DAOHN Gov't Affairs Jan 15

DAOHN Update Govt Affairs
CDC Investigating 43-State Salmonella Outbreak
Changes to NIOSH-Approved Spirometry Training Program Begin 2009
FMLA Final Regulations Become Effective January 16, 2009
Michigan Draft Ergonomics Standard Under Fire from Business Groups

CDC Investigating 43-State Salmonella Outbreak
The Centers for Disease Control and Prevention (CDC) is collaborating with public health officials in many states and the U.S. Food and Drug Administration (FDA) to investigate a multi-state outbreak of human infections due to Salmonella serotype Typhimurium.
Preliminary analysis of an epidemiologic study conducted by CDC and public health officials in multiple states comparing foods eaten by ill and well persons has suggested peanut butter as a likely source. To date, no association has been found with common brand names of peanut butter sold in grocery stores.
The Minnesota Department of Agriculture Laboratory isolated the outbreak strains of Salmonella Typhimurium from an open 5-pound container of King Nut brand creamy peanut butter. The product is distributed in Minnesota to establishments such as long-term care facilities, hospitals, schools, universities, restaurants, delis, cafeterias, and bakeries. It is not sold directly to consumers and is not known to be distributed for retail sale in grocery stores.

Updates on the outbreak and investigation can be found at http://www.cdc.gov/salmonella/typhimurium/.
Changes to NIOSH-Approved Spirometry Training Program Begin 2009

Two important program changes to the National Institute of Occupational Safety and Health (NIOSH) Spirometry Training Program will take effect January 1, 2009.

First, a time limitation will be placed on the certificates awarded to students who successfully complete NIOSH-approved spirometry training. Second, NIOSH will begin reviewing and approving dedicated spirometry refresher training courses designed for technicians who have previously completed a NIOSH-approved spirometry course and are seeking recertification.

For additional information contact Lu-Ann Beeckman-Wagner at lbb3@cdc.gov.

Visit the NIOSH Spirometry Training Course Web page at http://www.cdc.gov/niosh/topics/spirometry/.

FMLA Final Regulations Become Effective January 16, 2009

The Final Regulations of the Family and Medical Leave Act (FMLA) were crafted from over 4,600 public comments and implement two important new military family leave entitlements for eligible specified family members.
The Final Regulations (PDF) implement:
1. Up to 12 weeks of leave for certain qualifying exigencies arising out of a covered military member's active duty status, or notification of an impending call or order to active duty status, in support of a contingency operation, and
2. Up to 26 weeks of leave in a single 12-month period to care for a covered service member recovering from a serious injury or illness incurred in the line of duty on active duty. Eligible employees are entitled to a combined total of up to 26 weeks of all types of FMLA leave during the single 12-month period.
For more information, including links to the entire Rule (200+ page PDF) and a summary fact sheet (4 page PDF) visit http://www.dol.gov/esa/whd/fmla/finalrule.htm.
NIOSH Guide Available for Improving Worker Health and Well-being
The National Institute of Occupational Safety and Health has a guide for employers and employer-employee partnerships wishing to establish effective workplace programs that sustain and improve worker health.

The guide, Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Well-being, is a key part of the NIOSH WorkLife Initiative, which is intended to identify and support comprehensive approaches to reduce workplace hazards and promote worker health and well-being. Essential Elements document identifies twenty components of a comprehensive work-based health protection and health promotion program and includes both guiding principles and practical direction for organizations seeking to develop effective workplace programs.

The guide is available at http://www.cdc.gov/niosh/worklife/essentials.html.
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E-Prescribing Initiative on Medicare Calendar for 2009

The Centers for Medicare & Medicaid Services (CMS) has announced that physicians and other eligible professionals who adopt and use qualified electronic prescribing (e-prescribing) systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009.

The initiative is included in the Medicare Physician Fee Schedule (MPFS) final rule for calendar year 2009. This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI), and both incentive payments are in addition to the 1.1 percent fee schedule update required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Thus, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009.

Widespread adoption of electronic prescribing can eliminate medication errors that result from the misreading of handwritten prescriptions. Medicare beneficiaries may also have reduced out-of-pocket costs as e-prescribing facilitates communication between prescribers and pharmacies on lower-cost generic alternatives.

