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March 2023 Report to the Congress: Medicare Payment Policy

Executive summary.

By law, the Medicare Payment Advisory Commission reports to the Congress each March on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). 

In this year’s report, we consider the context of the Medicare program, including the near-term consequences of the coronavirus pandemic and the longer-term effects of program spending on the federal budget and the program’s financial sustainability. We evaluate payment adequacy and make recommendations concerning Medicare FFS payment policy in 2024 for seven FFS payment systems: acute care hospital, physician and other health professional, outpatient dialysis facility, skilled nursing facility, home health agency, inpatient rehabilitation facility, and hospice services. We also include recommendations to redistribute current disproportionate share hospital and uncompensated care payments, and to provide additional resources to Medicare safety-net hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes. Previously, the Commission also considered an annual update recommendation for long-term care hospitals (LTCHs). But as the number of cases that qualified for payment under Medicare’s prospective payment system for LTCHs declined, we became increasingly concerned about small sample sizes in our analyses of this sector. As a result, we will no longer provide an annual payment adequacy analysis for LTCHs but will continue to monitor that sector and provide periodic status reports. The Commission also previously considered an annual update recommendation for ambulatory surgical centers (ASCs). However, because Medicare does not require ASCs to submit data on the cost of treating beneficiaries, we have no new significant data to inform an ASC update recommendation for 2024 and thus decided to provide a status report on ASCs instead of an update recommendation. We also review the status of the MA program (Medicare Part C) through which beneficiaries can join private plans in lieu of traditional FFS Medicare. Finally, we review the status of the Medicare program that provides prescription drug coverage (Medicare Part D). 

Executive Summary (March 2023 Report)

Chapter 1: context for medicare payment policy (march 2023 report), chapter 2: assessing payment adequacy and updating payments in fee-for-service medicare (march 2023 report), chapter 3: hospital inpatient and outpatient services (march 2023 report), chapter 4: physician and other health professional services (march 2023 report), chapter 5: ambulatory surgical center services: status report (march 2023 report), chapter 6: outpatient dialysis services (march 2023 report), chapter 7: skilled nursing facility services (march 2023 report), chapter 8: home health care services (march 2023 report), chapter 9: inpatient rehabilitation facility services (march 2023 report), chapter 10: hospice services (march 2023 report), chapter 11: the medicare advantage program: status report (march 2023 report), chapter 12: the medicare prescription drug program (part d): status report (march 2023 report), appendix a: commissioners' voting on recommendations (march 2023 report).

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2 river flood warnings in effect for brantley and glynn counties, decrease in drug-related deaths in florida gives new glimmer of hope to families affected by addiction.

Erik Avanier , Reporter

JACKSONVILLE, Fla. – A recent report by the Florida Medical Examiner’s Commission revealed a slight decrease in the number of drug-related deaths in 2022, bringing a new glimmer of hope for families who have loved ones battling drug addiction.

A local parent who lost a son to fentanyl said the 3% decline in fentanyl deaths in Florida is progress.

“There is a very long way to go with it. Every single life is worth it. But if we get the word out and continue to see a decrease in fentanyl deaths, then our goal is met,” Carroll Miniard said.

Miniard knows all too well about the pain of losing a child to a fentanyl overdose.

“I would never wish this on any parent. To lose your child. It’s the worst possible nightmare,” Miniard said.

Watch the full interview with Carroll Miniard below:

RELATED | ‘Your family is not immune’: Mother knows pain of losing loved one to drug addiction

Back in 2019, her son Evan was battling a drug addiction following a car crash that left him in pain. When prescription pain medication wasn’t enough, he turned to street drugs. His life ended when he used heroin that was laced with fentanyl.

“It was two policemen from the Jacksonville Sheriff’s Office when I opened the front door. We all went to the door together because we just knew something wasn’t right on a Sunday night in 2019,” Miniard said.

According to the recently released final report on drug deaths by the Florida Medical Examiner’s Commission, the year after Evan’s death, 5,302 people in Florida died from fentanyl. The following year, the number jumped to 5,791. Then in 2022, fatalities dropped to 5,522.

“It’s a low percentage but it’s something. It’s giving me hope. It’s giving other families hope. There’s hopefully an end to this crisis,” Miniard said.

Federal prosecutors said factors that led to the 3% drop include indictments of Chinese companies and individuals who supply Mexican drug cartels with chemicals used to produce fentanyl. Other contributing factors were the increase in criminal convictions for fentanyl trafficking and distribution.

MORE | The US sanctions Mexican Sinaloa cartel members and firms over fentanyl trafficking

There was also an increase in seizures of fentanyl powder and pills, seizures that have not slowed down.

According to the DEA’s tracker of fentanyl seizures across the U.S., as of Monday, 11.7 million fentanyl pills and 730 pounds of fentanyl powder have been seized since the beginning of the year. But in reality, the numbers are likely much higher when you add fentanyl seizures from local law enforcement agencies.

