Tag Archives: Mental Health

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CMS: ACOs are producing savings, physician-based models faring best

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Accountable care organizations (ACOs) are paying off big time, the Centers for Medicare & Medicaid Services (CMS) said, with the programs generating more than $739 million in net savings in 2018.ACOs are designed to lower growth in expenditures and improve care quality.

For its part, an ACO agrees to be held accountable for the quality, cost, and experience of care of an assigned Medicare beneficiary population. According to Health Affairs, ACOs that successfully meet quality and savings requirements share a percentage of the achieved savings with Medicare.

In December 2018, the Trump administration overhauled the Shared Savings Program, the primary Medicare program for ACOs. The overhaul was fueled by analysis of the program’s first six years in existence and was based on experience testing of Medicare ACO initiatives by the Center for Medicare and Medicaid Innovation (Innovation Center).

The Shared Savings Program savings were the net savings across 548 ACOs. ACOs taking accountability for cost increases performed better than ACOs that did not. For example, ACOs taking on downside risk showed an average reduction in spending relative to their targets of $96 per beneficiary, compared to $68 for ACOs that did not take on downside risk.

Likewise, ACOs led by physicians (“low-revenue” ACOs) perform better than ACOs led by hospital systems (“high-revenue” ACOs). In 2018, low-revenue ACOs showed an average reduction in spending relative to targets of $180 per beneficiary, compared to just $27 for high-revenue ACOs.

The number of Medicare beneficiaries receiving care from a provider in an ACO as of July 1, 2019, increased by 400,000 to more than 10.9 million Medicare fee-for-service beneficiaries.

CMS’s Office of the Actuary projected $2.9 billion in savings over 10 years from the Pathways to Success program redesign, CMS said. ACO trends for 2019 have the agency on track to generate the initially projected amount.

“CMS is continuing to monitor the Shared Savings Program,” CMS said. “We are excited to see growing interest, and we will continue to support health care providers on the front lines who are hard at work building new ways to deliver higher quality care at a lower cost. Patients are receiving better care as a result of these efforts, and we look forward to continuing on this journey.”

“This trend is one of the reasons that the greater accountability for ACOs included in Pathways to Success, along with greater flexibility for them to innovate, will lead to better, more efficient care for Medicare beneficiaries,” CMS Administrator Seema Verma wrote in a blog post published by the journal Health Affairs.

The Trump administration pushed the changes to the Medicare Shared Savings Program (MSSP), the program that oversees ACOs.

Verma criticized the program for letting an ACO remain in “one-sided” risk for too long; “one-sided” risk refers to when an ACO can get a share of any cost savings but does not have to pay the government for not meeting savings targets.

A new ACO must take on financial risk after three years of participation in “Pathways to Success.” Previously, an ACO could wait six years before facing financial risk.

“Pathways to Success” offers ACOs two opportunities to sign up: July 1 or Jan. 1, 2020. Verma wrote: “We are excited to see growing interest.”

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The upside of grief

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The loss of a loved one is a major event in one’s life. There’s no way to prepare for it or to lessen its emotional impact.

It’s one of life’s inevitable natural disasters, leaving in its wake families in varying degrees of shock, disagreements over the deceased’s possessions and myriad casualties from regrets over things said, left unsaid or undone to the daunting task of adjusting to life without this person.

There’s not much good to be found at the end of someone’s life…or is there?

I’ve spent the better part of the past year grieving the loss of my mother, who died on Oct. 15, 2018, after a long decline due to Alzheimer’s disease. It’s been excruciatingly painful, beyond anything I could have anticipated, in spite of the fact that my father died when I was 21.

Yes, his death was shocking and painful, but I had my mother to lean on and help me through it. Her death, on the other hand, meant that I had no living parents left in the world.

Now, I had to face the reality that both of their lives were over: no longer could I visit with them, no longer could I turn to them for comfort or advice, no longer was my own morality buffered by their existence.

Given that my mother had dementia, I essentially “lost” the mother I had known years before she actually died. In many ways, her death was a relief because it ended her days locked in a memory care facility. But still, having her physically gone triggered all kinds of unexpected feelings.

All of this sounds rather bleak. But as I began to reflect on the past year of living without her, I saw that my mother’s death, while painful, has added a whole host of benefits in my life. I might even go so far as to call them gifts or blessings.

