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DAILY UPDATE

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July 31, 2014   Download print version

Peace Corps leaves West Africa as Ebola outbreak expands

Boston hospitals say they’re ready for Ebola cases

'Flesh-eating' bacteria warning in Florida

Uncomfortable symptoms of pregnancy linked to healthier babies, study finds

Gap separates payers and physicians on value-based arrangements, according to a new study

MEDICAL WORLD AMERICAS returns in 2015 with new partners and their co-located events

Obamacare dividends pile up for hospitals as patients pay

Asbestos revisited: A new autoimmune disease?

 

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Peace Corps leaves West Africa as Ebola outbreak expands

The US Peace Corps announced on Wednesday that it was removing its 340 volunteers from West Africa due to recent Ebola outbreak, while the federal government is being urged to fast-track a new a drug that could possibly stave off a global pandemic.

According to Reuters, 130 volunteers will leave Sierra Leone, while another 108 and 102 will depart Liberia and Guinea, respectively. The Peace Corps blamed the virus’ continued spread for the decision.

"The Peace Corps announced that it is temporarily removing its volunteers from Liberia, Sierra Leone and Guinea due to the increasing spread of the Ebola virus," the organization said in a statement to the news service.

Meanwhile, the US State Department confirmed one American citizen has died from the virus – which triggers diarrhea and vomiting before causing internal and external bleeding. Two other aid workers have been infected and are in serious condition.

As RT reported on Tuesday, Sierra Leone’s only specialist on Ebola has also died, not even one week after being diagnosed with the virus. The current fatality rate stands at 60 percent, which is lower than the 90 percent rate typically associated with the disease.

As the highly contagious virus continues to raise concern across the world, activists have started a petition on Change.org pushing the US Food and Drug Administration to speed up the authorization of new medication that could potentially stop the virus in its tracks. There’s currently no cure for Ebola, but several drugs and vaccines are currently being tested.

“One of the most promising is TKM-Ebola manufactured by Tekmira Pharmaceuticals,” the petition states. “This drug has been shown to be highly effective in killing the virus in primates and Phase 1 clinical trials to assess its safety in humans were started earlier this year.”

The petition points to the fact that there’s been one confirmed case of the disease being transferred via air travel – from Liberia to Nigeria – and suggests the impending shadow of a pandemic makes fast-tracking the drug’s approval necessary.

“In view of this it’s imperative that the development of these drugs be fast-tracked by the FDA and the first step should be releasing the hold on TKM-Ebola. There is a precedent for fast tracking anti-Ebola drugs in emergency cases as happened last year when a researcher was exposed to the virus and received an experimental vaccine.”

Visit RT for the report.

 

 

Boston hospitals say they’re ready for Ebola cases

In response to the West African outbreak of the deadly Ebola virus, some Boston hospitals are instructing clinical staff to ask patients as soon as they arrive about their travel histories, and reminding doctors and nurses of the symptoms. But hospital officials say they would be ready to quickly identify the illness and prevent its spread if an infected patient showed up, using protocols and equipment already in place.

The question of whether a traveler could bring the illness to the United States took on new urgency after a Liberian infected with Ebola flew to Nigeria and died there Friday.

The federal Centers for Disease Control and Prevention, in an alert sent to healthcare facilities Monday, said that Ebola “poses little risk to the US general population at this time” but urged health workers to be alert for signs and symptoms in people who recently traveled to Africa.

Boston physicians interviewed Tuesday said they considered it unlikely that a person with Ebola would arrive here — but still within the realm of possibility.

“I think we would be naive to think it’s not possible,” said Dr. Nahid Bhadelia, associate hospital epidemiologist at Boston Medical Center.

“It’s such a small world now,” said Dr. Deborah Yokoe, medical director of infection control and hospital epidemiologist at Brigham and Women’s Hospital. “We want to be prepared even though the likelihood is small.”

All hospitals have protocols in place for dealing with dangerous and unusual infectious diseases. Typically, a patient with suspected Ebola would be put in an isolation room and staff would wear gowns, gloves, goggles, and masks.

Dr. Shira Doron, associate epidemiologist at Tufts Medical Center, said that normally a patient’s travel history might not come up until the person has already interacted with doctors and other staff. “Given the increase in the number of cases of Ebola and the recent importation to Nigeria, we are taking it even more seriously right now,” she said. “We’re developing a plan to more aggressively screen patients who present to our hospital, our emergency room and our clinics, for travel history.”

Massachusetts General Hospital is directing emergency room doctors to ask about travel history, a spokesman said; other hospitals said it was already standard practice.

