University Medical Center named Healthcare Purchasing News' 2014 Supply
Chain Department of the Year
Healthcare Purchasing News
named Nashville, TN-based Vanderbilt University Medical Center as the
recipient of its 11th Annual Supply Chain Department of the Year Award.
HPN, which provides clinical intelligence for supply chain leadership
monthly in print and daily online, selected the multi-hospital systemâ€™s
Supply Chain team for the strong bonds it forged with surgeons and other
clinicians and clinical specialties, as well as the C-suite, en route to
consolidating and centralizing operations and processes.
Under the leadership of Teresa Dail, R.N., Chief Supply Chain Officer, the
Supply Chain team at Vanderbilt rallied to fuse a department previously
split between the healthcare and university realms, developing and
implementing strategic and tactical improvements that started from the
ground up â€“ solidifying the fundamentals before building on that foundation.
â€śFirst, it was critical that there be an integration of the supply chain
with the clinical and operational leadership of the hospitals and clinics to
be able to build relationships, trust and collaboration,â€ť Dail told
Healthcare Purchasing News. â€śSecond, medical contracting and purchasing
is completely different than what universities typically do. It is a very
complex environment that requires different skill sets and focus.
â€śBenchmarks and metrics were established, dashboards were developed,
standard operating procedures were put into place and accountability for
success was shared amongst all team members working in supply chain, from
the supply techs to the Chief Supply Chain Officer,â€ť Dail added. â€śToday, we
are a mature, talented, highly productive, clinically integrated team
involved in every aspect of our organization. We have a very lean
organizational structure that is centralized and responsible for supporting
the entire clinical enterprise.â€ť
Dail marveled at the â€śstrong supportive and collaborative relationshipâ€ť
among Supply Chain team members and clinical and leadership team members,
which typically results in average savings of $10 million to $15 million per
year through analytics, information technology, utilization management and
value analysis. Dailâ€™s team also operates a full-service 50,000-square-foot
off-site case cart center that incorporates central sterile processing and
supply and third-party logistics capabilities for high-dollar procedural
products in low units of measure.
"During a turbulent economic period spanning the last seven years,
Vanderbiltâ€™s Supply Chain team underwent a remarkable transformation that
logically unified operations but also attracted and engaged surgeons and
other clinical leaders to assume active roles in supply chain matters,â€ť said
HPN Senior Editor Rick Dana Barlow. â€śHowever the healthcare industry
emerges from market reformation in the coming years, one definitive outcome
tethered to costs and quality involves clinicians as willing and dedicated
players in supply chain activities. Vanderbilt already is there.â€ť
Vanderbiltâ€™s Supply Chain team will be featured in HPN's August edition and
distributed at the 2014 Annual Conference of the Association for Healthcare
Resource & Materials Management (AHRMM) in Orlando.
Visit HPN Online for the article.
subsidies upheld, conflicting with ruling hours earlier
Two federal appeals court panels issued conflicting rulings Tuesday on
whether the government could subsidize health insurance premiums for people
in three dozen states that use the federal insurance exchange. The decisions
are the latest in a series of legal challenges to central components of
President Obamaâ€™s healthcare law.
The United States Court of Appeals for the Fourth Circuit, in Richmond,
upheld the subsidies, saying that a rule issued by the Internal Revenue
Service was â€śa permissible exercise of the agencyâ€™s discretion.â€ť
The ruling came within hours of a 2-to-1 ruling by a panel of the United
States Court of Appeals for the District of Columbia Circuit, which said
that the government could not subsidize insurance for people in states that
use the federal exchange.
That decision could cut potentially off financial assistance for more than
4.5 million people who were found eligible for subsidized insurance in the
federal exchange, or marketplace.
Under the Affordable Care Act, the appeals court here said, subsidies are
available only to people who obtained insurance through exchanges
established by states.
