sends Loweâ€™s flying to Cleveland Clinic
In the changing world of healthcare, patients are finding that the best care
may be several hundred miles away.
To encourage employees, Loweâ€™s covers the full cost of surgery, as well as
travel and lodging for the worker and a relative. The company health plan
wonâ€™t cover thousands of dollars of unbundled costs at local hospitals.
â€śItâ€™s a win-win-winâ€ť for patients, employers and the hospital, said Michael
McMillan, Cleveland Clinicâ€™s executive director of market and network
services. â€śThe patient has no out-of-pocket responsibility, employers have a
better long-term financial result and we get patients.â€ť
U.S. employers are seeking innovative ways to trim health expenses as costs
rise and the government mandates broader coverage for employees under the
Patient Protection and Affordable Care Act. Medical centers, meanwhile, get
an extra burst of patients at a time when hospitals nationwide are
struggling with sluggish volumes in a tough economy and cutting jobs. Last
year, the Cleveland Clinic closed several hundred open positions and gave
700 workers early retirement, citing pressures of health-care reform.
The Clinic, an early pioneer in offering flying-surgery care, has
partnerships with more than a half-dozen large employers and has completed
about 200 surgeries in the program over the past three years, according to
McMillan. More recently, itâ€™s been joined by other centers, including Johns
Hopkins Bayview Medical Center in Baltimore, that see the same
â€śItâ€™s new volume that we wouldnâ€™t have otherwise, which means new revenue
for us,â€ť Trisha Frick, assistant director of managed-care contracting at
Johns Hopkins, said in a telephone interview. â€śIt also gives us
predictability in reimbursement rates.â€ť
The fixed rate also provides incentive for both the hospital and its medical
professionals to be more efficient, she said. If the hospital manages to
save costs, it gets a higher profit margin from the agreed-upon
Providers are â€śvery interested in extending their market share nationally,â€ť
said Susan Connolly, a partner at Mercer LLC who specializes in clinical
consulting. Contracting with Loweâ€™s or Wal-Mart Stores Inc., â€śyou know
youâ€™re going to get a lot of volume because theyâ€™re so big.â€ť
Loweâ€™s, based in Mooresville, NC, employs 161,000 people. Other companies
now using the travel surgery option are Wal-Mart, the biggest private
employer in the U.S. with 1.3 million workers, and PepsiCo Inc., the worldâ€™s
largest snack maker, with 106,000 U.S. employees.
Surgery costs can vary widely by hospital, making it tough for large
companies to budget for health-care expenses. For instance, the price of a
full-hip replacement ranges from $15,464 to $76,785, according to the
pricing guide Healthcare Bluebook. By contracting for care at hospitals that
agree to a bundled cost based on a set medical diagnosis, self-insured
employers can better plan out their expenses based primarily on the number
of employees they cover.
Loweâ€™s, the second-biggest U.S. home-improvement chain, was one of the first
big companies to fly employees to the Cleveland Clinic for cardiac
procedures, starting in 2011. Since then, more than 60 employees have taken
part in the program, said spokeswoman Amanda Manna. She declined to say how
much Loweâ€™s has saved in this time.
Wal-Mart instituted its own program last year. More than a million of the
retailerâ€™s employees and family members have opted to be covered by the
plan, which flies them to six providers, including the Cleveland Clinic,
Virginia Mason Medical Center in Seattle and Scott & White Memorial Hospital
in Temple, TX, for heart, spine and transplant surgery.
In January, Wal-Mart added another program, joining Loweâ€™s and other
companies in the Pacific Business Group on Health, a San Francisco-based
nonprofit business coalition, that schedules hip and knee replacements with
centers that include Johns Hopkins, and Kaiser Permanente in Irvine, CA.
PepsiCo and Boeing Co. have similar plans.
Big companies arenâ€™t the only ones seeking to take advantage of the idea.
Alliances such as the non-profit Employers Health Coalition, which
represents about 300 companies, began a travel-surgery program last month
for smaller employers, Bruce Sherman, the medical director for the Canton,
OH-based group, said in a telephone interview.
Only 3 to 4 percent of travel surgery patients at the Cleveland Clinic have
been readmitted in the last three years, said spokeswoman Heather Phillips.
