News

Are new nurses interested in ongoing education?

Anne Zieger — Wed, 25 Nov 2009 12:22:21 -0500

Here's a column which might raise a few heckles. In it, a nurse-editor writes about an experience she had where she attended a seminar on H1N1 vaccination programs in New York City. The editor, Christin Moffa, MS, RN, says the young recent nursing grads weren't convinced they needed be there--and she was shocked. Article

20 percent of diabetics are 100 pounds overweight, study concludes

Anne Zieger — Wed, 25 Nov 2009 12:17:10 -0500

A team of researchers with Loyola University Health System has concluded that the problem of obesity in the population of type 2 diabetics may be even worse than expected. The findings are troubling given the stress extra weight puts on a type 2 diabetic's condition--and are likely to serve as a jumping-off point for ongoing discussions of how to manage the staggering diabetes problem in the U.S.

Through their analysis, researchers found a 141 percent increase in the rate of morbid obesity among type 2 diabetics between 1976 to 1980 and 2005 to 2006. They also found that almost 21 percent of diabetics with type 2 diabetes are morbidly obese, and that 62.4 percent of U.S. adults with type 2 diabetes are obese.

To draw this conclusion, the research team looked at data from the National Health and Nutrition Examination surveys done from 1976 to 2006. These findings were just published in the Journal of Diabetes and its Complications.

Get more information from the study:
- read this UPI item

Related Articles:
Study: Early insulin use for Type 2 diabetics is safe for diabetics
Studies offer mixed grades for remote diabetes care
Study: Measurements of chronic disease management savings understate case

DTC pharma ads could raise Medicaid costs

Anne Zieger — Wed, 25 Nov 2009 12:05:16 -0500

In recent times, a vocal bloc of critics have been working to reduce the volume of direct-to-consumer advertisements placed by pharmaceutical companies or even eliminate such ads altogether. The following study, if widely read, may do something to advance their cause.

The study, which looked at state data from 1999 to 2005 for 27 state programs, found that DTC ads for antiplatelet drug Plavix (clopidogrel) seemed to be associated with higher drug costs and Medicaid pharmacy spending (though oddly, the ads didn't directly increase patients' use of the medication).

Specifically, between 2001 and 2005, pharma spending on DTC ads promoting clopidogrel was more than $350 million, or about $70 million per year. During that time period, cost per unit per quarter increased by 40 cents, or 12 percent. That added $40.58 in pharmacy costs per 1,000 Medicaid enrollees, researchers said.

To find out more about the study:
- read this HealthDay News piece

Related Articles:
FDA should regulate medical devicemakers' DTC advertising, advocates say
Drugmakers face direct-to-consumer ad ban
AMA to study the impact of drug advertising

Changes in Medicare oxygen-supplier rules drive some providers to close

Anne Zieger — Wed, 25 Nov 2009 11:41:23 -0500

Starting January 1, new Medicare rules intended to cut waste and fraud in payments to medical equipment suppliers go into effect. When faced with these rules--along with another kicking off last month which requires them to be accredited and post a surety bond--the expected cut in reimbursement is driving some home-oxygen companies out of business and leaving some patients hanging.

The new rules allow Medicare to pay suppliers at the existing rate for the first three years after patients begin using their services. Medicare pays 80 percent of charges, and patient 20 percent, usually contributing a total of about $200 per month.

But after that, providers will get far less; nonetheless, they'll be required to keep providing services for two more years. The move should save CMS about $220 million in the fiscal year that began in October, the Wall Street Journal reports.

Suppliers, for their part, say that the new calculations don't address the actual costs of providing services, and are beginning to turn away patients who are already reaching their three-year limit. Meanwhile, small providers say that they're struggling to pay the cost of getting accredited, which can be $2,500 to $3,500 at minimum or mount up to tens of thousands of dollars.

To learn more about this situation:
- read this Wall Street Journal piece (sub. req.)

Related Articles:
Competitive DME bidding could save CMS $1B
FL DME companies named in $142M fraud
Medicare fraud costs CMS billions

Alabama MDs say state Blue plan hasn't followed class-action agreement

Anne Zieger — Wed, 25 Nov 2009 11:18:24 -0500

Working with 20 specialist physicians and practices, the Medical Association of the State of Alabama has filed formal complaints arguing that Blue Cross and Blue Shield of Alabama hasn't been following the terms of a class-action settlement.

