viernes, 5 de junio de 2015



CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.

A Weekly Compilation of Clinical Laboratory and Related Information
From The Division Of Laboratory Systems

June 04, 2015

News Highlights

  • Interim Guidance on Testing, Specimen Collection, and Processing for Patients with Suspected Infection with Novel Influenza A Viruses with the Potential to Cause Severe Disease in Humans
  • Dozens of Genes in Breast Cancer Tests Lack Link to Risk
  • ‘Devious Defecator’ Case Tests Genetics Law
  • Educational Material for Developing an Individualized Quality Control Plan (IQCP)
  • Technology: New Assays Capture Clusters of Tumor Cells—Test Identifies Cells Ripe for Metastases
  • Laboratory Diagnosis of Noroviruses: Present and Future
  • Flawed PSA Data in SEER Make Past Studies Suspect
  • Removing Mutant p53 Significantly Regresses Tumors, Improves Cancer Survival
  • 'Achilles' Heel for Ebola Virus Infection' Protein Identified
  • Laboratory Leadership Service (LLS)
  • Rates of New Melanomas – Deadly Skin Cancers – Have Doubled over Last Three Decades
  • White House Meeting Elicits Pledges to Reduce Antibiotic Use
  • What Will EHRs Look Like in 2020?
  • Medicaid Rule Could Extend Health IT Support to Behavioral Health, Long-term Care
  • Nevada, Minnesota, Indiana Enact Telehealth Parity Laws

