 |
MGH Community News |
|
MGH Community News |
| March 2019 | Volume 23 • Issue 3 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Elena Chace, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
After Deaths and Injuries, Nursing Homes Agree to Penalties, Closures in State Settlement Attorney General Maura Healey reached settlements with seven Massachusetts nursing homes after deaths and allegations of poor care at some facilities. In one case, an operator must leave the state for the next seven years. Five patients died as the result of poor care, state officials said, and hundreds more were put at risk. The settlements include Oxford Rehabilitation & Healthcare Center in Haverhill, Woodbriar Health Center in Wilmington, Wakefield Center in Wakefield, The Rehabilitation & Nursing Center at Everett, Beaumont Rehabilitation & Skilled Nursing Center in Westborough, Braemoor Health Center in Brockton and Jewish Nursing Home of Longmeadow. The facilities will subsequently submit to monitoring, and have agreed to pay approximately $500,000 in penalties. Healey said the settlements send a message to the 400 nursing home facilities in the state, which care for 45,000 people, and ensure that long-term care facilities are providing quality care. The majority of the settlement payments will go to a fund administered by the state Department of Public Health to improve safety and quality in nursing facilities. The department has already worked over the last three years to increase inspections and hire more staff, as well as improving its website, and new funding would continue that work, said Monica Bharel, the public health commissioner. Synergy Health Centers, the operator of Woodbriar Health Center in Wilmington and Braemoor Health Center in Brockton, and its two owners, Avi Lipschutz and Dov Newmark, won't participate in state or federal health care programs in Massachusetts for the next seven years, according to Healey's office. Woodbriar is in the process of being sold and Braemoor Health Center is closed. Senior advocates said legislative changes were needed to increase funding to nursing homes and spending on education for nursing home employees, according to Ernie Corrigan, a spokesman with the Massachusetts Senior Care Association. -See the full Boston Business Journal article.
|
Quincy Center for Compassion to Close After Four Decades A Quincy organization that has provided a 24-hour crisis hotline, a traveling food pantry and a residential educational program for struggling families will close its doors next month after four decades. The Esther R. Sanger Center for Compassion will close on April 30 under a significant financial deficit. The organization announced the closing in a letter sent this month by board of directors Chairman Jeremy Scott, Executive Director the Rev. Herbert Newell and Program Director David Wooster. The center for decades has worked to meet the needs of disenfranchised and marginalized residents of the South Shore. It operates the Quincy Crisis Center and a 24-hour hotline for those seeking help and runs a pantry that delivers food to more than 1,300 elderly and disabled residents and those who can’t access other pantries. It also operated the Mary-Martha Learning Center in Hingham, where women and children who would otherwise be homeless were provided training and services. The center closed in 2010 as the Sanger Center struggled financially, having served more than 800 homeless families in the 25 years it was open. Wooster, the program director, said the agency serves about 2,400 people and delivers 125 tons of food each year. In 2014, the Sanger Center became an affiliated subsidiary of Friends of the Homeless of the South Shore. The two agencies had worked together on various projects, and the merger was intended to strengthen both agencies, reduce administrative costs and improve fundraising and service capabilities. The Rev. Newell became executive director of both agencies, which shared a governing board and staff. But the financial situation did not improve, which Scott said led to this “very difficult decision” by the board of directors. -See the full Patriot Ledger article. -Thanks to Melissa Alao for sharing this sad news.
ICE made more than 100 arrests at Massachusetts courthouses in the past year Lawyers for Civil Rights, has tracked more than 100 arrests in the past year by Immigration and Customs Enforcement at local courthouses. Espinoza-Madrigal says ICE activity is deterring victims of domestic violence and other crimes from coming forward. And it’s impacting witnesses cooperating with prosecutors. “This is a growing and persistent problem that prevents access to justice,” said Espinoza-Madrigal, executive director of Lawyers for Civil Rights. A memorandum released this week by District Attorney Rachael Rollins attempts to address concerns about ICE arrests in Suffolk County courthouses. Several attorneys and advocates, including Espinoza-Madrigal, welcomed the guidelines but said some details remain unclear. One the top questions is what exactly will the District Attorney’s Office do the next time ICE arrests someone inside the courthouse, and how the federal agency will react.
In her memo, Rollins asked assistant district attorneys, witness advocates or other employees to notify her if they see ICE agents arresting people scheduled to appear in court or asking them about their immigration status. The memorandum did not elaborate on how the office would react if ICE agents are seen making arrests or interrogating people in local courthouses. Nor does the memo appear to stop ICE agents from monitoring people in or around courtrooms or making arrests outside of the buildings.
Immigration authorities say courthouses are fair game — unlike schools, churches or other places ICE considers “sensitive locations” — and that it’s safer for agents to make an arrest in a place that screens civilians for weapons. -See the full MassLive article.
