February 2008
February 8, 2008 Download print version
Merck to pay $650 million in Medicaid
settlement
AHRMM announces grants
Severe stressful events early in pregnancy may
be associated with schizophrenia among offspring
Merck to pay $650 million in Medicaid settlement
Merck agreed yesterday to pay more than $650 million to settle
charges that it routinely overbilled the government for its
most popular medicines, the arthritis drug Vioxx and the
cholesterol drug Zocor, cheating Medicaid out of millions of
dollars in discounts over eight years. Prosecutors say the
drugmaker gave pills to hospitals at virtually no cost to hook
poor patients on expensive medicine. When the patients left
the hospital, they often continued taking the drugs, but with
the government footing the higher bill. The Merck settlement
culminates an investigation that began in 2000 and is one of
the first in a series of cases centering on whether drugmakers
used unfair pricing practices to bilk the government. The
Justice Department is looking into 630 healthcare
whistleblower claims.
H. Dean
Steinke, a district sales manager for Merck, set off the investigation after
he noticed his company was using questionable sales tactics. Steinke
complained to his supervisors, who brushed him off, so he turned to federal
authorities.Steinke, a 51-year-old Michigan native, will receive about $68
million from the settlement as a whistleblower reward. He said he was
prompted to go to authorities after his direct supervisor told him: "I don't
care how you do it, but get the damn business," when he questioned the sales
practices. "There comes a time when you just dig in your heels and say, 'You
know what? They're not going to get away with it,' " Steinke said.
The agreement yesterday, one of the largest health-care fraud
recoveries, also closes a related case about Merck overcharging for the
antacid Pepcid. William St. John LaCorte, a doctor in New Orleans who
questioned the Pepcid charges, will receive a yet-to-be-determined share of
the settlement proceeds.
Merck did
not admit wrongdoing. The country's third-largest drugmaker stood by its
pricing strategies but wanted to resolve the disputes, executives said in a
statement. Merck agreed to heightened oversight by regulators for five years
as part of the deal. The company remains the focus of a separate grand jury
investigation related to Vioxx marketing and is striving to execute another
multibillion-dollar settlement of thousands of lawsuits filed by people who
had heart attacks after taking the painkiller.
The
whistleblowing case centered on Merck's giving hospitals across the country
92 percent discounts on Vioxx, an arthritis drug pulled from the market
three years ago for safety concerns; Zocor, a popular cholesterol-lowering
medicine that drew intense competition from rivals; and Pepcid, an antacid
tablet now sold over-the-counter. Merck offered the pills at the discount
under a legal loophole, known as nominal pricing, that Congress created a
generation ago to give poor patients access to medicine.
Merck and industry experts had argued that the pricing
strategy fell within the law and helped reduce costs for many
government-funded hospitals. But prosecutors said the Whitehouse Station,
N.J., drugmaker used the discounts to outflank its competition, offering
massive markdowns to hospitals that agreed to put its medicines on a list of
preferred drugs or to prescribe them for as many as three-quarters of
eligible patients. In some cases, hospitals favored Merck's drugs over
cheaper generics. This practice conflicted with the law because Merck did
not offer Medicaid the same discounts, authorities said. The law requires
the government be charged no more than other customers. (Washington Post)
Click here for the complete story.
AHRMM announces grants
The Board of Directors of the Association for Healthcare Resource &
Materials Management (AHRMM) has donated over $175,000 in research grants to
three groups supported by collegiate institutions.
AHRMM contributed $75,000 to ASU to support further development and
implementation of SCMetrix - a sophisticated online benchmarking tool to
help hospitals compare their supply expense and supply chain processes to
those of peer hospitals. AHRMM and the W.P. Carey School of Business began
work on the joint project in 2007. In 2006, AHRMM granted ASU $100,000 to
determine the study's metrics, build the survey tool and the program's Web
site, and host several educational seminars to help hospitals gain a better
understanding of SCMetrix and promote project participation. This year's
grant will support the tool's continued development and refinement and will
further assist with the marketing and educational efforts so that more
hospitals will learn how to become part of SCMetrix and begin importing
their data into the online system. A hospital does not have to attend the
webinar to obtain the tools. Instead, they recommend that you listen to the
web recording and download the tools at this site. The
downloadable tools are located on the web page under Participate.
AHRMM also donated $50,000 to the MEHD Group, a healthcare supply chain
initiative within the MIT Center for Transportation & Logistics created to
drive innovation in the field. The MEHD Group will use the AHRMM grant to
create new insights, technologies, and business practices to improve
healthcare delivery everywhere. In doing so, they will conduct research to
identify the dynamics of the current healthcare supply chain, apply
scenario-based planning methodologies to the healthcare supply chain, and
recommend and develop innovative strategies, policies, and technologies. The
MEHD Group has partnered with several companies to move this initiative
forward including Caremark, Pfizer, Cardinal Health, and Cephalon.
