May 2020 • Vol.11 • No.3
MRSA: Still a threat
Thank you for your commitment to protecting and saving lives In this time of crisis we are here to support you by focusing on supplying infusion therapy and other life-sustaining products that are vital to patient care. Together we will work with the healthcare supply chain and all healthcare providers who are fighting this battle.
Thank you for the sacrifices you are making. Please visit bbraunusa.com for updated information on how we are responding to the COVID-19 crisis. Š2020 B. Braun Medical Inc., Bethlehem PA. All rights reserved. 4/20
CONTENTS »» MAY 2020
2 Sustainability is a full-time job IDNs such as Virginia Mason Medical Center are serious about sustainability. John Leigh is proof.
7
MRSA: Still a threat
10 Diabetes
Diabetes affects more than 25% of Americans aged 65 or older, and its prevalence is projected to increase two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue.
16 Contracting News & Notes
The Journal of Healthcare Contracting is published bi-monthly by Share Moving Media 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770/263-5262 FAX: 770/236-8023 e-mail: info@jhconline.com www.jhconline.com
PUBLISHER John Pritchard
EDITOR Graham Garrison
EVENT COORDINATOR AND ANAE PRODUCT MANAGER Anna McCormick
MANAGING EDITOR Daniel Beaird
jpritchard@sharemovingmedia.com
amccormick@sharemovingmedia.com
ggarrison@sharemovingmedia.com
dbeaird@sharemovingmedia.com
CIRCULATION Laura Gantert
lgantert@sharemovingmedia.com
VICE PRESIDENT OF SALES
Katie Educate keducate@sharemovingmedia.com
ART DIRECTOR Brent Cashman
bcashman@sharemovingmedia.com
The Journal of Healthcare Contracting (ISSN 1548-4165) is published bi-monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media All rights reserved. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. The Journal of Healthcare Contracting | May 2020
1
SUSTAINABILITY
Sustainability is a full-time job IDNs such as Virginia Mason Medical Center are serious about sustainability. John Leigh is proof.
In December 2019, eight major health systems in Washington state formed
optimistic about where we are today
the Washington Health Care Climate Alliance, whose mission is to advocate for
as a society in general, and health-
“climate-smart” policies. The participating systems represent 40 hospitals and more than
care providers specifically?
1,000 healthcare facilities. Specific policy areas the coalition plans to take on include
Leigh: One thing that gives me hope in
energy, transportation, food, waste, infrastructure and community resilience.
the face of the climate crisis is the rapidly growing awareness of its importance, especially among younger generations
John Leigh is director of sustainability
I am frequently urging my colleagues
and among healthcare providers, which is
for one of the participating systems –
within the organization to find ways, with
spurring a desire for action. I’ve noticed
Virginia Mason Medical Center in Seattle.
my help, to reduce the environmental
that many more clinicians are recognizing
Share Moving Media, publisher of The
footprint of their department or opera-
that climate change is already occur-
Journal of Healthcare Contracting, presented
tional area. Another is that I am regularly
ring, and that it will have dramatic public
Leigh with some questions about health-
interacting with my counterparts at other
health and well-being impacts. There
care providers’ concerns and goals regard-
organizations regarding best practices,
is a quickly growing sentiment that we
ing sustainability, and how distributors
learning what others are up to in the
have an ethical obligation to act on this
can address them.
sustainability space, and sharing what we
knowledge and reduce greenhouse gas
are doing.
emissions in a variety of ways.
Please talk about your role as director
JHC: You have been involved in sus-
declining cost and improving efficiency
of sustainability at Virginia Mason.
tainability all the way back to 1990,
of renewable energy technologies and
What are your days/weeks like?
when you went to work for the U.S.
electric vehicles.
John Leigh: In general, they’re full of
Environmental Protection Agency.
variety. But one constant element is that
Thirty years later, what makes you
Trends that will help with this are the
The Journal of Healthcare Contracting:
2
Another trend that gives me hope are plant-based materials being used
May 2020 | The Journal of Healthcare Contracting
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SUSTAINABILITY
to make medical supplies in place of
verification, certification or comparison
certainly not in the healthcare products
single-use plastics.
services. Some of those exist and more
industry, to my knowledge.
continue to emerge.
Extended Producer Responsibility laws shift the responsibility for the
JHC: We have read that buyers might be more interested in “environmen-
JHC: It seems that the difficulty of
treatment or disposal of post-consumer
tally preferable purchasing” if they
performing life cycle analyses is the
products to producers. This gives them a
had access to life cycle analyses of
fact that there are so many play-
strong incentive to design with environ-
medical products or equipment --
ers involved in the manufacturing,
mental impact in mind, prevent wastes
that is, analyses that account for raw
distribution, usage and disposal of
at the source, and integrate the cost of
material consumption, cost of manu-
a medical device or supply. Just as
treatment, reuse, recycling or disposal into
facturing and distribution, actual
providers struggle to create a “con-
the purchase price. It’s an approach that
usage by the provider, and disposal.
tinuum of care” for their patients
we’d greatly benefit from adopting, from
Are healthcare providers capable of
(encompassing preventive care, pre-
the sustainability perspective.
performing such analyses?
admission, acute-care stay, JHC: Please talk about the Washington Health Care Climate Alliance.
