A Weekly Compilation of Clinical Laboratory and Related Information
from The Division of Laboratory Science and Standards
August 29, 2013
View Previous Issues - Healthcare News Archive
Organized Medicine Groups Line Up Against Proposed Stark Law Changes
Citing the need for patient access to critical services and other concerns, the American Medical Association and 31 other organized medicine groups and associations representing practice administrators stated their strong opposition to federal legislation that would give more teeth to the physician self-referral law. The physician self-referral law, also known as the Stark law after the 1989 authorizing legislation’s sponsor, initially prohibited doctors from ordering lab services from entities with which they have a financial relationship. The law later was expanded to prohibit physicians from referring Medicare patients to receive certain additional services when there is a direct or indirect financial link. These services include home health, prescription drugs and hospital services.
However, the Stark law includes an in-office ancillary services exception. The new legislation introduced by Rep. Jackie Speier (D, Calif.) would prohibit advanced imaging, anatomic pathology, radiation therapy and physical therapy services from taking advantage of that exception. Proponents of the change have argued that these services typically are not fulfilled during an initial patient visit. The American Clinical Laboratory Assn., the American Physical Therapy Assn., the American College of Radiology and others support the legislation.
Reps. Brady and McDermott Introduce Medicare Anti-fraud Bill
Representatives Kevin Brady (R-TX) and Jim McDermott (D-WA) recently introduced H.R.2925, the Strengthening Medicare Anti-fraud Measures Act of 2013, which would give the Department of Health and Human Services authority to exclude individuals from the Medicare program if they are affiliated with a person or entity that has been sanctioned for fraud. Specifically, the measure would ban executives whose companies have been convicted of fraud from circumventing the system by moving to another company.
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CDC Study Will Track Long-term Effects of Meningitis Outbreak
Federal regulators have launched a study of the long-term health effects of a lethal fungal meningitis outbreak last fall linked to tainted steroids from a Framingham pharmacy. The federal Centers for Disease Control and Prevention said that it would fund a $216,000 study led by Dr. Peter Pappas, an infectious disease specialist at the University of Alabama School of Medicine, who leads a nationwide consortium of scientists who specialize in fungal infections. Pappas’s team will track 500 patients from the states hardest hit in the outbreak — Indiana, Michigan, Tennessee, and Virginia — said Dr. Mary Brandt, who leads the CDC’s fungal diseases branch. Overall, the CDC says medications from the New England Compounding Center of Framingham are believed to have sickened 749 people, including 63 who have since died.
CDC Awards $75.8 Million to States to Fight Disease Threats
The U.S. Centers for Disease Control and Prevention announced an award of approximately $75.8 million to help states and communities improve core epidemiology and laboratory capacity for disease response. The funding, which was distributed through the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement, will provide funding to all 50 state health departments, eight territories or U.S. affiliates and six local health departments. The funding will pay for more than 1,000 full- and part-time positions, in addition to tools to more effectively respond to outbreaks, conduct surveillance and prevent illnesses and deaths.
CDC Study: Schools Are Getting Healthier
Nowadays, the hub for developing healthy habits isn’t just the gym or home. For kids, at least, it’s increasingly their schools, according to a study released by the Centers for Disease Control and Prevention. School districts across the country are demonstrating a range of improvements in terms of nutrition, exercise and tobacco policies. For instance, after years of efforts to phase out junk food like candy and chips, the percentage of school districts that prohibited such food in vending machines increased from 29.8 percent in 2006 to 43.4 percent in 2012, according to the CDC’s 2012 School Health Policies and Practices Study. Also, slightly more than half of school districts – up from about 35 percent in 2000 — made information available to families on the nutrition and caloric content of foods available to students.
Needlestick and sharps injuries affect more than half a million healthcare personnel every year, creating over $1 billion in preventable healthcare costs every year and an immeasurable emotional toll on millions of healthcare personnel, according to a Safe in Common review of U.S. healthcare industry statistics. Safe in Common (SIC)—a non-profit organization that represents healthcare personnel, industry leaders, policymakers and scientists —studied rates and costs of needlestick injuries within U.S. healthcare facilities as part of its ongoing work to raise awareness of advanced safety engineered devices and work practices that can prevent these injuries. After examining the findings from the Massachusetts Sharps Injury Surveillance System, SIC determined approximately 1,000 percutaneous injuries per day in U.S. hospitals alone adds $1 billion in unnecessary annual costs. Cross referenced with the most recent CDC reports of the cost to treat healthcare personnel, that amounts to an estimated $3,042 per victim each year. The costs are attributed to laboratory fees for testing exposed employees, labor associated with testing and counseling, and the costs of post-exposure follow-ups.
