9 Burst results for "Dr Rachel Dolan"

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

03:14 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"Custer's <Speech_Male> bill with two <Speech_Male> cosponsors <Speech_Male> requesting cms <Speech_Male> to study antipsychotic <Speech_Male> prescribing <Speech_Male> practices <Speech_Male> in non nursing <Speech_Male> home. Settings, <Speech_Male> was there any other legislation <Speech_Male> related <Silence> the session <SpeakerChange> to your knowledge? <Speech_Male> <Speech_Female> I'm <Speech_Female> not. Sure. <Speech_Female> <Silence> But just you <Speech_Female> know. Just, <Speech_Female> because there's no <Speech_Female> legislation out there doesn't <Speech_Female> mean that folks <Speech_Female> are thinking about or working <Speech_Female> on on issues <Speech_Male> <SpeakerChange> <hes> <Speech_Male> for the longer term. <Speech_Male> Okay. <Speech_Male> Okay. Thank <Speech_Male> you. I. Do have this somewhat <Speech_Male> formula <Speech_Male> a final question. I'll <Speech_Male> just throw in <Speech_Male> here and <Speech_Male> that is <hes> <Speech_Male> again formula <Speech_Male> what <Speech_Male> would you advise <Speech_Male> having studied this <Speech_Male> subject? <Speech_Male> <hes> extent <Speech_Male> that you have. What would you <Speech_Male> advise family members? <Speech_Male> <Speech_Male> Relative <Speech_Male> to <Speech_Male> <hes> either <Speech_Male> admitting <Speech_Male> an overseeing their <Speech_Male> family members <Speech_Male> care nursing home <Speech_Male> facility. What what <Speech_Male> should family caregivers <Speech_Male> <Speech_Male> <hes> pay <SpeakerChange> attention <Speech_Female> to? <Speech_Female> I <Speech_Female> think you know <Speech_Female> our experience <Speech_Female> with Kobe has highlighted <Speech_Female> how important <Speech_Female> family members <Speech_Female> are in this whole process <Speech_Female> of overseeing <Speech_Music_Female> care for patients <Speech_Music_Female> right. So when <Speech_Music_Female> <hes> you know <Speech_Female> everything closed down <Speech_Female> in in <Speech_Female> March and families <Speech_Female> were not able <Speech_Female> to go in to see <Speech_Female> their loved ones that <Speech_Female> was critical <Speech_Female> oversight <Speech_Female> tool that <Speech_Female> was missing <Speech_Female> and so <Speech_Female> I think <SpeakerChange> the important <Speech_Female> thing to the extent people <Speech_Female> are able to <Speech_Female> really be <Speech_Female> involved in <Speech_Female> the care of their <Speech_Female> loved <Speech_Female> ones <hes> <Speech_Female> because we we <Speech_Female> know this is happening <Speech_Female> and you <Speech_Female> know making. <Speech_Female> Sure that your <Speech_Female> your loved <Speech_Female> one is getting the right <Speech_Female> care a vital <Speech_Female> support tool <Speech_Female> to exercise <Speech_Female> <SpeakerChange> as as <Speech_Female> caregivers <Speech_Female> So I. think <Speech_Female> that is important <Speech_Female> point and night you <Speech_Female> know a lot of a <Speech_Female> lot of this is also <Speech_Female> importance of being <Speech_Female> aware that this is <Speech_Female> an issue to begin <Speech_Female> with and and that's part <Speech_Female> of the reason that <Speech_Female> on my gosh has been so <Speech_Female> vocal about <Speech_Female> about this <Speech_Female> issue is making sure <Speech_Female> the public is aware <Speech_Music_Female> as we continue to <Speech_Music_Female> think through <Speech_Music_Female> <hes> options <Speech_Female> and you <Speech_Female> know frankly I think <Speech_Female> this. <Speech_Female> Is. Something that really needs <Speech_Female> to be handled on an <Speech_Female> administrative. <Speech_Female> <Speech_Female> Level, but you know. <Speech_Female> <Speech_Female> If the trump administration <Speech_Female> was doing their <Speech_Female> their job <Speech_Female> on overseeing <Speech_Female> this <Speech_Female> report points out <Speech_Female> that maybe this would be <Speech_Female> less of an issue but <Speech_Female> you know <Speech_Female> we we <SpeakerChange> all have a <Speech_Music_Female> role in in making <Speech_Music_Female> sure that there is accountability <Speech_Music_Female> on this <Speech_Music_Female> front on. Because at <Speech_Music_Female> the end of the day, the important <Speech_Music_Female> point here is to keep <Speech_Female> patients safe <Speech_Female> <hes> and <Speech_Music_Female> families are. <Speech_Female> Aware. <Speech_Male> <SpeakerChange> What's going <Speech_Male> on? <Speech_Male> Yes. Absolutely. <Speech_Male> So I would <Speech_Male> say in towards pay <Speech_Male> attention, correct <Speech_Male> yes. Absolutely. <Speech_Male> So <Speech_Male> Rachel thank you for <Speech_Male> this review <Speech_Male> <hes> Mike congratulations <Speech_Male> to you and your <Speech_Male> colleagues on producing <Speech_Male> this report I will <Speech_Male> say. <Speech_Male> Obviously. It would <Speech_Male> be nice. If <Speech_Male> next session next <Speech_Male> Congress, next administration <Speech_Male> <Speech_Male> we could <Speech_Male> see some related legislation. <Speech_Male> <Speech_Male> <hes> <Speech_Male> long <Speech_Male> since passed do but <Speech_Male> thank you again for your time. <Speech_Female> <Speech_Male> Thanks <SpeakerChange> for having me. <Speech_Male> Take. Care David. You have just heard another <Speech_Male> edition of the healthcare <Speech_Male> policy podcast <Speech_Male> hosted by. <Speech_Male> David. ENSOR. Cosso <Speech_Male> to comment <Speech_Male> on this program or others <Speech_Male> to <Speech_Male> see information about upcoming <Speech_Male> interviews <Speech_Male> to suggest <Speech_Male> a program topic <Speech_Male> or to here an archive <Speech_Male> program. <Speech_Male> Please visit our website <Speech_Male> the healthcare <Speech_Male> policy podcast <Silence> dot com. Thank you for listening. Please listen again soon.

