McCoy Faulkner collects $81 a day as a substitute teacher in the Wake County Public School System. A mere sub, he has no benefits.

The 62-year-old former Raleigh police officer shells out $580 a month for an individual insurance policy, more than half his monthly pay. The full-time teachers for whom Faulkner fills in, however, are eligible for free health insurance, with no monthly premiums, through their employer.

That's why Faulkner was looking forward to the Patient Protection and Affordable Care Act, figuring he was the kind of person that the health care reform law was designed to help. Under the new law, anyone who works 30 hours or more a week for a large business will be eligible for employer-sponsored health care.

But instead of adding subs like Faulkner to its health care plan, the school system is looking for ways to avoid doing so. Wake is considering restricting its 3,300-plus substitutes to working less than 30 hours a week, effective July 1.

The reason: If just a third of the system's subs were to qualify for employer-sponsored insurance, it would cost Wake schools about $5.2 million, chief business officer David Neter said.

"We'll have some difficult decisions to make," Neter said. "Something else would have to get cut. It's equivalent to 20 full-time teachers or 40 teaching assistants. That's how significant it is."

The system is among the many employers across the country seeking ways to dodge the higher health care expenses that will arrive in January as a result of the Affordable Care Act.

While many businesses are scaling back work hours to keep part-timers out of the company insurance plan, others are not hiring so as not to cross the 50-employee definition for large employers -- the federal threshold for having to insure full-time employees. Still other businesses are mulling the option of scotching company health coverage altogether and paying a federal fine instead.

The calculations often come down to counting full-time versus part-time workers, adjustments driven by legal definitions in the new law, said Brydon DeWitt, a lawyer at the Williams Mullen firm who advises businesses on the health care law.

DeWitt predicts some businesses will restructure themselves to employ mostly, or only, part-timers.

"They will have to monitor work hours like a hawk," DeWitt said. " 'That person cannot work another hour this week because we can't have him exceeding the threshold.' "

Faulkner, who lives in Wake Forest, said the response of Wake schools is frustrating for many reasons. Some subs had hoped to qualify for the system's premium insurance plan. Others, however, already have insurance through spouses and simply want to put in a full week's work.

"I never expected the Wake County Public School System to circumvent the intent of the law," Faulkner said. "The biggest complaint I hear is from people who don't need the insurance but will be limited in the amount of time they can work."

The new law

The federal law is intended to reduce the numbers of uninsured by making health coverage more affordable for those who had been shut out of the health care system. The law prohibits long-accepted insurance practices, such as denying coverage for pre-existing conditions, charging more to insure women and significantly marking up premiums for older people.

It also makes insurance mandatory, with fines for individuals and companies for failing to comply.

It's expected that some will opt for the fines. Nancy Adams, owner of Piggly Wiggly grocery stores in Sanford and in Broadway, said that's one option under consideration for her business. The $2,000-per-worker fine would apply to just five full-time employees at the two Piggly Wiggly stores, amounting to $10,000 a year, she said, because the law exempts the first 30 workers from the fine.

Adams said the company would save considerably and likely give workers a $2-an-hour pay raise to help them buy individual policies on a health care exchange. Such exchanges, created by the Affordable Care Act, are designed for those who buy coverage on their own.

Adams' grocery business has 86 employees and currently provides insurance to 31 of them at a cost of about $120,000 a year. Insuring all those who work at least 30 hours would raise the cost to about $165,000, she said.

"We don't have the pockets to pay an extra $45,000 for health insurance," Adams said. "It's huge."

Work schedules

Employees who work just over 30 hours are most vulnerable to a reduction in work time, according to an analysis of labor data done in February by the University of California Berkeley's Labor Center. The jobs most affected span the economic spectrum: restaurants, nursing homes, health care, retail, education and building services.

In April, 9.9 million U.S. workers logged 30 to 34 hours a week, according to the U.S. Bureau of Labors Statistics.

The most recent figures from North Carolina, from 2011, show 291,000 workers -- or 7.3 percent of the state's labor force -- working 30 to 34 hours.

Some are self-employed, and others work for small businesses that are exempt from the Affordable Care Act's insurance mandate. But many are classified as full-timers at large companies and fall into the category of those who are likely to have their schedules reduced.

One of those is Susanne Brown, 42, a stay-at-home-mom who lives in Wake Forest and has been subbing in Wake schools for the past four years.

Brown typically works three days a week, well below the 30-hour trigger point. But she said on occasion she has worked a five-day week or several weeks in a row to fill in for a teacher on leave, an option that would no longer be open to her if Wake elects to limit substitute hours.

"That would be disappointing," Brown said. "It would be disappointing for the teacher -- they like the consistency as well."

Buying coverage

Those who can't buy insurance through work will have a backup option: buying coverage through a health exchange. The Affordable Care Act even includes federal subsidies for people at certain income levels to offset insurance costs. The subsidies are available to individuals making as much as $45,960 a year, and for a family of four making as much as $94,200 a year -- well within range for substitute teachers and Piggly Wiggly clerks.

Nearly 900,000 North Carolinians are eligible for these subsidies, according to a recent report issued by the N.C. Institute of Medicine, a nonpartisan research organization in Morrisville.

Health exchange details are not out yet, so Faulkner doesn't know how that option will compare to the Wake schools plan, but he doubts the exchanges will be able to compete with the county's health plan.

"People who need the benefits won't be able to get in," Faulkner said. "They were hoping they would be able to have insurance, which is what the law was designed to do."

(c)2013 The News & Observer (Raleigh, N.C.)

Despite reported cuts in reimbursements, the average physician enjoyed a moderate-to-significant boost in income this year. But that came at a price. Namely, docs are spending way more time on paperwork, thinking more about ACOs and stressing about the future of reimbursement.

According to Medscape’s 2013 Physician Compensation Report, the actual number of patients that physicians are see per day doesn’t appear to be going up. Nor do doctors seem to be spending less time with patients; more than half report spending 13-20 minutes with each patient. But, more of that time likely includes typing data into a computer: In 2012, more than half of physicians said they spent less than five hours per week on paperwork, which includes working with electronic medical records. This year, more than half said they spend 5-14 hours per week.

The online survey conducted in February reached 21,878 U.S. physicians across 25 specialties and demonstrates some other ways that healthcare reform has impacted physicians’ jobs and attitudes. For example, the influx of hospital M&A seems to be making it harder for independent physicians to compete: In last year’s report, solo physicians earned an average of $220,000 – more than employed physicians. This year, however, their average salary dropped to $216,000, whereas employed physicians’ average salaries rose.

Specialists in orthopedics, cardiology and radiology were the top three earners again this year, all with average salaries well above $300,000. But they also saw more patients — 27 percent of orthopedic specialists said they saw patients for more than 50 hours a week, compared to 18 percent across all respondents.

Some other interesting points from the report:

• Career satisfaction rates were steady compared to last year, when a little more than half of doctors said they would choose the same career if they could do it over. But that’s coming off of a huge drop from the 2011 survey, in which two-thirds said they would.
• The percentage of physicians who feel they are fairly compensated has slowly dropped over the past two years, from 53 percent in 2011 to 48 percent this year.
• Orthopedic surgeons saw the biggest spike in pay, experiencing an average 27 percent increase, potentially due to more elective procedures in aging adults as the economy continues to recover.
• Oncologists and endocrinologists were the only specialists whose average salaries dropped.
• Last year, less than 10 percent of physicians were involved in an ACO or planned to be within a year. This year, nearly one in four said they were either in an ACO or plan to be in one within the coming year.
• Medicare reimbursement is a huge questions mark. Nearly 30 percent of physicians said they haven’t yet decided whether they will continue to accept Medicare patients. Nine percent said they plan to stop taking new Medicare patients, but will continue caring for current ones. Two percent said they won’t even treat current Medicare patients.
• On that same note, nearly one in four physician plans to drop lowest-paying insurers
• To create more opportunities for income, nearly 1 in 5 respondents has begun offering ancillary services
• About two-thirds of physicians said they regularly or occasionally discuss the cost of treatment with patients, compared with 84 percent last year. But that’s not necessarily bad. As physicians become employed, those costs may be discussed by other staff members.