1. Making my health and well-being a priority.

For several month’s following my mother’s death, I experienced what is now commonly known as PTSD. Lots of old memories and feelings came up. It was overwhelming, so I reached out for help from friends, coaches and healers.

I allowed myself to receive in ways that I hadn’t in years. During that time, I was supported to make sure I had enough sleep, healthy food, downtime from my business, quiet periods for meditation and reading, fresh air and exercise and so on.

2. Appreciation for each moment.

Death puts time into a new perspective. In fact, each moment becomes more precious. Each time I faced the fact that I could no longer hear my mother’s voice or hug her, I found myself appreciating the voices, hugs and time spent with the people around me who were still living. Little things became so much more meaningful, filling me with immense gratitude.

3. Making better choices.

One of the greatest gifts of loss and grieving was the clarity that surfaced regarding the choices I’ve made. This resulted in radical shifts in my perspective, making it obvious which choices were serving me and which weren’t.

Moving forward, I am confident that my choices will be informed by my increasing awareness of my own mortality, specifically that I don’t have unlimited time to waste and I am responsible for making the best of what time I do have.

4. Slowing down.

As a business owner, it had become too easy for me to let me work take over my life, especially because I’d recently been doing lots of restructuring. My mother’s death dramatically shifted this tendency and forced me to slow down.

As I did this, I began to see how I wasn’t allowing myself enough time to simply be and play. For years, I had been taking life way too seriously. Play has since become something I want more of in my life.

5. Offering comfort to others.

Because I spent months grieving and being vulnerable, I found my sensitivity and compassion with others expand. It was much easier to tune in and know how the people around me were feeling.

It was also much easier to offer comfort to others either by simply listening or by being present with them. It meant so much to me when others were there for me, I happily returned the favor whenever the opportunity arose.

6. Creating a better death experience for my sons.

When I was only 21, I was the co-administrator of my father’s estate, along with my 19-year-old sister. It was a very complicated estate situation that required a dozen attorneys and thousands of hours of work to sort out.

My mother did her best to take preventive measures for her own death. She purchased long-term care insurance and wrote a living will. Unfortunately, once the dementia set in, she wasn’t able to educate us on all of her wishes and the associated paperwork that she’d so carefully arranged when she was lucid, thus requiring us to navigate the process based on our own assumptions.

For my two sons’ sakes, I am working on a simple plan for potential options for them upon my death, which I intend to communicate to both of them in great detail. I believe it is unconscionable for parents to ask a grieving child to clean up the mess of a parent who has just died. (I had to do it for my paternal grandparents as well.)

Yes, death is a painful part of life. Like it or not, it changes us. However, if you’re open and paying attention, you might also notice there’s an upside to the grief you’re experiencing, and that surrounding that loss is significant number of blessings.

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Healthcare groups: ONC should delay data-blocking rules, focus on security

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Federal policymakers in healthcare IT are up against it. As many as seven healthcare industry groups are encouraging these rulemakers to begin dealing with data-blocking regulations now, including delaying the publication of a final rule. The groups are raising the flag toward the Office of the National Coordinator for Health IT (ONC) to get the organization to issue another supplemental notice of rulemaking and clarify the language in the rules.

The organizations cite confusion regarding ONC’s definition and scope of electronic health information and health information networks.

ONC released its proposed information-blocking rule in February 2019, defining seven exceptions to data blocking and fines associated with the practice, mandated by the 21st Century Cures Act.

Mari Savickis, vice president of federal affairs for the College of Healthcare Information Management, asked ONC to allow more time to address questions pertaining to the data-blocking proposals.

Savickis represented CHIME, the American Medical Association, the American Health Information Management Association (AHIMA), the Federation of American Hospitals, the Medical Group Medical Association, the American Medical Informatics Association, and the Premier Healthcare Alliance.

The Centers for Medicare & Medicaid Services’ (CMS) proposed interoperability rule requires insurers participating in CMS-run programs (Medicare, Medicaid and the federal Affordable Care Act exchanges) by Jan. 1. This rule is designed to provide 125 million patients with electronic access to their personal health information at no cost to patients.

