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hpnonline Daily Update


January 27-31, 2014
January 27 January 28 January 29 January 30 January 31

January 31, 2014   Download print version

Poll reveals that 84% of practicing physicians haven’t received enough information on the ACA

More than 7,100 deaths likely from states' rejection of Medicaid expansion: Health Affairs Blog

Kimberly-Clark deadline for the 2014 HAI WATCHDOG Awards

Medicare’s delivery system reform initiatives achieve significant savings and quality improvements - off to a strong start

Obesity is found to gain its hold in earliest years

CDC panels establish anthrax prevention, treatment guidelines

Why some flu viruses may be more contagious

Oncologists call for single-payer system

Poll reveals that 84% of practicing physicians haven’t received enough information on the ACA

QuantiaMD, the largest social learning network for physicians, developed by Quantia, Inc., conducted a recent poll of its members in order to understand physician perspectives regarding the implementation of the Affordable Care Act. Despite millions of enrollees, individuals and doctors remain confused about the law – a troubling fact as many patients look to their physicians as a primary resource on healthcare policy.

The poll garnered responses from 1,265 physicians from around the country and opened up a dialog about the ACA. Results of the study included:

·         84% of physicians said they did not feel like they had enough information on the ACA to serve as a reliable resource to their patients.

·         81% of physicians don’t feel they have enough information on the ACA to understand its impact on their practice and comply with its requirements.

·         When asked where they get the most reliable information about the ACA, the majority (35%) of physicians responded saying there aren’t any reliable sources of information.

·         79% said they would use an HHS-produced FAQ with their patients if such a resource were available.

The QuantiaMD faculty is comprised of 1,000 leading experts from US News & World Report Top 20 “Honor Roll” hospitals. A typical physician now spends 20 minutes per session consuming content and interacting with peers on QuantiaMD, making it an ideal platform to communicate and share knowledge. Nationwide, 1 in 3 physicians visits QuantiaMD each quarter. Additionally, more than 50% of members visit QuantiaMD on a mobile device. (BusinessWire) Visit Yahoo for the report.


More than 7,100 deaths likely from states' rejection of Medicaid expansion: Health Affairs Blog

Harvard and CUNY researchers say the death toll from 25-states ‘opting-out’ may be as high as 17,100 annually; hundreds of thousands more will be harmed by depression, untreated diabetes, and skipping mammograms and pap smears.

The decision by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act will result in between 7,115 and 17,104 more deaths than had all states opted in, according to researchers at Harvard Medical School and the City University of New York.

The study, the first detailed estimate of the health impact of the states’ decision to reject the Medicaid expansion (with state-by-state data as well), has been published at the Health Affairs Blog.

The researchers found that because of the states’ “opting out” of the Medicaid expansion, 7.78 million people who would have gained coverage will remain uninsured. In addition to the thousands of excess deaths associated with that lack of coverage, the rejection of the Medicaid expansion will have the following likely impacts:

·         712,037 more persons diagnosed with depression

·         240,700 more persons suffering catastrophic medical expenses

·         422,533 fewer diabetics receiving medication

·         195,492 fewer women receiving mammograms and

·         443,677 fewer women receiving pap smears

“We calculated the number and characteristics of people who will remain uninsured as a result of their state’s opting out of the Medicaid expansion, and applied these figures to the known effects of insurance expansion from prior studies,” said Samuel Dickman, a third-year medical student at Harvard Medical School and the study’s lead author.

“The results were sobering. Political decisions have consequences, some of them lethal.”

Dickman and his colleagues, longtime health researchers at Harvard Medical School and the City University of New York, drew on demographic data from the Census Bureau’s 2013 Current Population Survey and estimates on Medicaid take-up rates from the Congressional Budget Office and elsewhere to characterize those who would remain uninsured in states opting out of Medicaid expansion.

They developed estimates of the health effects of remaining uninsured based on previous studies that used state-level data on Medicaid expansions and death rates, the National Health and Nutrition Examination Survey Mortality Follow-up, and the Oregon Health Insurance Experiment.

In addition to arriving at national estimates, the researchers were able to break the findings down by state.

For example, in Texas, the largest state opting out of the Medicaid expansion, approximately 2 million people who would otherwise have been insured will remain uninsured as a result of the state’s action.

"Texas' refusal to accept federal money to expand Medicaid will result in 184,192 more people experiencing depression, 62,610 more people suffering catastrophic medical expenses, and as many as 3,035 avoidable deaths,” said Dr. Steffie Woolhandler, a professor of public health at the City University of New York who is also on the faculty at Harvard Medical School.

The study includes a table showing expected excess deaths and other harms from opting out of the Medicaid expansion on a state-by-state basis.

“Medicaid is far from perfect,” said Dr. David Himmelstein, who also teaches at CUNY and Harvard. “In many parts of the country Medicaid pays so little that patients have trouble finding a doctor who will accept it. A single-payer program like Canada’s that covers all Americans is a far better solution for both the poor and the middle class. But until we get to single payer, Medicaid is the only safety net for many low-income Americans.”

A link to the study at the Health Affairs Blog is available here.


Kimberly-Clark deadline for the 2014 HAI WATCHDOG Awards

Healthcare facilities continue to make strides in preventing HAIs, thanks to innovative and effective techniques of dedicated healthcare professionals. Kimberly-Clark created the HAI WATCHDOG Awards in recognition of HAI champions who are making a difference in reducing and preventing these serious, often life-threatening infections.

The 2014 HAI WATCHDOG Awards are now open.

Check out the 2013 HAI WATCHDOG Award winners and honorable mentions in your region Congratulations to all those who participated!


First place:

·         More than 300 Beds: UC Davis Medical Center

·         Patient HAI Education Initiative: Huntsville Hospital

·         Environmental Services: NYU Langone Medical Centers

·         Fewer Than 300 Beds: Wilmington Hospital, Christiana Care Health System

·         Health System: Christiana Care Health System

Honorable mentions:

·         Fewer Than 300 Beds: Methodist Willowbrook Hospital

·         Clinician’s Choice: Specialty Hospital Washington, Hadley

·         Health System: Georgia Regents Medical Centers

·         More than 300 Beds: Lakeridge Health Oshawa

 Visit Kimberly-Clark for more information.


Medicare’s delivery system reform initiatives achieve significant savings and quality improvements - off to a strong start

The Centers for Medicare & Medicaid Services (CMS) released findings on a number of its initiatives to reform the healthcare delivery system.  These include interim financial results for select Medicare Accountable Care Organization (ACO) initiatives, an in-depth savings analysis for Pioneer ACOs, results from the Physician Group Practice demonstration, and expanded participation in the Bundled Payments for Care Improvement Initiative.  Savings from both the Medicare ACOs and Pioneer ACOs exceed $380 million.

While ACOs are designed to achieve savings over several years, not always on an annual basis, the interim financial results released today for the Medicare Shared Savings Program ACOs show that, in their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first 12 months, 29 generated shared savings totaling more than $126 million – a strong start this early in the program.

In addition, these ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. ACOs share with Medicare any savings generated from lowering the growth in health care costs while meeting standards for high quality care. Final performance year-one results will be released later this year.

While evaluation of the program’s overall impact is ongoing, the interim results are currently within the range originally projected for the program’s first year. A great majority of the program’s overall net impact was projected to phase-in over the program’s ensuing performance years. Moreover, through regular webinars; tools for sharing information and best practices; opportunities for ACOs to connect with one another; and other activities, ACOs are being provided the infrastructure and resources to learn from one another and to then diffuse what’s working and what is not.

“Our experience has shown that ACOs can increase quality while lowering costs. As a result of the programs we’ve initiated, our patients have experienced better access to their primary care physician, higher quality measures, and fewer trips to the hospital,” said Dr. Kenneth W. Wilkins, president of Coastal Carolina Health Care. “We look forward to making continued progress and seeing future results, and we are grateful to CMS whose advance funding made these initiatives possible.”

“We are delighted to be participating in the Shared Savings Program because of its goal to reduce costs while simultaneously increasing the quality of care and services we provide to our patients and community,” said Dr. John B. Chessare, president and chief executive officer of the Greater Baltimore Medical Center (GBMC) HealthCare system. “The Shared Savings Program is a tangible reminder of the historic transformation taking place in our health care system and we are pleased to be a part of it.”

An independent preliminary evaluation of the Pioneer ACO Model - the ACO model designed for more experienced organizations prepared to take on greater financial risk –also released today shows Pioneer ACOs generated gross savings of $147 million in their first year while continuing to deliver high quality care. Results showed that of the 23 Pioneer ACOs, nine had significantly lower spending growth relative to Medicare fee for service while exceeding quality reporting requirements. These savings far exceed findings from a previous analysis conducted by CMS, which used a different methodology. 

“We are still early on in the program, but are encouraged by these results and are on track to meet our goals for participation in the Pioneer Accountable Care Organization Model”, said Dr. Barbara Walters, executive medical director for accountable care, with the Dartmouth-Hitchcock ACO.  “Our strategies of using patient outreach and education and regular follow up for targeted chronic disease programs are allowing us to anticipate patient needs before their health problems become worse. Involvement in the Pioneer Model is helping us provide better treatment for our patients across a wide-range of health challenges.”

CMS also released results for the Physician Group Practice Demonstration initiatives, which offered incentive payments for delivering high-quality, coordinated healthcare that generates Medicare savings. The Physician Group Practice Demonstration evaluation report confirmed overall savings over the 5 year experience with 7 out of 10 physician group practices earning shared savings payments for improving the quality and cost efficiency totaling $108 million over the course of the Demonstration. The participating organizations consistently demonstrated high quality of care on a broad range of chronic disease and preventive care measures.

CMS announced that 232 acute care hospitals, skilled nursing homes, physician group practices, long-term care hospitals, and home health agencies have entered into agreements to participate in the Bundled Payments for Care Improvement initiative. Bundling payment for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement, is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients, both when they are in the hospital and after they are discharged.

To learn more about the ways HHS is working to reform the healthcare delivery system visit here.

To learn more about the Bundled Payments for Care Improvement initiative, including program participants, visit here.

To learn more about the Medicare Shared Savings Program visit here.

To learn more about Pioneer ACOs visit here.

To learn more about the Physician Group Practice Demonstration visit here.


Obesity is found to gain its hold in earliest years

For many obese adults, the die was cast by the time they were 5 years old. A major new study of more than 7,000 children has found that a third of children who were overweight in kindergarten were obese by eighth grade. And almost every child who was very obese remained that way.

Some obese or overweight kindergartners lost their excess weight, and some children of normal weight got fat over the years. But every year, the chances that a child would slide into or out of being overweight or obese diminished. By age 11, there were few additional changes: Those who were obese or overweight stayed that way, and those whose weight was normal did not become fat.

“The main message is that obesity is established very early in life, and that it basically tracks through adolescence to adulthood,” said Ruth Loos, a professor of preventive medicine at the Icahn School of Medicine at Mount Sinai in New York, who was not involved in the study.

These results, surprising to many experts, arose from a rare study that tracked children’s body weight for years, from kindergarten through eighth grade. Experts say they may reshape approaches to combating the nation’s obesity epidemic, suggesting that efforts must start much earlier and focus more on the children at greatest risk.

The findings, published Thursday in The New England Journal of Medicine, do not explain why the effect occurs. Researchers say it may be a combination of genetic predispositions to being heavy and environments that encourage overeating in those prone to it. But the results do provide a possible explanation for why efforts to help children lose weight have often had disappointing results. The steps may have aimed too broadly at all schoolchildren, rather than starting before children enrolled in kindergarten and concentrating on those who were already fat at very young ages.

Previous studies established how many children were fat at each age but not whether their weight changed as they grew up. While valuable in documenting the extent of childhood obesity, they gave an incomplete picture of how the condition developed, researchers said.

