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DaVita HealthCare CFO resigns after settlements sting dialysis provider - Healthcare Finance News PDF Print

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DaVita HealthCare Partners CFO Garry Menzel has resigned to return to the biopharmaceutical industry, the company announced. The news comes after the company saw a slate of high-profile civil and criminal investigations over the past few years.

In October 2014, DaVita Healthcare Partners, a leading provider of dialysis services that has clinics in 46 states, agreed to pay $350 million and another $39 million in civil forfeiture to resolve claims it violated the False Claims Act by paying kickbacks to induce the referral of patients to its dialysis clinics, according to the U.S. Department of Justice.

DaVita also allegedly offered physician groups lucrative opportunities to partner with DaVita by acquiring and/or selling an interest in dialysis clinics to which their patients would be referred for treatment, according to the U.S. Department of Justice.

[Also:Running list of notable 2015 healthcare frauds]

The allegations were brought under the False Claims Act whistleblower provision in a lawsuit filed by a former senior financial analyst for DaVita, according to the Justice Department.

This February, the company settled a related case with four states, agreeing to pay $22 million, it stated.

Menzel said he would remain with the company to ensure a smooth transition as Chief Accounting Officer James Hilger takes over CFO duties on an interim basis, according to the Denver Post.

The change was effective Monday.

Menzel has been CFO since 2013, taking over from Hilger, who had served as DaVita's interim CFO.

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In announcing the news, DaVita said the company has "long maintained a strong finance leadership team" that will aid Hilger in "guiding and executing the financial strategy of the organization."

Menzel, who earned a Ph.D. in molecular biology from the University of Cambridge and a MBA from Stanford University, was previously COO and CFO at the biopharmaceutical company Regulus Therapeutics.

Menzel also had been a managing director and global head of life sciences for Credit Suisse and a managing director and global head of biotechnology for Goldman Sachs.

Twitter: @SusanMorseHFN

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Athabasca Minerals Inc. Announces Thirteen Months Ended 2014 Results - Marketwired (press release) PDF Print

EDMONTON, ALBERTA--(Marketwired - March 31, 2015) - Athabasca Minerals Inc. ("Athabasca" or the "Corporation") (TSX VENTURE:ABM) is pleased to announce its financial results for the fourth quarter and thirteen months ended December 31, 2014. The Corporation's audited financial statements and management's discussion and analysis ("MD&A") for the thirteen months ended December 31, 2014 are available on SEDAR at www.sedar.com and on the Athabasca Minerals website at www.athabascaminerals.com.

2014 Highlights

Aggregate Operations

  • Revenue, net of royalties at Susan Lake, was $26.33 million for 2014 as compared to $25.36 million in 2013.
  • EBITDA for 2014 (thirteen months) improved significantly as the year progressed due to improved sales volumes and improved production costs. Annual EBITDA of $3.5 million consisted of $5.1 million from June to December 2014 as compared to $(1.6) million from December 2013 to May 2014.
  • A net loss of $0.83 million was recorded for the thirteen month period in 2014 as compared to a net profit of $1.92 million for the twelve month period in 2013.
  • Developed two new aggregate operations at the Cowper and KM248 pits through agreements with DeneCo Aggregates Ltd., a First Nations company.
  • Management entered into a Joint Venture Agreement with Wood Buffalo Métis Corporation to explore, develop, and produce aggregates for ten years.

