A Weekly Compilation of Clinical Laboratory and Related Information
from The Division of Laboratory Science and Standards
March 7, 2013
View Previous Issues - Healthcare News Archive
Deadly Bacteria That Resist Strongest Drugs Are Spreading
Deadly infections with bacteria that resist even the strongest antibiotics are on the rise in hospitals in the United States, and there is only a “limited window of opportunity” to halt their spread, health officials warned. The bacteria, normally found in the gut, have acquired a lethal trait: they are unscathed by antibiotics, including carbapenems, a group of drugs that are generally considered a last resort. When these resistant germs invade parts of the body where they do not belong, like the bloodstream, lungs or urinary tract, the illness may be untreatable. The death rate from bloodstream infections can reach 50 percent.
Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, called the organisms “nightmare bacteria” during a telephone news conference, and noted that they could pass their trait for drug resistance — encoded in a scrap of genetic material called a plasmid — along to other bacteria.
'Sequester' Cuts to Hit Healthcare Hard
Expected Medicare payment cuts have hospitals and doctors worried. Public health and medical research programs may suffer disproportionately more.
As the Obama administration begins to implement $85 billion in cuts to federal spending this year, no part of the budget other than defense will take a bigger hit than healthcare. And the so-called sequester appears likely to have a disproportionate effect on areas of the health system already hobbled by years of retrenchment or underfunding, including public health and medical research.
Nationwide, as many as 46,000 public health jobs have been eliminated in the last five years, the Assn. of State and Territorial Health Officials and the National Assn. of County and City Health Officials estimate. Now, the federal Centers for Disease Control and Prevention plans to cut more. Health and Human Services Secretary Kathleen Sebelius told Congress this month that the CDC cuts could result in 424,000 fewer HIV tests by state and local health programs the agency funds. Of the agency's $6-billion budget, 70% goes as grants to state and local health efforts.
Congress Once Again Tackles Workforce Training
U.S. Reps. John Tierney (D-Mass.), George Miller (D-Calif.), and Ruben Hinojosa (D-Texas) reintroduced Workforce Investment Act (WIA) as the Workforce Investment Act of 2013 (HR798). The bill is, in essence, the same as last year's version of the legislation, HR4227. The legislation is supported in large measure by adult education and workforce skills development leaders. www.thomas.gov.
California Senate Bill Would Require ACOs to Establish Laboratory Testing Panels
On Feb. 13, California State Sen. Fran Pavley (D-Calabasas) introduced legislation, SB 264, requiring Accountable Care Organizations (ACOs) operating within the state to establish clinical laboratory testing advisory boards to recommend testing guidelines for ACOs to adopt. The bill’s intent is to ensure safe and cost-effective laboratory testing and guidelines for diagnostic procedures. On Feb. 21, SB 264 was referred to the California Senate Health Committee, of which Sen. Pavley is a member.
House Says $1B Wasted on Veterans' Medical e-Records
The departments of Defense and Veterans Affairs have wasted about $1 billion in a failed effort to streamline medical record-keeping, the chairman of the House Veterans' Affairs Committee said in a hearing. "I'm concerned we're taking a step back toward a model that has been tried and failed," said committee Chairman Rep. Jeff Miller, R-Fla., at a hearing to examine the project. Defense and VA officials said this month they had abandoned an ambitious plan to integrate medical records for both active-duty service members and veterans into a single electronic system to make the records more accessible for patients and doctors. After cost estimates doubled and technology problems persisted, they decided on a less expensive plan to keep their current systems while making them "interoperable."
Two Malpractice Bills Stir Passions Under Dome
Proposed changes to Georgia’s medical malpractice system consumed a marathon Senate committee hearing, as nursing home representatives, physicians, lawyers and patient advocates battled over two bills breaking late in the General Assembly session. The first bill would promote the signing of voluntary agreements that would send nursing home patients’ injury claims to arbitration. The second bill proposes a novel type of tort reform that would shift the process of pursuing injury claims to a system modeled after workers’ compensation.
Cataloging Health Care's Excesses
Nonprofit hospitals, the cornerstone of many communities, capriciously overcharge patients, sticking the powerless with exorbitant bills, while paying lavish salaries to their executives; drug companies, which charge humongous markups to American customers, rake in huge profits; trial lawyers, with the threat of legal action, add to the cost of defensive medicine; President Barack Obama’s Affordable Care Act does little to bend the cost curve.