View Previous Issues - Healthcare News Archive

Leading News

Interim Guidance on Testing, Specimen Collection, and Processing for Patients with Suspected Infection with Novel Influenza A Viruses with the Potential to Cause Severe Disease in Humans
This document provides interim guidance for clinicians and public health professionals in the United States on appropriate testing, specimen collection and processing for patients who may be infected with novel influenza A viruses with the potential to cause severe illness in people. Examples of such viruses include Asian-lineage avian influenza A (H5N2), (H5N8), and (H5N1)1 viruses, which were detected in wild and domestic birds in North America in December 2014 and January 2015; these viruses may have some or all of their genes from Asian avian influenza viruses, but for simplicity will all be referred to as “newly detected avian influenza A H5” viruses in this guidance document. Other newly detected avian influenza A H5 viruses also may have the potential to cause severe disease in humans. For a list of avian influenza A H5 virus infections identified in birds in the United States, and their locations, please see an update on avian influenza findings maintained by the US Department of Agriculture. CDC will update this guidance as additional information becomes available.
Dozens of Genes in Breast Cancer Tests Lack Link to Risk
Genetic tests for breast cancer risk often look for DNA flaws that haven’t been reliably linked to the disease, a new report found, casting doubt on diagnostics that examine dozens of genes to calculate a patient’s susceptibility. Only 11 genes have potential mutations shown to raise the chance of getting breast cancer, according to the article published in the New England Journal of Medicine. Some genes included in tests by Illumina Inc. and other companies haven’t been conclusively tied to breast cancer risk, the report said. The cost of analyzing DNA -- the molecule containing the body’s code for making proteins, cells and tissues -- has dropped precipitously, and companies have added breadth to genetic tests for breast cancer risk. Yet more may not necessarily be better, according to an international team of researchers led by Douglas Easton, a cancer epidemiologist at the University of Cambridge in the U.K. “If you’re selling tests with 100 genes when only 10 are important, that’s not very helpful,” Easton said in a telephone interview.
 ‘Devious Defecator’ Case Tests Genetics Law
Seven years ago, Congress prohibited employers and insurers from discriminating against people with genes that increase their risks for costly diseases, but the case that experts believe is the first to go to trial under the law involves something completely different: an effort by an employer to detect employee wrongdoing with genetic sleuthing. Amy Totenberg, the federal district judge in Atlanta who is hearing the case, called it the mystery of the devious defecator. Frustrated supervisors at a warehouse outside Atlanta were trying to figure out who was leaving piles of feces around the facility. They pulled aside two laborers whom they suspected. The men, fearing for their jobs, agreed to have the inside of their cheeks swabbed for a genetic analysis that would compare their DNA with that of the feces. Jack Lowe, a forklift operator, said word quickly spread and they became the objects of humiliating jokes.The two men were cleared — their DNA was not a match. They kept their jobs but sued the company. On May 5, Judge Totenberg ruled in favor of the laborers and set a jury trial for June 17 to decide on damages. She determined that even though the DNA test did not reveal any medical information, it nonetheless fell under the Genetic Information Nondiscrimination Act, or GINA.
‘Paradigm Change’ Could Mean Faster Access to More Effective Cancer Drugs
The National Cancer Institute’s announcement Monday that it will soon begin a nationwide trial to test treatments based on the genetic mutations in patients’ tumors, rather than on where the tumors occur in the body, highlights a profound shift taking place in the development of cancer drugs. Researchers increasingly are using DNA sequencing, which has become far faster and cheaper over time, to identify molecular abnormalities in cancers. That technology is allowing them to develop drugs they hope will prove more effective in specific sets of patients and to design clinical trials that get the most promising drugs to market more quickly. “We are truly in a paradigm change,” James H. Doroshow, director of the division of cancer treatment and diagnosis at the NCI, said in announcing the initiative Monday. He called the project “the largest and most rigorous precision oncology trial that’s ever been attempted.”
'Less Is More': The Next Big Thing for Medicine
Proponents of less-is-more medicine stress that its focus is avoiding harm rather than mere cost-cutting, which consumers fear might reduce access to necessary care. The less-is-more movement has percolated against this backdrop over the past decade, gaining traction with the 2012 launch of theChoosing Wisely campaign by the American Board of Internal Medicine (ABIM) Foundation. The campaign enlisted clinician groups to help galvanize change by naming an evidence-based top 5 list of tests and procedures that physicians and patients should question because they offer little or no benefit and may cause harm. To date, more than 70 specialty societies have joined the campaign, each offering a top 5 list (some later updated to a top 10 or 15 list). Consumer Reports and other consumer groups have also signed on to help educate patients about how more medicine can be harmful. In addition, major medical journals are highlighting research findings that provide data illuminating low-value care, including the JAMA Internal MedicineLess is More series and the BMJ's Too Much Medicine campaign. Annual conferences, such as Preventing Overdiagnosis and the Lown Institute-sponsored RightCare Conference, are raising the medical community's consciousness about medical overuse. A national survey of primary-care and specialist physicians commissioned for the ABIM Foundation found that nearly three in four physicians said that unnecessary tests and procedures are a serious problem and 72% said the average physician prescribes an unnecessary test or procedure at least once a week. Doctors in the trenches have their own ideas about what will help foster a less-is-more culture. In the ABIM Foundation's survey, 91% said malpractice reform; 85% said specific, evidence-based recommendations that a physician can use with patients; 78% said having more time with patients to discuss alternatives; and 61% said changing the system of financial rewards some physicians receive for ordering tests or procedures.

Laboratory Testing / Diagnostics

Educational Material for Developing an Individualized Quality Control Plan (IQCP)
The Centers for Disease Control and Prevention’s Division of Laboratory Systems is pleased to announce the availability of a free tool, developed in conjunction with the Centers for Medicare & Medicaid Services, Division of Laboratory Services. This tool, a step-by-step instructional workbook, is designed to assist laboratory professionals develop Individualized Quality Control Plans (IQCPs) for tests they perform.  Using an example scenario, “Developing an IQCP; A Step-By-Step Guide” walks readers through the process of developing an IQCP that can be sustained and modified, as needed, over time.  It describes how laboratory professionals can perform a risk assessment to evaluate and record their current quality activities on an IQCP worksheet, create a Quality Control Plan from the risk assessment information, and establish a Quality Assessment for the test system being evaluated for an IQCP. The approach outlined in this workbook is not mandatory nor is it the only example that can be used. “Developing an IQCP; A Step-By-Step Guide” is freely available online through the CDC’s website at:

