Nursing organizations are uniting in a national effort to enhance education on opioid prescription and administration practices.
Seventy eight people die each day from an opioid overdose, says the Centers for Disease Control and Prevention, and half of opioid overdose deaths involve prescription opioids.
In an effort to address this issue, the following nursing organizations have committed to educating nursing faculty, students, and clinicians, across the advanced practice registered nurse education continuum, regarding the CDC’s Guideline for Prescribing Opioids for Chronic Pain:
The American Association of Colleges of Nursing
The American Association of Nurse Anesthetists
The American Association of Nurse Practitioners
The American College of Nurse-Midwives
The American Nurses Association
The National Association of Clinical Nurse Specialists
The National Organization of Nurse Practitioner Faculties
"Our joint commitment reaffirms AANP's dedication to promoting evidence-based standards for opioid abuse prevention and education, while recognizing the need for patients suffering from chronic and acute pain to access essential pain care," said AANP President Cindy Cooke, DNP, FNP-C, FAANP, president of AANP, in a news release announcing the commitment.
AANP will provide continuing education. In addition, 191 schools of nursing with APRN programs have pledged to educate their APRN students on the CDC’s guidelines as a way to enhance existing education on managing pain through pharmacologic and non-pharmacologic interventions.
"Academic nursing is committed to protecting the public's health by taking decisive action to address the nation's opioid epidemic," said Deborah Trautman, PhD, RN, FAAN, president and chief executive officer of AACN, in a news release.
"I applaud my colleagues in the nursing community who have made it a priority to prepare the next generation of APRNs on best practices for prescribing opioids."
The CDC guidelines focus on three main areas:
Determining when to initiate or continue opioids for chronic pain
Opioid selection, dosage, duration, follow-up, and discontinuation
Assessing risk and addressing harms of opioid use
The announcement of the educational initiative took place on April 25 at a White House event Champions of Change for Prevention, Treatment, and Recovery event in Washington, D.C., which recognized those people and organizations taking steps to address the opioid epidemic.
The board chair of the College of Healthcare Information Management Executives also cautioned against making the HHS chief information security officer a presidential appointment.
Coordination, not organizational reporting structure, should be the focus of federal efforts to defend against cyber criminals, College of Healthcare Information Management Executives (CHIME) Board Chair Marc Probst told a congressional panel on Wednesday.
"Just as healthcare institutions must coordinate efforts to thwart cyber threats, it is vital that the Department of Health and Humans Services have a coordinated plan to address threats to the data and systems used and housed by the department," said Probst, vice president and chief information officer at Intermountain Healthcare in Salt Lake City, UT.
Probst was part of a panel testifying before the House Energy and Commerce Subcommittee on Health, which is examining how HHS aligns its cybersecurity programs and is soliciting comments on the HHS Data Protection Act (H.R. 5068).
Among other things, the legislation would change the reporting structure at HHS by making the department's chief information security officer (CISO) a presidential appointee and removing security responsibilities from HHS' chief information officer (CIO).
CISO Reporting Structures Vary in Healthcare
By way of comparison, Probst noted that CISO reporting structures vary greatly across the healthcare industry.
At Intermountain Healthcare, for instance, the CISO reports directly to Probst, the CIO. A similar reporting structure exists at Penn State Hershey Medical Center.
But at a multi-state health system, the CISO reports the chief technology officer. At many smaller hospitals, CHIME members often fill the dual role of CIO and CISO.
Ultimately, Probst said, it depends on how the organization defines security and the role of the CISO. What's most important, he told subcommittee members, is that there is coordination across the enterprise and a series of checks and balances.
In the past two years, 81% of hospitals and health insurance companies have had a data breach, according to a 2015 study by KPMG.
Commenting specifically on the HHS Data Protection Act, Probst said that legislation should account for ongoing efforts at HHS to coordinate cybersecurity programs.
He noted that the Cybersecurity Act of 2015 calls on the department to issue a report to Congress by the end of this year identifying the individual who will be responsible for coordinating and leading efforts to combat cybersecurity threats.
HHS is also required to present a plan from each relevant operating division detailing how each will address cybersecurity threats in the healthcare industry.
Probst cautioned subcommittee members to fully evaluate the potential negative consequences that could result from making the HHS CISO a presidential appointment.