More Info on Proper Billing for Diabetes Test Strips Needed: OIG
To address questionable Medicare payments for diabetes test strips [DTS], the CMS should provide more education to suppliers and beneficiaries about proper billing practices for these products, according to a report from HHS' Office of the Inspector General. It found that Medicare allowed $425 million in questionable bills from about 10% of DTS suppliers in 2011. The report also concluded that Medicare's competitive bidding program, which has come under fire from the medical supply industry, achieved some success in this area. According to the report, the CMS reviewed a draft of the OIG's analysis and concurred in part with two of its recommendations: to enforce existing edits and to increase monitoring of DTS suppliers' Medicare billing. The agency concurred with the OIG's suggestions to provide more education to suppliers and Medicare beneficiaries and a fourth recommendation to take appropriate action regarding inappropriate Medicare DTS claims and suppliers with questionable DTS billing.
Point-of-Care Urinalysis Lacks Accuracy in Pediatric UTIs
Although point-of-care urinalysis yields fast results, its utility is limited by a lack of sensitivity for diagnosing pediatric urinary tract infection (UTI), according to new research. Urinalysis is commonly used to diagnose UTI in young children who present with nonspecific symptoms, but previous studies have called into question its accuracy. Laboratory-based urinalysis was more sensitive (89.1%) and yielded significantly higher negative predictive value (98.9%) than point-of-care urinalysis. On the other hand, it was less specific (76.1%), with a positive predictive value of just 22.7%.
The test measures three biological markers in the blood that indicate arterial plaque is becoming unstable and may rupture, said Thomas Silberg, GenWay’s president and chief executive. Doctors can then give these patients preventive care, Silberg said. It distinguishes between those whose disease is stable and those at heightened risk of heart attack. The three biomarkers indicate the activity of independent molecular “pathways” linked to plaque rupture, indicating inflammation, stress and coagulation. The more pathways at work in a patient, the greater the chance of rupture.
Assay Accurately Predicts Tx Response in Ovarian Cancer
A new assay appears to be able to accurately predict chemotherapy response in ovarian cancer, and as a result, improves both overall and progression-free survival. Women who were treated with a chemotherapy agent identified as sensitive by the ChemoFx drug response assay (Precision Therapeutics, Inc) survived 14 months longer as compared with those treated by nonsensitive chemotherapies identified by the assay. The finding comes from a 262-patient study published online August 13 in Gynecologic Oncology and sponsored by the manufacturer.
CK-18 Levels Inadequate as Stand-alone NASH, Fibrosis Test
Levels of cytokeratin-18 did not perform well as a stand-alone method to distinguish nonalcoholic fatty liver disease and nonalcoholic steatohepatitis or determine fibrosis severity in a recent study. Researchers evaluated levels of plasma caspase-generated cytokeratin-18 fragments (CK-18), adipose tissue, insulin resistance and hepatic fat in 424 middle-aged overweight or obese patients with no evidence of serious chronic illness. The cohort included 300 patients with nonalcoholic fatty liver disease (NAFLD), diagnosed via magnetic resonance imaging and spectroscopy (MRS) in 229 cases, liver biopsy in 66 cases and positive ultrasound in five patients. Nonalcoholic steatohepatitis (NASH) was observed in 199 cases out of 318 liver biopsy recipients.
Blood Test May ID Suicide Risk
It may one day be possible to identify and treat those at risk for suicide based on gene expressions of elevated blood biomarkers, researchers suggested. In a cohort of 42 bipolar patients, the nine who had a dramatic shift from no suicidal thoughts to strong suicidal ideation also had marked increases in levels of SAT1 (spermidine/spermine N1–acetyltransferase 1), as well as other RNA biomarkers, Alexander B. Niculescu III, MD, PhD, director of the Laboratory of Neurophenomics at the Institute of Psychiatric Research at the Indiana University School of Medicine, and colleagues reported online in Molecular Psychiatry.
