often lacked the specific training needed to spot sexual abuse, keeping reports of abuse from ever reaching authorities, and the reputation and safety of the facility may have taken priority if there was fear that bringing investigators into a cash-strapped facility could expose other issues or threaten a nursing home with closure or costly lawsuits.</p> <p>As for Wednesday's hearing, Kosieradzki said he hopes for more awareness about various types of abuse: sexual abuse, overmedicating with opioids and neglect.</p> <p>"I'm looking for the CMS and the [state] Department of Health to start looking at these consumers and these patients to help them."</p> <p>Despite the litany of abuses detailed in government reports, there is no comprehensive national data on how many cases of sexual abuse have been reported in facilities housing the elderly.</p> <p>In CNN's 2017 analysis, the health departments and other agencies that oversee long-term care facilities in all 50 states were surveyed. Of the states that could provide at least some data, the responses varied widely.</p> <h3>Some improvements in care</h3> <p>There can be difficulty in identifying abuse and neglect in nursing homes, and so gathering that data has been a challenge, said David Stevenson, assistant professor of health policy at the <a href="https://www.vumc.org/health-policy/person/david-stevenson-phd" target="_blank">Vanderbilt University School of Medicine</a> in Nashville, who has conducted research on <a href="https://www.ncbi.nlm.nih.gov/pubmed/23552438" target="_blank">negligence claims against nursing homes</a>.</p> <p>"We try to identify broader trends about quality of care, but specifically identifying abuse and neglect can be challenging," Stevenson said, adding that progress has been made recently.</p> <p>"Broadly speaking, I think there have been a lot of quality improvements in nursing home care over the last few decades," he said. "But I also think that data have shown that also poor-quality care has been kind of frustratingly persistent and has been around for a long time."</p> <p>Get CNN Health's weekly newsletter</p> <p><a href="https://mailchi.mp/cnn/resultsarein" target="_blank">Sign up here to get <strong>The Results Are In with Dr. Sanjay Gupta</strong></a> every Tuesday from the CNN Health team.</p> <p>Stevenson added that he hopes Wednesday's hearing called attention to the issue.</p> <ul data-layout="list-hierarchical-xs"> </ul> <p>"Hearing from the relatives of people who have suffered abuse and neglect in nursing homes will be incredibly important and powerful, and also hearing from industry leaders and researchers and those who are engaged in nursing home oversight and accountability I think will be really important," said Stevenson, who was not involved in the hearing.</p> <p>"The big challenge of abuse and neglect in nursing homes is, I think, it has been persistent over a number of years," he said. "I don't think it's incredibly prevalent, but really having any abuse and neglect in nursing homes is not acceptable."</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 06 Mar 2019 21:05:56 +0000 lovellks 1262 at https://www.vumc.org/health-policy Forbes: Think Generics Will Lower the Cost of Chemo? Think Again https://www.vumc.org/health-policy/press-room/forbes-think-generics-will-lower-cost-chemo-think-again <span class="field field--name-title field--type-string field--label-hidden">Forbes: Think Generics Will Lower the Cost of Chemo? 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But not in Tennessee https://www.vumc.org/health-policy/press-room/tennessean-cancer-deaths-are-dropping-nationwide-not-tennessee <span class="field field--name-title field--type-string field--label-hidden">The Tennessean: Cancer deaths are dropping nationwide. But not in Tennessee</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Visitor</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 12/26/2018 - 00:00</span> <a href="/health-policy/blog-post-rss/1232" class="feed-icon" title="Subscribe to The Tennessean: Cancer deaths are dropping nationwide. 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