Once cash cows,
university hospitals now source of worry for schools
Teaching hospitals have long been points of pride for major universities,
and in recent years revenue from medical services has served as a lifeline
for some schools that have struggled with falling state aid and pressure to
slow tuition increases.
Now the marriages between universities and their cash-cow clinical
operations are starting to fray as changes stemming from the 2010 healthcare
law threaten to make university hospitals less profitable.
Some schools are keeping a closer eye on their hospital operations to
weather the coming storm, but others, including Vanderbilt University and
Emory University, are distancing themselves from their medical centers and
returning to their teaching roots.
University-affiliated hospitals tend to charge more for their services than
so-called community hospitals because they are also funding research and
instruction and handling particularly complex cases. That makes them less
attractive to the exchange-based insurance networks created under the
Affordable Care Act. Another factor raising costs: Most university hospitals
are in urban areas and treat a high share of patients who are uninsured or
covered by Medicaid.
Hospital‚ÄĒand therefore university‚ÄĒadministrators have also been spooked by
impending cuts to ‚Äúdisproportionate share‚ÄĚ hospitals, which treat indigent
patients, and uncertainty over how states will continue to fund Medicaid
Academic medical centers have historically run operating margins of 3% to
5%, but McKinsey predicted in a 2013 report that those margins could drop by
four to five percentage points by 2019, pushing some into the red.
Officials from those schools acknowledged the volatility ahead and said they
were comfortable with their hospital operations but monitoring the changing
Moody‚Äôs raised its outlook on the University of Arizona to stable from
negative last month after that school‚Äôs struggling hospitals, clinics and
insurance company were acquired by nonprofit Banner Health.
The U.S. has about 120 academic health centers, composed of teaching
hospitals with close ties to medical schools. Major teaching hospitals make
up about 5% of all hospitals, but account for nearly a quarter of clinical
care based on total hospital revenue, according to the Association of
American Medical Colleges.
Some of the largest are now getting a checkup. Vanderbilt, a private
university in Nashville, TN, said in November it was spinning off its
medical center, which narrowly avoided a fiscal 2014 loss thanks to steep
cost cuts. The two will still be affiliated, but the university will shed
its significant exposure to the struggling hospital: about $3 billion of the
$4 billion the school forecasts in fiscal 2015 revenue is related to its
healthcare arm. The hospital, meanwhile, will gain flexibility to raise more
debt because it won‚Äôt be limited by the university‚Äôs plan to maintain an Aa2
A similar deal was struck by Emory, which gets $2.5 billion, or more than
61% of total revenue, from clinical operations, up from 47.4% a decade ago.
The Atlanta university said in February that it is in talks to spin off its
Emory Healthcare arm, which consists of six hospitals plus outpatient
clinics, in a partnership with nonprofit WellStar Health System.
Still, other schools are taking the opposite tack, hoping that pulling their
hospitals closer can unearth cost savings and better align clinical
operations with research and teaching needs.
Loma Linda University, a health-sciences institution in Southern California,
in coming months is set to announce a single governance structure for its
schools, hospital system and physician practices.
That will mean a radical change in its financial statements. Net patient
revenue for fiscal 2014 at Loma Linda University Medical Center was $1.08
billion, dwarfing university revenue of $304 million.
‚ÄúEvery time the environment becomes unstable, universities that own their
systems are trying to sell them and universities that don‚Äôt are trying to
buy them,‚ÄĚ said Daniel Jones, chancellor at the University of Mississippi, a
state school. ‚ÄúEverybody‚Äôs unhappy with their circumstances.‚ÄĚ Jones had
argued against spinning off the institution‚Äôs medical center in Jackson,
saying that a singular focus on financial returns would hurt the public
mission of the state‚Äôs only comprehensive trauma center. Instead, he has
expanded patient volume and maintained a large referral base by teaming up
with community hospitals. The medical center brought in more than 40% of
operating revenue for Mississippi‚Äôs eight-school higher-education system
last year, up from 27% a decade earlier.
Ohio State University, which gets nearly half its system operating revenue
from healthcare, initiated a plan last year to improve margins and save $100
million by pursuing more competitive pricing for supplies and services and
taking a more conservative approach to hiring.
Visit the Wall Street Journal for the story.
Proper diet might
cut the risk of developing Alzheimer‚Äôs
Researchers successfully tested a special diet they designed that appears to
reduce the risk for developing Alzheimer‚Äôs disease.
The study compared the so-called MIND diet with the popular, heart-healthy
Mediterranean diet and the DASH diet, which is intended to help control high
blood pressure. The MIND diet borrows significantly from the other two, and
all are largely plant-based and low in high-fat foods. But the MIND diet
places particular emphasis on eating ‚Äúbrain-healthy‚ÄĚ foods such as green
leafy vegetables and berries, among other recommendations.
