February 13, 2009 Download print version

At Wal-Mart, a healthcare turnaround

Researchers crack the code of the common cold; Study also sheds light on the suspected cause of asthma and acute asthma attacks

Delay lets military health fraud suspects off hook

Medicare blow to virtual colonoscopies

San Jose hospital scare linked to sewer gas

Hospitals now using consistent codes to avoid confusion

Atlanta hospital finds Legionnaire’s bacteria

RSS plans cow urine drink to rival sodas, claims it fights diabetes and cancer

At Wal-Mart, a healthcare turnaround

Washington policymakers contemplating a fundamental overhaul of the nation’s troubled healthcare system may want to study the saga of Wal-Mart, reported the Washington Post. Once vilified for its stingy health benefits, the world’s largest company has become an unlikely leader in the effort to provide affordable care without bankrupting employers, their workers or taxpayers in the process. From its headquarters in Bentonville, AR, the retailer is doing in the real world what many in Washington are only beginning to talk about.

At a time when other firms are scaling back or eliminating health coverage, Wal-Mart has made a serious dent in the problem of the uninsured. New figures being released today show that 5.5 percent of its employees now lack health insurance, compared with a nationwide rate of 18 percent.

The company has also put into practice many of the innovations that experts say will lead to higher-quality, more efficient care. Using its high-tech marketing savvy, Wal-Mart has introduced digital records, partnered with prestigious organizations such as the Mayo Clinic, and begun targeting costly health problems such as obesity and premature births.

Yet for all of Wal-Mart’s achievements, the story of its immersion in the world of health policy is also a warning about the depth and breadth of one of the thorniest challenges facing the country today. In attempting to strike a balance between healthy profits and healthy workers, Wal-Mart, like many businesses, still falls short of the comprehensive care that President Obama says he wants for Americans.

To reach near-universal coverage, the largest private employer in the nation relies heavily on the government and other employers to play a role. Of the company’s 1.4 million workers, 52 percent are in a Wal-Mart health plan. Despite revenue that is expected to exceed $400 billion for 2008, the company charges its low-wage workers a substantial portion of their income for medical coverage.

Though proud of what it sees as dramatic progress, Wal-Mart itself warns that in a global market with a weakened economy, it cannot or will not be able to – accept annual healthcare increases of about 8 percent indefinitely. “It starts to impact us competitively,” said Linda Dillman, the company vice president tapped to oversee the health plan.

According to Mark Smith, head of the California HealthCare Foundation, an independent nonprofit focused on healthcare quality and efficiency, “Even a company as big and successful as Wal-Mart cannot possibly solve this problem on its own.” 

In 2006, in the midst of bad press and growing criticism from labor activists over the company’s health plan, then-chief executive Lee Scott appointed Dillman, his technology guru at the time, to take over healthcare.

First, the wait to enroll in the health plan was reduced from two years to one for part-time employees and to six months for full-time workers. By the following year, an additional 50,000 workers were eligible. Next, Wal-Mart put its marketing genius to work, doing sophisticated research on its own personnel. Employees said they wanted more choices, especially low-cost emergency coverage options. Wal-Mart responded with a menu of deductibles, co-payments and maximum out-of-pocket costs. It teamed up with the Internet site WebMD to simplify enrollment, created electronic health records and expanded its $4 generic drug plan from the 350 medications available to customers to more than 2,000 for employees.

Wal-Mart also contracted with the Mayo Clinic for all transplant services, calculating that it could save money by using a single provider with a sterling performance record. Where other medical centers might recommend a heart transplant, for example, Mayo might opt for a simpler valve surgery. The strategy of evaluating various treatments, known as comparative effectiveness research, is gaining currency in policy circles. The economic stimulus bill sets aside $1 billion to pursue it. (Washington Post)
http://www.washingtonpost.com/wp-dyn/content/article/2009/02/12/AR2009021204096.html

Researchers crack the code of the common cold; Study also sheds light on the suspected cause of asthma and acute asthma attacks

Scientists have begun to solve some of the mysteries of the common cold by putting together the pieces of the genetic codes for all the known strains of the human rhinovirus. Researchers at the University of Maryland School of Medicine in Baltimore and colleagues at the University of Wisconsin-Madison have completed the genomic sequences of the viruses and assembled them into a “family tree,” which shows how the viruses are related, with their commonalities and differences. The study was released on the online version of the journal Science (Science Express) on February 12.

The researchers say this work provides a powerful tool that may lead to the development of the first effective treatments against the common cold. “There has been no success in developing effective drugs to cure the common cold, which we believe is due to incomplete information about the genetic composition of all these strains,” said the study’s senior author, Stephen B. Liggett, M.D., professor of medicine and physiology at the University of Maryland School of Medicine and director of its Cardiopulmonary Genomics Program.

“We generally think of colds as a nuisance, but they can be debilitating in the very young and in older individuals, and can trigger asthma attacks at any age. Also, recent studies indicate that early rhinovirus infection in children can program their immune system to develop asthma by adolescence,” said Dr. Liggett, who is a pulmonologist and molecular geneticist.

The researchers found that human rhinoviruses are organized into about 15 small groups that come from distant ancestors. The discovery of these multiple groups explains why a “one drug fits all” approach for anti-viral agents does not work. But, said Dr. Liggett, “Perhaps several anti-viral drugs could be developed, targeted to specific genetic regions of certain groups. The choice of which drug to prescribe would be based on the genetic characteristics of a patient’s rhinovirus infection.”

Dr. Liggett adds that while anti-viral drugs seem to be the most likely to succeed, “the data gathered from these full genome sequences gives us an opportunity to reconsider vaccines as a possibility, particularly as we gather multiple-patient samples and sequence the entire genomes, to see how frequently they mutate during a cold season. That work is underway now.”

The researchers also found that the human rhinovirus skips a step when it makes its protein product, a shortcut that probably speeds up its ability to make a person feel sick soon after infection. 

The analysis shows that some human rhinoviruses result from the exchange of genetic material between two separate strains of the virus that infect the same person. Such a swap, known as recombination, was previously not thought possible in human rhinovirus. During cold season, when many different strains of rhinovirus may be causing infections, recombination could rapidly produce new strains.

Delay lets military health fraud suspects off hook

MADISON, WI -- A dozen defendants who allegedly swindled the military’s healthcare program out of hundreds of thousands of dollars in the Philippines won’t face justice or pay any restitution after authorities failed to arrest them. The U.S. Attorney’s Office in Madison, WI, has dismissed indictments against the suspects – Philippine doctors, spouses of military retirees and one Navy veteran – because of lengthy pretrial delays.

Several of them had confessed to their roles in schemes in the 1990s and early 2000s in which they filed fraudulent claims to the military’s Tricare program, which paid out money to cover health services never provided, court records show. They were indicted between 1999 and 2003 as part of an investigation into widespread Tricare fraud.

But U.S. authorities decided to wait for the suspects to step foot on U.S. soil so they could be arrested but they either never did or weren’t caught. In 2006, prosecutors finally asked the Philippines government to arrest and extradite five of the suspects but those attempts failed.

The 12 cases were dismissed last month after U.S. District Judge Barbara Crabb in November threw out an indictment against a Filipino doctor accused of submitting $2 million in fraudulent claims. Crabb said his right to a speedy trial was violated because investigators waited until 2008 to arrest him when he set foot in Guam, four years after he was indicted. Crabb said the delay made it difficult for the doctor to prepare a defense because the passage of time meant the memories of witnesses had faded. She said prosecutors’ “decision to do nothing for more than four years” wasn’t justified.

Based on that ruling, Assistant U.S. Attorney Peter Jarosz said it was clear he had to dismiss cases against the others. He said it is difficult to quantify the exact amount they were accused of obtaining fraudulently. Court documents suggest it was at least $400,000 but likely more since prosecutors did not file charges for every suspect claim.

Among those getting off the hook is a doctor who told investigators how she would make false claims on behalf of military retirees and their dependents and then give them a portion of the money. She gave investigators two log books filled with the names of patients her clinic had falsely claimed to treat. Also off the hook is a U.S. Navy retiree, who was accused of working with a doctor to submit 21 false claims for him and his dependents totaling $133,000; the wife of a retired Marine who submitted false claims totaling $49,000 for her and her child; the wife of a retired U.S. Air Force serviceman who said she used her windfall to pay for her children’s education.

More than a dozen people have been convicted of Tricare fraud in recent years, including U.S. military retirees. In the biggest case, Health Visions Corp. submitted fraudulent and inflated claims to bilk the U.S. government of $100 million between 1998 and 2004. The company and a former executive have been ordered to pay back the full amount and the government is in the process of trying to recoup some money from the sale of its assets.

A string of internal audits have faulted the Pentagon’s management of Tricare, warning that lax controls make the program vulnerable to fraud overseas. Its managers say they are taking steps to tighten them but note the complexity of a program that provides benefits all over the globe. (The Associated Press) http://www.washingtonpost.com/wp-dyn/content/article/2009/02/12/AR2009021202070.html

Medicare blow to virtual colonoscopies

Medicare has tentatively decided not to pay for virtual colonoscopies, dealing a setback to a technique that some medical experts recommend as a more tolerable alternative to conventional colonoscopy in screening for colon cancer.

