Hospitals and imaging centers forced to limit scans amid IV contrast shortage

 Due to global shortages of iohexol and iodixanol, contrast media products injected into patients during CT scans and other commonly used diagnostic imaging studies, some providers are having to postpone non-emergency imaging.

GE Healthcare, one of two major suppliers of contrast media in the US, has experienced manufacturing disruptions at its Shanghai facility amid China’s COVID lockdowns, and the company estimates the shortages could last through June. It is increasing production at an Ireland factory, and shipping via air cargo to the US, to speed up delivery.

The Gist: This shortage will have wider ranging impacts than just
delayed imaging procedures, as so many treatment decisions rely on the results of imaging tests. Contrast fluids are also used for vascular imaging, heart catheterization, and spinal interventions. A prolonged shortage could have far-reaching implications, limiting doctors’ ability to plan surgeries, monitor cancer progression, and perform imaging-guided treatments. 

Like so many recent supply shortages, this latest one shines a spotlight on providers’ “just-in-time” supply chain, and their over-reliance on single-source vendors.

Walmart to expand health centers to Arkansas this month

Walmart Opening More Healthcare 'Super Centers'

Walmart will open two more standalone health clinics this month, including a site in Arkansas, the company said June 17.

The health clinics, called Walmart Health, will offer primary care, imaging, lab, dental and behavioral health services. 

The health clinics opening this month will be in Loganville, Ga., and Springdale, Ark. The Loganville Walmart Health opened June 17. The first Arkansas location will open June 24.

The company already has clinics in the Georgia cities of Dallas and Calhoun.

Walmart said it believes that expanding the standalone clinics will help bring affordable, quality healthcare to more Americans, because 90 percent of them live within 10 miles of a Walmart store. 

“Patients have responded favorably to our low, transparent pricing for key healthcare services, regardless of insurance status,” Walmart’s senior vice president of health and wellness, Sean Slovenski wrote in a blog post. “They’re also appreciative of the convenience of our facilities that offer primary and urgent care, labs, X-ray and diagnostics, counseling, dental, optical and hearing services, all in one central facility.”





Dubai’s Super-Ambulance Is a Mini Hospital-on-Wheels with an Operating Room and X-Ray Unit

Dubai’s Super-Ambulance Is a Mini Hospital-on-Wheels with an Operating Room and X-Ray Unit

Dubai is proud to introduce its impressive fleet of the “world’s largest ambulances,” or “Mercedes-Benz large-capacity ambulances” which were created to give rapid medical assistance in the event of major emergencies with large numbers of causalities. These new emergency vehicles offer a fully-equipped, mobile clinic with an intensive-care unit and an operating room.

Equipped with an X-ray unit and ultrasonic equipment for further evaluation, each super ambulance bus carries 12,000 liters of oxygen, which ensures a dependable supply for up to three days. With the press of a button, oxygen masks fall from special holders, and the oxygen flow to each mask can be individually controlled.

They’re also equipped with an ECG and an InSpectra shock monitor, which monitors the oxygen saturation in tissue-matter and warns doctors of the onset of shock minutes before it occurs. This unit can also detect and monitor internal bleeding. If an emergency caesarian birth is needed, essential obstetrical instruments, including an incubator, are on board.





Geisinger taps Siemens as strategic partner to provide diagnostic imaging, AI applications

Geisinger taps Siemens as strategic partner to provide diagnostic ...

Geisinger Health System has inked a 10-year technology agreement with Siemens Healthineers to access diagnostic imaging equipment and artificial intelligence applications.

The Danville, Pennsylvania-based health system said the partnership will advance and support elements of its strategic priorities related to continually improving care for their patients, communities and the region.

The medical technology company will provide Geisinger access to its latest digital health innovations, diagnostic imaging equipment and on-site staff to support improvements. Education and workflow resources will also be available, which will provide Geisinger staff with the ability to efficiently make decisions and continually optimize workflows, the companies said.

Siemens provides AI-based radiology software that analyzes chest CT scans, brain MRIs and other images as well as AI-based clinical decision support tools and services to help advance digitization.

Financial terms of the deal were not disclosed.

“By expanding our relationship with Geisinger, this becomes one of the largest value partnership relationships in North America and will allow us to work together to improve the patient experience for residents of Pennsylvania and the region,” said David Pacitti, president and head of the Americas for Siemens Healthineers, in a statement.

