As urbanization increases, an older, sicker and poorer population remains in rural America. New infographics from the National Institute for Health Care Management (NIHCM) Foundation depict the population shifts driving these changes, the corresponding health care challenges, and promising tools to improve rural health. In rural areas, 18.4 percent of the population is over 65 years of age compared to 14.5 percent in urban areas, and rates of obesity, diabetes and smoking are higher.   The infographics can be accessed here.

Depression is on the rise. So is suicide, particularly among young people and military veterans. And Pennsylvania recently concluded that addressing mental health needs is the best defense against school shootings.

Yet, because of a shortage of psychiatrists, people commonly wait six months for an appointment in central Pennsylvania. That means some people badly in need of help continue suffering, and may become dangerous to themselves or others, before they can begin getting better.

“It’s terrible,” says Marge Chapman, executive director of the Dauphin County chapter of the National Alliance on Mental Illness, or NAMI.

Kathleen Zwierzyna, head of the NAMI chapter for Cumberland and Perry counties, tells of a relative who waited more than five months for an appointment with a psychiatrist. “We know many families who have lived through it,” she says.

Long waits extend to young people who show signs of mental illness at school and are referred by school staff, says Dan Daniels, executive director of the NAMI organization serving York and Adams counties.

Nearly half of Pennsylvania counties have no psychiatrist, says Christine Michaels, CEO of NAMI Keystone Pennsylvania.

“Yet there’s a crisis with suicide,” she says, noting areas that lack psychiatrists tend to be economically-depressed and have higher rates of depression among residents.

Psychiatrists, who are medical doctors, play a key role in diagnosing mental illness and deciding what treatment and medication should be used. Sometimes, symptoms return in patients who have been doing well, putting them in need of a psychiatrist to change or adjust their medication.

When people experiencing mental illness have to wait to be diagnosed, or begin medication or have it adjusted, it can disrupt their ability to work, attend school or care for their family, says Dr. Erika Saunders, chair of psychiatry at Penn State Health Milton S. Hershey Medical Center. Worse, it can put them at high risk of having to be hospitalized, ending up in jail or committing suicide, she says

Beyond that, delays can trigger other health problems and cause harrowing and destabilizing times for families. “There is a huge burden on families who are trying to care for their loved one,” Saunders says.

One central Pennsylvania resident who doesn’t want his name published experienced a return of a condition that had been well-controlled for years with medication. He learned his Harrisburg-area psychiatrist had retired. He says he contacted the area’s three major health systems: Penn State Health, UPMC Pinnacle and Geisinger Holy Spirit.

None could offer a near-term appointment, he says. One provided a list of private psychiatrists, but none were available. One suggested he try again in fall.  “We have a severe shortage of mental health professionals,” Saunders says. “We’re doing our best to care for [the sickest] patients, but we need to expand access for all patients.”

The shortage is severe not only in Pennsylvania but in much of the United States.

Read the entire article here.

She started having suicidal thoughts at 11 or 12. She didn’t know the words to name it. She had no idea what it was, but she consistently had these urges to end her life.  “I just wanted to be dead,” she says.

One night when she was 24, and already long diagnosed with clinical depression, she succumbed to the feelings.  “I couldn’t suppress these thoughts anymore,” she recalls. “I had thought about ending my life for eight straight months.  “I texted a friend and said, ‘It would be better if I wasn’t here.’ That friend did not know that I had already taken substances in the hope that I would go to sleep and not wake up. And while I was waiting to die, the police showed up.”

T-Kea Blackman, now 29, survived that attempt and dedicated her life to helping others navigate the darkness of depression and mental health crises.

Read the entire article here.

Updated Oct 04, 2019; Posted Oct 04, 2019

ECRI Institute this week released its annual list of the 10 biggest patient-safety concerns in 2020, with misuse of surgical staplers ranking No. 1. Marcus Schabacker, president and CEO of ECRI, said, “Injuries and deaths from the misuse of surgical staplers” were found to be “substantial and preventable.” (Source: HealthLeaders Media, 10/8)

The Josiah Macy Jr. Foundation has released a blog on Social Determinants of Health: A required Curriculum. The blog discusses the importance of understanding all the social factors that can affect a patient’s health and how medical professionals need to understand the conditions in their communities if they are going to help their patients live their healthiest lives. This blog can be applied to all health professionals.

Click here to read the blog.