To Miniard, the seizure numbers represent something else.

“That’s lives that are being saved and we can’t put a price on that,” Miniard said.

RELATED | Opioid addiction: This story is bigger than me

If you or anyone you know has a drug addiction problem, please seek help.

You can call the Florida Addiction Hotline at 866-210-1303.

Copyright 2024 by WJXT News4JAX - All rights reserved.

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Introduction

Foundational recommendations, recommendations for population-wide policies and programs, recommendations for diabetes prevention in people at high risk, recommendations for diabetes treatment and complications, developing and implementing a national diabetes strategy, article information, the national clinical care commission report to congress: summary and next steps.

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Paul R. Conlin , John M. Boltri , Ann Bullock , M. Carol Greenlee , Aaron M. Lopata , Clydette Powell , Dean Schillinger , Howard Tracer , William H. Herman; The National Clinical Care Commission Report to Congress: Summary and Next Steps. Diabetes Care 1 February 2023; 46 (2): e60–e63. https://doi.org/10.2337/dc22-0622

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The U.S. is experiencing an epidemic of type 2 diabetes. Socioeconomically disadvantaged and certain racial and ethnic groups experience a disproportionate burden from diabetes and are subject to disparities in treatment and outcomes. The National Clinical Care Commission (NCCC) was charged with making recommendations to leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC determined that diabetes cannot be addressed simply as a medical problem but must also be addressed as a societal problem requiring social, clinical, and public health policy solutions. As a result, the NCCC’s recommendations address policies and programs of both non–health-related and health-related federal agencies. The NCCC report, submitted to the U.S. Congress on 6 January 2022, makes 39 specific recommendations, including three foundational recommendations that non–health-related and health-related federal agencies coordinate their activities to better address diabetes, that all federal agencies and departments ensure that health equity is a guiding principle for their policies and programs that impact diabetes, and that all Americans have access to comprehensive and affordable health care. Specific recommendations are also made to improve general population-wide policies and programs that impact diabetes risk and control, to increase awareness and prevention efforts among those at high risk for type 2 diabetes, and to remove barriers to access to effective treatments for diabetes and its complications. Finally, the NCCC recommends that an Office of National Diabetes Policy be established to coordinate the activities of health-related and non–health-related federal agencies to address diabetes prevention and treatment. The NCCC urges Congress and the Secretary of Health and Human Services to implement these recommendations to protect the health and well-being of the more than 130 million Americans at risk for and living with diabetes.

Graphical Abstract

graphic

Diabetes is a major clinical and public health problem in the U.S. The disease and its complications affect millions of Americans of all ages, lead to preventable suffering and death, impact families, contribute to health inequities, and impose an enormous financial burden on our nation. The number of Americans with diabetes and its complications has grown each year despite advances in prevention and treatment ( 1 , 2 ).

The social and environmental conditions that shape people’s daily experiences across their life span have a huge impact on whether people develop diabetes or suffer from its complications ( 3 ). Accordingly, diabetes in the U.S. cannot simply be addressed as a medical problem. It must also be addressed as a societal problem involving diverse sectors including food, housing, commerce, transportation, and the environment ( 1 , 4 ). The recommendations of the National Clinical Care Commission (NCCC) are rooted in the understanding that to improve the health outcomes of people at risk for and with diabetes, all of these sectors must be engaged. The recommendations of the NCCC are informed by both the Socioecological Model and the Chronic Care Model and are aligned with a “health-in-all-policies” approach ( 1 , 4 , 5 ).

The NCCC was charged by Congress to make recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. The NCCC formed three subcommittees to make recommendations 1 ) at the general population level’ 2 ) for high-risk individuals with prediabetes; and 3 ) for people with diabetes and its complications. It surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non–health-related federal agencies. It held 12 public meetings, solicited public comments, met with numerous stakeholders and key informants, and performed comprehensive literature reviews ( 1 , 4 ).

The recommendations of the NCCC focused on federal policies and programs and were prioritized according to the strength of evidence, the recommendations’ reach and scope, practicability, likely effectiveness and safety, affordability, and impact on health equity. The NCCC Final Report, which was transmitted to Congress in January 2022, included 39 specific recommendations. In this article we briefly summarize the Commission’s recommendations and propose steps for developing and implementing a new national strategy to coordinate federal efforts to prevent and control diabetes in the U.S.

Non–health-related and health-related federal agencies should coordinate their activities to comprehensively address diabetes prevention and treatment.

Health equity should be addressed in all federal policies and programs that impact people at risk for or with diabetes.

All people at risk for and with diabetes should have access to comprehensive, high-quality, and affordable health care.

