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The paper focuses on preventing and mitigating drug shortages

Janette Wider

April 2, 2024,

On April 2, the U.S. Department of Health and Human Services (HHS) announced via a press release that it has released a white paper highlighting steps HHS has taken to prevent and mitigate drug shortages and proposing additional solutions for policymakers to consider.

The press release says that “Drug shortages have occurred in the nation’s health care system for several decades, largely due to market failures and misaligned incentives. With today’s white paper, HHS offers solutions and stands ready to work with Congress to ensure no patient faces the devastating consequences of drug shortages or goes without needed medicines.”

Further, “Through the Assistant Secretary for Planning and Evaluation (ASPE), Administration for Strategic Preparedness and Response (ASPR), the Food and Drug Administration (FDA), the Centers for Medicare & Medicaid Services (CMS), and others, HHS has been working to improve how the department monitors the pharmaceutical supply chain and responds to disruptions. HHS has established a new Supply Chain Resilience and Shortage Coordinator role to strengthen implementation of strategies to enhance supply chain resilience for pharmaceuticals and other medical products, and has issued guidance to increase supply chain transparency, while continuing to consider additional long and short-term solutions. FDA discloses certain inspection information to provide the public with an understanding of actions the Agency takes to protect public health and is also developing a quality management maturity framework that may support adoption of manufacturing practices that are more resilient. HHS has also collaborated with other government agencies on this critical issue. For example, last month HHS and the Federal Trade Commission jointly issued a Request for Information to better understand the causes – and potential solutions – of generic drug shortages.”

HHS has also taken steps to increase resilience and redundancy within the market, according to the press release. Additionally, HHS acknowledges that longer-term solutions may require additional input from authorities and resources.

HHS has the press release.

HHS Publishes White Paper on Supply Chain | Healthcare Purchasing News (hpnonline.com)

Molly Gamble February 28th, 2024

Below are the adjusted expenses for nonprofit, for-profit and government hospitals per inpatient day in 2022 in every U.S. state, according to the latest estimates provided by Kaiser State Health Facts. 

The figures are based on information from the 2022 American Hospital Association Annual Survey. They are an estimate of the expenses incurred in a day of inpatient care and have been adjusted higher to reflect an estimate of outpatient service volumes, according to the Kaiser Family Foundation. 

The foundation notes the figures are “only an estimate of expenses incurred by the hospital” for one day of inpatient care and do not substitute actual charges or reimbursement for care provided.

National average 
Nonprofit hospitals: $3,167
For-profit hospitals: $2,383 
State/local government hospitals: $2,857

Alabama
Nonprofit hospitals: $1,984
For-profit hospitals: $1,723
State/local government hospitals: $1,929

Alaska 
Nonprofit hospitals: $2,130
For-profit hospitals: $3,152
State/local government hospitals: $1,905

Arizona
Nonprofit hospitals: $3,430
For-profit hospitals: $2,746
State/local government hospitals: $2,833

Arkansas
Nonprofit hospitals: $2,082
For-profit hospitals: $1,942
State/local government hospitals: $4,263

California
Nonprofit hospitals: $4,719
For-profit hospitals: $2,655
State/local government hospitals: $4,338

Colorado 
Nonprofit hospitals: $3,862
For-profit hospitals: $3,408
State/local government hospitals: $2,528

Connecticut 
Nonprofit hospitals: $3,223
For-profit hospitals: $2,584
State/local government hospitals: $5,234

Delaware
Nonprofit hospitals: $3,399
For-profit hospitals: $1,429
State/local government hospitals: n/a

District of Columbia
Nonprofit hospitals: $4,272
For-profit hospitals: $3,081
State/local government hospitals: n/a

Florida 
Nonprofit hospitals: $3,063
For-profit hospitals: $2,301
State/local government hospitals: $2,884

Georgia 
Nonprofit hospitals: $2,556
For-profit hospitals: $2,312
State/local government hospitals: $814

Hawaii
Nonprofit hospitals: $3,551
For-profit hospitals: n/a
State/local government hospitals: $1,598

Idaho
Nonprofit hospitals: $4,570
For-profit hospitals: $2,944
State/local government hospitals: $2,406

Illinois 
Nonprofit hospitals: $3,168
For-profit hospitals: $2,403
State/local government hospitals: $3,862

Indiana
Nonprofit hospitals: $3,327
For-profit hospitals: $2,865
State/local government hospitals: $2,686

Iowa
Nonprofit hospitals: $1,847
For-profit hospitals: $1,596
State/local government hospitals: $1,942

