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NEW NEWS - CLASS 4

8-20-07

Joint Commission Resources (JCR), a not-for-profit affiliate of The Joint Commission, announces its Multi-Drug-Resistant Organism (MDRO) consulting service to help health care organizations prevent and control MDROs.  JCR will assess an organization’s risks and capacity to address MDRO prevention, and use evidence-based processes to implement sustainable changes with the goals to reduce MDRO infection rates, improve patient safety, lower operational costs and increase consumer confidence.  The framework for JCR’s MDRO consulting service is based on guidelines from leading organizations including the CDC, the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA) and The Joint Commission.

Specialty Hospitals  

Controversy Rising

The Medicare Payment Advisory Commission (MedPAC) advises Congress on Medicare payment issues and has been studying the specialty hospital issue under a mandate from the Medicare Modernization Act.  A preliminary conclusion of this study indicates that physician-owned specialty hospitals treat a more favorable selection of patients than the average community hospital which supports arguments made by the acute-care industry that specialized facilities take the most profitable cases from nearby general hospitals.  

At its fall meeting, MedPAC said all hospitals have an incentive to specialize in certain DRGs, such as coronary bypass with cardiac catheterization, and to treat low-severity patients within those DRGs.  Accordingly, it is attractive for physicians to set up specialized hospitals that focus exclusively on high-paying heart, orthopedic or surgical services.  However, according to MedPAC Commissioner, Ralph Muller, "It destroys our payment system to have this going on"  and MEDPAC will release a larger report on specialty hospitals in March. ( Modern Healthcare 10-29-04)

GAO Report

A new report by the General Accounting Office (GAO), "Specialty Hospitals: Geographic Location, Services Provided, and Financial Performance," (GAO-04-167) found Specialty hospitals treat fewer Medicaid patients than general hospitals and are less likely to have emergency departments. The report found that Specialty hospitals are largely for-profit, often owned in part by physicians, and tended to be less likely to have emergency departments - with 72% of cardiac hospitals, 50% of women's hospitals, 39% of surgical hospitals, and 33% of orthopedic hospitals having emergency departments as compared to 92% of general hospitals with emergency departments.  See GAO report at: http://www.healthlawyers.org/docs/ask2003/GAO_04_167.pdf  

Nighthawking

"Nighthawking" sending X-rays, CAT scans and MRIs to Israel, India and Australia, in time zones seven, 10, 14 hours ahead, to be read by doctors in the light of day.  Some of the hospitals going overseas overnight include:  Albert Einstein Healthcare Network, Temple University Health System, Crozer-Keystone Health System, Chester County Hospital, and Phoenixville Hospital. (Modern Healthcare 10-12-04)

Environmental Health for Pediatric Health Care Providers
Provider Training

A new study funded by the National Institute of Environmental Health Sciences recommends medical and nursing schools add environmental health topics to training programs.  Childhood diseases related to the environment in American children, include lead poisoning, asthma and cancer, and cost Americans billions annually.  Key medical and nursing organizations that could help promote environmental health training include the American Academy of Pediatrics and the Association of Faculties of Pediatric Nurse Practitioners.  (NIH News 10-21-4)

Bone Health 

Patients

U.S. Surgeon General warns that by 2020, half of all American citizens older than 50 will be at risk for fractures from osteoporosis and low bone mass if no immediate action is taken by individuals at risk, doctors, health systems, and policymakers.  See:  "Bone Health and Osteoporosis: A Report of the Surgeon General".

·      About 20 percent of senior citizens who suffer a hip fracture die
within a year of fracture.
·       About 20 percent of individuals with a hip fracture end up in a
nursing home within a year.
·       Hip fractures account for 300,000 hospitalizations each year.
·       The direct care costs for osteoporotic fractures alone are already
up to $18 billion each year. That number is expected to increase if action to prevent osteoporosis is not taken now.

Recommendations:

·       All health care professionals need to be aware of the early indicators of bone disease.  The report also calls on health care professionals to help Americans maintain healthy bones by evaluating risks for patients of all ages, recommending bone density tests for women over the age of 65 and for any man or woman who suffers even a minor fracture after the age of 50.  Also, the report calls on health care professionals to look for "red flags" that may indicate that someone is at risk, including people who are under 50 who have had multiple fractures, or patients who take medications or have a disease that can lead to bone loss.

