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October 1, 2014   Download print version

CDC confirms first case of Ebola in the U.S.

Ebola shot turned down by WHO is best hope as virus rages

In India, are profits from medical devices used to bribe doctors?

Costs can go up fast when E.R. is in network but the doctors are not

Register now for early registration discounts to the 9th Annual World Congress Leadership Summit on Healthcare Supply Chain Management

As Obamacare pays medical bills, red states pressured on Medicaid

Healthcare supply chain pressured by cost increases, government regulations, study says

More than half in U.S. at greater risk in disasters

Spread the word: National Breast Cancer Awareness Month Starts NOW!


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CDC confirms first case of Ebola in the U.S.

The Centers for Disease Control and Prevention confirmed on Tuesday the first case of Ebola diagnosed in the United States.

"An individual traveling from Liberia has been diagnosed with Ebola in the United States," Thomas Frieden, director of the CDC, said in a news conference Tuesday afternoon.

State and federal health officials announcing the confirmed case repeatedly stressed the difficulties of contracting Ebola, which can be spread through bodily fluids or infected animals but not through the air or by water.

This person who is infected left Liberia on Sept. 19 and arrived in the U.S. the following day to visit family in this country. The person, who was not identified, had no symptoms at the time and began showing symptoms four days after arriving in the U.S.

"The bottom line here is that I have no doubt that we will control this importation, or this case of Ebola, so that it does not spread widely in this country," he said. "It is certainly possible that someone who had contact with this individual could develop Ebola in the coming weeks. But there is no doubt in my mind that we will stop it here."

This is the first time Ebola has been diagnosed in the U.S. and the first time someone was diagnosed with this particular strain outside of Africa, he said. Still, health officials expressed optimism going forward.

The patient with Ebola is being treated in intensive care, according to Edward Goodman, the hospital epidemiologist at Texas Health Presbyterian Hospital Dallas

Health officials are going to work to identify everyone who may have been exposed to this patient, Frieden said. This group, described as a "handful" of people by Frieden, will be watched for three weeks to see if any symptoms emerge. People who traveled on the flight with this man are not in danger because the patient was not symptomatic at the time.

"There is zero risk of transmission on the flight," Frieden said. Frieden declined to say if the person with Ebola is a U.S. citizen. This man was visiting family members and staying with family members, he said.

David Lakey, head of the Texas Department of Health Services, said the state's laboratory in Austin, Tex., was certified last month to do Ebola testing. That laboratory received a blood sample from the patient on Tuesday morning and confirmed it was Ebola shortly after 1 p.m., he said.

The Texas Department of Health Services said that the patient is at Texas Health Presbyterian Hospital in Dallas.

The test, the Texas health department said, was conducted at the state public health laboratory in Austin and later confirmed by the CDC.

In the statement, the health department said: The CDC recommends that individuals protect themselves by avoiding contact with the blood and body fluids of people who are ill with Ebola. DSHS also encourages healthcare providers to ask patients about recent travel and consider Ebola in patients with fever and a history of travel to Sierra Leone, Guinea, Liberia, and some parts of Nigeria within 21 days of the onset of symptoms.

No Ebola cases had been confirmed in the United States previously, although several American doctors and aid workers who were infected in West Africa have returned home for treatment. Visit the Washington Post for the story.



Ebola shot turned down by WHO is best hope as virus rages

The calls started coming in August to the office of GlaxoSmithKline Plc Chief Executive Officer Andrew Witty from the head of the World Health Organization, Margaret Chan. The Ebola outbreak was raging out of control and Chan needed the drugmaker?s vaccine as quickly as possible.

The sudden sense of urgency for an Ebola vaccine was an about face from a few months earlier when Glaxo contacted the WHO, asking whether its vaccine could help with the outbreak. At that time, the company was told the focus was on containment and the WHO didn?t have a policy for using vaccines in this type of situation. ?We?ll get back to you? was the message, said Ripley Ballou, head of Glaxo?s Ebola vaccine program.