“Making better health easier by bringing world-class care close to home is central to everything we do at Geisinger,” said Matthew Walsh, chief operating officer at Geisinger. “This partnership will allow us to continue to equip our facilities with the most advanced diagnostic imaging technology in the market to care for our patients.”

Michael Haynes, associate vice president of operations, Geisinger Radiology, said the collaboration with Siemens will enable the health system to identify and respond to health concerns more quickly.

Geisinger operates 13 hospitals across Pennsylvania and New Jersey as well as a 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. 

Partnerships between health systems and tech companies are becoming fairly common as the healthcare industry pushes forward to use data analytics, AI and machine learning to improve clinical diagnosis and better predict disease.

Mayo Clinic announced a high-profile, 10-year strategic partnership with Google in September to use advanced cloud computing, data analytics, machine learning and AI to advance the diagnosis and treatment of disease.

Providence St. Joseph Health inked a multiyear strategic alliance with Microsoft to modernize its health IT infrastructure and leverage cloud and AI technologies.





ICUs become a ‘delirium factory’ for Covid-19 patients

ICUs Become A 'Delirium Factory' For COVID-19 Patients | Health ...

Doctors are fighting not only to save lives from Covid-19, but also to protect patients’ brains.

Although Covid-19 is best known for damaging the lungs, it also increases the risk of life-threatening brain injuries — from mental confusion to hallucinations, seizures, coma, stroke and paralysis. The virus may invade the brain, and it can starve the brain of oxygen by damaging the lungs. To fight the infection, the immune system sometimes overreacts, battering the brain and other organs it normally protects.
Yet the pandemic has severely limited the ability of doctors and nurses to prevent and treat neurological complications. The severity of the disease and the heightened risk of infection have forced medical teams to abandon many of the practices that help them protect patients from delirium, a common side effect of mechanical ventilators and intensive care.
And while Covid-19 increases the risk of strokes, the pandemic has made it harder to diagnose them.
When doctors suspect a stroke, they usually order a brain MRI — a sophisticated type of scan. But many patients hospitalized with Covid-19 are too sick or unstable to be wheeled across the hospital to a scanner, said Dr. Kevin Sheth, a professor of neurology and neurosurgery at the Yale School of Medicine.
Many doctors also hesitate to request MRIs for fear that patients will contaminate the scanner and infect other patients and staff members.
“Our hands are much more tied right now than before the pandemic,” said Dr. Sherry Chou, an associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine.
In many cases, doctors can’t even examine patients’ reflexes and coordination because patients are so heavily sedated.
“We may not know if they’ve had a stroke,” Sheth said.
study from Wuhan, China — where the first Covid-19 cases were detected — found 36% of patients had neurological symptoms, including headaches, changes in consciousness, strokes and lack of muscle coordination.
“Our hands are much more tied right now than before the pandemic,” said Dr. Sherry Chou, an associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine.
In many cases, doctors can’t even examine patients’ reflexes and coordination because patients are so heavily sedated.
“We may not know if they’ve had a stroke,” Sheth said.
smaller, French study observed such symptoms in 84% of patients, many of which persisted after people left the hospital.
Some hospitals are trying to get around these problems by using new technology to monitor and image the brain.
New York’s Northwell Health is using a mobile MRI machine for Covid patients, said Dr. Richard Temes, the health system’s director of neurocritical care. The scanner uses a low-field magnet, so it can be wheeled into hospital rooms and take pictures of the brain while patients are in bed.
Staffers at Northwell were also concerned about the infection risk from performing EEGs, tests that measure the brain’s electrical activity and help diagnose seizures, Temes said. Typically, technicians spend 30 to 40 minutes in close contact with patients in order to place electrodes around their skulls.
“Right now, we actually don’t know enough to say definitely how Covid-19 affects the brain and nervous system,” said Chou, who is leading an international study of neurological effects of the virus. “Until we can answer some of the most fundamental questions, it would be too early to speculate on treatments.”
To reduce the risk of infection, Northwell is using a headband covered in electrodes, which can be placed on patients in just a couple of minutes, he said.