The Centers for Medicare and Medicaid Services said in a decision posted on its website that there was “insufficient evidence” to conclude that virtual colonoscopy “improves outcomes in Medicare beneficiaries.” The agency is taking public comments for 30 days before issuing a final decision.

Virtual colonoscopy, formally known as CT colonography, uses noninvasive CT scans, which depend on X-rays to get images of the inside of the colon for polyps. Supporters of CT scans denounced the decision. “It seems to defy logic,” said Dr. Perry J. Pickhardt, associate professor of radiology at the University of Wisconsin, who has consulted for some makers of software used to analyze the CT scans. Dr. Pickhardt said the virtual colonoscopy was “better, safer, faster, cheaper” than conventional colonoscopy.

The cancer society, in partnership with other groups, last year began recommending virtual colonoscopy as one option for colon cancer screening. But the United States Preventive Services Task Force, which advises the government on prevention, said last year that there was insufficient evidence to assess the benefits and harms of the CT technique. Some private insurers pay for the tests; others do not.

CT scans detect larger polyps about as well as colonoscopy, according to Medicare’s analysis. They are not as good at detecting smaller polyps, although there is debate over whether such smaller growths are dangerous.

The CT scans do not require the sedation often used for colonoscopies, and they have a lower risk of bowel perforations. But they still require unpleasant bowel preparation, and they do expose patients to radiation. If polyps are detected, a patient would typically undergo a regular colonoscopy to have them removed.

“Why do a test that will pretty much require another test to be done?” said Dr. John Petrini, president of the American Society for Gastrointestinal Endoscopy. The society, whose members perform conventional colonoscopies, supported Medicare’s decision.

In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare’s older population. For instance, older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater. That would make the CT scan less cost-effective. (NY Times) http://www.nytimes.com/2009/02/13/health/policy/13colon.html?partner=rssnyt&emc=rss

San Jose hospital scare linked to sewer gas

SAN JOSE – The emergency room of Santa Clara County’s busiest hospital was closed for more than four hours Thursday because of a scare involving a man who had been overcome by a byproduct of sewer gas at his home.

The 18-year-old man was brought to Santa Clara Valley Medical Center in San Jose, CA, after being found unconscious in his home on Yucca Avenue after 8 a.m., authorities said. He was not decontaminated before being admitted, and at first authorities had no idea what had felled him.

As a precaution, the emergency department was quarantined, and dozens of people were decontaminated. It reopened around 1 p.m. after investigators determined the man had been overcome by hydrogen sulfide and that there was no risk to the public. (San Francisco Chronicle) http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/13/BANI15SVUQ.DTL

Hospitals now using consistent codes to avoid confusion

Washington hospitals are adopting new communication safety measures so that no matter what medical center a patient is in, “code blue,” for example, means cardiac arrest. The changes result from a survey that discovered at least eight codes were used to call for help when a patient's heart stopped.

“Clearly, this was variation we had to eliminate,” said Carol Wagner, vice president of patient safety for the Washington State Hospital Association.

Hospitals use codes to call for emergency assistance. It’s a way to summon help without alarming patients and visitors. With a fluid job market that leads to staff turnover or even some professionals working at more than one hospital, different code meanings could be confusing.

“When someone calls a ‘code blue’ for a patient going into cardiac arrest, it is vital that a crash team and not the security guards race to the patient's room,” said Larry Schecter, chief medical officer at Providence Regional Medical Center in Everett.

The safety measures are to be implemented by October. Other new measures include: Procedures for isolation precautions that use colors on patient-room doors to indicate contagious diseases. Having these isolation measures in place is considered a key for curbing the spread of Methicillin-resistant Staphylococcus aureus (MRSA); color-coded wristbands that help hospital staff identify things such as allergies; and a surgical checklist that includes a timeout before an operation to reduce errors. (The Seattle Times) http://seattletimes.nwsource.com/html/localnews/2008738429_webhospitals12.html

Atlanta hospital finds Legionnaire’s bacteria

ATLANTA (AP) — Atlanta’s largest hospital has found the bacteria that causes Legionnaire's disease in patients’ rooms, and officials said Thursday it likely sickened four people who were treated there. Lab tests showed legionella bacteria in water samples taken from Grady Memorial Hospital rooms on two floors where the patients came down with the disease since Jan. 1, said Dr. Leon Haley, the hospital’s deputy chief of staff.

Legionnaire’s can be deadly, but was not in these cases. However, 80 beds are off limits while the hospital tests and flushes the water system with hyperchlorinated water. The positive samples were taken from bathroom areas, not air vents. No signs of the bacteria were found in other parts of the hospital, Haley said, adding that nearly 300 samples were taken.

Legionnaires’ disease is a bacterial infection that can cause deadly pneumonia. It does not spread from person to person. Instead, people get it from inhaling contaminated mist or vapor. Tainted shower water, air conditioning systems or whirlpool spas are among the ways the bacteria can get in the air.

The four patients all had been treated at Grady, released, then came down with the disease and returned to the hospital where they were diagnosed. One remains hospitalized.

Grady — a public hospital in downtown Atlanta with about 950 beds — customarily sees only two or three cases of infection with the bacteria each year, officials said. (AP, The Spokesman-Review) http://news.yahoo.com/s/ap/20090212/ap_on_he_me/med_hospital_legionnaires

RSS plans cow urine drink to rival sodas, claims it fights diabetes and cancer

NEW DELHI – A hardline Hindu organization, known for its opposition to “corrupting” Western food imports, is planning to launch a new soft drink made from cow’s urine, often seen as sacred in parts of India. The Rashtriya Swayamsevak Sangh (RSS), or National Volunteer Corps, said the bovine beverage is undergoing laboratory tests for the next 2 to 3 months but did not give a specific date for its commercial release.

The flavor is not yet known, but the RSS said the liquid produced by Hinduism’s revered holy cows is being mixed with products such as aloe vera and gooseberry to fight diseases such as diabetes and cancer.

Many Hindus consider cow urine to have medicinal properties and it is often drunk in religious festivals. “Cow urine offers a cure for around 70 to 80 incurable diseases like diabetes. All are curable by cow urine,” Om Prakash, the head of the RSS Cow Protection Department, told Reuters by phone.

Prakash said the product will be sold nationwide but did not rule out international success. “It is useful for the whole country and the world as well. It will be done through shops and through corporates,” he said.

The Hindu group has campaigned against foreign imports such as Pepsi and Coca Cola in the past, which it sees as a corrupting influence and a tool of Western imperialism.

The Shiv Sena, a hardline Hindu political party also known for attacking what it sees as threats to Indian culture such as Valentine’s Day, started a similar initiative last year to appeal to its powerbase in Mumbai. To promote the food of the native Marathi culture, the Shiv Sena said it was “making a chain like McDonalds” to sell a popular local fried snack. (Reuters Life!, Yahoo) http://news.yahoo.com/s/nm/20090212/india_nm/india379765

February 12, 2009 Download print version

Bone drugs may help fight breast cancer

Health Net agrees to settle rescission lawsuits; Anthem Blue Cross agrees to take back clients, pay $1-million fine

Sobering results for cost-cutting Medicare project

Peanut executive takes the fifth; lawmakers question firm’s president

New hospital first in Atlanta to have state-of-the-art patient education, entertainment system

Tenet to sell USC University Hospital for $275 million

Alpha Source, Inc. / Access Battery, LLC Class 2 battery packs licensed with Health Canada

Reminder to nominate your team for HPN’s 17th annual 2009 CS/SPD Department of the Year award

Bone drugs may help fight breast cancer

A drug of a class commonly used to combat bone loss may reduce by a third the chance that some breast cancers will spread or recur, a large study has found. While it may sound odd to treat cancer with a drug that acts on bone, evidence is accumulating that such drugs may do more than just prevent the loss of bone. Other studies are testing the drugs in patients with prostate or lung cancer.

The new study, published in Thursday’s New England Journal of Medicine, involved 1,803 premenopausal women with tumors that were fueled by estrogen. As part of their treatment, all received drugs that shut down their ovaries, preventing them from making estrogen, along with drugs that stymie cancer cells from using estrogen to grow.

Half also got the bone drug zoledronic acid, or Zometa, as an intravenous infusion twice a year for three years. Those who took the drug had a 36 percent reduction in cancer recurrences and metastases, compared with women who did not get it. After nearly four years, 54 women who received zoledronic acid and 83 who did not had a recurrence of their cancer or had a new cancer in the opposite breast or a metastasis to their bones.

