Verma, Azar take aim at ‘Medicare for All’ proposals

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma took another swipe at calls for a “Medicare for All” healthcare system this week, saying expanding those benefits to every American would “dilute” the program.

Verma’s comments, made at a session of The Atlantic Festival, echo a speech before the Commonwealth Club in July, where she said calls to expand Medicare are built on a “fundamental lack of understanding about the uniqueness of Medicare to the very specific population it serves.”

At the festival, Verma said instead that the Centers for Medicare & Medicaid Services must focus on the steps it’s taking to “strengthen” the program and ensure its long-term sustainability.

“Putting more people in the program is not going to solve the problem, and actually threatens the focus and security of the program for seniors,” Verma said.

When FierceHealthcare requested more details on how expanded enrollment would hurt seniors, CMS declined to provide specific data. But Verma did say in a statement that a single-payer health system built on Medicare would shift the focus of a program aimed at seniors to a larger population.

It was also unclear if Verma was also dismissing Democratic plans for a Medicare buy-in, which would expand enrollment voluntarily to people between the ages of 55 and 64.

Plans for either expanding Medicare enrollment through voluntary buy-ins or fully transforming Medicare into a single-payer system are still in their nascent stages, but with backers like Sens. Cory Booker, Kamala Harris and Elizabeth Warren—all in the 2020 presidential conversation—calls for growing government healthcare are going mainstream.

A recent survey from the Bipartisan Policy Center found that 37% of adults want the government to play a greater role in regulating the price of healthcare goods, and nearly half (43%) of Democrats feel that ensuring greater access to health insurance is a key priority.

Department of Health and Human Services Secretary Alex Azar has also drawn a clear line in the sand on Medicare for All. In a speech last week, hosted by the Nashville Healthcare Council, Azar said that expanding the program to all Americans would eliminate their ability to make health choices for themselves.

In addition, Azar said, paying everyone at Medicare rates—which are about 40% less than private insurance rates—could lead some physicians to reject insurance entirely and “move to accepting cash” for care. Azar warned that buy-ins would cut down on private insurance enrollment, which could “consolidate” access to the best doctors to just that population.

“It’s simple math: Higher payments from commercial insurers help doctors take on seniors whose Medicare plans pay less,” Azar said. “It’s far from an ideal set-up, but a single government system would completely unravel it, without a theory for how seniors’ access would be protected.”

https://www.fiercehealthcare.com/payer/verma-azar-take-aim-at-medicare-for-all-proposals

Radius Health announces Medicare Part D coverage

Waltham, Mass.-based Radius Health, a science-driven fully integrated biopharmaceutical company that is committed to developing and commercializing innovative endocrine therapeutics in the areas of osteoporosis and oncology, recently announced the latest 2019 Medicare Part D coverage for TYMLOS which increased to approximately 26.2 million lives or 64 percent of those enrolled in Medicare Part D plans in the U.S.Effective Jan. 1, 2019, SilverScript Insurance Company (a CVS Caremark company), WellCare Health Plans and Prime Therapeutics will become the latest Medicare Part D prescription drug plan sponsors to cover TYMLOS (abaloparatide) injection for their beneficiaries. Express Scripts, Inc., UnitedHealthcare, Kaiser Permanente and EnvisionRx, among others, have decided to continue Medicare Part D coverage of TYMLOS through 2019. Over the next couple weeks, payers and PBMs will continue to make publicly available their Medicare Part D 2019 drug formularies. Radius plans to provide a detailed update on TYMLOS’ 2019 formulary coverage at the company’s third quarter earnings call in November.

https://www.marketscreener.com/RADIUS-HEALTH-INC-16646142/news/Radius-Health-MetroWest-Business-Digest-for-Oct-6-2018-27382195/

Chemo may lead to mitochondrial dysfunction in skeletal muscle

Chemotherapy drugs to treat breast cancer may promote muscle mitochondrial dysfunction, according to new research. Dysfunctional mitochondria, the energy centers of the cells, may contribute to fatigue and weakness that some people with breast cancer experience through the course of disease treatment. The study is published ahead of print in the American Journal of Physiology — Cell Physiology.

Breast cancer, the most commonly diagnosed cancer in the U.S., has been considered one of the less-damaging cancers in terms of severe muscle wasting and weight loss (cachexia). However, some people with breast cancer may also suffer from muscle loss and fatigue that limits their daily activities. There is limited research on the effect of breast cancer and its treatments on the muscles in human patients.

Researchers from the University of Vermont compared muscle fibers from women with breast cancer who were undergoing chemotherapy after surgical removal of cancerous tumors. The women had a lower cross-sectional area of muscle fibers — an indication of muscle loss — when compared to a healthy control group. A reduced number of mitochondria was also seen in the cancer group.