CIHL, a collaboration of University of Arkansas researchers, healthcare
providers, interested corporations, and government agencies seeking
healthcare supply chain and logistic innovations, received $50,000 for its
initiative "Identifying Opportunities for Cost and Quality Improvements in
Healthcare Logistics." CIHL was established through an initial investment of
$1 million and primary funding commitments from strategic partners Wal-Mart,
Blue Cross and Blue Shield (of Arkansas, Alabama, and Illinois) and VHA to
recover significant costs and achieve new efficiencies through the
healthcare supply chain while improving safety, quality, and equity of
patient care.
For more information on SCMetrix, please
visit. For more information on the work of the MEHD Group,
please visit. For more information on CIHL,
please visit
http://cihl.uark.edu.
New
strategy helps reduce errors in obstetrical care
Researchers at Yale
School of Medicine have implemented patient safety enhancements to
dramatically reduce errors and improve the staff’s own perception of the
safety climate in obstetrical care. Edmund F. Funai, M.D., associate
professor in the Department of Obstetrics, Gynecology & Reproductive
Sciences at Yale, presented preliminary results from this research at the
Society for Maternal Fetal Medicine Annual Meeting. An estimated 44,000 to
98,000 Americans die in hospitals each year as a result of errors. About
half of medical errors are linked to communication errors and system
failures. Obstetrics has lagged behind other specialties in attempts to
improve safety because perinatal adverse events are both relatively uncommon
and usually unexpected, occurring in previously healthy patients who are
anticipating good outcomes.
Funai
and his team designed and implemented clinical patient safety interventions
at Yale-New Haven Hospital. These included communication training,
standardizing interpretation of fetal monitoring, and creating a novel staff
role—the patient safety nurse. In tracking and analyzing 14 markers for
adverse outcomes, the team found that the rate of adverse events decreased
by about 60 percent over 2.5 years, while the staff’s own perception of the
overall safety climate increased by 30 percent, according to a survey given
by a third party. Funai said that the main cause of adverse events and
patient injury is a breakdown in communication, usually involving failure to
recognize the severity of a given situation or condition, often involving a
newborn’s status.
Funai
said, “After taking these surprisingly simple steps to address safety, both
patients and staff report that the care is much more seamless and better
organized,” he said. “The staff is more comfortable and empowered to
communicate their concerns about a patient. A comfortable staff often leads
to more successful patient outcomes.”
See this link
Severe stressful
events early in pregnancy may be associated with schizophrenia among
offspring
Children of women who undergo an extremely stressful event, such as the
death of a close relative, during the first trimester of pregnancy appear
more likely to develop schizophrenia, according to a report in the February
issue of Archives of General Psychiatry.
“The common conception that a mother’s psychological state can influence her
unborn baby is to some extent substantiated by the literature,” the authors
write as background information in the article. “Severe life events during
pregnancy are consistently associated with an elevated risk of low birth
weight and prematurity.” Schizophrenia, a disabling condition associated
with abnormal brain structure and function, is increasingly believed to
begin in early brain development. Environmental factors, including those
occurring during pregnancy, and susceptibility genes may interact to
influence risk.
Ali S. Khashan, M.Sc., of the University of Manchester, England, and
colleagues used data from 1.38 million Danish births occurring between 1973
and 1995. Women were linked to close family members using a national
registry, and the same registry was used to determine if any of these
relatives died or received a diagnosis of cancer, heart attack or stroke
during each mother’s pregnancy. Their children were followed from the 10th
birthday through June 30, 2005 or until they died, moved out of the country,
or developed schizophrenia.
During the study period, mothers of 21,987 children were exposed to the
death of a relative during pregnancy, 14,206 were exposed to a relatives’
serious illness during pregnancy and 7,331 of the offspring developed
schizophrenia. The risk of schizophrenia and related disorders was
approximately 67 percent greater among the offspring of women who were
exposed to the death of a relative during the first trimester. However,
death of a relative up to six months before or any other time during
pregnancy was not related to risk for schizophrenia in the child, nor was
exposure to serious illness in a relative. The association between a family
death and risk of schizophrenia appeared to be significant only for
individuals without a family history (parents, grandparents or siblings) of
mental illness.
Pre-chewed baby food said to transmit H.I.V.
Researchers have identified another way that babies can be infected with
H.I.V. — through food pre-chewed by an infected parent or caretaker.
Although thousands of babies have been infected in the United States over
the last 15 years, pre-chewed food has been documented as the cause of just
three cases, federal epidemiologists said wednesday. But such transmission
may not be so rare, Dr. Kenneth L. Dominguez’s team from the Centers for
Disease Control and Prevention said at the 15th Conference on Retroviruses
and Opportunistic Infections.