The brain under attack

Answering those questions is complicated by the limited data from patient autopsies, said Lena Al-Harthi, a professor and the chair of the microbial pathogens and immunity department at Rush Medical College in Chicago.
But many neuropathologists are unwilling or unable to perform brain autopsies, Al-Harthi said.
That’s because performing autopsies on patients who died of Covid-19 carries special risks, such as the aerosolization of the virus during brain removal. Pathologists need specialized facilities and equipment to conduct an autopsy safely.
Some of the best-known symptoms of Covid-19 might be caused by the virus invading the brain, said Dr. Robert Stevens, an associate professor of anesthesiology and critical care medicine at Johns Hopkins University.
Authors of a recent study from Germany found the novel coronavirus in patients’ brains.
Research shows that the coronavirus may enter a cell through a molecular gateway known as the ACE-2 receptor. These receptors are found not only in the lung, but also other organs, including many parts of the brain.
In a recent study, Japanese researchers reported finding the novel coronavirus in the cerebrospinal fluid that surrounds the brain and spinal cord.
Some of the most surprising symptoms of Covid-19 ― the loss of the senses of smell and taste ― remain incompletely understood, but may be related to the brain, Stevens said.
A study from Europe published in May found that 87% of patients with mild or moderate Covid-19 lost their sense of smell. Patients’ loss of smell couldn’t be explained by inflammation or nasal congestion, the researchers said. Stevens said it’s possible that the coronavirus interacts with nerve pathways from the nose to the brain, potentially affecting systems involved with processing scent.
new study in JAMA provides additional evidence that the coronavirus invades the brain. Italian researchers found abnormalities in an MRI of the brain of a Covid-19 patient who lost her sense of smell.
Many coronavirus patients also develop “silent hypoxia,” in which they are unaware that their oxygen levels have plummeted dangerously low, Stevens added.
When hypoxia occurs, regulatory centers in the brain stem — which control respiration — signal to the diaphragm and the muscles of the chest wall to work harder and faster to get more oxygen into the body and force out more carbon dioxide, Stevens said. The lack of this response in some patients with Covid-19 could indicate the brain stem is impaired.
Scientists suspect the virus is infecting the brain stem, preventing it from sending these signals, Temes said.

Collateral damage

Well-intentioned efforts to save lives can also cause serious complications.
Many doctors put patients who are on mechanical ventilators into a deep sleep to prevent them from pulling out their breathing tubes, which would kill them, said Dr. Pratik Pandharipande, chief of anesthesiology and critical care medicine at Vanderbilt University School of Medicine in Nashville, Tennessee.
Both the disease itself and the use of sedatives can cause hallucinations, delirium and memory problems, said Dr. Jaspal Singh, a pulmonologist and critical care specialist at Atrium Health in Charlotte, North Carolina.
Many sedated patients experience terrifying hallucinations, which may return in recovery as nightmares and post-traumatic stress disorder.
Research shows 70% to 75% of patients on ventilators traditionally develop delirium. Delirious patients often “don’t realize they’re in the hospital,” Singh said. “They don’t recognize their family.”
In the French study in the New England Journal of Medicine, one-third of discharged Covid-19 patients suffered from “dysexecutive syndrome,” characterized by inattention, disorientation or poorly organized movements in response to commands.
Research shows that patients who develop delirium — which can be an early sign of brain injury — are more likely to die than others. Those who survive often endure lengthy hospitalizations and are more likely to develop a long-term disability.
Under normal circumstances, hospitals would invite family members into the ICU to reassure patients and keep them grounded, said Dr. Carla Sevin, director of the ICU Recovery Center, also at Vanderbilt.
Simply allowing a family member to hold a patient’s hand can help, according to Dr. Lee Fleisher, chair of an American Society of Anesthesiologists committee on brain health. Nurses normally spend considerable time each day orienting patients by talking to them, reminding them where they are and why they’re in the hospital.
“You can decrease the need for some of these drugs just by talking to patients and providing light touch and comfort,” Fleisher said.
These and certain innovative practices — such as helping patients to move around and get off a ventilator as soon as possible — can reduce the rate of delirium to 50%.
Hospitals have banned visitors, however, to avoid spreading the virus. That leaves Covid-19 patients to suffer alone, even though it’s well known that isolation increases the risk of delirium, Fleisher said.
Although many hospitals offer patients tablets or smartphones to allow them to videoconference with family, these devices provide limited comfort and companionship.
Doctors are also positioning patients with Covid-19 on their stomachs, rather than their backs, because a prone position seems to help clear the lungs and let patients breathe more comfortably.
But a prone position also can be uncomfortable, so that patients need more medication, Pandharipande said.
All of these factors make coronavirus patients extremely vulnerable to delirium. In a recent article in Critical Care, researchers said the intensive care unit has become a “delirium factory.”
“The way we’re having to care for patients right now is probably contributing to more mortality and bad outcomes than the virus itself,” said Dr. Sharon Inouye, a geriatrician at Harvard Medical School and Hebrew SeniorLife, a long-term care facility in Boston. “A lot of the things we’d like to do are just very difficult.”

