Clinicians Who Learn Of A Patient’s Opioid Death Modestly Cut Back On Prescriptions

New research has found that physicians modestly reduced the volume of opioids they prescribed after being told one of their patients had died of an overdose.

Anna Gorman, Kaiser Health News

Physicians and other medical providers modestly reduced the volume of opioids they prescribed after being told one of their patients had died of an overdose, according to research published Thursday.

“You can hear a lot of statistics about the crisis,” said Jason Doctor, lead author of the study, published Thursday in the journal Science. “But it always feels like it is happening elsewhere if you are not aware of any deaths in your own practice.”

The research included more than 800 clinicians — doctors, nurse practitioners, physician assistants and dentists — comparing those who received a letter from the medical examiner about a patient’s death and those who didn’t. The ones who knew about the overdose death cut the overall volume of opioids they prescribed by almost 10 percent over three months, while those who didn’t know prescribed roughly the same amount as before.

The study shows that awareness and education can change prescribing behavior, said Doctor, a director at University of Southern California’s Schaeffer Center for Health Policy & Economics. The modest size of the reduction among those who were notified of a death suggests “that clinicians exercised greater caution with opioids rather than abandoning use,” according to the study.

The providers in the study who were informed about patients’ deaths were also 7 percent less likely to start new patients on opioids.

The letter did not blame providers for the deaths but showed that authorities were paying attention, according to the study.

“We were providing them with important information and also giving them a way to make things better by changing prescribing,” Doctor said. “Anyone who got the letter could continue to prescribe as much as they wanted, but we found that they didn’t. They became more judicious prescribers.”

Over 19,000 people died from prescription opioids in 2016, roughly double the number 14 years earlier, according to the National Institute on Drug Abuse. Most of that increase occurred from 2002 to 2011, and the numbers have been relatively stable since then, according to the NIDA.

Meanwhile, prescriptions of opioids are declining, and health officials are seeking ways to accelerate the trend.

The study did not measure whether the letters from the medical examiner or the changes in prescribing patterns had any effect on patient deaths.

Across the country, physicians have been accused of overprescribing opioids and have even faced charges related to patient overdose deaths. In an effort to better track prescribing patterns, states have started prescription drug monitoring databases.

The CDC recommends that providers avoid opioids if possible, but if they are necessary, they should start with the lowest effective dose.


Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Best Non-Clinical Side Hustles Any Clinician Can Start – Part 2

Part two of this series explores the non-clinical options of landing clinical speaking opportunities or joining paid medical market research panels.

By Jordan G Roberts, PA-C

Welcome back to our series on non-clinical careers for healthcare professionals. In part I, we discussed opportunities to start teaching in non-traditional ways and how to get into medical writing.

Today’s post will expand on this topic. First, we’ll show you how you can land clinical speaking opportunities. Next, you will learn about how to join paid medical market research panels to supplement your income and shape the direction of industry.

Speaking

It turns out that not many of us like the sound of our own voice. Even fewer people jump at the prospect at getting in front of a large crowd. That’s unfortunate, because your colleagues really do want to hear what you have to say.

The good news is that you can reach your fellow clinicians in a variety of ways, with or without a podium and a lectern.

While speaking at conferences is generally the first thing that comes to mind, it’s generally labor-intensive to get started. You not only need a great presentation, but you will also have to plan, apply for, and be selected for the spot. Therefore, this rigorous process makes it a prestigious, if not occasional option.

Other avenues take advantage of technology and the information boom. Medical podcasts and videos online are becoming more popular and starting to catch up with other social media trends. There are podcasts specific to certain groups of clinicians, podcasts for CME, and even specialty-specific podcasts. What will yours be?

Of course, one of the most lucrative ways to speak is for industry. Key opinion leaders (KOLs) give promotional talks for products they use and find to be the most beneficial for their patients. Teaching others about what you already use is a great way to get into this line of work.

Medical Market Research Panels

There are several companies who license their pool of clinicians to their clients who are developing a new healthcare product or service. The best ones pay cash honorariums that are worth your hourly rate. You also help shape the direction of these companies by providing your expertise and experience for these companies to consider in their future strategy.

