November 2019 • Vol.10 • No.6
The Heat is On Post-acute providers must reduce readmissions. They could use some help.
CONTENTS »» NOVEMBER 2019
2 Drone Delivery
12 The Heat is On
Walgreens announces pilot program in one market to deliver products to customers via drones
6 Wearables: Are they anything like the ‘real thing?’
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Post-acute providers must reduce readmissions. They could use some help.
20 It’s not nice to fool Mother Nature. 22 Health news and notes
PUBLISHER John Pritchard
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The Journal of Healthcare Contracting | November 2019
1
HEALTHCARE INNOVATION
Drone Delivery Walgreens announces pilot program in one market to deliver products to customers via drones
Walgreens and Wing Aviation LLC, a drone operator certified as an air carrier by the Federal Aviation Administration earlier this year, will begin offering drone delivery service to eligible residents of Christiansburg, Virginia beginning next month, according to a release. The com-
2
Walgreens announced a partnership to to pilot drone
panies will utilize the pilot program to
deliveries beginning in October to local customers in Chris-
further explore the future of health and
tiansburg, Virginia.
wellness product and retail delivery November 2019 | The Journal of Healthcare Contracting
Lowering total cost of ownership together. Learn how we worked with one medical center to:
Increase efficiencies
Reduce freight costs
Lower packaging costs
Reduce shipping weight
Read the full case study:
cookmedical.com/tcotogether
cookmedical.com Š COOK 01/2017 HBS-D33288-EN
HEALTHCARE INNOVATION
No car? No problem. Walgreens now delivers what you need, when you want it, direct to your door via the Wing app.
through the air, offering product availability and home delivery
customers may want health and well-
minutes after placing orders via the Wing app.
ness or food and beverage items imme-
“Walgreens continues to explore partnerships to transform and modernize our customer experience and we are proud to be the first retailer in the U.S. to offer an on-demand commer-
diately, but leaving home is not ideal. For example: • Parents at home with a sick child
cial drone delivery option with Wing,” said Vish Sankaran, chief
can order the “baby pack” with items
innovation officer, Walgreens Boots Alliance, Inc. “With a cus-
such as children's ibuprofen, water
tomer-led focus, we continue to create differentiated shopping
and more to nurse their little one
experiences that provide the products and services consumers
back to health while never having to
need wherever, whenever and however they may want them.
leave their side.
This is the kind of omni-channel partnership and offering that
• Those with a common cold or flu can
can redefine convenience for our customers and communities –
avoid spreading germs to others by
delivering items to homes in minutes, not hours or days.”
ordering the “cough/cold pack” with
Why Christiansburg? The market was selected because Wing has been working closely with nearby Virginia Tech in Blacksburg to test drone delivery as part of the U.S. Department of Transportation’s Integration Pilot Program since 2016.
a variety of cough and cold products needed to get healthy. • No car? No problem. Walgreens now delivers what you need, when you want it, direct to your door via the
How It Will Work
Wing app.
Eligible customers in the Christiansburg area will have access to more than 100 products and six convenient “packs” via the Wing
Over the coming weeks, Wing and
app. Customers can either choose the individual products they
Walgreens will be reaching out to Chris-
need or choose one of the pre-built packs in the following cat-
tiansburg residents to provide additional
egories: allergy, baby, cough/cold, first aid, pain, and kids’ snacks.
information about the new offering. The companies will also be hosting a drone
4
Prescription deliveries are not available via this service, the re-
delivery demonstration for community
lease said. The drone delivery option meets use cases where
members later this month. November 2019 | The Journal of Healthcare Contracting
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WEARABLES AND THE SUPPLY CHAIN
Wearables: Are they anything like the ‘real thing?’ New mobile medical applications – often in the form of
for Civil Rights. The purpose was to give
watches, patches or apparel – keep on coming. Consumers have
app developers clear information about
little to lose – except cash – by buying (or subscribing to) them.
the laws that apply to their health-relat-
But for doctors, nurse practitioners and others, the stakes are
ed products. Three and a half years lat-
higher. They need to know, “Are these things accurate?” “Can I
er, how would you characterize mobile
trust them enough to base treatment plans on the information
app developers’ understanding and
they give me?” “Do they really work?”
compliance with those laws?
