Today, @OIGatHHS released two reports on #hospice quality and oversight. The reports highlight poor-quality care and gaps in current hospice quality oversight and reporting. 1/ oig.hhs.gov/newsroom/media…
The primary finding of @OIGatHHS’s important work is that most #hospice agencies had care deficiencies over the last several years, some of which were quite serious. 4/
Some of the findings in the @PalliativeMed_j studies are especially relevant for understanding today’s reports and where to go from here. 5/
First, increasing numbers of #hospice agencies are privately accredited. Between 2006-2015, the proportion of privately-accredited hospice agencies increased from 15% to 39%, a #trend driven largely by its increased use among for-profit agencies. 6/
As the 2019 study notes, the trend toward private accreditation “necessarily lessens the role of government oversight.” This is not good or bad per se – both #Government agencies and private organizations can falter or excel in their oversight activities. 7/
YET, the private accreditation process is much less #transparent than that conducted by governmental agencies. 8/
One recommendation was to make accreditation data more available to the public, something @OIGatHHS also emphasizes. 9/
.@OIGatHHS recommends @CMSGov make deficiency and complaint data more public, educating hospices about common deficiencies, and increasing oversight of agencies with a history of serious problems, a central issue in this story from @InaJaffeNPR 10/ npr.org/sections/healt…
But nota bene – @CMSGov cannot do this on its own; it would require a statutory change. 11/
Second, #hospice agencies only have to be surveyed for compliance once every 3 years. So, even though the studies and the investigation by @OIGatHHS found that agencies often have problems ID'd during inspections, the inspections occur are infrequent. 12/
Finally, when problems are found at a #hospice agency, government oversight agencies have few options. 13/
Unlike for nursing homes, there are no intermediate sanctions, like fines or temporarily suspending new admissions, which @PostRowland notes in the @washingtonpost report. Instead, there is only termination from #Medicare, a remedy rarely used. 14/ washingtonpost.com/business/econo…
.@CMSGov cannot implement intermediate sanctions on its own. The law would have to change. Instead, @OIGatHHS recommends increasing oversight of hospices with a history of serious deficiencies. 15/
Although this is appealing, some skepticism is warranted based on recent shortcomings in the nursing home Special Focus Facilities program detailed by @SenBobCasey, @SenToomey, and @SenateAging. 16/
#Hospice quality oversight needs attention, and hopefully the @OIGatHHS reports will generate a constructive dialogue about how best to assure high-quality hospice care for all #Medicare beneficiaries who use it. 17/
Today's reports only build on prior work by @OIGatHHS and are consistent with concerns raised in a 2017 @KHNews investigation by @JoNel_Aleccia and @mmbaily 18/
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NEW: Today, #Tennessee hit an unfortunate milestone in the pandemic, reaching the highest level of hospitalizations (~3,500) from the virus yet. Several other regions are above the highest points from the winter as well. Many regions are still increasing very rapidly. 1/
Additionally, the use of ICU beds and ventilators are also well above their previous peak, which can impact access to vitally important care for anyone, not just COVID patients.
ICU use is 20% above previous peak. (⚫️ line)
Ventilator use is 40% above previous peak. (🟣 line) 2/
But the good news! In W. Tennessee and Memphis, the hospitalizations relative to Aug. 25 are down 10% and 4%, respectively. These are areas where we've seen high increases week-over-week in vaccinations, though it's not 100% certain the 2 are related. (Here thru 8/23) 3/
#COVID-19 in #Tennessee: TN leads the U.S. in cases reported per population this week. This is very serious but raises an important question: How should we interpret the latest numbers? A thread … 1/ nytimes.com/live/2020/12/2…
Let’s be clear on 1 thing: @TNDeptofHealth is correct that hospitals are beyond their “bend” point and quickly heading to their breaking point. We’re at 2,900 hospitalized and rising. A continued surge following the holidays will create a truly dire situation. 2/
But what about those case numbers? We’ve had several days of 11k+ reported in a single day…
Q: Are we really seeing daily case numbers that high?
NEW: Nashville news media have seen and reported rising #coronavirus hospitalizations in the past week, a trend we have also observed... 1/
However, what we have also seen is a shift in the age distribution of new #COVID19 cases in #Tennessee regions recently into older age groups, which we know to be at higher risk of poor outcomes, like hospitalization and death. 2/
So what does this mean? This is a trend to watch closely. New cases happen before hospitalizations, which could mean we might see increasing stress on the state’s health care system. 3/
“Only about half of women were given an appointment for treatment with their insurance, the rest were either told no or had to pay cash. In some states, only about 1-in-5 women were given appointments with their insurance,” @stephenwpatrick said.
NEW: Hospitalizations for #COVID__19 continue to rise across #Tennessee, and age demographics for those patients is changing. Learn more in our newest report on the epidemic in Tennessee. ➡️ vumc.org/health-policy/…
Here is a "heat map" of median age by region over time. It's a very different situation depending where you are in Tennessee. Age is a leading risk factor, per the @CDCgov
Overall, #Covid hospitalizations are on a steep incline in different parts of the state as well. Read the full report here ➡️vumc.org/health-policy/…
NEW: Here's an updated look at Tennessee's #COVID19 transmission number (R0), and where the most cases are over the last 10 days. (Data current as of July 6.)
Find this and more resources on the public health response to the pandemic here ➡️ vumc.org/health-policy/…
As a reminder, an R0 above 1.0 means the virus is spreading and gaining momentum, and people who are infected are infecting more than 1 other person on average.
Here's a closer look at the area around #Memphis. (Note: Gray boundaries are counties, shaded areas are ZIP codes)