March 2020 • Vol.11 • No.2
Outbreak Response Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak.
CONTENTS »» MARCH 2020
2 Cardinal announces surgical gown recall 4 Integrating Health Data 8 Outbreak Response
Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak.
12 Identifying Gaps
ECRI Institute’s consulting helps providers respond to a multitude of issues related to infection control and prevention
14 Heart Disease: Talking Points Start a conversation with your physician customers by sharing news from the most recent American Heart Association’s Scientific Sessions Conferences
24 Industry News
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
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MANAGING EDITOR Daniel Beaird
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CIRCULATION Wai Bun Cheung
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VICE PRESIDENT OF SALES
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ART DIRECTOR Brent Cashman
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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 | March 2020
1
SUPPLY CHAIN
Cardinal announces surgical gown recall “To help address recall-related supply shortages, we have increased our own production of similar products and our employees have been working to identify alternative products,” Cardinal said. “In many cases, we have been working with industry partners who offer competing products. We are also offering AAMI Level 4 Gowns to help bridge the supply gap.” Since the product hold was announced, Cardinal Health has terminated its relationship with the contract manufacturer. As of early January, the contract manufacturer is no longer registered with the FDA. “The top priority for hospitals and health systems is the safety and well-being of their patients,” said Tom Nickels, executive vice president, American Hospital In late January 2020, Cardinal Health informed customers of a voluntary recall
Association. “The AHA urges the FDA
for the surgical gowns produced by a contract manufacturer after “discovering that
and Cardinal Health to continue to provide
some gowns were produced in unapproved locations that did not maintain proper
more information and instructions for
environmental conditions as required by law, were not registered with the U.S. Food and
hospitals and health systems in order to ad-
Drug Administration (FDA) and were not qualified by Cardinal Health.”
dress their concerns about the impact this issue could have on their ability to provide care to patients. We have also encouraged
Upon learning of the issue, Cardinal
issue a hold for AAMI Level 3 surgical
member hospitals to notify the FDA about
Health said it initiated an investiga-
gowns produced by a contract manufac-
potential or actual supply issues.”
tion, quarantined the gowns, placed a
turer since September 2018,” the distribu-
hold on distribution of the gowns and
tor said in a release. “Those gowns are
priority is the safety of patients and
started communicating with customers
now subject to this voluntary recall.” Of
healthcare workers. “We apologize for
to ensure that the affected gowns were
the 9.1 million gowns included in this
the hardship caused by the recall and are
removed from use.
recall, 7.7 million units were distributed to
doing everything we can to help resolve
2,807 facilities, Cardinal said, and 1.4 mil-
this issue for our customers and the
lion were produced but not distributed.
patients they serve.”
“Based on the information we had, we determined it was necessary to proactively
2
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March 2020 | The Journal of Healthcare Contracting
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TRENDS
Integrating Health Data Physicians are preparing to integrate health data – and the technologies that
In fact, doctors and medical
harness it – into the clinical setting, writes Lloyd B. Minor, MD, dean of the Stanford
students are pursuing supplemental
University School of Medicine, in the 2020 Stanford Medicine Health Trends Report,
education in such things as advanced
“The Rise of the Data-Driven Physician.”
statistics, coding and population health, and they are open to using tools such as health apps and wearables as part of routine care, he adds. In addition to conducting a secondary review of news articles, white papers and peer-review research for the 2020 Health Trends Report, Stanford Medicine worked with Brunswick Insight to conduct a survey of 523 U.S. physicians and 210 medical students and residents.
Algorithms and AI Approval of medical algorithms by the U.S. Food and Drug Administration has seen rapid growth over the past several
Which of the following innovations do you think have the most potential to transform the healthcare sector in the next five years?
years, according to the researchers. The
Personalized medicine Telemedicine Artificial intelligence Wearable consumer health monitoring devices Genetic screening for health risks Electronic health records Robotic surgery Virtual reality
of those algorithms are imaging-related,
Medical Futurist Institute reported in June 2019 that the FDA had approved a total of 46 algorithms since 2014. Many
Students and residents Physicians 64% 61% 58% 52% 40% 42% 41% 33% 32% 16% 15%
40% 43% 23% 19% 12%
Source: The Rise of the Data-Driven Physician, Stanford Medicine 2020 Health Trends Report
but some are being explored as tools to improve clinical workflows. “There are still many outstanding questions about the technology, including what role AI should have in the patient-doctor relationship, ethical considerations, and, more practically, how it can best alleviate clinical practice burdens,” according to the Stanford researchers. “Having a basic fluency in AI will be important for clinicians to engage in these critical discussions going forward.”
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March 2020 | The Journal of Healthcare Contracting
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POST-ACUTE CARE
Advanced education Nearly three-quarters of all medical students and nearly half of physicians are planning to pursue additional education in data science, according to the Stanford report.
ʯ ʯ ʯ ʯ
34% artificial intelligence.
Physicians and medical students
31% population health management.
also attribute clinical value to this data
27% clinical genomics.
when it comes to their patients as well.
23% advanced statistics and
Eighty percent of physicians and 78%
data science.
of students and residents said that
ʯ 22% coding and programming.
self-reported data from a health app is
Among medical students planning to take
“very” or “somewhat” valuable in terms
additional classes:
of clinical value, and 83% of physicians
ʯ 44% said they will pursue advanced
Wearables
and 79% of students and residents
statistics and data science.
Tomorrow’s physician will most likely
answered the same about data from a
36% population health management.
take wearables seriously. Already, 47% of
wearable device.
30% genetic counseling.
medical students, 50% of residents and
25% clinical genomics.
44% of physicians reported using a wear-
Physician is an unprecedented op-
23% coding and programming.
able health monitoring device, according
portunity to transform medicine and
13% artificial intelligence.
to the Stanford researchers. Furthermore,
improve patient outcomes,” conclude
when asked if they use the results of data
the researchers in the Stanford report.
Among physicians planning to take ad-
from their own wearable device to help
“And we are encouraged to see current
ditional classes:
inform their personal healthcare deci-
and future physicians taking steps to
sions, 67% of students, 56% of residents
actively prepare for this new era of data
and 71% of physicians said “yes.”
and digital health.”
ʯ ʯ ʯ ʯ ʯ
ʯ 38% said they will pursue genetic counseling.