The Clinic tracks patients after they go home, allowing them to count
readmissions to any hospital afterward, she said. Nationally, the average
readmissions rate for heart surgeries is 9 to 13 percent, according to the
Society of Thoracic Surgeons. Once a travel program is set in place,
employers have one more challenge: getting employees to sign on.
Visit Bloomberg for the article.
PDI Super Sani-Cloth
Wipes receive EPA acceptance for three new kill claims
PDI has announced changes to the Super Sani-Cloth Germicidal Disposable
Wipes Master Label, including EPA acceptance on kill claims for three key
microorganisms: Bordetella pertussis, Enterobacter cloacae
(NDM-1 Positive) and Klebsiella pneumoniae (KPC-2 positive,
multi-drug and carbapenem resistant). The formulation of Super-Sani Cloth
has not changed. Additional label enhancements include listing Isopropyl
Alcohol as an active ingredient and improved language in the directions for
Super Sani-Cloth is tested effective against 30 microorganisms with a
contact time of two minutes, making it ideal for fast-paced environments
that require quick room turnover. It is formulated to serve as a house-wide
solution for disinfecting high-touch, non-porous surfaces and is compatible
with a broad range of equipment. It is available in multiple sizes including
a large canister (6â€ť x 6.75â€ť wipe), extra-large canister (7.5â€ť X 15â€ť wipe),
large individual packets (5â€ť x 8â€ť wipe) and extra-large individual packets
(11.5â€ť x 11.75â€ť wipe).
The Sani-Cloth line from PDI is the number one brand of surface disinfecting
wipes in healthcare and includes Super Sani-Cloth, Sani-Cloth AF3, and Sani-Cloth
Bleach. Complemented by PDIâ€™s range of compliance tools, ongoing clinical
support and comprehensive implementation training for staff, The San-Cloth
Environmental Hygiene system offers a complete solution for house-wide and
Visit here for the release.
making more money for hospitals: report
Maternity care is delivering bundles of cash to a slew of hospitals that for
years ran the services at a loss, Crainâ€™s New York Business reported on
Sunday. The high-tech services made hospitals consolidate or close their
labor and delivery wards altogether, the report said.
But higher payments from insurers and New Yorkâ€™s Medicaid program, along
with a spike in high-risk mothers and fragile newborns, have all helped
hospitals cash in. Payments to hospitals for an average delivery rose from
$5,600 from 2009 to $7,400 in 2013, according to the report, which cited
figures from Truven Health Analytics.
Payments for Caesarean sections, which made up a third of citywide births in
2012, also jumped from $10,800 to $14,100, the report said. Care for
newborns spiked from $2,100 to $2,800, while care for premature infants rose
from $35,800 in 2009 to $41,600 in 2013, the report said.
Visit NY Daily News for the story.
Blood test touted
for predicting Alzheimer's
Blood biomarkers in cognitively normal seniors were associated with their
3-year risk of developing mild cognitive impairment or Alzheimer's disease,
researchers said, although the accuracy fell short of what would normally be
acceptable for a screening test.
Levels of 10 plasma phospholipid molecules -- none of them conventional
markers for Alzheimer's disease -- distinguished initially healthy
individuals 70 and older who developed cognitive impairments during
follow-up from those who remained cognitively normal in a 525-person study,
according to Howard J. Federoff, MD, PhD, of Georgetown University in
Washington, D.C., and colleagues.
For this distinction, the 10-marker panel had an area under the
receiver-operating characteristic curve (AU-ROC) of 0.92, with sensitivity
and specificity each at 90%, they reported online in Nature Medicine.
But the data did not appear to fully support that optimism. If the study
cohort's 5% rate of conversion from normal cognition to mild impairment or
Alzheimer's disease is representative of a real-world screening population,
then the test would have a positive predictive value of just 35%. That is,
nearly two-thirds of positive screening results would be false. In general,
a positive predictive value of 90% is considered the minimum for any kind of
screening test in normal-risk individuals.
On the other hand, the use of markers unrelated to the APOE gene or beta-amyloid
and tau proteins may represent a welcome new direction for Alzheimer's
disease risk prediction.
For instance, the test could hold promise as part of clinical trials of new
treatments, by enriching patient samples with those progressing quickly to
clear impairment, Gisele Wolf-Klein, MD, director of geriatric education at
North Shore-LIJ Health System in New Hyde Park, NY, told MedPage Today in an
email."[It] would be a major step in assisting the pharmaceutical industry
in producing disease-modifying therapies at both early and preclinical
stages of dementia," she said.
