November 6, 2009 Download print version

Costs surge for medical devices, but benefits are opaque

Cat catches swine flu

State launches effort to improve hand-washing in hospitals

VHA DataLYNX allows hospitals to perfect supply chain information

Swine flu vaccine going to Goldman Sachs, Columbia U., and other big NYC employers

Advocacy alert regarding 2.5% excise tax on medical devices

InnerSpace's SpaceTRAX plus RFID awarded Novation contract for RFID clinical inventory management systems

GCI ConnectMD links Swedish Medical Center neuroscience stroke specialists and patients

Costs surge for medical devices, but benefits are opaque

When makers of heart defibrillators wanted Medicare to vastly expand the types of patients eligible to receive the devices, which can cost upward of $25,000, agency officials were skeptical. It was not clear how many of those patients would actually need a defibrillator, a device that can deliver a life-saving shock to restore a faltering heart to normal rhythm.

So government and industry struck a deal back in 2004. Medicare agreed to expand the device’s use, nearly doubling the number of patients who qualified for one. The companies, in return, agreed to pay for a study to see which patients really benefited.

Five years later, Medicare underwrites more than half of the $4 billion the nation now spends annually on defibrillators, but the agency is no closer to knowing how many lives that big investment is saving. That is because the device companies did not finance the study beyond their initial $4 million commitment, and Medicare did not pick up the slack. As a result, researchers still cannot gather data that would identify the types of patients who would most benefit from a defibrillator.

As Congress seeks to revamp the nation’s healthcare system, medical devices might seem an inviting target to better control Medicare spending. Outlays on implanted devices stand at about $76 billion annually in this country and are rising at a rate faster than the cost of drugs, according to a recent study by the McKinsey Global Institute, a consulting group. With an aging population in America, Medicare is picking up more of those costs.

Unlike other hospital products, implants are so-called physician preference items, meaning that doctors — not the hospitals — often choose which manufacturer’s implant to use. It is a decision that can be skewed by a doctor’s relationship to a company and can also undercut a hospital’s ability to negotiate the best price, experts say.

In an effort to slow federal spending, the bill passed by the Senate Finance Committee would require the device industry to pay the government $4 billion a year for five years, with the portions allocated among individual companies based on their market shares. But device makers, including the ones that initially financed the defibrillator study — Medtronic, Boston Scientific and St. Jude Medical — have fiercely resisted the provision, calling it an unfair “tax” that will stifle innovation and cause job losses.

The big problems, in such experts’ view, is that there is little data available to compare the benefits of competing makers’ products or to determine how much buyers, like hospitals, should be paying for them, said Eugene Schneller, a business professor at Arizona State University in Tempe.

For example, even doctors acknowledge that they typically have little reason to be concerned about a device’s costs when it comes to deciding which one to use. One doctor compared it to giving a car buyer a blank check and letting him choose between a Maserati or Honda.

Meanwhile, hospitals are often hampered in their ability to negotiate prices with device makers because the selling price of a defibrillator or hip joint is not easy to determine. In selling products, device companies have required hospitals to sign contracts that contain confidentiality clauses under which facilities agree not to disclose what they paid for the product.

As a result, a big hospital that is a large-volume buyer of heart devices or hips may pay higher prices than a smaller one that buys fewer units, said Dr. Lerner of ECRI. In some other countries, medical device databases have been established to provide both doctors and patients with more data about how competing products differ. In such a database, or a registry, information about a product and the surgical technique used by a doctor is recorded at the time of an implant. And then by tracking whether and when the patients return for a replacement procedure, or experience other problems, registries can show which producers’ models are failing faster than others.

The information can help doctors and insurers avoid less reliable devices, while also avoiding the high additional medical costs of remedial treatments and replacement procedures.

Eliminating unnecessary replacement procedures could potentially save Medicare hundreds of millions annually. But Medicare has not pushed the use of registries, and the industry has also not embraced it. To date, hip and knee producers have contributed $500,000 to underwrite an effort by the American Academy of Orthopaedic Surgeons, a professional group, to create a national artificial hip and knee registry. But that is a relative pittance — about what many individual companies pay to a few doctors each year to retain them as consultants.

The federal government could also play a more aggressive role in making sure it is getting better value for its money, he added. A case in point — requiring that makers of heart devices use batteries that last longer than five years, the period of time when patients must now undergo an additional, potentially dangerous operation to have a costly device replaced. Visit the New York Times for the article.

Cat catches swine flu

Does the swine flu pandemic pose a threat to your pet? Yes, according to a report out Thursday from the American Veterinary Medical Association.

A cat in Iowa has tested positive for the H1N1 virus, state officials confirmed this morning, "marking the first time a cat has been diagnosed with this strain of influenza," the association said in a statement.

"The cat, which has recovered, is believed to have caught the virus from someone in the household who was sick with H1N1. There are no indications that the cat passed the virus on to any other animals or people," the statement said.

The cat is 13 years old, and state health officials said two of the three family members that own the cat had suffered "influenza-like illness" before the cat got sick.They recovered too.

Before this kitty was diagnosed with the swine flu, the virus had been found in humans, pigs, birds and ferrets, the association said.

It is well known that some viruses can be transmitted from people to their pets so the case of the Iowa cat isn't a surprise. But the case is prompting the association, along with the American Association of Feline Practitioners, to remind pet owners "they should monitor their pets' health very closely, no matter what type of animal, and visit a veterinarian if there are any signs of illness." Visit the Washington Post for the article.

State launches effort to improve hand-washing in hospitals

A state panel charged with healthcare unveiled its first major initiative Tuesday: an effort to improve hand-washing at Maryland hospitals. Called the Maryland Hospital Hand Hygiene Collaborative, it's funded by $100,000 in federal stimulus money provided through the U.S. Centers for Disease Control and Prevention. It's voluntary, but state officials expect almost all of the 47 acute-care hospitals in Maryland to participate because they want to reduce potentially avoidable infections that have large human and financial costs.

Most already have begun efforts to improve hand-washing by employees - which started before the recent H1N1 flu pandemic but could help control the spread. The main benefits of the new program are creation of a system for officials to share best practices and to uniformly report progress, said Health and Mental Hygiene Secretary John Colmers.

Colmers said he hopes the program becomes a model for other states. Across the nation, there are an estimated 1.7 million hospital-acquired infections annually, 100,000 deaths and $30 billion in additional healthcare costs, according to estimates from the CDC this year. The state began collecting data about certain infections acquired in hospital intensive-care units only in the last year, and results are not yet available, according to the Maryland Health Care Commission.

The state and federal governments have other plans in place to decrease the occurrence of hospital-acquired infections. Maryland, for example, is considering financial incentives for hospitals. Visit the Baltimore Sun for the article.

VHA DataLYNX allows hospitals to perfect supply chain information

As hospitals escalate their efforts to decrease supply chain expenses, VHA Inc., the national healthcare network, has launched VHA DataLYNX, the newest component in its robust VHA SupplyLYNX analytics arsenal. Designed to help hospitals improve the quality of their item master, increase their efficiency and shrink their supply chain costs by linking data with insight, VHA SupplyLYNX helped hospitals save more than $700 million in 2008. 

Using the industry's most robust data and applying open industry standards, VHA DataLYNX helps hospitals analyze, consolidate, categorize and classify their item master data to improve its quality and accuracy. This process allows hospitals to better understand their supply spend and initiate more efficient purchasing. Incorporating exclusive quarterly reports, VHA DataLYNX assures continuing data accuracy and ongoing cost-savings opportunities. 

Hospitals that are using VHA DataLYNX benefit from increased labor efficiencies, a reduction in inventory levels and reduced logistic costs, all attributable to the improved quality of their item master.

Swine flu vaccine going to Goldman Sachs, Columbia U., and other big NYC employers

Some of New York City's largest employers — including Wall Street firms like Goldman Sachs and big universities — have started receiving doses of the much-in-demand swine flu vaccine for their at-risk employees.

The government-funded vaccine is being distributed to states, where health departments decide where to send the limited doses. In New York, health officials are allowing businesses with onsite medical staff to apply for the vaccine.

Doctors for large companies can ask for the vaccine along with other doctors but must agree to vaccinate only high-risk employees like pregnant women and those with chronic illnesses, said Jessica Scaperotti, a spokeswoman for New York City's Department of Health and Mental Hygiene.

Last month, the city began offering vaccine to schoolchildren, as well as the offices of pediatricians and obstetricians that asked for it. Scaperotti said only half of the pediatricians in New York City have requested vaccine

"As the vaccine became more available we expanded it to adult providers," Scaperotti said. She called the large employers "a great avenue for vaccinating people at risk."

But a critic said Wall Street firms shouldn't have access to the vaccine before less wealthy Americans. "Wall Street banks have already taken so much from us. They've taken trillions of our tax dollars. They've taken away people's homes who are struggling to pay the bills," union official John VanDeventer wrote on the Service Employees International Union Web site. "But they should not be allowed to take away our health and well-being."

The union has about 2 million members, including healthcare workers.

The swine flu vaccine has been in short supply nationwide because of manufacturing delays, resulting in long lines at clinics and patients being turned away at doctor's offices. The vaccine started trickling out in early October, and there are now nearly 36 million doses available.