Ovarian Cancer Screening 'Has Potential'
A new way of screening for ovarian cancer is showing "potential", according to researchers in the US. Tumours in the ovaries are hard to detect in the earliest stages meaning it can be too late to treat them effectively by the time they are found. A trial of 4,051 women, reported in the journal Cancer, showed the method could identify those needing treatment. But a huge study taking place in the UK will give a final verdict on the test when it is completed in 2015. There is a survival rate of up to 90% when ovarian cancer is caught early, compared with less than 30% if it is discovered in the later stages. Unlike other cancers, the symptoms, such as pelvic and abdominal pain or persistent bloating, are often put down to other common ailments and the tumour can be missed.
Scientists already know that levels of a protein in the blood, called CA125, are often higher with ovarian cancer. However, it is too unreliable on its own. It misses some patients and tells others they have the cancer when they are actually healthy. Researchers are now testing the idea of using the blood test to sort patients in risk groups based on levels of CA125. Instead of going straight for surgery, low-risk patients are tested again in a year, medium-risk ones after three months and high-risk patients have an ultrasound scan to hunt for tumours. The US study, at the University of Texas, followed post-menopausal women for 11 years on average.
CSF Proteins Flag Early Parkinson's
Decreased levels of cerebrospinal fluid (CSF) proteins were associated with the presence of early Parkinson's disease and/or increased motor symptoms, researchers said. In a study of 63 previously untreated, early-stage Parkinson's disease patients (median duration 5 months) and 39 healthy controls, CSF levels of the 42-amino acid version of beta-amyloid protein (AB42), total tau protein (T-tau), tau phosphorylated at the threonine-181 position (P-tau), and alpha-synuclein were all slightly but significantly lower in the patients versus controls, according to Leslie M. Shaw, PhD, of the University of Pennsylvania Perelman School of Medicine and colleagues. A more sophisticated modeling analysis showed that only AB42 and P-tau levels were significantly associated with Parkinson's disease diagnosis, the researchers reported online in JAMA Neurology. Moreover, lower levels of these two proteins were also associated with a specific clinical presentation in Parkinson's disease known as postural instability-gait disturbance (PIGD), in which patients mainly have difficulty with balance and walking.
Researchers who identified 105 new genetic mutations that cause cystic fibrosis say their findings will improve diagnosis and could increase the number of patients who receive individualized drug treatment. Cystic fibrosis is a genetic disorder that causes a buildup of thick mucus in the lungs, resulting in frequent lung infections, breathing problems and decreased lung function. Eventually, the repeated infections destroy the lungs. More than 1,900 mutations had already been identified in the gene responsible for cystic fibrosis, but it was unclear how many of them actually contribute to the disease. In this study, researchers analyzed genetic information from nearly 40,000 cystic fibrosis patients in order to determine which of the 1,900 mutations are benign and which are harmful. Their findings increased the number of mutations known to cause cystic fibrosis from 22 to 127. The study was published online Aug. 25 in the journal Nature Genetics.
Magellan Gets U.S. Approval for Lead Poisoning Test
The company announced that they have received FDA approval to market the new device, dubbed LeadCare Ultra, According to company president Amy Winslow. “It’s based on an electro-chemical technique we’ve used with our portable system since the 2005,” Winslow said. “It’s called anodic stripping voltammetry. A testing strip with a gold cathodic is inserted into an analyzer. By using an electric impulse, lead is collected on the gold. By rapidly switching the current from negative to positive, you can collect and measure the lead.”
Imugen Develops Deer Tick-Borne Blood Test to Detect Infection
Imugen Inc., a clinical laboratory specializing in specimen testing of tick-borne disease, has launched a new blood test designed to detect the presence of the deer tick-borne bacteria, Borrelia miyamotoi. Miyamotoi is recognized as the fourth deer tick-borne infection alongside Lyme disease, Babesia and Anaplasma. Prior to the miyamotoi blood test, a doctor would typically order a package of tests for all three agents (Lyme disease, Babesia, and Anaplasma) when symptoms of deer tick-borne disease were present.