custer Kobe Congress Mike David
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

04:49 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"So you know it is it is challenging to create change, devote significant number of resources to Inari of the healthcare system where people just don't really WanNa WanNa, think about it or invest in it so I think this goes to the broader questions about where we are in nursing homes right now in our country and whether what we're seeing there with the number of deaths and in all of the infection control issues that have been become so public whether this will be a turning point for us and in truly taking the time to invest in our patients. Receiving institutional care and the families so rely on the. On the Senate. While let's let's hope. That is the case I I will say per your point about infections you do not on the report. And this is researched I. believe from Oh I G. Wonder one, two, three, million, series infections occur and sniffs each year. and more than sixty percent of these facilities have been cited for deficiencies in relation or related to infection control since the beginning of twenty seventeen. so antipsychotic overuse infections covered the list goes on. Let me go to. The conclusion report, the majority staff did not make recommendations. So my question is why was that and I ask particularly because he do state in conclusion, the report states quote unquote that the paper makes a case for specific policy proposal tricky. Since report concludes it is reasonable to conclude overuse is pervasive and continues to occur an unacceptably high rates close quote and amidst the intent of eighty-seven Nursing Home Before Act just mentioned have not. been realized I might mention to encourage listeners to to read mullets November testimony that we've already referenced because he has you're well aware. Makes several recommendations including arguing for more formal informed consent. So again. why did the report pass on on recommendations? So I think you know in terms of the purpose of this report, it was really to draw public attention to this..