Kansas
Nonprofit hospitals: $2,287
For-profit hospitals: $2,551
State/local government hospitals: $2,314

Kentucky
Nonprofit hospitals: $2,485
For-profit hospitals: $2,637
State/local government hospitals: $3,484

Louisiana
Nonprofit hospitals: $2,788
For-profit hospitals: $2,336
State/local government hospitals: $2,345

Maine
Nonprofit hospitals: $2,944
For-profit hospitals: $1,154
State/local government hospitals: $1,082

Maryland
Nonprofit hospitals: $3,617
For-profit hospitals: $1,734
State/local government hospitals: n/a

Massachusetts
Nonprofit hospitals: $3,670
For-profit hospitals: $2,559
State/local government hospitals: $2,545

Michigan
Nonprofit hospitals: $2,546
For-profit hospitals: $2,449
State/local government hospitals: $893

Minnesota 
Nonprofit hospitals: $2,813
For-profit hospitals: n/a
State/local government hospitals: $2,273

Mississippi
Nonprofit hospitals: $1,615
For-profit hospitals: $1,753
State/local government hospitals: $1,229

Missouri
Nonprofit hospitals: $2,864
For-profit hospitals: $2298
State/local government hospitals: $2,379

Montana
Nonprofit hospitals: $2,192
For-profit hospitals: $2,708
State/local government hospitals: $750

Nebraska 
Nonprofit hospitals: $2,832
For-profit hospitals: $4,769
State/local government hospitals: $1,765

Nevada 
Nonprofit hospitals: $2,771
For-profit hospitals: $2,127
State/local government hospitals: $2,972

New Hampshire
Nonprofit hospitals: $3,030
For-profit hospitals: $2,720
State/local government hospitals: n/a

New Jersey
Nonprofit hospitals: $3,415
For-profit hospitals: $2,361
State/local government hospitals: $2,451

New Mexico 
Nonprofit hospitals: $2,973
For-profit hospitals: $2,686
State/local government hospitals: $3,710

New York 
Nonprofit hospitals: $3,721
For-profit hospitals: n/a
State/local government hospitals: $3,675

North Carolina 
Nonprofit hospitals: $2,810
For-profit hospitals: $2,391
State/local government hospitals: $2,411

North Dakota
Nonprofit hospitals: $2,308
For-profit hospitals: $4,196
State/local government hospitals: n/a

Ohio
Nonprofit hospitals: $3,402
For-profit hospitals: $2,447
State/local government hospitals: $3,761

Oklahoma
Nonprofit hospitals: $2,450
For-profit hospitals: $2,580
State/local government hospitals: $1,964

Oregon
Nonprofit hospitals: $3,827
For-profit hospitals: $3,368
State/local government hospitals: $5,155

Pennsylvania 
Nonprofit hospitals: $3,045
For-profit hospitals: $2,251
State/local government hospitals: $1,609

Rhode Island 
Nonprofit hospitals: $3,102
For-profit hospitals: n/a
State/local government hospitals: n/a

South Carolina 
Nonprofit hospitals: $2,430
For-profit hospitals: $1,874
State/local government hospitals: $2,598

South Dakota 
Nonprofit hospitals: $1,673
For-profit hospitals: $4,275
State/local government hospitals: $780

Tennessee
Nonprofit hospitals: $2,960
For-profit hospitals: $2,133
State/local government hospitals: $2,019

Texas
Nonprofit hospitals: $3,291
For-profit hospitals: $2,325
State/local government hospitals: $3,768

Utah
Nonprofit hospitals: $3,550
For-profit hospitals: $3,232
State/local government hospitals: $3,542

Vermont
Nonprofit hospitals: $3,079
For-profit hospitals: n/a
State/local government hospitals: n/a

Virginia
Nonprofit hospitals: $2,813
For-profit hospitals: $2,194
State/local government hospitals: $4,208

Washington
Nonprofit hospitals: $3,753
For-profit hospitals: $3,696
State/local government hospitals: $4,079

West Virginia
Nonprofit hospitals: $2,447
For-profit hospitals: $1,206
State/local government hospitals: $1,500

Wisconsin 
Nonprofit hospitals: $2,796
For-profit hospitals: $3,055
State/local government hospitals: $3,641

Wyoming 
Nonprofit hospitals: $3,092
For-profit hospitals: $3,133
State/local government hospitals: $1,485

Hospital expenses per inpatient day across 50 states (beckershospitalreview.com)

Naomi Diaz 

Seventy-one percent of healthcare executives say that implementing new technology has not lowered overall hospital expenses, a Feb. 9 survey from Ernst & Young found. 