Some cancer researchers said they wanted to see the results from two other large studies of bone drugs and breast cancer before advocating that all women with breast cancer get such drugs. The studies, which include both premenopausal and postmenopausal women, are nearing completion, and their results should be available within the next few years. (NY Times) http://www.nytimes.com/2009/02/12/health/research/12bone.html?_r=1&ref=health

Health Net agrees to settle rescission lawsuits; Anthem Blue Cross agrees to take back clients, pay $1-million fine

Woodland Hills, CA-based insurer Health Net has agreed to pay as much as $14 million to settle a pair of lawsuits brought on behalf of 800 former policyholders whose coverage was dropped after they submitted substantial medical bills. Under the deal, which won preliminary court approval Wednesday, individuals whose health insurance policies were canceled since 2004 are eligible for payments of up to $218,000. The average payment is expected to be $7,836.

The settlement would resolve a class-action lawsuit filed by Claremont lawyer William Shernoff, as well as a suit filed by Los Angeles City Atty. Rocky Delgadillo. In addition to the payments to customers, it requires Health Net to pay a fine of $2 million to the city attorney and to contribute $500,000 to charities.

It follows a two-year crackdown by state regulators on the widespread and controversial practice known as rescission. In deals with regulators, insurance providers Health Net, Anthem Blue Cross and Blue Shield all have agreed to make substantial changes in the way they sell individual coverage in an effort to reduce the number of rescissions. In all, Health Net has agreed to pay more than $40 million to resolve the regulatory actions and litigation over rescission.

Health Net is the only company that has been forced to defend rescission at trial. Nearly a year ago, an arbitration judge awarded $9 million to Patsy Bates, a Gardena hair salon owner whose coverage Health Net dropped after she was diagnosed with breast cancer. The rescission forced her to suspend her chemotherapy treatments for several months.

That was one of 1,600 rescissions that helped Health Net save $35.5 million over several years, according to trial documents. The trial also revealed that Health Net paid bonuses to an employee based in part on how many rescissions she carried out. Health Net stopped those bonuses and, under the settlement, agreed not to reinstate them.

Also, on Wednesday, Anthem Blue Cross, the state’s largest for-profit health insurer, agreed to pay a $1-million fine and offer new coverage – no questions asked – to 2,330 people it dropped after they submitted bills for expensive medical care.

As part of a deal announced by the California Department of Insurance, Anthem also will offer to reimburse those people for medical expenses that they paid out of pocket after they were dropped. The company, a subsidiary of Indianapolis-based WellPoint Inc., estimated that those reimbursements could reach $14 million.

In exchange, the state agreed to drop its prosecution of its accusation that the company broke state laws in the way it rescinded members in preferred provider organization (PPO) policies between 2004 and 2008. (Los Angeles Times) Visit http://www.latimes.com/features/health/la-fi-settle12-2009feb12,0,2086863.story and http://www.latimes.com/features/health/la-fi-bluecross11-2009feb11,0,4156502.story

Sobering results for cost-cutting Medicare project

CHICAGO (AP) — An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn’t work, a government-contracted study found. The disappointing results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many different doctors and sometimes get conflicting medical advice.

Most of the patients had serious, but common, age-related illnesses including diabetes, heart disease and lung disease. Programs were set up at 15 centers around the country. Only two cut the number of times these patients were hospitalized, and those are still in operation. None saved Medicare any money.

Many patients in the study had more than one chronic disease, a common Medicare scenario. Often, these patients need to stop smoking, or lose weight, exercise more, eat healthier foods — a challenge even for generally healthy people. Those changes are especially tough for sick, older patients who often are set in their ways.

Seeking ways to reduce those costs and improve care, the Centers for Medicare & Medicaid Services selected 15 proposals for test-site programs in 2002. The sites developed their own programs, enrolling a total of 18,309 fee-for-service Medicare patients through 2006. About half got the patients got the usual care. The others got more intensive, coordinated care. That often involved nurses who acted as go-betweens, helping doctors give patients clear, appropriate advice; counseling patients on changing bad habits and recognizing worrisome symptoms. The nurses were available on a regular basis by phone or in person to answer patients’ questions.

The study cited two successful programs including a test program run by Health Quality Partners, a nonprofit group in Doylestown, PA, and a still-operating program, at Mercy Medical Center-North Iowa in Mason City, IA, both of which featured close, in-person contact with nurses. In both programs, each patient had face-to-face contact an average of about once a month with a nurse. That was far more frequent personal contact than in other programs. Both reduced hospitalizations — 17 percent yearly compared with usual-care patients at Mercy, and by about 20 percent in the Pennsylvania program, but only among its sicker patients.

Targeting sicker patients and providing frequent in-person contact show the approach has some benefits and that success with future reform efforts “is possible, but it’s not easy,” said study author Randall Brown, a researcher at Mathematica Policy Research Inc., in Princeton, NJ, which was hired to evaluate the programs. The study appeared Wednesday in the Journal of the American Medical Association.

Peter Ashkenaz, a spokesman for the Centers for Medicare & Medicaid Services, said the agency is evaluating the Iowa and Pennsylvania programs to see if their positive results persist. He said there are other approaches being tested, some that offer incentives to doctors who meet quality benchmarks, or who use electronic health records to improve quality. (AP) http://seattletimes.nwsource.com/html/health/2008729522_apmedmedicaredisappointment.html?syndication=rss

Peanut executive takes the fifth; lawmakers question firm’s president

As salmonella illness began spreading across the country last fall, the owner of a Georgia peanut plant that was causing the outbreak railed against the cost and delays that the contamination was causing his businesses, according to internal company documents obtained by Congress.

Stewart Parnell, president of Peanut Corporation of America, also pressed federal regulators to allow him to continue using peanuts from the tainted plant and shipped contaminated products to customers with a homemade certificate that falsely attested to their purity, according to e-mails and memos made public yesterday at a hearing of the House Energy and Commerce Committee.

Parnell, whose Virginia-based company is at the center of a massive food-contamination scandal and a federal criminal investigation, was compelled by subpoena to appear before lawmakers but refused to answer questions.

The e-mails and records also show how Parnell repeatedly tried to get around internal laboratory tests that showed salmonella contamination by sending the samples to a different laboratory for new tests. When confronted with a positive reading for salmonella in October, instead of destroying the tainted product – a standard industry response – Parnell sent it to a different lab and then complained about the delay. “The time lapse, besides the cost is costing us huge $$$$$,” Parnell wrote in an October e-mail to plant manager Sammy Lightsey.

In another e-mail between Parnell and Lightsey, the manager reported that samples from the plant taken on Aug. 11 had tested positive for salmonella but had been sent to another laboratory and received a negative result. “Okay, let’s turn them loose then,” Parnell wrote.

Until last Thursday, Parnell served on an Agriculture Department advisory board on peanut quality. The committee dismissed Parnell yesterday after it was clear he would not answer its questions.

The death toll from the contamination rose to nine yesterday as health officials linked the death of an Ohio woman to the outbreak, which has sickened at least 600 people since September. (Washington Post) http://www.washingtonpost.com/wp-dyn/content/article/2009/02/11/AR2009021104174.html?sub=AR

New hospital first in Atlanta to have state-of-the-art patient education, entertainment system

Imagine waking up after surgery in a spacious, private suite. You realize you’re hungry, so you turn to the interactive display at the foot of your bed to check today’s available meal options. You use that same flat-screen display to take a look at your schedule for the day, and see that you have a physical therapy appointment at 4 p.m. and that your nurse will be by to administer your medications at 5 p.m.

While you’re waiting for your room-service style meal to arrive, you think of a question to ask your doctor. You turn back to the screen and type in your question using the wireless keyboard at your bedside. Your note will display on the screen the next time your doctor comes to your room. You browse through the other options on the screen and decide to review the photos and biographies of the doctors and nurses taking care of you, then you do a quick check of your e-mail.

This patient experience is a reality at The Emory University Orthopaedics & Spine Hospital (EUOSH), which celebrates its grand opening Feb. 12. The hospital aims to set the national standard for patient- and family-centered care, and it is using advanced technology to help it accomplish that goal.

Each of the 45 patient rooms, and several family waiting areas at EUOSH, will have a Cerner CareAware myStation patient education and entertainment system. The Cerner CareAware myStation system gives patients a way to stay engaged with their care by allowing them to access educational materials related to their condition, view their personal health record (PHR), communicate with their caregivers and manage their schedule. The Cerner CareAware myStation is connected directly to the hospital’s Cerner Millennium electronic medical record (EMR). This feature allows doctors to pull up the patient’s chart at the bedside to discuss treatment options and answer questions, involving patients and their loved ones in the care process.

