Hospitals can lower the risk of M. chimaera outbreaks by keeping heater-cooler devices out of the clinical area.
Hospitals should remove heater-cooler devices (HCD) used in cardiac surgery from operating rooms and other clinical areas to reduce the risk of M. chimaera outbreaks.
Researchers from Bern University Hospital in Switzerland offered several steps hospitals can take to prevent outbreaks linked to HCDs. M. chimaera is bacterium known to cause lung infections that have been fatal in half of the 70 cases identified in the US and Europe, the study noted.
The Food and Drug Administration issued a "safety communication" in 2015 offering guidance to hospitals on how to prevent the infections, which have been linked to aerosolization of M. chimaera by fans in the HCD.
The timing and source of contamination of the HCDs remain unknown, the Swiss researchers acknowledged.
"While our understanding of the causes and the extent of the M. chimaera outbreak is growing, several aspects of patient management, device handling, and risk mitigation still require clarification," they wrote.
The FDA recommended that hospitals direct the HCD's vent exhaust away from the surgical field to mitigate the risk of aerosolizing heater-cooler tank water into the sterile field and exposing the patient.
However, the Swiss researchers instead suggested "strict separation of the HCD from operating room air is necessary to ensure patient safety, and these efforts may require engineering solutions."
Keeping HCD exhaust out of OR air might involve constructing a custom-built housing for the device that sucks the HCD's exhaust out of the operating room. Another way would be to keep the HCD outside the OR in a room with a separate air ventilation system, although this solution presents logistical challenges.
Hospitals that can't immediately remove the HCD from the OR should position the device so the airflow is directed away from the patient as an interim solution. However, "these hospitals should be aware of the potentially increased infectious risk," they wrote.
"For the long term, separation of the exhaust air of any potentially aerosol-generating device from critical areas in the OR should be achieved."
Patients prescribed diabetes, hypertension, and high cholesterol medications had higher levels of adherence than patients receiving care in other settings.
Patients in patient-centered medical homes are 2% to 3% more likely to take medicine as instructed that those in traditional practices, according to a new study in the Annals of Internal Medicine.
Researchers at Brigham and Women's Hospital and Harvard Medical School reviewed national claims data from the insurer Aetna, including patient-level claims for outpatient pharmacy prescription drug claims.
They compared patients enrolled in 3,533 medical homes to those treated at more than 50,000 control practices. All patients used medications for three chronic conditions—diabetes, hypertension and high cholesterol.
The study compared medication use for these patients to other patients in the same region by looking at the days covered by prescription claims for the same or similar medications.
The researchers found that patients seen at medical homes had levels of adherence that were an average of 2% to 3% higher than patients receiving care in other practices.
"In chronic conditions, such as hypertension, diabetes, and hyperlipidemia, medication adherence (the extent to which patients take their medications as prescribed) has become a growing concern for clinicians and payers," the researchers noted.
"Poor adherence is strongly associated with worse patient outcomes and high healthcare spending."
Although the study authors acknowledged the limitations of claims data, they concluded that "medical homes were shown to lead to significantly better medication adherence, a vital measure of health care quality for chronic diseases."
Adults with chronic conditions leave up to 30% of new prescriptions unfilled and properly take only about 50% of chronic disease medications, according to an editorial that accompanied the research.
"The current study represents a useful initial step toward longer-term studies of diverse populations that examine adherence, clinical, and other patient-centered outcomes associated with different types of patient-centered medical homes," the editorial stated.
An app developed by Mount Sinai researchers enables medical doctors to recommend evidence-based mobile health applications to patients at their point of care.
Deciding which digital health tools are worth physicians' and patients' time can be daunting, but now there's—what else?—a digital tool that can help.
RxUniverse is the nation's first enterprisewide digital medicine care delivery system, according to the researchers who developed it at the Sinai AppLab at the Icahn School of Medicine at Mount Sinai, in New York.
RxUniverse features a list of apps that have been evaluated for efficacy based on published evidence and incorporated into a digital prescription delivery system. Physicians can digitally "prescribe" these apps at the point of care.
The platform was launched in August in a pilot phase in five Mount Sinai clinical areas. Since then, participating physicians have prescribed more than 2,000 apps, or 20 times more than the pilot goal, according to the Sinai AppLab's RxUniverse website.
"RxUniverse allows physicians and other healthcare providers to confidently integrate evidence-based digital health tools into their practice," Ashish Atreja, MD, MPH, Chief Technology Innovation and Engagement Officer and Director of the Sinai AppLab, said in a statement.
The platform seamlessly integrated with providers' work flow, and patients reported that they liked being able to use the apps to manage their own health, according to the website.
