Slightly more than half of 1,502 surveyed U.S. adults agree that H1N1 is a serious threat, but that doesn't mean those same people are protecting themselves against the virus.
The survey, conducted last month by the Burlington, MA-based healthcare communications company Silverlink Communications, Inc., found that less than one-third of those same 1,502 Americans plan on getting the H1N1 vaccine. I can relate.
I cover healthcare and speak to countless health officials and executives each month, but I don't plan on getting an H1N1 flu shot either—or a seasonal flu shot for that matter.
Sure, President Barack Obama can declare that the swine flu is a national emergency, but that doesn't mean that someone like me who has never had any kind of flu shot will get vaccinated.
Those in their 20s are even less apt than a thirty-something like myself to head to their doctors or clinics to get their H1N1 shots. Silverlink found that more than 70% of 18- to 24-year-olds—considered high risk of contracting H1N1—will not get the H1N1 vaccine. Meanwhile, almost half of seniors plan on getting the H1N1 vaccine, which could ultimately drain the availability of it—despite the fact that seniors are not considered a high-risk group.
So, if you couple the public's indifference and suspicion with a lack of knowledge about the vaccine (one-quarter of people surveyed didn't know there were different vaccines for H1N1 and seasonal flu), you see why the government and health officials are trying to educate the public.
But there are healthcare stakeholders with a wealth of patient information and resources that could help push people like me to get their H1N1 shots: health insurers.
Jan Berger, MD, chief medical officer at Silverlink and a healthcare leader for more than 25 years, says insurers could play a key role in the fight against H1N1, which Berger predicts will have a "significant financial impact on health plans."
In response to a potential pandemic, many health insurers are offering H1N1 vaccinations free of charge to members, but Berger suggests there are three other important functions that health plans could provide:
Communication. Other than getting people vaccinated, Berger says the second most important tool is communicating with the public about H1N1 and the importance of basic personal hygiene, such as washing your hands and sneezing into the bend in your arm. But this isn't just a regular seasonal flu season in which an insurer can send a mass mailing to members in the fall about flu shots, says Berger. Insurers will have to continuously use multiple communication avenues, particularly for young adults. Health insurers are more likely to connect with young adults through text messages, e-mails, and social networking—and don't expect all twenty-somethings will have a home phone. "This is going to require ongoing communication—not a one-time blitz," she says.
Collaboration. Berger suggests health plans work with physicians within their networks and employers to provide accurate information about H1N1 to members. This can include providing stuffers to go into pay stub envelopes and working with employers so that automated H1N1 education phone calls have the employers' name come up on caller ID. Having the employer on the caller ID will make people more apt to answer the phone, says Berger.
Coordination. Health plans can work with physicians and emergency departments to find alternate locations in which to see H1N1 patients. Rather than have those with H1N1 flood EDs and possibly infect more people, insurers, physicians, and hospitals can work together to set up mini-clinics or other off-site locations, she says.
Berger says the H1N1 outbreak requires the healthcare system to set up better coordination and communication—two words not often used when describing the U.S. system.
"In years like this, when everyone is really confused, [communication and trust] become even more important," she says.
That kind of collaboration and communication are needed if health officials are to inspire healthy people to get their H1N1 vaccinations. Call me a cynic, but I'm not sure if that's going to happen.
A formula being considered by the Centers for Medicare and Medicaid Services (CMS) that reflects how physicians use resources—ranging from hospital services to durable medical equipment—and how that influences patients’ decisions appears to work, according to a new report from the U.S. Government Accountability Office (GAO).
In 2008, the Medicare Improvements for Patients and Providers Act directed the Department of Health and Human Services Secretary to develop a program to provide physicians with confidential feedback on the Medicare resources they used to provide care to Medicare patients. GAO was asked to evaluate the "per capita methodology" for profiling physicians—a method that measured a patient’s resource use over a fixed period of time and connected that resource use to physicians.