·      Get the recommended amounts of calcium and vitamin D.

·       Maintain a healthy weight and being physically active at least 30
minutes a day for adults and 60 minutes a day for children.

·       Take steps to minimize the risk of falls by removing items that
might cause tripping, improve lighting, and encourage regular exercise
and vision tests to improve balance and coordination.

·       The Surgeon General has published a "People's Piece" specifically written for the American people with ready-to-use information on
how people can improve their bone health. (HHS press release, SG Bone Health Report, 10-14-04)

National Center for Complementary and Alternative Medicine (NCCAM) grants awards to strengthen research in osteopathy, dietary supplements, mind-body medicine, and acupuncture, for major public
health conditions including HIV/AIDS, cancer, asthma, chronic pain,
alcoholism, and drug addiction. (NIH news 10-13-04)

Chronic Sinusitis

Nearly 30 million people were diagnosed with sinusitis in 2002, according to U.S. Centers for Disease Control and Prevention, and direct costs of the illness exceed $ 5.6 billion per year yet the condition is very poorly understood.  (NIH news 10-13-04)

Bioterrorism Research Funding  

Systems Interfacing

HHS issued $232 million to fund development of new vaccines against three potential agents of bioterrorism: smallpox, plague and tularemia to develop new vaccines to ensure that our nation is protected against an array of potential bioterror agents.  The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH),greatly expanded its partnerships with industry to spur the development of vaccines against the most deadly agents of bioterrorism. (HHS Release 10-7-04)

Mental Health

According to a study by Human Rights Watch:  jails and prisons have become the nation's default mental health system, as more state hospitals have closed and as the country's prison system has quadrupled over the past 30 years.  As many as one in five of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering the number of mentally ill who are in mental hospitals with fewer than 80,000 people in mental hospitals.  (Modern Healthcare 10/22/03 ).

New Era of Heart Disease Detection

A new study indicates that a blood test can better predict which chest pain sufferers will have heart attacks has been developed.  The test gives doctors a way to diagnose an imminent heart attack and act to prevent it.   Doctors believe the test would be used first in ERs to distinguish people who are genuinely on the brink of a cardiac emergency from millions more who have chest pain from other causes.  Tests available today often don't detect heart attacks until hours after they have occurred.  The new test measures the enzyme myeloperoxidase, which is produced when arteries are inflamed and have rupture-prone fatty deposits.  (Modern Healthcare 10/24/03 ).

Troublemaker status for speaking up

Edward Dench Jr completed his one-year term as president of the Pennsylvania Medical Society, said his "troublemaker" label started in 1991 after he informed hospital officials at Centre Community Hospital, State College, Pa that a fellow anesthesiologist was working three and four surgeries simultaneously, leaving nurse anesthetists in charge as he moved from operating room to operating room and was billing Medicare for all the procedures. Dench said that within a month he was the one who started getting written up for various infractions and was told he was uncooperative.  (Modern Healthcare 10/29/03 ).

Parkinson's disease - Research

Per NIH 10-30-03 :  Growing body of evidence suggests that genetic variations in alpha-synuclein contribute to Parkinson's disease.  Individual's having too much synuclein - this protein buildup - is believed to cause the Parkinson's disease symptoms.  The mechanism of disease in this study is similar to that seen in people with Down syndrome, where patients make an excess of a protein, beta-amyloid, which accumulates leading to a form of Alzheimer's disease.  This suggests that the same kind of disease mechanisms may be at work in a variety of diseases characterized by protein accumulation in and around cells in the brain.

Parkinson's disease is the second most common neurodegenerative disease, after Alzheimer's disease. It is estimated that the disease currently affects at least 500,000 Americans. The disease occurs when nerve cells in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. The loss of dopamine-producing brain cells results in the four main symptoms of Parkinson's disease: tremors, rigidity of the limbs, slowness of movement, and impaired balance and coordination.