WanNa Senate
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

05:18 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"So we saw an one hundred and ninety nine percent increase in citation rates So that's two thousand two, hundred, twenty, one more citations an every state experienced a large increase, the largest being California, Ohio Texas New, York and Pennsylvania and then we saw between twenty sixteen, Seventeen Things stabilized and then in twenty seventeen to twenty eighteen rates decreased by twenty two point. One percent of the largest in California Ohio, Indiana and New York. Okay. Thank you. So this is not surprising. to summarize the trump administration. Provides essentially, this moratorium on Reagan forcement and not surprising. This is the effect we get a relative citations I do have A. Question I believe you make brief mention of state. Regulatory. Action and I asked that specifically because. The issue here largely gets at informed consent. And you do make note of this issue some tangentially about states having passed laws. Requiring, informed consent what's comet or Sussman of states policing? Their nursing homes. So we didn't look into that I specifically for the report as I mentioned is in the background section I, think oversight of nursing homes is is always going to be escape federal venture because you know the surveyors are are you know work for at state surveyors and so there's always variability there I I can't speak to this specific policies in states in the extent to which they have worked or not worked because we didn't really look at that but that is to say that there is some variation in how states have have handled this particular issue. Okay thank you. I'll just note and this is buried somewhere in in your report and typed it in my notes you stayed over all the state focus our state of to reduce have been largely stagnant focus is more on physical rather than chemical restraints, but you do note three states. California Oklahoma and Illinois Nara require. Physician obtained a form consent. Let me go to. the latter part of the report, and before we get to that I do have to ask you and I feel largely remiss if I didn't ask you, this is calling for your interpretation Again, before we get reports conclusions in what we may see in the next Congress relative to legislation in responses. report. As you well, where the federal government has for decades used taxpayer dollars to pay for sniffs are reimbursed them, and this has been under the guise of providing healthcare for over and let's be clear hair. Moreover, these are frail elderly women who reside in these facilities The result of which L. were well aware per my mention of David Graham. has resulted in likely the deaths of many thousands of these residents and to say further as an I cited. Intentionally. Richard MODs testimony. You heard in November. This behavior may actually violate international treaty. So my question is concerning how long this has persisted. what's your interpretation explanation as to why we can't seem to resolve a remedy or address successfully this problem It's a good question I think it's this is kind of a tricky issue I'm I would say to to preface it. This is not specifically what our report looked into could. So I am. Speaking more from my experience working in this space. But I think this. This question really gets to the broader issue of quality in nursing homes and wide. We continues to struggle even after the Nursing Home Reform Act. was passed in one, thousand, nine, hundred, seven. Thirty three years ago at this point, and that was really meant to to overhaul nursing homes and and provide a safe environment for patients and and I also want to mention sort of the current. The current backdrop today with covid nineteen and how long.

California California Ohio York federal government Pennsylvania New York Reagan Sussman Indiana Ohio Illinois Nara Texas Congress David Graham. Richard Oklahoma
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

05:33 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"The first point is you know Rates are still high. If we look at the patients with the serious conditions that would require an antipsychotic. I, mean, the rate should be around you know two percent or something, and still we have a significant number of patients that are getting these drugs that shouldn't be. So you know relative success, it's just that it's relative and it really doesn't mean anything for the for the patients and families who are suffering for the inappropriate use of these drugs, and then the other thing I wanted to point out is that the data. Sort of raise some questions because the way that cms calculates the data are they removed the short stay nursing home resident and they removed people with psychosis diagnosis from that calculation. So the report you know, we point to the fact that there has actually been an uptick in reporting of of the falsifying of psychosis diagnoses to avoid the surveyors, and so if you exclude those people from the calculation, you have a significant underestimate on which is why our numbers are substantially higher than those reported by the National Partnership and CMS. Okay let's let's get more on target relative to the report and let's go into if you could step us through what exactly did the trump administration do when it took off his relative to regulatory oversight of use of these meds in. Post Acute. So I I want to paint sort of broader picture, which is one of right? You know regulatory reduction. The administration has been touting their patients over paperwork campaign, which is not specific to nursing homes at sort of you know cross cutting around. The all of the different providers in Medicare, and so you know every time they issue a rule they talk about what they've done to reduce the burden on providers So that sort of part of this, but I think specific to this particular report. The important thing to highlight is the trump administration eliminated on you all the Obama era per day finding practices that were implemented in July two thousand seventeen, right. So if you have a fraction, you're find every day until he remedy that. And what the trump administration did was they issued a single fine instead and that you know in the case of inappropriate anti psychotic citations that was accounted for two thirds of all citations in that space you know I, I think the Kaiser. Health. News. Had A report that showed that average aggregate fines on nursing homes. That endangered or injured residents dropped from forty one, thousand, two, hundred, sixty under President Obama class year in office in two thousand sixteen to Twenty eight, thousand, four, hundred, five in the period between April twenty, seventeen and March two, thousand, eighteen, and I think that's really one of the important points to raise here in the context of this report and how he saw the rates of citations decrease under the trump administration. Okay thank you, There is some discussion about the interaction between the committee and cms you do site the fact that the chairman Neil wrote a letter on this matter to cms in seven eighteen or July eighteen he do make nor the fact that cms never provided the committee with a written plan to reduce use to reduce falsified diagnoses..