To gain clarity, JHC asked Bakul Patel, director of the U.S. Food
Bakul Patel: The FDA often engages
and Drug Administration’s digital health division, to respond to
with digital health developers through
some questions.
a variety of channels to ensure that developers are aware of FDA regulations.
6
JHC: In April 2016, the Federal Trade Commission created a
Through guidances, webinars, external
web-based tool for developers of health-related mobile apps
conferences and our email address (Digi-
in conjunction with FDA, the Office of the National Coordina-
talHealth@fda.hhs.gov), developers have
tor for Health Information Technology (ONC) and the Office
multiple ways to engage with the FDA. November 2019 | The Journal of Healthcare Contracting
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WEARABLES AND THE SUPPLY CHAIN
Some of the bright spots include our engagement with com-
following: sinus rhythm, AF, inconclusive
panies and organizations as we design and develop the software
due to other rhythms, or inconclusive
precertification pilot program for software as a medical device.
due to poor signal quality. The ECG data
While nine companies are formally involved in the program, the
displayed is intended for informational
FDA has engaged with many companies and stakeholders to
use only and does not replace traditional
hear critical feedback as we look at ways to find efficiencies in
methods of diagnosis or treatment. If AF
our regulation of digital health products.
is detected, a health care provider should be consulted for additional testing and
JHC: It has been reported that the industry is seeing a rise
monitoring. The ECG App is not recom-
in FDA-cleared digital therapeutics. Do these things really
mended for patients with other known
work? Can a doctor trust the EKG readings that a patient’s
arrhythmias.”
watch is recording? Can he or she feel confident making a diagnosis or treatment plan based on it?
JHC: Who decides if a developer of a
Patel: [Makers of] medical devices – including software as a med-
mobile medical application or device
ical device (SaMD) – that require premarket review by the FDA
should seek FDA clearance? Is it the
demonstrate to the agency
developer of the application or de-
in their application that the
vice? The FDA? Somebody else?
product is both safe and ef-
Patel: Medical device manufacturers or
fective for the intended use.
developers are responsible for ensuring
It is important to note,
they fulfill all applicable FDA regulatory
though, that many medical
requirements. FDA has several resourc-
products,
SaMD,
es and has published several guidances
may have limitations in their
to help developers decide when a clear-
use. These limitations, contra-
ance is required. We encourage all de-
indications and other impor-
velopers to review these resources and
including
tant information about the use of the product are included in
8
make that determination. Bakul Patel
the FDA-required labeling for a
JHC: Who decides whether a mobile
product. Doctors, patients and
medical application or “wearable”
their caregivers can understand the specific FDA-reviewed use of
can be administered only through a
the product. In the case of SaMD product, it could include informa-
prescription?
tion about additional confirmatory tests being required.
Patel: Manufacturers submit product
For example, the Apple ECG application provides users very
applications (premarket approval, a de
specific guidelines in its labeling: “The ECG App is a mobile app
novo or premarket clearance) with in-
that is used with the Apple Watch to create, record, store, transfer
formation about the intended use of the
and display a single channel electrocardiogram (ECG). The ECG
product, including whether the product
App is also intended to detect the presence of AF and regular
will be for prescription use only or over
(sinus) rhythm. The app displays the heart rhythm as one of the
the counter. November 2019 | The Journal of Healthcare Contracting
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WEARABLES AND THE SUPPLY CHAIN
JHC: The FDA defines a device as something “intended for
To view a sampling of pre-market sub-
use in the diagnosis of disease or other conditions, or in the
missions that include mobile medical
cure, mitigation, treatment, or prevention of disease, in man
applications cleared or approved by the
or other animals.” If that’s the case, shouldn’t all mobile medi-
FDA, go to www.fda.gov/medical-devic-
cal applications be subject to FDA approval?
es/mobile-medical-applications/exam-
Patel: No, not all mobile medical applications are making a
ples-pre-market-submissions-include-
claim to treat, cure, mitigate or prevent a disease or condition.
mmas-cleared-or-approved-fda.