GAO focused its study on four "diverse specialties": a medical specialty (cardiology), a diagnostic specialty (diagnostic radiology), a primary care specialty (internal medicine), and a surgical specialty (orthopedic surgery). Four metropolitan areas—Miami, Phoenix, Pittsburgh, and Sacramento, CA—were selected for their geographic diversity, range in average Medicare spending per beneficiary, and number of physicians in each of the four specialties. Study was limited to physicians who participated in Medicare fee for service.
To measure individual Medicare patients' resource use, GAO initially made adjustments for the patients' health conditions. They were placed into 25 risk categories.
Using a per capita method to profile specialists, GAO found that their practice patterns—as measured by the level of their resource use—was relatively stable over 2005 and 2006 despite high patient turnover. This is true despite two facts: the physicians’ resource use was derived from their patients’ resource use and that the specific patients whom physicians see were not always the same every year.
In each of the four metropolitan areas, physicians showed greater stability in their resource use than individual patients—although the percentages varied.
Patients seen by "high-resource use" physicians generally were heavier users of institutional services (such as hospital services) than those seen by lower resource use physicians. GAO noted that institutional services were the "major driver of Medicare expenditures" for beneficiaries in physicians' practices—accounting on average for 54% of expenditures.
Individual services provided to a patient by a particular physician accounted for only 2% of total expenditures—about $350 for each Medicare patient in a physician’s practice, GAO said. All other services—including those provided by other physicians, home health care, hospice care, outpatient services, and durable medical equipment—accounted for the remaining 44% of expenditures.
Profiling physicians to improve efficiency has been used by some private insurance companies. Overall, GAO said a per capita methodology is "a useful approach" to profiling physicians on their practice efficiency and could become part of a feedback program that includes quality measures and episode based resource-use measures.
The American Nurses Association says it remains opposed to mandatory influenza vaccine policies, but it is also urging all registered nurses to get the H1N1 vaccine to protect themselves and the patients they serve.
"ANA understands the potential need for a mandatory vaccination policy during a pandemic, but we are committed to ensuring that such policies are not discriminatory or punitive and contain appropriate exemptions," said ANA President Rebecca M. Patton. "The bottom line is no registered nurse should be fired for not being vaccinated. That said, we should all be vaccinated, since no one has immunity to this new H1N1 strain. While some groups may be more vulnerable to severe illness and death, we are all susceptible."
ANA believes mandatory H1N1 vaccination policies should only be implemented under these conditions:
The mandatory policy comes from the highest level of legal authority, ideally state government
Suitable exemptions, such as for those allergic to components of the vaccine, are included
Discriminating against or disciplining nurses who choose not to participate is prohibited
The policy is part of a comprehensive infection control program that includes personal protective equipment, such as N95 respirators, to increase safety
Vaccinations are free and provided at convenient times and locations to foster compliance
The employer negotiates with worker union representatives to resolve any differences when the policy is implemented at a healthcare facility
Patton said ANA's protection of nurses' workplace rights should not be confused with the message ANA is delivering to nurses: Get the H1N1 vaccine. To promote vaccinations, ANA is sending a letter to its members and affiliated specialty nursing organizations encouraging immunization for H1N1 and seasonal influenza.
Seasonal influenza vaccination rate for nurses and all healthcare workers consistently remains below 50%. "Nurses have an ethical obligation to protect ourselves, our patients, and our families from illness," Patton said. "Vaccination is one simple step we can take to do that, and it's even more crucial during this H1N1 pandemic. We strongly encourage nurses to lead the way to increasing vaccination rates among healthcare workers."
The chance a hospital will have to deal with a patient acquiring methicillin-resistant Staphylococcus aureus, or MRSA, while receiving care has more than tripled between 2000 and 2005, with 386,600 infections. And it's only getting worse.
Hospital acquired infections (HAI) like MRSA, which is the most common, contribute to at least 99,000 deaths a year, and an additional $28 billion to $33 billion in healthcare costs.