With no approved Ebola medicines, and experimental treatments in short supply, a vaccine is now one of the best hopes for halting the virus?s spread before it becomes entrenched in the region. That puts pressure on the few drugmakers with a vaccine in development as they shift resources, delay other projects, and spend millions in a race to immunize patients. Glaxo and Johnson & Johnson are preparing thousands of doses of their experimental vaccines to test in Africa as early as January.

When Glaxo contacted the WHO in March, the vaccine was seen as a ?diversion of energy? at a time when it was believed the outbreak would be controlled with traditional measures, such as contact tracing and safe burials, that have helped contain every previous outbreak, said Marie-Paule Kieny, the WHO?s assistant director-general for health systems and innovation. At the end of March, there were about 100 cases of Ebola in Guinea, with early reports the virus was spreading to Liberia and Sierra Leone, according to the U.S. Centers for Disease Control and Prevention.

After receiving the request from Kieny and Chan last month, Glaxo pulled 20 people off various projects, many from its malaria vaccine program, one of its most highly publicized research initiatives, and assigned them full-time to the Ebola vaccine.

The company is aiming to have 10,000 to 15,000 doses by January to start vaccinating healthcare workers on the front lines of the Ebola outbreak as part of the next stage of testing. Glaxo will need six months to figure out how to eventually produce hundreds of thousands of doses for wider use, Ballou said.

The U.K. government, the non-profit Wellcome Trust, and the Medical Research Council, a U.K. research-funding organization are funding the production of about 10,000 doses. Gavi, the world?s biggest funder of vaccines for developing countries, which is backed by the Bill & Melinda Gates Foundation, said today it is examining how it can help accelerate the availability of Ebola vaccines.

Glaxo is among at least five companies that have announced plans to start human testing of an Ebola vaccine, including Johnson & Johnson, Inovio Pharmaceuticals Inc., NewLink Genetics Corp., and Profectus Biosciences Inc.

Glaxo started giving doses to healthy volunteers in the U.K. and U.S. this month. Within the next four weeks, as many as six different trials will be under way in the U.S., U.K., Switzerland and Mali. Early results on the safety and efficacy of the Glaxo and NewLink shots, the most advanced in development, should be available by November, Kieny said.

Until a few months ago, Glaxo?s vaccine got little attention out of the London-based company?s hundreds of experimental compounds, and the drugmaker has been ?essentially starting from ground zero,? said Ballou. Glaxo acquired the vaccine last year as part of its $324 million purchase of Okairos AG, which has inoculations in more advanced stages of testing for hepatitis C and malaria.

 ?It wasn?t really until the first week in August when it was clear that the epidemic was something very different from what we had ever seen before that WHO came to us and said we really need you to accelerate this vaccine,? Ballou said. ?Within 24 hours, we had all of our partners on the phone.? Three weeks later, the first patient received the vaccine to kick off the early-stage human trials. ?That?s an amazingly fast process,? he said.

Not far behind Glaxo in the race to get a vaccine to patients is Johnson & Johnson, which plans to start human testing in March. J&J expects to have hundreds of thousands of doses available through the course of 2015 and more than a million in 2016, said Paul Stoffels, the New Brunswick, NJ-based company?s chief scientific officer. Stoffels began ramping up work on the vaccine on his own, without prodding from the WHO, as he saw Ebola beginning to accelerate and making its way into cities in West Africa. He knew first-hand the devastation it could cause. In 1995, a few years after completing his training as an infectious disease doctor at a hospital in Kikwit, he was told his former colleagues were infected with Ebola and would be among more than 250 who died in that outbreak.

J&J?s vaccine has been more than a decade in the making. It started in 2002, in the labs of Netherlands-based Crucell, which J&J bought in 2010.

The next steps won?t be cheap or easy, said Stoffels. J&J must develop manufacturing capabilities for the vaccine, which must be made in a carefully controlled environment, and develop and implement a plan for testing it in volunteers. Visit Bloomberg for the story.



