Paralysed Man Walks Again Via Thought-Controlled Implants

People with Disabilities Need More Access to HCBS, Researchers Say

McKnight’s Home Care / By Liza Berger
 
Long-term care reform in the post-COVID-19 era must include an expansion of home- and community-based services (HCBS) for people with disabilities, two Harvard University researchers said in an article in The New England Journal of Medicine.
 
“Although the public may think of nursing home placement as the inevitable result of impairment, it is frequently driven by social rather than clinical factors,” authors David Grabowski, PhD, and Ari Ne’eman, wrote. “Many people with disabilities end up in nursing homes because of inadequate services or housing. This problem is particularly acute for persons with serious mental illness (SMI), who account for one third of long-stay residents under 65 years of age.”
 
There is an inherent bias toward institutional care for people with disabilities, they said. While Medicaid, the primary payer of HCBS, requires states to cover nursing home care without a waiting list, it permits states to maintain long waiting lists for HCBS.
 
“Long waits exacerbate unmet care needs by denying people access to services until they face a crisis — such as a medical emergency or the death of a family member — that may drive them into a nursing home or other institution,” they said.
 
HCBS rebalancing tweaks
 
While there has been a gradual rebalancing toward Medicaid HCBS versus nursing home care, people with disabilities still tend to end up in nursing homes, Ne’eman told McKnight’s Home Care Daily Pulse. Generally, state long-term services and supports systems tend to distinguish between people with developmental disabilities, and older adults and non-elderly with physical disabilities, he said.
 
“The aggregate numbers are a little misleading because the developmental disability system has a much higher percentage of HCBS funding than the aging and physical disability system,” he said.
 
A new BIP
 
Some possible avenues to grow HCBS for people with disabilities include establishing a successor to the Affordable Care Act’s Balancing Incentive Program (BIP). This initiative provided additional funding to states with low HCBS spending in exchange for meeting specific benchmarks.
 
A new BIP program would allow for targeting of specific subgroups in a state so a state would have to meet HCBS thresholds for both the developmental disability system and aging and physical disability system, Ne’eman said.
 
Legislators also could reform the Preadmission Screening and Resident Review program, the federally mandated screening system designed to divert people with SMI or intellectual disability from nursing home placement. The Section 1115 Medicaid waiver program could be yet another way for the Centers for the Medicare & Medicaid Services to allow states to pay for ongoing rental systems for people at greatest risk of institutionalization, Ne’eman said.
 
“There remains more work to be done in order to broaden the scope of individuals who can access support in their homes and communities in order to divert people from nursing homes and support some people currently residing within them to transition back to the community,” Ne’eman said.

ChatGPT in Medicine: STAT Answers Readers’ Burning Questions About AI

Stat News / By Lizzy Lawrence, Mohana Ravindranath and Brittany Trang 
 
Artificial intelligence is often described as a black box: an unknowable, mysterious force that operates inside the critical world of health care. If it’s hard for experts to wrap their heads around at times, it’s almost impossible for patients or the general public to grasp.
 
While AI-powered tools like ChatGPT are swiftly gaining steam in medicine, patients rarely have any say — or even any insight — into how these powerful technologies are being used in their own care.
 
To get a handle on the most pressing concerns among patients, STAT asked our readers what they most wanted to know about generative AI’s use in medicine. Their submissions ranged from fundamental questions about how the technology works to concerns about bias and error creeping further into our health systems.
 
It’s clear that the potential of large language models, which are trained on massive amounts of data and can generate answers to myriad prompts, is vast. It goes beyond ChatGPT and the ability for humans and AI to talk to each other. AI tools can help doctors predict medical harm on a broader scale, leading to better patient outcomes. They’re currently being used for medical note-taking, and analysis of X-rays and mammograms. Health tech companies are eager to tout their AI-powered algorithms at every turn.
 
But the harm is equally vast as long as AI tools go unregulated. Inaccurate, biased training data deepen health disparities. Algorithms not properly vetted deliver incorrect information on patients in critical condition. And insurers use AI algorithms to cut off care for patients before they’re fully recovered.
 
When it comes to generative artificial intelligence, there are certainly more questions than answers right now. STAT asked experts in the field to tackle some of our reader’s thoughtful questions, revealing the good, the bad, and the ugly sides of AI.
 