Technology: New Assays Capture Clusters of Tumor Cells—Test Identifies Cells Ripe for Metastases
A routine blood sample -- filtered through a device the size of a credit card -- could help detect aggressive cancers earlier, according to findings published in Nature Methods last week. Around 90% of cancer deaths are caused not by the primary tumor but by metastases, according to Roderic Pettigrew, MD, PhD, director of the National Institutes of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH). A new device aimed at detecting the early signs of metastasizing tumors might help reduce that toll, Pettigrew said, presenting the study at the Mayo Clinic at a fellowship sponsored by the Clinic and the National Press Foundation. Mehmet Toner, PhD, professor of biomedical engineering at Massachusetts General Hospital, Harvard Medical School, and an author of the study set a goal of creating a technology to capture and identify tumor cells at the molecular level using blood samples.
Laboratory Diagnosis of Noroviruses: Present and Future
Norovirus is an important cause of gastroenteritis outbreaks globally and the most prevalent cause of sporadic gastroenteritis in many regions. Rapid and accurate identification of causative viral agents is critical for outbreak investigation, disease surveillance, and management. Because norovirus is not cultivable and has a highly diversified and variable genome, it is difficult to develop diagnostic assays. Detection methods have evolved from electron microscopy to conventional end-point reverse transcription polymerase chain reaction (RT-PCR), immunoassay, real-time RT-PCR, other molecular technologies, and nanotechnology array-based assays. The status and features of various testing methods are summarized in this review.
New Consumer-Oriented Diagnostic Device Will Let Athletes Test Themselves for Lactic Acid without the Need for a Medical Laboratory Test
For two decades, healthcare policy experts have regularly predicted that a boom in consumer demand for clinical laboratory testing is just around the corner. Yet, in 2015, the Direct Access Testing (DAT) segment of the medical laboratory profession remains relatively small when measured by specimen volume and revenue. Dark Daily believes that consumer interest in self-testing may actually be tapped by a different approach to diagnostic testing. It will come by serving the large number of athletes competing in triathlons, other strenuous sports, and extreme athletic events like 24-hour races. Pathologists and clinical laboratory scientists will be fascinated to learn that one early product entry in this emerging category is a non-invasive test for lactic acid. BSX Athletics of Houston, Texas, has developed a non-invasive, wearable device that monitors lactic acid levels in real time.
Verax Biomedical Gains FDA Clearance for Expanded Platelet Safety Measure Testing Indications
Verax Biomedical has announced that the company has gained FDA clearance to expand the use of its Verax Platelet PGD® test - a rapid test for the detection of bacterial contamination in platelets intended for transfusion. The new FDA clearance makes the Verax Platelet PGD test the only rapid test on the market cleared by the FDA to check every commonly distributed platelet type in the United States. Annually, more than 6 million platelet doses are transfused worldwide, and approximately 1 in 2,000 doses are contaminated by bacteria. The Verax Platelet PGD test is an immunoassay used on the day of transfusion at the point of care - a hospital or transfusion service - to quickly detect bacterial contamination in platelets and protect patients from receiving contaminated transfusions. The presence of bacteria in platelets can pose serious risks for patients, including sepsis - a life-threatening infection in the blood stream.