The study involved 7,738 children from a nationally representative sample. Researchers measured the children’s height and weight seven times from kindergarten to eighth grade. When the children entered kindergarten, 12.4 percent were obese — defined as having a body mass index at or above the 95th percentile — and 14.9 percent were overweight, with a B.M.I. at or above the 85th percentile. By eighth grade, 20.8 percent were obese and 17 percent were overweight. Half of the obese kindergartners were obese when they were in eighth grade, and nearly three-quarters of the very obese kindergartners were obese in eighth grade. The risk that fat kindergartners would be obese in eighth grade was four to five times that of their thinner classmates, the study found.

Steven L. Gortmaker, a professor of the practice of health sociology at the Harvard School of Public Health, said he saw a bright side to the findings. Young children, he said, can cross a line between being fat or normal weight by gaining or losing just a few pounds. For adults, it can be 20 to 30 pounds, or even 40 to 50 pounds.

And, he said, a number of randomized studies involving young children have shown that it is possible to stop or reverse excess weight gain. One, for example, had some fat children ages 4 to 7 reduce their television and computer viewing time, and had others keep theirs the same. Children in the intervention group — especially those from poorer families — consumed fewer calories, and their body mass index fell.

But effective programs for young children involve time and effort, and the costs are not reimbursed by health insurers, said Denise Wilfley, an obesity researcher at Washington University in St. Louis. “We can effectively treat these children,” Dr. Wilfley said. But other than entering children in research studies, parents can get help only by paying out of their pocket — about $1,500 to $3,000 for an intervention that usually lasts a year. Visit the New York Times for the study.


CDC panels establish anthrax prevention, treatment guidelines

The CDC recently updated its guidelines for anthrax postexposure prophylaxis and treatment, and also drafted guidance relating specifically to pregnant and postpartum women in the setting of anthrax exposure during a bioterrorist attack.

The CDC’s Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults included anthrax and critical care experts based on recommendations from the CDC, NIH, FDA and university medical centers.

The panel determined that the initial assessment of patients with suspected anthrax should prioritize obtaining pretreatment blood samples and other cultures. The panel also recommended that hemodynamic monitoring should be maintained, including continuous pulse oximetry and telemetry, for patients hospitalized with suspected anthrax. Patients with inhalation anthrax may require mechanical ventilation for breathing difficulties or airway swelling.

The experts advised that anyone exposed to inhalation Bacillus anthracisspores should undergo a 30-day postexposure prophylaxis (PEP) regimen of antimicrobial drugs, regardless of vaccination status. Oral doxycycline and ciprofloxacin are the first-line antimicrobial treatments for anthrax PEP.

The panel members said antitoxin drugs such as raxibacumab (GlaxoSmithKline) and anthrax immune globulin also appear to be effective; however, antimicrobial drugs are effective alone if given early enough in the disease process.

For anthrax cases in which anthrax meningitis is suspected, the panel recommended treatment with at least three antimicrobial drugs. The drugs of choice are ciprofloxacin, meropenem and linezolid (Zyvox, Pharmacia & Upjohn).This IV combination treatment should be maintained for at least 2 weeks or until the patient’s symptoms have stabilized.

The panel members said anthrax vaccine adsorbed is a possible agent of seroconversion and could be given at diagnosis and at 2 and 4 weeks after diagnosis. However, it is not FDA approved for PEP but may be available under an investigational new drug protocol or emergency use authorization.

In the clinical information update for physicians specifically dealing with pregnant, postpartum and lactating women, the CDC panel — in a separate meeting consisting of a compendium of experts in obstetrics, infectious disease and maternal fetal medicine — discussed established guidelines for this unique population because it may require different treatment protocols for anthrax.

One deviation from protocol is that doxycycline is contraindicated in pregnancy due to a small risk for orofacial clefts in the fetus. Ciprofloxacin is the suggested first-line antimicrobial for pregnant women. Some panel members suggested that higher antimicrobial drug doses might be indicated for this patient demographic.

The experts also recommended a maternal regimen of corticosteroids to reduce the risk of preterm labor and improve fetal outcome. Visit Healio for the guidelines.


Why some flu viruses may be more contagious

Some influenza viruses can survive and remain infectious on the fingertips for at least 30 minutes, long enough to transmit the flu to oneself or others, says a study in the January issue of Clinical Microbiology and Infection.

Flu is transmitted from person to person mainly by inhaling tiny virus particles that are released into the air when infected individuals cough and sneeze. Direct contact with contaminated fingers is considered an equally important method of transmission. Researchers sought to find out if the type or size of the flu virus affects its survival.

Experiments in Geneva involved two common influenza viruses: H3N2 and H1N1, the virus that triggered a global flu pandemic in 2009. Both viruses are included in the 2013-14 flu vaccine and are causing most of the world's current flu illnesses, according to a recent World Health Organization bulletin.

Six volunteers with experience handling laboratory viruses were recruited. In separate experiments, droplets of H3N2 and H1N1 mixed with respiratory secretions from infected patients were deposited on three fingertips of each volunteer. The subjects' fingers were undisturbed and kept at room temperature before testing for the presence of viral particles at various intervals. Particles were classed as "survived" if they were capable of propagating in laboratory cell cultures.

Both flu viruses were infectious on all 18 fingers after one minute. At three minutes, H3N2 was infectious on six fingers while H1N1 remained infectious on 15. At five minutes, H3N2 and H1N1 were infectious on five and eight fingers, respectively. H1N1 remained infectious on five fingers after 15 minutes compared with four fingers contaminated with the H3N2 virus. After 30 minutes, the number of infectious fingers dropped to two for each virus.

Larger droplets of H3N2 and H1N1 were found to contain a higher concentration of viral particles and remained infectious longer than smaller droplets with fewer particles. But smearing flu droplets over the fingertip reduced their infectiousness compared with untouched droplets, the study found. H1N1 appeared to be hardier than H3N2, the researchers said. Visit the Wall Street Journal for the article.


Oncologists call for single-payer system

Oncologists have a "moral and ethical obligation" to their patients to advocate for a single-payer universal health insurance program, according to two oncologists who stated their case in an editorial.

A single-payer system would simplify healthcare delivery for patients and providers without sacrificing quality of care, said Ray Derasga, MD, and Lawrence Einhorn, MD, in an editorial published online in the Journal of Oncology Practice, a journal of the American Society of Clinical Oncology.

The switch to such a national system would face huge and innumerable challenges, but gradual implementation, perhaps even on a state-by-state basis, would reduce the administrative burdens, they wrote.

"Because the [Affordable Care Act or ACA] will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over care giving, we cannot in good conscience stand by and remain silent," said Derasga, a retired oncologist in Chicago, and Einhorn, of Indiana University in Indianapolis.

Derasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:

·         Reduced administrative costs, which currently account for almost a third of healthcare expenditures

·         Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report

·         Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%

·         Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded

·         Implementation of proven cost-containment strategies, which are absent from the ACA

·         Improving quality of care and outcomes by increasing access to care

·         Reverse the trend toward for-profit, investor-owned healthcare plans

·         Preserve physician's income potential, as judged by experience with the Canadian healthcare system

The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.

The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.

"Lower drug prices would not jeopardize drug innovation," Derasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research."

The issue of drug pricing is especially relevant to oncology, they added, where the median cost of a new drug has risen to $10,000 a month since 2010. The authors called on ASCO to lead the way in advocating for a single-payer system, which would orient healthcare "toward care giving, not toward maximizing investors' profits."

ASCO has taken no position on a single-payer or other type of healthcare system, said ASCO chief executive officer Allen Lichter, MD.

"We have long advocated that every American deserves to have insurance coverage," Lichter told MedPage Today. "We have advocated that those patients who receive a new cancer diagnosis and don't have insurance should be placed into Medicare because facing a cancer diagnosis without insurance lowers your risk of survival, as Dr. Derasga and Dr. Einhorn pointed out in their paper."

Coinciding with the Derasga-Einhorn editorial, ASCO and the Community Oncology Alliance (COA) jointly issued principles for achieving payment reform in oncology.

The six principles focus on:

·         Oncologists taking a leadership role in payment reform

·         The inadequacy of current reimbursement models

·         The need for new models for delivering oncology services to ensure high quality and value

·         Retaining choices in payment models at the local level

·         Improved measurement of quality

·         The inadequacy and inequity of reimbursement for oncology drugs under Medicare Part B

The editorial provides "a good look at Nirvana," but most community-based oncologists would find it difficult to embrace, said Mark Thompson, MD, president of the COA, which represents community oncology practices and centers.

Strong opposition to a single-payer system is to be expected because a lot of money is at stake, Drasga told MedPage Today. Several academic oncologists turned down Derasga's offer of co-authorship before Einhorn accepted.

Nirvana or not, the single-payer approach is coming, Derasga continued. Vermont has set the process in motion by starting implementation of a state-run single-payer system. Total implementation is anticipated by 2017.

The Vermont program is envisioned as "kind of a Medicare for all, but at the state level," said Deb Richter, MD, a primary care physician from Montpelier who also is on the board of directors of Green Mountain Care, the organization coordinating implementation of the state's single-payer plan. Visit MedPage Today for the article.


January 30, 2014   Download print version

Comparing quality and prices among hospitals

Severe sepsis mortality rate lower in hospitals with higher case volumes

New benefits come with Obamacare

Guns sent 20 children to U.S. hospitals every single day, study finds

Infection control practices not adequately implemented at many hospital ICUs: study

How vaccine fears fueled the resurgence of preventable diseases

Deloitte invites Medical Device Manufacturers to a UDI Roundtable

Do doctors spend too much time looking at computer screen?

Antibiotics in animals tied to risk of human infection

Comparing quality and prices among hospitals

With the development of tools such as Hospital Compare, consumers have more ways to contrast the costs and quality of different hospitals. A new study, being released as a Web First by Health Affairs, explored why some hospitals are more successful at negotiating higher prices than nearby competitors--and linked hospital-specific negotiated private prices with detailed information of hospital characteristics. The study found that high-price hospitals averaged 474 staffed beds--more than double the average number of beds in the low-price hospitals--and had market shares about three times as large as those of low-price hospitals.

The high-price hospitals were almost three times as likely to be teaching hospitals, were much more likely to offer specialized facilities and services, and received significantly higher revenues from sources other than patient care. In national rankings of hospitals' reputations, high-price hospitals scored higher, but clinical outcomes measures were mixed. High-price hospitals performed better on one measure of mortality (for patients with heart failure), but performed worse than the low-price hospitals on measures of excess readmissions and on patient-safety indicators, including postsurgical deaths and complications.

The study, "Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs", is by Chapin White, James D. Reschovsky, and Amelia M. Bond. White is affiliated with RAND; Reschovsky is with Mathematica Policy Institute; and Bond is a PhD candidate at the Wharton School of the University of Pennsylvania. The study, which was funded by the National Institute for Health Care Reform, will also appear in the February issue of Health Affairs.

The study used 2011 facility claims for current and retired autoworkers and their dependants in ten US metropolitan markets. There were a total of 110 hospitals evaluated in the study, based on 24,187 inpatient stays.

"Insurers may face resistance if they attempt to steer patients away from high-price hospitals because they have good reputations and offer specialized services that may be unique in their markets," concluded the authors. "More radical approaches--such as state-based rate setting or restrictions on contracting arrangements between hospitals and health plans--may gain traction."

Visit Health Affairs for the study.


Severe sepsis mortality rate lower in hospitals with higher case volumes

“In the absence of novel therapeutics, processes of care are important determinants of outcomes in patients with severe sepsis,” study researcher Allan J. Walkey, MD, MSc, of the Boston University School of Medicine, told Infectious Disease News. “Whether academic hospitals with more experience caring for severe sepsis patients have better patient outcomes is currently unclear.”

