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CHRT Fellow Dr. Romesh Nalliah warns against dental opioid prescriptions in American Journal of Preventive Medicine study covered by U.S. News

Dr. Nalliah warns against dental opioid prescriptions

Dr. Nalliah warns against dental opioid prescriptionsCHRT Health Policy fellow Dr. Romesh Nalliah recently published an article entitled “Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families” in the American Journal of Preventative Medicine.

Dental opioid prescriptions are one of the most widely used medications for chronic pain. When a patient receives a dental procedure, such as a tooth extraction or root canal, they are often given an opioid prescription to treat their pain. These medications can be very beneficial for treating chronic pain, but there are also many potential side effects that patients should be aware of before taking them.

The study analyzed data from 8.5 million Americans who received dental work between 2011 and 2018. They found that the overall rate of opioid overdoses was 2.5 times higher among patients who filled an opioid prescription after their procedure compared to those who did not. The rate of overdose among family members of the dental patient was also higher if the patient filled an opioid prescription: 1.7 per 10,000 procedures versus 1 per 10,000 procedures.

U.S. News covered the study in a story by Robert Preidt titled Opioids After Dental Work May Be Dangerous. The story quoted Dr. Nalliah saying, “When a dentist, like me, prescribes an opioid to a patient I am putting their entire family at risk of overdose. Dentists should consider, if the family concerned was yours, would you take that risk?”

Dr. Romesh Nalliah is a former CHRT Health Policy Fellow, associate dean for patient services, and clinical professor of dentistry at the U-M School of Dentistry.

Freep reports Michigan did not undercount nursing home COVID-19 deaths, citing CHRT study

Senior in Nursing Home during Covid-19

On June 3, 2021, the Detroit Free Press cited the Center for Health and Research Transformation’s (CHRT) report on nursing home policies in Michigan during COVID-19 for an article about whether or not the state undercounted assisted living facility COVID-19 deaths.  Senior in Nursing Home during Covid-19

Written by Dave Boucher, the Freep article describes the claims that Michigan is undercounting pandemic-related assisted living facility deaths and that the policies of Gov. Grethen Whitmer contributed to those deaths. Boucher reports that Michigan did not undercount pandemic-related nursing home deaths, though deaths at smaller long-term care facilities may have been missed.

Department of Health and Human Services Director Elizabeth Hertel said,

The number (of pandemic-related nursing home deaths) that is being reported is accurate because the number that we have reported on our website is the self-reported number from the nursing homes.

Michigan Attorney General Dana Nessel announced that she would not investigate Gov. Whitmer or her administration on the subject of nursing home policies, and cited CHRT’s report which found no evidence that Gov. Whitmer’s nursing home policies contributed to COVID-19 transmission, and concluded that the decision “was executed in a crisis situation and was an appropriate response to the surge of COVID-19 cases in Michigan.”

CHRT’s study did, however, include a number of recommendations for the state to implement to improve wellness and safety for nursing home residents during the remainder of the pandemic. A number of these have already been implemented. 

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MLive quotes Jaque King and Robyn Rontal on how the pandemic is galvanizing shifts in how we care for the elderly

Elderly during the Covid 19 Pandemic

An elderly woman during the Covid 19 PandemicMLive’s Julie Mack quotes Jaque King, lead healthcare analyst at the Center for Health and Research Transformation (CHRT), and Robyn Rontal, CHRT’s policy analytics director, in “COVID-19 pandemic hit seniors hard. Could it lead to a rethinking of how we care for the elderly?” The article describes how the COVID-19 pandemic brought to light many chronic problems in the way our health care system cares for the elderly.

King discusses research CHRT conducted on how nursing homes responded to the pandemic. “There’s really a clear need to care for and support staff,” she said. “During our study, we heard a lot of issues around being undervalued and underpaid, and about the need for training and education going forward.” In addition, “staffing levels are really important to keeping nursing home residents safe,” said King. “Those are the kinds of challenges the pandemic really highlighted and brought to light.”

Rontal notes that the pandemic is galvanizing a shift to home-based care. For years, Rontal says, there has been a movement “to find ways to shift care to the home with supportive services. There are a lot of good examples [of innovative] programs and polices that are starting to test that approach,” she says. “But I think the pandemic shone a spotlight on the need for better services in the home.”

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Detroit News quotes Terrisca Des Jardins on whether hospital price transparency provides meaningful information

A hospital bill on a blue table.

A hospital bill on a blue table.In a Detroit News article by Karen Bouffard, Price shopping in Michigan proves difficult despite new rule for hospital costs, Terrisca Des Jardins, the executive director of the Center for Health and Research Transformation (CHRT), discusses the complexity of hospital price transparency.