“The Rise of the Data-Driven
Editor’s note: Stanford Medicine 2020 Health Trends Report, “The Rise of the Data-Driven Physician” can be found at http://med.stanford.edu/ content/dam/sm/school/documents/Health-Trends-Report/Stanford%20Medicine%20Health%20Trends%20Report%202020.pdf.
Next month: National Public Health Week Helping your provider customers deliver high-quality medical care is your daily concern. But today, the line between medicine and public health is disappearing, as providers examine the impact of things like poverty, malnutrition and inadequate housing on people’s health. During National Public Health Week – April 6-12 – The Journal of Healthcare Contracting readers will have a chance to talk about some of these big-picture issues with customers. The American Public Health Association has posted these daily themes for NPHW 2020: ʯ Monday, April 6: Mental health (Advocate for and promote emotional well-being.) ʯ Tuesday, April 7: Maternal and child health. (Ensure the health of mothers and babies throughout the lifespan.) ʯ Wednesday, April 8: Violence prevention. (Reduce personal and community violence to improve health.) ʯ Thursday, April 9: Environmental health. (Help protect and maintain a healthy planet.) ʯ Friday, April 10: Education. (Advocate for quality education and tools.) ʯ Saturday, April 11: Healthy housing. (Ensure access to affordable and safe housing.) ʯ Sunday, April 12: Economics. (Advocate for economic empowerment as the key to a healthy life.) For more information on National Public Health Week, go to http://www.nphw.org/nphw-2020
6
March 2020 | The Journal of Healthcare Contracting
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8
March 2020 | The Journal of Healthcare Contracting
Outbreak Response Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak.
The novel coronavirus (COVID-19) is not the first, nor will it be the last, infec-
making. SHEA members – healthcare
tious disease outbreak to make global headlines. “There have been a number of
epidemiologists and other experts in in-
outbreaks that have taught us that routine healthcare infection prevention is not enough
fection prevention and infectious diseases
when dealing with a novel infectious disease or an infection that has potential for caus-
working in collaboration with public
ing a lot of morbidity and mortality,” said Jennifer Anne Hanrahan, DO, an infection
health – are experienced in outbreak
disease specialist from the University of Toledo.
management, having overseen preparedness and management of COVID-19,
SARS, MERS-CoV, and Ebola have been transmitted in healthcare facilities, and preventing the spread of infection in hospitals is critical to containing these infections worldwide. “These outbreaks have shown that emerging pathogen outbreaks can occur with little forewarning and cause disruption to hospitals and their ability to care for patients and keep healthcare workers safe,” Dr. Hanrahan said.
Being prepared The Society for Healthcare Epidemiology of America (SHEA) emphasizes the importance of supporting novel Coronavirus (COVID-19) preparedness efforts with rigorous commitment to infection prevention and science-based decision
Being prepared takes time, Hanrahan said. “It can feel overwhelming when starting from scratch, and these tools help make preparation manageable.”
The Journal of Healthcare Contracting | March 2020
SARS, MERS-CoV, H1N1, influenza, and other infectious diseases, and are working diligently to ensure safety. SHEA works closely with the Centers for Disease Control and Prevention (CDC), and over the past several years has given particular focus and investment to strengthen the infection prevention and control infrastructure for preparedness and response to emerging pathogens. The SHEA/CDC Outbreak Response Training Program (ORTP), created from 2016 to 2018, is a comprehensive program for hospital epidemiologists to be maximally effective to protect their patients, colleagues, and community from facility-level outbreaks to emerging pathogens, such as COVID-19. The ORTP provides expert-authored and selected resources in incident management, with tools and trainings
9
CORONAVIRUS
for development and implementation of
ponents of preparedness and response,
“Every outbreak has taught us a little
policies and identification of resources.
including successful implementation of
bit more and it is important to incorpo-
“The ORTP was developed to make sure
policies, and provides quick, direct access
rate these lessons into future planning,”
that those working in infection prevention,
to resources and tools selected by experts
said Hanrahan.
specifically healthcare epidemiologists and
as the most important and useful. The
infection preventionists, are knowledgeable
ORTP was created so the experts tasked
SHEA/CDC Outbreak Response
in incident management and the structures,
with preparedness and response can apply
Training Program (ORTP), visit
frameworks, and resources that help limit
their expertise to stopping the outbreak,
https://learningce.shea-online.org/
facility disruption, supplement resources, and
rather than spending precious time track-
content/sheacdc-outbreak-response-
prevent the spread of the pathogen,” said
ing down resources and navigating new or
training-program-ortp#group-tabs-
Hanrahan. “These outbreaks showed that
unpracticed roles.
node-course-default4.
For more information on the
education in incident management and preparation to work within an emergency response framework is essential stopping an emerging pathogen crisis.” Being prepared takes time, Hanrahan said. “It can feel overwhelming when starting from scratch, and these tools help make preparation manageable.” There are several different things that hospitals and healthcare workers have to think about in terms of their process for taking care of patients. For example, these outbreaks have demonstrated that training in proper donning and doffing techniques for personal protective equipment
Identifying gaps Both Ebola and SARS demonstrated that routine personal protective equipment was not sufficient to prevent infection in healthcare workers, said Jennifer Anne Hanrahan, DO, from the University of Toledo. “Learning how to don and doff the personal protective equipment properly takes time and practice and is specific to the type of equipment being used. Training is critical to properly donning and doffing PPE.” A number of other issues have also been identified and these are outlined in the SHEA Expert Guidance: Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals https://doi.org/10.1017/ice.2017.212.
(PPE) is critical in order to decrease risk of infection to healthcare workers and
Tool kits: https://ortp.guidelinecentral.com
other patients, Hanrahan said. The ORTP guides healthcare workers in the com-
10
March 2020 | The Journal of Healthcare Contracting
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INFECTION PREVENTION
Identifying Gaps ECRI Institute’s consulting helps providers respond to a multitude of issues related to infection control and prevention
On any given day in the United States, about 1 in 25 hospital patients has at least one healthcare-associated infection (HAI), according to estimates.
