The Department of Health and Human Services on Wednesday unveiled a new National Vaccine Plan – the first major revamp since the plan was created in 1994 -- to coordinate and improve public access to federal vaccine and immunization programs over the next decade.
The new 10-year plan addresses a range of issues, including research and development, supply, financing, distribution, safety, global cooperation, and informed decision-making among consumers and healthcare providers, HHS said.
"Vaccines are a critical cornerstone of the public health system," said Assistant Secretary for Health Howard K. Koh, MD. "The National Vaccine Plan articulates a vision that will ensure that the nation's prevention strategies protect the public for the next decade and beyond."
Many Americans still suffer from infectious diseases that can be prevented by vaccines, and the updated plan calls for improve delivery of existing vaccines and to spur development of new products to prevent infectious disease. The National Vaccine Plan uses input from public health and medical experts, federal, state, and local government officials, and the public, HHS said.
"This plan is a 10-year vision for the nation to more effectively prevent infectious diseases and reduce adverse reactions to vaccines," said Bruce Gellin, MD, director of the National Vaccine Program Office and Deputy Assistant Secretary for Health. "The plan is national in scope. Implementation will require a well-organized effort among stakeholders, including federal, state and local policymakers, health care providers, manufacturers, academia, philanthropic organizations, and the public."
HHS will sponsor regional meetings with stakeholders this spring and summer, which will focus on implementing the strategies in the plan. Final implementation of the plan will be completed by the end of the year.
Three Florida physicians were among the 20 people charged Tuesday in federal court in Miami on healthcare fraud, kickback and money laundering charges for their alleged roles in a $200 million Medicare fraud scheme, federal officials said.
The 38-count indictment unsealed Tuesday in U.S. District Court in the Southern District of Florida alleges that the defendants created and worked with American Therapeutic Corp. and Medlink Professional Management Group Inc., to defraud Medicare by submitting false claims for mental health services that were unnecessary or not provided, according to a joint media release from the Department of Justice, and the Department of Health and Human Services.
U.S. Attorney Wifredo A. Ferrer in Miami said the case shows that Medicare scams have evolved from DME fraud, to infusion fraud, to home healthcare fraud, to community mental health treatment fraud. "Worse yet, healthcare fraud has come to permeate every level of the healthcare industry, from the owners and managers of dirty clinics, to complicit doctors, program directors, therapists, marketers, and patient recruiters," Ferrer said.
The indictment alleges that the defendants paid kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities that delivered patients to ATC clinics. The defendants are charged with money laundering related to the cash-for-kickback payments. Sixteen defendants were arrested Tuesday in the South Florida, and more arrests are expected in the coming days.
ATC and Medlink owners Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, were first indicted in October, along with the corporate entities, ATC and Medlink. A superseding 38-count indictment unsealed Tuesday charges them with additional offenses.
Prosecutors said Miami-based ATC operated purported partial hospitalization programs in seven different cities in Florida, from Homestead to Orlando, and that Duran and Valera ran the fraud, kickback and money laundering schemes, Negron abetted them, and Acevedo ran the kickback scheme.
Physicians Mark Willner, MD, Alan Gumer, MD, and Alberta Ayala, MD, were medical directors for ATC, and prosecutors allege that the trio signed false patient charts authorizing unnecessary treatment or continued treatment for patients who were not eligible for PHP treatment, without examining the patients or the charts.
Willner, Gumer and Ayala also allegedly altered diagnoses and medication types and levels to falsely make it appear that the patients qualified for PHP treatments, and manipulated the length of patients' stays in order to maximize the number of days Medicare would pay for the PHP services, prosecutors said.
According to a separate civil complaint, ATC routinely admitted patients to the PHP program who suffered from Alzheimer's and dementia and were ineligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.
The indictments allege that the kickback scheme was supported by a money laundering scheme that issued checks in the names of the defendants or shell corporations they created, cashed the checks and returned the cash to Duran and Valera, who paid the kickbacks.
Earlier this month the Office of the Inspector General for the Department of Health and Human Resources posted a list of 'most wanted' Medicare fraudsters.
The major trade groups for healthcare providers offered a decidedly mixed reaction to President Barack Obama's Fiscal 2012 budget proposal released Monday, with doctors praising the plan and hospitals panning it.