The settlement, which took place in 2007, regarded payment practices of 30 health plans affiliated with the BlueCross BlueShield Association, including the Alabama plan. Physicians say that the Alabama Blue plan has failed to give doctors enough notice of planned fee schedule changes, has not paid for claims including CPT modifiers 25 and 59, and has never formed a specialty physician advisory committee as required by the agreement.

Settling this matter is particularly important to physicians given that the Alabama Blues hold an estimated 89 percent market share in the state, according to AMA projections. That makes the plans the dominant single-state health insurer within the states tracked by the AMA.

The complaint follows other controversies over compliance with the settlement agreement. In August, Independence Blue Cross of Pennsylvania was ruled to be in violation of the agreement when it attempted to collect what it deemed to be overpayments going out to surgeons.

For more information on the suit:
- read this American Medical News article

Related Articles:
Renal svcs provider sues BCBS of Georgia
SPOTLIGHT: IN doctors file payment, claims processing grievance
IN, OH state medical groups demanding claims payment from Anthem

MRSA invading hospitals through outpatient traffic

Anne Zieger — Wed, 25 Nov 2009 10:52:07 -0500

Fighting MRSA within hospitals is tough enough. Now, a new study suggests that community-associated MRSA carriers are bringing their own strains of the bug into hospital facilities, adding to the existing strains which populate hospital inpatient wards.

Researchers found that the community-based strain (CA-MRSA), which is picked up in public places like gyms and schools, is being tracked into hospitals already plagued with hospital-associated MRSA (HA-MRSA).

The study appears in the journal Emerging Infectious Diseases, which is published by the CDC. To do the study, researchers analyzed data from 300+ microbiology labs used by U.S. hospitals to determine MRSA patterns. They found that between 1999 and 2006 there was a seven-fold rise in the proportion of CA-MRSA found in hospital outpatient units.

Specifically, CA-MRSA infection rates rose from 3.6 percent of all MRSA infections (1999) to 28.2 percent in 2006. Researchers found similar rates of MRSA infection in inpatients.

To get more information from the study:
- read this Medical News Today article

Related Articles:
Study: Community MRSA infection rates increasing
Trend: MRSA growing more common in children
Community MRSA getting more dangerous, CDC says

Have health reform plans ignored wellness?

Anne Zieger — Tue, 24 Nov 2009 12:59:41 -0500

Members of Congress have certainly churned out a lot of paper in the name of reform, and have touched upon many important health system issues in their debate. Still neglected, however, is the potential impact of focusing on wellness, some critics argue. In fact, some advocates would like to see Congress require employer-sponsored health plans to cover more wellness and prevention strategies. Article

"Cadillac tax" on health plans brings opposing parties together for challenge

Anne Zieger — Tue, 24 Nov 2009 12:56:20 -0500

Ordinarily, unions and big business leaders are on opposite sides of the table, especially when the nation is in the middle of changes as significant as what reform may bring. This time around, however, the two interest groups have come together to oppose a measure that both feel will pinch them hard.

Unions and big business leaders have come together to oppose a proposed 40 percent excise tax on high-premium health plans, dubbed "Cadillac health plans" during the ongoing debate. The tax would consist of a levy of 40 percent on premiums above $8,500 for an individual and $23,000 for a family. Members of Congress say that this tax can raise $149 billion over 10 years.

Union leaders say that such a tax could lead to high cost increases for health insurance or big benefit cuts. Meanwhile, the U.S. Chamber of Commerce argues that such a tax is "irresponsible and dangerous" and that its members will pay most of the costs of this measure.

More likely to be harmed, some analysts say, are middle class Americans who pay high premiums because they must to keep their coverage. These people, who are caught in the middle, are likely to be the focus of some debate as well.

Learn more about this dispute:
- read this Kaiser Health News piece

Related Articles:
Senators ponder varied tax increases, including non-profit hospital taxes
Non-profit hospital tax exemptions still under the gun
CBO: Middle-income consumers are costly under House reform bill

Doctors win 4th delay of FTC "red flag" rules

Anne Zieger — Tue, 24 Nov 2009 12:44:28 -0500

Doctors have won a fourth delay in enforcement of the FTC's "red flags" rules, which would require them to establish and kick off a formal policy for finding and preventing identity theft. The AMA has claimed that the rules, which treat physicians as creditors, would impose too much of a strain on practices.