Pre-chewing food apparently occurs among many groups in this country and
elsewhere. So transmission of H.I.V., the AIDS virus, to infants may be an
unrecognized problem in developing countries where dental care is lacking,
commercially prepared baby foods and blenders are not available and parents
and caretakers may need to soften foods, Dr. Dominguez said in an interview.
His team said there were several reasons for reporting the three cases,
dating from 1993, for the first time. One was to make healthcare providers
and caregivers of infected children aware of the potential risk of
pre-chewing. Another was to ask doctors and family members to report
suspected cases to health officials to quantify the threat.
Human immunodeficiency virus is present in saliva, but usually in amounts
too low to cause transmission. So, presumably, blood, which has larger
amounts of the virus, is also needed for transmission. Infected chewers with
inflammations or open mouth sores can pass the virus to infants through cuts
or other common teething conditions, Dr. Dominguez said.
Although the three cases were among African-Americans born in the United
States, pre-chewing is prevalent among many ethnic and racial groups,
according to a recent national survey of infant feeding by the C.D.C., Dr.
Dominguez said. “It’s likely that some cultural influences are involved, and
I am sure that people are doing what their grandmothers and aunties did in
practices carried through generations,” Dr. Dominguez said.
The first two cases involved boys from Miami infected in the mid-’90s. One
boy’s infection was detected when he was 39 months old, shortly before his
death, after previously testing negative for the virus twice. The mother,
who was infected, reported pre-chewing food for the boy.
The second boy’s mother was uninfected but lived with an infected aunt who
pre-chewed his food. He survives. In the third case, a girl from Memphis was
found to be infected in 2004 at 9 months old after testing negative for the
virus three times. Her mother was infected and pre-chewed food for her
daughter.
Researchers will try to determine whether other dangerous microbes like
hepatitis B virus and Helicobacter pylori might be transmitted through
pre-chewed food. (NY Times)
http://www.nytimes.com/2008/02/07/us/07hiv.html?ref=health
Study suggests new therapy for lung disease patients
A
new study by researchers at Northwestern University's Feinberg School of
Medicine may change current thinking about how best to treat patients in
respiratory distress in hospital intensive care units. It has been commonly
believed that high levels of carbon dioxide (CO2) or hypercapnia in the
blood and lungs of patients with acute lung disease may be beneficial to
them. Now, for the first time, scientists have shown how elevated levels of
CO2 actually have the opposite effect. The excessive CO2 impairs the
functioning of the lungs. Jacob Sznajder, M.D., chief of pulmonary and
critical care at the Feinberg School, and his research team found that high
levels of CO2 make it harder for the lungs to clear fluid.
The excess CO2 initiates a signaling cascade leading to the inhibition of
the action of sodium “pumps” that help move water out of the air spaces.
This creates a greater risk of edema in which the lungs flood with fluid.
The investigators worked with rats and human cells for the study, which was
published in the February issue of the Journal of Clinical Investigation.
"Allowing high levels of CO2 may contribute to the high mortality of
patients with diseases like chronic obstructive pulmonary disease (COPD),"
said Sznajder, a professor of medicine and of cell and molecular biology at
the Feinberg School and a physician at Northwestern Memorial Hospital. "This
study argues toward therapies to reduce the high CO2 levels of patients
toward normal levels, which is not the current practice in the intensive
care unit."
COPD is the fourth leading cause of death in the United States, killing more
than 120,000 people, according to the National Institutes of Health. When
people have COPD, their lungs lose elasticity and have trouble exchanging
carbon dioxide for oxygen. COPD used to be strictly a disease of smokers,
but now it's also crippling the lungs of non-smokers.
WHO releases new report on global tobacco control efforts
WHO has released new data showing that while progress has been made, not a
single country fully implements all key tobacco control measures, and
outlined an approach that governments can adopt to prevent tens of millions
of premature deaths by the middle of this century. In a new report which
presents the first comprehensive analysis of global tobacco use and control
efforts, WHO finds that only 5% of the world’s population live in countries
that fully protect their population with any one of the key measures that
reduce smoking rates. The report also reveals that governments around the
world collect 500 times more money in tobacco taxes each year than they
spend on anti-tobacco efforts. It finds that tobacco taxes, the single most
effective strategy, could be significantly increased in nearly all
countries, providing a source of sustainable funding to implement and
enforce the recommended approach, a package of six policies called MPOWER.