True life cycle analyses are too involved and complicated for health systems to perform ourselves. But there is environmental attribute information short of a life cycle analysis that can be useful in getting a feel for the environmental preferability of many products.
Can you elaborate about what your eight members can do better than each of you could do on your own? Leigh: First, we are already talking about climate issues across our own health systems as well as with other Washington Health Care Climate Alliance members in ways that we had not done before. We are talking about climate mitigation and resilience legislation with our government affairs directors, and about energy conservation targets among our facilities directors.
4
Leigh: No. True life cycle analyses are
post-acute care), are the various sup-
We’ve already succeeded in fostering much
too involved and complicated for health
ply chain players collaborating on
greater engagement and agreement on cli-
systems to perform ourselves. But there is
conducting reliable life cycle analy-
mate and energy topics within our industry
environmental attribute information short
ses regarding the sustainability of
in Washington. This has been valuable.
of a life cycle analysis that can be useful
their products and equipment?
in getting a feel for the environmental
Leigh: The short answer is “No, I don’t
tive voice, representing 40% of the hos-
preferability of many products, such as
believe such collaboration is taking place,
pitals in the state, we are a more powerful
durability, reusability or added chemicals
unfortunately.” But I also believe what
advocate for climate and health, using
of concern.
you’re describing is very similar to Ex-
our trusted role in the community along
tended Producer Responsibility, a con-
with our influence as large employers
JHC: If the vendor were to perform
cept that has been around since my time
who serve more than 8 million patients
such an analysis, how can the provider
at the EPA in the 1990s. This has been
each year. The Alliance structure will help
ensure that the analysis is accurate?
far more widely accepted and regulated
us be more effective on policy issues as
Leigh: By relying on the establishment
within the European Union, but only
well as technical issues, with the goal of
of accepted standards and on indepen-
barely in some product areas in North
protecting people from the worst health
dent, third party organizations to perform
America (like rechargeable batteries), and
impacts of climate change.
Second, by speaking with one collec-
May 2020 | The Journal of Healthcare Contracting
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6
May 2020 | The Journal of Healthcare Contracting
MRSA: Still a threat COVID-19 has dominated the news since January, and rightly so. Yet MRSA –
and other types of resistant staph major
short for methicillin-resistant Staphylococcus aureus – remains a threat in the community, in
antibiotic-resistance problems.
physicians’ offices, and in hospitals and nursing homes. As with COVID-19, the keys are early detection, treatment, disinfection … and knowledge.
In the community (that is, where people live, work, shop, and go to school), MRSA most often causes skin infections. In some cases, it causes pneumonia (lung
A well-informed sales rep can initiate
Some of the people who carry MRSA
infection) and other infections. If left un-
dialogue and appropriate action among
contract a MRSA infection. Non-intact
treated, MRSA infections can become se-
caregivers. With that in mind, The Journal
skin, such as when there are abrasions
vere and cause sepsis – the body’s extreme
of Healthcare Contracting offers some
or incisions, is often the site of such an
response to an infection. In healthcare set-
factual points about MRSA from the
infection. Athletes, daycare and school
tings, such as a hospital or nursing home,
Centers for Disease Control and Preven-
students, military personnel in barracks,
MRSA can lead to bloodstream infections,
tion (CDC).
and those who receive inpatient medical
pneumonia or surgical site infections.
care or have surgery or medical devices inserted in their body are at higher risk
What is MRSA?
of MRSA infection.
How is MRSA identified?
MRSA stands for methicillin-resistant
Recent data suggest that MRSA as a cause
Staphylococcus aureus, a type of bacteria that
of skin infections in the general com-
is resistant to several antibiotics.
How is MRSA spread in the community?
munity remains a high probability. CDC encourages clinicians to consider MRSA
MRSA is usually spread in the community
in the differential diagnosis of skin and
How common is it?
by contact with infected people or things
soft tissue infections (SSTIs) compatible
Studies show that about one in three
that carry the bacteria. This includes
with S. aureus infections, especially those
(33%) people carry S. aureus bacteria in
contact with a contaminated wound or
that are purulent (fluctuant or palpable
their nose, usually without any illness.
sharing personal items – such as towels or
fluid-filled cavity, yellow or white center,
About two in every 100 people carry
razors – that have touched infected skin.
central point or “head,” draining pus, or
MRSA. Although many people carry
The opioid epidemic may also be con-
that are possible to aspirate with needle
MRSA bacteria in their nose, most do not
nected to the rise of staph infections in
or syringe). A patient who complains of
develop serious MRSA infections.
communities. People who inject drugs are
“spider bite” should raise suspicion of an
16 times more likely to develop a serious
S. aureus infection.
staph infection.