The Commission also developed recommendations to address 1 ) population-wide policies and federal programs that can affect diabetes prevention and treatment; 2 ) diabetes prevention in populations at high risk for developing type 2 diabetes; and 3 ) the treatment of diabetes and its complications. These are discussed in detail in other articles in this series ( 7 – 12 ). We summarize key recommendations below.

Updating and revising the U.S. Department of Agriculture’s nutrition assistance programs to promote both food security and dietary quality across the life span.

Increasing breastfeeding rates and duration through effective federal programs and paid maternity leave.

Implementing federal strategies to encourage the consumption of water rather than sugar-sweetened beverages.

Updating the Food and Drug Administration’s food and beverage labeling policies and practices to ensure that labels are science-based, clear, direct, and not misleading so individuals can identify and reduce consumption of foods and beverages associated with a higher burden of diabetes.

Providing the Federal Trade Commission with the authority and resources to regulate the food and beverage industry’s marketing and advertising to children, who lack the skills to determine if they are being deceived.

Reducing exposure to environmental toxins associated with diabetes (polluted air, contaminated water, and pollutants in the land) and exposure to endocrine-disrupting chemicals through Environmental Protection Agency programs and policies.

Improving the built environment to enhance walkability, green spaces, physical activity resources, and active transport opportunities through programs and policies of the Department of Transportation.

Expanding housing opportunities in health-promoting environments for low-income individuals and families through programs of the Department of Housing and Urban Development and the Internal Revenue Service.

The NCCC also recommends that the federal government support research to increase our understanding of the social and environmental conditions associated with the risk of diabetes and its complications and to evaluate the impact of interventions on diabetes-related outcomes ( 7 , 8 ).

Increasing awareness of prediabetes and the availability of effective lifestyle intervention programs, in particular the National Diabetes Prevention Program (DPP) and the Medicare DPP.

Covering hemoglobin A 1c as a screening test for prediabetes.

Adopting clinical quality measures, such as those recommended by the American Medical Association, that assess screening for prediabetes, interventions for prediabetes, and retesting of patients with prediabetes to serve as an impetus for continuous quality improvement.

Providing insurance coverage for proven effective in-person, telehealth, and virtual delivery modalities for diabetes prevention.

Approving the Medicare DPP as a permanent covered benefit.

Streamlining and harmonizing the recognition and payment processes for DPPs.

Improving payment models and payment levels for DPP providers to ensure program sustainability.

Incentivizing state Medicaid programs to provide coverage for the National DPP.

Providing additional support for federal programs that focus on type 2 diabetes prevention.

Providing funding to the National Institutes of Health to facilitate a third party to collect, analyze, and summarize available data for a Food and Drug Administration application to consider approval of metformin for diabetes prevention in high-risk patients with prediabetes.

The NCCC also recommends that research be supported to develop new and better methods for preventing type 1 and type 2 diabetes ( 9 , 10 ).

At the patient level, the NCCC recommends reducing barriers and streamlining administrative processes to facilitate the delivery of diabetes self-management training, increasing patient engagement, ensuring access to affordable medications (including insulin), and regularly updating eligibility criteria for diabetes supplies, technologies, and devices.

At the practice level, the NCCC recommends developing capacity to support technology-enabled interventions, increasing access to virtual care for all patients with diabetes, and enhancing programs that support team-based care.

At the health system level, the NCCC recommends addressing health care workforce needs by directing training programs funded by the Department of Health and Human Services to identify workforce needs and to train individuals to meet those needs in the diabetes workforce and by implementing new payment models to sustain team-based care.

At the health policy level, the NCCC recommends providing insurance coverage at no out-of-pocket cost for high-value diabetes treatments and services and developing a quality measure that enhances patient safety by encouraging treatment deintensification in patients at high risk for severe hypoglycemia.

The NCCC also recommends that research be supported to identify and address barriers to uptake of diabetes self-management education and support, address digital connectivity as a social determinant of health, and identify methods to enhance team-based care ( 11 , 12 ).

Ensuring that the policies and programs of both non–health-related and health-related federal agencies are coordinated to improve social and environmental conditions that contribute to diabetes incidence and adversely impact its treatment.

Ensuring that achieving health equity is a guiding principle for all federal policies and programs addressing diabetes.

Implementing policies to ensure that all Americans at risk for and with diabetes have access to comprehensive and affordable health care.

Expanding and strengthening policies and programs to increase awareness of and the diagnosis of prediabetes and the availability of, referral to, and insurance coverage for intensive lifestyle intervention programs for diabetes prevention.

Facilitating the Food and Drug Administration review and approval of metformin for diabetes prevention.

Increasing the size, makeup, and competence of the workforce to treat diabetes and its complications.

Implementing new payment models to support access to lifesaving medications and proven effective treatments for diabetes and its complications at no out-of-pocket cost.