“ECRI’s engineering team has performed comparative evaluations in our testing laboratory of automated handhygiene devices and equipment to help
Indeed, there are quite a few areas that
12
For example, lapses in sterilization and
hospitals know which products are best
create vulnerabilities for infections at hos-
high-level disinfection are especially con-
for reducing infection risks,” said Davis.
pitals and health systems, said James Davis,
cerning, he said. There are environmental
“Other areas of vulnerability involve in-
MSN, RN, CCRN-K, HEM, CIC, FAPIC,
and construction-related factors. Hand
fection prevention program management,
Senior Infection Prevention & Patient
hygiene is a well-known concern for the
medical device issues broadly, as well as
Safety Analyst/Consultant, ECRI Institute.
spread of infections.
infection prevention considerations in the
March 2020 | The Journal of Healthcare Contracting
expert), we fly them out to get the job The following are best practices ECRI helps hospitals and health systems develop for better infection prevention: ʯ Situational awareness processes, policies, procedures, supply procurement and facility risk assessment – (Ebola, SARS, Influenza, COVID-19) ʯ Health IT: For example, modification of the electronic health record (EHR) to capture process and outcome measures for infection-related issues. The Partnership for Health IT Patient Safety, a multi-stakeholder collaborative convened and operated by ECRI Institute looks at these types of issues and our infection preventionists add to the content where/ when appropriate. ʯ Regulatory and certification preparedness and response to regulators/inspectors.
done right the first time.” Davis said the ECRI Infection Preventionists look at a variety of inputs to develop the gap analysis and action plans from (but not limited to): 1. Systems (physical and electronic) 2. Devices (medical and standard) 3. Mechanicals/plant engineering 4. Staffing 5. Workflow 6. Infection prevention program effectiveness 7. Data validation 8. Surveillance techniques
“ Behind each consultant stands the power of ECRI’s full knowledge base of multidisciplinary experts, making ECRI unique in these consultations.” – James Davis
(manual and electronic) 9. Epidemiologic data and analysis 10. Human factors/ergonomics 11. Cleaning and disinfection 12. Sterilization/high level disinfection 13. Environmental factors/ industrial hygiene 14. Infection control risk assessment for construction (consultation, planning, program evaluation,
selection and procurement of equipment
while ECRI staff of medical device
and devices.”
engineers, epidemiologists, architects,
15. Policy and procedure review
accident and forensics specialists, and
16. Implementation science
clinicians review findings and provide
17. Infection forensics
Consultation ECRI receives a broad range of requests
onsite and online training)
additional recommendations. “For example, if we are onsite for
“ECRI is basically a one-stop shop for
from hospitals and healthcare systems for
an outbreak and the consultant sus-
infection prevention and control consulta-
infection prevention and control (IPC)
pects that that the potential reservoir
tion and resources.”
consultation. To meet those requests,
is medical-device related, we immedi-
ECRI has developed an IPC consultation
ately call in the expertise of the clinical
that is led by certified infection control-
engineering staff in our Health Devices
prepared experts with advanced degrees.
group,” said Davis. “That instant ex-
“Behind each consultant stands the
pertise advises us, in real time, about
power of ECRI’s full knowledge base of
the nature of the device and potential
multi-disciplinary experts, making ECRI
mechanisms that would put the device
unique in these consultations,” said Davis.
at risk for being a causative factor.
ECRI Institute’s certified infection
If we need an engineer or a medical
preventionists conduct onsite consultations,
forensics expert onsite (or any other
The Journal of Healthcare Contracting | March 2020
ECRI has been updating its Coronavirus Outbreak Preparedness Center on a regular basis. The resources include very specific information on emergency preparedness supplies.
13
HEALTH FOCUS
Heart Disease: Talking Points Start a conversation with your physician customers by sharing news from the most recent American Heart Association’s Scientific Sessions Conferences
E-cigarettes match traditional smoking in some heart risks
even more than traditional cigarettes. The preliminary findings were presented at
blood flow in 19 smokers, ages 24 to 32,
E-cigarettes may be perceived as safer
the American Heart Association's most
immediately before and after using either
than traditional cigarettes, but two studies
recent Scientific Sessions meeting, held in
e-cigarettes or traditional cigarettes. Blood
say they are just as dangerous, or even
November 2019 in Philadelphia.
flow was measured while participants
worse, for your heart. One study found
14
In the first study, which included 476
The second study analyzed heart
were at rest and again as they performed a
vaping can worsen several heart disease
healthy adults, e-cigarette users had higher
risk factors – cholesterol, triglycerides and
“bad” LDL cholesterol and lower overall
glucose levels – at levels equal to tradi-
cholesterol compared to nonsmokers.
director of public health research at
tional cigarettes. A second study found e-
In people who both vaped and smoked,
Cedars-Sinai Medical Center, said the
cigarettes decrease blood flow in the heart
“good” HDL cholesterol was lower.
finding that heart blood flow was reduced
handgrip exercise. Study co-author Dr. Susan Cheng,
March 2020 | The Journal of Healthcare Contracting
in e-cigarette users while at rest was a
People who follow DASH eat foods
have worse outcomes than people who
surprise. “Providers counseling patients
low in salt and that contain high levels
on the use of nicotine products will want
of nutrients to help lower blood pres-
to consider the possibility that e-cigs may
sure, such as potassium, magnesium and
data on 5,747 HIV-positive and 33,497
confer as much and potentially even more
calcium. These foods include fresh fruit
HIV-negative veterans with heart failure
harm to users and especially patients at
and vegetables, beans and lentils, and
being cared for from 2000 to 2018 in the
risk for vascular disease,” she said.
whole grains.
