Monthly Archives: June 2015

06.12.15
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Is this the End of the Charge Nurse as We Know It?

Mat Keller headshot
By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

It is with growing concern that MNA has received reports of increasingly ineffective charge nurse utilization in our hospitals.  If you’ve been in nursing for more than a few years, you’ve seen the trend yourself: charge nurses have quickly gone from having no patient assignment, to having a few admits or discharges as needed, to always having half of an assignment, to always having a full assignment… to having two floors?

This alarming new trend is to assign the nurse variously described as a given unit’s “resource,” “foreperson,” and “air-traffic controller” to two units at once. This disastrous model stretches already thin nurse staffing even thinner while eliminating an essential resource for both routine and emergency nursing care. Furthermore, it requires the charge nurse to be in two places at once while making safe, accurate, and timely staff assignments without knowing half the staff being assigning.

When a hospital requires a charge nurse to take on a full patient load, or to be in two places at once, that hospital is putting its bottom line ahead of patient safety. This is dangerous for both the hospital and the charge nurse. In fact,  many experienced nurses are now turning down charge nurse assignments due to their unwillingness to take on the legal risk such unsafe assignments entail.

Charge nurses are essential tools to ensure the right nurse is assigned to the right patient, to help navigate crisis situations, and to ensure care that would otherwise be missed is performed. As one researcher put it, the role of a charge nurse is a “skillful balancing act.” But how can one perform a skillful balancing act on two floors at once?

Is this the end of the charge nurse as we know it? Maybe. It’s up to nurses to stand strong together: do not accept unsafe charge nurse assignments. Do not enable your facility to cut corners and put patients at risk. Do not perform your skillful balancing act with a full patient load on two floors at once. Our patients deserve better.

06.12.15
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Is The Uninsured Rate The Lowest Ever?

Almost no one disputes that the implementation of the federal health law has helped Americans who were previously uninsured gain coverage. But exactly how much has the uninsured rate dropped?

A whole lot, says President Barack Obama.

“Nearly one in three uninsured Americans have already been covered — more than 16 million people -– driving our uninsured rate to its lowest level ever,” he told a cheering crowd at the Catholic Health Association’s annual conference earlier this week.  “Ever,” he added for emphasis.

But is the uninsured rate really the lowest ever? Maybe, say experts. But you can’t really tell.

Many pundits and others have been citing periodic polling by the Gallup organization. The 11.9 percent uninsured rate (among adults) it reported in April for this year’s first quarter is the lowest measured since it’s been keeping track. But Gallup has been measuring only since 2008.

A survey with a longer history – the one conducted by the National Center for Health Statistics at the Centers for Disease Control and Prevention – also found an uninsured rate of 11.9 percent for the first three-quarters of 2014. That was down from 16 percent in 2010, the year the Affordable Care Act became law.

But even that survey changed its methodology back in 1997, which was well after employers had begun shedding coverage for workers and families.

“I would say that we have definitive evidence that the uninsured rate for the nonelderly is the lowest it has been since 1997,” said Genevieve Kenney, a policy researcher at the Urban Institute and co-director of its Health Policy Center. (Most surveys only measure the nonelderly because nearly everyone over age 65 has Medicare.) “Before that we are on less solid ground because of data limitations.”

“Some of the surveys being used now to determine the rate weren’t even around or weren’t asking health insurance questions a decade ago,” agreed Paul Fronstin, who’s been studying the uninsured at the Employee Benefit Research Institute since 1993. “The surveys that have been around have changed.”

Indeed, the administration’s own numbers suggest that in the 1970s and 1980s, the uninsured rate might have been almost the same as it is now or even lower. A December report by the President’s Council of Economic Advisers noted that that the uninsured rate at the end of 2014 was “at or near historic lows.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

06.12.15
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Too Soon To Deride High Obamacare Rate Hikes

Some health insurance companies are asking for big price increases next year and that has again riled critics of the federal health care law.

The numbers released last week came out of an Affordable Care Act requirement that insurance companies tell government regulators by June 1 if they’re requesting price hikes of more than 10 percent. But not all of the story is yet reported. Take, for example, Montana.

Some officials opposed to the law, like U.S. Sen. Steve Daines, R-Mont., decried the increases in a speech on the Senate floor. “Blue Cross Blue Shield, which is Montana’s largest insurer, is asking for an average increase of 23 percent for Montanans enrolled in individual plans,” he told colleagues last week.