Since January 1, hospitals have been required to publish their discounted cash prices and the prices they have negotiated with insurance companies for 300 medical services. Supporters of hospital price transparency hope the publicly available price information will help consumers make decisions as well as reduce prices by creating competition between hospitals.

However, pricing information at hospitals is complex and difficult to compare. Some hospitals include doctor fees in their prices, for instance, and some don’t. Hospitals may offer different versions of procedures with different aspects included. Adding complex medical language makes the pricing information even more difficult for consumers to understand. Consumers find it difficult to evaluate pricing and make knowledgeable decisions about their healthcare options due to all of these factors. 

“Our biggest concern is whether price transparency is going to provide meaningful and actionable information to consumers about what the actual cost of their care is,” Des Jardins said. “And unless there is a clear and consistent process for translating and comparing price data, it may be confusing to consumers.”

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No evidence of transmission between COVID-19 patients in nursing homes

Covid test strip reads positive

Covid test strip reads positiveOn March 12, 2021, PolitiFact reported on the criticism surrounding Michigan Gov. Gretchen Whitmer’s nursing home COVID-19 policies. Clara Hendrickson and Kristen Jordan Shamus reported that under Gov. Whitmer’s administration’s policies, elderly patients with COVID-19 were released back to their long-term care facilities or to nursing home hubs designated for COVID-19 patients. The Michigan Republican Party has said that this policy caused the deaths of other seniors in nursing homes. 

In the article, Hendrickson and Shamus cite a Center for Health and Research Transformation (CHRT) report that showed no evidence of transmission between COVID-19 patients admitted from hospitals to nursing home hubs. CHRT did, however, find that the overall COVID-19 death rate was lower (17% vs. 26%) at nursing homes that were classified as regional centers than at nursing homes that weren’t. Non-hub facilities admitted more than twice as many COVID-19 patients in recovery during the course of the study period.

CHRT’s findings do not mean that there wasn’t the transmission, emphasized Udow-Phillips. But Udow-Phillips suggested that COVID-19 may have been transmitted from staff to residents, instead of between residents. “Most of the national data has supported this observation that it’s the transmission from the community into nursing homes,” she said. 

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Michigan’s mental health system is a complex web, not an easy system to navigate writes Crain’s Detroit citing CHRT

In “State of confusion: Michigan’s mental health system has many layers for those in need to navigate,” Chad Livengood of Crain’s Detroit describes Michigan’s complex and daunting mental health system. Livengood notes that the system is facing financial hardships due to its complexity, as well as the huge financial hit caused by the COVID-19 pandemic itself.

COVID-19 has delayed state plans to improve the mental health system and provide more resources for those with severe mental health issues (SMI). Individuals with SMI often find themselves lost in the medical system, or the ER, instead of getting adequate mental health treatment from the proper organizations.

Livengood writes that when mental health facilities do receive funding from the Michigan Department of Health and Human Services, those funds tend to come with a long list of requirements that cost money to implement.

Certified Community Behavioral Health Clinics (CCBHC) are designed to address this issue by integrating primary care with mental health treatment. Experts hope that integrated health networks like these will dramatically improve the state’s mental health system.

Livengood cites the Center for Health Research and Transformation’s recent brief on CCBHCs, which notes that there are 18 CCBHCs across the state, and none in the northern Lower Peninsula and Upper Peninsula.

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Bloomberg cites CHRT’s nursing home policy research; argues that criticism of the Whitmer Administration is unfounded

Nurse wearing a mask cares for an elderly man wearing a mask in a nursing home.In a Bloomberg News article, Republicans Seize on Nursing-Home Deaths to Weaken Democrats, David Welch and Gabrielle Coppola quote Marianne Udow-Phillips discussing the Center for Health and Research Transformation’s (CHRT) recent research on Michigan’s nursing-home policies during the COVID-19 pandemic.

Michigan Republicans have asked the state’s attorney general to investigate how Governor Gretchen Whitmer handled nursing home policy during the early stages of the pandemic. This is part of a nationwide pattern of Republican lawmakers criticizing Democrats for their handling of the pandemic, and specifically for the rates of deaths in nursing homes.

Welch and Coppola argue that these accusations are unfounded. In the case of Governor Whitmer’s policies in Michigan, they observe that CHRT’s research into nursing home policies in the state found no major problems. Overall, CHRT discovered that Michigan’s hub concept worked successfully. In Michigan’s nursing home hubs as compared to non-hub nursing facilities, the percentage of COVID-19-positive residents who passed away was significantly lower. This research, conducted by Cristin Cole, Erica Matti, Robyn Rontal, Jaque King, and Marianne Udow-Phillips, evaluated Michigan’s COVID-19 nursing home strategy and made recommendations for improvements.

