Medication errors in nursing homes, mental health parity law fails patients, and Medicare successes

August 6, 2015

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

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Motivated by growing evidence of mismanagement of the blood thinner Coumadin (warfarin) in nursing homes, the Centers for Medicare & Medicaid Services recently sent a memo to state health agencies warning of the drug’s risks. Charles Ornstein of ProPublica reports that from 2011 to 2014, approximately 165 nursing home residents were hospitalized or died as a result of Coumadin medication errors. The CMS memo also alerts its recipients to a new tool that helps inspectors identify and reduce medication errors in nursing homes, developed in partnership with the Agency for Healthcare Research and Quality. While this may be a step in the right direction, experts like David Gifford, MD, MPH, of the American Health Care Association, warn that this issue will require quality improvement efforts that help clinicians and patients weigh the therapeutic benefit against the risks, while putting systems into place that catch medication errors before they occur.


The federal mental health parity law, passed in 2008, was meant to expand access and eliminate the financial barriers to obtaining mental health care. While this has resulted in some positive changeJenny Gold highlights in Kaiser Health News that individuals with mental illness still face discrimination when seeking treatment. Allegedly to blame are both insurance companies for sidestepping the law, and the government for failing to enforce it. In spite of insurers’ use of tactics to limit treatment like “medical necessity” review or “preauthorization” for office visits, the government has not taken a single action to enforce compliance with the law. And, though individuals and families navigating the world of insurance and mental healthcare may feel frustrated by the obstacles they encounter when attempting to access care, many may not even be aware of their rights under the law. Indeed, of the 1.5 million health insurance inquiries made to the department responsible for monitoring employer-sponsored coverage, only 867 were related to the parity law. Another challenge is the lack of transparency in the process behind insurers’ coverage determinations, though one trend does seem apparent—mental health patients face significant and unnecessary barriers in accessing the care they need.


Medicare’s 50th birthday last week was an opportunity to recognize one of the most successful government programs in the nation—one that has helped millions of seniors live healthier, longer lives. A short video from Vikas Saini, MD, president of the Lown Institute, notes that the program has also protected seniors from poverty. And there are other Medicare gains. In a study conducted by Harlan Krumholz, MD, et al., in JAMA and reported in USA Today, we learn the particulars, including data on mortality, hospitalizations and expenditures for millions of fee-for-service beneficiaries from 1999-2013. Among the findings are that mortality rates dropped 16 percent during that period; hospitalization rates fell 24 percent and 45 percent were less likely to die during their hospitalization. Many factors may be at play, Krumholz suggests, including that hospitals are focusing on increased safety and public health improvements. Also reported last week in Kaiser Health News and Modern Healthcare was that half of all hospitals in the United States are facing 30-day readmission penalties from Medicare for the 2016 fiscal year, losing a combined $420 million in government payments as a result. About one in five Medicare patients who went to the hospital had to return within a month. Part of the Affordable Care Act, the Hospital Readmissions Reduction Program was designed to make hospitals pay more attention to what happens to their patients after discharge.





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