Ebola is a frightening illness because it dispatches its victims so quickly and violently. Within two to 21 days of exposure to the virus, an infected person rapidly comes down with symptoms that include fever, headache, weakness, vomiting, and diarrhea. Some will bleed inside and outside the body. Blood pressure plummets, and within a few days the organs fail. There is no treatment to attack the virus, but hospital care can sometimes keep a person alive until the infection clears. Visit the Boston Globe for the article.

 

 

'Flesh-eating' bacteria warning in Florida

Sarasota, FL - Two cases this month of a serious marine bacterial infection — one of them fatal — prompted local health officials this week to issue a warning against eating raw oysters and exposing open flesh wounds to coastal and inland waters.

This urgent advisory applies pointedly to residents and visitors with chronic diseases that make them more vulnerable to the dangerous infection. Highest on the list is liver disease — including Hepatitis C and cirrhosis — but other conditions are hemochromatosis (iron overload), diabetes, cancer, stomach disorders or any illness or treatment that weakens the immune system.

Of the 11 cases reported statewide in 2014, both individuals in Sarasota County were middle-aged and had medically compromising conditions, according to the local Florida Department of Health. Both are believed to have contracted the infection when bacteria entered an open wound. There were 41 Florida cases in 2013.

The Vibrio vulnificus bacteria — increasingly but not quite accurately referred to as “flesh-eating” — occur naturally in coastal waters, perhaps more abundantly in the summer months. Symptoms include stomach illness, fever or shock after eating raw seafood, especially oysters, or a wound infection after exposure to seawater or brackish water.

Michael Drennon, epidemiologist for Sarasota County, said that this year does not appear to be any worse or better than any other, in terms of presence of the bacteria. “Floridians and visitors without flesh wounds or underlying medical conditions should not be alarmed, he added.

Jay Grimes, a professor at the University of Southern Mississippi's Gulf Coast Research Laboratory who has studied Vibrio bacteria since 1980, agrees. Swallowing water while swimming is not a danger, Drennon and Grimes said. The gastrointestinal form of the infection can only be contracted by eating raw or undercooked fish.

V. vulnificus, a relative of the bacteria that cause cholera, requires salt to survive. Most U.S. cases occur in the Gulf Coast states, according to the Centers for Disease Control and Prevention. Severe infections have a 50 percent chance of becoming fatal. Although anyone can be exposed to the bacteria through an open wound, exposure through a puncture wound is more apt to lead to an infection. Swelling, pain or redness at the site can signal the need for immediate medical attention.

Drennon said the Southwest Florida healthcare community is aware of the Vibrio threat and “will test appropriately” for it. Antibiotic treatment, if administered early, greatly increases the chances of survival. Those who recover from the infection should not expect any long-term consequences.

While the department tests Gulf waters in beach areas for enteric bacteria — from human or animal waste — there is no testing for V. vulnificus. Even legally harvested oysters can be contaminated, because the bacterium is naturally present in marine environments. The appearance, taste, or odor of oysters are no indication that they are safe to eat, according to the CDC.

More recent media reports about V. vulnificus are referring to them as “flesh-eating bacteria,” a term originally applied to streptococcus and staph infections — often acquired in hospitals — also known as Necrotizing Fasciitis. Vulnificus is the only form of 12 Vibrio bacteria that can cause flesh-eating, Grimes said. They co-evolved with crabs and fish, and he has seen cases of fatalities in red snapper grown in fish farms at his university. Visit the Sarasota Herald Tribune for the story.

 

 

Uncomfortable symptoms of pregnancy linked to healthier babies, study finds

A new study found that women with symptoms of nausea and vomiting during pregnancy had fewer miscarriages and gave birth to bigger, healthier babies than women without symptoms. Morning sickness also was associated with fewer birth defects and better long-term development for the child, according to the study, a meta-analysis published in the August issue of Reproductive Toxicology.

As many as 85% of pregnant women develop morning sickness, with symptoms ranging from mild to severe, the researchers said. Rapid increases in human gonadotropin, a hormone released by the placenta, are believed to help trigger the symptoms. At the same time, relatively high levels of the hormone, and possibly other hormones not yet identified, may contribute to a more favorable prenatal environment, the researchers said.

Smaller studies had previously indicated possible benefits to morning sickness. The latest analysis, which was conducted at the Hospital for Sick Children in Toronto, pooled data from 10 separate studies that had been conducted in five countries between 1992 and 2012.

The studies involved an estimated 850,000 pregnant women. They examined associations between nausea and vomiting and miscarriage rates, prematurity, birth weight, congenital abnormalities such as cardiac defects and cleft palate, and long-term child development.