Find out more about the CMS initiative at
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3330&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.

Michigan Draft Ergonomics Standard Under Fire from Business Groups
Michigan’s business and manufacturing groups want to halt efforts to adopt a mandatory workplace ergonomics standard in the state. They have fought hard against the standard from the start, and the worsening economic crisis has given them a new weapon. Calling on Gov. Jennifer Granholm to kill the process, they argue the standard is unnecessary and a job killer. A key vote is due this week.

Commissions set up by state regulators are scheduled to take a preliminary—but key—vote on potential rules this week.

The Michigan Occupational Safety and Health Administration (MIOSHA) released a new draft of the standard in 2008. Four years in the making, it is designed to reduce occupational risk factors for musculoskeletal disorders (MSDs).

Its opponents see it as a financial drain in a state already hard hit by the nation’s economic downturn. A coalition including the National Federation of Independent Business argued at a Lansing news conference on January 9 that the rules are not needed because many employers voluntarily make improvements aimed at reducing the number of workplace injuries caused by repetitive movements. They say mandatory ergonomics training and reporting would raise the cost of doing business at a time many employers are struggling because of Michigan's poor economy.

Christmas Safety tips

We strongly urge you to make a pre-holiday
review of safety practices in your home to help reduce
the chances of accidents and injuries.
Here are tips for a safe and accident free holiday:

Lighted candles and electric Christmas tree lights are potential fire hazards. Homeowners are advised to inspect the string of lights for possible frayed wires,
crimped wires that could lead to short circuits, or defective sockets that could create special electrical problems of their own. While lighted candles lend special
effects to the holiday season, they should never be displayed on the tree or near any evergreen boughs. They should be used only in glass containers designed
for candle illumination.

Because gift wrappings, boxes, cartons, and packing materials burn very fast and generally high heat, they should never be burned in the fireplace. There is a tendency to allow the overloading of extension cords and the scattering of cords on the
floor during the holiday season because it is a temporary condition.
It is safer to avoid these practices, even temporarily. NEVER overload an electrical circuit and NEVER leave extension cords out where someone can
trip over them. Finally - two good Christmas gifts for the entire family are an extra smoke detector an a fire extinguisher (for both home and car)
Prepare your car for winter. Start with a checkup that includes:
-Checking the ignition, brakes, wiring, hoses and fan belts
-Changing and adjusting the spark plugs
-Checking the air, fuel and emission filters, and the pvc valve
- inspecting the distributor and the battery
-Checking the tires for air, sidewall wear and tread depth, and
antifreeze levels and the freeze line
Your car should have a tune up to ensure better gas mileage,
quicker starts and faster response on pick-up and passing power

Toy safety depends on the toy itself, the child’s ability to use it safely, and on an adult’s instruction and supervision for proper use. With so many different toys on the market, it is not easy to choose the right one.
Parents are urged to select toys carefully, following these guidelines
for safety:
- Look for well-made, sturdy toys which will take a pounding
- Insist on smooth, rolled edges that won’t cut young fingers
- Be sure they have no parts small enough to fit into the mouth,
ears, or nose
-make sure toys are made of non-flammable material and that
painted surfaces are labeled “non-toxic.”
- Look for Underwriters laboratories (UL) listing on electrical
toys.

A toy that is too simple or too complicated for a small child is
frustrating and unsafe.
Be aware that in a family with children of different ages toys
used by older children can be hazardous for the younger children.
Teach children to put toys away and NEVER to leave toys in walkways or stairways
Parents can protect their children from painful accidents by
keeping toys in good repair, checking frequently for hazard producing
damage, and by discarding toys that can’t be repaired to a safe condition

Check for the safety labels on the gifts and toys you buy. Make sure the gift is appropriate, not just one that caught your eye.
When you decorate the tree keep this thought in mind: Lights and wires and plugs get old and must be checked from time to time.

Pet Safety
Poinsettias are toxic to cats, chocolate and many nuts are hazardous for pets to eat, and tinsel and ornaments can become an intestinal obstruction if eaten
Now that you’re thinking safety in all the many different ways, we know that you’ll have a SAFE AND HAPPY HOLIDAY.