Trial lawyers are right that the impact of malpractice suits is exaggerated; Texas has enacted one of the toughest limits on them, and it hasn’t really driven down overall costs. In fact, the threat of litigation is often used as an excuse to perform profitable procedures. Still, something like the safe harbor standard could make some difference and eliminate a distracting argument.
Medicare gets whacked a lot these days by politicians. Mr. Brill demonstrates that the program is more cost-effective than the private system. He says that rather than, raising the eligibility age for benefits, lowering the age limit and allowing more people to qualify would decrease health-care costs.
Update on New Federal Regulations Affecting Clinical Pathology Laboratories: Stage 2 ‘Meaningful Use’ Rules Top the List
Final Stage 2 rules give providers another year to meet Stage 1 ‘meaningful use’ criteria and shorten Stage 2 requirements from one-year to just 90 days Clinical laboratory managers and pathologists may be interested to know that, over the fall months, the U.S. Department of Health and Human Services (HHS) released three new rules that affect users of health information technology (HIT). One rule covers Stage Two of Meaningful Use and includes guidance on how providers should address the need to encrypt patient data. The second rule updates eligibility criteria that providers implementing electronic health record (EHR) systems must meet to qualify for federal incentives. Because medical laboratories and pathology groups maintain ongoing electronic interfaces with hospitals and office-based physicians, it is useful to know some of the key elements of these three recently issued federal regulations. The third rule establishes a date for conversion to ICD-10.
ICD-10 Implementation Guide for Small and Medium Practices
Benefits of ICD-10
By contrast, ICD-10 provides more specific data than ICD-9 and better reflects current medical practice. The added detail embedded within ICD-10 codes informs health care providers and health plans of patient incidence and history, which allows for more effective case management and better coordination of care. Accurate coding also reduces the volume of claims rejected due to ambiguity. The new code sets will:
- Improve operational processes across the health care industry by classifying detail within codes to accurately reflect patients’ conditions and improve payment processing and reimbursements.
- Update disease classifications to be consistent with current clinical practice and medical and technological advances.
- Increase flexibility for future updates as necessary by expanding the available space for adding new codes.
- Enhance coding accuracy and specificity to classify anatomic site, cause, and severity.
- Support refined reimbursement models to provide appropriate payment for more complex conditions.
- Streamline payment operations by allowing for greater automation and fewer payer-physician inquiries, decreasing delays and inappropriate denials.
- Provide more detailed data to better analyze disease patterns and track and respond to public health outbreaks; the United States will join the rest of the developed world in using ICD-10, and will be able to compare public health trends and pandemics across borders.
- Provide opportunities to develop and implement new pricing and reimbursement structures including fee schedules and hospital and ancillary pricing scenarios based on greater diagnostic specificity.
- Provide payers, program integrity contractors, and oversight agencies with improved methods for detecting fraud.
- Provide more accurate information to support the development and implementation of important health care policies nationally and regionally.
Source: http://www.cms.gov/ [PDF 2.51MB]
Evidence as Antidote
Will Comparative Effectiveness Research Help Labs?
With the ever-increasing price tag of Medicare contributing to a mindset of perpetual fiscal crisis in Washington, policymakers and pundits alike are demanding that more healthcare choices in the U.S. be steered by real data rather than guesses, predilections, or profits. So it's no accident that at the same time Medicare is moving to reward providers for improving quality and thrift, public funding for evidence-based medicine is also coming into its own, with billions of dollars for comparative effectiveness research becoming available under the healthcare reform law.
In the midst of this push for better evidence, AACC has partnered with researchers in the federal government to steer attention toward lab medicine. Major systematic evidence reviews proposed by the association are now completed or underway in the U.S. Agency for Healthcare Research and Quality's (AHRQ) Effective Healthcare Program.
Prostate Screening Tests In Older Men Decline, but Many Still Get Them, Study Finds
Fewer men over age 75 are being routinely screened for cancer with a prostate-specific antigen (PSA) test following a 2008 recommendation against the tests, researchers said, suggesting a less-is-more approach sometimes works. But while the numbers have declined, they remain significant – more than 4 in 10 men in that group still get the tests.