New Reports Paint Dismal Picture of Care at VA Nursing Homes Nine months after USA Today and The Boston Globe reported that veterans received substandard care at many Department of Veterans Affairs nursing homes, newly released inspection reports paint a discouraging picture of the care that sick and frail veterans continued to receive at these federal nursing homes. From April through December 2018, outside inspectors found deficiencies that caused “actual harm” to veterans at 52 out of the 99 VA nursing homes they reviewed. In three facilities, they found veterans’ health or safety in “immediate jeopardy.” In eight, inspectors found veterans both harmed and in jeopardy. Inspectors found that staff at more than two dozen VA nursing homes, including in Brockton, Bedford, and Cincinnati, failed to take steps to ensure existing bedsores healed or new ones didn’t develop. Bedsores are “almost always preventable, and quickly treatable,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a New York-based nonprofit advocate of nursing home care improvement. said. “So there’s just no excuse.” The inspection results were made public nearly a year after the Globe and USA Today disclosed that the VA possessed the reports as well as the results of a star-based rating system for VA nursing homes. The reports’ release provides valuable information for the 41,000 elderly and infirm veterans who stay in the homes each year, as well as for their families. “The results of these independent inspections show that serious deficiencies in care remain at VA nursing homes in Brockton and Bedford, among others,” said Senator Elizabeth Warren of Massachusetts. “We must keep conducting rigorous oversight until performance and quality of care issues are fully addressed and our veterans are receiving excellent care across the board.” Widespread deficiencies Across the country, inspectors found that VA nursing homes failed in one of their most fundamental duties: taking steps to prevent and control infection. At two-thirds of VA nursing homes, they found staff often didn’t follow simple protocols, such as wearing sterile gowns and gloves when treating residents. Reviewers found residents weren’t properly monitored or were subjected to hazardous conditions at more than 50 VA nursing homes. In Bedford, inspectors concluded veterans were in “immediate jeopardy” because a resident with dementia who was physically unable to hold, light, or extinguish a cigarette was allowed to go outside to smoke by himself. And it wasn’t the first time. Previously, he had returned with burn holes in his clothing and on the seat cushion of his wheelchair. In an e-mail to congressional aides earlier this month, Bedford VA director Joan Clifford said that the new findings were better than the last inspection in 2017 because inspectors identified only six problem areas compared to nine the previous year. However, the six remaining deficiencies were serious, including three that caused actual harm or immediate danger to residents. Uneven transparency record Despite the vast public investment in VA nursing homes — more than $3.6 billion in 2018 — the agency until recently had kept the findings of its annual inspections of its nursing homes confidential. The Globe and USA Today revealed last June that the VA had quietly tracked the quality of care at its nursing homes through inspection reports as well as star ratings. Under pressure from the Globe and USA Today, the VA pledged to release the inspection reports. But that did not happen until this month, when the VA posted the reports for 99 of its nursing homes. The agency said in a release that it planned to post the remainder — 35 more reports — by October. The news organizations reported that more than 100 VA nursing homes scored worse than private nursing homes in 2017 in quality ratings. At more than two-thirds of the homes, residents were more likely to have serious bedsores, as well as suffer serious pain. -See the full Boston Globe article.
Robert’s Program – Support for Families Who’ve Experienced Sudden Unexplained Death in Pediatrics Robert’s Program is a clinical service offered to families in Massachusetts who have lost a child under the age of three years suddenly and unexpectedly. We help understand the cause of the child’s death while supporting families through a very difficult time. Based at Boston Children's Hospital, our multidisciplinary team uses the most current medical knowledge about sudden and unexpected death and works to find answers. We contribute to the care of Sudden Unexpected Death in Pediatrics (SUDP) - which encompasses Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Death in Childhood (SUDC). We have a research registry for families living outside of Massachusetts. Our far-reaching program involves clinicians and scientists from the fields of:
Mission Robert’s Program offers clinical care in the aftermath of sudden unexplained deaths while contributing to research that seeks to prevent such deaths. Clinical mission: To provide comprehensive clinical care to families that have suffered the sudden and unexpected death of a child under the age of three due to natural causes, including:
Research Mission: Robert’s Program performs state-of-the-art research into sudden unexpected death in pediatrics to understand fatal underlying vulnerabilities in children and prevent them. For more information please visit Frequently asked Questions. ContactAddress:
Massachusetts Center for Unexpected Infant and Child Death The Massachusetts Center for Unexpected Infant and Child Death supports families, communities, and professionals after an unexpected death during pregnancy, infancy, or early childhood (under the age of 3). The Center's mission is to provide an individualized and compassionate response to bereaved families, offer integrated, meaningful, and professional resources, and help affected families and their communities grieve. Support for bereaved families - If you have experienced the unexpected or sudden death of a child under age three, a stillbirth, or a miscarriage, we would like to offer you the following support. You should not have to feel alone. Available services include bereavement counseling home visits, parent support group, parent-to-parent contact and information and referral. Training- The Center also offers training for therapists, teachers, child care providers, medical providers, first-responders, emergency departments, mental health professionals, home visitors, and related professionals. Training topics can include:
Contact
The Massachusetts Center for Unexpected Infant and Child Death Website: http://www.magriefcenter.org/
Managed Medical Transport- Long-Distance Non-Emergency Medical Transport Managed Medical Transport (MMT) provides long-distance, non-emergency stretcher transportation to and from medical facilities, private residences, nursing homes and retirement centers anywhere in the United States (with a 350 mile minimum). According to informational materials MMT provided to the Department, their personnel can accommodate patients who are on feeding tubes, are incontinent, have oxygen needs, receive breathing treatments or need medication schedules maintained in transit, and “most anything” geared toward non-emergency comfort care. “Before MMT, emergency ambulance services were the only option for people who needed stretcher transportation even if they didn’t need all of the acute medical care available on board.” MMT vehicles themselves are not equipped for emergency intervention, the emphasis is placed on patient comfort and safe transport. Examples of conditions that may benefit from this form of travel:
A family member is welcome to ride along if they wish. ContactTo schedule transportation or inquire about rates, please contact their dispatch center toll free at 1-888-668-4911 -Thanks to Marie Elena Gioiella for forwarding this information.