Doctors with Vested Interest in Specialty Hospitals

Per Chicago Tribune (December 1, 2002), "Specialty Hospitals a Pain for Rivals" with subtitle "A group of neurosurgeons and their financial backer have won state approval for a facility that some say will siphon off the most lucrative cases":  this article lists the pros and cons of specialty hospitals and gives a chart of the Annual Revenue Generated Per Hospital Physician.

Radiology Carve-Out

Per Modern Healthcare (7-02):  A radiology benefits manager, National Imaging Associates, Hackensack, N.J. manages care for about 7 million health plan enrollees in 27 states and operates a network of about 150,000 physicians and other providers.  TA Associates, Boston, invested $20 million in NIA that was established in 1995 as a division of Quest Diagnostics and became a separate private company in 1996.  TA Principal David S.B. Langcq will join the NIA board said the company is positioned to capitalize on payers' need to manage growing radiology costs.

Nurse Anesthetists  vs. Anesthesiologists in New Hampshire

Per Modern Healthcare (7-12-02): New Hampshire hospitals and other providers supported Gov. Jeanne Shaheen's recent decision to allow nurse anesthetists to administer anesthesia without the direct supervision of a physician, after a series of harshly critical newspaper advertisements by the American Society of Anesthesiologists.  The New Hampshire Hospital Association said at a news conference in the state capital, medical care in the state would have suffered if the governor had not chosen to exempt the state from Medicare rules requiring supervision and that about 10 rural facilities must rely on nurse anesthetists because they can't recruit anesthesiologists. Steven Hattamer, M.D., president of the New Hampshire/Vermont Society of Anesthesiology, described the governor's decision as a threat to patients, saying nurse anesthetists don't have adequate training to replace anesthesiologists.

Keeping Score - Holding Doctors Accountable

6-28-02:  Per Modern Healthcare:  Seven years ago the radiology chief at Kaiser Permanente Colorado started keeping score to hold his mammography doctors accountable for their work.  Dr. Adcock printed bar charts and graphs of the doctors batting averages in comparing doctors records and counting the cancers they had missed.  One doctor had missed 10 cancers in 18 months so Dr. Adcock fired him.  Over the next two years he fired two others who were missing more than their share of tumors and he reassigned eight doctors who were not reading enough films.  Today, Dr. Adcock's team is missing one-third fewer cancers and has achieved what experts claim is about as high a level of accuracy as mammography can offer.

The Denver doctors have to go through the psychic roughing up, confronting their errors on a regular basis to improve skills and increase quality.  Some states publish individual doctors' death rates for open heart surgery.

Modern Healthcare (7-25-02):  Risa Lavizzo-Mourey, M.D. a geriatrics specialist, was named President and CEO of the Robert Wood Johnson Foundation, Princeton, N.J., the nation's largest healthcare philanthropy.  She replaces outgoing President and CEO Steven Schroeder, M.D., who retires in December. Lavizzo-Mourey,  has been senior vice president at the foundation, since 2001. Previously she was Professor of Medicine and Health Care Systems at the University of Pennsylvania School of Medicine, Philadelphia. She also directed the university's Institute on Aging and was chief of the medical school's division of geriatric medicine. While on leave from Penn from 1992 to 1994, she served as deputy administrator of the federal Agency for Health Care Policy and Research.

 3-8-02:  From HHS press release:    HHS is funding a total of $301 million in response and recovery activities as a result of the Sept. 11 attacks

NATIONAL HUMAN GENOME RESEARCH INSTITUTE AND THE NIH OFFICE OF RARE DISEASES LAUNCH NEW INFORMATION CENTER 

2-22-02:  From HHS National Institutes of Health (NIH) press release:  There are more than 6,000 genetic and rare diseases afflicting more than 25 million Americans, yet many of these illnesses affect relatively few individuals.  The National Human Genome Research Institute (NHGRI) and the National Institutes of Health's Office of Rare Diseases (ORD) have launched a new information center that, for the first time, delivers free and immediate access to information specialists who can provide accurate, reliable information about genetic and rare diseases to patients and their families.  Opened in February 2002, the new service, called the Genetic and Rare Diseases Information Center, will help relieve this problem by providing reliable information about individual disorders.  Francis Collins, M.D., Ph.D. is director of NHGRI and ORD Director is Stephen C. Groft, Pharm.D., who currently is
on detail as executive director of the White House Commission on Complementary and Alternative Medicine Policy. (The Genetic and Rare Disease Information Center, Gaithersburg, MD, Voice 1-888-205-2311)