The FTC has delayed enforcement of the rule until June 1, 2010, the fourth such delay to be imposed. The AMA hopes to see a bill put into place which would permanently exempt practices with 20 or fewer employees from having to comply with the FTC rules.

Meanwhile, a recent case brought by the American Bar Association won a preliminary ruling blocking the agency form applying the rules to attorneys. If the U.S. District Court for the District of Columbia's ruling is upheld on the basis that the FTC overreached, this could help doctors make the same case, attorneys say.

To learn more about this issue:
- read this American Medical News article

Related Articles:
FTC cracks down on medical identity theft
Trend: Identity thieves get better at stealing medical records
The growing problem of medical identity theft

Medical liability premiums dropping nationwide

Anne Zieger — Tue, 24 Nov 2009 12:27:17 -0500

Medical liability premiums have fallen for the fourth straight year in a row, aided by a drop in the volume of lawsuits filed, according to the latest annual update by researchers focused on the issue.

The Medical Liability Monitor survey concluded that 94 percent of med mal premiums were level or fell in 2009. Thirty-six percent fell, down from 43 percent last year, and 58 percent held steady, up from 50 percent the previous year.

Jury awards in medical malpractice cases continue to climb, the study found. This has prevented premiums from falling to levels seen before a premium spike in the early 2000s.

That being said, premium increases have slowed significantly, companies note. This year, only 6 percent of premiums nationally went up, down from 7 percent last year and 16 percent in '07. Most increases were under 10 percent, the report notes.

Get more data from the report:
- read this American Medical News item

Related Articles:
Ohio medical malpractice premiums keep dropping
State high courts consider challenges to medical malpractice award caps
Judge overturns GA's medical malpractice damages limit

Surgeons experiencing burnout, worried about medical errors

Anne Zieger — Tue, 24 Nov 2009 12:00:54 -0500

A new study of surgeons has concluded that they're tapped out and may be making more mistakes than people think. The survey, designed to measure burnout and assess surgeons' quality of life, found that nine percent of surgeons were afraid they'd made a "major medical error" within the past three months alone.

The study, which appeared in the Annals of Surgery, was based on a survey commisioned by the American College of Surgeons. It concludes that 40 percent of those who responded were "burned out," and that 30 percent showed symptoms of depression.

Researchers found that surgeons who said they'd made an error showed more signs of emotional exhaustion and depression than their peers, though it's not clear whether their state caused the errors or the errors generated bad feelings.

The survey went out to 25,000 surgeons, and just under 8,000 of them responded to the request, the authors note.

To find out more about the study:
- read this Wall Street Journal Health Blog item

Related Articles:
Study: Doctors' personal problems can lead to medical errors
Quaid working to reduce medical errors
Study: Doctors avoid medical error disclosures

Case study: NYC works to manage diabetes

Anne Zieger — Tue, 24 Nov 2009 10:25:32 -0500

New York City has launched a collection of programs designed to tame its diabetes problem, noting that diabetes is the fifth leading cause of death there. The city's efforts may offer interesting lessons for the rest of the U.S., given the challenge inherent in reaching its large and diverse population.

City officials say that diabetes if the fifth-leading cause of death there, in addition to contributing to other causes. Meanwhile, a study led by the New York City Department of Health and Mental Hygiene, published early this year, concluded that the prevalence of diabetes in the city was 12.5 percent. Almost 4 percent have not been diagnosed, researchers project.

Unfortunately, many of these patients aren't getting adequate healthcare. More than one-third of NYC adults with diabetes hadn't gotten a foot or eye exam in the past year, and 56 percent had never taken a diabetes self-management class, the city's research indicates.

To help address this crisis, the city has been maintaining a citywide registry of blood sugar readings intendede to help doctors improve diabetes management. It's also been requiring chain restaurants there to post calorie counts for its meals, and making fresh fruits and vegetables available in underserved neighborhoods.