In India, are profits from medical devices used to bribe doctors?

India - A detailed investigation by the Maharashtra Food and Drug Administration (FDA) had exposed how drug eluting stents are sold at triple the price at which they are imported in India. A complaint sent to one of the largest medical device companies, Medtronic USA, revealed how local distributors for major medical device companies were allowed to charge huge margins on devices and how the cash thus generated was used to bribe doctors to persuade them to use their company's devices.

In March 2012, Medtronic USA had received a complaint about widespread bribing of doctors by its distributor Bhalani. According to the complaint, IMPL, the India arm of Medtronic, used distributors to distance itself from the bribery as it went against the corporate ethics Medtronic claims to adhere to. The complaint pointed out that the huge margin distributors were allowed to charge was used to bribe doctors, thus leaving Medtronics' books clean and yet ensuring that the corrupt practices help push their products.

In September 2012, a newspaper report in Mumbai exposed corruption in sale of stents to government hospitals. Medtronics USA was informed about this report and company officials said they took the allegations seriously and initiated an investigation. Till June 2013, they claimed investigations were on. They even took away the distributorship from Bhalani. But those in the business of medical device distribution claim that business practices have not changed as doctors and hospital managements continue to be bribed through distributors to increase sales of devices.

When contacted by TOI, Medtronic USA declined to comment about the investigation they had carried out into the allegations of bribing by their distributor. They merely stated: "Medtronic has an extensive compliance program to assess the conduct of its employees and representatives, including distributors, and if necessary takes action against those who violate its policies and the law. Furthermore, our employees and representatives are provided extensive training and resources to ensure they fully understand our business conduct requirements and local laws. We do not condone nor do we tolerate improper payments of any kind, and we will continue our efforts to ensure compliance with all applicable Indian and US laws."

The Maharashtra FDA report included details of overcharging by Abbott as well as Johnson and Johnson. Interestingly, while these multinationals claim to have stringent compliance programs in place to prevent bribing and other unlawful activities, almost all of them have been penalized heavily in the US for bribing doctors to boost their sales. In May this year, Medtronic agreed to pay $9.9 million to resolve allegations that the company used various types of payments to induce physicians to implant its pacemakers and defibrillators. This was a repeat offense for Medtronic, which had to pay $23.5 million in 2011 too for settling charges of kickbacks to doctors.

Other US companies have also had to resolve allegations that the company paid kickbacks to induce doctors to use their products. Visit the Times of India for the report.



Costs can go up fast when E.R. is in network but the doctors are not

Patients have no choice about which physician they see when they go to an emergency room, even if they have the presence of mind to visit a hospital that is in their insurance network. In the piles of forms that patients sign in those chaotic first moments is often an acknowledgment that they understand some providers may be out of network.

But even the most basic visits with emergency room physicians and other doctors called in to consult are increasingly leaving patients with hefty bills: More and more, doctors who work in emergency rooms are private contractors who are out of network or do not accept any insurance plans.

When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana and Blue Cross-Blue Shield ? Texas?s three biggest insurers ? had no in-network emergency room doctors. Out-of-network payments to emergency room physicians accounted for 40 to 70 percent of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found.

?It?s very common and there?s little consumers can do to prevent it and protect themselves ? it?s a roll of the dice,? said Stacey Pogue, a senior policy analyst with the nonpartisan center and an author of the study.

While patients have complained of surprise out-of-network charges in hospitals from some other specialists ? particularly anesthesiologists, radiologists and pathologists ? the situation with emergency room doctors is even more troubling, patient advocates say. For one thing, patients cannot be expected to review provider networks in a crisis, and the information to do so is usually not readily available anyway. Moreover, the Texas study found that out-of-network fees paid to emergency room physicians eclipsed the amount of money paid to those other specialists.