The study, conducted by researchers at Rush University Medical Center in
Chicago, found strict adherence to any of the three diets lessened the
chances of getting Alzheimer‚Äôs. But only the MIND diet seemed to help
counter the disease even when people followed only some of the diet‚Äôs
recommendations. The research was observational, not randomized or
controlled, and therefore isn‚Äôt evidence the MIND diet caused a reduced risk
for Alzheimer‚Äôs. Instead, the research shows there is an association between
The MIND diet combines elements of the heart-healthy Mediterranean diet and
the DASH diet, which aims to reduce high blood pressure. The MIND diet also
includes ‚Äėbrain-healthy‚Äô foods such as lots of green leafy vegetables,
blueberries and nuts. A study found adhering strictly to any of the three
diets lowered the risk for Alzheimer‚Äôs disease. But only the MIND diet had
significant benefits even with moderate adherence.
The study is part of a small body of research investigating how nutrition
can improve brain health and stave off the cognitive decline and memory
impairment that comes with Alzheimer‚Äôs disease and other forms of dementia.
Experts say there is growing awareness that lifestyle factors‚ÄĒnot just
genetics‚ÄĒplay a prominent role in the development of Alzheimer‚Äôs, and
researchers hope to come up with an optimal diet that will lessen the
chances of developing the disease. An estimated 5.1 million people in the
U.S. have Alzheimer‚Äôs, a number expected to grow to 7.1 million by 2025,
according to the Alzheimer‚Äôs Association.
‚ÄúIt‚Äôs a relatively new field compared with heart disease and diabetes and
nutrition,‚ÄĚ said Martha Clare Morris, a professor of neurological
epidemiology at Rush. ‚ÄúAs we learn more and more I think we would definitely
modify or update the [MIND] diet based on the latest research,‚ÄĚ said Dr.
Morris, who was first author of the study, published recently in the journal
Alzheimer‚Äôs & Dementia.
The MIND diet, which took two years to develop, stands for
Mediterranean-DASH Intervention for Neurodegenerative Delay. Researchers
modified the Mediterranean and DASH diets based on evidence from animal and
human studies looking at nutrition and the brain. DASH stands for Dietary
Approaches to Stop Hypertension.
The study involved 923 participants who didn‚Äôt have dementia at the start of
the research. Their ages ranged from 58 to 98, with a median age of 81.
Participants, who were followed on average for 4.5 years, were questioned
annually on how often they ate from among 144 different food items. Subjects
whose diet choices adhered closely to the MIND diet had a 53% reduced risk
for developing Alzheimer‚Äôs. Risk was reduced by 54% with the Mediterranean
diet and 39% with the DASH diet.
Significantly, even moderate adherence to the MIND diet helped lessen the
risk for Alzheimer‚Äôs, by 35%. By comparison, moderate adherence to the
Mediterranean or DASH diets didn‚Äôt affect the chances of getting the
Visit the Daily Times for the study.
sides on USPSTF recommendation
In reaffirming its position on breast cancer screening, the United States
Preventive Services Task Force (USPSTF) received mixed but mostly
unfavorable reviews from a small sample of practicing physicians responding
to a MedPage Today request.
Representing radiologists, primary care physicians, and
obstetrician/gynecologists, the respondents focused on the same two issues
that have kept the USPSTF recommendation at the center of controversy:
routine screening starting at age 50 and biennial screening, irrespective of
age. Some comments credited the task force with trying to make the best of a
"Though the USPSTF report text skillfully addresses the complexities in
assessing whether there is a true benefit to breast cancer screening,
communicating these benefits to women and their physicians is a fraught
process," said Kenneth D. Mandl, MD, of Boston Children's Hospital and
Harvard. "In general, women have been advised to undergo mammography and to
believe that it is purely beneficial. Sometimes pamphlets with selected
misleading statistics support the advice. The data on harms, however, are
clear and rarely communicated."
In contrast, other respondents went on the attack from the beginning and
never let up. Radiologist Daniel Kopans, MD, a long-time vocal advocate for
breast cancer screening, took issue with virtually the entire 50-page
document, providing comments too extensive to include in a single news
story. A sampling of his reaction:
Biennial screening starting at age 50 -- "a specious and cynical suggestion.
The USPSTF suggests that women should decide for themselves, but since [the
USPSTF] ratings determine insurance, they have taken away the decision for
women ages 40 to 49, and women ages 50 to 74 will only have screening
coverage every 2 years. The panel based their recommendations on a
subjective value judgment."
Most of the benefits of screening are limited to women 50 to 74 -- "The
USPSTF appears to be unaware that more than 40% of the years of life lost to
breast cancer are among women diagnosed in their 40s."
