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August 27, 2015   Download print version

Ob-gyn group advises on spotting dangerous pregnancy complication

Medicare fraud is committed well beyond U.S. borders

Vomit machine shows why Norovirus spreads so fast

Wary of Medicaid overcharging, Gov. Scott orders hospital audits

With mergers, concerns grow about private Medicare

Regular use of aspirin, NSAIDs may reduce risk of colon cancer

UK Sunshine Rule for tackling healthcare lobbying corruption needs clarity, says GlobalData analyst

Testers find twice as many ‘superbugs’ in conventional hamburger as organic ones


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Self Study Series:
September 2015

CQI in device decontamination: the role of washer indicators

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Ob-gyn group advises on spotting dangerous pregnancy complication

Preeclampsia -- a condition where blood pressure in a pregnant woman can rise to life-threatening levels -- is a key complication obstetricians try and predict early in pregnancy.

While commercial tests are being marketed for use in the first trimester to predict the risk of early onset preeclampsia, new recommendations from the American College of Obstetricians and Gynecologists (ACOG) say there's a lack of evidence that the tests offer any benefits, and they may do more harm than good.

Instead, ACOG is holding to its position that taking a detailed medical history to assess a woman's risk factors in the first trimester is still the recommended screening approach for early-onset preeclampsia.

This approach should remain the only method of screening for preeclampsia until studies can prove that aspirin or other treatments reduce the incidence of preeclampsia among women who are considered at high risk, based on predictive tests conducted in the first trimester, ACOG said.

Preeclampsia occurs in 5 percent to 10 percent of pregnancies and can lead to preterm birth, complications and death in mothers, and also increase women's long-term risk of heart disease, the group noted. (HealthDay) Visit NIH for the report.

Medicare fraud is committed well beyond U.S. borders

On the streets of Managua, the shuttle bus wrapped in a giant ad for free healthcare stood out. “Medicare for people living abroad,” it proclaimed above the image of a cheerful older woman playing golf. But Medicare, the American public health insurance program for the elderly and disabled, isn’t available in Nicaragua or anywhere outside the U.S., except in emergency circumstances. The clinic advertised, Nostrum Medical Center, had a way around that: Patients were required to provide a U.S. address, so their visits could be billed to American taxpayers.

Before the Nicaraguan scheme and a related one in the Dominican Republic were shut down last fall, the U.S. government paid out $25 million from 2011 to 2014 for medical care received by more than 1,000 foreign residents who signed up using post office boxes, mail-forwarding services, or the addresses of friends or relatives in Florida to conceal that they lived overseas.

Ten people, including a Managua physician and his son, have pleaded guilty in the swindle; one remains at large. Four conspirators, including two executives at Florida Healthcare Plus, one of the companies that billed Medicare for the patients seen abroad, will be sentenced in Miami on Aug. 27. (Florida Healthcare wasn’t accused of wrongdoing.) The investigation is ongoing, with the HHS inspector general, the FBI, and the U.S. Department of State looking at other countries where Medicare scammers are recruiting patients.

The foreign-enrollment dodge is a new twist on Medicare fraud, which costs American taxpayers billions of dollars a year, according to FBI estimates. For years, the Centers for Medicare and Medicaid Services (CMS), which administers Medicare, had relied on the pay-and-chase method, paying claims first and going after those that looked suspicious after the fact. Recently, the government has increased efforts to boost detection before cheaters can start collecting reimbursements for falsified bills.

Ramped-up screening under the Affordable Care Act has resulted in the revocation of Medicare billing privileges for about 34,000 providers, says Medicare spokesman Tony Salters. Medicare also fingerprints some applicants and makes unannounced site visits to providers’ and suppliers’ offices to weed out scammers.

The U.S. has recouped only $1 million in the Nicaragua case. When the defendants were arrested last October, one was leasing six new Mercedes-Benz sedans and living in a 14,000-square-foot Miami mansion, according to investigators. Only one of the 11—the son of the Managua doctor—reported significant assets, about $429,000 in a bank. Four told the court they couldn’t afford lawyers. Eight cooperated with the investigation, according to the U.S. Department of Justice. Six have already been sentenced and received prison terms ranging from 15 months to four years.