Learn the skills and get the resources you need to get started in the original article. Continue reading the second of our three-part series on non-clinical opportunities here


Jordan G Roberts, PA-C helps medical education companies create and distribute the best medical education around. He helps students and clinicians improve their clinical game by using his background in neuroscience to teach simple ways to learn complex medical topics. He is a published researcher, national speaker, and medical writer. He can be found at Modern MedEd where he promotes clinical updates, medical writing, and medical education.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Kim’s Blog: Stand Up and Support Patients’ Wishes

What effort does it take to support a patient’s wishes? It’s not merely documenting them, but putting the wheels into motion to do, or to NOT do things.

by Kimberly Spering, MSN, FNP-BC

What effort does it take to support a patient or family’s wishes? It’s often not merely documenting those wishes, but putting the wheels into motion to do, or to NOT do things.

I received a request from my staff the other day to open a palliative care case – a new patient, on a Friday. Typically, I like my new patients to be earlier in the week, as those visits can last for hours, and, quite frankly, I like to be done at a reasonable hour prior to the start of my weekend, rather than chart until 8 – 9 PM.

“We think she may need hospice support. It’s not urgent, of course,” I was told.

I reviewed the patient’s chart. A nonagenarian at almost 91 years old, she had dementia, which unfortunately worsened after a CVA several years ago. She had been a fully independent, active person until she fell and suffered pelvic fractures almost two months ago. She went to rehabilitation, came home, then was found lethargic with a low SpO2 in the 70s. She returned to the hospital and was diagnosed with bilateral pulmonary emboli. She was started on anti-coagulation, which was quickly stopped due to GI bleeding. An IVC filter was placed. The GI specialists felt she was too frail and declined any invasive evaluation of the bleeding. Our palliative care inpatient team saw her and discussed hospice, but the son was not ready to make that decision.

Due to concerns about her care with the nursing home with her first rehabilitation stay, her son requested that she come home, where she has had 16 hours/day of aide support.

I arrived to find her son on the phone with her PCP’s office. Her hemoglobin had decreased from 11.8 to 10.2 in several days, so the PCP recommended ED evaluation.

Three days ago, however, she had presented to the ED for black, tarry stools (which continued after anti-coagulation was stopped). Her hemoglobin was stable, so she was discharged home.

Her son was irate, because it took hours for an ambulance transport to bring her home (at 1:30 AM), and when she got there, she was full of feces that hadn’t been cleaned up.

So, when the PCP office called today, saying, “take her back to the ED,” he was less than willing to do so.

I spoke with the office staff during that call, telling them I was there to evaluate her, and we would see how she was.

I started the conversation by reviewing her hospital stays, then led this into discussion of their goals of care.

“I don’t want her to go back to the hospital,” he first said. “I want to keep her at home and care for her here.”

After much discussion of hospice support, he admitted that he wasn’t ready for hospice, as he wanted to keep checking her CBC and have her get blood if needed. At the same time, he declined an EGD and colonoscopy, and he really did not want her to go back to the hospital, although he “would if it was needed.”

We discussed her decreased Hgb level, as well as his wishes for further care. Because he wanted the option to return to the hospital, getting blood if needed, she would not be appropriate for hospice anyway.

I gently explained my worries that with a continued slow GI bleed, that she eventually would become hypoxic and more lethargic, but unfortunately, with her current Hgb of 10.2, likely the hospital would NOT transfuse her at this point. In fact, the hospitalist previously documented transfusions only if her Hgb was < 7.5. Going to the ED would not be beneficial today, given that her vitals were stable, she was not SOB, and did not appear toxic.

Her son was relieved after this discussion. He has his own significant health issues, and in fact had an appointment today. We reviewed danger signs – increased dyspnea, lower SpO2, increased lethargy/weakness, increased black stools, etc.

I made another phone call to the PCP office and also messaged the patient’s PCP about the symptoms, evaluation, and son’s preference for repeat labs in a few days. As of this blog, I have not heard back.

What was important was to advocate for the patient and son. Had she seemed toxic or decompensated, given that he wanted labs and blood, I would have reiterated the need for ED evaluation.

Looking at the bigger picture, however, brought up a few points:

  • GI did not want to perform invasive testing.
  • Her Hgb was stable and not at a level to warrant transfusion.
  • The son’s goal is to keep her at home and minimize any invasive testing or hospitalization.

So, can one simply look at a hemoglobin level and recommend ED evaluation?