The retrospective cohort study gleaned data related to US-based sepsis hospitalizations in 2011 from the University HealthSystem Consortium clinical database. Researchers accessed information from 124 academic medical centers and utilized the consortium standardized mortality index to quantify severe sepsis mortality.

Hospital features such as the number of acute care beds, ICU structure, long-term acute care hospital referral practices and geographic location were documented. For severe sepsis cases, the researchers also compiled data pertaining to hospital length of stay, direct costs and mortality.

The researchers identified for analysis 56,997 adult patients aged 18 to 95 years. Severe sepsis case volumes were calculated using algorithms from the ICD-9-CM. B-spline regression was used to determine the unadjusted association between severe sepsis case volume and severe sepsis-related mortality, whereas multivariable analysis of covariance models were used to determine the adjusted correlation between quartiles of severe sepsis case volume and severe sepsis death.

Researchers found that during 2011, hospitals admitted patients with severe sepsis, with a median length of stay of 12.5 days. The median direct cost was $26,304, and the average hospital mortality rate was 25.6. An association was seen between higher severe sepsis case volume and lower unadjusted severe sepsis mortality, as well as between higher case volume and risk-adjusted severe sepsis mortality.

Hospitals in the highest quartile of severe sepsis case volume were found to have an absolute 7% lower hospital mortality than those in the lowest quartile, after adjusting for geographic region, number of beds and long-term acute care referrals.

The researchers theorized that hospitals with more severe sepsis cases — and therefore more experience — may become more skilled in the care of these patients.

“Further studies that seek to determine the specific structures and processes of care associated with improved outcomes at the high volume hospitals are needed to reduce the disparities in severe sepsis outcomes at lower severe sepsis case volume centers,” Walkey and colleagues wrote.

Visit Healio for the study.


New benefits come with Obamacare

People who buy health insurance as on their own are seeing big changes as their coverage gets more comprehensive this year. The Affordable Care Act, also known as Obamacare, requires that all new plans offered in 2014 cover a set of "essential health benefits," some at no cost to enrollees.

The benefits are modeled after those typically offered by large employers and fall into 10 broad categories: outpatient care; emergency care; hospitalization; maternity and newborn care; mental-health services and addiction treatment; prescription drugs; rehabilitative services and devices; laboratory, preventive and pediatric services. That's good news for the 14 million people who buy individual insurance, a number that's expected to rise substantially in coming years, health-policy experts say.

One of the biggest gains is maternity care. Before Jan. 1, women who bought individual insurance policies typically found that plans excluded pregnancy or offered them a rider to cover it that was prohibitively expensive, says Karen Davenport, director of health policy for the National Women's Law Center, a nonprofit group in Washington.

Now all new health plans, whether in or out of the insurance exchanges, must cover pregnancy, labor and delivery. And prenatal visits are considered well-woman preventive-care visits that are covered at no charge to enrollees. Coverage extends not just to the policyholder but to dependents as well.

Nearly four million people who buy health plans on their own will gain coverage for mental-health care, substance-use disorder or both, according to federal estimates.

The list of preventive-care benefits available at no cost to enrollees is long. It includes immunizations such as flu shots, colonoscopy screenings and polyp removal, mammograms, autism screening and vision testing for children, a host of contraceptive methods, breast pumps and lactation support for nursing mothers and over-the-counter products that are prescribed by a healthcare provider.

Health plans have some discretion as to how the benefits are applied. There "may be some variation from state to state and plan to plan within large categories of covered services," says Alina Salganicoff, vice president for women's health policy at the Kaiser Family Foundation in Menlo Park, CA.

The law grants an exception for grandfathered health plans, those that existed on March 23, 2010, when the law was enacted and that have made only modest changes to benefits and cost-sharing.

Those plans don't have to comply with certain essential-benefit rules until they lose their grandfathered status. Unlike new health plans, grandfathered plans may charge enrollees for immunizations and other preventive care. Visit the Wall Street Journal for the article.


Guns sent 20 children to U.S. hospitals every single day, study finds

Twenty children or adolescents were hospitalized for firearm-related injuries every day in 2009, and 453 died of their wounds, a new report says. The study provides one of the most comprehensive recent efforts to tally the number of children hurt nationally in gun-related incidents. It was published Monday in the journal Pediatrics.

A national database of patients younger than 20 who were admitted to hospitals in 2009 shows that boys represented nearly 90% of the total, and that the rate of gunshot-related hospitalizations for African American males was 10 times that of white males.

Blacks ages 15 to 19 were 13 times more likely than their white peers to be injured by gunfire. And 70% of all black children hospitalized for gun injury (compared with 32% of all white children injured by firearms) were classified as victims of assault. Latino children and adolescents were three times likelier than white children to be hospitalized with a firearm-related injury.

Hospital care for youths injured by gunfire cost $147 million in 2009, according to the report, but that is a fraction of the overall cost of the injuries. It doesn't include physician-related services, rehabilitation and ongoing care and rehospitalization, and does not take into account many victims' loss of future productivity. (Past research has found that almost half of children hospitalized for gun-related injury are discharged with a disability.) The latest estimate boosts the number of those younger than 20 hurt by firearms in 2009 to 7,391, from 6,496.

For years, public health researchers have relied on the National Epidemiological Injury Surveillance System to track gunfire-related injuries in the United States. Though that system is to be expanded under an Obama administration initiative launched last year, it has based its national estimates of all kinds of injuries -- including those resulting from gunfire -- on a yearly sampling of 66 hospital emergency departments across the country.

The database used in the latest research samples a larger number of hospitals and is thus likely to generate a more accurate accounting of firearms' toll on children and adolescents. The database covers all but six states, covering 96% of the U.S. populace.

In the latest accounting, researchers from the medical schools of Yale and Boston universities asserted that decades of aggressive injury-prevention efforts have driven down the pediatric toll of poisonings, household fires and drownings. By contrast, they said, "there have been no robust public health efforts to reduce firearms injuries." They suggest that is largely because, since 1996, federal law has essentially blocked the use of taxpayer dollars for research that might bolster calls for gun control measures.

Meanwhile, the researchers wrote, gun-related injuries have followed a pattern of inequality seen elsewhere on the American health landscape: Victims are far more likely to be poor and members of an ethnic minority than they are to be white and affluent.

Victims ages 15 to 19 made up 84% of the children brought to the hospital with gunshot wounds, and two-thirds of those injuries were attributed to assault. Among these older children, roughly 24% of the cases were considered unintentional. Suicide attempts accounted for 239 of 4,143 of those firearm-related hospitalizations.

Among younger children, accidental firearm injuries were most common. Of the 378 children under 10 brought to the hospital in connection with a firearm injury, roughly three-quarters were considered victims of an accidental or unintended shooting. Thirty-one children younger than 5 and 47 ages 5 to 9 were injured in gun-related assaults in 2009. Visit the Los Angeles Times for the article.


Infection control practices not adequately implemented at many hospital ICUs: study

U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

In the largest study of its kind, researchers from Columbia University collaborated with the Centers for Disease Control and Prevention (CDC) to undertake a nationwide survey of 1,534 ICUs at 975 hospitals as part of the larger Prevention of Nosocomial Infections and Cost Effectiveness Refined (P-NICER) study.

The survey inquired about the implementation of 16 prescribed infection prevention measures at point-of-care, and clinician adherence to these policies for the prevention of central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI). These infections are among the most common infections acquired by patients in ICUs.

According to the survey, hospitals have more policies in place to prevent CLABSI and VAP, than CAUTI. The presence of infection control policies to prevent CLABSI ranged from 87 to 97 percent depending on the measure being counted; the presence of policies for VAP ranged from 69 to 91 percent; and policies for CAUTI lagged behind with only 27 to 68 percent of ICUs reporting prevention policies. The use of a checklist for CLABSI insertion practices was reported by the vast majority of hospitals (92 percent), while the use of a ventilator bundle checklist was reported by fewer hospitals (74 percent).

“Evidence-based practices related to CAUTI prevention measures have not been well implemented,” state the authors. “These findings are surprising, given that CAUTI is the most frequent healthcare-associated infection. Clearly, more focus on CAUTI is needed, and dissemination and implementation studies to inform how best to improve evidence-based practices should be helpful.”

In adhering to policies, many hospital ICUs fell short, according to the survey. Adherence to prevention policies ranged from 37 to 71 percent for CLABSI, 45 to 55 percent for VAP, and 6 to 27 percent for CAUTI.

“Establishing policies does not ensure clinician adherence at the bedside,” state the authors. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”

The survey also assessed structure and resources of infection prevention and control programs, evaluating characteristics such as staffing, use of electronic surveillance systems, and proportion of infection preventionists with certification.

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. Many of these infections occur in the ICU setting and are associated with an invasive device such as central line, ventilator, or indwelling urinary catheter. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. The estimated annual costs associated with HAIs in the U.S. are up to $33 billion. Visit APIC for the study.


How vaccine fears fueled the resurgence of preventable diseases

For most of us, measles and whooping cough are diseases of the past. You get a few shots as a kid and then hardly think about them again. But that's not the case in all parts of the world — not even parts of the U.S.

Several diseases that are easily prevented with vaccines have made a comeback in the past few years. Their resurgence coincides with changes in perceptions about vaccine safety.

Since 2008 folks at the think tank CFR have been plotting all the cases of measles, mumps, rubella, polio and whooping cough around the world. Two trends have emerged: measles has surged back in Europe, while whooping cough is has become a problem here in the U.S.

Childhood immunization rates plummeted in parts of Europe and the U.K. after a 1998 study falsely claimed that the vaccine for measles, mumps and rubella was linked to autism. That study has since been found to be fraudulent. But fears about vaccine safety have stuck around in Europe and here in the U.S.

Viruses and bacteria have taken full advantage of the immunization gaps. In 2011, France reported a massive measles outbreak with nearly 15,000 cases. Only the Democratic Republic of Congo, India, Indonesia, Nigeria and Somalia suffered larger measles outbreaks that year.

In 2012, the U.K. reported more than 2,000 measles cases, the largest number since 1994. Here in the U.S., the prevalence of whooping cough shot up in 2012 to nearly 50,000 cases. Last year cases declined to about 24,000 — which is still more than tenfold the number reported back in the early '80s when the bacteria infected less than 2,000 people. Visit NPR for the study.


Deloitte invites Medical Device Manufacturers to a UDI Roundtable

Deloitte invites medical device manufacturers to attend a complimentary UDI roundtable on February 6th. The roundtable will provide an opportunity to discuss best practices to overcome the toughest implementation challenges in achieving UDI compliance.

Topics will be driven by the attendees and may include challenges in supply chain, operations, quality/regulatory, and information technology. Deloitte will host medical device manufacturing executives across four locations to network with their peers, share regulation interpretation, and actions currently being taken to meet this new regulation. The FDA will participate from the Rosslyn, Virginia location.

The event is being hosted from 11:00 AM to 5:30 PM EST at four Deloitte video conference centers: (1) Rosslyn, VA, acting as main presentation and facilitation hub, (2) Chicago, IL, (3) Minneapolis, MN, and (4) Los Angeles, CA. The telesuites will provide a live broadcast from Rosslyn with the ability of other locations to interact across locations.  Lunch will be served at no expense. For more information or questions email udi_roundtables@deloitte.com.


Do doctors spend too much time looking at computer screen?

When physicians spend too much time looking at the computer screen in the exam room, nonverbal cues may get overlooked and affect doctors' ability to pay attention and communicate with patients, according to a Northwestern Medicine study.

Published online in January in the journal Medical Informatics, the study found that doctors who use electronic health records (EHR) in the exam room spend about a third of their visits looking at a computer screen.

"When doctors spend that much time looking at the computer, it can be difficult for patients to get their attention," said Enid Montague, first author of the study. "It's likely that the ability to listen, problem-solve and think creatively is not optimal when physicians' eyes are glued to the screen." Montague is an assistant professor in medicine, general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and an assistant professor in industrial engineering at the McCormick School of Engineering and Applied Science.

