Contagion Live had a discussion with Nicola Thompson, PhD, epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention who shared what is needed to estimate the burden of healthcare-associated infections in nursing homes.

Interview Transcript (slightly modified for readability):  “There has been a lot of work outside of the United States, in Europe, and also recently in the United States by the Centers for Disease Control and Prevention (CDC) to look at the prevalence of healthcare-associated infections in acute care hospitals. That data that has been collected has been used to translate the prevalence of infection into the burden over the course of the year. That has been done by a long-standing formula that has been out and has been published and used many times. That formula includes in it information on the average length of stay [for a patient].

Essentially the model that is used to estimate the burden of healthcare-associated infections from the prevalence takes into account the average length of hospital stay for people with a healthcare-associated infection, compared [with] the average length of hospital stay for people without a healthcare-associated infection. Those are the pieces for the inputs for the model. The differences between lengths of stay is used to estimate the national burden [of disease].

The concept of ‘length of stay’ does not really hold up when we think about the nursing home setting because the vast majority of people that are in a nursing home go there long-term to receive care and they are not anticipating a discharge. [Therefore,] we need to come up with a different approach to estimating the burden of [healthcare-associated] infections in nursing homes that does not rely on information, or take into account information on length of stay. That is really where the work that has been done by the European CDC (ECDC) to look at the burden estimation in nursing homes has been helpful to us.”

Salon had an interesting perspective on TrumpCare.  The new freedom is based on individual choice according to ideologues. “You’re free to be poor, free to be politically powerless or free to be ill and uncared for; it’s all a matter of decisions you freely make in life, and our larger society has no business interfering with your free will.” So that’s what Republicans’ Trumpcare is offering us, this “freedom” from health care.

“This is what passes for a philosophical framework behind many of the policies of today’s Republican congressional leaders. For example, they say their plan to eliminate health coverage for millions of Americans and do away with such essential health benefits as maternity care for millions more is just a matter of good old free-market consumerism. As explained by Jason Chaffetz, a Utah Tea Party Republican, “Americans have choices. And so maybe, rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care.”

Paul Ryan: “Freedom is the ability to buy what you want to fit what you need.” Yes, apparently, you are as free as you can afford to be.

Illinois Public Media News reported that Champaign County Administrator Rick Snider says his nursing home is cooperating with an investigation into the death of a resident of the home. According to the News-Gazette, the county coroner and Illinois State Police are investigating the death of a 78-year-old woman who was discovered in the courtyard and may have been outside in high temperatures for as many as three hours.

The investigation comes as the county board looks to hire a management firm to run the nursing home and continues to discuss options for selling it. A majority of voters in April’s election backed a referendum in support of selling or closing the nursing home.

New York and California are taking steps toward state-based single-payer health insurance systems that would provide universal coverage without insurance premiums, deductibles, or co-pays.

In New York last week the State Assembly passed a single-payer proposal for the third consecutive year. Prospects for Senate passage have gone up significantly thanks to backing from the Independent Democratic Caucus.   The New York bill contemplates that all existing federal health-care dollars will be “pooled” in the state trust fund that would pay for services and insulate patients from virtually all out-of-pocket costs. Assuming Obamacare is not repealed, it’s possible the state could get megawaivers to use both Obamacare individual insurance subsidies and Medicaid for a new system.

In California, Democratic supermajorities in both legislative chambers have enhanced prospects for single payer among other progressive priorities, and a new bill has already cleared one hurdle in the lower chamber of the legislature.

NPR reported on the new Propublica investigation into wasted prescription drugs at nursing homes.  Millions of dollars of perfectly useful drugs are thrown away every year instead of being recycled.  In Iowa, they have a program set up to retrieve these drugs and redistribute them to uninsured or underinsured patients for free. And they’re getting about $5 million worth of these drugs this year.

These drugs, experts say, might be wasting hundreds of millions of dollars a year.

