DAILY UPDATE

Nearly 365,000 Americans selected plans in the Health Insurance Marketplace in October and November

Health and Human Services (HHS) Secretary Kathleen Sebelius announced that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November. November alone added more than a quarter million enrollees in state and federal Marketplaces. Enrollment in the federal Marketplace in November was more than four times greater than October’s reported federal enrollment number.

Since October 1, 1.9 million have made it through another critical step, the eligibility process, by applying and receiving an eligibility determination, but have not yet selected a plan. An additional 803,077 were determined or assessed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in October and November by the Health Insurance Marketplace.

The HHS issue brief highlights the following key findings, which are among many newly available data reported today on national and state-level enrollment-related information:

·         November’s federal enrollment number outpaced the October number by more than four times.

·         Nearly 1.2 million Americans, based only on the first two months of open enrollment, have selected a plan or had a Medicaid or CHIP eligibility determination;

·         Of those, 364,682 Americans selected plans from the state and federal Marketplaces; and

·         803,077 Americans were determined or assessed eligible for Medicaid or CHIP by the Health Insurance Marketplace.

·         39.1 million visitors have visited the state and federal sites to date.

·         There were an estimated 5.2 million calls to the state and federal call centers.

The report groups findings by state and federal marketplaces. In some cases only partial datasets were available for state marketplaces. The report features cumulative data for the two month period because some people apply, shop, and select a plan across monthly reporting periods.

These counts avoid potential duplication associated with monthly reporting. For example, if a person submitted an application in October, and then selected a Marketplace plan in November, this person would only be counted once in the cumulative data.  To read the report visit here.

Joint Commission "R3 Report" explains new clinical alarm National Patient Safety Goal

The Joint Commission released an “R3 Report” for the new National Patient Safety Goal (NPSG) that requires accredited hospitals and critical access hospitals to improve the safety of their clinical alarm systems. “R3 Report” provides accredited healthcare organizations and interested healthcare professionals in-depth information about the rationale and references that were employed in the development of the new alarm NPSG.

The alarm NPSG is being implemented in two phases. The first phase will go into effect on January 1, 2014, and heightens awareness of the potential risks associated with clinical alarms. The second phase, will be effective January 1, 2016, and introduces requirements to mitigate those risks. The goal addresses clinical alarms that can compromise patient safety if they are not properly managed. This includes alarms from equipment such as cardiac monitors, IV machines, ventilators, etc. that have visual and/or auditory components. In general, this does not include items such as nurse call systems, alerts from computerized provider order entry, or other information technology systems.

Highlights of the report include:

·         The history of the first alarm NPSG, and why a new NPSG is needed.

·         Activities that led up to the development of the current NPSG, including a summit co-convened by The Joint Commission, the Association for the Advancement of Medical Instrumentation, ECRI Institute, the American College of Clinical Engineering, and the Food and Drug Administration.

·         Information about responses from the field on the proposed NPSG and how it affected the current version of the goal and how future input will be used.

·         A select bibliography of sources that informed development of the NPSG.

To view “R3 Report,” visit www.jointcommission.org/r3_report_issue5/.

AHRMM releases new white paper - Cost, Quality, and Outcomes: The Supply Chain Value Equation

AHRMM has released a white paper, “Cost, Quality, and Outcomes: The Supply Chain Value Equation” that presents healthcare supply chain tools and strategies for navigating the Cost, Quality, and Outcomes (CQO) Movement, and explores new initiatives designed to advance the supply chain from a transactional program to a strategic contributor to organizational success.

The paper, which is split into five parts, opens with a strategic discussion, led by AHRMM13 keynote presenters, Annette Pummel and Christopher O’Connor, which focuses on AHRMM’s CQO Movement and examines where the supply chain is in relation to CQO and what additional resources may be needed to advance the supply chain profession.

“The executive thought leaders agreed that the supply chain must operate from the intersection of cost, quality, and outcomes in order to succeed. CQO is boosting strategic thinking, which will help to facilitate advancement of the supply chain to the C-suite," noted Annette Pummel, RN, CMRP, Chair of AHRMM.