The report also documents the epidemic's shift to the developing world,
where 80% of the more than eight million annual tobacco-related deaths
projected by 2030 are expected to occur. Other key findings in the report
include:40% of countries still allow smoking in hospitals and schools; Only
5% of the world’s population lives in countries with comprehensive national
bans on tobacco advertising and promotion; Just 15 countries, representing
6% of the global population, mandate pictorial warnings on tobacco
packaging; Services to treat tobacco dependence are fully available in only
nine countries, covering 5% of the world’s people; Tobacco tax revenues are
more than 4000 times greater than spending on tobacco control in
middle-income countries and more than 9000 times greater in lower-income
countries. High- income countries collect about 340 times more money in
tobacco taxes than they spend on tobacco control. See this link
http://www.who.int/mediacentre/news/releases/2008/pr04/en/index.html
Comatose locusts may help relieve migraines
The way locusts react to stress may provide an important clue to
understanding what causes human migraines – and how to reduce their painful
effects, says Queen’s University, Kingston, ON, Canada, Biology professor,
Mel Robertson. With PhD student Corinne Rodgers, Dr. Robertson is using
insect models to examine how the nervous system controls breathing when
stress is induced through high temperatures and oxygen deprivation. They
have discovered that the locust’s reaction to extreme heat is very similar
to a disturbance in mammals that has been associated with human migraines
and stroke.
As a way of temporarily shutting down and conserving energy when conditions
are dangerous, the locust’s coma has many of the same characteristics seen
in people at the onset of a migraine. “We feel there may be an evolutionary
link between the two,” Dr. Robertson suggests. His team’s findings are
published on-line in the journal PLoS
ONE.
The study monitors locust breathing cycles, which are controlled by a
collection of nerve cells in the central nervous system. With heat or lack
of oxygen, the insects initially breathe more quickly and then go into a
coma. They recover when the temperature comes down again, or oxygen levels
rise.
“We find that the point of coma is always associated with a surge of
extra-cellular potassium ions: the same as has been observed in human brain
tissue during surgery,” says Rodgers. For the nervous system to work
properly, potassium should be high inside cells and low outside, she points
out. “What we’re seeing is a failure of that ability to maintain this
equilibrium – but in fact, in the locust, it appears to be an adaptive
response to protect the system.”
Previous research in Dr. Robertson’s lab has shown a genetic component to
this response, which indicates there may be an evolutionary link to what
happens during migraines in people. “It’s possible, for example, that the
brain architecture necessary for increased sensitivity also predisposes
areas of some people’s brains to become over-excited, and that migraines
provide a means of temporarily ‘shutting things down,’” he suggests.
While migraine has been associated with this disturbance for some time, the
mechanisms underlying the phenomenon are not yet well understood. And that
understanding will be key to designing new migraine treatments.
“We found that we could precondition the locust system to be more
stress-tolerant. If the mechanisms are the same as those in humans, then
similar manipulations could help to protect brain function under stressful
conditions, such as those leading to migraine,” says Dr. Robertson.
“Something is triggering events like this,” he adds. “Maybe we can just bias
that slightly, so it won’t trigger as often, or the consequences will not be
as severe.” See this link
February 7, 2008 Download print version
Intensive blood sugar treatment in trial of
diabetes and cardiovascular disease changed
Safety of drug imports questioned; Some in
Congress want FDA to expand overseas inspections
Broadlane announces strategic relationship
with ECRI Institute
Intensive blood sugar treatment in trial of
diabetes and cardiovascular disease changed
The National Heart, Lung, and Blood Institute (NHLBI) of the
National Institutes of Health has stopped one treatment within
a large, ongoing North American clinical trial of diabetes and
cardiovascular disease 18 months early due to safety concerns
after review of available data, although the study will
continue. In this trial of adults with type 2 diabetes at
especially high risk for heart attack and stroke, the medical
strategy to intensively lower blood glucose (sugar) below
current recommendations increased the risk of death compared
with a less-intensive standard treatment strategy.
Study participants receiving intensive blood glucose
lowering treatment will now receive the less-intensive
standard treatment. The ACCORD (Action to Control
Cardiovascular Risk in Diabetes) study enrolled 10,251
participants. Of these, 257 in the intensive treatment group
have died, compared with 203 within the standard treatment
group. This is a difference of 54 deaths, or 3 per 1,000
participants each year, over an average of almost four years
of treatment. The death rates in both groups were lower than
seen in similar populations in other studies.
“A thorough review of the data shows that the
medical treatment strategy of intensively reducing blood sugar
below current clinical guidelines causes harm in these
especially high-risk patients with type 2 diabetes,” said
Elizabeth G. Nabel, M.D., director, NHLBI. “Though we have
stopped this part of the trial, we will continue to care for
these participants, who now will receive the less-intensive
standard treatment. In addition, we will continue to monitor
the health of all participants, seek the underlying causes for
this finding, and carry on with other important research
within ACCORD.”
