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09/18/2015

Bringing Transfusion Practice into the 21st Century

Last year, America’s Blood Centers created the Transfusion Safety Committee as a subcommittee of ABC’s Scientific, Medical, and Technical (SMT) Committee. Our charge is to organize and promote the integration of ABC centers with their customers through transfusion safety officer (TSO) services, including patient edu-cation, clinical staff education, and patient blood management. We developed a transfusion safety project list via a survey of the ABC Transfusion Safety Forum members. Read Full Post >

09/11/2015

Spreading the Word

Last week marked the end of a successful America’s Blood Centers-led grassroots campaign, culminating in the submission of two comment letters from ABC within a one week period and a face-to-face meeting with the Centers for Medicare & Medicaid Services (CMS) and the blood community delegation. During the past seven days, ABC has commented to CMS in opposition to the proposed cuts in reimbursement for blood and blood products, as well as to the Department of Labor expressing concern about the impact of the proposed increase in the threshold for exempt status and payment of overtime on non-profit organizations like blood centers. Read Full Post >

09/04/2015

For Some Years, I Have Been Afflicted with the Belief that Flight is Possible to Man – Wilbur Wright

My grandparents had beach cottages at Nags Head, on the Outer Banks of North Carolina. We went there almost every summer while I was growing up. Mostly, I remember playing in the surf and watching the adults play long, spirited games of Monopoly. There was always a trip up the beach to Kill Devil Hills where the obelisk of the Wright Brothers Memorial sits atop a small dune, and to the museum with tools and models of their early planes, which they tested in the winds off the ocean. Read Full Post >

08/28/2015

Innovation Over Faster Horses and Great White Whales

Economic pressures within the healthcare industry and, specifically the blood enterprise, have exposed a red ocean of competition replete with sharks attacking for the lowest price, mercenaries invading territories to acquire new market share, and a landscape ringed by beachheads strategically positioned to stave off conquest for a shrinking transaction base. Mergers and acquisitions in the supply chain and customer base have yielded market consolidation and blood has become commoditized as hospital administrators squeeze every cent from the supply chain. Long gone is the laissez-faire magnanimity, once the hallmark of the blood banker, replaced instead by fierce competition for the lowest possible price with the fervor of Captain Ahab’s quest for the Moby Dick. Read Full Post >

08/21/2015

Patient Blood Management: Some Comments from Others and Some From Us

“The Ethics of Bloodless Medicine,” published Aug. 14, was the last in a trilogy of articles in The New Yorker discussing lessons learned from transfusing, and not transfusing Jehovah’s Witnesses. The reports are in keeping with the magazine’s habit of regularly addressing medical topics (see also “The Excrement Experiment, How a stranger’s feces might save your life,” Nov. 24, 2014 and “Can AIDS be Cured? Researchers get close to outwitting a killer,” Dec. 15, 2014). Read Full Post >

08/14/2015

When ‘Sorta You’ Isn’t You (or Why we Need the Data Warehouse)

Many of you may have seen the recent Esurance commercials with the theme “sorta you, isn’t you.” In one, Giants catcher Buster Posey runs into a maternity room ready to deliver a baby stating that he is “sorta like a doctor because he wears a glove and delivers in the clutch.” Needless to say, the expectant father so infatuated with Buster that he considers allowing him to deliver, but the expectant mother wants her physician, not someone “sorta like” her physician, to actually do the delivery. Read Full Post >

08/07/2015

Are we Suicidal or … ?

I’m corresponding with a healthcare economist (that can’t be good) about framing the medical, insurance, and public health value of blood in light of historic and future safety and regulatory imperatives. The goal is to describe our business and how to make it sustainable. When Centers for Medicare and Medicaid Services (CMS) proposed cuts (≈30 percent on average) to outpatient reimbursement for blood were published in the Federal Register, adding to our fiscal miseries, my old pal asked: “Why is the market for human blood not creating the efficiencies among the suppliers that the demanders want, yet leaving them a normal [sic] profit?” Read Full Post >

07/24/2015

Check Out ABC’s New Member Site

With the summer months upon us, and what may be considered a slightly slower pace, many of us use these quieter times around the office to catch up on tasks we’ve been putting off. While it can bring such simple satisfaction to cross items such as “clean out inbox” and “dust keyboard” from your to-do list, it is also the perfect time to take part in professional development. And, what better way to do so than by checking out America’s Blood Centers’ new Member Site launched just last month? Read Full Post >

07/17/2015

Organizational Resistance and Resilience

Change seems to be everywhere in the blood community these days – evolving business relationships, new technologies such as pathogen reduction, and emerging transfusion-transmitted biological agents such as Babesia. The ever-changing regulatory landscape is another key element in our environment that can create commotion in the blood industry. Read Full Post >

07/10/2015

Genetic Testing – What Does it Mean to us?