Who is at risk? How about point-of-care testing?
Anyone can get MRSA. The risk increases with activities or places that
How serious is MRSA?
Rapid tests are available. One such test
involve crowding, skin-to-skin contact,
Staphylococcus aureus (staph) has become re-
identifies S. aureus and PBP2a, a common
and shared equipment or supplies.
sistant to several antibiotics, making MRSA
marker for MRSA, from blood culture.
The Journal of Healthcare Contracting | May 2020
7
MRSA
Another identifies PBP2a in S. aureus culture
Keeping one’s hands clean is one of the
The disinfectant’s label will have a list
isolates. In December 2019, the U.S. Food
most important steps office staff can take
of germs that the product can kill,
and Drug Administration authorized mar-
to avoid getting sick and spreading germs
along with an Environmental Protection
keting of a test that uses a bacteriophage
like MRSA. Soap and water should be used,
Agency (EPA) registration number.
technology based on bioluminescence to
if available. After wetting hands and adding
detect MRSA from nasal swab samples.
soap, scrub hands for at least 20 seconds. If patients should use an alcohol-based hand
What should be cleaned to prevent MRSA from spreading?
How is MRSA typically treated on an outpatient basis?
sanitizer that contains at least 60% alcohol to
When cleaning and disinfecting, focus on
clean hands. Apply the sanitizer to one hand,
surfaces that frequently contact people’s
If the lesion is purulent (e.g., fluid-filled,
rub hands together, covering all surfaces of
bare skin, like desks, chairs, light switches,
has a yellow or white center, is draining
hands and fingers until hands are dry.
faucets, remote controls, benches, gym
soap and water cannot be accessed, staff and
pus, etc.), the clinician typically:
equipment and lockers. In particular, clean
1. Drains the lesion. 2. Sends wound drainage for culture and susceptibility testing. 3. Advises patient on wound care and hygiene.
any surfaces that could come into contact
How can the physician practice clean and disinfect surfaces to prevent MRSA infection?
with uncovered wounds, cuts, or boils. In
Cleaners or detergents are products that
ered keeps MRSA from spreading.
addition to cleaning surfaces, frequently cleaning hands and keeping wounds cov-
remove soil, dirt, dust, organic matter and
Large surfaces, such as floors and
patient, including the possibil-
germs (like bacteria, viruses, and fungi). They
walls, have not been associated with the
ity of antimicrobial therapy
lift dirt and germs off surfaces so they can be
spread of staph and MRSA. There is no
if incision and drainage don’t
rinsed away with water. Cleaning with a de-
evidence that spraying or fogging rooms
work. MRSA skin infections
tergent is necessary to remove dirt, which can
or surfaces with disinfectants prevents
can develop into more serious
prevent disinfectants from working. Some
MRSA infections more effectively than
infections. It is important that
disinfectants have a cleaning agent mixed in.
the targeted approach of cleaning fre-
4. Discusses follow-up plan with
the physician discuss a follow-up
quently touched surfaces and surfaces that
plan with the patient in case they
Disinfectants are chemical products
develop systemic symptoms or
that are used to kill germs in healthcare
worsening local symptoms, or if
settings. Disinfectants effective against
Primary source: Centers for Disease Con-
symptoms do not improve within
S. aureus are also effective against MRSA.
trol and Prevention, www.cdc.gov/mrsa/
have been exposed to open wounds.
48 hours.
What safeguards should physician practices put in place to prevent the spread of MRSA among healthcare workers or patients? MRSA can survive on some surfaces, like furniture, towels, razors, and athletic equipment, for hours, days or even weeks. It can spread to people who touch a contaminated surface and can cause infec-
Best way to prevent a MRSA infection? ʯ Maintain good hand and body hygiene. Clean hands often, and clean your body regularly, especially after exercise.
ʯ Keep cuts, scrapes, and wounds clean and covered until healed. ʯ Avoid sharing personal items, such as towels and razors. ʯ Get care early if you think you might have an infection.
tions if MRSA gets into a cut, scrape or open wound.
8
May 2020 | The Journal of Healthcare Contracting
Delivering for you, so you can deliver a difference. Every day you’re making a difference in patients’ lives. We want to help make that easier. From our teams packing boxes to the ones bringing them to your door, we’re all-in to support the work you do. While you deliver care to those in need, we’ll deliver for you.
mms.mckesson.com/coronavirus © 2020 McKesson Medical-Surgical Inc.