Pulse Oximeters - Premarket Notification Submissions [510(k)s]: Guidance for Industry and Food and Drug Administration Staff
FDA has developed this guidance document to assist industry in preparing premarket notifications (510(k)s) for pulse oximeters. These devices are intended for non-invasive measurement of the arterial blood oxygen saturation and pulse rate.
FDA's guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe the Agency's current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency guidances means that something is suggested or recommended, but not required.
NanoVelcro Microfluidic Device for Detection, Isolation, and Molecular Analysis of Circulating Tumor Cells
Researchers from University of California, Los Angeles are reporting the development of a new detector that captures circulating tumor cells (CTCs) in whole blood and extracts them individually for further analysis. The microfluidic device features tiny rods that are coated with antibodies of proteins found on CTC’s. After blood passes through, a laser is used to pull CTC’s out of the device for genetic identification of the mutation. The device is an advancement over an earlier prototype by introducing a new transparent substrate that more efficiently captures CTC’s allowing for blood to be screened quickly from a reasonable sample amount.
Affy Files CytoScan With FDA, Plans 'Aggressive' Marketing Campaign to Grow Cyto Business
Affy is the first of the three major array manufacturers to state publicly that it has filed a chromosomal microarray product with the FDA for clearance. The company said previously that it expects the FDA could clear CytoScan by the middle of this year, a timeline that Illumina has also provided for its chromosomal microarray product. Representatives from Agilent Technologies have told BioArray News in recent weeks that they are eyeing a 2014 submission date for a cyto-related package
UW Team Develops Single-Molecule Tagging Method to Reduce Sequencing Errors, Detect Very Rare Variants
Building on a targeted sequencing method that uses molecular inversion probes to capture and sequence genes, researchers at the University of Washington have added a single-molecule tagging component to reduce the sequencing error rate and enable the detection of low-frequency variants.
The method, described in a recent paper in Genome Research, "has relevance for tackling different kinds of heterogeneity," both in research and eventually the clinic, by enabling the detection of rare mutations in cancer, somatic mosaic mutations in Mendelian or other disorders, and mutations from a blood sample that may be present at a lower frequency than in the diseased tissue, senior author Jay Shendure told In Sequence.
New Smaller, Cheaper PCR Machine for Disease Diagnosis in Remote Parts of the World
Back in 2006, researchers at Caltech created a relatively small and cheap PCR machine that was commercialized as the Eco device and sold for $13,000. The Eco was still too bulky to use in areas where proper clinics don’t exist. To help tame disease in the world’s remote areas, the same team create[d] a new PCR machine that is smaller, lighter, and operates at the push of a button. The team hopes that the final version of the device will cost within $1000 and each test it performs will be around $5.
Cancer Genetics Adds DLBCL Assay to Menu of CLIA- and New York State-Cleared Microarray Tests
Cancer Genetics this week said that its microarray-based test for diagnosing and monitoring diffuse large B-cell lymphoma has been deemed by regulatory authorities to be compliant with the US Clinical Laboratory Improvement Amendments as well as New York State regulations. The clearances enable the Rutherford, NJ-based, company to add the test to the menu of array-based assays it currently offers to clinicians.
Life Technologies Licenses Stem Cell Assay Tech from Harvard
Life Technologies announced that it has signed a research agreement and licensing deal with Harvard University focused on stem cell assays. The firm said that it has acquired exclusive rights from Harvard to develop a panel of characterization assays designed to rapidly evaluate human pluripotent stem cells for their use in a variety of discovery and translational research applications. The panel is expected to be offered on Life Tech's Ion Torrent semiconductor sequencing platforms, as well as its PCR-based systems.
Alere Garners Up to $42.2M in Grants and Loans from Gates Foundation for POC MDx Platforms
Alere said that it has been awarded a grant of up to $21.6 million and debt financing of up to $20.6 million from the Bill and Melinda Gates Foundation to further develop a pair of point-of-care molecular testing platforms. Under the $21.6 million grant, Alere will develop a tuberculosis assay designed for use in both resource-poor and industrialized settings. The grant will also support Alere's efforts to incorporate one of its isothermal amplification technologies for TB detection on the Alere Q, a compact, portable device intended for molecular testing at the point of care.