The paper also summarizes the core organizational competencies and key transitional steps required for hospitals to successfully transition from the first curve to the second curve as presented by Heather Jorna, Vice President of AHA affiliate, Health Research and Education Trust (HRET).

The next part presents the results of the 2013 Healthcare Provider Executive Supply Chain Survey, which were presented by Jamie Kowalski, Jamie C. Kowalski, FACHE, FAHRMM, Jamie C. Kowalski Consulting, LLC. Key findings from C-level and supply chain professionals include agreement that:

·         the need for the supply chain to optimize will intensify,

·         optimization is one of the top three expense reduction strategies used to meet the challenge of reform,

·         supply chain management must become a core competency,

·         and the supply chain has a direct, critical relationship and impact on patient safety, quality outcomes, and margin management.

Finally, John Gaida and Mary Starr, both AHRMM past presidents, discussed the new AHRMM Mentor Program. Refer to www.ahrmm.org/mentor for additional information.

The white paper was written as a result of the AHRMM Executive Thought Leader Forum, sponsored by VHA, held during the AHRMM13 Conference & Exhibition in San Diego, California. This full-day forum on the effects and implications of the transforming healthcare environment hosted approximately 30 healthcare supply chain executives.

Download the complete white paper (pdf).

For more information about CQO Movement, please visit www.ahrmm.org/CQO or email your questions to AHRMMCQO@aha.org.

STERIS launches Prolystica HP in response to healthcare industry demand for better performing cleaning chemistries

STERIS Corporation, with more than 100 years of experience in surgical and infection control environments, has introduced Prolystica Ultra Concentrate HP Cleaning Chemistries; a new innovation to its premium instrument cleaning chemistries, specifically designed for high-performance in today’s challenging healthcare environments.

The latest Prolystica formulations are a 10x concentrate with added de-foaming properties to further reduce the time and effort it takes to rinse surgical tools and equipment. Additionally, the chemistries have proven stronger in removing difficult healthcare soils such as lipids and blood, including those associated with orthopedic surgeries, and cleans devices in less time than previous formulations.

The Prolystica Ultra Concentrate HP cleaning chemistries are designed for use in hospital washer/disinfectors. They are formulated for processing surgical instruments and are compatible with an extensive range of substrates, even soft metals.

With Prolystica HP Cleaning Chemistries, performance qualities, that already set the brand apart from competitors, have been enhanced to provide improved levels of productivity and flexibility as well as cost savings. In addition to removing difficult soils, rinsing easily and employing faster cycle times, they are effective across a broad range of water quality.

Further, Prolystica HP Cleaning Chemistries are designed to protect and maintain the life of the instruments and washers in which they are used; resulting in reductions in inventory and utility consumption. Visit STERIS for the release.

More than 100 hospitals in Northeast Purchasing Coalition select aptitude for online direct contracting benefits

aptitude LLC, the healthcare industry's first online direct contracting market, today announced an agreement with the Northeast Purchasing Coalition (NPC) that will enable more than 100 hospitals in the New England area to execute and manage contracts for medical supplies, devices, and products via the online market.

While consolidation is a trend in the industry, consensus on how to source supplies for hospitals can be complex. As a contracting market, aptitude facilitates agreements between hospitals and suppliers, empowering both parties with this direct approach. Cost savings through online contracting as well as the ability to source, bid, execute and monitor contracts more efficiently is compelling to the NPC and are the primary reasons to begin contracting through aptitude.

"When you look at the pressures on the healthcare industry and the challenges of the future, we felt compelled to be an early adopter of the aptitude platform," said Leanne Todisco, Vice President of Supply Chain Operations for the NPC. "Through its unique approach, our group stands to benefit from the fact that aptitude can help us contract more efficiently, while also giving us the flexibility to align resources by integrating evidence-based practice with strategic sourcing to deliver the best overall value to the NPC members."