Cepheid Xpert TB Test Gets CLIA 'Moderately Complex' Rating
The assay provides results in two hours, compared to up to three months with traditional methods of detecting drug-resistant TB, according to Cepheid. The FDA granted de novo 510(k) clearance to Xpert MTB/RIF last month. Cepheid has been selling the assay outside the US for nearly two years under its high-burden developing country program. The assay becomes the first and only molecular TB test to be categorized as CLIA moderately complex, said Cepheid.
Response Genetics Salvages Pathwork Dx's Tissue of Origin Test Assets
The Tissue of Origin Test, a microarray-based gene expression assay commercialized by the defunct firm Pathwork Diagnostics, may soon become available again. Los Angeles-based Response Genetics announced that it has agreed to acquire all intellectual property, know-how, data, equipment, and materials formerly owned by Pathwork that relate to the TOO test. The TOO test compares the expression of 2,000 genes in a patient's tumor with a panel of 15 known tumor types that represent 90 percent of all cancers in order to diagnose patients who have metastatic, poorly differentiated, and undifferentiated cancer.
Irish Company Buys Immco Diagnostics Inc.
Immco Diagnostics Inc. has been acquired by a Dublin company in a $32.75 million deal. The sale brings Amherst-based Immco under the umbrella of Trinity Biotech plc (NASDAQ: TRIB), an international diagnostic products company that focuses on the point-of-care and clinical laboratory markets.
Researcher Remotely Controls Colleague's Body With Brain
In the first demonstration of human brain-to-brain control, a scientist wearing an electrical brain-signal reading cap triggered motion in his colleague across campus. Shades of Darth Vader and demonic possession? Brain researchers say that for the first time one person has remotely triggered another person's movement, a flicking finger, through a signal sent to him by thought. On Aug. 12, University of Washington researcher Rajesh Rao sent the finger-flicking brain signal to his colleague, Andrea Stocco, in a demonstration of human-to-human brain signaling, according to a university announcement. "The Internet was a way to connect computers, and now it can be a way to connect brains," Stocco said, in a statement. "We want to take the knowledge of a brain and transmit it directly from brain to brain." The researchers received approval from the university's medical ethics board before proceeding with the experiment.
Results from a recent study suggest that multiple myeloma patients whose monoclonal (M) protein levels continue to decrease after 100 days following stem cell transplantation may experience improved survival. Both progression-free survival and overall survival were longer in patients who showed such a continued response without additional therapy after autologous stem cell transplantation (using their own cells).
Possible Treatment Target for Type 2 Diabetes Identified
Researchers at the NIH have clarified in rodent and test tube experiments the role that inflammation plays in type 2 diabetes, revealing a possible molecular target for treating the disease. George Kunos, M.D., Ph.D. "Our study connects endocannabinoids to an inflammatory cascade leading to the loss of beta cells in the pancreas, which is a hallmark of type 2 diabetes." Working with a strain of genetically obese rats that serve as a model for human type 2 diabetes, Dr. Kunos and his colleagues used a combination of pharmacological and genetic tools to show that endocannabinoids trigger receptors on macrophages in the pancreas. Macrophages are immune system cells, present in all tissues that rid the body of cellular debris and pathogens. The authors conclude that the findings point to a key role in type 2 diabetes for endocannabinoid-induced inflammasome activation in macrophages, and identify cannabinoid receptors on macrophages as a new therapeutic target.
Scientists are one step closer to explaining how Typhoid Mary could have infected dozens of New Yorkers over a 12-year career as a cook, killing at least three of them, without having ever been sick herself. A new study by scientists at Stanford University’s medical school, published this month in the journal Cell Host & Microbe, sheds more light on how Salmonella typhi, the bacteria that cause typhoid fever, hide in the body. It has long been known that S. typhi can colonize the gall bladder, living on gallstones largely beyond the reach of antibiotics. (Mallon rebuffed suggestions that she have her gallbladder removed.) The bacteria also invade macrophages, the immune system’s “attack cells,” which normally engulf and digest invading bacteria. The new study, led by Denise M. Monack, a Stanford immunologist, showed in mice that Salmonella persist in macrophages that have cycled from an inflammatory state to a noninflammatory one, and appear to be able to influence the macrophage’s metabolism to produce more glucose, which the bacteria feed on.
Can Bacteria Use Pain to Tamp Down the Immune System?