Politicizing health IT policy can hamper the department's ability to influence change. As a former member of the Health IT Policy Committee, a federal advisory committee created under Health Information Technology for Economic and Clinical Health Act (HITECH), Probst witnessed how important initiatives for improving care delivery got bogged down in politics and bureaucracy.
"As a healthcare CIO, I again echo the importance of coordination," Probst told the subcommittee.
"What's central to this conversation is meaningful coordination, avoiding any unintended consequences of complex reporting that instead may impede the coordination and flow of information necessary to thwart cyber threats."
In addition to aligning with coming standards from The Joint Commission, the document also promises to help hospitals follow existing guidelines from CMS and the CDC.
A new "playbook" on the appropriate use of antibiotics aims to help hospitals reduce rates of drug-resistant infections and prepare for new standards to be implemented in 2017 by The Joint Commission.
The playbook was released Wednesday by a group convened through the National Quality Forum's National Quality Partners and was the subject of a telephone briefing with media in the afternoon.
In addition to aligning with Joint Commission coming standards, the document also promises to help hospitals follow existing guidelines from the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention.
"We know antibiotics are critically important drugs when we need them," said Arjun Srinivasan, MD, of the CDC, during an online release of the document. He is associate director for healthcare-associated infection prevention programs in the division of healthcare quality promotion.
"At the same time, we know that they are often times used when they are not needed and sometimes, even when they are needed, they are use incorrectly."
Srinivasan is co-chair of the group that generated the document. Framed by a committee that included patient advocates, infectious disease specialists, pharmacists, and hospital representatives, the effort was designed to give hospitals guidance on how to adopt guidelines issued by the CDC in 2014.
An estimated 30% to 50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. That has led to increasing resistance and difficult to treat so-called super bugs. The agency received positive feedback on that plan, but hospitals asked for help with implementing the recommendations, Srinivasan said.
"Misuse occurs in healthcare settings for a variety of reasons, including use of antibiotics when not needed, continued treatment when no longer necessary, wrong dose, use of broad-spectrum agents to treat very susceptible bacteria, and wrong antibiotic to treat an infection," the document notes.
Ed Septimus, MD, the director of infection prevention at Hospital Corporation of America (HCA) co-chairs the group that produced the guidelines.
He emphasized that the playbook was designed in a way that will allow each hospital to customize a program to its size, patient population and other needs.
"We hope that this document will enable success on a local level, because we all know that local execution is what really matters," Septimus said.
5 Elements of Antibiotic Stewardship
The playbook is broken up into five "core elements" considered key to a successful stewardship program:
Leadership commitment
Accountability
Drug expertise
Action
Tracking
Each section offers examples of implementation, a list of potential barriers and links to resources.
Under the leadership commitment heading, the playbook notes that the effort must have commitment and financial support from hospital boards and executive teams.
Potential barriers to getting leadership on board include lack of C-suite awareness of the issue, as well as competing priorities or "commitment fatigue."
The document suggests that hospital leadership consider the effort as part of a health system's quality improvement and patient safety programs. It also notes that stewardship effort will help hospitals maintain accreditation.
Margaret Van Amringe, vice president for public policy at The Joint Commission, said the accreditation body incorporated the CDC guideline into the "Antimicrobial Stewardship Standard" that will be published in July and will go into effect sometime during the first quarter of 2017.
The Joint Commission will be looking at whether hospital leaders are behind the effort and have committed resources to it.
Articulating the effort in language that resonates in the C-suite is important, said Kristi Kuper, a pharmacist and clinical manager with Vizient, the purchasing and performance improvement company formed by last year's merger of the non-profit hospitals of the VHA and the academic medical centers of UHC.
"Some of the most successful programs I've developed started with a good business plan," she said.
The creation of a dual-role position at Partners HealthCare and Neighborhood Health Plan is designed to boost population health efforts at the integrated health system.
With the announcement of a C-Suite appointment, Partners HealthCare and the Boston-based health system's insurance business unit are stepping up their population health game.
Douglas Thompson, MPP, will be serving as Partners' vice president of population health finance and CFO of Neighborhood Health Plan, according to a statement released Monday by the integrated health system.
In addition to supervising the financial operations of NHP, he will help coordinate population health efforts at Partners and the health plan.
"Thompson will provide leadership on integration and advancement of new population health models, including payment mechanisms and investments, with the goal of keeping members and patients healthy by avoiding the need for emergency room visits or costly hospitalizations," according to the health system.