TRENDS
Diabetes Diabetes affects more than 25% of Americans aged 65 or older, and its prevalence is projected to increase two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue.
The Standards of Care is available online at https://care.diabetesjournals.org, and is published as a supplement to the January 2020 issue of “Diabetes Care.”
Diabetes and heart failure Diabetes is an independent risk factor and is associated with the development of heart failure over time, conclude researchers at Mayo Clinic, who reported their findings in January 2020 “Mayo Clinic Proceedings.” Approximately 21% (22 of 116) of patients with diabetes mellitus developed heart failure over a 10-year period, which is significantly elevated when compared with patients without diabetes (12% [24 of 232]). In the study, researchers say they have also shown that participants with diabetes – even in the absence of diastolic dysfunction (that is, abnormal pumping of the heart) – are
Cardiovascular disease and diabetes
10
or ASCVD risk factors, diabetic kidney
more likely than those without diabetes
disease or heart failure.
to develop heart failure. Future research
Cardiovascular disease is the leading
The Standards say that in asymptomat-
should be focused on whether aggressive
cause of morbidity and mortality for
ic patients, routine screening for coronary
management of risk factors such as BMI
people with diabetes. The 2020 Standards
artery disease is not recommended, as it
and glucose and cholesterol levels will
of Medical Care in Diabetes, published
does not improve outcomes as long as
decrease the development of heart failure
in December 2019 by the American
ASCVD risk factors are treated. However,
in patients with diabetes.
Diabetes Association, offers recom-
providers should consider investigating
mendations for screening, testing and
for coronary artery disease in the pres-
treating people with diabetes to reduce
ence of atypical cardiac symptoms (e.g.,
The elderly and type 1 diabetes
the occurrence of cardiovascular dis-
unexplained dyspnea, chest discomfort);
People with type 1 diabetes are living longer.
ease. The recommendations have been
signs or symptoms of associated vascular
Hence the American Diabetes Association
individualized based on patients’ risk,
disease, including transient ischemic
has added a subsection focusing on special
including the presence of atheroscle-
attack or stroke; or electrocardiogram
considerations for older adults with type 1
rotic cardiovascular disease (ASCVD)
abnormalities (e.g., Q waves).
diabetes in the 2020 Standards of Medical Care
May 2020 | The Journal of Healthcare Contracting
Patient positioning can make all the difference for consistent BP measurements. We know you realize the importance of blood pressure capture, the effects it can have on diagnosis and the impact to your patients. However, following AHA/AMA recommendations for patient positioning during BP capture will help ensure more consistent, accurate and repeatable BP measurements. Something as simple as the patient’s feet not resting flat on the floor can increase the measurement by 5 to 15 points.1
May is National Blood Pressure Education month. Learn more about consistent BP capture and download the Better BP Checklist at: midmark.com/JHCmay
1
https://www.ncbi.nlm.nih.gov/pubmed/10450120
Š 2020 Midmark Corporation, Miamisburg, Ohio USA
TRENDS
Young people and types 1 and 2 diabetes
an analysis of one of the initial studies
The incidence of type 1 and type 2 diabetes
sociated with diabetes risk, the reduction
ketoacidosis, older adults with type
among young people in the United States is
in cardiovascular events far outweighed
1 diabetes need some form of basal
on the rise, and has been since at least 2002,
the risk of incident diabetes even for
insulin even when they are unable to
especially among racial and ethnic minority
patients at highest risk for diabetes. The
ingest meals. Insulin may be delivered
populations, according to the Centers for
absolute risk increase was small: Over five
through insulin pump or injections.
Disease Control and Prevention.
years of follow-up, 1.2% of participants
in Diabetes. Some points for doctors and their patients to keep in mind:
ʯ In order to avoid diabetic
ʯ Continuous glucose monitoring
From 2002 to 2012, type 1 and type
on placebo developed diabetes, and 1.5%
(CGM) is approved for use by
2 diabetes incidence increased 1.4% and
on rosuvastatin developed diabetes. A
Medicare and can play a critical role
7.1%, respectively, among U.S. youths. To
meta-analysis of 13 randomized statin
in improving A1C, reducing glycemic
assess recent trends in incidence of dia-
trials with 91,140 participants showed that
variability, and reducing risk of
betes in youths (defined as persons under
(on average) treatment of 255 patients
hypoglycemia.
age 20), researchers analyzed 2002–2015
with statins for four years resulted in one
data from the SEARCH for Diabetes
additional case of diabetes while simul-
more difficult as complications,
in Youth Study, a U.S. population-based
taneously preventing 5.4 vascular events
cognitive impairment, and functional
registry study with surveillance of 69.5
among those 255 patients.
impairment arise in older people with
million youths in five states. Among all
type 1 diabetes. This increases the
youths, the incidence of type 1 diabe-
searchers concluded in a study published
importance of caregivers in the lives
tes increased from 19.5 per 100,000 in
in October 2019 in the “British Journal of
of these patients.
