|January 27-31, 2014
January 31, 2014
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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
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
CDC panels establish anthrax prevention,
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
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.
garnered responses from 1,265 physicians from around the country and opened
up a dialog about the ACA. Results of the study included:
physicians said they did not feel like they had enough information on the
ACA to serve as a reliable resource to their patients.
physicians don’t feel they have enough information on the ACA to understand
its impact on their practice and comply with its requirements.
where they get the most reliable information about the ACA, the majority
(35%) of physicians responded saying there aren’t any reliable sources of
they would use an HHS-produced FAQ with their patients if such a resource
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
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.
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 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.
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:
more persons diagnosed with depression
more persons suffering catastrophic medical expenses
fewer diabetics receiving medication
fewer women receiving mammograms and
fewer women receiving pap smears
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.
results were sobering. Political decisions have consequences, some of them
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.
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.
to arriving at national estimates, the researchers were able to break the
findings down by state.
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.
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.
includes a table showing expected excess deaths and other harms from opting
out of the Medicaid expansion on a state-by-state basis.
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
Kimberly-Clark deadline for the 2014 HAI WATCHDOG Awards
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.
HAI WATCHDOG Awards are now open.
the 2013 HAI WATCHDOG Award winners and honorable mentions in your region
Congratulations to all those who participated!
300 Beds: UC Davis Medical Center
Education Initiative: Huntsville Hospital
Environmental Services: NYU Langone Medical Centers
300 Beds: Wilmington Hospital, Christiana Care Health System
System: Christiana Care Health System
300 Beds: Methodist Willowbrook Hospital
Choice: Specialty Hospital Washington, Hadley
System: Georgia Regents Medical Centers
300 Beds: Lakeridge Health Oshawa
Kimberly-Clark for more information.
Medicare’s delivery system reform initiatives achieve
significant savings and quality improvements - off to a strong start
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.
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.
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
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.
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.”
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.”
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
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
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.
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.
more about the ways HHS is working to reform the healthcare delivery system
more about the Bundled Payments for Care Improvement initiative, including
more about the Medicare Shared Savings Program
more about Pioneer ACOs
more about the Physician Group Practice Demonstration
Obesity is found to gain its hold in earliest years
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.
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
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.
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.
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
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.
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
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.
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.
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
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
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.
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.
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.
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.
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.
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.
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
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
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
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.
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.
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.
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.
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.
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
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.
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
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.
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.
Einhorn state their case for a single-payer system by delineating problems
that such a system could address:
administrative costs, which currently account for almost a third of
many bankruptcies attributable to healthcare costs, which accounted for more
than 60% of family bankruptcies identified in a 2009 report
health, as indicated by evidence that being uninsured increases the
mortality hazard by 40%
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
quality of care and outcomes by increasing access to care
trend toward for-profit, investor-owned healthcare plans
physician's income potential, as judged by experience with the Canadian
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.
Department of Veterans Affairs gets a 40% discount on medication by buying
in bulk. Medicare is legally forbidden to negotiate drug prices.
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
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."
taken no position on a single-payer or other type of healthcare system, said
ASCO chief executive officer Allen Lichter, MD.
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
with the Derasga-Einhorn editorial, ASCO and the Community Oncology Alliance
(COA) jointly issued principles for achieving payment reform in oncology.
principles focus on:
taking a leadership role in payment reform
inadequacy of current reimbursement models
for new models for delivering oncology services to ensure high quality and
choices in payment models at the local level
measurement of quality
inadequacy and inequity of reimbursement for oncology drugs under Medicare
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
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.
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.
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
Deloitte invites Medical Device Manufacturers
to a UDI Roundtable
Do doctors spend too much time looking at
Antibiotics in animals tied to risk of human
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
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
“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
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,
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
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
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
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
“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
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
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
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
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
Do doctors spend too much time looking at computer
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
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
Mouthwashes 'can raise risk of heart attack
and strokes': Antiseptic gargles kill good bacteria that help keep blood
Princeton hospital no longer delivering
'Doctor, please review this checklist before
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
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
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
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
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
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 £180 million 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
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
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
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
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
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
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
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,”
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
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
January 28, 2014
Download print version
How much do medical devices cost? Doctors
have no idea
Doctors abusing Medicare face fines and
Beijing’s bad air would be step up for smoggy
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
More infected in fresh wave of China bird flu
Hospital costs key for Medtronic rival valve
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
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
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
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
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
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
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
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
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
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
Visit The Economic Times for the article.
Little-known aspect of Medicaid now causing people to
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
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
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
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
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
Long term exposure to air pollution linked to coronary
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
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
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
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
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
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
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
We look forward to sharing your successes. Please submit by February 1,
2014. Send your stories to
firstname.lastname@example.org. 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
Metropolitan Hospital of Miami to be sold
More than 300 people fall ill aboard cruise
Infections damage our ability to form spatial
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
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
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
email@example.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
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
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
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
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
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
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
“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
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
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
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
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
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
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
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
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
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
Visit the Washington Post for the article.
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