Cartoon – Close to a Breakthrough
Monthly Archives: February 2018
Cartoon – Historical Perspective on Innovation
Sepsis: the Achilles’ heel of health care
As health care systems look to lower costs and improve patient outcomes, controlling sepsis is a great place to start. Ignoring that opportunity is a huge mistake.
Sepsis is caused by the body’s exuberant response to an infection. It is the No. 1 inpatient hospital expense in the United States, with costs tripling over the last decade to $27 billion. Nearly half of all hospital deaths are caused by sepsis. And the problem is growing — it’s now one of the top five causes of hospitalization in age groups over 18. This is why a comprehensive plan to detect, treat, and prevent sepsis must be an essential pillar of any serious effort to improve care and drive down costs.
When a patient spikes a fever for an unknown reason, doctors usually send blood samples to be cultured. But it can take an enormously long time — up to six days — to get the results. In addition, these cultures miss 35 percent to 50 percent of infections.
Given the possible delay and uncertainty of blood cultures, if a patient is at high risk for sepsis, his or her clinician will immediately prescribe antibiotics. Doctors know that this represents overtreatment, since sepsis can be indistinguishable from other less-serious health concerns. But you can’t guess wrong if you suspect sepsis, because a patient’s risk of dying rises as much as 8 percent per hour if the infection is improperly treated.
If the patient does not respond to the antibiotic and the fever does not break after 12 to 24 hours, clinicians usually switch to a different antibiotic, and then maybe another, and then possibly to an antifungal drug.
Hospitals are getting better at combating sepsis. Doctors and nurses across the country have done incredible work to improve sepsis awareness. They are preventing more sepsis-causing infections before they ever occur, and they are reaching for antibiotics quicker when sepsis is suspected.
Yet advances in sepsis treatment protocols are fueling another massive health care issue: the rise of drug resistance and superbugs. On the individual level, even one exposure to an antimicrobial drug can reduce the therapy’s effectiveness for that same patient later on. The overuse of antibiotics and other antimicrobial drugs also kills beneficial bacteria and microbes, which can weaken the immune system and lead to hospital readmission. On the global level, drug-resistant infections are predicted to kill more than 10 million people per year by 2050.
To solve the sepsis problem, we need a three-pronged solution: continued improvements in hospital processes to prevent sepsis; improved diagnostics to get patients on targeted treatment faster; and development of new antibiotics.
Hospitals need to aggressively pursue sepsis initiatives. Huntsville Hospital in Alabama is one of many hospitals on the leading edge of refining their processes around sepsis. Clinicians at Huntsville went on the offense, catching suspected sepsis cases early, improving protocols and education, and creating clinical teams focused on sepsis. The result was a reduction of sepsis mortality by more than 50 percent and a significant decrease in hospital readmissions.
Improving the detection of sepsis is bounded by the limitations of current diagnostic tools. The current standard of care for diagnosing sepsis has remained the same since the 1930s — the lengthy process of culturing blood to detect infection-causing organisms. Diagnostic companies must provide new breakthrough technologies to minimize the one- to six-day dark period in which clinicians work without strong diagnostic information. Without better diagnostic tools, solutions to improve sepsis care and fight drug resistance will remain on a collision course.
Our team at T2 Biosystems is one of many trying to support hospitals in this effort by developing blood tests that can detect the microbes that cause sepsis within hours, not days, and with more than 90 percent sensitivity. Instead of culturing blood, our tests use magnetic resonance technology to identify microbes directly in blood, a much faster approach.
Finally, we need to develop new drugs to combat sepsis. While antimicrobial resistance limits the effectiveness of many existing drugs, the number of new ones to address this problem have dwindled in recent years. We must accelerate clinical trials to develop and release antimicrobial drugs faster and help clinicians apply the best one to the right patient at the right time.
For too long, combating sepsis has been an unspoken problem in health care, taking lives and driving up costs. With thousands of lives and billions of dollars at stake, it is time to place a greater emphasis on new models for sepsis prevention, detection, and treatment.