Using video cameras, Northwestern scientists recorded 100 doctor-patient visits in which doctors used computers to access electronic health records. The videos were used to analyze eye-gaze patterns and how they affected communication behavior between patients and clinicians.

"We found that physician–patient eye-gaze patterns are different during a visit in which electronic health records versus a paper-chart visit are used," Montague said. "Not only does the doctor spend less time looking at the patient, the patient also almost always looks at the computer screen, whether or not the patient can see or understand what is on the screen."

Understanding physicians' eye-gaze patterns and their effects on patients can contribute to more effective training guidelines and better-designed technology. Future systems, for example, could include more interactive screen sharing between physicians and patients, Montague said.

"The purpose of electronic health records is to enable healthcare workers to provide more effective, efficient, coordinated care," Montague said. "By understanding the dynamic nature of eye-gaze patterns and how technology impacts these patterns, we can contribute to future EHR designs that foster more effective doctor–patient interaction."

This study validates previous research that suggests the way EHRs are currently used in the exam room affects physicians' communication quality, cognitive functioning and the ability of patients and physicians to build rapport and establish emotional common ground. Visit Northwestern for the study.


Antibiotics in animals tied to risk of human infection

A federal analysis of 30 antibiotics used in animal feed found that the majority of them were likely to be contributing to the growing problem of bacterial infections that are resistant to treatment in people, according to documents released Monday by a health advocacy group.

The analysis, conducted by the Food and Drug Administration and covering the years 2001 to 2010, was detailed in internal records that the nonprofit group, the Natural Resources Defense Council, obtained through a Freedom of Information Act request and subsequent litigation.

In the documents, scientists from the FDA studied 30 penicillin and tetracycline additives in animal feed. They found that 18 of them posed a high risk of exposing humans to antibiotic-resistant bacteria through food. Resistant bacteria make it difficult and sometimes impossible to treat infections with ordinary antibiotics. The scientists did not have enough data to judge the other 12 drugs.

Farmers and ranchers feed small amounts of the drugs to animals over their lifetimes to keep them healthy in crowded conditions, causing bacteria to develop a resistance passed on to people through the environment and eating meat from the animals.

In a statement, the FDA said the drugs under review had been “older, approved penicillin and tetracycline products,” and that the agency had issued letters to their producers asking for additional safety data. It said those efforts had been part of a broader assessment of antibiotics, also called antimicrobials, given to animals raised for food, and that it has since made major policy changes to address them.

The FDA has taken some steps in recent years. In 2012, it restricted the use of cephalosporins in animals. They are drugs that are also prescribed to treat pneumonia and strep throat in people. Last year, the FDA moved to phase out the indiscriminate use of antibiotics in cows, pigs and chickens, though it continued to allow them for the treatment of illness, a policy decision that consumer health advocates said weakened the new rule.

“In December 2013, the F.D.A. began formal implementation of a strategy to phase out the use of all medically important antimicrobials,” the agency said. “The FDA is confident that its current strategy to protect the effectiveness of medically important antimicrobials, including penicillins and tetracyclines, is the most efficient and effective way to change the use of these products in animal agriculture.”

Visit the New York Times for the article.


January 29, 2014   Download print version

Obama to GOP: Let's see your health plan

Silencing many hospital alarms leads to better healthcare

Mouthwashes 'can raise risk of heart attack and strokes': Antiseptic gargles kill good bacteria that help keep blood pressure down

Princeton hospital no longer delivering babies

'Doctor, please review this checklist before my surgery'

Seniors on Medicare fraud patrol in Miami

Doctors cut from Medicare Advantage networks struggle with what to tell patients

New study confirms Exergen temporal artery thermometer accuracy in hospitals

Obama to GOP: Let's see your health plan

President Barack Obama chided Republicans during his State of the Union address Tuesday night for their repeated efforts to repeal the Affordable Care Act (ACA), and he challenged them to come up with a health reform plan of their own.

"If you have specific plans to cut costs, cover more people, and increase choice, tell America what you'd do differently," Obama said. "Let's see if the numbers add up, but let's not have another 40-something votes to repeal a law that's already helping millions of Americans."

The president was referring to the more than 40 House votes to repeal part or all of the law or change or block different aspects of it. The votes passed the House but none of the legislation was taken up by the Senate.

The line drew a long standing ovation from his Democratic lawmakers, but didn't draw a smile from House Speaker John Boehner (R-Ohio), who was seated behind the president.

Senate Republicans this week introduced their bill to replace the ACA, a bill that largely relies on tax credits to help cover the uninsured. The bill was co-sponsored by Sens. Richard Burr (R-NC), Tom Coburn, MD (R-OK), and Orrin Hatch (R-UT).

But now that Americans are gaining coverage under the ACA, Republicans bear a greater burden, since Democrats only need to argue they know the ACA has problems that can be addressed, Bob Laszewski, president of Health Policy and Strategy Associates in Alexandria, VA, said.

Obama said he was in the process of fixing a broken healthcare system. He delivered familiar talking points on what the ACA has accomplished, such as banning limits on pre-existing conditions and allowing dependents through age 26 to stay on their parent's health plans.

"Because of this law, no American can ever again -- none, zero -- be dropped or denied coverage for a preexisting condition like asthma, back pain, or cancer," Obama said. "No woman can ever be charged more just because she's a woman. And we did all this while adding years to Medicare's finances, keeping Medicare premiums flat, and lowering prescription costs for millions of seniors."

Although the president mentioned 9 million people have signed up for coverage under the ACA either through Medicaid or private coverage, he didn't mention the improvements Healthcare.gov has made since its rocky launch in October. Obama encouraged those who know someone without health coverage to sign up for coverage by March 31 when the ACA's open enrollment ends.

The president promised to meet the needs of returning veterans, especially their need for healthcare and mental healthcare. Obama also gave a nod to the work of the first lady and her "Let's Move" campaign, which seeks to encourage kids to eat healthier and exercise more. Visit MedPage Today for the article.


Silencing many hospital alarms leads to better healthcare

Go into almost any hospital these days and you'll hear a constant stream of beeps and boops. To most people it sounds like medical Muzak. But to doctors and nurses, it's not just sonic wallpaper. Those incessant beeps contain important coded messages.

"The three-burst is a crisis alarm," systems engineer James Piepenbrink of Boston Medical Center explains on a tour of 7 North, the hospital's cardiac care unit. That might signal that a patient's heart has gone into a potentially fatal arrhythmia or even stopped altogether. "Two tones is a warning," he says. That can mean something ominous — or nothing worth worrying about.

Alarms are good and necessary things in hospital care, except when there are so many of them that caregivers can't keep track of the ones that signal a crisis that requires immediate attention. Then it may be that less technology can actually be more effective.

In the case of Boston Medical Center, an analysis found that 7 North was experiencing 12,000 alarms a day, on average. That kind of cacophony was producing a growing problem known as "alarm fatigue."

"Alarm fatigue is when there are so many noises on the unit that it actually desensitizes the staff," says Deborah Whalen, a clinical nurse manager at the Boston hospital. "If you have multiple, multiple alarms going off with varying frequencies, you just don't hear them."

That can be dangerous. Patients can die when an important alarm is missed, or an electrode on a patient's chest comes unstuck, or a monitor's battery goes dead.

Boston Medical Center hasn't recorded any patient deaths because of alarm failure, but, Whalen says, "we were lucky." A Boston Globe investigation in 2011 found more than 200 deaths nationally related to alarm problems. Last year, the Joint Commission, a national quality-control group, warned of 98 alarm-related instances of patient harm, including 80 deaths and 13 cases of permanent disability.

The known alarm-related problems are just the tip of an iceberg, according to Dr. Ana McKee, the Joint Commission's chief medical officer, because such cases are seriously underreported. "It is pervasive in almost any accident that occurs in a hospital," McKee says. "If you look carefully, you will most likely find that there was an alarm as a contributing factor." 

That's why the Joint Commission has put alarm problems at the top of its current list of issues that hospitals are expected to tackle. McKee says technology has gotten out of control. "We have devices that beep when they are working normally," she says. "We have devices that beep when they're not working."

Boston Medical Center is attracting national attention as a hospital that apparently has conquered alarm fatigue. Its analysis showed the vast majority of so-called "warning" alarms, indicating potential problems with such things as low heart rate, don't need an audible signal. The hospital decided it was safe to switch them off. The hospital also upgraded some low-level "warning" alarms to a higher level, signifying "crisis" — for instance, a pause in heart rhythm. And nurses were given authority to change alarm settings to account for patients' differences.

"Once that happened," nurse Deborah Whalen says, "many, many, many alarms disappeared. And instead of 90,000 alarms a week, we dropped to 10,000 alarms a week." That's on 7 North alone.

The hospital's success in reducing alarm fatigue is detailed in the Journal of Cardiovascular Nursing. Visit NPR for the story.


Mouthwashes 'can raise risk of heart attack and strokes': Antiseptic gargles kill good bacteria that help keep blood pressure down

Mouthwash brand Corsodyl has been found to increase blood pressure. A study found blood pressure rose between 2 and 3.5 units for daily users. Using mouthwash is a ‘disaster’ for health, increasing the risk of heart attacks and strokes, scientists are warning. Swilling kills off ‘good’ bacteria that help blood vessels relax – so increasing blood pressure. When healthy volunteers used Corsodyl, a brand containing a powerful antiseptic, their blood pressure rose within hours.

Professor Amrita Ahluwalia, who led the study, condemned the widespread use of antiseptic mouthwash. She said: ‘Killing off all these bugs each day is a disaster, when small rises in blood pressure have significant impact on morbidity and mortality from heart disease and stroke.’

More than half of British adults regularly use mouthwash, creating a market worth £180million a year.

The study compared blood pressure levels in 19 healthy volunteers who started using Corsodyl twice daily. Their blood pressure rose by between 2 and 3.5 units (mmgh).

This effect ‘appeared within one day’ of using the mouthwash, researchers wrote in the journal Free Radical Biology And Medicine.

For each two-point rise in blood pressure, the risk of dying from heart disease rises by seven percent, according to separate research. Such a rise also increases the risk of dying from stroke by ten percent. Corsodyl contains 0.2 percent by volume of the antiseptic chlorhexidine. Other antiseptic mouthwashes made by Boots and Superdrug contain the chemical in the same concentration. It kills microbes needed to help create nitrite, essential for blood vessels to dilate properly. But the mouthwash caused nitrite production in the mouth to fall by over 90 percent, and blood nitrite to fall by 25 percent.

Not all mouthwashes contain chlorhexidine: Listerine, for example, does not. However, Prof Ahluwalia said: ‘Other mouthwashes could still disrupt the healthy bacteria.’

Corsodyl makers GlaxoSmithKline said their product was for short-term use to stop plaque and prevent gum disease and it also makes another product, Corsodyl Daily, which contains 0.06 percent chlorhexidine for everyday use. The spokesman said their own research had ‘not highlighted any concerns regarding the use of Corsodyl 0.2 percent mouthwash as directed and increases in blood pressure’. Visit the Daily Mail for the study.


Princeton hospital no longer delivering babies

Perry Memorial Hospital in Princeton, IL, lost $500,000 on its obstetrics program last year. Under the Affordable Care Act's new payment rules for Medicare, which primarily covers people over 65, and previous federal budget cuts under sequestration, the hospital is also facing $1 million in federal cuts.

The hospital decided to quit delivering babies unless it was an emergency. Perry Memorial is one of many hospitals around the country making difficult choices about saving or closing programs in the wake of federal cuts under the Affordable Care Act, the nation's new health law.

