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| Report: Electronic Records Implementation Not on Track |
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CENTERS FOR MEDICARE AND MEDICAID SERVICES ADMINISTRATOR Mark McClellan, MD, PhD, will resign the position he's held since 2004 in October, the agency says. According to published reports, Dr. McClellan says he is leaving to spend more time with his family. He says he will likely join a think tank or accept an academic position. No replacement has yet been named, but The Washington Post reports that potential candidates include CMS Deputy Administrator Leslie Norwalk; CMS Director of the Center for Medicare Management Herb Kuhn; and Julie Goon, a special assistant to President Bush and the former director of Medicare outreach at HHS.
CMS IS REMINDING HEALTHCARE PROVIDERS who bill Medicare for services rendered that a nine-day hold will be placed on payments for all claims between Sept. 22 and Sept. 30, the end of the federal fiscal year. Claim payment will resume the following Monday, Oct. 2. This one-time payment hold has been mandated by Section 5203 of the Deficit Reduction Act of 2005. For more information, read the Medicare Learning Network article. CMS has also posted a supporting data file for use in modeling the agency's methodology for calculating proposed facility payment amounts under the revised ASC payment system, scheduled to take effect in January 2008. The file contains the pricing and historical utilization data used to established the proposed ASC conversion factor calculation. To obtain the data, visit the CMS's Web page on the subject and click on the link titled "CMS-1506-P" under the "Downloads" heading.
JCAHO HAS ISSUED A SENTINEL EVENT ALERT urging facilities to develop protocols that will keep patients safe in the event of power outages. The alert recommends that organizations match the critical equipment and systems that would be needed in an extended emergency against those actually on the emergency power system; inventory emergency power systems and the loads they serve; provide training for those who operate and maintain the emergency power system; ensure that generator fuel is available and usable; ensure that the organization's management and clinical leaders know how long emergency power will be available, as well as what locations within the facility will and won't have emergency power; and establish contingency plans for doctors and other caregivers to follow during electrical power failures. |
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| Crustaceans Can Help Limit Implant Infections
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Put away the Old Bay Seasoning and cocktail sauce. Researchers at Montana State University have discovered that chitosan, a chemical compound found in crabs and shrimp, can prevent the formation of infectious cells on implantable medical devices. The findings were presented last week at the national meeting of the American Chemical Society in San Francisco.
Philip Stewart, PhD, director of MSU's Center for Biofilm Engineering, and Ross Carlson, PhD, assistant professor of chemical engineering, say chitosan inhibits the growth of glue-like layers of infectious cells, known as biofilms. Dr. Stewart notes that biofilms can form on any device implanted in the body, including artificial hips, knees and breast implants. He believes coating these devices with chitosan could serve as a first line of defense against infection.
"This developing research brings up exciting possibilities and the concept is already in use, as some implants are coated with an antibiotic intended to help heal infection from within," says Steve Johnson, manager of sterile processing at Tacoma General and Mary Bridge hospitals in Tacoma, Wash.
Biofilm buildup and the resulting contamination of an implantable device can result from improperly cleaned orthopedic screws and plates, says Mr. Johnson.
Mr. Johnson recommends following the standards for processing, biological monitoring and quarantining implantable devices that have been outlined by AORN and the Association for the Advancement of Medical Instrumentation.
"The risk of infection is greatly reduced simply by providing a higher degree of sterility assurance," says Mr. Johnson. "Careful cleaning and pre-sterilization checking is critical for all instruments, but especially so for instrumentation used in the placement of implants."
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| Study: Is BIS Useful for NAPS During Colonoscopy?
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Is bispectral index monitoring a useful adjunctive maneuver to registered nurse-administered propofol sedation? Researchers who studied the question found that BIS didn't lead to reductions in mean propofol dose or recovery time when used as an adjunct to NAPS for colonoscopy or when used as the primary target for sedation, according to their report in the September American Journal of Gastroenterology. "No clinically important role for BIS monitoring as an adjunct to NAPS has yet been established," the researchers concluded.
A randomized controlled trial of 102 outpatients presenting for colonoscopy was performed. BIS values were recorded continuously in all subjects. Patients were randomized to receive NAPS with BIS visible to nurse and endoscopist versus BIS invisible to nurse and endoscopist. In phase 1 (47 patients), the nurse and endoscopist team were instructed to consider BIS (when visible) as only adjunctive information with regard to titrating sedation. In phase 2 (55 patients), the nurse endoscopist team was instructed to use BIS as the primary endpoint for titration of sedation and to target BIS to greater than 60 (60-70 is deep sedation).
In phase 1, the mean (SD) BIS value from scope-in (SI) to scope-out (SO) for BIS was 59.3 (9.9) and was not different from controls at 59.9 (10.1; p=0.82). The mean propofol dose (expresseed in mg/min) was 15.8 (5.6) and 17.2 (6.2) for BIS and controls, respectively (p=0.45). The mean (SD) recovery time with BIS visible in phase 1 was 20.6 minutes (5.5) versus 19.2 minutes (4.5) in controls (p=0.34). In phase 2, the mean (SD) BIS from SI to SO in those randomized to have BIS visible was 64.1 (5.4) versus 63.1 (8.5) in controls (p=0.58). The mean (SD) dose of propofol (mg/min) was 16.1 (11.2) and 16.4 (12.3) for BIS and control groups, respectively (p=0.92). The mean (SD) recovery time in phase 2 with BIS visible was 18.7 minutes (3.5) versus 20.1 minutes (5.6) in controls (p=0.27).
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| News and Notes |
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STERIS AND THE FDA HAVE ISSUED A RECALL of the Amsco Sonic Energy Cleaner and Amsco Sonic Energy Console, used for cleaning reusable medical equipment, due to fire risk. The location of the lid switch cable wiring harness in these units makes them susceptible to water damage in the electrical connections. If this occurs, it can cause overheating of the electrical system in the unit and lead to damage of the wiring harness, resulting in smoking, sparking and fire. The affected products were manufactured from November 2000 until January 2005 and bear serial numbers from 0403105051 to 0432000018. According to a field correction notice from Steris, the company will be sending technicians to replace the wire harnesses and associated components of the affected units. Until then, healthcare providers using the devices are instructed to follow proper safety precautions to prevent water from contacting the electrical wiring.
THE RISK OF ENDOPHTHALMITIS AFTER PHACOEMULSIFICATION cataract surgery can be reduced by a post-op injection of cefuroxime, according to a published report of a study presented last week in London at the Congress of the European Society of Cataract and Refractive Surgeons. Researchers discovered that the injection reduced the rate of presumed and proven infective endophthalmitis to fewer than five in 10,000 cases, says the report. The study reportedly identified risk factors for endophthalmitis, including implantation of a silicone IOL instead of an acrylic lens and clear corneal incision instead of scleral incisions.
MEDICARE'S PROPOSED 5.1 PERCENT CUT to physician reimbursement rates could lead 39 percent of medical group practices to limit how many Medicare patients they treat and 19 percent to stop accepting new Medicare patients, according to a survey by the Medical Group Management Association, the Englewood, Colo.-based industry observer. The survey, which polled more than 1,600 representatives of group practices in June 2006, sought out views on Medicare's 2007 physician fee schedule, which is expected to take effect in January. In the survey, 67 percent of respondents said they would modify or eliminate employee health benefits in an effort to maintain fiscal balance, 54 percent would lay off administrative or support staff and 39 percent would lay off clinical staff. |
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