“The
ACCORD findings are important, but will not change therapy for
most patients with type 2 diabetes. Few patients with high
cardiovascular risk like those studied in ACCORD are treated
to blood sugar levels as low as those tested in this study, “
said Judith Fradkin, M.D., director, Division of Diabetes,
Endocrinology, and Metabolic Diseases at the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
“People with diabetes should never adjust their treatment plan
or goals without consulting their healthcare providers.” See
THIS LINK
Safety of drug imports questioned; Some in
Congress want FDA to expand overseas inspections
With an ever-larger percentage of prescription drugs and drug
ingredients coming to the U.S. market from developing nations
such as
China
and
India,
Congress is voicing concern that the number of inspections of
those plants by the
Food and
Drug Administration has grown far more slowly. In a
Feb. 1 letter to the FDA,
Sen. Charles
E. Grassley (R-IA) said that the small number of
inspections in these newer markets is putting consumers at
risk.
In particular, he wrote, he was concerned that the
number of inspections in
China, a major supplier of active drug ingredients, is small
and actually dropped from 18 in 2004 to 11 in 2007.
China
is believed to have hundreds, if not thousands, of plants that
make ingredients for drugs headed to the
United States.
"I found these numbers very troubling," Grassley wrote. "Since
the beginning of FY 2002, the FDA conducted approximately
1,379 inspections of foreign pharmaceutical facilities, often
focused in countries with few reported quality concerns."
Other lawmakers and outside experts are worried that drugs
from low-cost producers in
India, China and elsewhere are not receiving the FDA scrutiny
they require. Grassley's staff asked the FDA last year if it
is planning to open an office in India.
In December, the agency said it was considering a new office
only in China. Last month, however, FDA Commissioner Andrew C.
von Eschenbach told reporters that he was working on a plan to
station inspectors in six regions abroad so they can inspect
plants on an "ongoing and continuous basis rather than
episodic and periodic."
According to the statistics provided to Grassley,
even that kind of inspection does not happen very often. And
an overwhelming number of inspections are conducted in nations
such as
Germany,
Switzerland,
Italy
and
Canada
rather than in countries with much weaker drug inspection
programs of their own. This is largely because the FDA can
allocate "user fees" provided by brand-name drug companies to
pay for inspections of their plants, many of which are in
Europe.
The agency does not have nearly as much money to pay for
inspections for low-cost generic drugs because those
manufacturers do not pay such fees. Grassley said in his
letter that "this seems to be a misplacement of limited FDA
resources."
The FDA says that consumers still can be confident
in the quality of the drugs they take. The agency says it has
required improvements in the entire drug manufacturing process
and does not rely entirely on inspections. Responding to an
October letter from Grassley's staff, Stephen R. Mason, the
FDA's acting commissioner for legislation, said it cost the
agency $6.2 million in fiscal 2007 to pay for about 300
foreign drug inspections. The Bush administration has proposed
a budget increase of 5.7 percent for the FDA, with additional
money for foreign inspections, especially of food. But critics
said those funds will barely keep up with scheduled pay
raises. The
Government
Accountability Office reported last year that the
FDA does not know how many foreign plants are manufacturing
products for the American drug market, and is unaware whether
they are being inspected effectively. (Washington Post) See
THIS LINK
Last chance to register for the Supply Chain
Technology Symposium in
Orlando
The HIMSS-AHRMM pre-conference Supply Chain Technology
symposium, previously sold out, has announced that they were
able to add room for just 25 more attendees. These spots are
available on a first come basis only.
For
registration information see
THIS LINK
HIMSS (The Healthcare Information and Management Systems
Society) is collaborating with the Association for Healthcare
Resource & Materials Management (AHRMM) to provide a
value-packed, one-day preconference symposium on healthcare
supply chain technology, to be held Sunday, February 24,
from
8 am
to
4 pm ET
in
Orlando,
FL at the Orange County Convention Center.
Educational
sessions will focus on the supply chain process and the
information systems that support it. This event is essential
for materials managers, Logisticians, Supply Chain Officers
and IT professionals to learn about leading practices in the
industry, data management and utilization, and integration and
implementation solutions. Join AHRMM at the HIMSS08 Annual
Conference. Supply chain solutions are constantly moving
ahead...don’t get left behind!
Topics of discussion include: “Best practices from around the
world that can be applied in the U.S.”;
“The next generation in supply chain benchmarking”; “How to
create an effective data warehouse in a provider setting”;
“How proposed standards could impact quality and patient
safety”. Join your peers to learn the very latest in your
profession today, and what it could mean for all of us
tomorrow. Opening keynote speaker, Jay Kirkpatrick, CMRP, CEO,
Nashville Supply Chain Services, will address: “Supply Chain
Management from A to Z; Where we are, Where we need to go, and
What we need to do to get there”.
To view
the agenda see
THIS LINK
For more information on the HIMSS conference see
THIS LINK
In
addition, there will be an annual Supply Chain Management
Special Interest Group (SIG) meeting at the HIMSS conference:
"Disaster Planning from the Supply Chain Perspective" on
Tuesday, Feb. 26, 1:30- 3 pm, Orlando Convention Center, Room
240C. No registration is necessary for the SIG meeting –
please join us!
