CMS Awards $347 Million for Patient Safety Initiative

October 2, 2016

Money will go toward reducing inpatient harm, readmissions.

By Joyce Frieden/News Editor/MedPage Today/September 30, 2016

WASHINGTON — The Centers for Medicare & Medicaid Services (CMS) is awarding $347 million to healthcare organizations in an effort to reduce patient harm and decrease readmissions, the agency announced Thursday.

The money will go to 16 different groups, including hospital associations, quality improvement organizations, and health systems as part of an effort to reduce hospital-acquired conditions and readmissions among Medicare beneficiaries.

We made significant and successful progress in keeping patients safe over the last few years,” CMS chief medical officer Patrick Conway, MD, said on a conference call with reporters. “Since 2010, we have seen an unprecedented reduction in preventable patient harm in hospitals across the U.S., resulting in 2.1 million fewer people harmed, 87,000 lives saved and $20 billion in costs saved.”

Now CMS wants to continue these efforts and set additional goals, Conway explained, noting that these improvements would not have been possible without the Affordable Care Act and the work of CMS’s innovation center.

A Minnesota Doctor Is Trying Get a $50 EpiPen Alternative to Market

September 18, 2016

By   SEPTEMBER 15, 2016, 1:31 PM EDT, Fortune

To provide an option other than Mylan’s pricey device.

A Minnesota doctor wants to make fighting deadly allergies cheaper—a lot cheaper.

Douglas McMahon of the Allergy and Asthma Center of Minnesota in Eagan has created what he says is a more convenient epinephrine-delivering device for treating anaphylaxis—a severe allergic reaction which can cause difficulty breathing and other dangerous symptoms—that would be available at about a tenth of the price of Mylan’s MYL 0.67% brand name EpiPen, according to a local CBS affiliate.

“By chance I came to realize how inexpensive the parts were, including the medicine, and I realized we can sell it to patients for a very reasonable cost,” McMahon told the network in an interview.

Mylan has been under intense scrutiny since reports emerged that the pharma giant had raised the price of the EpiPen from less than $100 for a one-year, two-pack supply to about $600 over the course of a decade. The firm scrambled to bolster price-lowering coupons for patients after its share value nosedived and has pledged to release a generic competitor to its own product that will be about half the cost of the branded one.

But McMahon says his alternative device, dubbed theAllergyStop, would cost as little as $50. And he believes the technology itself is superior to Mylan’s since it is far more compact and easier to carry—particularly important since most Americans who die from anaphylaxis do not have their epinephrine with them. The device can also be customized to provide different dosages for different body types.Still, there are some big hurdles that need to be cleared before the AllergyStop can reach the market. For one, McMahon needs to conduct the thorough, expensive safety and clinical trials necessary for Food and Drug Administration (FDA) clearance. Such testing can easily cost upwards of $1 million, which is why McMahon is currently trying to raise money through an Indiegogo campaign.

There’s also the question of how realistically the physician can stick to his low target price. If he opens up the product to outside investors, they may press him to raise its tab, he admits.

In the meantime, Mylan is still facing tough questions (and an investigation by New York’s Attorney General) about its decision to hike the EpiPen’s price. CEO Heather Bresch is slated to testify in front of the U.S. House Committee on Government and Oversight in a September 21 congressional hearing.

Aetna to Quit Most Obamacare Markets, Joining Major Insurers

August 18, 2016

By Zackery Tracer/Bloomberg/August 16, 2016

Health insurer Aetna Inc. will stop selling individual Obamacare plans next year in 11 of the 15 states where it had been participating in the program, joining other major insurers that have pulled out of the government-run markets in the face of mounting losses.

Aetna will exit markets including North Carolina, Pennsylvania and Florida, and keep selling plans on state exchanges only in Iowa, Delaware, Nebraska and Virginia, according to a statement Monday evening. In most areas it’s exiting, Aetna will offer individual coverage outside of the program’s exchanges.

State of the union: Overworked nurses, docs organize nationwide

August 4, 2016

by Zack Budryk |Aug 4, 2016 10:47am – Fierce Healthcare

Union activity is on the rise in hospitals across the nation as frustrated doctors and nurses say hospitals value profits over patients and encourage a culture of overwork to make up for inadequate staffing.

For example, nurses at Einstein Medical Center in Philadelphia voted to form a union in April, to protest unsafe conditions and inadequate staffing, according to The Nation.

