University of Rochester researchers have developed SOPHIE, a virtual ‘patient’ that trains doctors in explaining end-of-life options.

As many as 68 percent of late-stage cancer patients leave their doctor’s offices either underestimating the severity of their disease, overestimating their life expectancy—or both. These misunderstandings can hinder the ability of patients and their families to make realistic decisions about whether to continue aggressive treatments or instead turn to palliative care.

To address the problem, University of Rochester computer scientists, palliative care specialists, and practicing oncologists are perfecting SOPHIE (Standardized Online Patient for Healthcare Interaction Education)—an online virtual “patient” that helps physicians practice how to communicate effectively with late-stage cancer patients about their disease.

Effective communication in this context often means demonstrating empathy and understanding of the complex emotions that patients are experiencing.

“During difficult conversations about facing the potential of one’s own death, patients are frightened and don’t know how to ask the right questions, and clinicians may oversimplify, omit, or sugar-coat information, or feel too pressed for time to address patients’ emotions,” says Ehsan Hoque, an associate professor of computer science at Rochester’s Hajim School of Engineering and Applied Sciences. The COVID-19 pandemic has made effective communication even more difficult by causing increasing reliance on virtual rather than in-person interactions between patients and physicians, adds Hoque.

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WISH Act Would Provide Long-Term Care Insurance

Rep. Tom Suozzi (D-NY-3) has introduced the Well-Being Insurance for Seniors to be at Home (WISH) Act, H.R. 4289, in the House of Representatives to create a catastrophic long-term care insurance program.

The WISH Act calls for the creation of a public-private relationship to provide long-term care coverage for older adults. On the public side, the federal government would collect a new payroll tax of 0.3 percent of wages from both employer and employee, or a combined 0.6 percent from the self-employed. On the private side, it is expected that private insurance companies would be unburdened of providing catastrophic levels of coverage and would create more affordable long-term care coverage options.

Eligible beneficiaries would need to either suffer from dementia or require assistance with at least two activities of daily living. Beneficiaries would also be required to have worked and contributed for 40 quarters to a new Long-Term Care Insurance Trust Fund. Upon meeting these requirements, and subject to the applicable waiting period, beneficiaries would be eligible to receive up to approximately $3,600 per month, enough to cover approximately six hours of daily care...

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OSHA Revises its National Emphasis Program, Updates Interim Enforcement Response Plan for COVID-19

WASHINGTON - The U.S. Department of Labor’s Occupational Safety and Health Administration has revised its National Emphasis Program (NEP) for COVID-19. The agency launched the NEP on March 12, 2021, to focus on companies that put the largest number of workers at serious risk of contracting the coronavirus, and on employers that engage in retaliation against employees who complain about unsafe or unhealthful conditions or exercise other rights under the Occupational Safety and Health Act.

Based on an evaluation of inspection and illness data, the revised NEP (DIR 2021-03 (CPL 03), adjusts the targeted industries to those most at risk for COVID-19 exposure, but still includes healthcare and non-healthcare, such as meat and poultry processing. The revised NEP also removes an appendix that provided a list of Secondary Target Industries for the former COVID-19 NEP. For inspections in healthcare, the revised NEP refers compliance safety and health officers (CSHOs) to the new directive, DIR 2021-02 (CPL 02), Inspection Procedures for the COVID-19 Emergency Temporary Standard, issued on June 28, 2021.

Inspections in non-healthcare establishments will follow procedures outlined in the Updated Interim Enforcement Response Plan published July 7, 2021. The updated interim enforcement response plan (IERP) replaces the memorandum dated March 12, 2021. Updates in the July 2021 IERP include:

• Enforcing protections for workers in non-healthcare industries who are unvaccinated or not fully vaccinated;

• Where respirator supplies and services are readily available, OSHA will stop exercising enforcement discretion for temporary noncompliance with the Respiratory Protection standard based on employers’ claims of supply shortages due to the COVID-19 pandemic;

• OSHA will no longer exercise enforcement discretion for the same requirements in other health standards, where full compliance may have been difficult for some non-healthcare employers due to the COVID-19 pandemic;

• Updated instructions and guidance for OSHA area offices and CSHOs for handling COVID-19-related complaints, referrals and severe illness reports;

• Ensuring workers are protected from retaliation; and

• References to the revised NEP for COVID-19.

The goals of the IERP are to identify exposures to COVID-19 hazards, ensure appropriate control measures are implemented, and address violations of OSHA standards (other than the ETS) and the General Duty Clause. The updated IERP will remain in effect until further notice and is intended to be time-limited to the current COVID-19 public health crisis.

The ETS became effective June 21, 2021.  Healthcare employers must comply with most provisions by July 6, 2021, and with training, ventilation, and barrier provisions by July 21, 2021.

Learn more about the COVID-19 Healthcare ETS.

Quality Reporting Program: Non-Compliance Letters for FY 2022 APU

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2020, which will affect their FY 2022 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into facilities’ CASPER folders in QIES, for Hospice and SNFs, and into facilities’ My Reports folders in iQIES, for IRFs and LTCHs, on July 14, 2021. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 13, 2021.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the appropriate QRP webpage:

• IRF Quality Reporting Reconsideration and Exception & Extension·
• LTCH Quality Reporting Reconsideration and Exception & Extension
• SNF Quality Reporting Reconsideration and Exception & Extension
• Hospice Quality Reporting Reconsideration Requests

[Please note that non-compliance letters related to the hospice quality reporting program are now available in CASPER folders.  The penalty is 2% for providers that are not in compliance. 

The penalty associated with CY2022 HQRP submissions (Jan. 1 through Dec. 31, 2022) will increase to 4% and will be applicable to FY2024 payments.  Any provider who is currently out of compliance with the HQRP may want to contemplate ways to improve compliance scores to avoid the 4% penalty in FY2024.]