2002–2003 to 22.3 in 2014–2015. Among
Clinical Pharmacology”: Clinicians should
ʯ Administration of insulin may become
ʯ Many older patients with type 1
Here’s the bottom line for patients, re-
persons aged 10–19 years, type 2 diabetes
be aware of the association between
diabetes require placement in long-
incidence increased from 9.0 per 100,000
statins and skin and soft-tissue infections
term care settings. Unfortunately,
in 2002–2003 to 13.8 in 2014–2015. For
(which are associated with diabetes), and,
these patients may encounter
both type 1 and type 2 diabetes, the rates
where appropriate, monitor blood glucose
providers who are unfamiliar with
of increase were generally higher among
levels of statin users.
insulin pumps or CGM. Some
racial/ethnic minority populations than
providers may be unaware of the
among whites.
distinction between type 1 and
Diabetes is a chronic disease that re-
The financial cost of diabetes
type 2 diabetes. In these instances,
quires lifelong treatment and management,
The Centers for Medicare & Medicaid
the patient or the patient’s family
point out CDC researchers. Better under-
Services (CMS) estimates that Medi-
may be more familiar with diabetes
standing of the number of new cases of
care spent $42 billion more in the
management than the providers.
diabetes among youths helps in planning
single year of 2016 on beneficiaries
for healthcare needs and resources.
with diabetes than it would have spent
ʯ Education of relevant support staff and providers in rehabilitation
if those beneficiaries did not have
and LTC settings regarding insulin
diabetes. Per beneficiary, Medicare
dosing and use of pumps and CGM
Statins and diabetes
spent an estimated $1,500 more on
is recommended as part of general
Several studies have reported a modestly
Part D prescription drugs, $3,100 more
diabetes education.
increased risk of incident diabetes with
for hospital and facility services, and
statin use, which may be limited to those
$2,700 more in physician and other
with diabetes risk factors, according to the
clinical services for those with diabetes
at https://care.diabetesjournals.org, and
2020 Standards of Medical Care in Diabetes,
than those without diabetes. (Estimates
is published as a supplement to the Janu-
published in December 2019 by the
based on fee-for-service, non-dual
ary 2020 issue of Diabetes Care.
American Diabetes Association. However,
eligible, over-age-65 beneficiaries.)
The Standards of Care is available online
12
suggested that although statin use was as-
May 2020 | The Journal of Healthcare Contracting
American Made and Delivered. Over 99% of our injectable drugs are manufactured in America.
*
According to the FDA, manufacturing facilities located in the US scored statistically higher in terms of quality than sites located in the rest of the world.1 With our exclusively US-based manufacturing facilities, as well as US sourcing of the majority of our product components and active pharmaceutical ingredients, we are able to quickly mobilize resources and respond to market shortages with the quality products your patients need.
Committed to US-Based Manufacturing *More than 99% of units manufactured in 2018 were manufactured in America, with remaining unit volume coming from Canada and France. Reference: 1. Report on the State of Pharmaceutical Quality https://www.fda.gov/media/125001/download May 13, 2019. Accessed July 3, 2019. Š 2019 American Regent, Inc. PP-NA-US-0064 12/2019
1.800.645.1706
AMERICAN REGENT.COM
TRENDS
Diabetes complications can snowball
long time without any symptoms. That’s
tion for its automated bionic pancreas.
Diabetes complications often share the
why it’s so important for patients to make
The iLet Bionic Pancreas System is a
same risk factors, and one complica-
and keep doctor and dentist appoint-
pocket-sized, wearable device designed
tion can make other complications
ments, even if they feel fine.
to autonomously control blood-sugar
Complications usually develop over a
worse, says the Centers for Disease
levels. The on-body wear is similar to
Control and Prevention (CDC).
that of an insulin pump. Unlike insulin
Life insurance for people with diabetes
pump therapy, however, the iLet system
with diabetes are two times more
Half of Americans with diabetes lack
weight for the iLet to initialize therapy.
likely than people without diabetes
an adequate amount of life insurance,
Immediately thereafter, the iLet begins
to have heart disease or a stroke.
or don’t have any life insurance at all,
controlling blood-sugar levels auto-
reports insurance company John Han-
matically, without requiring the user to
problems: Diabetes can lead
cock. Many worry they won’t qualify for
count carbohydrates, set insulin delivery
to blood vessels in the retina,
life insurance because they have diabe-
rates, or deliver bolus insulin for meals
cataracts, glaucoma.
tes, or that a life insurance policy would
or corrections.