The American Medical Association looked favorably upon the president's plan to shift about $50 billion in Medicare and Medicaid payments away from states, insurers and drug companies over the next 10 years, and use the money to improve physician reimbursements.
"Based on preliminary reports, the AMA is pleased that President Obama's proposed budget includes funding to address Medicare physician payments and medical liability -- two broken policies that are driving up cost and compromising patients' access to physician care in our nation," said AMA President Cecil B. Wilson, MD.
"Permanent reform of the Medicare physician payment system is essential to ensuring seniors and baby boomers now entering Medicare can receive the physician care they deserve. The president's budget includes a renewed commitment to permanently fix the broken Medicare physician payment system, which the AMA strongly supports. It also contains funding to delay the devastating cuts scheduled to occur Jan. 1, 2012 for another two years, which is important for providing stability in the Medicare system while a permanent solution is enacted."
Wilson said the AMA was also pleased to see funding included in the budget for "testing innovative medical liability measures (as) an important way to augment efforts to enact the proven reforms such as those included in the HEALTH Act (HR 5)."
"The AMA supports the proven medical liability reforms in HR 5, which have been shown effective in states such as California and Texas, as well as the testing of innovative measures such as those funded in the President's budget proposal," Wilson said.
American Hospital Association President Rich Umbdenstock said the trade group was "deeply disappointed" that the president's call for about $18 billion in Medicaid cuts over the next decade.
"At a time when hospitals have already been asked to absorb big cuts at the state level, and state budgets are already stretched, it is unwise to ask states to continue to do more with less," Umbdenstock said. "In addition, we are also disappointed to see elimination of funding for the children's graduate medical education program at a time when there is a need for an expanded physician workforce. While we fully support eliminating future reductions to physicians, the answer to the physician payment issue is not cutting one provider to reimburse another."
With the recent theft of an electronic medical records file now confirmed, New York City officials have begun the arduous process of notifying 1.7 million patients, staff, contractors, vendors and others who were treated or who provided services during the past 20 years at two public hospitals in the Bronx.
The New York City Health and Hospitals Corporation said the theft could endanger the personal information of basically anyone who shared personal information with Jacobi Medical Center, North Central Bronx Hospital, or their offsite clinics, which comprise the North Bronx Healthcare Network.
The stolen electronic records contained personal information, protected health information, or personally identifiable employee medical information. Personal information can include social security numbers, names, addresses, and other information that may be used to identify individuals. PHI can include personal information and patients' medical histories. PIEMI can include personal information and employees' health information.
HHC said in a statement that it “values and protects individuals' privacy and confidentiality and deeply regrets any inconvenience and concern this may create for patients, staff and others affected. The loss of this data occurred through the negligence of a contracted firm that specializes in the secure transport and storage of sensitive data.”
There is no evidence that the data have been inappropriately accessed or misused, HHC said. However, HHC is providing information and one year of free credit monitoring services to anyone who may be worried about possible identity theft.
Here's a pop quiz on street gang affiliation: Can you tell the difference between a Crip and a Blood, or a Latin King, a Neta, an Aryan Brother, a Pagan, or an MS13? More importantly, can your staff identify a gang banger when he walks through the doors of your emergency department seeking treatment, or helping a wounded "posse" member with a work-related injury?
So far, we appear to have dodged a bullet – literally and figuratively -- on the issue of gang violence spilling into the hospitals. Violence, however, is intrinsic with street gangs, and there is an uneasy fear that at some point, somewhere, rival gangs seeking treatment for their injured friends could confront one another in the emotionally charged confines of an emergency department.
Police estimate that there are hundreds of thousands of gang members of every race and ethnicity in every state in the union. That being the case, it's probably a good idea to provide staff with education on street gangs, how to spot them, and how to respond when they're in your ED to defuse potential violence.
Since 2007, hospital and law enforcement officials have been preparing for that contingency. The New Jersey Hospital Association has worked with the state's Parole Board to offer a one-day crash course called "Gang Awareness Training for Healthcare Workers."