 

With the aging of America comes the constant debate on the issue of stay at-home care verses nursing home care. The Louisiana AARP has strong opinions, claiming we are heading the wrong way.  Listen to the AARP’s Andrew Muhl with WWL’s Tommy Tucker here.  AARP spokesman Andrew Muhl breaks down the finances:

Right now the annual cost per person on average for at-home or community based services is around $18,000 a year,” said Muhl, “while the average cost for nursing home care runs close to $50,000 a year.”

Muhl says stay at-home care is not always possible but it’s by far more popular.

Overwhelmingly, what we’ve learned is that people want to age in place and receive care at home,” he explained. “There is a large majority of people in nursing homes that don’t need 24-7 care, they just need a little care that they can receive at home,” Muhl said.

Unfortunately, Muhl says there are fewer and fewer resources for the elderly who want to stay at home and live independently.

Secretary Tom Price had a strange and somewhat incoherent interview with CNN’s Dr. Sanjay Gupta.

Here are the most insane moments of their interview:

#1 – Price refused to admit that it “defies common sense” to strip away $1 trillion from healthcare funding when Trump promised to get all Americans insured with the government’s help.

#2 – Price declared that Medicaid patients are only concerned about losing their Medicaid because they are afraid of something “new.”

#3 – Price struggled to defend efforts to gut the requirement for essential health benefits, which provide coverage for things like hospitalizations, maternity care and prescription drugs, offering such sweeping generalities that the only reply Dr. Gupta could offer was, “I don’t know what that means.”

#4 – Price could not refute Gupta’s assertion that TrumpCare would legalize healthcare “plans that are cheap but useless.”

#5 – Even though the TrumpCare plan he tried to push through Congress would put insurance out of reach for 24 million people and repeal the individual mandate, Price proved himself utterly divorced from realty by agreeing that “absolutely,” everyone should have insurance.

Vox had two great articles on the opiod crisis.  Drug overdoses now kill more Americans than HIV/AIDS did at its peak. In 2015, more than 52,000 people died of drug overdoses, nearly two-thirds of which were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. That’s more drug overdose deaths than any other period in US history — even more than past heroin epidemics, the crack epidemic, or the recent meth epidemic. And the preliminary data we have from 2016 suggests that the epidemic may have gotten worse since 2015.  Vox has maps and charts that tell the story:

  1.  Drug overdoses now kill more people than gun homicides and car crashes combined.
  2. Drug, painkiller, heroin, and other opioid overdose deaths are still on the rise.
  3. Opioid overdoses are one reason US life expectancy declined for the first time in decades.
  4. The epidemic is much worse in some states than others.
  5. By and large, the drug overdose epidemic has hit white Americans the hardest.
  6. Americans consume more opioids than any other country.
  7. In some states such as South Carolina, doctors have filled out more painkiller prescriptions than there are people.
  8. Drug companies have made a lot of money from opioids.
  9. At the same time, Americans report greater levels of pain.

A Senate investigation into the pharmaceutical companies’ role and responsibility for the nation’s worst drug overdose crisis in history:  Sen. Claire McCaskill (D-MO), the top Democrat on the Senate Homeland Security and Governmental Affairs Committee, announced that she is requesting marketing, sales, and addiction study material from the companies behind America’s top five opioid products. The investigation, she said, will draw out the role that opioid manufacturers played in causing the epidemic and letting it continue.

As USA Today noted, McCaskill will need Republican support on the committee to be able to subpoena opioid makers’ documents should the companies not comply with her requests.

Drug manufacturers played a major role in the epidemic. By marketing their opioid painkillers as safe and effective, they convinced doctors to prescribe painkillers in droves to patients. That allowed the drugs to proliferate, leading not just to widespread painkiller misuse but also to the misuse of more dangerous opioids like heroin and illegally manufactured fentanyl. With this, the risk of overdose increased — spawning the opioid crisis we have today. As opioid painkiller sales increased, more people got addicted — and died.Annual Review of Public Health

Much of this was the result of misleading marketing by major drug companies. In fact, Purdue Pharma, a producer of “hillbilly herion” OxyContin, in 2007 was forced to pay hundreds of millions of dollars in fines due to its false claims about opioids.

