House Committee Greenlights New Bill that Would Extend Hospital-at-Home, Telehealth Flexibilities

McKnight’s Home Care / By Adam Healy
 
A House Ways & Means health subcommittee on Wednesday unanimously approved a new bill that would extend the Acute Hospital Care at Home waiver by five years and pandemic-era telehealth flexibilities by two years. 
 
The subcommittee’s bipartisan group of lawmakers voted 41 to 0 in favor of the “Preserving Telehealth, Hospital and Ambulance Act,” which was introduced on Tuesday. Representatives called out the need to extend the hospital-at-home waiver, which is set to expire at the end of 2024. 
 
“Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home starting at the end of this year,” Rep. Jason Smith (R-MO) said during the hearing. “Only a few short years ago, these possibilities seemed unthinkable, but are now revolutionizing care for seniors on Medicare and those living in rural areas.”
 
The Centers for Medicare & Medicaid Services created the Acute Hospital Care At Home Waiver in November 2020 to free up hospital bed supply during the COVID-19 pandemic. In the years since, the hospital-at-home program has expanded. More than 300 hospitals across 129 health systems in 37 states are operating under the waiver. In March, more than 50 hospitals and home care firms sent a letter to House lawmakers asking them to extend the program. 
 
Policymakers on Wednesday also approved of the bill’s support of telehealth flexibilities instituted during the COVID-19 pandemic. These flexibilities allow any Medicare-certified healthcare provider to furnish telehealth services to patients, even across state lines. The pandemic-era allowances are also set to expire at the end of the year, and likewise, stakeholders have called on policymakers to pass an extension.
 
Some lawmakers even expressed interest in making telehealth a permanent fixture in Medicare-covered services…

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Can AI Reduce Patient Violence Against Clinicians?

Modern Healthcare / By Gabriel Perna

Artificial intelligence is touted as a way to ease clinicians' workload. A hospital in Dallas is using it to keep them safe. 
 
Parkland Memorial Hospital, the city's large safety-net hospital, is using AI to protect its doctors and nurses from violent patients. It joins a growing number of health systems deploying AI to tackle the pressing issue. 
 
“We feel that workplace violence, particularly in healthcare, was an epidemic before the pandemic. But then with the pandemic, it just got even more pronounced,” said Steve Miff, CEO of Parkland Center for Clinical Innovation, the health system's research institute. “When you’re at the hospital, it’s one of most vulnerable times in your life. So, you can understand why it’s a setting that’s probably more primed for irrational behavior.” 
 
A team from the research institute developed an predictive AI tool within its electronic health record to generate a risk assessment score that informs clinicians which patients are more likely to be violent. 
 
The development of the AI tool comes as violence against doctors and nurses is on the rise. More than 80% of nurses said they experienced some form of workplace violence in 2022 and 2023, according to a February survey by National Nurses United. In a January survey by the American College of Emergency Physicians, 71% of emergency physicians said violence in the emergency department was worse in 2023 than in 2022.
 
The American Hospital Association has endorsed a bill that would make it a federal crime to attack healthcare workers in the process of doing their jobs. 
 
Parkland has about 400 incidents per year that can include verbal threats, hair pulling, biting or hitting. Often, they are underreported by clinicians, Miff said. 
 
“Just hearing the frontline staff stories is just heartbreaking because they're passionate about helping people and then they themselves become a victim,” Miff said…

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In-Home Health Risk Assessments May be Responsible for Billions in MA Overpayments, Study Finds

McKnight’s Home Care / By Adam Healy 
 
Medicare Advantage insurers may be upcoding patients’ risk scores during health risk assessments (HRAs) — and collecting billions of dollars in payments as a result of this practice, according to a new study published in HealthAffairs.
 
“There is significant concern that plans may seek to maximize risk-adjusted payment rates through the addition or escalation of diagnosis codes,” the researchers said. “Given that MA plans are responsible for the actual cost of care for their enrollees, coding efforts that increase plan payments have the potential to equip plans with additional resources that they may invest in additional or enhanced benefits … or instead, plans may retain additional payments as profits.”
 
