July 17, 2008 Download print version

Congress easily overrides Medicare veto

Senate Agrees to $50 Billion AIDS Plan

Novation first to have national agreement with Abbott Vascular for its XIENCE V Everolimus-Eluting Stent

Consumption of nut products during pregnancy linked to increased asthma in children

Breast self-exams do not appear to reduce breast cancer deaths

Children's physical activity drops from age 9 to 15, NIH study indicates

Patient reports can add to efforts to identify, reduce adverse events in hospitals

Small business is latest focus in health fight

Congress easily overrides Medicare veto

President Bush sought to block a bill Tuesday aimed at forestalling an 11 percent cut in payments to doctors taking care of Medicare patients, but Congress quickly overrode his veto. The House voted 383 to 41 to override the veto, while the Senate voted 70 to 26, in both cases far more than the two-thirds necessary to block the president's action.

With organized medicine and other lobbies promoting the popular measure in an election year, Republicans broke heavily from the White House. A total of 153 House Republicans voted to defy the White House, 24 more than in a June 24 vote that started the momentum toward passage of the Medicare doctors' bill yesterday. Twenty-one Senate Republicans voted for the bill this time, including four senators who had voted "nay" in the two previous Medicare votes.

At issue in this bill was how the government should respond to a planned reduction in Medicare doctors' fees, mandated by a formula that requires the cuts if certain spending targets are not reached. Under the formula, a 10.6 percent cut in fees for doctors was supposed to go into effect July 1, but Congress overwhelmingly voted instead to reduce the reimbursement to insurance companies that serve Medicare beneficiaries under its managed-care program. Those reductions would allow the postponement of the pay cut to doctors for 18 months, but would cost the insurers $14 billion over five years.

The House and Senate votes followed a large political push by the American Medical Association -- which ran ads in home states and districts of key Republicans -- and AARP, which held a lobbying campaign in which 1.2 million of its activists contacted members of Congress urging the veto override. Health-care experts said Congress is simply moving the problem down the road, since lawmakers will be confronted within the year with the need to take additional steps or allow a major cut in physician fees. (Washington Post) Read the original article.

Senate Agrees to $50 Billion AIDS Plan

The Senate approved legislation yesterday that would triple funding to fight AIDS and other diseases around the globe, rejecting efforts to pare down the bill's $50 billion price tag. On an 80 to 16 vote, the Senate dramatically increased the U.S. contribution to a global fund to combat AIDS, tuberculosis and malaria. President Bush, who requested $30 billion over the next five years, has agreed to the larger amount for a program he started in 2003.

"We've made tremendous strides, but our work is not nearly finished. Two million people died last year of HIV-AIDS. Over two and a half million people died of malaria and TB," said Senate Foreign Relations Committee Chairman Joseph R. Biden Jr. (D-Del.). He praised Bush's "bold" support for AIDS funding, launched in the 2003 State of the Union address, calling it his greatest achievement as president.

Some Senate conservatives were divided over supporting the costly program, though they acknowledged its success. According to the Office of the U.S. Global AIDS Coordinator, the money has provided services in poor nations that have prevented 194,000 HIV infections among infants. The program originally focused on 15 poor nations, but the legislation would expand it to help provide prevention and treatment services in more than 100 countries.

The House has passed its own version of the bill, but Biden said there are only minor differences between the two and predicted a final version would soon be crafted and sent to the president for his signature. (Washington Post) Read the original story.

Novation first to have national agreement with Abbott Vascular for its XIENCE V Everolimus-Eluting Stent

Novation, LLC, the contracting services company of VHA Inc. and the University HealthSystem Consortium (UHC), announced that it has added the Abbott Vascular XIENCE V everolimus-eluting stent, one of the newest cobalt drug-eluting coronary stents on the U.S. market, to its national agreement. XIENCE V is immediately available in diameters of 2.5 mm, 2.75 mm, 3.0 mm, 3.5 mm and 4.0 mm adding both a larger and smaller size to the DES range. The available stent lengths are 8, 12, 15, 18, 23 and 28 mm. The device will be available in both rapid-exchange and over-the-wire delivery system designs.

Consumption of nut products during pregnancy linked to increased asthma in children

Expectant mothers who eat nuts or nut products like peanut butter daily during pregnancy increase their children's risk of developing asthma by more than 50 percent over women who rarely or never consume nut products during pregnancy, according to new research from the Netherlands. The study appeared in the second issue for July of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

"We were pretty surprised to see the adverse associations between daily versus rare nut product consumption during pregnancy and symptoms of asthma in children, because we haven't seen this in similar previous studies," said the study's lead author, Saskia M. Willers, M.Sc. While noting that it is "too early to make recommendations of avoidance," Ms. Willers also points out that "it's important for pregnant women to eat healthily, and what is true for many foods is that too much is never good."

Maternal consumption of allergenic foods during pregnancy may increase the risk that the fetuses they carry would become sensitized to certain allergens. Research on the topic, however, has been contradictory and inconclusive. Nearly 4,000 expectant mothers from the Prevention and Incidence of Asthma and Mite Allergy study conducted by the Dutch government completed a dietary questionnaire that asked how often they consumed vegetables, fresh fruit, fish, eggs, milk, milk products, nuts and nut products during the last month. Their children's diets were also assessed at two years of age, and their asthma and allergy symptoms were assessed yearly until eight years of age. By the end of the eight years, the researchers had complete data for 2,832 children and their mothers.

"The only consistent association between the maternal intake of the investigated food groups during pregnancy and childhood asthma symptoms until eight years of age that we found was with nut products," said Ms. Willers. "Daily versus rare consumption of nut products—which we assumed was largely peanut butter—was consistently and positively associated with childhood asthma symptoms, including wheeze, dyspnea, doctor diagnosed asthma and asthma-associated steroid use."

The association remained even after controlling for the child's diet.

While a strict low-allergen diet is not recommended for most expectant mothers because it risks both maternal and fetal malnutrition, Ms. Willers notes that peanuts may be the exception to that general recommendation. "Peanut is a potent allergen, and peanut allergy is associated with anaphylactic shock and is less likely to be outgrown than other allergies."