Rules vary by state on how the vaccine is distributed. For example, Illinois and Chicago's health departments are initially excluding businesses. Others, like New York, said they would allowing businesses with medical staffs to vaccinate those in the priority groups.

The Centers for Disease Control and Prevention does not review and sign off on the decisions of state and city health departments as to which doctor's offices and businesses will be sent vaccine doses, said spokesman Tom Skinner.

The CDC director, Dr. Thomas Frieden, however, did send a letter Thursday to state and local health departments asking them to review their distribution plans and make sure the vaccine is getting to high-risk groups. Frieden said any decisions that appear to direct vaccine outside priority groups "have the potential to undermine the credibility of the program."

The agency has set guidelines on which patients should be at the front of the line: children and young people through age 24, people caring for infants under 6 months, pregnant women, healthcare workers and adults with health conditions such as asthma and diabetes.

Swine flu — which scientists call the 2009 H1N1 strain — is widespread throughout the country now, much earlier than seasonal flu usually hits.

Other big New York City employers that have received doses of the vaccine include Columbia University, Time Inc., the Federal Reserve Bank and several hospitals. The distribution was first reported by Business Week.

Goldman Sachs has received 200 doses and Citigroup has received 1,200, health officials said. So far, 800,000 doses have been delivered to 1,400 healthcare providers in New York City, including public schools, pediatricians and hospitals.

In statements, Citigroup and Goldman Sachs said the vaccine would only go to those in high-risk groups.

"Goldman Sachs, like other responsible employers, has requested vaccine and will supply it only to employees who qualify," said spokesman Ed Canaday.

Morgan Stanley received 1,000 doses of the vaccine for its New York and suburban offices, but turned over its entire supply to local hospitals when it learned it received shipments before some area hospitals, spokeswoman Jeanmarie McFadden said.

Some New York pediatricians' offices that have gotten vaccine say the supply is not meeting the demand.

Manager Linda O'Hanlon at Uptown Pediatrics in Manhattan, said her office has received 500 doses so far — not enough for a practice with almost 7,000 patients.

"We have about 800 appointments" set up for patients who want to get vaccinated, she said. (AP) Visit the Chicago Tribune for the article.

Advocacy alert regarding 2.5% excise tax on medical devices

The Affordable Health Care for America Act includes a new revenue provision that would establish a 2.5 percent excise tax on medical devices sold for use in the U.S. The tax applies to the “first sale” of all devices (Class I, II, and III) sold in the U.S. Device sales for resale, after production, manufacture or importation are not considered “first sale” and the tax would not apply. There is no exception for devices with prices below or above a certain price. The tax does not apply to exported devices and does not apply to retail sales of devices. That means devices sold directly to the general public at local drug stores and other establishments are excluded from the tax. Hospital charges for devices that are used for patients are not considered “resale” or “retail” for purposes of the device tax.

Hospitals purchase devices directly from manufacturers or from wholesalers distributor. Many of these wholesalers help hospitals manage their “just in time” inventory of devices rather than storing lots of devices on site at the hospital. Hospitals often use group purchasing organizations to negotiate with manufacturers on prices for drugs and devices, however, hospitals are still purchasing the devices directly from the manufacturer.

Medical device manufacturers would pay the excise tax. While it is not a “sales” tax, it is a tax on each individual device and it is likely that manufacturers will tack-on the 2.5 percent tax at the time of sale. When a hospital purchases directly from the manufacturer, the hospital would likely be charged the 2.5 percent tax. When a wholesale distributor sells a device, the distributor would be charged the tax. Distributors may pass the tax back to the device manufacturer. Device manufacturers again may try to pass that on to hospitals.

The AHA’s view: Paying for health reform requires a shared commitment from all: employers, payers, providers and patients. This includes medical device manufacturers. Hospitals are already doing their share in helping fund healthcare reform. However, the House bill’s 2.5 percent excise tax on each device sold likely would be, in part, a direct transfer to America’s hospitals, thereby increasing the level of cuts to hospitals. Hospitals would have limited negotiating ability to avoid paying this tax.

Adopt a global fee or a tax on income for medical device manufacturers. The Senate reform bill would establish an annual fee on medical device companies that would be distributed across device manufacturers based on their market share. Alternatively, a tax on profits or on gross sales of devices is another way of applying a tax. While device manufacturers would likely try to shift this new global tax on to customers, hospitals and other purchasers of medical devices would have more ability to negotiate on total price and create pressure for device companies to contribute their share to the cost of health reform. Applying a discrete tax on each device, as established in the House bill, would be easier for device manufacturers to pass on.

We need your help to ensure that this issue is addressed in a way that helps you take care of patients and serve your communities. Please visit Voter Voice to send an e-mail message to your legislators.

InnerSpace's SpaceTRAX plus RFID awarded Novation contract for RFID clinical inventory management systems

Stanley InnerSpace announced that SpaceTRAX has been awarded the Novation contract, effective for three years, to provide RFID and barcoding clinical inventory management solutions to its members.

Novation is a supply contracting company for the healthcare industry, providing savings to members and affiliates of VHA Inc., the University HealthSystem Consortium, and Provista.

The contract affords administrators flexibility in creating a cost-effective and easy-to-manage clinical inventory process. SpaceTRAX, a simple-to-use, web-based solution tracks clinical inventory utilizing manufacturer barcode labels and allows for adding on RFID-enabled carts to securely store and automatically account for high-dollar implants and clinical inventory.

SpaceTRAX plus RFID is available for no upfront capital which allows for an immediate and high return on investment. The innovative solution provides many operational benefits including optimized workflow, increased charge capture, expiration management, and valuable usage reports by patient and physician. SpaceTRAX fits easily within existing clinical workflow and can be utilized independently or interfaced into existing hospital information systems. For more information visit www.StanleyInnerSpace.com.

GCI ConnectMD links Swedish Medical Center neuroscience stroke specialists and patients

GCI ConnectMD, connecting over 200 clinics, hospitals, and medical organizations have partnered with Swedish Medical Center to enable components of the “virtual” bedside neurological evaluations for patients in hospitals throughout Washington State. The Swedish Acute TeleStroke Program bolsters remote hospitals’ stroke support services through 24/7 access to Swedish’s nationally-recognized stroke team experts via real-time, telemedicine-based technology.

Through GCI ConnectMD’s secure medical network, a link between the contracted remote emergency rooms and the comprehensive team of stroke team neurologists based at the Swedish/Cherry Hill campus in Seattle is completed, providing the infrastructure for the Swedish Stroke Team to view the brain images for Telestroke cases, a vital component of an acute Telestroke encounter. 

Working very closely with Swedish Medical Center hospital IT experts, GCI ConnectMD has helped to facilitate the operation of the Swedish TeleStroke Program by managing aspects of its external TeleStroke infrastructure, while local IT professionals continue to focus on big picture internal technological issues. Through GCI ConnectMD, Swedish can quickly set up encrypted connections and transfer Head CT images while maintaining HIPAA compliancy. Working with GCI ConnectMD also ensures that Swedish bandwidth growth for large image transfers will never compete with Internet usage, nor be subject to inconsistencies. While GCI ConnectMD oversees the secure medical network, Swedish hospital engineers can focus on more strategic initiatives like further building out their “Hub and Spoke Telestroke Program” model as the network expands. Visit www.connectmd.com

November 5, 2009 Download print version

Study: Dirty restrooms on cruise ships linked to norovirus outbreaks

Centurion Medical Products Premie Pack and Meconium Pack Recall

Freedom Medical signs agreement with MedAssets for rental equipment

Medicare cost-lowering experiments rarely acted on

Hospital Value Index Quality Award recipients released

How will bundling impact dialysis units nationwide? Geographic discrepancies likely; impact may be greatest in southern states

MedAssets’ Service Line Analytics drives business intelligence to control and reduce supply costs for hospitals

Rutgers University launches RFID Research Center

New hospital’s therapeutic design supports healing, green practices

Study: Dirty restrooms on cruise ships linked to norovirus outbreaks

How clean are the public restrooms on cruise ships? Not clean at all, according to what’s billed as the first scientific study of environmental hygiene in the industry.

A team of researchers from several Boston-area institutions report in the current issue of the medical journal Clinical Infectious Diseases that they found “widespread poor compliance” with regular cleaning during unannounced inspections of dozens of cruise ship restrooms.

Moreover, the researchers found a link between the dirty restrooms on ships and subsequent outbreaks of norovirus – a common gastrointestinal illness that has caused problems for the industry.

The researchers – from the Boston University School, Carney Hospital, Cambridge Health Alliance and Tufts University School of Medicine – booked trained healthcare professionals onto ships to evaluated the thoroughness of disinfection, and they found that only 37% of 273 randomly selected restrooms that they evaluated were cleaned daily.

The study examines the cleanliness of six standardized objects in restrooms that have a high potential for fecal contamination: toilet seats, flush handles or buttons, toilet stall inner handholds, stall inner door handles, restroom inner door handles, and baby changing table surfaces. Although some objects in most restrooms were cleaned at least daily, on 275 occasions no objects in a restroom were cleaned for at least 24 hours, the study finds.

The researchers say that, overall, the toilet seat was the best-cleaned object in the restrooms. The least thoroughly cleaned object was the baby changing table. Nineteen objects in restrooms in 13 ships were not cleaned at all during the entire five-to-seven-day monitoring period.