Benefits versus harms -- "The panel is misleading women and the public in
suggesting that there is any major 'overdiagnosis' of invasive breast
cancers ... . "The inexperienced panel is perpetuating misinformation that
has been shown to be based on flawed analyses, but the panel is clearly
unaware of the facts. There is little if any 'overdiagnosis' of invasive
Kopans, senior radiologist in breast imaging at Massachusetts General
Hospital in Boston, cited the makeup of the USPSTF as the principal source
for the flaws he found in the draft recommendation.
"None of the members of the 2014 to 2015 United States Preventive Services
Task Force panel had any expertise in breast cancer care, and no one on the
panel had any expertise in breast cancer screening," said Kopans. "The lack
of knowledge and lack of experience on the panel are evident in the numerous
errors found in almost every paragraph of this summary document."
The 2015 recommendation does recognize the potential benefit of
individualized screening for high-risk women, "a welcome change from the
2009 guidelines," said Davide Bova, MD, medical director of diagnostic
radiology at Loyola University Medical Center in Chicago. However, Bova took
issue with the core recommendations: biennial screening ("greater risk of
advanced-stage disease at diagnosis), lack of benefit for routine
mammography in women younger than 50, and lack of support for women older
than 74. In his practice, radiologists follow recommendations supported by
the American Cancer Society and American College of Radiology.
Family physician B. Lewis Barnett Jr., MD, of the University of Virginia in
Charlottesville, offered support for the USPSTF process, but noted how
primary care and radiology often are at odds about how to advise patients
regarding breast cancer screening. "Our family medicine department closely
pays attention to the USPSTF recommendations on all evidence summary issues,
so we've basically been following these recommendations on all evidence
summary issues," said Barnett.
The concept of "pseudo-disease," the diagnosis and treatment of benign or
inconsequential breast disease, is difficult for patients -- and many
physicians -- to grasp.
Visit MedPage Today for the report.
share real-time genetic data on deadly MERS, Ebola
Genetic sequence data on two of the deadliest yet most poorly understood
viruses are to be made available to researchers worldwide in real time as
scientists seek to speed up understanding of Ebola and MERS infections.
The project, led by British scientists with West African and Saudi Arabian
collaboration, hopes to encourage laboratories around the world to use the
live data -- updated as new cases emerge -- to find new ways to diagnose and
treat the killer diseases, and ideally, ultimately, prevent them.
"The collective expertise of the world's infectious disease experts is more
powerful than any single lab, and the best way of tapping into this...is to
make data freely available as soon as possible," said Jeremy Farrar,
director of the Wellcome Trust global health charity which is funding the
The gene sequences, already available for MERS cases and soon to come in the
case of Ebola, will be posted on the website virological.org for
anyone to see, access and use.
Middle East Respiratory Syndrome (MERS) is a viral disease which first
emerged in humans in 2012 and has been spreading in Saudi Arabia and
neighboring countries since then. It is caused by a coronavirus and has
already killed more than 430 people.
An unprecedented epidemic of Ebola virus in West Africa has killed more than
10,000 people in the past year and infected more than 25,000 mainly in
Guinea, Sierra Leone and Liberia.
Despite the many deaths caused by Ebola and MERS, researchers still know
relatively little about the viruses -- including what animals might be
acting as "viral reservoirs" -- and scientists are battling to develop safe
and effective cures or vaccines against them.
Paul Kellam, a professor at Britain's Sanger Institute, said mapping the
gene structure, or sequencing the genome, of a virus can tell scientists a
lot about how it is spreading and changing, and help in the search for
better ways to diagnose, treat and prevent infections.
Yet while this kind of data is invaluable to researchers, it is rarely
shared swiftly or freely enough among them. Saudi Arabia was widely
criticized at the start of the MERS outbreak for being slow to cooperate
with experts around the world wanting to conduct crucial research on the
Kellam said Saudi authorities are now committed to sharing viral data widely
and immediately, keen to enlist the help of international scientists in
Visit Reuters for the story.
More than 26,000
have been infected with Ebola: WHO
More than 26,000 people have been infected with Ebola since the outbreak
began and more than 10,800 have died, the World Health Organization said
Wednesday. The UN health body also warned that the decline in confirmed
cases appeared to have stagnated, urging increased efforts to stop
transmission of the deadly virus.
In all, 26,079 people have contracted the disease over the past 16 months,
and 10,823 of them have died, almost all of them in Guinea, Liberia and
After tearing through the three countries like wildfire, the spread of the
virus has slowed to a crawl. In the week leading to April 19, 33 new
confirmed cases were reported, with 21 in Guinea, 12 in Sierra Leone and
none in Liberia. That compares to 37 new confirmed cases the week before,
and 30 the week before that.