Meanwhile, in January, nurses at Hahnemann University Hospital in Philadelphia, owned by the for-profit Tenet chain, voted by a wide margin to join the Pennsylvania Association of Staff Nurses & Allied Professionals (PASNAP), The Nation reports. St. Christopher’s Hospital for Children in Philadelphia joined shortly after.

Even doctors are fed up, according to the article. After years of tension within the workplace, three doctors in Minnesota joined a professional unit of Steelworkers Local 9460, which finalized its first contract at Lake Superior Community Health Center in Duluth.

Lack of adequate staffing is frequently cited as the reason for such organizing efforts, according to the article. A March PASNAP survey of recently organized nurses found that 70 percent say they’ve never worked in an organization that had sufficient staffing. Yet, research shows that in addition to improving workplace conditions, increased staffing levels leads to better patient outcomes, while inadequate staffing is a major driver of mortality.

Established healthcare unions also report recent successes. Just this week, the 1199 SEIU United Healthcare Workers East, which represents 5,000 workers at Boston’s Steward Health Care System, signed a contract with the system to maintain health benefits while agreeing on a 5.5 percent raise over three years for its technicians and non-clinical staff, according to The Boston Globe.

In West Virginia, the 4th Circuit Court of Appeals has ordered Bluefield Regional Medical Center and Greenbrier Valley Medical Center to recognize nurses’ right to organize and join them at the collective bargaining table, according to the Register-Herald.

Nurses and doctors who serve on the frontline of care are ideally poised to lead on labor issues, PASNAP President Patty Eakin told The Nation. “One of the biggest things we’re going to get out of [a union],” she said, “is a legal voice, and a way to raise our voices up together and say, ‘This has to change.’”

Freestanding ERs May Freeze Out Poor, Minorities

July 17, 2016

Fierce Healthcare/By Zack Budryk/July 14, 2016

The freestanding emergency room mode is taking healthcare delivery by storm, but concerns linger about their effect on care access, according to a new study published in theAnnals of Emergency Medicine.

These stand-alone facilities are physicially separate from acute care hospitals but are available 24/7 for emergency care, and offer many of the same services as traditional emergency departments, including on-site advanced diagnostic imaging and laboratory testing.

Researchers from Boston’s Brigham and Women’s Hospital assembled a national database of freestanding ERs, determining that 360 existed across 30 states as of spring 2015, up from 222 in 2009. They found growth of the ERs is concentrated in high-income areas with growing populations, more traditional ERs, a higher proportion of privately insured patients and a lower proportion of Medicaid beneficiaries.

Ohio, Texas and Colorado led the other states for number of freestanding ERs, and in Texas and Ohio specifically, freestanding ERs were concentrated in ZIP codes with more privately-insured patients, according to the research. Texas’ freestanding ERs are more likely to be in ZIP codes with fewer Hispanics and higher annual spending.

Therefore, researchers concluded that although the model is on the rise, the facilities grow in areas that need the least help with care access.

“In the states with the most freestanding EDs, it seems less likely that they will expand access to underserved populations,” corresponding author Jeremiah Schuur, M.D., vice chair, Clinical Affairs, Department of Emergency Medicine, Brigham and Women’s Hospital, said in astatement, “as they are preferentially located in areas where people had more available health services, higher rates of private health insurance, lower rates of Medicaid and higher median incomes.”

The findings echo concerns voiced last year by the Medicare Payment Advisory Commission (MedPAC), which noted that two-thirds of Houston’s for-profit freestanding ERs are in ZIP codes with an average income higher than $53,000, FierceHealthcare previously reported.

Battlefield lessons for trauma care: National system could save 200K lives

June 21, 2016

Fierce Healthcare – by Zack Budryk |Jun 20, 2016 10:10am

Improved trauma care could prevent 20 percent of deaths from injuries such as gunshots or car accidents, according to a new report from the National Academies of Sciences, Engineering and Medicine.

The report, co-authored by Donald Berwick, M.D., former administrator for the Centers for Medicare & Medicaid Services, calls for healthcare leaders to set a national goal of zero preventable deaths from injury. As a model for such a strategy, the report cites the U.S. Army’s 75th Ranger Regiment, which managed to nearly eliminate preventable deaths.

Between 2001 and 2011, if all trauma centers nationwide had achieved outcomes on the level of the top-performing centers, 200,000 fewer patients would have died, according to the report. As it stands, however, research shows all trauma providers are not created equal, withtrauma centers serving a predominantly minority population seeing higher mortality rates.