“We support the intent of the Cures Act to eradicate practices that unreasonably limit the access, exchange, and use of electronic health information,” said AHIMA CEO Wylecia Wiggs Harris, Ph.D., CAE. “However, in light of the lessons learned from the meaningful use program, we believe it is crucial that we get this right.”

AHIMA recommendations include:

Additional rulemaking before finalization: ONC should seek further input from impacted stakeholders on issues, including modifying the information blocking proposal to ensure that the requirements and exceptions are well-defined and understandable.

Clinicians, hospitals, and health information professionals are not penalized inappropriately if they are unable to provide a patient’s complete electronic health information through an application programming interface (API).

Enhanced privacy and security: The proposed rule doesn’t sufficiently address the Cures Act directives to protect patient data privacy and ensure health IT security. The Committee must continue its oversight of privacy and security issues that fall outside of the Health Insurance Portability and Accountability Act (HIPAA) framework.

Appropriate implementation timelines: ONC should establish reasonable deadlines for any required use of certified health IT. Providers must have sufficient time to deploy and test these systems, which must take into account competing regulatory mandates.

Revised enforcement: The U.S. Department of Health and Human Services should use discretion in its initial enforcement of the data-blocking provisions of the regulation, prioritizing education, and corrective action plans over monetary penalties.

The information-blocking rule requires electronic health records and other health IT vendors to change their technologies, so they want ONC to create a new version of its health IT certification rather than updating the 2015 certification. Advocates say that creating a new version of the certification should reduce confusion and enhance implementation.

Under the proposed rule, those that violate the prohibition against data blocking may be penalized $1 million per blocking instance.

The groups are calling for ONC to soften the rule enforcement as well. “Given the confusion regarding the definitions contained in the rule, including exceptions to the information blocking rule, we believe a more fruitful approach would be one that centers around education and opportunities for corrective action,” Savickis said.

ONC also needs to focus on data privacy and security in the proposed rules, opponents say.

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Resistance to change in healthcare: Our fatal flaw

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It’s been said that change is the only constant in the universe, and that also pertains to healthcare. Since the days of Hippocrates, Florence Nightingale, and many others, medicine and nursing have continued to morph, and those individuals and organizations willing to do so have also evolved apace.

But for those who resist or fight change, becoming an irrelevant dinosaur is the likely result. Are you and your organization willing to play along?

“But That’s How We’ve Always Done It”

“But that’s how we’ve always done it” are seven of the most dangerous words vis-à-vis the delivery of healthcare services. When providers use the excuse that things have always been done a certain way and don’t need to change, they clearly demonstrate a lack of creativity, poor critical thinking, and intellectual laziness.

Evidence-based medicine is probably our greatest defense against such slothful thinking. If you’re proposing a new practice algorithm or procedure, basing your proposal on the most recent, robust research is a powerful bulwark against naysayers and resisters who readily throw up road blocks to change.

While needles are still cleaned and reused in some developing countries where supplies are thin, we’ve learned in the industrialized world that reusing certain pieces of equipment is a questionable practice that can lead to very unhappy outcomes. That said, in the face of

climate change, there are innovative thinkers trying to find ways to reduce waste caused by our “use-it-once-and-discard-it” healthcare supply chain.

Meanwhile, we see positive changes in chemotherapy, the diagnosing parameters of chronic illnesses like diabetes, and how we teach nutritional concepts. Long gone are the four food groups, as are other grossly outdated patient education materials.

“But that’s how we’ve always done it” doesn’t cut it anymore, unless a particular old practice holds up under scrutiny or proposed changes lack sufficient evidence.

Change or Die

Homo sapiens means “wise man” in Latin,and of all humanoid species having ever lived on planet Earth, only we have survived (with some Neanderthal in our genome, of course, as we’ve learned in recent years).

Why did homo sapiens thrive while others disappeared into history? Perhaps it was mostly our willingness to learn new skills and invent novel ways of surviving using the prefrontal cortex that we developed.

And what about those other proto-humans we cohabitated with for a while? They remained in a less developed state, clinging to what they knew, and summarily vanished from sight.

In the healthcare milieu, there are naturally Neanderthals (you probably know who they are among your colleagues without even thinking) and their homo sapiens counterparts. To which camp do you and your peers belong?