The research team also treated mouse muscle cells with the chemotherapy drugs doxorubicin and paclitaxel, medications that are commonly used to treat breast cancer. Both of the drugs led to a lower number of mitochondria, increased oxidative stress and atrophy. Oxidative stress is a type of cellular damage that can lead to cell death and chronic disease.

The negative effect of chemotherapy drugs on muscle mitochondria “provides a possible explanation for the high prevalence of fatigue and functional disability across all cancer types, including those not typically characterized by cachexia, such as breast cancer,” the researchers wrote. “Interventions designed to counter these effects on muscle may help alleviate some of the burden of the disease on patients.”

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Story Source:

Materials provided by American Physiological Society. Note: Content may be edited for style and length.

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Journal Reference:

1. Blas A. Guigni, Damien M. Callahan, Timothy W. Tourville, Mark S. Miller, Brad Fiske, Thomas Voigt, Bethany Korwin-Mihavics, Vikas Anathy, Kim Dittus, Michael J. Toth. Skeletal muscle atrophy and dysfunction in breast cancer patients: role for chemotherapy-derived oxidant stress. American Journal of Physiology-Cell Physiology, 2018; DOI: 10.1152/ajpcell.00002.2018

https://www.sciencedaily.com/releases/2018/10/181004131819.htm

GE Healthcare to build AI-based command center at NHS hospital

GE Healthcare has been tapped to build a centralized healthcare “command center” at the Bradford Royal Infirmary, an NHS teaching hospital in the U.K., to direct patient care delivery and allocate resources.

The first of its kind in Europe, the center will use artificial intelligence and real-time information and analytics to help anticipate bottlenecks across the 800-bed hospital and recommend actions—streaming data to a wall of screens monitored by up to 20 Bradford staff, as well as to tablets and mobile devices across the building.

The project aims to cut waiting times and reduce pressure on staff by reducing the unnecessary time spent in a hospital after a patient is fit to leave, as well as increase the total number of patients treated. In addition, it hopes to increase the number of patients who arrive and are admitted, transferred or discharged from the emergency department within four hours.

Bradford’s emergency department sees about 125,000 patients each year—up by more than 40% over the past decade, with about 350 to 400 patients a day—and with 96% of the hospital’s bed capacity being used on a regular basis.

“Hospitals are increasingly looking to boost the efficiency of their operations so they can continue to deliver high quality care as patient volume increases,” said Mark Ebbens, European command center lead at GE Healthcare, which plans to have the center operational early next year.

The command center model has been employed in the U.S. and Canada, including at The Johns Hopkins Hospital in Baltimore and Toronto’s Humber River Hospital.

According to GE, since the launch of Johns Hopkins’ center, patients from other hospitals have been transferred 60% faster, ER wait times have been cut by 25%, and the time spent waiting in the operating theater for a post-surgical bed decreased by 70%.

“Command centers help to orchestrate the delivery of care across the organization, bringing consistency to processes, prioritizing actions, eliminating waste and predicting tomorrow’s pressure points,” Ebbens said.

https://www.fiercebiotech.com/medtech/ge-healthcare-to-build-ai-based-command-center-at-nhs-teaching-hospital

Top 10 Health Tech Hazards for 2019, Not All What You Would Think

The potential for hackers to exploit remote access systems to infiltrate a healthcare organization’s networked devices and systems is the number one health technology hazard that hospitals should focus on in 2019, according to the ECRI Institute.

Such attacks can disrupt healthcare operations, hinder the delivery of care, and put patients at risk, the nonprofit research organization warns in its just-released 2019 Top 10 Health Technology Hazards.

Produced each year by ECRI’s Health Devices Group, the list identifies potential sources of danger that ECRI believes warrant the greatest attention for the coming year. The list is accompanied by practical strategies hospitals and healthcare providers can take to reduce the risks.

Cybersecurity is clearly a growing concern. In the past 18 months, the ECRI published 50 cybersecurity-related alerts and problem reports, a major increase over the prior period, the group notes.

“The consequences of an attack can be widespread and severe, making this a priority concern for all healthcare organizations. In critical situations, this could cause harm or death,” David Jamison, executive director of the Health Devices Group at the ECRI, said in a news release.

Organizations need to identify, protect, and monitor all remote access points and adhere to recommended cybersecurity practices, such as instituting a strong password policy, maintaining and patching systems, and logging system access, the group says.

Taking the number 2 spot on the latest top tech hazards list are mattresses and mattress covers that remain contaminated with blood and other bodily fluids after cleaning, posing an infection risk. “Healthcare facilities must take care to use appropriate products and procedures for cleaning and disinfecting mattress covers, and they should regularly inspect mattresses and covers for signs of damage or contamination,” the group advises.

“One key challenge, however, is that not all mattress cover suppliers recommend products and procedures that will successfully remove the likely surface contaminants without compromising the cover’s integrity (ie, creating weak spots that could allow leaks). This situation needs to be remedied,” they conclude.