People with Disabilities are Entitled to a Free Lifetime Pass to National Parks If you or your child has a permanent disability you may be entitled to a free, lifetime pass to visit the National Parks and Federal Recreational Lands. Qualifying disabilities include physical, mental, or sensory impairments. The pass can be used at over 2000 Federal recreation sites across the nation. Those include National Parks, National Wildlife Refuges, National Forests, and other federal recreation lands. It also extends that same privilege to everyone in the vehicle with the pass holder. So, if one person in your family qualifies, you can all visit a park for free with that person’s pass. In order to get a pass you’ll need:
Once your application is processed, you’ll receive a physical card that can be used for park admission. -See the full LifeHacker.com article. -Thanks to Melanie Cohn-Hopwood for sharing this reminder.
MassHealth Adult Dental to Cover Additional Periodontal Services Effective April 22, 2019 The FY 2019 budget directed MassHealth to expand adult dental to include periodontal services by June 1, 2019. The MassHealth Dental Office issued a notice of new rates & periodontal procedure codes for services starting April 22 2019 including for gingivectomy, gingivoplasty, periodontal scaling and root planning. Proposed regs were issued in November 2018 and should be finalized soon. -From March Health Updates, Health-announce listserv on behalf of Vicky Pulos, Mass Law Reform Institute, March 21, 2019.
Medicare Reminder: Medicare Ambulance Coverage and NO Coverage of Chair-Cars
Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by any other means. If your trip is scheduled when your health is not in immediate danger, it is not considered an emergency. Part B covers emergency ambulance services if:
To be eligible for coverage of non-emergency ambulance services, you must:
Note that if you are receiving skilled nursing facility (SNF) care under Part A, most ambulance transportation should be paid for by the SNF. The SNF should not bill Medicare for this service. Under Original Medicare, Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($185 in 2019). All ambulance companies that receive Medicare payments must be participating providers who accept assignment in all cases. If you have a Medicare Advantage Plan, contact your plan to learn about the costs of ambulance transportation. Chair-Car is NOT a Medicare Covered Service Original Medicare never covers the services of ambulettes, wheelchair vans, or litter-vans. These are wheelchair-accessible vans that provide non-emergency transportation. Medicare also does not cover ambulance transportation just because you lack access to alternative transportation.
Medicare Advantage Plans must cover the same services as Original Medicare, and may offer some additional transportation services. Check with your plan to learn about its coverage of non-emergency ambulance transportation.
Why Do People Leave Medicare Advantage for Original Medicare? Researchers have released an analysis of patterns in Medicare showing that people with high needs—like significant chronic illness—and people with both Medicare and Medicaid coverage choose to leave their Medicare Advantage (MA) plans more often than people without similar health issues or Medicaid coverage. The researchers sought to discover why these patterns exist and what the implications might be for MA going forward. While most people with Medicare get their coverage from Original Medicare, some choose Medicare Advantage plans instead. MA plans are private health plans that are paid a fixed amount per person to provide all of the same benefits as Original Medicare. They can also offer some additional benefits, like limited dental and vision coverage, and have an out-of-pocket cap on beneficiary expenses. However, MA plans also have different coverage rules, like requiring enrollees to remain in-network for services. People with Original Medicare can choose any doctor that accepts Medicare. People with MA must choose from the list of doctors that contract with the MA plan. Similarly, though MA plans must cover the same health services as Original Medicare, people with MA may have to pay more for certain services or take additional steps to obtain needed care. For example, an MA plan may require a referrals to see a specialist or require providers to request prior authorization before some services are covered. In studying the patterns around MA enrollment and disenrollment, researchers found that people with Medicare who have complex medical needs or Medicaid coverage are far more likely to leave MA for Original Medicare than beneficiaries who are not covered by Medicaid or who are in better health. Importantly, though high-quality MA plans saw fewer people dropping out in favor of Original Medicare in general, disenrollment rates remained high among both people with complex needs and those with Medicaid eligibility. According to the researchers, this suggests that some aspect of MA plans, especially lower quality plans, may be unattractive to sicker enrollees, and to people with fewer financial resources. The researchers suggest that these unattractive qualities might be the limited networks MA plans offer, driving sicker beneficiaries into Original Medicare where they have a wider choice of doctors. They also suggest that more should be done to ensure that people with complex conditions or Medicaid eligibility get the coverage and care they need within MA. Choosing between MA and Original Medicare can be a complicated decision, and if mismanaged, beneficiaries may end up in coverage that is not the best fit for their unique circumstances. The Medicare Rights Center urges the Administration and Congress to do more to empower people with Medicare to make informed, timely, optimal coverage choices, and to ensure they get the care they need regardless of the coverage pathway they select. -See the full Medicare Rights Center blog post.
Trump’s Budget Proposal Calls for Deep Medicaid Cuts and Adding Work Requirements President Trump released his FY2020 budget proposal this month, calling for deep cuts to Medicaid and adding work requirements for Medicaid beneficiaries in every state. Members of Congress asked Secretary of HHS Alex Azar about these and other cuts to healthcare spending in a series of hearings. His responses did not allay our concerns that the President's vision outlined in the budget proposal would increase poverty and make it harder for older Americans and their families to access health care and meet their basic needs. Justice in Aging, in a statement said: By calling for block grants, caps and cuts to Medicaid on top of cuts to Medicare, Supplemental Security Income, and other critical programs, this proposal would make it harder for older adults to see their doctors, pay rent, put food on the table, and meet their basic needs. By seeking to make the 2017 tax cuts for the wealthiest permanent, the President's budget would worsen inequality, increase disparities, and make life more difficult for poor seniors and their families. -See the full Justice in Aging statement. -Adapted in part from The Week in Health Care Defense, Justice in Aging, March 15, 2019.