While that sounds scary, it turns out that Blue Cross Blue Shield in Montana is actually asking for large price hikes on just two plans it wants to offer in the state. While it’s not yet public how many they’ll offer in 2016, they currently offer 50 plans.

Caroline Pearson, vice president for health reform at the consulting firm Avalere Health, has been digging into available numbers on insurance pricing across several states. She said such price hikes are not the norm. She’s not seeing anything like a 20 percent average increase in the price of monthly premiums.

“Those are not necessarily the plans that hold the bulk of enrollment,” she says. “So, while some of those plans may be going up a lot in price, that doesn’t mean a lot of enrollees are necessarily affected.”

In the handful of states where data is available (Connecticut, Maryland, Michigan, Oregon, Virginia, Vermont, Washington state and Washington, D.C.), Pearson says the majority of people buying health coverage on exchanges won’t face serious sticker shock.

“We have seen that about 6 percent average rate increases are expected for 2016,” Pearson says.

As Avalere looks at the less expensive plans, she adds, “We’re seeing anywhere from a 5 percent increase for the lowest-cost plan available, to a 1 percent increase for the second-lowest-cost plan available. So we’re really looking at very modest increases — very consistent with what we saw from 2014 to 2015.”

Pearson also points out that the price increases — big or small — are by no means final. They’re requests from insurance companies. And, in some states, insurance commissioners have the ability to negotiate with the companies to moderate rate increases. The actual prices of health plans being sold on the exchanges will be final this fall.

This story is part of a reporting partnership that includes Montana Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

06.12.15
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Medicare Drug Plans Favor Generic Opioids Over Those Designed To Avoid Abuse, Study Finds

The abuse of prescription painkillers is a growing problem for seniors, as it is for other age groups. But Medicare drug plans are cutting back on coverage for a specially designated type of painkiller that deters abuse in favor of cheaper generics that don’t have the same deterrent qualities, a new study found.

Overall, Medicare coverage for long-acting prescription opioids declined from an average 46 percent of plans in 2012 to 36 percent of plans in 2015, the study by Avalere Health found.

But coverage of OxyContin, a brand-name drug that has received “abuse-deterrent labeling” from the Food and Drug Administration, fell off more sharply than other long-acting opioids that didn’t receive the deterrent labeling during that time period.

OxyContin, originally introduced in 1995, gained notoriety because people soon realized that the extended release oxycodone hydrochloride tablets could be crushed and then injected or snorted for a euphoric rush. Sometimes called “hillbilly heroin,” the drug was reformulated in 2010 by the manufacturer, Purdue Pharma, to make it harder to manipulate.

The abuse-deterrent labeling approval means a drug is formulated to make it tougher for patients to snort, inject or otherwise misuse. OxyContin received the designation in 2013; the FDA announcement noted the pills were difficult to crush, break or dissolve, forming a “viscous hydrogel” when tampered with that can’t be easily injected.

Three other extended release opioid drugs were approved for abuse-deterrent labeling in 2014, outside the timeframe of the Avalere study.

Despite its abuse-deterrent labeling, OxyContin’s coverage rate in the Medicare drug plans, sometimes called Part D plans, dropped from 61 percent in 2012 to 33 percent in 2015, the study found.

Although there’s no generic equivalent for OxyContin, the Avalere analysis found that generic oxycodone, which contains the same active ingredient as OxyContin but lacks its special abuse-deterrent labeling, was covered by nearly 100 percent of plans in each of the years studied.

The coverage decisions “suggest that the Part D plans are not considering abuse deterrents as any meaningful part of the coverage decision,” says Caroline Pearson, a senior vice president at Avalere and co-author of the study.

OxyContin is significantly more expensive than generic hydrocodone. A 120-day supply of generic hydrocodone might cost $28, according to Healthcare bluebook, which estimates prices based on a nationwide database of payment data. [A similar prescription of OxyContin, on the other hand, might cost $632, more than 20 times the generic price.

Pearson notes that as more drugs receive the abuse-deterrent labeling, competition may bring prices down somewhat.

“But they’re never going to be the same price as a generic,” she says. “At some point, payers or policymakers need to decide whether they’re willing to pay a premium to avoid abuse.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.