Are you an intrapreneur and innovative thinker who’s always bringing your A-game to the table and helping things change in a positive direction? Do you have coworkers who always seem to throw a wet blanket over new ideas?

Science may show that humans are wired for negativity based on our evolutionary drive to survive, but there aren’t any saber-toothed tigers out there waiting to eat us (except for that mean old charge nurse you despise) and we can let down our guard and open our minds to needed, thoughtful change.

Be a Change Agent

Being a change agent in healthcare means that you naturally champion sensible change. The increased use of robotics, artificial intelligence (AI), and other technological developments may give you pause, but the tide is rising, and we must rise with it or drown.

When changes are proposed that may compromise patient safety or your ability to maintain your license, speaking up is important. Change for the sake of change is as bad as resisting for the sake of resistance.

Every facility, organization, and agency in the healthcare ecosystem needs the influence of those who will champion innovation, use critical thinking for the good of the whole, and not resist when it’s unnecessary and unhelpful to do so. Change agents and intrapreneurs are the lifeblood of healthcare organizations’ ability to evolve, and those willing to embody that spirit are worth their weight in gold.

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Pilot study: Treating opioid use disorder with naltrexone during pregnancy shows promise

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Neonatal opioid withdrawal syndrome (NOWS) is common due to the current opioid addiction epidemic. The incidence of infant opioid withdrawal has grown rapidly in many countries over the last decade, nearly a fivefold increase, presenting significant health and early brain development concerns.

The rise in prenatal exposure to opioids reflects increasing prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies.

The incidence of NOWS has increased, with the costs of treatment in the United States reaching approximately $1.5 billion in 2015. Opioid abuse in pregnant women presents additional risks for the fetus and newborn.

Opioid use during pregnancy, whether prescribed or illicit, can be associated with negative pregnancy and infant outcomes, including prematurity, low birth weight, increased risk of spontaneous abortion, sudden infant death syndrome, and infant neurobehavioral abnormalities. Infants who are at high risk for experiencing symptoms of abstinence or withdrawal may require assessment and treatment.

About 50% to 80% of opioid-exposed infants have required medication to manage their withdrawal symptoms, including irritability, trouble eating and sleeping, diarrhea, and muscle rigidity, which usually appear two to three days after birth.

Naltrexone, buprenorphine, and methadone are three medications approved by the Food and Drug Administration to treat opioid use disorder. Buprenorphine is a newer treatment for maternal opioid addiction and appears to result in a milder withdrawal syndrome than methadone.

However, a recent study led by researchers at Boston Medical Center showed that infants of mothers taking naltrexone during pregnancy had shorter hospital stays than infants of mothers who took buprenorphine during pregnancy.

The researchers followed mother-infant dyads during their pregnancies and after delivery at one academic medical center between 2017 and 2019. Six of the mothers were taking naltrexone to treat their opioid use disorder before and during their pregnancies, and 12 were taking buprenorphine.

The two groups were monitored and compared based on participants’ opioid use via urine toxicology reports, provider reports during pregnancy and six months post-delivery, delivery outcomes, gestational age, birth weight, APGAR scores, NICU admission, and NOWS outcomes (diagnosis, pharmacologic treatment, total hospital length of stay). Maternal demographics were also compared between all participants.

The infants born to women taking naltrexone showed no withdrawal symptoms during their initial hospitalization, compared to 92% of infants born to women taking buprenorphine. Of infants with withdrawal symptoms, 46% required medication.

Another important finding in the study was that women taking naltrexone received prenatal care later during their pregnancies than women taking buprenorphine, suggesting that patients and/or providers are not clear on its safety during pregnancy.

According to Elisha Wachman, MD, a neonatologist at Boston Medical College, the preliminary study outcomes are promising and support the need for a larger study examining the long-term maternal and child safety and efficacy outcomes of naltrexone during pregnancy.

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Researchers find controversial results after investigating opioid use, misuse after ED visit

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It is almost universally agreed that opioid prescription in the emergency department (ED) is risky, largely because of the risk of abuse. The results of a recent study suggest the risk of long-term prescription opioid use and potential misuse stemming from ED prescriptions for opioids to treat acute pain is less than some might expect.