Far from being a product of an inflamed immune system, aggravated nerves far from the spine and brain appear to communicate with invading bacteria and regulate the fight against them, according to a study published online in the journal Nature. And at least one tenacious bacterium shows the ability to manipulate a pain signal to put the brakes on a mammal's molecular defenses, the study suggests.
Scientists are scouring the globe for mystery bacteria to help reduce our dependence on fertilizer. Researchers from Michigan State University and Imperial College London have just received $1.87 million in funding to conduct a treasure hunt. It will take them from Germany to Hawaii in the US and elsewhere, in search of the smallest needle—a particular type of bacteria—in a haystack the size of the globe. If it pays off, it could contribute to lowering the world’s reliance on toxic—and expensive—fertilizer, replacing it with bacteria.
People With Red Hair May Face Higher Melanoma Risk Due to Genetic Mutation
It's long been known that people with naturally red hair also have a higher risk of the skin cancer melanoma, and now scientists might have uncovered why. Researchers from Beth Israel Deaconess Medical Center and Boston University School of Medicine found that the same genetic mutation that gives a person red hair -- a mutation on the melanocortin-1 (MC1R) gene receptor -- also seems to play a role in the development of cancer. When a person with red hair is exposed to UV radiation, this gene mutation seems to promote a signaling pathway known to play a role in cancer development. The signaling pathway, called PI3K/Akt, has been linked with other cancers, including lung, ovarian and breast.
Cocaine 'Rapidly Changes the Brain'
Taking cocaine can change the structure of the brain within hours in what could be the first steps of drug addiction, according to US researchers. Animal tests, reported in the journal Nature Neuroscience, showed new structures linked to learning and memory began to grow soon after the drug was taken. Mice with the most brain changes showed a greater preference for cocaine. Experts described it as the brain "learning addiction". The team at University of California, Berkeley and UC San Francisco looked for tiny protrusions from brain cells called dendritic spines. They are heavily implicated in memory formation.
Most Vaccines, Medications Safe for Nursing Mothers
Most drugs and vaccines are safe for women to take while breastfeeding, the American Academy of Pediatrics re-emphasized, noting proposed changes to drug labeling that should make checking easier. Caution is needed for the small proportion of drugs that are concentrated in human milk, have a long half-life, have known toxicity to mother or child, or expose the infant to relatively high doses or detectable serum concentrations, according to a clinical guidance report in the September issue of Pediatrics.
Vaccinating Babies for Rotavirus Protects the Whole Family
A 7-year-old vaccine that has drastically cut intestinal infections in infants is benefiting the rest of America, too. A study published from the Centers for Disease Control and Prevention shows that vaccinating infants against rotavirus has also caused a striking decline in serious infections among older children and adults who didn't get vaccinated. "This is called herd immunity," the CDC's Ben Lopman tells Shots. "By vaccinating young children, we not only prevent them from getting infected, but we also prevent them from transmitting [the virus] to their siblings, their parents and their classmates." Rotavirus is highly contagious and hardy — it can persist on doorknobs and other surfaces. It causes abdominal cramps and severe watery diarrhea, often accompanied by vomiting and fever. The indirect benefit of rotavirus vaccination is enormous, among both the vaccinated kids and everyone else.
Ebola Drug, Grown in Tobacco, Effective in Monkeys With Symptoms
An experimental Ebola treatment -- produced in the leaves of specially engineered tobacco plants -- saved the lives of three monkeys who were already showing symptoms of the illness, according to a report published in the journal Science Translational Medicine. The report suggests that it may be possible someday to treat people who show up in medical facilities already sickened with the horrific disease. While scientists already knew that various Ebola treatments administered before symptoms appeared were effective in animals such as monkeys, they hadn't yet shown that such treatments worked once fevers and other symptoms had set in -- a key capability in real-world outbreak situations, said study coauthor and virologist Gene Olinger of the Army Medical Research Institute of Infectious Diseases at Ft. Detrick, Md.
Looking to Genes for the Secret to Happiness
Our genes may have a more elevated moral sense than our minds do, according to a new study of the genetic effects of happiness. They can, it seems, reward us with healthy gene activity when we’re unselfish — and chastise us, at a microscopic level, when we put our own needs and desires first.