12/3/01:  Per amednews.com:  According to Merritt, Hawkins & Associates 2001 recruiting incentive study:  Newly hired radiologists saw the biggest increases in average salaries, 20.4% to $271,000; cardiologists salary offers increase 12.2% to $267,000 and orthopedic surgeons' pay increase 11.7% to $287,000.  Cardiology is in top demand especially for those working in the fields of nuclear medicine, electrophysiology and interventional cardiology.  Demand is steady for primary care physicians, internists' salary offers increase 4.3% to average $145,000 compared with family physician offers that rose 0.7% to $136,000.  Incentives such as vacation time, bonuses, and income guarantees continue to be popular.  Due to patient demand for specialists, aging population, mid-1990s tilt toward primary care residency training that reduced the number of young specialists, especially radiologists and anesthesiologists, now there appears to be a building demand for specialists - based on supply and demand.  

JCAHO - Sentinel Event Alert - Issue 24, 12/5/01

According to this JCAHO Alert:  "Surgeries on the wrong site, or on the wrong patient, or performance of the wrong procedure on a patient are completely preventable and should never happen, according to a special alert issued today by the Joint Commission on Accreditation of Healthcare Organizations to nearly 18,000 health care facilities nationwide."

"A follow-up review of wrong site surgery 

In August 1998, the Joint Commission issued a Sentinel Event Alert
examining the problem of wrong site surgery, including a review of 15
cases that had been reported to JCAHO. Today, the sentinel event database includes 150 reported cases of wrong site, wrong person or wrong procedure surgery, of which 126 have root cause analysis information. Of the 126 cases, 41 percent relate to orthopedic/podiatric surgery; 20 percent relate to general surgery; 14 percent to neurosurgery; 11 percent to urologic surgery; and the remaining to dental/oral maxillofacial, cardiovascular-thoracic, ear-nose-throat, and ophthalmologic surgery.  Fifty-eight percent of the cases occurred in either a hospital-based ambulatory surgery unit or freestanding ambulatory setting, with 29 percent occurring in the inpatient operating room and 13 percent in other inpatient sites such as the Emergency Department or ICU. Seventy-six percent involved surgery on the wrong body part or site; 13 percent involved surgery on the wrong patient; and 11 percent involved the wrong surgical procedure."

11/6/01: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will be offering a Disease-Specific Care Certification Program to evaluate providers of comprehensive services for patients with chronic illnesses.  This Certification program is expected to start February 2002 for chronic care services that are provided by health plans, hospitals and disease management service companies.  According to a press release by JCAHO: "Such disease-specific services are increasingly being offered by provider organizations, health plans, and disease management service companies (DMSCs). The evaluation and resulting certification decision will be based on: an assessment of compliance with consensus national standards; the demonstrated effective use of established clinical guidelines to manage and optimize care; and the measurement and improvement of health outcomes."  According to the press release, chronic conditions are the leading cause of morbidity, disability and death, and account for the majority of health care expenditures. Disease-specific services target populations that are suffering from or are at risk for specific chronic illnesses and the emphasis is on prevention and optimizing the individual's ability to function with minimal disease burden. 

For more information about Accreditation see class

10-4-01: DO NOT BILL FOR FREE DRUG SAMPLES

According to the Chicago Tribune (October 4, 2001), "Cancer Drug Probe Nets $875 Million Settlement"  the largest healthcare fraud settlement in the U.S. occurred on Wednesday when drugmaker TAP Pharmaceutical Products Inc. of Lake Forest, IL agreed to pay $875 million and plead guilty to criminal charge of conspiring with doctors to overbill government insurers for its prostrate cancer drug Lupron.  Six current and former TAP managers and a Massachusetts physician were also charged with conspiring to pay kickbacks and bribes to doctors and other customers at the expense of Medicare and Medicaid.  According to the indictment, TAP officials offered doctors enticements from free drug samples to "educational grants" that were sometimes used to pay country club bar tabs and the President of TAP admitted it provided free samples for physicians to bill health insurers which is a violation of federal law.  "The U.S. Attorney whose office handled the 41/2 year old investigation said: "The urologists and the TAP employees who knowingly participated in this broad conspiracy took advantage of older Americans suffering from prostrate cancer."  Further, prosecutors said more charges could be brought against individuals.  