[Medical bag photo from BigStock Photos; graph from Medscape]

How many nurses does it take to run a hospital?

Legislatures in at least seven states and the District of Columbia are trying to answer that question as they debate bills that would require hospitals to have a minimum number of nurses on staff at all times.

So far, only one state has such a law. California's state legislature passed a minimum nurse staffing law in 1999. Since then, similar nurse staffing laws have failed in every other state where they were proposed. But the nursing unions backing the bills have grown increasingly powerful in statehouses across the country.

Hospital administrators are vehemently opposed. They argue the bills would strip them of their ability to make basic staffing decisions and be a financial burden. Many nurses and nursing unions say legislation is needed to prevent cost-conscious hospitals from endangering patients by putting too large of a workload on too few nurses.

"Hospitals right now are run like businesses and they're focused on the short-term bottom line," said Jeff Breslin, president of the Michigan Nurses Association, a union backing a minimum staffing bill in the Michigan legislature. If the bill becomes law, he said, "it doesn't matter what part of the state you're in, you can be assured you’re going to have adequate nursing care whatever place you're going into."

Lawmakers in D.C., New York, Texas, Florida, New Jersey, Iowa and Minnesota are also considering legislation. While the language differs across the states, at the heart of all these bills is a minimum nurse-to-patient ratio -- a fixed number of nurses per patient.

The bills call for a different ratio in different parts of a hospital. For example, the proposed law in Michigan would require hospitals to maintain a one-to-one ratio -- no less than one nurse for every patient -- in all operating rooms across the state. In pediatric units, that ratio can go as high as one nurse for every four patients. 

A 2004 survey of research conducted by the U.S. Agency for Healthcare Research and Quality found that patients at hospitals with low nurse-to-patient ratios fare worse than those at hospitals with higher ratios. But nursing and hospital advocates say there is scant research on what the ideal ratios should be, and there are conflicting studies about whether mandating a ratio by law ultimately improves patients' health, according to hospital and nurses' groups.

"We're trying to create a standard where hospitals will be required to have adequate staffing levels," said Dawn Kettinger, a spokesperson with the MNA. "It would be great if hospitals did this on their own, but unfortunately they're not doing that."

Joyce Young, a nursing administrator with St. Joseph Mercy Health System in the Detroit area, said many hospitals are, in fact, creating minimum staffing levels on their own, especially now that they’re penalized for certain negative patient outcomes under the federal health law.

"Hospital nursing leaders are in positions such that they can be able to determine staffing levels," Young said. It shouldn't be "based upon a legislator who mandates a number. It should be left to the nurses."

The California Experiment

Today, only California requires all of its hospitals to maintain a minimum nurse-to-patient ratio. If a hospital sees a surge of patients due to something unexpected, like a car crash or an outbreak, it still must meet the minimum ratio. The only time a hospital can go under the minimum ratio is during what the statute calls a "healthcare emergency."

Jolee Cochran, a registered oncology nurse who has been working at Cedars-Sinai Medical Center in Los Angeles for 26 years, said the law has made her job more manageable. Before, she said, it wasn't uncommon for a nurse to be responsible for seven patients at a time. Now, it would be a violation of the law for her to have more than five patients under her care.

Cochran said patients in her hospital are much sicker than they used to be and require much more complex care. "I can't imagine having more than five patients with one nurse, with the type of patients we have now," she said.

But she also said the law has made scheduling shifts more challenging. Because the staffing ratios in California apply at all times, if a nurse goes on a break, "there has to be someone there to cover you," Cochran said. "By law, you can't fudge that or else you get fined."

Jan Emerson-Shea, vice president of the California Hospital Association, said hospitals in her state have slowly learned to live with the law. She said many hospitals had to rely on temporary nurses for the first few years, but ultimately the hospitals didn't suffer financially "to any significant degree." 

"We don't fight this issue now," Emerson-Shea said. "It's the law of the state. … It's over. It's done."

Victory, Then Defeats

What was a major victory for nurses in the Golden State 14 years ago has been followed by a string of defeats elsewhere. "Hospitals go to holy war to prevent it," said Chuck Idelson, a spokesman for National Nurses United, a 185,000-member labor union founded four years ago in California.

NNU is the primary backer of the staffing ratio bills currently working their way through various state capitols. However, not all nurses back the union's legislative push.

The American Nurses Association, a professional trade group that advocates on behalf of both unionized and non-unionized nurses, opposes staffing ratio bills. Janet Haebler, the association's director of state government affairs, said she doesn't expect any others will pass this year. 

Haebler said understaffing is a major problem, but that calcifying a nurse-to-patient ratio into law isn't the right way to solve it. The association instead favors laws that require hospitals to set up committees made up of nurses and administrators that work together to create staffing plans.

"We're respectful of all approaches as long as nurses have input," she said. "In California, there's no input. It's just … 'This is what it will be at all times.'"

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Madison's new cluster of health care technology companies is coming into its own.

With at least five local businesses started by former Epic Systems Corp. employees that have created about 400 jobs in the past three years as well as other companies without Epic ties, a Madison health tech meetup group has been formed. The group has nearly 150 participants, organizer Jonathan Baran said.

"The premise is: How do we turn Madison into 'the' place to be for people looking to innovate in health care IT?" he said.

Baran, who's not from Epic, is co-founder of HealthFinch, which makes productivity applications for physicians. The two-year-old company has six full-time and three part-time employees.

The Madison area already has health care companies such as Epic; several hospitals; GE Healthcare; data analytics company Forward Health Group; and promising medical device companies such as Asthmapolis, said Baran, who was born in Appleton and grew up near Cincinnati.

Madison may not be able to become another Silicon Valley, Baran said. "But what we could be really good at is health care IT. And one of the reasons is Epic."

Leaders of the meetup group have a "grand vision," Baran said, with two main goals:

--Create a space where health care IT companies can set up shop together, preferably Downtown.

--Organize a summit to showcase local companies to potential investors and customers.

The president of St. Mary's Hospital, Dr. Frank Byrne, said he's excited about the innovative ideas the young entrepreneurs are bringing to the industry.

"I love the vibrancy that these bright folks ... bring to our community in general and bring to health care," Byrne said. "We have an obligation as a community to create an environment here where dreams can come true." ___

Mark Zuckerberg: Billionaire, social network tycoon, and now, activist.

Last week the San Francisco Chronicle reported that the Facebook CEO was planning his own advocacy group, and now a new report from Politco says the group is getting it own lobbyists: big shot firms Peck, Madigan, Jones & Stewart and Fierce, Isakowitz & Blalock. 

While we don’t know many details about Zuckerberg’s group (like its name, for instance), the selection of the two firms — and their lead lobbyists – meshes well with one the main issues the group will focus on: immigration, which has become a major issue for tech companies.

Zuckerberg’s interest in immigration is unsurprising. After all, making it easier for people to enter and work in the United States would certainly give tech companies like Facebook access to more bright minds.

So while immigration in the United States has as of late been focused on our southern border, Zuckerberg’s interests are much larger — and potentially hugely beneficial to Facebook.

This article originally appeared on VentureBeat

A surprising number of the nation's neonatal intensive care units (NICUs) have too few nurses, a new study by researchers from the University of Pennsylvania and the University of Medicine and Dentistry of New Jersey (UMDNJ) has found.

Infants in understaffed units were more likely to get infections, which decrease the chance that these fragile babies will survive, the study also found. Infections also increase costs. An added wrinkle is that Medicaid, which pays for the care of 42 percent of preterm and low-birth-weight infants, no longer reimburses hospitals for expenses associated with infections acquired in the facility.