For example, sleep tracking applications may help users track
Readers should also note that the
their sleep patterns, which is informational only and not meant
FDA launched its “Pre-cert pilot pro-
to diagnose or treat a disease or condition.
gram” as part of its “Digital Health Innovation Action Plan” in July 2017. The gist
JHC: In April 2019, then-FDA Commissioner Scott Gottlieb
is to scrutinize the software developer
announced that the agency was building a Digital Health
or digital health technology developer,
Center of Excellence “to develop more efficient ways to en-
rather than primarily at the product. Af-
sure the safety and effectiveness of technologies like smart
ter reviewing systems for software de-
watches with medical apps.” Can you talk about the two or
sign, validation and maintenance, FDA
three most important initiatives in which the Center of Ex-
would determine whether the company
cellence is engaged?
meets quality standards and if so, would
Patel: The Center is not yet formally launched. We plan to create a Center of Excellence on Digital Health to establish
the
regulatory
paradigm, build new capacity to evaluate and recognize third-party certifiers, and support a cybersecurity unit to complement the advances in softwarebased devices. Implement-
10
Implementing regulatory innovations and information technology improvements are essential for advancing softwarebased technologies that improve the health and quality of life of patients.
precertify the company. The agency compares it to the Transportation Security Administration’s Precheck program, which screens travelers and awards them with a “Known Traveler Number,” speeding up their airport security checks. With the information gleaned through the pilot program, the agency hopes to determine the key metrics and performance indicators for precertification and identify ways that precertified com-
ing these regulatory in-
panies could potentially submit less in-
novations and information
formation to the FDA than is currently
technology improvements are essential for advancing soft-
required before marketing a new digital
ware-based technologies that improve the health and qual-
health tool. The FDA is also considering
ity of life of patients while assuring critical safeguards, as the
-- as part of the pilot program – whether
current regulatory framework is not well-suited for driving the
and how precertified companies may not
development of safer, more effective software-based devices,
have to submit a product for premarket
including the use of machine learning and artificial intelligence.
review in some cases. November 2019 | The Journal of Healthcare Contracting
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November 2019 | The Journal of Healthcare Contracting
The Heat is On
Post-acute providers must reduce readmissions. They could use some help.
About 20% – or one in five – Medicare beneficiaries who are sent to a skilled nursing facility from a hospital are readmitted to the hospital within 30 days, points out Dr. David Gifford, senior vice president of quality and regulatory affairs and chief medical officer for the American Health Care Association. That’s too many, according to Medicare and, no doubt, to SNFs and their residents as well. Sales reps can help their post-acute-care cus-
managed care for network selection, and CMS for SNF
tomers by trying to understand the causes of ex-
Part A payments and its Five-Star rating system. Families
cessive readmissions and the ways in which SNFs
and residents want to avoid rehospitalizations as well.”
are trying to address the problem.
The CMS SNF VBP program adjusts a center’s Part A payment based on its 30-day rehospitalization
Value-Based Purchasing
rate, he explains. The adjustment can range from a
Medicare’s SNF Value-Based Purchasing (VBP) Pro-
cut of 2% to an increase of about 1%, which is ap-
gram rewards – or penalizes – skilled nursing fa-
plied for all claims submitted during a fiscal year, he
cilities based on the quality of care they provide to
says. Each year, the facility is assigned a new adjust-
Medicare beneficiaries as measured by a hospital
ment factor for the next fiscal year. The 30-day rehos-
readmissions measure.
pitalization rates are converted into a score based
“In today’s healthcare market, rehospitalizations
on the facility’s ranking on their risk-adjusted rate
from nursing centers is one of the most common met-
or the amount of improvement over the prior two
rics that hospitals, managed care organizations, and
years. Centers are then ranked on their score, and
nursing centers themselves focus on,” says Gifford. “The
their ranking is converted into a payment adjust-
measure is used by hospitals for referral decisions,
ment factor as described above.
