New staffing guideliens for nursing homes
April 28, 2024
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
April 28, 2024
The Department of Health and Human Services issued new regulations that mandates specific staffing requirements for nursing homes, such as the amount of care that must be provided (on average) to each resident. KFF Family Health News reported on various reactions to the new rules.
The different political parties were quoted with reactions as one might expect: Democrats praised the change with one saying "much more is needed to ensure sufficient care and resident safety"; a Republican was quoted as saying that the new regulations would "devastate nursing homes across the country and worsen the staffing shortages we are already facing." Understandably, advocates for nursing home residents praised the move, while an industry association that represents nursing homes said that the regulation "creates an impossible task for providers."
Notably, the Centers for Medicare & Medicaid Services (CMS) estimated that the new rules will cost $6 billion, but there does not appear to be any plan for CMS to increase reimbursement. Many nursing homes rely on payments from Medicaid and those facilities most likely will not be able to raise prices in the short term. The additional costs would reduce profits for the owners of those facilities. Some have argued that nursing homes will close because of the additional cost, but the article linked to a study showing that nursing homes are generally more profitable than they appear, given that nursing home operators frequently inflate costs that they benefit from (e.g. cost of rent while they own the real estate as a separate business). It seems likely that at least a few nursing homes will close because of the regulation, but it is unclear how many will. On the other hand, the quality of life at these facilities will probably improve for residents at many nursing homes.
April 21, 2024
Sometimes, more care earlier on can be less costly in the long-term. KFF Health News reported on a program known as Chronic Care Management, where Medicare pays doctors extra to monitor the health of their patients who have two or more chronic conditions. The article reports that early research found that the program reduced total health spending (by decreasing visits to hospitals), but also that participation has been limited.
From the doctors' side, increased documentation is needed, and new staff might need to be hired to handle the increased work. Not all patients want to participate, since some of them do not want to "be bothered or asked if they are exercising or losing weight or watching their salt intake."
Nevertheless, this program seems innovative in that it appears to reduce the long-term total cost of care while actually improving quality of care for those who participate. The article also points out that companies have jumped in to offer their services to help reduce the workload for doctors' offices. Some services appear to work better than others, but overall, this appears to be another example of capitalism at work.
April 14, 2024
Conflicts of interest can pose thorny policy dilemmas. KFF Health News highlighted a recent situation in which ten members of a fourteen member committee had received funding from a manufacturer whose product was being considered for patient use. One member received almost $200,000 in funding. While none of the payments were directly related to the medical device in question, outside observers can easily ask whether the advisors can be impartial judges, especially those receiving substantial amounts of funding.
Apparently, FDA considers it a conflict of interest when the committee member has financial interests that "may be impacted" by his or her work on the committee. It also seems that part of the guideline is that if the relationship is more than a year in the past, it does not pose a problem. Those guidelines seem far less strict than what might exist for other industries. At the same time, it does seem difficult to craft guidelines, especially if there are only a few experts in a specific area and if there are only a few large companies and most advisor candidates have received some funding from them. Nevertheless, it seems that at the very least, such appearances of conflict of interest should be clearly disclosed publicly.
Interestingly, the committee member who received the most funding from the manufacturer ended up voting most negatively against the product (relative to other committee members). However, the policy for conflicts of interest should not be crafted based on a single example.
April 07, 2024
The federal health insurance exchange for the Affordable Care Act wants to make it easy for patients to sign up for and switch health insurance plans. However, is it too easy? KFF Health News reports on the increasing fraud among health insurance agents vying for monthly commissions. Apparently, with "only a person's name, date of birth, and state," an agent can switch a patient from one plan to another. Patient consent is assumed, but there seems to be inadequate measures to verify such consent.
Beyond being an inconvenience, such switches can have severe financial consequences, such as patients owing thousands of dollars for higher premiums that they did not sign up for. Patients might also delay medications and surgeries if they find out that their new plans do not cover what they need.
At least some state exchanges have implemented measures to thwart such fraud: "In Colorado, for example, customers create accounts on the state's online market and can choose which brokers have access. Pennsylvania has a similar setup. California sends a one-time password to the consumer, who then gives it to the agent before any changes can be made."
Where there is sufficient financial incentive, it seems that it would only be a matter of time before a naive system built on trust is abused. While the Centers for Medicare and Medicaid Services has announced plans to curb such abuse, it is concerning that they did not anticipate these problems earlier.
March 31, 2024
KFF Family News reported on recent legislation in California that allows teenagers on Medi-Cal insurance (in California) to gain access to mental health counseling without needing authorization from parents. Some lawmakers voted against the legislation, with the sentiment that "If my child is dealing with a mental health crisis, I want to know about it." However, teenagers on private health insurance plans already have access to mental health counseling without requiring parental authorization.
Both sides likely have a reasonable basis for their arguments: on one hand, parents should be involved with and consent to mental health treatment of their children, but on the other hand, there might be some situations (especially in abusive or neglectful households) where such requirements prove harmful. The particular example of the teenager who championed the legislation does not seem compelling based on what is presented in the article, although her accomplishment in seeing her advocacy result in a new law is noteworthy. Either way, there does seem to be an issue of consistency, where the requirement to have parental consent should not depend on whether the health insurance is private or public.