Some examples:
ʯ Heart disease and stroke: People
ʯ Blindness and other eye
ʯ Kidney disease: High blood sugar
allows users to enter only their body
be unaffordable. John Hancock – in
levels can damage the kidneys and
collaboration with Verily, an Alphabet
cause chronic kidney disease.
company, and Onduo, a virtual “clinic”
Smart insulin patch
ʯ Nerve damage (neuropathy):
for people with type 2 diabetes – now
UCLA bioengineers and colleagues at
Nerve damage most often affects
offers a life insurance policy specifically
UNC School of Medicine and MIT
the feet and legs but can also affect
for Americans with diabetes. Clients of
have further developed a smart insulin-
digestion, blood vessels, and heart.
John Hancock Aspire™ will receive a
delivery patch that could one day moni-
ʯ Amputation: Diabetes-related
blood glucose monitoring device which,
tor and manage glucose levels in people
damage to blood vessels and nerves,
when used in conjunction with the On-
with diabetes and deliver the necessary
especially in the feet, can lead to
duo app, provide insights into the user's
insulin dosage. The adhesive patch,
serious, hard-to-treat infections.
diabetes management. Onduo's “virtual
about the size of a quarter, is said to
Amputation can be necessary to
care team,” made up of dieticians,
be simple to manufacture and intended
stop the spread of infection.
diabetes educators and doctors, offers
for once-a-day use. The adhesive patch
ʯ Gum disease: Gum disease can
personalized guidance and support re-
monitors blood sugar, or glucose. It has
lead to tooth loss and increased
garding diet, activity, lifestyle habits and
doses of insulin pre-loaded in tiny mi-
blood sugar, making diabetes harder
medication management. Those using
croneedles, less than one-millimeter in
to manage. It can also increase the
Onduo to manage and improve their
length, which deliver medicine quickly
risk of type 2 diabetes.
health can earn points to further boost
when the blood sugar levels reach a
their overall Vitality rewards and lower
certain threshold. When blood sugar
their premiums.
returns to normal, the patch's insulin
ʯ Depression: Diabetes increases the risk of depression, and that risk grows as more diabetes-related
delivery also slows down. The research-
health problems develop.
ers said the advantage is that it can help
ʯ Gestational diabetes: Diagnosed
prevent overdosing of insulin, which
diabetes can lead to preeclampsia
Bionic pancreas gets FDA “Breakthrough Device” designation
(high blood pressure caused by
Beta Bionics Inc. (Boston, Massachu-
in Nature Biomedical Engineering,
pregnancy), injury from giving birth,
setts) received Breakthrough Device
describes research conducted on mice
and birth defects.
designation in December 2019 from
and pigs.
during pregnancy, gestational
14
the U.S. Food and Drug Administra-
can lead to hypoglycemia, seizures, coma or even death. A study, published
May 2020 | The Journal of Healthcare Contracting
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PATIENT CARE
INTERVENTIONAL CARE
ENVIRONMENT OF CARE
NEWS
Contracting News & Notes Recent headlines and trends to keep an eye on
GPO News Intalere signs agreement with BPI Medical, a full-service medical equipment company
most health systems lack visibility into
and face shields. Other key products for
what’s happening symptomatically in
which they have supply concerns include
the ambulatory space, before patients
thermometers, exam gloves, alcohol pads,
Intalere (St. Louis, MO) has announced
arrive in the emergency room with a
soap/detergent and hand sanitizer.
a new agreement with BPI Medical, a
confirmed COVID-19 case.” Premier
full-service medical equipment company.
is marshaling its data and technol-
states and healthcare providers are
Through this agreement, Intalere mem-
ogy capabilities to provide real-time,
contemplating how they can best provide
bers will receive negotiated pricing on
integrated solutions that help make it
care for patients who need medical at-
repair services for flexible endoscopes,
easier for clinicians to deliver in-
tention but are not critical care status,”
rigid endoscopes, handheld surgical
formed, coordinated care.
said John Sganga, senior vice president
power equipment, surgical instruments
of alternate site programs for Premier.
reporting and repairs. Intalere mem-
Vizient applauds FDA’s temporary policy enabling hospitals to compound medications
Vizient announces agreement with One Network Enterprises
bers also have access to BPI Medical’s
Vizient, Inc. (Irving, TX) applauds the
Vizient, Inc. (Irving, TX) has announced
continuing education courses on these
decision by the FDA to allow hospi-
an agreement with One Network En-
medical devices. The contract is effective
tal pharmacies to begin compounding
terprises to bring increased resiliency,
through Dec. 31, 2022.