Mary Ditri, director of professional practice NJHA, said the hospital trade group decided to address the issue before a violent gang-related incident occurred. "We know this is something our communities struggle with, gang violence, and it's not going away," Ditri says. "The training is really not geared to have healthcare workers do things they shouldn't be doing. It's geared toward giving them the tools they need to help them do what they do better, focusing on environmental safety for the patients, their families and the providers and their colleagues."
Lt. Daniel Riccardo, Field Coordinator for New Jersey State Parole Board Street Gang Unit, has brought gang awareness to dozens of hospitals across the Garden State. "I couldn't give you an exact number statewide of how many gang members there are in New Jersey. Let's put it this way: a lot," Riccardo says. "They should all be considered a threat because they have a violent nature that can come out at any given time."
"When one of them gets shot, or stabbed, or beaten up, where are they going to go? The ER. And the first people they are going to deal with are ER staff," he says.
Chances are that injured gang member and his running buddies aren't looking for trouble at your hospital. You aren't a threat to them, and they need treatment. The problem is what happens if the rival gang shows up. Maybe they've got a wounded friend who needs treatment too. That's when things get dicey. "If you have reason to believe you have a gang member you may want to put them in a separate room. You may want to put them off to the side so they aren't in the main view of the general public," he says.
It sounds easy to "profile" a gang member. Maybe he's wearing red or blue clothes, or he's covered with tattoos, of flashing hand signals. Maybe there are five guys in the waiting room dressed like him. They might be gang members, or not. Unfortunately, there really isn't one iron clad signal that will announce the presence of a gangbanger. "Self admission alone isn't good enough. Just because you tell me you're a Blood that is not enough. You could be a wannabe," Riccardo says.
Instead, he says hospital staffs need to understand a wide array of clues and behaviors that could signal gang affiliation and if suspicions are aroused, call the police. "I emphasize, do not confront them or ask: 'what crew are you running with?'" Riccardo says. "I don't want hospital personnel to say anything in regards to gangs with someone you believe is in a gang. I'm just saying if you have reason to believe let somebody know and let them deal with it. It's a safety issue. If law enforcement comes to the hospital, they talk to the person and he isn't a gang member, so be it. I would rather be safe than sorry and have a violent incident in the ER."
Riccardo says the gang awareness program is something that could easily be replicated in other states, because there are gangs in every state in the union, "including Hawaii and Alaska."
You may even consider expanding the scope of the training to include domestic violence, which perhaps poses an even greater threat to patients, and providers if the angry spouse walks into the ER.
We cannot control much of what goes on outside of the hospital doors. It's hard enough to control who walks through the hospital doors, with 24/7 access to everybody required by Emergency Medical Treatment and Active Labor Act (EMTALA) and usually with no security screens to walk through. That's why it's imperative that hospitals have a plan in place to react to violence. Even better, provide staff with the tools to identify the potential for violence before it occurs.
Nashville-based HCA announced on Friday an immediate "internal reorganization" that the nation's largest for-profit hospital chain said will "better align the company's structure with the future dynamics of the healthcare industry."
The changes include: the creation of a new subsidiary that will provide business services to other healthcare companies; a new structuring of provider operations; and integration of clinical quality performance with physician practice services, HCA said.
"Emerging changes in healthcare require us to take a new approach to many aspects of how we deliver care," said Richard M. Bracken, chairman/CEO of HCA. "Our refined structure is intended to better position HCA to take advantage of this evolution. In addition, we are excited about our plan to offer certain of HCA's industry-leading practices to other healthcare concerns."
Under the reorganization:
R. Milton Johnson has been named president of HCA, while retaining his title and responsibilities as CFO. Johnson has been with HCA for nearly 30 years and was elected to the board of directors in 2009.
Beverly B. Wallace, who most recently was president of HCA's Shared Services Group, becomes president of a new wholly-owned subsidiary that will provide revenue cycle, staffing services and supply chain management to other healthcare providers.
Further management changes under the HCA reorg announced Friday:
CMO Jonathan B. Perlin, MD, has been named president of HCA's Clinical and Physician Services Group. His expanded role will include responsibility for HCA affiliated physician practices, to integrate physician practices with the company's clinical and quality operations.
