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Montana calls for oversight of nonprofit hospitals charity gifts

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Montana health officials are proposing to monitor the charitable contributions that nonprofit hospitals make in their communities each year and set standards to justify their access to millions of dollars in tax exemptions.

The proposal is part of a package of legislation that the state’s Department of Public Health and Human Services will ask lawmakers to approve when it convenes in January. It comes two years after a state audit called for the department to play a stronger oversight role, and nine months after a KHN investigation found some of Montana’s wealthiest hospitals are lagging behind state and national averages in community donations .

Montana State Senator Bob Keenan, a Republican who has questioned whether nonprofit hospitals deserve their status as charities, said the proposal is a start that could be expanded later.

“Transparency is the name of the game here,” Keenan said.

The IRS requires nonprofit hospitals to count their “health promotion” spending to benefit “the community as a whole.” How hospitals credit such contributions to justify their tax exemptions is opaque and varies widely. National researchers studying community performance have called for tightening standards for what counts towards the requirement.

Montana is one of the latest states to consider introducing new rules or increasing oversight over nonprofit hospitals amid questions about whether they pay their fair share. dr Vikas Saini, president of the national health think tank Lown Institute, said people in California at both the state and local levels are considering whether to oversee hospital community performance and enforce new standards. Last year, Oregon introduced a minimum amount that nonprofit hospitals must spend on community services. And Massachusetts has updated its community service guidelines in recent years, urging hospitals to make more detailed assessments of how spending aligns with identified health needs.

Montana hospital industry officials said they wanted to work with the state to shape proposed legislation, which they said the industry would support if it did not conflict with federal regulations. Saini said to be effective, laws would have to go beyond federal requirements.

In recent years, more and more people like Keenan and Saini have questioned whether nonprofit hospitals contribute enough to their communities to deserve the big tax breaks they receive while becoming the city’s largest corporations.

“Hospitals are like the pillars of communities, but people are starting to ask these questions,” Saini said.

Saini’s institute reviews hospital donations each year and has found that the majority of nonprofit schemes nationwide spend less on what the institute calls “meaningful” services than the estimated value of their tax breaks. Actions counted by the Institute include financial assistance to patients and community investments such as food aid, health education or services provided at a loss, including addiction treatment.

The 2020 Montana Audit found hospitals benefit vague and inconsistent in the state report, making it difficult to determine whether their status as a charity is warranted. However, state legislatures did not address the issue during their 2021 biennial term, and a memorandum from the Legislative Audit Division issued in June found that the state health department has since made “no significant progress” in developing an oversight of charitable donations by nonprofits made hospitals.

KHN found that Montana’s nearly 50 nonprofit hospitals spent an average of about 8% of their total annual spending on charitable causes during the fiscal year ending 2019. The national average was 10%.

In some cases, hospital donation rates have since declined. For example, in the fiscal year ending 2019, Logan Health-Whitefish — a small hospital that’s part of Flathead Valley’s larger health care system — reported that less than 2% of its total spending went to charitable causes. In its most recent available documents, the hospital said it spent less than 1% of its spending on welfare for the period through 2021, while making $15 million more than it spent.

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Logan Health spokeswoman Mellody Sharpton said the medical system’s overall community benefit is nearly 9% of its spending and reaches its six hospitals. It also has clinics throughout the valley. “It’s important to consider the benefits our organization brings to the community as a whole as our facilities work together to ensure the appropriate care is provided in the appropriate facility to meet the healthcare needs of our patients,” Sharpton said.

State health officials are asking lawmakers to allow the agency to draft a bill that would give the Department of Health clear authority to require hospitals to submit annual reports that include data on community services and charities. The measure would also allow the Department to develop standards for these charitable spending, as described in the Department’s proposal.

“We see a great need to get the ball moving here,” Charlie Brereton, chief of the state health department, told lawmakers in August.

Montana Hospital Association President Rich Rasmussen said his organization wants to work with the Department of Health to refine the legislation, but said the definition of what counts as benefits should remain broad to allow hospitals to focus on the most pressing needs their region can react.

In addition, the hospitals are already working on their own reporting standards. This year, the association created a manual for members and set a goal for hospitals to report their services to the community consistently by 2023, Rasmussen said. The association declined to provide a copy of the manual, saying it will be available to the public once hospitals are trained to use it later this fall.

The association also plans to launch a website that will serve as a one-stop shop for people who want to know, among other things, how hospitals report on community services and address local health issues.

Republican Rep. Jane Gillette said she supports increased Health Department oversight and the idea behind the association’s website, but doesn’t believe the hospital industry should produce this public resource on its own. Gillette said she plans to introduce legislation that would require hospitals to report data on community services to a group outside the industry — like the state — which would then publish the information online.

