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Putting a lid on waste: Needless medical tests not only cost $200B - they can do harm
It's common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful. Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution.
The Sacramento-based health system deleted the button physicians used to order daily blood tests. "We took it out and couldn't wait to see the data," said Ann Marie Giusto, a Sutter Health executive.
Alas, the number of orders hardly changed. That's because the hospital's medical-records software "has this cool ability to let you save your favorites," Giusto said at a recent presentation to other hospital executives and physicians. "It had become a habit."
There are plenty of opportunities to trim waste in America's $3.4 trillion healthcare system - but, as the Sutter example illustrates, it's often not as simple as it seems.
Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.
In California, that sense of frustration has led three of the state's biggest healthcare purchasers to band together to promote care that's safer and more cost-effective. The California Public Employees' Retirement System (CalPERS), the Covered California insurance exchange and the state's Medicaid program, known as Medi-Cal - which collectively serve more than 15 million patients - are leading the initiative.
Progress may be slow, but there have been some encouraging signs. In San Diego, for instance, the Sharp Rees-Stealy Medical Group said it cut unnecessary lab tests by more than 10 percent by educating both doctors and patients about overuse.
A large public hospital, Los Angeles County-University of Southern California Medical Center, eliminated preoperative testing deemed superfluous before routine cataract surgery. As a result, patients on average received the surgery six months sooner.
These efforts were sparked by the Choosing Wisely campaign, a national effort launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation. The group asked medical societies to identify at least five common tests or procedures that often provide little benefit.
The campaign, also backed by Consumer Reports, encourages medical providers to hand out wallet-sized cards to patients with questions they should ask to determine whether they truly need a procedure.
Daniel Wolfson, chief operating officer at the ABIM Foundation, said the Choosing Wisely campaign has been successful at starting a national conversation about unwarranted care.
The state effort, dubbed Smart Care California, is in the early stages as well. Initially, the group has focused on cutting the number of elective cesarean sections, reducing opioid use and avoiding overtreatment for patients suffering low-back pain. In its contract with health insurers, the Covered California exchange requires that their in-network providers meet a range of quality standards, including low C-section rates.
Dr. Richard Sun, co-chairman of the Smart Care group and a medical consultant at CalPERS, said he's pursuing safer, more affordable treatments for low-back pain, a condition that cost the state agency $107 million in 2015.
To cut down on needless care, Cedars-Sinai arranged for doctors to be alerted electronically when they ordered tests or drugs that run contrary to 18 Choosing Wisely recommendations. The hospital analyzed alerts from 26,424 patient encounters from 2013 to 2016. All of the guidelines were followed in 6 percent of those cases, or 1,591 encounters.
Cedars-Sinai studied the rate of complications, readmissions, length of stay and direct cost of care among the patients in whose cases the guidelines were followed and compared those outcomes with cases where adherence was less than 50 percent.
In the group that didn't follow the guidelines, patients had a 14 percent higher incidence of readmission and 29 percent higher risk of complications. Those complications and longer stays increased the cost of care by 7 percent, according to the hospital.
In 2013, the first year of implementation of Choosing Wisely guidelines, Cedars-Sinai said it avoided $6 million in medical spending.
In Northern California, Sutter has incorporated more than 130 Choosing Wisely recommendations as part of a broader effort to reduce variation in care. In all, Sutter said, it has saved about $66 million since 2011. That's a significant sum. However, during the same period, Sutter reported $2.7 billion in profits. Last year alone, it posted an operating profit of $554 million on revenue of nearly $12 billion.
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Zika virus spread undetected for many months, NIH-supported study finds
Genetic analysis of samples collected as the Zika virus (ZIKV) spread throughout the Americas after its introduction in 2013 or 2014 has shown that the virus circulated undetected for up to a year in some regions before it came to the attention of public health authorities.
Genetic sequencing has also enabled scientists to recreate the epidemiological and evolutionary paths the virus took as it spread and split into the distinct subtypes - or clades - that have been detected in the Americas. The research, published in Nature, was supported in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
The researchers reconstructed Zika's dispersal by sequencing ZIKV genetic material collected from hundreds of patients in 10 countries and territories. They eventually amassed a database of 110 complete or partial ZIKV genomes - the largest collection to date - which they analyzed along with 64 published and publicly shared genomes.
