JHC Nov19

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

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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.

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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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