Conversion Therapy Bill Lacks Enforcement Mechanisms Massachusetts lawmakers have passed a conversion therapy bill that attempts to shield youths from therapists trying to tamper with their sexual or gender orientation. Assuming Gov. Baker signs the legislation (he has said the ban is “something we’d be inclined to support.”), it’s unclear how it would be implemented. The bill would prohibit licensed therapists from attempting to change the sexual orientation or gender identity of anyone under the age of 18 during treatment. Supporters say the bill is needed to protect minors who may be struggling with their sexual identity. Any provider that violates the law could lose their license and face prosecution for consumer fraud. Opponents say the bill is potentially intrusive in the therapist-client relationship and in many ways is trying to solve a problem that no longer exists. They note mental health professional groups, including the American Psychiatric Association, already condemn conversion therapy. The legislation would not apply to religious groups, which seem to be the most active players in conversion therapy. It’s also unclear how violators would be discovered. A previous version of the bill, which failed to pass last year, required mandatory reporting of violations by teachers, priests, and others, but the current bill has no similar reporting mechanism. It appears to put the onus on the patient to file a complaint against the therapist with the state licensing board online, according to one legislator’s office. Unlike with other states that have previously considered or passed a ban, specific implementation measures and standards that accused therapists will be held to are not explicit. The bill would not cover groups like the Christian-affiliated Recreation Ministries, which regards “homosexual behavior as a sin” and offers to help people impacted by “sexual brokenness.” The organization’s website, which offers meeting times in Massachusetts, does say it will make referrals to licensed mental health professionals for teenagers. Officials at Recreation Ministries could not be reached for comment. Arline Isaacson, the chair of the Massachusetts Gay and Lesbian Political Caucus, said the legislation is intended to prevent therapists from pressuring patients into changing their sexual orientation. “We say it doesn’t matter what form conversion therapy takes,” she said. “A normal, good qualified therapist will talk to you about what you may be experiencing and will not come into the therapy session with a predetermined outcome.” -See the full Commonwealth article.
Lawmakers Vote to Scrap the “Cap on Kids” Legislation that would abolish a Massachusetts rule that denies additional welfare benefits to children born into families already receiving public assistance is once again headed toward Gov. Charlie Baker’s desk. The Senate voted 37-1 on Thursday to lift the so-called Cap on Kids, following a similarly overwhelming vote in the House last week. Under the current rule, also called the “Family Cap” rule, TAFDC recipients do not receive any additional cash benefits if another child is born. The rule was intended to discourage people from having more children while on public assistance, but critics say the policy is outdated and hurts thousands of low-income children. Lawmakers voted last year to lift the cap but Baker vetoed the measure after the legislative session had ended. The Republican said he wanted the change tied to other welfare eligibility reforms. -See the Associated Press article.
Housing Crisis Has MA Seniors in a Squeeze A growing number of seniors in Massachusetts are struggling to keep stable housing over their heads in the twilight of their lives, which is an issue experts say will only worsen over the next couple of decades. The Gerontology Institute at the University of Massachusetts Boston tracks senior living expenses across the country, including individuals and families aged 65 years and older living with incomes above the federal poverty level, but below of true cost of living. Mississippi ranks No. 1 in the nation with the most seniors “living in the gap,” as it’s called, largely because incomes are so low. Massachusetts is No. 2, but for an entirely different reason. “It’s not because income is low, but because the cost of living is so high, and what’s driving that is housing,” said Len Fishman, director of the Gerontology Institute. The housing crisis facing seniors in Massachusetts is unique, multifaceted and has far-reaching repercussions. Limited housing stock coupled with economic growth and a growing population are driving up home prices in the Bay State, which in turn increase property tax bills. The growing costs are especially challenging to moderate- and low-income seniors who own homes and live on fixed incomes. Renters face rent hikes, especially as landlords pay more in taxes, and are enticed to push out renters in order to renovate and increase prices or sell their more valuable homes to the highest bidder. For many, getting pushed out can result in homelessness, which is a growing problem in Massachusetts, and especially taxing on seniors. “A homeless cohort at 55 years old has the geriatric profile in terms of disabilities and other health issues as a housed cohort of 70 to 75,” said Mark Hinderlie, president and CEO of Hearth Inc., a nonprofit focused on fighting elderly homelessness. In past generations, older adults would often look to downsize, especially as children left home. Depending on preference or need, housing options could include independent living, assisted living or nursing homes. But the home-to-senior-housing progression of life has changed in recent years, in part because seniors are living longer. And aging in place, meaning living the rest of life at home, is becoming ever more popular.