Based on changes to the viral genome that accumulated as the disease moved through new populations, the researchers concluded that ZIKV spread rapidly upon its initial introduction in Brazil, likely sometime in 2013. Later, at several points in early-to-mid 2015, the virus separated into at least three clades, or distinct genetic groups whose members share a common ancestor, in Colombia, Honduras, and Puerto Rico, as well as a fourth type found in parts of the Caribbean and the continental United States.
The researchers used innovative sequencing approaches to overcome the challenge of working with samples not originally intended for viral genetic sequencing. In future outbreaks, the researchers suggest, appropriate samples for genetic sequencing should be collected from the beginning to make retrospective and concurrent analysis much easier and more accurate.
These results also may have a direct impact on public health, as a clear understanding of the genetic changes to pathogens that can occur during emerging outbreaks will be key to informing disease surveillance and development of diagnostic tests. Similarly, genetic analysis and prompt sharing in public databases can enhance the understanding of the dynamics of disease spread, so that public health authorities may implement the best possible control and prevention strategies.
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23 million more uninsured by 2026 under GOP health care bill, new CBO analysis finds
The Congressional Budget Office says the healthcare bill Republicans pushed through the House this month would leave 23 million additional people uninsured in 2026, compared with former President Barack Obama's healthcare law.
The nonpartisan office also says that compared with Obama's 2010 overhaul, average premiums for people buying individual policies would be lower. The report says that is partly because insurance on average would cover less of people's healthcare costs.
The CBO also says an estimated 51 million people under age 65 would be uninsured in 2026. That compares with 28 million under age 65 who would lack insurance that year under the current health law.
The Republican legislation would reduce the federal deficit by $119 billion over the next 10 years, according to the CBO analysis. GOP leaders were quick to point to the deficit reduction figure as good news for their legislation - even though an earlier version of the bill, rejected by the House, would have reduced the deficit by more than twice as much.
The analysis undermines claims by House Republicans that their health legislation protects people with pre-existing conditions.
Instead, the Congressional Budget Office says that in some cases, people with pre-existing conditions would not be able to purchase comprehensive health insurance at premiums comparable to those under current law, "if they could purchase it at all."
The finding is a blow to arguments from House GOP leaders who managed to get their bill over the finish line by arguing that a last-minute addition of $8 billion would bolster protections for those with pre-existing conditions.
The CBO specifies that these people would have difficulty getting affordable coverage "despite the additional funding that would be available."
It was the budget office's first analysis of the bill that passed the House May 4 with only GOP votes.
Democrats have criticized Republicans for pushing people off coverage. Many Republicans have said their top goal is lowering premiums.
Senate Republicans have been holding closed-door meetings to try writing their own healthcare overhaul.
Visit Chicago Tribune for the article.
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Blood discovery could benefit preemies, help end platelet shortages
The emergency call issued by the American Red Cross earlier this year was of a sort all too common: Donations of platelets were needed, and desperately. But a new discovery from the University of Virginia School of Medicine may be the key to stopping shortages of these vital blood-clotting cells, cells that can represent the difference between life and death.
The finding also could offer big benefits for premature babies, opening the door to new treatments for a serious condition called neonatal thrombocytopenia that affects up to 30 percent of babies in neonatal intensive care units.
The UVA researchers have identified a "master switch" that they may be able to manipulate to overcome the obstacles that have prevented doctors from producing platelets in large quantities outside the body.
"The platelet supply is limited and the demand is growing," said researcher Adam Goldfarb, MD, of UVA's Department of Pathology. "The quantities we can produce outside the body are very, very small, and the inability to scale up right now is a major roadblock. We think that our understanding of this pathway is actually a critical step toward fixing that problem."
Scientists also may be able to use this master switch to battle neonatal thrombocytopenia, a condition that complicates the care of babies who are already at great risk. "It turns out in premature infants and newborns that [the platelet] reserve is compromised. They are less capable of responding to distress and the demand for increased platelet production,"
Goldfarb said. "A goodly percentage of those babies, these tiny little babies, require platelet transfusions to keep their platelets up."
The switch discovered by Goldfarb's team controls whether the bone marrow produces cells called megakaryocytes of the type seen in adults or of the sort found in infants. This is important because the adult and infantile versions have very different specialties: Adult megakaryocytes are great at making platelets. Lots and lots of them. Infantile megakaryocytes, on the other hand, are much smaller cells, and they concentrate on dividing to produce more megakaryocytes.
The ability to toggle between the two could be a huge asset for doctors. Now, doctors cannot produce large quantities of platelets in the lab and instead must rely on platelet donations for patients. The new finding, however, may help change that.