Study Raises Questions Over Effectiveness of Recommended Genetic Testing Strategy for Inherited High Cholesterol
Research published Online First in The Lancet provides new evidence that a substantial proportion of individuals with a clinical diagnosis of Familial Hypercholesterolaemia (FH) inherit a combination of small-effect changes in several genes (polygenic) rather than a large-effect mutation in a single gene (monogenic). These findings have implications for the majority of national guidelines on family screening for FH, that advocate testing relatives of all individuals with a clinical diagnosis of FH, including those of the UK National Institute for Health and Clinical Excellence (NICE).
"Cascade [family] testing of the roughly 40% of patients with a clinical diagnosis of FH and an identifiable causative mutation would eliminate staff and screening costs associated with screening relatives of the remaining 60% of patients without an identifiable mutation. This is very likely to be more cost-effective, but proving this will require a more detailed analysis"*, says British Heart Foundation Professor Steve Humphries from University College London, who led the research.
Blood Culture Medium Affects Bacterial Detection, Recovery
The choice of which blood culture medium to use in detecting possible sepsis in trauma and emergency patients can make a difference in time to bacterial detection and recovery, according to an article published in the March 15 issue of Clinical Infectious Diseases.
MRI May Link Skin Salt to Hypertension
Move over kidneys, brain, and blood vessels because there may be a new organ involved in hypertension control – the skin. Not only does the skin store sodium that is possibly related to hypertension, but the amount of sodium can be assessed with an MRI scan, Peter Linz, PhD, from Friedrich-Alexander-University in Erlangen, Germany, and colleagues found.
Kids, Seniors Prone to MRSA Infections Depending on Season: Study
The threat posed to children and seniors by potentially deadly strains of antibiotic-resistant staph bacteria varies by season, new research finds. Children have a greater risk for infection with methicillin-resistant Staphylococcus aureus (MRSA) in summer while seniors have a greater risk in winter, according to the study published online Feb. 28 in the American Journal of Epidemiology.
UCSF Discovery a Potential "Earthquake" for Stem Cell Therapies
A new type of stem cell, discovered by UCSF researchers, may open new possibilities for fixing damaged parts of the body while sidestepping the politically and morally thorny issues surrounding embryonic stem cell research. What’s more, so-called endogenous pluripotent somatic, or ePS, cells could give rise to a new line of companies hoping to harness the potential therapeutic power of the discovery. Like embryonic stem cells, ePS cells have the ability to become several sorts of cells, such as those that make up the heart, skin, brain, pancreas and other organs.
Synthetic Peptide Fools Immune System
Researchers have created a molecule that helps nanoparticles evade immune attack and could improve drug delivery.
A synthetic molecule attached to nanoparticles acts like a passport, convincing immune cells to let the particles pass unimpeded through the body, according to a study published (February 21) in Science. The computationally designed “self”-peptide could be used to better target drugs to tumors, to ensure pacemakers are not rejected, and to enhance medical imaging technologies.
“It’s the first molecule that can be attached to anything to attenuate the innate immune system, which is currently limiting us from delivering therapeutic particles and implanting devices,” said Dennis Discher, a professor of biophysical engineering at the University of Pennsylvania and a coauthor of the study.
5 Psych Disorders Have Common Genetics
Autism, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, and schizophrenia share common genetic underpinnings -- despite differences in symptoms and course of disease, researchers discovered. In particular, single nucleotide polymorphisms (SNPs) in two genes involved in calcium-channel activity appear to play a role in all five, Jordan Smoller, MD, ScD, of Massachusetts General Hospital in Boston, and colleagues reported online in The Lancet. The findings come from a genome-wide analysis of 33,332 cases and 27,888 controls in what the authors described as the largest-ever genetic study of psychiatric illness. The results are "new evidence that may inform a move beyond descriptive syndromes in psychiatry and towards classification based on underlying causes," Smoller said in a statement.
New Clues to Epstein-Barr Virus
Epstein-Barr virus (EBV) affects more than 90 percent of the population worldwide and was the first human virus found to be associated with cancer. Now, researchers from Beth Israel Deaconess Medical Center (BIDMC) have broadened the understanding of this widespread infection with their discovery of a second B-cell attachment receptor for EBV.
