The next Ebola
zone: Report finds 28 high-risk countries
Where else could an epidemic of Ebola or some other disease come? Try
Somalia, Chad, Nigeria, Afghanistan, Haiti, Ethiopia, Central Africa
Republic, Guinea, Niger, and then Mali. They all have weaker healthcare
systems than Sierra Leone, Save the Children warns. The group, which has
been fighting the epidemic ravaging Sierra Leone, Guinea and Liberia, says
28 countries have near-nonexistent health systems.
Public health experts agree that poor health systems helped Ebola turn from
a series of outbreaks into a full-fledged epidemic. It's infected nearly
24,000 people and killed around 10,000 by official count. People carried the
virus to the U.S., to Europe and to neighboring countries.
"A robust health system could have helped get Ebola under control much
sooner, saving thousands of children's lives and billions of dollars," Save
the Children says. And many other countries are just as vulnerable, if not
more so. The group devised an index of the public health systems of the
world's poorest countries based on the number of health workers, government
spending on health and mortality rates.
Somalia ranked worst, with the index finding there is one health worker for
every 6,711 people compared to one health worker for every 88 people in
Britain. Chad has one health worker for every 4,444 people and Niger one per
6,410 people. In Afghanistan, which was fourth-lowest, public spending on
health is $10.71 per person a year compared to more than $3,000 in Britain
and $4,000 in the United States. In Guinea, it's $9 a
"Without trained health workers and a functioning health system in place,
it's more likely that an epidemic could spread across international borders
with catastrophic effects," said Carolyn Miles, president and CEO of Save
the Children USA. "The world woke up to Ebola but now people need to wake up
to the scandal of weak health systems, which not only risk new diseases
spreading, but also contribute to the deaths of 17,000 children each day
from preventable causes like pneumonia and malaria."
Building better public health systems would be cheaper than fighting
epidemics, the report argues. It says the cost of dealing with this Ebola
outbreak has been nearly three times the annual cost of investing in
building a universal health service in all three affected countries.
The World Bank projected that fighting this Ebola epidemic could cost $30
billion. The U.S. spent $1 million to treat just two of its 10 Ebola
Visit NBC News for the article.
nearly 3 dozen at Phoenix VA
Norovirus has sickened nearly three dozen patients and staff members at the
Phoenix VA Health Care System, prompting the hospital to halt admission of
new patients to two mental-health units contaminated with the highly
Phoenix VA officials said that laboratory-confirmed norovirus has infected
16 patients and 19 staff members. All have recovered except three people who
are being treated in a medical unit, VA officials said. The Carl T. Hayden
Veterans Affairs Medical Center stopped taking new patients at two
mental-health units with 48 beds on the hospital's fifth floor. Veterans who
need mental-healthcare will be evaluated at the hospital's emergency
department or outpatient clinics, according to VA officials. Those who need
inpatient care will be sent to other VA units or to mental-health providers
in metro Phoenix.
VA officials have embarked on a cleaning regimen to rid the hospital of the
virus. Some steps include limiting staff members who are allowed to access
the affected floors and using paper trays to deliver food, according to
Phoenix VA Health Care spokeswoman Jean M. Schaefer. The VA also has
informed staff and patients about steps they can take to prevent the spread
Visit AZ Central for the story.
testing as Portland, Oregon sees rise in syphilis cases
A spike in syphilis cases in Portland in the past three years has prompted
concerned public health officials to urge more sexually active adults to get
tested regularly for the treatable bacterial infection. The Portland metro
area has seen about 240 new cases of the disease on average each year since
2012, many times more than the 10 to 30 cases that were detected annually
Across the country, incidences of syphilis are on the rise. The Centers for
Disease Control and Prevention said last year the number of infections in
the United States climbed by more than 10 percent in 2013 to 17,535 cases,
compared with the previous year.
"Nationally there's been an increase in syphilis diagnoses but our increase
has exceeded the national average," Kim Toevs, a senior manager with the
Multnomah County Health Department, said on Tuesday. Health officials in
Oregon's biggest city asked the CDC for help last year, she said, and it
enlisted social and behavioral scientists, as well as public health
physicians, to study what caused the increase.