Firebag Silica Sand Project Development

  • Received the completed National Instrument 43-101 ("NI 43-101") Technical Report titled "Inferred Frac Sand Resource Estimate for the Firebag Property, Northeastern Alberta, Canada" dated effective September 19, 2014 and prepared by Mr. Roy Eccles, MSc. P. Geol. and Mr. Steven Nicholls, BA. Sc., MAIG, of APEX Geoscience Ltd. headquartered in Edmonton, Alberta, and Mr. Mark Zdunczyk, CPG, a New York based consulting geologist specializing in sand and aggregates (each a "qualified person" as defined under NI 43-101), with respect to the Corporation's Firebag property located in Northeastern Alberta, Canada, approximately 95 km north of Fort McMurray The Technical Report was filed, and is available for viewing, on the Corporation's SEDAR profile at www.sedar.com.
  • Engaged Norwest Corporation ("Norwest") of Calgary, Alberta to complete a Preliminary Economic Assessment ("PEA") to demonstrate the viability of the Firebag Silica Sand Project ("Firebag Project"), the results of which are set forth in the report titled "Preliminary Economic Assessment - Firebag River Sand Property" dated March 3, 2015 and effective as at November 26, 2014, which was filed, and is available for viewing, on the Corporation's SEDAR profile at www.sedar.com.
  • Submitted the Conservation and Reclamation Business Plan ("CRBP") to the Alberta Environment and Sustainable Resource Development ("ESRD").
  • The Firebag Project received approval for the Surface Material Lease ("SML") and the right to work and remove sand from Phase One from Alberta ESRD.
  • Retained the services of AECOM of Edmonton, Alberta for engineering work on the development of the Lynton trans-loading facility near Fort McMurray.

President and CEO Dom Kriangkum said; "We have recognized significant success through the implementation of a number of cost reduction opportunities in the extraction and processing of aggregates in 2014. Despite slow demand during the first two quarters, we supplied in excess of 8,000,000 tonnes of aggregates to regional customers, and built up significant inventory at our corporate owned aggregate operations to meet future demand. In addition to our aggregates business, we are extremely pleased with the positive results of the Preliminary Economic Assessment for the Firebag Project, and will continue development in 2015 targeting becoming a quality frac sand supplier to the oil and gas industry in Western Canada in 2016."

Operations Update

Susan Lake sales volumes in 2014 of 7.5 million tonnes were 20% lower than 2013. Demand levels were impacted by poor weather in the first half of the year and the impact of dropping oil prices in the last quarter of the year. Management maintained operations at historical levels, while continuing to clear land and strip topsoil which should enable the Corporation to maximize sales volumes in future periods.

Athabasca managed to increase aggregate sales volumes slightly from the Corporate owned pits in 2014 to 571,000 tonnes. In the latter half of 2014, Athabasca management implemented several cost improvement strategies which enabled the Corporation to produce gravel at a lower operating cost. By optimizing production levels at the crusher, labour requirements were reduced and associated equipment hours were minimized reducing maintenance and operational costs to ensure a higher margin product going forward.

Financial Highlights (in thousands of CDN, unless otherwise noted)

Four Months Q4 and Thirteen Month Ended December 31, 2014
Four Months
Q4 2014
($000,s)
Three Months
Q4 2013
($000,s)
Thirteen Months
Dec 31, 2014
($000's)
Twelve Months
Nov 30, 2013
($000,s)
Aggregate management fees $3,283 $2,884 $8,709 $10,419
Net aggregate sales $6,396 $3,759 $17,623 $14,944
Total revenue $9,679 $6,643 $26,332 $25,364
Gross profit $3,105 $2,453 $6,287 $7,954
Net income and comprehensive income $12 $390 $(831) $1,922
Total aggregate tonnes sold (MT) 3,013,860 2,704,301 8,085,480 9,911,381
Basic income per common share ($/share) $0.000 $0.014 $(0.026) $0.068

Net (loss) during fiscal 2014 decreased to ($0.83) million from a net income of $1.92 million in the prior year, a reduction of $2.75 million. There were four primary contributing factors: 1) a $1.71 million reduction in aggregate management fees resulting from a 1.8 million (or 20%) reduction in aggregate tonnes sold from Susan Lake; 2) higher operating costs in the first half of 2014; 3) higher share-based compensation expense of $0.86 million due to the non-cash expense booked on the options issued in 2014; and 4) higher G&A costs due primarily to potential acquisition due diligence, and additional expenses related to the development and analysis of the Firebag Project.