"When patients go to the hospital, they expect to get better, not worse," said HHS Secretary Kathleen Sebelius. "Eliminating infections is critical to making care safer for patients and to improving the overall quality and safety of the healthcare system. We know that it can be done, and this new initiative will help us reach our goal."
Of the $17 million, $8 million will fund expansion of the Keystone Project in Michigan, which has reduced central line blood stream infections in more than 100 Michigan intensive care units and saved 1,500 lives and $200 million, according to the federal Agency for Healthcare Research and Quality.
Launched by the Michigan Health and Hospital Association and Johns Hopkins University in Baltimore, the project uses an evidence-based checklist to consistently measure infection rates and tools to improve teamwork among doctors, nurses, and others in the hospital setting, especially the intensive care unit.
Last year, the agency expanded Keystone to 10 states. And with additional funds from the federal government and a private foundation, Keystone will operate in 50 states, Puerto Rico, and the District of Columbia. The new funding will extend the project outside of the intensive care unit and broaden the focus to other types of infections.
Here's how this $8 million will be spent:
$6 million will fund the Health Research and Educational Trust to expand the Comprehensive Unit-Based Patient Safety Program to Reduce Central Line-Associated Blood Stream Infections.
$1 million will go to the Health Research and Educational Trust for a demonstration project to fight catheter-associated urinary tract infections.
$1 million will go to Yale University to prevent bloodstream infections in hemodialysis patients.
The remaining $9 million will go toward reducing MRSA and other types of hospital acquired infections.
They include reducing Clostridium difficile infections, reducing the overuse of antibiotics by primary care clinicians who treat patients in ambulatory and long-term care settings, evaluating two ways to eliminate MRSA in intensive care units, and improving the measurement of the risk of infection after surgery.
The effort will target ways of reducing Klebsiella pneumoniae Carbapenemase-producing organisms.
The money will also target a project to identify variations in regional and state rates of infections acquired in acute care settings.
Five of the Senate Democratic leaders who have been key in pushing through healthcare legislation created a united front on Tuesday on Capitol Hill—predicting in a news conference that Congress will pass a reform bill by the end of the year. This will be achieved, they declared, even if Republicans decline to go along with the legislative process to overhaul healthcare.
Senate Majority Leader Harry Reid (D-NV), who was joined by Senators Max Baucus (D-MT), Chris Dodd (D-CT), Jay Rockefeller (D-WV), and Jeff Bingaman (D-NM), said the issue of "guaranteeing access to quality, affordable care transcends liberals, moderates, and conservatives.” They are still working on a bill that will be introduced on the Senate floor soon.
Referring to his announcement about a public option the day before, Reid said they all supported "the public option with the state opt-out as a wise path forward. Our public option isn't a left proposal or a right proposal. This is a consensus compromise that represents months of hard work and debate."
Rockefeller, a strong supporter of a public option, said Reid was "courageous" to include the option. "What you're struck by is the opportunity we have here to put the momentum for healthcare [reform] in the hands of the people who need it rather that the insurance companies who profit from it," he said.
Baucus, chairman of the Senate Finance Committee, which was the only committee to pass a reform bill without a public insurance option, admitted that the process followed "a really torturous route."
"This is not a public option bill. This is a healthcare reform bill—this is so massive," Baucus said. He admitted, though, that a fight is ahead to get the 60 votes needed to pass legislation.
One of the senators who might preclude reaching that number is Sen. Joe Lieberman (I-CT), who frequently votes along with members of his former party, the Democrats. Lieberman had said that he would not support a bill that contained a public option.
Calling Lieberman "his friend," Reid said that there "are a lot of senators—Democrat and Republican—who don't like part of what is in this bill that we sent over to the Congressional Budget Office (CBO)." Reid predicted that Lieberman will work with them and have "interesting things to do in the way of amendments" when the bill gets to the floor.