Court sets speedy 340B lawsuit schedule, siding with AHA
https://www.healthcaredive.com/news/court-sets-speedy-340b-lawsuit-schedule-siding-with-aha/515988/
Dive Brief:
- The American Hospital Association and other parties’ request for an expedited brief schedule for the group’s lawsuit over CMS cuts to the 340B program was agreed to by the U.S. Court of Appeals for the District of Columbia Circuit Tuesday, despite the government’s request for more time to respond to the lawsuit.
- U.S. District Judge Rudolph Contreras dismissed the initial lawsuit in December, saying the groups did not have standing to sue because the cuts hadn’t yet taken effect. On January 11, AHA and the other groups appealed the decision, and then asked the court to expedite the case citing the immediate impact the cuts have on 340B hospitals’ ability to provide services to underserved communities.
- Attorneys for the Department of Justice argued the compressed briefing schedule would not give adequate time for the government to prepare its brief and coordinate with affected agencies.
Dive Insight:
The lawsuit concerns a HHS final rule that took effect at the start of the year changing the amount 340B hospitals are paid for drugs to 22.5% less than the average sales price. Last year, hospitals paid the average price plus 6%.
“America’s hospitals and health systems are pleased that the U.S. Court of Appeals has accepted our expedited brief schedule in our appeal to reverse the significant cuts to the 340B Drug Savings Program, which for over 25 years has played a vital role in helping hospitals stretch scarce federal resources to expand and enhance patient services and access to care for vulnerable communities without any cost to the government,” Melinda Hatton, general counsel for the American Hospital Association, told Healthcare Dive.
AHA is joined in the lawsuit by America’s Essential Hospitals, the Association of American Medical Colleges, Eastern Maine Healthcare Systems (Brewer, Maine), Henry Ford Health System (Detroit) and Adventist Health System’s Park Ridge Health (Henderson, North Carolina).
The groups argue the cuts will hurt 340B hospitals’ budgeted operations, bond covenants and other items necessary to provide community care, and say the reimbursement change exceeds HHS’ authority.
“For 340B hospitals, the ability to provide care to their communities is tied to receipt of third-party reimbursements; constriction in the flow of Medicare revenues to 340B hospitals will increasingly constrict funds for medical care for all their patients, most particularly those who are poor and underserved and most reliant on these services,” the groups wrote in their request to expiate the appeal brief schedule.
AHA noted that it is actively exploring other options to address the cuts.
“We will continue to pursue our legislative and legal strategies to reverse these cuts, and expect to prevail in holding the agency accountable for overstepping its authority,” Hatton said.
The Court of Appeals set the the brief schedule to conclude by April 2, appearing to allow AHA’s request that oral arguments to occur by May, prior to the summer recess. “Otherwise the next opportunity for argument would be in September, which would likely significantly delay the resolution of this action,” the plaintiff attorneys had argued.
How Are Health Centers Responding to the Funding Delay?
Health centers play an important role in our health care system, providing comprehensive primary care services as well as dental, mental health, and addiction treatment services to over 25 million patients in medically underserved rural and urban areas throughout the country. Health care anchors in their communities and on the front lines of health care crises, including the opioid epidemic and the current flu outbreak, health centers rely on federal grant funds to support the care they provide, particularly to patients who lack insurance coverage. However, the Community Health Center Fund (CHCF), a key source of funding for community health centers, expired on September 30, 2017, and has since been extended through only March 31, 2018. The CHCF provides 70% of grant funding to health centers. With these funds at risk, health centers have taken or are considering taking a number of actions that will affect their capacity to provide care to their patients. This fact sheet presents preliminary findings on how health centers are responding to the funding uncertainty.
WHAT FUNDING IS AT STAKE FOR HEALTH CENTERS
The Community Health Center Fund represents 70% of federal grant funding for health centers. Established by the Affordable Care Act, the CHCF increased federal grant fund support for health centers, growing from $1 billion in 2011 to $3.6 billion in 2017.1Authorized for five years beginning in 2010, and extended for two years through September 2017, the CHCF also provided a more stable source of grant funding for health centers that was separate from the annual appropriations process. Prior to the CHCF, federal 330 grant funds were appropriated annually. In fiscal year 2017, federal section 330 grant funding totaled $5.1 billion, $3.6 billion from the CHCF and $1.5 billion from the annual appropriation.
