Articles Posted in Certification and Licensure

toomey-150x150casey-150x150Federal regulators have given up the unwarranted secrecy enshrouding their watchdog efforts on the nation’s most problematic nursing homes.

With prodding from the U.S. senators from Pennsylvania, Democrat Bob Casey (above left) and Republican Pat Toomey (above right), the Centers for Medicare and Medicaid Services (CMS) disclosed its list of hundreds of nursing homes that perform so poorly they are on the brink of regulators’ most dire supervision.

CMS had declined to disclose its candidates for designation  as a “Special Focus Facility” (SFF), preferring instead just to tell the public about its worst of the worst nursing homes, 88 facilities with the SFF tag that receive a targeted, higher level of inspection because of their poor performance. The most rigorous oversight can be resource intensive, and CMS can only scrutinize at the highest level a few poor performing homes, whose infamy is made public. When one facility “works its way off” an SFF designation by improving its failings, others are on the heretofore secret list to take their place.

carter-300x300The rich and powerful may seem to run amok as the nation lurches through its latest gilded age. But sometimes:

allenplaque-240x300Truth can be stranger than fiction, and for an investigative journalist covering the outrages of health care costs, ProPublica reporter Marshall Allen had a dream medical story call him on his phone: A well-known New York company reached out and told him he had been “honored” as one of the nation’s Top Doctors.

Not bad for a guy with an English degree from the University of Colorado and zero medical credentials, he reported in a recent, wry article.

He tried to explain to a saleswoman for the company how unqualified he was. But after a chat and after negotiating a “nominal fee” for his accolade — down to $99 from $289 — he bought a plaque and the right to promote himself as a specialist in “investigations” and a Top Doctor.

dumbrella-300x256They look like nursing homes, but they’re not. And for the health and safety of our elderly loved ones, we must know the difference.

These so-called assisted living facilities, operating with much less regulation and oversight than nursing homes, are raising concerns about the safety and quality of their dealings with a growing number of elderly Americans. That’s because they’re full not only of older residents but also difficult — and costly to care for — seniors with dementia.

Jordan Rau, of the independent, nonpartisan Kaiser Health News Service, deserves credit for diving deep into rising complaints and documented harms to residents of facilities “originally designed for people who were largely independent but required help bathing, eating or other daily tasks.” These places, “unlike nursing homes … generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.”

leapfrog-300x300A familiar health care advocacy group will expand its grading of 2,000 or so hospitals across the country to also provide new safety and quality information on 5,600 stand-alone surgical centers that perform millions of procedures annually.

It may seem like a small step, and the devil will be in the details of the new data that will be voluntarily reported, analyzed, and then made public by the Leapfrog Group, a national health care nonprofit that describes itself as being “driven by employers and other purchasers of health care.”

Surgical centers have burgeoned because they can be nimbler than the hospitals and academic medical centers they now outnumber. The centers can be set up without hospitals’ high overhead costs, including for staff and equipment that may be unnecessary for a specialty practice. The facilities also can be set up closer to patients, theoretically offering them greater access and convenience, including with easy navigation and parking.

docshistoric-300x234Doctors put their patients at grave risk by failing to stay current with professional best practices, eliminating outdated and ineffective therapies and approaches and instead learning and adapting better ways of care, notably treatments to help deal with the opioid crisis.

Vulnerable children can pay an unacceptable price, for example, for pediatricians’ unwillingness to “unlearn” what they were taught decades earlier in medical school, reported Aaron Carrol, a professor of pediatrics at Indiana University School of Medicine, a health researcher, and a contributor to the New York Times’ evidence-based column “The Upshot.” As he wrote:

In May, a systematic review in JAMA Pediatrics looked at the medical literature related to overuse in pediatric care published in 2016. The articles were ranked by the quality of methods; the magnitude of potential harm to patients from overuse; and the potential number of children that might be harmed. In 2016 alone, studies were published that showed that we still recommend that children consume commercial rehydration drinks (like Pedialyte), which cost more, when their drink of choice would do. We give antidepressants to children too often. We induce deliveries too early, instead of waiting for labor to kick in naturally, which is associated with developmental issues in children born that way. We get X-rays of ankles looking for injuries we almost never find. And although there’s almost no evidence that hydrolyzed formulas do anything to prevent allergic or autoimmune disease, they’re still recommended in many guidelines.

hjobs-300x174It’s unlikely to surprise anyone who has visited friends or loved ones at a nursing home that such facilities too often are woefully staffed.