The Journal of Healthcare Contracting | November 2019
13
THE HEAT IS ON
Payment adjustments were first applied to post-
if there are any early changes in their conditions. Many
acute-care providers for FY19, which started Oct. 1,
are also using nurse practitioners to see residents more
2018. The program is expected to last 10 years.
frequently, rather than sending them to the hospital.” Says Shawn Scott, vice president of strategic busi-
Cause and effect
ness development for Medline, “Our skilled nursing
“Reasons for rehospitalizations are complex,” says
customers as a whole have always delivered good
Gifford. Many residents who are sent to skilled nurs-
care and will continue to do so under VBP and [the
ing facilities have very complex conditions, with
patient-driven payment model, or] PDPM. The differ-
most taking over 10 medications and having over 10
ence we are seeing is more attention being placed
different diagnoses, he points out. A lack of informa-
on better monitoring of their residents to catch
tion during transfers exacerbates the problem.
acute changes of conditions before they need to be readmitted to a hospital. They are investing in IT and training
“ At the end of the day, to be successful in the skilled nursing arena, you have to be able to measure all quality metrics and to be able to move quickly to correct areas where you might be deficient, because the reimbursement dollars depend on it.”
so they can handle higher acuity residents. This added attention, along with better communication with the hospital, has helped reduce readmissions over the last couple of years.”
Future The Value-Based Program will last
– Shawn Scott, vice president of strategic business development, Medline
at least 10 years, but will probably be tweaked between now and then. Already, the Centers for
“[P]roviding better information at the time of
Medicare & Medicaid Services is preparing to change
transfers, better access to nurse practitioners and
the rehospitalization incentives and penalties from
physicians to avoid sending residents to the emer-
an “all-cause” measure to “potentially preventable”
gency room, and any way to more effectively moni-
ones, says Gifford.
tor a resident’s condition will be important to help lower the risk of rehospitalization.”
14
“They have not yet specified when that migration will occur, but they have specified how the
Skilled nursing facilities are doing what they can
potentially preventable rehospitalization measure
to improve the way they receive incoming residents’
will be calculated,” he says. “They will use the diag-
information – including equipment and medications
nosis on the hospital claim from the readmission
– before they arrive from the hospital, says Gifford.
to determine if a readmission was potentially pre-
“Facilities are also looking at how they monitor resi-
ventable. The list of diagnoses and ICD codes cap-
dents’ conditions, and they are contacting physicians
tures about two-thirds of all hospital admissions, November 2019 | The Journal of Healthcare Contracting
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PATIENT CARE
INTERVENTIONAL CARE
ENVIRONMENT OF CARE
THE HEAT IS ON
“ Providing better information at the time of transfers, better access to nurse practitioners and physicians to avoid sending residents to the emergency room, and any way to more effectively monitor a resident’s condition will be important to help lower the risk of rehospitalization.”
able to move quickly to correct areas where you might be deficient, because the reimbursement dollars depend on it.” A closer relationship between acute-care providers and postacute providers will help. Bob Miller, vice president of Gericare Medical Supply, points to data showing that increased cooperation between acute-care providers and post-acute provid-
and includes diagnoses such as hypertension, dia-
ers not only can maximize reimbursement, but cut
betes, asthma and congestive heart failure.”
down on readmissions.
