A new study conducted by Muse and Associates (Washington) for the Health Industry Group Purchasing Association (HIGPA; Washington) concludes that group purchasing organizations saved hospitals from 10% to 15% in costs of non-labor items – that is, medical equipment, supplies, pharmaceuticals, and food. Purchases of those items accounted for $179 billion in all hospital expenditures, with $128 billion channeled through group purchasing contracts, the estimated savings thus ranging from $12.8 billion to $19.2 billion, the survey found. HIGPA said this study represents the first attempt at sampling hospital purchasing executives concerning their non-labor purchasing expenditures.

"This study shows that GPOs save hospitals billions of dollars each year," said HIGPA Executive Director Robert Betz. "It also is evident from the study that GPOs have room to grow in helping hospitals and other providers realize even more savings in their non-labor costs." The survey also found that GPOs help hospital staff with product standardization, comparison shopping and streamlining of health care products and services, while also assisting in procurement, storage, and transfer of non-labor items.

Among other conclusions, the study found that:

About one-third of the hospitals surveyed currently make purchases over the Internet, totaling about 5% of purchases.

Hospital spending for medical/surgical equipment and supplies averaged just over 19% ($34.1 billion) of total non-labor expenditures in 1999.

Hospitals spent an average of 12.5% ($21.9 billion) of all non-labor expenditures on pharmaceuticals in 1999.

Hospital purchasing managers said they know they receive a fair price.

The study surveyed by phone 221 purchasing managers at community hospitals in the fall of 1999. The survey is not a statistical sample and it was designed to supplement the limited data concerning GPOs, which must be extrapolated from a combination of government and private-sector data sources, including the Health Care Financing Administration (Baltimore, Maryland), the Congressional Budget Office and the American Hospital Association (Washington).

HIGPA's web site is www.higpa.org.

Magnetic stimulation to replace electroshock?

Pulsed, repetitive transcranial magnetic stimulation (TMS) has been shown to be therapeutic in depressed patients who are resistant to at least one course of antidepressants, and now, a first time comparison of TMS with electroconvulsive therapy (ECT) shows that TMS is a reliable alternative to electroconvulsive therapy (ECT) for a major cohort of clinically depressed patients without psychoses whose only treatment recourse had been shock therapy. TMS, discovered in 1985, initially was used to measure nerve conduction in assessments of conditions such as multiple sclerosis, Parkinson's disease, CVAs, etc.

"Unlike transcranial electrical stimulation, TMS is painless, but the effect is potent. During the last few years, there has been exponential growth in clinical interest in TMS on a yearly basis. We found that it is effective in the most severely depressed patients," said Leon Grunhaus, head of the psychiatry division of Sheba Hospital (Tel Hashomer, Israel), whose team of psychiatrists is now examining TMS in depressive disorders (MDD).

Grunhaus's group uses the MagStim (Sheffield, United Kingdom) electromagnetic "hat," about 14 cm long in a figure-eight shape. Two other companies produce TMS devices: Cadwell Laboratories (Kennewick, Washington) and Dantec Medical A/S (Skovlunde, Denmark). ECT is literally shocking and painful and so must be administrated under general anesthesia; even so, it still causes gaping memory loss. By contrast, TMS shows no side effects except transient mild headaches in about a third of patients. Overall, ECT was a more potent treatment for patients with MDD and psychosis; but, in patients with MDD without psychosis, the effects of TMS were similar to those of ECT and "would be preferred treatment considering that depression is a chronic condition, and patients need to be followed and treated over years," Grunhaus said. The results of this comparison were reported in Biological Psychiatry 2000, and the team is now recruiting patients for a long-term study.

Eighty volunteer outpatients were tested, with 40 of the MDD patients referred for ECT and randomly assigned to either ECT or TMS. Repetitive transcranial magnetic stimulation was performed at 90% power of the motor threshold over 20 days. Electroconvulsive therapy was performed according to standard protocols. "With our results, and the clinical history of TMS, we have proposed magnetic therapy as a treatment method worthy of further exploration, but its efficacy for clinically depressed patients who are not delusional or psychotic, is clear, and with finessing of the treatment regime, may be able to entirely replace electroconvulsive therapy for this patient group," Grunhaus said. The Sheba group is doing additional studies to define the parameters of treatment.