Really, it’s an individual decision, based on individual factors. Not simply a hemoglobin level. I imagine that the ED staff would roll their eyes having a patient with this hemoglobin roll in, particularly since parameters were clearly set only days ago.

So, once again – it points out that we need to advocate for our patients, explain their diagnoses, treatment options, risks, and benefits. Discussing their goals of care is essential. Do the possibilities of treatment coincide with their goals? Are we simply chasing “numbers,” rather than looking at the whole picture?

I get it, from my palliative perspective, it’s all about quality of life. Function. Comfort. Goals of care.

In this case, however, I think her goals are clear. Minimize hospitalizations if possible, but still check labs and transfuse if needed. There will be more discussions of her goals at my next visit. This is an on-going conversation, not a once-and-done deal.

Think about discussing your patients’ goals of care, whether or not they currently face life-limiting illness. It may only occur during an annual wellness visit. It may occur after a significant health crisis. But please, discuss it. You may be the only person willing to do so.

Wouldn’t we all want the same? Think about it.


Kim Spering has been a nurse for over 25 years and worked as an NP over the past 15 years in Family Medicine, Women’s Health, Internal Medicine, and now Palliative Medicine. She serves as an editorial board member of Clinician 1 and submit blogs to the website, with a goal of highlighting both the clinician and patient experience in health care.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

First Generic EpiPen Approved by FDA

On the heels of a massive EpiPen shortage, the U.S. Food and Drug Administration has approved the first generic alternative.

The U.S. Food and Drug Administration has approved the first generic alternative to the EpiPen and EpiPen Jr (epinephrine) auto-injector, which is used for the emergency treatment of allergic reactions, including those that are life-threatening, in adults and children.

The approval of a generic alternative to the EpiPen and EpiPen Jr., made by Teva Pharmaceuticals USA, comes on the heels of a major EpiPen shortage that has left parents of school-age children scrambling to find them as the school year begins, and which has resulted in the FDA extending EpiPen expiration dates. The FDA came to this decision after Mylan, the manufacturers of the EpiPen, requested the extension, and provided data to show that it would be safe to use them past their 20-month listed shelf life.

This approval was described as, “part of our longstanding commitment to advance access to lower cost, safe and effective generic alternatives once patents and other exclusivities no longer prevent approval,” by FDA Commissioner Scott Gottlieb, M.D.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Trump Administration Sinks Teeth Into Paring Down Drug Prices, On 5 Key Points

Three months after President Trump announced his blueprint to bring down drug prices, administration officials have begun putting some teeth behind the rhetoric.

Sarah Jane Tribble, Kaiser Health News

Three months after President Donald Trump announced his blueprint to bring down drug prices, administration officials have begun putting some teeth behind the rhetoric.

Many details have yet to be announced. But experts who pay close attention to federal drug policy and Medicare rules say the administration is preparing to incrementally roll out a multipronged plan that tasks the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration with promoting competition, attacking the complicated drug rebate system and introducing tactics to lower what the government pays for drugs.

Mark McClellan, director of the Duke-Margolis Center for Health Policy in Durham, N.C., and a former CMS administrator, said that although none of the initial steps has “fundamentally transformed drug prices,” there is “a lot going on inside the administration.”

Two HHS officials who are rolling out the plan, Dan Best and John O’Brien, described their efforts to Kaiser Health News not as a public relations strategy but a push to reform the system.

“This administration is trying to go after root causes” of high drug prices, said Wells Fargo analyst David Maris.

But others are not so optimistic.

Ameet Sarpatwari, an instructor in medicine at Harvard Medical School in Boston, said policies the administration has rolled out thus far “alone will not translate into meaningful cost savings for most Americans.”

Broadly, the strategy falls under a handful of steps:

1. Attacking The Rebates

Health and Human Services Secretary Alex Azar has said Americans “do not have a real market for prescription drugs” because drug middlemen and insurers get a wide range of hidden rebates from drugmakers, but those savings may not be passed on to consumers or Medicare. In July, the administration submitted a proposed rule that could change the way rebates are handled.

Details of the proposal have not been made public. But O’Brien, a deputy assistant secretary at HHS, explained during a recent conference on federal drug spending sponsored by the Pew Charitable Trust: “You don’t have to use market power to get rebates, you can use market power to obtain discounts, to actually lower the price of the drug on the front end.”