Breast self-exams do not appear to reduce breast cancer deaths

It is a staple of women's health advice and visits to the OB/GYN: the monthly breast self-exam to check for lumps or other changes that might signal breast cancer. However, a review of recent studies says there is no evidence that self-exams actually reduce breast cancer deaths. Instead, the practice may be doing more harm than good, since it led to almost twice as many biopsies that turned up no cancer in women who performed the self-exams, compared to women who did not do the exams.

"At present, screening by breast self-examination or physical examination [by a trained health worker] cannot be recommended," Jan Peter Kosters, Ph.D., and Peter Gotzsche, Ph.D., of the Nordic Cochrane Centre, conclude in the review. However, the authors recognize that some women will want to continue with breast self-exams and women should always "seek medical advice if they detect any change in their breasts that might be breast cancer," Kosters said.

Carolyn Runowicz, director of The Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center, encourages women to do the self-exams if they are comfortable with them, noting that 50 percent to 60 percent of women detect their own breast masses. "I think what we are seeing is that women are familiar with their breast through breast self-exam and when there is a lump, they notice the difference," she said.

The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

In the two large studies of 388,535 women in Russia and China included in the review, women who used self-breast exams had 3,406 biopsies, compared with 1,856 biopsies in the group that did not do the exams. At the same time, there was no significant difference in breast cancer deaths between the two groups.

The China study published data on how breast cancers detected in the women were treated. Rates of both mastectomy and breast-conserving surgery such as lumpectomy were very similar between the exam and no-exam groups.

Children's physical activity drops from age 9 to 15, NIH study indicates

The activity level of a large group of American children dropped sharply between age 9 and age 15, when most failed to reach the daily recommended activity level, according to the latest findings from a long-term study by the National Institutes of Health. The analysis is one of the largest, most comprehensive of its kind to date.

The researchers evaluated the children to determine whether they achieved the minimum 60 minutes per day of moderate to vigorous physical activity (MVPA) recommended for children.

At age 9, the children averaged roughly three hours of MVPA on weekdays and weekends. By age 15, however, they averaged only 40 minutes per weekday, and 35 minutes per weekend.

"Lack of physical activity in childhood raises the risk for obesity and its attendant health problems later in life," said Duane Alexander, M.D., Director of NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Helping American children maintain appropriate activity levels is a major public health goal requiring immediate action."

The analysis, appearing in the July 16 Journal of the American Medical Association, was undertaken by Philip Nader, M.D., Emeritus Professor of Pediatrics at the University of California San Diego, and other coauthors from the study.

Beginning at age 9, the researchers recorded the activity levels of more than 800 children for four to seven days. The children's activity was recorded with an accelerometer, a device that records movement, which the children wore on a belt. The researchers conducted follow up tracking at ages 11, 12, and 15. As examples of moderate physical activity, the Centers for Disease Control and Prevention list walking briskly, dancing, swimming, or bicycling on level terrain. Vigorous physical activity includes such activities as jogging, high-impact aerobic dancing, swimming continuous laps, or bicycling uphill.

The researchers found that, at ages 9 and 11, more than 90 percent of the children met the recommended level of 60 minutes or more of MVPA each day. By age 15, however, only 31 percent met the recommended level on weekdays, and 17 percent met the recommended level on weekends. The researchers estimated that physical activity declined by about 40 minutes per day each year until, by age 15, most failed to reach the daily recommended activity level.

Dr. Nader explained that local school systems have a role to play, by ensuring children receive periodic recess breaks and daily active physical education. He added that local governments also could strive to provide safe biking and walking routes around schools. More information is available at http://wecan.nhlbi.nih.gov 

Patient reports can add to efforts to identify, reduce adverse events in hospitals

Hospitals' efforts to improve patient safety rely on several methods of monitoring and evaluating the occurrence of adverse events: including incident reports from members of the health care team, automated surveillance of clinical data, and review of medical records. A group of Massachusetts researchers report in the July 15 Annals of Internal Medicine that surveying patients about their experiences can provide additional important information. They found that nearly 23 percent of patients reported experiencing a complication during or immediately after their hospital stay, compared with about 11 percent of patients whose adverse events were identified through medical record review.

"Every approach to monitoring adverse events or complications has its limitations, even record review, which has been regarded as the "gold standard," says lead author Joel Weissman, PhD, of the Massachusetts General Hospital (MGH) Institute for Health Policy. "Our research demonstrates that patients themselves can be a valuable source of information about unexpected complications that occur as a result of medical care, both during their hospital stay and after they are discharged."

While many hospitals regularly survey patients after discharge, those surveys are usually focused on patients' satisfaction with their care and not on whether they experienced injuries or complications. The current study was designed to evaluate whether patients can accurately report adverse events they experienced, the types of events patients were most likely to report and how well patient reports matched what in the medical record. It consisted of two primary phases: a telephone survey of patients admitted to 16 Massachusetts hospitals during six months in 2003 and a review of the medical records of survey participants who gave written permission for the review.

Weissman explains, "Adverse events are complications or injuries to patients, some of which may due to preventable errors, and some which are neither preventable nor error-related. For example, an allergic reaction to a drug is an adverse drug event. If the allergy was known, administering that drug was a preventable error. But if the allergy was unknown, it was not preventable, although still an adverse event. Patients may be more likely to know about complications than about errors in their care."

The study identified 281 patients who experienced some sort of adverse event, 229 were identified in the interview and 105 in the medical record, but only 53 were noted by both sources. Less than 10 percent of events identified by either method were serious or life-threatening, and under a third were determined to be probably or definitely preventable. Most of the events that took place after patients were discharged from the hospital were related to their care but did not become evident until they left the hospital.

"This study shows very clearly that additional tools can and should be added to hospitals' efforts to evaluate patient safety," says study co-author Nancy Ridley, MS, of the Massachusetts Department of Public Health. "Patient involvement plays an important role in the safety and delivery of health care services, and we encourage hospitals to enlist patients in these efforts wherever possible."