When emergency medicine emerged as a specialty in the 1980s, almost all E.R. doctors were hospital employees who typically did not bill separately for their services. Today, 65 percent of hospitals contract out that function. And some emergency medicine staffing groups ? many serve a large number of hospitals, either nationally or locally ? opt out of all insurance plans.

As more insurance plans contract with narrower networks of doctors to form offerings tailored to the Affordable Care Act, insurers have acquired greater leverage in cutting payments to physicians. While an insurer would have little power to drive a hard bargain with a major hospital that the company needs in its network, it can often pick and choose among physicians, excluding some or offering rates so low that many doctors say their practices are unsustainable.

The average salary of an emergency room physician was $311,000 in 2014, rising from $247,000 since 2010 ? a period when many other types of doctors experienced declines in salaries, according to Merritt Hawkins, a physician staffing firm.

Hospital charges for emergency care vary widely. A recent study found that hospital charges for a visit involving a serious medical issue in California varied between $275 and $6,662, just for the facility fee. ?Much of the variation we observe may in fact be entirely random,? wrote the authors, emergency physicians at the University of California San Francisco Medical Center. But that variation often does not directly affect patients, since most hospitals participate in the big insurance plans in their area, and patients tend to know which are in their network, so the insurer covers most of the bill. But it is a different matter with emergency room doctors who bill out-of-network fees, experts say.

Emergency physicians say they are not to blame. ?In general, E.R. physicians try to align themselves with whatever networks their hospitals are in, but sometimes the rates pale compared to what is offered to the hospitals,? said Dr. Jeffrey Bettinger of the American College of Emergency Physicians. That often leads to protracted negotiations, he said, but eventually the insurers and the doctors come to agreement and sign a contract.

In the meantime, patients are stuck with out-of-pocket charges. Regulations created by the Affordable Care Act specify that insurers must use the best-paying among three methods for reimbursing out-of-network physicians dispensing emergency care: pay the Medicare rate; pay the median in-network amount for the service; or apply the usual formula they use to determine out-of-network reimbursement, which often depends on ?usual and customary rates? in the area.

But in most states, doctors can then bill patients for the difference between their charge and what the insurer paid. Visit the New York Times for the story.



Register now for early registration discounts to the 9th Annual World Congress Leadership Summit on Healthcare Supply Chain Management

Don?t miss your chance to join Healthcare Purchasing News and an amazing speaker line up at the World Congress 9th Annual Leadership Summit on Health Care Supply Chain taking place in New Orleans, January 26 ? 27, 2015.

Join us to hear industry experts as they address critical issues facing healthcare supply chain operations today.  Sessions include thought-provoking panels and case studies by healthcare executives from leading organizations who will address how they transformed their supply chain departments into systems with a strategic, collaborative and innovative focus to accomplish the overall business and clinical goals of the organization.

Technology, value analysis, and integration are all new and vital components to consider when developing future healthcare supply chain strategy. The Summit session will feature presentations on how hospitals and health systems are addressing these components and others relating to physician engagement, variation, utilization, distribution, clinical outcomes, transparency, and new issues such as automation, value based contracts, and bundled payments.

The 2015 Summit will also focus on big-data and evidence-based purchasing, including key insights to supplier-provider relationships that focus on value, improved outcomes, and reduced costs. We?ll delve into strategies for payer relations as well as creative approaches to value analysis, clinical engagement, and cost control that will improve supply chain sustainability.

Hospitals and health systems can register for only $295 until October 17, 2014, a $600 savings on your registration fee! Don?t miss this outstanding value.

Visit World Congress for more information and to register



As Obamacare pays medical bills, red states pressured on Medicaid

A new report showing the continued pileup of unpaid medical bills in states that didn?t expand Medicaid under the Affordable Care Act is escalating criticism on these Republican-led areas of the country to expand the health insurance program for the poor.