The survey interviewed 101 U.S.-based healthcare executives and payers between Sept. 26 and Oct. 6 about their digital investments and how they are affecting their bottom lines and found that:

• Ninety-six percent believe that investment in technology is worth it.
  
• Ninety percent said after they shifted administrative responsibilities to a digital system, their organizations were able to focus more on the needs of their providers.
  
• Seven out of 10 respondents in the survey said they have yet to see return on investment with their digital investments.
  
• Fifty percent of respondents said they may not be seeing a return on investment due to “siloed tracking metrics.”

Tech isn’t lowering hospital expenses: Survey (beckershospitalreview.com)

Giles Bruce – Tuesday, January 23rd, 2024

Hackers have been impersonating hospital revenue cycle workers and tricking IT staff into giving them log-in credentials to steal money from the health systems, the American Hospital Association warned.

As part of the so-called “social engineering scheme,” presumably foreign-based cybercriminals steal the identities of revenue cycle employees or other finance staffers, calling IT help desks and correctly answering security questions, the AHA reported Jan. 12. They then request to reset their passwords and enroll new devices, getting full access to the employees’ accounts and diverting payments to fraudulent bank accounts.

“This scheme once again demonstrates how our cyber adversaries are quickly evolving their tactics to defeat technological cyber defenses through social engineering schemes,” said John Riggi, AHA’s national advisor for cybersecurity and risk, in the article.

Mr. Riggi recommends at minimum calling back the employee requesting a new password or device at their number on record, and also contacting their supervisor. One large health system now requires that employees make these types of IT requests in person. Healthcare organizations that lose money in a scheme like this should contact their financial institution and the FBI’s Internet Crime Complaint Center, or IC3.

Andrew Cass

Hospitals’ median operating margin was 2% through November, up from 1.5% in October, according to Kaufman Hall’s “National Hospital Flash Report,” released Jan. 9. 

Kaufman Hall said hospital performance in November signals “continued stabilization and growth.” The firm’s report is based on data from more than 1,300 hospitals. 

“Operating margins improved compared to the previous month and last year, and other data points indicate movement towards recovery, though the gap between high and low performers remains quite wide,” Kaufman Hall said in the report. 

Inpatient and outpatient revenue increased by 5% and 9%, respectively, year over year, according to a Jan. 9 Kaufman Hall news release shared with Becker’s. Total expense per adjusted discharge declined, while revenue per adjusted discharge increased, which the firm said is “a sign of financial recovery.”

“This reflects the efforts organizations have taken to deliver care in the most effective settings and reduce reliance on contract labor where possible,” the report said. 

“As performance indicators stabilize, hospitals should take advantage of the relative stability and re-embrace strategic growth if they hope to see continued success in 2024,” Erik Swanson,  Kaufman Hall’s senior vice president of data and analytics, said in the release. “Growth strategies may vary from hospital to hospital, but all leaders should ensure that they are supporting goals beyond just profitability and scale, including business model transformation and diversification.”

Hospital performance points toward recovery: Kaufman Hall (beckershospitalreview.com)

12/11/2023

New Thermo Scientific KingFisher Apex Dx system and Applied Biosystems MagMAX Dx Isolation Kit improve preanalytical workflows for clinical laboratories.

CARLSBAD, Calif.–(BUSINESS WIRE)– Thermo Fisher Scientific Inc., the world leader in serving science, today announced the launch of the Thermo Scientific™ KingFisher™ Apex™ Dx, an automated nucleic acid purification instrument, and Applied Biosystems™ MagMAX™ Dx Viral/Pathogen NA Isolation Kit for the isolation and purification of viral and bacterial pathogens from respiratory biological specimens. Together these products provide laboratories with an in vitro diagnostic (IVD) and in vitro diagnostic regulation (IVD-R) approved automated sample preparation solutions for increased confidence in downstream results.

Clinical laboratories that perform respiratory testing need to generate the highest quality results. To meet their needs, the high-throughput, versatile KingFisher Apex Dx system enables scientists’ labs to recover quality nucleic acids for sensitive downstream applications with maximum consistency, reproducibility, and reliability. The system is designed to be a part of a modular sample preparation to real-time PCR analysis workflow* providing precise results, accurate data management, and robust security features that meet cybersecurity and diagnostic regulatory standards. Additionally, the MagMAX Dx Viral/Pathogen NA Isolation kit offers advanced formulation to ensure reproducible results and is automation compatible with the KingFisher Apex Dx.