Says Scott, “Readmissions is one of many things
“The challenge is to get more hospitals and
long-term care providers are concerned about. Al-
post-acute facilities working more closely together
though it’s an indicator of quality care, and is some-
to make a difference in readmissions,” he says.
thing referral sources are looking at, they must also
The new PDPM payment program could also
look closely at their length of stay, discharge to
have an effect. “The record-keeping and the attitude
community, staffing ratios, turnover, five star, and
of accountability when it comes to measuring suc-
many other indicators that are driving quality re-
cess should all help in the readmission challenge –
sults at their building. At the end of the day, to be
especially the initial assessment of a resident when
successful in the skilled nursing arena, you have
they are taken in by the post-acute facility.
to be able to measure all quality metrics and to be 16
“This will be a crucial part of the process.” November 2019 | The Journal of Healthcare Contracting
THE HEAT IS ON
Can primary care providers help reduce readmissions? The 30-day period immediately following hospital discharge is a particularly vulnerable time for patients. According to the Agency for Healthcare Research and Quality, each year in the United States more than 35 million patients are discharged from the hospital. Among the Medicare fee-for-service population, approximately 18 percent of discharged patients are readmitted to a hospital facility within 30 days, and among the adult Medicaid population, the rate is even higher. To date, most efforts to reduce readmissions have focused on hospital-based interventions. Yet hospital providers have only a limited ability to affect what occurs once the patient has left the hospital. In fact, despite concerted national efforts from such programs as the Hospital Readmissions Reduction Program, an estimated 27 percent of hospital readmissions may still be avoidable. Less attention and study has been paid to the role of primary care providers in reducing readmissions, despite the fact that primary care is increasingly being called on to play a key role in integrating care across the continuum. To address this gap, AHRQ funded research on what is currently known about reducing readmissions from the primary care perspective.
Challenges and opportunities According to AHRQ, the literature suggests that primary care providers face several challenges to caring appropri-
discharge care plan, and lack of social support to address nonmedical needs, such as housing and transportation.
ately for their patients at the time of, and immediately after, hospital discharge. They include: •A lack of compensation for peridischarge care coordination. •O rganizational challenges, including poor communication between the hospital and ambulatory environments. •A lack of time and support to communicate with inpatient providers and understand medication and other changes that occurred during hospitalization. •P atients’ difficulty in financing post-discharge care, inadequate physical and emotional support to comply with the post-
Independent community primarycare practices face particular challenges coordinating care for patients following hospitalization because they are not affiliated with hospitals or other networks that can assist with coordination efforts during care transitions. Further, many of the primary carebased interventions reviewed by AHRQ were funded by grants or other temporary funding mechanisms. Many staff members used in these interventions – nurses, pharmacists, and care managers – did not provide directly reimbursable services. Thus, additional clinics could not initiate similar programs without external support, raising concerns about the sustainability of these programs. AHRQ found that coordinated, or bundled, interventions by hospitals, primary care providers and postacute providers offer the best shot at reducing readmissions. They include coordinated medication management, post-discharge telephonic outreach, and patient education. In addition, transition efforts can be facilitated by clinical and financial integration of clinics and hospitals. Primary care clinics that lack the scale to hire their own dedicated care coordination staff may attempt to leverage community resources, such as those available through third-party payers or hospitals, to support their patients.
Source: Environmental Scan of Primary Care-Based Efforts to Reduce Readmissions, Agency for Healthcare Research and Quality, March 2019
18
November 2019 | The Journal of Healthcare Contracting
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LEADERSHIP
By Lisa Earle McLeod
It’s not nice to fool Mother Nature.
Molly and John Chester, as they trade city living for 200 acres of barren farmland and a dream to harvest in harmony with nature. I’m recommending this to my executive coaching clients because it’s a lesson in overcoming setbacks and the
If you’re old enough to remember this ad campaign,
interconnectedness of everything. The
you’re probably also old enough to remember when people
Biggest Little Farm provides three big in-
threw trash out the car window, and kids were allowed to follow
sights for leaders:
chemical trucks spraying for mosquitoes. For younger readers, this alternative universe was called the ‘70s. Flash forward to today, where the balance between ecosys-
20
1. Verbalize your vision, and share it often
tem and commerce is a subject of fierce debate. But what if in-
Molly Chester’s vision to run a tradition-
stead of trying to balance nature and commerce, we looked to
al foods farm was rooted in her training as
Mother Nature as a model of organizational effectiveness.