The report out last week from the Obama administration shows the costs of uncompensated care are projected to fall by $5.7 billion this year largely because millions of Americans are eligible for expanded Medicaid insurance for the poor under the Affordable Care Act and they are taking advantage. About half of U.S. states opted in favor of expanding Medicaid which the Supreme Court allowed when it upheld the law two years ago.

?The projections?suggest that $4.2 billion of this reduction will come from the 25 states plus Washington D.C. expanding Medicaid as of the beginning of FY2014, representing a 25 percent reduction from baseline uncompensated care spending and 74 percent total savings,? the authors of the report from the Department of Health and Human Services? Office of the Assistant Secretary for Planning and Evaluation wrote.

But public hospitals generally in rural areas and inner cities where there are large numbers of uninsured say they are hit particularly hard in states that haven?t expanded Medicaid.

?Essential hospitals still face high levels of uncompensated care and looming cuts to disproportionate share hospital funding ? a problem of particular concern in states that have denied patients the same opportunity for Medicaid coverage so many others enjoy today,? said Dr. Bruce Siegel, president and chief executive officer of America?s Essential Hospitals, which represents public health systems across the U.S., in a statement following the release of the uncompensated care report.

Pressure on GOP-led states has worked in some cases. In Pennsylvania, for example, Republican Gov. Tom Corbett, who is facing a difficult re-election challenge, dropped his opposition to the Medicaid expansion a few months ago.

The federal government traditionally picks up a little more than half of the cost of Medicaid. But funding under the health law is unlike past efforts to expand Medicaid in that the federal government will pick up the full tab this year as well as 2015 and 2016. The state gradually has to pick up some costs in 2017, but by 2020, the federal government is still picking up 90 percent or more of the Medicaid tab. Visit Forbes for the report.



Healthcare supply chain pressured by cost increases, government regulations, study says

An environment of increasing risks, complex regulations and continuing cost pressures is impeding healthcare executives from moving quickly to seize untapped industry opportunities, according to the 7th annual UPS "Pain in the (Supply) Chain" survey. Globally, healthcare executives are planning for strategic partnerships and technology investment to mitigate risks and capitalize on growth opportunities.

The most significant factors contributing to uncertainty in the healthcare supply chain are more stringent regulations and increased product protection challenges. For the third consecutive year, regulatory compliance is the top supply chain pain point, cited by 60 percent of respondents. Further, 78 percent cite regulatory compliance and increasing regulations as a top trend driving business and supply chain changes. Product protection also is increasingly challenging in a highly global marketplace, with 46 percent citing product security as a top challenge and 40 percent citing product damage and spoilage as a top concern.

Economic factors are also at play, with 49 percent of those surveyed still feeling an impact from the economic downturn six years later. The highest percentage of respondents to express this are located in the U.S., where 60 percent of healthcare logistics decision makers cite economic concerns. In this global economic environment, cost management remains top of mind, with 44 percent citing it as a top supply chain concern.

Despite operating in a risk-inherent environment, only 26 percent of healthcare executives cite contingency planning as a top supply chain concern. Meanwhile, 34 percent of those surveyed in Asia and 22 percent in Latin America say that more than one-quarter of their companies? supply chains were impacted by unplanned events in the past three to five years. Specific challenges to addressing business continuity include events being too unlikely or infrequent (61 percent), back-up infrastructure being too expensive to deploy (46 percent) and little to no prioritization being given to this area (42 percent) versus other more urgent matters.

Of those companies that are successful in mitigating risk and increasing competitiveness, the majority are leveraging partnerships along with ongoing technology investments. Of logistics decision makers surveyed worldwide:

?         78 percent cite logistics and distribution partnerships as a top strategy to manage supply chain costs

?         65 percent use logistics and distribution partnerships to successfully access global markets

?         61 percent use collaboration, including vested logistics and distribution partnerships, to successfully embrace new distribution and go-to-market channels, while 23 percent use mergers and acquisitions to do so

?         59 percent are working with a 3PL as a top strategy to increase efficiencies and improve competitiveness

Again this year, investing in new technologies is a top strategy to increase efficiencies and competitiveness for the next five years. Globally, over the next three to five years, 80 percent of respondents say they will invest in new technologies.

