​  CAPSULES

Anticoagulation protocol benefits patients with traumatic brain injury

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. In the United States, approximately 2.8 million people sustain a TBI annually. A new study in the April issue of The Joint Commission Journal on Quality and Patient Safety details how a prophylactic anticoagulation protocol helped decrease venous thromboembolisms (VTEs) in patients with TBI.

Patients with TBI have an increased risk of developing complications from VTEs, a condition in which a blood clot forms and travels to the lungs, due to prolonged immobilization and a systemic hypercoagulability state. Recent reports suggest that prophylactic anticoagulation—preventive anti-clotting medication—can be safely used in patients with life-threatening TBI if the brain injury is stable.

In the study, “Implementation of a Prophylactic Anticoagulation Guideline for Patients with Traumatic Brain Injury” (https://tinyurl.com/hcn-tbi), researchers at North Memorial Health Hospital, Robbinsdale, used a trauma registry to identify patients with TBI before and after implementation of a new prophylactic anticoagulation protocol that incorporates education, weekly audits, and real-time adherence feedback.

A total of 681 patients with TBI were identified—368 pre-implementation (PRE) and 313 post-implementation (POST) of the VTE protocol. Findings showed:

• 80.5% of POST patients received anticoagulation compared to 39.4% of PRE patients.
• Time to initiation for anticoagulation averaged 59 hours for POST patients compared to 140 hours for PRE patients.
• POST patients (2.2%) had fewer VTE events compared to PRE patients (5.2%).

Researchers concluded that the hospital-wide prophylactic anticoagulation protocol improved process measures and outcomes. They also concluded that benchmarking can assist institutions in identifying potential clinically relevant areas for quality improvement in real time.

Insulin price relief bill clears state Legislature

Minnesota’s Alec Smith Emergency Insulin Act—named for a man who died of ketoacidosis after rationing his insulin—is now law. The House of Representatives voted 112–22 in support of the bill, with a Senate tally of 67-0. Gov. Tim Walz signed the legislation on April 15.

Nicole Smith-Holt and James Holt, parents of Alec Smith, had advocated before lawmakers for a year and a half in support of insulin price relief.

Legislators had long recognized the need for action, but disagreed on the best path forward. In summer 2019, Sen. Eric Pratt, R-Prior Lake, suggested using existing patient assistance programs run by insulin manufacturers to provide a supply to those who meet income requirements.

In its final form, the new law will impose fines on companies who fail to participate. Those fines increase as non-participation continues—$200,000 per month for six months, increasing to $400,000 per month for the next six months. After a year of non-participation, fines go to $600,000 a month.

The industry had opposed this provision, arguing that it is an unconstitutional taking of personal property under the 4th Amendment to the U.S. Constitution. But authors of the law say it is preferable to the drug companies to large licensing fees, which were part of a bill that passed the House this year that could have totaled $38 million, with most paid by the big-three insulin providers: Lilly, Sanofi, and Novo-Nordisk.

The new bill creates an emergency supply for 30 days for diabetics who need insulin now and can’t afford it. It also sets up a longer-term program for those under certain income limits and for those who don’t have insurance (or have insurance with large co-pays). Both have the companies providing the product, either by resupplying pharmacists or sending insulin directly to patients.

UCare to cover novel coronavirus-related hospital costs

Coinsurance, copays, and deductibles for UCare members who receive in-network hospital services to treat COVID-19 will now be covered through May 31, 2020. UCare will continue to track the situation and determine whether to extend this coverage beyond May 31.

UCare has been working closely with state leaders and public health authorities to keep its members, employees, and communities safe. Like many health care organizations, it has temporarily closed its doors, but encourages members and providers to call or communicate online with questions on plans and coverage.

To learn more about UCare’s services and coverage during this pandemic, visit https://tinyurl.com/hcn-ucare.

COVID-19 response grants provide short-term emergency funding

In March, Minnesota lawmakers passed an emergency law authorizing $200 million be used to support eligible health care costs related to planning for, preparing for, or responding to the outbreak of COVID-19. Fifty million dollars was set aside as short-term emergency funding to provide immediate emergency cash flow relief to health care organizations to cover their highest-priority needs in the first few weeks of the COVID-19 outbreak. The Minnesota Department of Health (MDH) received more than 1,600 grant applications requesting more than $300 million.

The grant application process is now closed and MDH has awarded $50 million in emergency funding to some 350 provider organizations across the state. Grant amounts ranged from several hundred dollars to $5 million dollars.

The grants were awarded to assisted living facilities, health care clinics, Federally Qualified Health Centers, hospitals, health systems, pharmacies, ambulance services, and tribal health providers. Nursing homes had previously been eligible to get most expenses covered by the Minnesota Department of Human Services (DHS). They will now be able to apply for the upcoming $150 million COVID-19 Health Care Response Grant for items DHS was not able to cover, such as capital improvements.