The researchers focused on unconventional markers considered to be
components of the blood "metabolome" and "lipidome" -- that is, metabolites
resulting from cellular processes and lipid molecules. Ten of these were
ultimately found to be either significantly increased or decreased in the
impaired individuals versus the normal controls. They included amino acids
such as proline and lysine, the neurotransmitter serotonin, and others that
Federoff and colleagues suggested were indicators of "cell membrane
Federoff and colleagues indicated that their biomarker panel's performance
in picking up incipient cognitive impairment was better than blood tests for
beta-amyloid and tau proteins. Levels of these classical markers of
Alzheimer's disease in cerebrospinal fluid have shown better predictive and
diagnostic power, but no test requiring lumbar puncture will catch on for
large-scale screening of asymptomatic people.
On the other hand, at least two other blood tests for unconventional markers
had shown good results for discriminating individuals with current
impairment from normal controls and for predicting progression from mild
impairment to overt dementia, Federoff and colleagues noted, suggesting that
this is a fruitful area to explore.
Keith L. Black, MD, a neurosurgeon and researcher at Cedars-Sinai Medical
Center in Los Angeles, told MedPage Today that it would be important to
learn more about how these markers connect with neurological dysfunction.
Visit MedPage Today for the study.
multi-drug resistant infections lack standard definition and treatment
Infection control practices for detecting and treating patients infected
with emerging multidrug-resistant gram-negative bacteria (MDR-GNB) vary
significantly between hospitals. A study from the Society for Healthcare
Epidemiology of America Research Network, a consortium of more than 200
hospitals collaborating on multi-center research projects, found this
inconsistency could be contributing to the increase in multidrug-resistant
bacteria. The study is published in the April issue of Infection Control
and Hospital Epidemiology.
"Differences in definitions and practices for multidrug-resistant bacteria
confuse healthcare workers and hinder communication when patients are
transferred between hospitals," said Marci Drees, MD, MS, a lead author of
the study. "The danger these inconsistencies represent affects not only
individual hospitals, but the broader community because patients are
frequently transferred between healthcare centers, including long-term care
facilities, furthering their spread."
Researchers reviewed results of an online survey of 70 hospitals,
representing 26 states and 15 foreign countries. The survey looked at how
different hospitals detect and treat MDR-GNB, including microbiological
definition of these pathogens and whether and how long patients are treated
under contact precautions in the hospital.
The recent emergence of multidrug-resistant gram-negative bacteria (MDR-GNB)
is a growing problem that is more difficult to detect and treat than the
more commonly known MRSA (methicillin-resistant Staphylococcus aureus).
No single test can determine whether bacteria are multidrug-resistant, and
researchers found that participating hospitals had up to 22 unique
definitions. These definitions determine whether or not a patient requires
contact precautions. The variations in infection control practices for
MDR-GNB were significant: Some hospitals isolated patients only when they
found bacteria resistant to three or more classes of antimicrobials, while
others would isolate if there was resistance to only one. Depending on
which specific bacteria were found, the duration of isolation also varied
greatly; from none to indefinite.
"Public health agencies need to promote standard definitions and management
to enable broader initiatives to limit emergence of multidrug-resistant
bacteria," said Drees.
Visit SHEA for the study.
Pitfalls seen in
a turn to privately run long-term care
Even as public attention is focused on the Affordable Care Act, another
healthcare overhaul is underway in many states: an ambitious effort to
restrain the ballooning Medicaid cost of long-term care as people live
longer and survive more disabling conditions.
At least 26 states, including California, Florida, Illinois and New York,
are rolling out mandatory programs that put billions of public dollars into
privately managed long-term care plans, in hopes of keeping people in their
homes longer, and expanding alternatives to nursing homes.
Subway advertisements and highway billboards feature smiling old people as
plans jockey for shares of this vast new market. Companies promise profits
for investors and taxpayer savings, too. And some states say the new system
is already working.
