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Congress Targets Misuse Of Hospice Drugs Hospice workers would be allowed to destroy patients’ unneeded opioids, reducing the risk that families misuse them, according to one little-noticed provision in the bipartisan opioids bill headed to President Donald Trump’s desk for his likely signature. The bill would empower hospice staff to destroy opioid medications that are expired, no longer needed by the patient because of a change in treatment or left over after the patient dies. A spokesperson for Massachusetts Sen. Elizabeth Warren, one of the Democrats who pushed for this provision to be included in the overall opioid package that the Senate passed Wednesday, said the idea was sparked by Kaiser Health News’ reporting. Last August, a KHN investigation found that as more people die at home on hospice, some of the addictive drugs they are prescribed are being stolen by neighbors, relatives and paid caregivers —

contributing to an opioid epidemic that kills an average 115 people a day in the U.S. The article quoted a Washington state woman named Sarah B. who stole hundreds of pills — Norco, oxycodone and morphine — that were left on her father’s bedside table after he died at home on hospice care. The hospice staff never talked about addiction or how to safely dispose of drugs after a person dies, she told KHN. Hospices have largely been exempt from crackdowns in many states on opioid prescriptions because people may need high doses of opioids as they approach death. Under current law, hospices cannot directly destroy patients’ unneeded opioid medications in the home. Instead, they direct families to mix them with kitty litter or coffee grounds before throwing them in the trash (flushing them down the toilet is considered environmentally

unsound). Hospice, available through Medicare to those who are expected to die within six months, sends staff and medication to care for patients wherever they live. About 45 percent of hospice patients receive care in a private home. In a statement, the National Hospice and Palliative Care Organization (NHPCO), an industry group, applauded the proposed change in policy: “Granting appropriate hospice professionals the legal authority to dispose of unused medication after a hospice patient’s death would not only alleviate grieving families of this responsibility but also help prevent potential diversion or illicit use of these drugs.” “Families dealing with the loss of a loved one shouldn’t also have to worry about leftover medication ending up in the wrong hands,” Warren said in a statement. “I’m glad to be working with my colleagues to

help reduce the number of opioids in circulation by allowing hospice employees to step in and help families safely dispose of these medications.” The bill requires hospices to document policies on the disposal of opioid medications, and to discuss those policies with families. It also calls for the Government Accountability Office to study hospices’ disposal of controlled substances in patients’ homes. The bill does not specify, however, what happens if a family refuses to give up the drugs. By federal law, medications are considered property of the patient or whoever inherits that person’s property after they die. According to the bill, a hospice worker would not need formal written consent from families to destroy the medications, NHPCO spokesman Jon Radulovic said, but if a family objects, the worker would leave the drugs alone.

Medicare Eases Readmission Penalties Against Safety-Net Hospitals Penalties will total $566 million for all hospitals. But many that serve a large share of low-income patients will lose less money than they did in previous years. On orders from Congress, Medicare is easing up on its annual readmission penalties on hundreds of hospitals serving the most low-income residents, records released last week show. GET THE DATA READMISSION PENALTIES BY HOSPITAL AND STATE Medicare is penalizing hospitals that see patients return to the hospital too soon after being discharged. Medicare reduces what it pays each hospital per patient, per stay. Medicare Readmission Penalties By Hospital (.csv)

Medicare Readmissions By State (.csv) Questions about republishing our content? Click here. Since 2012, Medicare has punished hospitals for having too many patients end up back in their care within a month. The government estimates the hospital industry will lose $566 million in the latest round of penalties that will stretch over the next 12 months. The penalties are a signature part of the Affordable Care Act’s effort to encourage better care. But starting next month, lawmakers mandated that Medicare take into account a long-standing complaint from safety-net hospitals. They have argued that their patients are

more likely to suffer complications after leaving the hospital through no fault of the institutions, but r ather because they cannot afford medications or don’t have regular doctors to monitor their recoveries. The Medicare sanctions have been especially painful for this class of hospitals, which often struggle to stay afloat because so many of their patients carry lowpaying insurance or none at all. In a major change to its evaluation, the federal Centers for Medicare & Medicaid Services (CMS) this year ceased judging each hospital against all others. Instead, it assigned hospitals to five peer groups of facilities with similar

proportions of low-income patients. Medicare then compared each hospital’s readmission rates from July 2014 through June 2017 against the readmission rates of its peer group during those three years to determine if they warranted a penalty and, if so, how much it should be. The broader issue is whether medical providers that serve the poor can be fairly judged against those that care for the affluent. This has been a continuing topic of contention as the government seeks to accurately measure health care quality. It is particularly a concern in efforts to consider patient outcomes in setting pay rates for doctors, nursing homes, hospitals and other providers….Read More

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RI ARA October 14, 2018 E-Newsletter  

RI ARA October 14, 2018 E-Newsletter  

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