ED Doc Testifies Before Congress About “National Crisis” In Regard to America’s Mental Health Patients

From ACEP:

Appearing before Congress on Wednesday morning, Dr. Jon Mark Hirshon, an emergency physician from Maryland, called on representatives to increase resources for psychiatric care in the United States, saying  there has been a dramatic rise in emergency patients with chronic psychiatric conditions, and these patients often waits days in the emergency department until psychiatric beds become available.

Dr. Hirshon, who served as the Task Force Chair for the 2014 ACEP Report Card on America’s Emergency Care Environment, testified before the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, which is chaired by Rep. Tim Murphy (R-PA).

“The health care system is failing to address the needs of patients with chronic psychiatric conditions,” said Dr. Hirshon.  “Until more funding and services are made available, emergency departments will continue to serve as a safety set for  them” said Dr. Hirshon.

According to Dr. Hirshon, solutions include:

  • Increased hospital inpatient staffing and capacity . Additional psychiatric inpatient beds would help to alleviate boarding for those patients who require hospital-level care.
  • Better case management of patients to decrease psychiatric emergencies.
  • Increased Outpatient Capacity/Community Alternatives. Two specific community services that have shown promise as part of system-wide improvements of mental health services were crisis residential services and mobile crisis teams. Crisis residential settings could care for patients who do not need to be in a hospital setting, allowing the ED to see more acute medical patients.  Mobile crisis, often referred to as diversion teams, provide crisis intervention and stabilization services to psychiatric patients in the community, preventing many patients from seeking care in the ED.
  • Innovative Psychiatry (Tele-Psychiatry & Psychiatrists as Hospitalists). Use of tele-medicine would allow psychiatrists to perform evaluations and screenings of psychiatric patients when they cannot be physically present in the ED. This may alleviate inappropriate inpatient admission, and thus, lead to reduced boarding.
  • Eliminate Out-of-Network Insurance Issues. Hospitals that have available psychiatric beds are not always authorized to accept patients if these hospitals are not in the patients’ insurance network.  Eliminating the in-network requirement would increase available options for inpatient care.

Federal Court Vacates 340B Rule Regarding Orphan Drugs

From NationalLawReview.com:

On May 23, 2014, the U.S. District Court for the District of Columbia issued a Memorandum Opinion in Pharmaceutical Research and Manufacturers of America v. United States Department of Health and Human Services, et al. (the May 23rd Opinion), a case involving the federal government’s authority to implement regulations affecting the 340B Federal Drug Pricing Program (the 340B Program).  At issue in the case was a final rule (the Orphan Drug Rule) published by the Department of Health and Human Services (HHS) on July 23, 2013, regarding the purchase, pursuant to the 340B Program, of certain drugs designated by the Food and Drug Administration (FDA) as “orphan drugs.”  In the end, the court vacated the Orphan Drug Rule, holding that HHS did not possess the requisite statutory authority to implement such a rule.\

As a result of the court’s decision, there is a risk that any drug with an FDA orphan designation may not be considered a covered outpatient drug with respect to Newly Eligible Providers.  Thus, manufacturers may cease offering orphan drugs to these hospitals at the discounted 340B prices.  Importantly, if orphan drugs used for a non-orphan condition are excluded from the definition of covered outpatient drug, cancer hospitals, which are prohibited from purchasing covered outpatient drugs through a group purchasing organization (GPO), may be able to purchase orphan drugs for use in treating any condition through their GPO.