Number 3 on this year’s list are surgical sponges unintentionally left inside the patient after the surgical site is closed, which can lead to infection and other serious complications, including the need for another surgery.

Manual counts, in which the surgical team verifies that all sponges are accounted for before concluding the procedure, are standard practice, but errors in counting can occur, the group notes. “Technologies that supplement the manual counting process are available and have been found to be effective when used correctly. ECRI Institute contends that broader adoption of these technologies could further reduce the risk that a surgical sponge will be unintentionally retained during a procedure,” they say.

Number 4 on the list is improperly set alarms on ventilators, which put patients at risk for hypoxic brain injury and death. “Properly set alarms can prevent such consequences. Yet ECRI Institute continues to investigate deaths resulting from breathing circuit disconnections during which no alarm activated. In two cases from early 2018, alarms to detect inadequate ventilation, such as the minute-volume and low-pressure alarms, were not set appropriately,” the group notes. “Healthcare facilities need policies on setting user-adjustable ventilator alarms and protocols for verifying that the policies are being followed and that component connections are secure.”

Number 5 on the list is mishandling flexible endoscopes after disinfection, which can cause infections in patients. Cleaning and disinfecting flexible endoscopes between uses can be challenging, and failure to adhere to a strict reprocessing protocol can lead to infections. “Less well known is that improper handling and storage practices can recontaminate previously disinfected scopes, heightening the risk of patient infections,” the group notes.

When endoscopes are not completely dried after disinfection, any remaining viable microbes can rapidly proliferate and colonize the instruments. “To promote drying, ECRI Institute and relevant professional societies recommend purging endoscope channels with clean air at the end of the reprocessing process,” the group states.

The “clean” status of endoscopes can also be compromised if the instruments are handled with unclean gloves, which the ECRI has observed. “Endoscopes that have been cleaned but not yet high-level disinfected are still contaminated with viable microbes; thus gloves used to handle an endoscope at that stage must not be used to remove the scope from the reprocessing machine,” they caution.

“Recontamination can also occur when transporting and storing endoscopes. Disinfected and dried endoscopes should be transported in a clean enclosed container, dedicated to that purpose, and should be prevented from contacting potentially unclean surfaces,” they add.

The Final Five

Rounding out the top 10 technology hazards ECRI says warrant the greatest attention in the coming year are the following:

6. Confusing dose rate with flow rate, which can lead to infusion pump medication errors.

7. Improper customization of physiologic monitor alarm settings, which may result in missed alarms.

8. Injury risk from overhead patient lift systems.

9. Cleaning fluid seeping into electrical components, which can lead to equipment damage and fires.

10. Flawed battery charging systems and practices that can affect device operation.

More information about the ECRI ranking is available on the group’s website.

https://www.medscape.com/viewarticle/902856#vp_1

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts of Interest

Despite potential benefits of joint ventures between dialysis companies and nephrologists, these arrangements raise legal and ethical concerns. And because of a lack of transparency, it is impossible to study whether these concerns are borne out in practice.

From the Perelman School of Medicine at the University of Pennsylvania (J.S.B., A.G., M.S.M.), and the Hospital of the University of Pennsylvania (J.S.B.) — both in Philadelphia.

https://www.nejm.org/doi/full/10.1056/NEJMp1805097

Fitbit data helps police arrest another murder suspect

Fitbit may have helped police solve the murder of one of its users, after investigators used heart rate data to determine the identity of the alleged killer. On September 8th, Anthony Aiello visited his 67-year-old stepdaughter Karen Navarra in San Jose. He claims he brought homemade pizza and biscotti for her, and she walked him to the door and gave him a couple of roses as a thank you. But data from Navarra’s Fitbit Alta showed a different story, according to investigators.

The data indicated that Navarra’s heart rate “spiked significantly,” then rapidly slowed and stopped — all during the 15 minutes or so that Aiello, 90, was in her home, the New York Times reports. One of Navarra’s coworkers found her body five days after Aiello’s visit.

Investigators used surveillance footage to determine that Aiello’s car was parked in Navarra’s driveway during the unusual heart rate activity. They found that he left around five minutes after her heart stopped. Police arrested Aiello September 25th and he’s been charged with murder.

After obtaining a search warrant, investigators procured the Fitbit data with the company’s help. Fitbit’s privacy policy states that it “may preserve or disclose information about you to comply with a law, regulation, legal process, or governmental request.”

It’s not the first time Fitbit data has helped police find an alleged killer. Data from a Connecticut woman’s fitness tracker led police to charge her husband with her 2015 murder. He was arrested last year and is awaiting trial. Earlier this year, investigators used Fitbit data in the case of Iowa student Mollie Tibbetts. The 20-year-old student was missing for around a month before her body was found in August, and a 24-year-old man has been charged with her murder.

https://www.engadget.com/2018/10/04/fitbit-data-heart-rate-murder-arrest/