Outlook

AGGREGATE OPERATIONS:

  • Corporate-Owned Pits

The Corporation is well positioned from a resource and equipment base to increase production tonnes based on the successful award of contracts and overall demand in the target areas. Management continues to focus on further developing existing relationships with the major oil sands and SAGD operators, including continued analysis and exploration of new aggregate deposits.

Sales guidance for 2015 at the Corporate pits is 0.5 million tonnes. Management continues to strive for production optimization levels and tighter cost controls as it prepares for the heavy demand aggregate season. Strategic inventory was established in 2014 in core areas which will allow management to quickly react to any sudden demand changes as the economy changes.

Capital spending in 2015 for the existing gravel operations is anticipated to be lower than previous years as the existing infrastructure allows management to meet the forecasted product demands.

The Company has secured contracts for approximately 50% of their production for 2015.

  • Susan Lake Public Pit

With the uncertainty in the region due to the drop in oil prices, sales from Susan Lake in 2015 have been forecasted for 6.5 million tonnes. While recognizing that the potential impact of lower oil prices could be significant, management believes that this projected tonnage is still appropriate and conservative, as it would be comparable to the 2009 annual sales volume recorded at Susan Lake.

EXPLORATON AND DEVELOPMENT PROJECTS:

  • Firebag Silica Sand Project

The Corporation's Firebag Project is located 95 km north of Fort McMurray, is accessible via Highway 63. The planned operation is for the production of industrial proppant for use in the fracking industry.

During August 2014 the Corporation received approval from the Alberta ESRD for an 80 acre SML for the development of a silica sand mining operation, which is the first phase of development of an overall 500 acre project. The Corporation also received the completed Technical Report disclosing an inferred mineral resource of approximately 45 million tonnes of silica sand within the Corporation's Firebag property located in Northeastern Alberta, Canada, approximately 95 km north of Fort McMurray. The Technical Report was filed, and is available for viewing, on the Corporation's SEDAR profile at www.sedar.com.

A significant amount of testing was conducted on the Firebag Project sand to verify the consistency of the silica sand at various depths within the deposit. Independent testing by both Stim-Lab Inc. and PropTester Inc. confirm a high quality product with crush strength meeting or exceeding API and ISO standards for frac sand. The PEA report is filed on Sedar and the press release "Athabasca Minerals Reports Positive Preliminary Economic Assessment for the Firebag Silica Sand Project"dated February 12, 2015 will provide the detailed analysis and results.

Advancements on the trans-loading sites and detailed engineering are underway. Athabasca has been in active discussions with a major railway company and the Regional Municipality of Wood Buffalo in developing a private switch and trans-loading facility in Fort McMurray.

The Corporation's second phase of development includes plans to develop a larger adjacent 420 acre SML for which applications have been submitted. The Corporation holds 100% rights to seven Industrial and Metallic mineral leases covering 12,800 hectares (31,629 acres) in the Fort McMurray region of northeast Alberta.

Resources have been allocated to advance the engineering surrounding the final plant design, complete permitting at both trans-loading sites and evaluate procurement opportunities on longer lead time items. The majority of capital spending in 2015 will be in relation to the Firebag Project. Management is identifying cost saving opportunities to reduce the initial capital estimates, and is looking at several options surrounding financing of the Firebag Project which includes joint venture, offtake arrangements, and alternative financing options. Management has been able to fund the development of Firebag Project to date from its existing cash flow.

The Corporation is committed to becoming a major domestic supplier of high quality industrial proppant for use in the fracking industry as it actively pursue the development of its Firebag Project.

The complete financial statements for Athabasca for the year-ended December 31, 2014 and Management's Discussion & Analysis for the same period are available for viewing on the Corporation's website at www.athabascaminerals.com and on SEDAR at www.sedar.com.