In the past, hospitals have resisted attempts to introduce new rules for the issuance of benefits. In an interview with KHN last year, Jason Smith, Bozeman Health’s then chief advancement officer, said the system supported efforts to improve reporting of posts “outside of new laws,” adding that hospitals could do better without “government regulators to use”. arena with us.”

When asked if the health system still stands by the statement, Denise Juneau, Bozeman Health’s chief government and community affairs officer, said hospital officials hope any new laws will be aligned with existing federal guidelines. She said Bozeman Health will continue to work with the Montana Hospital Association to define and provide better information on community benefits, with or without new legislation.

A lawmaker would have to support the state’s proposal by mid-December to keep it alive.

Kaiser Health News is a national health news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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Boy with heart failure saved by doctor who revolutionised transplants

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Nine-year-old Rafi is just a child who is now thriving thanks to Richard’s research (Image: Richard Issitt/Katy Levett)

“One reason for our work is to give away a future,” explains Dr. Richard Issitt, whose pioneering research in pediatric heart transplantation has already helped save dozens of lives.

dr Richard, senior pediatric perfusionist at Great Ormond Street Hospital for Children, knew that young children awaiting heart transplants face many obstacles.

In particular, when a child receives a heart from a donor who does not match their blood type, it takes many liters of donor blood products to flush out their own. If not, the child’s blood would attack the new mismatched organ.

This meant that unfortunately only very young children could receive mismatched hearts – to reduce the amount of blood lost and discarded – and older children had to wait for life-saving transplants.

And so one night in the pub in 2014, with colleagues Alex Robertson and Richard Crook, he came up with a revolutionary idea that would change the future of pediatric heart transplants – with an original sketch drawn on the back of a beer mat.

Richard explains his work in more detail: “We don’t have that many hearts, especially for children, which is obviously a good thing (because it means children don’t die). But alas, for people waiting for a heart, it’s bittersweet. So we need to maximize the use of the donors we have.’

Richard emphasizes that in adult heart transplants, it is crucial to match a patient with a donor of the right blood type. However, this is not the case for children – they can be given a heart of a different blood group as a gift.

He says: “As we age, our immune system builds up the ability to distinguish between blood groups.

“For example, if you’re a type A and I’m a type B and your heart beat to me, my body would realize it was the wrong blood type and start attacking it; it behaves as if it encountered a virus and can’t really tell the difference. Of course, that can lead to rejection.”

The blood filter device developed by Richard and his team (Image: Richard Issitt)

This previously meant mismatched heart transplants were limited to smaller children up to four years old – to reduce the amount of blood lost and discarded.

For decades, this was a major stumbling block faced by the medical world.

But that night in the pub, Richard and his colleagues found a solution. The antibodies that cause rejection are removed during the transplantation with a special blood filter device – which drastically reduces the amount of donor blood required.

“Part of the reason we do our work is to give away a future” (Photo: Richard Issitt)

He explains: “We actually thought well, rather than just throwing away everything related to the blood surrounding the patient, why don’t we see if we can start targeting the actual antibodies that are causing the problem of rejection.”

Richard and his team experimented with specific antibody targets so that antibodies would stick to them – and not to the donated heart. After successful testing in a laboratory, it was adopted in a clinical setting.

Now, seven years later, the practice is being adopted by more and more hospitals around the world, and it also means transplants can be performed on older children too.

One of those children who received a transplant thanks to Richard’s research – which was funded by the British Heart Foundation – is nine-year-old Rafi, who was diagnosed with a heart murmur at just six weeks old.

Rafi spent much of his childhood in hospital (Image: Katy Levett)

After having open-heart surgery at the age of one and receiving a HeartWare – a mechanical pump – at the age of five, Rafi was still in need of a heart transplant at the age of six.

Various complications caused Rafi’s health to deteriorate rapidly and his mother, Katy Levett, was told in 2019 that (thanks to the team’s new technique) her son could receive a mismatched transplant of a different blood type as his only real option for survival.

By this point, Rafi had spent so much of his childhood in the hospital that Katy was willing to try anything to improve his deteriorating condition.

“If that heart hadn’t come along, he wouldn’t have made it” (Image: Katy Levett)

Katy says: “Before his transplant he had no hope. If that heart hadn’t come along, he wouldn’t have made it.

“Rafi was in the hospital for so long he couldn’t live his life and if he hadn’t gotten the heart his life would never have started.”

In a strange twist of fate, Richard himself was also involved in Rafi’s Great Ormond Street transplant on December 29, 2019 – with Katy calling it “the best Christmas present ever”.

Luckily the transplant was a success and now Rafi is a thriving little boy who has his life back.

