Ten Connecticut prescribers, including a Derby nurse who is at the center of a federal kickback probe, were responsible for more than 23 percent of the state’s Medicare spending on opioids in 2014, suggesting that the largest share of those prescriptions is concentrated among a small number of clinicians. Recently released federal Medicare data show that Heather Alfonso, formerly a nurse with the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, and four other advanced practice registered nurses (APRNs) at the clinic in 2014 dispensed more than $8.4 million in opioids in the Medicare program – accounting for a full 15 percent of all such prescriptions in the state. They were among the top 10 opioid prescribers in 2014, who accounted for $13 million of the $56 million spent on the drugs, the data show. More than 4,800 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, fentanyl and other opioids. But the prescribing was not evenly spread out – only two-dozen prescribers wrote out more than $250,000 worth of prescriptions.
The rates of asthma-related emergency room visits and hospitalizations dropped in many Connecticut communities, the latest data from the state Department of Public Health show. Overall, 58 percent of communities saw a decrease in the age-adjusted rate of emergency room visits, while 63 percent saw a decrease in the rate of hospitalizations for asthma, according to a C-HIT analysis of the data. Some 36 percent saw improvement in both areas. The data compares age-adjusted rates for each town for 2005-2009 and for 2010-2014 per 10,000 people. Meanwhile, the state’s overall rate for emergency room visits in 2014 was lower than recent years but still was higher than it was 10 years ago.
Four nurses, all of them affiliated with a Derby pain clinic, were responsible for nearly all of the state’s 2014 Medicare spending on the powerful opioid painkiller Subsys, which is at the center of a kickback probe. New Medicare data for 2014 show the four nurses, all who worked at the Comprehensive Pain and Headache Treatment Center of Derby, were responsible for 279 claims for Subsys, at a cost of $2.3 million. The highest prescriber was Heather Alfonso, an advanced practice registered nurse (APRN) formerly employed by the clinic who is awaiting sentencing on charges she took kickbacks from Arizona-based Insys Therapeutics for dispensing Subsys to patients. The new data is the first indication that the propensity to prescribe Subsys extended beyond Alfonso, to other clinic staff. None of the other three nurses has been implicated in an ongoing federal probe of Insys’ marketing of Subsys that resulted in the criminal charges against Alfonso.
Connecticut hospitals reported fewer numbers of patients killed or seriously injured by falls or perforations during surgery or suffering from severe pressure ulcers in 2014 than in 2013, but the incidence of such “adverse events” still remains higher than in 2012, a new state report shows. The report by the Department of Public Health (DPH) shows that the total number of hospital adverse events, or errors, dropped by 12 percent — from 534 in 2013, to 471 last year. Deaths or serious injuries from falls declined from 90 to 78; perforations during surgical procedures fell from 79 to 70; and life-threatening medication errors fell from six to one. The number of patients with serious pressure ulcers dropped from 277 to 245. Rates of all four of those incidents had climbed in 2013, in part because of an expansion of required reporting on pressure sores to include “unstageable” ulcers.
The medical director of a pain clinic in Derby was reprimanded and fined $7,500 on Tuesday by the state Medical Examining Board for writing prescriptions for patients based on assessments of their appearance or behavior conducted by unlicensed medical assistants. Dr. Mark Thimineur, medical director of the privately run Comprehensive Pain & Headache Treatment Centers, LLC, housed at Griffin Hospital, signed a consent order on June 1 agreeing to the punishment. In the order, he did not contest the findings by the board and the state Department of Public Health. The consent order states that from 2011 to the present, Thimineur failed to meet the standard of care when treating one or more patients for chronic pain. It said he wrote prescriptions for patients based on assessments by unlicensed medical assistants of the patients’ physical appearance, behavior, pain levels or lab test results.
Morbidly obese individuals who had weight loss surgery are seeking treatment for eating disorders years after their procedure, prompting concerns among some experts about the assessment process used to identify surgical candidates. “They are terrified of gaining the weight back,” said Dr. Sara Niego, medical director of the Eating Disorders Program at Hartford Hospital’s Institute of Living, who has treated patients with anorexia, bulimia and binge eating disorder years after weight loss surgery. The lack of a national “gold standard” to psychologically assess prospective patients has led Connecticut mental health professionals to call for standardized criteria to identify those who are at risk before and after surgery. They worry some patients with mental health problems may slip through the cracks because each hospital and insurance company has different psychological screening requirements. “Unfortunately, there is no consensus in the field regarding what constitutes a psychological evaluation or what would prohibit an individual from obtaining surgery from a psychological standpoint,” said Kimberly Daniels, a clinical psychologist with the Center for Weight Loss Surgery at Middlesex Hospital.
More than two-thirds of Connecticut hospitals will face Medicare penalties for lagging clinical-care measures in the fiscal year that began Oct. 1, with smaller hospitals including Johnson Memorial, Windham and New Milford losing the highest percentage of reimbursement. The penalties, under a federal program known as Value-Based Purchasing, average .26 percent nationally, with Connecticut’s hospitals losing an average of .23 percent, according to federal data compiled by Kaiser Health News. None of the state’s hospitals will lose the maximum possible penalty, 1.25 percent of funding, federal data shows. Johnson Memorial and Windham are the only two hospitals that will lose more than .5 percent of their Medicare payments – up slightly from the penalties they faced last year.
Connecticut’s acute-care hospitals ended the last fiscal year in slightly better financial health than in the prior year, with just five of 30 hospitals reporting losses, according to a new state report. Data filed with the state Office of Health Care Access (OHCA) shows that six hospitals had operating losses in the 2012 fiscal year – the same number as in 2011, but fewer than in 2010. When non-operating gains and losses are included, five hospitals had negative total margins, or deficits – down from eight in 2011. The annual OHCA report paints a positive picture of the overall financial health of hospitals, highlighting that Connecticut’s hospitals had a total gain from operations of about $513 million in the last fiscal year – a substantial increase, of close to 70 percent, over the prior year. Total hospital net assets also increased.
What if you needed a hip replacement and could click through a list of area hospitals to compare costs and outcomes for the procedure? That kind of transparency of information might go a long way towards improving quality of care and lowering costs, a panel of experts suggested Monday at a forum on health care costs convened by the Universal Health Care Foundation of Connecticut. “I look at the variance in some of the costs, when we’ve got three or four times the variance in cost for a hip (replacement), for the same hardware . . .
With health care in the headlines, the Universal Health Care Foundation of Connecticut is hosting a public forum Monday at Quinnipiac University’s North Haven campus that will feature a panel of experts weighing in on the high costs of health care. The forum, “Drowning in Health Care Costs: All Hands on Deck,” features prominent author Steven Brill, whose 36-page cover story in Time magazine in February 2013 delved into the arbitrary and largely hidden system of hospital pricing. Brill will be joined by Patrick Charmel, president and CEO of Griffin Hospital in Derby, and Kevin Lembo, state comptroller. Journalist Susan Campbell, a contributor to the Connecticut Health I-Team, will moderate the discussion. The event is the first in a series of forums planned by the foundation and its parent organization, the Connecticut Health Advancement and Research Trust (CHART), to discuss health care challenges facing the state.