Udow-Phillips told Bloomberg, “I hear these allegations [against Governor Whitmer] and ask, ‘Where is the evidence?’ There is no evidence. We found the governor’s strategy to be reasonable and appropriate, especially at the time.”

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Fox 17 Interviews CHRT Health Policy Analyst Ryan Bartholomew about special open enrollment period

Special Enrollment Period From February 2020 to May 2020, there was a 46 percent increase in uninsured Michiganders due to residents losing their jobs during the early days of the pandemic. This means about 834,000 Michiganders newly found themselves without insurance. Via executive order, President Biden enabled the federal government to reopen the ACA  Health Insurance Marketplace for a special enrollment period from February 15th-May 15th “for those who didn’t sign up for healthcare during the fall open enrollment period, or lost their private insurance during the pandemic.”

In a Fox17 interview, Doug Reardon talked with CHRT Health Policy Analyst, Ryan Bartholomew about what the special enrollment period for ACA insurance would mean for Michiganders.

Bartholomew emphasizes that having health care coverage can save Michiganders dollars: “Just being hospitalized for COVID-19 can c[ost] tens of thousands of dollars and having health insurance can be what prevents individuals and families from going bankrupt.” This special open enrollment period will extend access to affordable health care.

“Nine-in-ten Michiganders qualify for additional support and subsidy through the exchange,” says Carrie Kincaid, vice president of individual markets for Priority Health. Many people will get help paying for their premiums, “plus you could qualify for the Healthy Michigan program or Medicaid expansions.”

For more information on marketplace rates, read CHRT’s Rate Analysis: 2021 ACA Health Insurance Marketplace for Michigan or go to www.healthcare.gov

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Detroit Free Press quotes Terrisca Des Jardins on the unintended consequences of hospital price transparency

Image of a man holding a hospital bill

Image of a man holding a hospital billIn a Detroit Free Press article, Trump rule forces Michigan hospitals to reveal secret prices, JC Reindl quotes Terrisca Des Jardins on the potential consequences of hospitals’ price transparency. 

New rules, which took effect Jan. 1, require hospitals to disclose the rates they have negotiated with insurers–information that was previously secret. Most hospitals in southeast Michigan have complied. The Free Press found significant differences in the price of procedures between hospitals and between insurers at the same hospital. 

Supporters of the hospital price transparency rule believe price transparency will lower healthcare costs. For instance, an insurance company may demand a reduction from a hospital if it discovers that it is paying more than a competitor.  Des Jardins, however, warns, “There is not yet enough evidence that shows that price transparency will indeed lower costs. Sometimes, these types of efforts have unintended consequences.”

The American Hospital Association opposed the disclosures, contending that hospitals are too overwhelmed currently with COVID-19 treatment and vaccine administration. They have asked President-elect Joe Biden’s transition team to roll back the rules. The association’s CEO Richard Pollack highlighted that hospitals should focus their time and resources on delivering patient care and giving vaccines rather than being overburdened with additional requirements. 

 

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Riba and Adams op-ed: Four ways Michigan providers can prepare to serve aging veterans

MI Provided serving a veteran

MI Provided serving a veteran

The COVID-19 pandemic has raised awareness of the need for aging veterans’ healthcare. The situation has become more serious as many aging veterans have put off getting medical and mental health treatment because of the pandemic. A recent assessment was conducted to determine the number of health and mental healthcare specialists in Michigan who are qualified to offer the veterans of the state high-quality, competent care.

In a Lansing State Journal op-ed, CHRT Research and Evaluation Director Melissa Riba, and VA Ann Arbor health physician Dr. Megan Adams, share findings from a recent analysis of the readiness and capacity of Michigan’s primary and specialty care providers to serve and provide high-quality care to, the state’s aging veterans. 

Based on the assessment, Riba and Adams also offer four recommendations for Michigan health and mental health care providers, payers, and systems–recommendations that may be of interest to other states–that wish to improve community-based health care for aging veterans:

  1. Screen all patients for veteran status,
  2. Learn about the specific health needs of veterans,
  3. Explore veteran and military culture, and 
  4. A better understanding of the resources and services covered and offered by the Veterans Health Administration.

By following these recommendations, healthcare organizations and systems can contribute to aging veterans’ quality of life improvements and give them the care and assistance they require to age with respect and dignity.

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