Whistleblower Suits

In addition, this article gives a good example of the behind the scenes of how these type of cases come-about.  For example. the article states that "The wrongdoing came to light in a 1996 whistleblower suit filed by former TAP vice president...who left the company after concerns about 'illegal marketing conduct of some of its employees."  This whistle blower is slated to receive $77 million because under the federal False Claims Act, individuals filing suits that uncover wrongdoing can share from 15% to 25% of the civil damages recovered.  In addition, another whistleblower, in about 1997, a medical director at Tufts Associated HMO, a non-profit HMO outside Boston, alleged in a suit that he was offered bribes by TAP executives to switch prostrate cancer patients to Lupron from a less expensive competitor.  This medical director turned down the offer and notified federal authorities and then he and Tufts filed a whistleblower suit.  According to this article, this medical director will receive a small portion of the $17 million awarded to Tufts and the remainder will be spent on charitable projects.

{For further information about fraud and abuse laws see class 10}

Remote Care

Consider bringing the ICU bay to the patient as indicated in an article in PC Magazine (June 26, 2001, page 69).  This article indicates that the IMS LSTAT (Life Support for Trauma and Transport) system from Integrated Medical Systems is a computerized "smart bed with a built-in defibrillator, ventilator, suction pump, three-channel fluid/ drug infusion pump, clinical blood analyzer and physiological monitor.  The unique twist to this besides having the patient receiving continuous care and monitoring, is that the LSTAT platform has a network capable computer monitoring system on-board, which can send real-time patient information to hospital databases and remote locations.  Before the LSTAT platform was used only in the military, but now it may become to be used in ambulances, pre-hospital care and elsewhere.  According to an officer with the company this is a system to provide hospital level ICU care in mass casualty situations to save a lot of lives.

{For further information about Telemedicine see class 9}

10/01:    NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING WEB SITE LAUNCHED

The Web site for the National Institute of Biomedical
Imaging and Bioengineering (NIBIB) is now operational at
http://www.nibib.nih.gov/.  The NIBIB is the newest of the NIH research institutes and is mandated by the National Institute of Biomedical Imaging and Bioengineering Establishment Act (H.R. 1795), which was
signed into law by President Clinton on December 29, 2000.  The mission of the NIBIB is to improve health by promoting fundamental discoveries, design and development, and translation and assessment of technological capabilities in biomedical imaging and bioengineering enabled by relevant areas of the physical, engineering, and computational sciences. The Web site for the NIH Bioengineering Consortium (BECON), is part of the NIBIB Web site. 

10/1/01:    HHS Secretary Tommy G. Thompson today announced the creation of four new National Community Centers of Excellence in Women's Health (CCOEs) to provide integrated health and social services to women in their communities.

The new CCOEs -- in Minneapolis, Cleveland, St. Johnsbury, Vt., and Santa Fe, N.M. -- will coordinate all aspects of issues related to women's health at every stage of life, including active management of socioeconomic and cultural obstacles to quality health care for underserved women. HHS will provide $150,000 annually to each center for each of the next five years to support the program.

"These new centers of excellence will provide real help to women who
otherwise would face serious challenges in getting needed health care and social services," Secretary Thompson said. "These projects will serve as models for how best to meet the health needs of women in local communities."

4/26/01    According to the Chicago Tribune (April 26, 2001), section 3, pages 1, 5, "U.S. Probes 2 Doctors' Heart Work" with subtitle "Tests Dangerous, Unnecessary One Expert Says":  Two Chicago cardiologists are under federal investigation for allegedly performing unnecessary cardiac procedures on dozens of patients at North Side hospital exposing them to serious health risk.  The investigation does not extend to the hospital where the procedures were performed.  The two doctors involved had admitting privileges at Edgewater hospital but were not employees.