Adopting the NCCC’s recommendations can substantially reduce diabetes incidence, complications, and costs in the U.S. However, enabling the frameshift needed to translate these recommendations into policy will require substantial political resolve ( 13 ). Some of the NCCC’s recommendations will require new legislation. Others will require administrative action and rulemaking at the level of agencies or departments. Still others, such as mandating front-of-package labeling, may require input from the Department of Justice.

Policy makers, diabetes stakeholders (including patient organizations and organizations of physicians, nurses, dietitians, social workers, diabetes educators, pharmacists, and nurse practitioners), health plans, health departments, community organizations such as the YMCA, and more and more Americans are recognizing how social and environmental conditions shape health. The COVID-19 pandemic has led many to reckon with the consequences of the nation’s failure to implement an all-of-government approach to disease prevention and treatment. By recommending health-in-all-policies and an equity-based approach to governance, and by making recommendations specific to non–health-related and health-related federal agencies, the NCCC Report has the potential to contribute to meaningful change. The potential costs and consequences of the federal government not comprehensively addressing diabetes prevention and treatment are substantial. The NCCC urges Congress and the Secretary of Health and Human Services to promptly implement the Commission’s recommendations to coordinate federal policies and programs to prevent and control diabetes, to protect the health and well-being of current and future generations of Americans at risk for diabetes, and to improve the health of millions of Americans with diabetes.

See accompanying articles, pp. 252 , 255 , e14 , e24 , e39 , and e51 .

C.P. was the Designated Federal Officer for the National Clinical Care Commission. All other authors were members of the National Clinical Care Commission.

This article is part of a special article collection available at https://diabetesjournals.org/collection/1586/The-Clinical-Care-Commission-Report-to-Congress .

Acknowledgments. The NCCC acknowledges Alicia A. Livinski and Nancy L. Terry, biomedical librarians from the National Institutes of Health Library, Division of Library Services, Office of Research Services, who performed the literature searches. The NCCC also thanks Yanni Wang (International Biomedical Communications) and Heather Stites (University of Michigan) for their editorial assistance.

Funding. The NCCC was supported through a Joint Funding Agreement among eight federal agencies: The Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the National Institutes of Health (NIH), and the Office of Minority Health (OMH). The Office of the Assistant Secretary for Health (OASH), the Office of Disease Prevention and Health Promotion (ODPHP), and the Office on Women’s Health (OWH) provided management staff and contractor support.

The funders had no role in the preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Health and Human Services or other departments and agencies of the federal government.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Prior Presentation. Parts of this study were presented at the 82nd Scientific Sessions of the American Diabetes Association, New Orleans, LA, 3–7 June 2022.

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North Carolina Health News

News. Policy. Trends. North Carolina.

Read all of our joint coverage with The Charlotte Ledger here. 

‘the patient was subsequently found unresponsive in a hallway bed’: cms report on mission hospital details deaths of patients, significant delays in care.

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By Andrew R. Jones

Asheville watchdog.

At least three patients died and others were endangered at Mission Hospital in 2022 and 2023 following significant delays and lapses of care in the emergency department and other areas, according to a scathing U.S. Centers for Medicare & Medicaid Services report obtained Thursday by  Asheville Watchdog .

The  384-page document  details why CMS placed the hospital in immediate jeopardy, the most serious sanction a hospital can face. It spotlights not only patient deaths and long delays in care but also a lack of available rooms, a lack of governing bodies “responsible for the conduct of the hospital,” and multiple leadership failures.

“The hospital’s leadership failed to ensure a medical provider was responsible for monitoring and ensuring the delivery of care to patients presenting to the emergency department,” the report states.

Hospital leadership also “failed to ensure emergency care and services were provided according to policy” and “failed to ensure adverse events were documented, tracked, trended, and analyzed in order to implement preventive actions and identify success of actions taken.”

While the report focuses on issues in the emergency department, it also described deficiencies in care in other areas, including the oncology unit, where it said a patient received expired chemotherapy. It also described an incident in the behavior health unit in which a child was given medication without authorization from a parent or guardian.

The report also includes Mission’s plan of correction, which it was required to submit or face loss of its Medicare and Medicaid funding, a significant threat to its financial viability. 

“We are pleased that CMS has accepted our Plan of Correction,” Mission health spokesperson Nancy Lindell said Thursday. “Mission Health began implementing changes based on preliminary findings shared in December. We are pleased to hear from our EMS partners and patients that those actions are yielding positive results, including decreased wait times for care. 

“Again, these findings are not the standard of care we expect, nor that our patients deserve, and we are working diligently to ensure Mission Hospital successfully serves the needs of the Western North Carolina community.”

The report chronicles numerous breakdowns and delays in care and details the deaths of at least three patients in the emergency department or intensive care unit.

Patient #2: ‘Delayed triage, care, and treatment’

The report lists a 66-year-old male as patient #2, who was brought into the ED shortly before 6 p.m. Oct. 17, 2023, with chest pain after fainting at home. A physician assistant interviewed in the report said there were no rooms available when the man arrived.