Sam Hazen has been named president of Operations, a new position that will oversee operations at HCA's 164 hospitals and 106 freestanding surgery centers, in the United States and the United Kingdom. Since 2001, Hazen had been president of HCA's Western Group, where he oversaw operations at 63 hospitals in nine states. HCA's four operational group presidents now report to Hazen.
Jon M. Foster, who has been president of HCA's Central and West Texas Division in Austin, TX, is now responsible for the company's operations in Texas, Colorado, Oklahoma and Wichita, KS.
Chuck Hall, who has been president of HCA's Eastern Group in Florida, South Carolina and southern Georgia, now will be responsible for HCA's operations in Alaska, California, Nevada, Utah and Idaho.
Bruce Moore, who has been president of HCA's Outpatient Services Group, becomes president, Operations and Service Lines Integration and is responsible for the company's Ambulatory Surgery Division, and service line integration, including behavioral health sciences and oncology.
Paul Rutledge will continue to oversee HCA operations in Louisiana, Indiana, Kentucky, Tennessee, Virginia, New Hampshire, northern Georgia, Kansas City, and London, England.
Duke University Health System will provide cardiovascular services, including open heart surgery and elective angioplasty, at Lexington Medical Center in West Columbia, SC, the two health systems announced this week.
Lexington Medical Center said its new affiliation with DUHS will help achieve a long-sought goal of providing a full range of cardiovascular services for the service area around the state capital. Lexington County is one of the fastest growing counties in South Carolina, and the largest without an open heart surgery program.
LMC operates the second busiest emergency department in South Carolina, treating more than 94,000 patients each year. The hospital also operates two catheterization labs. The South Carolina Office of Research and Statistics shows that 337 people from Lexington County required open heart surgery in 2007, LMC said.
DUHS, based in Durham, NC, will lend its experience and brand name in recruiting blue chip cardiovascular surgeons and cardiac anesthesiologists to work at LMC. DUHS will also help recruit and train of nurses and staff, design of the open heart surgery operating room, implementation of policies and procedures, and oversee quality and development for all cardiovascular services at LMC.
In fiscal 2010, the DUHS performed more than 8,500 diagnostic catheterizations, 2,000 angioplasties, more than 1,800 open heart surgeries, 100 lung transplants and 64 heart transplants.
LMC expects to begin its new cardiac surgical program in 2011, with two heart surgeons and a team of nurses and staff with special training in cardiac care, including intensive post-surgery cardiac and pulmonary monitoring. Procedures to be included in LMC’s cardiovascular program will be open heart surgery and expansion of therapeutic catheterizations to include elective angioplasty, LMC said.
The 414-bed LMC anchors a countywide health care network that includes six community medical centers and employs 5,100 health care professionals. The network also includes the largest extended care facility in the state, two occupational health centers and more than 40 physician practices, LMC said.
On Feb. 1, DUHS and LifePoint Hospitals partnered to create “flexible affiliation options” that will range from joint ventures to outright ownership of community hospitals in North Carolina, the two healthcare providers announced. The joint venture -- DLP Healthcare, LLC -- is one of the first between an academic health system and a for-profit hospital company, Duke/LifePoint said.
After an eight-hour shift, there is no difference in contamination among physicians wearing long- and short-sleeved shirts, or on the skin at the physicians' wrists, according to a new study published today in the Journal of Hospital Medicine.
Researchers from the University of Colorado assessed the claim that longer sleeves lead to more contamination by testing the uniforms of 100 physicians at Denver Health who were randomly assigned to wearing a freshly washed, short-sleeved uniform or their usual long-sleeved white coat.
"We were surprised to find no statistical difference in contamination between the short- and long-sleeved workwear," said lead researcher Marisha Burden, MD, a hospitalist at Denver Health, and assistant professor of medicine at the University of Colorado Health Sciences Center. "We also found bacterial contamination of newly laundered uniforms occurs within hours of putting them on."
In the study, 50 physicians were asked to start the day of the trial in a standard, freshly washed, short-sleeved uniform. The 50 physicians wearing their usual long-sleeved white coats were not made aware of the trial date until shortly before the cultures were obtained, to ensure that they did not change or wash their coats. Cultures were taken from the physicians' wrists, cuffs and pockets. No significant differences were found in bacteria colony counts between each style.
