Tag Archives: Pharmacy

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What’s next for association health plans after federal judge’s ruling?

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U.S. District Court Judge John D. Bates found that the Department of Labor’s issuance of a final rule last June 19 that lets groups of small businesses offer association health plans (AHPs), are “clearly an end-run” around the 2010 Affordable Care Act’s consumer protections that became law under President Obama. Kev Coleman, president and founder of AssociationHealthPlans.com, disputes Judge Bates’ ruling.

“The new study on chamber of commerce association health plans painfully illustrates the insurance gains that will be lost to small businesses if the recent court ruling is not overturned,” Coleman said in a prepared statement. “Should the ruling stand, we will return to the prior unfair system where large companies will pay less than small companies for the same health benefits.”

The study, “Chamber of Commerce Association Health Plans Building Political Bridges While Refuting Opposition,” finds, in part, that: “Through the new Department of Labor regulation, the same large company insurance model that already covers roughly 95 million Americans was made available to small businesses through associations. This change has been a matter of market access. The definition and rules related to large company health insurance have not changed. Instead, the playing field between small companies and large companies was leveled with respect to health insurance costs.”

An improved and more level field of play between large and small companies regarding the prices of health insurance is less than meets the eye, though, according to David I. Levine, a professor of law at University of California Hastings, where he teaches civil litigation and remedies.

“It looks as if the federal judge was on very solid legal ground in rejecting the labor department regulations,” he told MultiBriefs via email. “If the administration wants to make the necessary changes to allow these plans, the changes must be done through legislation approved by Congress.”

That branch of government, not the White House, must deliberate and legislate AHP changes.

Anthony Wright, head of Health Access California, a statewide healthcare consumer advocacy coalition, also agrees with Judge Bates’ action. “In California, we have already banned so-called short-term plans and have put strong standards for association health plans,” Wright told MultiBriefs in an email interview, “but it benefits our whole health system to prevent these junk plans at the federal level. These substandard plans not only trap people in junk insurance that may not cover them when they need it, but also destabilize the overall market and raise premiums for the rest of us.”

America’s Health Insurance Plans (AHIP), a political advocacy and national trade association, declined a MultiBriefs request to comment on Judge Bates’ recent ruling. However, after the DOL finalized its AHP rule in June 2018, the AHIP did comment on possible outcomes.

“We remain concerned that broadly expanding the use of AHPs may lead to higher premiums for consumers who depend on the individual or small group market for their coverage,” Kristine Grow, AHIP senior vice president of communications, said in a statement.

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Are e-consults right for your practice?

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Studies show that referring a patient to a specialist can often be a stressful and time-consuming enterprise for a primary care physician. Not only does that PCP have to identify the correct doctor to refer to, he or she must then set up a meeting in many cases to discuss the patient’s case.

What’s the latest high-tech solution to save this kind of effort and energy? Electronic consultations, often called e-consults or e-referrals. The process works this way: a PCP who needs to ask a specialist about a specific patient’s care — such as a symptom that needs to be discussed or further info about testing — emails a specialist. Then, the PCP and specialist discuss the patient’s situation through messages.

Often, the process cuts the need for a patient to even see a specialist altogether. The electronic ease by which PCP and the specialist cooperate helps foster better communication, according to research from Brigham and Women’s Hospital, Harvard Medical School, and Massachusetts General Hospital.

Implementing an e-consult system into a practice works as described in research from San Francisco General Hospital and the RAND Corporation: A doctor submits a referral request to a specialist through a predesigned web-based program or service, often embedded in the doctor’s overall electronic health record system.

The doctor then enters a consult question in free text format. A designated specialist then reviews and responds to each referral request directly. The system can eliminate inappropriate referrals, move urgent cases more quickly, and assure a complete primary care work-up before a patient even schedules a specialist appointment.

Are e-consults right for your practice? Consider the following possible benefits:

  • Specialist costs for patients lacking insurance can be eliminated completely.
  • You can take more Medicaid patients into your practice; this allows these patients more comprehensive complete care. Previously, they may have not had sufficient access to specialists.
  • Travel time and costs will be less for patients who live at a distance from a specialist’s office you would normally refer them to.
  • Waiting times will be cut for patients who do need to be seen by specialists, since you as their PCP and the specialists you consult can communicate easily prior to the visit. Also, less prep time is needed for patient appointments.
  • You’ll enjoy expanded efficiency in your office — e-consults can allow doctors to preserve more time during their workdays.
  • High satisfaction. Research reviews have shown both doctors and patients find the e-consult process medically accurate and very convenient.