a natural foods chef. Her passion inspired
My new favorite movie is The Biggest Little Farm, a feel
(persuaded) her husband filmmaker
good film that chronicles the eight-year quest of two idealists,
John Chester to help find investors and November 2019 | The Journal of Healthcare Contracting
purchase Apricot Lane Farms, an en-
you find people who have studied your field, listen to them. You’ll
deavor most of their friends thought
save yourself years of frustration.
was crazy. The film is an intimate look who start out naively. Yet, as BiggestLit-
3. Don’t cave on principles, get creative with resources instead
tleFarmmovie.com
“Through
Watching pests destroy the Chester’s hard won progress is
dogged perseverance and embracing
heartbreaking. During a snail invasion John asks Molly, “I don’t
the opportunity provided by nature’s
suppose we can use chemicals?” She responds. No, we’re not.
conflicts, the Chesters unlock and un-
Lesser leaders would have called in a chemical truck.
inside the lives of two young people says,
cover a bio diverse design for living that exists far beyond their farm, its seasons, and our wildest imagination.” Without a vision, the Chesters would have been simply scratching away at the dirt trying to make ends meet. Molly’s vision kept them going, and inspired others to join their cause. Verbalizing your dream often keeps it real.
2. F ind good mentors, and invite them to participate
Mother Nature shows us, for every action there is an equal and opposite reaction. If you kill off one thing, it’s going to impact something else.
After buying 200 acres of neglected land in Moon Park California, the Chesters ask
Instead, the Chesters solve the problem by cross training
farming guru, biodynamic consultant
their animals, no joke. I don’t want to ruin the surprise, but
Alan York to help them. York challenged
ducks are involved, it’s ecofriendly and it’s hilarious.
them. Instead of planting one or two
I never dreamed I’d cry over a farm movie, but I did, and so did my
crops, as most farms do, York recommend-
big strong husband who says, “I loved the transformation. Watch-
ed diverse orchards with over 75 types of
ing them turn something almost like a dust bowl into something
fruit, and cover crops to keep soil in place.
so lush, beautiful and bountiful, was stunning.”
Over the course of a few years, their soil
Mother Nature shows us, for every action there is an equal and
became richer, and when heavy rains hit,
opposite reaction. If you kill off one thing, it’s going to impact
Apricot Farms didn’t lose mountains of
something else. But if you’re willing to nurture and grow your
dirt to runoff as other farmers did. When
dreams, they affect everything and everyone around you.
Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, Selling with Noble Purpose. Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.
The Journal of Healthcare Contracting | November 2019
21
HEALTH NEWS
Health news and notes HPV vaccination recommendation expanded
women who slept with a light or television
The Centers for Disease Control and Prevention in August rec-
on were 17% more likely to have gained
ommended that females and males through the age of 26 who
5 kilograms, approximately 11 pounds, or
failed to get vaccinated against human papillomavirus (HPV)
more over the follow-up period. The asso-
by age 11 or 12 receive a “catch-up” vaccination. It’s a change:
ciation with having light coming from out-
Catch-up vaccination has been recommended since 2006 for fe-
side the room was more modest. Scientists
males through age 26 years, and since 2011 for males through
cautioned that this is a basic research find-
age 21 years and certain spe-
ing, and wondered if not getting enough
cial populations through age
rest factored into the findings.
26 years. (For adults aged 27 gards the public health ben-
Emergency hypoglycemia treatment OK’d
efit of HPV vaccination to be
The U.S. Food and Drug Administration
minimal; shared clinical deci-
in July approved Baqsimi nasal powder,
sion-making is recommended
the first glucagon (hormone) therapy
because some persons who
approved for the emergency treatment
are not adequately vaccinat-
of severe hypoglycemia that can be ad-
through 45 years, CDC re-
ed might benefit.).
