News
A Review: Unhealthy Alcohol Use in Primary Care - The Elephant in the Examination Room

by Dan Osterweil, MD, FACP, CMD

Unhealthy Alcohol Use in Primary Care—The Elephant in the Examination Room, by Jennifer Edelman, MD, MHS; Jeanette M. Tetrault, MD, raises the important distinction between alcohol use disorder and unhealthy drinking associated with health status. CALTCM has been on the vanguard of this notion, collaborating with researchers from UCLA and Harvard, offering a CME program aimed at educating primary care physicians in identifying elders at risk for alcohol-related/associated health problems. The program is interactive and a fun way to learn about the subject. It focuses on knowledge and skills required in the primary care office to identify individuals who should be screened and counseled versus those who should be referred to addiction specialists or  psychiatrists.

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Call for Posters for Annual CALTCM Meeting!

I have found one of the most educational and enjoyable aspects of our annual meeting to be taking in the individual research projects that are completed and presented in “poster” form during our annual meeting. The presenters in the past have been very diverse: from distinguished academic researchers to medical students; from DONs to CNAs; from PharmDs to pharmacy students.

How does one go about creating and presenting a poster at our meeting? Since I really wanted to become further involved with this process, I asked for and received a “mentor”; someone who has much experience in this realm, and can help “walk me through” the particulars.

I would encourage anyone who has any interest in sharing a “best practice” or a research project to reach out to the CALTCM board; we will be delighted to set you up with a mentor to help you go about presenting it!

It is only through sharing of our clinical knowledge and experience that we can continue to improve the quality of care for our residents!

Click here to learn about the Poster Session guidelines and abstract needs. 

 
The “Death Certificate Project”

by Flora Y. Bessey, Pharm.D., BCGP

As many members may recall, since 2013 the Medical Board of California (MBC) and the California Department of Public Health have been working with various state legislature subcommittees to try and address the issue of opioid “overprescribing.” One initiative of this project is now known as the “Death Certificate Project.” 

This Project is a good faith effort to address the crisis of accidental deaths due to prescription opioid overdoses. To very briefly recap: the MBC has obtained data from the CDPH for 2012 and 2013 related to opioid prescriptions. These data used codes that the CDPH uses to identify underlying AND “contributing” causes of death in order to identify opioid-“related” deaths. The MBC began to examine these data in 2015, cross-referencing them with the California Controlled Substance Utilization Review and Evaluation System (CURES) database to determine who was prescribing to these individuals, and also looked at the prescribing habits of the attending physician, or the physician who certified death. These data were then sent to “experts” to evaluate whether there might have been inappropriate prescribing.

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Is Your Facility a Part of Your Hospital’s Preferred Provider Network?

by Tim Gieseke MD, CMD

In the August 1st edition of the WAVE, I wrote an article about Developing Meaningful Objective Metrics to help facilities narrow their network of post-acute nursing facilities {providers) assuming that the quality of the facilities’ performance would be the key issue.  In my area, I was aware that Kaiser had a preferred provider network, but was not aware that the 2 other local hospital systems had developed their own networks. I found out about one network from one of the preferred facilities’ intake coordinators (a point of their pride) and I just found out this week about the other hospital system having set up their network.  Both hospitals had done so without any public knowledge that it had occurred. Surprisingly, a facility that varies between 4 and 5 stars where I’m Medical Director, was not even contacted to be a part of any of these networks, and they are the only facility in that part of our county.

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Reform for a Gamified Payment System?

by Dan Osterweil, MD, FACP, CMD

The phenomenon of prescribing rehab services to some nursing home residents towards the end of their life was highlighted in a paper published in JAMDA and got wide citations in the New York Times and other publications. It was a courageous stance to shine a spotlight on the fact that between 2012-2016 NH’s in the State of New York were observed to provide rehab services in greater quantity to nursing home residents in their last month of life. While this data comes from one state, they resonated with data from CMS indicating a steep increase in the number of nursing home residents receiving high intensity of rehab services (at least 325 min/week) in the last month of life. This was almost a two-fold increase in this phenomenon in for-profit facilities compared to non-profit facilities.  While the authors and commentators focus on the economics and appropriateness of this phenomenon, it also indicates to a flaw in the way CMS pays for services in the nursing home. While some of the services seem excessive and inappropriate, they may point to need to find a way to be able to care for these patients who have functional and medical problems in post-acute care. The current reimbursement scheme does not recognize non-curative or non-rehabilitative services as eligible for SNF coverage, thus putting a huge burden on families who care for those complex patients who may be nearing the end of life and are not good rehabilitation candidates.

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