Veterans Affairs Health Care System.
don't have HIV.” Erqou and his colleagues analyzed
The study found 30.7% of HIV-positive veterans with heart failure died from any
High blood pressure, unhealthy diets in women of childbearing age
HIV could increase risk of death from heart failure
cause, compared with 20.3% of HIV-neg-
After a heart failure diagnosis, people who
admission rates for any cause were 50.2%
One in five women of childbearing age
are HIV-positive are more likely to be hos-
for those with HIV compared with 38.5%
has high blood pressure, and a new study
pitalized or die of any cause than those not
for those without.
shows that few of them are on a diet that
infected with HIV, new research shows.
could help them – and their babies – re-
The study is the largest to date to look at
duce their risk for health problems.
how HIV status affects people diagnosed
ative veterans with heart failure. Hospital
with heart failure, a chronic condition in
Obesity, other factors may speed up brain aging
any cause are associated with hyperten-
which the heart is unable to pump enough
The brains of middle-age adults may be
sion. Women who go into a pregnancy
blood and oxygen that cells need.
aging prematurely if they have obesity
Nearly 40% of maternal deaths from
with high blood pressure are at risk of having a baby who has a low birth weight or is born premature. Dr. Lara Kovell, an assistant professor of cardiology at the University of Massachusetts Medical School in Worcester, presented preliminary findings of the study at the American Heart Association's Scientific Sessions in Philadelphia. Kovell and her colleagues analyzed data
People who follow DASH eat foods low in salt and that contain high levels of nutrients to help lower blood pressure, such as potassium, magnesium and calcium. These foods include fresh fruit and vegetables, beans and lentils, and whole grains.
collected on 8,740 women ages 20 to 50 taking part in a national health and nutrition study from 2001 to 2016. They found that 22.4% had high blood pressure.
“We found that people with heart failure who are HIV-positive are more
or other factors linked to cardiovascular disease, new research has found.
Researchers scored how healthy
likely than those who are HIV-negative to
Almost one-quarter of adults have
the women ate and how much salt they
be smokers, have heart and liver disease,
metabolic syndrome, a set of factors that
consumed compared to guidelines set
and have depression or abuse drugs,” said
in combination amplify a person's risk of
out in the Dietary Approaches to Stop
lead study author Dr. Sebhat Erqou, an
heart disease, diabetes, stroke and other
Hypertension – or DASH – diet. It is
assistant professor of medicine at Brown
illnesses. In the research, participants were
recommended for all adults with high
University in Providence, Rhode Island.
considered metabolically unhealthy if they
blood pressure. They found that 7% of
He also is a cardiologist at the Providence
had two or more such factors: high blood
the women who had high blood pressure
VA Medical Center and Lifespan Cardio-
pressure; high blood sugar; high blood
were adhering to a DASH-like diet, while
vascular Institute. “But even after taking
triglyceride levels; or low levels of HDL,
10% with normal blood pressure were.
this into account, people with HIV still
the "good" cholesterol – or if they took
The Journal of Healthcare Contracting | March 2020
15
HEALTH FOCUS
medicine for diabetes, high blood pressure or cholesterol.
Participants were part of the Fram-
to the loss of neurons and supporting
ingham Heart Study, a decades-long
cells, said lead researcher Dr. Rebecca
investigation of cardiovascular disease
Angoff, clinical fellow in medicine at Har-
imaging and tests of thinking skills to
risk. None had diabetes or neurological
vard Medical School's Beth Israel Dea-
evaluate more than 2,100 women and
conditions such as stroke or dementia.
coness Medical Center in Boston. "Aging,
men ages 37 to 55. Compared with the
Among people who were metabolically
decreased blood flow and diseases like
healthiest participants, those who were
unhealthy, MRIs revealed lower total cere-
Alzheimer's can lead to a smaller brain."
metabolically unhealthy, obese or both
bral brain volume – in essence, a smaller
showed evidence of brain decline. The
brain – than was measured in metaboli-
cally unhealthy and obese showed the
preliminary study was presented in No-
cally healthy people.
most signs of subtle injury to the brain's
Researchers used magnetic resonance
vember at the American Heart Associa-
Lower cerebral brain volume is a sign
tion's Scientific Sessions in Philadelphia.
of injury throughout the brain that leads
Participants who were both metaboli-
white matter – tissue that provides crucial connections throughout the brain. These injuries, which have been linked to early
Research has begun to reveal a link between calcium buildup in the breast and coronary artery calcification, an established measure that helps predict cardiovascular disease risk.
Alzheimer's disease, result from blood vessel abnormalities and may be due to risk factors such as high blood pressure and diabetes, Angoff said. On the cognitive tests, obesity was linked to poorer scores. Specifically, those who were obese but metabolically healthy performed worse on a combination of six tests of thinking skills, and on individual tests that measured verbal memory and abstract reasoning. Participants who were obese and metabolically unhealthy scored lower for abstract reasoning and on a test measuring visual details and spatial memory.
Could mammograms screen for heart disease? By screening for breast cancer, mammography has helped save hundreds of thousands of lives. Using the test to also screen for heart disease might someday help save many more. Besides revealing masses that may be tumors, digital mammography – a technique in which low-dose X-ray images are captured and enhanced using computer technology – can reveal buildup of calcium in the arteries in the breast. About 13% of women are estimated to have this buildup, called breast arterial calcification,
16
March 2020 | The Journal of Healthcare Contracting
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HEALTH FOCUS
or BAC, including about 10% of women
colleagues presented preliminary research
in their 40s and around half of women in
examining the utility of BAC in predicting
their 80s.
existing or future heart failure, a condi-
Meth use producing younger, harder-to-treat heart failure patients
tion in which the heart is weakened and
Widespread methamphetamine use is
doesn't pump properly.
creating a unique form of severe heart
Early studies so far have found BAC’s presence appears to signal an elevated risk for heart attack, stroke and other car-
failure, according to research that shows
diovascular consequences. Research has
2006-2016 for 278 middle-aged and older
these patients tend to be younger and
begun to reveal a link between calcium
women who had both a mammogram and
have poor outcomes, according to the
buildup in the breast and coronary artery
coronary calcium test within a one-year
American Heart Association. “This is a
calcification, an established measure that
window. Almost one-third of the women
strikingly different type of patient,” said
helps predict cardiovascular disease risk.
had BAC, and 7% had heart failure. Even
Dr. Isac Thomas, an assistant professor
after accounting for age, diabetes and
at the University of California, San Diego
Scientific Sessions conference in Novem-
high blood pressure, all heart failure risk
School of Medicine, and lead author of a
ber 2019, Dr. Quan Minh Bui, general
factors, women with calcium buildup in
study released at the American Heart As-
cardiology fellow at the University of
the breast arteries had 2.2 times the odds
sociation’s Scientific Sessions conference
California, San Diego, and his UCSD
of having or developing heart failure.
in Chicago in November 2018.