The aging in-place attitude is further encouraged by the fact that smaller units at affordable rates are scant. Many communities, including Hyannis, Lexington, Medfield and Taunton, recognize this is a growing issue, and are searching for solutions. But Massachusetts historically has done a bad job building affordable housing. The bad news is that 10,000 baby boomers will enter retirement age each day until 2030, meaning the competition for affordable housing units is growing faster than new units are coming online. The demographics shift and housing constraints, along with the growing desire to age at home, is having a multigenerational effect. This has a domino effect across the ages because seniors can’t put their oversized homes on the market, so younger people are dealing with a supply of housing that is smaller than it would otherwise be. Until about three decades ago, federal subsidized housing for seniors was commonplace in the United States, giving older residents a clearer path to downsizing into something they could afford. Today, nearly one-third of the 4.5 million American seniors who need some type of housing subsidy cannot find one available, and the affordable housing waiting lists can be daunting. “Many organizations’ waiting lists are closed because they’re so long that people who are on them will never make it. They either die first, or find housing elsewhere,” said Fishman. Last month, Republican Gov. Charlie Baker, of Swampscott, announced he would take another shot at passing legislation to make it easier for cities and towns to overhaul local zoning ordinances surrounding housing. A similar effort begun in 2017 by the governor failed to pass the state Legislature, and the state’s housing situation, according to Baker, has only worsened in the two years since. “We’re making a big mistake with respect to the future that we all want if we don’t step up and fix this,” Baker told State House News Service. In Boston, Mayor Martin J. Walsh has turned back the clocks, introducing a local law that would limit landlords’ ability to raise rent on tenants aged 75 years and older by more than 5 percent each year. The proposal would bring back to Boston a form of rent control, which was voted against by all Massachusetts residents in the 1990s, even though it was only allowed in Boston, Brookline and Cambridge. The three communities overwhelmingly supported keeping rent control, but were narrowly defeated largely by voters from other cities and towns. -See the full Wicked Local (Needham) article.
Why the Promise Of Electronic Health Records Has Gone Unfulfilled A decade ago, the U.S. government claimed that ditching paper medical charts for electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, the digital revolution has gone awry, an investigation by Kaiser Health News and Fortune magazine has found. Veteran reporters Fred Schulte of KHN and Erika Fry of Fortune spent months digging into what has happened as a result. (You can read the cover story here.) Here are five takeaways from the investigation. Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other system flaws have piled up for years in government and private repositories. Yet no central database exists to compile and study these incidents to improve safety. Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as "upcoding." And some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software-makers have paid a total of more than $200 million to settle fraud allegations. Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the United States. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical-records software unable to exchange information among one another. Doctor burnout: Many doctors say they spend half their day or more clicking pull-down menus and typing rather than interacting with patients. An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout, which a January report by the Harvard T.H. Chan School of Public Health, the Massachusetts Medical Society and two other organizations called a "public health crisis." Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual "gag clauses" that discourage buyers from speaking out about safety issues and disastrous software installations — and some hospitals fight to withhold records from injured patients or their families. -See the full NPR story.
Surprise Medical Bills: The Doctor is Not in Your Insurance Plan The expectant mother was in labor at South Shore Hospital when she requested a common pain medicine, which was administered by an anesthesiologist. Home with a newborn days later, she was surprised when a bill arrived from the doctor’s group for $2,143.44. Another patient who went to Emerson Hospital’s emergency department for what turned out to be a broken rib also received a surprise bill: $300.91, for the services of the doctor who read the X-ray. Neither of the patients initially knew the reason behind the hefty additional charges, according to complaints they filed with state regulators. They sought care at hospitals that were fully covered by their insurance plans. What they didn’t know was that the two doctors were not — and had billed the patients directly for their services. Getting an out-of-the-blue medical bill — such as when a hospital uses doctors that are outside a patient’s insurance network — has become a nationwide phenomenon. It’s one that has forced exasperated patients to fight with medical providers and insurers at a time when they are already paying for a greater share of their health care. An analysis by the policy commission found that 10,000 Massachusetts patients in just one year may have received surprise bills for so-called out-of-network care, and policy experts believe that figure underestimates the extent of the problem. States are increasingly passing laws to protect patients from these charges, such as limiting the dollar amount of out-of-network fees. Massachusetts legislators last year considered doing just that, but failed to pass a sweeping health care bill by the end of the session. A key legislator said approving stricter rules around out-of-networking billing is a priority this year. A bipartisan group of US senators is also taking up the issue. Over the past two years, about 115 patients have filed formal complaints about surprise medical bills with Massachusetts Attorney General Maura Healey’s office, including the two patients at South Shore and Emerson hospitals, according to a Globe review of the documents obtained through a public records request. Some patients received surprise bills for so-called facility fees, assessed when a patient is treated in an ordinary physician’s office or urgent-care center, but then receives an expensive outpatient bill from the hospital that owns the facility. An investigation by Healey’s office into facility fees charged by Partners HealthCare and its hospitals, including Massachusetts General and Brigham and Women’s, led to a settlement in September requiring Partners to better notify patients of the fees. It’s also not unusual for a hospital to have practitioners working in their facilities who are not covered by all their agreements with insurers, a technicality that is often not apparent to patients. Compounding their exasperation, patients often said that despite repeated calls, hospital and insurance company staff could not — or would not — explain the bills. One person wrote of making 20 phone calls, and many patients said they never received return calls. Some of these complaints may have been resolved after the patient contacted Healey’s office, which tries to mediate disputes. The problem is more pronounced for consumers insured by large national companies such as Aetna, Cigna, and UnitedHealthcare, which contract with most hospitals but not all local physicians’ groups, experts said. Most of the complaints reviewed by the Globe were filed by patients with national insurers. Massachusetts has a consumer protection law that provides some recourse for patients, but health care experts and state legislators believe it should be strengthened. And, it does not apply to self-insured companies, which account for 60 percent of patients with commercial insurance in Massachusetts, and are regulated under federal, not state law. -See the full Boston Globe article.