Small business is latest focus in health fight

As the number of people without health insurance continues to rise, many states and Congress have begun to focus on one of the biggest causes: the growing number of small business owners and their workers who are unable to afford coverage. The states are taking a variety of approaches. To help ease the burden of insurance premiums that have roughly doubled since 2000, some, like Arizona, are extending tax credits to small employers that provide medical coverage.

Others, including New Mexico and Montana, are exploring ways to let small businesses band together to amass the purchasing power of big employers. Massachusetts plans to let small businesses benefit from its state-supervised insurance program. And some states, like Colorado, have passed tougher laws governing what insurers can charge small companies.

“States are being aggressive experimenters, and those lessons learned are going to be invaluable to us in looking at national health reform,” said Michelle Dimarob, manager of legislative affairs for the National Federation of Independent Business.

Congress, meanwhile, is considering legislation that, among other steps, would make it significantly easier for small businesses to organize insurance-buying pools. Despite bipartisan backing in both the House and Senate, it is uncertain whether the bills can be passed in this, an election year. But proponents say the legislation would almost certainly be reintroduced next term.

Because smaller businesses cannot spread the costs and risks of an individual’s high medical bills over a large work force the way a big company can, they often must settle for less-generous coverage that leaves workers with substantial out-of-pocket medical expenses. Many small employers simply choose not to provide health benefits, which can cost more than $12,000 a year for a family of four.

Of the 47 million uninsured people in this country, at least 20 million are employed by small businesses or work for themselves — a figure that has increased by an average of more than 500,000 a year since 2000. That is why, even as the presidential candidates John McCain and Barack Obama are floating ideas for making insurance easier to obtain by individuals, there are also efforts under way to address the needs of small businesses.

“Half of the uninsured people in our state are working for small business,” said Nancy Wyman, the state comptroller for Connecticut. Despite broad interest in the issue, though, making significant changes at the state level can be difficult, politically and practically, as Connecticut’s recent experience shows.

July 16, 2008 Download print version

House overrides Bush’s Medicare bill veto

CBSPD announces re-accreditation from the National Commission for Certifying Agencies
until May 31, 2013

New RFID study presents safe results:
Testing Potential Interference with RFID Usage in the Patient Care Environment

Global warming to spark rise in kidney stone cases, study says

Health system to use SafetySurveillor to increase patient safety

APIC announces new title for infection control profession

Smiths Medical PM offers pocketsize capnometer

New technologies for medical treatment can push prices sharply higher,
even when the benefits are modest

House overrides Bush’s Medicare bill veto

In what likely is the last big showdown between President George W. Bush and congressional Democrats over the popular Medicare health care program, the House of Representatives on Tuesday voted to override his veto of a bill to keep doctors' payments from being slashed. By a vote of 383-41, the House voted to overturn Bush's action, just hours after he vetoed the legislation. The Senate was expected to vote on the veto override later on Tuesday.

Supporters of the legislation argued that the scheduled 11 percent pay cut for doctors would discourage many of them from taking on Medicare patients. The bill would offset the cost to the government of restoring the doctors' pay by cutting payments to big insurers, such as UnitedHealth Group Inc. and Aetna Inc., which have contracts with the Medicare program.

Democrats argued that those contracts with private health care plans, which were encouraged in the 2003 legislation creating a new government drug benefit for the elderly, cost more than providing health coverage under the traditional Medicare program. They also argued that more generous subsidies to private health plans threaten to undermine the traditional Medicare program.

If the Senate follows the House's lead, it will be the fourth time in two terms that Bush has had a veto overturned by Congress. Bush has vetoed 12 bills during nearly eight years as president. Nearly all of those vetoes were since Democrats gained their congressional majority in 2007.

Bush said the $13 billion in reimbursement cuts to insurers will discourage program participation and reduce choices for the elderly. "I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it," Bush said in a statement to the House.

The bill is a temporary measure designed to stop the pay cut for doctors and give Congress and the next president, who takes office January 20, 2009, time to review broader issues surrounding Medicare. The health care program faces growing financial strains as the 77 million baby boom generation retires and begins to draw on government benefits. (Yahoo News – Reuters)  Read the original article.

CBSPD announces re-accreditation from the National Commission for Certifying Agencies
until May 31, 2013

The Board of Directors of the Certification Board for Sterile Processing & Distribution, Inc. has announced that their Technician, Supervisor and Manager certification examinations have received full re-accreditation from the National Commission for Certifying Agencies until May 31, 2013.

In its letter to the CBSPD, the NCCA indicated “The NCCA appreciates the continued interest of the CBSPD in providing high quality certification programs.”   As a result of the re-accreditation, the CBSPD can advertise that the Technician, Supervisor and Manager certification programs are accredited by the NCCA and the CBSPD may use the NCCA logo to attest accreditation.

According to Nancy Chobin, RN, AAS, ACSP, CSPDM, Executive Director of the CBSPD, this re-accreditation validates the processes implemented by the CBSPD in 1988 when the organization was formed and are followed to this day.  The CBSPD Board also applauds the CBSPD staff and Board members who worked diligently to prepare the accreditation application.  Many individuals have provided the expertise to maintain a high quality, secure, certification program.  These individuals include the members of the CBSPD Item Review/Test Development Committee and the CBSPD Continuing Education Committee among others.

The CBSPD is now updating its Certified Surgical Instrument Processor examination and then will apply for accreditation for that certification as well. The CBSPD offers 6 certification programs; Certified Sterile Processing & Distribution Technician, Certified Sterile Processing & Distribution Supervisor, Certified Sterile Processing & Distribution Manager, Certified Ambulatory Surgery Sterile Processing & Distribution Technician; Certified Surgical Instrument Processor and the new Certified Flexible Endoscope Reprocessor examination which deals exclusively with processing of flexible GI and bronchoscopes. For more information contact the CBSPD at: www.sterileprocessing.org or 800-555-9765.

