第五屆中美健康峰會綜論中美醫改概況

(本報記者菊子波士頓報導)第五屆中美健康峰會昨（28）日在哈佛大學公衛學院揭幕，從美國的推行可負擔保險法，試圖藉改革醫療付費方式，來提高醫療品質，降低醫療費用，談到中國的正積極培養全科醫生，推動分級醫療制度，改變人們獲取醫療方式等作法。

            中美健康峰會是由曾在哈佛公衛學院任職，現為北京協和醫學院公共衛生學院院長的劉遠立創辦的。今年跨入第五屆，邀來國務院醫改辦主任孫志剛和美國衛生與人類服務部全球事務辦公室亞洲主任Erika Elvander做主旨發言。

            為期兩天的會議，將共探討六個主題，包括昨日舉行的”中美醫療衛生體制改革比較“，改善獲取醫療衛生服務渠道”，“以證據為基礎的醫療衛生改革評估”，醫療及製藥政策及規範“，以及訂今（29）日舉行的“醫藥創新”，“使用科技來改善醫療護理”。

            今日下午，中美健康峰會將推出首屆“中美青年領導論壇”，並將由出版了“中國能領導嗎（Can China Lead）“一書的哈佛大學中國基金主席柯偉林（William Kirby）做閉幕講話。

            在昨日的主旨發言中，孫志剛坦言中國正在試行分級診療制度，並希望2020年時，每戶人家都和一名全科醫生簽了約。

孫志剛指出，中國國務院早已通過實施全科醫生計畫，有廿多個醫院設立了培訓基地，最近還正在推動民眾和全科醫生簽約服務，約有十個大城市績效不錯，但要讓這做法深入農村，還面對著一般民眾不習慣的困難。

改善醫生的待遇，也是政府正在努力的方向之一。

            Erika Elvander表示，美國正在推行可負擔保險法，其中的一大環節是改革付費方式，包括根據醫療效果來付費，以要求醫生對醫療結果承擔相當責任等的做法。政府也計劃設立兩套系統，來支持15萬名醫生互通有無。

            Erika Elvander自從實施可負擔醫療法以來，大約多了1760萬名美國人獲得了醫療保險，約有30%的醫護機構都採用了新的制度。消費者去年能在十個醫療護理市場中的大約八個，獲得扣除抵稅優惠後，每月付款低於一百元的醫療保險。他們希望到2018年時，有50%的醫療護理付費都能經由替代付款模式來達到責成醫療品質或價值的目的。

            昨日的開幕式由哈佛大學陳曾熙公衛學院院長David Hunter，北京協和醫學院公共衛生學院院長劉遠立，國家衛生和計劃生育委辦公廳主任于學軍，美國衛生與人類服務部全球事務辦公室亞洲主任Erika Elvander做開幕講話，由國務院醫改辦主任孫志剛，美國衛生及人類服務部醫改辦主任Kelly Cronin以“中美兩國的醫療衛生改革”為題，做主旨發言。

            在”中美醫療衛生體制改革比較“這場會議中，哈佛大學陳曾熙公共衛生學院終身教授蕭慶倫申論“全球面臨的挑戰和中美經驗”，拋出中國醫改面對著公、私立醫院全都追逐營利的僵局；公立醫院不知道何謂公益性；經濟政策與衛生政策互相矛盾等挑戰的問題，促請與會者討論。

            第五屆中美健康峰會今日下午還將舉行“中美青年領袖健康論壇”。

圖片說明：

            哈佛大學陳曾熙公衛學院院長David Hunter（左起）和美國衛生與人類服務部全球事務辦公室亞洲主任Erika Elvander，國務院醫改辦主任孫志剛，北京協和醫學院公共衛生學院院長的劉遠立，哈佛教授馬晶。（菊子攝）       