"The decline in confirmed cases of Ebola virus disease has halted over the
last three weeks," the WHO said in its latest report. "To accelerate the
decline towards zero cases will require stronger community engagement,
improved contact tracing and earlier case identification," it said.
On the bright side, Liberia, once the hardest hit country, has reported no
new cases of Ebola since the last confirmed case died on March 27 and was
buried a day later.
If no new cases emerge, Liberia should be declared Ebola-free on May 9, 42
days, or two incubation periods, after the burial of the last confirmed
The situation was more mixed in Guinea. The 21 new confirmed cases there
marked a decrease from 28 a week earlier, and only one new confirmed case
was reported in the capital Conakry, down from six the week before. But of
11 confirmed Ebola deaths during the week leading to Sunday, six died in
their communities with the diagnosis only made post-mortem.
And for three consecutive weeks, fewer than half of new cases have come from
lists of people known to have been in contact with Ebola patients, meaning
health authorities still lack a full overview of transmission chains.
Perhaps most worrying: last week Guinea reported 163 unsafe burials of
victims of the highly contagious disease, up from 72 a week earlier.
The WHO however said the sharp increase was likely due to more reporting of
such burials amid increased vigilance.
Community resistance to efforts to halt the outbreak also continue to be a
problem in Guinea, where 11 people were sentenced Wednesday to life in
prison for murdering eight Ebola workers last September.
Visit Yahoo for the report.
Recall: LuSys Laboratories, Inc., Ebola Virus One-Step
A recall has been issued for the LuSys Laboratories, Inc., Ebola Virus
One-Step Test Kits because the FDA has not cleared or approved the kits for
use or sale. The results obtained from these test kits have not demonstrated
to be accurate and should not be used as in vitro diagnostic tests for Ebola
infection. A false positive result may be life-threatening by potentially
placing the patient in an isolation cohort with Ebola infected patients. A
false negative test result may be life-threatening by causing a lack or
delay in treatment of the patient and risking infecting healthcare
providers, family and other close contacts.
Visit here for the recall notice.
Could maple syrup
help cut use of antibiotics?
A concentrated extract of maple syrup makes disease-causing bacteria more
susceptible to antibiotics, according to laboratory experiments by
researchers at McGill University.
The findings, which will be published in the journal Applied and
Environmental Microbiology, suggest that combining maple syrup extract
with common antibiotics could increase the microbes‚Äô susceptibility, leading
to lower antibiotic usage. Overuse of antibiotics fuels the emergence of
drug-resistant bacteria, which has become a major public-health concern
Prof. Nathalie Tufenkji‚Äôs research team in McGill‚Äôs Department of Chemical
Engineering prepared a concentrated extract of maple syrup that consists
mainly of phenolic compounds. Maple syrup, made by concentrating the sap
from North American maple trees, is a rich source of phenolic compounds.
The researchers tested the extract‚Äôs effect in the laboratory on
infection-causing strains of certain bacteria, including E. coli and Proteus
mirabilis (a common cause of urinary tract infection). By itself, the
extract was mildly effective in combating bacteria. But the maple syrup
extract was particularly effective when applied in combination with
antibiotics. The extract also acted synergistically with antibiotics in
destroying resistant communities of bacteria known as biofilms, which are
common in difficult-to-treat infections, such as catheter-associated urinary
The scientists also found that the extract affects the gene expression of
the bacteria, by repressing a number of genes linked with antibiotic
resistance and virulence.
Visit McGill for the study.
3M new Tegaderm
CHG I.V. Port Dressing
3M Critical and Chronic Care Solutions announces the launch of its new 3M
Tegaderm CHG Chlorhexidine Gluconate I.V. Port Dressing, designed for
patients with implanted port devices under their skin and connected to a
catheter for the purpose of central venous infusions.
The new offering combines, for the first time, a transparent, port-site
dressing with a separate, compatible antimicrobial CHG gel pad device that‚Äôs
also clear and designed specifically for ports. This allows for continuous,
unobstructed observation of the I.V. insertion site, even in the presence of
saline, blood and exudates.
In addition, an adhesive-free window on the dressing ensures that it doesn‚Äôt
stick to the needle or patient during dressing removal. And the CHG gel pad
not only provides immediate and continuous antimicrobial protection, but it
is designed to conform around the needle at the insertion site. Because the
cover dressing and CHG gel pad accommodate a variety of non-coring Huber
needles, only one size is needed, making it a versatile option. Both the
dressing and pad flex with patient movement and can be worn for up to seven
A version of the product containing the dressing but not the CHG gel pad
device will be made available later this summer.
Visit 3M for more information.