Pharmaceutical waste: Turning hazard into opportunity


Pharmaceutical waste management is one of the most complex sustainability issues. People and ecosystems are increasingly subjected to medication exposure through the manufacture and disposal of medication. The emergence of drug-resistant “superbugs” in patients and the impact of endocrine disruptors on humans and wildlife are issues of deep concern.

What do regulations say, and how can healthcare sustainability leaders prevent waste from being generated while improving environmental impact through new practices, staff education and the pursuit of more healthful options?

In 2008, the Associated Press reported that 250 million pounds of medication waste were generated each year in the United States. It is safe to assume this number has been growing ever since, as more Americans consume more prescription drugs every year, much of which goes down the drain.

The U.S. GeologicalSurvey reported that sewage sludge used as fertilizer on farms can leave traces of prescription drugs and household chemicals deep in the soil. Furthermore, persistent pharmaceuticals in the environment are not removed in wastewater treatment plants, and can be found in drinking water. Numerous studies and reports detail the feminization of fish, where they have both testes and eggs. And this month, a study in Science Daily showed that many endocrine-disrupting chemicals interfere with human sperm function.

Despite existing Drug Enforcement Administration and Environmental Protection Agency regulations, proper management of pharmaceutical waste remains on the to-do list for many hospitals. Top compliance barriers are staff training challenges, complexity of regulations, lack of storage space, lack of in-house expertise and unclear regulations for “controlled” addictive substances, according to the latest annual survey by Pharmacy Purchasing and Products.

Read more here.

AHA and others continue challenge of the two-midnight rule

From EHRIntelligence:

Several healthcare organizations have redoubled their efforts to challenge the Department of Health & Human Services (HHS) over its implementation and enforcement of the two-midnight rule, according to a summary judgment filed in United States District Court. The plaintiffs comprise the same healthcare organizations that brought a lawsuit against HHS last month.

The Centers for Medicare & Medicaid Services (“CMS”) has slashed Medicare payments to hospitals across the board by 0.2 percent, and it has done so without any basis in law,” state court documents. “A 0.2 percent cut may sound small, but it is not — it will deprive the nation’s hospitals of more than $200 million, by CMS’s own estimation. The payment cut should be vacated as arbitrary, capricious, and otherwise unlawful.”
Last month’s complaint called into question the decision to withhold reimbursement for admissions of less than three days based upon a new definition of inpatient as well as two other policies related to reimbursement conditions for inpatient services.
Now, the same group of plaintiffs is seeking to expedite the process by urging the federal court to grant an immediate ruling in their favor.
The request for summary judgment argues that CMS is placing burdens on hospitals in an attempt to drive down the more expensive costs associated with inpatient care by redefining a key term:
That new definition makes it more difficult to categorize patients as “inpatients.” And since Medicare generally pays more for hospitals to treat inpatients as opposed to outpatients, the logical result should be that the new policy drives Medicare payments to hospitals down. Yet, in the same rulemaking in which it adopted the new definition of inpatient, CMS somehow concluded that the new definition will drive Medicare payments to hospitals up.
In contesting the 0.2-percent reduction in reimbursement rates, the plaintiffs have put forward three arguments challenging the validity of the payment cut.
Read more here.

Behind the white coats: Looking at the lifestyles of today’s physicians

From Multibrief:

When we visit our physicians, we usually don’t think about the commitment they made to be able to treat us — four years of medical school, three to seven years of residency, another few years of fellowship. Most likely, physicians have spent seven to 10 years of their lives preparing to practice medicine.

But that across-the-board time commitment doesn’t make all physicians the same. In fact, a national survey of 125,000 practicing physicians revealed intriguing differences from finances and career plans to personal lifestyles.

Here are some of the relevant findings by the AMA Insurance survey:

  • Gender gap: There is no gender gap in the under-age-40 physician world.
  • Work hours: 20 percent of female physicians under 40 with children at home work less than 40 hours per week.
  • Retirement savings: Asked about more retirement savings, physicians under age 40 (65 percent) said they would like to have $200,000-$500,000 more in savings at this point in their life; physicians over age 60 would like to have $1 million-plus more. Males in all age groups were more likely to want $1 million-plus in incremental savings than female physicians.
  • Social media: Female physicians are more likely to use Facebook than males. Male physicians, especially under age 40, are more likely to use LinkedIn than female counterparts.

