PSI National Dialogue on Medical Sharps

1
PSI National Dialogue on Medical Sharps

• Slides for Discussion of Issues
• Day 1 (Key Issues 1, 2, 4)

2
Issue/Strategy Discussions

• Background technical information
• Clarify issues and strategies
• Additional strategies
• Prioritize strategies
• Workgroups at end of 2nd day - top 2 strategies

2
3
Issue 1 Source Reduction

• Starting point for lifecycle management of any
  product.
• What are the possibilities for medical sharps?
• Variations in devices (including with safety
  features)
• Variations in treatment

4
Potential Strategies

• a) Investigate whether devices with safety
  features that are already required at health
  facilities would remain intact during typical
  waste hauling and disposal processes. If they
  would, promote these alternatives outside of
  health facilities.

5
Issue 2 Collection, transportation, and
disposal infrastructure

• Maximizing safe disposal requires collection
  opportunities that are safe, convenient, cost
  effective, and address cultural/privacy concerns.
• A range of options is probably necessary to meet
  the diverse needs within a community.

6
Potential Strategies

• Better data on numbers of sharps used by
  different consumer groups?
• Determine whether an FDA/OSHA-approved sharps
  container is necessary for safe collection at
  drop-off locations.
• Determine the target parameters for convenient
  collection locations based on population
  statistics (including urban/rural, of people
  with diabetes, IDUs, etc.).
• Develop best practices for collection locations,
  including parameters/standards for kiosks/bins
  used at collection sites.

7
Issue 4 Sustainable Financing

• A sustainable financing system is needed to
  conduct widespread safe collection,
  transportation, and collection. Current financing
  by governments and consumers at end-of-life is
  not sustainable.

7
8
Who pays?

• Consumer (product user)
• Taxpayer (all residents)

8
9
Financial Problem

• Externalities
• Safety
• Injuries
• Environment
• No such thing as a free lunch!

9
10
What needs to be funded?

• Disposal container
• Disposal
• Education
• Planning/oversight
• Enforcement

10
11
Who pays now?

• Government/tax payer (collections)
• Consumer (mail-back)

11
12
Trends in Waste Management Financing

• Government programs
• End-of-life (consumer)
• Manufacturer (advanced recycling fee)
• Manufacturer (extended producer responsibility)
• ISO
• Visible fee to consumers
• Invisible fee

12
13
Options

• Government/taxpayers
• Centers for Medicare/Medicaid Svcs.
• State/local programs
• Tax incentives (collection)
• Sharps mfrs
• Pharmaceutical mfrs
• Consumers

13
14
Stakeholder Input

• What are the 2 main things about financing that
  you would like addressed in the dialogue?
• Additional research/information you need to be
  prepared to discuss financing in more detail?

14
15
Potential Strategies

• Develop a financing system that covers the
  collection, transportation, and disposal costs
  for medical sharps generated out the traditional
  healthcare setting.
• Develop cost estimates for different options
  nationally.
• Advocate for Medicare Part D/health insurance
  plans to cover cost of safe disposal.

15
16
Issue 3 Regulation and enforcement

• Growing number of efforts to regulate sharps
  disposal
• Effective regulation requires effective
  enforcement, which is challenging

17
Potential Strategies

• a) Develop model state legislation (or menu of
  options), including financing, convenience,
  education, and an implementation schedule.
• b) Identify and overcome regulatory obstacles to
  the collection, transportation, and disposal of
  sharps. This may include requirements for staff
  at collection locations or waste handling
  requirements.
• c) Advocate for change in FDA regulations to
  require sharps disposal costs/methods to be
  included with all self-injected medications.