The risk of miscarriage was more than three times as high in women without symptoms of nausea and vomiting as in those with symptoms. Women 35 years old or older, who generally have a relatively high risk for miscarriage, appeared to benefit the most from the "protective effect" associated with morning-sickness symptoms, the study said.

Nausea and vomiting during pregnancy were associated with a reduced risk for low birth weight and short body length. Women with morning-sickness symptoms also had fewer preterm births: 6.4% compared with 9.5% for those without symptoms, one of the underlying studies found. Visit the Wall Street Journal for the study.

 

 

Gap separates payers and physicians on value-based arrangements, according to a new study

FTI Consulting, Inc., a global business advisory firm dedicated to helping organizations protect and enhance their enterprise value, announced the results of a new study of healthcare payers and providers that suggests a stumbling-block in the transition to the new and much-heralded value-based relationships between them. 

According to the study, 41 percent of primary care physicians, who are not currently in a value-based relationship, say their biggest obstacle before agreeing to enter into one is their distrust of payers. The study also found that only 16 percent of all physicians surveyed were willing to accept the financial risk – a key element of many value-based relationships sought by insurers.

Since the 2010 Affordable Care Act, healthcare payers and providers, both in concert and independently, have been preparing for value-based reimbursement programs in which meeting quality-of-care and cost-reduction targets would result in benefits for both groups and the nation as a whole. This has manifested itself in the growth of Accountable Care Organizations, bundled arrangements and new relationships that have blurred the lines between insurers and providers.  

In bundled payments and other value-based arrangements, many experts believe it is essential that payers and providers eventually share risks to control costs and improve quality. However, the study found that the gap between them continues to widen. Payers believe that a mere five percent of providers are willing to accept the downside risks necessary for value-based arrangements to work.

Payers want to see providers invest in Healthcare IT, especially in software and systems supporting clinical integration and Population Health Management. Eighty percent of payers say they would be likely to contract with a clinically-integrated hospital and provider system. However, only 50 percent of healthcare providers report that their organizations have implemented new technology or software to support PHM and value-based reimbursement, 32 percent have not, and 18 percent either “don’t know” or are “unsure”.

Most payers and providers are taking steps to prepare for the value-based arrangements incentivized by the ACA. Eighty percent of payers in the survey say these types of contracts are “very important” to their strategic objectives, and 92 percent of providers say they are either “somewhat” or “very important” to them. However, the traditional fee-for-service contract still predominates in the healthcare industry.

Fifty-five percent of payers say that many of their commercial contracts remain fee-for-service, and only 10 percent report that they no longer have any fee-for-service contracts. At the same time, 15 percent of polled providers say they are “only interested” in the fee-for-service reimbursement model, which the American Public Health Association has said directly leads to “overtreatment and overbilling”.

The full survey findings from FTI Consulting will be released in the September 2014 online edition of the FTI Journal. Visit www.fticonsulting.com/hcls.

 

 

MEDICAL WORLD AMERICAS returns in 2015 with new partners and their co-located events

MEDICAL WORLD AMERICAS (MWA) is pleased to announce a pair of strategic co-location partners for the upcoming 2015 conference and expo (April 27 - 29, 2015). Both events will run concurrently with MWA programming at the George R. Brown Convention Center in Houston and will augment the event with over 500 new, high-level industry attendees.

The American College of Healthcare Executives Southeast Texas Chapter (ACHE-SETC) will hold its annual educational meeting at MWA and will integrate into the overall conference programming by offering valuable CEU’s to attendees. Vendome Group’s Healthcare Design Academy also sees the value in collaborating with MWA and offering business intersections between attendees through this co-location.

ACHE is a national organization that is the professional society for healthcare executives dedicated to improving healthcare delivery. It has a national membership of over 40,000 healthcare professionals (CEOs, COOs, CFOs, CIO, CNOs, MDs, department directors, student associates, etc.). The Southeast Texas Chapter (ACHE-SETC) is one of the largest regional chapters with an average annual membership of 1,300 covering 29 counties in the southeast Texas region.

According to the officers of the ACHE-SETC and Foundation Board of Directors, "a partnership with MWA will provide an educational opportunity that will substantively enhance the image, presence, and value for our membership in our region. In addition, our Chapter takes great pride in our responsibility to provide educational sessions, in more venues, with the broadest possible topical themes as appropriate - designed to reach the greatest number of people to support and improve their work toward enhancing their professional growth. It is our desire to move forward in partnership with MWA and to collaborate with and augment the educational imperative of ACHE national."

For further information visit www.medicalworldamericas.com/.