Eileen Lake, an associate professor of nursing and health policy at Penn, said most infections -- staph bacteria are the most common culprit -- stem from the tiny catheters that give these immature bodies fluids, nutrition, and medicine. She suspects that overworked nurses may have less time to devote to catheter hygiene. The babies, she said, "are a uniquely vulnerable group."

The study, published last week in JAMA Pediatrics, looked at staffing in 560 of the nation's 900 NICUs in 2008 and 2009.

The group included a disproportionate number of magnet hospitals for nursing. That designation certifies that those hospitals provide high- quality nursing care, but it does not consider staffing ratios, said Lake, a coauthor. The research team compared staffing levels to those recommended by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Association of Women's Health Obstetric and Neonatal Nurses. These are guidelines, not regulation or law. Lake said some hospitals might have had trouble interpreting the guidelines. Her inter- disciplinary team, she said, has created clearer definitions for what kind of patient needs a particular level of staffing.

The study found that NICUs were understaffed for 32 percent of their patients. Staffing was inadequate for 68 percent of high-acuity infants, or the sickest 8 percent.

Lake said an average NICU in the study had 30 beds. While the standards would have called for 15 nurses per shift, the average was 12.

The infection rate in NICUs that had proper staffing was 9 percent. It was closer to 20 percent for hospitals in the bottom 10 percent for staffing. Those hospitals, Lake said, would have had about nine nurses for 30 babies.

"There is a definite need for NICUs to assess their compliance with guidelines," said Jeannette Rogowski, a health economist at UMDNJ and lead author of the study.

Hospitals, Lake said, now "have an opportunity to evaluate what their staffing is and decide whether they want to staff differently."

--

Contact Stacey Burling

at 215-854-4944 or sburling@phillynews.com. ___

Actavis, a global pharmaceutical company formerly known as Watson Pharmaceuticals that had nearly $6 million in revenues last year, plans to expand its pharmaceutical manufacturing plant and warehouse in Davie, creating 220 jobs, the Governor's Office and Greater Fort Lauderdale Alliance announced Thursday.

The expansion is another step toward Broward County developing its medical manufacturing sector, part of a burgeoning life sciences industry in South Florida.

Companies like Acatvis are expanding in Broward because it offers the "perfect mix of talent, cultural diversity in the workforce and consumers," said David Coddington, vice president for development with the Alliance. He said South Florida offers an aging and diverse population, which is attractive to pharmaceutical research and development firms.

Broward already has Mako Surgical Corp., a medical device manufacturer in Davie, and Nipro Diagnostics, a diabetic-testing product company in Fort Lauderdale. ECI Pharmaceuticals in Fort Lauderdale is expanding and the owner brought BioRamo, a specialty pharmaceutical firm from Texas. Two other manufacturers are considering locations in Coral Springs and Tamarac, according to the Alliance.

The Parsippany, N.J.-based company, which makes FDA-approved drugs in tablet and capsule form, will build a 30,000-square-foot addition with about 16,700 square feet of pharmaceutical manufacturing space and 13,000 square feet of warehouse space, according to the Alliance.

Actavis brands include products ranging from male testosterone replacement to treatment for an overactive bladder. The company also makes generics of drugs including Lipitor, Plavix, Nicorette, Percocet and many others.

The jobs will be technical manufacturing and warehouse jobs paying an average of $56,000 a year, which is above Broward's average wage, the Alliance said.

The company will invest about $40.5 million at the Davie site. Construction is slated to begin in the third quarter of 2013, with completion expected in one year.

Actavis already has packaging and distribution functions in Sunrise and pharmaceutical research and development operations in Weston. Its Anda Inc. division, the fourth largest distributor of pharmaceuticals in the U.S., also is located in Weston.

The company currently employs about 1,400 people in Florida, Actavis president and CEP Paul Bisaro said in a statement.

Based on meeting its performance goals, Actavis will receive $690,000 in funds from the Governor's discretionary Quick Closing Fund as well as $1.1 million in job-creation incentives, which is $3,000 per job created. The Town of Davie is contributing $440,000 and the company is eligible for $584,500 in training grants.

The jobs, which won't be available until late 2014, will be posted on the company's website, actavis.com.

The company considered expansion at its other plants across the globe, including California and New Jersey, before deciding on Davie, said spokesman Charlie Mayr. The expanded plant will allow Actavis to increase its volume of production and do additional research and development for new products, he said.

Watson Pharmaceuticals acquired Actavis Group in October 2012 and changed the corporate name to Actavis. The company has operations in more than 60 countries. Actavis reported $5.9 billion in revenues for 2012, a 29 percent increase over the prior year.

Actavis is a publicly held company whose stock is traded on the New York Stock Exchange. Its stock closed at $90.12, up 26 cents Thursday.

mpounds@tribune.com or 561-243-6650 ___

Alexander Heydemann and Dillon Bannis, both University of Miami students -- Heydemann in law school, Bannis in medical -- are learning fast about each other's worlds.

"As a medical student and future physician, a lot of time we get stuck in our own worlds, writing notes for ourselves and our colleagues. My time here, at the medical-legal partnership, has helped me see that the documentation I put into place has overarching reaches further than just the hospital," Bannis says in a video presented by the school to detail its health/law Pathways program.

Pathways, which immerses students in both curricula, will lead to a dual medical-law degree program UM plans to offer in the fall. The pathways program is "a four-year longitudinal experience for medical students in law," explains Jonel Newman, a clinical professor and director of the Health and Elder Law Clinic at the University of Miami. Medical and law students travel to the downtown Miami medical campus and Coral Gables campus to enmesh themselves in the study of both disciplines.

UM's Miller School of Medicine and School of Law will then offer a joint M.D. and J.D. degree program that can be completed in six years, which shaves off a year's time -- and tuition -- had the participants pursued each degree separately. Medical students who enroll in the joint program and also pass the Law School Admission test will begin the law school portion of their studies in the fall.

The rigorous dual program is designed to prepare students for careers in health sector law, leadership and policy, or to give tools to physicians who might wish to run a private medical or group practice.

"Many doctors graduate from medical school with not really being equipped to start their own practice to deal with and understand the billing, the insurance, some of the legal aspects. Other legal aspects of great interest to the medical field include bioethics, ethical decision making and exposure to health-related legal needs," Newman said.

Heydemann, the budding attorney, has already seen the collaboration pay off -- both personally and for the public he will one day serve regularly.

"I was real excited to get hands-on experience. The clinics at the law school offer a great opportunity to get great mentorship and experience early on," Heydemann said. "One client was struggling with severe medical impairments and poverty, and I had to work closely with him to get to know his personal background and his story and hoped to finally get to the stage where he could become a legal permanent resident. That was rewarding and demanding at the very same time."

Bannis recounts a similar experience.

"I met one of the patients one of the law students was working on and had the opportunity to tag along and add a little bit of my insight into the patient's case. This gentleman was a veteran who had served his country in the Korean War and I helped him get benefits at the end and it was very rewarding," Bannis said.

Traditionally, medical degrees provide entree to hospitals, urgent care centers and doctor's offices while a law degree is the key to a courtroom, boardroom or local or federal government dais where policies are set and debated. But the two fields frequently intersect and overlap, to the point that medical and law schools will need to partner to offer such dual degree programs to train the next generation of medical and legal students so that they will have the skills to navigate the complex hallways of contemporary healthcare.

The Pathways immersion program, in place now with about seven students taking part, helps students determine if this dual role makes sense for them.

"One of the things the health pathway does is it helps lawyers and doctors break down the barriers between the two professions," said Melissa Swain, Associate Director and Clinical Instructor, Health & Elder Law Clinic. "When they find out they have to work together one has a black jacket, one has a white jacket and they don't want to talk to each other. By the end of the session, they are starting to work with each other and figuring out the different roles in their different professions and can work together on a case and tap into the strengths of both professions and make the case work better than if they were separate."