The researchers found that one particularly troubling area for cleanliness in ship restrooms are the toilet area handholds, which were largely neglected. They accounted for more than half of the uncleaned objects on 11 ships.

The study does not disclose which ships from which lines were tested, but the researchers say the thoroughness of cleaning did not differ by line.

The findings, notably, did not correlate with Center for Disease Control and Prevention Vessel Sanitation Program inspection scores for the ships, the researchers say. They say the CDC, which inspects every cruise ship operating out of the United States for cleanliness, had given the ships tested an average score of 97 out 100.

The researchers note that near-perfect cleaning was documented on several vessels, proving that a high level of environmental hygiene is achievable. Visit USA Today for the article.

Centurion Medical Products Premie Pack and Meconium Pack Recall

Centurion Medical Products and FDA notified healthcare professionals about a Class I recall of Premie Pack, Kit Code LM 110 and Full Term Meconium Pack, Kit Code LM115. The pediatric tracheal tubes used in these kits were manufactured with an internal diameter smaller than indicated on the label, which could result in an inability to remove secretions and cause partial or complete blockage of the airway and the inability to ventilate the patient. These products were distributed from January 1, 2007 through September 22, 2009.  Read the MedWatch safety summary.

Freedom Medical signs agreement with MedAssets for rental equipment

Freedom Medical Inc. (Exton, PA), a national provider of moveable medical equipment rental, announced an agreement effective Dec. 1, 2009, with MedAssets Supply Chain Systems (Alpharetta, GA). Freedom Medical has local branches throughout the U.S. and offers daily, weekly, monthly and long term rental of ventilators, infusion devices, monitors and general biomedical equipment.

Freedom Medical has developed a comprehensive Emergency Preparedness Program to help hospitals prepare for a flu pandemic, terrorist attack or natural disaster. 

As part of this agreement, MedAssets’ member facilities can access very competitive rental rates on all types of moveable medical equipment. For more information see www.freedommedical.com.

Medicare cost-lowering experiments rarely acted on

The Democratic health-reform legislation comes studded with cautious plans to test proposals reining in Medicare costs. But history suggests that even if the experiments are successful, the odds aren’t high that their lessons will be applied to the entire program.

Consider the case of a 1990s pilot project that earned the support of a president, several key legislators and successive Medicare leaders — from both parties. A five-year test showed that lumping together payments for doctors and hospitals for some heart surgeries encouraged them to be more efficient and reduced Medicare’s cost by 10 percent. But the project ran into relentless opposition from doctors and hospitals. The result: Congress has never approved the change for widespread Medicare use and Medicare continues to study the issue.

Successful Medicare experiments are “certainly not enough to change policy,” said Paul Ginsburg, director of the Center for Studying Health System Change, a nonpartisan research group in Washington. Yet Democrats’ hopes to “bend the cost curve” hinge in large part on introducing successful Medicare experiments into the system. And because of Medicare’s clout as the insurer for 45 million older and disabled Americans, many private insurers follow its lead.

Medicare has conducted hundreds of tests, called pilots or demonstration projects, since the mid-1970s, but can’t apply them to the entire system without congressional approval. Lawmakers have made other important changes to Medicare, but pilot projects have rarely been the catalyst.

Most of these experiments haven’t been expanded because they failed a threshold test; they didn’t save money or improve care. Others passed that test but were derailed by objections from hospitals, doctors and other providers — or were caught up in political fights as control of Congress shifted. Only a handful resulted in broad health system changes. Two became permanent programs. And the biggest success — a more efficient way to pay hospitals — occurred 27 years ago.

Congress is frustrated at the lack of innovation, aides said. But they note that political leaders are hesitant to make changes to the Medicare system without such rigorous study and without consensus because they fear alterations could result in unintended dire consequences on a massive scale.

Still, in the health overhaul legislation working its way through Congress, lawmakers have added provisions that they hope can improve the odds for implementing successful demonstrations. One measure seeks to circumvent the difficulties of getting congressional approval for changes. It would give the secretary of Health and Human Services the authority to expand demonstrations that work; Congress’ permission wouldn’t be needed. Another would create an Innovation Center that would allow Medicare to pursue promising ideas more quickly. Yet another would set up an independent Medicare commission to recommend Medicare savings that would be implemented if Congress didn’t act.

A rare victory came in the 1980s. In 1981 Medicare’s hospital costs were up more than 17 percent. That put pressure on Congress to find a way to bend the cost curve. One demonstration found that paying a flat rate for hospital services limited spending growth compared with the traditional method of reimbursing hospitals based on how much they spent, plus a small bonus. Congress approved that change in the way hospitals were paid in 1983. By 1985, hospital spending was growing by only 5.7 percent, according to federal officials.

In the current legislation are demonstrations that would test accountable-care organizations, medical homes and combining physician and hospital payments for post-acute care. These projects could change the way healthcare is delivered, increase its efficiency and, over time, lower costs for consumers.

“Out of those pilot projects could come significant changes in Medicare,” said Clifford Gaus, who directed Medicare's demonstration programs in the 1970s. “It just could take a long time. The bending the cost curve problem is now, not in five years.” Visit NPR for the original article.

Hospital Value Index Quality Award recipients released

Data Advantage LLC announced Monday 75 hospitals receiving a Best in Value: Superior Quality Merit Award from the 2009-2010 Hospital Value Index, the first and only national study on U.S. hospitals and the value of care they provide.

The 2009-2010 Hospital Value Index is an independent analysis of each hospital’s performance in the categories of: quality, affordability & efficiency and patient satisfaction. Out of the more than 4,500 hospitals that were analyzed, 75 received the Superior Quality Merit Award for achieving high marks in the quality category.

“This group of hospitals has a proven ability to deliver high quality care, a key element in providing overall value to their communities,” said Hal Andrews, CEO of Data Advantage. “Our study suggests that hospitals that achieve outstanding scores in the area of quality will be rewarded in the new world of Value-Based Purchasing, so each of these hospitals is off to a good start.”

The quality category is analyzed using data from the Centers for Medicare and Medicaid Services (CMS) Core Measures, AHRQ Patient Safety Indicators, CMS 30-day mortality scores and CMS reported hospital readmission rates. In order to receive the award, hospitals were first considered as Best in Value, or in The top 25 percent of all hospitals in the study. The top 10 percent of this group were then ranked in the quality category in order to receive the Superior Quality Merit Award.

“The Hospital Value Index study found that all hospitals recognized as Best in Value improved their quality scores by an average of 8.14% since March 2009, while those that were not recognized as Best in Value saw a drop in quality by 1.1% during the same term,” said John Morrow, a founder of the Hospital Value Index study.

The Superior Quality Merit Award recipients from the 2009-2010 Hospital Value Index study are available at http://www.HospitalValueIndex.com.

How will bundling impact dialysis units nationwide? Geographic discrepancies likely; impact may be greatest in southern states

The proposed Medicare “bundled” payment system for dialysis is likely to reduce government reimbursements for dialysis units in certain regions of the United States and for some types of facilities, according to research being presented at the American Society of Nephrology’s 42nd Annual Meeting and Scientific Exposition in San Diego, CA.

“Our facility-level analysis suggests considerable geographic variation in the impact of bundled payments on dialysis centers across the country,” commented Sumit Mohan, MD (Columbia University/Harlem Hospital). “Dialysis centers in the east and southeast are particularly likely to feel an adverse financial impact.”

The researchers used data from the Centers for Medicare & Medicaid Services (CMS) and other federal sources to estimate the financial effects of the bundled payment model on different categories of dialysis units. Under the proposed system, dialysis centers will receive “bundled” payments covering dialysis, medications, and laboratory tests.

“Our analysis suggested unanticipated geographic variation in facility reimbursement payments,” according to Mohan. The percentage of dialysis centers likely to receive lower payments under the new plan varied widely between states. Estimates suggested that in several states, no dialysis centers would be at risk of receiving lower reimbursements. In contrast, in one state (Delaware), 100 percent of centers are likely to see an adverse financial impact.

The plan would have a greater financial impact on dialysis centers in some parts of the country, especially the south and east. On average, 59 percent of dialysis centers would be affected in states east of the Mississppi River, compared to 33 percent in states west of the Mississippi. “The impact appeared to disproportionately affect the South census region, which also has the highest intensity of poverty,” Mohan added.

The study adds to other recent reports raising concerns about potential inequities under the proposed payment system. According to a CMS statement, public comments on the proposed payment plan will be accepted through November 16, 2009, with a final plan to be issued in 2010.

The study was limited in that it used only publicly available, facility-level data. In contrast, the analysis used to develop the proposed bundled payment model also included patient-level data.

MedAssets’ Service Line Analytics drives business intelligence to control and reduce supply costs for hospitals

MedAssets has launched Service Line Analytics, an on-demand business intelligence solution designed to identify and drive sustainable financial improvement in the management of high-cost medical devices, supplies, pharmaceuticals, ancillary services, length of stay, and other key hospital cost drivers.

Service Line Analytics combines MedAssets’ technology with the clinical utilization expertise of its Aspen Healthcare Metrics subsidiary to gather, interpret and report on actionable clinical, financial and supply cost data by clinical service line and specific patient population. Service Line Analytics helps healthcare executives significantly reduce costs while improving patient outcomes through a cohesive understanding of interlinked reimbursement, supply cost, supply utilization, clinical factors and other resource utilization by physician and MS-DRG. Opportunity areas include medical, surgical and implant supply price, utilization of those supplies, pharmacy utilization, physician preference item (PPI) pricing and length of stay (LOS) supply usage.