Visit the New York Times for the story.
standards for medical devices
UL (Underwriters Laboratories) has announced that the U.S. Food and Drug
Administration (FDA) has recognized two UL battery safety standards as
consensus standards for medical devices incorporating lithium or
nickel-based batteries. The two standards are UL 2054 - Standard for
Household and Commercial Batteries, and UL 1642 - Standard for Lithium
Consensus standards are standards recognized by the FDA for use in
evaluating medical devices before they are approved for market entry. The
FDA's Center for Devices and Radiological Health (CDRH) believes that
conformance with recognized consensus standards can support a reasonable
assurance of safety and/or effectiveness for many applicable aspects of
medical devices. In the case of medical devices using batteries,
manufacturers can now use the proof of compliance with UL 2054 and UL 1642
as evidence of a device's safety and effectiveness.
According to Ibrahim Jilani, Battery Manager for UL's Consumer Technology
Division, consensus standards are also a means to streamline the premarket
review process. "The use of these recognized standards will not only help
medical device manufacturers reduce regulatory obstacles to enter the U.S.
and international markets but also help them satisfy FDA premarket review
Although certification is voluntary, UL anticipates this announcement will
likely be a sizeable regulatory driver going forward whereby medical device
manufacturers will look to have UL 2054 Compliant Nickel Cell Type(s), UL
1642 Compliant Lithium Cell Type(s), and/or UL 2054 Compliant Battery Pack(s).
For more information about UL's battery testing & certification, visit
www.ul.com/largebatt for large format batteries.
health insurer signals rate hikes ahead
Florida Blue, the stateâ€™s dominant health insurer, snagged more than one in
three consumers on the health lawâ€™s exchange this year, but many could face
rate hikes as the carrier struggles with an influx of older and sicker
enrollees, said the companyâ€™s top executive. Several factors could drive up
rates next year â€” including a paucity of younger and healthy enrollees and a
greater-than-expected surge in people seeking expensive health services, CEO
Patrick Geraghty said in an interview.
The nonprofit Blue Cross and Blue Shield affiliate added 339,000 customers
through the Affordable Care Actâ€™s federal marketplace this yearâ€” or about 34
percent of the nearly 1 million who signed up in the state, Geraghty said.
Florida Blue would not reveal its proposed 2015 rates, which were submitted
to state regulators last month. State officials are expected to disclose the
rates for the nearly dozen carriers in the marketplace at the end of July.
Open enrollment begins Nov. 15 and goes through Feb. 15.
To date, only two insurers have disclosed their 2015 rate proposals. Humana
proposed an average 14.1 percent increase in two separate filings for its
health maintenance organizations (HMOs), while its preferred provider
organizations (PPO) have a 2.2 percent average rate increase. Molina has
proposed an 11.6 percent average rate decrease for all its plans.
Florida Blue has been one of the nationâ€™s most fiscally stable health
insurers. In 2012, the latest year for which data is available, Florida Blue
achieved its 24th consecutive profitable year, as the company made $217
million net income on about $9 billion in revenue. It has about 4 million
customers in Florida across all lines of health insurance.
About 23 percent of those who bought exchange policies from Florida Blue
this year were in the 18-to-34 age category, Geraghty said. That compares to
28 percent nationally. Initial federal projections were that 40 percent of
enrollees nationally would be young adults. Geraghty said he knew the
percentage of young adults signing up in Florida would be lower than the
national average because of the stateâ€™s older population. Still, 23 percent
was lower than the company projected.
It was also harder to sign up younger adults in Florida, he said, because
they faced higher rates under the lawâ€™s requirement that the oldest person
buying coverage pay no more than three times the rate paid by the youngest
enrollee. Another factor that could lead to higher premiums in 2015 is that
demand for expensive health services exceeded the insurerâ€™s expectations,
About 300,000 Florida Blue customers were given that option and 90 percent
kept the grandfathered plans, Geraghty said. Because they are healthier as
a group than the broader market, the company underpriced its marketplace
plans, he said.
Despite these challenges, Geraghty said he was generally pleased with the
results of the exchangeâ€™s first year of enrollment. The company had about
50 percent of the individual state insurance market in 2014, and today has
about a 40 percent share, including people buying on and off the exchange.
While losing some market share, the company gained many new members.