Four Cups of Coffee a Day May Keep Cancer Recurrence Away
Coffee consumption is associated with a lower risk of prostate cancer recurrence and progression, according to a new study by Fred Hutchinson Cancer Research Center scientists that is online ahead of print in Cancer Causes & Control. Corresponding author Janet Stanford, co-director of the Program in Prostate Cancer Research in the Fred Hutch Public Health Sciences Division, conducted the study to determine whether the bioactive compounds in coffee and tea may prevent prostate cancer recurrence and delay progression of the disease. Stanford and colleagues found that men who drank four or more cups of coffee per day experienced a 59 percent reduced risk of prostate cancer recurrence and/or progression as compared to those who drank only one or fewer cups per week. They did not, however, find an association between coffee drinking and reduced mortality from prostate cancer, although the study included too few men who died of prostate cancer to address that issue separately. Further research is required to understand the mechanisms underlying the results of the study, but biological activities associated with consumption of phytochemical compounds found in coffee include anti-inflammatory and antioxidant effects and modulation of glucose metabolism.
Weight Control, Not Loss, Is Winning Strategy
A weight-management intervention that emphasized prevention of weight gain, rather than weight loss, achieved the goal in a majority of overweight and obese African-American women, who maintained their weight for 18 months, investigators reported. After a year of follow-up, patients in the intervention group had a mean weight loss of more than 2 pounds versus continued weight gain in a control group that received usual care. Significantly more patients in the intervention group were at or below their baseline weight than in the control group. At 18 months a significant difference in mean weight persisted in favor of the intervention, Gary G. Bennett, PhD, of Duke University, and co-authors reported online in JAMA Internal Medicine.
Lyme Disease Figures Soar, Mostly in Northeast
New estimates indicate that Lyme disease is 10 times more common than previous national counts showed, the federal government announced, with about 300,000 people getting the disease each year — most in the Northeast. The updated total, compiled by the Centers for Disease Control and Prevention, is based on data from health insurance claims, laboratories, and public surveys. Past estimates of 30,000 cases a year relied on physicians’ reports to states, and the illnesses were widely considered underreported.
Another Study of Preemies Blasted Over Ethical Concerns
For the second time in four months, the consumer group Public Citizen is alleging that a large, federally funded study of premature infants is ethically flawed. Both complaints raise a big issue that's certain to get more attention beyond these particular studies: What's the ethically right way to do research on the validity of the usual care that doctors provide every day. The U.S. Department of Health and Human Services will host an unusual forum on that question stimulated by the sharp questions raised by Public Citizen. This time around, the group is focusing on a study called TOP, short for Transfusion of Prematures. The project hopes to enroll more than 1,800 severely premature infants to test when blood transfusions should be given to treat anemia, a common and serious problem for tiny newborns.
After a long delay at the White House and heavy pressure from public health groups, the Labor Department proposed a new regulation that would tighten standards on silica dust on U.S. work sites, saving thousands of lives and curbing lung disease, according to occupational health experts. Known as the silica rule, the regulation would cut the allowable amount of respirable silica dust in U.S. workplaces by at least half. Silica, considered a carcinogen by the National Institute for Occupational Safety and Health, has for years been known to lead to debilitating lung conditions, including lung cancer, in industries like coal mining and construction where workers breathe tiny particles of the dust.
Limit Urged for Cancer-Causing Chromium in California Drinking Water
State public health officials proposed the nation's first drinking-water standard for the carcinogen hexavalent chromium, at a level that elicited sighs of relief from municipal water managers and criticism from environmentalists. At 10 parts per billion, the standard is 500 times greater than the non-enforceable public health goal set two years ago by the state Environmental Protection Agency.
Shopping for HealthCare Services Not Easy Due to Lack of Publicly Available Information on Quality and Value
Study Finds Most State Websites Aimed at Transparency in Healthcare Pricing Inaccurate and Basically Useless in Helping Consumers Shop for Services With growth in high-deductible health plans, healthcare is becoming increasingly consumer-driven. But shopping for healthcare services isn’t easy due to lack of available resources that enable consumers to compare price and quality, according to a recent study published in the Journal of the American Medical Association (JAMA). Recently, the U.S. Department of Health and Human Services (HHS) revealed the arbitrary nature of hospital prices by publishing hospital-specific costs and outcomes data for 3,000 hospitals nationwide, according to a report published by Dark Daily. This step towards full transparency is aimed at helping consumers comparative shop for hospitals based on both quality and value.