The system can help improve patient safety by allowing patients to see the allergy and medication information EUOSH has on file for the patient. If an allergy or medication isn’t noted, the patient can notify their care team to update their EMR. The Cerner CareAware myStation system also gives patients access to the Internet, movies, music and games to keep them and their families entertained during their hospital stay. Visit here for more information. http://www.globenewswire.com/newsroom/news.html?d=159404

Tenet to sell USC University Hospital for $275 million

Tenet Healthcare Corporation said Tuesday it has signed an agreement to sell USC University Hospital and its Kenneth Norris Jr. Cancer Hospital to the University of Southern California $275 million cash. The Dallas-based healthcare company said $30 million of the sale price will be deferred and placed in an escrow account for up to four years. Tenet’s subsidiaries will retain substantially all of the hospitals’ working capital, which is expected to result in approximately $35 million of incremental cash proceeds, which Tenet said it plans to use “for general corporate purposes.” The deal is expected to close by March 31 and will result in a fourth-quarter impairment charge of approximately $40 million, Tenet said. Visit here for more information. http://www.marketwatch.com/news/story/Tenet-sell-USC-University-Hospital/story.aspx?guid=%7B4BA3BB8D-0D8A-4E7E-8A0C-B10E3214CB0A%7D

Alpha Source, Inc. / Access Battery, LLC Class 2 battery packs licensed with Health Canada

Alpha Source / Access Battery’s Class 2 Battery Packs are now licensed with Health Canada. Licensing from Health Canada authorizes Alpha Source and Access Battery to export Class 2 battery packs used in life support applications such as syringe pumps, ventilators, defibrillators, and infusion pumps for use and sale within the Canadian market.     

Health Canada as compared with the United State’s Federal Drug Administration (FDA) helps protect the Canadian public by researching, assessing and collaborating in the management of the health risks and safety hazards associated with Canadian consumer products. As a part of its function, Health Canada implements a licensing process that ensures Canadian institutions that receive medical devices are receiving products manufactured to the highest quality standards. 

The Alpha Source / Access Battery licensing process took approximately six months and included registering their ISO 13485:2003 Quality System, which was achieved in October 2006. Visit here for more information. http://www.alphasource.com/

Reminder to nominate your team for HPN’s 17th annual 2009 CS/SPD Department of the Year award

The winning Central Service/Sterile Processing Department will be featured on the cover of the May 2009 issue of Healthcare Purchasing News as recognition of the winning department’s outstanding contributions to patient care and to the CS/SPD profession. HPN is looking for entries that tell the story of the many ways that CS/SPD professionals add to the valuable mix of patient care and safety.

Entries will be judged on elements in the following 5 areas:

Customer service – How the department has handled supply processing and distribution for internal customers, including the operating room and nursing floors.

Productivity – How the department has increased output, improved service levels, and enhanced quality, cost savings, and patient benefits.

Teamwork – How well department staff members work together; how they work to make the department greater than the sum of its parts.

Education and training – How well the department prepares staff members to do a safe, cost-effective, efficient job; how well it prepares members for career advancement.

Strategic outlook – Does the department have a strategic plan? What does it entail? What are its elements of innovation, creativity, and originality?

There are no limits on the length of your entry, and it is helpful to document any claims made.

A judging panel of respected central service professionals from across the country, as well as HPN staff representatives and our editorial advisory board, will evaluate each nomination in the five areas above.

For the nomination, highlight as many specific, measurable achievements and goals over the past year. Please don’t forget these elements about the nominated department: name, telephone number, number of full-time equivalents, scope of responsibilities, and number of beds at the facility.

Also, for your nomination to qualify, please be sure to comply with the following rules:

1. Any nomination must be original and exclusive to HPN and not have been submitted – either original or edited – to any other publication or online media outlet currently or within the previous year.

2. GPO, distributor, manufacturer, software company and consultant support is commendable, but we’re looking for internally driven details beyond those contributions.

3. Any nominated organization must be willing to share relevant basic financial details with us (in dollar and/or percentage format), including annual revenues, annual expenses, annual purchasing volume and annual savings.

Deadline for nominations is Monday, March 2, 2009.

Document your accomplishments in these five areas and submit by Monday, March 2 to Editor, Healthcare Purchasing News, 2477 Stickney Point Rd., Suite 315B, Sarasota, FL 34231 Fax: (941) 927-9588 or e-mail: editor@hpnonline.com.

February 11, 2009 Download print version

Reminder on the FDA UDI public workshop tomorrow

Peanut company shuts second plant: Salmonella found at its Texas facility

FDA and SAEC release first data on genetic basis of adverse drug events

Anti-HIV gel shows promise in large-scale study in women

Study proves that practice makes perfect in PCI for heart attack

Stroke therapy window might be extended past nine hours for some

Happy hospitals make happy patients

Lee Memorial Hospital System makes high-tech debut

Reminder on the FDA UDI public workshop tomorrow

The FDA is holding a public workshop Thursday, February 12, 2009, from 9 a.m. to 5 p.m. Registration is full and now closed, however a webcast link is available for you to view. Live Web Cast Link: http://www.ConnectLive.com/events/fdauniquedevice/fda-live.asx

This link will "Go Live" about 15 minutes before the event starts. You will need to open this link at that time to view the webcast.

The FDA is seeking comments, questions and opinions regardless of attendance at the public workshop. Interested persons may submit written or electronic comments to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852. Visit here to send electronic comments http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.regulations.gov.

The deadline for submitting comments regarding this public workshop is February 27, 2009. Received comments may be seen in the Division of Dockets Management between 9 a.m. and 4 p.m., Monday through Friday.

View the Federal Register document and see current considerations on the UDI initiative http://www.fda.gov/OHRMS/DOCKETS/98fr/E9-784.htm

Peanut company shuts second plant: Salmonella found at its Texas facility

A second peanut-processing plant owned by the company at the heart of a nationwide outbreak of salmonella-related illness has been shut down after Texas authorities discovered the bacteria in products there. Late yesterday, Congress issued a subpoena to compel Stewart Parnell, president of Peanut Corporation of America, to appear this morning at a hearing of the House Energy and Commerce Committee. Parnell, 54, of Lynchburg, VA, has stayed out of public view since investigators first traced the contamination to his family-owned company in early January.

The federal investigation into the salmonella outbreak, which has killed eight people and sickened 600 others in 44 states, has centered on the company's Blakely, GA plant, which was shut down last month. Monday night, the company also shuttered its Plainview, TX plant at the request of state health officials after laboratory results showed salmonella in samples of roasted peanuts, peanut meal and granulated peanuts taken last week, said Doug McBride, a spokesman for the Texas Department of State Health Services. Additional analysis is needed to confirm the contamination and determine if the bacteria are the same type of salmonella linked to the outbreak, McBride said.

The bacteria were discovered before the affected granulated peanuts and meal left the Texas plant, but the roasted nuts had already been shipped out of state, McBride said. Company officials notified the distributor Monday night and recalled the roasted peanuts, he said. Texas officials believe none of the contaminated products reached consumers, McBride said.

The list of recalled products, which is updated regularly, can be found at http://www.fda.gov.

The Justice Department has launched a criminal investigation of the company, and several civil lawsuits filed by victims of the outbreak are pending. Meanwhile, the Union of Orthodox Jewish Congregations of America sent a letter to the company yesterday saying it was terminating its kosher certification for all three plants. (Washington Post) http://www.washingtonpost.com/wp-dyn/content/article/2009/02/10/AR2009021001933.html

FDA and SAEC release first data on genetic basis of adverse drug events

The first data offering healthcare professionals a better look into the genetic basis of certain types of adverse drug events was released by the FDA and the International Serious Adverse Event Consortium (SAEC). The data are focused on the genetics associated with drug-induced serious skin rashes, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, and helps better predict an individual’s risk of developing these reactions.
 
Both skin conditions appear as allergic-like skin reactions associated with blistering and peeling, and are considered life-threatening. Medications causing these serious allergic reactions should be discontinued; and if such signs and symptoms are not quickly recognized, these reactions can be fatal.

The SAEC is a nonprofit partnership of pharmaceutical companies, the Wellcome Trust, and academic institutions focused on research relating to the genetics of drug-induced serious adverse events. The consortium will publish its initial research results later this year.

For more information on the International Serious Adverse Event Consortium see www.saeconsortium.org.

For information on the FDA’s Critical Path Initiative see http://www.fda.gov/oc/initiatives/criticalpath/

Anti-HIV gel shows promise in large-scale study in women

An investigational vaginal gel intended to prevent HIV infection in women has demonstrated encouraging signs of success in a clinical trial conducted in Africa and the United States. Findings of the recently concluded study, funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal.

The study investigators found the microbicide gel—known as PRO 2000 (Indevus Pharmaceuticals, Inc., Lexington, MA)—to be safe and approximately 30 percent effective (33 percent effectiveness would have been considered statistically significant). This is the first human clinical study to suggest that a microbicide—a gel, foam or cream intended to prevent the sexual transmission of HIV and other sexually transmitted infections when applied topically inside the vagina or rectum—may prevent male-to-female sexual transmission of HIV infection.

"The study, while not conclusive, provides a glimmer of hope to millions of women at risk for HIV, especially young women in Africa," adds lead investigator Salim S. Abdool Karim, MBChB, Ph.D., from the Center for the AIDS Program of Research in South Africa, who presented the findings at CROI. "It provides the first signal that a microbicide gel may be able to protect women from HIV infection."

Currently, women make up half of all people worldwide living with HIV. In sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV, and in several southern African countries young women are at least three times more likely to be HIV-positive than young men. In most cases, women become infected with HIV through sexual intercourse with an infected male partner. An effective microbicide could provide women with an HIV prevention method they initiate. This would be particularly helpful in situations where it is difficult or impossible for women to refuse sex or negotiate condom use with their male partners. For more information about the HPTN 035 clinical study, see http://www3.niaid.nih.gov/news/QA/HPTN_035_qa.htm.