 

 

Obamacare dividends pile up for hospitals as patients pay

Even as Obamacare continues to be attacked by foes and challenged in court, hospital chains and insurers are making more money, more patients using ERs are paying for their care, and the country as a whole is enjoying slower growth in its healthcare spending.

HCA Holdings Inc., the largest for-profit hospital chain, raised its forecast and reported a 6.6 percent drop in uninsured patients at its 165 hospitals, a reduction that grows to 48 percent in four states that expanded Medicaid, a top initiative of the Patient Protection and Affordable Care Act. WellPoint Inc., which made the biggest commitment of any publicly traded insurer to the Obamacare markets, raised its guidance today after handily beating analyst estimates for the quarter on rising membership linked to the overhaul.

Taxpayers too may be benefiting from the law approved in 2010. Medicare spending rose by just $1 per beneficiary in 2013, the fourth year in a row that saw a slowdown, the government reported.

LifePoint Hospitals Inc., another for-profit chain, also raises its forecast while the largest insurer, UnitedHealth Group Inc.  said earlier this month it added 635,000 people to its Medicaid plans and was expanding into two dozen Obamacare exchanges in 2015, from five this year.

Costs are a top concern, as insurers and state regulators decide premiums for 2015. If rates rise too much in the future, people who don’t receive U.S. subsidies to help with the bill may drop coverage, undercutting the act’s intent to have everyone insured.

The proportion of the U.S. population without insurance has fallen 3.7 percentage points to 13.4 percent since the end of the 2013, according to Gallup Inc., the lowest rate since the firm began surveys of coverage in 2008.

The law contributed as much as $13 million to LifePoint’s earnings in the second quarter, about 40 percent more than the company had expected, he said. People paying bills themselves, a proxy for the uninsured, represented just 4.8 percent of admissions, down from 7.1 percent a year earlier. About 40 percent of customers with plans from the law’s insurance exchanges

UnitedHealth, the largest for-profit insurer, said on July 17 it would offer plans in as many as two dozen exchanges in 2015, from five this year. The company also added 635,000 people to its Medicaid plans, growth that Gail Boudreaux, the CEO of United Healthcare, the company’s insurance division, called “tremendous” in a conference call with analysts. Visit Bloomberg for the story.

 

 

Asbestos revisited: A new autoimmune disease?

In the small town of Libby in northwestern Montana, prospectors in 1916 discovered an unusual mineral known as vermiculite that appeared to be resistant to fire after initial exposure to high heat. The early owners of the mine called their product Zonolite, and for the next half century they dug it out of the Libby mountain and shipped it across the continent for use as insulation and in various commercial products.

Unfortunately, the mine and its product also contained asbestos, and by the 1980s, hundreds of the miners who worked at Zonolite mountain -- and their family members -- had sickened and died of asbestos-related diseases at rates 40 times higher than the U.S. as a whole.

Little was known outside of Libby about the cluster of diseases until 1999, when Seattle Post-Intelligencer reporter Andrew Schneider published a series of stories called "Uncivil Action: A Town Left to Die," which began by saying "First, it killed some miners. Then it killed wives and children, slipping into their homes on the dusty clothing of hard-working men. Now the mine is closed, but in Libby, the killing goes on."

The mine closed in 1990, and W.R. Grace Company, the owner, has since faced hundreds of thousands of lawsuits for asbestos-related illness, most often cancer and asbestosis. (The company was acquitted in 2009 of knowingly harming the people of Libby and of covering up its knowledge of the health hazards from the mine.)

But now, a group of researchers from Idaho State University and the Center for Environmental Health Sciences at the University of Montana are suggesting that a further health concern should be added to the list of woes faced by the Libby residents: autoimmune disease, including an as-yet undescribed autoimmune condition affecting the lungs.

It's long been known that exposure to another silicate dust, crystalline silica, is associated with the development of autoimmunity, but this had not been recognized for asbestos. The term asbestos refers to a group of mineral fibers that are classified as "serpentine" or "amphibole," and most studies of occupational exposure have focused on the serpentine fiber chrysotile. In contrast, the Libby asbestos contained a variety of amphibole fibers, including winchite, richterite, and tremolite.

It was used as insulation in millions of homes, and among the many other construction projects that utilized Zonolite for insulation was the World Trade Center. When the towers fell on 9/11, the airborne debris that covered lower Manhattan and blew across the region contained an unknown quantity of fibers that originated on that mountainside in Montana.

And Libby isn't the only source of potential amphibole contamination. Recently, another group of mineral experts reported high levels in samples of soil and airborne dust obtained in the vicinity of Las Vegas. Visit MedPage Today for the story.