hpn_daily_update090119 by zhouwenjuan


									April 18, 2013

System gave some facilities millions beyond Medicaid reimbursements

For the past few years, a handful of Mississippi hospitals have won a lottery - extra money from Medicaid in formulas so complex many
administrators can’t explain them.

State Medicaid officials “should be ashamed and embarrassed at such poor and inequitable administration of public funds in such a way as
to create these windfalls in a few hospitals while others struggle to survive week to week,” said Daryl Weaver, chief executive officer for
King’s Daughters Hospital in Yazoo City, MS.

Medicaid regularly reimburses hospitals for medical care for the poor. The agency’s Upper Payment Limit and Disproportionate Share
Hospital payment programs aim to make up for gaps Medicaid doesn’t cover. That has led to windfalls for some Mississippi facilities, such as
the 82-bed Neshoba County General Hospital. The county-owned hospital received more than $19.5 million beyond its regular Medicaid
reimbursements, despite the fact its total tab for uninsured care ran less than $1.7 million last year.

Such windfalls could hurt rural Mississippians, who could see their hometown hospitals run out of business by neighboring hospitals that
reap such windfalls. State Medicaid officials acknowledge many rural hospitals are hurting financially but defend the system that led to the
windfalls, saying they were simply following state and federal law.

Hospitals are put in three categories: state, county and private. Each category gets a portion of this extra Medicaid money, and under the
rules, money can’t be shifted from one category to next. As a result, a number of county hospitals ended up splitting a huge amount of
money. “We ended up with a pile of money to give hospitals, but we were required to give it to certain hospitals, which resulted in certain
windfalls,” said Robert Robinson, executive director for the state Division of Medicaid.

Weaver said Medicaid officials have almost doubled the federal matching dollars the state received when the program was managed by the
state hospital association. Until 2007, hospitals received extra Medicaid money based on a formula administered by the Mississippi Hospital
Association, but federal officials ordered a change. State Medicaid officials now administer the formula.

Robinson said Medicaid officials want to level the playing field but can’t because the Mississippi Hospital Association is still battling a change
to a system that would shorten hospital stays by means of diagnosis-related groupings. For the past three years, Medicaid officials have
fought “for some way to treat the small hospitals better,” he said.

Under the current system in Mississippi, hospitals get reimbursed per diem for Medicaid patients. Robinson said that means the longer
hospitals keep patients, the more they get paid. (The Clarion-Ledger)

Privacy issue complicates push to link medical data

President-elect Barack Obama’s plan to link up doctors and hospitals with new information technology, as part of an ambitious job-creation
program, is imperiled by a bitter, seemingly intractable dispute over how to protect the privacy of electronic medical records. Lawmakers,
caught in a crossfire of lobbying by the healthcare industry and consumer groups, have been unable to agree on privacy safeguards that
would allow patients to control the use of their medical records. Congressional leaders plan to provide $20 billion for such technology in an
economic stimulus bill whose cost could top $825 billion.

In a speech outlining his economic recovery plan, Obama said, “We will make the immediate investments necessary to ensure that within
five years all of America’s medical records are computerized.” Digital medical records could prevent medical errors, save lives and create
hundreds of thousands of jobs, Obama has said.

So far, the only jobs created have been for a small army of lobbyists trying to secure money for health information technology. They say
doctors, hospitals, drugstores and insurance companies would be much more efficient if they could exchange data instantaneously through
electronic health information networks. Consumer groups and some members of Congress insist that the new spending must be
accompanied by stronger privacy protections in an era when digital data can be sent around the world or posted on the Web with the click of
a mouse.

Lawmakers leading the campaign for such safeguards include Representatives Edward J. Markey of Massachusetts and Pete Stark of
California, both Democrats; Senator Patrick J. Leahy, Democrat of Vermont; and Senator Olympia J. Snowe, Republican of Maine.

In the last few years, personal health information on hundreds of thousands of people has been compromised because of security lapses at
hospitals, insurance companies and government agencies. These breaches occurred despite federal privacy rules issued under a 1996 law.
Congress is trying to strengthen those privacy protections and make sure they apply to computer records. Lobbyists for insurers, drug benefit
managers and others in the health industry are mobilizing a campaign to persuade Congress that overly stringent privacy protections would
frustrate the potential benefits of digital records.

One of the proposed safeguards would outlaw the sale of any personal health information in an electronic medical record, except with the
patient’s permission. Another would allow patients to impose additional controls on certain particularly sensitive information, like records of
psychotherapy, abortions and tests for the virus that causes AIDS. Patients could demand that such information be segregated from the rest
of their medical records.