Law students go weekly to Jackson Memorial Hospital or the Miami VA Healthcare System or University of Miami Hospital to see doctors in action, for example. "It's a different setting than sitting in a law office," Swain said. "They see the difference. Doctors running around all day, they don't have office secretarial help. The doctor comes into the law office and, wow, it's so quiet. They get to work in each others' setting."

Indeed, said Bannis. "Working at Jackson, we have patients with multiple legal as well as medical and surgical issues. My time at the medical school taught me to deal with medical surgical issues but didn't do that good a job at teaching me legal issues. This helps in making these issues more tangible and we are able to attack those issues in comprehensive fashion."

The coming UM dual program has its origins at Arizona State University under the direction of Dean Patricia White, who is now Dean of UM's Law School. She is working on the program's launch with law school colleague Sandy Abraham and Doctors Mark O'Connell and Alex J. Mechaber.

Last March, White and Mechaber, senior associate dean for undergraduate medical education and associate professor of medicine, hosted a session at the Miller School to detail the program for interested students. The pair drew more than 20 students, Swain said.

Call them the super achievers.

"There's been tremendous interest and we can gauge that interest based on the health way pathway we're offering," Swain said.

"The students have impressed us as extraordinarily motivated and engaged, bright and analytical," Newman added.

In a statement, White reflected on the complexity of the dual program. "It would take a certain kind of person who would be able to undertake the intensity to have this done in six years," she said. "But it also creates an extraordinarily well-educated person who would have an amazing complement of talent and would be able to do any number of things." ___

Its U.S. operations will shed 650 jobs. Although Wilmington, Delaware, will remain its U.S. headquarters with 2,000 staff, about 170 will be relocated to other AstraZeneca sites in the U.S. and overseas. Gaithersburg is home to MedImmune, an AstraZeneca subsidiary acquired in 2007. It will see a net gain of 300 roles.

It will focus R&D operations across three sites: Gaithersburg, Cambridge and Mölndal, Sweden, near Gothenburg. Gaithersburg will house many of the company’s U.S.-based global medicines development activities for small and large molecules. The company is also shifting some of its global marketing and U.S. specialty care commercial functions to its offices there. Boston will also continue to support R&D for AstraZeneca with a focus on small molecules.

The pharmaceutical company said shifting its R&D sites to “bioscience hot spots” will make it easier to develop collaboration and partnership agreements. It will also help teams work more closely “to create a more vibrant environment” that puts more emphasis on science and patients. The changes will also “simplify the company’s footprint” and scale back and cut unnecessary costs.

The company expects the changes to result in a onetime $1.4 billion restructuring charge, but it sees annualized benefits of $190 million by 2016. Pharmalot noted that it marks the second significant overhaul for AstraZeneca in less than three months. In January, the company said Martin Mackay, its president of research and development was leaving as well as Tony Zook, its executive vice president for global commercial activities. At the time it said it was creating a new executive role that would bridge R&D and sales responsibilities, and adding new R&D roles.

The move by AstraZeneca reflects the pressure a lot of pharmaceuticals are feeling to cut costs and simultaneously inject more innovation into their businesses, with academic partnerships and collaborations offering one way to achieve that (here, here and here).  Gaithersburg, for example, is home to several research laboratories and biotech companies, and sits just outside Baltimore, home to Johns Hopkins University, with its extensive health and medical research facilities.

A start-up company formed by the founder of a Milwaukee-area drug ingredient maker is proposing to build a pharmaceutical research-and-development facility in Mequon, creating 50 jobs.

Major Pharmaceuticals LLC wants to develop a two-story, 79,000-square-foot facility on a 7.7-acre parcel immediately south of Executive Drive and east of Commerce St., according to a filing with the city Plan Commission. That site is in Mequon Business Park, near the northeast corner of W. Donges Bay and N. Wauwatosa roads.

The company, which will produce injectable serums, expects to complete the $10 million office and laboratory by late 2013, the filing said.

Major Pharmaceuticals will have an estimated 50 full-time employees, including 10 chemists and pharmacists, 15 lab quality-assurance technicians and 25 process operators. The commission was to review the proposal at its Monday night meeting.

The company was launched by Michael Major, according to state corporation records.

Major is the founder of Cambridge Major Laboratories Inc., a Germantown supplier of active pharmaceutical ingredients to the biotech and pharmaceutical industries.

In 2011, he announced his retirement as Cambridge Major's chief executive officer but said he would remain as the company's nonexecutive chairman and scientific adviser.

Major made the corporate filing for his new company on Dec. 28, according to state records.

That was one day after Cambridge Major said its majority owner, Arlington Capital Partners, had sold its entire stake in the firm to another private-equity partner, American Capital Ltd. of Bethesda, Md. ___

The Ohio Hospital Association and social media agency Mindset Digital conducted an email survey among OHA-member organizations last fall. Of the 84 hospitals that responded, only 15 percent said they had full-time personnel to manage their social media channels, and those tended to be large health systems. The Cleveland Clinic, for one, last year made some of its part-time social media staff full time. But most of the people doing this job at other hospitals are full-time employees with other duties. Six percent of hospitals said their social media manager was an intern and 4 percent said it was a part-time employee.

But is that necessarily a bad thing? Having multiple people within an organization working part time on social media might even be a good strategy for ensuring that it’s delivering a variety of fresh, interesting content across multiple channels.

It also doesn’t mean they aren’t focusing serious time and effort on building social repertoires. According to OHA and Mindset Digital’s report, A Healthy Dose of Social Media (PDF), about half of the hospitals surveyed said they are devoting more time and staff toward social media efforts in 2013.

As for the other half? Most said their efforts will be about the same. Only 2 percent said they were devoting less time or fewer staff. And unanimously these hospitals agreed that they would spend at least as much money, if not more, on social media efforts.

Most of that effort is going toward Facebook, which still remains hospitals’ top priority for social media, followed by Twitter, YouTube and LinkedIn. Despite its popularity among consumers in general, Pinterest isn’t of particular interest here: 71 percent of the Ohio hospitals surveyed said it was not a priority. That makes sense given that the hospitals reported their top priorities with social media as building community relationships, sharing hospital news and building a local reputation.

The infographic below summarizes the survey results. Or you can check out the whole report here.

Merck (NYSE: MRK), known as MSD outside the United States and Canada, today announced the appointment of Roger M. Perlmutter, M.D., Ph.D., as executive vice president and president of Merck Research Laboratories (MRL), effective April 15. Dr. Perlmutter will succeed Peter S. Kim, Ph.D., who has served in the role since 2003. To ensure a seamless transition, Dr. Perlmutter and Dr. Kim will work closely together for an initial period, after which Dr. Kim will remain with the company as an advisor until his retirement in August.

“Roger is a world-class physician-scientist with a proven track record of leading large research organizations and delivering a broad and diverse pipeline of medicines,” said Kenneth C. Frazier, chairman and chief executive officer, Merck. “With his deep knowledge of the ongoing changes in the industry's external environment and their implications for how we use R&D resources, Roger is ideally suited to lead Merck's global research and development. I am confident that under Roger's leadership, Merck will continue to build upon our legacy of translating cutting edge science into medically important products that make a difference for patients.”

Dr. Perlmutter was executive vice president and head of R&D at Amgen Inc. from January 2001 to February 2012. During his tenure, Dr. Perlmutter oversaw the development and subsequent approval of a number of novel biologic and small molecule medicines in the areas of cancer, endocrinology, hematology, inflammation and osteoporosis. Prior to joining Amgen, he was executive vice president of worldwide basic research and preclinical development at Merck. He joined Merck as a senior vice president in February 1997.