Reid said he had hoped to see more cooperation from Republican members. "It would be nice if we had a Republican who would help us," he said. "When I came [to the Senate many years ago}, we had Republicans and Democrats work together. But [now] you can't dance if your partner is unwilling to get off the chair."
The push by Senate Majority Leader Harry Reid for a public health-insurance option is creating new obstacles for healthcare legislation in the Senate, despite new poll data suggesting a plurality of Americans support the idea. Connecticut independent Sen. Joe Lieberman said that he would vote to block passage of the Senate healthcare bill in its current form, dealing an initial blow to Reid's effort to gather 60 votes. But a Wall Street Journal/NBC News poll suggested the public option is gaining support: 48% of respondents supported the idea; 42% were opposed, and 10% weren't sure. In a September poll, 46% of respondents supported it, 48% opposed it and 6% were undecided.
Senate Majority Leader Harry M. Reid's decision to bring to the chamber's floor a healthcare bill containing a government insurance plan was met with skepticism by moderate Democrats, who said they still do not know whether they could support a public option on a final vote. Democrats expect Reid to attempt to secure commitments from all 60 members of his caucus to allow the Senate to begin debate on the legislation, aimed at lowering healthcare costs, reforming insurance practices, and expanding coverage to about 30 million uninsured Americans.
Catholic Health Initiatives has signed a deal that will give it a 25% equity stake in Pathology Associates Medical Laboratories, a medical reference laboratory owned by Providence Health & Services, the three companies announced Tuesday.
Through PAML, CHI and Providence will develop a national network of regional laboratories at select CHI hospitals, using PAML's hospital-based laboratory outreach program, the two health systems announced. The partnership creates one of the nation's largest medical reference laboratories, using economies of scale to build efficiencies, cut costs, and improve services.
Financial terms of the deal were not disclosed.
"This is a partnership that will provide for the current and future laboratory needs of our medical facilities, affiliated physicians, and, most important, our patients," said CHI CEO Kevin Lofton. "The partnership affords both CHI and PAML the opportunity to leverage laboratory expertise and best practices to gain significant economies of scale and new efficiencies across the business line."
Seattle-based Providence, a nonprofit health system with 27 hospitals and more than 35 non-acute care facilities in the western United States, is the largest healthcare provider in the Northwest. Denver-based CHI, the second-largest Catholic healthcare system in the nation, includes 78 hospitals in 20 states. PAML is ranked among the top reference laboratories in the United States and is considered an industry leader in joint venture partnerships with community-based hospitals, according to the companies.
"This partnership with CHI is an important milestone for PAML as we continue to expand our laboratory joint ventures with leading hospital systems across the country," said Thomas Tiffany, PAML's CEO and president. "We are confident our partner health systems will realize the benefits of working in collaboration to expand the outreach lab business and provide an opportunity for CHI and Providence to grow the esoteric reference laboratory to better support the hospital systems' service lines."
PAML, headquartered in Spokane, WA, now partners with 22 hospitals in five hospital-based laboratory joint ventures throughout the northwest.
New York Attorney General Andrew M. Cuomo announced the details of a new national database that would help determine how much insurance companies should reimburse patients who go out of network to see a doctor. Consumers would also be able to check a new Web site to see what an insurer was likely to pay before they went to an out-of-network doctor. The announcement is part of a settlement reached with more than a dozen insurance companies concerning the industry's controversial payment of out-of-network claims.
People have lined up across the country in recent days in the hope of getting a H1N1 vaccine, but a dearth of the vaccine has forced local government officials, hospital workers, and doctors in private practice to be conscripted as ad hoc swine flu police. The goal is to make sure that those Americans with the highest risk for contracting the virus get injected first. But the somewhat haphazard nature of the vaccine's distribution in some areas and the rather large population legitimately considered high risk have brought hundreds of thousands of people to vaccine distribution points, the New York Times reports.