Rahm Emanuel, who will be the White House chief of staff for Obama, advocated such safeguards when he was a House member from
Illinois. Advisers to Obama say he favors strong privacy protections but does not want the dispute to slow down the bill. (NY Times)

Final medical identity theft report released

The Office of the National Coordinator for Health Information Technology (ONC) has released a final report on the medical identity theft. This
report represents the conclusion of the work undertaken by ONC as part of its efforts to proactively assess and evaluate the scope of the
medical identity theft problem in the U.S., and was completed by Booz Allen Hamilton.

The report summarizes health IT and medical identify theft issues and sets forth possible potential actions for the Federal government and
other stakeholders in the areas of prevention, detection, and remediation of medical identify theft. The use of health information technology
has the potential for being a powerful tool for prevention and detection of medical identity theft.

For additional information about the medical identity theft project, and to download a copy of the report, visit www.hhs.gov/healthit.

Obesity is likely to become one of the biggest problems keeping young people from entering the military

FORT JACKSON, SC -- The Army has been dismissing so many overweight applicants that its top recruiter, trying to keep troop numbers up
in wartime, is considering starting a program to transform chubby trainees into svelte soldiers. Maj. Gen. Thomas Bostick, head of the Army
Recruiting Command, said he wants to see a formal diet and fitness regimen running alongside a new school at Fort Jackson that helps
aspiring troops earn their GEDs.

Bostick said obesity looms as “a bigger challenge for us in the years ahead” than any other problem that keeps young people from entering
the military, including lack of a GED or high school diploma, misconduct or criminal behavior, and other health issues such as eye or ear

According to Defense Department figures provided to the Associated Press, over the past four years 47,447 potential recruits flunked
induction physicals at the nation’s 35 Military Entrance Processing Stations because they were overweight. That is a small fraction of the
205,902 such exams given in 2005 and 250,764 in 2008, but it still amounts to a significant number and comes at a time when the military is
more interested than ever in recruits. The Defense Department has announced plans to boost the active-duty Army by 65,000 to a total of
547,000 soldiers by next year, and grow the Marines from 175,000 to 202,000 by 2011.

Obesity afflicts recruits for other physically demanding jobs, including firefighting. Deputy Chief Ed Nied, a leader of the safety, health and
survival section of the International Association of Fire Chiefs, said fire departments are making a “major push” to encourage better fitness
among young people who want to join. “We draw from the same exact population that they [the armed services] draw from,” Nied told the
Associated Press. “This comes from a lack of physical education in the high schools.” (Associated Press, Washington Post)
Level set for chemical in nonstick products

The Environmental Protection Agency has issued the first national guidelines establishing safe levels for perfluorinated chemicals used to
make nonstick and stain-resistant materials in the nation’s drinking water. The chemical, which has been linked to cancer and birth defects in
animals, is a key processing agent used to make products including microwave popcorn bags and nonstick pans. It has been seeping into
drinking water supplies around the country and has been detected in the blood of 95 percent of Americans, including pregnant women, as
well as in the blood of marine organisms and Arctic polar bears.

Environmentalists criticized the “provisional health advisory” setting the acceptable level of short-term exposure to perfluorooctanoic acid
(PFOA) at 0.4 parts per billion. They noted that Lisa P. Jackson, who headed New Jersey’s Department of Environmental Protection and has
been nominated by President-elect Barack Obama to take over the EPA, set a chronic exposure standard of 0.04 ppb in 2007 while heading
the state agency.

Benjamin H. Grumbles, the EPA’s assistant administrator for water, said that the agency decided to issue guidelines Thursday after it had
found elevated levels of both PFOA and perfluorooctane sulfonate (PFOS) in sewage sludge from a wastewater treatment plant that was
used to fertilize farm crops near Decatur, AL. The agency set a standard of 0.2 ppb for PFOS.

“We have no evidence of levels that would present a risk to public health,” Grumbles said of the drinking water near Decatur, adding that the
agency defines “short-term exposure” as lasting as much as two years. He said the suggested safety levels apply nationwide but could be
revised by the next administration. “I’ve no doubt scientists in the agency will continue to look at this, and policymakers may revisit it,”
Grumbles said.