Umer Raffat, an investment analyst with EverCore ISI, said “it’s not clear [that drug prices are going down]” but the “rebate structure is changing.”

2. Bringing More Negotiation To Medicare

This week, CMS Administrator Seema Verma announced that Medicare Advantage insurers can use a step-therapy approach to negotiate better prices for Part B drugs — those administered in hospitals and doctors’ offices. These private plans will be allowed to require patients to first select the least expensive drug before stepping up to more costly drugs if the original medications aren’t working.

The administration is also looking at ways to introduce more competition into Part B drug purchasing. That idea was mentioned deep inside the annual Medicare outpatient payment rule released last month.

Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes in New York, pointed to the possible introduction of a competitive purchasing program in which a firm negotiates with drugmakers to buy their drugs and then sells them to the doctors and hospitals that will administer the medications. Bach said that helps ensure that hospitals and doctors can’t make more money by prescribing more expensive drugs.

Currently, Medicare pays the average sales price plus 6 percent to doctors or hospitals when they purchase drugs, a pricing mechanism that can benefit the providers if the drug costs go up. If there were a third party buying the drugs, it would “have a huge effect,” Bach said.

3. Paying For Value

Trump’s blueprint calls for CMS to encourage “value-based care” to lower drug prices, shifting from paying a set fee for drugs to basing payments on how well the patient does on them.

Louisiana’s Medicaid program could show the way. The state is working with CMS to explore a subscription-based model to pay for hepatitis C medicines. Louisiana would pay a fixed price to a drug manufacturer that would then get unlimited access to treat patients enrolled in Louisiana’s Medicaid program or in prison.

The program would move “from a big payment upfront to paying less over time based on actual outcomes,” said McClellan, who also serves on the boards of health care giant Johnson & Johnson and insurer Cigna.

CMS also approved a Medicaid waiver from Oklahoma in June. Medicaid programs are allowed to negotiate drug prices. Oklahoma’s plan would expand that to negotiate additional prescription price reductions based on value-based purchasing agreements.

Still, CMS’ recent rejection of a related Massachusetts proposal makes it difficult to believe negotiating drug prices will really happen, said Sara Rosenbaum, a professor of health law and policy at George Washington University.

That proposal would have allowed Massachusetts’ Medicaid program to choose drugs based on cost and how well the medicines work.

“They have been very good and quite careful with their [Medicaid] program and so why not let them try this?” Rosenbaum said.

4. Tackling Foreign Drug Costs

Pharmaceutical makers often sell their drugs at substantially lower prices in many foreign countries than they do in the United States. Trump emphasized in May that “it’s time to end the global freeloading once and for all,” saying U.S. consumers were paying part of the cost of the medicines that patients in other countries use.

He directed U.S. Trade Representative Robert Lighthizer to address the situation. Lighthizer’s office declined to comment.

When Sen. Todd Young (R-Ind.) asked during a Senate health committee hearing in June whether trade agreements with other countries should be used to “level the playing field,” Azar’s response was swift: “We absolutely believe we should be using our trade agreements to get them to pay more even as we have our job to pay less.”

Avalere Health President Matt Brow, who has been involved in talks with the administration, said it’s clear the focus on overseas pricing isn’t going away and the administration is “talking a lot about how to get the president what he wants.”

5. Increasing Competition

FDA Commissioner Scott Gottlieb has become the Trump administration’s lead proponent for increasing competition among drugmakers.

Competition resonates with Americans “because people see it every day in their experience in Costco and other places,” said Rena Conti, an associate professor at the University of Chicago.

Gottlieb has announced plans to bolster the use of generic drugs and an “action plan” to encourage the development of biosimilars, which are copycat versions of expensive biologic drugs made from living organisms.

And to combat anti-competitive behavior in the market, Gottlieb said the FDA has passed along information to the Federal Trade Commission and hinted at potential action to come: “I think we’ve handed them some pretty good facts.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.


Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Great Podcasts for PTs, OTs, and SLPs

Podcasts are a great way for busy therapy professionals to absorb practical advice and tips, and maybe even be entertained, while you’re on the go.

Podcasts are a fantastic and free way to absorb information—and often be entertained—while on the go, which can be quite beneficial for busy therapy professionals. Below are some great podcasts, broken down by specialty, for your listening pleasure.