To learn more about this research:
- read this study on diabetes in NYC
- read this UPI piece
- read this city health department press release

Related Articles:
Study: Value-based insurance design improves diabetes medicine use
Cost of diabetes care has nearly doubled in six years
Studies offer mixed grades for remote diabetes care

SPOTLIGHT: Senators optimistic on public option

Anne Zieger — Mon, 23 Nov 2009 13:46:39 -0500

Rightly or wrongly, the public option has been a major sticking point in the health debate. Now, however, with a House reform bill passed and the Senate beginning floor debate, some Senate Democrats have begun to believe that they will be able to keep a public option in the final healthcare bill--at least if they stick with the conservative Senate version of the concept. Article

Health lobbying explodes in 2009

Anne Zieger — Mon, 23 Nov 2009 13:36:38 -0500

We all know that the Hill has been thick with lobbyists since reform debates began in earnest this year. Just how thick? Well, according to a new analysis appearing in USA Today, the number of companies and groups lobbying Congress on reform issues has almost doubled this year.

The newspaper's analysis concluded that as many as 1,000 groups have hired lobbyists to represent them on the Hill since January of this year, as compared with 505 during the same period in 2008. Meanwhile, firms and groups have spent $422 million during the first nine months of '09, up 10 percent from the same period in 2008.

As no one will be surprised to hear, one of the big spenders in the lobbying game has been PhRMA, which has laid out $30 million so far on an advertising campaign promoting its version of health reform. The campaign, which is working through Americans for Stable Quality Care, is targeting pro-reform Senators in Alaska, Arkansas, Colorado, Indiana, Louisiana, Maine, Montana, Nebraska, Nevada, North Carolina, North Dakota and South Dakota.

Get more perspective on reform lobbying efforts:
- read this Kaiser Health News article

Related Articles:
Healthcare lobbying spend second only to financial services industry
Google spending big bucks on health IT lobbying
GOP protests rules barring health plans from lobbying seniors

Groups recommend less screening for breast, cervical cancer screenings

Anne Zieger — Mon, 23 Nov 2009 13:34:48 -0500

The American College of Obstetricians and Gynecologists has announced that it's recommending young women begin getting Pap smear tests at a later age than before, and less frequently than is currently standard.

The new ACOG guidelines say women between the ages of 21 and 30 should be screened once every two years, rather than annually. Previous guidelines, issued in 2003, had recommended women begin cervical screening three years after first having sexual intercourse, or by age 21.

This announcement follows closely in the wake of similar recommendations by the U.S. Preventive Services Task Force, which kicked off a major controversy when it called for women to begin getting mammograms at age 50 rather than 40, and bi-annually rather than every year.

The ACOG denies charges by critics that the new guidelines are designed merely to save money. However, the group admits that more frequent screenings may waste money, and that this factor was included in the overall risk-benefit calculations it made in issuing the new recommendations.

To find out more about the recommendations:
- read this Wall Street Journal piece

Related Articles:
Health plans will still pay for under-50 mammograms
SPOTLIGHT: Want women to get tested? Throw a mammogram party
Report: Breast cancer rates fall 2 percent per year

Conservatives on Hill say individual mandate is unconstitutional

Anne Zieger — Mon, 23 Nov 2009 13:22:16 -0500

One of the centerpieces of the Obama Administration's health reform program is a requirement that every American be insured--or face the financial consequences.

This is the principle which governed the (arguably) successful Massachusetts healthcare reforms; it's a central demand of the health insurance industry, which will end up being the parties who figure out how to pay for many of these changes; and in lieu of single-payer, government-delivered healthcare, the only way to spread medical risk across an entire population.

Unfortunately, it's an unconstitutional demand, say some Senate Republicans, who have launched a movement against the mandate as the debate on the bill reaches the eleventh hour. Sen. Orrin Hatch (R-Utah), for example, is arguing that if the federal government had the right to order that Americans buy certain products, the Cash for Clunkers program would not have been necessary.

Democrats on the Hill insist that this is just the another tactic the opposition has taking in an effort to stall the process. But it seems that even the nonpartisan Congressional Research Service had its doubts, saying that it "seemed possible" that the mandate was acceptable and noting its concerns.

Meanwhile, it's worth noting that the Senate's massive health reform bill includes five pages defending the constitutionality of the individual mandate, arguing that the measure would benefit interstate commerce.