Many older Pennsylvanians wish to continue living in their homes and their communities for as long as economically and medically feasible; and Pennsylvania’s LIFE and Community HealthChoices programs enables participants remain in their own homes and communities and live happier, more productive, and more fulfilling lives.

The Wolf Administration recently announced a 14-county expansion of the Living Independence for the Elderly (LIFE) program, a long-term care program that helps seniors live in their homes and coordinates their health and personal needs. Through this expansion under the jurisdiction of the Department of Human Services (DHS), LIFE programs will be established in Bradford, Cameron, Carbon, Centre, Clearfield, Elk, Fulton, Jefferson, Monroe, Potter, Sullivan, Susquehanna, Tioga, and Wayne counties.

For more information: http://dhs.pa.gov/citizens/life/

The number of U.S. residents diagnosed with a sexually transmitted infection (STI) hit a record high in 2018, with almost 2.46 million reported cases of chlamydia, gonorrhea, syphilis, and other STIs, according to a CDC report released this week. The report noted that the rate of STIs has increased steadily since 2014, and the report’s authors blamed budget cuts at both the state and local level for the increases. The authors wrote that the cuts resulted in staff reductions and clinic closures, which in turn led to fewer screenings and patient follow-ups. (Source: Reuters, 10/8)

U.S. News & World Report last week released its Best States for Aging list, which ranks all 50 states on how they address the needs of older adults. Maine ranked No. 1 on the list, while Kentucky ranked last. (Source: U.S. News & World Report, 9/30)

The Trump administration has proposed new exemptions and safe harbors to the Stark Law and anti-kickback statute to spur more physicians and healthcare facilities into value-based care arrangements.

The reforms, a proposed rule from the Centers for Medicare & Medicaid Services and another proposal from Health and Human Services’ Office of Inspector General, aim to update the 1989 Stark Law that bans physicians from referring patients to facilities they have a financial stake in. The proposed regulations would create a permanent exception to the law to shield legitimate value-based deals from penalties.

“Unfortunately the looming threat of liability under the Stark Law has discouraged many providers from entering into value-based arrangements in the first place,” Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said in a call with reporters Tuesday.

Verma said that currently, CMS does provide waivers for value-based care arrangements, but they are only for Medicare-based payment models such as accountable care organizations.

“The proposal would allow for these similar types of exceptions for these other models that are Medicare or in the private sector,” she said.

CMS’ proposed rule would require healthcare entities to provide a written document to the government that “spells out the arrangements between them and indicate what patient population they are going to target and what outcomes they are going to measure in terms of what value they are going to produce here,” said Deputy HHS Secretary Eric Hargan on a call with reporters.

Those outcomes will be monitored to ensure the value-based arrangement doesn’t violate the law.

Some examples of value-based care arrangements include if a hospital discharges a patient after a diabetes emergency and assigns a nurse educator and equipment to help the patient keep their diabetes under control.

“All of those things could be viewed as an inducement” under the current law, HHS Secretary Alex Azar said.

The proposed rule would also provide flexibility for sharing information. For example, if a cardiologist has data analytics they currently under Stark can’t give that information to the primary care practice for free, Verma said. The primary care doctor has to pay a price because it refers patients to the cardiologist.

“Our proposed rule would address that problem,” she said.

Another new proposed exception to Stark would protect the donation of cybersecurity software from a hospital to a doctor’s office.

“A hospital that wants to protect electronic health records and other data may be worried about providing cybersecurity software to physicians for free or reduced due to the Stark Law,” Verma said. “Our proposed rule would allow for such a common-sense arrangement while ensuring physicians won’t be obligated to make referrals.”

HHS expects to also propose clarifications to terms in the Stark Law to help hospitals with compliance, but HHS officials did not divulge what terms would be affected.

The agency is also soliciting comments on what role price transparency will play in the regulations. CMS wants to know if it should require cost-of-care information when a physician or hospital issues a referral, a fact sheet on the new regulations said.

The proposed rule would also provide additional guidance on how to determine if compensation from one physician to another runs afoul of Stark.

OIG’s proposed rule has changes to safe harbors to ensure that the new exceptions and changes to Stark also don’t violate the federal anti-kickback law.

Article: https://www.fiercehealthcare.com/payer/hhs-will-release-regulations-to-overhaul-stark-law-to-entice-value-based-payment-arrangements?elq_cid=2420582&x_id=