Research and Development

Flawed PSA Data in SEER Make Past Studies Suspect
When the National Cancer Institute (NCI) removed all prostate-specific antigen (PSA) data from the Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare programs, it rendered many of the studies that used the flawed data useless. The PSA data were removed after quality control checks revealed that a substantial number of PSA values included in the programs were incorrect. The SEER program, which was initiated by the NCI in 1973, is legislatively mandated to collect cancer incidence and survival data from 17 population-based tumor registries across the United States. It represents roughly 28% of the US population. The SEER-Medicare dataset links the cancer information in SEER to administrative claims data for patients in SEER covered under the Medicare program. In an editorial in The Journal of Urology, David F. Penson, MD, MPH, Hamilton and Howd Chair in Urologic Oncology and professor, Vanderbilt University School of Medicine, Nashville, Tennessee, warns that withdrawal of the PSA data from the SEER datasets will have important effects on prostate cancer research.
Removing Mutant p53 Significantly Regresses Tumors, Improves Cancer Survival
Removing accumulated mutant p53 protein from a cancer model showed that tumors regress significantly and survival increases. This finding, by an international team of cancer researchers led by Ute Moll, MD, Professor of Pathology at Stony Brook University School of Medicine, is reported in a paper published advanced online in Nature. For two decades cancer researchers have looked unsuccessfully for ways to develop compounds to restore the function of mutant p53 proteins. This team discovered that eliminating the abnormally stabilized mutant p53 protein in cancer in vivo has positive therapeutic effects.
'Achilles' Heel for Ebola Virus Infection' Protein Identified
A new mouse study published in mBio has revealed that the Ebola virus is unable to infect cells without first attaching to a host protein called Niemann-Pick C1. Niemann-Pick C1 (NPC1) is found in the membranes of tiny enzyme-filled compartments known as lysosomes that digest and recycle cellular components and are located within cells. "Our study reveals NPC1 to be an Achilles' heel for Ebola virus infection," says co-study leader Kartik Chandran, an associate professor of microbiology and immunology at Albert Einstein College of Medicine of Yeshiva University, NY. "Mice lacking both copies of the NPC1 gene, and therefore devoid of the NPC1 protein, were completely resistant to infection."
All Is Not Quiet on the Western Front
If you don’t look too closely, Western blots are seemingly the same slog as when they were first described in 1979. Western blotting is moving in the right direction, though. In recent years, new reagents and instruments have made Westerns more sensitive and have condensed some of the main steps, namely electrophoresis, blotting, and visualization. Although many researchers still use chemiluminescence detection and X-ray film, the introduction of digital fluorescence imaging has boosted the technique’s sensitivity and reliability and pushed it into the “quantitative” rather than semiquantitative realm. New advances are also making it possible to study proteins in single cells, or to probe limited or precious samples—and to automate some parts of the process. And users are taking greater care in addressing the issue of reliable controls.
Tsukuba Scientists Reverse Aging in Human Cell Lines and Give Theory of Aging a New Lease of Life
Can the process of aging be delayed or even reversed? Research led by specially appointed Professor Jun-Ichi Hayashi from the University of Tsukuba in Japan has shown that, in human cell lines at least, it can. They also found that the regulation of two genes involved with the production of glycine, the smallest and simplest amino acid, is partly responsible for some of the characteristics of aging. The research, published this month in the prestigious journal Nature’s ‘Scientific Reports’, looked at the function of the mitochondria in human fibroblast cell lines derived from young people (ranging in age from a fetus to a 12 year old) and elderly people (ranging in age from 80-97 years old). In a compelling finding, the addition of glycine for 10 days to the culture medium of the 97 year old fibroblast cell line restored its respiratory function. This suggests that glycine treatment can reverse the age-associated respiration defects in the elderly human fibroblasts. These findings reveal that, contrary to the mitochondrial theory of aging, epigenetic regulation controls age-associated respiration defects in human fibroblast cell lines.
Machine-Learning Breakthrough Paves Way for Medical Screening, Prevention and Treatment
A breakthrough in machine learning has also brought about a "game changer" for the science of metabolomics - and will hasten the development of diagnostic and predictive tests for Alzheimer's, cancer, diabetes and numerous other conditions, leading to improved prevention and treatment. University of Alberta computing science PhD graduate Siamak Ravanbakhsh published his research in the scientific journal PLOS ONE on an automated process that increases the speed and accuracy of producing a person's metabolic profile from a sample of biofluid such as blood serum or cerebrospinal fluid using NMR spectrometry. Such a profile can provide a functional read-out of the developmental, physiological or pathological state of a biological system. This ability to quickly and accurately measure the levels of various molecules in a single sample of biofluid marks a significant advance for simple, cost-effective, predictive medical screening.
Diagnosing Cancer with Help from Bacteria
Engineers at MIT and the University of California at San Diego (UCSD) have devised a new way to detect cancer that has spread to the liver, by enlisting help from probiotics -- beneficial bacteria similar to those found in yogurt. Many types of cancer, including colon and pancreatic, tend to metastasize to the liver. The earlier doctors can find these tumors, the more likely that they can successfully treat them. Using a harmless strain of E. coli that colonizes the liver, the researchers programmed the bacteria to produce a luminescent signal that can be detected with a simple urine test. The MIT team is now pursuing the idea of using probiotic bacteria to treat cancer, as well as for diagnosing it.
Protecting Women from Multiple Sclerosis
An innocent mistake made by a graduate student in a Northwestern Medicine lab (she accidentally used male mice instead of female mice during an experiment) has led scientists to a novel discovery that offers new insight into why women are more likely than men to develop autoimmune diseases such as multiple sclerosis (MS). The finding, detailed in a paper published in The Journal of Immunology, focuses on a type of white blood cell, the innate lymphoid cell that exhibits different immune activities in males versus females. The research opens up new avenues for investigation into sex-determined disease susceptibility and could one day lead to better therapies for both men and women with MS and other autoimmune diseases. Type 2 innate lymphoid cells have been well studied in allergy, where they are thought to promote allergic inflammation. But this is the first study to show these cells exhibit sex differences in their activity and actually can protect in autoimmune disease.

