CVS is now limiting opioid prescriptions

From Becker’s:

As part of several new measures to curb the rate of opioid addiction and overdoses, CVS Health is enacting seven-day opioid prescription limitations for acute conditions, the company announced Thursday.

The prescription limits will be carried out by the company’s prescription drug management division, CVS Caremark. In addition to the seven-day cap for acute prescriptions, CVS Caremark will limit the daily dose of opioids dispensed based on the strength of the opioid and initially require patients to use immediate-release opioids for pain before moving to extended-release formulations.

If pharmacists encounter a prescription that is not in accordance with these guidelines, they will contact the physician and ask him or her to revise the prescription.

Guns help explain difference in urban and rural suicide rates

From Reuters:

Suicides rates may be higher in rural America than in cities at least in part because gun ownership is more common outside of urban areas, a recent study suggests.

For the study, researchers examined data on 6,196 adult suicides from 2003 to 2015 in the state of Maryland. Overall, suicide rates were 35 percent higher in rural counties than in urban counties, the study found.

Firearm suicide rates were 66 percent higher in rural counties than in urban counties, the study also found. But there wasn’t a meaningful difference in suicide rates for cases that didn’t involve guns.

Sen. Grassley calls for public disclosure of hospital safety inspections

From Becker’s:

Senator Chuck Grassley, R-Iowa, is calling for changes to a federal law that allows accrediting organizations overseen by CMS, like The Joint Commission, to keep hospital inspection reports private, according to The Wall Street Journal.

The senator, who also serves as chairman of the Senate Judiciary Committee, sent a letter on Monday to CMS Administrator Seema Verma asking for more information on what statutory changes would need to be made to end the confidentiality around inspection reports.

Mr. Grassley’s letter follows a Sept. 8 investigative report WSJ published, which found The Joint Commission seldom revokes its seal of approval for hospitals who do not comply with Medicare regulations — even after violations that seriously threaten patient safety.

“The Joint Commission appears to be unable to aggressively enforce the necessary standards on all facilities,” Mr. Grassley wrote in the letter.

Private vehicles beat ambulances in saving gunshot and stabbing victims

From Reuters:

Inner-city gunshot and stabbing victims had a better chance of surviving when they rode to trauma centers in private vehicles, rather than in ambulances, a new study showed.

Those transported to urban U.S. hospitals in emergency vehicles were 62 percent more likely to die of gunshot or stab wounds than patients with similar injuries who arrived in private vehicles, researchers reported in JAMA Surgery.

“In this narrow population of trauma patients, emergency medical services is not the answer,” said senior author Dr. Elliott Haut, a professor at The Johns Hopkins University School of Medicine in Baltimore.

Sen. Grassley: Tax-exempt hospitals shouldn’t need ‘herculean oversight’ to meet charitable obligations

From Becker’s:

Tax-exempt hospitals across the nation are using aggressive collection practices and withholding services until patients prove their ability to pay, Sen. Chuck Grassley, R-Iowa, wrote in a recent op-ed in STAT.

Mr. Grassley cited to several examples of tax-exempt hospitals demanding payment before providing care, steering uninsured patients to local clinics instead of treating them in the emergency department and referring patient accounts to for-profit collection agencies.

“All of this is contrary to the philosophy behind tax exemption,” wrote Mr. Grassley. “In exchange for the taxes they’d have to pay if they were for-profit businesses, nonprofit hospitals are supposed to provide treatment for those who can’t pay or can’t pay enough toward the cost of their own care.”

When Does EMTALA Apply? The Semantics of Emergency Care

From Emergency Physicians (hat tip: Dr. Menadue):

CMS is expanding the definition of “emergency department” under EMTALA
Hospital-based urgent care clinics may have EMTALA duty even though those clinics are not equipped to stabilize true emergency medical conditions. If an urgent care clinic cannot provide diagnostic testing and treatment similar to that provided in an emergency department, there may be a duty to transfer patients with potential emergency medical conditions to a formal emergency department. Determinations of potential EMTALA violations are made retrospectively. As with this case—where the patient’s pain did not seem to be cardiac-related—retrospective bias will likely affect the determination if a patient suffers a bad outcome (i.e. “Since the patient died from cardiac disease, the atypical chest pain must have represented an emergency medical condition that wasn’t stabilized.”). So far, this decision only applies to Rhode Island, but the court’s reasoning may be used by other courts in the future.


Ohio doctors adjust to new opioid prescription rules

From the Courier:

Ohio has new rules about prescribing opioids for acute pain.

The rules, which went into effect Aug. 31, state that no more than seven days of opioids can be prescribed for acute pain for adults, and no more than five days for minors, and only with a parent’s or guardian’s written consent.

Health care providers may prescribe opioids in excess of these limits only if they provide a specific reason in the patient’s medical record.

These limits do not apply to the use of opioids for the treatment of chronic pain, or opioids prescribed for cancer, palliative care, end-of-life/hospice care, or medication-assisted treatment for addiction.