That PA “saw the patient while in the hallway and placed orders.” The PA’s interview also revealed “the patient had not been triaged, he was still in the hall,” the report states.

“The provider ordered labs at [6:41 p.m.] (48 minutes after Patient #2 arrived), and the labs were not collected by nursing staff until [7:20 p.m.] (39 minutes after the lab were ordered), after the patient was triaged at [7 p.m.] (1 hour and 7 minutes after arrival).” 

Patient #2 was on a cardiac monitor and received vital signs by EMS until triage at 7 p.m., according to the report, but no hospital EKG was obtained until 7:05 p.m, 24 minutes after ordered and 1 hour and 12 minutes after the patient arrived at the hospital.

At 7:53 p.m., amid other delays, a physician responded to the patient’s bedside because the patient was having a heart attack. “CPR was started and the patient expired,” the report states. A doctor interviewed in the report said efforts to resuscitate the man lasted for about 30 minutes.  

“Nursing staff failed to accept the patient upon arrival to the ED, resulting in delayed triage, care, and treatment,” the report states. 

Patient #29: Left alone and unmonitored in hallway 

In another case, patient #29, a 78-year-old woman, arrived at the hospital via EMS at 2:51 p.m. on April 5, 2022, with abnormal heart rhythms. She had fallen at home and had an open fracture of her right shin bone. A pulse oximetry reading in the ambulance was 94 percent, but no oxygen was administered. Another pulse oximetry reading more than an hour and a half later was even lower, at 90 percent, but again no oxygen was given. 

Nurses gave her narcotic pain medication at 4:30 p.m. and 6:16 p.m., but did not take her vital signs or check her oxygen levels afterward.  

Shortly after 7 p.m., “the patient was subsequently found unresponsive in a hallway bed, in “asystole” — also known as flatlined, indicating no heart activity  — “and expired.” The report did not say why the patient had been left alone and unmonitored in the hallway. 

“Nursing staff failed to reassess the patient after narcotic administration. Nursing staff failed to monitor and evaluate the patient for a change in condition (not breathing),” the report concluded.

More coverage on Mission Hospital

Feds cite Asheville’s Mission Hospital for ‘immediate jeopardy,’ HCA division president tells staff 

Feds cite Asheville’s Mission Hospital for ‘immediate jeopardy,’ HCA division president tells staff 

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50 doctors, including a former board member, publicly decry HCA’s management of Mission Hospital system

Doctors’ lawsuit: HCA Healthcare and TeamHealth overcharged patients

Doctors’ lawsuit: HCA Healthcare and TeamHealth overcharged patients

Patient #83: a ‘potentially life-threatening request,’ then delays.

A 74-year-old woman with dizziness arrived in the emergency department from her doctor’s office at 12:16 p.m. on Nov. 28, 2023. A blood workup was ordered STAT, “an emergent, potentially life-threatening request,” the report said. But her blood was not drawn for another hour and 40 minutes, and the results came back three hours and 14 minutes after the original order.

The patient’s lab work showed a critically high glucose level. An infusion of insulin was ordered but not initiated for an hour and 13 minutes. “Orders for continuous ECG (heart) monitoring placed at [12:18 p.m] and vital signs every 2 hours ordered at [5:39 p.m.] were never initiated,” the report said.

A lactic acid blood test ordered in the emergency department was not done until the patient was moved to an inpatient bed, nine hours and 41 minutes later. That test revealed a critically high level. The patient was moved to an intensive care unit and placed on a ventilator.

She died at 1:37 p.m. on Nov. 30.

Mission issues plan of correction

Mission’s plan of correction states that the hospital began to make changes on Dec. 1. 

Those included a memo to all medical staff setting expectations around responsiveness to emergent patients.  Asheville Watchdog  detailed the email  in an exclusive story on Dec. 12. At the time of the story, Lindell described the memo to  The Watchdog  as “a point of clarification to our team and is not new information.” 

The plan of correction states that the hospital is making permanent changes to procedures and has required staff to undergo training sessions. It also describes a series of new lab order processes and the deployment of additional equipment, such as a monitor to “Air Traffic Control (ATC) desk to display and allow total visibility of ER patients with unassigned beds in waiting room, EMS entrance and pre-arrivals.”

The plan also states that the hospital’s governing body “will provide oversight of the plan of correction implementation and sustained improvements.”

Mission nurses have said for years that HCA has purposefully  understaffed numerous departments  and refused to provide necessary resources for the hospital to function safely.

Nurses had sent formal complaints to the North Carolina Department of Health and Human Services since early 2022 , some about transfer procedures in the hospital’s emergency department that they contended endangered patients,  The Watchdog  reported in late August. At that time, NCDHHS had not visited the hospital, citing its own staff shortages.