After years of tentative but promising steps, telemedicine is primed to take off in South Carolina with the backing of two of the state’s major insurers. BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina announced this month that they will begin to pay claims for some telemedicine services. “It’s a very big step, and it shows that they have a sense of commitment to telehealth,” said Dr. James T. McElligott, medical director of telehealth at MUSC. Medicare and Medicaid stepped up their coverage of telemedicine claims two years ago, but Medicaid paid for telemedicine procedures for only 403 patients in 2011 and 2012.
Study: EHR Adoption Fueling Health Information Exchange
Health information exchange between hospitals and other providers increased 41 percent between 2008 and 2012, according to recently published research from the Office of the National Coordinator for Health Information Technology. In an effort to promote the use of electronic health records nationwide, the Centers for Medicare and Medicaid Services in September 2012 announced the final rule to govern Stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs"Stage 2 Meaningful Use, which requires eligible hospitals to exchange with outside organizations using different EHR systems and share summary of care records during transitions of care, can help accelerate hospital use of HIE as a means to enhance care quality and safety," states a press release announcing the study results, which found that six in 10 hospitals actively exchanged electronic health information with providers and hospitals outside their organization in 2012.
Medical scribes move beyond the emergency room
Hospitalist Marek Filipiuk is working the room like a master of the bedside manner. An electronic health-record system is documenting the encounter, but the doctor never touches a computer. Dr. Filipiuk is free to focus on questioning his patient and listening to her without distraction, because his hands and mind are free from typing into the EHR. Matt Restko, a medical scribe who is positioned across the room, laptop perched on a window ledge, is doing the computer entry work for him. Their collaboration exemplifies the migration of scribes from their initial beachhead in hospital emergency departments into hospital medical wards and office-based physician practices. The movement has been fueled in part by $15.5 billion in federal payments under the American Recovery and Reinvestment Act that have motivated more than 4,000 hospitals and 300,000 physicians to use EHRs. Scott Hagood is vice president of marketing at Fort Worth, Texas-based PhysAssist Scribes, which provides and trains scribes for 109 sites, mostly emergency physician groups. He says his firm now is getting three or four times as many requests for scribes from clinic-based physicians as from emergency medicine groups.
Online Patient Portals Aid Underserved, Undereducated Populations
Patient portals have the potential for great utility and value for underserved patients with lower education levels--as long as the technology meets certain criteria--a new study from researchers at City University of New York (CUNY)-Hunter College finds, published in the Journal of Medical Internet Research. Major themes of the study included: enhanced consumer engagement/patient empowerment, extending the doctor's visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance and privacy and security concerns.
Clinical Data Analytics Next Big Thing
The clinical data analytics market is about to get red hot. With the shift toward new payment models and the sheer amount of clinical data contained in electronic health records, more and more healthcare groups are looking to analytics solutions for population health management, according to a new report released. The clinical analytics market report, conducted by Chilmark Research, describes a relatively immature but burgeoning market for clinical analytics solutions, driven primarily by the major new challenge of population health management.
Medical Residents Left Out of New CMS Hospital Admission Policy
CMS recently may have inadvertently made it impossible for medical residents to admit patients to hospitals. In the Medicare inpatient prospective payment system final rule, released Aug. 2, CMS instituted a time-based presumption period for medically necessary inpatient care. Under the rule, Medicare contractors are instructed to define that period as “two midnights.” The policy was made in response to concerns with the overuse of observation status by hospitals. However, in attempting to solve one issue, CMS may have created another. As pointed out in a letter to the agency from the Association of American Medical Colleges, the final rule requires that the order to admit a patient must be written by a practitioner “who has admitting privileges at the hospital.” Medical residents, who are under the supervision of an attending physician, rarely have that ability, as they are not considered to be members of the hospital’s medical staff, the AAMC said.
California's latest round of penalties for hospital blunders that resulted in patient harm or death includes a wrong-site surgery, feeding errors, a retained surgical object, and a number of unnecessary "emergency" coronary interventions. An unapproved fecal transplant research experiment in end-stage brain cancer patients in Davis, a 'time out' lapse resulting in an incision to the wrong testicle in San Diego, and a failure to connect a ventilator in Greenbrae are among the latest round of immediate jeopardy penalties for 10 California hospitals.