About Athabasca Minerals

The Corporation is a resource company involved in the management, exploration and development of aggregate projects. These activities include contracts works, aggregate pit management, aggregate production and sales from corporate-owned pits, new aggregate development and acquisitions of sand and gravel operations. The Corporation also has industrial mineral land holdings for the purpose of locating and developing sources of industrial minerals and aggregates essential to high growth economic development.

Neither the TSX Venture nor its Regulation Services Provider (as that term is defined in the policies of the TSX Venture) accepts responsibility for the adequacy or accuracy of this release.

This news release contains forward-looking statements that involve risks and uncertainties. Forward-looking statements or information are based on current expectations, estimates and projections that involve a number of risks and uncertainties which could cause actual results to differ materially from those anticipated by the Corporation. The forward-looking statements or information contained in this news release are made as of the date hereof and the Corporation does not undertake any obligation to update publicly or revise any forward-looking statements or information, whether as a result of new information, future events or otherwise, unless so required by applicable securities laws.

The securities of Athabasca have not been, nor will be, registered under the United States Securities Act of 1933, as amended, and may not be offered or sold within the United States or to, or for the account or benefit of, U.S. persons absent U.S. registration or an applicable exemption from U.S. registration requirements. This release does not constitute an offer for sale of securities in the United States.

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Physicians Urge Better Decision Making on Dialysis - New America Media PDF Print
 
More than 20 million Americans, have some form of chronic kidney disease or end-stage renal disease (ESRD), dialysis is a commonly recommended treatment. But a story published in this week’s New York Times “Science Times” section reports that for older patients the treatment is increasingly being seen as an choice, not an imperative, and “a growing number of nephrologists and researchers are pushing for more educated and deliberative decision making when seniors contemplate dialysis.”

NY Times “New Old Age” reporter Paula Span writes, “Unquestionably, dialysis has helped save lives.” But for those age 75 or older, about 40 percent of ESRD or advanced kidney failure patients die within a year, and only 19 percent survive beyond four years, the renal data system has reported. And a Canadian survey of patients revealed that six in 10 regretted starting dialysis, “a decision they attributed to physicians’ and families’ wishes more than their own.”

Stanford University School of Medicine geriatrician V. J. Periyakoil, MD, said, “People drift into these decisions because they’re presented as the only recourse.” An expert on multicultural aging, she produced a moving video showing an African American elder deciding to stop dialysis after 12 years. (“If I would get a kidney now, it would be a waste… I’m not the person I used to be.” says Christopher Whitney.)

Periyakoil urges patients to “think about what your life goals are as well as what matters most to you at life’s end. Be sure to discuss these important issues with your doctor so you can make your wishes known and make decisions that are right for you and your family.”

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Dialysis: Gauging its need, and how to reduce its stress - McKnight's Long Term Care News PDF Print
March 31, 2015 Dr. Eleanor Feldman Barbera
Dr. Eleanor Feldman Barbera

As a psychologist observing the effects of medical interventions on the mental health of the long-term care resident, I often ask, “Is this aggressive procedure helping?”

Such a well-intended question can prompt the team to reconsider the course of treatment or to affirm that care is in line with the wishes of the resident and their family.

Conversely, I do what I can to encourage my residents to comply with medical recommendations. When a resident presents with end-stage renal disease (ESRD) and the inevitable recommendation of hemodialysis is given, I work with them to adjust to this turn of events.

That's why I was surprised to read in Paula Span's “New Old Age” article in the New York Times last week, “Learning to Say No to Dialysis,” that dialysis isn't always the best course of treatment for older patients.

Span reports that while dialysis can be very successful for younger and healthier patients, about 40% of patients with ESRD over the age of 75 die within a year and only 19% survive over four years. One study found that 58% of nursing home residents died within a year. Meanwhile, 61% of patients in a Canadian study said they regretted starting dialysis.