Their Baby Died During His Nap Then Medical Bureaucrats Deepened the Parents’ Anguish The parents were allowed to hold their baby until the medical examiner’s van arrived. Then, they’d have to hand his body over. So Holly and Eric High did what they could to say goodbye. They huddled in an alcove of the emergency room, cradling James in their arms, kissing him, rubbing his hair. They wished the police officer would stop questioning them. They knew she was trying to be gentle. But now, in these last moments with their son, it couldn’t help feeling like an interrogation. When an infant unexpectedly stops breathing during sleep, the usual bureaucracy of death is multiplied, the paperwork thickened with accusation. Investigations are triggered with the local police, the state police, the agency that checks for child abuse. In some jurisdictions, officials appear soon afterward, asking parents to re-enact what happened, a doll standing in for their baby. The medical examiner or coroner takes the body, to determine a cause of death, looking for hints of “foul play.” These protocols are designed to protect. Often they do. But how an officer or medical examiner carries them out can sharpen the suspicion inherent in any investigation, heightening parents’ self-blame even when there’s no evidence of wrongdoing. As director of a Boston Children’s Hospital program (Roberts Program – see accompanying story) that studies unexpected child deaths, Dr. Richard Goldstein hears such stories all the time. An officer tells parents their house is a crime scene; a state employee says no, you can’t hold your baby, we’re putting him into a body bag. Goldstein knows such lapses in compassion are partially born of confusion. It’s lurked on death certificates for ages, but took a new, more visible turn in the 1980s, with growing evidence that “cot deaths” were rarer when infants slept on their backs. The news traveled through Australian studies and European advisories, eventually bursting out of American radios and TVs in 1994, with a public health campaign called “Back to Sleep.” The rate of “sudden infant death syndrome” plummeted — and kindled that old nemesis of statisticians everywhere, the conflation of risk factor and cause. Americans mistakenly thought that belly sleeping, which can increase a baby’s likelihood of dying, was the clear-cut reason someone’s infant died. The decline was real at first — a triumph attributed largely to “Back to Sleep,” but also to upticks in breastfeeding and prenatal care alongside decreases in teen pregnancy and maternal smoking. Then, toward 2000, the downward slope of SIDS began to coincide with increases in other, similar causes of death. What looked like fewer babies dying, the evidence suggested, was now a trend of tragedies being given other names. The experts all agree: Babies should sleep on their backs, alone, with no soft bedding. That isn’t a cure-all, though. “The predominant messages are, ‘This problem’s solved, you put your baby on their back and nobody dies from SIDS,’” Goldstein said. “But look at James High. No risk factors.” The medical examiner’s office was supposed to refer parents like the Highs to the Massachusetts Center for Unexpected Infant and Child Death (see accompanying story), for free grief support. Parents’ isolation can be intense, explained Shari King, who directs that program. Friends become afraid to say the baby’s name. Some parents, consumed with loss, see their child’s face in the features of strangers. “People need to know they aren’t crazy,” King said. But the Highs heard nothing. Wedged between hospitals and highways, the Massachusetts Office of the Chief Medical Examiner is a squat construction of redbrick and gray, its concrete crumbling at the corners. Outside, ambulance drivers take cigarette breaks as traffic whispers on and off I-93. Inside, the place has been troubled for years: short-staffed, underfunded, backlogged, overwhelmed by the bodies of the opioid crisis. When the last chief retired, the agency was not meeting the national target of finishing 90 percent of autopsy reports within 90 days of examining the cadaver. Then, in October 2017, Dr. Mindy Hull took over the job. By August 2018, she’d met that goal — but not for infants, whose cases tend to be more complex. Sixteen of the 56 baby investigations from 2017 and 23 of the 57 from 2018 were still pending this month, said spokesman Felix Browne. What bereaved parents noticed about Hull’s tenure, besides the wait, was the slashing of support services. When the two licensed social workers employed as family liaisons left, Hull didn’t replace them. Instead, in a January 2018 email to employees, chief of staff Lisa Riccobene said she would handle any “family that is difficult to reason with” — a duty she kept after the Boston Globe revealed, months later, that she’d falsely claimed to have a psychology degree. Hull’s staff stopped meeting with Robert’s Program families and Goldstein. Her office also stopped automatically making referrals to the Center for Unexpected Infant and Child Death; the center’s grief counseling caseload plummeted from 30 or 35 families a year to under 20. Cutting off these referrals, Goldstein worries, will exacerbate a problem that’s already apparent. Sudden unexpected infant deaths are significantly more common in poor, Native American, and black families, but those groups are less likely to get support services. The office does not consider such programs essential, Browne said, and needs fewer liaisons because wait times have decreased overall (though the agency’s pace is now behind the national standard again, the Globe reported this month). The agency, he added, is hiring more doctors and “remains focused on its mission to deliver timely information to citizens of the Commonwealth.” -See the full Statnews.com story.
How to Communicate With Children on Difficult Subjects Such as Death NPR and child development experts behind Sesame Street have teamed up on a parenting podcast. Life Kit For Parents With Sesame Workshop is meant to help adults navigate tough conversations with kids. Here's a sample. In what would become one of Sesame Street's most famous episodes, broadcast on Thanksgiving Day 1983, when show executives knew grown-ups would be home watching with their kids, Big Bird learned that Mister Hooper, who ran Sesame's corner store and lovingly made his birdseed milkshakes, had died.