            第五屆哈佛中美健康峰會昨日在哈佛公衛學院舉行。（菊子攝）

            哈佛教授蕭慶倫（左）和北京協和醫學院校長曾益新（右）等人回答現場提問。（菊子攝）

            哈佛教授蕭慶倫（右）和哈佛全球健康研究所所長Ashish Jha（右）等人回答現場提問。（菊子攝）

            清華大學教授薛瀾（左）和比翼醫療基金合夥人何淑圭（右）都是中美健康峰會的董事。（菊子攝）

            新任加斯林糖尿病中心創新國際部副總裁的徐千田（右）和InterSystem的產品創新主任李琦（左）都是與會者之一。（菊子攝）

教育組邀宴 頂大學人、訪問學者歡慶中秋

哈佛大學6人，麻省理工學院2人。今年共有8名頂大聯盟學者到波士頓訪學，比去年的3人暴增一倍半。

            駐波士頓台北經濟文化辦事處教育組9月27日在龍鳳酒樓擺點心宴，請紐英崙中華專業人員協會，以及從其他不同機構來的訪問學者們做陪，同慶中秋佳節，聯絡情誼。

“頂大學人”是由台灣12所頂尖大學組成聯盟，和美國哈佛大學，麻省理工學院，加州柏克萊大學，芝加哥大學，英國倫敦帝國學院等五所英美頂尖大學簽署學術合作備忘錄，從2011年起，每年選送優秀學者前往進修的一項交流計畫。獲選的學者都被稱為“頂大學人”。

根據經文處教育組的資料，今年到訪波士頓的頂大學人，有六人到哈佛大學，二人到麻省理工學院進修。

到哈佛大學的6人包括到公衛學院的成大經濟系劉亞明，到建築與藝術史系的臺大歷史系劉巧楣，到公衛學院危機分析中心的蕭蘋，到亞洲研究中心的中山大學歷史系郭秀玲，到東亞語言文明系的政大政治系教授葉浩，到教育研究所的中興大學外文系張玉芳。

到麻省理工學院的2人為，到政治系的中山大學政治經濟系李明軒，到經濟系的台大經濟系陳釗而。

紐英崙中華專業人員協會原本就是個會員多半是本地學者的組織，包括顧問蔣宗壬，董事長王世輝，前任董事長張重華，會長周萬欽，前任會長游子揚等與學者們分桌聚談，交流得格外投契。

中華專協的永久會員，東北大學電機系終身教授王申培還趁著自我介紹時間，宣佈他最近又出版了一本新書“劍橋狂想曲”，有台灣名人，宏碁電腦創辦人施振榮，神探李昌鈺，以及張系國等人為他作序。

            周萬欽發給與會學人每人一本紐英崙中華專業人員協會的去年年刊，提醒他們該會即將舉辦年會，將來還要陸續請頂大學人們做演講。

            經文處教育組組長黃薳玉表示，這場聚會是給短期來訪的頂大學人、訪問學者送溫暖，讓他們在他鄉過節也能享受熱鬧，在學者與學者交流中，激發更多研究火花。

圖片說明：

            經文處教育組組長黃薳玉（前左五）和出席學者及專協會員們合影。（菊子攝）

            左起，經文處教育組組長黃薳玉組長（左五）和當天到會的七名頂大學人，郭秀鈴、蕭蘋、葉浩、劉巧楣、 張玉芳、劉亞明、李明軒等合影。（菊子攝）

            王申培教授介紹他出版的新書。（菊子攝）

MGH TO PAY $2.3 MILLION TO RESOLVE DRUG DIVERSION ALLEGATIONS

聯邦總檢察官辦公室昨（28）日宣佈，麻省總醫院（MGH）同意付款二百三十萬元給美國政府，以平息該院未能防止員工把受管制藥物拿來做私人用途。

聯邦總檢察辦公室表示，這是醫院涉及藥物流向不當案件中，和解金額最高的一宗。

麻省總醫院在同意付出這破紀錄額度款項之外，還同意今後採行更為完善的糾正辦法，來防止，辨認並解決這藥物流向問題。

聯邦檢察官卡門歐提姿（Carmen M. Ortiz）表示，諸如麻省總醫院這樣的醫院，有確保受控制的藥物是給病人治病，而不是用在非醫療用途上的特別責任。

2013年時，麻省總醫院項藥物執法局（DEA）透露，有兩名護士從醫院偷取了大量受管制藥物後，檢方開始調查。

這兩名護士共偷走了將近16,000顆藥，大部份是止痛劑羥考酮（oxycodone）。

在調查中，檢方發現其中一名護士染有毒癮已12年。

MGH TO PAY $2.3 MILLION TO RESOLVE DRUG DIVERSION ALLEGATIONS

BOSTON – In the largest settlement of its kind involving allegations of drug diversion at a hospital, Massachusetts General Hospital (MGH) has agreed to pay the United States $2.3 million to resolve allegations that lax controls enabled MGH employees to divert controlled substances for personal use.  In conjunction with this record monetary settlement, MGH has agreed to implement a comprehensive corrective action plan to prevent, identify, and address future diversions. 