“The KingFisher Apex Dx system builds on decades of product expertise and innovation customers have come to trust in our KingFisher instrument line,” said Ellie Mahjubi, vice president and general manager, sample preparation at Thermo Fisher Scientific. “The combination of the Apex Dx system and the MagMAX Dx Viral/Pathogen NA Isolation Kit further simplifies sample preparation for clinical labs so they can have confidence in downstream results when testing for respiratory diseases.”

The KingFisher Apex Dx system automates the extraction of up to 24 or 96 DNA, RNA, protein, or cell samples and transitions from clinical research to diagnostics by offering research use only (RUO) and IVD software modes. It can be integrated with a Laboratory Information Management System (LIMS) or Laboratory Information System (LIS) via Diomni Enterprise Software for enhanced data management and workflow optimization.

The MagMAX Dx Viral/Pathogen NA Isolation Kit offers a new advanced formulation to maximize nucleic acid yield from routinely tested respiratory pathogens such as S. aureus, M. tuberculosis, influenza, RSV, and SARS-CoV-2. This kit also helps laboratories meet greener policies with REACH-compliant components and responsibly sourced packaging.

For more information including technical specifications, applications, and consumables, please visit www.thermofisher.com/kingfisherapex and MagMAX Dx Viral/Pathogen Nucleic Acid Isolation Kit. The MagMAX Dx Viral/Pathogen NA Isolation Kit is currently available in North America and coming soon to other regions.

*Enable in Diomni Integrated mode with QuantStudio 5 and 7 Pro Dx Instruments

For In Vitro Diagnostic Use. Regulatory requirements vary by country. Product may not be available in your geographic region.

Thermo Fisher Scientific Introduces New Sample Preparation Solutions to Simplify and Automate Respiratory Diagnostic Testing | Newsroom | Thermo Fisher Scientific

Laura Dyrda and Naomi Diaz 

Hospitals in at least four states across across the South and Midwest experienced disruptions Nov. 24 due to potential cybersecurity incidents, although there is no evidence officially linking the incidences.

On Thanksgiving Day, UT Health East Texas in Tyler told CNN its hospitals reverted to downtime procedures after a security incident forced computer systems offline. The 10-hospital system locked down its network after network outage, according to the report. During the downtime, the hospital diverted ambulances to other ERs.

BSA Health System in Amarillo, Texas, also reported an outage and diverted ambulances after a “potential security incident,” according to a report from ABC affiliate KVII. A hospital spokesperson told the news outlet BSA experienced the outage Nov. 24 and reverted to paper records.

The University of Kansas Health System St. Francis Campus in Topeka also went on ER diversion after a network outage Nov. 24. The health system noted a “potential security incident” led to the outage and the hospital practiced standard downtime protocols, according to news station WIBW.

Tulsa, Okla.-based Hillcrest HealthCare System discovered a potential security incident Nov. 24 as well and told the Tulsa World the issue affected access to patient charts. The health system diverted some ER patients as a precaution but told the publication patient care has not been negatively affected.

Vanderbilt University Medical Center in Nashville, Tenn., identified a cybersecurity incident Nov. 24 that compromised a database, according to The Record. The health system said the database did not contain personal or protected information. Ransomware gang Meow added VUMC to its “leak site,” indicating information was leaked on the dark web.

Lovelace Health System in Albuquerque, N.M., is experiencing a network outage that is affecting its emergency care and told KOAT Action News that local EMS are rerouting patients requiring emergency care to alternative facilities. The health system also said it is in the process of rescheduling certain non-urgent elective surgeries while it works to restore its systems.

Multiple hospitals report IT disruptions on Thanksgiving (beckershospitalreview.com)

Giles Bruce

Amazon Prime members can now get healthcare for an extra $9 a month.

The tech giant launched One Medical for Prime on Nov. 8, hoping to capitalize on its nearly $4 billion acquisition of the membership-based primary care company earlier this year.

The new service offers One Medical subscriptions to Prime members at a discounted rate, giving them unlimited 24/7 virtual visits and online scheduling for same- or next-day appointments at One Medical’s more than 200 brick-and-mortar clinics.

“When it is easier for people to get the care they need, they engage more in their health, and realize better health outcomes,” said Neil Lindsay, senior vice president of Amazon Health, in a Nov. 8 blog post. “That’s why we are bringing One Medical’s exceptional experience to Prime members — it’s healthcare that makes it dramatically easier to get and stay healthy.”