Health systems representing more than 30 facilities have assisted in the product development through beta testing of the Software as a Service (SaaS) offering, including Atlantic Health, Baptist Health System, Carilion Clinic and Carondelet Health Network.

“Service Line Analytics provides a detailed and comprehensive analysis with an easy to use interface that is unlike any other solution we have seen. It helps us define our strategy and engage our clinical staff as part of the cost savings identification process, which leads to sustainable financial improvement. Service Line Analytics is an incredibly effective tool for deep-dive views into supply cost and utilization. It highlights their effect on patient outcomes so that we are armed with the information we need to affect change in a relevant time frame,” said Joe DiPaolo, Chief Supply Chain Officer, Atlantic Health.

Service Line Analytics helps a hospital or health system to: Answer “What should our supply spend be?” by using MedAssets’ Supply Intensity Metric; Define cost savings opportunities by dissecting data down to the service line, physician or patient level; Measure and track an organization’s progress on a month-by-month basis through a real-time dashboard; and Partner with expert Service Line Analytics “coaches”.

To learn more visit www.medassets.com/servicelineanalytics.

Rutgers University launches RFID Research Center

The Rutgers Center for Innovative Ventures of Emerging Technologies (CIVET), together with RFID TagSource, announce the launch of the new Rutgers University RFID Research Center. The center is located on the Rutgers Busch Campus in Piscataway, NJ.

The newly established Research Center combines laboratory facilities with real world insight into how RFID is being utilized across the globe to provide real business value. This provides the Rutgers community and industry sponsors with the tools required to support research activities that have near term commercial value. The center will also be used to host industry seminars and executive forums, continuing education classes, and independent research projects to support industry, government, and department of defense RFID initiatives.

For more information on CIVET see www.civet.rutgers.edu

For more on RFID TagSource see www.rfidtagsource.com.

New hospital’s therapeutic design supports healing, green practices

These days, the newest member of your medical team just might be the building itself – and it’s likely to play a bigger role in your healing than you might think. New trends in hospital design are helping healthcare systems to better choreograph care and provide a soothing yet energy-efficient environment.

Consider the Shands Cancer Hospital at the University of Florida, which opened Nov. 1 in Gainesville, FL. The new 500,000-square-foot, $388-million medical tower is an extension of the Shands at UF academic medical center on its new south campus. The tower will feature 192 private beds and will house the Shands Critical Care Center for emergency and trauma services. Medical teams will serve a variety of inpatients, including those receiving diagnostic and therapeutic oncology care.

Shands and Gainesville Regional Utilities partnered to establish the GRU South Energy Center to provide 100 percent of the hospital’s energy needs. The onsite power plant will ensure uninterrupted power, independent of the city’s energy grid, regardless of a prolonged outage elsewhere in the community. It will efficiently convert fuel into electricity and provide 46 percent savings compared with traditional fossil fuel-burning generations. Officials estimate this will save 27 million kilowatts per year, enough to power about 3,000 homes.

The commitment to use environmentally sustainable construction methods to build the hospital has earned Shands HealthCare the silver Leadership in Energy and Environmental Design designation per the U.S. Green Building Council rating system.

“We used insulated windows that are treated to reduce solar glare and white rooftops designed to reflect heat,” said Brad Pollitt, Shands HealthCare vice president for facilities. “The facility’s air-conditioning heat wheels help to recover lost energy and irrigation and drainage systems use reclaimed water.” Pollitt said that Shands is now being considered for gold-level LEED certification and will be one of a few academic medical centers nationwide to achieve this rating.

In designing the building, hospital facilities teams worked with architects whose expertise is healthcare environments. Nursing and medical staff provided input to incorporate features such as nurse stations that improve sight lines to patients and monitoring systems and details that give patients control of their environment, allowing them to adjust lighting and window shades with the click of a remote. There is abundant natural light on each floor and hallway lights are wall-mounted or recessed so patients aren’t subjected to blinding glare as they are wheeled from place to place.

The new tower also includes the Shands Critical Care Center at UF, which combines an emergency department and Level I trauma center. The emergency room has 62 treatment areas and provides clinical teams the capacity to treat 100,000 patients a year. The trauma center has four large treatment rooms and is strategically located directly beneath the rooftop helipad that can hold the weight of two helicopters at once.

In mass-casualty situations the emergency department capacity can be quickly doubled. The private exam rooms have break-away doors, are 18 inches wider than code requirements and can hold side-by-side beds. The hospital also includes 12 high-tech operating rooms designed to accommodate anticipated evolutions in robotics and 3-D imaging; surgical intensive and intermediate care units; and a bone marrow transplant unit, outpatient clinic and stem cell lab. Visit Shands Healthcare for the press release.  

November 4, 2009 Download print version

Swine-flu deaths higher in the elderly

Report: Problems still plague Illinois VA Hospital

Glass thermometers still a safety hazard

Premature births are fueling higher rates of infant mortality in U.S., report says

Data show swine flu vaccine’s potency

US DOJ confirms large corporate owned hospitals involved in illegal contracting schemes

New DISPATCH patient transport solution

Georgia-Pacific Professional named Core Committee member for information-based labeling initiative

Swine-flu deaths higher in the elderly

People age 50 and older who were hospitalized with the swine flu in California had the highest fatality rate from the illness, while those younger than 18 had the lowest death rates. Researchers from the California Department of Public Health looked at 1,088 cases of hospitalization and death attributed to H1N1 from April 23—shortly after the virus was discovered—through Aug. 11. The findings will be published in this week's Journal of the American Medical Association.

While hospitalization rates in California were highest for infants and young adults ages 18 to 29 and lower for older people, the findings suggest older people who are hospitalized are more likely to die. "Despite reports that elderly persons may be 'protected' by pre-existing immunity, clinicians should closely monitor and promptly treat hospitalized patients with pandemic 2009 influenza A H1N1 infection," researchers wrote.

Still, similar to statistics collected by the federal Centers for Disease Control and Prevention, data in California show H1N1 is hitting young people harder than what's typically seen for seasonal flu. The median age of hospitalized patients in California was 27. Of the 1,088 hospitalization and death reports in California, 118 were deaths, which translates into fatality rate of 11%, researchers said.

For people age 50 and older, the fatality rate was as high as 20%. Eight of the 118 deaths were reported in children younger than age 18, while 110 were in people age 18 and older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome, which are complications of influenza.

The proportion of deaths seen over the spring and summer in California differs from a recent analysis conducted by the CDC involving 292 deaths reported by 28 states from Aug. 30 to Oct. 10. The percentage of deaths in people age 24 and younger was 24%, and in those ages 25 to 64, it was 64%. Twelve percent of the deaths occurred in people age 65 and older. Visit the Wall Street Journal for the article.

Report: Problems still plague Illinois VA Hospital

A new report from the inspector general in the Department of Veterans Affairs finds that the VA Medical Center in Marion, IL continues to be plagued by quality management and patient care problems some two years after a suspicious spike in the number of post-surgical patient deaths there. A 2008 investigation found that at least nine patients died because of surgical mistakes and poor post-surgical care at the VA hospital in Marion, which is in southern Illinois. That report made recommendations to improve conditions at the facility.

The new report finds poor quality management oversight, inconsistencies in the way patient deaths are reported and continuing problems with ensuring patient safety — including the discovery that surgeons were performing procedures they were not authorized to handle.

Richard Durbin (D-IL) and other members of the state's congressional delegation, sent a sharply worded letter to Veterans Affairs Secretary Eric Shinseki in which they demanded that VA management be held accountable for the problems at the Marion facility.

A suspicious spike in post-surgical patient deaths between October 2006 and August 2007 led the VA to abruptly suspend surgical operations at the Marion VA Medical Center. NPR reported the story of a Kentucky woman whose husband died suddenly after what was considered to be relatively minor surgery for gallstones.

In January 2008, the VA's inspector general found that the surgical unit in the VA Medical Center in Marion was in complete disarray, with doctors performing surgeries they weren't qualified to perform. Hospital administrators were found to respond slowly, if at all, to complaints or problems when they surfaced.

Serious quality management and care problems were found in the surgical unit's preoperative care, intraoperative care and postoperative care. The inspector general's report found that the deaths of at least nine patients were "directly attributable" to surgical mistakes and substandard care at the Marion VA hospital. More than a dozen additional patients suffered serious harm because of such mistakes, according to the inspector general's report, and as many as 10 additional patients may have died because of poor care at Marion.

Shinseki has agreed to meet with members of the Illinois delegation on Wednesday to discuss the ongoing problems at the Marion VA Medical Center. Visit NPR for the story.

Glass thermometers still a safety hazard

A study by emergency physicians at Children's Hospital Boston provides a wake-up call to parents to get rid of their old glass thermometers. A 12-year review of patients seen in Children's emergency department (ED) shows that glass thermometers pose one more safety hazard in addition to mercury exposure: injuries from broken glass. Moreover, the incidence of glass thermometer injuries has only decreased minimally despite bans on mercury-containing glass thermometers in several states, including Massachusetts.