Practice size is not a factor when it comes to using e-consults, although practices with larger populations can benefit more expansively from the process.

Interested in trying the idea out? Talk to your organization’s administration — and ask your patients if they like the idea. E-consults can be a great way to streamline a key medical process when implemented correctly.

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Tips to help your staff prevent patient data breaches

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As a hospital administrator, you know how important it is to reduce any risk of a patient health information (PHI) data breach. Yet, breaches continue to be a vexing and dangerous problem.

A study from Michigan State University found that about 1,800 large data breaches over the course of seven years had to do with lax hospital policies putting information at risk. How can you best assist your staff and your IT to secure the data at your organization?

Let this research-based advice be your guide:

Monitor unintentional mistakes.

A second Michigan State study determined that half of the recent PHI breaches at U.S. hospitals were not caused by hackers; instead, they happened because of internal issues, often because employees were simply unaware that things they did were putting data at risk.

Behavior such as transferring PHI to personal devices, mistakenly sending protected info to the wrong parties via email and disclosing PHI without knowing how to seek the proper authorization are common ways employees contributed to breaches.

Ask your department managers to review employee behavior, and then work consistently to emphasize procedural do’s and don’ts whenever their workers handle sensitive data.

Provide more options for compliance.

Research from Washington State University found that when employees are given options as to how they can make the info they handle more secure, they do a much better job at locking that information down in a company system.

The researchers recommend avoiding cold, commanding language when issuing security messages. Instead, you should give options about different ways to choose passwords or carry out existing safeguard tasks in a conversational way. When employees think they are collaborating to make a difference, they stay on top of data protection much more stringently.

Break bad habits.

Employees can become desensitized to signs of email phishing over time — including phishing scams targeting critical PHI. Your staff members may not be picking up on clues that indicate an email is suspicious if they are distracted by multitasking.

Stress the importance of being completely focused on the red flags of suspicious emails by setting aside specific times per hour to check email, rather than doing so constantly when focus may be split.

Make security training a monthly mandate.

Up the frequency of your training workshops and refresher courses for each of your departments. Make sure the info you’re providing your workers is completely up-to-date and useful by conferring regularly with your IT managers.

Do your own homework.

Read up regularly on innovative technology regarding hospital data protection and alert your hospital CEO to updates you feel should be implemented within your organization. Being as personally proactive as you can in terms of PHI protection knowledge is the best way to stop breaches before they happen.

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Growing the muscles of communication in healthcare

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In most every aspect of healthcare, communication is key to positive patient outcomes, stellar teamwork, and the seamless operation of organizations and facilities of every size and type.

A Tower of Babel scenario in a healthcare-related circumstance is never acceptable; thus, excellent communication must be at the forefront of the education of healthcare providers and serve as a central pillar of any high-functioning institution.

How, why, and when we grow our individual and collective muscles of discourse and conversation are of utmost importance. If you, your colleagues, your leaders, or your employing institution itself are lacking in this regard, it’s not too late to change that calculus for the better.

Why Communication Matters

For nurses, physicians, case managers, executives, and other members of the healthcare team, having high-level communication skills is paramount, although many may fall short in this regard. Your ability to communicate with compassion, clarity, and coherence is essential, as is your colleagues’ abilities to do the same.

Communication is like rocket fuel for the engine of healthcare delivery — when it’s practiced well, everyone benefits, not just patients. Communication within the healthcare milieu can occur in many forms, including but not limited to:

  • Nurse-patient relationships
  • Doctor-patient relationships
  • Staff members’ relationships with one another
  • Communication between executive leadership, management, and staff
  • Institutional communication with the general public and surrounding communities
  • Inter-facility relationships
  • Cooperation and conversation within and between teams

Casual conversations occur over lunch, in the hallway, at the water fountain, and in the parking lot. In the clinical setting, urgent transmission of key information occurs during a code, in the emergency room, and any other situation requiring the flawless conveyance of crucial data, orders, and feedback.

For patients, being educated well about their symptoms, disease processes, and treatment options could not be more important. If you hear a patient complain about their healthcare experiences, it’s sadly not a surprise if they explain how they’d been left in the dark about some aspect of their care — this is unacceptable for any possible reason and no excuses can possibly hold water.