ECRI issues health care standards book

ECRI (Plymouth Meeting, Pennsylvania) last month issued its Healthcare Standards 2000, a 4-inch-thick volume containing 40,000 citations and a variety of related information on all types of medical standards and guidelines. It is the 12th such volume produced by the organization and suggests the broad proliferation of medical device standards, health care regulations, and laws supported by information concerning the organizations producing them. Elizabeth Richardson, project manager for the 2000 edition, told BBI that the new edition includes more coverage of European standards, a feature that will be continuously expanded in future editions. "We are always adding new titles, identifying new regulations and new clinical practice guidelines," she said. "We also try to identify new organizations and add them to the database." ECRI also is working to put the entire database online, Richardson said, and subscribers who purchase the volume can contact ECRI staff for updates.

Healthcare Standards 2000 is "an extremely heterogeneous set of documents," Richardson said. "What we do is bring them all together and organize them in a way that people can look up and find this information very effectively." She said there is no typical profile for those using the standards volume and the database, but noted some typical questions: "Is there a standard related to such and such clinical topic?" Or, "what is the most recent document for accrediting organization or behavioral management?"

Besides mining traditional sources, ECRI sifts through what Richardson termed "gray or fugitive literature, things not published via traditional publishing channels." It then verifies the information through "some level of endorsement, such as a clinical specialty society, government agency, health care institution or other authoritative body," she said.

ECRI is a non-profit collaborating center of the World Health Organization (Geneva, Switzerland) and serves as an office archive for official guidelines, standards and other documents.

IEEE releases new protocol software

The Medical Device Communications Industry Group (MDCIG; Piscataway, New Jersey), a program of the IEEE Industry Standards and Technology Organization (IEEE-ISTO), has released a new protocol data unit (PDU) software tool to facilitate implementation and adoption of the IEEE 1073 Medical Information Bus (MIB) Standards. It is designed to assist vendors in developing and testing medical device communications software, specifically IEEE 1074 data messages.

The software is an enhancement of that used in the first public demonstration of the complete IEEE 1073 Standard for Medical Device Communications held at Massachusetts General Hospital (Boston, Massachusetts) in February 1999. The tool assists a software engineer in designing IEEE 1073-compliant data messages. MDCIG sponsor Agilant Technologies developed the PDU tool and granted a license to the MDCIG to distribute the software via its web site – www.ieee0isto.org/mdcig – at no charge.

MDCIG was formed to promote the activities of the IEEE 1073 Standards Committee of the IEEE Standards Association, and to foster adoption of the IEEE 1073 family. The IEEE 1073 Standard allows clinicians to link patient connected bedside medical devices to a bedside patient monitoring device or a computer network in a simple fashion. This permits comprehensive data capture from devices such as infusion pumps, ventilators, and patient monitors connected to acutely ill patients. Sponsor members of the MDCIG are Agilent Technologies, Alaris Medical Systems, Baxter Laboratories, GE Marquette Medical Systems, and Siemens Medical Systems. Abbott Laboratories is a supporter member.

MDMA cites survey on FDA relationships

The Medical Device Manufacturers Association (MDMA; Washington) said a survey showing improvements in the working relationship between the FDA and the device industry "validates the positive changes created through the implementation of the FDA Modernization Act of 1997."

The MDMA added that the survey, conducted by the University of California, San Diego, and Pricewaterhouse Coopers, also highlights areas of the relationship that still need improvement – most significantly, the high rate of turnover of key reviewers, up 15% from 1997.

HIMA launches associate member program

The Health Industry Manufacturers Association (HIMA; Washington) has launched an associate membership program enabling professional service firms in the medical device industry to join the association. President Pamela Bailey said that the new program will enable such firms to gain more insight into the industry and "participate in advocacy activities." Additionally, she said the program "provides the opportunity for these companies to make HIMA an even more effective advocate for this vibrant and growing sector of the economy."

The associate members will receive HIMA information concerning industry developments, have access to the association's member web links, be invited to member-only programming, and be able to participate in the Associate Member Council and in HIMA's innovation councils.

Additional information about the program can be found at www.himanet.com or by contacting Mary Hogan at (202) 434-7235.

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