Physical Therapy:

Senior Rehab ProjectListen Now
The Senior Rehab Podcast brings you helpful conversations for rehab clinicians that serve older adults. Dustin Jones, PT, DPT, CSCS, RKC, speaks with industry leaders to draw out useful, practical information for YOU – the rehab clinician. Whether you’re a physical therapist, PTA, student, or seasoned veteran, the Senior Rehab Podcast will prove to be helpful for you in your practice.

Dr. Scott Gray’s Redefining Physical Therapy PodcastListen Now
Sport and spine injury specialist, Dr. Scott Gray, interviews other elite level physical therapists helping to redefine the physical therapy profession. Practical advice and tips are shared on this podcast that clinicians can apply TODAY in their practice, not research.

Therapy Insiders PodcastListen Now
Hosts Gene Shirokobrod PT, DPT, OMPT, Joe Palmer PT, DPT, OMPT, CSCS, and Erson Religioso III, DPT, MS, MTC, CertMDT, CFC, CSCS, FMT, FAAOMPT interview prominent guests to help shed light on various therapeutic topics ranging from joint manipulations, functional training, business ownership while being a clinician, sports rehab and much more. We cover Physical Therapy (PT), Manual therapy, rehab, sports medicine, business practice, and many more topics.

The PT SourceListen Now
The PT Source Podcast with Matt Laporte brings you the latest articles, blog posts, research and web content in an easily digestible format. Welcome to the easy way to stay up to date with the latest in the field of physical therapy and exercise science.

Physical Therapy ForensicsListen Now
Evidence truly meets practice on this podcast where we take a look at the latest research affecting the treatment of your patients/clients. Taking a practical approach to evidence-based practice.

Occupational Therapy:

Seniors Flourish PodcastListen Now
The Seniors Flourish Podcast helps occupational therapy practitioners working with older adults be the best they can be – not only by showcasing relevant interviews, answering questions, current articles and hot topics, but also to get OT practitioners EXCITED about working with older adults, give actionable ideas that listeners can take and use in their own practice and have some FUN along the way.

Occupational Therapy InsightsListen Now
Occupational Therapy Insights is a show for parents, educational professionals, and occupational therapists, that delves into the world of occupational therapy. Here occupational therapy is broken down into its simplest form for all to understand. The show is hosted by Dr. Frederick Covington, an occupational therapy professor, author, award winning inventor, and occupational therapy private practice owner.

OccupiedListen Now
A creative project exploring all things Occupation, Occupational Science, and Occupational Therapy. Each fortnight I am to showcase a topic or therapist and to have a discussion exploring OT related ideas and concepts. My aim is to challenge you, make you think and provide you with guidance wherever possible.

Joyriding In Autismland: Autism Podcast with Kid GigawattListen Now
Launched by parents of an infectiously funny and *mostly* happy boy on the spectrum, the Joyriding in Autismland podcast chats with ASD parents, kiddos, therapists, writers, and artists about the unexpected, charming, and funny moments with autism. Because laughing? Is the best vacation.

ADHD Experts PodcastListen Now
Leading ADHD experts give real-life answers to questions submitted by ADD adults and parents raising children with attention deficit disorder across a range of topics covering symptoms, school, work, and family life. Note on audio quality: This podcast is a recording of a webinar series, and the audio has been captured from telephone conversations, not recorded in a studio.

Speech Therapy:

The Speech Space PodcastListen Now
Looking for some fresh ideas for your speech therapy sessions? The Speech Space podcast is a podcast full of tips and resources for speech-language pathologists working in the schools or private practice.

Speech and Language Kids PodcastListen Now
Carrie Clark, a speech-language pathologist from Columbia, Missouri, offers resources, information, and activities for speech therapists and parents of children with speech and language development and delays. While Carrie’s materials will provide great information for speech therapists, they will also empower families to use fun and easy activities to improve their child’s speech and language skills at home. Activities and information cover a range of ages, ability levels, and disabilities. Topics covered include: articulation, apraxia, phonology, language, late talkers, alternative/augmentative communication (AAC), autism, stuttering, reading, social skills, down syndrome, following directions, answering questions, grammar, etc. Educators and other professionals will also love this easy-to-follow information and the step-by-step guides.