Public Health and Patient Safety

Laboratory Leadership Service (LLS)
LLS is a new 2-year CDC laboratory fellowship program that combines competency-based public health laboratory training with practical, applied investigations and service. LLS focuses on biosafety, quality management systems, and management and leadership competencies. The program is aligned with CDC’s Epidemic Intelligence Service (EIS) to promote interdisciplinary training, applied learning, and networking. EIS has successfully trained epidemiologists for more than 60 years. The 2015 inaugural class of 7 LLS fellows will begin in July 2015. Applications will be accepted for the 2016 class from mid-May to mid-August 2015.
The LLS fellowship:
  • Provides high-quality training that focuses on biosafety, quality management systems, and management and leadership competencies
  • Includes a unique curriculum, core activities for learning, and mentorship to focus on the requirements of public health laboratories
  • Aligns with CDC’s Epidemic Intelligence Service (EIS)fellowship program to promote interdisciplinary training, applied learning, and networking
Rates of New Melanomas – Deadly Skin Cancers – Have Doubled over Last Three Decades
Melanoma rates doubled between 1982 and 2011 but comprehensive skin cancer prevention programs could prevent 20 percent of new cases between 2020 and 2030, according to this month’s Vital Signs report.  Skin cancer is the most common form of cancer in the U.S., and melanoma is the most deadly type of skin cancer. More than 90 percent of melanoma skin cancers are due to skin cell damage from ultraviolet (UV) radiation exposure. Melanoma rates increased from 11.2 per 100,000 in 1982 to 22.7 per 100,000 in 2011. The report notes that without additional community prevention efforts, melanoma will continue to increase over the next 15 years, with 112,000 new cases projected in 2030. The annual cost of treating new melanoma cases is projected to nearly triple from $457 million in 2011 to $1.6 billion in 2030. This Vital Signs report shows that melanoma is responsible for more than 9,000 skin cancer deaths each year. In 2011, more than 65,000 melanoma skin cancers were diagnosed. By 2030, according to the report, effective community skin cancer prevention programs could prevent an estimated 230,000 melanoma skin cancers and save $2.7 billion dollars in treatment costs. Successful programs feature community efforts that combine education, mass media campaigns, and policy changes to increase skin protection for children and adults.
White House Meeting Elicits Pledges to Reduce Antibiotic Use
The Obama administration convened representatives of hospitals, food producers, professional medical societies and restaurant chains on Tuesday and extracted pledges to reduce the use of lifesaving antibiotics, whose effectiveness is waning because of overuse. The meeting at the White House highlighted the problem of antibiotic resistance, a public health crisis that every year kills at least 23,000 of the more than two million Americans who fall ill from infections that are impervious to the drugs.
Triglyceride-Rich-Lipoprotein Cholesterol Predicts CV Events
Triglyceride-rich-lipoprotein (TRL) cholesterol could be "the next target" to lower a person's risk of cardiovascular events, said Dr Kausik Ray (University of London, UK), speaking at the International Symposium on Atherosclerosis. Their research, based on data from the Treating to New Targets (TNT) trial[2], showed that higher levels of TRL cholesterol (which is calculated by subtracting non-HDL cholesterol from LDL cholesterol) were associated with an increased 5-year risk of a major cardiovascular event—coronary heart disease death, nonfatal MI, resuscitated cardiac arrest, or stroke—independent of LDL cholesterol. Moreover, the increased risk of a cardiovascular event with higher levels of TRL cholesterol was significantly reduced with intensive 80-mg/day atorvastatin therapy. Thus, TRL cholesterol "is a great marker of [cardiovascular] risk, [and] we know it's modifiable with higher-intensity statins," Ray summarized. "The fact that we can lower this [marker] and that the percentage lowering predicts outcome suggest it might be a future target beyond LDL cholesterol."