When looking at long-term prescription opioid use, most research uses retrospective studies based on the information on filled opioid prescriptions obtained from government databases.

While the studies provide helpful information on the number of opioids prescriptions filled, they cannot determine if the patients ever consumed the opioid. The research also cannot differentiate if the patients used the opioids for new pain or for chronic pain, and if the patients misused the opioids.

Lead author of the study, Raoul Daoust, MD, MSc, and his team wanted to assess opioid use rate and the reasons patients continue to consume opioids three months after discharge from the emergency department with an opioid prescription. They found that opioid use was relatively low three months after discharge from the ED with an opioid prescription.

The researchers conducted the prospective cohort study of 1,316 patients aged 18 years who went to the emergency department of a tertiary care urban center for an acute pain condition. The team followed up by phone with the patients three months after the ED visit and asked about the patients’ opioid consumption in the previous two-week period.

The researchers also inquired about their reasons for consuming opioids for pain related to the initial ED visit, for new and unrelated pain, or for another reason.

Mean age of the participants was 51 years; 47% were female. Mean pain intensity at triage was 7.7, decreasing to 5.2 by discharge from the ED. At discharge from the emergency department, patients received a prescription for a median of 30 tablets of 5 mg of morphine or its equivalent. 94% of patients filled the prescription and 79% consumed opioids during the first two weeks following the ED visit.

Of the 524 study participants questioned at three months, 9% of the patients still used opioids three months after discharge from the ED with an acute pain condition. Of those that continued to use opioids, 91% did so to manage pain — 72% to control initial pain, 19% to manage new pain unrelated to the ED visit, and 9% for another reason.

The researchers also found that participants who used opioids in the two weeks following the ED visit were 3.8 times more likely to consume the painkillers at three months.

The researchers published the results of their study in the August 2019 issue of the journal of the Society for Academic Emergency Medicine (SAEM), Academic Emergency Medicine (AEM).

The Results are Controversial

Most notably, less than 1% consumed opioids for reasons other than pain, suggesting a low level of opioid misuse among patients 3 months after an ED visit.

The results of the study are controversial because they undermine the widely accepted theory that all opioid prescribing — whether for acute pain or chronic pain — is risky.

“The clear and present applied implication for research from Daoust et al is the need to test non-narcotic methods to treat acute pain. The more theoretical research implication is the need to better understand the neurobiology that drives the conversion of acute to chronic pain,” said Jeffrey A. Kline, AEM Editor-in-Chief.

Critics also question the author’s methodology. Gail D’Onofrio, MD, a professor of emergency medicine and chair in the department of emergency medicine at Yale University, says, “Emergency physicians should not be reassured by the authors’ findings. The lack of a denominator, poor response rate (56%), and applied definition of misuse are significant limitations. Shah et al (MMWR 2017) demonstrated the escalating probability of continued opioid use among opioid-naïve patients at one and three year if greater than three days were prescribed.”

Daoust is a clinical professor and researcher in the Department of Family Medicine and Emergency Medicine at the University of Montreal. He is known internationally for his work in alcohol and substance use disorders. He has developed and tested interventions for opioids, alcohol and other substance abuse disorders, and has served as a principal investigator on a number of large National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and Substance Abuse and Mental Health Services Administration (SAMHSA) studies.

Dr. D’Onofrio is also a founding board member of the Board of Addiction Medicine, which the American Board of Specialties has recently recognized as a subspecialty.

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Exercise can help relieve depression

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In her TED Talk, “The brain changing benefits of exercise,” Dr. Wendy Suzuki, neuroscientist and author of the book, “Healthy Brain, Happy Life” says, “Exercise is the most transformative thing you can do for your brain.”

Moving our bodies helps our mood. It’s akin to taking an internal shower. Getting the blood moving flushes out our systems and brings oxygen to our muscles and organs, providing us with detoxifying benefits and endorphins.

This connection between exercise and mood is especially important given that approximately 17% of people in the U.S. will suffer at least one major depressive episode during their lifetime.

And yet, for many, telling someone to exercise may seem like it’s minimizing the seriousness of the symptoms; however, for many with mild to moderate depression, exercise offers one easily accessible and affordable way to ease suffering.