Richard Wiles, executive director of the Environmental Working Group, said the EPA failed to take into account that drinking water exposure
to PFOA produces a hundredfold concentration of the chemical in human’s blood. “Nobody would say that’s safe,” Wiles said of a 40 ppb

DuPont issued a statement saying the new advisory is in line with other exposure guidelines. Parkersburg, WV, which is near a DuPont plant
that produces the chemical, has set a local safety limit of 0.5 ppb, which is identical to the level established by the Minnesota Department of

Eight U.S. companies, including DuPont, have agreed that by 2015, they will no longer release PFOA into the environment from finished
products or manufacturing plants, and that they will cut emissions of the chemical 95 percent by next year. (Washington Post)

Free antibiotics: The wrong prescription for cold and flu season; Free flu shots are a better option

With an epidemic of antibiotic-resistant infections growing, experts are warning grocery-store pharmacies that antibiotics giveaways are an
unhealthy promotional gimmick. If grocery stores want to help customers and save them money during cold and flu season, the Infectious
Diseases Society of America (IDSA) says, they should offer free influenza vaccinations instead.

Giant, Stop & Shop, and other grocery stores have recently begun offering free antibiotics at their pharmacies. Most concerning are
promotions such as Wegmans’ that link antibiotics to the winter cold-and-flu season—despite the fact that antibiotics will have no effect on
these viral illnesses and carry risks of serious side effects.

A new study in the February 1 issue of Clinical Infectious Diseases shows that workers age 50-64 who received influenza vaccine lost
substantially fewer days of work and worked fewer days while ill. But influenza vaccine is underutilized. Millions of doses were thrown away
at the end of the last two flu seasons.

“The opposite is true for antibiotics,” said Lauri Hicks, DO, medical director for the “Get Smart: Know When Antibiotics Work” program at the
Centers for Disease Control and Prevention (CDC). “Each year tens of millions of antibiotics are prescribed for viral conditions, like the
common cold, for which antibiotics are totally ineffective. Overuse of antibiotics is jeopardizing the effectiveness of these essential drugs.”

For example, in some parts of the country methicillin-resistant Staphylococcus aureus (MRSA) is the leading cause of emergency room visits
for skin and soft tissue infections. To make matters worse, there are very few new antibiotics under development to fight resistant bacteria. In
addition, the risks associated with antibiotics are under-appreciated. Allergic reactions and other adverse events cause an estimated 142,000
emergency room visits annually, according to a recent study by CDC.
“Most doctors know better than to prescribe antibiotics when they are not needed,” said IDSA President Anne Gershon, MD. “But many find it
hard to say ‘no’ to sick patients who think antibiotics will make them feel better. We are concerned that these pharmacy marketing efforts will
encourage patients to ask for antibiotics prescriptions.”

IDSA urges grocery store pharmacies to partner with the CDC’s “Get Smart” program. CDC and its partners educate the public and
healthcare providers about when antibiotics will and won’t work and the dangers of antibiotic resistance. For more information, see the Get
Smart website. http://www.cdc.gov/drugresistance/community/

Study shows rise in antibiotic resistant pediatric head and neck infections

A report by researchers in the Jan. 19, 2009 Archives of Otolaryngology-Head and Neck Surgery shows that there was nationwide increase
in the prevalence of pediatric methicillin-resistant Staphylococcus aureus (MRSA) head and neck infections from January 2001 to December

In an attempt to identify trends in the susceptibility of antibiotic-resistant infections, researchers from Emory University School of Medicine
and Children’s Healthcare of Atlanta studied data on pediatric patients from nationwide hospitals.

The researchers reviewed a total of 21,009 pediatric head and neck S. aureus infections from 300 hospitals nationwide that occurred
between Jan. 1, 2001 and Dec. 31, 2006. Patients ranged in ages from birth to 18. In 2001, approximately 12 percent of all isolated S.
aureus in the study was methicillin resistant. During the following five years, the number steadily rose to more than 28 percent. Overall during
those six years there was a 16.3 percent increase in the percentage of resistance for all pediatric head and neck S. aureus infections.

“There is a nationwide increase in the prevalence of MRSA in children with head and neck infections that is alarming,” said Steven E. Sobol,
MD, MSc, primary investigator of the study and director of Pediatric Otolaryngology in the Department of Otolaryngology - Head and Neck
Surgery at Emory. “Clinicians must use antibiotic agents judiciously in order to reduce further antimicrobial drug resistance,” he said.

Sobol suggests that there be careful testing of suspected head and neck infections, leading to more appropriate antimicrobial drug selection.
He also recommends further studies to gain additional insight into this organism. This study was supported by a grant from Alcon
Laboratories Inc.