CMS rolls back more Medicare, telehealth regs for providers working through pandemic


How Telemedicine Is Changing Healthcare

Dive Brief:

  • CMS issued a another round of sweeping regulatory rollbacks Thursday that will temporarily change how some providers care for patients and get compensated during the ongoing pandemic.
  • Practitioners such as therapists previously restricted from providing telehealth services for reimbursement can now do so, and CMS is also upping payments for telephone-only telehealth visits. Accountable care organizations also scored a major win in the Thursday rule drop, with CMS pledging they wouldn’t be dinged financially for lower-than-expected health outcomes in their patient populations from COVID-19.​
  • Other major changes are related to COVID-19 testing for Medicare and Medicaid beneficiaries. A written practitioner’s order is no longer needed for diagnostic testing for Medicare payment purposes. The agency also said it will cover serology, or antibody testing, including certain FDA-authorized tests that patients self-collect at home.

Dive Insight:

The new rules come out of the recent public health emergency declaration, building on others announced in late March and early April. This round of changes, which take effect immediately, focuses on expanding testing capacity to help reopen the U.S. economy, according to CMS, along with delivering expanded care to seniors.

Major provider lobbies the American Hospital Association and American Medical Association praised the changes, noting that Medicare patients have been canceling needed medical appointments because of physical distancing and transportation challenges.

The Trump administration, which allowed traditional Medicare to temporarily cover telehealth in March, continues to expand virtual care access. CMS is expanding the types of specialists allowed to provide telehealth services for reimbursement to include physical therapists, occupational therapists, speech language pathologists and others. In the past, only doctors, nurse practitioners, physician assistants and certain others could do so.

Earlier changes included waiving the video requirement for telehealth patients without access to interactive audio-video technology – particularly those in rural areas. CMS is increasing payments for telephone visits from a range of about $14-$41 to about $46-$110, according to the release.

The rollbacks are a “major victory for medicine that will enable physicians to care for their patients, especially their elderly patients with chronic conditions who may not have access to audio-visual technology or high-speed Internet,” the AMA said.

Michael Abrams, managing partner of Numerof & Associates, a healthcare consulting firm, said the current, rapid adoption of telehealth is an experiment, and depending on the results, waivers could eventually become permanent.

“Once you increase pricing, you almost never roll it back,” Abrams said. “If this new pricing on telehealth visits makes it more attractive, attractive enough to substitute telehealth for in-office visits, that not only lowers the cost of care, but makes it very much more accessible, particularly for those whose ability to see a physician is limited.”

In a victory for ACOs, CMS said the value-based organizations wouldn’t incur any financial penalties because of COVID-19 testing and treatment for their patient populations. Roughly 60% of ACOs said previously they were likely to drop out of their risk-based model to avoid potential losses, according to the National Association of ACOs.

CMS is also allowing ACOs to remain at the same level of risk for another year, instead of bumping them up to the next risk level. NAACOs said it was “appreciative” of the changes in a statement, though they asked for additional relief for providers in two-sided risk arrangements.

Other loosened restrictions include those on who can administer COVID-19 diagnostic tests for payment to include any healthcare professional authorized to do so under state law, including pharmacists. Medicare and Medicaid recipients can now get tested at parking lot sites operated by pharmacies and other entities for reimbursement.

Outpatient hospital services such as wound care, drug administration, and behavioral health services can now be delivered in temporary expansion locations, including parking lot tents, converted hotels or patients’ homes for reimbursement, so long as they’re temporarily designated as part of a hospital.

Hospital outpatient departments that relocate off-campus are paid at lower rates under current law, but CMS is making a temporary exception to continue paying those physicians at their standard rates.