Despite progress in addressing industry challenges, opportunities remain. One of these areas is in leveraging new distribution channels and models to meet changing customer demands as ecommerce, urbanization and home healthcare grow.

The rise of home healthcare is taking off with growth surges expected over the next decade. Globally, 21 percent of survey respondents cite the shift to home healthcare as a key trend driving business and supply chain changes. Respondents report that 30 percent of products will support the home healthcare channel in the next seven to 10 years.

Another area with untapped potential is collaborative partnerships. According to this year?s findings, 59 percent cite it as a strategy over the past 18 months and also over the next few years, indicating that while the healthcare industry recognizes the importance of implementing these strategies to increase competitiveness, companies are slow to act. Visit UPS for the report.



More than half in U.S. at greater risk in disasters

More than 50% of the U.S. population may be in need of special attention during extreme weather events, with such emergencies putting the disabled, seniors and children at greater risk. Nearly one in five Americans is disabled, which means about 60 million people are more at risk during times of emergency.

"Very little is known as to how to make these individuals safe," says Irwin Redlener, head of the National Center for Disaster Preparedness at Columbia University's Earth Institute and one of the foremost authorities on disaster relief. Case in point, he says, are the many problems that arose during 2012's Hurricane Sandy, such as seniors stuck in high-rise buildings in New York City, left without power or use of elevators.

Too few emergency planners have the expertise necessary to ensure preparations make adequate provisions for disabilities, according to the National Organization on Disability (NOD).

To their credit, government agencies such as the Federal Emergency Management Agency (FEMA) and relief organizations such as the American Red Cross as well as non-profits such as NOD have tips and information available for people with disabilities to help them or caregivers during hazardous events. There is even a campaign, eSSENTIAL Accessibility, to help people with disabilities access vital information online.

Yet, until further studies are completed on how to better respond to those impaired during emergency situations, millions of Americans remain at risk. But those studies cost money, and funding for disasters largely comes after the fact.

"Our response to disaster planning in this country is very reactionary," says Robert Ottenhoff, chief executive of the Center for Disaster Philanthropy in Washington, DC, adding that about 90% of all donations for disasters are given within 90 days of the event, and there is little in the way of advance funding for disaster planning.

To be sure, the U.S. is not alone in its vulnerability problem. During a brutal heatwave in the summer of 2003, an estimated 70,000 people died in Europe, mostly seniors in France whose homes did not have air conditioning.

High temperatures affect seniors and children most, in terms of age groups, because they have deteriorating or developing central nervous systems, respectively. As numerous studies released during Climate Week in New York prove, global temperatures will continue to rise, meaning more people will be vulnerable to extreme weather events.

To prepare and care for those impaired, FEMA's website recommends customizing an emergency supply kit with medical equipment, prescription medications and medical necessities, including food for special diets.

Visit USA Today for the story.



Spread the word: National Breast Cancer Awareness Month Starts NOW!

Healthcare Purchasing News would like to remind everyone that National Breast Cancer Awareness Month starts today, October 1, and is a chance to raise awareness about the importance of early detection of breast cancer, a disease that affects about 1 in 8 women in the United States.

The good news is that many women can survive breast cancer if it?s found and treated early. A mammogram ? the screening test for breast cancer ? can help find breast cancer early when it?s easier to treat.

Please help make a difference by spreading the word about mammograms and encourage communities, organizations, families, and individuals to get involved. For resources and information about how you and your organization can help, visit the U.S. Department of Health and Human Services.

The American Cancer Society (ACS) also needs your help to ?create an unstoppable wave on Facebook to honor survivors and remind women everywhere to get regular screenings for breast cancer.?  Visit the American Cancer Society on Facebook to help spread the news with the ACS?s 2014 Breast Cancer Awareness image.