a range of pharmaceuticals used for
transparency and collaboration to the
and cameras. BPI Medical also conducts on-site medical equipment inspection,
COVID-19 patients, including many
healthcare supply chain. It will facilitate
Premier using data, tech capabilities for clinicians to deliver coordinated care
medications necessary for those on ven-
the rapid development of a two-sided
tilators. The medications include forms
marketplace that adds visibility and
of fentanyl, midazolam, cistracurium and
improves collaboration between health-
Premier Inc. (Charlotte, NC) is en-
ketamine that have seen unprecedented
care organizations and suppliers around
hancing its solutions to surveil for
levels of demand and declining fill rates
the forecast, inventory availability and
COVID-19 symptoms and pinpoint
as the number of coronavirus patients
consumption of goods. It is expected to
hotspots, predict disease progression
has increased.
launch by April 20 at no cost during this
and surge, determine the supplies nec-
crisis to Vizient’s healthcare members,
interventions and ultimately prevent
Premier survey: 24% of skilled nursing, assisted living facilities do not have N95 masks on hand
the spread of the disease. “COVID-19
A Premier Inc. (Charlotte, NC) survey of
Intalere selects Consus and Ivalua for source to contract solution
has exposed one of healthcare’s funda-
2,500 skilled nursing and assisted living fa-
Intalere (St. Louis, MO) has gone
mental weaknesses: the fragmented and
cilities found that 24% of facilities do not
live with Ivalua’s source to contract
siloed nature of care delivery,” said
have N95 masks on hand, and the majority
solution through a partnership with
Leigh Anderson, president of perfor-
of respondents have fewer than two weeks
Consus, a procurement services pro-
mance services for Premier. “Today,
supply of surgical masks, isolation gowns
vider. Ivalua leads the implementation
essary to care for the infected population, improve the quality of medical
16
“In this next phase of the outbreak,
distributors and suppliers.
May 2020 | The Journal of Healthcare Contracting
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NEWS
and transformation effort at Intalere
of multi-year category roadmaps,” said
and the hospital community for the cre-
to drive cost savings, transparency and
Todd Larkin, COO at Intalere. “And
ation of the Dynamic Ventilator Reserve.
improved efficiencies across contain-
our partnership with Consus Global
This program will provide life-saving
ing and category management across
provided us with a faster time to value
equipment to hot spots that need surge
the organization. “The flexibility and
and overall return on investment.”
supplies in order to provide appropriate
configurability of the Ivalua platform
care to COVID-19 patients. These are
Premier on the creation of the dynamic ventilator reserve
exactly the types of creative solutions that
value for our membership, especially due to the platform’s ability to enable
Susan DeVore, CEO of Premier, writes
cal care equipment that can easily dip into
the development and implementation
“Premier commends the Administration
shortage when there’s an uptick in cases.”
will enable Intalere to drive significant
will enable us to conserve and stretch criti-
Hospitals, Health Systems and IDN News St. Vincent Medical Center purchased for $135 million
dent that Dr. Soon-Shiong and his team
estimates suggest hospitals are losing $50
will continue to enhance the collaboration
billion per month.
Dr. Patrick Soon-Shiong, the owner of
with the state and local governments to
the Los Angeles Times, has purchased St.
address COVID-19,” said Rich Adcock,
Vincent Medical Center in Los Angeles
CEO of Verity Health.
Allegheny Health Network launches own COVID-19 test kit Allegheny Health Network (AHN) (Pitts-
from Verity Health (El Segundo, CA) for
burgh, PA) is making thousands of its own
cent Medical Center in January. Under the
‘Greatest challenge’ hospitals have faced in their history, says AHA head
purchase agreement, Dr. Soon-Shiong will
The cost of treating coronavirus patients,
unteered to assemble specimen collection
take over the state of California’s lease
combined with the loss of revenue
kits, for use at AHN hospitals and its
obligations at St. Vincent. In March, the
from canceling elective procedures, has
drive-up COVID-19 collection sites around
state used emergency COVID-19 funding
left many hospitals in desperate finan-
Western Pennsylvania. Typically, COVID-19
to lease St. Vincent. The state reopened
cial straits. “I think it’s fair to say that
specimen kits come fully assembled from
the facility, now called the Los Angeles
hospitals are facing perhaps the greatest
a vendor. The kits that AHN uses include
Surge Hospital, through a partnership
challenge that they have ever faced in
two biohazard bags, labels, a naso-pharyn-
with Kaiser Permanente and Dignity
their history,” Rick Pollack, president and
geal swab, an instruction sheet and a tube
Health. “Verity is proud of its partnership
CEO of the American Hospital Associa-
containing viral transport media, so the
with the State of California and is confi-
tion (AHA), told NPR. He says some
collected sample can be tested later.
HHS awards close to $165M to rural hospitals, telehealth centers
to 1,779 small rural hospitals and 14
HHS, through the Health Resources
ters. The funds target smaller, rural hos-
CMS releases guidance for health systems restarting elective procedures
and Services Administration, is award-
pitals and is separate from the CARES
CMS has released new guidelines for
ing rural hospitals the telehealth
Act. Approximately $30 billion in the
health systems on when and how to
resource centers nearly $165 million
CARES Act was recently distributed to
resume elective procedures that have been
to combat COVID-19. Funds will go
hospitals nationwide.
delayed since the COVID-19 outbreak.