Learning Communication Skills

When they’re lacking or could be taken up a few notches, communication skills can be taught and learned in a variety of settings. Individuals, teams, and entire institutions can choose to up-level their communication skills — all it takes is the will to make it happen and securing the best method for such important learning experiences.

Medical improv” is growing in popularity as a strategy for teaching communication and listening skills, and there are a number of instructors and consultants who bring these instructional programs to medical schools, organizations, and hospitals.

Rather than being based on comedy improv like we see at clubs and on television, these are improv-based exercises that help healthcare professionals learn new skills, practice them in a safe environment, and receive and give feedback to one another in real time.

Additionally, online courses in communication are ubiquitous, as are books, audiobooks, podcasts, and other platforms.

Communication skills can be learned individually, in groups, and as a facilitywide initiative. For healthcare executives and leaders who wish to spearhead such endeavors, “walking your talk” and practicing what you preach is essential; rather than making a top-down edict about improving communication, we can lead by example and model the behavior we wish to see in the larger employee population.

Communication Leads to Success

When nurses and physicians have more effective conversations, care is streamlined and cohesive. When patients understand the education being provided to them, outcomes and adherence are improved. High-level inter- and intra-team communication are essential ingredients for success.

When healthcare institutions choose to communicate well with the surrounding community, alliances and partnerships can be formed while trust is simultaneously engendered.

As mentioned above, communication is like fuel for the engine of healthcare delivery, and the higher the quality the fuel, the more efficient and effective the engine. It’s a simple formula: improve communication on all levels, walk your talk, and watch the results roll in.

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What do elder care, robots and Japan have in common?

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While there is no shortage of attempts to stop or reverse it, we are all still aging. This year, for the first time in our history, there will be more of us over 65 than under 5 years old.

This demographic shift, combined with our increasing longevity, will continue to exacerbate the disparities between the elderly population and those available to care for them. Japan is at the forefront of this new world; providing lessons for us all to consider.

Relatable challenges

Two key concepts are critical to understanding the situation an increasing number of countries, including the U.S., are facing: demographic transition and dependency ratio. According to Population Reference Bureau (PRB), the first describes the long-term shift in birth and death rates.

For example, Japan and most countries in Europe are in what PRB identifies as the third phase, which is low levels of both fertility and mortality. A major implication of this being a shrinking working population and an increasing elderly population.

The second concept, dependency ratio reflects the relationship between the number of those who need care (children or elderly) and those who can provide care. In this case, Japan has a high elderly dependency ratio.

In addition to Japan’s aging workforce and increasing elderly population, its immigration laws, and language barriers are limiting its ability to supplement its shrinking workforce with skilled labor from other countries.

Domo arigato

These issues related to an increase in the aging population and a decrease in the labor pool able to care for them will become more common in more countries. Technology may provide some solutions and Japan is at the forefront of exploring these options.

Current real-world experiments to use robots for eldercare fall into the following categories, as outlined in this graphic by Reuters: lifting, moving, monitoring and entertainment and companionship.

While no one believes robots will replace the need for humans in caring for the elderly, robots and other technologies can address a significant number of tasks that then free up healthcare specialists to provide more specific, complicated, or individualized support.

Consider the tools we have now that already allow us to remotely monitor patients; conduct virtual video visits; alert emergency services; clean the floor; and order groceries. None of these options were available a generation ago. At the pace of technological development, we can expect even more advances within the next generation.

To infinity… and beyond!

As leaders, what can we do today to prepare for tomorrow? In addition to recognizing the significant demographic shifts around the world and keeping an eye on the tech pioneers making the link between robots and healthcare, those in the healthcare industry can stay ahead of the curve by thinking outside traditional solutions for opportunities to solve care problems.

In other words, cross-functional teams can work together to ensure we are maximizing the technology we already have, like video calling, email, and document sharing to provide care solutions instead of just addressing operational productivity. HR can begin to understand and plan for labor shortages by creating career pipelines that attract and grow new talent as well as draw from national and international sources. Leaders at all levels can support and embrace opportunities to participate in innovative professional development that embraces new technologies, like virtual reality.

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Common pain relievers may promote C. difficile

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A 2015 study by the Centers for Disease Control found that Clostridioides difficile (C. diff), a bacterium that causes inflammation, caused almost 500,000 infections among patients in the United States in a single year.

C. diff is the most commonly diagnosed cause of antibiotic-associated diarrhea and has surpassed methicillin-resistant Staphylococcus aureus (MRSA) as the most common healthcare-associated infection in many U.S. hospitals. Healthcare costs attributed to C. diff infections can reach nearly $5 billion each year.