The researchers analyzed 2019 MA encounter data for more than 4 million beneficiaries. They found that beneficiaries who received HRAs — which are typically performed in beneficiaries’ homes — were given risk scores that were almost 13% higher, on average, compared to those that did not. As a dollar amount, risk coding from HRAs could run the Centers for Medicare & Medicaid Services a bill as high as $12.3 billion annually, the study found.
 
HRAs allow insurers to capture patient information that is used to determine risk-adjusted payments. While these payments are intended to give insurers the resources to better support sicker patients, MA plans have drawn scrutiny in recent years for allegedly upcoding patients’ risk scores to increase payment rates from CMS.
 
Calls for crackdown
 
Most recently, the Better Medicare Alliance published a report in October calling for MA insurers to be more transparent about their HRA practices amid reports of upcoding. In 2020, the Department of Health and Human Services Office of Inspector General raised concerns that MA plans were abusing HRAs to reap billions of dollars in overpayments. And in 2015, the Medicare Payment Advisory Commission found that risk scores among MA beneficiaries were about 8% higher, on average, than traditional Medicare enrollees. 
 
About 44% of community-dwelling MA beneficiaries had received at least one HRA in the prior year, according to the HealthAffairs study. But despite HRAs’ widespread use, the researchers found little connection to their impact on patients’ care quality or health outcomes.
 
“The overuse of HRAs by some plans may lead to substantial payment distortions in the MA program if the risk score increases due to HRAs are not necessarily associated with increased resource use,” they wrote.

Vaccine Against Urinary Tract Infections in Development

Medscape / By Dominique Baudon, MD, PhD

Urinary tract infections are among the most common bacterial infections. They can be painful, require antibiotic treatments, and recur in 20%-30% of cases. With the risk for the emergence or increase of resistance to antibiotics, it is important to search for potential therapeutic alternatives to treat or prevent urinary tract infections.

The MV140 Vaccine

The MV140 vaccine is produced by the Spanish pharmaceutical company Immunotek. MV140, known as Uromune, consists of a suspension of whole heat-inactivated bacteria in glycerol, sodium chloride, an artificial pineapple flavor, and water. It includes equal percentages of strains from four bacterial species (V121 Escherichia coli, V113 Klebsiella pneumoniae, V125 Enterococcus faecalis, and V127 Proteus vulgaris). MV140 is administered sublingually by spraying two 100-µL doses daily for 3 months.

The vaccine is in phase 2-3 of development. It is available under special access programs outside of marketing authorization in 26 countries, including Spain, Portugal, the United Kingdom, Lithuania, the Netherlands, Sweden, Norway, Australia, New Zealand, and Chile. Recently, MV140 was approved in Mexico and the Dominican Republic and submitted to Health Canada for registration.

A randomized study published in 2022 showed the vaccine's efficacy in preventing urinary tract infections over 9 months. In total, 240 women with a urinary tract infection received MV140 for either 3 or 6 months or a placebo for 6 months. The primary outcome was the number of urinary tract infection episodes during the 9-month study period after vaccination.

In this pivotal study, MV140 administration for 3 and 6 months was associated with a significant reduction in the median number of urinary tract infection episodes, from 3.0 to 0.0 compared with the placebo during the 9-month efficacy period. The median time to the first urinary tract infection after 3 months of treatment was 275.0 days in the MV140 groups compared with 48.0 days in the placebo group.

Nine-Year Follow-Up

On April 6 at the 2024 congress of The European Association of Urology, urologists from the Royal Berkshire NHS Foundation Trust presented the results of a study evaluating the MV140 vaccine spray for long-term prevention of bacterial urinary tract infections.

This was a prospective cohort study involving 89 participants (72 women and 17 men) older than 18 years with recurrent urinary tract infections who received a course of MV140 for 3 months. Participants had no urinary tract infection when offered the vaccine and had no other urinary abnormalities (such as tumors, stones, or kidney infections).

Postvaccination follow-up was conducted over a 9-year period, during which researchers analyzed the data from the electronic health records of their initial cohort. They queried participants about the occurrence of urinary tract infections since receiving the vaccine and about potential related side effects. Thus, the results were self-reported…

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