“Under the law, hospitals like MGH have a special responsibility to ensure that controlled substances are used for patient care and are not diverted for non-medical uses,” said U.S. Attorney Carmen M. Ortiz.  “Diversion of these drugs feeds addiction, contributes to potential illegal drug sales, and fuels the opioid epidemic that has had a devastating effect on the Commonwealth.  We commend MGH for disclosing and addressing its diversion problems and for taking steps to ameliorate future diversion by hospital personnel.” 

“The DEA is committed to investigating hospitals that are not in compliance with the Controlled Substances Act (CSA),” said Special Agent in Charge Michael J. Ferguson.  “Failure to do so increases the potential for diversion and jeopardizes the public health and safety.  The diversion of prescription pain killers, in this case oxycodone, contributes to the widespread abuse of opiates, is the gateway to heroin addiction, and is devastating our communities.  DEA pledges to work with our law enforcement and regulatory partners throughout the Commonwealth and nationwide to ensure that these rules and regulations are followed.”

In 2013, an investigation was launched after MGH disclosed to the Drug Enforcement Administration (DEA) that two of its nurses had stolen large volumes of controlled substances (prescription medications) from the hospital.  Altogether, the two nurses stole nearly 16,000 pills, mostly oxycodone, an addictive painkiller.  Both nurses stole from automated dispensing machines that MGH used to store and dispense prescription medications.  DEA’s ensuing audit of MGH’s controlled substances revealed pill count discrepancies totaling over 20,000, missing or incomplete medication inventories, and hundreds of missing drug records, all in violation of the hospital’s responsibilities under the Controlled Substances Act (CSA). 

MGH cooperated with the DEA’s investigation and subsequently disclosed additional violations of the CSA.  Specifically, MGH disclosed that a pediatric nurse with a 12-year substance abuse problem had injected himself with Dilaudid at work; a physician had prescribed controlled substances for patients without seeing them and without maintaining medical records; several nurses were able to divert prescription drugs for many years without being detected; and medical staff had failed to properly secure controlled substances, even, on occasion, bringing them to lunch. 

Since the investigation began, MGH has worked cooperatively with the DEA and the U.S. Attorney’s Office to develop a detailed corrective action plan to address the identified deficiencies in MGH’s handling of controlled substances.  Components of the plan include the establishment of an internal drug diversion team; the creation of a full-time drug diversion compliance officer position; mandatory training of all staff with access to controlled substances, including on how to identify the signs and symptoms of substance abuse; enhanced diversion monitoring by supervisors and management; annual external audits to ensure compliance with the CSA; and increased physical controls of controlled substances, including limiting and monitoring access to automated dispensing machines through fingerprint identification. 

U.S. Attorney Ortiz and DEA SAC Ferguson made the announcement today.  The case was handled by Assistant U.S. Attorneys Jessica Driscoll and Christine Wichers of Ortiz’s Civil Division. 

A copy of the settlement agreement, which includes a detailed addendum with the United States’ statement of relevant conduct and MGH’s corrective action plan, is attached below. 

Governor Baker, Frontline Child Protection Workers Announce DCF Reforms

Governor Baker, Frontline Child Protection Workers Announce DCF Reforms

System-Wide Reforms to Strengthen Child Protection Efforts

BOSTON – Today, Governor Charlie Baker, child protection workers and Department of Children and Families (DCF) officials jointly announced system-wide reforms to Department policies and efforts to support frontline social workers and protect the Commonwealth’s children. The reforms include new intake and supervisor policies for the first time in a decade, and the reestablishment of the DCF Central Regional Office.

“Systemic policy reforms are necessary to support the efforts of our social workers, supervisors and managers who are on the front lines protecting the Commonwealth’s children,” said Governor Charlie Baker.  “Reducing caseloads, retaining and recruiting social workers and ensuring clear and concise policies for supervision and case management are all necessary to ensuring the agency is able to focus on its primary duty of keeping children safe. Our administration looks forward to working with House Speaker DeLeo, Senate President Rosenberg and the legislature on this important work moving forward.”

Management and union leadership have agreed to enact several further reforms and recommendations that accelerate the implementation of key priorities from the Child Welfare League of America (CWLA) report issued in May of 2014, in addition to action steps in the wake of recent tragedies involving the Department.

Governor Baker also requested an independent review of the recent Bella Bond case by the independent Office of the Child Advocate (OCA).

The 2014 CWLA report is the blueprint for change within the agency. The report’s author, Linda Spears, was named by Governor Baker to lead DCF beginning in February 2015. Recommendations including Criminal Offender Record Information (CORI) background checks for foster homes, photo-documentation for all cases and those transferred between offices and social workers, and new guidance for home visits have already been implemented.