To properly address trauma care, the authors write, healthcare needs a nationwide trauma care system that provides education across the entire continuum of trauma care, from the actual injury scene to rehabilitation and post-rehabilitation. Currently, “we do not have a cogent or well-designed research strategy on trauma care,” Berwick said in a public briefing on the report last week, according to Kaiser Health News.

Trauma care also needs a bigger research budget, according to the report; while trauma is the top cause of death for civilian Americans under 46, its research budget was less than 1 percent of the National Institutes of Health’s 2015 biomedical research budget.

In the wake of mass casualty events such as this month’s mass shooting in Orlando, Florida, which killed 49 people, the presence nearby of emergency personnel with battlefield experience provides a clear advantage.

“The tragedy is that a lot of this likely could be helped by that hard-won knowledge gained on the battlefield,” John B. Holcomb, a retired colonel and chairman of surgery at the University of Texas Health Science Center, who served on the committee, told Stars & Stripes. “No one knows where the next Orlando is going to happen.”

Psoriasis Linked to AAA – —Shared inflammatory mechanisms may explain the association

April 17, 2016

by Nancy Walsh, Senior Staff Writer, MedPage Today

Patients with psoriasis — whether mild or severe — are at increased risk of abdominal aortic aneurysms (AAA), a Danish nationwide cohort study found.

“These findings add importantly to current evidence of psoriasis as a clinically relevant risk factor for cardiovascular disease and may require increased focus on heightened risk of AAA in patients with psoriasis,” the researchers wrote in Atherosclerosis, Thrombosis, and Vascular Biology.

Systemic inflammatory markers such as C-reactive protein and tumor necrosis factor (TNF)-α also are elevated in patients with AAA and in those with psoriasis.

Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner.

Blood Test For Concussion

April 1, 2016

Researchers at Orlando Health detected evidence of concussions in patients up to 7 days after their injury using a simple blood test, according to a new study published in JAMA Neurology. The discovery could greatly expand the window for diagnosing concussions, especially in patients who experience a delayed onset of symptoms.

Science Daily, March 28, 2016.

N.F.L. Great Ken Stabler Had Brain Disease C.T.E.

February 3, 2016

Pro Football by John Branch, February 3, 2016.

Shortly before he died last July, the former N.F.L. quarterback Ken Stablerwas rushed away by doctors, desperate to save him, in a Mississippi hospital. His longtime partner followed the scrum to the elevator, holding his hand. She told him that she loved him. Stabler said that he loved her, too.

“I turned my head to wipe the tears away,” his partner, Kim Bush, said recently. “And when I looked back, he looked me dead in the eye and said, ‘I’m tired.’ ”

They were the last words anyone in Stabler’s family heard him speak.

“I knew that was it,” Bush said. “I knew that he had gone the distance. Because Kenny Stabler was never tired.

The day after Stabler died on July 8, a victim of colon cancer at age 69, his brain was removed during an autopsy and ferried to scientists in Massachusetts. It weighed 1,318 grams, or just under three pounds. Over several months, it was dissected for clues, as Stabler had wished, to help those left behind understand why his mind seemed to slip so precipitously in his final years.

On a scale of 1 to 4, Stabler had high Stage 3 chronic traumaticencephalopathy, or C.T.E., the degenerative brain disease believed to be caused by repeated blows to the head, according to researchers at Boston University. The relationship between blows to the head and brain degeneration is still poorly understood, and some experts caution that other factors, like unrelated mood problems or dementia, might contribute to symptoms experienced by those later found to have had C.T.E.

Drug Overdoses Propel Rise in Mortality Rates of Young Whites

January 22, 2016

The New York Times. By Gina Kolata and Sarah Cohen. January 16, 2016

Drug overdoses are driving up the death rate of young white adults in the United States to levels not seen since the end of the AIDS epidemic more than two decades ago — a turn of fortune that stands in sharp contrast to falling death rates for young blacks, a New York Times analysis of death certificates has found.

The rising death rates for those young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.

The Times analyzed nearly 60 million death certificates collected by the Centers for Disease Control and Prevention from 1990 to 2014. It found death rates for non-Hispanic whites either rising or flattening for all the adult age groups under 65 — a trend that was particularly pronounced in women — even as medical advances sharply reduce deaths from traditional killers like heart disease. Death rates for blacks and most Hispanic groups continued to fall.