Syphilis can be cured with penicillin but if left untreated can cause
blindness, hearing loss, neurological damage and birth defects in children
born to affected mothers. Half of the men with syphilis nationwide also are
infected with HIV, according to the CDC.
Visit Reuters for the report.
The ACAâs hospital
tax-exemption rules and the practice of medicine
The Affordable Care Act (ACA) and related regulations include obligations
for nonprofit (and some government) hospitals to provide benefits, such as
free care, to their communities. On their face, these new obligations seem a
valuable response to longstanding concerns of some legislators, litigators,
and scholars that some nonprofit hospitals are really âfor-profits in
disguiseâ and to the related calls to eliminate tax-deductions for gifts to
nonprofit hospitals. Moreover, the requirements have been lauded for their
potential to improve public health, particularly in leading to better
consultation and collaboration with local public health officials.
The ACA, through new Internal Revenue Code Â§501(r), creates additional
conditions for charitable hospitals to qualify for federal income tax
exemption and related benefits. To maintain such status, nonprofit hospitals
must 1) establish financial assistance and emergency medical care policies,
2) limit charges to patients eligible for assistance under those policies,
and 3) make reasonable efforts to identify eligible patients before engaging
in extraordinary collection actions against them.
Hospitals must also conduct community health needs assessments and adopt
implementation strategies to meet those needs at least once every three
years. Although final regulations (released December 31, 2014) offer
hospitals slightly more flexibility in defining the relevant community and
its health needs than the proposed rules, they still place poverty relief as
an important, probably central, consideration.
Hospitals that do not report on and comply with the requirements risk
financial penalties in the form of excise taxes ($50,000 on each hospital
that fails to meet the new requirements). Hospitals that do not comply with
the new regulations also risk losing their tax exemptions altogether.
Many in Congress saw this provision as a way of fostering accountability by
nonprofit institutions. In addition, Congress likely intended this section
of the law to improve access to care for needy patients. This is a laudable
goal, as even after the full implementation of the ACA, the Congressional
Budget Office has estimated that approximately 30 million people will remain
uninsured. Others will have difficulty making co-payments.
Many advocates suggest that nonprofit hospitals should provide free care
equal to the value of their federal tax exemptions. The U.S. Government
Accountability Office (GAO) has estimated that tax-exempt status saved
hospitals $12.6 billion in federal, state, and local taxes in 2002 ($16.1
billion in 2012 dollars). Other estimates peg the value from $8.5 to $21
It is estimated that all hospitals combined spend a total of $25.4 billion
on uncompensated care, which corresponds to about $16 billion at nonprofits.
Including other community benefits such as outreach and education,
researchers have estimated that the total accounts for 7.5 percent of
operating expenses at nonprofit hospitals. Thus, existing spending might
fulfill the new requirements in total. However, spending on uncompensated
care is not uniform across hospitals. Some hospitals will have to devote
If not from profits or existing uncompensated care programs, where will
hospitals get the resources to meet their new obligation? Some of the
response could involve converting bad debt (payments that a hospital
anticipated but did not receive) into charitable uncompensated care (care
for which a hospital never expected to be reimbursed).
Another approach would be for hospitals to add more profitable services,
such as diagnostic imaging or invasive cardiac services, to raise revenue to
fund the new requirements. There may well be room for growth in provision of
these profitable services given that nonprofit hospitals are less likely
than for-profit hospitals to provide them. However, many analysts worry that
these services are already over provided. This strategy thus raises the risk
of overuse of services.
In other cases, nonprofit hospitals may find resources to pay for new
requirements through selectively reducing the provision of services that are
unprofitable for hospitals, such as psychiatric emergency or trauma care.
Since nonprofit hospitals are more likely than comparable for-profits to
provide low- or negative-margin services, there will be room to cut here.
The losses saved in these areas can then be used to offset the requirement
to provide more indigent care in other areas â for example, providing more
free services in domains of care that are otherwise profitable to staff.
Visit Health Affairs for the report.