$135 million. Verity filed for Chapter 11 bankruptcy in 2018 and closed St. Vin-
COVID-19 test kits in the face of a national shortage. About 15 AHN employees vol-
Government and Regulatory News
18
HRSA-funded telehealth resource cen-
May 2020 | The Journal of Healthcare Contracting
The only publication dedicated solely to the healthcare supply chain.
REACHING 4,400 IDN EXECUTIVES, 2,500 HOSPITAL EXECUTIVES, 600 GPO DECISION MAKERS AND 3,500 SUPPLIERS/MANUFACTURERS
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NEWS
“Healthcare officials must ensure they can
that attempting to adjust 2020 spending
beneficiaries) could distort ACO
handle any surges,” said CMS Administra-
and benchmarks for COVID-19 will be
assignment. A determination could
tor Seema Verma. “They have a plan to
impractical due to the dramatic shifts
be made later about whether to use
conserve supplies and screen healthcare
in care delivery that have occurred in
2019 and/or 2021 claims to assign
workers for coronavirus.” A facility that
2020. MedPAC urged CMS not to use
beneficiaries to ACOs in 2021.
decides to reopen procedures should also
data from 2020 when evaluating ACOs.
create areas to reduce the risk and expo-
Specifically, MedPAC wants CMS to
the NextGen ACO model through
sure to COVID-19. Any patient coming
consider four actions:
2023. This will allow ACOs that have
in for a procedure must also be screened for COVID-19 symptoms.
ʯ Do not use 2020 data to determine
ʯ Allow a three-year extension of
invested in the model to continue in
ACO performance for purposes of
the ACO program without having
computing ACO quality, bonuses,
to adapt to a new model during this
MedPAC recommends ACO providers focus on COVID-19 rather than shared savings
or penalties. Consider extending all one year. In addition, do not use
Medicare and Medicaid Innovation
The Medicare Payment Advisory Com-
2020 data in calculating baseline year
Direct Contracting model by a
mission (MedPAC) sent a letter to Seema
spending for future benchmarks.
minimum of one year to allow
Verma, MPH, administrator of CMS, rec-
ʯ Do not use 2020 claims to assign
ommending ACOs focus on their response
beneficiaries to ACOs, since the
new model (some features of which
to COVID-19 without concern for shared
shift to telehealth (possibly with
have not yet been established) prior
ACO savings or losses. MedPAC stated
physicians located very far away from
to making commitments.
current ACO agreement periods by
difficult time.
ʯ Delay the start of the Center for
providers time to understand the
Healthcare IT News Coronavirus outbreak emphasizes importance of secure access to data
Temporary hospitals rife with cybersecurity vulnerabilities
ing 3D printers to make plastic components
Ad hoc COVID-19 medical centers have
Carbon is using its highly elastic polymer
The COVID-19 outbreak has em-
a unique set of vulnerabilities. They are
to produce more than 15,000 face shields
phasized the importance of the data
remote. They sit outside of a defense-in-
weekly for healthcare workers. Ford, Boe-
exchange and patient access provisions
depth architecture. And the very nature of
ing, HP, Medtronic and the U.S military are
stipulated in the Office of the National
their purpose – care in a time of crisis –
among the manufacturing powers funding,
Coordinator for Health IT and CMS
means security is a lower priority. These sit-
designing and producing protective gear and
as providers are preoccupied with
uations give hackers more opportunities to
medical equipment to fill in supply short-
battling coronavirus. Seema Verma,
perpetrate attacks and they could infiltrate
ages around the world, and 3D printing
CMS Administrator, said that, “now
devices there to steal a patient’s personal
firms are making a broader call to action
more than ever, patients need secure
health information, causing complications
possible. Rapid prototyping has been the
access to their healthcare data,” as
for both the users of these devices and the
hallmark of 3D printing’s role in manu-
she announced extended compliance
health providers themselves.
facturing the for the 30 years the industry
timelines for interoperability rules dur-
has existed. Universities and 3D printing companies like Stratasys and Carbon are
exchange, where apps and APIs help
3D printing helps combat medical equipment shortages
patients aggregate data where and when
GE Healthcare is using 3D printing to make
as many products as they can. Demand is
they wish are set to offer new opportu-
tools that accelerate ventilator production.
high as Stratasys says it’s receiving requests
nities for population health.
Jeff Bezos’ space venture Blue Origin is us-
for 40,000 face shields per week.
ing the pandemic. Consumer-directed
20
for face shields. Digital manufacturing firm
crowdsourcing industrial customers to print
May 2020 | The Journal of Healthcare Contracting
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