To get more background on this issue:
- read this Kaiser Health News piece
- read this Salt Lake Tribune item

Related Articles:
Target joins coalition behind employer healthcare mandate
Commercial health plans need individual mandate
SPOTLIGHT: Health insurance mandate could squeeze middle class

Disparity researchers still stumped on colon cancer outcome differences

Anne Zieger — Mon, 23 Nov 2009 10:35:26 -0500

At present, it's well known that African-American patients have lower individual survival rates for just about every type of cancer. Researchers have looked at a number of reasons why this might be the case, including the nature of the tumors themselves, the level of exposure to risk factors and differences in access to care, but no one factor has emerged to explain these disparities.

A recent effort to identify the reasons for lower colon cancer survival rates among black Americans doesn't seem to have had any more success. The study, which looked at the impact of patient weight and comorbidity on patient survival, examined data on 496 colon cancer patients getting surgery between 1981 and 2002. Researchers found that neither factor could account for a 34 percent higher likelihood of black patients having died by 2008.

The authors, who are affiliated with the University of Alabama at Birmingham, concluded that among patients with early-stage cancer, the risk of death from any cause was 2.2 times higher in those with a high level of comorbid illness. Being underweight was associated with an 87 percent increased risk of death, researchers found, while being overweight or obese reduced the risk of death by 42 percent among patients with stage IV colon cancer.

To get more information from the study:
- read this HealthDay News piece

Related Articles:
Black cancer patients less likely than whites to receive preferred end-of-life care
Study: African-Americans with equal care more likely to die of some cancers
Doctor bias may affect transplant process

CDC: H1N1 cases down in some parts of U.S.

Anne Zieger — Sun, 22 Nov 2009 19:13:41 -0500

While most states are still reporting some cases, overall H1N1 incidence is dropping in some parts of the U.S., according to a new update from the CDC.

The latest H1N1 flu report cited cases in 43 states, down from 46 in the last report. While CDC officials aren't ready to say that the flu has peaked, but other observers have suggested that this is the case.

For example, laboratory services provider Quest Diagnostics has concluded that flu rates may have hit their high point in October. Quest, which analyzed results of more than 142,000 de-identified patient specimens tested for the H1N1 influenza virus between May 11 and Nov. 10 in the U.S., found that in the weeks following Oct. 27, H1N1 test demand declined after several weeks of strong growth.

CDC officials are taking a more guarded approach, warning that even if flu rates are falling, they could surge again. When a peak happens, half of those who are likely to catch the virus still haven't done so, according to Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

To learn more about the U.S. H1N1 status:
- read these UPI articles (here and here)

Related Articles:
Most people who want H1N1 vaccine can't get it
Hospitals will have more leeway thanks to H1N1 emergency
Microsoft offers online H1N1 screening service

SPOTLIGHT: Top health insurance company earnings reports for Q3

Anne Zieger — Fri, 20 Nov 2009 12:13:48 -0500

With the Q3 earnings report season upon us--and health plan operations in the spotlight as reform legislation progresses--it's time to take a look at which health plans fared well, and which ones are merely treading water. Our sister publication FierceHealthFinance dug into the earnings reports of some of the largest insurers to find out more. FierceHealthFinance

Proposed cosmetic surgery tax is wrinkling a few brows

Anne Zieger — Fri, 20 Nov 2009 12:06:28 -0500

As the Senate version of the health reform package moves towards a vote this weekend, more than a few hot issues are still hanging fire.

One that hasn't gotten much attention is a 5 percent tax on cosmetic procedures included in the Senate bill, which would take effect in January if passed. The so-called "Botax," which is projected to raise $5 billion over the next ten years, is seen as just one more way to fund the $848 billion healthcare bill's costs. It would affect about 12 million cosmetic procedures and surgeries.

Plastic surgeons, of course, are livid over the proposal. They're arguing that they're still reeling from the damage imposed by the recession, and that if their prices go up even 5 percent to compensate, patients are likely to walk away, particularly given that many clients pay for these services out of pocket. They're also suggesting that if passed, the tax could become the doorway to taxes on other surgeries in the future -- though no one seems likely to be proposing a knee-replacement surgery tax anytime soon.