Katy adds: “He can now do all these normal things: he can go to school, he can play football and he’s learning to swim – which he couldn’t do before.

“He’s a kid now and that’s all I ever wanted.”

“If he hadn’t got the heart, his life would never have started” (Image: Katy Levett)
Rafi is now thriving and loves to play football (Image: Katy Levett)

When we see a kid running around and making absolute havoc on the parents after a transplant, that’s my goal.

Richard and his colleague’s work means they have doubled the age group of children eligible for patients with a mismatched heart transplant – and significantly reduced the amount of blood used during those surgeries.

“Rafi was kind of a trailblazer in a lot of ways, actually due to the fact that Katy was willing to help us push the boundaries of what was possible,” explains Richard.

“It’s nice to know we’re making a difference – so when we see a kid running around and causing absolute chaos for the parents after a transplant, that’s my goal.

“There is no greater reward to see someone come out on the other side and be full of life.”

Were it not for Richard and the team’s novel idea in 2014, Rafi would likely still have been waiting for a blood-group-matched donor heart — more than a year after his mismatched transplant.

“You never think you’ll be able to need an organ, let alone your child need a heart.” (Image: Katy Levett)

Both Katy and Richard also hope their story sheds light on the importance of organ donation and blood donation – and encourage parents to have more open discussions about donating their children’s organs.

Katy adds: “None of this would have been possible without a heart donation and it’s such a taboo subject – especially with children. It is important to emphasize that without donated organs none of this can happen.

“Rafi has probably had 10 blood transfusions in total, including the blood he needed for his transplant.

“We tend to think something for old people when it comes to organ donation, but what we don’t think is a one-year-old who hasn’t lived a life.

“You never think you’ll be able to need an organ, let alone your child need a heart.”

While Richard adds, “The parents who are able to put other children first at such a devastating point in their lives are undoubtedly the unsung heroes of this. Your selflessness and generosity have made it possible for a seriously ill child somewhere to have a chance at life thanks to you.”

More at Centre County Report.co.uk The Heart Hero Awards 2022 campaign can be found here.

Do you have a story to share?

Get in touch via email Centre County [email protected] County Report.co.uk.

MORE : Grandfather joked minutes before the heart attack: “Better finish the defib”.

MORE : The “medical feminist” nurse who advocates for women’s heart health

MORE : A £50 blood test could cut deaths from heart disease


The British Heart Foundation Heart Hero Awards 2022

A BHF heart herowith Centre County Report.co.uk as a media partner this year, anyone can be, from a healthcare professional doing exceptional work, to a young person with heart disease who has shown incredible courage and determination, to an inspirational fundraiser who is creative found ways to fund research.

Those shortlisted will be invited to an awards ceremony hosted by Vernon Kay at Glaziers Hall in London on December 1, where the winners will be announced.

You can Register to watch the celebration online via live stream in the evening from 8 p.m. Guest stars will announce some of the winners.

Category judging is now complete, with Scottish footballer Scott Allan and TV and radio presenter Will Njobvu among this year’s celebrity judges.

But the Young Heart Hero and CPR Hero categories remain open for nominations throughout the year.

The awards raise awareness of the continued need for funding for the groundbreaking research that is turning science fiction into reality and bringing hope to more than seven million people in the UK living with cardiovascular problems.

To find out more about the categories or to make a nomination, Visit the British Heart Foundation website.

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AI ‘Simulants’ Could Save Time and Money on New Medications

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Nov. 30, 2022 – Artificial intelligence is poised to make clinical trials and drug development faster, cheaper, and more efficient. Part of this strategy is to create “synthetic control arms” that use data to create “simulants” or computer-generated “patients” in a study.

This allows researchers to enroll fewer real people and recruit enough participants in half the time.

Both patients and drug companies could benefit, say experts. For example, one benefit for people is that simulants receive standard treatment or placebo treatment, which means that everyone in the study ends up receiving the experimental treatment. For pharmaceutical companies unsure which of their drug candidates holds the most promise, AI and machine learning can narrow the prospects.

“Until now, machine learning has primarily been effective for optimizing efficiency – not for getting a better drug, but for optimizing screening efficiency. AI uses knowledge from the past to make drug discovery more effective and efficient,” says Dr. Angeli Moeller, Head of Data and Integrations Generating Insights at drugmaker Roche in Berlin and Deputy Chair of the Board of the Alliance for Artificial Intelligence in Healthcare.

“I’ll give you an example. You might have a thousand small molecules and you want to see which one binds to a receptor involved in a disease. With AI, you don’t have to screen thousands of candidates. Maybe you can only test a hundred,” she says.