Broadlane announces strategic relationship
with ECRI Institute
ECRI
Institute, an independent, nonprofit organization that
researches the best approaches to improving patient care, will
serve as an unbiased expert, offering equipment purchasing
clients the inside track on the latest medical equipment at
Broadlane’s upcoming Computed Tomography (CT) Live Group Buy.
“Roughly 41 percent of hospitals will be purchasing a CT this
year,” said Kerry Tucker, vice president, supply chain
services, Broadlane. “By combining ECRI Institute’s
state-of-the-art technology and marketplace insight with
Broadlane’s rigorous Live Group Buy process, attendees should
achieve double-digit savings and confidence they are making
wise product choices based on the best information available.”
ECRI Institute will present a technology session and be
on-hand as an expert resource during the CT Live Group Buy,
which will occur March 26-28. ECRI Institute will provide
event participants insight into: The state of the marketplace:
What technologies are available now and where are they
heading? Key clinical issues: What issues are most important
when considering a purchase? Recent technological advances:
How do these advances impact performance and value?
Participants have three options: 1.) Attend the Live Group Buy
with the ECRI Institute technology seminar 2.) Attend only the
ECRI Institute technology seminar 3.) Call into an audio
conference for key topics in the ECRI Institute seminar
Future
Live Group Buys: The Cardiac Cath Lab/Angio Suites Live Group
Buy will be held April 23-25; and the MRI Live Group Buy will
be held May 28-30. Other Live Group Buys scheduled for 2008
include Ultrasound, Nuclear Medicine/PET-CT, Digital
Mammography, Digital Radiography and Radiography and
Fluoroscopy (R&F).
The
Broadlane Live Group Buy process is unique within the
industry: Participants determine and weight the criteria used
to evaluate the equipment and suppliers. Participants then
rate supplier technology, identify key operational support
components, participate in live negotiations and ultimately
make a contract award.
If you are interested in attending a Broadlane Live Group Buy
or have any other questions, please visit
www.broadlane.com/groupbuyad.html or contact Patricia
Coffey at 866.276.2356, ext. 7520 or patricia.coffey@broadlane.com.
For more information see
THIS LINK.
Wal-Mart will expand in-store medical
clinics
Moving to upgrade its walk-in medical clinic business,
Wal-Mart
is set to announce on Thursday plans for several hundred new
clinics at its stores, using a standardized format and jointly
branded with
hospitals
and medical groups. The first of the new Clinic at Wal-Mart
walk-in centers, as they will be called, is to open in Little
Rock, AR, in April and be run by
nurse
practitioners employed by the St. Vincent Health
System, a three-hospital group in central Arkansas. Wal-Mart
also says it plans to brand 200 of the new clinics with
RediClinics, one of the Revolution Health companies of Steven
Case, the
AOL
co-founder. Those are to be operated in partnership with
various local healthcare providers. RediClinic, which already
operates 13 clinics in Wal-Mart stores, plans to open one of
the new units in Atlanta
in April and another in Dallas
next summer.
“We have learned that people are willing to receive
their healthcare from the front of a store or the back of a
drugstore,” said Dr. John Agwunobi, a medical doctor who is a
Wal-Mart senior vice president. “But customers also have said
they would rather it be delivered by a trusted name, a local
healthcare practice, a trusted local provider of care.”
In all, Wal-Mart plans to have 400 store clinics by
2010, including current units that will be converted to the
new brand as their leases come up for renewal. The company
currently has 78 in-store clinics around the country, but has
had uneven performance in some cases. Wal-Mart does not
operate any clinics itself but is seeking local hospitals and
medical practices as partners, said Deisha Galberth, a
Wal-Mart spokeswoman.
Walk-in medical clinics are a growing industry, with
numerous competitors that include big-box retailers,
drugstores and even grocery chains around the country.
Industry executives say 1,500 to 1,800 clinics will be open by
the end of the year. Propelled by the drugstore chains
CVS
and
Walgreens,
by far the biggest sponsors of the clinics to date, more than
700 clinics have opened in the last 15 months. But the
business model is unproven so far. Few, if any, clinics are
profitable, according to industry analysts, and only a handful
have broken even on daily operations. Most have been open a
year or less, and executives say it takes up to three years
for a clinic to become profitable enough to recover start-up
costs.
Medical societies are inclined to be skeptical of
the clinics. The
American
Academy of Pediatrics opposes them, saying they add
to fragmentation in the healthcare system. Dr. Edward Zissman,
a pediatrician in central Florida, said he had qualms about
hospitals that hook up with the clinics. “Putting their name
on a product that I don’t think has the highest quality,” he
said, “is going to cost them dearly with physicians.”