New RFID study presents safe results:
Testing Potential Interference with RFID Usage in the Patient Care Environment

A new study on the effects of passive ultrahigh-frequency (UHF) RFID systems on medical equipment did not discover any problems with electromagnetic interference (EMI). The clinical study was conducted in March of this year at Community North Hospital in Indianapolis, by researchers at Indiana University Purdue University Indianapolis (IUPUI) and by RFID consulting and systems integration firm BlueBean. BlueBean, based in Carmel, Ind., initiated the study because there had been a scarcity of research on EMI and radio frequency identification, and the company hoped to have definitive answers for customers as it builds out an RFID practice for the health-care market.

The study, entitled "RFID Usage in the Patient-Care Environment," is released just two weeks after a prior study was published in the Journal of the American Medical Association (JAMA) that found incidents of EMI by RFID on critical-care equipment in a non-clinical setting (see Researchers Warn RFID May Disrupt Medical Equipment). That study was conducted by researchers at the University of Amsterdam's Academic Medical Center in the Netherlands as part of a government research project.

Both studies examined whether electromagnetic radiation from RFID systems would disrupt infusion pumps, EKG monitors and other medical equipment. The Dutch group employed an active 124 kHz battery-powered tag and reader, as well as a passive 868 MHz tag and interrogator, to study RFID's effect on 41 medical devices. The IUPUI-BlueBean group studied RFID's effects on 25 medical devices and used only passive UHF (902-928 MHz) RFID tags and readers, which included one system (host computer, transceiver, antenna and tag) containing a near-field antenna operating in a "dense reader mode" and a near-field tag, and another system consisting of a far-field antenna operating in a "high-throughput" mode and a far-field tag. Researchers from both studies carried out their tests operating the RFID devices continuously at full power (2 to 4 watts).

The Dutch study was performed in a one-bed patient room with no patients present. The IUPUI-BlueBean study was conducted in a patient care room in a hospital, but was staged to best replicate the setting in which both antennas and clinical devices would be utilized. "Our layout was a real-life scenario, and we put the antenna where you'd expect to put an antenna, and the equipment where you'd expect the equipment to be," says Barbara Christe, associate professor and program director of IUPUI's biomedical engineering technology department, and the study's lead researcher. "Their test, while physically housed in a patient room, used a scenario where devices and systems were physically placed where you'd not expect them to be."

For the most part, Christe's group utilized patient simulators, though in some cases, test subjects were involved. The non-invasive blood pressure devices, for instance, were triggered to measure the blood pressure of a human subject during testing, but the EKG monitors were tested while connected to patient simulators. Christe believes the non-clinical setting and the close proximity of the RFID systems to the medical devices is the reason the Dutch researchers recorded so many incidents of EMI.

According to Christe, the Dutch study was designed to determine whether there was any EMI at all with regard to RFID systems, and was never intended to mimic a clinical study. "In the JAMA article, it says this was a controlled, non-clinical study," she says. The IUPUI study, on the other hand, was designed to look for EMI with RFID in a clinical setting. "Our assumption, rightly so, is that there certainly should not be an antenna within a foot of a medical device. That is not good practice; that is not how you should design a system. Our study wasn't intended to find out, Is there ever interference? We know—even BlueBean agrees—that yes, there is likely to be some interference with devices when RFID systems are not used as intended."

There may be some applications, Christe says, in which an antenna might be closer than 1 foot, but in these applications—such as an RFID-enabled wand used to detect tags sewn into surgical sponges that may have inadvertently been left inside a patient—the system's power would only be on for a short time, while the patient is scanned, and not continuously.

Gregg Maggioli, president and CEO of BlueBean, and one of the study's authors, says he wanted to conduct the EMI study simply because he could not find any research studies examining EMI and RFID systems. BlueBean wants to extend its consulting and systems integration services to the health-care market, Maggioli says—specifically with passive UHF RFID systems for tracking assets and drug dispensing and administering. (RFID Journal) Read the whitepaper from Bluebean.

Global warming to spark rise in kidney stone cases, study says

It may not be the most profound effect of global warming, but it could be the most painful: Climate change could bring a sharp increase in cases of kidney stones in Illinois and other Midwestern states, according to a new study. Linking climate change to kidney stones seems odd, but it's based on the solid medical finding that people in warm regions develop the condition at increased rates. Sweating in warm weather removes fluid from the body and increases the salt concentration in urine, which can spur the growth of kidney stones.

By the year 2050, the new report estimates that a large chunk of Illinois will fall within America's "kidney-stone belt," which currently includes only Southern states. The Chicago area alone would see up to 100,000 extra cases each year, according to the report published in the journal, Proceedings of the National Academy of Sciences.

That sort of medical chain reaction may barely hint at the looming public health threat of global warming, researchers say. The federal Centers for Disease Control and Prevention has warned that higher temperatures could bring more lethal heat waves, more blooms of algae that infect fish with toxins, and the easier spread of some insect-borne illnesses such as Lyme disease and Rocky Mountain spotted fever.

The effects also could be expensive. The authors of the study estimate that the extra kidney stone cases would cost an additional $1 billion each year to treat. Counteracting the effects of temperature may be as simple as having people drink more water. But doctors said getting an entire region of the country to change drinking habits could prove difficult.

Most climate researchers believe emissions of carbon dioxide and other greenhouse gases are raising average temperatures worldwide and that North America will see a rise of at least 2 degrees Fahrenheit in the 21st Century. The new study, by researchers at the University of Texas at Dallas and the University of Texas Southwestern Medical School, combined medical studies of how regional temperature affects kidney stones with climate forecasts by the Intergovernmental Panel on Climate Change.

The effect of temperature on kidney-stone formation is a fundamental teaching of urology, said Dr. Mark Litwin, a professor of urology and public health at UCLA. He said the Texas team's blending of that physiological fact with climate data was "flawless."

Kidney stones pose an unusual public health challenge. Rarely fatal, they nonetheless create one of the most painful medical conditions—in some cases more excruciating than childbirth, according to some victims. Researchers have known for years that cases of kidney stones peak soon after the hottest summer months and that people in warm climates are at added risk. The dehydration that often comes from sweating means there's less fluid to dilute the salts in urine, which can more easily clump together into crystals.

More than 5 percent of the U.S. population has kidney stones, accounting for about half a million emergency room visits each year, according to federal estimates. Treatment costs range from about $8,000 for most noninvasive techniques to $50,000 or more when patients need surgery.