The agency will also pay for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patient homes.

CMS is also now requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities.




“I’ll take my chances with breast cancer”

Local Health Officials Prepared for Coronavirus - Social Security ...

It’s entirely understandable that consumers would be reticent to visit in-person care settings right now. Given that doctors’ offices and urgent care facilities are where sick people congregate, a patient might well assume their chances of contracting COVID-19 would be higher there than in almost any other public space. But a story we heard this week from a health system chief strategy officer (CSO) reveals just how frightened patients may be to return.

Last week the system began to reach out to patients who had positive screening mammograms in February, before elective procedures and tests were cancelled, and who now needed to return for more detailed diagnostic images. A full 75 percent of these patients were unwilling to schedule a diagnostic mammogram within the next month, with one patient even saying, “I’ll take my chances with breast cancer over COVID!”.

Women with a concerning mammogram finding are typically among the most motivated patients in seeking follow-up care. If a majority of them are unwilling to pursue in-person follow-up, the same will likely be true of scores of patients with other possible cancers, heart disease, and other serious conditions. As fear delays needed care, patients are likely to end up much sicker, with more advanced disease, when they do return. With rigorous attention to symptom and temperature screening, visiting a doctor’s office should be less risky than going to the grocery store—but providers will have to publicly communicate the steps they are taking to keep patients safe before many will be willing to come in the door.





Quest Diagnostics furloughing 4,000 employees

Quest Diagnostics is a monopoly, schemed with insurers, California ...

Quest Diagnostics, the commercial lab that has performed about 800,000 COVID-19 tests, is furloughing more than 4,000 employees, which is about 9 percent of its workforce, CBS News reports.

Demand for COVID-19 testing has only partially offset a sharp drop in business for the company, according to CEO Steve Rusckowski.

The Secaucus, N.J.-based company has so far performed about 800,000 COVID-19 tests, making up about 40 percent of all testing done by commercial labs in the U.S. The company can process 45,000 diagnostic tests per day. 

But, Quest saw its overall testing volumes drop by more than 40 percent in the last two weeks of March, CBS News reported.

In addition to the furloughs, members of the company’s executive board are all taking 25 percent pay cuts for the next 12 weeks and other employees’ salaries are being cut between 5 percent and 20 percent. 

Quest has also suspended 401(k) matching for its employees and is dismissing temporary contract workers. 

The company said its cost-cutting efforts won’t impact COVID-19 testing.

Read the full article here.




Congress releases $8.3B coronavirus funding package. Here’s what’s in it

Image result for Congress releases $8.3B coronavirus funding package. Here's what's in it

Congress is expected to pass a major $8.3 billion spending package to help providers and local governments handle the spread of the coronavirus and to boost the development of vaccines and tests of the virus.

Here are key parts of the spending package released Wednesday:

  • $500 million for an emergency telehealth waiver. The bill would waive certain Medicare restrictions for telehealth, including that a Medicare beneficiary can use telehealth services even if they aren’t in a rural community. “This provision would also allow beneficiaries to receive care from physicians and other practitioners in their homes,” a summary of the package said;
  • $2.2 billion to the Centers for Disease Control and Prevention to help state and local health agencies. The funding would include a provision to reimburse state or local costs for coronavirus response and preparedness activities from Jan. 20 to the end of this supplemental;
  • Nearly $1 billion to buy drugs and medical supplies. This procurement will include $500 million for drugs, masks and personal protective equipment that can be distributed to state and local health agencies in areas that are in shortage. It also includes funding for increasing the supply of biocontainment beds, which are secured areas used for patients with highly contagious diseases; and
  • More than $3 billion to support the research and development of vaccines, diagnostics and other treatments for the coronavirus. Any vaccine or diagnostic developed via taxpayer funds must also “be available for purchase by the federal government at a fair and reasonable price,” the summary said. The bill also enables the Department of Health and Human Services to ensure any vaccine or diagnostic can be affordable in the commercial market, but doesn’t elaborate on how.

The package sailed through the House on Wednesday and could be taken up quickly by the Senate.

Provider groups bracing for a coronavirus outbreak praised the spending package.

“This bill will provide essential assistance to caregivers and communities on the front lines of this battle,” said Chip Kahn, president and CEO of the Federation of American Hospitals, in a statement.