Supporters of the proposal, meanwhile, say this tax is no different than taxes on luxury goods and services. According to Diane Archer, director of the health care project at Institute for America's Future, cosmetic surgery "is not a medical service. It's the equivalent of a facial or a massage."

It's a bit early for the plastic surgery industry to be alarmed, however. With so many substantial differences between the House and Senate reform bills, it's anybody's guess what will shake out.

To learn more about the bill:
- read this Kaiser Health News piece

Related Articles:
Senators ponder varied tax increases, including non-profit hospital tax
Senate Finance struggles with health reform funding options
Readers take issue with challenge to non-profit hospital tax

Illinois launches healthcare quality data site

Anne Zieger — Fri, 20 Nov 2009 11:54:37 -0500

Though the evidence continues to be contradictory as to whether report cards and healthcare data have much impact on quality--or whether consumers even use such data--public policymakers continue to take a "build it and they will come" attitude.

The most recent example of such faith comes from Illinois, where the state has launched a new site (www.healthcarereportcard.illinois.gov) offering data on its hospitals and surgery centers. The data listed includes pricing information, procedure volume, how often care meets recommendations and how the facilities rate with consumers. Some of the data on the site comes from Medicare Compare data collected by HHS.

The state site also offers information on how facilities are staffed. For example, it allows consumers to contrast hospitals which use registered nurses heavily with those that lean on nursing assistants more.

Perhaps the most immediate effect of the data may be to help patients get care discounts. A new state law requires hospitals to offer price cuts to patients making up to 600 percent of the federal poverty level in Chicago, and with prices laid out on the Web, patients are more likely to be aware of whether they're getting discounts. The site also highlights big pricing differences between facilities, which can vary by a factor of four from one point to another on some procedures.

To learn more about the new effort:
- read this Chicago Tribune piece

Related Articles:
Hospital report cards may not generate quality improvement
Study: Hospital report cards less valuable for neurology
Patient advocates fight for MRSA screenings, report cards

VA study: Communication is main cause of surgical errors

Anne Zieger — Fri, 20 Nov 2009 11:42:53 -0500

Surgical never-events have attreacted lots of national attention recently, particularly the case of a Rhode Island hospital which saw five wrong-side or wrong-part surgeries over the past two years alone.

Now, researchers at the Veterans' Administration have taken an in-house look at such problems, concluding, as have others, that poor communication is the principal reason for surgical errors.

In 2003, the VA's National Center for Patient Safety put out a directive that all surgeries should follow standard safety protocols, including a "time out" in which medical staff stop and make sure they're operating on the correct patient, the correct body part and the correct side of the patient.

To see how that played out, the NCPS reviewed 342 surgical problems which nonetheless took place at 130 VA hospitals from 2001 through the middle of 2006.

Upon review, VA researchers found that adverse events occured once in every 18,000 procedures. Among the data they reviewed were 212 adverse events, where wrong procedures were performed, the procedure was performed in the wrong patient, or at the wrong site. Researchers also found 130 "close calls," in which clinical staffers corrected a problem before a procedure took place.

VA research concluded that the in 21 percent of errors, the root of the problem was poor communication between surgical team members. In some of these cases, the "time-out" procedure would not have been enough to address the problems involved.

To find out more about this study:
- read this HealthDay News piece

Related Articles:
Study: Wrong-site surgeries, close calls common
Study: Pre-op briefing can lower surgical errors
Study: Surgical safety checklists cut complications, death rates

CT angiography best for chest pain in ED, study suggests

Anne Zieger — Fri, 20 Nov 2009 11:31:12 -0500

Going straight to CT angiography when patients present at an emergency department with chest pain offers a faster, cheaper and more accurate diagnosis for some patients, a new study concludes.

The study, which reviewed 759 acute chest pain patients at 16 EDs, randomly assigned patients to get either standard screening with myocardial perfusion imaging or computed tomographic angiography.

While both methods appeared to be safe, diagnosis times for patients who had CCTA were 54 percent shorter (3 hours rather than 6.3 hours) and cost of care for CCTA patients was 38.2 lower ($2,137 compared with $3,458 for patients geting standard myocardial perfusion tests).