Study proves that practice makes perfect in PCI for heart attack

When it comes to treating heart attacks, experience matters. New research shows that patients have a much better chance of survival when both their hospital and their physician have a strong track record in treating heart attack with angioplasty and stenting. The new research, published in the February 17, 2009, issue of the Journal of the American College of Cardiology (JACC), found that the risk of dying was cut by nearly half when interventional therapy was performed by an experienced physician in a hospital with plenty of practice in providing the rapid, intense attention that heart attack patients need.

"Even in this day of advanced technology and advanced training, physician and hospital volume still matter, and they matter most in high-risk patients," said V.S. Srinivas, M.B.B.S., an associate professor of clinical medicine at Montefiore Medical Center in New York City. "In coronary interventions, nothing is higher risk than a heart attack."

Today it is widely acknowledged that primary PCI is the safest and most effective treatment for heart attack—provided it can be accomplished quickly. As a result, many communities are establishing primary PCI programs to provide rapid, local care. This trend is raising questions, however. For example, in large cities that already have a primary PCI program, are more programs better for patients, if it means that each hospital and physician performs fewer cases? In smaller communities, can the benefit of having an experienced interventional cardiologist on staff overcome the inexperience of a fledgling primary PCI program that treats only a small number of heart attack patients each year?

Hospitals performing an average of more than 50 primary PCIs each year were defined as high-volume centers, while those performing 50 cases or fewer each year were defined as low-volume centers. Similarly high-volume physicians were defined as those performing more than 10 primary PCIs each year, while low-volume physicians were defined as those performing 10 or fewer cases each year.

Patients who were treated at low-volume hospitals and by low-volume physicians tended to be older and sicker, and to have other characteristics that placed them at higher risk. But even when these factors were taken into account, being treated by an experienced physician in an experienced hospital was clearly associated with better survival after primary PCI.

Overall, in high-volume hospitals, the risk of dying in the hospital was 42 percent lower when compared to low-volume hospitals. Among patients treated by high-volume physicians, the risk of in-hospital death was 34 percent lower overall when compared to patients treated by low-volume physicians.

Stroke therapy window might be extended past nine hours for some

Some patients who suffer a stroke as a result of a blockage in an artery in the brain may benefit from a clot-busting drug nine or more hours after the onset of symptoms. The findings are published in the online edition of Radiology.

The most common type of stroke is called ischemic stroke. These strokes occur when a blood clot blocks a blood vessel supplying blood to the brain. Some ischemic strokes can be treated with thrombolytic, or clot-busting, therapy using tissue plasminogen activator (t-PA), which helps dissolve the blockage. However, the window of opportunity to safely administer the medication is generally considered to be just three hours. Because few patients get to the hospital to be diagnosed and treated within that time frame, fewer than seven percent of patients receive the drug.

In this retrospective study, researchers analyzed the test results of 109 ischemic stroke patients at MGH. The testing methods included two different MRI scanning techniques: perfusion MRI, which measures blood flow in the brain, and diffusion MRI, which measures the movement of water molecules in tissue.

In the study, most patients with blockage in a proximal artery, close to the base of the brain, continued to demonstrate a diffusion-perfusion mismatch between nine and 24 hours after the onset of their strokes.

Happy hospitals make happy patients

Imagine a hospital where morale is high, employee turnover is low and patient call buttons rarely go unanswered - and if they do, you can call the hospital's CEO. That's exactly the type of culture and service that "delights" patients and makes for the most successful community hospitals in the country, as rated by caregivers and patients, says John Griffith, professor in the University of Michigan School of Public Health.

In a newly published report, Griffith examined the attributes of 34 community hospitals in nine states that have earned the Health Care Sector Malcolm Baldrige National Quality Award, a nationally recognized quality benchmark for various industries.

Griffith's findings suggest that the single-biggest factor in patient satisfaction is hospital employee morale, which starts with outside-the-box thinking at the very top management levels. These community hospitals had the happiest patients and caregivers, but only because these hospitals departed radically from traditional hospital management, Griffith says.

For instance, at the Florida hospital where patients receive a welcome letter with the CEO's signature and home phone number, they're also paid a visit by their unit's nurse manager, who also leaves cell and office phone numbers. This personal service doesn't come cheaply, yet the hospitals kept costs low enough to thrive financially on standard Medicare and insurance payments, despite paying employees "extremely well," Griffith says.

Traditionally, hospitals emphasize static domains of authority and don't formally measure performance, goal setting or continuous improvement, the paper said. The shift in management thinking has astonishing results in worker and patient satisfaction, Griffith says.

"The key issue for the patient is the answer to two questions, 'Will you return and will you refer?'" he said. "A loyal patient will do both. These places got that in 90 percent of patients. The usual answer is a little better than half."

The 34 hospitals scored in the top 50 percent in nearly all quality and satisfaction measures and were frequently in the top 10 percent of national rankings, the study shows. They also spend lots of time training employees. Bronson, for example, offers more than two weeks of full-time training to every full-time employee. The national average is no more than one week.

The study, "Finding the Frontier of Hospital Management," appears in the Journal of Healthcare Management. Visit here for the article http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-J249A7

Lee Memorial Hospital System makes high-tech debut

Fort Myers, FL - On March 8, Southwest Florida Regional Medical Center in central Fort Myers and Gulf Coast Hospital, its little sister hospital in south Fort Myers, will merge and create a high-tech hub in a $285 million, 436,000-square-foot addition to Gulf Coast Hospital.

The hospitals belong to Lee Memorial Health System, but the merger and construction plan was drawn by their former owner, Hospital Corporation of America, or HCA. The for-profit sold the two hospitals to Lee Memorial in 2006. As part of the deal, Lee took on the project.

The new owners stuck largely to the plan, tweaking it so the hospital would be easier to expand - the merger results in a loss of 171 beds - and revising the equipment plan so the new hospital got new devices instead of reinstalled ones from Southwest.

Doctors stressed it's the quality of the caregivers that matters most in healthcare, and in that respect nothing is changing. The same faces will staff the merged hospital.

Here are a few highlights: Gulf Coast will be Lee Memorial's first all-digital hospital. No more X-ray films. And that could speed the diagnostic process. Lee Memorial bought two 40-slice CAT scans. Every patient room has a bedside computer, which includes a medication scanner. The two hospitals, under an HCA initiative, debuted the scanners a few years back. Nurses scan a barcode on a patient wrist band to pull up the patient's prescriptions, dosages, time of administration, allergies and related information. They combined and expanded the ER. Waiting rooms are clustered on the first floor. Services are laid out so patients, particularly outpatient ones, can get in and out quickly. Nurses have substations on their floors, minimizing footsteps; supply rooms are identical and color-coded so a nurse, if transferred to another unit, can find what he or she needs immediately. And in the new hospital, the heart catherization and angiogram labs are in one suite. (News-Press)  http://www.news-press.com/article/20090208/NEWS01/902080404/1075

February 10, 2009 Download print version

Prescription pain reliever misuse increases among young adults from 2002 to 2007

Army suspends germ research at Maryland Lab

FDA to place new limits on prescriptions of narcotics

Louisiana hospital empty as debate rages over funds

University of Chicago Hospital fires 450, cuts beds

Link found between influenza, absolute humidity

New guideline for prescribing opioid pain drugs published

B. Braun wins Premier contract for full line of dialysis products 

Prescription pain reliever misuse increases among young adults from 2002 to 2007

Adults aged 18 to 25 currently using pain relievers for non-medical reasons increased from 4.1 percent in 2002 to 4.6 percent in 2007, according to a report based on a series of nationwide surveys. However, this report showed encouraging findings among youths aged 12 to 17 in that non-medical use of pain relievers in the past month had declined from 3.2 percent in 2002 to 2.7 percent in 2007. The report released Monday by the Substance Abuse and Mental Health Services Administration (SAMHSA) says 1.5 million of these young adults used prescription pain relievers nonmedically in the past month in 2007. Overall, 5.2 million people aged 12 years or older reported using prescription pain relievers nonmedically in the past month in 2007. The full report is available at http://oas.samhsa.gov/2k9/painRelievers/nonmedicalTrends.cfm

Army suspends germ research at Maryland Lab

Army officials have suspended most research involving dangerous germs at the biodefense laboratory at Fort Detrick, MD, which the FBI has linked to the anthrax attacks of 2001, after discovering that some pathogens stored there were not listed in a laboratory database. The suspension, which began Friday and could last three months, is intended to allow a complete inventory of hazardous bacteria, viruses and toxins stored in refrigerators, freezers and cabinets in the facility, the Army Medical Research Institute of Infectious Diseases.

The inventory was ordered by the institute’s commander after officials found that the database of specimens was incomplete. In a memorandum to employees last week, he said there was a high probability that some germs and toxins in storage were not in the database.