Lights out Sleeping with a TV or light on in the room may be a risk factor for gaining weight or developing obesity, according to scientists at the National Institutes of Health. The research, which
Sleeping with a TV or light on in the room may be a risk factor for gaining weight or developing obesity, according to scientists at the National Institutes of Health.
ministered without an injection. Severe hypoglycemia occurs when a patient’s blood sugar levels fall to a point where he or she becomes confused or unconscious or suffers from other symptoms that require assistance from another person to treat. Typically, severe hypoglycemia occurs in people with diabetes who are using insulin treatment. Baqsi-
was published online June 10
mi is approved to treat severe hypogly-
in JAMA Internal Medicine, is the first to find an association be-
cemia in patients with diabetes ages
tween any exposure to artificial light at night while sleeping and
four and older.
weight gain in women. The results of a questionnaire submitted by
22
43,722 women suggest that cutting off lights at bedtime could re-
Pregnant women and group B strep
duce women’s chances of becoming obese. The results varied with
Most babies born to women who test
the level of artificial light at night exposure. For example, using
positive for group B strep (GBS) bacteria
a small nightlight was not associated with weight gain, whereas
do not need treatment if their mother November 2019 | The Journal of Healthcare Contracting
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HEALTH NEWS
received antibiotics during labor. The American College of
become infected with hepatitis B from
Obstetricians and Gynecologists and American College of
their mothers, they have a 90 percent
Nurse-Midwives (ACNM) recommend women get tested for
chance of developing these lifelong
GBS bacteria when they are 36 through 37 weeks pregnant.
chronic infections.) Although babies are
To administer the test, clinicians use a sterile swab to collect a
now routinely vaccinated for hepatitis B
sample from the vagina and the rectum. Women who test pos-
virus shortly after birth, rates of maternal
itive for GBS are not sick. However, they are at increased risk
hepatitis B virus infection have increased
for passing the bacteria to their babies during birth. Babies
by more than 5 percent each year since
born to women with GBS who receive antibiotics have about
1998, the Task Force noted. This is why it is
a one-in-4,000 chance of developing GBS disease; but babies
important to screen all pregnant people.
born to women who fail to get antibiotics have a one-in-200 chance of doing so.
Pivot point for low-dose aspirin Medical consensus once supported daily
Blood pressure control may be good for the brain
use of low-dose aspirin to prevent heart
Intensive blood-pressure control may slow age-related brain
attack and stroke in people at increased
damage, report researchers in a National Institutes of Health
risk for cardiovascular disease. But in 2018,
study. Researchers using magnetic resonance imaging to
three major clinical trials cast doubt on
scan the brains of hundreds of participants in the National
that conventional wisdom, finding few
Institutes of Health’s Systolic Blood Pressure Intervention Trial
benefits and consistent bleeding risks
(SPRINT) found that intensively controlling a person’s blood
associated with daily aspirin use, accord-
pressure was more effective at slowing the accumulation of
ing to Harvard Medical School. Taken
white matter lesions than standard treatment of high blood
together, the findings led the American
pressure. The results complement a previous study published
Heart Association and American College
by the same research group that showed that intensive treat-
of Cardiology to change clinical practice
ment of BP significantly lowered the chances that participants
guidelines earlier this year, recommend-
developed mild cognitive impairment. Several studies have
ing against the routine use of aspirin in
suggested that people who have hypertension have a greater
people older than 70 years or people with
chance of accumulating white matter lesions and also of expe-
increased bleeding risk who do not have
riencing cognitive disorders and dementia later in life.
existing cardiovascular disease. “Our findings show a tremendous need for health
24
Pregnancy and hepatitis B screening
care practitioners to ask their patients
The U.S. Preventive Services Task Force in July published a final
about ongoing aspirin use and to advise
recommendation statement on screening for hepatitis B virus
them about the importance of balancing
infection in pregnant women. The Task Force recommended
the benefits and harms, especially among
that all pregnant women be screened for hepatitis B infec-
older adults and those with prior peptic ul-
tion at their first prenatal visit to prevent infection in newborns.
cer disease,” said lead author Colin O’Brien,
(Hepatitis B is a viral infection of the liver that can cause chronic
Harvard Medical School clinical fellow in
conditions such as liver disease or liver cancer. When babies
medicine at Beth Israel Deaconess. November 2019 | The Journal of Healthcare Contracting
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