Shows a large brick building with a sign in the foreground that reads "emergency." Hospital emergency department. Mission Hospital plan of correction.

Mark Klein, a vascular nurse who serves in a leadership role with the hospital’s nurses union and who  helped bring several complaints about systemic and leadership failures to light in 2023 , said his initial impression of the CMS report was one of “heartbreak, and, sadly validation.” 

Klein remains sharply critical of the leadership of Mission and HCA Healthcare, which purchased the hospital system for $1.5 billion in 2019.

“We did the right thing by bringing HCA’s horrific, injurious, profit-centric care models to the attention of regulatory authorities,” Klein said. “I believe HCA is sincere in its desire to remove the immediate jeopardy status to ensure the protection of income streams. I do not think HCA leadership is sincere about transformative change.”

He added that “HCA egregiously understaffed the hospital, not just the ER, and it is understandable why over 50 percent of the ER nurses leave every year. Senior leaders who put the policies that imperiled and harmed patients in place need to be held accountable.”

NCDHHS inspections on behalf of CMS occurred at the hospital Nov. 13-17, Nov. 27-Dec. 1, and Dec. 4-9. Beginning Nov. 14, while inspectors were at the hospital,  The Watchdog  reported,  Mission offered extra shifts to doctors in the emergency department  and on Nov. 20, halted some patient transfers from other hospitals, which reduced the burden on staff.  

As  The Watchdog  was first to report, HCA Healthcare North Carolina Division President Greg Lowe  announced the finding of immediate jeopardy  in an email to Mission’s staff Feb. 2.

Mission has until Feb. 24 to get the hospital out of immediate jeopardy. The state will visit soon to make sure the hospital is in compliance. 

Immediate jeopardy is rare, according to  a 2021 study  from the National Library of Medicine, which reviewed 30,808 hospital deficiencies between 2007-2017. Only 2.4 percent, or 730, of those resulted in immediate jeopardy, according to the study.

Separately, North Carolina Attorney General Josh Stein filed a lawsuit against HCA Dec. 14, alleging it failed to comply with two of 15 commitments made when it bought the Mission Health system for $1.5 billion in 2019. Specifically, those commitments were related to keeping services in the emergency department and cancer care program open and running. 

Headshot of NC Attorney General Josh Stein, who is dressed in a blue suit jacket, red and blue striped tie and light blue shirt. He is also smiling.

While Stein alleges that systemic breakdowns leading to exiting doctors and curbed care measures have constituted breaches of the commitments, Mission contended Thursday in a response to Stein’s lawsuit that it had upheld its end of the deal and, furthermore,  wasn’t required by the purchase contract to provide quality care in the first place .

The Asset Purchase Agreement — the legal contract of the sale of Mission to HCA — is “silent as to the quantity or quality of services required” at Mission Hospital, lawyers for HCA wrote in their response. “The contractual language, as well as the underlying negotiations, demonstrate that Mission’s Hospital Service Commitments are not promises to meet subjective healthcare standards,” the response stated.

HCA maintains that it provides quality care. “Fact:   The quality of care at Mission Hospital is among the best in the nation,”  HCA’s website states .

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email [email protected].  The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to  avlwatchdog.org/donate.

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Some states are trying to protect health care data so it isn’t used against people seeking abortions

FILE - Supporters of Issue 1, the Right to Reproductive Freedom amendment, attend a rally in Columbus, Ohio, Oct. 8, 2023. Some state governments and a federal agency are moving to block companies from selling geolocation data that shows who's been to abortion providers, among other places. (AP Photo/Joe Maiorana, File)

FILE - Supporters of Issue 1, the Right to Reproductive Freedom amendment, attend a rally in Columbus, Ohio, Oct. 8, 2023. Some state governments and a federal agency are moving to block companies from selling geolocation data that shows who’s been to abortion providers, among other places. (AP Photo/Joe Maiorana, File)

FILE - This Friday, June 21, 2019 photo, shows the exterior of the Planned Parenthood of the St. Louis Region and Southwest Missouri, the state’s last operating abortion clinic, in St. Louis. Some state governments and a federal agency are moving to block companies from selling geolocation data that shows who’s been to abortion providers, among other places. (Christian Gooden/St. Louis Post-Dispatch via AP, File)

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Some state governments and federal regulators were already moving to keep individuals’ reproductive health information private when a U.S. senator’s report last week offered a new jolt, describing how cellphone location data was used to send millions of anti-abortion ads to people who visited Planned Parenthood offices.

Federal law bars medical providers from sharing health data without a patient’s consent but doesn’t prevent digital tech companies from tracking menstrual cycles or an individual’s location and selling it to data brokers. Legislation for federal bans have never gained momentum, largely because of opposition from the tech industry.

Whether that should change has become another political fault line in a nation where most Republican-controlled states have restricted abortion — including 14 with bans in place at every stage of pregnancy — and most Democratic ones have sought to protect access since the U.S. Supreme Court in 2022 overturned Roe v. Wade.

