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Senate weighs in on simultaneous surgery, health care for the recently incarcerated, and 21st Century Cures Act passes

December 8, 2016

In order to bring you more of the news you want to read, Right Care Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, Right Care Weekly presents articles related to moving our healthcare system toward the right care for all patients.

 

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Simultaneous surgery, where one surgeon works on multiple surgeries at the same time in different operating rooms, is a relatively common practice, which may threaten patient safety and is often performed without informed patient consent. Earlier this year, members of the Right Care Alliance’s Councils on Surgery and Musculoskeletal Care were invited to submit a letter to the Senate Finance Committee, expressing their concerns about simultaneous surgery. In the letter, they note that patients are rarely informed prior to the day of surgery that their surgeon won’t be with them during the entire procedure. When they are informed, the information is often vague, incomplete, or disclosed just before the patient is wheeled into the operating room. This week, the Senate Finance Committee issued a report echoing the Right Care Alliance’s recommendations: It urged hospitals to prohibit concurrent surgeries except in emergency situations; to obtain patient consent for overlapping surgeries before the date of the operation; to provide patients with clear information about the procedure; and to develop mechanisms to enforce these guidelines. In the Boston Globe this week, James Rickert, MD, one of the authors of the RCA letter, commended the Committee for prioritizing informed consent. “Following these standards would allow patients to know that the individual to whom they are entrusting their body is the surgeon who will actually operate on them,’’ said Rickert.

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The US has the largest prison population in the world. Prisoners tend to be sicker than most Americans: they’re more likely to have mental health and substance abuse problems, as well as infectious diseases like HIV and hepatitis C, and chronic illnesses like diabetes and heart disease. But prisons and the medical system often do a lousy job of coordinating care for incarcerated people, especially after they are released from custody. This week, NPR wrote about the Transitions Clinic Network, which provides medical care and support to people moving between prison life and the community. Like many other intensive primary care programs, the clinic network is an interdisciplinary project that uses physicians, community health workers, and others to develop collaborative relationships with their patients. The clinics are a promising model for getting people through the first few weeks outside of prison, which can be an especially dangerous time for people with no social supports. It’s a model that deserves a lot of attention, especially relative to the status quo: In a related story, Kaiser Health News and the Marshall Project wrote that many states (especially those that did not expand Medicaid) provide little or nothing to help people leaving prison get signed up for health insurance or to help them find care on the outside.

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Wednesday night, the Senate passed the 21st Century Cures Act. Although this legislation contains funding increases for the National Institutes of Health (NIH) and state grants for addiction treatment and research, it also weakens drug and device approval standards and removes disclosure requirements for industry funding associated with “medical education.” As two members of the National Physicians Alliance write in STAT, this legislation would pressure the Food and Drug Administration (FDA) to approve certain antibiotics and high-risk medical devices based on “anecdotal case studies” rather than clinical trials, a far more reliable form of evidence. The act would also allow companies to promote products for off-label use, based on that same low standard of evidence, an outcome Lown Institute president Vikas Saini, MD, testified at a recent FDA hearing as “tantamount to approving human experimentation on the public.” Additionally, the Cures Act would roll back parts of the Physician Payments Sunshine Act, allowing industry to fund continuing education for marketing purposes without making these payments public. While the increase in sorely-needed research funding offers the potential to help patients, other provisions in the Act are almost certain to lead to the delivery of unproven and ineffective treatment that may put patients at risk.

Announcements

There are only 10 days left to submit your research abstracts and conference workshop proposals for the 2017  Lown Conference! Abstracts are a great way to disseminate new research on overuse, underuse, and other aspects of right care. Workshops allow you to share how you practice right care with RCA members from around the country. Both abstract and workshop proposal submissions are due Sunday, December 18th. Learn more about the conference and registration here.

Last October, Right Care Alliance members across the country organized over 100 Right Care Action Week events to demonstrate what right care looks like. Our post-RCAW report is now available, including fast facts, descriptions of selected events, and the top concerns from collected “What Worries You” cards.

 

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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.