At the American Heart Association's
18
The study looked at records from
March 2020 | The Journal of Healthcare Contracting
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of their non-acute facilities — from surgery centers to doctors’ offices to long-term care facilities and even to patients’ homes. McKesson can help you implement comprehensive strategies that drive out costs and provide better care across the non-acute continuum.
McKesson.com/TakeControl Medical-Surgical. Pharmaceutical. Lab. Equipment. © 2019 McKesson Medical-Surgical Inc. All rights reserved. *HIDA Hospital And Health System Provider Survey, June 2018.
• • • •
Supply Cost Management Visibility Standardization Post-Acute Care
• Laboratory • Pharmaceuticals • Leading Change
HEALTH FOCUS
In the study, Thomas and his colleagues reviewed electronic health records for patients treated at UC San Diego Health between 2005 and 2016. They identified 4,470 patients with methamphetamine abuse; 20,576 patients with heart failure; and 896 patients with both meth abuse and heart failure.
Compared to the average 67-year-old heart failure patient in the study, people with heart failure who use meth were 17 years younger and predominantly male.
Compared to the average 67-year-old heart failure patient in the study, people with heart failure who use meth were 17
The CAC takes cross-sectional images
American Heart Association's Scientific
years younger and predominantly male.
of the vessels that supply blood to the
Sessions meeting.
They also were more likely to have other
heart muscle, to check for the buildup of
substance abuse or psychiatric problems,
calcified plaque. The measurement can
rates in the U.S. have declined in recent
such as mood and anxiety disorders. Even
help a doctor identify who is at risk for
decades among 35- to 74-year-olds.
though meth-using patients were younger,
heart disease before a person has signs or
But in a more recent study, research-
they had a higher five-year hospital read-
symptoms. The test isn’t recommended
ers wanted to look specifically at how
mission rate for heart failure.
for everyone, but according to the guide-
many younger people were having heart
lines, some groups where CAC testing
attacks. They included data from a multi-
may be useful are:
state study of more than 28,000 people
The good news is, other studies suggest that if meth users with heart failure go through a treatment program and
ʯ People reluctant to begin statin
hospitalized for heart attacks from 1995
stop using the drug, depending on the
therapy and who want to understand
to 2014. The results showed 30% of
amount of inflammation and scarring,
their risk and potential benefit
those patients were young, age 35 to 54.
there is the potential to reverse some of the heart damage. The challenge, says Thomas, is for doctors to identify these patients, who can mistrust healthcare providers and don't always disclose drug use.
Coronary calcium test could help clarify heart disease risk – and control cholesterol
more precisely.
More important, they found the
ʯ People concerned about restarting
people having heart attacks were
statin therapy after stopping
increasingly young, from 27% at the
treatment because of side effects.
start of the study to 32% at the end.
ʯ Men ages 55 to 80 or women 60
Among women having heart attacks,
to 80 with few risk factors who
the increase in young patients went
question whether they would benefit
from 21% to 31%, a bigger jump
from statin therapy.
than in young men. Researchers also
ʯ People ages 40 to 55 with an
found that young women had a lower
estimated 10-year risk for developing
probability than men of getting lipid-
heart disease between 5% and 7.5%,
lowering therapy, including antiplatelet
When doctors are sorting out what to
and risk factors that increase their
drugs, beta blockers, coronary angiog-
do about a patient's cholesterol, a key
chances of heart disease.
raphy and coronary revascularization.
calculation is the patient's future risk for
“Traditionally, coronary artery disease
developing heart disease. But what if that
is seen as a man's disease, so women who come to the emergency department with
coronary artery calcium test (CAC) can
Heart attacks are becoming more common in younger people, especially women
help identify patients between 40 and 75
Heart attacks are increasingly occurring
author and a cardiology fellow at the Uni-
years who will benefit from statins when
in younger people, especially women,
versity of North Carolina School of Medi-
risk status is uncertain.
according to a study presented at the 2018
cine. “Also, the presentation of heart attack
risk is uncertain? Cholesterol guidelines released in November 2018 suggest a
20
Past research has shown heart attack
chest pain might not be seen as high-risk,” said Dr. Sameer Arora, the study's lead
March 2020 | The Journal of Healthcare Contracting
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HEALTH FOCUS
is different in men and women. Women
people with diabetes who are age 40 to
be diagnosed as Type 2 diabetes. Over
are more likely to present with atypical
75. The guidelines also give other recom-
the past 20 years, the number of adults
symptoms compared to men, and their
mendations for people with diabetes
diagnosed with diabetes has more than
heart attack is more likely to be missed.”
based on age and other risk factors.
tripled as the population has aged and
The reality has been scientifically clear for a while, but many people are not aware
become more overweight or obese. There are well-established risk factors
People with diabetes need to monitor cholesterol
of the connection: Middle-age adults with
for heart disease, such as smoking, high
diabetes are usually considered at moderate
blood pressure and high blood sugar.
For people with diabetes, blood sugar
to high risk for cardiovascular disease.
There also are what the new cholesterol
isn’t the only important measurement.
More than 30 million people in the
guidelines call “risk-enhancing factors”
The most recent cholesterol guidelines,
United States have diabetes, although
such as family history, chronic kidney dis-
issued in November 2018, suggest the
one in four doesn't know it, accord-
ease and metabolic syndrome. Metabolic
more than 110 million U.S. adults with
ing to Centers for Disease Control and
syndrome is a cluster of at least three
diabetes or prediabetes also should
Prevention (CDC). Another 80 million
diagnosed conditions, including high
manage their cholesterol. The guidelines
have prediabetes, a serious health condi-
blood pressure, high blood sugar, excess
suggest doctors consider prescribing
tion where blood sugar levels are higher
body fat around the waist and abnormal
cholesterol-lowering drugs (statins) to
than normal, but not high enough yet to
cholesterol levels.
Medicare adds coronary angioplasty to ASC coverage The Centers for Medicare & Medicaid Services (CMS) added six coronary intervention procedures to its list of ambulatorysurgery-center-covered surgical procedures. Effective Jan. 1, the following three coronary intervention procedures, and three associated add-on procedures, were to be covered by Medicare:
ʯ CPT code 92920 (Percutaneous transluminal coronary ʯ ʯ ʯ
angioplasty; single major coronary artery or branch). CPT code 92921 (Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure). CPT code 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch). CPT code 92929 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major
ʯ
ʯ
coronary artery (list separately in addition to code for primary procedure). CPT code C9600 (Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch). CPT code C9601 (Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) to the ASC CPL.
