New Law

State Prepares To Tighten Prescription Monitoring

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Connecticut’s shift next month from weekly to “real-time” reporting of prescriptions for opioids and other controlled substances is an effective way to help stem opioid-related deaths, a new study suggests. Researchers from Vanderbilt University who analyzed states’ prescription drug monitoring programs – central databases that log controlled substances dispensed to patients — found that programs that were “updated with greater frequency” and that reported data for a broad range of drugs were associated with greater declines in opioid-related deaths. The study in the journal Health Affairs comes as Connecticut prepares to put a policy in place requiring that pharmacies report controlled substance (Schedule II to V) prescriptions “immediately,” or at least within 24 hours after they are dispensed, into the central database, known as the Connecticut Prescription Monitoring and Reporting System (CPMRS). The CPMRS, maintained by the Department of Consumer Protection, can be accessed by doctors and pharmacists to give them a complete picture of a patient’s medication use, including prescriptions by other providers. It also can be used by law enforcement officials to investigate physician prescribing.

I-Team In-Depth

Derby Nurse Cooperating In Broadening Federal Probe

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A Derby nurse who admitted taking kickbacks from a drug company that makes the powerful opioid painkiller Subsys is cooperating with federal investigators, who recently charged two drug company employees with violating kickback laws, court documents show. Documents filed earlier this year show that Heather Alfonso, a nurse formerly employed by a Derby pain clinic, requested a delay in sentencing because she was “actively cooperating in an ongoing investigation in several jurisdictions, including Connecticut,” in which arrests were expected. “Ms. Alfonso’s cooperation with both state and federal investigations is significant when qualifying her character and conduct, relative to sentencing,” her attorney said in filings in U.S. District Court in Hartford. A judge agreed to delay Alfonso’s sentencing until Sept. 13.

health care

State’s Ambulatory Surgery Centers Get Mixed Ratings

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Connecticut’s outpatient surgery centers fare well in preventing patient falls and wrong-site surgeries, compared to national rates, but poorly in avoiding patient burns and in ensuring that surgical patients get intravenous antibiotics, new federal data show. In addition, many of the state’s 45 Medicare-certified centers perform significantly more surgical procedures than the national average, with eight centers reporting more than double the average caseload. The data — recently made public by the Centers for Medicare & Medicaid Services (CMS)  – show that Connecticut’s ambulatory surgery centers (ASCs) have a lower average rate of patients who suffer falls than the national average — .077, compared to .095. The data is from 2013 and 2014, the most recent years available. The state’s ASCs also have a lower rate, on average, of patients who experience a wrong-site, wrong-patient or wrong-procedure error — .017, compared to the national average of .028.

Fines & Sanctions

State Hospital Inspection Reports Now Available On C-HIT

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Lapses in cleanliness, infection-control procedures and in the treatment of patients with behavioral health problems were among the most common violations found in Connecticut hospitals inspected by the state health department in 2015, reports collected by C-HIT show. Inspection reports from the state Department of Public Health, spanning 2013 through 2015 – posted in C-HIT’s Data Mine section — show a mix of citations for poor physical conditions, such as mold and fungus in pharmacy preparation areas, and inadequate patient care, including improper evaluation and treatment of psychiatric patients and use of restraints. The state DPH inspects hospitals, which are all Medicare-certified through the federal government, once every four years. Inspections also occur when the DPH receives a complaint against a facility or is following up to ensure compliance with a corrective action plan. C-HIT’s database, based on DPH records through late 2015, includes reports on all 29 acute-care hospitals.

I-Team In-Depth

Report: Private Insurers Deny More Claims For Mental Health Care

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The rate of denials by the state’s largest managed care insurers of requests for mental health services rose nearly 70 percent between 2013 and 2014, with an average of about one in 12 requests for prescribed treatment initially rejected, a new state report shows. At the same time, the proportion of enrollees in the largest managed care companies who received outpatient or emergency department care for mental health doubled, from an average of 9.4 percent in 2013 to 20.8 percent in 2014, according to an analysis of the 2015 Consumer Report Card on Health Insurance Carriers in Connecticut, issued by the state Insurance Department. The percentage of members who received inpatient mental health care also doubled, although it remained low, with most companies providing inpatient services for less than .5 percent of all enrollees. The rise in rejections by the state’s 10 largest indemnity managed care companies – private health insurers, not including Medicare or Medicaid — came as state officials focused on improving mental health outreach and treatment, in the wake of the Sandy Hook school shooting in December 2012. The managed care organizations include companies such as Aetna Life Insurance Co., Anthem Health Plans, CIGNA Health and Life Insurance Co., and UnitedHealthcare Insurance Co.

health disparities

Federal Report Finds Wide Disparities Among Medicare Recipients

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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.

Veterans' Health

New Report Cites Long Wait Times For VA Primary Care

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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.

Injury Death

In Connecticut, Suffocation Deaths “Distinctive Injury”

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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.

Pain Treatment

Critics Of Opioid Overprescribing Take Aim At Hospital Surveys

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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.

I-Team In-Depth

Death At Surgery Center Raises Questions About Emergency Care

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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.