New Treatment guidelines in works for Carpal Tunnel Syndrome

“Carpal tunnel syndrome, otherwise known as CTS, is among the most common disorders of the upper extremity. It affects up to 10 percent of the population and is related to many factors, but is thought to be caused by increased pressure on the median nerve in the carpal tunnel in the wrist,” said Michael Keith, M.D., chair of the AAOS work group responsible for creating the new guideline.

According to the National Center for Health Statistics, in 2005, an estimated 3.1 million people sought help from physicians for the treatment of CTS.

“The Academy created this clinical practice guideline to improve patient care for those suffering from Carpal Tunnel Syndrome,” said Keith. “The document serves as a point of reference and educational tool for both family practitioners and orthopaedic surgeons, streamlining possible treatment processes for this ever-so common ailment.”

In June 2007, the Journal of the Academy of Orthopaedic Surgeons (JAAOS) reported about 500,000 CTS surgical procedures are performed each year. The same study also reported the economic impact due to CTS is estimated to exceed $2 billion annually.

The final CTS treatment guideline contains nine recommendations that include both operative and non-operative treatment options, as well as alternative techniques. Some of the recommendations include:

• Traditional bracing or splinting

• Local steroid injection 

• Oral steroids
• Ultrasound

• Carpal tunnel release surgery

After doing a thorough analysis of the current literature, the work group found no evidence that supports the following treatments:

• Heat therapy

• Acupuncture

• Diuretics

• Electric stimulation

• Massage therapy

• Magnet therapy

• Nutritional supplements.

“This guideline is not intended to stand alone,” added. Keith. “It can be used as a starting point for physicians and can open up the lines of patient-physician communication on possible treatment options.”

As new research, knowledge and literature on CTS becomes available, this guideline will be reviewed and re-evaluated by the Guidelines and Technology Oversight Committee. It will be considered for updating in 3 to 5 years, which is consistent with evidence-based standards.

The guideline was developed by an AAOS physician volunteer work group and was based upon a systematic review of the current scientific and clinical information on accepted approaches to treatment and/or diagnosis. The entire process lasted about 18 months and included a review panel consisting of internal and external committees, public commentaries and final approval by the AAOS Board of Directors.

Thanksgiving safety

Safety Tips from the Red Cross
November 24, 2008 – The American Red Cross wants to remind everyone of important safety issues that will help ensure a safe and happy Thanksgiving holiday.
Since Thanksgiving usually involves preparing lots of food, cooking safety should be a priority. Unfortunately, cooking fires are more likely to occur on Thanksgiving Day than any other day of the year according to the National Fire Protection Association.
The Red Cross offers the following tips to prevent home fires this Thanksgiving:
• Monitor your cooking at all times. Unattended cooking is the leading cause of Thanksgiving Day home fires.
• Keep potholders and food wrappers at least three feet away from heat sources while cooking.
• Wear tighter fitting clothing with shorter sleeves when cooking.
• Make sure all stoves and ranges have been turned off when you leave the kitchen, and that ovens are turned off when you leave the house.
• Set timers to keep track of turkeys and other food items that require extended cooking times.
• Turn handles of pots and pans on the stove inward to avoid accidents.
• Follow all manufacturer guidelines regarding the appropriate use of appliances.
• After guests leave, designate a responsible adult to walk around the home, making sure that all candles and smoking materials are extinguished.
Finally, it’s important for every household to make sure to have working smoke alarms. The Red Cross encourages people to install smoke alarms on every level of their house and outside sleeping areas and to test the batteries once a month.
Even with the best preparation and precautions, accidents can happen. Cooking-related burns are a common hazard of the Thanksgiving holiday. For a superficial burn, cool the area by running it under cold water until the heat eases and then loosely cover the burn with a sterile dressing to help prevent infection. A critical burn requires medical attention.
Choking is another threat to a happy holiday dinner. Common causes of choking include talking while eating; eating too fast; and trying to swallow large pieces of poorly chewed food. If you feel as if food may be caught in your throat, never leave the room-stay where others can see you and help if your airway becomes blocked.
To help someone who is choking, remember “FIVE-and-FIVE Can Keep Them Alive.” First, ask the person if they are able to breathe and if you can help. Once you know the person is unable to cough, speak or breathe, have someone call 9-1-1 or your local emergency number.
Lean the person forward and give FIVE sharp back blows between the shoulder blades with the heel of your hand. If the obstruction isn’t dislodged, stand behind the person and give FIVE quick, upward thrusts into the abdomen. Repeat back blows and abdominal thrusts as necessary. If you are alone, you can perform abdominal thrusts on yourself, just as you would on someone else. Thrusts can also be administered by leaning over and pressing your abdomen firmly against an object such as the back of a chair