As a patient, how can I best avoid any product, service or company using generative AI? I want absolutely nothing to do with it. Is my quest to avoid it hopeless? 
 
Experts agreed that avoiding generative AI entirely would be very, very difficult. At the moment, there aren’t laws governing how it’s used, nor explicit regulations forcing health companies to disclose that they’re using it.
 
“Without being too alarmist, the window where everyone has the ability to completely avoid this technology is likely closing,” John Kirchenbauer, a Ph.D. student researching machine learning and natural language processing at the University of Maryland, told STAT. Companies are already exploring using generative AI to handle simple customer service requests or frequently asked questions, and health providers are likely looking to the technology to automate some communication with patients, said Cobun Zweifel-Keegan, managing director of the International Association of Privacy Professionals.
 
But there are steps patients can take to at least ensure they’re informed when providers or insurers are using it.
 
Despite a lack of clear limits on the use of generative AI, regulatory agencies like the Federal Trade Commission “will not look kindly if patients are surprised by the use of automated systems,” so providers will likely start proactively disclosing if they’re incorporating generative AI into their messaging systems, Zweifel-Keegan said.
 
“If you have concerns about generative AI, look out for these disclosures and always feel empowered to ask questions of your provider,” Zweifel-Keegan said, adding that patients can report any concerning practices to their state attorney general, the FTC and the Department of Health and Human Services.

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COVID-19 Vaccination Requirements

NAHC

We want to remind providers that with the end of the PHE the requirement for Medicare and Medicaid-certified providers and suppliers to ensure that their staff are fully vaccinated for COVID-19 (or meet exemption criteria) is still in effect.  The White House announced on May 1 that it will start the process to end the vaccination requirements for CMS-certified healthcare facilities and CMS stated in a memo on the same day that  "CMS will soon end the requirement that covered providers and suppliers establish policies and procedures for staff vaccination. CMS will share more details regarding ending this requirement at the anticipated end of the public health emergency. We continue to remind everyone that the strongest protection from COVID-19 is the vaccine. Therefore, CMS urges everyone to stay up to date with your COVID-19 vaccine."  

The requirements are part of the interim final rule with comment period (IFC), Medicare and Medicaid Programs; Omnibus COVID–19 Health Care Staff Vaccination, and requires certified providers to establish and implement policies and procedures for COVID–19 vaccination of all staff (includes employees; licensed practitioner; students, trainees, and volunteers; and other individuals) who provide care, treatment, or other services for the provider or its patients.  As of today, CMS has not released any information about the ending of this requirement.

Home Health Stakeholders Call On CMS To Rectify ‘Significant’ Forecast Errors From 2021, 2022

Home Health Care News

Home health stakeholders are urging the Centers for Medicare & Medicaid Services (CMS) to address an alleged forecast error in the home health market basket for 2021 and 2022.

Broadly, CMS calculates the expected impact of cost inflation for home health agencies annually. In order to do this, CMS relies on a forecasting methodology from a private entity that is applied to the most recent cost data available for home health care.

“That forecasting tool attempts to gauge cost trends as an indicator of where future costs in the upcoming year will end up,” William A. Dombi, the president of the National Association of Home Care & Hospice, told Home Health Care News in an email. “As with any forecasting, errors can and do occur once actual cost changes are known. Over the years, these errors have sometimes been in the provider’s favor and other times not.”

The forecasting errors for 2021 and 2022 were significant, according to Dombi.

They resulted in a 5.1% shortfall in the annual payment rate updates for those years.

Last month, The Partnership for Quality Home Healthcare (PQHH) and the NAHC penned a joint letter to CMS. In the letter, PQHH and NAHC recommended that CMS advance a proposal for a one-time forecast error correction for 2021 and 2022 in the upcoming proposed rule.

“After a conversation we had with senior officials at CMS – who were asking about some of the economic conditions related to workforce, and the costs of retention and recruitment – we did take the opportunity to follow up our conversation with a letter that really focused on showcasing the fact that in 2021 and 2022, for home health, the market basket was significantly off,” PQHH CEO Joanne Cunningham told HHCN. “This translates to billions of dollars that did not go into the rate structure for home health, which is really important.”

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