The American Academy of Family Physicians and the
American
Medical Association have set forth principles for
clinics to observe, including sending patients’ medical record
to their doctors and finding doctors for patients who do not
already have them. Most states require varying degrees of
physician supervision of the clinic nurses. Clinic operators
say they are complying.
Wal-Mart, for its part, rents store space to clinics
operated by eight independent clinic companies and two
hospital systems:
Aurora Health in
Wisconsin and North Broward Hospital District in
Florida.
The company plans to convert all of them to the Clinic at
Wal-Mart brand as those leases expire, Galberth said. (The
New York Times)
See
THIS LINK
Over half all hospital patients are at risk
of venous thromboembolism and need prophylaxis
More than half of all hospital patients are at risk of venous
thromboembolism (VTE), and steps must be taken to ensure that
these patients are given appropriate preventive treatment to
reduce this risk (prophylaxis). These are the conclusions of
authors of an Article published in this week's edition of
The Lancet. VTE is a common complication during and after
hospitalization for acute medical illness or surgery. One type
of VTE, pulmonary embolism, accounts for 5-10% of deaths in
hospitalized patients, making VTE the most common preventable
cause of in-hospital death (VTE results in over 20 times more
hospital deaths than MRSA).
A
US government review comparing 79 hospital preventive
strategies (including hand-washing, antibiotic prophylaxis and
pressure care) has rated VTE prophylaxis as the single most
important strategy, based on efficacy, safety and cost. While
guidelines for VTE prophylaxis have been available for over 15
years, such treatment remains underused, and the proportion of
patients who should receive it globally remains unknown.
Appropriate treatments include anticoagulant drugs such as
heparins and warfarin and mechanical methods such as
intermittent pneumatic compression and graduated compression
stockings.
Dr. Ander Cohen, Vascular Medicine, King's College London, UK,
and Professor Ajay Kakkar, Barts and The London School of
Medicine and Dentistry, London, UK, and colleagues did the
ENDORSE study, which was designed to assess the prevalence of
VTE risk in the acute hospital care setting, and determine the
proportion of at-risk patients who receive effective
prophylaxis. The study analyzed all hospital inpatients aged
40 years or over admitted to a medical ward, or those aged 18
or over admitted to a surgical ward, in 358 hospitals across
32 countries, and assessed them for VTE risk on the basis of
hospital chart review. The 2004
American College of Chest Physicians (ACCP) evidence-based
consensus guidelines were used to assess VTE risk and
determine whether patients were receiving recommended
prophylaxis.
The researchers found that of 68,183 patients enrolled, 30,827
(45%) were categorized as surgical, and 37,356 (55%) as
medical. Using ACCP criteria, 35,329 patients (51.8%) were
judged to be at risk for VTE, including 19,842 (64.4%) of
surgical patients and 15,487 (41.5%) of medical patients. Of
the surgical patients at risk, 11,613 (58.5%) received ACCP-recommended
VTE prophylaxis, compared with 6,119 (39.5%) of at-risk
medical patients.
The proportions of patients receiving ACCP recommended VTE
prophylaxis varied widely across the 32 countries, but did not
necessarily follow the high-middle-low income gradient. For
example, for at-risk medical patients the three countries with
the highest proportions receiving prophylaxis were
Germany (70%), Spain (64%), and Colombia (64%). Those with the
lowest were
Bangladesh
(3%), Thailand (4%), and Romania (18%). In this category, the
US
scored 48% and the UK just 37%. For at-risk surgical patients,
the best performing countries were again Germany (92%),
Hungary (87%) and again Spain (82%); and the worst were again
Bangladesh and Thailand (both 0.2%), and Pakistan (10%). The
UK scored 74% and the US 71%.
The authors say: "The data gathered show that, worldwide, more
than half of all hospitalized patients are at risk for VTE,
and that surgical patients seem to be at higher risk than
medical patients." And, most significantly, they add:
"Furthermore, only half of at risk patients received an ACCP-recommended
method of prophylaxis." They conclude: "Hospital-wide
strategies to assess patients' VTE risk should be implemented,
together with measures that ensure that at-risk patients
receive appropriate VTE prophylaxis."
FDA takes action to stop the marketing of
unapproved injectable drugs containing colchicine
The U.S. Food and Drug Administration announced its intention
to take enforcement action against companies marketing
unapproved injectable colchicine, a drug used to treat gout.
Colchicine is a highly toxic drug that can easily be
administered in excessive doses, especially when given
intravenously. There is a narrow margin between an effective
dose of the drug and a toxic dose that can result in serious
health risks, including death. The FDA is aware of 50 reports
of adverse events associated with the use of intravenous
colchicine, including 23 deaths. Potentially fatal effects
include low blood cell counts, cardiac events, and organ
failure. Individuals and companies must stop making these
products within 30 days and stop shipping the product within
180 days or face regulatory action which could include
seizure, injunction or other legal action deemed appropriate
by the agency. After these dates, all injectable colchicine
drug products must have FDA approval to be manufactured or
shipped interstate.