Princeton is like many rural communities in which populations are declining, and those who stay are getting older. The hospital delivered about 380 babies per year 15 years ago, but that number has dropped to 100 births per year. And a growing percentage of births today are to mothers covered under Medicaid, which cover low-income people. The hospital receives about 16 cents on the dollar for care given to those patients.

Running the under-utilized obstetrics units just got too expensive. In Illinois, even if the unit is empty, the hospital is required to have a nurse on duty and to maintain Caesarian surgical services.

Rex Conger, president and CEO, said he wonders what closing the obstetrics unit will mean for his hospital's future.

"At larger community hospitals, people assume they would have OB services," Conger said. "It is one of those basic services hospitals historically offer. I am concerned about the long term. Will we be able to continue to exist? I think, 'What have I done?' But then I think about the half a million dollars a year we were losing."

When the hospital's obstetrics department closed, prenatal and postnatal programs also ended. Women now have to travel about 25 miles to the nearest hospitals for deliveries and those programs. Visit the Journal Star for the story.


'Doctor, please review this checklist before my surgery'

Surgery might be less risky for patients if they have their surgical team follow a safety checklist, according to new research. The study looked at the use of the World Health Organization's surgical safety checklist, which was created in 2009 to reduce complications. It outlines 26 tasks that should be undertaken during the three phases of surgery: before anesthesia, before the incision is made and before the patient leaves the operating room.

Specific items on the checklist include reviewing a patient's allergies before administering anesthesia, confirming the surgical site before cutting and making sure sponges and all other surgical instruments are accounted for before wheeling a patient out of the operating room.

Researchers gave the checklist to 43 patients who had their surgical team sign it to confirm they would follow it. Another group of 61 patients did not know about or receive the checklist. Surgical teams were more likely to follow all 26 checklist items when operating on patients who had the checklists.

For example, allergies were confirmed in 95 percent of patients in the checklist group and 69 percent of patients without the checklist. The surgical site was confirmed before incision in 74 percent of checklist patients and 54 percent of those without a checklist. And formal counts of sponges and surgical instruments were done in 87 percent of checklist patients and 19 percent of those without a checklist. (HealthDay) Visit NIH for the study.


Seniors on Medicare fraud patrol in Miami

It’s a crime that requires no guns. It frequently goes unnoticed until after the fact, and the victims are unwitting U.S. taxpayers duped to the tune of $68 billion a year. Medicare fraud has become one of the most profitable illegal activities in the country — and South Florida is the most likely place to get fleeced.

But Joe Schwartz is on the case now, trying to change all that. The retired pharmaceutical executive joined the Senior Medicare Patrol, a national group, to help teach seniors how to educate other seniors and their caregivers about Medicare fraud, waste and abuse. In presentations at health fairs, senior centers, assisted living facilities — anywhere seniors or caregivers congregate — volunteers like Schwartz show Medicare and Medicaid recipients how to protect, detect and report scams.

“It’s a responsibility we all have, not only to ourselves but also to others,” Schwartz said. “If funds are depleted, if they’re spent on paying bogus claims, what’s going to be left for our children and even our grandchildren?”

Florida, and Miami in particular, is considered the epicenter of illegal claims against Medicare, a government insurance program that provides health care to more than 46 million elderly and disabled Americans. Though there is no recent analysis of the Florida Medicare Program, the National Health Care Anti-Fraud Association estimates that at least 3 percent of all healthcare spending is lost to fraud. In Florida, there are more than 3 million Medicare beneficiaries and the estimated cost of fraud to taxpayers is $3 billion to $4 billion a year.

So Schwartz, who gives his age as “over 65,” is among a small cadre of fraud fighters who crisscross Miami-Dade and Broward counties to preach the gospel of protection. Sometimes he joins forces with Gustavo Franco, another volunteer who, at 59, is “semi-retired.” Schwartz does his presentation in English. Franco extols in Spanish. Whatever the language, the message is the same: “It’s our responsibility,” Franco said. “Fraud costs us money and it’s money that can be spent on programs we need.”

“Anybody can be a Medicare criminal,” said Franco, holding up the cover of an AARP Bulletin which featured clean-cut scammers who looked like the neighbor next door. “Don’t be fooled by appearances.”

The Senior Medicare Patrol program, funded through the Older Americans Act, was established nationally in 1995 to recruit the public in the fight of what was even then a growing fraud problem. It eventually launched in five states with large senior populations and high fraud incidence rates. Florida was one of them.

Volunteers like Schwartz and Franco attend training that introduces them to the complex world of Medicare and Medicaid benefits. They also learn about the different kinds of scams and how to differentiate between an actual fraud and a billing error. Statewide webinars, as well as conference calls, are offered as refreshers. These are necessary because scams are ever-changing.

One of the most common frauds involves medical equipment. In 2009, Medicare spent more than $10 billion on medical equipment, according to SMP, and more than half of that was improperly spent — either it was unnecessary or the bill was wrong. Medicare recipients can be on the frontline of prevention and detection by doing one simple thing.

“You have to read your Medicare Summary Notices or Explanation of Benefits very, very carefully,” Franco said. “That is an important first step.” Such close scrutiny helps a consumer detect if he is being billed for a service he didn’t receive.

Makeba Huntington-Symons, the state’s SMP manager, said the program is always looking for volunteers of any age. But seniors are ideal because they have the time, the skills and the experience to understand the audience. And because they, too, are stakeholders in the Medicare program, they can evoke a feeling of ownership in those who receive government healthcare benefits. Visit the Miami Herald for the story.


Doctors cut from Medicare Advantage networks struggle with what to tell patients

Thousands of primary-care doctors and specialists across the country have been terminated from privately run Medicare Advantage plans, sparking a battle between doctors who say patient care is being threatened and insurers that insist they have to reduce costs and streamline their operations.

Medical associations, which describe the dismissals as the largest in the program’s history, say the cuts are forcing some patients to leave their doctors in mid-treatment and creating gaps in the types of medical specialists covered in some areas. They’re taking their protests to court, and having some success.

In December, a federal judge in Connecticut issued an injunction that temporarily prohibits an insurer from dismissing doctors in Fairfield and Hartford counties, and an appeals court in Texas has upheld a similar court order. Another lawsuit is pending in New York, and doctors groups in several other states are threatening legal action.

The American Medical Association, the nation’s premier doctors organization — along with 39 state affiliates and 42 patient and medical specialty groups — has called on the Obama administration to intervene and put pressure on insurers to reverse the terminations.

Insurers say they must shrink their physician networks because they face billions of dollars in government-payment cuts over the next decade — reductions that are being used partly to fund insurance coverage for millions of people under the federal Affordable Care Act. They also say the smaller networks will allow them to curb premium increases and to remain nimble as they prepare for an influx of patients under the law.

Medicare Advantage, an alternative to traditional Medicare, covers 13 million beneficiaries, or 27 percent of the people in the federal healthcare program for the elderly. Besides providing the standard benefits, the thousands of Medicare Advantage plans often offer extra perks such as free eyeglasses and adhesive bandages. They can do that because, for years, the government has paid the plans more, per patient, than it spends on regular Medicare.

The doctor terminations, most of which took effect Jan. 1, are striking a nerve partly because of the way insurers have notified some physicians.

Arthur Vogelman, a gastroenterologist, received a letter in the fall from United Healthcare informing him that he had been dropped from the insurer’s physician network. He said the letter contained no information about the reason for the termination. He appealed to the company and documented his successful treatment of thousands of patients, but his request was denied with no reason given.

“It is an outrage. I have patients in their 80s and 90s who have been with me 20 years, and I’m having to tell them that their insurer won’t pay for them to see me anymore. The worst thing is I can’t even tell them why,” Vogelman said.

Medical associations say a number of insurers are trimming their networks this year, but the most dramatic reductions may be occurring in United Healthcare’s Medicare Advantage plan. With 3 million members, the AARP-endorsed plan is the largest of its kind in the nation. United Healthcare said that it aims to reduce its national network of physicians by 10 to 15 percent by the end of 2014. The company declined to provide specific numbers, but medical associations say that in some states, thousands of doctors have been cut.

Jack Larson, United Healthcare chief executive for Medicare and retirement, said in an interview that he believes the smaller networks will lead to better patient care, because insurers will be able to work more closely with doctors.

A few weeks ago, the insurance industry, led by America’s Health Insurance Plans, a trade group, launched a public-awareness campaign that includes TV, print, digital and display ads and encourages seniors, a group with substantial political clout, to write and tweet about their concerns over the payment cuts. Industry officials have been appearing on Sunday talk shows and pressing lawmakers to restore some of the funding.

A spokesman for the federal Centers for Medicare and Medicaid Services said that the agency is reviewing information about affected areas of the country but that health plans are allowed to change their networks at any time of year, as long as they provide adequate notice to providers and patients.

Doctors who have been cut from the networks say they are angry and confused about the sudden terminations, how they were communicated, the possible damage to their reputations, and the financial effect on their practices.

The terminations have forced doctors to make difficult decisions about how to handle longtime patients whose insurance will no longer pay for the doctors’ services. Vogelman’s office is canceling appointments made by his 143 patients enrolled in United Healthcare’s Medicare Advantage plan, because, he explained, “I won’t get paid.” He is referring those patients to doctors he trusts. Visit the Washington Post for the article.


New study confirms Exergen temporal artery thermometer accuracy in hospitals

A recent study published in MEDSURG Nursing, the official Journal of the Academy of

Medical-Surgical Nurses, reported: "Based on the results of this study, temporal artery thermometers appear to be a reliable way to measure temperature noninvasively in hospitalized patients."

The study was undertaken to evaluate the agreement of temperatures measured with a temporal artery thermometer when sequentially used by the same person and a second user in 34 postoperative patients. The differences in two temperatures measured by a single user and between two persons were small and within the range of acceptable values set by experts when evaluating thermometers for hospital use. The researchers

also concluded that while oral electronic temperatures are commonly used in acute care settings, the temporal artery thermometer provides another accurate method for temperature assessment.

The study was conducted in a 400-bed not-for-profit community hospital in the Rocky Mountain region of the United States in a 37-bed orthopedic and general surgical care unit. Data collection was completed over three months. For additional information, visit www.exergen.com.


January 28, 2014   Download print version

How much do medical devices cost? Doctors have no idea

Doctors abusing Medicare face fines and expulsion

Beijing’s bad air would be step up for smoggy Delhi

Little-known aspect of Medicaid now causing people to avoid coverage

Atlas Linen & Alliance Laundry change name to Clarus Linen Systems

Long term exposure to air pollution linked to coronary events

More infected in fresh wave of China bird flu

Hospital costs key for Medtronic rival valve to Edwards

February 1 deadline: HPN is looking for your Infection Prevention success stories

How much do medical devices cost? Doctors have no idea

Imagine taking your car to a mechanic who has no clue how much a battery or muffler costs—and has no way of finding out. Substitute “artificial hip” for “battery” and “doctor” for “mechanic” and you get a pretty good picture of the convoluted market for medical implants. Asked to estimate the cost of common devices such as replacement knees or spinal screws, physicians at seven major academic hospitals in the U.S. were wrong 81 percent of the time, according to a January study published in the journal Health Affairs.

The survey of 503 orthopedists at institutions including Harvard, Stanford, and the Mayo Clinic considered doctors’ answers correct if they came within 20 percent of what their hospital paid suppliers. The worst guesses ranged from a small fraction of the actual price to more than 50 times what the hospital paid.

The doctors did so poorly in part because many medical device manufacturers require hospital purchasing departments to keep prices confidential, allowing sellers to charge some institutions more than others for the same products. “Widespread dissemination of device prices is not an option at many institutions,” note the authors of the study, which didn’t disclose what hospitals included in the survey paid. Prices “often varied considerably across institutions.” 