The new study predicts about 2.2 million additional climate-related kidney stone cases each year by 2050. No one expects a kidney-stone catastrophe. But experts said the problem offers a glimpse at a future in which the effects of climate change may be difficult to predict. (Chicago Tribune) Read the original story.

Health system to use SafetySurveillor to increase patient safety

The Premier healthcare alliance announced that it is expanding its relationship with North Mississippi Medical Center (NMMC). The Tupelo, Miss.-based healthcare system, which in 2006 was named a Malcolm Baldrige National Quality Award recipient along with Premier Inc., will deploy both the infection control and pharmacy modules of Premier’s SafetySurveillor. The third largest rural healthcare system in the nation will use SafetySurveillor to track and prevent healthcare-associated infections (HAIs) and to optimize antibiotic use, thereby increasing patient safety and reducing costs.

NMMC also joins QUEST: High Performing Hospitals, a Premier program designed to help hospitals and healthcare systems drive healthcare to new levels of performance. QUEST will develop next-generation quality, safety and cost metrics with a level of consistency and standardization that does not exist today.

APIC announces new title for infection control profession

To articulate the expanding roles of its members, APIC has announced that Infection Control Professionals will now be referred to as Infection Preventionists. This newly created term joins the list of professional titles such as hospitalists, intensivists and interventionists introduced by the healthcare industry over the past several years.

Infection Preventionists direct interventions that protect patients from healthcare-associated infections (HAIs) in clinical and other settings around the world. They work with clinicians and administrators to improve patient and systems-level outcomes and reduce HAIs and related adverse events.

“The term Infection Preventionist clearly and effectively communicates who our members are and what they do,” said APIC CEO Kathy Warye. “Infection Preventionists develop and direct performance improvement initiatives that save lives and resources for healthcare facilities, so this was a natural transition – or a right-sizing of the name – to more accurately reflect their role. By creating a new word, we hope to raise awareness about what Infection Preventionists uniquely contribute to patient safety, improved outcomes and bottom line savings to healthcare institutions.”

APIC also introduced a new corporate logo and tagline which encapsulate the organization’s global reach and focus on prevention: "Spreading knowledge. Preventing infection." The new elements are the result of months of research and development by APIC's Branding Task Force and are designed to promote Infection Preventionists as a separate and distinct profession, whose members are poised for leadership roles in healthcare. Visit www.apic.org for more information.

Smiths Medical PM offers pocketsize capnometer

Smiths Medical PM Inc. offers the BCI Capnocheck capnometer. Unlike other capnometers, the Capnocheck capnometer does not need routine calibration. Powered by two AAA batteries, the device has multiple applications including intubation verification, an indicator for return of spontaneous circulation, routine airway management, ventilator transport and weaning. Unlike colorimetric and other qualitative mechanical devices, the Capnocheck capnometer provides a fully quantitative numeric value that is now recommended in the American Heart Association (AHA) 2005 guidelines.

During resuscitation the Capnocheck capnometer can be an effective noninvasive indicator of cardiac output, CPR effectiveness, and indicator for return of spontaneous circulation. The device’s simple operation and accuracy make it an invaluable tool in all areas of clinical practice. For more information, see www.smiths-medical.com.

New technologies for medical treatment can push prices sharply higher, even when the benefits are modest

Why do medical costs keep going up? Walk into the University of Maryland Medical Center for a heart bypass operation and you'll see one reason. Maryland is one of the few hospitals in the country to use a robot for heart surgery. Developed first by the military and then for commercial use by Intuitive Surgical (ISRG), the da Vinci robot is manipulated by a surgeon seated several feet away from the patient. The machine takes minimally invasive surgery to a new level, allowing the tiniest of incisions and enabling doctors to operate in extremely tight places. The robot is already a popular option for prostate surgery, and proponents praise its ability to trim patient recovery time by a third.

It does not, however, do the same for the hospital bill. A da Vinci robot costs $1.5 million, and every time it is used in the operating room, some $2,000 worth of parts must be replaced (for safety reasons). It takes a surgeon 12 to 18 months to learn how to use the machine, and a da Vinci operation usually takes longer than a hands-on procedure. Consequently, a University of Maryland study estimates that the robot adds about $8,000 to the price of bypass surgery.

Another study from Dartmouth Hitchcock Medical Center points out that it's tough for most hospitals to earn back the price of the machine, if it wasn't donated. On top of all that, "There is really no convincing evidence that the da Vinci is any better than standard surgery," says Paul Levy, president of Boston's Beth Israel Deaconess Medical Center (which does not have one). "Doctors and hospitals that have one are promoting it, and patients are demanding it," Levy says. Patients are usually unaware of the increased cost of the robot, since their insurance pays the bills. Also there's no competitive pressure to lower costs, as Intuitive Surgery is the only company that makes a surgical robot.

Price insensitivity on behalf of customers, lack of competition, technological complexity—they all adds up to immense inflationary pressures on health-care costs. Technological advances go hand in hand with productivity gains in most industries, but in medicine, better technology almost always means higher expenses. PricewaterhouseCoopers estimates that medical costs will rise 9.9% this year and 9.6% in 2009, even though the overall inflation rate for the most recent quarter was 4.2%.

Some of this higher spending can be attributed to the greater medical demands of an aging, overweight population. But the California Healthcare Foundation says medical price inflation, not increased use, drives 51% of the growth in health-care spending. The federal Agency for Healthcare Research & Quality (AHRQ) found that from 2000 to 2004, the mean cost of a hospital stay per patient rose 15%.

Rising costs could be seen as a sign of progress: The cheapest medical outcome, after all, is death. Major advances in the treatment of heart disease, cancer, pulmonary disorders, and a broad range of once-fatal diseases have prolonged life, but the longer the life, the higher the medical costs. "We're not realizing cost reductions as a result of increased longevity," says Michael Thompson, principal with PriceWaterhouse Coopers. Survive a heart attack, for example, and you raise your chances of living long enough to die of cancer or Alzheimer's disease, two of the most expensive diseases. Not to mention the cost of the drugs and follow-up care you'll need to avoid another heart attack.