This is not new information. Studies dating back as far as 1981 have shown that exercise plays a role in improving the symptoms of depression. What’s troubling is that even with the popularity of yoga, High Intensity Interval Training (HIIT), spin classes and so on, the U.S. Department of Health and Human Services reports that, “less than 5% of adults participate in 30 minutes of physical activity each day and only one in three adults receive the recommended amount of physical activity each week.”

Our electronic age has resulted in far more sedentary behavior than previous generations. Add to that the increased isolation resulting from the dependence on our phones and other devices for social interactions, and it’s no surprise that researchers at Columbia University’s Mailman School of Public Health and the CUNY Graduate School of Public Health and Health Policy are reporting a rise in depression.

The good news is that technology is making it easier to access exercise programs without even having to leave home. There are now thousands of fitness apps on the market and trendy wearable fitness devices. Add to that the growing number of online classes and neighborhood fitness facilities, and there is no good reason not to engage in some form of exercise.

Of course, getting started is the most difficult part. Here are some suggestions to make it easier:

Find a friend or acquaintance to be an exercise buddy.

It’s much more difficult to motivate yourself to exercise all alone. When you know that someone else will be showing up at a class or at a hiking trail or running track, it’s help you stay accountable.

Pick a form of exercise that you enjoy.

Some people love swimming. Others love being outdoors or part of a class that moves to music. See what inspires and excites you. Otherwise, you will find reasons not to do it.

Choose a time of day that works best.

If you’re a morning person, you may enjoy getting your daily dose of fitness done early, and having it set the tone for the rest of your day; or you may prefer to exercise after a day or work to relieve stress and discharge energy.

Lunch time may give you a much-needed break away from your desk, allowing you to return to the remainder of your workday energized and upbeat.

Work with a teacher or trainer.

If you need some extra motivation and attention, taking classes or working with a personal trainer may boost your confidence and help you overcome resistance to stretching beyond what you think is possible. It’s also good to get some help (including discussing options with your doctor) if you’ve recently recovered from an injury or illness.

Sign up for an exercise challenge.

People often offer 21-day and 30-day challenges on Facebook and other social media channels. This can be a fun way to get yourself motivated while having the support of a group of people. It can help jumpstart an exercise program that you will eventually feel motivated to continue on your own.

Set realistic goals.

You may enjoy having a goal such as running a 10-kilometer race or marathon or getting certified as a yoga teacher. While big goals are great motivators, they can also be discouraging if you’re not able to maintain the consistency needed to achieve them.

It’s better to start with smaller goals that you can achieve more quickly such as exercising three times per week or completing an exercise challenge.

No matter what you choose, the important thing is to start. If you currently have symptoms of depression, exercise may improve your mood. If you don’t, regular exercise may prevent you from experiencing depression in the future. Dr. Suzuki says it best, “You can think of exercise as a supercharged 401(k) for your brain. And it’s free!”

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Will AI and robots steal your healthcare job?

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Robots and artificial intelligence are becoming increasingly pervasive in most aspects of 21st-century life, including healthcare, medicine, and nursing. Fears abound that jobs are going to be lost to machines that can do our jobs 24/7 without needing to be paid or call out when the kids are home sick from school.

Are these fears well-founded or are we looking down the wrong tech rabbit hole?

A Digital Pink Slip?

Science fiction often depicts the coming of the robot army as the end of human civilization as we know it. We have deep-seated fears that we’ll be replaced by robots who can outperform us in every way. Some fears are warranted, but many predict that certain jobs simply can’t be appropriately performed by non-humans.

Watch almost any film featuring robots, and you’ll surmise that their evil plan is to send us to the unemployment line — or worse. From a violent takeover of the world to falling in love with a nonphysical AI, Hollywood foments fear to sell tickets.

When it comes to the tech-heavy future of healthcare, it’s not so simple, and we need to remain calm and go about our lives without looking over our shoulders for the robot who hands us a digital pink slip.

What’s the Healthcare Tech Reality?

The reality of healthcare technology in 2019 isn’t necessarily a robot revolution, but things are changing and some concern is understandable.

In Japan, robotics is highly popular; according to Reuters, nursing homes and other facilities offering care for the elderly employ numerous robotic technologies. A Japanese robot can lead exercise classes, and a furry robot seal offers comfort to the bed-bound. Japanese society is experiencing a massive shortage of young people, so turning to AI makes sense.