"Our discovery that CD35 is an attachment receptor for EBV helps explain several previously unsolved observations," explains the study's senior author Joyce Fingeroth, MD, a member of the Division of Infectious Diseases at BIDMC and Associate Professor of Medicine at Harvard Medical School.
Man Infected With Smallpox-Like Virus Through Sex
A man in San Diego was infected with the vaccinia virus — the virus in the smallpox vaccine — in June, 2012 after having sexual contact with someone who'd recently been vaccinated, according to a new report from the Centers for Disease Control and Prevention.
What's more, the infected man also passed the virus along to another unvaccinated individual during sexual activity, a phenomenon known as tertiary transmission, the report said. The smallpox vaccine contains the live vaccinia virus, which is similar to smallpox but doesn't actually cause the disease. In 1972, the United States stopped vaccinating members of the public against smallpox because the disease had been eradicated. However, in 2002, the Department of Defense resumed smallpox vaccination for its military personnel and civilian employees.
In Medical First, a Baby With H.I.V. Is Deemed Cured
Doctors announced that a baby had been cured of an H.I.V. infection for the first time, a startling development that could change how infected newborns are treated and sharply reduce the number of children living with the virus that causes AIDS. The baby, born in rural Mississippi, was treated aggressively with antiretroviral drugs starting around 30 hours after birth, something that is not usually done. If further study shows this works in other babies, it will almost certainly be recommended globally. The United Nations estimates that 330,000 babies were newly infected in 2011, the most recent year for which there is data, and that more than three million children globally are living with H.I.V.
Flu breakthrough: New Drug Could Combat Flu Pandemic
Scientists have discovered a new drug that, in the lab models, has proven effective in preventing the spread of different strains of influenza, Australian top science institute CSIRO said Flu viruses spread by binding onto sugars on a cell's surface and then removing these sugars. The new drug prevents the virus from removing the sugar. If effective, the new drug could be a worldwide breakthrough. The World Health Organization reports influenza kills about 500,000 people every year, including tens of thousands every year in the United States.
In Prevention of Hospital-acquired Infection, Informatics Tools Are Underutilized
Advances in electronic medical record systems and health information exchange are shifting efforts in public health toward greater use of information systems to automate disease surveillance, but a study from the Regenstrief Institute has found that these technologies' capabilities are underutilized by those on the front lines of preventing and reporting infections. The new study measured the awareness, adoption and use of electronic medical record systems and health information exchange by hospital-based infection preventionists (formerly known as infection control professionals) to report and share information critical to public health
For Doctors, too Much Information?
What if your test results became just another electronic blip on your doctor’s busy radar?
A new research letter published in JAMA Internal Medicine finds just that: Electronic health records may cause doctors the unintended side effect of information overload. The survey of primary-care practitioners from the Department of Veterans Affairs shows nearly one-third of those using the EHR system reported having missed or failed to follow up on key electronic alerts about patient test results. The study suggests that’s because the primary-care practitioners were getting too many alerts from the VA’s EHR system. That system automatically generates a notification if a patient receives abnormal results from a lab or imaging test. The median number of alerts VA providers received was 63 per day.
More than half of those surveyed said the system, as it currently works, makes it possible for providers to miss test results. About 30 percent reported an incidence in which they missed patient test results — which resulted in delays in care for patients. Of course, doctors have plenty of trouble tracking masses of test results on faxes and paper, too. The research letter does not address the rate at which providers missed or overlooked test result information when using solely paper records for patients.
Upgrading Physician Websites for a Post-ACA World
Whether a practice is launching a website or rebuilding one, thanks to a changing health care landscape of the Affordable Care Act, the websites physicians need by 2014 will look much different from the ones online today. Today’s sites are little more than an electronic version of a Yellow Pages ad. In the near future, websites will need to do more than tell a visitor the practice’s address and phone number. They will be a key part of the physician-patient relationship. “There’s definitely a need for docs to get more out of their websites, which typically are static and rarely change,” said Susan Tellem, RN, partner at Tellem Grody Public Relations in Los Angeles.