This hardy type of bacteria is very difficult to treat. An estimated 15,000 deaths are directly attributable to C. diff infections, making it a substantial cause of infectious disease death, with most deaths occurring among people age 65 years or older.

Commonly occurring in older hospitalized adults after the use of antibiotic medications, C. diff affects the normal flora of the gut. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce fever, also promote C. diff infection.

David Aronoff, a microbiologist and infectious diseases expert at Vanderbilt University in Nashville, and researchers from the University of Michigan and the University of Arizona conducted a study with mice that they infected with C. diff.

They divided the mice into two groups and treated one group with an NSAID (indomethacin) before infection. At the end of the observation period, about 20 percent of the mice in the treatment group were still alive; about 80 percent of the group that did not receive the NSAID had also survived.

Aronoff and his team determined that even brief exposure to the NSAID before C. diff inoculation increased the severity of infections and shortened survival. Further cellular and genetic analyses revealed that the NSAID exposure altered the gut microbiota and depleted the production of prostaglandins, which play an important role in gastrointestinal health.

Those observations align with previous studies reporting that NSAIDs can cause or exacerbate inflammatory diseases such as colitis, also by inhibiting the body’s production of prostaglandins.

In this new study, the researchers concluded that NSAID-driven changes worsened C. diff infections by impairing epithelial cells and disturbing the normal immune response. Although the team studied the impact of only one NSAID, indomethacin, these findings might extend to other common NSAIDs, including ibuprofen and aspirin since they all have roughly the same biological mechanism.

Experts agree that C. diff infections are on the rise and are becoming increasingly difficult to treat, which may encourage researchers to find new and better ways of targeting such a stubborn bacterium.

According to Aronoff, although it’s too early for the results of this study to guide clinical care, the results might guide how people with C. diff are treated, particularly with pain management, as well as encourage future studies.

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Evidence continues to show that youth e-cigarette use is growing

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Yet another survey is demonstrating that teenagers are adopting the use of electronic cigarettes at an alarming rate. One of the latest, released in December 2018, is called “Monitoring the Future.” It was administered by the University of Michigan and was given to 14,000 eighth-, 10th and 12th-graders across the United States.

Other risk behaviors monitored in the survey, such as opioid use, binge drinking, and conventional cigarette use, either remained level or declined. The use of nicotine vaping products showed the largest and most significant increase in any category since the survey began in 1975.

Electronic cigarettes are marketed as a smoking cessation aid, but with the numbers of teens adopting their use, they are potentially doing more harm than good. There has been a considerable amount of evidence over the years that these products are attractive to adolescents and teens.

This latest survey shows an increase in usage from 11 percent to 21 percent among twelfth-graders in the past year and an increase from 8 percent usage to 16 percent among 10th-graders.

“Vaping is reversing hard-fought declines in the number of adolescents who use nicotine,” said Richard Miech, the lead author and principal investigator of the study. “These results suggest that vaping is leading youth into nicotine use and nicotine addiction, not away from it.”

Miech went on to comment, “Vaping is making substantial inroads among adolescents, no matter the substance vaped. In 2018 we saw substantial increases in vaping across all substances, including nicotine, marijuana, and adolescents who reported vaping ‘just flavoring.’ Factors that make vaping so attractive to youth include its novelty and the easy concealability of the latest vaping devices, which better allows youth to vape without adults knowing about it. If we want to prevent youth from using drugs, including nicotine, vaping will warrant special attention in terms of policy, education campaigns, and prevention programs in the coming years.”

There was a near doubling of the use of vaping for marijuana products in all age groups. Twelfth-graders’ usage went from 4.9 to 7.5 percent; 10th-graders from 4.3 to 7.0 percent; and eighth-graders rate increased from 1.6 to 2.6 percent.

Efforts to regulate the marketing and sales of electronic cigarettes seem to have fallen short. Further, there are an increasing number of products, both nicotine and marijuana, that are what appeal to youth.

Research shows that it is not just the drug that is appealing but the sweeter flavorings that enhance the pleasure and create a greater enjoyment of nicotine vapes for those who would otherwise not respond positively. The use of flavoring in marijuana vape products attracts younger, teen and adolescent user populations.

Nicotine and marijuana are harmful to developing brains, vascular systems and lungs. Much more needs to be done to prevent the lifelong health, work and social difficulties that the vulnerable youth population will suffer with the use of electronic cigarettes.

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