New York City rats
carry fleas known to transmit plague
Rats in New York City are brimming with fleas and other parasites that can
carry a number of diseases, including the plague, a new study reports.
Researchers analyzed 6,500 specimens of five well-known species of fleas,
lice and mites found on over 130 rats from around the city.
The samples included Oriental rat fleas, a type of flea that can transmit
bubonic plague, also called the Black Death. However, it's important to note
that while the researchers found fleas capable of transmitting plague, they
didn't find the bacteria that causes the plague in the fleas or rats.
"If these rats carry fleas that could transmit the plague to people, then
the pathogen itself is the only piece missing from the transmission cycle,"
study author Matthew Frye, an urban entomologist at Cornell University in
Ithaca, NY, said in a university news release.
In the United States, the plague is found among ground squirrels, prairie
dogs and the fleas they carry. About 10 people are infected each year,
according to the researchers. However, they said plague is more common in
some other parts of the world.
The researchers did find that Oriental rat fleas in New York City carry
several species of Bartonella bacteria. This bacteria can cause a wide range
of health problems, some of them severe, according to study co-author Cadhla
Firth, a research scientist at Columbia University's Center for Infection
and Immunity in New York City.
The study is the first of its kind since the 1920s, according to the
researchers. Findings from the study were published March 2 in the
Journal of Medical Entomology.
The research suggests that public health officials need to closely monitor
city rats and the fleas they carry, Frye said. He also urged everyone to
take steps to control rat populations. (HealthDay)
Visit NIH for the study.
Do heart surgery
patients get too many blood tests?
The high number of blood tests done before and after heart surgery can
sometimes lead to excessive blood loss, possibly causing anemia and the need
for a blood transfusion, new research suggests.
The study included almost 1,900 patients who had heart surgery at the
Cleveland Clinic between January 2012 and June 2012. From the time they
first met their heart surgeons until they left the hospital, the patients
collectively had more than 221,000 blood tests. That works out to 116 tests
per patient, according to the study. The total median amount of blood
gathered during an entire hospital stay was about 15 ounces (454
milliliters) per patient, the researchers found.
"We were astonished by the amount of blood taken from our patients for
laboratory testing. Total phlebotomy volumes approached 1 to 2 units of red
blood cells, which is roughly equivalent to one to two cans of soda," study
leader Dr. Colleen Koch of the Cleveland Clinic said. The highest amounts of
blood loss occurred among patients undergoing the most complex heart
The greater the number of lab tests and the longer patients stayed in the
hospital, the more likely they were to require transfusions.
"Prior research shows that patients who receive blood transfusions during
heart surgery have more infections after surgery, spend more time on the
ventilator, and die more frequently -- even after adjusting for how sick
they were prior to surgery," Koch said. "They should inquire whether
smaller-volume test tubes could be used for the tests that are deemed
necessary. Every attempt should be made to conserve the patient's own blood
-- every drop of blood counts," Koch concluded. (HealthDay)
Visit US News for the story.
What are the best
hospitals? Rankings disagree
What makes a top hospital? Four services that publish hospital ratings for
consumers strongly disagree, according to a study in the journal Health
Affairs. No single hospital received high marks from all four
servicesâU.S. News & World Report, Consumer Reports, the Leapfrog Group and
Healthgradesâand only 10% of the 844 hospitals that were rated highly by one
service received top marks from another, the study published Monday found.
The measures were so divergent that 27 hospitals were simultaneously rated
among the nationâs best by one service and among the worst by another.
The Health Affairs study didnât name individual hospitals, but UCLAâs
Ronald Reagan Medical Center in Los Angeles was among U.S. Newsâ top 18
hospitals in the nation in 2013, while receiving a âDâ safety rating from
Leapfrog that year. Demand for such data is surging, the authors wrote, as
consumers increasingly comparison shop for medical services and efforts
accelerate to tie payment to the quality of care. But they warned that
widely varying definitions of quality could create more confusion than
clarityâand make it difficult for hospitals to know where to focus
âYou can go into most towns in America and the local hospital is on
somebodyâs list of top somethings,â the studyâs senior author, Peter
Pronovost, said in an interview. âThe public deserves much more transparency
about what these quality measures mean so it isnât just a beauty pageant,â
added Dr. Pronovost, director of the Armstrong Institute for Patient Safety
and Quality at Johns Hopkins Medicine in Baltimore.