Blood centers are probably the largest providers of “genetic testing” for adults in the country. Of course, we do serological ABO and RhD typing on every sample. We can also test for many other antigen systems. Until recently this was a common way of doing paternity testing. We are doing ever more red cell genotyping and using these results to provide better patient care for patients with multiple antibodies, enriching our inventory of rare units. We screen for sickle cell trait in a substantial number of cases by both chemical and molecular methods. We are in the genetics world, whether we think of ourselves in that way or not. Read Full Post >

07/02/2015

The Red, White, and Blue

Saturday is the Fourth of July – a day when we celebrate our country and our freedom. So it’s a particularly appropriate time to consider the relationship between the blood world and our government. (Okay, the decla-ration of independence was signed on July 4, establishing the anti-government; the government we have now was not really established until several years and a failed try later. But we will celebrate this government anyway.) Read Full Post >

06/26/2015

Just Say No?

Donors often visit places where infections not (yet?) endemic in the US are spreading. Dengue and chikungunya viruses are the current hotties, with Zika and Ross River viruses coming on strong. Each of these viruses, like West Nile virus, is characterized by asymptomatic viremia – the virus circulating in the blood before any illness – for several days, which may pose a transfusion risk. Potential exposures to malaria exclude many such donors, but nowhere near all of them. A short deferral of 14-28 days after return from international travel will get these donors past the risk. Can we do it? Asked more directly, how would such a deferral affect the blood supply? Read Full Post >

06/19/2015

An Organization Without Data is Doomed to Follow, Never Lead

This past week, I launched two important surveys on behalf of America’s Blood Centers to our members. Despite having retired from ABC in April, I agreed to conduct them again, because I have done them for several years and have learned from our members the importance of the final reports. The data from these two reports – the Executive Compensation Survey and the Financial Ratio Survey – have generated more discussion and are more useful to ABC members than most of the other surveys that I have facilitated. Read Full Post >

06/12/2015

What is a “Member” and Why Does it Matter?

It seems like a simple question with a simple answer, but in the past year, America’s Blood Centers has been struggling to answer it. First, a member is a dues-paying entity. There are currently 65 members in the net-work (down from 78 when I joined ABC in 2002). For the official definition, we turn to the ABC Bylaws, in which an active member is defined as a US or Canadian government-licensed, non-profit community or re-gional blood program governed by an independent board of directors serving two or more hospitals. In reali-ty, however, members come in a variety of shapes and forms. The current healthcare environment, which has placed blood centers under strenuous financial pressure, has led to the adoption of both traditional and inno-vative business models that have reshaped ABC membership. Today, 76 percent of members fit the definition above. However, the remaining 24 percent are either independently licensed affiliates, units or divisions of other members (14 percent), holding companies (five percent), or “other” (academic, hospital-based, or non-US). Nothing prevents that 14 percent from being folded into their parent company’s membership, receiving the same membership benefits (minus the right to vote). Read Full Post >

06/05/2015

Always Be Prepared

Spring has arrived, but unfortunately, with it comes tornado season brought on by the collision of warm air of the South and the colder air still creeping down from the North. As we’ve already seen in Oklahoma, spring tornadoes can be devastating. Memorial Day signaled the “unofficial” start of summer and just this week was the official start of hurricane season. This is always an opportune time to review local disaster/emergency operations plans. These should be reviewed at least annually, if not more frequently, with a critical eye. Below are some key questions to keep in mind when reviewing your plans. Read Full Post >