Visit Kaiser Health News for the story.
hospital chief's fraud trial to begin
TYLER, TX (AP) â€” Hospitals operated by a Dallas businessman improperly
billed Medicare 80 percent of the time and continued the fraudulent billing
even after being warned by government auditors, prosecutors contend in
federal court records. Details of the prosecution's case against Dr. Tariq
Mahmood were disclosed in the recent court filings. Mahmood's trial on
charges of fraud conspiracy began Friday with jury selection and will
continue this week in Tyler.
Federal indictments say he conspired to submit more than $1.1 million in
false billings to enrich himself even as his hospitals in East Texas and
elsewhere lacked funding to operate effectively, The Dallas Morning News
Mahmood has pleaded not guilty to healthcare-billing fraud and aggravated
identity theft counts. He faces more than two decades in prison if convicted
on all 15 fraud counts. Mahmood's attorneys have sought in pretrial motions
to block an audit from being used as evidence. They also want to omit
details of his hospitals' poor conditions and his lifestyle â€” he owns a
10,000-square-foot gated estate and has been driven to court hearings in a
"When this evidence is coupled with witness testimony that the defendant was
directing individuals to submit fraudulently changed codes, it proves the
existence of the defendant's scheme to defraud Medicare," according to a
motion filed by the U.S. attorney's office.
The trial marks the first major proceeding in a series of criminal and civil
legal actions against Mahmood and his former hospital chain. At least eight
government agencies have been drawn into investigations of financial
mismanagement and patient care at Mahmood's facilities. His six rural
hospitals are now closed or struggling under new ownership, the newspaper
reported. The fraud case against Mahmood focuses on billings at three
hospitals: Renaissance Hospital Terrell, Cozby Germany Hospital in Grand
Saline and Central Texas Hospital in Cameron.
A former administrator for Renaissance, Edwina Henry, told authorities that
in 2008 she witnessed Mahmood opening charts of other doctors' patients and
writing in them. She told investigators she thought they were fraudulent
entries aimed at boosting hospital billing revenue.
Visit the Sacramento Bee for the story.
disease fight focuses on preventive treatment, delaying onset by 5 years
could greatly reduce the number of patients
"Earlier is better" has become a mantra in the field of Alzheimer's disease.
Experts are targeting the prevention or delay of memory decline more,
instead of just focusing on treating patients who have the disease.
Results from one of the largest randomized prevention trial to date
presented Sunday here at the Alzheimer's Association International
Conference suggest why scientists are thinking this way. The trial found
that intervention involving exercise, diet and other behavioral changes
significantly improved overall cognitive functioning in patients after two
years, compared with patients in a control group.
The trial known as Finger and conducted in Finland, is only one of roughly
25 such studies under way, experts say. More are set to begin, examining
different preventive strategies in cognitively normal people or those
exhibiting mild memory problems who are at high risk for developing
Some focus on lifestyle activities and others on medications to slow or stop
the ravages of the disease on brain tissue and neurons.
The largest involve thousands of participants and cost tens if not hundreds
of millions of dollars funded by combination of the government, private
foundations and pharmaceutical companies. The latest partnership is expected
to be announced Tuesday, with Novartis AG providing significant funding to
the Banner Alzheimer's Institute in Phoenix for a prevention trial starting
next year likely to cost over $100 million. The National Institutes of
Health is also providing over $30 million for the study.
The number of Alzheimer's sufferers in the U.S. is expected to roughly
triple between 2010 and 2050, growing to 13.5 million in 2050 from 5.1
million in 2010. If the disease could be delayed by just five years, the
number of people with Alzheimer's at age 65 in 2050 could be reduced by
nearly six million people, according to a report published by the
Alzheimer's Association in 2010.
Globally, one-third of Alzheimer's disease is related to risk factors that
can be potentially changed, such as lack of education and exercise,
according to a study published in the journal Lancet Neurology.
"Forestalling the appearance of symptoms by five to 10 years would have a
tremendous public health impact and essentially would allow people to live
the rest of their lives without real symptoms," says Laurie Ryan, chief of
the Dementias of Aging branch at the National Institute on Aging.
Prevention efforts are receiving more attention and financial backing in the
field because of growing recognition in recent years that disease-related
changes in the brain begin decades before memory problems become obvious.