The dual role is a new position at the integrated health system. The post was created in response to "changes in healthcare that require providers and insurers to share the financial risk for treatment outcomes as the industry evolves from a traditional fee-for-service payment system to an alternative system based on defined budgets calculated to meet individual patient needs."
Thompson had been serving as interim CFO of NHP since November 2014. He has prior experience in several healthcare CFO roles, including serving as the Medicaid CFO for the Commonwealth of Massachusetts from 2007 to 2009.
Partners was founded in 1994, in an affiliation deal between Brigham and Women's Hospital and Massachusetts General Hospital. Today, the health system operates five acute-care hospitals in Greater Boston, a critical access hospital on Nantucket, a behavioral health hospital, and NHP.
Partners reported total operating revenue at $11.7 billion last year, according to the health system's 2015 Annual Report.
NHP, which was incorporated in 1986, provides health coverage for more than 450,000 commercial beneficiaries and Medicaid enrollees. The Massachusetts Division of Insurance approved Partners' acquisition of NHP in September 2012.
"By entering into partnership talks, we expect that Stratus and CGHN will find ways to work together to improve the health of our patients and that these lessons will set the stage for our discussions with physicians throughout the Stratus region," said Dean Burke, MD, chair of the Stratus Governing Board, in remarks accompanying the announcement.
Greensboro, GA-based Stratus is a non-equity collaboration of health systems, hospitals and physicians formed in July 2013.
CGHN is a consolidated local healthcare network comprised of almost 1,000 physicians and, along with Navicent health facilities, serves communities across more than 15 counties in central Georgia.
A media release announcing the potential alignment provided no details about what the partnership might look like, who would lead it, if cash or other assets were involved, and when talks would be finalized.
"Healthcare has gone through significant changes in the last few years and more changes are coming, particularly in the way that physicians are reimbursed for the care they provide," Freddy Gaton, MD, chair of the CGHN board, said in prepared remarks.
"To thrive in this new system, physicians must be able to prove, through robust data, that they are providing high quality care to their patients. We believe that our talks with Stratus could lead to a partnership that will better enable us to prove that we provide outstanding care to our patients."
CGHN CEO Chuck Carroll said patients and providers "need options" as the healthcare sector transitions to value-based reimbursements.
"CGHN is physician-focused and committed to patient-friendly, cost-efficient, locally appropriate care solutions, value-based contracting and education," he said. "CGHN is committed to extending quality healthcare to rural Georgia communities and the Stratus partnership is another step in extending collaboration, communication and better health throughout central and South Georgia."
If required by CMS to take on downside risk, nearly half would leave the program, according to data from the National Association of ACOs.
A survey of ACOs finds more than half of the respondents would leave the Medicare Shared Savings Program (MSSP) if they were not eligible for the 5% Advanced Alternative Payment Model (APM) bonus.
The bonus is a provision of the proposed rule for the Medicare Access and CHIP Reauthorization Act (MACRA) released in April.
The National Association of ACOs (NAACOS) reports in its spring survey that 56% of 144 ACOs surveyed in 40 states would be very unlikely or somewhat unlikely to stay in the MSSP.
Eleven percent said they were unsure, 32% said they were very likely or somewhat likely to stay, and 2% were ineligible to stay in the MSSP Track 1 program beyond their current agreement, based on CMS policy.
Source: NAACOS
Of multi-ACO organizations, 42% are very or somewhat unlikely to stay in MSSP, 2% are unsure, and 56% are very or somewhat likely to stay in MSSP, the survey reports.
Slightly more than half (51%) of the ACOs described their ongoing operational costs as "very significant" and only 6% described these costs as "nominal or negligible".
If required by the Centers for Medicare and Medicaid Services, to take on downside risk, 43% of ACOs surveyed said they would leave the program and 33% would stay, NACCOS reports.
The majority (84%) of respondents said they would be ready for downside risk within the next six years, with 44% of those ready as soon as one to three years.
NAACOS says it hopes that these findings will spark conversations about the investment, risk, and policy challenges facing ACOs and healthcare systems in today's rapidly evolving environment.
"As the survey findings demonstrate, ACOs are investing a significant amount and are maturing in their readiness to take on downside risk, surprisingly fast considering how few years the program has been in place," the report concludes.