05/29/2015

Standing on the Shoulders of Giants

Isaac Newton once wrote to rival Robert Hooke in 1676, “If I have seen further it is by standing on the shoulders of giants.” Many years ago, when I was a young “wet behind the ears” medical director of a small blood center in the middle of nowhere, I received a phone call that changed my professional life. Celso Bianco, MD, then-president of ABC, shocked me by calling to graciously invite me to serve as co-chair of ABC’s Scientific, Medical, and Technical (SMT) Committee, along with Lou Katz, MD. As a relative newbie from a small blood center, I felt inadequate in the face of such a challenge, but Celso assured me I would be provided lots of assistance. After consulting my CEO at the time, John Guthrie, I accepted Celso’s offer. I both survived and enjoyed my stint as SMT chair, going on to serve on other committees at both ABC and AABB. I tell this story partly to thank Celso and Lou, both of whom have become personal friends over the years, but also to highlight their generosity and graciousness in confidently handing the torch to the next generation. Read Full Post >

05/22/2015

Why FDA Should Refer Babesia Policy Discussion to the ACBTSA

The Food and Drug Administration’s Blood Products Advisory Committee (BPAC), rejecting recommenda-tions from the blood community, endorsed nationwide serological testing for Babesia microti, combined with nucleic acid testing (NAT) of donations collected in high-risk states (see ABC, AABB statements). This means testing millions of donors with virtually no infection risk, consuming limited resources that might be better used elsewhere in pursuit of patient safety. The model presented to BPAC by the agency on the impact of testing is based on unvalidated diagnoses of babesiosis derived from Centers for Medicare & Medicaid Services (CMS) claims data in a population (elderly Medicare beneficiaries) that does not reflect donors (see BPAC issue summary). This is in contrast to direct evidence from prospective Babesia screening by the American Red Cross, suggesting that much more limited testing is just as protective as extended screening and more cost effective. Read Full Post >

05/15/2015

Pathogen Reduction: What’s Changed in the Last Two Years?

When I last commented on pathogen reduction (PR) in an “Our Space” two years ago, there was a sense of hope that PR was at our doorstep. Cerus had just received the greenlight from FDA to submit Premarket Ap-proval applications for its Intercept system for platelets and for plasma, which gained licensure in 2014. Now, Terumo BCT has submitted an Investigational Device Exemption (IDE) to begin its MiPLATE study for the Mirasol PRT system for platelets, which is expected to lead to licensure of the system. Terumo BCT is also developing a PR platform for whole blood. Data from the company’s IMPROVE II feasibility study, focused on radiolabel recovery of red blood cells after 21 day storage from PR-treated whole blood, has been submit-ted as an abstract for the 2015 AABB meeting in Anaheim, Calif. Read Full Post >

05/08/2015

The Value of Continuing Education

Shortly after completing my graduate education, I pondered how I would gain knowledge in the future, assuming it would come from my routine work activities. Surely just “doing my job” would keep me updated on issues affecting my environment and prepare me to meet challenges and accomplish goals. Well, not quite. Entering a tightly regulated industry that is highly reliant on technology and the ability to touch peoples’ hearts and minds left much to learn that could not be provided by on-the-job training alone. I am grateful that ABC invests in staff education and development to familiarize me with blood banking and association management – at the core of what we do. Read Full Post >

04/24/2015

Technology: Use It Right

I once came across a quote online that read, “The whole idea is not about the choice between using or not using technology. The challenge is to use it right.” While that quote was unattributed, I could not agree more with whoever said it. Read Full Post >

04/17/2015

Anemia Management and the Perioperative Surgical Home

While moving towards a value-based payment system has been disruptive to the healthcare industry, the benefits of these changes are now apparent in reduced patient complications and mortality due to a stronger focus on patient-centric care. As experts in transfusion medicine, we are vital to the patient care experience and it is essential to understand that improving patient outcomes is a top priority for our hospital partners. Through understanding the reimbursement process, blood centers can work alongside hospitals and physicians to share in the benefits of improved patient outcomes. This strategy is critical for blood centers to move our discussions away from blood product costs and to truly align ourselves as partners with the healthcare systems in our communities. Read Full Post >

04/10/2015

A Walk in the Park

A study published in JAMA Internal Medicine suggested we may have been fooling ourselves a bit about the value of moderate exercise. Among Australians who exercised at all, the ratio of vigorous to moderate activity was an important predictor of mortality. This was true regardless of the total amount of exercise. Vigorous activity was defined as activity “that made you breathe harder or puff and pant,” like jogging, cycling, aerobics, or competitive tennis (“Social” tennis and gentle swimming were examples of moderate activity.) Controlling for various demographic, dietary, and physical factors, the amount of overall activity was important in reducing mortality. That is no surprise. Read Full Post >