The researchers also found that although the newly laundered uniforms were nearly sterile before putting them on, three hours into a shift nearly 50% of the bacteria counted at eight hours were already present.
"By the end of an eight-hour work day, we found no data supporting the contention that long-sleeved white coats were more heavily contaminated than short-sleeved uniforms," Burden said. "Our data do not support discarding white coats for uniforms that are changed on a daily basis, or for requiring healthcare workers to avoid long-sleeved garments."
Burden's study notes that some British government agencies have instituted guidelines banning physicians' white coats and the wearing of long-sleeved garments to decrease the transmission of bacteria in hospitals in the belief that cuffs of long-sleeved shirts carry more bacteria.
Motorcycle helmets, which dramatically reduce brain injuries and deaths from crashes, also lower the risk of spinal injuries, a Johns Hopkins study shows.
While that may seem as obvious as a bump on the head, Johns Hopkins researchers say their findings actually debunk a decades-old popular myth among anti-helmet lobbyists that wearing a helmet can hurt the spine during a crash.
“Using this new evidence, legislators should revisit the need for mandatory helmet laws,” said study leader Adil H. Haider, MD, a trauma surgeon, and assistant professor of surgery at the Johns Hopkins University School of Medicine. “There is no doubt that helmets save lives and reduce head injury. And now we know they are also associated with a decreased risk of cervical spine injury.”
Haider said the new data refutes a 1986 study by Jonathan P. Goldstein, an economics professor at Bowdoin College, that suggested that the weight of a helmet could cause significant torque on the neck that would be devastating to the spine. The Johns Hopkins study, published online in the Journal of the American College of Surgeons, shows that helmeted riders were 22% less likely to suffer cervical spine injury than those without helmets. The study reviewed the National Trauma Databank on more than 40,000 motorcycle collisions between 2002 and 2006.
Even with what he called mountains of evidence that helmets reduce mortality and traumatic brain injury after a collision, Haider said several states, including Florida, Pennsylvania and Texas, have over the past 15 years repealed mandatory helmet laws after lobbying from motorcyclists.
Anti-helmet groups often cite the Goldstein study which found more spine injuries in helmet wearers. The National Highway Traffic Safety Administration rapped the Goldstein study’s flawed statistical reasoning. “Additionally, helmet technology has significantly improved since that time; now helmets are much lighter, but even sturdier and more protective,” Haider says.
Forty years ago, Haider says, nearly all states required helmets for all motorcyclists. Today, helmets are mandatory for all riders in only 20 states, Puerto Rico and the District of Columbia.
Motorcycle use has risen sharply over the past 10 years in the United States. Since 1997, motorcycle injuries in the U.S. have increased by roughly 5,000 per year and motorcycle fatalities have nearly doubled, according to the new journal article.
Haider's study, like many others before, found a reduction in risk of traumatic brain injury in helmet wearers (65%) and decreased odds of death (37%). But the new paper is the strongest evidence yet that helmets significantly reduce cervical spine injury, which can result in paralysis, Haider said.
Warming local anesthetics before injecting them significantly reduces the pain of the injection, according to a study published online this week in Annals of Emergency Medicine.
"Warming an injection is a cost-free step that emergency physicians can take to reduce pain from a shot," said Anna Taddio, MD, of the University of Toronto in Canada, and lead author of the study: Systematic Review and Meta-Analysis of the Effect of Warming Local Anesthetics on Injection Pain.
"Patients often dread the sight of a needle, but doing something as simple as warming the injection to body temperature can make a painful part of an emergency department visit more tolerable," Taddio said.
Taddio reviewed 18 previous studies involving 831 patients, and found that warming injections consistently produced a "clinically meaningful reduction in pain" regardless of whether the anesthetic had been buffered or not, regardless of whether the shot was administered subcutaneously or intradermally and regardless of whether the amount being injected was small or large.
Injections were warmed using controlled water baths, incubators, fluid warmers, baby food warmers, a warming tray and a syringe warmer. Some emergency physicians warm injections in their hands prior to administering them, the research found.
"Future research should examine the effects of warming local anesthetics for dental procedures and for procedures specifically involving children," Taddio said. "This is an area where a small change may make a big difference for a patient."