Since aptitude launched in April, the company emphasized its ability to drive innovation in the healthcare supply chain environment by bridging the relationship between hospitals and suppliers. Based on current market conditions, hospitals and suppliers are agreeing to contracts in an average of 38 days with an average savings of 10 to 15 percent.

Self-contracting represents about 40 percent of healthcare purchasing, a $55 billion spend nationwide. Before online contracting, these agreements often took between six and nine months from proposal to contract. Visit here for more information.

You are what your father eats

Mothers get all the attention. But a study led by McGill researcher Sarah Kimmins suggests that the father’s diet before conception may play an equally important role in the health of their offspring. It also raises concerns about the long-term effects of current Western diets and of food insecurity.

The research focused on vitamin B9, also called folate, which is found in a range of green leafy vegetables, cereals, fruit and meats. It is well known that in order to prevent miscarriages and birth defects mothers need to get adequate amounts of folate in their diet. But the way that a father’s diet can influence the health and development of their offspring has received almost no attention.

Now research from the Kimmins group shows for the first time that the father’s folate levels may be just as important to the development and health of their offspring as are those of the mother. Indeed, the study suggests that fathers should pay as much attention to their lifestyle and diet before they set out to conceive a child as mothers do.

“Despite the fact that folic acid is now added to a variety of foods, fathers who are eating high-fat, fast food diets or who are obese may not be able to use or metabolize folate in the same way as those with adequate levels of the vitamin,” says Kimmins. “People who live in the Canadian North or in other parts of the world where there is food insecurity may also be particularly at risk for folate deficiency. And we now know that this information will be passed on from the father to the embryo with consequences that may be quite serious.”

The researchers arrived at this conclusion by working with mice, and comparing the offspring of fathers with insufficient folate in their diets with the offspring of fathers whose diets contained sufficient levels of the vitamin. They found that paternal folate deficiency was associated with an increase in birth defects of various kinds in the offspring, compared to the offspring of mice whose fathers were fed a diet with sufficient folate.

The research from the Kimmins’ group shows that there are regions of the sperm epigenome that are sensitive to life experience and particularly to diet. And that this information is in turn transferred to a so-called epigenomic map that influences development and may also influence metabolism and disease in the offspring in the long-term. (The epigenome is like a switch, which is affected by environmental cues, and is involved in many diseases including cancer and diabetes. The epigenome influences the way that genes are turned on or off, and hence how heritable information gets passed along). To read the full article visit here.

China drugmakers face U.S. scrutiny on investigator bump

U.S. regulators are more than tripling to 27 the number of workers they’ll have in China to inspect pharmaceutical plants and products, a move that may spur a wave of enforcement similar to what’s happening in India.

An increased number of Food and Drug Administration investigators in India this year led to import bans against some generic drugs from Ranbaxy Laboratories Ltd. and Wockhardt Ltd. for failure to meet U.S. standards. The China expansion is the culmination of almost two years of negotiations with government officials, Christopher Hickey, director of the FDA’s China office, said in a telephone interview from Beijing.

China, like India, has become a significant supplier around the world of the active ingredients found in prescription drugs, Hickey said. U.S. Vice President Joe Biden visited the capital, Beijing, last week and was able to secure a final commitment from the government to allow more inspectors into China to routinely review drug manufacturing practices and conditions.

Among the 19 new employees stationed in China, 10 will be pharmaceutical inspectors, Hickey said. The number of food inspectors will increase to eight over the next year, allowing the FDA to complete about 160 inspections a year, compared with 20 to 25 now, he said. Drugmakers will see a similar increase.

China became a particular point of focus after contaminated doses of Baxter International Inc.’s blood thinner heparin was linked to 246 death reports from Jan. 1, 2007, to May 31, 2008. The active pharmaceutical ingredient was made in China. Around that same time, tainted jerky treats imported from China began to be linked to thousands of dog illnesses in the U.S.