The CT was particularly effective at speeding things up and improving accuracy for patients with chest pain who have low to moderate enzyme and EKG scores, reported researchers, who presented this week at the American Heart Association's annual meeting.

Get more background on the study:
- read this HealthDay News piece

Related Articles:
EMRs backed major study on heart-attack outcomes
Study: Remote monitoring improves heart failure outcomes
CMS to post hospital heart attack care data

Doctors' neckties may transmit illness, AMA says

Anne Zieger — Fri, 20 Nov 2009 11:11:28 -0500

For a while now, U.S. infection control experts have mulled whether such extraneous objects as neckties can cause physicians to spread infections. Until now, most observers have argued that the evidence wasn't clear as to whether ties really did pick up and transmit germs. But now, physicians themselves seem to have decided not to take a chance.

The American Medical Association is now considering a resolution which would recommend a ban on doctors wearing ties while in contact with patients. The same ban could also apply to wearing long sleeves or other excess clothing that could potentially serve as a vector of infection.

The resolution follows a similar move by the British Medical Assocation, which recommended doctors stop wearing what it dubbed "functionless" clothing back in 2006. Meanwhile, some U.S. hospitals have begun to follow the BMA's lead.

The AMA has said that its members are seeking more information on this issue before they take a final vote. However, given existing trends, our guess is that they'll implement this recommendation. Better safe than sorry, after all.

To learn more about this issue:
- read this UPI piece

Related Articles:
Hospitals consider role of clothes in infection control
Study: Hospitals cutting back on infection-control education
HHS releases new infection-control action plan

SPOTLIGHT: Program uses education, bundled payment to improve kidney patient care

Anne Zieger — Thu, 19 Nov 2009 13:45:36 -0500

Medicare has decided to begin funding a new program educating the public about treatment options for dialysis patients. This comes in the wake of CMS's decision to propose a single bundled payment to facilities covering dialysis and other outpatient care, prescription drugs and lab tests. Article

Senate releases $848 billion health reform bill

Anne Zieger — Thu, 19 Nov 2009 13:39:12 -0500

Senate Majority Leader Harry Reid has released a 10-year, $848 billion health reform bill--featuring a much-lower sticker price than the House's $1.05 trillion bill--which highlights some of the significant differences between the two branches of Congress on the issues.

As expected by most observers, the new bill differs from the House version on key questions like taxation, abortion coverage and the public option. According to the CBO, the Senate version of health reform would cut the federal budget deficit by $130 billion over the first decade after being enacted.

Despite loud outcries against the model from some Senators, the Senate version of the health reform bill would feature a public option plan, though states would be allowed to opt out if they wished. The Senate version of the public plan would negotiate with providers directly to establish rates, rather than tying rates to Medicare.

One controversial section of the bill, added by Reid, would increase the Medicare payroll tax for high-income earners by 0.5 percent to 1.95 percent of adjusted gross income. This new tax, which would raise $54 billion, would affect individuals making more than $200,000 or families earning more than $250,000.

Given the widely varying postures the two chambers have taken on key issues, the process of reconciling the two proposals is likely to be arduous, observers note.

To learn more about the Senate reform bill:
- read this Kaiser Health News item

Related Articles:
Senate reform proposal would exclude undocumented aliens
Hope for public option remains, despite Senate set-back
Senate Dems consider procedural move to pass reform with public option

Pennsylvania ambulatory surgery centers flourishing despite recession

Anne Zieger — Thu, 19 Nov 2009 13:15:26 -0500

Last time we checked in on the ambulatory surgery center market, it was doing very nicely overall, but that was before the worst of the economic crisis had hit. You could be forgiven if you thought that perhaps the ASC market had since gotten swamped by the recession--but you'd be wrong.

At least in Pennsylvania, ASCs did very well during some of the worst months of the financial crash, actually growing their total margins from 24.31 percent in fiscal '07 to 26.06 percent in fiscal 2008 (June 2008 to May 2009). That's a 15 percent increase in total margin since fiscal 2001, according to the Pennsylvania Health Care Cost Containment Council (PHC3).