But why have federal regulators allowed themselves to be gulled about nursing home personnel levels, and how will not just these care-giving sites but also others, notably hospitals, deal with the growing need for and imbalances in health care staff, including a tilt toward “astonishingly high” numbers of costly administrative staff folks who don’t provide direct patient care?

Jordan Rau, a reporter for Kaiser Health News Service, deserves credit for digging into daily payroll records that Medicare only recently has gathered and published from 14,000 nursing homes nationwide. Rau found that:

SCImaginvestigation-300x147The federal Food and Drug Administration has turned a blind eye to tens of millions of dollars paid by Big Pharma to doctors who play crucial roles in advising the nation’s prescription drug watchdog on the safety and effectiveness of medications sold for billions of dollars annually to the American public.

Science magazine deserves credit for its investigation of conflicts of interest it found by examining readily available public records on payments received by more than 100 physician advisers to the FDA over a four-year period.

Reporter Charles Piller and graphics editor Jia  You took an important and different look at records, scrutinizing doctors disclosed drug company funding after their service on elite panels that assist FDA staff in the review and approval of products before they can go to market. Under fire by drug safety and other public advocates, and with intense peer pressure, doctors — grudgingly — have come to accept the notion that they should avoid conflicts of interest before sitting on such influential oversight groups.

CMS-300x105As many as 2 million already ailing Americans will acquire an infection while hospitalized, with 90,000 of them dying as a result. Hospital acquired infections (HAIs) will add to the cost of an individual patient’s care anywhere from $1,000 to $50,000, while they will impose a direct hit of anywhere from $28 billion to $45 billion for institutions’ bottom lines. If HAIs seem like a problem for U.S. health care, they certainly are —  why is Uncle Sam suddenly proposing to retreat on regulations to crack down on them?

USA Today reported that patient safety advocates are sounding alarms about new rules, set to take effect in November, from the Centers for Medicare and Medicaid Services (CMS). The agency, which wields great sway over hospitals because so many patients’ medical costs are covered by Medicaid and Medicare, plans to slash the information it provides to the public on HAIs involving: “super bugs” like MRSA (methicillin-resistant Staphylococcus aureus), post-operative sepsis and surgical site infections, as well as accidents and injuries ranging from bedsores to respiratory failure after surgery.

CMS also would stop informing the public about “never events,” medical mistakes committed in hospitals and considered so ghastly that they “never” are supposed to occur.

coveredcalif-300x169Although Republicans have ripped at the health insurance offered under the Affordable Care Act, a less known but also important aspect of Obamacare may soon benefit Californians. This West Coast ACA-related move also may be worth watching by patients and medical safety advocates, as well as employers and insurers.

The Golden State, the San Francisco public radio station KQED reported, soon will tell hospitals that “time’s up” for them to improve their care, and, if they fail to hit new quality and safety targets that will be part of an impending three-year contract with Covered California, the ACA marketplace operator, they will get the boot from Obamacare coverage.

Because bluer-than-blue Democratic California has gone all-in in supporting and putting ACA coverages in place, the state’s Obamacare exchange is big (more than 1 million customers and 11 approved companies) and lucrative — so much so hospitals and insurers can’t ignore the quality demands. They’re neither extreme nor should they be surprising, because state officials emphasize they have consulted with key parties for several years now in the “Smart Care California” collaborative about the plans they intend to put in place.

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