China has been a growing player in the healthcare industry, with sales there for eight foreign drugmakers, including GlaxoSmithKline Plc, Pfizer Inc. and Merck & Co., climbing 40 percent in 2011. Growth has slowed to 20 percent this year, data compiled by Bloomberg show, mainly because of more modest expansion of the Chinese economy.

Glaxo, based in London, also faces a corruption probe in China for allegedly bribing hospitals and doctors that may further shrink growth.

As part of the agreement secured by Biden, the Chinese government also will take steps to register bulk chemical manufacturers that make active ingredients. The industry is currently unregulated in China and more oversight could help combat counterfeit medicines worldwide, the White House said.

The FDA first started discussions with Chinese officials after U.S. President Barack Obama’s fiscal 2013 budget request included funds for additional inspectors. The State Department became concerned in October 2012 that an FDA hire hadn’t gotten a visa applied for in August, Hickey said. Visit Bloomberg for the story.

Task force: Ban drug reps from 'Ivory Towers'

Drug sales reps should be banned from academic medical centers, but mingling between faculty and pharma researchers is not a problem, according to a conflict-of-interest task force.

"Pharmaceutical sales representatives should not be allowed access to any faculty, students, or trainees in academic medical centers or affiliated entities," the task force, convened by the Pew Charitable Trusts, wrote in a 30-page report released Tuesday. "However, faculty may invite pharmaceutical scientists for specific educational or scientific discussions that do not involve marketing of a specific product."

The task force -- with representatives from seven academic medical centers, various consumer organizations, the Association of American Medical Colleges (AAMC), and the American Medical Student Association -- referenced a review of 29 studies that found physicians who interacted with sales reps prescribed lower-quality, higher-cost drugs compared with non-exposed doctors.

Current AAMC policy recommends that sales reps only be allowed on academic medical centers by appointment and that they be prohibited from entering patient-care areas. Banning sales reps is one of seven recommendations the task force made, all of which would tighten current AAMC recommendations.

Pew convened the task force as the last comprehensive standards were released by the AAMC in 2008, and the group believed it was time to update recommendations now that more data on industry influence have been published.

"The guiding principle was to balance appropriate boundaries in physician-industry relationships with the need to encourage collaborations crucial for improving medical care and practice," David Korn, MD, a former vice provost for research at Harvard Medical School, and Daniel Carlat, MD, director of Pew's Prescription Project, wrote in a Viewpoint article published simultaneously in the Journal of the American Medical Association.

The conflict-of-interest policies should also apply to training sites such as affiliated hospitals and clinics, the task force recommended.

Of the 15 recommendations made, several vary at least somewhat slightly from what the AAMC already recommends to its member schools, including:

·         No gifts or meals of any value should be accepted, including gifts deemed "educational" for medical staff. However, patient educational materials are allowed.

·         Drug samples are only allowed if they aren't used for marketing purposes.

·         Faculty shouldn't accept funding for speaking engagements directed toward physicians, students, health professionals, or the public. The restriction doesn't apply to scientific presentations made to industry employees.

·         Residents and medical students may not accept industry-sponsored fellowships for clinical training.

·         Members of pharmacy and therapeutics committees should be recused from discussion and voting if conflicts arise.

Continuing medical education (CME) should be limited to specialized training "such as new medical devices for which expertise may be very limited and cost of training high," Carlat and Korn wrote. Existing industry-funded CME may continue provided that safeguards are in place.

A statement from the Pharmaceutical Research and Manufacturers of America, the trade group of drugmakers, wasn't immediately available as its offices were closed Tuesday due to inclement weather in Washington.

The seven academic medical centers participating in the task force included the University of Michigan Medical School, Stanford University School of Medicine, Harvard Medical School, Cleveland Clinic, University of Pittsburgh School of Medicine, UMass Memorial Healthcare, and Kaiser Permanente.

Work published earlier this year in BMJ found physicians who attended a medical school with a policy that banned gifts from drug companies were less likely to prescribe two of three newly marketed psychotropic drugs once in practice. Visit MedPageToday for the article.