04/03/2015

How a Meeting Turned into an Event

Every March the ABC office is pulsing with energy. From early morning into the late evening, lots of synchronized teamwork takes place with every staff member playing a critical role, all to ensure the Annual Meeting runs without a hitch. This year was especially noteworthy; with several new features and announcements, we placed our focus on turning the meeting into an exceptional event. Read Full Post >

03/20/2015

Involvement = Opportunity = Success

I never would have thought that 47 years ago, when interning for a local Certified Public Accounting (CPA) firm that performed the annual audit for the Community Blood Center of Greater Kansas City, that I would end up with a 40-plus-year career in blood banking. This will be my last opportunity to write an article for Our Space as an ABC staff member, so I thought I would use this opportunity to reminisce and share with you how ABC (formerly the Council of Community Blood Centers) has been a major part of my career. Read Full Post >

03/13/2015

ABC Talks About Bugs in Platelets

Last fall, I said that a Food and Drug Administration Guidance on detection of bacteria in platelets was expected, and we got a draft in December. ABC’s Scientific, Medical, and Technical (SMT) group has spent the interval assembling comments on the guidance to submit to FDA. There is a strong sense that FDA’s approach in the draft is complex enough that the incentive of possibly extending platelet dating is inadequate to promote the critical intervention for sepsis mitigation, i.e. voluntary secondary bacterial testing with rapid assays or culture-based methods. ABC is asking that FDA reconsider and mandate the use of secondary testing in the transfusion service. Moreover, we propose simpler alternative strategies that would improve patient safety and allow extended platelet dating. For example, delaying primary culture until later in storage combined with the use of larger inocula in our culture systems will reduce the risk of bacterial contamination, while extending platelet storage to seven days without secondary testing. Such approaches are not perfect, but represent progress and would balance operational burdens and consumption of resources with a more flexible inventory. Going forward, we would be responsible for conducting surveillance to assess their impact and amending our approaches, when appropriate, based on the data. Read Full Post >

03/06/2015

What We’ve Done For You Lately

Hopefully you attended Wednesday’s webinar on the recommendations of the ABC Dues Task Force and heard directly from ABC CEO Christine Zambricki about how ABC is working to accomplish our strategic goals. In the next couple of weeks, all ABC member CEOs and member voting representatives will receive their 2014 Member Value Report. I encourage you to review it and share it with your blood center colleagues. Read Full Post >

02/27/2015

What About Fill Rate?

Effective patient blood management (PBM) is clearly an important principle in blood banking and, as part of any reasonable PBM approach, ensuring that we minimize waste is crucial to maintain credibility with our donors and control costs for our hospital customers. But blood product waste management does not equal PBM, and single-focused efforts on waste management could produce unintended (and unacceptable) consequences. In addition to the clinical aspects of PBM, I firmly believe any waste management initiative should have product “fill rate” as a crucial measure of success. If we do not include such a basic measure of performance in our studies and management strategies, we run the risk of cutting waste at the cost of reduced product availability. But how do we measure fill rate? How do we define it? Read Full Post >

02/20/2015

Checking Our Iron Will

“Just let me check your iron,” the nice phlebotomist says to the prospective blood donor as she reaches to do the fingerstick. If only!! We do not in fact check anyone’s iron level; we check hemoglobin. While iron is necessary to produce hemoglobin, there is no direct relationship between the two. Even donors meeting our hemoglobin standard will, especially with repeated donation, have reduced iron stores. Low iron stores have been associated with fatigue, mental changes, and decreased exercise capacity. Last week, the Newsletter highlighted the Hemoglobin and Iron Recovery Study (HEIRS), which provided direct evidence that giving donors iron pills can reduce the time until hemoglobin level and iron stores are replaced. Should blood centers act on this and give our donors iron? Read Full Post >

02/13/2015

No Experience Required

Are you the type of person who makes a to-do list? If so, I hope that the No. 1 item is your Capitol Hill visit on Tuesday, March 24, in conjunction with the ABC Annual Meeting. If you are like me, your to-do list needs specific boxes to check off. Here at ABC, we’ve taken the guess work out of your planning. Start early and you will be ready for this premier grassroots advocacy opportunity. Believe me, your members of Congress (MOC) will be delighted to meet with you, their constituent. Read Full Post >

02/06/2015

Pathogen Reduction & Platelets: Are We Inflating Our Balls Enough?