For example, babies might be given a drug that would prompt their bodies to make more platelets. Researcher Kamal Elagib, MBBS, PhD, noted that the research team already has identified compounds that can flip the switch in the lab, but that those compounds likely aren't the best option for treatment.
The researchers, however, have already identified other drugs that look much more promising. "Our future efforts that Kamal is working on now are to identify better, cleaner, more effective approaches at flipping this switch," Goldfarb said. "Understanding this process could really enhance the future approaches towards treating patients with low platelet counts."
University of Virginia has the study.
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Almost 700 positions remain unfilled at the CDC due to hiring freeze
Almost 700 jobs at the Centers for Disease Control and Prevention (CDC) in Atlanta are vacant due to the recent federal government hiring freeze. This same issue is causing a variety of problems at the U.S. Department of Health and Human Services (HHS) and the National Institutes of Health (NIH).
The hiring freeze was technically lifted last month, but because the agencies have been charged with reorganizing and reducing their workforces, the practical effect has been a continued freeze. The Washington Post reports that researchers and officials at the CDC say the vacancies are affecting "programs supporting local and state public health emergency readiness, infectious disease control and chronic disease prevention."
An unnamed senior CDC official told the organization that critical public health analysts, scientists, and advisers are among the unfilled positions. These are the people who help ensure that scientists working in labs and the field all over the country have sufficient equipment and support to remain operational.
The CDC's problems are made even worse, the senior official said, because the agency is operating without a director. The former permanent director, Tom Frieden, resigned in January from the position, which is one of the most important roles in the fight against infectious diseases in the U.S. and everywhere else in the world. Since that time, the CDC has essentially been rudderless, trying to cope with a difficult transition without the benefit of leadership.
According to the Sierra Club, whose Freedom of Information Act (FOIA) request yielded the data on the results of the hiring freeze, the frozen jobs remaining open at the CDC are mostly medical experts and scientists (26 percent of positions) and policy experts (19 percent). In other words, the freeze is not affecting "bureaucratic" jobs and is instead preventing the CDC from hiring chemists, economists, epidemiologists, microbiologists, statisticians, and other high-level professionals.
The CDC isn't the only agency feeling the impact of these policies. HHS is facing the same problem and is trying to get by without dozens of people who help the department respond to public health and cybersecurity emergencies. Meanwhile, NIH staff indicate that the vacancies are causing patient care, clinical work, and recruitment to suffer.
In January, the White House ordered a hiring freeze in support of President Trump's new budgetary goals. In March, the administration released its "skinny budget," which proposed major cuts to several agencies, including the Environmental Protection Agency (EPA) and HHS. Since that time, Congress pushed through a compromise budget with fewer cuts. However, it is only in place until October.
In the meantime, the White House and the Office of Management and Budget (OMB) have directed all federal agencies to submit plans by June 30 reflecting how they will reduce their civilian workforces. The administration will soon release its new budget, which is expected to be in line with its previously stated goals.
The impact of these agencies extend far beyond their cost, however. The Washington Post reports that multiple positions remaining vacant are in the Office of Public Health Preparedness and Response (PHPR), the body that maintains the country's store of emergency medical countermeasures and regulates some of the most dangerous viruses and bacteria in the world. Jobs in the infectious disease offices also remain open, as do positions in the office for noncommunicable diseases, injury, and environmental health.
Liz Perera, the public health policy director of the Sierra Club, told The Washington Post that the administration's "thoughtless freeze on hiring public servants prevented the CDC from filling critical roles at programs essential to preventing chronic and infectious diseases, advancing immunization, and safeguarding environmental health."
Drastic budget cuts to science and public health have serious consequences that are worrying professionals who work in these areas. Furthermore, experts argue that research affects more than our understanding of the world. It also supports local economies and fosters new industries. Now, at the dawn of the age of automation, this is more important than ever.
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Zika virus carrying mosquito can also transmit Chikungunya and Dengue in one bite
A new research indicates that a bite from the Aedes aegypti mosquito, which spreads Zika, could simultaneously infect people with other diseases such as dengue and chikungunya.
Scientists at the Colorado State University conducted the research regarding the viruses the Aedes aegypti mosquito carries. For the study, researchers infected the mosquitoes in the lab with different viruses and analyzed the virus' transmission.
They discovered that a mosquito carrying the Zika virus could also be infected with both chikungunya and dengue, which it could spread to any individual with one bite. The multiple infections from a single bite is what researchers call coinfection.
Coinfection is common in areas where mosquito-borne diseases are prevalent and this new study may throw some light into what causes multiple infections simultaneously.