Medical costs are also affected by the Field of Dreams syndrome. If you build it, patients will come. Develop or improve a treatment for an unmet medical need, and demand will soar. Take anesthesia: Studies by the Kaiser Family Foundation show that better anesthetic drugs have resulted in faster patient recoveries and lower cost per patient. But the improvements also made it possible to perform surgery on patients once considered too frail, adding to the healthcare burden. These patients are inevitably costlier to treat than their more robust counterparts.

Better medical technology is rarely simpler technology. Implantable cardiac defibrillators, used to regulate the heartbeat of patients who have suffered serious damage to the heart, took decades to perfect. These tiny and complex devices, made by Medtronic (MDT) and St. Jude Medical (STJ), can reduce the risk of death from a heart attack by 30%, a significant benefit. Almost half of heart attack survivors now receive one, up from 9.5% in 1995. But the cost of implanting one can run anywhere from $68,000 to $102,000.

At least the value of the implantable defibrillator is well established. The Congressional Budget Office has estimated that less than half of all medical treatments are supported by rigorous evidence proving they work. And cost-benefit analysis, required by many countries before a new treatment can be approved, is almost taboo in the U.S. The Food & Drug Administration is forbidden by law from considering the cost of a new device or drug when deciding whether to approve it. Thus treatment with the new generation of highly individualized, targeted cancer drugs, such as Genentech's (DNA) Avastin or ImClone's (IMCL) Erbitux, can cost $100,000 or more, though they add only a few months of life for most patients. They do offer, however, a slim chance of a longer benefit to some patients.

That doesn't happen in countries with universal health care. In Europe, for example, the cost-benefit of a new treatment is part of its evaluation. Britain's powerful National Institute for Health & Clinical Excellence (NICE) just recommended against using Avastin for early treatment for lung and breast cancer because it didn't believe data support the high price. In the U.S., an insurer will rarely deny payment for a treatment based on price. Also in other nations, drug prices are determined by the national health service, a bargaining power legally denied Medicare.

New treatments can also go quite wrong, expensively wrong, especially early in their product life as doctors adjust to using them. Bernard Friedman, senior economist with the AHRQ, says complications and malfunctions are among the main causes of the rising cost of individual treatments. Bariatric surgery, can dramatically improve health outcomes, but as many as 14% of patients may end up back in the hospital from complications. Spine surgery, one of the more common surgical procedures, also has a notably high complication rate, and the sophisticated tools used to perform the operation are becoming more and more costly. As a result, the cost of a spinal fusion rose 93.6% from 2000 to 2004, to an average of $50,000.

The one area of medicine where innovation has been rare and costs are still low is prevention. "Right now, we spend a lot on the last 30 days of a patient's life," says Dr. Daniel Jones, chief of minimally invasive medicine at Beth Israel. "We could think of improving the quality of a patient's life rather than the length, by spending more money on preventive care." Getting patients to lose weight, quit smoking, and exercise more would go a long way toward reducing medical costs, he said. In medicine, the low-tech solution can be the most productive. (Business Week) Read the complete story.

July 15, 2008 Download print version

Study evaluates a circle of netting in preventing heart failure

FDA notification: Possible malfunction of electronic medical devices caused by computed tomography (CT) scanning

GAO: States are planning for medical surge, but could benefit from shared guidance for allocating scarce medical resources

Novation first to have a national agreement with Boston Scientific for the Promus Everolimus-eluting stent

UIHC expansion to raise costs: How much more patients will pay is not known

Broadlane’s Live Group Buy awards high-field open MRI Contract to Hitachi Medical Systems America Inc.

Intel receives FDA market clearance on in-home medical device for management of health conditions

Arizant Healthcare addresses surgical need with new Ranger Irrigation Fluid Warming System

Study evaluates a circle of netting in preventing heart failure

A new device could offer hope to people suffering from heart failure–more than 5 million Americans are living with it, according to the American Heart Association–depending on how the study turns out. The procedure itself is relatively non-invasive and quick. The idea is that the nylon net, developed by Paracor Medical in California, will combat advanced heart failure by supporting the heart and keeping it from getting any larger, and thus less efficient at pumping, and will actually cause it to shrink over time. The HeartNet Ventricular Support System is placed around a patient’s heart. It was part of a clinical research study of the device, which, as the name implies, is a net that surrounds a failing heart.

After an echo-cardiogram determines the exact placement of the heart and with the patient under anesthesia, an incision is made between the ribs on the left side. The doctor employs instruments devised by Paracor that first attach to the heart. Plastic fingers extend from the umbrella-like end of the delivery device, spreading the net over the lower portion of the heart. The fingers pull back and the delivery system is withdrawn, a fluoroscope is used for a final check to make sure the net is in the right position, and the doctor then closes.

Surgery takes less than an hour and is comparatively bloodless. And the patient can go home in three or four days. The first patient received a HeartNet in November 2006. About 100 have been implanted so far, and the results are promising.

The HeartNet isn't the first product along these lines. Acorn Cardiovascular, a Minnesota company, tested a similar device but the FDA declined to approve it in 2005 and 2007 because it was not shown to improve survival rates.

Still, says Dr. Robert Bonow, the data from that study did provide some good news.
"The good news is that it appears to do what it was supposed to do, limit the heart's enlargement with time because it has a restraining device on the outside," says Bonow, chief of cardiology and co-director of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital and past president of the American Heart Association. Bonow says the Acorn device has been approved for use in Europe, but the benefits of such restraining devices are still open for discussion.

Dr. Russell Ivanhoe, the chief medical officer for Paracor, points out that the Acorn device and procedure differ from the HeartNet in several ways. The Acorn implantation was done through open-heart surgery with the patient on bypass, and the device itself was made of fabric and didn't have the flexibility of the HeartNet, he says. The Paracor study is still enrolling patients, though not every person with heart failure is a candidate. People who have had previous heart surgery, who have inflammation around the heart or who may be future candidates for bypass surgery don't make the cut.