The Food and Drug Administration has approved a pathogen reduction (PR) process for platelets. For much of my career, this would have been as big a deal as finding the grail. But, in the weeks since, I have heard (a not unexpected chorus) telling me that “we” cannot afford it. There are two “we’s” in this opera. The first is the blood community, living with the realities of DRG (diagnosis related group) reimbursement and horrid pressures to cut our prices to hospitals. It will cost more than $50 per platelet dose, and we do not think we can pass it through. The second “we” is the hospitals. They may have higher safety priorities (consider healthcare-associated infections, medication errors, falls), and don’t think the main driver for platelet PR – bacterial contamination of platelets – merits the use of limited resources. I would have more sympathy for the latter argument if I believed dollars not spent to fix platelet sepsis would be diverted to the “larger” issues. Read Full Post >

01/30/2015

I Didn’t Know What I Didn’t Know

I’d like to tell you I entered the Army solely out of patriotism. The truth is, my father strongly suggested it because he thought I was lazy and undisciplined. As it turned out, it was an excellent experience and a strong sense of patriotism eventually followed. I often wondered if I would have developed a similar sense of responsibility without the rather abrupt culture change introduced by my basic training drill sergeant and nine years in the Army. In retrospect, I think my military service accelerated changes that would have occurred regardless as I matured. Then again, compared to my father, I’m still lazy and undisciplined. Read Full Post >

01/23/2015

Bring Back the Table

Is it time to bring back the big table for ABC Member Meetings? ABC’s history is rooted in a time when business was conducted with every ABC member CEO seated at a large rectangular table. The story goes that the table got bigger and bigger. Eventually a new leadership paradigm was necessary, and our current governance model with a board of directors was born. Read Full Post >

01/16/2015

Introducing the ABC Business Forum

By now, I hope you have had a chance to review the upcoming ABC Annual Meeting program. You will notice an interesting new addition to the program: “The ABC Business Forum: The Economics of Plasma,” on Saturday, March 21. This addition could not be timelier or more relevant. First, it complements the executive management and scientific and medical discussions in the Blood Center Leadership and SMT Forums by providing valuable information and education on the operations side of blood banking. Second, it ties in with ABC’s current advocacy agenda on the issue of plasma flexibility. Read Full Post >

01/09/2015

Vote Early and Vote Often

Brace yourself. Get ready … “ABC’s Got Talent” has arrived! Experience ABC supporters including CEOs, blood center employees, and even family members and friends of blood centers like you’ve never seen them before, all while raising money for a good cause. This week kicks off “ABC’s Got Talent,” a truly fun fundraiser. So, what do you need to do? Read Full Post >

12/19/2014

The Value of Blood

I’ve long been fascinated by cost accounting in blood bank operations. We often talk about the cost of producing a red cell unit. But is this the right way to think about our costs? I do not think so. Read Full Post >

12/12/2014

'Tis The Season

As the holidays approach, many begin to ponder which charitable organizations they would like to support. We hope that you consider the Foundation for America’s Blood Centers (FABC) in your charitable gift planning this year! 2014 has been an exciting year for both ABC and the FABC. Read Full Post >

12/05/2014

Washington Matters

The Food and Drug Administration is working with ABC and the blood community to promote the most efficient use of apheresis plasma from unpaid volunteer donors for further manufacturing into life-saving derivatives, according to Jay Epstein, MD, director of FDA’s Office of Blood Research and Review (OBRR) in the Center for Biologics Evaluation and Research (CBER). An ABC delegation including President Dave Green, President-Elect Susan Rossmann, MD, PhD, Chief Medical Officer Louis Katz, MD, and myself, met at the FDA White Oak campus yesterday with OBRR representatives to discuss these plasma requirements and other topics of interest to ABC members. In addition to Dr. Epstein, key members of the OBRR leadership team participated in the meeting. Read Full Post >

11/14/2014

Paving the Way for the ABC Professional Institute

Last week, members of the ABC Professional Institute (API) Curriculum Development Committee, and invited guests, gathered in the ABC office for a retreat to scope out and prioritize the services and products offered to members through the API, which is currently under development. Led by committee chair and facilitator, Michelle Johnson, from Carter BloodCare, the group spent a day sorting through the results of a recent membership survey about the API, and worked to identify the content of potential subjects and certificate programs that would be of value to ABC members. Read Full Post >