Data collected from prescribed apps and wearables can help providers tailor treatment plans for individual patients, the site says.
The Sinai AppLab has partnered with Mount Sinai Innovation Partners to launch a startup company, Responsive Health, which will license RxUniverse for use by other health systems.
"Apps have typically been recommended to patients verbally, but with the myriad of mobile health apps on the market, many with no proven evidence, it is a challenge for providers and patients. RxUniverse eliminates these uncertainties and barriers to digital medicine," Atreja said on the website.
RxUniverse is part of a larger ecosystem called the Network of Digital Evidence, which provides a community forum for health system technology experts, digital medicine tech companies, clinicians, and patients around digital medicine and scientific evidence regarding its design, efficacy, and implementation.
The applications for RxUniverse don't apply only to mobile health apps, according to the AppLab website. Specifically tailored educational content, patient satisfaction surveys, and other tools can be prescribed to individual patients or entire populations.
Zwanger & Pesiri pleaded guilty to whistleblower allegations of systemic Medicare and Medicaid fraud.
Zwanger & Pesiri Radiology Group, LLP, Zwanger Radiology P.C., and Steven Mendelson, MD, have pleaded guilty to Medicare and Medicaid fraud, Attorney General Eric T. Schneiderman and United States Attorney Robert L. Capers announced earler this week.
The firm will pay more than $8.1 million in civil damages to settle allegations plus another $2.4 million in criminal restitution as part of a guilty plea to a criminal charge of healthcare fraud.
The investigation into Zwanger's billing practices began after two billers, known as "relators," filed suit under provisions of the state and federal False Claims Acts.
They alleged that the practice routinely performed unnecessary and excessive testing, and split testing into multiple appointments for financial gain.
In addition, the firm falsified the identity of rendering radiologists for services performed by uncredentialed physicians, and charged for services not performed, stated Constantine Cannon, LLP, the law firm representing the whistleblowers.
As a result of the investigation prompted by the relators' allegations, the Federal Bureau of Investigation and U.S. Department of Health & Human Services' Office of Inspector General raided Zwanger's Lindenhurst offices in 2014.
The settlement resolves allegations spanning from 2003 to 2015.
The state will pay a relator's share of $221,802 after full payment by the defendants. New York State's share of the total settlement is $1,232,236.
"These defendants knowingly overbilled Medicaid by millions, draining the program of important resources meant to help some of our most vulnerable individuals," said Schneiderman.
"I thank our partners in law enforcement for helping us protect New York taxpayer dollars against fraud and waste. We will continue to vigilantly guard the integrity of Medicaid, and punish those who steal from our state."
The punishment did not address claims related to the practice's "splitting" behavior, or forcing patients to schedule appointments over the course of several days to increase reimbursement, because of "a technicality," said Constantine Cannon Attorney Timothy McCormack.
"Our clients' hope is that CMS sees the damage that this practice can do to patients and closes the door on this abusive behavior. Patients deserve better from their physicians," McCormack said.
Under a new agreement, SSM Health's integrated delivery network will gain 23 Oklahoma hospitals and affiliates.
After 18 years, HCA and the Oklahoma University Medical Center (OUMC) have agreed to terminate their operating relationship.
University Hospitals Authority and Trust (UHAT), the operating authority that united the state, OUMC, and HCA under a joint operating agreement, will pay HCA $750 million for its interest in the medical center and OUMC Edmond, and the parties will terminate the lease of The Children's Hospital at OUMC in Oklahoma City.
UHAT will partner with St. Louis-based SSM Health, a 20-hospital Catholic health system with operations in Missouri, Illinois, Wisconsin and Oklahoma, in a joint operating agreement. The transaction is expected to be completed in the first half of 2017.
As part of SSM's integrated delivery network, which adds a flagship health system to SSM Health's Oklahoma operations in the deal, UHAT and SSM Health will share financial oversight and governance, and SSM Health will manage the day-to-day operations.
"This agreement represents the beginning of a new era in Oklahoma healthcare, as it brings outstanding medical education and clinical research together with a faith-based system known for quality and compassionate care," said Bill Thompson, president and CEO of SSM Health.
He says the new deal will meet the changing needs of the community and the healthcare industry and deliver improved, more seamless care to Oklahomans.
SSM Health's goal is to create a comprehensive network of high quality, coordinated services in each community where it has a presence. "In doing so, we are able to improve the patient experience, manage the health of populations, and ultimately lower the total cost of care," said Thompson.
More than 23 hospitals and affiliates in the state of Oklahoma will be part of the new integrated delivery network.
"For almost 20 years, we have collaborated with our partners at UHAT to provide leading quality care and to enhance the range of services available to the greater Oklahoma City community," said Sam Hazen, HCA's chief operating officer, in a press release.