However, the researchers assert that a person becoming infected with three diseases from one bite is quite rare, but becoming infected with two diseases is quite common.
Researchers were also surprised to see that in a mosquito infected with all three viruses, each infection seemed to be working independently of the other two. The researchers had theorized that the viruses either compete with each other or enhance each other's capabilities. However, none of the viruses in the mosquitoes' bodies showed any of these traits.
The research proved that the Aedes aegypti mosquito may cause coinfection in people it bites. However, researchers asserted that further studies needs to be conducted to determine whether coinfection causes diseases and infections, which may be clinically more severe. Previous studies on the subject have produced inconclusive results.
Researchers shared that it is highly likely that doctors are unable to diagnose coinfection and may write off the symptoms as a result of one single disease.
Researchers will also attempt to determine whether yellow fever, another virus carried by the Aedes aegypti mosquito, can co-exist with dengue, chikungunya, and Zika inside a single host.
Tech Times has the report.
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Intestinal fungi linked to worsening of alcoholic liver disease
A new study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is among the first to suggest that intestinal fungi may contribute to the development of alcoholic liver disease (ALD). ALD encompasses a broad range of liver diseases, from simple steatosis (fatty liver) to end-stage liver disease, or cirrhosis (liver cell death). Liver cirrhosis is the 12th leading cause of mortality worldwide, with approximately half of those deaths due to alcohol misuse. NIAAA is part of the National Institutes of Health.
Researchers at the University of California, San Diego and the J. Craig Venter Institute in Rockville, MD, demonstrated that oral antifungal treatment protects mice from alcohol-related liver disease progression. In separate components of the study conducted in humans, the researchers linked intestinal fungi to ALD and to increased risk of death for people with ALD.
ALD has previously been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. Until now, little was known about the role of intestinal fungi in ALD.
The researchers also conducted small preliminary studies with humans to examine intestinal fungi of people with alcohol use disorder and various stages of liver disease. They observed an overgrowth of a specific fungal species compared to healthy control subjects, as well as less fungal diversity in individuals with alcohol use disorder and ALD. They also found that the more prevalent the fungal overgrowth in individuals with ALD, the higher the likelihood of mortality.
Taken together, this research suggests that fungi may play a greater role than previously understood in controlling the diverse array of microbes that live on and inside the human body.
If further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species living in the intestine of a person with ALD.
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Last call: HPN offers discount for the 2017 UDI Conference June 7 & 8 in Baltimore
As an educational authority on UDI, the 9th annual UDI Conference will once again bring industry stakeholders together with the FDA UDI Team to provide direct and accurate UDI implementation guidance.
The UDI Conference is THE annual industry gathering for medical device manufacturers, distributors, and hospitals to convene to learn about, and understand, the UDI Regulation and the Global UDI Database (GUDID).
There is something for everyone at this year's Conference... instruction and training for those facing imminent compliance dates; progress reports on UDI implementation; case studies on real-world applications; AHRMM sponsored sessions on UDI use and value within hospitals; and workshops on data quality and data management.
Attend the Conference to:
- Meet with the FDA UDI Team
- Learn how to harness the data in the Global UDI Database (GUDID)
- Understand the requirements for your automatic identification systems
- Create your plan for implementation
- Gain the knowledge & establish resources needed to guide your organization
Teams from the following should attend:
- Medical Device Manufacturers
- Healthcare Distributors
- Group Purchasing Organizations
- Hospitals and Health Care Providers
- Healthcare Industry Professionals
The UDI-enabling Technologies: The UDI Regulation requires new/improved systems and processes to efficiently mark/tag equipment, scan device information at various points in its life cycle, and transmit that data to the GUDID and other software systems.
The UDI Conference allows you to interact directly with the FDA UDI team, investigate UDI technology in the exhibit hall, plan your migration path, and network with peers in the healthcare industry in one place, at one time.
HPN
readers to receive $100 savings:
Register today at the link below and enter "HPN" in the discount field to receive a $100 savings. Team registrations are encouraged. If 2 or more from the same company are planning to attend, contact [email protected] to get a discount code. (Please note only one discount code may be applied per registrant.)
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Last call: Nominate your team for HPN's 2017 Supply Chain Department of the Year!
Does your team excel at:
- Teamwork
- Innovation
- Customer Service
- Patient Care
- Financial/Operational Cost Savings
- Comprehensive Strategic planning
Deadline is May 26, 2017. Nominate them today!
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