Archives for January 29, 2013

CDC Breaks Down Common Causes of Foodborne Illness

During 2009 and 2010, beef, dairy, fish, and poultry were associated with the largest number of foodborne disease outbreaks, according to the Centers for Disease Control (CDC) (Morbidity and Mortality Weekly Report, January 25, 2013). During the preceding 11 years, beef, fish, and poultry were consistently among the commodities most commonly associated with outbreaks. The large number of outbreaks caused by unpasteurized dairy products is consistent with findings that more outbreaks occur in states that permit the sale of unpasteurized dairy products. Sixty percent of states permit sales of raw milk in some form, according to a 2011 survey by the National Association of State Departments of Agriculture, the CDC commented.

According to the CDC, 675 foodborne disease outbreaks were reported in 2009 and 852 in 2010. Of the outbreaks with a single cause, norovirus was the most commonly reported, accounting for 42 percent of outbreaks. Salmonella was second, accounting for 30 percent of outbreaks. Among the 299 outbreaks attributed to a food composed of ingredients from mutually exclusive food commodities, those most often implicated were beef (13 percent), dairy (12 percent), fish (12 percent), and poultry (11 percent). The commodities in the 299 outbreaks associated with the most illnesses were eggs (27 percent of illnesses), beef (11 percent), and poultry (10 percent).

The reported outbreaks during 2009 and 2010 resulted in 29,444 cases of illness; 1,184 hospitalizations; and 23 deaths. Public health, regulatory, and food industry professionals can use this information when creating targeted control strategies along the farm-to-table continuum for specific agents, specific foods, and specific pairs of agents and foods. This information also supports efforts to promote safe food-handling practices among food workers and the public.

Among the 790 outbreaks with a single confirmed cause, bacteria caused 413 (52 percent) outbreaks, viruses caused 336 (42 percent), chemicals and toxins caused 39 (5 percent), and parasites caused 2 (0.2 percent). Salmonella was next, causing 234 (30 percent) of confirmed, single-etiology outbreaks and 7,039 (36 percent) illnesses. Among the 225 confirmed Salmonella outbreaks with a serotype reported, Enteritidis was the most common serotype with 76 outbreaks (34 percent). Shiga toxin–producing Escherichia coli (STEC) caused 58 confirmed, single-etiology outbreaks, of which 53 were caused by serogroup O157.

Thirty-eight multistate outbreaks were reported in 2009 and 2010. Twenty-one were caused by Salmonella, 15 by STEC (13 O157, one O145, and one O26), and two by Listeria. The causative agent was isolated from an implicated food in 11 multistate outbreaks. Five of the multistate outbreaks were caused by Salmonella (in alfalfa sprouts, ground turkey, shell eggs, and a frozen entrée). Six were caused by STEC (in ground beef, unpasteurized Gouda cheese, multiple unpasteurized cheeses, hazelnuts, and cookie dough).

Among the 766 outbreaks with a known single setting where food was consumed, 48 percent were caused by food consumed in a restaurant or deli, and 21 percent were caused by food consumed in a private home. Forty-three outbreaks resulted in product recalls. The recalled foods were ground beef (eight outbreaks), sprouts (seven), cheese and cheese-containing products (six), oysters (five), raw milk (three), eggs (three), and salami (ground pepper), bison, sirloin steak, unpasteurized apple cider, cookie dough, frozen mamey fruit, hazelnuts, Romaine lettuce, ground turkey burger, tuna steak, and a frozen entrée (one each).


Can KanCare Live Up to Its Promise?

On December 27, 2012, CMS approved KanCare, the mandatory managed care demonstration project proposed by Kansas Governor Sam Brownback (R). The premise behind KanCare is that the state will limit its costs by making capitated payments to managed care organizations (MCOs), who will improve health outcomes and make a profit without cutting eligibility, services, or payment rates.  Lt. Governor Jeff Colyer says the state will save at least $1 billion over the five years of the demonstration.

In prior posts, we have questioned such optimistic predictions. And so have others. The Kansas Health Institute (KHI) teamed up with Kansas Public Radio (KPR) to create a five-part series on KanCare and the state’s implementation of Medicaid managed care. Until recently, Medicaid managed care programs have focused on low-income families with children, not the elderly or people with disabilities. The overwhelming majority of Medicaid beneficiaries are children and low-income parents, but most of them have low needs for health care. On the other hand, according to KHI and KPR, the Medicaid payment for nursing home care is 10 times the average payment for children and families, and the costs for other individuals with disabilities can be even higher.

Proponents of KanCare say there is a potential for huge savings if people with chronic illnesses get preventative care, case management or other services that keep them out of the hospital. Carole Romm, a nurse who directs the quality and accountability programs at the Oregon Medicaid agency, told KHI about a woman with congestive heart failure whose breathing difficulties landed her in the hospital whenever the weather was hot. Her Medicaid MCO solved the problem by buying her an air conditioner—an expenditure that the state Medicaid program couldn’t have made. But Columbia Professor Michael Sharer told KHI that there is little evidence in the published literature that Medicaid MCOs save money. He said that studies with favorable results were paid for by the MCOs and, therefore, were likely to be less objective than those of academicians.

Some people, including advocates for beneficiaries, worry about the decisions a managed care company might make when it must answer to shareholders. And the problems implementing managed care in Kentucky don’t reassure them. In addition to the delayed and denied payments we’ve reported previously, there are continuing concerns about inadequate networks, especially in rural areas with few providers.  Both the state and CMS, which was recently added to the lawsuit between Coventry and Kentucky officials, appear to have learned from the Kentucky catastrophe.  The agency imposed several conditions on the KanCare waiver and denied or delayed some terms the state had requested. For example, the state agency must monitor the MCOs’ implementation of the care plans for beneficiaries receiving long-term care and must approve any reduction in services to these individuals. Cost savings in the long-term care program must be earmarked for expanding the number of slots available in home and community-based services (HCBS) waiver programs. The program must have an Ombudsman not affiliated with the MCOs or the Medicaid agency to address consumers’ concerns. Both the state agency and the MCOs are held accountable for achieving milestones. And Kansas will hold back $500 million of the contract payments, which the MCOs must earn by reaching its goals for savings and health outcomes.

Do you think these precautions will resolve the concerns of providers and beneficiaries’ advocates?