“While we acknowledge that a majority of Medicare beneficiaries may not be suitable candidates to receive these procedures in an ASC setting due to factors such as age and comorbidities, we believe it is important to make these procedures payable in the ASC setting, in order to ensure access to these coronary intervention procedures for those beneficiaries who are appropriate candidates to receive them in an ASC setting,” wrote CMS in its Final Rule. (https://www.federalregister.gov/documents/2019/11/12/2019-24138/medicare-program-changes-to-hospitaloutpatient-prospective-payment-and-ambulatory-surgical-center)
22
March 2020 | The Journal of Healthcare Contracting
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PATIENT CARE
INTERVENTIONAL CARE
ENVIRONMENT OF CARE
NEWS
CORONAVIRUS NEWS • WEEK OF FEB. 17-21 China reports sharp drop in new cases, but doubts re-emerge over data
situation, [and] the Australians, Canadians.
U.S. lawmakers to boost U.S. production
I’m speaking mostly generic medicines,
of medical masks. Bowen wrote President
which are 90% of the medicines we take.”
Barack Obama in 2010 and President
The Hubei province at the center of the
Read more of Gibson’s opinions here.
Donald Trump in 2017, warning of the
novel coronavirus outbreak reported
million masks a day if it runs its machines
infections raised concerns about the reliability of the data. The China death toll
Drugmakers in India, which produce 20%
Texas facility, scarred by the boom-bust
tops 2,000 and cases top 75,000. Initially,
of the world’s drug supply by volume, are
cycle that occurred after the swine flu
Chinese authorities were using nucleic
bracing for potential disruption from the
pandemic in 2009. Read more here.
acid tests to confirm virus presence, but
coronavirus. The outbreak threatens to
those tests require days of processing and
disrupt the supply of raw materials from
led to nucleic acid shortages. The Hubei
China. Enough supplies are currently on
U.S. hospitals prep for spread of coronavirus in the states
province introduced a faster diagnostic
hand to continue production, but opera-
Hospitals are bracing for the potential
method last week through CT scans to
tions could be threatened if the outbreak
spread of coronavirus in the U.S. The
reveal lung infections and confirm the
continues to cause disruption in China.
strict quarantine and screening measures
virus, leading to a sharp increase in cases.
Approximately 70% of the raw materi-
enacted by the CDC have given hospi-
However, on Wednesday, authorities said
als India uses in drug manufacturing are
tals time to review their pandemic plans
they were removing that category of clini-
imported from China, and the Hubei
and stockpile needed equipment. “We’re
cally diagnosed cases from their criteria
province is a major production hub. India
buying some time now that it hasn’t really
of confirmed cases, resulting in 279 cases
is the world’s largest exporter of generic
spread so much in the United States,” Dr.
being removed from the Hubei count.
drugs, sending large volumes to the U.S.
Mark Jarrett, the chief quality officer for
Read more here.
It’s estimated that companies that make
Northwell Health (New York, NY), told
anti-infective and hormone therapies
MedicineNet. “That’s giving us a chance
are most at risk from material shortages.
to gear up factories and address supply
Read more here.
chain issues.” The coronavirus epidemic
another change in how China diagnoses
Expert warns of mass U.S. medicine shortages by mid-March if COVID-19 continues to ravage China
24
shortage. Prestige Ameritech can make 1
Drugmakers in India particularly vulnerable to shortages due to coronavirus
a steep drop in new cases. However,
around the clock. However, Bowen is hesitant to ramp up production at his
has hampered supply chains out of China and is highlighting the problems with U.S.
Rosemary Gibson wrote the book, “China
Texas manufacturer caught in coronavirus supply chain panic
Rx: Exposing the Risks of America’s
Prestige Ameritech (Fort Worth, TX), a
supply orders. That, on top of a tough
Dependence on China for Medicine,” and
full-line domestic surgical mask manufac-
U.S. flu season, is straining the capacity of
she predicts the U.S. will see shortages of
turer, was producing 600,000 masks each
many hospitals. Read more here.
medicines by mid-March if conditions
day but struggling to meet demand as the
do not vastly improve in China due to
number of coronavirus cases in China
coronavirus. “We should never have been
skyrocketed in the past week. CEO Mike
Outbreak helps U.S. lawmakers push case on drug shortage bills
in this situation,” Gibson told WCNC
Bowen was receiving cold calls on his cell
With no end in sight for the coronavirus
(Charlotte, NC). “All roads lead to China
phone from people saying they represent-
outbreak, it is prompting fears of drug
in the core ingredients, the chemicals, the
ed foreign governments and wanted to
shortages in the U.S. due to the pharma-
molecules – the real starting material to
make bulk purchases. Bowen said this was
ceutical supply chain’s reliance on China.
make our medicines. China’s dominance
the exact scenario he predicted 15 years
The epidemic is helping U.S. lawmakers
is global. The Europeans are in the same
ago when he asked federal agencies and
who were already working on bills to
hospitals’ dependence on “just-in-time”
March 2020 | The Journal of Healthcare Contracting
NEWS
address drug shortages prove their point.
and other drugs if supply problems from
global supply chain for many prod-
Rep. Anna Eshoo (D-CA) chairs the
China’s coronavirus outbreak cannot be
ucts. Some drugmakers in China have
Energy and Commerce Health Subcom-
resolved soon. EU Chamber of Com-
restarted production after an extended
mittee and has been looking at this issue
merce President Joerg Wuttke added that
break for the Chinese New Year, but
since last fall when her panel held a hear-
Beijing was making supply chain problems
worldwide governments are trying to
ing on the drug supply chain. Read more
worse with a mandatory quarantine of
determine whether drug shortages will
about her thoughts here and what she
arrivals from abroad. The capital city in
result from the continued coronavirus
told Roll Call, a newspaper and website
China is requiring a 14-day quarantine for
outbreak. Concerns were raised by health
in Washington, D.C., in a podcast.
all arrivals, which Wuttke said would make
ministers from France and Finland at an
it difficult to fly in technical experts to help
emergency meeting Brussels (Belgium)
SARS-like damage seen in dead coronavirus patient
if facilities are down. Wuttke called the
about shortages. The FDA has stated
measures against WHO guidelines. He also
that it is vigilant about added resources
A lung biopsy of a Chinese patient who
said the disruption from the epidemic had
and is monitoring the situation closely.
died of the coronavirus COVID-19
driven home diversifying away from China.