After dispersing the Short-Term Emergency funding, the remaining $150 million COVID-19 Health Care Response Grant is intended to cover costs related to planning for, preparing for, or responding to the COVID-19 outbreak. These funds will be awarded through a Request for Proposal (RFP) process. Learn more at https://tinyurl.com/hcn-rfp.

Fulcrum Health to deliver chiropractic telehealth

Fulcrum Health has teamed up with health plan clients to deliver chiropractic telehealth services for its members. This approach is designed to support chiropractors in their efforts to safely and effectively use technology to deliver virtual care to patients and reduce potential exposure to COVID-19, while helping them manage their overall health and well-being during mandated stay-at-home orders, shutdowns, and access restrictions.

Chiropractic care is a hands-on business, but with social distancing and mandated shutdowns due to COVID-19, providers are experiencing a significant reduction in the number of patients seeking care, potentially exacerbating existing health problems.

“While some [chiropractic patients] may be able to forego treatment until the risks of in-person visits have abated, others could end up in already overtaxed emergency rooms due to unmanageable pain if they are not able to receive care,” said Fulcrum CEO Patricia Dennis. “Our goal is to make it easy and safe for our network of chiropractic providers to evaluate patients and provide direction for steps they can take to manage existing issues and support ongoing mental and physical health.”

Fulcrum’s program will:

• Consult with patients regarding their current condition and potential treatment needs;
• Reduce the risk of COVID-19 exposure associated with in-person visits;
• Educate and reassure patients who are experiencing severe pain and offer appropriate at-home care advice, including the use of hot or cold therapies and stretching;
• Provide active care instructions for achieving personal health goals, such as demonstrating exercises that can be done at home to manage low-back pain without narcotics; and
• Offer home instruction on daily living activities, such as how to achieve an ergonomically safe remote work environment or to modify activities to reduce pain or injury.

Workers compensation expands for nurses

Contraction of COVID-19 at work had previously been considered an “occupational disease” under Minnesota’s Workers’ Compensation program, with workers required to provide evidence that they had contracted the virus at work. Under a new Minnesota law, nurses and workers who are on the frontlines of this pandemic are now presumed to have contracted COVID-19 through their employment. Under the new legislation, employers will need to provide proof that nurses and other health care professionals did not contract COVID-19 through the course of their employment.

The law applies to corrections officers and security counselors, licensed peace officers, firefighters, paramedics, EMTs, workers required to provide childcare to first responders, and health care workers under Executive Order 20-02 and Executive Order 20-19.

A nurse must either test positive for COVID-19 or be diagnosed by a physician or APRN. Then, either the positive test or documentation of the diagnosis must be provided to the employer. The only cause for rebuttal is if the employer can show that employment was not a direct cause.

The date of injury is the date on which a nurse was unable to work after receiving a positive test or by exhibiting symptoms that were later diagnosed as COVID-19, whichever came first.

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​  Medicus

Timothy Kufahl, MD, has joined St. Luke’s Mount Royal Medical Clinic. Board-certified in family medicine by the American Board of Family Medicine, Dr. Kufahl is a member of the American Academy of Family Physicians, the Minnesota Academy of Family Physicians, the Lake Superior Medical Society, and the Wilderness Medical Society. His procedures include dermatology and orthopedic injections, diet and nutrition, addiction medicine, and wilderness medicine.

Stephen Richardson, MD, a cardiac anesthesiology fellow at the University of Minnesota Medical School, is among the interdisciplinary developers of the Coventor, a compact, low-cost ventilator recently authorized for production and use by the FDA under the agency’s Emergency Use Authorization for the COVID-19 outbreak. The Coventor’s specifications will be made open source so other manufacturers globally can begin their regulatory and production processes.

Charles Bruen, MD, a critical care and emergency medicine physician and researcher at Regions Hospital, is leading a HealthPartners Institute study of a drug for severe COVID-19 pneumonia that may prevent lung inflammation in hospitalized patients with COVID-19, after receiving fast-track investigational approval from the FDA. The intravenous drug, formally called CM4620-IE, blocks the body’s production and release of molecules that cause inflammation, potentially reducing lung damage and the need for a ventilator. Historically, it has been proven safe and effective in patients with acute pancreatitis with below-normal levels of oxygen.

William Lundberg, MD, has joined St. Luke’s Orthopedics & Sports Medicine. Board-certified in orthopedic surgery with a sports medicine sub-specialty by the American Board of Orthopaedic Surgery, Dr. Lundberg received his medical degree from the Medical College of Wisconsin in Milwaukee. He completed his orthopedic surgery residency at the University of Minnesota in Minneapolis.