Better Safeguards Urged for Medical Records
Hacking into patient medical records can be as easy as tapping into a hospital's unsecured wireless network from a laptop in the parking lot. Government auditors proved it "by sitting in hospital parking lots with simple laptop computers" and obtaining "patient information from unsecured hospital wireless networks," according to Julie K. Taitsman, M.D., J.D., and colleagues from the Office of the Inspector General at the Department of Health and Human Services (HHS). "Healthcare providers should follow best practices to ensure that computer networks are more secure," they wrote online in a Perspective piece in the New England Journal of Medicine. Nearly 300,000 Medicare beneficiary numbers have been compromised and are now being tracked by the Centers for Medicare and Medicaid Services, according to the article
For providers using mobile devices, the authors cited these recommendations from the Office of the National Coordinator for Health Information Technology:
- Use encryption, a password or other user authentication.
- Ensure wiping and/or remote disabling in case a device is stolen or lost.
- Don't use file-sharing. Do use firewalls.
- Use security software to detect viruses, spyware, malware, and keep it current.
- Don't download apps casually; research, them.
- Don't let your devices out of your control.
- Use security when using public Wi-Fi.
- Wipe devices clean before discarding them.
Computerized Provider Order Entry Cuts Medication Error Likelihood in Half
Processing a prescription through an electronic ordering system can reduce the likelihood of a drug error by half and avoid more than 17 million such incidents in U.S. hospitals in one year alone, according to a new study supported by AHRQ. The study authors, evaluated evidence on the impact of computerized provider order entry (CPOE) on hospital drug errors and combined this information with data on CPOE adoption and the volume of medication orders processed annually. They found that CPOE adoption reduced drug errors and concluded that CPOE could substantially reduce the annual number of those errors if widely implemented. Select to access the study, “Reduction in Medication Errors in Hospitals due to Adoption of Computerized Provider Order Entry Systems,” which was published online on February 20 in the Journal of the American Medical Informatics Association.
Source: AHRQ Electronic Newsletter - March 4, 2013 Issue #370
Meaningful Use Stage 2 Interoperability Criteria Training Course
Online Interoperability Criteria Training Course is Now Live
The State HIE Program Policy Office and the Regional Extension Center Program recently issued Interoperability Basics, a 75-minute online training course offering in-depth information to:
- define the Meaningful Use Stage 2 data exchange requirements,
- explain the necessary interoperability building blocks,
- outline the path to meeting the Stage 2 criteria, and
- highlight the effect of health data exchange on specific categories of care.
Doctors Who Sued EHR Company Win First Round
March 4, a group of doctors who are suing their electronic health record (EHR) manufacturer for selling them a "buggy" product and then discontinuing it learned that the defendant's motion to block the lawsuit and compel them to accept binding arbitration was overruled by a judge in Miami, the first step in getting a court date in what is believed to be a first-of-its-kind case.
At issue is the quality of the product the doctors were sold and the defendant's subsequent failure to support or improve it as promised. Anesthesiologist Robert J. Joseph, MD, of the Pain Clinic of Northwest Florida in Panama City, a plaintiff in the suit, makes no bones about it. "Our EHR is a piece of crap," he states.
Six HIT Heavy-Hitters Announce Interoperability Organization
Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth announce landmark partnership
Big news was made at HIMSS13 when, in an unprecedented collaboration, some health IT heavy-hitters joined forces in an effort to push the needle on interoperability. In announcing the launch of the CommonWell Health Alliance, executives from Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth touted what they say is a first-of-its-kind organization: a collaboration of rival vendors, uniting to enable care integration and data liquidity.
Healthcare Mergers Don't Improve Quality, Experts Warn
Hospital mergers and the monopolies they create are causing healthcare costs to rise without an accompanying improvement in quality, three experts argued during a panel hosted by the American Enterprise Institute in Washington, D.C. Incentives to create accountable care organizations (ACOs) could cause even more problems by encouraging additional consolidation, they warned.
Report: Kill Fee-For-Service by Decade's End
Fee-for-service payments to physicians should be eliminated by the end of this decade, fundamentally changing the way doctors are paid, according to a report released.
The National Commission on Physician Payment Reform called for replacing standalone fee-for-service with a blended payment system based on new delivery and reimbursement models.