Dr. David Cziperle of Cardiac Surgery Associates and the cardiothoracic surgeon who has done more than a half-dozen of the procedures at Edward, said that an underlying aim is to get as much mileage as possible out of a failing heart. "If this is a way of keeping a heart from failing in the future, I think it's going to help a lot of people because there are roughly a half-million patients a year [diagnosed] with heart failure. And a significant number die, 250,000 to 300,000, die of heart failure. This isn't going to be for all those people, but if we can help a significant number of that population, it will decrease health costs, keep them out of the hospital, help them be functional and enjoying life. That's really what the goal is." (Chicago Tribune)  Read the complete story.

FDA notification: Possible malfunction of electronic medical devices caused by computed tomography (CT) scanning

The FDA has issued an alert to the possibility that the x-rays used during CT examinations may cause some implanted and external electronic medical devices to malfunction, and to provide recommendations to reduce the potential risk. Most patients with electronic medical devices undergo CT scans without any adverse consequences. However, FDA has received a small number of reports of adverse events in which CT scans may have interfered with electronic medical devices, including pacemakers, defibrillators, neurostimulators, and implanted or externally worn drug infusion pumps. There have been similar reports in the literature.

It is possible that this interference is being reported more frequently now because of the increased utilization of CT, the higher dose-rate capability of newer CT machines, an increase in the number of patients with implanted and externally worn electronic medical devices, and better reporting systems.

The FDA is continuing to investigate this issue while working with device manufacturers and raising awareness in the healthcare community. To date, no patient deaths have been reported from CT scanning of implanted or externally worn electronic medical devices.

In the reports received by FDA, the following adverse events were likely to have been caused by x-rays from CT scans: Unintended “shocks” (i.e., stimuli) from neurostimulators; Malfunctions of insulin infusion pumps; Transient changes in pacemaker output pulse rate.

Note that malfunctions of this kind, which can result from direct exposure of the medical device to the high x-ray dose rates generated by some CT equipment, are different from those related to MRI scanning, which are caused by strong electric and magnetic fields.

Before beginning a CT scan, the operator should use CT scout views to determine if implanted or externally worn electronic medical devices are present and if so, their location relative to the programmed scan range. For CT procedures in which the medical device is in or immediately adjacent to the programmed scan range, the operator should: Determine the device type; If practical, try to move external devices out of the scan range; Ask patients with neurostimulators to shut off the device temporarily while the scan is performed; Minimize x-ray exposure to the implanted or externally worn electronic medical device by: Using the lowest possible x-ray tube current consistent with obtaining the required image quality; and Making sure that the x-ray beam does not dwell over the device for more than a few seconds;

Important note: For CT procedures that require scanning over the medical device continuously for more than a few seconds, as with CT perfusion or interventional exams, attending staff should be ready to take emergency measures to treat adverse reactions if they occur.

After CT scanning directly over the implanted or externally worn electronic medical device: Have the patient turn the device back on if it had been turned off prior to scanning.; Have the patient check the device for proper functioning, even if the device was turned off.; Advise patients to contact their healthcare provider as soon as possible if they suspect their device is not functioning properly after a CT scan. Read the FDA reeport.

GAO: States are planning for medical surge, but could benefit from shared guidance for allocating scarce medical resources

Following a mass casualty event that could involve thousands, or even tens of thousands, of injured or ill victims, health care systems would need the ability to “surge,” that is, to adequately care for a large number of patients or patients with unusual medical needs.

The federal government has provided funding, guidance, and other assistance to help states prepare for medical surge in a mass casualty event. From fiscal years 2002 to 2007, the federal government awarded the states about $2.2 billion through the Office of the Assistant Secretary for Preparedness and Response’s Hospital Preparedness Program to support activities to meet their preparedness priorities and goals, including medical surge. Further, the federal government provided guidance for states to use when preparing for medical surge, including Reopening Shuttered Hospitals to Expand Surge Capacity, which contains a checklist that states can use to identify entities that could provide more resources during a medical surge.

GAO identified four key components of preparing for medical surge: (1) increasing hospital capacity, (2) identifying alternate care sites, (3) registering medical volunteers, and (4) planning for altering established standards of care. GAO found that many states had made efforts related to three of the key components of medical surge, but fewer have implemented the fourth. More than half of the 50 states had met or were close to meeting the criteria for the five medical-surge-related sentinel indicators for hospital capacity reported in the Hospital Preparedness Program’s 2006 midyear progress reports.

State officials in GAO’s 20-state review reported that they faced challenges relating to all four key components in preparing for medical surge. For example, some states reported concerns related to maintaining adequate staffing levels to increase hospital capacity, and some reported concerns about reimbursement for medical services provided at alternate care sites. According to some state officials, volunteers were concerned that if state registries became part of a national database they might be required to provide services outside their own state.

Some states reported that they had not begun work on or completed altered standards of care guidelines due to the difficulty of addressing the medical, ethical, and legal issues involved in making life-or-death decisions about which patients would get access to scarce resources. While most of the states that had adopted or were drafting altered standards of care guidelines reported using federal guidance as they developed these guidelines, some states also reported that they needed additional assistance. Read the GAO report.

Novation first to have a national agreement with Boston Scientific for the Promus Everolimus-eluting stent

Novation, LLC, the health care contracting services company of VHA Inc. and the University HealthSystem Consortium (UHC), announced that it has added the Boston Scientific PROMUS everolimus-eluting stent to its national agreement. On contract with Novation the day after receiving Federal Drug Administration (FDA) approval, it is the newest cobalt drug-eluting coronary stent on the U.S. market.

Promus is immediately available in diameters of 2.5 mm, 2.75 mm, 3.0 mm, 3.5 mm and 4.0 mm. The available stent lengths are 8, 12, 15, 18, 23 and 28 mm. The device will be available in both rapid-exchange and over-the-wire delivery system designs. The contract is effective July 3, 2008 - Sept. 30, 2010.

UIHC expansion to raise costs: How much more patients will pay is not known

Iowa City - The planned $700 million to $850 million expansion of University Hospitals will increase patient costs, but by how much isn't known. According to a recent study by auditor PricewaterhouseCoopers, University Hospitals is following a national hospital building boom. Hospitals nationwide spent about $15 billion on construction in 1999, compared to about $30 billion in 2007. The study also states that the building boom is one of two main factors for the rising cost of health care, which they predict will increase by 9.9 percent this year and 9.6 percent in 2009.