Compare that with an average acute-care hospital margin of 4 percent for fiscal 2008, and you begin to get a sense of how successful these entities really are. (Rest assured that hospital leaders in the state are doing so!) The ASCs enjoy a higher proportion of privately insured patients than hospitals (54 percent vs. 47 percent), and only 3.4 percent are covered by Medicaid, vs. 10.4 percent on average for hospitals.

The number of ASCs in the state climbed by 17 during fiscal 2008, though three also closed, reaching a final total of 261 during that period. This number has quadrupled over the past decade.

Learn more about the PA ASC market:
- read this Philadelphia Inquirer article

Related Articles:
Trend: Hospitals embracing ASC trend
CMS updating rules for ASC Medicare participation
ASC market continues to expand

Health plans will still pay for under-50 mammograms

Anne Zieger — Thu, 19 Nov 2009 12:52:01 -0500

Recently, a group of independent physicians proposed new guidelines for mammograms that have generated a significant amount of controversy. Rather than getting regular screenings after age 40, the group changed its recommendations to embrace women ages 50 and over, as risks outweigh benefits for younger women, members said.

While health plans are often the first to jump on new guidelines that favor them financially, this time it doesn't seem to be happening. If nothing else, federally-backed plans are not planning to change coverage standards, according to HHS Secretary Kathleen Sebelius.

Commercial health plans have weighed in to reassure women in their 40s, too. For example, Kaiser Permanente, Aetna (AET), CIGNA (CI), Geisinger Health Plan, Group Health Cooperative and WellPoint (WLP) told USA Today that they had no current plans to change mammogram coverage.

Realistically, low reimbursements pose a bigger threat to women's mammogram access than policy debates like these, according to an analysis by The New York Times. With Medicare mammogram reimbursements at around $95, and commercial payers coming in only slightly higher, the number of imaging centers willing to conduct mammograms is falling, the newspaper reports.

Find out more about reactions to the new guidelines:
- read this Kaiser Health News piece

Related Articles:
SPOTLIGHT: Task force recommends delaying mammograms
SPOTLIGHT: Want women to get tested? Throw a mammogram party
Report: Breast cancer rates fall 2 percent per year

Hospital report cards may not generate quality improvement

Anne Zieger — Thu, 19 Nov 2009 12:23:49 -0500

It's a common assumption among health planners--nay, an article of faith--that publishing hospital report cards can prompt lagging facilities to improve their quality of care. However, a new study suggests that at minimum, report cards alone aren't enough to spur significant changes.

A new Canadian study concluded that heart patients received the same quality of care from hospitals in the province of Ontario before and after quality report cards were released. These findings were published this week in the online version of the Journal of the American Medical Association.

To conduct their study, researchers looked at medical records from 85 hospitals based in Ontario that admitted patients suffering from heart failure or heart attacks. After examining the process of care, they concluded that in general, the hospitals had not shown improvement since the release of the report cards.

Folks, this finding isn't particularly surprising. After all, making big process changes takes time, money and management commitment, and getting all three in place can be tough to swing. If patients start quoting report cards in detail, it may motivate hospital leaders to take them more seriously, but in the mean time, hospitals are likely to set their own priorities rather than address report card issues.

To get more context on the study:
- read this HealthDay News item

Related Articles:
Patient advocates fight for MRSA screenings, report cards
Study: Hospital report cards less valuable for neurology
Calif. groups release hospital report card

Doctor bias may affect transplant process

Anne Zieger — Thu, 19 Nov 2009 11:51:15 -0500

Bias by physicians could potentially be keeping Hispanic and African-American patients from receiving organ transplants, according to a newly-published study.

To examine the issue of who gets transplants, Dr. Keith Melancon of Georgetown University Hospital looked at the list of patients ready for the procedure.

The study, which can be found in the American Journal of Transplantation, found that African-Americans were 27 percent less likely than Caucasians to be recommended for a kidney-pancreas transplant, and Hispanics 25 percent less likely. This was true despite the fact that Medicare had increased coverage for people needing the simultaneous transplant of both organs.

Dr. Melancon suggests that physicians might be incorrectly assuming African-Americans have type 2 diabetes, when many met the criteria for Type 1.

To learn more about this trend:
- read this UPI piece

Related Articles:
Study: Gender, race influence liver transplants
Reform bills may extend Medicare coverage for kidney transplant
Study: African-Americans with equal care more likely to die of some cancers