Abortion rights advocates fear that that if such data is not kept private, it could be used not only in targeted ads but also in law enforcement investigations or by abortion opponents looking to harm those who seek to end pregnancies.

Members of the Utah House of Representatives applaud for the athlete who was the subject of school board member Natalie Cline's comments on social media after passing the House Concurrent Resolution Condemning and Censuring State School Board Member Natalie Cline at the Capitol in Salt Lake City on Thursday, Feb. 15, 2024. (Megan Nielsen/The Deseret News via AP)

“It isn’t just sort of creepy,” said Washington state Rep. Vandana Slatter, the sponsor of a law her state adopted last year to rein in unauthorized use of health information. “It’s actually harmful.”

But so far, there’s no evidence of widespread use of this kind of data in law enforcement investigations.

“We’re generally talking about a future risk, not something that’s happening on the ground yet,” said Albert Fox Cahn, executive director of the Surveillance Technology Oversight Project and an advocate of protections.

The report last week from Sen. Ron Wyden , an Oregon Democrat, showed the biggest known anti-abortion ad campaign directed to people who had been identified as having visited abortion providers.

Wyden’s investigation found that the information gathered by a now-defunct data broker called Near Intelligence was used by ads from The Veritas Society, a nonprofit founded by Wisconsin Right to Life. The ads targeted people who visited 600 locations in 48 states from 2019 through 2022. There were more than 14 million ads in Wisconsin alone.

Wyden called on the Federal Trade Commission to intervene in the bankruptcy case for Near to make sure the location information collected on Americans is destroyed and not sold to another data broker. He’s also asking the Securities Exchange Commission to investigate whether the company committed securities fraud by making misleading statements to investors about the senator’s investigation.

It’s not the first time the issue has come up.

Massachusetts reached a settlement in 2017 with an ad agency that ran a similar campaign nearly a decade ago.

The FTC sued one data broker , Kochava, over similar claims in 2022 in an ongoing case, and settled last month with another, X-Mode Social, and its successor, Outlogic, which the government said sold location data of even users who opted out of such sharing. X-Mode was also found to have sold location data to the U.S. military.

In both cases, the FTC relied on a law against unfair or deceptive practices.

States are also passing or considering their own laws aimed specifically at protecting sensitive health information.

Washington’s Slatter, a Democrat, has worked on digital privacy issues for years, but wasn’t able to get a bill with comprehensive protections adopted in her state.

She said things changed when Roe was overturned. She went to a rally in 2022 and heard women talking about deleting period-tracking apps out of fear of how their data could be exploited.

When she introduced a health-specific data privacy bill last year, it wasn’t just lawyers and lobbyists testifying; women of all ages and from many walks of life showed up to support it, too.

The measure, which bars selling personal health data without a consumer’s consent and prohibits tracking who visits reproductive or sexual health facilities, was adopted with the support of nearly all the state’s Democratic lawmakers and opposition from all the Republicans.

Connecticut and Nevada adopted similar laws last year. New York enacted one that bars using tracking around health care facilities.

California and Maryland took another approach, enacting laws that prevent computerized health networks from sharing information about sensitive health care with other providers without consent.

“We’re really pushing forward with the free-flowing and seamless exchange of health care data with the intend of having information accessible so that providers can treat the whole person,” said Andrea Frey, a lawyer who represents health care providers and digital health systems across. “Conversely, these privacy concerns come into play.”

Illinois, which already had a law limiting how health tracking data — measuring heart rates, steps and others — can be shared, adopted a new one last year that took effect Jan. 1 and that bans providing government license plate reading data to law enforcement in states with abortion bans.

Bills addressing the issue in some form have been introduced in several states this year, including Hawaii, Illinois, Maine, Maryland, Massachusetts, Missouri, South Carolina and Vermont.

In Virginia, legislation that would prohibit the issuance of search warrants, subpoenas or court orders for electronic or digital menstrual health data recently cleared both chambers of the Democratic-controlled General Assembly.

Democratic Sen. Barbara Favola said she saw the bill as a necessary precaution when Republican politicians, including Virginia Gov. Glenn Youngkin, have sought restrictions on abortion.

“The next step to enforcing an abortion ban could be accessing menstrual health data, which is why I’m trying to protect that data,” Favola said in a committee hearing.

Opponents asked whether such data had ever been sought by law enforcement, and Favola responded that she wasn’t aware of a particular example.

“It’s just in search of a problem that does not exist,” said Republican Sen. Mark Peake.

Youngkin’s administration made it clear he opposed similar legislation last year, but his press office didn’t respond to a request for comment on where he stands on the current version.

Sean O’Brien, founder of the Yale Privacy Lab, says there is a problem with the way health information is being used, but he’s not sure laws will be the answer because companies could choose to ignore the potential consequences and continue scooping up and selling sensitive information.