"Just because glass thermometers are not sold doesn't mean people don't have them in their homes," says co-author Lois Lee, MD, MPH, of Children's Division of Emergency Medicine, who also directs the hospital's Injury Prevention Program. "They may not realize what the dangers are."

Researchers reviewed records from Children's ED from October 1995 to October 2007. During this period, the ED saw 33 patients with glass thermometer-related injuries, approximately one to six injuries per year (including three in 2007, despite the 2002 ban in Massachusetts). The findings are detailed in the October issue of Pediatric Emergency Care.

Out of all the patients treated: 84 percent had broken glass injuries to their mouth or rectum, 66 percent required imaging procedures for a potential foreign object; 42 percent were exposed to mercury; about 80 percent were younger than 4 years; despite repeated warnings and legislation, glass thermometer-related injuries decreased by less than 9 percent annually.

The authors of the study suggest that pediatricians discuss safer, non-glass thermometers with parents as part of well-child appointments or while talking about fever management. If parents are still insistent on using the most accurate thermometers, pediatricians should be prepared to discuss the different thermometers readily available. The difference in temperature readings is often within tenths of a degree - too small to justify exposing children to the risk of the thermometer breaking.

Nadine Aprahamian, MD, of Children's Division of Emergency Medicine was the first author of the study, titled "Glass Thermometer Injuries: It is Not Just About the Mercury." For more information visit Children's Hospital newsroom.

Premature births are fueling higher rates of infant mortality in U.S., report says

High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem. In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available. Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with 2.4 in Sweden. Twenty-nine other countries also had lower rates. If the United States could match Sweden’s prematurity rate, the new report said, “nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be one-third lower.”

The first author of the report, Marian F. MacDorman, a statistician at the National Center for Health Statistics, said in an interview that the strong role prematurity played came as a surprise to her.

Dr. Alan R. Fleischman, medical director for the March of Dimes, said the new report was “an indictment of the U.S. healthcare system” and the poor job it had done in taking care of women and children. The report, Dr. Fleischman added, “puts together two very important issues, both of which we knew about but hadn’t linked tightly.”

Infant mortality is widely used as a way to gauge the health of a nation, and the relatively high rates in the United States have long dismayed health officials. Most European countries — as well as Australia, Canada, Hong Kong, Israel, Japan, New Zealand and Singapore — have lower rates of infant death than the United States.

Premature infants in the United States are more likely to survive than those elsewhere. Yet they are still more likely to die than full-term babies, and the sheer numbers born prematurely in the United States — more than 540,000 per year — drive up infant mortality. The high levels of prematurity in the United States have various causes.

Dr. Fleischman said the smallest, earliest and most fragile babies were often born to poor and minority women who lacked healthcare and social support. The highest rates of infant mortality occur in non-Hispanic black, American Indian, Alaska Native and Puerto Rican women. But other minorities have some of the lowest infant mortality rates in the United States: Asian and Pacific Islanders, Central and South Americans, Mexicans and Cubans.

When it comes to prematurity, infertility treatments — drugs that stimulate ovulation and procedures that implant more than one embryo in the uterus — also play a role by raising the odds of twins or higher multiples, which have an increased risk of being born too soon.

Professional groups for fertility doctors recommend limiting the number of embryos transferred to avoid multiple births, but ultimately doctors and patients make their own decisions. Dr. MacDorman said that because most insurance in the United States did not cover infertility treatments, some patients chose to transfer multiple eggs in hopes that doing so would increase the odds of pregnancy and reduce expensive procedures. “In Europe, they may have been more successful in limiting the number of embryos transferred,” Dr. MacDorman said, “because there is more national health insurance and people don’t have to pay out of pocket.”

Another factor in the United States, she said, is the increasing use of Caesarean sections and labor-inducing drugs to deliver babies early. The American College of Obstetricians and Gynecologists has guidelines stating that babies should not be delivered before 39 weeks without a medical reason, but doctors may be declaring a medical need more quickly than they did in the past.

Dr. MacDorman said prematurity was not the only factor behind infant mortality in the United States. She said full-term babies in this country also had higher death rates than those in Europe from sudden infant death syndrome, accidents, assaults and homicides. Visit the New York Times for the article.

Data show swine flu vaccine’s potency

Pregnant women need only one dose of vaccine to protect them from the swine flu, according to government data released yesterday that confirm what officials have been recommending. Federally funded studies also affirmed that children age 9 and younger will need two doses of vaccine to produce a strong enough response by their immune systems to protect them against the H1N1 virus, officials reported.

“No safety concerns have arisen,’’ said Anthony Fauci of the National Institute of Allergy and Infectious Diseases, which has been leading the government’s efforts to test the vaccine.

In the new results, an analysis of samples from 50 pregnant women in their second or third trimesters taken 21 days after they received a standard dose of vaccine found that 92 percent experienced a sufficient response to assume they would be protected. Previous results showed that most other adults also need only one shot.

Additional data from blood tests on 583 children, however, found that only 25 percent of those ages 6 months to 35 months, and only 55 percent of those ages 3 to 9 years, had a strong enough immune response to protect them 21 days after getting only one shot. But 100 percent of the young children and 94 percent of those ages 3 to 9 experienced a strong enough response eight to 10 days after a booster. Visit the Boston Globe for the article.

US DOJ confirms large corporate owned hospitals involved in illegal contracting schemes

Over the last few months, concern over healthcare costs in McAllen, TX has been incorrectly aimed by a few in Congress toward physician ownership. However, current federal action in McAllen has uncovered the real problem - large, corporate hospitals who now owe millions for their illegal contracting schemes.

Last week, the Department of Justice (DOJ) announced that its McAllen, TX investigation of violations of the “False Claims Act, the Anti-Kickback Statute and the Stark Statute” has resulted in a $27.5 million settlement with Universal Health Services Inc., a company based in Pennsylvania that owns South Texas Health System and other hospitals around the country. [Source: USDOJ 10/30/09]

The one physician owned hospital in McAllen, TX, Doctors Hospital at Renaissance, was never part of the DOJ investigation and no allegations have ever been brought against the facility.

“Our opposition has attempted to pass the blame to physician owned hospitals for cost concerns brought to light by a June 2009 article published in the New Yorker. As the DOJ settlement demonstrates, that is simply not the case. The problem has never been physician ownership. The real problem lies with big corporate hospital chains,” said Molly Sandvig, JD Executive Director of Physician Hospitals of America (PHA).

Despite this and other convincing evidence that points away from physician ownership as a concern, language that attacks physician ownership has been inserted by corporate hospital lobbyists in both the House and Senate versions of healthcare reform bills.

The Justice Department announcement specifically noted that the settlement, "...involved allegations that the defendants had entered into financial relationships with several doctors in McAllen in order to induce them to refer patients to the defendants' hospitals. The government alleged that these payments were disguised through a series of sham contracts, including medical directorships and lease agreements.”

Sandvig commented that PHA is pleased to see that the real problem has been identified. “We have said for many years that we share concerns about illegal kickback schemes and that enforcement must be targeted to protect Medicare andtax money,” commented Sandvig.” Visit www.physicianhospitals.org for the story.

New DISPATCH patient transport solution

Caltech Industries, Inc., introduces the DISPATCH Patient Transport Solution. The new solution is designed to travel on wheelchairs, gurneys, IV poles, beds, and other transport devices. The package is designed to attach directly to any type of point-of-care equipment or fit into a small drawer. The new package features an easy open (with one hand) resealable closure and comes with versatile fasteners to: Vertically attach to poles, attach at a 45-degree angle to side rails, horizontally attach to flat surfaces, and stow away inside wheelchair pockets or drawers.

The DISPATCH Patient Transport Solution provides opportunity to lower the rate of HAIs (Healthcare-Associated Infections) in medical facilities. Studies have shown that mobile equipment surfaces become contaminated with infectious organisms from use with patients throughout the day. Patient and transport worker safety is improved with convenient access to fast-acting DISPATCH Hospital Cleaner Disinfectant Towels with Bleach to use between trips. Visit www.caltechindustries.com for more information.

Georgia-Pacific Professional named Core Committee member for information-based labeling initiative

During this year’s ISSA/INTERCLEAN North America tradeshow (Oct. 6 – 9), ISSA and Ecoform announced the creation of an Information-Based Environmental Labeling (IBEL) initiative for the commercial cleaning industry. Georgia-Pacific Professional has been named to the development team comprised of 25 companies that will serve as Core Committee members to help develop new environmental labeling standards.

The IBEL initiative, according to the ISSA, offers the cleaning industry broader product ratings, inclusion of small and medium manufacturers, and a quantitative reporting system that rewards continued product innovation and reduced environmental impact. As a Core Committee member, Georgia-Pacific Professional will work with representatives from various stakeholder groups important to the commercial cleaning industry to implement new standards that address limitations of current labeling.

“We’re honored to work with ISSA and Ecoform to develop a program that provides in-depth understanding of sustainable products and their benefits,” said Dan Silk, vice president of sustainability, Georgia-Pacific Professional. “We hope to participate in the adoption of an inclusive program that takes many elements of life cycle assessment into consideration, encourages continuous improvement and offers easily understandable scientific data on which to make decisions.” For more information visit the Ecoform website at www.Ecoform.com.