Before assuming leadership roles in industry, Dr. Perlmutter was a professor in the Departments of Immunology, Biochemistry and Medicine at the University of Washington, where he also served as chairman of the Department of Immunology and was a Howard Hughes Medical Institute investigator. He is a Fellow of the American Academy of Arts and Sciences and an elected Fellow of the American Association for the Advancement of Science. Dr. Perlmutter graduated from Reed College in 1973 and received his M.D. and Ph.D. degrees from Washington

“I am honored to have the opportunity to return to Merck and to lead MRL,” said Dr. Perlmutter. “Throughout my career, as both a physician and a scientist, I have drawn inspiration from Merck's unwavering commitment to scientific excellence. Over time, this commitment has brought forth an unparalleled number of breakthrough medicines and vaccines that improve the lives of patients around the world.”

Mr. Frazier also reiterated Merck's commitment to delivering growth through innovation. “Merck continues to focus on increasing the productivity of our R&D investments to create value for patients, customers and shareholders,” said Frazier. “Under Roger's leadership, we will continue to build and expand in key therapeutic areas, advance our promising late-stage candidates and bring forth new therapeutic candidates that will fuel our future pipeline.”

Dr. Kim joined MRL as executive vice president, Research and Development in 2001 and was appointed president of MRL in 2003. Prior to joining Merck, he served as a professor of biology at Massachusetts Institute of Technology and was also a member of the Whitehead Institute and a Howard Hughes Medical Institute investigator. While at Merck, Dr. Kim served as a member of the Council of the Institute of Medicine of the National Academy of Sciences, a member of the Board of Directors of the Whitehead Institute for Biomedical Research and as a member of the Council of the Global HIV Vaccine Enterprise.

During Dr. Kim's tenure, Merck gained approval of more than 20 new medicines and vaccines that have sustained the company's growth and significantly improved global health. These include JANUVIA (sitagliptin), the first DPP-4 inhibitor for type 2 diabetes; GARDASIL [Human Papillomavirus Quadrivalent (Types 6, 11, 16 and 18) Vaccine, Recombinant], the first vaccine for prevention of cervical cancer; ISENTRESS (raltegravir), the first HIV integrase inhibitor; ZOSTAVAX (zoster vaccine live), the first herpes zoster vaccine for the prevention of shingles in adults; RotaTeq (Rotavirus Vaccine, Live, Oral, Pentavalent), an oral vaccine for the prevention of rotavirus infection in infants; and VICTRELIS (boceprevir), the first oral hepatitis C protease inhibitor. As of Feb. 22, 2013, Merck has 38 candidates in late-stage clinical development (Phase II and III).

“Peter has helped sustain Merck's commitment to outstanding science and innovation during a period of enormous change for our company and our industry,” said Frazier. “His contributions have positioned us well for future success. Over the past decade, Peter led MRL through an immense transition in pharmaceutical research and development, oversaw important advances in our use of new technologies, began leveraging external innovation and led the creation of an integrated, industry-leading pipeline following our merger with Schering-Plough.”

“I am deeply grateful to the incredibly talented and dedicated people of MRL who have worked with me over the past 12 years on our mission of delivering medicines and vaccines to improve human health around the world,” said Kim. “I am very pleased with Roger's appointment and confident that he is the right person to lead MRL into the future, and am committed to ensuring a seamless leadership transition for this truly special organization and its great people.”

About Merck

Today's Merck is a global healthcare leader working to help the world be well. Merck is known as MSD outside the United States and Canada. Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programs and partnerships. For more information, visit www.merck.com and connect with us on Twitter, Facebook and YouTube.

Forward-Looking Statement

This news release includes “forward-looking statements” within the meaning of the safe harbor provisions of the United States Private Securities Litigation Reform Act of 1995. These statements are based upon the current beliefs and expectations of Merck's management and are subject to significant risks and uncertainties. If underlying assumptions prove inaccurate or risks or uncertainties materialize, actual results may differ materially from those set forth in the forward-looking statements.

Risks and uncertainties include but are not limited to, general industry conditions and competition; general economic factors, including interest rate and currency exchange rate fluctuations; the impact of pharmaceutical industry regulation and health care legislation in the United States and internationally; global trends toward health care cost containment; technological advances, new products and patents attained by competitors; challenges inherent in new product development, including obtaining regulatory approval; Merck's ability to accurately predict future market conditions; manufacturing difficulties or delays; financial instability of international economies and sovereign risk; dependence on the effectiveness of Merck's patents and other protections for innovative products; and the exposure to litigation, including patent litigation, and/or regulatory actions.

Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in Merck's 2012 Annual Report on Form 10-K and the company's other filings with the Securities and Exchange Commission (SEC) available at the SEC's Internet site (www.sec.gov).

(c) 2013 Benzinga.com. Benzinga does not provide investment advice. All rights reserved.

"This will be my last year as Roche chairman," Humer, 66, told shareholders gathered in Basel for the company's annual general meeting.

"Roche is in excellent shape and well positioned to meet future challenges. This is a good time to hand over to a successor. I am looking forward to the next 12 months, and I intend to perform my duties as Chairman with enthusiasm and drive."

In January, Daniel Vasella, chairman of cross-town rival Novartis said he was stepping down as chairman.

(Reporting by Caroline Copley, editing by Emma Thomasson)

TEKsystems Healthcare Services Vice President Allen Kriete told MedCity News that the average health care IT professional is getting 26 job inquiry calls per week. “There is a shortage — real and perceived — in finding the right people.” Perceived? Kriete says part of the problem is that hospitals need to do a better job of selling themselves and enticing health care IT professionals to work for them.

Certified middle management training staff who can show clinicians how to use electronic medical records are much sought after.

There’s also a need for troubleshooters who can overcome the challenges of implementing technology. Rich Miller, senior vice president for Information Technology and talent strategies at health care professional recruiter B.E. Smith, told MedCity News that the adoption and utilization of health care IT systems was the focus right now for care providers and hospital staff and training is one element of that. “Hospital clients and individuals I speak to understand that just deploying technology is not enough. The only way to derive value from the technology is to gain acceptance from the clinicians.”

Various software suppliers have certification award to individuals to be certified trainers. Providers can decide whether it makes more sense for them to purchase those services or hire someone to do that.

Kriete said hospitals need to get better organized to hire healthcare IT staff they need so they can ensure staff are adequately trained before they begin using it. “A lot of hospitals are waiting too long in the process to get curriculum builders on staff,” Kriete said. It’s not like this problem has materialized overnight. Back in 2009, there were projections of a shortfall of 50,000 healthcare IT staff and that was thought to be significantly understated. But it is only getting worse.  “A crisis is coming as more and more organizations are forced to react in shorter and shorter timeframes and there will be tradeoffs,” Kriete said.

In a survey of 300 hospitals by TEKsystems and HIMSS Informatics, 57 percent of respondents said they struggle with finding the right people to build a training program.

The supply of HIT talent is not keeping pace with the demand –  from clinical trainers, builders and consultants to project and program managers, according to Kriete. Miller noted that clients are struggling to find individuals who have proven clinical backgrounds who also have the knowledge and comfort with information technology to lead the transformation of health care IT systems. There’s also a strong need for staff with a nursing informatics or a health care informatics background.

The irony of the timeline for providers to convert to electronic medical records and meet the requirements for ICD-10 as well as Meaningful Use in time to get the financial incentive to cover it is that it seems to have overlooked the shortage of qualified health IT staff to actually carry it out effectively. This could have significant repercussions on how well these systems function and the capability of health care professionals to use them, illustrated in a recent Pennsylvania Patient Safety Authority and ECRI Institute report. Healthcare facilities are facing a herculean task to balance financial considerations with advancing their IT systems. Hopefully providers will get more time to develop more sensible timelines to make implementation more organized and ensure staff get enough training time to be comfortable with these systems.

ATLANTA - A major healthcare software firm will expand in Atlanta, bringing 500 highly-paid jobs to the city in a deal that will help jump start redevelopment of the former City Hall East, a person with knowledge of the deal said.