A spokesman for the institute, Caree Vander Linden, said an earlier review had located all the germ samples listed in the database. But she said some “historical samples” in institute freezers were not in the database, and the new inventory was intended to identify them so they could be recorded and preserved, or destroyed if they no longer had scientific value.

The suspension will interrupt dozens of research projects at the institute, whose task is to develop vaccines, drugs and other measures to protect American troops from germ attacks and disease outbreaks. Vander Linden said some critical experiments involving animals — often used to test vaccines and drugs — would not be halted.

News of the suspension, first reported Monday by the Science magazine blog ScienceInsider, comes as the Justice Department has been interviewing scientists at the Army institute to prepare the government’s legal defense against a lawsuit filed by the family of Robert Stevens, the Florida tabloid photography editor who was the first to die in the 2001 letter attacks.

Before 2001, only a few dozen such facilities worked with anthrax. Today, the Centers for Disease Control and Prevention has registered 219 laboratories to do so, said an agency spokesman. He said 10,474 people had been cleared to work with dangerous pathogens and toxins nationwide after background checks by the Justice Department. (International Herald Tribune) http://www.iht.com/articles/2009/02/10/america/10germs.php

FDA to place new limits on prescriptions of narcotics

Many doctors may lose their ability to prescribe 24 popular narcotics as part of a new effort to reduce the deaths and injuries that result from these medicines’ inappropriate use, federal drug officials announced Monday. A new control program will result in further restrictions on the prescribing, dispensing and distribution of extended-release opioids like OxyContin, fentanyl patches, methadone tablets and some morphine tablets.

These products are classified as Schedule II narcotics and already are restricted according to rules jointly administered by the Food and Drug Administration and the Drug Enforcement Agency. But the current restrictions have failed to “fully meet the goals we want to achieve,” said Dr. John K. Jenkins, director of the FDA’s new drug center.

“What we’re talking about is putting in place a program to try to ensure that physicians prescribing these products are properly trained in their safe use, and that only those physicians are prescribing those products,” Dr. Jenkins said in a news conference on Monday. “This is going to be a massive program.”

Hundreds of patients die and thousands are injured every year in the United States because they were inappropriately prescribed drugs like OxyContin or Duragesic or they took the medicines when they should not have or in ways that made the drugs dangerous. The agency has issued increasingly urgent warnings about the risks, but the toll has only worsened in recent years.

The blame for this is shared among doctors who prescribe poorly, patients who pay little attention to instructions or get access to the medicines inappropriately, and companies that have marketed their products illegally.

The FDA this year will hold meetings with manufacturers, patient and consumer advocates, and the public to ask for advice on how to carry out the new control program, officials announced. The first meeting will be on March 3, and no immediate changes in access to the drugs are planned.

The 24 medicines under review had 21 million prescriptions written for them in 2007, to 3.7 million patients, Dr. Jenkins said. They are extremely effective in reducing pain, which many medical studies suggest is widely undertreated in patients suffering serious illness. (A complete list of the drugs is at www.fda.gov/cder.)

The FDA has received reports of patients’ being prescribed such medicines to treat something as simple as a sprained ankle, he said. In such patients, the medicines can be dangerous. Part of the problem is marketing. Several reports, for instance, have suggested that Purdue Pharma, the maker of OxyContin, helped fuel widespread abuse of the drug by aggressively promoting it to general practitioners not skilled in either pain treatment or in recognizing drug abuse.

The company has denied such a connection, but a holding company connected with Purdue and three top Purdue executives pleaded guilty last year to criminal charges that the company had misled doctors and patients by claiming for five years that OxyContin was less prone to abuse because it was a long-acting narcotic.

Doctors are also to blame. A common reason for disciplinary actions at state medical boards is the use of narcotics in patients who show clear signs of addiction or for whom the drugs are obviously inappropriate. (NY Times) http://www.nytimes.com/2009/02/10/health/policy/10fda.html?partner=rss&emc=rss

Louisiana hospital empty as debate rages over funds

NEW ORLEANS — Ever since Hurricane Katrina washed over this city, Charity Hospital has been an emblem of its misery. The storm left hundreds of patients stranded in sweltering agony, without power and with dwindling supplies of food, water and medicine. Bodies were piled in a stairwell because the morgue was underwater. Charity was the city's biggest public hospital, and it took authorities days to finally get everyone out.

Nearly 3½ years after the flood ended, Charity is still empty. Plans to replace the soaring Art Deco-era hospital with a new one are stalled. Instead, Charity has become perhaps the most notable symbol here of the languid pace of government efforts to rebuild or replace billions of dollars worth of public works wrecked when Katrina and Hurricane Rita hit the Gulf Coast in 2005. Among thousands of projects that still haven't moved forward, none has been as big or contentious as Charity.

The result, says Dr. Kevin Stephens, New Orleans' health director, is that the city lacks a hospital capable of handling the most severe trauma cases and isn't able to train enough new physicians. Without that, he says, the city will keep losing doctors, further straining its healthcare system. The sticking point over Charity's future is money.

Louisiana wants $492 million in federal disaster aid, money it says it needs to replace Charity with a new $1.2 billion teaching hospital and medical complex; the state plans to pay for the rest. The Federal Emergency Management Agency says much of the damage to Charity was caused by years of neglect that disaster aid wasn't intended to fix. Its latest offer was $150 million.

Even that number may be inflated. FEMA engineers identified only about $99 million in storm-related damage to the hospital, which was in poor shape before it flooded. The government tacked on another $51 million, partly out of "a desire to accelerate the recovery of the healthcare system in New Orleans," according to an agency report. Federal law generally limits disaster aid in the government's Public Assistance program to specific repairs.

After Katrina, Charity's doctors worked out of tents. Then they saw patients in shopping centers. They are still in temporary quarters, working out of another hospital near Charity that was hurriedly reopened after Katrina. Reports prepared for the state showed its roof leaked, and critical systems weren't up to code, requiring millions of dollars worth of repairs. Today, the hospital on Tulane Avenue is ringed by an 8-foot-tall chain-link fence topped by barbed wire. Sections of plywood cover windows that have blown out. (USA Today) http://www.usatoday.com/news/nation/2009-02-08-recover-side_N.htm

University of Chicago Hospital fires 450, cuts beds

The University of Chicago’s medical center, Chicago BioMedicine, is firing 450 people, or 5 percent of its staff, to save $100 million a year. The firings, announced in a statement on the center’s website, are in addition to 15 senior managers who were eliminated last month. The cuts were “accelerated by the economy,” the Chicago-based institution said in the statement.

Harvard University in Cambridge, Massachusetts, and Yale University in New Haven, Connecticut, are among Ivy League schools slashing budgets after losses in their endowment funds. Dartmouth College in Hanover, New Hampshire, said it will fire 60 employees, after its endowment value fell $700 million, or 18 percent. About 3.57 million jobs have been lost in the U.S. since the recession began in December 2007, the Labor Department said on Feb. 6.

“We deeply regret the loss of so many talented employees from our team, especially at such a challenging time in the job market,” the medical center’s chief executive officer, James L. Madara, said in the statement.

The medical center also will cut 30 inpatient beds, reduce weekend hours at a surgical unit and redirect non-emergency care patients to other facilities, according to the statement. (Bloomberg) http://www.bloomberg.com/apps/news?pid=20601103&sid=avL6kMB849rA&refer=us

Link found between influenza, absolute humidity

A new study by Oregon researchers has found a significant correlation between "absolute" humidity and influenza virus survival and transmission. When absolute humidity is low – as in peak flu months of January and February – the virus appears to survive longer and transmission rates increase. Results of the study were published this week in the Proceedings of the National Academy of Sciences (PNAS).

Researchers have long suspected a link between humidity and flu transmission and prevalence; however, these efforts have focused on relative humidity, according to lead author Jeffrey Shaman, an Oregon State University atmospheric scientist who specializes in ties between climate and disease transmission. Relative humidity is the ratio of air water vapor content to the saturating level, which itself varies with temperature, while absolute humidity quantifies the actual amount of water in the air, irrespective of temperature.

The PNAS study re-analyzed data from a 2007 study published in PLoS Pathogens, which found a tenuous relationship between influenza transmission and relative humidity. Shaman used the team's research data and substituted absolute humidity for relative humidity in analyzing potential correlations with flu transmission. This effort led to additional investigation of the relationship between absolute humidity and influenza "survival," which is the length of time the virus remains viable once airborne.

"The correlations were surprisingly strong," Shaman said. "When absolute humidity is low, influenza virus survival is prolonged and transmission rates go up." Shaman's co-author on the study is Melvin Kohn, an epidemiologist with the Oregon Department of Health Services.

In general, the study found that there were more infections when it was colder and drier. However, Shaman and Kohn demonstrated that relative humidity could only explain about 12 percent of the variability of influenza virus transmission from these data. In addition, numerous other experiments, dating back to the 1940s, have shown that low relative humidity favors increased influenza virus survival.