An expert witness for the government, Dr. Michael Lesch, chairman of internal medicine at St Luke's Roosevelt Hospital Center in New York City and professor at Columbia University, reviewed records of 27 cardiac catheterizations performed by one of the doctors between 1996 and 2000 and determined that all but three were medically unnecessary.  

The other doctor of Lake Forest, Illinois  was charged in November with fraudulently billing Medicare for thousands of nonexistent visits to patients, many elderly at their residences, nursing homes and hospitals.  He also allegedly claimed to have treated 49 patients during a blizzard in early 1999 and 32 patients after their deaths.  His attorney blamed sloppy billing and record-keeping by the doctor.  

The Illinois Health Facilities Planning Board which regulates hospital expansion and big-ticket equipment purchases, is evaluating the quality of all cardiac services in Illinois and to see if there is overlap.  

Illinois has about 90 hospital catheterization labs with 3 requests for new labs pending.  Hospitals claim the facilities are needed with the aging population and the rise of heart disease. 

See related article in class 10 dated May 18, 2001

See:  For Illinois,  Managed Care Reform and Patient Rights Act, see Public Act 91-0617.

Some interesting sections to note include:

Section 35.  Medically appropriate health care protection - (b)  This is basically a section stating the Illinois public policy that health care providers are to be patient advocates.  This section states that it "is the public policy of the State of Illinois that a health care provider be encouraged to advocate for medically appropriate health care services for his or her patients."  In this section look at Protest decisions, reasonable peer review, etc.

Section 40.  Access to specialists.  See re:  standing referral, etc.; provide regular updates to the enrollee's primary care physician.

Section 45.    Health care services appeals, complaints, and external independent reviews.  See re:  (b) (ii)  "a treatment referral, service, procedure, or other health care service, the denial of which could significantly increase the risk to the enrollee's health, the health care plan must allow for the filing of an appeal either orally or in writing." Basically, then the health plan is to notify the party filing the appeal within 24 hours after the submission of the appeal  of all information the health plan requires to evaluate the appeal and the the health plan must render a decision on the appeal within 24 hours after receipt of the required information.

Drugs/ Therapies to Follow:

10-28-02:  According to HHS, a new type of therapy, using a unique class of synthetic compounds, may someday protect both men and women from the bone-weakening disease osteoporosis. Researchers reported that early studies of one of these compounds called estren successfully preserved and even restored bone mass in laboratory mice without the side effects associated with traditional sex hormone therapies. These studies were funded by the National Institutes
of Health. 

See:  National Institute of Aging http://www.nia.nih.gov; or the National Institute of Arthritis and Musculoskeletal and Skin Diseases at http://www.niams.nih.gov

Nimodipine:  "We are finding a new use for an old drug," Dr. Fureman says.  "Drugs that have already gone through the FDA's rigorous safety testing, like nimodipine, are easier to move into clinical trials once the basic research progresses to that point."  "The next step is to start testing drugs that we think can interfere with those three triggers to stop the neurological dysfunction in humans," says Dr. Hess. One of the drugs tested, nimodipine, is commonly used in humans to treat cardiac problems like hypertension.  "We are finding a new use for an old drug," Dr. Fureman says.  "Drugs that have already gone through the FDA's rigorous safety testing, like nimodipine, are easier to move into clinical trials once the basic research progresses to that point."

"The next step is to start testing drugs that we think can interfere with
those three triggers to stop the neurological dysfunction in humans," says Dr. Hess.  Similarities in the factors that seem to trigger attacks in such episodic neurological disorders as migraine and dyskinesia.  Common triggers include psychological stress, caffeine or alcohol ingestion, fatigue, hormonal fluctuations and exercise. (Per NIH News release 8-5-02)

8-12-02:  The Food and Drug Administration (FDA) announced August 12 that it had approved Eloxatin injection for use in combination with other drugs for the treatment of colorectal cancer.  The combination of drugs including Eloxatin was shown to shrink tumors in some patients and delay recurrent tumor growth.

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