The new service marks the tech giant’s latest entry into healthcare following this year’s nationwide rollout of the Amazon Clinic telehealth platform and introduction of RxPass, which offers generic prescriptions to Prime members for $5 a month.

The move also shows Amazon’s willingness to integrate its new healthcare offerings into its existing services. Amazon Prime’s estimated 200 million members already pay $14.99 a month (or $139 annually) for free, speedy deliveries of everything from toothpaste to pillowcases — now they can add healthcare for an extra $9 monthly (or $99 for the whole year). The One Medical memberships typically run $199 per year.

“This new benefit is the latest example of how we’re making it easier for Prime members to take care of their health,” said Jamil Ghani, vice president of Amazon Prime, in the blog post.

One Medical for Prime members can access the on-demand virtual visits at no extra cost through the One Medical app, including messaging-based care for common conditions such as seasonal allergies or cold sores (via the Treat Me Now feature), or urgent video chats for issues like minor injuries or high fevers.

The virtual visits are staffed by One Medical primary care providers, of which the company has “thousands,” a spokesperson told Becker’s. In-person and scheduled remote appointments are not included in the membership and are billed to insurance or the patient via self-pay.

Like other healthcare disruptors, One Medical also continues to grow its hospital partnerships. The concierge primary care company has specialty care referral agreements with health systems in its nearly 20 local markets.

Amazon launches One Medical for Prime (beckershospitalreview.com)

Paige Twenter

Since mid-September, drugmakers have reported five new drug shortages, including medications for lung cancer, hypertension and eye infections. 

The scope of cancer drug shortages has slightly eased since spring, but with the latest addition, at least 15 chemotherapies are currently in short supply. 

Here are drug shortages recently reported by the FDA and the American Society of Health-System Pharmacists.

Editor’s note: The drugs are listed in alphabetical order. 

1. Betaxolol tablets: After KVK-Tech recalled one lot of betaxolol tablets because one oxycodone pill was found on the packaging line after a batch was packaged, the drugmaker is reporting a shortage of 10 milligram and 20 milligram tablets. The therapy is used to treat hypertension. KVK-Tech could not predict a resupply date for the former solutions but said the latter should be available in normal levels in early October.

2. Nitroglycerin injectable: American Regent and Baxter Healthcare have four solutions in shortage because of high demand for the hypertension drug. American Regent said it expects the supply issue of 5 milligram per 1 milliliter to resolve in January, and Baxter has 10, 20 and 40 milligram per 1 milliliter solutions on allocation until late November. 

3. Sulfacetamide sodium and prednisolone sodium phosphate ophthalmic solution: Bausch Health, the only supplier of this eye drop used to treat infections and swelling, has 10% per 0.23% ophthalmic solution in 5 milliliter bottles on back order without a release date. 

4. Topotecan capsules: The small cell lung cancer treatment is in short supply as Sandoz put its 0.25 milligram and 1 milligram solutions on back order. The company said supply levels should rebound in November. No other presentations are available. 

5. Trimethobenzamide injection: Par Pharmaceuticals, the sole supplier of this anti-nausea medicine, has its 100 milligram per milliliter, 2 milliliter vials on back order because of high demand. The drugmaker said it will release supply as it becomes available.

5 drugs now in shortage (beckershospitalreview.com)

Molly Gamble

Hospital margins are moving in the right direction, as the median year-to-date operating margin improved in August to 1.1 percent, according to Kaufman Hall.

August’s median of 1.1 percent marked an upswing from the 0.9 percent median margin recorded in July, according to Kaufman Hall’s latest “National Hospital Flash Report” — based on data from more than 1,300 hospitals.

Increased revenue offset hospitals’ increased supply and drug expenses in August. Decreased reliance on contract labor helped labor expenses decline on a volume-adjusted basis, while average lengths of stay also fell, by 4 percent month over month.

Although hospital margins sit below historical levels, 2023 has brought less variance as positive margins are becoming more frequent. This nonlinear recovery follows hospitals’ worst financial year since the COVID-19 pandemic. Erik Swanson, senior vice president of data and analytics with Kaufman Hall, said it is important for hospitals to look ahead in the current moment. 

“This period of relative stabilization is the time for hospitals to re-engage in capital planning efforts,” Mr. Swanson said. “Hospitals may be feeling reluctant given the last few years, but those that wait may find themselves falling behind their competitors and missing out on key opportunities.”

Hospital margins inch up to 1.1% in August (beckershospitalreview.com)