psychosis Obama Neil Medicare chairman President National Partnership
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

03:21 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"Disabilities one city in particular on for residents with and without dementia. One additional are an hour per resident day could reduce the odds of an antipsychotic use by fifty two percent and fifty six percent respectively for those patients without Dementia I. Think you know the Human Rights Watch report that you cited at the beginning of this introduction also confirmed this qualitatively through their interviews They actually were kind enough to provide us with some of the quotes that they collected during that. Study some additional quotes and we included them throughout the the report and and I just WanNa site one of those one of one family's from a Texas social worker who explained that quote the nursing homes don't want behaviors they want docile they want people with no cognitive deficits can take care of themselves and quote so I. Think this is you know discussed at the heart of the matter here is You know people without you know people can take care of themselves in a sense fills the gap in in created by not having enough staffing in these in these facilities. Okay thank you. I'll. I'll ask the first part or all answer the first part of this question, and you can ask the second part and that is. Seventy one percent of cornyn MED PEK seventy one, seventy, one percent of skilled nursing facilities are for profit. What is their profit margin? Well believe and? You may be you may have information in front of you. I don't have it but it for I believe the laugh nineteen consecutive years, we've seen Medicare nursing home profit margins in the double digits. that. You're exactly. You're exactly right. I just went back to the most. Recent. Med Pack. report. and. A double digits summit understated it's been at about twenty percent margin for the last twenty years. That's right and one thing I wanted to point out about that is is a lot of these nursing homes they. They have Medicare patients in also Medicaid and and you know the important point here is a medicaid reimbursements. At a much lower rate and not obviously varies by state. So one of the points that Med pack always you know says is that the Medicare payments tend to subsidize those Medicaid payments, which are you know in many senses under payments? Right. Defacto. Crack. Yes let let's let's go. Let's try to get into the chronology here or take this chronologically, and that is What was the majority staff conclusion regarding the success of the CMS voluntary program. that. Don Started in twenty twelve titled National Partnership to Improve Dementia Care in nursing homes. Sorry. That was not the the focal point of our research necessarily. But obviously, we did dig into it to a certain extent and you know I think, the important thing to point out here is that the national partnership has counted. You know a forty percent reduction in the use of anti psychotics since it began to twenty twelve and You know I think it's important to look at those numbers the..

Medicare Texas Don
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

03:35 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"Of all skilled nursing facility residents in the US. So that's about two, hundred, Ninety, eight, thousand, six, hundred, fifty people every week received some form of antipsychotic medication and most of that was without any psychosis diagnosis for which these drugs are indicated So specifically, we actually looked at trends and surveyor citations for unnecessary medication use in nursing home. So that's kind of the. Part of this study and what we found was a clear change in citation rates for these facilities between the change in administrations from the Obama Administration to trump administration So we found citations for antipsychotic misuse in sniffs increased by two hundred percent between twenty, fifteen, twenty seventeen but then declined by twenty two percent from two thousand, seventeen to twenty eighteen, and importantly a ten percent of citations associated with actual harm or immediate jeopardy to a residence health or safety. So those are some of the most severe citation surveyors ever capture resulted in no fine from twenty seventeen to twenty eighteen under the trump administration. So you know. I. Would say even though this study in particular couldn't determine causation we we did see a clear association between the Trump Administration's regulatory rollback campaign twenty, seventeen, twenty eighteen and a reduction in citations for these particular drugs. Okay thank you and we'll get into the trump administration's regulatory decisions in this regard in a minute let me just ask as a follow up or an aside question and I don't think I saw this new report. So you may not have these numbers top of mind but worth asking, can you give an approximation of the cost? To the Medicare program at least relative to the overuse I, mean, this is a massive amount of money in reimbursement for these medications. I don't remember offhand. Let's see I think in the in the actually in the report we got About one third of older adult Medicare part d enrolling with dementia who spent more than one hundred days in a nursing humber prescribed antipsychotic in two, thousand, twelve constituting roughly three, hundred, sixty, three, million part D plan payments that year and of course, there's also cost associated with hospitalizations for inappropriate use of these drugs So I would expect you know that that that is obviously very under an understatement understated estimate that does not capture the full realm of payments. So it's it's fairly substantial. Yes and again one of the. Side effects of this is increased rates of hospitalization. As you suggest, let's go to This is sort of the next So we have over used we've had over us for a long while. And increasing over you. So it appears we'll get back to trump but a what explains what's the motivation for over or misuse for these medications So that's a really important question because it gets to the crux of why this is happening So as explained, the background section of the study on prior research has shown that I use of Anti psychotics is likely related to sapping levels in nursing home. So lower staffing levels. Are Associated Higher rates of antipsychotic use. And really staffing in many ways a proxy for the resources available to deliver care to patients and.