What leads to regrets tend to be the following factors, which can contribute to feelings of depression among those on a renal program:

• Physical symptoms such as pain, fatigue, nausea and headaches

• The amount of time spent on dialysis

• Inability to travel

• Dietary restrictions

Span quotes nephrologist Dr. Alvin H. Moss, who notes, “Patients are told, ‘You have to go on dialysis or you'll die,' rather than, ‘You could have up to two years without the treatment, without the discomfort, with greater independence.'” I've been part of teams that have told residents the exact words of that first message.

Medical management

For older patients, particularly those with other health problems, Dr. Moss asserts that medical management might be a way for them to focus on extending their quality of life and avoiding the discomforts of dialysis. The American Society of Nephrology suggests discussing this alternative to dialysis with patients through a shared decision-making process, as noted in their Choosing Wisely guidelines.

Facilitating treatment discussions

ChoosingWisely.org is an initiative of the American Board of Internal Medicine whose goal is to spark educated conversations between providers and patients through their series of lists called, “Things Physicians and Providers Should Question.” Since its inception in 2012, more than 70 medical specialty societies have offered guidelines for decision-making about a wide variety of illnesses.

LTC providers will find there valuable guidance such as a list regarding general medical care of elders from AMDA — The Society for Post-Acute and Long-Term Care Medicine, as well as information to provide for families to aid discussions about care decisions. For example, there's advice on when to end cancer treatment and on when to consider feeding tubes for people with Alzheimer's disease.

Reducing stressors of dialysis programs

For ESRD patients who have come through the shared decision-making process and want to pursue dialysis, in-house dialysis programs offer the possibility of daily rather than thrice weekly treatment and thus allow for a more liberal diet. In-house dialysis also reduces the amount of time spent traveling to and from dialysis centers and involves shorter dialysis sessions so that people can enjoy more of their usual activities. Various operators provide services within skilled nursing settings and some can also train capable elders to provide their own treatment at home.

Adding aerobic exercise to a dialysis program has been shown in several studies to reduce symptoms of depression, so it's a component that could be considered for elders on dialysis.

End of life teamwork

As one of the non-medical members of the treatment team, it can be difficult to weigh in on medical issues. There are many of us — psychologists, social workers, rehab therapists, clergy, recreation staff, aides, family members and the residents themselves —and we understandably defer medical decisions to our physician and nurse colleagues.

As most of us in LTC have seen, however, it can be very difficult to stop the medical treatment “train” once it leaves the station. An important part of our role as team members, therefore, is to assess whether or not the treatment is benefitting our residents and if it's what they and their families desire.

We can all have a voice in that.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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Study: Screen ED Sufferers for Cardiovascular Disease - Renal and Urology News PDF Print
March 31, 2015

Screening for cardiovascular disease (CVD) in men who present with erectile dysfunction (ED) can be a cost-effective intervention for the secondary prevention of both conditions, according to a new study.

“As the link between the etiologies of ED and CVD grows stronger, both the healthcare community and patients stand to benefit from screening for and treating CVD in men with ED,” researchers wrote in an online report in the Journal of Sexual Medicine. "Such an approach could significantly decrease national healthcare costs and disease burden with significant societal implications.”

Using the known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD, Alexander W. Pastuszak, MD, PhD, of the Center for Reproductive Medicine at Baylor College of medicine in Houston, and colleagues modeled the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD.

Dr. Pastuszak's group found that men with CVD had a 47% increased relative risk of ED. They estimated that the co-prevalence of ED and CVD was 1,991,520 men. Additionally, 44% of men with CVD risk factors are unaware of their risk, they noted. CVD screening of all men who presented with ED would identify 5.8 million men with previously unknown CVD risk factors over 20 years at a cost of $2.7 billion to screen, the researchers reported. Assuming screening and subsequent treatment results in a 20% decrease in cardiovascular events, 1.1 million cardiovascular events would be avoided, for a cost savings of $21.3 billion over 20 years.

The investigators stated that based on their model, “we call for a paradigm shift that moves research and treatment of ED away from merely deriving symptomatic improvement in the disease to a proactive and comprehensive view that appreciates and attempts to reverse the underlying and concurrent vascular pathology.”

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