“Synthetic” subjects

The first clinical trials to use data-generated matches for patients – instead of control patients who are matched by age, gender or other characteristics – have already started. For example, Imunon Inc., a biotechnology company developing next-generation chemotherapy and immunotherapy, used a synthetic control arm in its Phase 1B study an agent added to preoperative chemotherapy for ovarian cancer.

This early study showed the researchers that it would be worth pursuing the new compound further in a phase 2 trial.

Using a synthetic control arm is “extremely cool,” said Sastry Chilukuri, co-CEO of Medidata, the company that provided the data for the Phase 1B study, and founder and president of Acorn AI.

“What we have is the first FDA and EMA approval of a synthetic control arm, where you replace the entire control arm with synthetic control patients, and those are patients that you pull out from historical clinical trial data,” he says.

A wave of AI-supported research?

The role of AI in research is expected to increase. Until now, most AI-driven drug research has focused on neurology and oncology. The launch in these specialties is “probably due to the high unmet medical need and many well-characterized targets,” notes a March 2022 News and analysis piece in the diary Nature.

It has been speculated that this use of AI is just the beginning of a “coming wave”.

“There is increasing interest in using synthetic control methods [that is, using external data to create controls]”, so a review article in naturopathy in September.

The FDA already said so approved a drug in 2017 for a form of a rare pediatric neurological disorder, Batten disease, based on a study of historical control “participants.”

An example in oncology where a synthetic control arm could make a difference is in glioblastoma research, says Chilukuri. This brain tumor is extremely difficult to treat, and patients typically drop out of the trials because they want the experimental treatment and don’t want to stay in the standard-of-care control group, he says. Also, “given life expectancy, it’s very difficult to complete a study.”

Using a synthetic control arm could speed up research and improve the chances of completing a glioblastoma trial, Chilukuri says. “And the patients are actually getting the experimental treatment.”

Still early days

AI could also help limit “non-responders” in research.

Clinical trials “are really difficult, they’re time-consuming, and they’re extremely expensive,” says Naheed Kurji, chairman of the board of directors of the Alliance for Artificial Intelligence in Healthcare and president and CEO of Cyclica Inc, a data-driven drug discovery company based in Toronto.

“Companies are working very hard to find more efficient ways to bring AI into clinical trials so they can get results faster at lower cost but also higher quality.”

There are many clinical trials that fail, not because the molecule isn’t effective… but because the patients enrolled in a trial include many non-responders. They just delete the responder data,” says Kurji.

“You’ve heard a lot of people talk about how we’re going to make more progress in the next decade than in the last century,” says Chilukuri. “And that’s just because of this availability of high-resolution data that allows you to understand what’s happening at an individual level.”

“That’s going to start this explosion in precision medicine,” he predicts.

In a way, AI is still in its infancy in clinical research. Kurji says, “There’s still a lot to do, but I think you can point to a lot of examples and a lot of companies that have made really big strides.”

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CDC starting wastewater testing for polio in select communities

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The U.S. Centers for Disease Control and Prevention is expanding its sewage testing for polio in parts of Michigan and Pennsylvania, officials announced Wednesday.

Polio outbreaks once caused panic in the United States, but those concerns died down when a vaccine was developed and widely available in the 1950s and 1960s.

However, concerns about the spread of polio have been renewed this year after the first case of paralytic polio in nearly a decade was diagnosed in Rockland County, NY in July in an unvaccinated man.

Since then, New York health officials have uncovered 89 “interesting cases,” 82 of which have been linked to the infected Rockland man. The virus has been found in sewage from New York City, Orange County, Sullivan County, Queens County and Nassau County.

The CDC will begin wastewater testing in Michigan’s Oakland County and an unspecified area around Philadelphia.

“Sewage testing can be an important tool in understanding whether poliovirus is circulating in communities under certain circumstances,” said Dr. José R. Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases. “Vaccination remains the best way to prevent another case of paralytic polio, and it is vital that people get vaccinated to protect themselves, their families and their communities from this devastating disease.”

Polio occurs in communities with low immunization rates, and the virus can spread quickly. One in four people who become infected with the virus eventually show flu-like symptoms such as diarrhea, fever, nausea, headaches and exhaustion.

However, according to the CDC, most people who contract the virus show no symptoms.

A smaller percentage of people will develop serious complications after contracting the virus.

There are two types of poliovirus vaccines. The first is a shot that can be administered in the leg or arm that has an inactivated spread of the virus, which has been present in the United States since 2000.

The second is the oral vaccine, which contains a weakened strain of the virus that is given via a few small drops in the mouth. The oral vaccine is widely available outside the United States, but in communities with low vaccination rates, this method can allow poliovirus to mutate, leading to the spread of vaccine-derived poliovirus.

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