Federal Report Finds Wide Disparities Among Medicare Recipients

Blacks and Hispanics are less likely than whites to get flu vaccines, have a preventive health care visit, or receive follow-up care after being hospitalized for a mental health disorder, according to a first-of-its kind federal report that looks at health disparities among people on Medicare Advantage plans. “While these data do not tell us why differences exist, they show where we have problems and can help spur efforts to understand what can be done to reduce or eliminate these differences, ” said Dr. Cara James, director of the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health, which released the report. The report looks at 27 clinical care measures and eight patient experiences to gauge differences in treatment among whites, blacks, Hispanics, and Asians or Pacific Islanders. It has some bright spots: Blacks and Hispanics reported slightly better communication with doctors than whites did. Hispanics had higher rates than non-Hispanic whites of colorectal screenings, blood sugar testing for diabetes, and treatment for osteoporosis (among women) after a fracture.

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New Report Cites Long Wait Times For VA Primary Care

Some newly enrolled veterans seeking a primary care appointment at the Department of Veterans Affairs (VA) wait more than 90 days before they see a provider, and the agency’s way of calculating wait times understates them, according to a new report by a government watchdog office. “This most recent work on veterans’ access to primary care expands further the litany of VA health care deficiencies and weaknesses that we have identified over the years,” Debra Draper, director of the Government Accountability Office’s (GAO) health-care team, said in testimony to the House Committee on Veterans’ Affairs. “As of April 1, 2016, there were about 90 GAO recommendations regarding veterans’ health care awaiting action by VHA … (including) more than a dozen recommendations to address weaknesses in the provision and oversight of veterans’ access to timely primary and specialty care, including mental health care. “Until VHA can make meaningful progress in addressing these and other recommendations,” she added, “the quality and safety of health care for our nation’s veterans is at risk.”

 

The new GAO report looked at wait times for newly enrolled veterans seeking primary care appointments at six VA medical centers around the country. Among a random sample of 180 of those veterans, 60 who requested care had not been seen at all by primary care providers, in some cases because the VA never contacted them or because they were left off an eligibility list in error.

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Baby sleeping

In Connecticut, Suffocation Deaths “Distinctive Injury”

A new report that identifies the most distinctive cause of injury death for each state, compared to national rates, has some findings that might be expected:

Seven states in Appalachia and the Southwest, for example, had unintentional firearms deaths roughly two to four times the national rate. Those states have high gun ownership rates and lack safe-storage laws. Three states – Montana, South Dakota and Nebraska – had as their most distinctive injury motor vehicle crashes involving passengers. Four safety provisions – primary seatbelt laws, mandatory key ignition locks for drunk drivers, booster seats, and nighttime driving restrictions for teens – are absent in Montana, while South Dakota and Nebraska have only one each. Connecticut had as its most distinctive cause of injury death “unintentional suffocation” – the only state with that outlier cause.

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Critics Of Opioid Overprescribing Take Aim At Hospital Surveys

More than 60 medical experts, state health directors and advocacy groups have asked federal Medicare officials to remove questions related to pain treatment from hospital patient surveys that are used to rate hospital quality, saying such questions “have had the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge.”

In a letter to Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), the group said “aggressive management of pain should not be equated with quality healthcare, as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids.” The coalition asked that CMS survey questions such as “During this hospital stay, how often was your pain well controlled?” be removed. The group sent a similar letter to the Joint Commission, which accredits U.S. hospitals, asking that it revise its pain management standards – specifically, guidelines directing doctors to ask patients to assess their pain, as they assess other “vital signs.”

“Mandating routine pain assessments for all patients in all settings is unwarranted and can lead to overtreatment and overuse of opioid analgesics,” they wrote. The letters come as Connecticut and other states grapple with a surge in opioid-related overdoses. Last week, U.S. Sen. Richard Blumenthal, D-Conn., joined several other senators to support a bill that would factor-out the pain-related questions on patient surveys from hospitals’ Medicare reimbursement determinations. Meanwhile, at the state legislature, the Public Health Committee has proposed a bill that would cap initial prescriptions of opioids to seven days for acute pain.

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Death At Surgery Center Raises Questions About Emergency Care

In surgery, when something goes wrong, minutes become hours. Minutes are the focus of a lawsuit filed by the family of a 29-year-old Seymour nurse who died in February 2015 after undergoing minor elective sinus surgery at the North Haven Surgery Center. The suit alleges that the center waited as long as 29 minutes to call an ambulance after Katherine O’Donnell’s blood pressure and pulse fell to critical levels on the operating table – and that doctors continued to proceed with surgery, even as their efforts to resuscitate her failed. The case raises questions about how well equipped freestanding surgical centers are to handle emergencies, and what sanctions they face for alleged lapses in care. The lawsuit alleges that the center and Fairfield Anesthesia Associates, LLC, which handled anesthesia in the case, failed to properly respond by stopping the surgery immediately and calling a “Code Blue” emergency when O’Donnell’s blood pressure and oxygen levels plummeted.