Trump Administration Obama Administration psychosis US
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

05:54 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"Welcome to the healthcare policy podcast on the host David Intra. . Kosovo. . With me today Dr Rachel Dolan the US House of Representatives ways and Means Committee majority staffer to discuss the majority staffs recently released report titled Under enforced and over prescribed. . ANTIPSYCHOTIC drug epidemic ravaging America's nursing homes. . Dr Dole and welcome to the program. . I David thanks so much for having me. . Please call me Rachel. . While this'll be the last time Dr Dolan's bio is posted on, , of course, , the podcast website. . In testimony before the House Energy and Commerce Committee two, , thousand seven, , the FDA's Dr David Graham stated quote. . Unquote. . Fifteen thousand adults elderly people in nursing homes are dying each year from the off label use of antipsychotic medications. . For an indication that the FDA knows the drug doesn't work the problem has been only FDA for years and years close quote. . Legal the FDA does provide a black box warning label. . Regarding off label use of these drugs, , eleven years later, , Human Rights Watch published a report titled They Want Docile. . How. . Nursing homes in the US overmedicated people with dementia. . The report found in two thousand, sixteen, , , seventeen quote unquote massive use or abuse of Anti Psychotics, , for example, , Sarah. . Quel. . Doll and Rispler doll that have serious side effects including sudden cardiac death. . The human rights report estimated in an average week over one hundred, , seventy, , nine, , thousand, , long-stay Nursing Home Facility patients who administered antipsychotic drugs. . Without a diagnosis which the drugs are indicated or approved rover, , polar disorder and schizophrenia in testimony the ways and means. . Committee. Heard . this past November Richard Mollet Executive Director of the Long Term Care Community coalition concluded quote the use of San Anti psychotics in skilled nursing facilities is so extensive that puts the US in violation of internal conventions and covenants on torture and cruel inhumane and degrading treatment or punishment. . Close quote. . This is my third related interview. . In December twenty twelve I discussed the topic with Diana Zuckerman. . And in February, , eighteen high interviewed Hannah Lamb who authored the above mentioned human rights report. . With me again to discuss the ways and means report just released titled Under enforced and over prescribed is Rachel Dolan the reports lead author. . So that Rachel as background let's get right into this or immediate <hes> neatly into the specifics of the report. . What did the report find regarding <hes> the extent to which? ? They're persists overuse or misuse of anti psychotics in skilled nursing. . David. . So the report showed what what you what we would expect from your introduction, , which is the use of antipsychotic does persist in nursing homes across the country and it remains quite high and not of course, , has implications for patient safety and and health <hes>. . We found in the fourth quarter of Twenty nineteen approximately twenty percent of all skilled nursing facility residents in the US. . So that's about two, , hundred, , Ninety, , eight, , thousand, , six, , hundred, , fifty people every week received some form of antipsychotic medication <hes>, , and most of that was without any psychosis diagnosis for which these drugs are indicated <hes>. . So specifically, , we actually looked at trends and surveyor citations for unnecessary medication use in nursing home. . So that's kind of the. . Part of this study and what we found was a clear change in citation rates for these facilities between the change in administrations from the Obama Administration to trump administration <hes>. . So we found citations for antipsychotic misuse in sniffs increased by two hundred percent between twenty, , fifteen, , twenty seventeen but then declined by twenty two percent from two thousand, , seventeen to twenty eighteen, , and importantly a ten percent of citations associated with actual harm or immediate jeopardy to a residence health or safety. . So those are some of the most severe citation surveyors ever capture resulted in no fine from twenty seventeen to twenty eighteen under the trump administration. . So you know. . I. . Would say even though this study in particular couldn't determine causation <hes> we we did see a clear association between the Trump Administration's regulatory rollback campaign twenty, , seventeen, , twenty eighteen and a reduction in citations for these particular drugs. . Okay thank you and we'll get into the trump administration's <hes> regulatory decisions in this regard in a minute let me just ask as a follow up or an aside question and I don't think I saw this new report. . So you may not have these numbers top of mind but worth asking, , can you give an approximation of the cost? ? To the Medicare program at least relative to the overuse I, , mean, , this is a massive amount of money in reimbursement for these medications. . I don't remember offhand. . Let's see I think in the in the actually in the report we got <hes>. . About one third of older adult Medicare part d enrolling with dementia who spent more than one hundred days in a nursing humber prescribed antipsychotic in two, , thousand, , twelve constituting roughly three, , hundred, , sixty, three, , , million part D plan payments that year <hes>, , and of course, , there's also cost associated with hospitalizations for inappropriate use of these drugs <hes>. . So I would expect you know that that that is obviously very under an understatement <hes> understated estimate that does not capture the full realm of payments. . So it's it's fairly substantial. .