Massachusetts-based Athenahealth, a player in the growing industry of healthcare information technology, will become the lead office tenant at the building rechristened as Ponce City Market, the ambitious redevelopment of the hulking former government center and Sears warehouse, the person said.

Metro Atlanta is a growing hub for healthcare IT, a sector booming as the world's vast volumes of medical records and other critical heath information is migrating from paper to electronic platforms. Athenahealth also is involved in healthcare practice management software and billing.

The project would be a relatively rare and major economic win in-town. Many of the latest jobs announcements have occurred in the suburbs or outside the city. But Atlanta has been highly active in recruit and has netted significant technology-related jobs deals in recent years. They include Asurion Insurance Services, which announced last year it would put up to 250 jobs in Buckhead.

Athenahealth will move its existing operations south from Alpharetta to the city and expand, the person said. Athenahealth has about 100 employees at its Alpharetta complex. The jobs will pay likely pay more than $65,000 annually on average.

The deal is expected to be announced in the coming days.

The Georgia Department of Economic Development, Invest Atlanta, the city's economic recruitment arm and the Metro Atlanta Chamber are said to be working on the deal.

Developing...Return to AJC.com for further updates. ___

PHILADELPHIA - Endo Health Solutions Inc., now has a new chief executive officer to go along with a new headquarters in Malvern, as the board of directors announced Monday that Rajiv De Silva will lead the drug and device company.

Investors hope the stock price, revenue, and profits will also take a new direction -- higher, of course -- when the former Novartis and Valeant Pharmaceuticals executive takes over on March 18. Dave Holveck announced late last year that he would retire.

De Silva, 46, will make $975,000 in salary and more through incentives and stock options, but he did not land this job because he mixed molecules in a lab. He earned degrees in civil engineering at Princeton and Stanford before getting his MBA at Wharton. After time at McKinsey & Co., he worked for Novartis and then Valeant Pharmaceuticals, where he was involved in the acquisition and integration of 40 companies.

"The board was focused on execution and continuing to integrate our four businesses," Endo board chairman Roger Kimmel said during a conference call with financial analysts. "We were looking for someone with substantial operating experience."

Founded as a separate company in 1997, Endo Pharmaceuticals adopted its current name -- Endo Health Solutions -- in May 2012 to reflect its diversification to areas of care and types of drug businesses.

But profiting through efficiency has been challenging, accentuated by regulatory and competitive hurdles related to key pain products, Lidoderm and Opana ER. Endo reportedly reached out to other companies, including Valeant, to explore being bought out. Amid that, Endo signed a 12-year lease to move from Chadds Ford into a new building in Malvern, where about 700 of the company's approximately 4,600 employees work.

"We were not of the view that Endo would end up being sold, so we think getting Rajiv as CEO was probably the next best outcome," Gary Nachman, of Susquehanna Financial Group, wrote in a note to clients.

The stock closed Monday at $30.26, up 7.9 percent. But almost every analyst asked Kimmel and De Silva about the possibility of being bought out or selling parts of the company. Neither would answer directly, though Kimmel said the board had the fiduciary responsibility to remain "flexible," and De Silva said he would assess the situation as quickly as possible.

--

Contact David Sell at dsell@ phillynews.com or 215-854-4506. Read his blog at www.philly.com/phillypharma and on Twitter @phillypharma. ___

For every nine women nurses working in hospitals, doctors’ offices and clinics, there’s one man doing the same job. That ratio might seem pretty small, but it’s a lot higher than it was 30 years ago, according to a new analysis of U.S. Census Bureau data.

“The aging of our population has fueled an increasing demand for long-term care and end-of-life services,” writes Liana Christin Landivar, a sociologist in the Census Bureau’s Industry and Occupation Statistics Branch, and author of a new data analysis called Men in Nursing Occupations. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses. These efforts have included recruiting men into nursing.”

Whereas in 1970, only 2.7 percent of nurses were men, the most recent Census Bureau data indicates that more than 9 percent of them are today.

Interestingly, the pay gap that persists in other areas of healthcare holds true here too. Men earn, on average, $60,700 per year compared to women’s $51,100 per year.

It might be tempting to attribute that to another point made in the analysis — that men’s representation is highest (41 percent) among nurse anesthetists, the nursing occupation in which salaries are highest.  (For the first time in 2010, the Census Bureau collected data of five different categories within the field: registered nurse, nurse anesthetist, nurse midwife, nurse practitioner, and licensed practical and licensed vocational nurse). But less than 4 percent of men in nursing fall into that category. Rather, Landivar, attributes that pay gap to the observed “glass escalator” effect in which men who enter women-dominated professions tend to advance quicker than their opposite-gender counterparts.

I sense, though, that the stereotypes associated with being a man in the field of nursing are still just as strong as they have been in the past.

PUEBLO - The Colorado Health Foundation this week released an independent report that predicts Medicaid expansion as part of federal health care reform will create thousands of jobs and inject $4.4 billion into the state's economy by fiscal year 2025-26.

Researched and written by three researchers with Charles Brown Consulting Inc., the report says Colorado's Medicaid costs will rise, but would rise more dramatically if the state hadn't agreed to expand eligibility guidelines as suggested in the federal Patient Protection and Affordable Care Act.

Under voluntary expansion guidelines, the federal government will pay all costs for the first three years after implementation in 2014, and drop funding to 90 percent of costs after that.

The report estimates that 22,388 new jobs will be created by Medicaid expansion, with 14,357 of those jobs coming within 18 months following expansion.

It also said that average household earnings will rise by $608, and the state's gross domestic product will grow by 0.74 percent in the next 12 years as a direct result of Medicaid expansion.

Researchers say state general fund appropriations for Medicaid will be a cumulative $133.8 million less for full Medicaid expansion than if Colorado had opted not to expand the program. Expansion will relax Medicaid income eligibility guidelines to include all Americans earning up to 138 percent of the Federal Poverty Level.

Compared to no expansion, the Brown report says, Medicaid expansion will add an additional 275,000 Coloradans to Medicaid enrollment by fiscal year 2025-26.

New Medicaid members will include 209,000 newly eligible adults without dependent children, 44,000 newly eligible parents, and an additional 22,000 currently eligible but not enrolled children and parents, the report said.

Go to www.chieftain.com for a link to the full report.

lorettas@chieftain.com ___

Recruiting departments of most firms are unaware how valuable job descriptions can be to their competitors.  To entice the best candidates, all too often postings give away invaluable tidbits on the inside structure and workings of a company … who this job reports to, what is its geographic coverage, why it has been created.  When pieced together with other intelligence on the company, it is sometimes amazing what you can understand about a company’s strategy and tactics.

Take AstraZeneca for example.  We know that this big pharma has been involved in researching the benefits of Big Data for some years.  In 2011, it announced a partnership with Healthcore to research Healthcore’s novel program to integrate data collected at retail pharmacies about individual patients and their prescription drug usage with Wellpoint’s transactional healthcare claims database.  Wellpoint, who owns Healthcore, covers the lives of 35 million individuals and has massive volumes of data on drug usage, diagnostics and hospital visits, again at the individual patient level.

Wendy Diller of the Pink Sheet recently reported on this partnership and that it has already completed 22 research projects and 40 feasibility studies. It has looked at a number of markets that are strategically important to AZ, such as compliance in the asthma market, re-admission rates for acute coronary care patients and issues around biopolar disorders.  However, little has been published and the success of this project is still unknown.

Is this program important competitively?

The answer has to be “Yes” if you are another pharma or biotech in any of the therapeutics market studied by AZ through this Big Data analysis partnership!

Why?  Well, if AZ is seeing opportunities to better treat patients through Big Data, this could be a serious threat to you.  AZ might be seeing better ways to position and message its existing drugs to physicians and patients, or unmet needs that it can fill by developing or acquiring very specific new drugs.  And without having access to the same analysis, you are blind to these opportunities, which can all too quickly become threats.