"We believe this relationship has been a successful example of how a public entity and a private entity can partner to improve overall performance. We wish them the best in their future endeavors."
UHAT Chairman Mike Samis also had kind words for the end of the partnership.
"It is clear that the OU Health Science campus has grown and improved its standing during our 18-year relationship with HCA," said Samis.
"I appreciate their efforts and hope that HCA is successful in their future undertakings. As we look forward, I'm pleased that we have a strong platform for the future of healthcare in Oklahoma."
Clinicians are being enlisted to vet the health systems' purchases of the products and services they use for patient care.
When the Johns Hopkins Health System needed new patient beds and mattresses, the purchase was vetted by more than materials management staff. A "supply chain" included 100 clinicians in the vetting process.
Johns Hopkins Health System and Allegheny Health Network created the supply chain company, called Nobilant, with the goal of engaging clinicians in the choice of products and services they use to care for patients, according to an announcement from Hopkins.
The approach enlists clinicians to help control non-labor spending—which accounts for as much as 45% of a healthcare provider's expenses. Leveraging supply chain management in this way can also lead to better patient outcomes, according to the Nobilant website.
In addition to working with clinicians, the company plans to transform supply chain management by focusing on total cost of ownership of products and services to assess value beyond price. Nobilant will contract and work with suppliers to improve service levels, efficiency and safety in patient care.
The company plans to tap into the expertise of staff at Hopkin's Armstrong Institute for Patient Safety and Quality, which focuses on improving clinical outcomes and experiences and reducing waste in healthcare delivery.
In the wake of voters' rejection of a local bond measure, Tulare Regional Medical Center has applied for a state loan.
Tulare Regional Medical Center has applied for a $55 million state loan to finish construction of a stalled hospital tower project.
Tulare officials have filed a preliminary application for a loan with the California Office of Statewide Health Planning and Development (OSHPD). The facility's main hospital building must be replaced by 2030 to meet state seismic safety standards.
OSHPD does not have a set timeline for reviewing loan applications but an official said the process could take up to six months.
"The timing on closing a loan from application to funding ranges anywhere from 90 days to six months, depending on the complexity of the transaction and how far along the applicant is with construction planning, permitting, and entitlements," said OSHPD Legislative and Public Affairs Information Officer David Byrnes.
"We're still collecting and assessing all of the information from Tulare and cannot commit to a timeframe at this point."
Tulare Regional applied for the loan just weeks after voters in the Tulare Local Health Care District voted down a $55 million bond measure to resume construction on the tower. Measure I, which would have created a new parcel tax to generate funding, was voted down by a 67% to 33% margin.
When complete, the four-story, 120,000-square-foot tower will feature a 24-bed emergency department, five surgical suites, and 27 private patient rooms.
The original project was funded by an $85 million bond measure approved by 83% of voters in 2005, but funding for the project ran out in 2015 and major construction stalled. Since then, healthcare district officials have come under fire for allegedly mishandling bond measure funds.
A 2016 report from the Tulare County Grand Jury titled "Tower of Shame" alleges healthcare district officials mismanaged the project and oversaw an estimated 700 change orders that generated $17.1 million in additional costs.
The report also alleges that healthcare district officials knew the original cost for the tower project would be as high as $120 million but made no effort to seek more funding after the $85 million bond measure was approved.
In response, the healthcare district board of directors said the report was "long on conclusions and short on facts," and unfairly blamed current board members for mistakes made by past boards.
The board also said that four independent examinations of bond measure spending were conducted and found no wrongdoing.
Transportation, housing, and food insecurity are cited as patients' most common nonmedical needs.
Research published in the journal Health Affairs indicates that accountable care organizations are well-suited to help patients meet nonmedical needs associated with significant medical and financial consequences.
Transportation, housing, and food insecurity were the most common nonmedical needs tackled at the 32 ACOs involved in the study, which was based on executive interviews and site visits.
"These needs were common among their patient populations, the needs affected how patients engaged in medical care, and the ACOs had the potential to address these needs," the authors wrote. The research was conducted in 2013 and 2014.
The research paper cites several earlier studies that show nonmedical patient needs have a profound impact on service utilization, clinical outcomes and cost of care.
"Estimates suggest that 40% to 90% of health outcomes are attributable to social, behavioral, and economic factors," the researchers wrote.
ACOs appear to offer a unique opportunity for healthcare providers to address the nonmedical needs of their patients.
"Given the significant impact of nonmedical factors on health costs and patient outcomes, ACOs may address underlying nonmedical factors to control costs and improve quality," the paper stated.
"Furthermore, proponents of the ACO model hope that it will afford providers the flexibility and incentives necessary to address patients' needs, including nonmedical needs, through better coordination and integration of care."