FDA Dr David Graham Rachel Dolan Dr Dole US Human Rights Watch Nursing Home Facility House Energy and Commerce Comm Diana Zuckerman Hannah Lamb Rispler Richard Mollet Sarah Executive Director Long Term Care Community
Dr. Rachel Dolan Discusses The Antipsychotic Drug Epidemic

The Healthcare Policy Podcast

05:54 min | 1 year ago

Dr. Rachel Dolan Discusses The Antipsychotic Drug Epidemic

"Welcome to the healthcare policy podcast on the host David Intra. Kosovo. With me today Dr Rachel Dolan the US House of Representatives ways and Means Committee majority staffer to discuss the majority staffs recently released report titled Under enforced and over prescribed. ANTIPSYCHOTIC drug epidemic ravaging America's nursing homes. Dr Dole and welcome to the program. I David thanks so much for having me. Please call me Rachel. While this'll be the last time Dr Dolan's bio is posted on, of course, the podcast website. In testimony before the House Energy and Commerce Committee two, thousand seven, the FDA's Dr David Graham stated quote. Unquote. Fifteen thousand adults elderly people in nursing homes are dying each year from the off label use of antipsychotic medications. For an indication that the FDA knows the drug doesn't work the problem has been only FDA for years and years close quote. Legal the FDA does provide a black box warning label. Regarding off label use of these drugs, eleven years later, Human Rights Watch published a report titled They Want Docile. How. Nursing homes in the US overmedicated people with dementia. The report found in two thousand, sixteen, seventeen quote unquote massive use or abuse of Anti Psychotics, for example, Sarah. Quel. Doll and Rispler doll that have serious side effects including sudden cardiac death. The human rights report estimated in an average week over one hundred, seventy, nine, thousand, long-stay Nursing Home Facility patients who administered antipsychotic drugs. Without a diagnosis which the drugs are indicated or approved rover, polar disorder and schizophrenia in testimony the ways and means. Committee. Heard this past November Richard Mollet Executive Director of the Long Term Care Community coalition concluded quote the use of San Anti psychotics in skilled nursing facilities is so extensive that puts the US in violation of internal conventions and covenants on torture and cruel inhumane and degrading treatment or punishment. Close quote. This is my third related interview. In December twenty twelve I discussed the topic with Diana Zuckerman. And in February, eighteen high interviewed Hannah Lamb who authored the above mentioned human rights report. With me again to discuss the ways and means report just released titled Under enforced and over prescribed is Rachel Dolan the reports lead author. So that Rachel as background let's get right into this or immediate neatly into the specifics of the report. What did the report find regarding the extent to which? They're persists overuse or misuse of anti psychotics in skilled nursing. David. So the report showed what what you what we would expect from your introduction, which is the use of antipsychotic does persist in nursing homes across the country and it remains quite high and not of course, has implications for patient safety and and health We found in the fourth quarter of Twenty nineteen approximately twenty percent of all skilled nursing facility residents in the US. So that's about two, hundred, Ninety, eight, thousand, six, hundred, fifty people every week received some form of antipsychotic medication and most of that was without any psychosis diagnosis for which these drugs are indicated So specifically, we actually looked at trends and surveyor citations for unnecessary medication use in nursing home. So that's kind of the. Part of this study and what we found was a clear change in citation rates for these facilities between the change in administrations from the Obama Administration to trump administration So we found citations for antipsychotic misuse in sniffs increased by two hundred percent between twenty, fifteen, twenty seventeen but then declined by twenty two percent from two thousand, seventeen to twenty eighteen, and importantly a ten percent of citations associated with actual harm or immediate jeopardy to a residence health or safety. So those are some of the most severe citation surveyors ever capture resulted in no fine from twenty seventeen to twenty eighteen under the trump administration. So you know. I. Would say even though this study in particular couldn't determine causation we we did see a clear association between the Trump Administration's regulatory rollback campaign twenty, seventeen, twenty eighteen and a reduction in citations for these particular drugs. Okay thank you and we'll get into the trump administration's regulatory decisions in this regard in a minute let me just ask as a follow up or an aside question and I don't think I saw this new report. So you may not have these numbers top of mind but worth asking, can you give an approximation of the cost? To the Medicare program at least relative to the overuse I, mean, this is a massive amount of money in reimbursement for these medications. I don't remember offhand. Let's see I think in the in the actually in the report we got About one third of older adult Medicare part d enrolling with dementia who spent more than one hundred days in a nursing humber prescribed antipsychotic in two, thousand, twelve constituting roughly three, hundred, sixty, three, million part D plan payments that year and of course, there's also cost associated with hospitalizations for inappropriate use of these drugs So I would expect you know that that that is obviously very under an understatement understated estimate that does not capture the full realm of payments. So it's it's fairly substantial.