In the U.S., the most widely accepted robot among nurses is the Pyxis, a machine that dispenses and tracks medications — some see it as a digital pharmacist that, like many forms of technology, still needs to be maintained by humans. We’ve also readily accepted robotic surgery wherein the surgeon sits behind a screen and manipulates precision robotic arms.

There is robust journalism on the future of tech-based workforce displacement and job loss, and institutions like MIT are creating these trends as their researchers create the next generation of tech, and even Google is working on a robotic nurse.

Another robotic nurse is Moxi, who completes menial tasks that distract nurses from direct patient care. An article by Fast Company shares the following:

“While Moxi’s job is to take as many mundane tasks as possible off nurses’ plates so that they could spend more time interacting with patients, the Diligent team was surprised to find that patients were fascinated by the robot and wanted to interact with it during their beta trials. Patients ended up being so infatuated with Moxi that they would ask for selfies with the robot; one child even sent Diligent Robotics a letter asking where Moxi lived.

“The robot was so popular that the Diligent team programmed superfluous activities for Moxi to do once an hour so that the robot would wander around the floor and flash heart eyes at people. ‘In between tasks Moxi would make a social lap to talk to her fans,’ Thomaz says. During the trials, Thomaz reports that the nurses and hospital staff had a similarly positive reaction—even from early skeptics. ‘Some nurses were like, ‘It creeps me out a little, I don’t like robots, I’m not into AI,’ Thomaz says.

“But by the end they [were] like, ‘Hey Moxi, hey girl, how’s it going?’ It was dramatic, in a matter of two to three weeks.”

No Turning Back

There is no preventing the exponential growth of technology in most sectors, including healthcare. Some job losses seem certain, and winners and losers will emerge along the way.

When horses were replaced by the steam engine, people panicked; when automation became widespread, many factory workers were displaced. Technology has been changing human society since early humans first carved bones into weapons, tamed fire, or invented the wheel.

Impacts on the 21st-century workforce are unavoidable, and we need political leaders, employers, the media, and savvy citizens to especially ensure that low-wage earners aren’t left in the economic dust. That said, it would behoove highly skilled healthcare workers to listen for the coming robot army; some jobs may be in jeopardy, but we can be prepared.

Is the world changing because of technology? Absolutely. Will it change beyond recognition in 50 or 100 years? Likely.

And can we lessen the negative impact of some changes and make sure that skilled human healthcare workers keep their foot in the door? We can if we have the will to understand the true reality and take inspired action in the interest of workers, patients, and society at large.

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New interpretation of public charge rule poses health threat to immigrant groups

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Recent immigrant mass detentions and deportations, including the practice of family separation and detention of children, have been controversial enough. Now, a new interpretation of the public charge rule, based on a provision of the Immigration and Nationality Act, will enact changes that some states claim target poor immigrants of color.

Immigration policy already makes it very prohibitive to become a U.S. citizen without additional rules. Since 2016, the citizenship application wait was an average of 4 to 6 months. Now, it takes up to an average of 10 months to a year.

In major cities, like Atlanta; Washington, D.C; and New York City it can take up to two years. The old public charge rule is being enforced to make it more difficult to achieve legal residency, and states are already challenging this mass green card denial in street protests and lawsuits.

Public charge has been used in immigration law since 1882, when the Chinese Exclusion Act targeted: “…convicts, lunatics, idiots, or any person unable to take care of himself or herself without becoming a public charge.” Given this wording, one can imagine how wide the net is here.

Predictably, it was used then to discriminate against single mothers and working-class people.

It is now being employed to further the Trump administration’s immigration policy goals, which have been controversial since Trump announced he would build a border wall and make Mexico pay for it.

According to the National Immigration Law Center, public charge has been applied in two ways: “(1) when a person applies to enter the U.S. or (2) when a person applies to adjust immigration status to become a lawful permanent resident (to get a green card). You apply for a visa or green card by submitting information on a form. Using the information from that form and from the interview that follows, the government decides if you are likely to become a public charge.”

With this expansion, public charge includes any noncitizen resident/worker who seeks permanent legal citizenship and may rely on Medicaid, housing, vouchers, and food stamps.