For more information about Green by Design, visit www.gppro.com.  

November 3, 2009 Download print version

ASHES elects Nemetz as 2010 President, Board adds two representatives

Prescription for success: Don't bother nurses

AP sources: House health bill totals $1.2 trillion

Hospitals cite worry on fees in health bill

RI Hospital fined $150,000 for wrong-site surgery

Could high blood pressure-related complications during pregnancy be tied to thinking skills in children years later?

Hospital grade disinfectant solution and wipes are safe and effective against H1N1 and Influenza A

Nominate a "Supply Chain-Focused CEO"

ASHES elects Nemetz as 2010 President, Board adds two representatives

The American Society for Healthcare Environmental Services (ASHES) board of directors announced the election of Fiona Nemetz, CHESP, as society president for 2010. Nemetz is currently serving as vice president. Nemetz’s year-long term as president begins January 1, 2010.

Nemetz is director of environmental services, patient transportation, safety, and parking at Saint Joseph’s Hospital of Atlanta. She has been an ASHES member since 1993 and has 25 years of environmental services experience. She began her career in 1982 in the hospitality field and transitioned over to health \care in 1993.

ASHES members also elected two representatives for the 2010-2012 board of directors with both having three-year terms beginning January 1, 2010: Kent Miller, CHESP: Miller is currently Director, Environmental Services for Carle Foundation Hospital Urbana, IL.His contribution to ASHES includes participation in various committees including his current position of Chair of the Knowledge Management Committee.

John Scherberger, CHESP: Scherberger is currently Director of Environmental Services, Pastoral Care, and Guest Services at Spartanburg Hospital for Restorative Care in Spartanburg, SC. He has served in various committees at the national level, including the 2009 Conference Planning Committee, and currently serves on the ASHES Advisory Council. www.ashes.org

Prescription for success: Don't bother nurses

For nurses, constant interruptions while tending to a patient are part of the job. But a distraction that happens while they're giving medications could have deadly results. A UCSF program to improve accuracy in administering drugs - with particular emphasis on reducing interruptions that often lead to mistakes - resulted in a nearly 88 percent drop in errors over 36 months at the nine Bay Area hospitals, according to results released Monday.

"Medication errors make up the largest slice of the medical error pie," said Julie Kliger, director of UCSF's Integrated Nurse Leadership Program, which developed the medication errors program. "Improving these numbers is a huge benefit to patient safety and, secondarily, it reduces costs."

The UCSF program, which was funded by the Gordon and Betty Moore Foundation, involved UCSF Medical Center, Kaiser hospitals in Hayward and Fremont, San Francisco General Hospital, St. Rose Hospital in Hayward, Contra Costa County Medical Center, Stanford Hospital in Palo Alto, San Mateo Medical Center and Sequoia Hospital in Redwood City.

Striving to reduce interruptions that lead to mistakes, teams of nurses at the different hospitals came up with a variety of methods - often surprisingly low tech - to alert others they were administering medications. The strategies included everything from wearing brightly colored vests or sashes to establishing "quiet zones" or making announcements at key points in the day when medications are being administered. At San Francisco General, for example, nurses found they were constantly being interrupted in the medication room because their colleagues could see them through the windows. So they covered the windows.

Some hospitals, such as Kaiser, have high-tech methods to reduce medication errors. Kaiser hospitals use barcoded patient identification bands, which allow nurses to scan the bar code on the medication against the patient's wristband to make sure they match. Such advances may reduce mistakes by decreasing the risk of giving the wrong medicines, but they don't stop interruptions or eliminate all mistakes, said Joanne Mette, chief nursing officer at Kaiser Permanente in Hayward and Fremont. Mette said nurses can be interrupted five to 10 times in the course of giving one medication. Kaiser nurses opted to use fluorescent sashes to signal they were in the middle of giving a patient medications and conducting necessary safety checks.

"We wear the sash because you can get interrupted doing the barcoding," Mette said, adding that a medication error isn't limited to giving the wrong medication, but includes even a minor delay in delivery. "We liken it to flying a 747. They never give up their safety checks and we don't give up ours."

Aside from reducing interruptions, the program established other safety techniques, including requiring nurses to check two forms of patient identification before giving medications, explaining the drug to the patient and keeping it in the package until they're at the bedside.

Nurses attributed much of the program's success to allowing those on the front lines to develop and tailor their own solutions. What worked in one hospital sometimes didn't work in another. Success also varied from unit to unit within each hospital.

At St. Rose Hospital in Hayward, for example, nurses in the maternity wards found the sashes too flimsy and opted instead to use bright green vests. In the large medical-surgical units, nurses rejected the vests and sashes in favor of carrying yellow folders. In the hospital's intensive care unit, nurses put a border on the floor around the electronic medication dispensing machine along with an overhead sign.

A 36-month program involving nine Bay Area hospitals found: Accuracy in administering medications improved from an average of 83.8 percent at the start of the program in 2006 to 93 percent after 18 months and 98 percent after 36 months. Between September 2006 and September 2009, medication errors at the hospitals dropped by an average of 87.7 percent. The adherence to a series of "best practice" principles, which included such techniques as checking two forms of patient identification before administering drugs and explaining each medication to the patient, increased from 79.5 percent at the start of the program to 96 percent after 36 months. Visit the San Francisco Chronicle for the article.

AP sources: House health bill totals $1.2 trillion

The healthcare bill headed for a vote in the House this week costs $1.2 trillion or more over a decade, according to numerous Democratic officials and figures contained in an analysis by congressional budget experts, far higher than the $900 billion cited by President Barack Obama as a price tag for his reform plan.

While the Congressional Budget Office has put the cost of expanding coverage in the legislation at roughly $1 trillion, Democrats added billions more on higher spending for public health, a reinsurance program to hold down retiree health costs, payments for preventive services and more. Many of the additions are designed to improve benefits or ease access to coverage in government programs. The officials who provided overall cost estimates did so on condition of anonymity, saying they were not authorized to discuss them.

House Speaker Nancy Pelosi has referred repeatedly to the bill's net cost of $894 billion over a decade for coverage. Asked about the higher estimate, Pelosi spokesman Brendan Daly said the measure not only insures 36 million more Americans, it provides critical health insurance reform in a way that is fiscally sound.

Whatever the final cost of legislation, the calendar is working increasingly against the White House and Democrats. While a House vote is possible late this week, Senate Majority Leader Harry Reid, D-NV, may not be able to begin debate on the issue until the week before Thanksgiving. Additionally, the Republican leader, Sen. Mitch McConnell of Kentucky, has hinted at efforts to extend the debate for weeks if not months, a timetable that could extend into 2010.

One casualty of the time crunch and threatened Republican delaying tactics may be formal House-Senate negotiations on a final compromise. An alternative is a less formal hurry-up final negotiation involving the White House and senior Democrats.

The bill includes an option for a government-run health plan. The leadership can afford more than two dozen defections and still be assured of the votes to prevail on the bill, one of the most sweeping measures in recent years. Republicans put the cost of the bill at nearly $1.3 trillion.

"Our goal is to make it as difficult as possible for" Democrats to pass it, House Republican leader John Boehner, R-OH, said at a news conference. "We believe it is the wrong prescription." One day after announcing Republicans would have an alternative measure, Boehner offered few details. He said it would omit one of the central provisions in Democratic bills - a ban on the insurance industry's practice of denying coverage on the basis of pre-existing medical conditions.

Instead, he said the Republicans would encourage creation of insurance pools for high-risk individuals and take other steps to ease their access to coverage. Boehner also said Republicans would propose limits on medical malpractice lawsuits in what he said was an attempt to reduce the cost of coverage.

Democrats have made elimination of the industry's practice a linchpin of their drive to overhaul the healthcare system. The industry has said it would not fight the change, and an accompanying restriction on its ability to charge higher premiums for certain groups, as the legislation includes a requirement for individuals to purchase insurance. Lacking that, the industry says millions of relatively healthy individuals would refuse to pay for coverage until they became sick, and the cost of premiums would rise sharply for everyone else. Visit the Washington Post for the article.

Hospitals cite worry on fees in health bill

As Congress struggles to rein in healthcare costs as part of its sweeping reform efforts, hospitals in New York City and other urban areas that provide some of the most expensive care are among the primary targets. The issue pits hospitals in more rural states like Iowa and Minnesota, where spending tends to be lower, against those in areas like New York and Los Angeles, and revolves around a question that has bedeviled the medical establishment for decades:  How much money do hospitals need to provide adequate care for patients, especially poor people who have not had regular access to healthcare.

A provision in the House healthcare bill, included over the objections of hospitals from New York and other cities, would order a neutral group, the Institute of Medicine, to conduct a two-year study of regional variations in Medicare spending. The bill requires the institute to recommend changes that would reward "quality and value," and those changes would take effect automatically unless Congress objected by May 31, 2012.

Proponents say the institute's findings could prove crucial to efforts to slow out-of-control costs. They argue that through greater efficiency, Medicare spending could be cut by 15 to 30 percent, and cite researchers at Dartmouth Medical School, who contend that Medicare could save $1.42 trillion by 2023, and eliminate a looming deficit, by reducing annual growth in per patient spending to 2.4 percent from the national average of 3.5 percent.