“For years, social workers and investigators have called for meaningful reform and investment at DCF, but we’ve only seen attempts at quick fixes,” said social workerPeter MacKinnon, DCF Chapter President of SEIU Local 509. “This is an unprecedented collaboration between frontline child protection workers and agency administrators. Working together, we will succeed in doing what has been necessary for so long – making deep, systemic changes.”

Among the reforms and changes announced today is the reinstatement of social work technician positions which will perform non-clinical support services, providing options for current DCF employees who have not yet become licensed. Since the licensing requirement was instituted for social workers last year, approximately 82% of workers have attained licensing, up from 50% when the law went into effect. These positions and the DCF Central Office were eliminated due to budget reductions in 2009.

“Social work technicians were an important resource providing non-clinical support such as a child’s transportation to and from appointments,” said Marylou Sudders, Secretary of the Executive Office of Health and Human Services.  “Reinstating this position will allow licensed social workers to focus more on case management and the children under their supervision.”

The Department will also augment efforts to increase the number of safe foster homes and families available to children by reducing the applicant backlog safely and efficiently.  DCF will also work with social service providers to review applications in the interim as new foster home social workers are recruited and hired.

“We are always in need of families willing to foster children and are committed to reducing the backlog for those who have applied,” said DCF Commissioner Linda Spears. “We look forward to partnering with the union and our social service providers in these efforts in order to ensure a thorough review and licensing process, and more strong families to care for children in need.”

In addition to the changes announced today, the administration also reminded the public that all have a responsibility to assist in keeping children safe and if given reason to suspect a child is being abused or neglected, should report anonymously by calling the Child Protection Hotline at 1-800-792-5200. 

New DCF Intake Policy

The Department’s intake policy covering the period of time from when an allegation of abuse or neglect is filed (51a) through the investigation, substantiation of a claim and opening of a case, has not been updated in 12 years. Through negotiations with SEIU Local 509 leadership already underway, the policy will be updated by November 17, 2015. Reforms will include:

·       Standardized risk assessment tools for social workers

·       CORI checks in all DCF cases (Currently used in approximately 70% of cases)

·       Review of the entire family or household’s prior or current involvement with DCF

·       Review of frequency and type of emergency (9-1-1 calls) responses to the home

·       Parental capacity assessment

New Supervisor Policy

The new supervisor policy to be implemented by November 17, 2015 consistently across all DCF offices, will include detailed, mandated steps for case review and management support necessary to working with all families and especially those with complex conditions, ensuring all information about the family is understood and special consultation is provided for thorough understanding of a case and decisions to protect the children involved.

Examine All Complex Cases Within the Department

Regional Directors began examining more complex in-home cases where there are multiple abuse reports.  DCF directors will use a nationally developed child welfare continuous quality improvement (CQI) tool to assess several facets of cases including: safety, stability, placement needs, permanency, wellbeing, engagement of service providers, understanding of case situation and context.

Retention and Recruitment of Social Workers; Reinstating Technicians

The stress of high caseloads at an average of 20.66:1 in July is cited as a primary reason for the loss of social workers and the Department continues to target an 18:1 average caseload. DCF management and union leadership will make a concerted effort to develop strategies for retention and recruitment of social workers by Fall of 2015, as the Department continues to hire new social workers with the $35.5 million increase provided in the Fiscal Year 2016 budget. DCF will also work towardsreinstating social work technicians, first eliminated due to budget reductions in 2009 and critical to providing non-clinical support for caseworkers and families.  

Reestablishing the Central Massachusetts Regional Office

Budget reductions in 2009 also forced the closing of DCF’s Central MA Regional Office, resulting in the Western Office taking on more than 50% of the state’s geography and caseload. The Department will reinstate the Central Regional Office in Worcester by January 1, 2016, with managerial, administrative, legal, nursing and other staff to increase frontline workers’ access to supervision and other support resources.

Reduce Backlog for Foster Home Applicants

The Department will initiate further efforts by this fall to meet the immediate needs for placing children in safe, caring foster homes, working with social service providers to review applicants and reduce the applicant backlog.

Other Reforms and Policy Updates

The Department and union leadership by March of 2016, will also develop and implement a new Practice Model as well as policies around Ongoing Casework, Family Assessment and Service Planning, Case Closing and Coordination with service partners, Data Integration, and Foster Homes – all reforms recommended by the CWLA Blueprint.

New Specialist Positions include: medical social workers statewide, Central Regional Director, Ombudsperson, Assistant Commissioner for Adoption and Foster Care, and Director of Strategic Initiatives.