Speech Therapy: Storm of the BrainsListen Now
Speech therapist Carrie Clark brainstorms ideas and answers to your speech therapy questions. Carrie Clark will bring on guest speech-language pathologists to answer your questions. Speech therapists can call in questions for Carrie and her guest to answer on air. Listen in as Carrie Clark and her guest brainstorm ideas to help you with your toughest cases. Plus, tune in each week for a giveaway!

True Confessions with Lisa & SarahListen Now
This is the true story of two school-based SLPs who decided to start a business and are stupid enough to record it. Find out what happens when we stop being polite and start getting real.

More than Child’s PlayListen Now
Join Speech Therapist Lacy Morise and Physical Therapist Nicole Sergent as the host warm and helpful conversations around their table where the early childhood world and daily parenting life meet. The friends and professionals from their village will inspire, challenge, and support you in your own journey as a parent, early childhood professional, or therapist.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

3 Settings to Consider Working in as a Medical Assistant

The number of Medical Assistants is expected to increase 29% percent through 2026, but there’s more to medical assisting than working in a doctor’s office.

Medical Assistants support a wide range of essential functions in healthcare, performing an array of administrative and clinical tasks in a variety of settings, and the need for Medical Assistants is only growing. The U.S. Bureau of Labor Statistics estimates the number of Medical Assistants is expected to increase 29% percent through 2026, making it a booming field that is growing more rapidly than the 11% growth expected for all occupations.

As a career that is relatively quick to get into, with a certification taking just 10 months to obtain, and one that has an average annual salary of more than $32,000, it is a solid career choice that cements you in the fabric of the ever-growing healthcare industry. It also affords an array of employment options, meaning that as a Medical Assistant, you can work in a variety of settings—not just in a doctor’s office, though that is where an estimated 62% of Medical Assistants are employed.

Here are a few different settings to consider, if you are interested in diversifying.

Hospitals

If you’re looking for a fast-paced environment and don’t necessarily want to be tied to a 9-to-5, working in a hospital may be a good fit for you. Given their 24/7 business hours and the diversity of cases (you will likely see everything from life-threatening trauma to routine procedures), this could be the job to keep you on your toes—morning, noon, nights, and weekends. There are also more than 5,500 hospitals in the United States, making it pretty likely there’s one hiring nearby.

Laboratories

If you prefer not interfacing with patients nearly as much, this might be the setting for you. Working as a Medical Assistant in a diagnostic laboratory means you will run tests on samples, record results, and input data. You could also be tasked with supporting scientists if the lab you’re working at is at a research university, and work in medical research and development.

Assisted Living Communities

If you have a passion for helping people, participating in geriatric care at an assisted living community may be the perfect Medical Assistant role for you. As the Baby Boomer generation ages into retirement, the demand for assistance in senior living communities across the country will only continue to grow. Help them make the most of their final years by performing daily living tasks, taking vital signs, and maintaining medical records.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Energy-Hog Hospitals: When They Start Thinking Green, They See Green

The health care sector is responsible for nearly 10% of all greenhouse gas emissions. That’s a good enough reason to go green, but it can also reduce costs.

Julie Appleby, Kaiser Health News

Hospitals are energy hogs.

With their 24/7 lighting, heating and water needs, they use up to five times more energy than a fancy hotel.

Executives at some systems view their facilities like hotel managers, adding amenities, upscale new lobbies and larger parking garages in an effort to attract patients and increase revenue. But some hospitals are revamping with a different goal in mind: becoming more energy-efficient, which can also boost the bottom line.

“We’re saving $1 [million] to $3 million a year in hard cash,” said Jeff Thompson, the former CEO of Gundersen Health System in La Crosse, Wis., the first hospital system in the U.S. to produce more energy than it consumed back in 2014. As an added benefit, he said, “we’re polluting a lot less.”

The health care sector — one of the nation’s largest industries — is responsible for nearly 10 percent of all greenhouse gas emissions — hundreds of millions of tons worth of carbon each year. Hospitals make up more than one-third of those emissions, according to a paper by researchers at Northeastern University and Yale.