All four services use different rating methodologies, eligibility criteria
and data sources and describe their results differently. Consumer Reports
calculates a safety score for hospitals from 0 to 100, based on rates of
infection, readmissions and other measures. Leapfrogâs Hospital Safety Score
assigns hospitals letter grades from A to F, reflecting how well they keep
patients from âpreventable harm and medical errors.â
Healthgrades calculates an annual list of the countryâs 50 and 100 best
hospitals, based on mortality and complication rates for a variety of
conditions. U.S. News focuses on care for serious conditions and scores
hospitals from 1 to 100 in 16 specialties, as well as ranking them
nationally and regionally. To compare them, the study authors defined âhigh
performingâ as a score of 65 or higher from Consumer Reports; an A from
Leapfrog; being listed in Healthgradesâ top 100 and being included in the
U.S. News Honor Roll of hospitals with high scores in at least six
Low performers were those with a score of 30 or lower from Consumer Reports,
a D or F from Leapfrog or a score of 10 or lower in at least one specialty
from U.S. News. Healthgrades doesnât list low-performing hospitals.
Officials from each of the services defended their approach and said they
publish more detailed information on their websites.
Visit the Wall Street Journal for the story.
life sans subsidies
The Supreme Court will hear arguments in a case, King v. Burwell, that
challenges the legality of the subsidies in more than 30 states, including
Florida. The case, developed by conservative legal scholars, argues that
only people using state-run marketplaces are entitled to subsidies.
If the court agrees -- a decision is expected in June -- subsidies will
disappear in states that do not have their own online marketplaces, almost
all of which have Republican-led governments that oppose the law and have
resisted creating state exchanges.
No state would be more affected than Florida, where more than 1.6 million
people have insurance plans under the Affordable Care Act, the most in the
nation, and almost all of them receive subsidies. Yet there is little talk
of a Plan B here, such as creating a state-run exchange where subsidies
would still be available, if the Supreme Court strikes down the subsidy
program. Asked about the case last month at the American Action Forum, a
conservative advocacy group, Gov. Rick Scott, a Republican, said, "This is
not my program." He added, "It's a federal problem."
The issue is particularly significant in southern Florida: All 10 of the ZIP
codes with the highest enrollments in the nation are in the Miami and Fort
Administration officials, as well as many Democrats in Congress, have also
been unwilling to discuss how they would handle a ruling that ended
subsidies in most states, preferring to focus attention on Republican
opposition to the law. After deflecting questions for weeks about whether
the administration had a contingency plan, Sylvia Mathews Burwell, the
secretary of health and human services, wrote in a letter to members of
Congress on Tuesday that it did not.
Still, some Republican leaders are showing signs that they are worried about
the party's liability on the issue. Rep. Paul Ryan of Wisconsin, chairman of
the House Ways and Means Committee, and Sen. Orrin Hatch of Utah, chairman
of the Senate Finance Committee, have announced that they are working on
ways to help people who might lose subsidies. And last week, former Sen.
Phil Gramm of Texas warned his fellow Republicans in an opinion article in
The Wall Street Journal that they would face "enormous" political
pressure to address the loss of subsidies if the court ruled against the
In Florida, insurance agents and health advocacy groups have worked
tenaciously to enroll people in coverage, with colorful marketing and
outreach campaigns. Partly as a result, healthcare experts say, Florida's
rate of uninsured residents -- among the nation's highest in 2013, at 22.1
percent -- dropped to 18.3 percent last year, according to the Gallup-Healthways
Well-Being Index. Should the subsidies be blocked, elected officials may
also come under pressure from insurers, 14 of which sell plans through the
federal marketplace in Florida, and providers.
Brian E. Keeley, the president and chief executive of Baptist Health South
Florida, which has seven hospitals around the region, said he found it
maddening that neither political party had offered a workaround. (New York
Visit the Herald Tribune for the article.