The scammers primarily enrolled people into a Medicare Advantage Plan run by Coral Gables-based Florida Healthcare Plus, which was liquidated earlier this year.

The company’s Medicare contract covered just a few Florida counties, so recruiters told prospective patients they couldn’t get the free medical care without an address in one of the counties. Along with the bus ads, Nostrum and other clinics in Managua drummed up interest with full-page newspaper ads and informational sessions at local hotels. American expats who saw the promotions, which promised care with no copays, tipped off U.S. Embassy officials. Investigators discovered that recruiters collected commissions of as much as to $300 for every enrollee. Visit Bloomberg for the article.

Vomit machine shows why Norovirus spreads so fast

Researchers have invented a "vomiting machine" that demonstrates just why the nauseating norovirus spreads so far and so fast. The nasty stomach bug can infect hundreds of passengers on a cruise ship, or every single person who sits at the same restaurant table as a victim. It sticks to silverware and counters, and survives being dried out for weeks. Scientists had also suspected that it floats in the air and spreads that way, too. But no one had actually demonstrated that it could.

Grace Tung-Thompson and colleagues at North Carolina State University and at Wake Forest University designed a device that they hope would perfectly replicate what happens when someone vomits, from a feeble dribble of bile to the explosive projectile vomiting that is one of the hallmarks of a norovirus infection.

The device has little tube that replicates the throat, and it's designed to push out liquids and semi-liquids in the same, downward-facing direction that people do when they vomit.

"This machine may seem odd, but it's helping us understand a disease that affects millions of people," says Lee-Ann Jaykus, the N.C. State food science professor who oversaw the work.

They used a range of materials, including instant vanilla Jell-o pudding, to replicate various textures. The biggest sticking point was how to replicate norovirus, which doesn't really like to grow in a lab dish and which the researchers wouldn't want to risk catching anyway.

They used another virus called MS2 that's similar to norovirus, that doesn't make people sick and that's easy to grow in the lab.

The researchers estimate that as many as 13,000 virus particles can be released into the air with a single retch. They made a video that shows how it works.

"There was evidence of aerosolized MS2 after every simulated vomiting episode," they wrote in their report, published in the Public Library of Science journal PLoS ONE.

People can be infected with as few as 20 to 1,300 microscopic viral particles, so their study shows that vomiting could indeed spread the infection through the air.

"But those airborne particles could also land on nearby surfaces like tables and door handles, causing environmental contamination. And norovirus can hang around for weeks, so anyone that touches that table and then puts their hand to their mouth could be at risk for infection."

The findings help explain a 2012 study that showed how the virus spread on a plastic bag that had been in a bathroom where a norovirus patient threw up. Visit NBC for the report.

Wary of Medicaid overcharging, Gov. Scott orders hospital audits

Playing hardball with Florida hospitals over their rising profits and growing reliance on government funding, Gov. Rick Scott revealed that he has ordered state regulators to audit 129 hospitals to ensure they are not overcharging for patients who have Medicaid, the public health insurance program for low-income people.

Scott’s office disclosed the number of audits — some of which are under way, others pending, and still more to be conducted at random — in a letter from the governor to Florida Attorney General Pam Bondi. Scott first ordered the audits on Aug. 3, two days after a state-imposed deadline for hospitals and health plans to certify that their business contracts did not exceed the statutory limit.

Earlier this month, state regulators announced audits for 31 hospitals. It is unclear from Scott’s letter to Bondi why more hospitals were added, but the performing the audits will be a challenge. Scott reduced funding for the state’s Agency for Health Care Administration, which will conduct the audits, by $64 million and about 80 positions this year.

“These agreements may ultimately result in overcharging the state for Medicaid and other healthcare services; and in some instances, could constitute Medicaid fraud and even deceptive and unfair trade practices,” Scott wrote in the letter.

State law caps the rates that hospitals can charge the private insurers that manage Florida’s Medicaid program. An estimated 3.5 million Floridians receive Medicaid through health maintenance organizations, or HMOs, under a program begun in 2006 and rolled out statewide in 2014.