Total spending on medical devices in the U.S. reached about $150 billion in 2010, or roughly a nickel of every healthcare dollar, according to the Advanced Medical Technology Association (AdvaMed), the industry’s trade group. The device is often the most expensive part of an orthopedic procedure, and the bill is ultimately paid by either private insurers or Medicare and Medicaid.

A 2012 study by the U.S. Government Accountability Office also found wide variation in prices. “Some hospitals have substantially less bargaining power with the small group of companies that manufacture particular [implantable medical devices] and consequently face challenges in obtaining more favorable prices,” the GAO wrote.

Martin Makary, a surgeon at Johns Hopkins Hospital (which was not part of the Health Affairs survey), points to the example of surgical mesh, which depending on the type ranges in price from $75 to $10,000. Because doctors never see the insurance bill and often aren’t privy to how much various options cost, they have little incentive to choose a less expensive mesh from one company that may work as well as a costlier one from another. “We don’t know what the patients end up getting charged for it and if there is an up-charge,” Makary wrote in an e-mail.

A 2007 Senate bill would have required device makers to report their average prices to regulators and the public, but medical device makers successfully lobbied against it. “It’s a market that’s working extraordinarily well,” says David Nexon, AdvaMed’s senior executive vice president. He points to research, funded by the lobbying group, showing that spending on medical devices has remained at about 6 percent of total U.S. healthcare costs since the early 1990s and that prices for major implants such as knees and hips have fallen since 2007.

In 2009 the Cleveland Clinic began using its clout to buck the system, enlisting surgeons on its staff to help contain costs by sharing prices with them and limiting the menu of devices they can choose from. Spinal implants that once came from 10 different companies have been narrowed to two, says Simrit Sandhu, who’s in charge of the clinic’s supply chain. Cleveland has kept some contracts with suppliers of expensive devices, but surgeons must justify using them instead of more economical options. Over the past four years, Sandhu says, the program has saved the hospital system $190 million. Last year, Cleveland Clinic formed a company called Excelerate Strategic Health Sourcing to help other hospitals copy its system.

Getting physicians to embrace such changes is easier in hospitals where doctors are salaried employees. John O’Brien, former president of UMass Memorial Health Care, says the Massachusetts hospital system encouraged its doctors to choose devices from a short list of suppliers, enabling the hospital to negotiate better prices.

That’s a harder sell with independent surgeons, who pick where they want to perform operations and can avoid hospitals that try to limit which devices they can use. “They don’t particularly care about the cost. They don’t know what the cost is,” says O’Brien, now a professor at Clark University in Worcester, MA. For that reason, hospitals competing to attract surgeons to perform joint replacements and other lucrative procedures will continue stocking their preferred devices, even if less expensive ones would suffice. Visit Business Week for the article.


Doctors abusing Medicare face fines and expulsion

The Obama administration is cracking down on doctors who repeatedly overcharge Medicare patients, and for the first time in more than 30 years the government may disclose how much is paid to individual doctors treating Medicare patients.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said that “recalcitrant providers” would face civil fines and could be expelled from Medicare and other federal health programs. In a directive that took effect on Jan. 15 but received little attention, Tavenner indicated that the agency was losing patience with habitual offenders. She ordered new steps to identify and punish such doctors.

A recalcitrant provider is defined as one who is “abusing the program and not changing inappropriate behavior even after extensive education to address these behaviors.” Cases will be referred to Daniel R. Levinson, the inspector general at the Department of Health and Human Services, who has authority to impose civil fines and exclude doctors from Medicare, Medicaid and other programs.

Federal officials estimate that 10 percent of payments in the traditional fee-for-service Medicare program are improper. That would suggest at least $6 billion a year in improper payments under Medicare’s physician fee schedule. But Malcolm K. Sparrow, a Harvard professor and an expert on healthcare fraud, has said the losses could be greater because the official statistics “fail to accurately capture fraud rates” in Medicare.

A new section of the Medicare manual encourages the use of fines to penalize doctors who generate a pattern of claims for goods and services that they know or “should know” are not medically necessary. Providers can also be barred from Medicare if they bill the program for “excessive charges” or for services substantially in excess of patients’ needs.

In a new report, Levinson said Medicare officials and contractors should focus on doctors with the highest Medicare billings because they often received improper payments. He said that about 300 doctors received more than $3 million each in yearly Medicare payments and that one-third of them had been singled out for special reviews because of questionable billings.

Levinson recommended that Medicare officials “establish a cumulative payment threshold” and closely examine claims filed by any doctor whose total exceeded that amount.

Tavenner, the top Medicare official, said, “High cumulative payments are not necessarily indicative of improper payments or fraud,” but she accepted the recommendation. “Reviewing claims from providers with high cumulative payments could be a valuable screening tool,” Tavenner said, and it may be appropriate to set the threshold at different levels for doctors in different specialties.

Most of the high-billing doctors specialize in internal medicine, radiation oncology or ophthalmology, investigators said.

In a related action, the Obama administration this month scrapped a policy that broadly prohibited the release of federal data showing how much Medicare paid individual doctors each year. The administration said it would consider releasing payment data in response to Freedom of Information Act requests. The policy, which goes into effect on March 18, says Medicare officials will, in each case, “weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information.”

Visit the New York Times for the article.


Beijing’s bad air would be step up for smoggy Delhi

NEW DELHI: In mid-January, air pollution in Beijing was so bad that the government issued urgent health warnings and closed four major highways, prompting the panicked buying of air filters and donning of face masks. But in New Delhi, where pea-soup smog created what was by some measurements even more dangerous air, there were few signs of alarm in the country's boisterous news media, or on its effervescent Twittersphere.

Despite Beijing's widespread reputation of having some of the most polluted air of any major city in the world, an examination of daily pollution figures collected from both cities suggests that New Delhi's air is more laden with dangerous small particles of pollution, more often, than Beijing's. Lately, a very bad air day in Beijing is about an average one in New Delhi.

The United States embassy in Beijing sent out warnings in mid-January, when a measure of harmful fine particulate matter known as PM2.5 went above 500, in the upper reaches of the measurement scale, for the first time this year. This refers to particulate matter less than 2.5 micrometers in diameter, which is believed to pose the greatest health risk because it penetrates deeply into lungs.

But for the first three weeks of this year, New Delhi's average daily peak reading of fine particulate matter from Punjabi Bagh, a monitor whose readings are often below those of other city and independent monitors, was 473, more than twice as high as the average of 227 in Beijing. By the time pollution breached 500 in Beijing for the first time on the night of Jan. 15, Delhi had already had eight such days. Indeed, only once in three weeks did New Delhi's daily peak value of fine particles fall below 300, a level more than 12 times the exposure limit recommended by the World Health Organization.

Experts have long known that India's air is among the worst in the world. A recent analysis by Yale researchers found that seven of the 10 countries with the worst air pollution exposures are in South Asia. And evidence is mounting that Indians pay a higher price for air pollution than almost anyone. A recent study showed that Indians have the world's weakest lungs, with far less capacity than Chinese lungs. Researchers are beginning to suspect that India's unusual mix of polluted air, poor sanitation and contaminated water may make the country among the most dangerous in the world for lungs.

India has the world's highest death rate because of chronic respiratory diseases, and it has more deaths from asthma than any other nation, according to the World Health Organization. A recent study found that half of all visits to doctors in India are for respiratory problems, according to Sundeep Salvi, director of the Chest Research Foundation in Pune.

Clean Air Asia, an advocacy group, found that another common measure of pollution known as PM10, for particulate matter less than 10 micrometers in diameter, averaged 117 in Beijing in a six-month period in 2011. In New Delhi, the Center for Science and Environment used government data and found that an average measure of PM10 in 2011 was 281, nearly two-and-a-half times higher.

Perhaps most worrisome, Delhi's peak daily fine particle pollution levels are 44 percent higher this year than they were last year, when they averaged 328 over the first three weeks of the year. Fine particle pollution has been strongly linked with premature death, heart attacks, strokes and heart failure. In October, the World Health Organization declared that it caused lung cancer.

In 1998, the Supreme Court ordered that Delhi's taxis, three-wheelers and buses be converted to compressed natural gas, but the resulting improvements in air quality were short-lived as cars flooded the roads. In the 1970s, Delhi had about 800,000 vehicles; now it has 7.5 million, with 1,400 more added daily. Visit The Economic Times for the article.


Little-known aspect of Medicaid now causing people to avoid coverage

Add this to the scary but improbable things people are hearing could happen because of the new federal healthcare law: After you die, the state could come after your house.

The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets.

This is not an issue for people buying private coverage on online marketplaces. And experts say it is unlikely that the millions of people in more than two dozen states becoming eligible for Medicaid under the program’s expansion will be affected by this rule. But the fear that the government could one day seize their homes is deterring some people from signing up.

It is the latest anxiety to spring from the healthcare law. After years of speculation about the sprawling legislation, which affects everything from the way people see their doctors to their finances, it is now a reality — and in some cases is causing fear.

Some worries stem from the law’s unintended consequences, such as last year’s cancellations of health plans by insurers whose old policies did not meet the new standards. The flare-up shook public confidence in the administration’s forthrightness about the impact of the measure.

Asset recovery predates the health-care law, but the legislation makes it apply to a larger pool of people. About half of the states took an option to expand Medicaid to anyone who makes up to 138 percent of the poverty level, or $15,900 for an individual. That includes childless adults and people with significant assets besides a home, who previously had been excluded in most states.

In 1993, concerned about rising Medicaid costs, Congress made it mandatory for states to try to recover money from the estates of people who used Medicaid for long-term care, which can cost taxpayers hundreds of thousands of dollars per person. They included exceptions in cases in which there is a surviving spouse, a minor child and other situations.

Congress also gave states the option to go further — to target the estates of all Medicaid recipients for any benefits they received after age 55, including routine medical care. Many states took that route, including Oregon, which from July 2011 to June 2013 recovered $41 million from about 8,900 people.

But after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

Advocates are pressing the Obama administration to specify that new Medicaid recipients nationally should not be subject to asset recovery.

Medicaid was supposed to serve as a health insurance bridge for these people until they turned 65 and could receive Medicare. Part of the issue is that people who qualify for expanded Medicaid do not have the option of choosing instead to get a tax subsidy to buy private coverage on the marketplaces. In the states expanding Medicaid, the subsidies are available only to those who make more than the Medicaid income cutoff.

That means that someone just under that threshold could be subject to asset recovery, while someone who earns slightly more — up to 400 percent of the poverty level, or $45,960 for an individual — could get a federal subsidy to buy private coverage on the marketplaces, with no strings attached. Visit the Washington Post for the article.


Atlas Linen & Alliance Laundry change name to Clarus Linen Systems

Effective January 22, 2014, Atlas Linen Healthcare Services and Alliance Laundry and Textile Services have officially become Clarus Linen Systems. The company, which provides linen management services to healthcare clients in six states from nine production facilities, selected the name Clarus from the Latin word for "clear" to represent the quality of its reusable linen products and its commitment to providing clear thinking about efficient patient care, according to Clarus CEO, John Giardino.

The company's rebranding is more than just a name change, noted Giardino. The selection of Clarus is an opportunity to "Change the Conversation" in healthcare linen management. "We want to partner with our healthcare clients to provide the best experience for patients and to manage costs for better financial results. By 'Changing the Conversation' we can focus on patient comfort and explore new ways to manage care."

The clearest commitment Clarus has made to "Changing the Conversation" is its Clarus Care program. A team of Patient Service Representatives, each of whom is a certified registered nurse, and Linen Assets Managers are dedicated to each client account.

Linen Asset Managers track the use of all reusable linen products within hospitals and nursing homes to manage inventory and costs of patient day needs. Clarus' asset managers are trained to look for greater efficiencies and new ways for Healthcare facilities to maximize the use of reusable linen products. Clarus' clients receive a "Clarus Client Scorecard," a proprietary reporting system that allows Healthcare managers to make clear decisions about how to provide the best care to their patients efficiently.