Half of the 32 ACOs in the study were attempting to meet nonmedical needs either through targeting individual patients or by establishing programs for broad populations of patients, researchers found.
The study includes a "typography" that organizes the efforts to address nonmedical needs into four categories. On one end of the spectrum, "fully integrated" services are provided across multiple organizations as well as across medical and nonmedical care programs in a coordinated fashion.
At the other end of the spectrum, "non-coordinated" approaches lack integration between multiple organizations as well as the delivery of services.
ACOs uses a variety of approaches to help patients meet nonmedical needs. An ACO's local geography, population density, and community infrastructure were key factors in addressing transportation needs.
"One ACO in an urban area with poor public transportation was considering developing a mobile device application that would allow patients to request transportation from local drivers, who would be paid by the ACO," they wrote.
ACO leaders said they drew on internal and external resources in their nonmedical need efforts.
"Internal resources often included staff members in existing team-based care management programs, with specific care teams assigned to assist patients with nonmedical needs… ACOs also used external resources such as community partners and public health agencies to meet nonmedical needs."
The Health Affairs paper identified scalability as a primary challenge of ACO efforts to meet nonmedical needs. "ACO leaders described instances in which they observed a general need but were able to provide only individual solutions, not broader programs," the study authors wrote.
"ACOs may encounter several barriers to developing formalized programs to meet patients' needs—barriers including lack of adequate financial resources, limited staffing capacity, lack of expertise, and competing clinical priorities."
Florida Hospital joins forces with the Tampa Bay Buccaneers to launch several community health initiatives throughout the year.
The NFL franchise has teamed up with its official hospital to promote breast cancer awareness and endorse a health-specific app and microsite.
About 4,000 participants gathered recently at Raymond James Stadium for the fourth annual Treasure Chests 5K Run/Walk, which benefited breast cancer research and patient services in the Tampa Bay area.
The Buccaneers invited participants back to the stadium the following day to cheer on the team as they played the Oakland Raiders.
More than 160 Florida Hospital employees supported the event, which plays a large role in supporting breast cancer awareness in the Tampa Bay community, hospital leaders said.
The hospital also hosted a breast cancer survivor at the Raider's game to highlight Breast Cancer Awareness month.
"As the exclusive hospital of the Tampa Bay Buccaneers, we partner on a number of health and wellness events throughout the year," said Lauren Key, vice president of marketing for the Florida Hospital West Florida Region, in a release.
"We know that early detection is key to winning the war against breast cancer and we look forward to participating in the race to raise funds for a good cause."
The hospital also ran a "selfie station" at the race, where runners and walkers could pose behind a cardboard frame that featured Florida Hospital and the Buccaneers logos.
The frame prominently displayed the #CatchBucsFever campaign—a joint initiative the football team and Florida Hospital are making a commitment to promote the health and wellness of the Tampa Bay community.
The microsite highlights the Florida Hospital and Tampa Bay Buccaneers' health-centric partnership initiatives. Tampa Bay residents can log on to view updates on health events, news clips, commercials, and share fan photos showcasing their "Bucs fever."
Florida Hospital and the Buccaneers plan to launch health initiatives throughout the year that will be designed to engage and help transform the health and wellness of the Tampa Bay community.
Patients at the UC San Diego Health facility can use the device to access their medical records, dim the lights, or watch movies.
When Jacobs Medical Center medical center opens later this year, patients at the 245-bed facility at UC San Diego Health will find an iPad and Apple TV in their room.
The goal of the initiative is to streamline communications and improve patients' healthcare experience, according to UC San Diego Health and officials from Jamf, a Minneapolis-based Apple device management company that is partnering with the facility on the project.
Patients will use the iPad as the control center of their hospital room, according to a recent news release. This control center will allow patients to:
Securely access personal medical information and educational materials via Epic's MyChart Bedside app.
Control their TV and room settings such as lights and blinds.
View movies, games, and other entertainment options.
Connect to family and friends using FaceTime, Skype, or other social apps.
Customize their device and apps without having to enter an Apple ID or password.
To protect patient data, the Jamf Pro program will automatically delete patient data from each iPad as soon as the patient is discharged, and will remotely prepare it for the next patient. The facility's IT department won't have to physically touch the device, which will save time.
UC San Diego Health evaluated other devices, but they required a manual reset. "This process took 15-20 minutes per device each time we needed to prepare a device for the next patient," said Marc Sylwestrzak, director of IS experience and web services for UC San Diego Health.
The program communicates with the EHR system already in place at UC San Diego Health, coordinating iPad management with patient records and ensuring that HIPAA is protected at all times, according to the release.