But it goes even further. The law also includes noncitizen residents who have ever used the programs. Will they go into old government records to search for people who once used these programs as an excuse to deny permanent citizenship?

In June 2018, the Department of Health and Human Services (HHS), which handles children’s detention, started sharing fingerprint submissions, “background checks, proofs of income and home visits” directly with Immigration Customs and Enforcement (ICE).

Does the public charge rule open up grounds for HHS to collaborate more directly with ICE in a broader capacity? Is the agency tasked with overseeing essential health services poised to become an agency along the lines of ICE or the Department of Homeland Security?

The Kaiser Family Foundation reports that: “The rule will likely increase confusion and fear broadly across immigrant families about using public programs for themselves and their children, regardless of whether they are directly affected by the changes.”

There are anywhere from 11 to 22 million noncitizen residents in the U.S. Many may experience poverty due to financial hardships in their native countries (frequently the reason they leave in the first place.)

They also have a difficult time getting housing and jobs because they cannot use proper documentation. There’s even the health toll of migration itself — especially for people crossing the weaponized U.S. border from Mexico and Central and South America. This is not to mention the additional mental health stressors resulting from the “confusion and fear” facilitated by the HHS and other noncombat-style government agencies.

The new rule considers noncash benefits and uses factors such as “age, health, household size, income, assets, debts and education and skill levels” to determine citizenship eligibility. These criteria add an additional speculative dimension to the rule, leaving it open to charges of profiling and wild bias.

California, Maine, Pennsylvania, Oregon, and D.C. are seeking an injunction to halt the rule, stating that the rule unfairly targets: “marginalized populations, such as children, students, individuals with disabilities, older adults, and low-wage working families.”

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5 ways to reduce alarm fatigue at your hospital

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Working at a hospital, you know that alarms on monitoring equipment in your ICU, step-down unit and general wards are a major challenge for your staff and patients. When false alarms happen, patients panic unnecessarily and staff become desensitized, increasing the chance of a missed emergency.

The noise pollution can fray nerves and keep patients from resting so they can heal faster. Stumped as to how to handle this issue? Science can offer you innovative answers.

Try implementing these pieces of research-driven advice to ease strain and make your wards more peaceful:

Make sure alarms are checked out promptly.

A study from the Acoustical Society of America found in a survey of patient experiences that 90% of clinical alarms went unanswered at bedsides. Make a mandatory policy that staff members in each ward use a time-sensitive system to check every alarm for patient safely.

If staff members are busy, work out a relay system so there’s always someone available to get to a bedside quickly.

Fix faulty equipment immediately.

This should be a no-brainer, but the Acoustical Society of America study also found that there are, on average, an astonishing 8 million alarm errors in hospitals per day.

Make sure malfunctioning equipment is not adversely affecting your patients in any way. Reprogram or replace the items immediately.

Use daily patient assessments to cut back on use.

Researchers at Cincinnati Children’s Hospital report that daily assessments of patient needs can help desensitize caregivers to alarms, either by safely allowing for patients to be taken off monitoring or by pinpointing an increased need to pay immediate attention if an alarm goes off for specific patients.

Keep team members in the loop regarding patients’ changing needs throughout each day.

Tailor alarms to each patient’s needs.

A study from the University of California, San Francisco found that 2.5 million alarms went off in one surveyed hospital in a single month. That prevalence of alarms can lead to patients experiencing anxiety and depression. In cardiac patients, it can cause small changes that could be responsible for ignoring a life-threatening heart rhythm crisis.

Tailoring alarms specifically to a patient’s condition, especially for cardiac patients, can alleviate these concerns dramatically. Work with your cardiology teams to facilitate this and ask your doctors to clearly explain why alarms will go off and in what situations.

Decrease “warning” alarms audibly.

A study from Boston University Medical Center found that differentiating between “warning” alarms and “crisis” alarms can decrease noise in hospitals can decrease audible noise significantly.

“Crisis” alarms should be audible and responded to instantly, while “warning” alarms can be programmed to sound different and can be rigged to be silent but viewed immediately at the nurses’ station.

Warning alarms should never be ignored — but they can be responded to more efficiency using this kind of strategy. Patient safety is always your first priority — deliver it as calmly and promptly as you can in all situations.

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