Some Older Breast Cancer Patients May Skip Invasive Biopsy
Older women with early-stage breast cancer might be able to skip a lymph node biopsy without changing their survival odds, a small study suggests. Researchers followed 140 women aged 70 or older who generally had smaller, slow-growing tumors. Even though none of the women got a so-called sentinel node biopsy to see where the tumors might have spread, over the next five years only four of them died of breast cancer. “For women this age with early breast cancer, a biopsy may not affect the treatment or the outcome,” said senior study author Dr. Armando Giuliano, head of surgical oncology at Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles.
South Korean MERS Outbreak Likely to Spread, Health Officials Say
A MERS outbreak in South Korea — the largest outside Saudi Arabia, where the disease first emerged in 2012 — is likely to grow, the World Health Organization said Tuesday. MERS, or Middle East Respiratory Syndrome, has infected at least 25 people in South Korea and killed two, according to the World Health Organization. Doctors have diagnosed five new cases not yet confirmed by the WHO, bringing the total to 30 cases, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who is in contact with South Korean doctors who are treating the patients. South Korean officials have isolated 680 people to limit the spread of the disease, which spreads when sick people cough. There have been at least 1,154 lab-confirmed cases of MERS worldwide since 2012, along with 431 deaths — a mortality rate of 37%.
DARPA Announces Winners for Most Accurate Forecasts of Infectious Mosquito-Spread Virus
Eleven teams won prizes in a Defense Advanced Research Projects Agency competition that challenged them to develop an infectious disease forecasting method for a debilitating disease being spread by mosquitoes. Thirty-eight teams from around the world participated in the competition to develop accurate predictions of the spread of the chikungunya (pronounced chik-en-gun-ye) virus, which is better known as CHIKV, across the Western Hemisphere from September 2014 to March 2015. "Predicting the speed, severity and direction of infectious disease outbreaks is incredibly challenging, in part because it's difficult to determine the relative contributions of multiple factors – such as weather and climate, population density and travel patterns – under various conditions," Col. Matt Hepburn, DARPA program manager for the CHIKV Challenge, said in a May 26 press release. He said the winning teams identified gaps in current forecasting capabilities and created tools to enhance predictions, which could help enable "a revolutionary improvement in disease forecasting, in much the same way that weather reports transitioned from surveillance to forecasting."
Scientists Detail All the Yucky Stuff in Your Eyes Because Of Your Contact Lenses
Scientists believe this may help explain the long-standing problem of why contact lens wearers are more prone to eye infection. The Centers for Disease Control has estimated that Americans make almost 1 million doctor's appointments or ER visits for eye infections.
The researchers said that the microbiome of contact lens wearers more closely resembled that of the skin than of non-wearers' eyes. Contact lens wearers had 5,245 distinct bacterial strains and subtypes. They had three times the usual proportion of four of them:
  • methylobacterium (often found in soil, sewage, and leaf surfaces),
  • lactobacillus (typically considered "friendly" bacteria that live in the digestive and urinary tract and does not cause disease),
  • acinetobacter (found in soil and water and responsible for the great majority of infections),
  • and pseudomonas (widely found in the environment and that can lead to everything from ear infections to more serious issues).