To support Clarus Care at all of its clients' facilities, the Company has introduced Clarus On Call, a 24-hour express service to respond to facility needs.  "Clarus on Call" is staffed by Healthcare professionals who understand how hospitals and nursing homes operate and provide immediate problem resolution. For more information, visit www.claruslinens.com.


Long term exposure to air pollution linked to coronary events

Long term exposure to particulate matter in outdoor air is strongly linked to heart attacks and angina, and this association persists at levels of exposure below the current European limits, suggests research conducted at the Department of Epidemiology in Rome, Italy and published on bmj.com.

The results support lowering of the EU limits for particulate matter air pollution.

Ambient particulate matter air pollution is estimated to cause 3.2 million deaths worldwide per year, but the association between long term exposure to air pollution and incidence of coronary events remains controversial.

In the European Union the current annual limit for particulate matter with a diameter of 2.5 micrometres (μm) or less (known as PM2.5) is 25 µg/m3, which is far above that implemented in the United States (12 µg/m3). And a 2013 BMJ study found average PM2.5 concentrations over a five year period in Beijing was more than 10 times the World Health Organization air quality guideline value of 10 µg/m3.

So an international team of researchers, coordinated by the University of Utrecht, the Netherlands, set out to study the effect of long term exposure to airborne pollutants on acute coronary events (heart attack and unstable angina) in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).

The study involved over 100,000 people with no history of heart disease enrolled from 1997 to 2007 and followed for an average of 11.5 years.

Mathematical models were used to estimate concentrations of air pollution from particulate matter at each participant's residential address. A total of 5,157 participants experienced coronary events during the follow-up period. After taking account of several other risk factors, including other illness, smoking, and socioeconomic factors, the researchers found that a 5 μg/m3 increase in PM2.5particulate matter was associated with a 13% increased risk of coronary events and a 10μg/m3 increase in PM10 particulate matter was associated with a 12% increased risk of coronary events.(British Medical Journal) Visit EurekAlert for the study.


More infected in fresh wave of China bird flu

LONDON — Another 23 people in China have been infected with the H7N9 strain of bird flu in recent days, the World Health Organization (WHO) said on Monday, adding to at least 24 new cases last week and confirming a fresh surge in the virus. With many people travelling within the country for upcoming Chinese New Year celebrations on January 31, the United Nations health agency also said people should be aware of the risk that flu viruses might spread more widely.

Among the new H7N9 cases, reported from several different provinces of China, was a 38-year-old man who died on January 9 and a five year-old girl from Guangdong province who became ill on January 14 and is now stable in hospital.

Many of the other new patients were either in a serious or critical condition in hospitals. Several had reported recent exposure to poultry or poultry markets, but the WHO said the source of infections was still under investigation.

The H7N9 bird flu virus emerged in March last year and has so far infected at least 199 people in China, Taiwan and Hong Kong, killing 52 of them, according to an update on Monday from the WHO's spokesman Gregory Hartl.

Several clusters of cases in people who had close contact with an infected person have been reported in China, but WHO reiterated on Monday that "so far, there is no evidence of sustained human-to-human transmission". Visit NBC News for the story.


Hospital costs key for Medtronic rival valve to Edwards

Medtronic Inc. and Edwards Lifesciences Corp. (EW), rival makers of innovative heart valves, are working with hospitals so the medical facilities can more easily afford the cost of their devices.

“In the U.S., the focus for hospitals switched pretty early in the year from ‘can I do great procedures’ to ‘I need to make money with this thing,’” Edwards’ Chief Executive Officer Michael Mussallem said at the JPMorgan Chase & Co. healthcare conference in San Francisco.

The Edwards valve at a cost of $30,000 represents the greatest expense in an operation that goes for $42,000 at community hospitals. The device maker is working to minimize patient stay times to cut costs, Mussallem said. Medtronic, whose valve is awaiting U.S. approval, plans to package its device with other products, lowering its as-yet unannounced cost by boosting sales volume, Chief Executive Officer Omar Ishrak said in an interview.

Edwards, based in Irvine, CA, started to focus on the economics of the procedure last year, Mussallem said. While the company expected its U.S. aortic valve sales to rise 70 percent in 2013, it saw an increase of 45 percent to 50 percent, he said, declining to give details until the company releases earnings next month.

The economics may have played a role in the shortfall. Hospitals are struggling as the healthcare system reforms and insurance payments fall, said Toby Cosgrove, chief executive officer of the Cleveland Clinic in Ohio, who is looking to trim $1.5 billion in the next five years. Picking products based on price and total cost to the system is critical, he said.

Edwards has had the U.S. market for minimally invasive aortic valves to itself since November 2011. Medtronic’s product may get U.S. Food and Drug Administration clearance soon, after the agency in an unexpected move said it didn’t need a review from outside advisers to approve it.

In both cases, the valves can be placed in the chest without cracking open the rib cage, an important advance in the field. At stake is a market that may reach $2.5 billion to $3 billion by 2019, Mussallem said.

Insurers, primarily Medicare, the U.S. health program for the elderly, paid $51,000 on average for all patients getting the surgery in 2012, according to government claims data. Teaching hospitals and academic medical centers get higher reimbursement than community hospitals, and payments for patients with additional ailments are also higher.

There are about 300,000 people worldwide with severe aortic stenosis, a narrowing of the valve between the left ventricle and the aorta. Blood can back up in the heart, leading to chest pain, breathlessness and weakness. One in three patients can’t tolerate the open-heart surgery that has been proven to improve quality and lengthen life. Half die within a year.

Medtronic’s product, called CoreValve, uses a smaller catheter to insert the device, will have a greater range of sizes for the valve itself and carries less risk of leakage around the device than the Edwards valve, a complication that boosts the risk of dying. It’s not clear, though, if those benefits can offset the Medtronic valve’s main drawback -- a greater need for expensive pacemakers to regulate the heart’s electrical rhythm.

Additionally, Medtronic hasn’t yet said what its device will cost, a key factor in the competitive arena. Edwards, which is awaiting approval of new models in the U.S. and Europe, plans to swap out the devices for the existing ones at the same price, Mussallem said. Edwards’ Sapien XT, expected to hit the U.S. this year, uses a smaller catheter and is easier to insert. Visit Bloomberg for the article.


February 1 deadline: HPN is looking for your Infection Prevention success stories

Healthcare Purchasing News is putting together our annual compilation of your facilities’ infection prevention success stories. They will appear in our April 2014 issue. It's easy to submit. Please think in terms of a short abstract that includes your stories background, methods, and results.

·         Please provide a brief description of your facility (eg, ABC Hospital is a 50-bed facility serving rural northeastern Tennessee and southeastern Kentucky with an average of 80 inpatient surgeries per year) and the population it serves (eg, immunocompromised, pediatric, oncological, etc).

·         What specific infection was your facility aiming to reduce or eliminate, and why was it chosen for the focus of the campaign?

·         When did your facility start─and end─this campaign to reduce or eliminate this specific infection?

·         What was the rate of this infection before your facility began their campaign to reduce or eliminate it?

·         What is the rate of infection currently, or at the end of the study?

·         Has the facility been able to sustain the reduced rate of infection?

·         Describe specific steps your facility took to reduce or eliminate this infection.

·         If a product(s) was part of the solution, identify it and explain how it contributed to reduction/elimination of this specific infection.

·         What department(s) was involved in formation and implementation of this campaign? Was teamwork involved?

·         Did those charged with the task meet with any resistance by administration or staff in implementing the changes? If so, how did they overcome it?

Please include how you quantified your successes with numbers and percentages, monetary savings, time savings, and/or patient safety enhancement figures.

We look forward to sharing your successes. Please submit by February 1, 2014. Send your stories to editor@hpnonline.com. Please contact us if you have any questions.


January 27, 2014   Download print version

Today is your last chance to save $30 for the Linking Technology and Supply Chain: Cost, Quality, and Outcomes symposium sponsored by AHRMM and HIMSS

CDC releases report on physician EHR adoption

IV saline in short supply

Hospital antitrust case won by U.S. over doctor-group merger

Metropolitan Hospital of Miami to be sold

More than 300 people fall ill aboard cruise ship

Infections damage our ability to form spatial memories

3 million people have signed up for private health insurance through marketplaces

Today is your last chance to save $30 for the Linking Technology and Supply Chain: Cost, Quality, and Outcomes symposium sponsored by AHRMM and HIMSS

The AHRMM and HIMSS associations are co-sponsoring The Linking Technology and Supply Chain: Cost, Quality, and Outcomes pre-conference symposium being held  Sunday, February 23, 2014, 8 AM to 4:PM, at the HIMSS14 conference at the Orlando Convention Center.

This session is important for any healthcare professionals working in healthcare IT, supply chain, revenue cycle management

By attending you can earn 7 CMRP Credit/Contact Hours. The pre-conference symposium will explain the potential for the supply chain to provide the data necessary to achieve better costs, quality and outcomes. Visit here for the brochure.

The symposium includes a series of in-depth sessions lead by industry experts. As healthcare moves from a fee-for-service to a fee-for-value environment, the supply chain can provide the critical needed data to help healthcare systems meet the requirements and objectives of healthcare reform: better quality at a more affordable cost.

In this day-long symposium, attendees will participate not only  in a critical dialogue to gain a greater understanding of the data supply chain can provide around care delivery performance and outcomes but also identify ways to align these key functions in supporting overall organizational objectives in this era of change.

As a source of essential data, the supply chain is well-positioned to help hospitals and health systems understand the analytical aspects of outcomes reporting that leads to its ability to deliver better quality at a more affordable price. The C-suite and healthcare IT team need to collaborate with supply chain in order to get valuable data into electronic medical records.

Stay for the whole HIMSS14 conference and save $300 today as an AHRMM Member - But this discount expires today, Monday, January 27th so register now. Don't miss this opportunity to see latest developments in healthcare technology in one location.

Register now at www.himssconference.org/Registration/.

Also at HIMSS14 - Don't miss the Special Interest Group (SIG) Supply Chain annual meeting on Tuesday, February 25, at 7:00AM - 8:30 AM in Room 209B at the Orange County Convention Center. We will be discussing the latest information on the UDI Legislation recently learned from Terrie Reed, Associate Director, Informatics at FDA, on UDI's impact on meaningful use requirements and hospital information workflows. Join the SIG group chairpersons Karen Conway, Director Industry Relations, GHX, and Dick Perrin, CEO, Advantech, and editors from HPN - Rick Dana Barlow and Kristine Russell. Breakfast refreshments will be hosted by Healthcare Purchasing News. Please send your RSVP's to krussell@hpnonline.com. We hope to see you at all 3 events.


CDC releases report on physician EHR adoption

This month, the Centers for Disease Control and Prevention released a new data brief titled "Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013." Authored by Chun-Ju Hsiao, Ph.D., and Esther Hing, M.P.H., the brief details key findings on the state of EHR adoption among practice-based physicians in 2013, as compared with previous years. The brief also reports trends on "physicians' intent to participate in the EHR Incentive Programs and their readiness to meet 14 of the Stage 2 Core Set objectives for meaningful use in 2013."

Key findings of the report include:

• In 2013, 78% of office-based physicians used any type of electronic health record (EHR) system, up from 18% in 2001.

• In 2013, 48% of office-based physicians reported having a system that met the criteria for a basic system, up from 11% in 2006. The percentage of physicians with basic systems by state ranged from 21% in New Jersey to 83% in North Dakota.

• In 2013, 69% of office-based physicians reported that they intended to participate (i.e., they planned to apply or already had applied) in "meaningful use" incentives. About 13% of all office-based physicians reported that they both intended to participate in meaningful use incentives and had EHR systems with the capabilities to support 14 of the Stage 2 Core Set objectives for meaningful use.