Increasingly, though, health systems are paying attention:

  • Gundersen Health System in Wisconsin employs wind, wood chips, landfill-produced methane gas — and even cow manure — to generate power, reporting more than a 95 percent drop in its emissions of carbon monoxide, particulate matter and mercury from 2008 to 2016.
  • Boston Medical Center analyzed its hospital for duplicative and underused space, then downsized while increasing patient capacity. Among other changes, it now has a gas-fired 2-megawatt cogeneration plant that traps and reuses heat, saving money and emissions, while supplying 41 percent of the hospital’s needs and acting as a backup for essential services if the municipal power grid goes out.
  • Theda Clark Medical Center in Wisconsin is saving nearly $800,000 a year — 30 percent of its energy costs — after making changes that included retrofitting lights, insulating pipes, taking the lights out of vending machines and turning off air exchangers in parts of its building after hours.
  • Kaiser Permanente aims to be “carbon-neutral” by 2020, mainly by incorporating solar energy at up to 100 of its hospitals and other facilities. One already in use — at its Richmond (Calif.) Medical Center — is credited with reducing electric bills by about $140,000 a year.

While the environmental benefits are important, “what I’ve seen over the years is cost reductions are the prime motivator,” said Patrick Kallerman, research manager at the Bay Area Council Economic Institute, which released a report this spring outlining ways the hospital industry can help states such as California reach environmental goals by becoming more efficient.

Some of its recommendations are simple: replacing old lighting and windows. Others are more complex: powering down heating and cooling in areas not being used and updating ventilation standards first set back in Florence Nightingale’s day. Such tight standards “might not be necessary,” Kallerman said. Loosening them could help save money and energy.

When Bob Biggio was hired in 2011 to oversee Boston Medical Center’s facilities, hospital leaders were about to launch a broad redesign. Yet the hospital was also facing serious financial struggles. He put the move on hold while analyzing how the hospital was using its existing space, looking for unused or duplicative areas.

“My first impression with data I had gathered was our campus was about 400,000 square feet bigger than it needed to be, said Biggio. “A square foot you never have to build is most efficient of all.”

The new design is smaller but more efficient, handling 20 percent higher patient volume and eliminating the need for ambulance transportation between far-flung areas of the campus. It also cut power consumption by 42 percent from a 2011 baseline.

While the hospital sunk a lot of money into the renovation, the center was able to sell off some of its land to help offset the costs, leading to about a five-year return on investment, Biggio said.

“We are a safety-net hospital with a large Medicaid population,” he said. “So this is the last place people expect to see the type of investments and progress we’ve made.”

But how to sell that in the C-suite?

The environmental argument wasn’t how Thompson convinced executives at Gundersen.

“At no point did I mention climate change or polar bears,” said Thompson.

Instead, he focused on the organization’s mission to improve health — and the potential cost savings.

“There are multiple examples — at Gundersen and other places — where, if we’re thoughtful, we can improve the local economy, lower the cost of health care and decrease the pollution that is making people sick,” he said.

But hospitals’ energy efficiency efforts vary, with only about 10 percent attempting changes as dramatic as those done at Gundersen, estimated Alex Thorpe, a hospital energy expert at Optum Advisory Services, a consulting firm owned by UnitedHealth Group.

“About 50 percent are in the middle,” he added, perhaps because these investments are weighed against other capital needs.

“If you have a well-known doctor that wants a new cutting-edge piece of equipment, then it can be hard to make the business case [for investing in alternative energy],” said Thorpe.

Of the more than 5,000 hospitals in the country, about 1,100 are members of Practice Greenhealth, a nonprofit that promotes environmental stewardship. Fewer than 300 hospitals qualify as Energy Star facilities, an Environmental Protection Agency program that recognizes buildings that rank in the top quartile for energy conservation among their peers.

Greenhealth estimates its members average about a million dollars a year in savings, but it all depends what steps they take.

There are modest savings from such things as reducing the heating and air conditioning in operating rooms during hours they are not in use, with median annual cost savings of $45,398, a report from the group notes. Other energy reduction efforts net another median $53,599 in annual savings, while swapping older lighting for new LED bulbs in operating rooms saves another $3,329.

Individually, those savings are not even rounding errors in most hospitals’ total expenses, which are measured in the millions of dollars.

Still, within facility expenses, energy use accounts for 51 percent of spending, so even modest cuts are “significant,” said Kara Brooks, sustainability program manager for the American Society for Healthcare Engineering.

Ultimately, that may affect what hospitals charge insurers and patients.

“If hospitals can lower peak demand through energy efficiency efforts, that will directly impact their pricing,” said Thorpe.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nurses Need to Stop “Eating Their Young”

As it was first said in 1986, “nurses eat their young,” and last week, that adage proved true for one young nurse who took her own life. Now is the time to end nurse bullying.