But, is AZ seeing anything interesting?

Enter the recruiting department of AZ from stage right.  They have recently posted a job ad for a Big Data Informatics Scientist that screams out success! (Maybe hiring success too as the posting is no longer active.)  What degree of success is not known, but some degree of success, otherwise why would AZ go to the effort of creating a budget for such a job if they had not seen that Big Data analysis can deliver real value?

AZ in Waltham, MA, is looking for a “Sr. Principal Informatics Scientist – Big Data Analytics.”  This “talented” individual will “drive the vision and strategy of Big Data Analytics in R&D and provide advanced hands on support to R&D activities across all therapeutics areas and phases of the drug discovery and development pipeline.”  He will “drive and develop Big Data Analytics to a world-class level that creates competitive advantage for AstraZeneca.”  He will use “multiple domains such as Pharmaceutical R&D data, clinical trials and health data, payer and claims data, patients’ data and business intelligence data” and will be the voice of AZ to “present to internal and external scientific communities on Big Data informatics solutions, best practices and scientific approaches, including external scientific publication.”

There would seem to be a very clear take home message for all pharma and biotechs, not just direct competitors of AZ.

You too should experiment with Big Data.  And, you should do this now, before competitors like AZ gain too much of a competitive advantage in understanding how to exploit Big Data.  As new datasets and analytical tools become available, Big Data analysis is an evolving skill and those companies that are at the cutting edge are most likely to be the one to reap the greatest rewards.  You should also note that this AZ job is focused on assisting R&D and not in-market products.  There is a message there, and where you should focus your efforts.

And, of course, there is other take home message … “make sure that your competitive intelligence group is looking out for unusual job ads by your direct competitors.”  You never know what you will discover!

About 32 percent of the 543 pre-med students who participated in the Kaplan Test Prep survey said they would pursue a career in primary care and 68 percent indicated they would go into a medical specialty. That’s not good news since the Association of American Medical Colleges is forecasting a shortfall of 90,000 physicians by 2020. Still, about 70 percent of the survey participants said they would be more likely to attend a three-year rather than four-year program. But how big an influence that would have on their career path is a bit fuzzy.

There’s currently a primary care doctor shortage of 9,000. But the rapid rate of doctors from the baby boomer generation reaching retirement age is making things worse.

Although three-year medical school programs could make sense, they are still in the experimental stage. So far at least three medical schools have introduced three-year programs for family medicine: Mercer University School of Medicine in Savannah, Georgia; Texas Tech School of Medicine in Lubbock, Texas; and New York University. In addition to a primary care track, NYU students could also pursue an accelerated track for internal medicine, pediatrics and obstetrics.

There has also been a surge in the number of medical schools that have been constructed in recent years and under development — 18 as of last July by Forbes’ count.

As if the physician shortage weren’t enough, there’s also a looming nursing shortage to contend with. The U.S. Bureau of Labor Statistics estimates that there will be a 26 percent increase in nursing positions by 2020.

The worrying question is who will treat the 32 million newly insured people expected to enter the healthcare system through the Affordable Care Act? Telemedicine can be a useful tool for healthcare access in rural and some urban communities, people with mobility issues and in emergencies, but I don’t see it as the desirable default option to address healthcare coverage concerns. Technology is a useful foil, but it doesn’t replace physicians or nurses for that matter.

[Photo credit: Carrying medical bag from BigStock Photo]

BOISE - While everyone in the Treasure Valley was chipping ice off their windshields last month, Patricia Somers was planning a business trip to Belize.

Somers had worked as a Boise-based insurance agent for about six years. She was licensed to sell life and health insurance plans for several Idaho insurance companies. She gave up that career and started a travel business, Global Odyssey Trips, in the fall.

Mounting questions about the future of health insurance and shrinking commissions pushed her out of the job, she says. Insurers wanted to cut costs, so they'd pay her $6 for something that paid $20 a few years ago, she says.

Some of her clients were dismayed when she told them their rates were going up, not down, despite health care reform. Some spent so much on health insurance that they had nothing left for life insurance.

Forget this, she thought. "It was depressing," she says.

The Caribbean beckoned. Somers saw clients taking trips even as they chafed at insurance prices. She loved travel herself. She decided to try making a living at it.

"People are traveling, but they're not taking care of what's in their future, or their health," Somers says.

Among health insurance salespeople, it's hard to tell how common Somers' story is.

Tom Shores, president of the Idaho Association of Health Underwriters, says health insurers have cut agents' commissions by 40 to 60 percent. Some agents shifted their focus to Medicare Advantage and other insurance products, "looking for other ways to increase their income," he says.

"One guy in particular, his wife came to him and said, 'You've got six months.' ... He concentrated pretty heavily on Medicare and got his numbers up where he can survive" on the insurance-based income, Shores says.

Shores says he's heard estimates that one-third of agents would leave the business. Many are near retirement age anyway, he says. But there are some who don't want to spend their time fighting for a paycheck and an uncertain role in a state-based health insurance marketplace.

And trying to divine the new playbook for insurance, Shores says, is "like nailing Jell-O to a tree."

The state's two-year cycle for licensing means people like Somers are still on record as agents. And the multidisciplinary nature of the profession means agents frequently toggle among life, disability, dental, health and other insurance, instead of focusing on health insurance alone.

But the Idaho Department of Insurance shows a steady growth in licensed insurance agents -- in all kinds of insurance -- over the past two years. The number of people licensed to sell health insurance also grew, from 21,788 as of Dec. 31, 2010, to 33,863 as of Dec. 31, 2012.

The growth in licensed agents may be due in part to health insurance call centers, says Darrald Bean, a Boise agent. An agent working in a call center out of Des Moines must have an Idaho license to do business with Idaho customers, Bean says.

Meanwhile, Somers is enjoying her new job, planning all-inclusive, chaperoned vacations for small groups.

"I see people happy again," she says.

Audrey Dutton: 377-6448 ___

NEW LONDON, Conn. - Pfizer Inc. has quietly cut hundreds of jobs at its Groton laboratories over the past year, leaving a workforce that is slightly smaller than what the pharmaceutical giant projected as it announced a downsizing of 1,100 positions two years ago.

Pfizer had 4,500 employees -- mostly scientists -- at its Groton and New London campuses two years ago, when the New York-based company announced a major downsizing that would cut the local workforce to slightly less than 3,400. By June of last year, Pfizer reported that reductions were well under way, with about 3,700 employees remaining on the Groton campus.

Pfizer's response to a request last week for an update on the local jobs number initially indicated there were now slightly fewer than 3,150 Pfizer employees at the company's consolidated site in Groton -- 250 fewer than had been anticipated when the local downsizing was announced. The company later amended the number, however, saying the initial report had neglected to count some personnel, and Pfizer gave a new census of about 3,300 employees, only a hundred less than what had been projected.

"There are no further planned reductions," said Lauren Starr, a Pfizer spokeswoman. "Groton is of central importance to the company."

The campus off Eastern Point Road became the company's sole local presence after the sale of the New London office complex -- Pfizer's former worldwide R&D headquarters -- to Electric Boat two years ago.

John Beauregard, executive director of the Eastern Connecticut Workforce Investment Board, said any job reductions by Pfizer mean additional cuts elsewhere in the labor force. He pointed out, however, that projected job increases at Electric Boat -- numbering at least 300 in the early part of this year -- will help compensate for any losses at Pfizer, assuming the drug company's downsizing levels off.

The Norwich-New London area, which includes Westerly, has been one of the hardest hit regions in the nation in terms of jobs recovery since the Great Recession ended in 2009. While most the rest of the state -- and the nation -- had reached a low point in jobs by early 2010, Beauregard said, this region didn't see the trough until August 2012, just a few months ago.

"We are continuing as an area to struggle to recover the number of jobs lost during the recession," Beauregard said.