Health IT

What Will EHRs Look Like in 2020?
In an article published online in JAMIA, the Journal of the American Medical Informatics Association, an AMIA task force takes on the thorny issues associated with the use of electronic medical record systems and offers recommendations for improvement. Members of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs are: Thomas H. Payne, Sarah Corley, Theresa A. Cullen, Tejal K. Gandhi, Linda Harrington, Gilad J. Kuperman, John E. Mattison, David P. McCallie, Clement J. McDonald, Paul C. Tang, William M. Tierney, Charlotte Weaver, Charlene R. Weir and Michael H. Zaroukian. The task force outlines five broad goals:
1. Simplify and speed documentation
2. Refocus regulation
3. Increase transparency and streamline certification
4. Foster innovation
5. Support person-centered care delivery
Read the task force's full report in JAMIA.
Medicaid Rule Could Extend Health IT Support to Behavioral Health, Long-term Care
A proposed new CMS rule to govern increasingly popular Medicaid managed-care plans encourages states to fund the purchase of electronic health-record systems for behavioral health, long-term care and other providers previously excluded from federal EHR incentive payments. The draft regulation also promotes health information exchange. The 653-page proposed  rule (PDF) is the first update of Medicaid managed-care regulations since 2003. Managed-care companies that contract with state Medicaid programs would be able to count activities that improve healthcare quality, such as external quality reviews and efforts “related to health information technology and meaningful use," as core services that contribute to their medical loss ratio.
Nevada, Minnesota, Indiana Enact Telehealth Parity Laws
Telemedicine parity laws now are in play in 27 states and the District of Columbia after Indiana, Minnesota and Nevada enacted their own laws this week. Reimbursement for telemedicine services has long been a barrier to use of the technology, however that is changing as more states realize the benefits of the services. Telemedicine is also high on the priority list for many providers this year.
AMA to Vote on Telehealth Guidance
At its annual meeting beginning Sunday, the American Medical Association's policy-making House of Delegates will vote on policy guidance to doctors on issues related to telehealth, according to Forbes. The move comes as insurers such as UnitedHealth Group, Anthem and Aetna expand coverage for virtual doctor visits. The delegates will vote on recommendations advising doctors to:
  • Inform patients about limitations of services provided
  • Advise telehealth users about how to arrange any needed follow-up care
  • Be proficient in telehealth technologies
AMA delegates could also change or table the recommendations
EPA Must Tackle Several Cybersecurity Issues to Deal with Persistent Threats, Watchdog Says
With advanced persistent cyber threats continuing to pose a challenge, the Environmental Protection Agency needs to make some tough choices on where it can spend its limited security budget to make the most impact, according to a recent report by the agency's watchdog. Overall, the EPA faces a wide range of computer security issues, including risk management planning, implementation of security tools, incident response capability and follow-up actions to correct problems, the inspector general said in a May 28 report (pdf) that looked at broad management challenges across the agency.

Other News

CMS Releases New Physician, Hospital Payment Data
Newly released data from the Centers for Medicare & Medicaid Services (CMS) show that Medicare reimbursements to doctors are far from evenly distributed, while hospital charges for top procedures and conditions have increased moderately. The Medicare Part B data tracks 2013 information for more than 950,000 providers who received $90 billion in Medicare payments. CMS' first annual release of provider payments last year indicated Medicare paid individual physicians more than $60 billion in 2012.

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