The recommendation that New York hospitals fear most is that Medicare should reduce payments to areas where costs grow fastest and increase payments to those who are best at controlling them. They argue that some of the most efficient hospitals are in affluent and rural areas that do not face the same challenges, including higher poverty and cost of living, as New York.

The study was so important to the fiscally conservative Blue Dog Democrats that they made it a condition of their support for the public option health insurance plan. House members from the West and Midwest argued that they had been historically shortchanged by Medicare, which essentially penalized them for providing more efficient care.

Two weeks ago, hospitals from New York and other urban areas succeeded in adding language that prevents the institute's recommendations from reducing payments for medical education, much of which occurs at New York's large teaching hospitals, or from reducing so-called disproportionate share payments for hospitals that serve large numbers of low-income patients.

The hospitals are watching to see whether the Senate will bring up the issue of geographic disparity in a floor fight. The current Senate bill would penalize doctors who order a high number of tests, but would compare Manhattan doctors with other Manhattan doctors, for example, and not with Iowa doctors, according to Senator Charles E. Schumer, Democrat of New York.

The issue highlights work by researchers at the Dartmouth Medical School's Institute for Health Policy and Clinical Practice, through its Dartmouth Atlas of Health Care. The atlas has found striking regional differences in the intensity and cost of healthcare.

The Dartmouth researchers say that high-cost hospitals - spurred by "volume-based payment systems" - are oriented toward providing more tests, like CT scans and M.R.I.'s; more surgeries; and more  admissions, and that evidence suggests that patient outcomes are better in low-spending regions. Visit the New York Times for the article.

RI Hospital fined $150,000 for wrong-site surgery

The Rhode Island Hospital surgical team that operated on the wrong finger on Oct. 22 violated its own policies intended to prevent such errors, a Health Department investigation has found. The state Health Department has reprimanded the hospital and fined it $150,000, citing a history of wrong-site surgeries and numerous violations leading to the recent error. This is only the second time that the state has fined a hospital; the first time was in 2007 when it fined Rhode Island Hospital $50,000 for the third wrong-site neurosurgery that year.

In the most recent incident, the surgeon had marked the patient's hand but not the individual fingers that needed surgery. He operated on two different parts of one finger rather than two separate fingers. When his error was noticed, he operated on the correct finger. It was the fifth wrong-site surgery at Rhode Island Hospital since 2007.

"The Hospital's continued failure to effectively implement policies and practices to ameliorate this particular problem is frustrating and significantly damages the public's perception of safety and the credibility of RI Hospital's ability to consistently provide for safe surgical procedures," Health Director David R. Gifford said in a letter to hospital president Timothy J. Babineau. Visit the Providence Journal for the story.

Could high blood pressure-related complications during pregnancy be tied to thinking skills in children years later?

A study from Denmark hints at "a modest association" between such complications and poorer reasoning, intuition, and perception skills in young adult men, report Dr. Vera Ehrenstein, at Aarhus University Hospital, and colleagues. The study compared intelligence tests measures for more than 17,000 men drafted into Danish military service. Of these men, tested at the age of 19, about 15 percent had poor thinking skills, measured by IQs below 85, the researchers report in the American Journal of Epidemiology.

The mothers of about 5 percent of the men in the study had either blood pressures above 140/90, protein in the urine, or swelling of the extremities. All of those are signs or symptoms of a life-threatening condition known as pre-eclampsia.

Poorer thinking skills were slightly more common among men whose mothers had any of those signs or symptoms. About 19 percent of the adults of affected mothers had poorer thinking skills, versus 15 percent among those whose mothers were not affected.

When the researchers accounted for being born small, which places infants at risk for delayed or impaired brain development, and for other factors, poor thinking skills were still as much as a third more likely among men whose mothers suffered from pre-eclampsia symptoms.

Ehrenstein's team notes the current findings cannot determine whether high blood pressure-related complications of pregnancy cause poorer thinking skills, nor why such complications would have any effect on those skills. Visit ABC News for the story.

Hospital grade disinfectant solution and wipes are safe and effective against H1N1 and Influenza A

Deemed by the EPA as effective against all Influenza A viruses, including Pandemic 2009 H1N1 influenza A virus (the swine flu), hospital-grade Sporicidin Disinfectants are safe for home, institutional, healthcare, and industrial use.

Created by the inventor of Chloraseptic throat spray, Sporicidin Brand Disinfectant solutions are broad-spectrum disinfectants that are EPA, FDA  and OSHA, compliant. Sporicidin is bactericidal, tuberculocidal, fungicidal and virucidal and has up to 6-months of residual bacteriostatic properties. These products provide 100% kill of pathogenic vegetative organisms and are safe for hard non-porous surfaces such as metals, plastics, Formica, vinyl, glass, wood, porcelain and paint. Ortho-phenylphenol free, bleach free, ammonia free, and alcohol free Sporicidin Disinfectants are available in convenient 22 ounce spray bottles and 1 gallon containers. Sporicidin disinfectant wipes are also available. To learn more about Contec and Sporicidin, visit www.contecinc.com and www.sporicidin.com.

Nominate a "Supply Chain-Focused CEO"

Many industries outside of healthcare recognize and respect the value that effective and efficient supply chain management contributes to the top and bottom lines. Among healthcare providers, such recognition and support is growing, slowly but surely, from the top post in the executive suite.

AHRMM is also pleased to support HPN's SURE award, recognizing the vital role a CEO plays in advancing healthcare through supply chain excellence.

That’s why Healthcare Purchasing News launched its yearly search for "supply chain focused CEOs" five years ago. We wanted to locate forward-thinking men and women to share their insights with you, and you’ve helped us do that. In fact, we’ve profiled of 16 of them already since January 2005.

Well, it’s that time of the year again – time to nominate noteworthy hospital presidents/CEOs for HPN’s 5th Annual "S.U.R.E. Award for Supply Chain Focused CEOs" award. We’re looking to recognize chief executives who support, understand, recognize and empower the materials management department to do what needs to be done to achieve bottom-line savings and top-line revenue.

We ask you, our dedicated and loyal readers, to recommend worthy candidates for recognition in our January 2010 edition by e-mailing us reasons how and why your CEO deserves the spotlight – no more than a couple of paragraphs are needed for each of the four S.U.R.E. categories listed above that comprise the "SURE" acronym. Please describe how and why he or she supports, how and why he or she understands, how and why he or she recognizes and how and why he or she empowers the materials management department and its top executive.

For your nomination to qualify, please comply with the following rules:

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

2. GPO and distributor support is commendable, but we’re looking for internally driven details beyond GPO- and distributor-driven contributions, including outsourcing operations to a GPO or distributor.

3. Any nominated executive (or nominator) must be willing to share relevant basic financial details with our readers – specifically annual revenues, annual expenses and annual purchasing volume.

4. Only administrators/CEOs are eligible for consideration – not COOs or executive/senior vice presidents.

5. Nomination deadline is Friday, November 6th, 2009.

Email nominations to editor@hpnonline.com. Help us share the stories of these remarkable CEOs in our January 2010 edition so that the industry may learn from them and be inspired. Thanks in advance.

November 2, 2009 Download print version

Authors retract N95 versus surgical masks to prevent flu recommendations, study flawed

Cordis initiates nationwide recall of CROSSOVER Sheath Introducer

A MRSA strain linked to high death rates

Independent experts to study safety data on H1N1 vaccine

HHS strengthens HIPAA enforcement

Nation's hip fracture rate could drop 25 percent with aggressive osteoporosis prevention

$172.8 billion in healthcare savings, explained

CMS announces payment, policy changes for physicians’ services to Medicare beneficiaries in 2010

Authors retract N95 versus surgical masks to prevent flu recommendations, study flawed

In a surprise twist, authors in Philadelphia, PA retracted findings of a study that found N95 respirators were better than surgical masks at preventing flu. After a re-analysis prompted by questions from reviewers, the findings were no longer significant, said Holly Seale of the University of New South Wales in Sydney, Australia.

The original study, presented earlier this year, formed the basis of some recommendations on the use of masks in a healthcare setting. The retraction, near the end of a presentation at the annual meeting of the Infectious Diseases Society of America, prompted a "rush to the microphones" by those involved in flu prevention, one expert said.

The findings appeared to differ, not only from previous reports, but also from the abstract submitted to this meeting, said Dr. Andrew Pavia of the University of Utah. Seale acknowledged those differences and agreed that the original results no longer stand. She was not immediately available for additional comment. The lead author of the study, Raina MacIntyre, also of the University of New South Wales, did not attend the meeting Philadelphia, PA.

The retraction took experts here by surprise, although many had been critical of some statistical aspects of the study, according to Dr. Neil Fishman of the University of Pennsylvania. The study was first presented in San Francisco earlier this year.

The N95 respirators are more costly than simple surgical masks and are in shorter supply. As well, there are costs involved if hospitals try to comply with guidance, he said. The original Australian finding was a surprise to many experts, Fishman said, because it did not accord with other findings or with clinical experience.

A Canadian study in the Journal of the American Medical Association in October found no difference between fit-tested N95 masks and surgical masks. The analysis, led by Mark Loeb of McMaster University in Hamilton, Ontario, was a true randomized trial among nurses in eight tertiary care hospitals in Canada.