Thousands of Doctors Practicing Despite Errors, Misconduct
A USA TODAY investigation shows that thousands of doctors who have been banned by hospitals or other medical facilities aren't punished by the state medical boards that license doctors. Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.
Patients Leaving Against Medical Advice 2.5 Times More Likely to Die
Leaving the hospital against medical advice more than doubles a patient's risk of dying within 90 days, finds a large, nearly two-decade study published in the Canadian Medical Association Journal (CMAJ). Patients leaving against medical advice also are three times as likely to be readmitted within 30 days, according to a CMAJ announcement describing the findings. Researchers looked at more than 1.9 million adult admissions and discharges over almost 20 years to make their determinations. About 1.1 percent (21,417) of patients left the hospital against medical advice.
Study: Spooked Docs Are Lining Dx Companies' Pockets
The pervasive fear of malpractice litigation is pushing many doctors to order more and more diagnostic tests, often unnecessarily, and the trend is jacking up both healthcare costs and testmakers' revenue. In a study in Health Affairs, researchers point out a practice they call "defensive medicine" in which doctors do all they can to cover their bases out of fear of legal reprisal. That usually means ordering test after test to steer clear of misdiagnosis claims, and the practice tacked $55.6 billion onto U.S. healthcare spending in 2008, accounting for 2.4% of medical costs, according to the study. And Medicare, the biggest buyer of lab-based diagnostic tests in the U.S., pays top dollar for those tests. According to a June report from the Inspector General, Medicare overpaid for diagnostics by about $910 million in 2011, as private insurers were charged between 18% and 30% less for 20 of the most popular lab tests.
How to Charge $546 for Six Liters of Saltwater
It is one of the most common components of emergency medicine: an intravenous bag of sterile saltwater. Luckily for anyone who has ever needed an IV bag to replenish lost fluids or to receive medication, it is also one of the least expensive. The average manufacturer’s price, according to government data, has fluctuated in recent years from 44 cents to $1. Yet there is nothing either cheap or simple about its ultimate cost, as I learned when I tried to trace the commercial path of IV bags from the factory to the veins of more than 100 patients struck by a May 2012 outbreak of food poisoning in upstate New York. Some of the patients’ bills would later include markups of 100 to 200 times the manufacturer’s price, not counting separate charges for “IV administration.” And on other bills, a bundled charge for “IV therapy” was almost 1,000 times the official cost of the solution. It is no secret that medical care in the United States is overpriced. But as the tale of the humble IV bag shows all too clearly, it is secrecy that helps keep prices high: hidden in the underbrush of transactions among multiple buyers and sellers, and in the hieroglyphics of hospital bills. At every step from manufacturer to patient, there are confidential deals among the major players, including drug companies, purchasing organizations and distributors, and insurers. These deals so obscure prices and profits that even participants cannot say what the simplest component of care actually costs, let alone what it should cost. And that leaves taxpayers and patients alike with an inflated bottom line and little or no way to challenge it.
Measles Outbreak Tied to Texas Megachurch Sickens 21
An outbreak of measles tied to a Texas megachurch where ministers have questioned vaccination has sickened at least 21 people, including a 4-month-old infant -- and it’s expected to grow, state and federal health officials said. “There’s likely a lot more susceptible people,” said Dr. Jane Seward, the deputy director for the viral diseases division at the Centers for Disease Control and Prevention. All of the cases are linked to the Eagle Mountain International Church in Newark, Texas, where a visitor who’d traveled to Indonesia became infected with measles – and then returned to the U.S., spreading it to the largely unvaccinated church community, said Russell Jones, the Texas state epidemiologist.
After Missteps in HIV Care, South Africa Finds Its Way
The South African government is simplifying AIDS care, cutting treatment costs and providing antiviral drugs to almost 2 million people every day. The country just rolled out a new treatment regimen, which involves just one pill a day and costs less than $120 a year per person. By comparison, similar treatment in the U.S. costs thousands of dollars a year for each person. The delivery of antiviral drugs through the public health care system has been so successful and saved so many lives that the overall life expectancy in the country has increased by eight years since the crest of South Africa's AIDS crisis in the mid-2000s.
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