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FDA Orders Study Of Essure Contraceptive

The U.S. Food and Drug Administration on Monday instructed the maker of Essure to conduct further studies on the controversial birth control device, and recommended that a warning be added to the product label. “While the FDA believes Essure remains an appropriate option for the majority of women seeking a permanent form of birth control, some women may be at risk for serious complications,” the agency said in a statement. “These may include persistent pain, perforation of the uterus or fallopian tubes from device migration, abnormal bleeding and allergy or hypersensitivity reactions.”

Essure, approved by the FDA in 2002 for women ages 21 to 45, is a flexible coil that is inserted by doctors into the fallopian tubes. An estimated 750,000 women have received the product, manufactured by Bayer. Essure has been the target of thousands of complaints from women across the country, including in Connecticut.

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Legislative Proposal Aims To Stem Suicides Of Women Vets

A study showing that women veterans commit suicide at six times the rate of civilian women has prompted U.S. Sen. Richard Blumenthal and colleagues to propose legislation requiring the VA to develop gender-specific suicide prevention programs.

The "Female Veterans Suicide Prevention Act" would expand the Department of Veterans Affairs’ annual evaluation of mental health and suicide-prevention programs to include data specific to female veterans. The act also would require the VA to determine which programs are the most effective for female veterans. “With suicide among women veterans happening at an alarming rate, (the proposed bill) will help save lives by ensuring VA is providing the care, counseling and outreach these veterans need,” Blumenthal said. Co-sponsors include Sens. Barbara Boxer (D-CA), Joni Ernst (R-IA), and Sherrod Brown (D-OH).

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CT BA Fatalities

Drunk-Driving Fatalities Decline, But State Ranks High In Impaired Drivers

Connecticut saw a decline in drunk-driving fatalities in 2014, but the state still ranks among the highest in the country in the percentage of traffic deaths involving alcohol-impaired drivers, new federal data show. Ninety-seven of the 248 traffic fatalities in Connecticut, or 39 percent, involved drivers with a blood-alcohol content (BAC) of .08 or higher, considered alcohol-impaired, according to statistics compiled by the National Highway Traffic Safety Administration (NHTSA). That rate is higher than the U.S. average of 31 percent, and is the fifth highest nationally -- behind Texas, North Dakota and Massachusetts, with rates of 41 percent, and Delaware, at 40 percent. Vermont had the lowest rate, at 20 percent. Total motor vehicle deaths in Connecticut declined from 276 in 2013 to 248, in line with a national trend.

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Report Raps Army For Not Monitoring Psychiatric Medication Use

The Army is not properly monitoring the prescribing of medications to treat post-traumatic stress disorder (PTSD) in active-duty soldiers to ensure that antipsychotics and sedatives are not being used, a new government report says. The report by the Government Accountability Office (GAO) recommends that the Secretary of Defense direct the Army to monitor prescribing practices in order to detect medications that are discouraged under PTSD treatment guidelines. Those guidelines caution against the use of antipsychotics and benzodiazepines, a class of sedatives, because of their ineffectiveness and potential risk. “The Army does not monitor the prescribing of medications to treat PTSD on an ongoing basis,” says the report, led by the GAO’s director of health care, Debra Draper. “Without such monitoring, the Army may be unable to identify and address practices that are inconsistent with the guideline.”

The Department of Defense did not dispute the GAO recommendations, but argued that it has worked to reduce antipsychotic prescribing.

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Patient and gurney

18 State Hospitals Penalized For High Infection Rates

Eighteen Connecticut hospitals will lose 1 percent of their Medicare payments in 2016 as a penalty for comparatively high rates of avoidable infections and other complications, such as pressure sores and post-operative blood clots, according to new federal data. The Centers for Medicare & Medicaid Services (CMS) announced this month that 758 of the nation’s hospitals – about 23 percent of all eligible hospitals -- would be penalized for patient safety lapses in the second year of the Hospital-Acquired Condition Reduction Program, which was mandated by federal health care reform. The penalties are based on rates of infections and other complications that occurred in hospitals between 2012 and 2014. The 18 hospitals in Connecticut include larger urban institutions, such as Yale-New Haven, Hartford and Bridgeport hospitals, and smaller hospitals, such as Manchester Memorial and Windham. They are among hospitals in the worst performing quartile nationally on patient-safety measures including the frequency of central-line and catheter-related infections, post-operative sepsis and accidental laceration.

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