The key findings of this survey revealed that there is no single profile for U.S. physicians when it comes to lifestyle but rather distinct profiles related to different age groups.

Read more here.

No Long-Term Benefit of Adrenaline in Cardiac Arrest

From Consultant360:

Administering adrenaline to patients after they suffer cardiac arrest outside of a hospital does not increase their chances of long-term survival, according to a new study.

Recommended practices dictate that most patients who suffer cardiac arrest receive adrenaline, yet, even with the drug, long-term survival rates are low – as many as 90% of people who experience cardiac arrest outside of a hospital die, even with adrenaline.

In order to further explore the efficacy of adrenaline in these patients, researchers at St. Michael’s Hospital in Toronto, Canada, looked at data from 14 randomized, controlled trials evaluating adrenaline vs placebo and vasopressin in adults with cardiac arrest.

Standard dose adrenaline (SDA) showed improved return of spontaneous circulation (ROSC) (RR 2.80, 95%CI 1.78–4.41, p < 0.001) and survival to admission (RR 1.95, 95%CI 1.34–2.84, p < 0.001) compared to placebo. SDA showed decreased ROSC (RR 0.85, 95%CI 0.75–0.97, p = 0.02; I2 = 48%) and survival to admission (RR 0.87, 95%CI 0.76–1.00, p = 0.049; I2 = 34%) compared to high dose andrenaline.

However, there was no benefit seen with adrenaline to either neurological outcomes or survival to discharge.

“It is thought that the short-term benefit of adrenaline in improving coronary blood flow may occur at the expense of other organs,” researchers wrote in an accompanying press release. “The drug can cause small blood vessels in other organs to contract, such as in the gut, liver, and kidneys, thus limiting the blood flow to these organs.”

The recommended that rather than administer adrenaline, paramedics instead focus on the use of CPR and defibrillators in patients with cardiac arrest.

Georgia Looks To Reopen Some Closed Rural Hospitals As E.R.s

From KaiserHealthNews:

With 25 beds, Charlton Memorial, like many rural hospitals, struggled to cope with a lack of high-tech specialty care, a big drop in local funding and populations that were getting older and poorer.

From his office in a trailer behind the hospital, Gowen can see the locked building that was once the second-largest employer in town.

“Ever since we closed, we’ve maintained hope that we’re going to open back up,” he says. “We’ve not sold any of our equipment, everything is ready.”

The state of Georgia just threw him a lifeline, offering a new kind of license to allow struggling hospitals and those that have closed in the past year to become rural freestanding emergency departments.

“The intent here is to have some kind of health care infrastructure in a community, as opposed to nothing at all,” says Clyde Reese, who runs the Georgia Department of Community Health.

He doesn’t know of another state that’s tried this approach. The new emergency departments would handle run-of-the-mill urgent care, such as broken bones. But they would also stabilize patients for transfer to larger hospitals that are better equipped and staffed.

Reese doesn’t know how the free-standing ER would be funded. Medicaid and Medicare could pay for some of the services, but at reduced, non-hospital rates. “This is a first step of not just looking at hospitals, but at health care in general in our rural areas,” he says.

VA investigation reveals larger primary care shortage


Last week, an investigative report revealed that 1,700 veterans who wanted to see a doctor at a Phoenix Veterans Affairs hospital were missing from an official waiting list, mirroring a tactic used at two dozen other facilities across the country to mask long waits for medical care.

A few hundred other people are missing from the Veterans Affairs system, too: doctors.

The Veterans Affairs Department is 400 doctors short, The New York Times reports. But the doctor deficit is not limited to the VA—it’s a nationwide problem.

America is running out of doctors. The country will be 91,500 physicians short of what it needs to treat patients by 2020, according to the Association of American Medical Colleges. By 2025, it will be short 130,600.

Like at the Veterans Affairs Department, demand will be highest for primary-care physicians, the kinds of doctors many people go to first before they are referred to specialists.

While students are applying to and enrolling in medical schools in record numbers, high interest does not necessarily mean more doctors. The number of residences—crucial stages of medical training—has not risen with the number of applicants, thanks to a government-imposed cap. The Association of American Medical Colleges has pushed Congress to change the law, predicting that there won’t be enough residencies for young doctors by next year.