Treating patients once the symptoms begin may be too late to make a major
impact on the disease, as demonstrated by the failure of several highly
anticipated experimental treatments in recent years.
Also, a greater ability to measure the progression of the disease in the
brain through the use of biological markers, such as the imaging of
disease-related proteins, has made it easier to detect the subtle and slow
progression of the disease in live humans. Before these biomarker tests,
Alzheimer's was diagnosed solely based on clinical symptoms. (It often still
is.) Its pathology in the brain could only be examined with autopsy.
And recent data from Eli Lilly & Co.'s clinical trial of its experimental
compound solanezumab showed that though the compound failed overall to
improve cognition in people with Alzheimer's, there was evidence that
participants with more mild symptoms of the disease did benefit.
The Finger trial randomly assigned 1,260 people ages 60 to 77. Some went to
a control group and were given basic health advice. Others underwent an
intervention that incorporated diet and exercise, cognitive training, social
activities and control of physical risk factors like high blood pressure and
cholesterol. After two years, those in the intervention group had
significantly improved performance on different memory measures compared
with the control group, according to Miia Kivipelto, a professor of clinical
geriatric epidemiology at Karolinska Institutet in Stockholm, who presented
the work. The participants will continue to be followed for seven years.
One Banner study expected to begin in 2015 and take nine years to complete
will focus on 1,300 cognitively normal people with mutations in the ApoE4
gene, which put them at higher risk of the disease, and test two different
anti-amyloid drugs, Pierre Tariot, director of the Banner Alzheimer's
There's also the 5,800-participant Tommorrow study, funded by Takeda
Pharmaceutical Co. and Zinfandel Pharmaceuticals Inc., to examine whether a
diabetes drugs called pioglitazone may delay symptoms in the next five years
in people at high risk as predicted by a combination of age and a gene
called TOMM40, who are cognitively normal.
Visit the Wall Street Journal for the article.
Hospital sales of
medical marijuana fraught with questions
A dangerous neighborhood. The threat of arrest, or worse. An unreliable
product, sold by criminals. For seriously ill patients who rely on medical
marijuana to ease their pain, paying for their treatment can be a â€śrisky
operation,â€ť according to multiple sclerosis patient Julie Falco.
But if officials at Swedish Covenant Hospital get their way, medical
marijuana users like Falco could one day purchase their cannabis at a
hospital dispensary â€” just like a patient buying a dosed antibiotic or a
powerful pain reliever at the hospitalâ€™s pharmacy.
â€śWe have professionals who very much would like to prescribe those drugs, we
have the system in place to manage it and we have the patient population
that needs it,â€ť said Marcia Jimenez, the hospitalâ€™s director of
intergovernmental affairs. â€śIt just made a lot of sense.â€ť
Swedish Covenant wants to be the first Illinois hospital to take advantage
of the stateâ€™s decision last year to legalize medical marijuana â€” a decision
thatâ€™s likely to trigger a marijuana â€śGold Rush.â€ť
The state has agreed to issue 60 permits to sell the drug â€” 13 of which will
be in Chicago. Swedish Covenant would like to grab one of them but is
hamstrung by federal law, which still treats all marijuana as illegal.
â€śIf the hospital were to become a dispensary at this point, we would be
violating the federal law and jeopardizing reimbursements for Medicare and
Medicaid,â€ť said Jimenez, who is calling for Congress to catch up with the
growing number of states allowing medical marijuana.
As it stands, hospital bosses are concerned they could also be targeted for
criminal activity or find themselves in trouble with the IRS.
â€śItâ€™s not something the hospital could risk and still stay financially
viable,â€ť Jimenez said. â€śSo weâ€™re outspoken about it. We think hospitals are
the best choice for dispensing. Unless someone speaks up, weâ€™re not going to
be able to change the federal law.â€ť
So far, no hospital in the 23 states or Washington, D.C., where medical pot
is legal, has sold marijuana, said Chris Lindsey, a legislative analyst for
the Marijuana Policy Project.
Some Chicago hospitals said theyâ€™re working out how to deal with patients
who use marijuana as medicine, but dispensary plans arenâ€™t in the works.