However, in their PNAS analysis, Shaman and Kohn demonstrated that relative humidity only explains about 36 percent of influenza virus survival. The Oregon researchers then retested the various data using absolute humidity and found a dramatic rise in accounting for both transmission (50 percent, up from 12 percent) and survival (90 percent, up from 36 percent).

For decades, researchers have been searching for answers as to why there is such a pronounced seasonality of influenza incidence, which peaks during the winter in temperate regions. Potential explanations are that people spend more time indoors and thus transmit the virus more easily; less sunlight may have a chemical effect on the virus and/or people's immune response; or there might be an unknown environmental control. (PhysOrg) http://www.physorg.com/news153423552.html

New guideline for prescribing opioid pain drugs published

A national panel of pain management experts representing the American Pain Society (APS) and the American Academy of Pain Medicine (AAPM) has published the first comprehensive, evidence-based clinical practice guideline to assist clinicians in prescribing potent opioid pain medications for patients with chronic non-cancer pain. The long-awaited guideline appears in the current issue of The Journal of Pain, www.jpain.org.

"This guideline was a true multidisciplinary effort that sought to address in a balanced manner the many challenging issues that clinicians face with regard to when and how to prescribe opioids for chronic non-cancer pain," said Roger Chou, M.D., principal investigator; director of the American Pain Society Clinical Practice Guidelines Program; scientific director of the Oregon Evidence-Based Practice Center at OHSU; and associate professor of medical informatics and clinical epidemiology, and medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.

The expert panel concluded that opioid pain medications are safe and effective for carefully selected, well-monitored patients with chronic non-cancer pain. They made 25 specific recommendations and achieved unanimous consensus on nearly all.

Opioid prescribing has increased significantly due to growing professional acceptance that the drugs can relieve chronic non-cancer pain, and the guideline acknowledges there are widespread concerns about increases in prescription opioid abuse, addiction and diversion.

Opioids, such as morphine, oxycodone, oxymorphone and fentanyl are potent analgesics. They traditionally have been used to relieve pain following surgery, from cancer and at the end of life. Today opioids are used widely to relieve severe pain caused by chronic low-back injury, accident trauma, crippling arthritis, sickle cell, fibromyalgia, and other painful conditions.

Prior to initiating chronic opioid therapy, the guideline advises clinicians to determine if the pain can be treated with other medications. If opioids are appropriate, the clinician should conduct a thorough medical history and examination and assess potential risk for substance abuse, misuse or addiction.

A key recommendation urges clinicians to continuously assess patients on chronic opioid therapy by monitoring pain intensity, level of functioning and adherence to prescribed treatments. Periodic drug screens should be ordered for patients at risk for aberrant drug behavior.

B. Braun wins Premier contract for full line of dialysis products 

B. Braun Medical Inc. announced that it has been awarded a three-year contract by Premier Purchasing Partners, LP for both hemodialysis and continuous renal replacement therapy (CRRT) dialysis products. The contract became effective on November 1, 2008, and offers Premier members access to contracted pricing on B. Braun’s full line of dialysis products. 

B. Braun’s dialysis product line offers a wide array of equipment and disposable products intended to help improve safety and reduce infection. These products include: Diacap Polysulfone dialyzers, DiaLines bloodlines and accessories, Solcart B bicarbonate cartridges, Duosol bicarbonate dialysate solutions for CRRT, catheter injection and dead-end caps, dialyzer reuse products and many other ancillary products for providing hemodialysis and CRRT therapy. Visit www.bbraunusa.com for more information.

Army hospital contacts hundreds in insulin scare

Hospitals often overlook problem of rooftop helipads

How is nonpayment for 'never events' affecting Medicaid?

FDA approves first ablation catheters for the treatment of atrial fibrillation

UnitedHealth and I.B.M. test healthcare plan

Drugmakers' push boosts 'murky' ailment

Study finds pregnancy has no impact on breast cancer survival, delays treatment, diagnosis

Army hospital contacts hundreds in insulin scare

EL PASO — Army medical officials have spoken with nearly 300 patients at risk of developing blood-borne illnesses, including hepatitis and HIV, because of improper insulin injections at a West Texas army hospital.

Officials at the Army’s William Beaumont Army Medical Center announced that as many as 2,114 diabetes patients treated at the hospital since August 2007 could have been infected because of an improper procedure for injecting insulin, the El Paso Times reported.

Hospital officials said Thursday the problem is related to the use of an insulin pen system designed to allow a patient to use the same pen several times. The pens, officials said, were inadvertently used multiple times on different patients.

Though a new sterile needle is used for every injection, health officials said the pens contain a reservoir of insulin that allows for multiple uses and blood could be transferred from the needle to the remaining insulin.

Army officials have insisted that that likelihood of infection is low, citing a study which concluded that in only 4 percent of cases blood traveled from a needle back into the insulin reservoir.

By midday Friday, 289 patients had been contacted and 105 had been tested for various infections, said Beaumont spokesman Clarence Davis. He added “either they called us or we called them.”

It will take three weeks to determine if any of the patients were infected by the flawed injection procedure, which has now been corrected. (Houston Chronicle, AP) http://www.chron.com/disp/story.mpl/front/6251679.html

Hospitals often overlook problem of rooftop helipads

For years, hospital officials across the nation have had to battle helicopter fumes getting sucked into ventilation systems from rooftop helipads. The problem is so well-known that the Federal Aviation Administration warns against placing helipads near a building's air vents. But officials from the Utah-based National EMS Pilots Assn., which includes cautions about the design flaw in a PowerPoint presentation, said the warning is too often overlooked.

"Some hospitals are unaware of the existence of the [FAA's recommendations] and hence are unaware of many of the best practices regarding design, safety and operations," the association said in a position statement submitted to a National Transportation Safety Board hearing earlier this week.

When fumes pour into hospitals, lab tests at several facilities have found that carbon monoxide levels do not approach toxic levels. Nonetheless, the odor can be an unpleasant experience, causing employees and patients to complain. In those cases, facilities managers are asked to take whatever measures they can to solve the problem.

After fumes caused complaints at MetroHealth Center in Cleveland, in the 1990s, technicians installed tiny microphones on the helipad so that when the noise level indicated a helicopter was nearby, air intake vents would automatically shut off, spokeswoman Eileen Korey said. A $100,000 charcoal filtration system was added in 2006, and costs $10,000 a year to maintain.

The system dramatically reduced the odors, but the exhaust continues to waft in from time to time, depending on winds and frequency of flights, Korey said.

At Akron General Medical Center, located about 40 miles south of Cleveland, managers had to take a different approach after carbon filters failed to work. "They just don't work very long. You have to keep replacing them," said Joe Plavecski, senior director of facilities management.

Instead, Plavecski had the air intakes moved higher than the helipad; placed fume sensors near the air handling units to automatically close them when they sense exhaust from an approaching helicopter; and installed a system that automatically switches the air system to temporarily circulate air, instead of pulling fresh air from outside, when helipad lights turn on as a helicopter approaches.

At Ronald Reagan UCLA Medical Center, which opened last year, architects designed an air intake system to keep exhaust from entering the hospital. "Even so, we initially did experience problems with helicopter fumes," spokeswoman Roxanne Yamaguchi Moster said. The hospital had to retrofit four air handlers with carbon filters, designed to absorb the odors, at a cost of $60,000. The filters are expected to last for about a year, and will cost about $3,500 per filter to be replaced. (LA Times) http://www.latimes.com/news/local/la-me-county-usc-helipadsidebar7-2009feb07,0,4538277.story

How is nonpayment for 'never events' affecting Medicaid?

Medicare no longer pays for a list of "never events" occurring after Oct. 1, 2008. State Medicaid payment policies are following suit. In a July 2008 letter to state Medicaid directors, the Centers for Medicaid & Medicare Services (CMS) provided guidance to states related to coordination of state Medicaid payment policies with those adopted by the Medicare program, to prevent payment liability as a secondary payer. According to the letter, nearly 20 states already have, or are considering, methods to eliminate payment for never events.

"States have traditionally been the innovators that Medicare has built off of, such as the Medicaid medical homes model," says Patricia MacTaggart, lead research scientist and associate professorial lecturer in the Department of Health Policy at George Washington University in Washington, DC.

However, the reverse is also true. When Medicare pilots an approach to payment or service delivery, states often leverage the Medicare pilots. "States are positioned to say to their providers, 'Why not?' for Medicaid rather than 'Why?' once the provider is already engaged in the initiative with Medicare," she says.

MacTaggart notes that Pennsylvania Medicaid has a preventable serious adverse events initiative as one component of that state's efforts to promote quality healthcare, building off the broader national focus on preventing medical errors. “This is one of the first states to link nonpayment to preventable serious adverse events," she points out.

In Minnesota, state law requires all hospitals and same-day surgery facilities to report never events, and the Minnesota Department of Health is responsible for producing reports of these. Two years ago, Governor Tim Pawlenty announced an agreement among all hospitals in Minnesota that they would not bill any payer, including Medicaid, for a never event.