Pfizer has indicated in financial statements that it was planning another $1.3 billion in R&D budget cuts this year, according to the industry blog FiercePharma, after reducing research spending by a similar amount last year. The most recent Pfizer cuts involve a clinical research program in Singapore announced just last week, according to The Business Times.

But Pfizer gave assurances that the company's transition of many local scientists to the Boston area is now complete and that reductions have now leveled off.

The company, in the midst of a worldwide downsizing over the past few years after it completed a series of megamergers and tried to compensate for the loss of patent protections for blockbuster medicines, had a local presence of about 6,000 just a few years ago. But a phase-out of Groton's manufacturing capability, the layoff of 500 local scientists related to Pfizer's acquisition of Wyeth Pharmaceuticals, a decision to get out of the antibiotics-discovery business and the move of the local lab's drug-discovery scientists to Cambridge, Mass., has inevitably whittled away at jobs numbers.

"They've been pretty secretive and pretty methodical about laying people off," said state Rep. Ted Moukawsher, D-Groton.

According to Pfizer, however, the job numbers they mentioned two years ago were simply projections. Through attrition and a variety of other factors, a spokeswoman said, the numbers are down slightly from what the company expected.

"Things have settled down there significantly," said Tony Sheridan, president of the Chamber of Commerce of Eastern Connecticut. "They're here to stay."

No public announcements about further job reductions below 3,400 were ever made, though Pfizer at one point last year did acknowledge a planned move this year of Groton's surveillance testing group to Singapore, which was to result in about 20 fewer local positions not originally counted in the company's job-cut plans.

Pfizer also announced last year that it would be starting to use two contract research organizations -- outside groups brought in to conduct basic scientific studies -- as it continued a worldwide downsizing. But a Pfizer spokeswoman said the increased use of these research firms, Boston-based PAREXEL International Corp. and Dublin-based ICON plc., was simply a streamlining of its use of outside firms and did not have any effect on local employment figures.

As scientists made the move out of Groton, Pfizer has been trying to market several of its buildings off Eastern Point Road for sale or lease, including the massive former R&D headquarters known as Building 118. The state has reported significant interest in the building, but so far no agreement has been announced.

Pfizer, which had begun clearing the way for a possible demolition of the building, has yet to obtain a permit, according to city Mayor Marian Galbraith.

l.howard@theday.com ___

A new initiative headed up by the Indiana Department of Labor is calling some attention to safety in healthcare facilities. Not patient safety though. It’s engaging businesses, labor and trade associations and schools to spread the word about best practices for healthcare worker safety.

In the state, the rate of injury and illness among healthcare workers is the second highest of all industries. It’s even higher than the rates in manufacturing and construction. While that may not hold true nationally, cases of workplace injury and illness in healthcare are among the highest of any sector.

The most common culprits? Muscle sprains, strains and tears; falls; workplace violence; incidental needle sticks and exposure to blood-borne pathogens.

The first collaborator on Indiana’s initiative is Union Hospital in Terre Haute, which recently reduced lost work time by 84 percent. It did so with continual safety and best practice education for staff, but also with evaluations of equipment, tools and staff behaviors, including the use of devices to prevent employee injuries like those caused by lifting patients.

Musculoskeletal injury, especially to the back and neck, among healthcare workers has actually inspired quite a bit of innovation among medical device makers across the country. For example, to reduce the risks associated with patient lifting, companies have created a wide range of mobility devices, including portable patient lifts and automated patient transfer devices.

Another type of occupational injury, needle sticks, has also inspired a broad range of innovative products. Various kinds of safety syringes have come from the likes of BD and Minnesota’s Protectus Medical. Revolutions Medical, SafeShot Technologies and Globe Medical Tech also make one-handed, autoretractable syringes. Additionally, the quest for a needle-free injector has also seen quite a bit of activity lately.

But a syringe is only one way needle sticks occur. Other products, like Tangent Medical’s and B.Braun’s closed-loop catheter systems, are hoping to make catheters safer for patients and healthcare workers. And, just recently, the New Jersey Health Foundation issued a grant to a surgeon to develop puncture-resistant gloves for surgery using a flexible, thin material.

What other companies or groups are making the workplace safer for healthcare workers? Share them in the comments or on Twitter @medcitynews.

Boston Scientific recently announced that it will be laying of 900 to 1,000 employees globally.

Here’s what every laid off employee should do — build a social resume. And here’s why:

A whopping 92 percent of employers reported using social media to recruit people. That’s up from 89 percent in 2011. Their preferred social network for recruiting purposes is LinkedIn, with 93 percent using that site compared with Facebook (66 percent) and Twitter (54 percent). Still, use of those sites have increased in the past year.

So where can you build a social resume and what should a social resume contain?

Other than the three mentioned above, look at Resumesocial.com, VisualCV.com, Razume.com and Ziggs.com, according to this infographic below created for Onlinecolleges.com.

As for content, use common sense. Steer clear of profanity and get a second pair of eyes to check for any typos or grammatical errors. Recruiters also like to see whether potential candidates are part of professional organizations and any volunteer work they are involved in.

For more, read the infographic below.

HACKENSACK, N.J. - Express Scripts Holding Co. is forging ahead with its realignment in Franklin Lakes, continuing to trim staff at Medco Health Solutions Inc.'s former headquarters by asking some employees to either take salary cuts or exit the company.

Express Scripts, the nation's largest pharmacy benefits manager, Monday confirmed that it is asking some workers at Medco -- acquired for $29.1 billion last year -- to agree to reductions in their overall compensation and title downgrades.

St. Louis-based Express Scripts is asking some employees to agree to double-digit pay decreases -- some as high as 35 percent to 40 percent, several sources said -- or take a severance package. The company declined to comment on what kind of pay cuts it is seeking.

The salary adjustments affect about 200 employees across the entire company, less than 1 percent of the total Express Scripts workforce, said Brian Henry, a spokesman. He declined to say how many of the 200 work in Bergen County, where the company has facilities in Franklin Lakes and Montvale. Express Scripts has more than 30,000 employees nationwide and more than 2,000 in Bergen.

"As part of the merger, we have aligned the compensation programs of Express Scripts and Medco to create consistent job titles and a competitive pay structure across the new organization," Henry said. "This process creates both internal as well as external equity and competitiveness in pay."

Since Express Scripts purchased Medco last April, it has laid off at least 425 employees in Bergen County in several rounds of cutbacks.

Express Scripts hasn't determined yet how many employees will exit rather than take salary cuts, he added.

Most recently, 103 Franklin Lakes employees were laid off in January. But the employees involved in the salary adjustments have nothing to do with those layoffs, Henry said.

"These are not workforce reductions," he said. "The alignment is for job titles and compensation across both legacy companies."

During the past few weeks, some Franklin Lakes workers have been called in by management and asked to take the title and salary downgrades, or take a severance package and leave, said several sources, including an employee who didn't want to be identified. One of the departments where that happened was information technology, a source said.

For example, a Franklin Lakes employee was asked to agree to a 27 percent pay cut, a bonus cap of 5 percent of salary and no stock options, one source said. That would add up to a double-digit annual reduction that could be in the 35 percent to 40 percent range.

"Out of respect for the privacy of our employees and their personal information, we are not going to comment about any potential compensation changes to specific employees or groups," Henry said.

Express Scripts also confirmed that it closed one of its facilities in Richmond, Va., last week, resulting in the idling of at least 21 pharmacists. "As we evaluated our business there, our decision was to no longer have a pharmacy in Virginia," Henry said.

The Franklin Lakes employee said the fear has surfaced again that the company will move out of the 166-acre campus. No such decision has been made, Henry said.

"As we've said before, we continually evaluate our business to make sure that wherever we operate, we're doing so in the most efficient way possible to benefit our clients and members," he said.

The employee described the mood at the Franklin Lakes facility as "very down," adding, "You walk in wondering if it is your last day ... hard to stay productive in an environment like this."

Email: moss@northjersey.com ___