"Mister Hooper's not coming back," one of the adult cast members, Susan, told Big Bird. All the adults were there, gathered in a semi-circle, exchanging the same pained glances my parents did across our table. What followed is a master class in how to talk with young children about death. My co-host for Life Kit's audio guide Parenting: Difficult Conversations, Anya Kamenetz, and I revisited that episode with Rosemarie Truglio, a developmental psychologist and senior vice president of education and research at Sesame Workshop, and together we distilled it to a handful of useful takeaways for parents. 1. Be honest and concrete. When it comes to describing the what of death to kids — what exactly happens to our bodies and what that means — Truglio says it's important to be straightforward. That's because children often struggle to grasp death's permanence. And parents only complicate matters when, instead of being concrete, they resort to euphemisms. In fairness, we do this to soften the blow for kids, but Truglio says euphemisms can confuse and even scare children Instead, Truglio says, be perfectly clear: "When you die, your heart stops, your body stops working. You don't eat. You don't breathe — to give more concrete information about what is the meaning of death," Truglio says. 2. Take it slowly. Kids process death in bits and pieces, over time, Truglio says. Don't sit them down once, overwhelm them with information and expect them to internalize it all. Parenting a child through death requires patience and persistence. You may explain, clearly and in concrete terms, that Grandma has died and, three days later, be asked, "When's Grandma coming back?" Truglio says a hospice social worker who specialized in talking with children about death once likened this process to the way a child eats an apple: "They take a bite, maybe two bites, then put it down," Truglio says. "That's probably how they're going to experience death as well. They're gonna take a couple of bites. They're gonna go on with their lives. And then they're gonna come back and they're gonna take a couple more bites." 3. It takes a village. Often, the death of a loved one can be destabilizing for a child, not simply because that person will no longer be in their lives but because it can stir deep fears of being alone or abandoned. That's why, Truglio says, when a child is mourning, make sure they know "that there are many people in their lives — there are grandparents, there are aunts, there are uncles, there are some really, really good friends who are like family." In short, Truglio says, kids need to be reassured: "You will always be cared for." 4. Grown-ups, it's OK to cry. That's especially true if you, the parent, are mourning the death of your own parent. Showing emotion and explaining the feelings that underlie those emotions helps prepare children for future moments when you may, again, feel overwhelmed by grief. 5. The funeral rule. One place kids will certainly be exposed to a lot of grown-up emotion is the funeral or memorial service, which is why many parents struggle with whether to bring them at all. When it comes to funerals, Sesame's Truglio has this advice: Give kids a choice. "You should never say, 'You have to do this,' or make them feel guilty if they choose not to participate," Truglio says. "You need to give them that wiggle room. You can't force them." But tell them what to expect, whatever they choose. So, if you're going to a funeral with an open casket, explain what that will mean. Again, be clear and concrete. Then let the child decide if she thinks she's ready for that. 6. Keep the hope alive. Finally, Truglio says, it's important to convey to your child that "life is going to go on. We're going to be OK. It's a tough time right now, but we have things to look forward to." Life Kit is NPR's family of podcasts for navigating your life — everything from your finances to diet and exercise to raising your kids. Look for new podcasts each month. Sign up for the newsletter to learn more and follow @NPRLifeKit on Twitter. Listen to all our Parenting: Difficult Conversations episodes. -See the full WBUR story.
10 Things We Know About Cannabis And Health Editor's Note: The trouble with writing about marijuana these days is that there's both a surfeit of online information on cannabis products and a near-total lack of the type of information considered most reliable for health related products: gold-standard clinical trials, FDA approvals, guidelines from medical societies. Amid that vacuum, I'm glad to rely — as I often do for food facts — on a trusted source: Nutrition Action Healthletter, the flagship publication of the nonprofit Center for Science in the Public Interest. Here, with their permission, is their Senior Nutrition Scientist Caitlin Dow's summary of the (limited) science on pot products. Here are 10 things you should know about cannabis. 1. Don’t confuse THC with CBD. Cannabis plants contain a class of compounds called cannabinoids. “We’ve identified just over 100 of them,” says Daniele Piomelli, professor of anatomy and neurobiology at the University of California, Irvine. The two most abundant: tetrahydrocannabinol (THC) and cannabidiol (CBD). “THC drives the hallmark features of feeling high, like getting the munchies and feeling relaxed, as well as the negative side effects, like feeling paranoid or anxious,” explains Vandrey. (In recent years, marijuana’s potency has soared. In 1980, marijuana averaged about 1 percent THC. In a recent report, marijuana sold at dispensaries averaged 21 percent THC, according to labels.) “CBD can produce drug effects, but it’s not the typical marijuana high,” notes Vandrey. “It’s not intoxicating, and it doesn’t come with THC-like side effects.” Proponents claim that CBD provides relief from anxiety, pain, insomnia and much more. For people who don’t enjoy the typical marijuana high but are looking for something to take the edge off, those claims may be particularly appealing. Hemp oil doesn’t have much CBD unless it’s added, because CBD is found only in hemp’s leaves and flowers (not its seeds). So if you want CBD, look for CBD — not cannabinoids — on the label. 2. Cannabis has few established medical benefits. In 2017, a National Academy of Medicine panel drew roughly 100 conclusions on the health effects of cannabis. Only three benefits stood out:
As for most other health problems, few good studies have been done. But the list of cannabis’s benefits may never be long. In fact, the Food and Drug Administration has approved just three (synthetic) THC drugs — Marinol and Syndros (dronabinol) and Cesamet (nabilone) — to treat nausea and vomiting from chemotherapy. And that approach, says Ryan Vandrey, associate professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine, is how cannabis should be tested and sold as medicine: “The ideal path forward is where we figure out which components of the cannabis plant help with specific symptoms or health conditions, and we develop refined and targeted medicines,” says Vandrey. 3. The evidence for CBD is scant. “CBD is promoted as this amazing, natural, healing product,” says Vandrey. “But many claims about CBD haven’t been substantiated in humans.” Not that CBD is worthless. Last year, the FDA approved a high-dose CBD drug to treat seizures in two rare severe forms of epilepsy. But beyond that, the evidence is preliminary. Only a few studies have looked at whether CBD relieves anxiety, the most common claim. No long-term trials have tested CBD for occasional anxiety or to treat people with a diagnosed anxiety disorder. And most studies have used doses of 100 mg or more. Few CBD products have more than 20 mg per dose. “There are a lot of possibilities for CBD,” notes Piomelli, “but they require controlled clinical trials. The smoking gun isn’t there yet.” 4. CBD can interfere with medicines. In animal and test-tube studies, CBD blocks some forms of an enzyme — cyto¬chrome P450 — that metabolizes many medicines, including some statins (which lower cholesterol), calcium channel blockers (which treat conditions including high blood pressure) and antidepressants. “We know that CBD can affect the metabolism of drugs, though the extent to which that happens is still not well understood,” says Vandrey. If you’re considering taking CBD, ask your doctor or pharmacist if it could interfere with your medications. 5. Smoking marijuana can harm your lungs.