At Swedish Covenant, Jeffrey Cilley, an oncologist, said doctors are
interested in using medical pot for their cancer patients to help them deal
with symptoms like pain, nausea and anxiety.
Falco, the multiple sclerosis patient who uses marijuana to help with
uncontrollable leg spasms and other symptoms, said that reasoning makes
sense. â€śHaving hospitals involved with this is certainly a plus because itâ€™s
evoking a safer situation for patients to go where theyâ€™re frequenting
already,â€ť said the 49-year-old from Ravenswood.
Swedish Covenantâ€™s boss, Mark Newton, acknowledged marijuana is a
Visit the Chicago Sun-Times for the article.
'Biomedical' Tx could slow HIV
Nearly all people living with HIV could be rendered noninfectious by a suite
of "biomedical interventions," according to new recommendations for HIV
prevention. Similarly, people at risk for HIV now have biomedical options
that can reduce their risk of acquiring the disease, according to
the International Antiviral Society-USA (IAS-USA).
It's the first time the IAS-USA has issued recommendations for HIV
prevention in clinical care settings. The new guidelines are twinned with
its usual recommendations -- updated every 2 years -- for the treatment of
HIV. "After more than 30 years, we are at a potential turning point in the
control of the global HIV epidemic," the recommendations concluded.
Clinicians, using evidence-based HIV prevention tools, are crucial in
implementing these new interventions, the guidelines panel said. Both
guidelines are based on a systematic review of HIV literature, either
published or presented at scientific conferences, with recommendations
arrived at by consensus among panel members.
In line with current recommendations from the CDC, the panel urged that all
adults and adolescents should be offered HIV testing at least once. People
at higher than average risk of HIV -- either because of risky behavior or
residence in a region with a high prevalence of the virus -- should be
tested more often "at intervals appropriate to the individual's situation,"
the panel recommended.
To direct that need for additional testing, clinicians from time to time
should assess risk, such as sexual and drug-use activities, the panel urged.
Patients must be informed of the testing, the panel noted, and the right to
refuse must be honored, but through pretest counseling "clinicians should
ensure that refusals are informed decisions."
For people with HIV, the first step is to offer antiretroviral therapy as
soon as the virus is diagnosed -- a recommendation that is echoed by the
Both guidelines panels urge therapy for all patients with HIV, for its
individual medical benefits and because accumulating evidence shows that
people with fully suppressed virus are almost completely noninfectious.
The prevention panel said that clinicians should educate patients about both
the personal and the public benefits of therapy and should assess patients'
"readiness to initiate and adhere" to long-term treatment. They should also
develop strategies to support adherence, tailored to the individual patient.
In addition, clinicians should be aware that acute HIV infection has a
nonspecific presentation and "urgently pursue" specific diagnostics, such as
a plasma HIV viral load, if there's a suspicion of infection.
HIV-positive injection drug users need access, simultaneously, to ART,
needle and syringe exchange programs, supervised injection sites,
medicalized heroin, and medically assisted therapy, including opioid-substitution
therapy, the panel said.
The panel also urged physicians to "actively" link patients to care as soon
as possible after a diagnosis. It also urged a range of supports to keep
people in care, including such things as "patient health navigation,
community and peer outreach, (and) provision of culturally appropriate print
For people not infected with HIV, the panel recommendations noted that there
are medical interventions that can reduce the risk of acquiring the virus,
including ART and PrEP.
Physicians should perform a risk assessment to decide the focus of risk
reduction counseling and services, the panel recommended. Also, for those at
high risk of catching HIV, risk reduction interventions and services are
"warranted, especially for individuals and couples who seek repeat HIV
testing to monitor seroconversion."
Daily PrEP, with the single pill combination emtricitabine/tenofovir (Truvada),
should be offered to those at high risk based either on a background HIV
incidence of greater than 2% or a recent diagnosis of a sexually transmitted
from its recommendation to offer ART to all newly diagnosed patients, the
prevention panel also modified its recommendations on which initial
treatments to offer, how often to monitor treatment, and how to care for
treatment-experienced patients. The therapy should be started as soon as
possible and preferably within 2 weeks of diagnosis for those with
opportunistic infections, the panel recommended.
For the full report visit the Journal of the American Medical Association.