• From 2010 (the earliest year that trend data are available) to 2013, physician adoption of EHRs able to support various Stage 2 meaningful use objectives increased significantly.

Of particular interest to HIMSS is the finding that 69% of physicians reported intent to participate in an EHR incentive program (Medicaid or Medicare) in 2013. This is good news for patients because participation in the programs requires successful attestation for various functionalities and processes that bring a modicum of uniformity to care coordination and patient engagement.

Further, the reports finding of an adoption rate of 78% among physicians brings the nation significantly closer to President Bush's 2004 State of the Union Address calling for a plan to ensure that most Americans would have an electronic health record in the next 10 years. 2014 is 10 years from that day. Visit CDC for the report.


IV saline in short supply

Hospitalists across the country are reporting a shortage of IV saline solution, blaming manufacturing problems and increased demand from a harsh flu season. The FDA said in a drug safety communication that it's aware of the shortage and is working with three manufacturers -- Baxter, Hospira, and B. Braun Medical -- to "preserve the supply of these necessary products."

Millions of bags of IV saline solution are used each week, and the American Society of Health-System Pharmacists called it a "critical shortage" in its notice to healthcare providers, urging doctors to follow conservation strategies. The organization said the shortage is a result of an unusual spike in demand, and that suppliers are "operating at full production but are still experiencing difficulty meeting increased demand."

A spokesperson for Baxter, one of the largest producers of IV saline in the country, said in an email to MedPage Today that the company "is making every effort to meet the needs of acute and critical care settings and other customers" and that the company's production "will be maintained at maximum levels."

It is also tightly managing its inventory through a "temporary allocation and fulfillment process in order to expedite product for urgent need."

An anesthesiologist at Emory University said Baxter notified their hospitals that the company had scheduled a 2-week shutdown over the holidays for an FDA inspection and upgrades, but it assured providers that they would have enough fluids to supply all of their customers during that time.

The Baxter spokesperson said the late December maintenance at Baxter's facility where saline products are produced was "planned, routine, and abbreviated, and was not the cause of any shortage situation," adding that required maintenance ensures that manufacturing "continues to run smoothly and efficiently."

In a letter to its customers in December, Baxter said it would temporarily suspend production of its 150 mL bags of saline solution because of a higher demand for the 250 mL product -- and that production of the smaller size would be restored by the second quarter of 2014. Visit MedPage Today for the story.


Hospital antitrust case won by U.S. over doctor-group merger

Idaho’s largest hospital chain and physician group must unwind their merger, a federal judge ruled, siding with U.S. regulators seeking to broaden antitrust enforcement in healthcare acquisitions.

The combination of St. Luke’s Health System Ltd. and the Saltzer Medical Group would raise prices for consumers even though it would improve patient care, U.S. District Judge B. Lynn Winmill in Boise, ID said today, ruling in a pair of cases brought by the Federal Trade Commission and local hospitals.

“There are other ways to achieve the same effect that do not run afoul of the antitrust laws and do not run such a risk of increased costs,” Winmill wrote in ordering the combination undone.

While the FTC has been active in taking on hospital deals it sees as anticompetitive, the Idaho case, won after a trial, underscores the agency’s new turn to block doctor-group acquisitions by hospitals. The FTC in 2012 settled a similar complaint brought over the acquisition of two cardiology groups in Nevada.

The ruling will embolden the commission in its efforts with physician groups and provides a precedent for taking on other mergers, Jeffrey Jacobovitz, an antitrust lawyer at Arnall Golden Gregory LLP in Washington, said in a phone interview.

“It’s a unique case, it’s an expansion of what they’ve been doing in the healthcare arena and they won,” said Jacobovitz, a former FTC lawyer. “It’s major a victory by the FTC.”

Jacobovitz said he expects the agency will challenge future mergers of this kind and possibly retroactively scrutinize consummated deals where hospitals acquired physician practices.

David Balto, an antitrust lawyer in Washington who has represented consumer groups, said the ruling could be read as conflicting with the Obama administration’s healthcare overhaul, which advocates reducing fragmentation of medical care to improve quality.

“St. Luke’s is extremely disappointed by the ruling” and anticipates appealing, Ken Dey, a spokesman for the hospital chain, said. The merger occurred in January 2013, Dey said.

Visit Business Week for the article.


Metropolitan Hospital of Miami to be sold

Metropolitan Hospital of Miami, a small private hospital struggling to compete in a changing market dominated by increasingly larger healthcare conglomerates, is being sold for the second time in seven years, according to several sources.

In a memo delivered Thursday to Metropolitan Hospital’s estimated 450 employees — with the subject, “Sale of Hospital” — Chief Executive Gene Marini urged the staff to continue working hard but made no promises that they would keep their jobs under the new owners. Marini’s memo hinted that some hospital employees may keep their jobs after interviews with the new buyer, whom he did not identify.

Marini did not return a message left at his office Friday, and the hospital’s administrative office was not accepting calls in the afternoon. Metropolitan Hospital’s website also has been down since at least Friday morning.

The hospital’s sale price has not been disclosed, and the transaction requires approval from Florida’s Agency for Health Care Administration, which received a change of ownership application for Metropolitan Hospital on Jan. 15, said Shelisha Coleman, a spokeswoman.

Coleman said a new owner would be permitted to continue providing general acute care, such as surgeries and emergency medical services. The only restriction is that the hospital cannot limit its services to cardiac-, orthopedic- or cancer-related diseases, and neither can 65 percent or more of patient discharges fall within those diagnoses groups, Coleman said.

Formerly called Pan American Hospital, Metropolitan changed ownership and names in 2007, when a Puerto Rico hospital chain bought the facility out of bankruptcy court for $34 million.

Despite new owners and a smaller staff no longer represented by the SEIU Florida Healthcare Union, Metropolitan Hospital has been losing money for several years, according to financial data reported by hospitals to the state.

Metropolitan administrators reported losing $4.4 million in 2011 on operating expenses of about $43.8 million. That was a bigger loss than 2010, when the hospital lost about $1.3 million on operating expenses of $42.1 million.

The hospital, located near Miami International Airport, was founded in 1963 by Cuban immigrants to serve their community. It’s licensed for 146 beds and includes an emergency room.

The hospital reported about 5,000 admissions in 2011, with patients experiencing an average length of stay of about five days. Its patients are predominantly Hispanic, and many are seniors on Original Medicare, in Medicare HMOs, such as Leon Medical Centers, and on Medicaid, according to state records. Visit the Miami Herald for the article.


More than 300 people fall ill aboard cruise ship

The Centers for Disease Control and Prevention are investigating how more than 300 people have fallen ill on board a ship cruising the Caribbean. The CDC said Saturday that health officials would board Royal Caribbean's Explorer of the Seas Sunday, when it is scheduled to dock at St. Thomas, U.S. Virgin Islands.

In all, 281 passengers and 22 crew members have reportedly fallen ill during the voyage, with most reporting vomiting and diarrhea. The CDC said it was not immediately clear what had caused the apparent outbreak. In response, the agency said that the ship's crew had stepped up its cleaning and disinfecting actions, encouraged passengers to report possible new cases, and prepared for new crew members to join the voyage midway through the journey.

The ship had departed Cape Liberty, NJ on January 21 for a scheduled 10-day cruise to the island of St. Maarten, which included scheduled stops in Haiti and Puerto Rico. There are a total of 3,050 passengers and 1,165 crew on board.

This marks the second gastrointestinal outbreak on a cruise ship stopping at US ports so far this year. An epidemiologist had to board a Norwegian Cruise Line ship in Miami on Jan. 19 after 130 passengers fell ill.

The last stricken Royal Caribbean ship was the Vision of the Seas, on board which 118 passengers fell ill last February, according to the CDC website. Visit Fox News for the story.


Infections damage our ability to form spatial memories

Increased inflammation following an infection impairs the brain's ability to form spatial memories – according to new research. The impairment results from a decrease in glucose metabolism in the brain's memory centre, disrupting the neural circuits involved in learning and memory.

Inflammation has long been linked to disorders of memory like Alzheimer's disease. Severe infections can also impair cognitive function in healthy elderly individuals. The new findings published in the journal Biological Psychiatry help explain why inflammation impairs memory and could spur the development of new drugs targeting the immune system to treat dementia.

In the first trial to image how inflammation impairs human memory, the team at Brighton and Sussex Medical School scanned 20 participants before and after either a benign salty water injection or typhoid vaccination, used to induce inflammation. Positron emission tomography (PET) was used to measure the effects of inflammation on the consumption of glucose in the brain and after each scan participants tested their spatial memory by performing a series of tasks in a virtual reality.

A reduction in glucose metabolism within the brain's memory centre, known as the Medial Temporal Lobe (MTL), was seen following inflammation. Participants also performed less well in spatial memory tasks, an effect that appeared to be directly mediated by the change in MTL metabolism.

"We have known for some time that severe infections can lead to long-term cognitive impairment in the elderly. Infections are also a common trigger for acute decline in function in patients with dementia and Alzheimer's disease," explains Dr Neil Harrison, a Wellcome Trust Intermediate Clinical Fellow at BSMS who led the study. "This study suggests that catching a cold or the flu, which leads to inflammation in the brain, could impair our memory."

Infections are unlikely to cause long-term detrimental impact in the young and healthy but the findings are of great significance in the elderly. The team now plans to investigate the role of inflammation in dementia, including insight into how acute infections such as influenza influence the rate of progression and decline.

"Our findings suggest that the brain's memory circuits are particularly sensitive to inflammation and help clarify the association between inflammation and decline in dementia," says Dr Harrison. "If we can control levels of inflammation, we may be able to reduce the rate of decline in patients' cognition."

Visit EurekAlert for the study.


3 million people have signed up for private health insurance through marketplaces

Three million people have signed up for private insurance coverage through the health-care law’s marketplaces, the Obama administration announced Friday. That lags behind its initial projections for overall enrollment — but it’s closer to hitting the monthly sign-up expectations the administration set in September.

In a blog post, the Department of Health and Human Services said that at least 800,000 people had signed up for coverage during the first three weeks of January.

In September, the Obama administration had projected that the insurance exchanges would add 1.1 million enrollees this month, a target that could be in reach with one week left in January for people to sign up.

“As our outreach efforts kick into even higher gear, we anticipate these numbers will continue to grow, particularly as we reach even more uninsured young adults so that they know that new options and new ways to help eligible individuals pay for their premium are now available, thanks to the Affordable Care Act,” Centers for Medicare and Medicaid Services administrator Marilyn Tavenner wrote in the Friday blog post.

Since the federal government implemented significant fixes to HealthCare.gov on Dec. 1, monthly enrollment totals have inched significantly closer to the targets. Instead of netting a quarter or a third of the expected sign-ups, as the administration did in October and November, now the numbers are coming in much more in range of expectations.

Generally, health policy experts had expected that enrollment in January would be lower than December sign-ups. That’s because December was a month with a key deadline: Shoppers had to pick a plan by Dec. 23 in order to be covered in January, the start of the insurance expansion.

For those who were transitioning into the exchanges from the individual market and didn’t want a gap in coverage — or those with costly pre-existing conditions eager to gain coverage — there were a lot of reasons to get signed up at the first possible moment.

Now that pressure has lifted a bit, and shoppers have through the end of March to purchase a policy. That probably means there will be another uptick in enrollment this spring, as potential enrollees get closer to the March 31 end of open enrollment.

The Obama administration has not yet released data on how many health insurance enrollees have paid their first month’s premium. One major health insurer, Aetna, had said that more than 70 percent of those signed up had paid for policies as of mid-January.

In Washington state, one of the few exchanges that does collect premium payments, slightly fewer than half of shoppers who selected a plan have sent a premium payment to that insurer: 67,200 paid customers versus 72,636 still awaiting payment. Visit the Washington Post for the article.  


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