Dr Rachel Dolan FDA David Intra United States Antipsychotic Trump Administration Nursing Home Facility Dr Dole Us House Of Representatives Dr David Graham Human Rights Watch Kosovo House Energy And Commerce Comm Means Committee Diana Zuckerman America Obama Administration Psychosis Rispler
"dr rachel dolan" Discussed on The Healthcare Policy Podcast

The Healthcare Policy Podcast

02:52 min | 1 year ago

"dr rachel dolan" Discussed on The Healthcare Policy Podcast

"Dr Dole and welcome to the program. I David thanks so much for having me. Please call me Rachel. While this'll be the last time Dr Dolan's bio is posted on, of course, the podcast website. In testimony before the House Energy and Commerce Committee two, thousand seven, the FDA's Dr David Graham stated quote. Unquote. Fifteen thousand adults elderly people in nursing homes are dying each year from the off label use of antipsychotic medications. For an indication that the FDA knows the drug doesn't work the problem has been only FDA for years and years close quote. Legal the FDA does provide a black box warning label. Regarding off label use of these drugs, eleven years later, Human Rights Watch published a report titled They Want Docile. How. Nursing homes in the US overmedicated people with dementia. The report found in two thousand, sixteen, seventeen quote unquote massive use or abuse of Anti Psychotics, for example, Sarah. Quel. Doll and Rispler doll that have serious side effects including sudden cardiac death. The human rights report estimated in an average week over one hundred, seventy, nine, thousand, long-stay Nursing Home Facility patients who administered antipsychotic drugs. Without a diagnosis which the drugs are indicated or approved rover, polar disorder and schizophrenia in testimony the ways and means. Committee. Heard this past November Richard Mollet Executive Director of the Long Term Care Community coalition concluded quote the use of San Anti psychotics in skilled nursing facilities is so extensive that puts the US in violation of internal conventions and covenants on torture and cruel inhumane and degrading treatment or punishment. Close quote. This is my third related interview. In December twenty twelve I discussed the topic with Diana Zuckerman. And in February, eighteen high interviewed Hannah Lamb who authored the above mentioned human rights report. With me again to discuss the ways and means report just released titled Under enforced and over prescribed is Rachel Dolan the reports lead author. So that Rachel as background let's get right into this or immediate neatly into the specifics of the report. What did the report find regarding the extent to which? They're persists overuse or misuse of anti psychotics in skilled nursing. David. So the report showed what what you what we would expect from your introduction, which is the use of antipsychotic does persist in nursing homes across the country and it remains quite high and not of course, has implications for patient safety and and health We found in the fourth quarter of Twenty nineteen approximately twenty percent.

FDA Dr David Graham Rachel Dolan Dr Dole US Human Rights Watch Nursing Home Facility House Energy and Commerce Comm Diana Zuckerman Hannah Lamb Rispler Richard Mollet Sarah Executive Director Long Term Care Community