“The software supply chain is extremely polluted with location tracking of individuals,” he said.

Mulvihill reported from Cherry Hill, New Jersey. Associated Press reporters Frank Bajak in Boston and Sarah Rankin in Richmond, Virginia, contributed to this article.

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WMBB Panama City

Colorado bans use of gas-powered lawn equipment by state agencies starting 2025

D ENVER ( KDVR ) — State agencies in Colorado will be banned from using certain gas-powered lawn equipment during the summer, according to a new rule adopted by the Colorado Air Quality Control Commission.

The rule applies from June to August. During this time, state agencies will not be allowed to use gas-powered lawn equipment with engines of 25 horsepower or less.

The new regulation also prohibits the use of gas-powered push lawnmowers and other lawn equipment under 10 horsepower on other public property within the Denver Metro and the nine-county North Front Range ozone nonattainment area.

This area includes the Denver metro, as well as areas north of it through Larimer and Weld counties. This new rule is also in effect from June through August, and does not impact homeowners on their own property.

The nonprofit CoPIRG Foundation released a report that found gas-powered lawnmowers and other lawn equipment generated an estimated 671 tons of fine particulate pollution in 2020.

This was equivalent to the pollution created by more than 7 million cars, according to the report.

CoPIRG also said lawn equipment contributes an estimated 9,811 tons of ozone-forming volatile organic compounds, along with 1,969 tons of nitrogen oxides every year.

The regulation will not go into effect until 2025.

Over the summer, the Regional Air Quality Council voted to ban the sale of small gas-powered lawn tools in select Colorado counties to improve air quality. This proposal was rejected by the state’s Air Quality Control Commission.

For the latest news, weather, sports, and streaming video, head to mypanhandle.com.

Colorado bans use of gas-powered lawn equipment by state agencies starting 2025

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February 17, 2024

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UK report: Innovative approaches by financial institutions can make a crucial difference in gambling-related harm

by Queen Mary, University of London

slot machine

With a record number of people seeking help for problem gambling through the National Gambling Helpline last year, and the Gambling Commission's new figures suggesting that as many as 1.3 million adults in Great Britain might experience gambling-related harm, new research from Queen Mary University of London reveals innovative and effective approaches by financial institutions to support affected individuals.

The Multidisciplinary Research Hub on the Prevention of Gambling Harms, under the leadership of Professor Julia Hörnle and Dr. Janelle Jones, has unveiled significant findings regarding the essential role of banks in preventing serious financial harm stemming from problem gambling among their customers. The evidence shows that financial institutions are in a unique position to offer effective support to reduce the gambling-related harm that can go unnoticed by other people in the affected person's social circle.

Approximately 44% of the population engaged in gambling activities in the year leading up to March 2023. However, for a significant minority, gambling can escalate into a problem, potentially resulting in severe financial indebtedness, mental health issues such as depression and anxiety, and an increased likelihood of suicidality and criminal involvement.

Co-Author, Dr. Janelle Jones, Senior Lecturer in Social Psychology, in the School of Biological and Behavioral Sciences at Queen Mary University of London said, "Our research underscores the devastating personal consequences of problem gambling. Banks, with their unique position and access to transactional and behavioral data, can effectively identify and assist customers in recognizing and addressing their gambling-related issues early."

Despite the inherent challenges posed by the hidden and secretive nature of compulsive gambling, the research suggests that by implementing tools such as gambling blocks, conducting spend analysis, and engaging in active communication, banks can effectively identify and assist customers in recognizing and addressing their gambling-related issues.

Furthermore, the research highlights the importance of banks actively signposting affected customers to specialized support agencies like Gamcare, the leading provider of information, advice and support for anyone affected by gambling harm. Such proactive measures not only align with the new Consumer Duty imposed by the Financial Conduct Authority (FCA) but also serve as crucial steps towards promoting customer well-being and financial stability.

However, the study revealed inconsistencies in the implementation of these measures across the banking industry, highlighting the urgent need for industry-wide standards and regulatory guidelines.

Co-Author, Professor Julia Hörnle, Professor of Internet Law, in the School of Law at Queen Mary University of London said, "While there is a fair amount of discussion and positive innovation, implementation is patchy. This means in practice that the degree of support for people experiencing harm is a question of luck. Clearer guidance and minimum standards as to what the new Consumer Duty means for protecting individuals experiencing serious gambling harm is necessary. We recommend that the FCA issues Guidance in this respect and we hope this report is instrumental for this purpose."

The report concludes that by establishing clearer standards, regulators can facilitate more effective prevention of serious gambling-related financial harm, ultimately saving lives and safeguarding individuals from the detrimental effects of problem gambling . The report also finds that banks and regulators should involve people with experience of gambling-related harm in designing the measures.

Provided by Queen Mary, University of London

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