According to the study: "When hospital costs increase because of higher capital spending, they attempt to pass along those costs to payers." University Hospitals Chief Financial Officer Ken Fisher agreed that the hospital industry is in the midst of a building boom and that consumers will have to pick up a portion of those costs. "There is some truth to that," he said of the study's findings.

He added that there's no way to tell how much patient costs at University Hospitals will go up because the size of the project and how it will be financed have not been resolved. Fisher and the study attribute the national building boom to low-interest rates that make financing expansion projects more cost efficient, combined with aging health care facilities that mostly were built during the last hospital construction boom in the 1970s and '80s.

Iowa Hospital Association Communications Director Scott McIntyre said the state is following the national hospital expansion trend. McIntyre added that many rural hospitals are updating facilities built more than 50 years ago.

Fisher said that ultimately building now rather than later is a good move for the consumer. With construction costs increasing each year and favorable lending conditions, the project would be more expensive in the future.

Fisher said that by adding about 500,000 square feet, the hospital will be about the same size as other major academic hospitals. Fisher added that the principle driver of patient costs is labor, consisting of 50 percent of the hospital's budget. The expansion will include a new children's care center and a critical care tower. Also, the expansion will result in the vast majority of the hospital's rooms becoming single-patient.

In May, the Iowa state Board of Regents approved a hospital plan to increase patient costs by 6 percent, as the cost of utilities, supplies and drugs all increased.

According to hospital figures, the adjusted cost per patient has gone from $14,438 in fiscal year 2004 to $15,257 in fiscal year 2006. Numbers for 2007 were not available. Projections show those costs for fiscal year 2008 at $16,096. (Iowa City Press-Citizen) Read the complete story.

Broadlane’s Live Group Buy awards high-field open MRI Contract to Hitachi Medical Systems America Inc.  

Broadlane recently held its 2008 Live Group Buy for Magnetic Resonance Imaging (MRI), and Broadlane’s clients awarded the High-Field Open MRI contract to Hitachi Medical Systems America Inc. A clinical committee of radiology department directors, physicians, administrators and technologists from participating Broadlane client health facilities attended the event. ECRI Institute, an independent, nonprofit organization, served as an unbiased guest expert, offering equipment purchasing clients the inside track on the latest MRI equipment.

The Broadlane Live Group Buy process is unique within the industry. Participants determine and weight the criteria used to evaluate the equipment and suppliers. Participants then rate supplier technology, identify key operational support components, participate in live negotiations and ultimately make a contract award based on the technology, service and total cost of ownership. As a result of the Broadlane Live Group Buy process, those clients who pre-committed to purchase a high-field MRI within the next 12 months will realize significant savings on their purchase.

Hitachi’s Oasis 1.2T High-Field Open MRI was chosen from a group of competitors based on assessment of technology, image quality, customer service, patient comfort and total life cycle cost.

Intel receives FDA market clearance on in-home medical device for management of health conditions

Intel Corporation announced the receipt of 510(k) market clearance from the U.S. Food and Drug Administration (FDA) on Intel's personal health system, the Intel Health Guide, a care management tool for healthcare professionals who manage patients with chronic conditions. The Intel Health Guide enables caregivers to provide their patients with more personalized care at home, while also engaging and empowering patients to take a more active and positive role in their own care. 

The Intel Health Guide is a comprehensive solution, combining an in-home patient device, as well as an online interface allowing clinicians to monitor patients and remotely manage care. The solution offers interactive tools for personalized care management and integrates vital sign collection, patient reminders, multimedia educational content and feedback and communications tools such as video conferencing and e-mail. The Health Guide can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales. The Health Guide stores and displays the collected information on a touch screen and sends to a secure host server, where health care professionals can review the information. Patients using the Health Guide can monitor their health status, communicate with care teams and learn about their medical conditions.

Arizant Healthcare addresses surgical need with new Ranger Irrigation Fluid Warming System

Arizant Healthcare Inc. has launched the Ranger Irrigation Fluid Warming System. The Ranger irrigation system offers the high-volume delivery of warmed fluids required by demanding urology, gynecology or orthopedic procedures while providing true temperature control, eliminating the potential cool down of fluid bags removed hours earlier from the warmer. The Ranger irrigation system’s dry heat technology also alleviates concerns about water in the OR and the potential sources of nosocomial pathogens associated with water bath-based warmers.

Unlike traditional warming cabinets where active warming ends when fluid is removed, the Ranger irrigation system warms fluid as it is being delivered to the patient through the use of highly responsive heating plates and a unique irrigation fluid warming disposable set. This SmartHeat technology eliminates potential dangerous hot spots and overheating of fluids, monitoring the temperature four times every second and automatically adjusting as needed to maintain a consistent 41°C set point. The end result delivers warmed irrigation fluids that are heated immediately and evenly, even with sudden changes in flow rates.

Sophisticated temperature monitoring also means alarm conditions in the normal operating mode are rare. When fluctuations outside the normal temperature range do occur, users are notified by both visible and audible alarms, allowing a quick response. The Ranger irrigation fluid warming set is designed only for use with the Ranger irrigation fluid warming unit. Ranger blood/I.V. fluid warming sets are not compatible with the Ranger irrigation warming unit.

July 14, 2008 Download print version

HPN and Lawson invite you to a Success Breakfast at the AHRMM conference to recognize HPN’s 2008 Materials Management Department of the Year

Are home births dangerous? AMA says women should use a hospital; some doctors disagree

A look inside the hospital rankings: How 170 out of 5,453 centers made the cut

At age 45, Toyota star Japanese engineer dies of overwork

Digestive Disease Week study examined ACR's guidelines for CT colonography interpretation

RF Technologies introduces enhanced clinical support service, step-by-step, a comprehensive program designed to ensure infant security

Researchers design model for automated, wearable artificial kidney

Pioneering heart surgeon dies