"Until recently, there was one manufacturer of
unapproved injectable colchicine, and that firm has ceased
manufacturing the product," said Deborah Autor, director of
the FDA's Office of Compliance, CDER. "This serves as the
agency's warning that firms wishing to make injectable
colchicine in the future must not manufacture the product
until they apply for and are granted approval by the FDA to do
so."
In addition to being manufactured by pharmaceutical
companies, injectable colchicine products are sometimes
formulated on a smaller scale by compounding pharmacies, often
for use in the treatment of back pain. Three of the deaths
from intravenous colchicine occurred in March and April of
2007 and were associated with the use of compounded colchicine
that, due to an error in preparation, was eight times more
potent than the amount stated on the label. The FDA has not
approved colchicine in any dosage form for the treatment of
back pain. This action does not affect colchicine products
that are dispensed in tablet form and are frequently used to
prevent gout attacks. For more information, see
THIS LINK.
February 6, 2008 Download print version
Bill aims to protect patients from paying for
hospital errors
Hospital diarrhea germ costs $1.3 billion in
U.S.
Drug-coated stents better than bare-metal ones
in complex cases
TSO3 announces contract with Broadlane
MedAssets expands relationship with Valley
Medical Center
for cash flow and margin enhancement
initiatives
WHO60 photo exhibition: public health over the
past 60 years
Bill aims to protect patients from paying
for hospital errors
The Maine Hospital Association recently announced a voluntary
statewide initiative aimed at preventing patients and
insurance companies from getting billed for the expense of
medical errors such as a bedsore, a medication error or the
wrong surgery. But a state lawmaker says the voluntary policy
doesn’t go far enough and is pushing for an enforceable law
that would make it illegal to charge patients or other payers
for medical missteps that should never have happened in the
first place. "Everyone knows mistakes happen, but that’s no
reason to punish the people they happen to," said Rep. Patsy
Crockett, D-Augusta, sponsor of LD 2044. "The person who makes
the mistake should absorb that cost." By protecting patients
and insurance companies, the measure also would help hold down
spiraling healthcare costs in Maine, she said.
Crockett’s bill, originally submitted to the
Legislature last fall, includes a roster of 27 "never events",
as they’re referred to in the healthcare world, because they
"never" should occur, including surgery performed on the wrong
body part; disability related to the use of contaminated
drugs; injuries suffered by falling, serious burns or
electrical shocks; and reactions to transfusions of
incompatible blood products. The list is drawn from the
National Quality Forum, an organization that promotes accurate
reporting of health care quality data.
The Maine Hospital Association, which represents all
39 hospitals in Maine, announced last Friday that its board
has approved a voluntary measure encouraging hospitals to
protect patients from being billed for costly care related to
preventable errors. The MHA’s list of "adverse health events"
is essentially identical to that included in Crockett’s bill,
with the addition of No. 28, "Artificial insemination with the
wrong donor sperm or egg." The 28th item reflects the most
recent addition to the National Quality Forum list.
Neither Crockett’s proposal nor the MHA policy pertains to
potentially lethal infections such as staph or C. difficile.
Crockett and
Mary Mayhew, vice president of
government affairs and communications for the hospital
association,
concurred that it’s too hard to know whether a patient
contracted an infection during a hospital stay or already was
carrying the infective organism when admitted. (Bangor Daily
News) See
THIS LINK
Hospital diarrhea germ costs $1.3 billion in
U.S.
A bacterial infection
that's acquired in hospitals and causes severe diarrhea costs more than $1.3
billion a year to treat in the U.S., a study found. Each infection of the
bacteria, called clostridium difficile, costs more than $7,000 to treat,
according to the study by researchers at Washington University School of
Medicine and the U.S. Centers for Disease Control and Prevention. It was
published today in the journal Clinical Infectious Diseases.
Clostridium difficile causes about 3 million cases of diarrhea in the U.S.
each year, according to a 2005 report by the American Academy of Family
Physicians, a professional group based in Leawood, Kansas. The emergence of
antibiotic-resistant strains has led to more complications and longer
hospital stays, creating demand for new treatments.
Clostridium difficile
“poses a significant financial burden to our healthcare system and to
society in general,” said Erik Dubberke, an assistant professor at the
Washington University School of Medicine and author of the study. “The true
costs are likely higher than our estimates, as our methods were very
conservative.”
Researchers analyzed the records of more than 24,000 patients
admitted to a hospital in St. Louis, MO, in 2003. Of those,
439 developed clostridium difficile, which affects hospital
patients who have taken antibiotics. Treating the disease in
the hospital cost from $2,454 to $3,240, and follow-up
treatments cost $5,042 to $7,179, the study found.
The |
