PCORI announces $6.5 million in grants to implement ‘shared decision making’

The Patient-Centered Outcomes Research Institute (PCORI) will release of $6.5 million in grant funding to organizations willing to implement shared decision making strategies for patients and care providers. According to the institute, the funding is designed to address concerns by doctors and other care providers that implementing the programs will cost too much time or “interfere with their routine clinical workflow.”

Shared decision making, research around which PCORI has provided nearly $200 million in funding, is an umbrella term for strategies that help patients better understand their treatment options in a given healthcare situation, particularly when the right choice is not clear or could be impacted by a patient’s preferences.

“PCORI recognizes that for many clinical situations, patients and clinicians need to work together to consider all available treatment options, informed by the patients’ preferences,” PCORI Executive Director Joe Selby said in a statement. “For a variety of reasons, shared decision making isn’t as widely used in practice as it should be.”

Examples of the research conducted includes a $1.6 million research project out of the Mayo Clinic, highlighted by PCORI in January of this year, looking at the implementation of “Chest Pain Choice.” The materials were developed in light of concerns that patients at a low-risk for heart attacks who reported chest pain in an emergency room were suffering unnecessary anxiety, as well as possibly increasing healthcare costs, after being transferred to the hospital for further testing. Another $1.4 million project from the University of Texas MD Anderson Cancer Center looked at the development of a video to help heavy smokers between the ages of 55 and 77 understand the risks and benefits of the CT lung cancer screenings, which were recently authorized by Medicare.

Grants are currently available only to those institutions that have served as past recipients of PCORI grants for shared decision making project, which they have completed, or new applicants working closely with one of those institutions to implement one of the research-based strategies. Clinicians have until October 2 of this year to submit their letters of intent for consideration, with an implementation start date of October 2018, at the earliest.

PCORI said it had funded $164 million in research on shared decision making projects as of September 2016. The initial funding comes with a commitment to authorize another $6.5 million to $8 million per cycle, with up to two cycles per year, for continued implementation.

HHS to receive $73.5B under House funding bill, ACA left out

The 2017 Omnibus Appropriations bill allocates a total of $73.5 billion to HHS for the 2017 Fiscal year, ending September 30, 2017. The House Appropriations Committee released the fiscal year 2017 Omnibus Appropriations bill on May 1, 2017. The bill provides discretionary funding for the federal government and prioritizes health while cutting funding for “ineffective or wasteful programs.”

HHS

The HHS funding represents an increase of $2.8 billion above the 2016 enacted funding level and $3.8 billion above the Obama Administration’s budget request. The budget is split among various agencies within HHS to fund what the bill calls “effective, proven programs.”

Funding

The bill allocates $34 billion to the National Institutes of Health (NIH) for research related to Alzheimer’s, antibiotic resistance, and precision medicine. The legislation includes funding for critical disease prevention and biodefense activities by allocating $7.3 billion for the Centers for Disease Control and Prevention (CDC). The bill provides the Substance Abuse and Mental Health Administration (SAMHSA) with $3.6 billion for 2017, with a focus on prevention and treatment of opioid and heroin use. The legislation provides $6.4 billion for HRSA Health Resources and Services Administration (HRSA), in part to fund Community Health Centers.

CMS and the ACA

The bill allocates $3 billion for CMS program management and operations and, notably, does not provide funding to implement Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) programs. The bill continues prohibitions and restrictions on use of federal funds related to the ACA.

Highlight on Alabama: Class action against state alleges inadequate prison mental health care

Focus on the issue of accessibility to quality mental health care has been growing in recent years, and the state of Alabama is facing intense scrutiny for the possible failure to treat mentally ill inmates. A federal trial began on December 5, 2016, in which dozens of inmates are expected to testify.

This trial is one part of a larger suit filed by the Southern Poverty Law Center (SPLC) in 2014 alleging that overall, medical care in the state’s prisons is below constitutional standards. Claims that the Department of Corrections (DOC) failed to accommodate prisoners with physical disabilities were previously settled, with the DOC agreeing to improve its facilities.

U.S. District Judge Myron Thompson granted class action status to the mental health portion of the case in November 2016,  noting that the failure to provide funding for staff creates an Eighth Amendment violation, even if this is caused by a lack of available money.

The claims currently being heard allege that the mental health care, provided through the contractor MHM Correctional Services, fails to provide enough providers to offer care, including psychiatrists, psychologists, and nurses. Additionally, the lack of security staff causes interruptions in care. This results in failing to identify mentally ill inmates and properly diagnose the severity of illness in those who are identified. These issues have led to a failure to prescribe medication, manage side effects, offer adequate counseling, and properly monitor and treat inmates who are suicidal and self harm.

According to a local news report, the first inmate witness had been in prison for six years and is currently at the Donaldson Correctional Facility. He testified that he had physical and mental illnesses and was prone to self harm, but he only sees mental health staff approximately every two months for sessions lasting about five or 10 minutes.

SPLC stated that other expected witnesses include a Dr. Kathryn Burns, a mental health expert who has inspected nine Alabama prisons and their mental health procedures.

This suit is not the only attention Alabama’s prisons are currently receiving. In October 2016, the Department of Justice began a statewide investigation into the conditions in Alabama’s prisons. This investigation is to focus on efforts to protect prisoners from abuse and excessive force at the hands of other prisoners or correctional offers, as well as the provision of sanitary, secure, and safe living conditions.

HHS funds cybersecurity sharing center to disseminate information about health care threats

HHS agencies have awarded the National Health Information Sharing and Analysis Center (NH-ISAC) $350,000 in cooperative agreements to allow it to disseminate information about cybersecurity threats among health care stakeholders. The agency hopes that increased information sharing in the health care community will alert stakeholders to threats more quickly, so that they can avoid them or mitigate the damages caused by breaches more efficiently. This type of information sharing was one goal of the Cybersecurity Information Sharing Act (CISA), enacted as part of the Consolidated Appropriations Act, 2016 (P.L. 114-113) and is part of the HHS’ ongoing efforts to reduce breaches among Health Care Portability and Accountability Act (HIPPA) (P.L. 104-191) covered entities and business associates (see Changes to ACA requirements, COOL, cybersecurity, and more in Appropriations Act, Health Law Daily, December 21, 2015).

The NH-ISAC is a member-owned non-profit that that offers non-profit and for-profit health care stakeholders, including independent hospitals, health insurance payers, and medical schools, a forum for sharing cyber and physical threat indicators. The HHS funding will prepare NH-ISAC to receive cyberthreat information from HHS and share it with stakeholders. Small providers, in particular, are expected to benefit from this process, which will alert them to threats and provide them with advice for responding to those threats. The agreements will also support NH-ISAC’s ability to receive threat information from stakeholders to provide other stakeholders with information about system breaches, including ransomware attacks.

The Office of the National Coordinator for Health Information Technology (ONC), which coordinates national health information technology and promotes the exchange of electronic health information, awarded $250,000 to build NH-ISAC’s capacity to receive and share cyber threat information with stakeholders and HHS and provide education about cyberthreats and appropriate responses. The Assistant Secretary for Preparedness and Response (ASPR), which prepares the nation to respond and recover from adverse health effects of emergencies, awarded a separate $150,000.