Historically, the FDA and drugmakers
found that he had lung damage reminis-
Read more here.
have turned to alternate suppliers to help
cent of two prior coronavirus-related
make up shortfalls. Read more here.
died on Jan. 27 after falling ill two weeks
Wuhan hospital director dies as death toll nears 2,000
earlier. He was treated with various medi-
Liu Zhiming, the director of Wuhan’s
cations, including anti-infection treatment
Wuchang Hospital, died Tuesday at the
FDA response to active supply chain surveillance amid outbreak
alfa-2b, HIV medications lopinavir and
age of 51. Wuhan Municipal Health
The FDA states that it is aware of the
ritonavir and the antibiotic moxifloxacin
Commission confirmed the death in a
likely impact on the medical product sup-
to prevent secondary bacterial infection.
statement saying, “Since the outbreak,
ply chain, including potential disruptions
His fever decreased as a result of the
Comrade Liu Zhiming, regardless of his
to supply or shortages of critical medical
treatment, but his breathing worsened,
personal safety, led the medical staff of
products in the U.S., due to the coronavi-
and his blood-oxygen levels fell dramati-
Wuchang Hospital to fight the epidemic,
rus outbreak. The FDA states that it is not
cally. According to a new report in The
and made important contributions to the
waiting for drug and device manufactur-
Lancet, “The pathological features of
prevention and control of new-type coro-
ers to report shortages, but is proactively
COVID-19 greatly resemble those seen in
navirus pneumonia in our city.” Thou-
reaching out to manufacturers as part
SARS and MERS coronavirus infection.
sands of medical workers from across
of its approach to identifying potential
In addition, the liver biopsy specimens
China have been sent to Wuhan in recent
disruptions or shortages. It has dedicated
of the patient with COVID-19 showed
weeks to help the overwhelmed local
additional resources to review and coor-
moderate microvascular steatosis and mild
authorities. Liu is the ninth known fatality
dinate data to better identify any potential
lobular and portal activity, indicating the
among medical personnel battling the
vulnerabilities to the U.S. medical product
injury could have been caused by either
epidemic in China. The current death toll
sector. Finally, it confirms that it has been
SARS-CoV-2 infection or drug-induced
is 1,868 dead with 72,436 confirmed cases
in contact with hundreds of manufacturers
liver injury.” Read more here.
in mainland China. Read more here.
of human and animal drugs and medical
outbreaks, SARS and MERS. The patient
devices, as well as syncing up with global
26
Pharmacies may face shortage of antibiotics, other drugs if supply problems cannot be resolved
Worldwide concern for drug shortages grows as outbreak continues
regulators, like the European Medicines
The head of a European business group
China is the largest producer of active
manufacturing discontinuances
in China warned Tuesday that the world’s
pharmaceutical ingredients (APIs) in
or interruptions due to the outbreak.
pharmacies may face a shortage of antibiotics
the world and is the starting point in the
Read more from the FDA here.
Agency, to assess and monitor for indications and early warning signs of potential
March 2020 | The Journal of Healthcare Contracting
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NEWS
WEEK OF FEB. 10-14 Coronavirus more contagious than flu, less deadly The new strain of coronavirus, now
Coronavirus exposes U.S. pharma’s supply chain vulnerability, writes Tennessee senator
Coronavirus test kits shipped to U.S. states are not working as expected
formally named COVID-19, is “a lot
It has been more than 50 years since
Some of the coronavirus test kits
more contagious” than the flu, ac-
the last federal quarantine was issued, to
shipped to labs across the U.S. are not
cording to AstraZeneca CEO Pascal
control a deadly smallpox outbreak. Dr.
working as they, according to the CDC.
Soriot. “What we have all learned is
Janet Woodcock, the director of the FDA’s
As a result, the CDC is remaking parts
that the virus leads to a lower mortal-
Center for Drug Evaluation and Research,
of the test kits after some produced
ity than the flu virus, but it’s a lot
testified before Congress this past October
inconclusive test results. The kits were
more contagious, the virus is very
that the U.S. “has become a world leader in
sent to states to speed up the testing
contagious,” Soriot told CNBC. At
drug discovery and development, but is no
process, but the states discovered the
least 19 million people across the
longer in the forefront of drug manufac-
flaw during the verification process.
U.S. have been infected with the flu
turing.” Sen. Marsha Blackburn (R-TN)
However, not all states have been af-
virus this flu season, according to the
writes on the U.S. pharma supply chain
fected. For example, the Illinois Depart-
CDC, and it has resulted in 10,000
and its reliance on China here.
ment of Public Health said it has not had any issues with the kits and it is
deaths and 180,000 hospitalizations.
continuing with its testing for the coro-
is optimistic that Chinese authorities
Coronavirus cases spike in China; death toll over 1,300, caseload over 60,000
would be able to contain the virus.
Doctors in China have adopted a new
with the latest one reported among U.S.
Read more here.
way of diagnosing the novel coronavirus,
evacuees at a military base in San Diego
leading to a spike of 23% in confirmed
County, CA. Read more here.
Soriot said, despite the high contagion rate of the COVID-19 virus he
28
navirus. There have been 14 confirmed coronavirus cases reported in the U.S.
