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Teaching Hospital Update - October 12-16, 2009


Email Alert

By Leah Voigt Romano*

October 16, 2009

Senate Finance Bill Contains Provisions Affecting Nonprofit Hospitals

The Senate Finance Committee approved legislation this week that contains four new provisions that aim to ensure that tax-exempt hospitals fulfill their charitable mission and maintain tax-exempt status. In addition, the legislation would create three new nonprofit entities that would provide an alternative to government-run insurance and help jump-start healthcare cooperatives as competitors to private insurers. Under a nonprofit cooperative proposal included in the legislation, $6 billion in federal grants and loans would be provided to create what would amount to nonprofit insurance companies such as the Group Health Cooperative in Seattle and Kaiser Permanente.

A new tax code section establishing standards for nonprofit hospitals is the likely outcome of the legislation, Senate Finance Committee aides said. The legislation would require that each nonprofit hospital conduct a community-needs assessment, charge patients who qualify for financial assistance no more than the rates paid by the hospital's highest paying insurance company or other payors, forgo aggressive collection practices before attempting to determine if the patient qualifies for financial assistance, and establish a written financial assistance policy.

While the Senate Finance panel's language on nonprofit hospitals remained intact this week, aides noted that the whole bill could be gutted or significantly changed as it is merged with four other healthcare bills in both the Senate and House.

Diane Freda, Senate Finance Bill Contains Provisions Affecting Nonprofit Hospitals, AHLA Told, BNA'S HEALTH L. REP. (Oct. 15, 2009) (note: registration is required to view this content).

Study Shows Texting May Help Young Transplant Recipients

According to a small study, text-message reminders appear to be effective in getting young liver transplant patients to take their immunosuppressive medications.

In forty-one patients with a median age of fifteen, there was a significant improvement in medication compliance after a year of receiving the reminders, researchers reported online in Pediatrics. This was accompanied by a drop in the number of histologically proven acute cellular rejection episodes, from twelve in the year before the study to two after one year of receiving the reminders.

"The results of this pilot study are encouraging," the researchers said. "However, larger, randomized controlled studies are needed to establish the efficacy of text messaging in improving medication adherence." Non-adherence with immunosuppressive medications, which increases morbidity and mortality after transplant, is more common in younger patients, they said.

Noncompliance has been noted in up to 40% of adolescent transplant recipients. The most common reason cited for not taking the drugs is forgetfulness. Because texting is so popular among the young and similar reminders have improved hemoglobin A1c levels in pediatric patients with type 1 diabetes, researchers designed this pilot study to see whether text messages could be used to improve compliance in liver transplant recipients.

The researchers set up a system that automatically sent text-message reminders to either the patient or the caregiver at scheduled times after a healthcare worker logged on. The medication was considered administered when the patient or caregiver replied to the text message. If no response was received after a certain period of time, another text message was sent to the caregiver.

T. Miloh et al., Improved Adherence and Outcomes for Pediatric Liver Transplant Recipients by Using Text Messaging, PEDIATRICS (2009).

Todd Neale, Texting May Help Young Transplant Recipients, MedPage Today (Oct. 12, 2009).

Scientists Question Results of Recent HIV Vaccine Trial

This week, The Wall Street Journal (WSJ) reported that weeks after clinical trial results showed an experimental HIV vaccine offered some potential protection against the virus, a second study suggests the results may have been a fluke. "The second analysis, which is considered a vital component of any vaccine study, shows the results weren't statistically significant, these scientists said," suggesting that the "results could have been due to chance and that the vaccine may not be effective."

The data from the second analysis "were available to the researchers in late September when they announced the trial results, but they chose not to disclose them, said Jerome Kim, a scientist with the U.S. Army who was involved in the study. The incomplete disclosure raises the question of whether the Army, the Thai government, and the U.S. National Institutes of Health--which helped fund the study--rushed to give a positive spin to what may turn out to be another inconclusive AIDS-vaccine effort," the WSJ writes.

According to The New York Times, "The debate is over which participants in the study should be counted - all 16,395 Thais who participated at some point or only the ones who got all the doses of the vaccine and stayed in the study for the full time." Typically when drug or vaccine trials are announced, both sets of statistics are included in the analysis.

Kaiser Daily Health Policy Report, Some Scientists Question Results of Recent HIV Vaccine Clinical Trial, Henry J. Kaiser Fam. Fdn. (Oct. 12, 2009).

Working Overnight Not Tied to Complications?

Researchers studying the connection between sleep and attending physicians' performance could not find that their work hours were associated with a significant increase in complication rates.

Daytime surgical and obstetrics procedures performed in one academic medical center had similar rates of complications, whether or not they were done the day after an attending physician had worked overnight, according to the study. However, there was an increased rate of complications among surgical procedures performed by doctors who had less than six hours to sleep between day and night shifts. Researchers studied procedures performed from January 1999 through June 2008. The study compares 919 surgical and 957 obstetrical cases done by doctors who had worked overnight to 3,552 surgical and 3,945 obstetrical cases those same physicians performed without having worked the night before. Results will be published in the October 14, 2009, issue of the Journal of the American Medical Association.

While resident physicians' fatigue and work hours have been under scrutiny, less attention has been paid to attending doctors and the possible effect of sleep deprivation on their work, the researchers said in their study. They suggested that while healthcare providers can do more to monitor fatigue levels, restricting the work hours of attending physicians might "lead to disruptions in care continuity or delays."

Jean DerGurahian, Working Overnight Not Tied to Complications: Study, Modern Healthcare's Daily Dose (Oct. 13, 2009) (note: registration is required to view this content).

Required Flu Vaccines for New York Health Workers Draws Criticism

The New York Civil Liberties Union (NYCLU) is criticizing a regulation that requires hundreds of thousands of state health workers to get both seasonal and swine flu vaccinations. Critics say it violates the workers' right to decide their own medical treatment. The New York Times reports that the executive director of the NYCLU, who testified before several State Assembly committees, "stopped short of saying that the civil liberties union would sue over the requirement, which was adopted by the state's Health Department as an emergency regulation in August. State health officials said Tuesday that the regulation affected 500,000 health care workers and volunteers statewide."

A state judge is expected to rule shortly on the issue in a lawsuit filed by a nurse in Poughkeepsie who contends "that the regulation is arbitrary and capricious because no other state is ordering mandatory vaccination despite concern about the H1N1 pandemic." Some legislators have also raised questions about the state regulation.

The Associated Press reports that nearly half of the adults hospitalized for swine flu are otherwise healthy: "Health officials released the surprising results at a news conference on Tuesday, noting that forty-six percent of 1,400 hospitalized adults did not have a chronic underlying condition. They have said before that the majority of swine flu patients who develop severe illness have some sort of pre-existing condition, but the new data suggest the majority may be slimmer than was previously thought. A study of 272 hospitalized swine flu patients, released by the New England Journal of Medicine earlier this month, concluded that eighty-three percent of adults and sixty percent of children had underlying conditions. However, health officials cautioned that the new analysis is preliminary and did not count obesity as an underlying condition."

Kaiser Daily Health Policy Report, Required Flu Vaccines for New York Health Workers Draws Criticism, Henry J. Kaiser Fam. Fdn. (Oct. 14, 2009).

*We would like to thank Leah Voigt Romano, Esquire (Hall Render Killian Heath & Lyman PLLC, Troy, MI), for providing this week's update.

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.

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