FDA alerts public about danger of skin numbing products

The U.S. Food and Drug Administration issued a Public Health Advisory to alert consumers, patients, healthcare professionals, and
caregivers about potentially serious and life-threatening side effects from the improper use of skin numbing products. The products, also
known as topical anesthetics, are available in over-the-counter (OTC) and prescription forms.

These topical anesthetics contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or
gel. When applied to the skin surface, they can be absorbed into the blood stream and, if used improperly, may cause life-threatening side
effects, such as irregular heartbeat, seizures, breathing difficulties, coma, or even death. FDA has received reports of adverse events and
deaths of two women who used topical anesthetics before laser hair removal. In February 2007, the FDA issued a Public Health Advisory -
“Life-Threatening Side Effects with the Use of Skin Products containing Numbing Ingredients for Cosmetic Procedures,” to warn consumers
about these products.

Patients for whom an over-the-counter or prescription topical anesthetic is recommended should consider using a topical anesthetic that
contains the lowest amount possible of medication that will relieve your pain. Also, healthcare professionals should determine whether
adequate pain relief can be safely achieved with a topical anesthetic, or whether a different treatment would be more appropriate.

The FDA strongly advises consumers not to: make heavy application of topical anesthetic products over large areas of skin; use formulations
that are stronger or more concentrated than necessary; apply these products to irritated or broken skin; wrap the treated skin with plastic
wrap or other dressings; and apply heat from a heating pad to skin treated with these products. When skin temperature increases, the
amount of anesthetic reaching the blood stream is unpredictable and the risk of life-threatening side effects increases with greater amounts
of lidocaine in the blood.

A recently published study in Radiology looked at women taking acetaminophen and ibuprofen by mouth versus applying lidocaine gel, a
topical anesthetic, to the skin to decrease discomfort during mammography. The lidocaine gel was applied to a wide skin surface area and
then covered with plastic wrap. There were no serious or life-threatening side effects reported in the study, nor were any reported when FDA
discussed the results with the doctor who performed the study. The study results favored the use of lidocaine as there was significantly less
discomfort than with the plain gel or oral acetaminophen or ibuprofen. However, given the life-threatening side effects associated with the
use of topical anesthetics during laser hair removal, FDA is concerned that similar side effects could occur when topical anesthetics are used
during mammography. Further, the study was small and it is possible that a larger study might show different findings.

Patients should talk with their healthcare professional if they are considering using a topical anesthetic before a mammogram.

Consumers and healthcare professionals may report adverse events to the FDA’s MedWatch program online at
www.fda.gov/medwatch/report.htm. https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

To read the FDA’s 2009 Public Health Advisory, visit here. http://www.fda.gov/cder/drug/advisory/topical_anesthetics2009.htm

Medicare announces next steps on competitive bidding program for certain medical equipment and supplies

The Centers for Medicare & Medicaid Services (CMS) issued an interim final regulation with comment period that incorporates changes
required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). This, along with a new Federal advisory committee,
are the next steps before CMS restarts the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and
supplies (DMEPOS) consistent with these regulations.

As part of MIPPA, Congress enacted a temporary delay in the competitive bidding program for Round One Competitive Bidding Areas. The
law required CMS to terminate the existing contracts that were awarded in Round One and recompete the contracts in 2009. Additionally, the
new law establishes a special document review process and a requirement for contracted suppliers to report relationships with suppliers with
whom they subcontract. MIPPA also excluded certain DMEPOS items and areas from competitive bidding and provided an exemption to the
program for hospitals that furnish certain types of DMEPOS items to their own patients.

In the lead up to Round One competitive bidding last year, many suppliers submitted bids outside of the competitive range, and there were
many concerns about financial documentation and standards accompanying the bids. In addition, there were questions about contracting
and subcontracting arrangements for winning suppliers and state licensure issues.

In addition, CMS announced the new Program Advisory and Oversight Committee (PAOC) members, who will provide advice to the
Secretary on a number of issues related to the implementation of the program and will assist the Secretary focus on key operational issues
because of their expertise in a broad range of issues, including quality standards, accreditation, and beneficiary issues. The committee
includes representatives of beneficiaries and consumers, physicians and other practitioners, suppliers, organizations that help to establish
professional standards, states, financial standards experts and representatives from industry associations.

Additional information is available here. http://www.cms.hhs.gov/DMEPOSCompetitiveBid/01_overview.asp#TopOfPage

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