CDC director says coronavirus could stay in U.S. through the year and beyond
cases and a jump in the number of deaths
Dr. Robert Redfield, the director of
when a person tested positively for the
the CDC, says that the coronavirus will
virus, but the government is no longer
Moody’s indicates healthcare companies to see mixed results from expanded coronavirus outbreak
likely stay for “beyond this season, or
requiring a positive test. New cases are
U.S. healthcare companies would see
beyond this year,” in the U.S. “Right
now being confirmed if a person is simply
mixed effects of a more significant
now, we’re in aggressive containment
diagnosed by a doctor. Officials in Hubei
coronavirus outbreak within and
mode,” said Redfield. “I think even-
province, the heart of the outbreak,
outside of China, according to a new
tually the virus will find a foothold
reported 254 new deaths and 15,152 new
stress report from Moody’s Inves-
and we will get community-based
cases of coronavirus. The increase brought
tors Service. If the outbreak spreads
transmission.” Redfield said it would
the death toll to at least 1,369 and the
significantly in China, it would dampen
become a disease like the seasonal flu
number of confirmed cases to more than
demand for U.S. healthcare companies
and questioned whether China has the
60,000. “We’re now getting a better indica-
that sell products there. Moody’s said
situation under control, suggesting that
tion of what’s actually happening in the
it is already seeing evidence of that
the country allow the CDC to conduct
community,” John Nicholls, a professor of
on medical device companies’ earn-
on-the-ground work. Only the World
pathology at the University of Hong Kong
ings calls. Companies that use Chinese
Health Organization (WHO) has been
and a prominent researcher during the
components, including pharmaceutical
helping China assess the outbreak so
SARS outbreak in 2003, told CBS News.
ingredients, to make their products could
far. Read more here.
Read more here.
also suffer supply chain disruptions. The
blamed on the virus. China previously only counted a coronavirus case as confirmed
March 2020 | The Journal of Healthcare Contracting
NEWS
turing and supply chain partners, as well
ences and Johnson & Johnson (J&J) are
Coronavirus may be over by April in China, but WHO warns of global threat
working to develop novel medications
Coronavirus infections in China may be
WHO, the Chinese Ministry of Health,
or use existing ones to treat or prevent
over by April, according to China’s senior
and the CDC, to address shortages as
conditions. Read more here.
medical advisor, but the WHO warns of
they occur. Given this situation and acute
outbreak also provides some opportunity. U.S. drug companies like Gilead Sci-
the Pandemic Supply Chain Network,
a “very grave” global threat. China’s fore-
market needs, we anticipate disruptions
CMS reminds providers to review infection control protocols amid outbreak
most medical advisor on the outbreak,
to orders for certain infection products
Zhong Nanshan, has said numbers of
in various markets. Please contact your
new cases were falling in some places and
local Henry Schein consultant for specific
CMS sent a memo to state survey
held out hope the epidemic may peak this
inventory inquiries.” A spokesperson
agency directors, encouraging all
month. Zhong won fame for his role in
for Henry Schein, speaking to Business
healthcare facilities to carefully review
combating the outbreak of SARS in 2003.
Insider, said, “It’s too soon to say what
their infection control information and
However, WHO chief Tedros Adhanom
the long-term effects will be on busi-
protocols amid the coronavirus out-
Ghebreyesus appealed for the sharing of
ness from the outbreak. Henry Schein
break. “Because coronavirus infections
virus samples and speeding up research
reports on our Q4 financial results later
can rapidly appear and spread, facilities
into drugs and vaccines. “With 99% of
this month, and we’ll have a better sense
must take steps to prepare, includ-
cases in China, this remains very mush an
by then of the impact of the outbreak.”
ing reviewing their infection control
emergency for that country, but one that
Read more about the concerns to
policies and practices to prevent the
holds a very grave threat for the rest of
medical practitioners here.
spread of infection,” CMS said in the
the world,” he says. Read more here.
It also states that healthcare staff and
Hospitals stockpile supplies amid coronavirus-related mask shortage; Schein makes statement
Boston Scientific puts dollar amount on possible losses to coronavirus, absorbs hits in supply chain
surveyors, including federal, state and
The coronavirus has fueled fears of
Boston Scientific (Marlborough, MA)
local contractors are expected to adhere
a shortage of key protective medical
has estimated the coronavirus outbreak
to standard infection control practices,
devices, namely the specialized N95 res-
will cost the company from $10 million
such as CDC recommendations on
pirator masks that are needed to protect
to $40 million in sales. Boston Scien-
standard hand hygiene practices.
health workers treating infectious patients.
tific expects $12 billion in sales this
Read the full memo here.
The CDC recommends that medical
year, but it’s a sign of how the effects
memo. The memo includes information and links to resources to combat the illness caused by the novel coronavirus.
30
as global health organizations including
employees working with coronavirus
of coronavirus are beginning to be felt
Coronavirus death toll surpasses 1,000 in mainland China
patients wear N95 masks, specifically. Any
across the global economy. The virus
disruption in the distribution of sup-
outbreak hit airline and oil stocks in
Monday saw the largest single-day death
plies like N95 masks could pose a risk to
late January, and the impact on much
tool yet in mainland China as 108 people
medical practitioners who rely on certain
of the rest of the corporate landscape
died, bringing the total to more than
pieces of protective equipment. Henry
is building slowly. Boston Scientific
1,000 deaths. More cases were identified,
Schein’s website now includes a notice for
says it expects to absorb revenue
bringing that total to 42,638 in mainland
consumers in the U.S. stating, “Due to the
hits from canceled surgeries in
China. Meanwhile, two senior health of-
coronavirus outbreak, we are experiencing
areas where the virus is prevalent, and
ficials in the Chinese province of Hubei,
higher than normal demand globally for
from disruptions in its supply chain.
the epicenter of the outbreak, have
infection control products such as masks,
Read more on Boston Scientific and
been fired. Read more about the latest
goggles and face shields, among other
other companies bracing for the im-
updates here.
items. We are working with our manufac-
pact of coronavirus here.
March 2020 | The Journal of Healthcare Contracting
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LUMCHECK™ The LumCheck™ is designed as an independent check on the cleaning performance of pulse-flow lumen washers. Embedded on the stainless steel plate is a specially formulated blood soil which includes the toughest components of blood to clean.
FLEXICHECK™ This kit simulates a flexible endoscope channel to challenge the cleaning efficiency of endoscope washers with channel irriga�on apparatus. A clear flexible tube is a�ached to a lumen device with a test coupon placed inside; the en�re device is hooked up to the irriga�on port of the endoscope washer.
HEMOCHECK™/PROCHEK-II™ Go beyond what you can see with all-in-one detec�on kits for blood or protein residue. HemoCheck™ is simple to interpret and indicates blood residue down to 0.1μg. The ProChek-II™ measures for residual protein on surfaces down to 0.1μg.
HEALTHMARK INDUSTRIES CO. | HMARK.COM | 800.521.6224 | HEALTHMARK@HMARK.COM
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