Federal health center grants represent nearly one-fifth of health center revenues. Federal Section 330 grant funds are the second largest source of revenues for health centers behind revenues from Medicaid. Overall, 19% of health center revenues (including US territories) come from federal grants; however, reliance on 330 grant funds varies across health centers. Federal grant funds are especially important for health centers in southern and rural non-expansion states where Medicaid accounts for a smaller share of revenue (Figure 1).2 These funds finance care for uninsured patients and support vital services, such as transportation and case management, that are not typically covered by insurance
HOW ARE HEALTH CENTERS RESPONDING TO THE LOSS OF FEDERAL FUNDS?
Health centers have taken or are considering taking a number of actions that will affect their ability to serve their patients. Overall, seven in ten responding health centers indicated they had taken or planned to take action to put off large expenditures or curtail expenses in face of reduced revenue. Some of these actions involve delaying or canceling capital projects and other investments or tapping into reserve funds. Other actions, however, have or will reduce the number of staff or the hours they work, which may in turn, affect the availability of services. Already 20% of health centers reported instituting a hiring freeze and 4% have laid off staff. Another 45% are considering a hiring freeze and 53% said they might lay off staff. While health centers seemed to focus on shorter-term actions that could easily be reversed were funding to be restored, 3% of responding health centers had already taken steps to close one or more sites and an additional 36% indicated they are considering doing so
ACA marketplace enrollment has beat expectations
Even with final numbers not yet in from several states, it’s fair to say that ACA marketplace enrollment has beat expectations.
More than 50 groups push Congress to extend Medicare programs
More than 50 groups push Congress to extend Medicare programs
More than 50 health-care organizations are urging Congress to quickly pass a package of Medicare extenders, ideally in an upcoming short-term spending bill, arguing the delay could hurt seniors.
“Now that we are well into 2018, Congress’ inaction on these important Medicare policies could mean real harm to the vulnerable patients we serve,” the groups, including the Caregiver Action Network, Medicare Rights Center and National Partnership for Hospice Innovation, wrote in a letter sent Friday to Republican and Democratic leaders.
Several Medicare programs expired last year. Other health-care programs in need of a long-term funding renewal include special diabetes programs and the community health centers that serve the nation’s most vulnerable.
The last stop-gap spending bill came on the heels of a three-day government shutdown and included funding for the Children’s Health Insurance Program. Senate Majority Leader Mitch McConnell (R-Ky.) predicted Thursday that the government wouldn’t shut down again, as Congress will race to keep the government’s lights on when it returns next week.
Short-term funding legislation hasn’t been released, and it’s unclear if extensions of health programs will make it into the final product.
Lawmakers near deal on funds for community health centers
Funding for community health centers could finally pass in the coming week as Congress faces a new government funding deadline.
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) told The Hill on Friday that lawmakers “hope” to add money for the health centers to the short-term spending bill to be considered before a Feb. 8 deadline for funding the government.
Funding for the health centers, which serve millions of primarily poor people, has been delayed for months, causing uncertainty and in some cases hiring freezes or other steps.
Lawmakers are considering providing two years of funding.
In addition, a number of other health-care items could ride on the next government funding bill, or wait until a longer-term deal in a few weeks. A range of Medicare programs known as “extenders” need to be renewed, for example.
There is also the more controversial issue of actions aimed at stabilizing the ObamaCare marketplaces.
Momentum appears to be increasing for funding known as reinsurance that is aimed at reducing premiums.
Walden is backing a bill to provide the funding in the House, and Sen. Susan Collins (R-Maine) has been pushing for a similar measure in the Senate.
There is still some uncertainty and many conservatives deride the funding as a “bailout” of ObamaCare insurers.
Any action on ObamaCare stabilization appears more likely to wait as lawmakers try to craft a longer-term government funding deal by March.
Congressional committees are stepping up their efforts to examine the opioid epidemic.
On Tuesday, the House Ways and Means Committee will hold a hearing on preventing opioid abuse through Medicare. On Thursday, the Senate health committee will hold a hearing on the effects of opioid abuse on children and families.
Later in February, the House Energy and Commerce Committee will begin holding hearings to examine specific legislation related to the crisis.
Cartoon – Are You a Late Adopter?
Cartoon – Definition of Change
HENRY KOTULA 