Smoking marijuana produces many of the same harmful chemicals and carcinogens as smoking tobacco. Yet marijuana smokers don’t have a higher risk of lung cancer than non-smokers. But smoking marijuana does increase the risk of chronic bronchitis and worsens respiratory symptoms like coughing and wheezing, said the Academy. Some small studies suggest that “vaping” — when marijuana is heated, not burned, and its vapors inhaled — may cause fewer respiratory symptoms. But no long-term studies have looked at this. 6. Cannabis ups your risk of a car crash. “We know from good, controlled research studies that cannabis impairs driving,” says Vandrey. But if a driver is in a crash and tests positive for THC, “we have no good way to know whether that person was intoxicated or under the influence at the time of the accident.” That’s because THC can be detected in blood long after the user is no longer impaired. What’s more, blood levels of THC increase rapidly after you’ve inhaled marijuana, but they stay low — below the limit that many state tests can detect — after you’ve had an edible (a food or drink that contains THC). “Unlike alcohol, blood levels of THC do not reflect intoxication,” says Piomelli. 7. Cannabis has other risks. The risk of cannabis abuse is fairly low. “Most people who use cannabis won’t have issues with it,” Vandrey notes. “The current estimate is that about 10 percent of people who try it will end up having problems.” That’s concerning, but it’s less than the roughly 20 percent of drinkers or 65 percent of nicotine users who become dependent. The Academy also found “substantial” evidence that cannabis use may increase the risk of psychotic disorders like schizophrenia, with the highest risk among the most frequent users. “Young adolescents also have a higher risk,” says Vandrey. “But a cause-and- effect relationship hasn’t been established for any group.” Still, he adds, “people with a family history of psychosis should avoid cannabis, especially products with high THC content.” 8. Don’t trust labels. “You can’t rely on labels,” says Piomelli. In states that test cannabis products, the results are troubling. For example, in 2018 the California Bureau of Cannabis Control tested nearly 26,000 products — plant material, vape pen cartridges, waxes, oils, tinctures, topical creams, edibles — sold at dispensaries. Almost 15 percent failed tests for potency or purity, typically because they were mislabeled or had detectable levels of pesticides, microbes or solvents. CBD-only products sold online or in stores fare no better. For example, only about 30 percent of 84 CBD products that Vandrey bought online were accurately labeled. “Some contained little to no CBD,” he says. And roughly one in five had detectable levels of THC. 9. A dose of THC varies. It’s up to each state to decide on an appropriate dose. In Washington and Colorado, for example, a dose of THC is 10 milligrams. In Oregon, it’s 5 mg. “There’s a fairly narrow dose window between somebody being OK and someone having uncomfortable adverse effects with THC,” Vandrey explains. What’s more, people were more intoxicated after vaping than after smoking the marijuana. The take-home message: If you try THC, start low. That means around 2 to 3 mg. “Work your way up slowly until you get the effect you want,” says Piomelli. “And treat it with respect. This is not a toy. This is a drug. I’m concerned that people think, ‘Oh, it’s natural. It can’t harm me.’ ” 10. Edibles: the Wild West. “THC edibles are problematic,” says Piomelli. “It’s easy to eat a cookie without knowing what’s in it.” And many edibles have much more than 5 to 10 mg of THC. For example, Dixie Elixirs’ line of 8.5 oz. juices has 100 mg of THC per bottle, but the labels list a serving as 6 mg of THC. Only people who use the “dosing cap” will get the three-teaspoon serving of juice that contains 6 mg of THC. And keep your edibles away from children. The Poison Control Center warns that some kids have gotten into their parents’ supplies. Another potential problem: “When you inhale cannabis, you feel the effects almost immediately,” says Vandrey. But it can take 30 to 90 minutes to feel the effects of an edible. If you don’t know that, you may think the dose is too low. “So then you eat more and you’re stoned for hours and hours,” says Piomelli. What’s more, the kind of food may affect how quickly the THC is absorbed.
-See the full WBUR story. |