As the healthcare system transitions from a fee-for-service model over the next 5 years, policymakers, providers, and insurers should consider:
- Including evaluation and management diagnostic codes, which are currently undervalued, in annual updates
- Eliminating higher payments for facility-based services that can be performed in a lower-cost setting
- Incorporating quality metrics into negotiated reimbursement rates of fee-for-service contracts
- Forming virtual relationships between small practices to share resources
- Including fixed payments where significant potential for cost savings exists such as care for people with multiple chronic conditions and in-hospital procedures and their follow-up
- Ensuring access to high-quality care and physician commitment for fixed payment models
Missed and Erroneous Diagnoses Common in Primary Care Visits
A large variety of common diseases are missed in the primary care setting, and according to a new study, almost 80% of these errors stem from breakdowns in the patient–practitioner clinical encounter. Most errors also have the potential to cause moderate to severe harm.
Hardeep Singh, MD, MPH, from Baylor College of Medicine in Houston, Texas, and colleagues published their medical record review online February 25 in JAMA Internal Medicine. Dr. Singh and colleagues developed automated "trigger tools" specifically to aid in the detection of diagnostic errors from electronic health records. The researchers acknowledge that although these trigger tools represent a significant improvement over traditional approaches of detecting diagnostic error, their study likely underestimates the full burden. "Diagnostic errors are associated with substantial harm at individual patient and public health levels, and their burden may be much greater than previously appreciated," David E. Newman-Toker, MD, PhD, and Martin A. Makary, MD, MPH, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, write in an accompanying invited commentary. "Trigger tools offer a promising means to measure the problem and explore the impact of error-reduction interventions.
Another Knock Against Doctors
The O Magazine is cautioning women that doctors' lack of genomics knowhow may harm their health. Citing a 2012 study by Arup Labs, which found that healthcare providers ordered the wrong genetic test approximately one-third of the time, reporter Cheryl Platzman Weinstock writes that although "research in the field of genetics has advanced at breakneck speed ... many doctors have little to no formal training in genetics, and that ... can lead to devastating mistakes." Increasing physicians' genomics education is undoubtedly a serious need.
Report: More Men Entering Nursing Profession
More men are pursuing nursing careers, according to a new study. The proportion of male registered nurses has more than tripled from 1970 to 2011, the study finds. A growing number of men are joining the ranks of nursing, finds a study that takes the pulse of a predominantly female profession. The percentage of male registered nurses jumped from 2.7% in 1970 to 9.6% in 2011.
PEPFAR's Successes Highlighted in New IOM Report
The President's Emergency Plan for AIDS Relief (PEPFAR) has saved and improved millions of lives worldwide and offered proof that HIV/AIDS services can be effectively delivered on a large scale even in countries with high rates of disease and resource constraints, says a new congressionally mandated evaluation conducted by the Institute of Medicine. Moving forward, PEPFAR needs to intensify efforts to help its partner countries develop the capacity to manage their own programs, sustain the gains that have been made in controlling the HIV epidemic, and improve their citizens' access to services, said the committee that wrote the report.
Europe Drops $190M Into Rare Disease Research Projects
The European Commission said that it has pumped €144 million ($188 million) into a number of new research projects that will target rare diseases, including 'omics-centered studies and efforts to understand the genetic diseases and develop personalized strategies for treating and managing them. The funding will support 26 research projects in 29 countries and involve more than 300 participants at academic institutions and patients' groups and in the business community who will share knowledge and resources to address rare diseases. A number of these wide-ranging projects will support the International Rare Diseases Research Consortium, an initiative launched by the EC, the National Institutes of Health, and other partners that seek to deliver 200 therapies and diagnostics for rare diseases by the year 2020.
Austrian Lab Accredited for NGS-based HLA Testing
The Red Cross Blood Transfusion Service of Upper Austria said it has been accredited by the European Federation for Immunogenetics for the use of human leukocyte antigen tests based on next-generation sequencing on Roche's GS Junior system.
The method provides more precise and rapid tissue-typing and donor selection for stem cell transplants, the laboratory said. The HLA testing had been use only for research, but will now be available as "a standard routine diagnostic procedure," it added.
Disclaimer- The information provided in this news digest is intended only to be general summary information. It does not represent the official position of the Centers for Disease Control and Prevention and is not intended to take the place of applicable laws or regulations.
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