As it was first said by nursing professor Judith Meissner in 1986, “nurses eat their young,” and last week, that adage proved true for one young nurse who took her own life. Rhian Collins, a 30-year-old nurse and mother of two, committed suicide after being bullied by her coworkers at a U.K. psychiatric hospital.

In light of this tragic news, we find it is our responsibility to have a frank and open discussion regarding nurse bullying and suicide. Because, at its core, the nursing profession is a caring one. It takes certain levels of empathy and heart to do what nurses do, day in and day out, and that should not only be reserved for patients, but also for your fellow nurses.

Stress and burnout among nurses are, understandably, pervasive. Shifts are long, hospitals are understaffed, and tensions are high, but to put it in perspective, research suggests that at least 85% of nurses have been bullied at some point in their nursing career, and the number could actually be higher, as it is often speculated that incidents are under-reported. One study has stated that depressive symptoms among nurses clock in at 18%, and another shows that number as high as 41%. Even more alarming, a U.K.-based study published last year found nurses are 23% more likely to commit suicide than women in general, and the BBC has reported that nurses are four times more likely to commit suicide than people working outside of medicine.

All of those staggering numbers, and yet, the culture of nurse-on-nurse bullying has not changed much, if at all, since it was first said that “nurses eat their young.” However, there is hope, as many younger nurses have been put through the paces of school-based anti-bullying initiatives as they have grown up and stigmas of mental health issues have began to lessen. But unless and until a different mindset takes over the nursing profession, the problem will persist.

You cannot eat your young and expect them to survive.

We know you are stressed out. We know your hours are long, your back is aching, and you probably didn’t get to have a real lunch break today. We are not negating those stresses in any way. However, it doesn’t take much effort to just be kind—to yourselves and to your fellow nurses. You may just save another life in doing so, and that is what nursing is all about, saving lives.

If you are having thoughts of hurting yourself or others, we encourage you to seek help by calling the National Suicide Prevention Lifeline at 800-273-8255 or by texting 741741 to have a conversation with a trained crisis counselor via the Crisis Text Line.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Mindset of Millennial Nurses

Millennials are quickly becoming the most dominant generation in nursing. What is their collective outlook on their professional futures? Take a look.

Millennials, as a whole, tend to get a bad rap. The generation, born in the 1980s and 1990s, is often stereotyped as being selfish and entitled, more interested in popular culture and handouts than hard work and drive. However, a recent survey by AMN Healthcare of nurses who fall into that age bracket shows that is not the case.

The Survey of Millennial Nurses: A Dynamic Influence on the Profession collected responses from 3,347 RNs, and compared the views of Millennial nurses (those aged 19 to 36) to those of Generation X (aged 37 to 53) and Baby Boomers (aged 54 to 71) in regards to their expectations of their work environments and professional futures.

The survey results show that Millennial nurses are more eager than their Gen X and Baby Boomer counterparts to seek new employment, including taking on travel nursing opportunities, pursue a higher degree or become Advanced Practitioners, such as Nurse Practitioners or Physician Assistants, and strive to obtain nursing leadership roles.

When asked about how the improving economy might impact their career plans, about 17% of Millennial RNs said they would seek a new place of employment as a nurse, as opposed to 15% of Gen X RNs and only 10% of Baby Boomer RN, and 10% of millennial RNs said they would work as a travel nurse, which is nearly the combined amount (11%) of Gen X and Boomer RNs who would consider the same.

The results also show that Millennial RNs are keen to obtain higher degrees and become APRNs. 70% of Millennial RNs said they want to pursue a higher degree, such as a BSN or MSN, which is significantly higher than the 56% Gen Xers and 20% Baby Boomers who would pursue the same, and 49% of Millennial RNs indicated becoming an Advanced Practitioner is a career path they want to consider. Only 35% of Gen X RNs and 12% of Baby Boomer RNs said they had the same APRN career ambitions.

Millennials are also more eager to lead, with 36% of Millennial RNs saying the pursuit of a nursing leadership role is something they are interested in, as opposed to 27% of Gen Xers and 10% of Baby Boomers.

With results like these, and Millennials quickly becoming the most dominant generation in nursing, it seems like there are a lot of bright futures to be had.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.