In contrast, the Australian study, conducted in China, was a cluster randomized trial in which the unit of analysis was the hospital, Fishman said. But the Australians were criticized because their control group of nine hospitals was not selected randomly, he said. When the data were re-analyzed excluding those hospitals, the differences between N95 respirators and surgical masks were no longer significant, Seale reported. "When the P-value was adjusted for clustering and multiple testing," she reported, there was "no significant difference between N95 respirators and medical masks."

Fishman said most clinical experience suggests that flu is spread by large droplets and should be blocked by even a simple barrier such as a surgical mask. Visit ABC News for the story.

Cordis initiates nationwide recall of CROSSOVER Sheath Introducer

Cordis Corporation announced today a nationwide voluntary recall of all lots of the CROSSOVER Sheath Introducer due to complaints about stretching or fracture of the sheath during use. The CROSSOVER Sheath Introducer is a product developed and manufactured by Thomas Medical Products, Inc., and distributed by Cordis. It is a long-coil reinforced, kink-resistant catheter sheath intended for use in arterial and venous procedures requiring the percutaneous, or through the skin, introduction of therapeutic or diagnostic intravascular devices or fluids. Visit the FDA Recall for the notice.

A MRSA strain linked to high death rates

A strain of MRSA that causes bloodstream infections is five times more lethal than other strains, and has shown to have some resistance to the potent antibiotic drug vancomycin used to treat MRSA, according to a Henry Ford Hospital study. The study found that 50 percent of the patients infected with the strain died within 30 days compared to 11 percent of patients infected with other MRSA strains. The average 30-day mortality rate for MRSA bloodstream infections ranges from 10 percent to 30 percent.

Researchers say the strain USA600 contains unique characteristics that may be linked to the high mortality rate. But they say it is unclear whether other factors like the patients' older age, diseases or the spread of infection contributed to the poor outcomes collectively or with other factors. The average age of patients with the USA600 strain was 64; the average age of patients with other MRSA strains was 52. The study is being presented at the 47th annual meeting of the Infectious Diseases Society of America.

"While many MRSA strains are associated with poor outcomes, the USA600 strain has shown to be more lethal and cause high mortality rates," said Carol Moore, PharmD., a research investigator in Henry Ford's Division of Infectious Diseases and lead author of the study. MRSA strains can be resistant to many drugs, though they are typically susceptible to the antibiotic vancomycin. MRSA infections are often treated with vancomycin administered intravenously. The USA600 strain in this study was shown to be more resistant to vancomycin. Visit redOrbit for the article.

Independent experts to study safety data on H1N1 vaccine

An independent panel of experts will meet Monday to review the safety of the swine flu vaccine as part of the government's efforts to monitor the unprecedented immunization campaign. The National Vaccine Advisory Committee's H1N1 Vaccine Safety Working Group will review the results of data being collected by the government to detect any problems with the vaccine as soon as possible.

According to a summary of data the panel will review, about 10,352 people have received the injected vaccine and 501 have gotten the FluMist nasal spray in 13 studies funded by the Health and Human Services Department's Biomedical Advanced Research and Development Authority.

Of those who received the injections, 6,098 got standard vaccine while 4,254 received shots containing a substance known as an "adjuvant," which is designed to boost the effectiveness but is not being used widely. That included 5,776 adults and 4,576 children. The subjects received two doses 21 or 28 days apart and were to be followed for six months if they did not receive an adjuvant and for a year if they did.

"After preliminary review of available safety data, the rate and nature of local and systemic reactions following each dose appear to be acceptable and similar to other influenza vaccines," according to the summary. "To date, no serious adverse events have suggested any safety signals with H1N1 vaccines. There have been no serious adverse events in the opinion of the investigator definitely related to the vaccine," the summary states.

The summary notes, however, that "the limited size of the database is not sufficient to exclude rate adverse events" and "the safety data available for review is limited because studies are still ongoing."

A second summary of data collected through Oct. 20 by the National Institutes of Health from its own studies involving 3,630 children, pregnant women and non-pregnant adults similarly found that there "have been 'adverse events,' but none that have been attributed directly to the vaccine."

"The most common issue is pain and some swelling at the injection site for a day or two. We see this with any injectable vaccine to one degree or another," it states. Visit the Washington Post for the article.

HHS strengthens HIPAA enforcement

The U.S. Department of Health and Human Services (HHS) issued an interim final rule with request for comments to strengthen its enforcement of the rules promulgated under the Health Insurance Portability and Accountability Act (HIPAA). The Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009, modified the HHS Secretary’s authority to impose civil money penalties for violations occurring after Feb. 18, 2009. These HITECH Act revisions significantly increase the penalty amounts the Secretary may impose for violations of the HIPAA rules and encourage prompt corrective action. 

Prior to the HITECH Act, the Secretary could not impose a penalty of more than $100 for each violation or $25,000 for all identical violations of the same provision. A covered healthcare provider, health plan or clearinghouse could also bar the Secretary’s imposition of a civil money penalty by demonstrating that it did not know that it violated the HIPAA rules. Section 13410(d) of the HITECH Act strengthened the civil money penalty scheme by establishing tiered ranges of increasing minimum penalty amounts, with a maximum penalty of $1.5 million for all violations of an identical provision. A covered entity can no longer bar the imposition of a civil money penalty for an unknown violation unless it corrects the violation within 30 days of discovery. It may be viewed and commented on at: www.regulations.gov. This rulemaking will become effective on Nov. 30, 2009, and HHS will consider all comments received by Dec. 29, 2009. Additional information about HIPAA and several related rulemakings may be found on OCR’s Web site: http://www.hhs.gov/ocr/privacy/.

Nation's hip fracture rate could drop 25 percent with aggressive osteoporosis prevention

Aggressively managing patients at risk for osteoporosis could reduce the hip fracture rate in the United States by 25 percent, according to a Kaiser Permanente study published in the November issue of the Journal of Bone & Joint Surgery. The first step must be a more active role by orthopedic surgeons in osteoporosis disease management, researchers say.

This study, the largest to look at osteoporosis management in men and women over 50 years old, followed 650,000 men and women in Kaiser Permanente's osteoporosis management program and found hip fractures dropped by 38 percent, preventing 970 hip fractures in 2007.

The Kaiser Healthy Bones Program aggressively targets people at risk for hip fractures by identifying them through KP HealthConnect to ensure they get the bone density screenings and medications they need. The multidisciplinary team includes orthopedic surgeons and providers from endocrinology, family practice, internal medicine, rheumatology, gynecology, physical therapy, disease/care management, radiology, and nursing education.

In this study, researchers found that annual bone density screening rates increased by 263 percent from 2002 to 2007. In 2002 there were 21,557 scans a year. In 2007, there were 78,262 scans. The number of people on anti-osteoporosis medications increased by 153 percent from 33,208 in 2002 to 84,155 a year in 2007.

"The most important thing an orthopedic surgeon should know about osteoporosis/fracture prevention is that we can take action that helps to prevent hip and other fragility fractures," said the study's lead author Richard M. Dell, MD, an orthopedic surgeon at Kaiser Permanente in Downey, CA. "Simple steps like suggesting calcium and vitamin D for all your patients and bone mineral density testing in patients at higher risk for osteoporosis should be considered part of your daily practice."

More than 300,000 hip fractures are reported annually in the United States. Twenty-four percent of people who experience a hip fracture end up in a nursing home, 50 percent never reach their functional capacity, and 25 percent of patients over 65 years of age with a hip fracture die in the first year after the incident. Visit PR Newswire for the article.

$172.8 billion in healthcare savings, explained

Wade through the Congressional Budget Office estimates of the House healthcare bill, and you’ll notice some big projected savings for things like this: Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.

In all, in fact, the CBO says there are $172.8 billion in savings (spread over 10 years) tied to these changes in “market basket updates.” The Wall Street Journal talked with Eric Hammelman, a senior manager at the D.C. analysis shop Avalere Health, to figure out what this means.

Every year, the feds adjust Medicare payments to hospitals, nursing homes and other facilities to account for inflation. The House bill would add in a second factor: productivity. Because workers’ productivity tends to increase over time, factoring in productivity increases would make Medicare payment increases lower than if they were tied only to inflation.

“We are getting more efficient as a nation; therefore, we shouldn’t have to do a pure inflationary update,” Hammelman said, explaining the rationale behind this shift.

The Senate Finance bill has similar language, Hammelman said, and including productivity was part of what the hospital industry agreed to when it cut a 10-year, $155 billion deal with the Dems. So if some big health-care bill makes it through Congress this year, market basket updates are likely to be in there somewhere. Visit the Wall Street Journal  for the story.

CMS announces payment, policy changes for physicians’ services to Medicare beneficiaries in 2010

The Centers for Medicare & Medicaid Services (CMS) announced Friday, final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.

In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.

In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association. CMS is finalizing the proposal, but will phase it in over a four year period. In addition, CMS will not use the PPIS data to determine the practice expenses for medical oncology, but instead will continue to use specialty supplemental survey data, as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).

CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.

In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.

CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. The IPPE benefit now pays for an initial assessment of key elements of a beneficiary’s health within one year of the beneficiary’s enrollment in Medicare Part B.

Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the Sustainable Growth Rate.

Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. The accreditation requirement will apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them. CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.

The rule also contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI).

The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010. To view a copy of the final rule with comment period, please see: www.federalregister.gov/inspection.aspx#special  

back to home page