Colorado is in the process of establishing a Medicaid list of serious reportable events. According to Jenny Nate, MSW, a health policy analyst with the state's Department of Health Care Policy and Financing, the policy on Medicaid nonpayment to hospitals for serious reportable events has been completed.

New York has a goal to not pay for avoidable complications and errors, using the CMS and National Quality Forum lists as the starting points. As of October 2008, the New York State Medicaid program has stopped reimbursement for three never events, with implementation of 11 other events to follow in early 2009. Hospitals receiving payment under New York Medicaid will be required to provide information on each admission designating which complications were present on admission, and which ones occurred during or as a result of hospital care.

"This information will help the Medicaid program determine when increased payment for complications will be denied," says Deborah Bachrach, Medicaid director and deputy commissioner in the Office of Health Insurance Programs. "Our initiative with respect to never events and preventable complications is one part of an overall goal of paying for value in Medicaid."  (TMC.Net) http://www.tmcnet.com/usubmit/2009/02/07/3971541.htm

FDA approves first ablation catheters for the treatment of atrial fibrillation

The U.S. Food and Drug Administration approved the first ablation catheters for the treatment of atrial fibrillation (uncoordinated contractions of the upper heart chambers), one of the most common types of arrhythmias—or abnormal heart rhythms--affecting more than two million Americans.

The devices approved are the NaviStar ThermoCool saline irrigated radio-frequency ablation catheter and the EZ Steer ThermoCool Nav, can be used to create small, strategically placed scars in heart tissue to block irregular electrical waves that cause atrial fibrillation. The FDA previously approved other ablation catheters to treat arrhythmias such as atrial flutter and ventricular tachyarrhythmia, but not atrial fibrillation.

 “This approval provides physicians with another option for treating this common and potentially debilitating condition,” said Daniel G. Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health.

While atrial fibrillation is a major risk factor related to stroke, there is no conclusive evidence that links the treatment of symptoms by ablation to a reduction in stroke. Therefore, the FDA agrees with the American College of Cardiology, the American Heart Association and the European Society of Cardiology, which recommend that patients at risk for stroke continue to take blood-thinning medications after ablation procedures for atrial fibrillation.

As a condition of approval, manufacturer BioSense Webster must establish a physician training program and conduct postmarket studies to collect data on these devices’ long-term safety and effectiveness (including incidence of stroke, mortality, cardiac arrest, major bleeding, and pulmonary vein stenosis), and the effect of physicians’ experience in operating the device on procedural safety. Both catheters are manufactured by BioSense Webster of Diamond Bar, CA.

UnitedHealth and I.B.M. test healthcare plan

The giant insurer UnitedHealth Group is testing a new model of healthcare that many policy experts say holds great promise but has yet to prove itself. An earlier trial of the model by UnitedHealth, in Florida, never got off the ground because doctors refused to participate. This time, however, the insurer is teaming up with seven doctors’ groups to make another attempt, in Arizona, at the prodding of one of the state’s big employers, I.B.M.

UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization. The insurer will also move away from paying doctors solely on the basis of how many services they provide, and will start rewarding them more for the overall quality of care patients receive.

The new approach, which is also being tested in various guises by other insurers around the country, is known as the “medical home” model of healthcare. Many experts hope it will prove one of the best ways to rein in the nation’s runaway medical costs, while making people healthier. The theory is that by providing a home base for patients and coordinating their treatment, doctors can improve care, prevent unnecessary visits to the emergency room, reduce hospitalizations and lower overall medical spending.

In Florida, UnitedHealth tried a similar experiment about a year and a half ago, only to meet resistance from doctors, who thought they were being asked to shoulder much of the burden with no guarantee the experiment would be successful. The insurer did not closely consult with the doctors in designing the pilot program, and the physicians argued that there was not enough help to pay for any necessary changes like improving their computer systems. The doctors would have received more money only if the pilot project achieved its goals.

In Arizona, where UnitedHealth is I.B.M.’s sole health plan, providing coverage for 11,000 of the company’s employees and their dependents, I.B.M. urged the insurer to give medical homes another try. I.B.M., which paid $21 million last year for its Arizona coverage, is among the nation’s employers that have been increasingly vocal about their dissatisfaction with the health system, in which they pay more money each year, regardless of the quality of the care their employees receive.

Giving patients a medical home is meant to fix some of the major shortcomings of how healthcare is delivered and paid for in this country. Insurers now typically reward doctors for how much they do — how many tests or procedures they perform — rather than how effective their care is. Doctors are not paid to help their patients navigate myriad specialists, and no one is held accountable for making sure that patients’ care is available whenever needed.

The other major component of the experiment involves how physicians are paid. While UnitedHealth will continue to pay doctors based on the services they perform, something around the state average of about $50 for an office visit, the doctors will also receive a quarterly management fee for overseeing their patients’ care. And they will be eligible for bonuses based on quality measures like keeping a patient happy, following established treatment guidelines and being able to avoid hospital stays. (NY Times) http://www.nytimes.com/2009/02/07/business/07medhome.html?_r=1&ref=health

Drugmakers' push boosts 'murky' ailment

(AP) Two drugmakers spent hundreds of millions of dollars last year to raise awareness of a murky illness, helping boost sales of pills recently approved as treatments and drowning out unresolved questions - including whether it's a real disease at all.

Key components of the industry-funded buzz over the pain-and-fatigue ailment fibromyalgia are grants of more than $6 million donated by drugmakers Eli Lilly and Pfizer in the first three quarters of 2008, to nonprofit groups for medical conferences and educational campaigns, an Associated Press analysis found. That's more than they gave for more accepted ailments such as diabetes and Alzheimer's. Among grants tied to specific diseases, fibromyalgia ranked third for each company, behind only cancer and AIDS for Pfizer and cancer and depression for Lilly.

Fibromyalgia draws skepticism for several reasons. The cause is unknown. There are no tests to confirm a diagnosis. Many patients also fit the criteria for chronic fatigue syndrome and other pain ailments. Experts don't doubt the patients are in pain. They differ on what to call it and how to treat it.

Many doctors and patients say the drugmakers are educating the medical establishment about a misunderstood illness, much as they did with depression in the 1980s. Those with fibromyalgia have often had to fight perceptions that they are hypochondriacs, or even faking their pain. But critics say the companies are hyping fibromyalgia along with their treatments, and that the grantmaking is a textbook example of how drugmakers unduly influence doctors and patients.

Whatever the motive, the push has paid off. Between the first quarter of 2007 and the fourth quarter of 2008, sales rose from $395 million to $702 million for Pfizer's Lyrica and $442 million to $721 million for Lilly's Cymbalta.

The drugmakers' grant-making is dwarfed by advertisement spending. Eli Lilly spent roughly $128.4 million in the first three quarters of 2008 on ads to promote Cymbalta, according to TNS Media Intelligence. Pfizer Inc. spent more than $125 million advertising Lyrica.

"The underlying purpose here is really marketing, and they do that by sponsoring symposia and hiring physicians to give lectures and prepare materials," said Dr. Frederick Wolfe, who directs the National Data Bank for Rheumatic Diseases in Wichita, KS.

Many of the grants go to educational programs for doctors that feature seminars on the latest treatments and discoveries. The American College of Rheumatology estimates that between 6 million and 12 million people in the U.S. have fibromyalgia, more than 80 percent of them women. (Washington Post) http://www.washingtonpost.com/wp-dyn/content/article/2009/02/08/AR2009020801008.html

Study finds pregnancy has no impact on breast cancer survival, delays treatment, diagnosis

Young women who develop breast cancer during their pregnancy, or who are diagnosed within one year of their pregnancy, have no difference in rates of local recurrence, distant metastases and overall survival compared to other young women with the disease, according to researchers at The University of Texas M. D. Anderson Cancer Center.

However, the largest single-institution study to look at pregnant breast cancer patients finds that women with Pregnancy Associated Breast Cancer (PABC) are more likely to be diagnosed later with advanced stages of the disease and, thus, have necessary treatment delayed. The findings are published in the March 15 issue of the journal Cancer.

It's estimated that up to 3.8 percent of pregnancies are complicated by breast cancer, and approximately 10 percent of breast cancer patients under age 40 develop the disease during pregnancy, said the researchers. As the age for first and subsequent pregnancies increases and intersects with advances in imaging and screening, this statistic will only continue to climb, explained George Perkins, M.D., associate professor in M. D. Anderson's Department of Radiation Oncology.

In PABC patients, the overall survival in those who received therapy was 78.7 percent, compared to 44.7 percent in those who receive none, though researchers caution that these statistics reflect a small sample size. Regardless, the researchers say it's important to note that there was no difference in the statistic by decade, reiterating there's still progress to be made in terms of diagnosing and treating the disease during pregnancy.

"Women really need to be aware of changes to their breasts that persist, even during pregnancy and to discuss these changes immediately with their doctor," said Perkins. "The study also proves that there's a vital opportunity for physicians to focus on complete breast care during a patient's pregnancy, and should include cancer as a possible diagnosis. Persistent complaints should be monitored aggressively, with breast exams, imaging and biopsy, all being conducted as necessary." 

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