But Medicaid HMOs reported steep financial losses after the roll out, and they asked the state for a mid-year pay increase of $400 million, and a 12 percent overall increase in their rates for next year. That led Florida healthcare regulators to raise concerns that the managed care plans may be paying hospitals too much. Visit the Miami Herald for the story.

With mergers, concerns grow about private Medicare

As some of the nation’s largest health insurers plan to merge, a new report raises fresh concern over the lack of competition in the private Medicare market. The analysis concludes “there is little competition anywhere in the nation.”

The report from the Commonwealth Fund, a research group, looked at the market share of insurance companies offering private Medicare Advantage plans in 2012. The authors found that 97 percent of markets in United States counties were “highly concentrated,” in which a small number of insurers dominated. The lack of competition was worse in rural markets.

Only one county, Riverside, CA, qualified as a competitive market, according to the report.

For decades, insurers have offered private plans as an alternative to traditional Medicare, the government-run program that provides coverage to about two-thirds of beneficiaries.

UnitedHealth Group, Humana and Aetna are all major players in the private Medicare Advantage market. While UnitedHealth remains independent, Humana and Aetna announced this year that they planned to combine forces.

Proponents of these plans say competition from private insurers benefits consumers by reducing Medicare costs and improving the quality of their coverage.

“Seniors are overwhelmingly satisfied with Medicare Advantage because of the wide range of coverage options available and the overall value these plans provide,” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a Washington trade association, said in an email. “This market remains competitive, particularly with Medicare Advantage plans demonstrating improved care delivery for beneficiaries compared to traditional Medicare.”

But the study’s findings come at a point when the proposed mergers of Aetna and Humana, as well as that of Anthem and Cigna, could allow the nation’s largest insurers to gain even more leverage in a market. Consumer advocates and others have raised concerns over whether individuals will benefit from the mergers, which reduce the number of the five largest for-profit companies to three.

The effects on consumers are expected to vary widely, depending on the place and the type of market, and whether policies are sold to individuals, large employers or Medicare beneficiaries.

Federal regulators will have to determine whether the mergers could result in higher prices or fewer options for consumers, particularly in some locations. In Kansas, for example, Aetna and Humana have 90 percent of the Medicare Advantage market, according to data from the Kaiser Family Foundation.

The insurers argue that consumers will still have plenty of options, even if the proposed combinations take place. “The Medicare space is highly competitive,” said Cynthia B. Michener, a spokeswoman for Aetna. “A combined Aetna-Humana would serve only 8 percent of the current 54 million Medicare beneficiaries, with the remainder being served by the government and more than 140 private insurers,” she said. The acquisition will allow Aetna to expand Humana’s highly regarded model of care to more people, Michener said. Visit the New York Times for the article.

Regular use of aspirin, NSAIDs may reduce risk of colon cancer

A new study has revealed that regular use of aspirin and other Nonaspirin Nonsteroidal Anti-inflammatory Drugs (NSAID) could reduce the risk of colorectal cancer. In the study, researchers reviewed data on drug use, comorbid conditions, and history of colonoscopy from prescription and patient registries.

Based on the prescriptions filled, taking 75 to 150 mg of aspirin continuously for five years or longer was associated with a 27 percent reduced risk for colorectal cancer and five or more years of continuous nonaspirin NSAID use was associated with a 30 to 45 percent reduction in colorectal cancer risk.

The authors caution that patients with the highest adherence comprised only about 2 to 3 percent of all low-dose aspirin users in the study population, and these persons may have a risk profile for colorectal cancer that differs from that of the general population.

However, a recent comprehensive review concluded that more research is needed to determine the optimal use of aspirin for cancer prevention.

The study is published in the journal Annals of Internal Medicine. Visit ZeeNews for the study.  

UK Sunshine Rule for tackling healthcare lobbying corruption needs clarity, says GlobalData analyst

The United Kingdom’s (UK) new Sunshine rule, introduced by Health Secretary Jeremy Hunt to abolish healthcare industry corruption, has already met with criticism from some National Health Service (NHS) staff members, and requires clarity if it is to be successfully implemented from 2016, says an analyst with research and consulting firm GlobalData.