Are Disease managment Programs effective or too costly- review of recent research

A review of current peer reviewed research or research presented by professional organizations with peer reviewed journals reveals that Disease Management programs are not cost effective for direct costs without inclusion of indirect costs, societal costs. In addition Programs that are effective are long term, and targeted to selected populations.
In effect Insurance companies who must manage a broad scope of health care costs and over a long period of time may benefit from disease management programs for targeted patients. Firms that are out sourcing these models, will find reactive disease management programs too expensive. But other research indicates that proactive programs for health coaching are on the increase and profitable in 2008.

Nov. 9, 2004 (New Orleans) — Disease management improves survival in patients with congestive heart failure (CHF), especially in those with advanced disease. But the program does not save healthcare utilization or costs, according to results of a late-breaking clinical trial presented here at the American Heart Association 2004 Scientific Sessions.
"Disease management promised a lot but those promises may be empty," lead investigator Autumn Dawn Galbreath, MD, vice chairman for clinical programs in the Department of Medicine at the University of Texas in San Antonio, said when presenting the results at an early morning press conference. The formal results were presented at the meeting by coinvestigator Gregory I. Freeman, MD, from the University of Texas Health Science Center in San Antonio.
The investigators randomized 1,069 community-based patients with CHF to receive disease management or usual care. Average age of the group was 70.9 years. All had systolic heart failure with ejection fractions averaging 35% or echo-confirmed diastolic heart failure. Patients were followed for 18 months, with investigators conducting assessments of clinical status by telephone at six-month intervals.
http://www.medscape.com/viewarticle/582790


October 29, 2008 (Philadelphia, PA) — A heart-failure disease-management program that had cut the risk of hospitalization in a predominantly Hispanic and black population [1] is also cost-effective in that the benefit came at an expected societal cost under $25 000 per quality-adjusted life-year (QALY) gained
In the current analysis, the nurse-led intervention cost an average of $2177 per patient but reduced hospital costs by $2378 per patient; however, "higher costs for outpatient procedures, medications, and home healthcare prevented the intervention from being cost-saving over the 12-month study," according to the authors.
The incremental cost per QALY gained for the intervention program was estimated at $19 691 or $21 470, depending on the quality-of-life instrument used, either the Health Utility Index Mark 3 or EuroQol-5D, respectively, after adjustment for baseline quality-of-life differences between groups.
The estimated net 12-month cost to Medicare associated with implementation of the disease-management program was either $3176 or $3673 per QALY, respectively.
The study's results are consistent with an ongoing Medicare demonstration product, according to Hebert et al, that "found no evidence that [its] nurse-management interventions were cost-saving or cost-neutral.

http://www.medscape.com/viewarticle/582790


The economic effectiveness of disease management programs, which are designed to improve the clinical and economic outcomes for chronically ill individuals, has been evaluated extensively. A literature search was performed with MEDLINE and other published sources for the period covering January 1995 to September 2003. The search was limited to empirical articles that measured the direct economic outcomes for asthma, diabetes, and heart disease management programs. Of the 360 articles and presentations evaluated, only 67 met the selection criteria for meta-analysis, which included 32,041 subjects. Based on the studies included in the research, a meta-analysis provided a statistically significant answer to the question of whether disease management programs are economically effective. The magnitude of the observed average effect size for equally weighted studies was 0.311 (95% CI = 0.272-0.350).

The results suggest that disease management programs are more effective economically with severely ill enrollees and that chronic disease program interventions are most effective when coordinated with the overall level of disease severity.

http://www.citeulike.org/user/waffle168/article/197597

Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF.
METHODS: This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. RESULTS: The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. CONCLUSIONS: Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient
risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.

http://www.ncbi.nlm.nih.gov/pubmed/18215605
Here is the video link
http://www.bupafoundation.co.uk/asp/awards/08_awards/health_at_work_award.asp