In wide-ranging investigations, the Los Angeles Times has uncovered more evidence of how Purdue’s misleading advertisement played out at the ground level. It found that Purdue exaggerated the effectiveness and safety of OxyContin, while covering up any criticisms and complaints about the drug. As a particularly egregious example of why Purdue and its marketers did this, one sales memo uncovered by the Times was literally titled “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!”

Other opioid makers have faced similar allegations. Insys, a drugmaker, allegedly pushed its fentanyl spray for uses far beyond late-stage cancer pain treatment, according to McCaskill’s office. A sales representative claimed that the company’s informal motto was, “Start them high and hope they don’t die.”

A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

Most Americans (50%) get health insurance through their work, and another 34 percent rely on the government through Medicare or Medicaid. Because of the ACA, only 9 percent are uninsured. The rest — those who are too young to qualify for Medicare and too rich to qualify for Medicaid but want to buy insurance — deal with insurers that sell plans to individuals.

The Obamacare exchanges created to help some 13 million Americans buy quality and affordable insurance outside of the employer-based market. And the overwhelming majority of these people happen to live in rural parts of the country — the very same places that voted for Donald Trump.

Map of counties with 1 ACA insurer and how they voted in the 2016 election

Will Trump undermine these marketplaces or try to make them work by messing with or weakening provisions like the individual mandate or the subsidies?

If Trump wants to reduce the whole structure of the ACA into unworkable rubble so that Democrats will have to agree to replace it, the administration will have to sabotage it. Unfortunately, there’s a pretty easy path for them to do it.

First, the administration could eliminate enforcement of the individual mandate, which requires Americans to buy health insurance or pay a tax penalty.

Second, the administration could cut outreach about open enrollment.

Third, if Trump wants to throw Obamacare’s exchanges into chaos, he could choose to stop defending a lawsuit filed by the House of Representatives that attempted to halt the government from making what are known as “cost-sharing reduction” payments to insurers. Under the Affordable Care Act, carriers are required to limit how much low-income customers pay out of pocket for things like deductibles and co-pays. In return, the companies are supposed to get direct subsidy payments from Washington to cover the expense. Those checks are worth billions to the industry, since more than half of marketplace enrollees benefit from cost-sharing reductions, and are absolutely essential to making the marketplaces work.

Republicans in the House of Representatives sued the Obama administration a few years ago to stop the payments, arguing that because Congress had never technically allocated the money to fund them, the government was disbursing the cash illegally. If Trump drops the appeal, it could have profoundly damaging consequences for the insurance market. Insurers would still be required to keep offering low-income customers their discounts but wouldn’t be compensated for it. The result would be financially disastrous.  Ending the cost-sharing reduction payments would require an active decision on the Trump administration’s part.

Buzzfeed had an article about Secretary Tom Price’s refusal to acknowledge his Constitutional duty to follow the law of the land as it pertains to regulations in the ACA.  Price is the man in charge of either fixing Obamacare, or neglecting Obamacare but he refuses to disclose what he will do after Republicans failed to pass a bill repealing the law.  Price avoided giving direct answers about whether he will try to strengthen or weaken Affordable Care Act regulations when he appeared before the House Appropriations Committee last week.

He could make changes that independent experts, insurers, and health care providers are calling for to stabilize markets and bring down prices. Or, as Trump proposed, he could do nothing and cause some markets to fail.

Larry Levitt of the Kaiser Family Foundation told BuzzFeed News the best thing the Trump administration could do for markets is clear up this uncertainty.

“The single most important thing the Trump administration could do right now is to assure insurance companies that it intends to run the program effectively,” said Levitt.

“That would include things like continuing outreach, enforcing the individual mandate, making the cost-sharing subsidy payments to insurers, and settling the lawsuit over the risk corridor program and making those payments.”

The administration could significantly bring down premiums by supporting these programs and enforcing the individual mandate, Andy Slavitt, an administrator at the Centers for Medicare and Medicaid Services, argued in a recent op-ed.