The new rule follows an investigation by The Telegraph into pharmaceutical and medical device companies’ alleged bribery of NHS decision makers in efforts to lobby for their products’ promotion over those of their competitors.

However, Amendeep Sanghera, GlobalData’s Analyst covering Medical Devices, states that such lobbying is not a new issue. It is particularly prominent in countries with extensive private healthcare systems, such as the US.

Indeed, efforts to stamp out corruption began with the US government’s implementation of the Sunshine Act in 2013, which aimed to lift the curtain on physician and healthcare firms’ interactions, especially regarding financial transactions and gifts.

Sanghera says: “While the exact specifics of the UK’s Sunshine rule are currently unknown, it can be assumed that the new law will closely reflect its American predecessor.

“GlobalData therefore expects physicians and influential board members to be more conservative when approached by pharmaceutical and medical device industry representatives. Due to the threat of an unlimited fine and a maximum jail sentence of 10 years under the Bribery Act, they should consider the effects of products on consumers and payers, rather than chasing a quick payday.”

The analyst adds that if the information provided by the Sunshine rule is made publicly available, as with the US Sunshine Act, then it will allow patients to review their doctor’s interactions with drug and device manufacturers.

However, caution must be exercised if publicizing this information, as it may cause needless damage to the reputations of doctors and healthcare firms, for whom a positive collaboration is necessary to aid product development and delivery. Visit here to read the full Expert Insight on the UK Sunshine rule.

Testers find twice as many ‘superbugs’ in conventional hamburger as organic ones

Most people know that you can get sick from eating tainted ground beef. Now a new report has a lot more detail about the safety of ground beef tested across the United States. Some of it has bacteria that produces a toxin that can't be destroyed, even with proper cooking. And it turns out that conventionally produced beef — the kind sold in most stores — had twice as many superbugs as beef raised in more sustainable ways. (At the most basic level, that means beef raised without antibiotics.)

Consumer Reports tested 458 pounds (or the equivalent of 1,832 quarter-pounders) from 103 grocery, big-box and natural-food stores in 26 cities across the country. They analyzed the samples from five common types of bacteria found on beef: Clostridium perfringens, E. coli (including the deadly O157 and six other toxin-producing strains), enterococcus, salmonella and Staphylococcus aureus

All 458 pounds of beef contained at least one of the types of bacteria. Ten percent of the samples were contaminated with a strain of S. aureus that, under certain circumstances, can produce a toxin that can make you sick -- and that can't be destroyed with proper cooking. However, other experts say it would be difficult for these conditions to exist in the average consumer's kitchen.

The meat industry said the findings actually show the overall safety of beef. Testers did not find the deadly strain of E. coli O157, according to a statement from the North American Meat Institute.

The U.S. Department of Agriculture says it has implemented tighter food safety standards than ever before on ground beef and the overall meat industry. They include measures that include a zero-tolerance policy for six dangerous strains of E. coli and better procedures for detecting the source of outbreaks.

One of the most significant findings, said Urvashi Rangan, executive director of the Center for Food Safety and Sustainability at Consumer Reports, is that beef from conventionally raised cows was more likely to have bacteria overall, as well as bacteria that are resistant to antibiotics, than beef from sustainably raised cows.

Sustainable methods range from the basic, such as beef raised without antibiotics, to the most sustainable, which is grass-fed organic. Grass-fed cattle usually don't get antibiotics and spend their lives on pasture, not feedlots, according to Consumer Reports.

In the past, when the group tested for bacteria in shrimp, ground turkey and chicken, testers weren't able to obtain large samples of sustainably raised products, Rangan said. Nor did testers find a big difference in the prevalence of bacteria between conventional and sustainable meat-production methods.

But this time, Consumer Reports found that of the conventional beef samples, 18 percent were contaminated with superbugs — dangerous bacteria that are resistant to three or more classes of antibiotics — compared with 9 percent of beef from samples that were sustainably produced.

Bottom line: If you cook your meat to 160 degrees, that should kill all the bacteria. Period.

Visit the Washington Post for the article.