â€śItâ€™s a success story,â€ť said Patti Killingsworth, director of long-term
services and supports in Tennessee, pointing out that the state was serving
a quarter more people with inexpensive home and community services. But a
closer look at Tennessee, widely cited as a model, reveals hidden pitfalls
as the system of caring for the frail comes under the twin pressures of cost
containment and profit motive. In many cases, care was denied after needs
grew costlier â€” including care that people would have received under the old
â€śThe notion of prevention saving money in the long run only works if you
actually provide care in the long run,â€ť said Gordon Bonnyman, former
director of the Tennessee Justice Center, a patient advocacy group.
â€śTennessee is probably as good as it gets in terms of oversight and
financial regulation, and thus I think it is a cautionary tale.â€ť
Like many advocates, he originally supported managed long-term care, seeing
it as a way to break the stranglehold of nursing home lobbies that opposed
shifting more Medicaid money to home and community-based care. But now he
says too high a price is being paid by very debilitated people denied care
when they need it most â€” people like Billy Scarlett II, who was 33 in 2005
when he sustained severe brain injuries in an A.T.V. accident, and Glenn
McClanahan, who is 79.
McClanahanâ€™s case illustrates both the appeal and the perils of the new
system. Once a high school quarterback, a successful car salesman and a
ladiesâ€™ man, he was living alone on Social Security, already hobbled by
arthritis and emphysema, when at 75 he abruptly lost nearly all of his
sight. For years, Tennessee residents like him had to move to nursing homes,
with Medicaid paying the bills from a mix of state and federal money.
But in 2010 the new program gave McClanahan another choice: Stay at home
with daily help, and go to a nursing home later if he needed it. Medicaid
paid a fixed monthly sum to an insurance company to cover and coordinate his
future care. For about 30 months, McClanahan was happy to manage at home
with four hours of help daily. The government and the insurance company
benefited, too, because his care cost much less than the monthly Medicaid
sum paid to the plan â€” $3,820, which was less than the $4,583 a nursing home
would have cost.
But when he developed dementia and his health fell apart in the fall of
2012, the state and the insurer denied his application for nursing home
placement and told him he would lose his home care, too. Under tighter rules
adopted by the state to serve more people without spending more, McClanahan
was one of thousands of applicants deemed not disabled enough for Medicaid
to pay for any help.
The change was new scoring that sharply raised the disability threshold
required to get into a nursing home, or to get equivalent care at home. Such
thresholds vary from state to state. But in Tennessee, 41 percent of 34,000
applications for care were denied over the 13 months after the change,
compared with under 10 percent previously.
Long-term care cases traditionally were considered too vulnerable and
politically sensitive to be assigned to a managed care company. But between
recession-starved budgets and the looming costs of an aging population, many
states have decided the old system is unsustainable. About 4.2 million
people receive long-term services paid by Medicaid, representing only 6
percent of Medicaid beneficiaries, but about $136 billion, or one-third of
all Medicaid spending. They include many formerly well-off people in nursing
homes who have â€śspent downâ€ť their â€ścountableâ€ť assets â€” the primary home is
the major exclusion â€” to less than $2,000, the maximum for Medicaid
eligibility in many states.
Under the old system, providers bill Medicaid directly, a model plagued by
perverse incentives for expensive, unnecessary and even fraudulent care.
Despite arguments that people should not have to enter high-priced
institutions to get help with activities of daily life like bathing and
eating, relatively little Medicaid money was available for cheaper
alternatives. Nursing homes have often used political muscle to keep it that
Managed care promises more predictable, controlled spending. From a fixed
sum per enrollee, plans pay networks of providers to deliver care, which
could be as cheap as a recorded medication reminder, or as costly as a
nursing home stay.
Like the rationale behind health maintenance organizations, the idea is that
plans will benefit financially by keeping costs lower and people healthier,
and that the expense of customers who need more care will be counterbalanced
by those who need less. But now, as the formula is applied to a more fragile
population, some states have already run into problems that marred the early
history of H.M.O.s.
WellPoint, which recently acquired AmeriGroup for $4.9 billion, referred
questions to TennCare, where officials said privacy laws did not allow
discussion of the case. But Kelly Gunderson, a TennCare spokeswoman, added
that in any long-term care program, â€śdifficult public policy decisions must
be made, including whether to provide an unlimited array of benefits to a
few, or a reasonable package of benefits sufficient to safely serve
individuals in the community to many.â€ť
Tennessee has chosen to be as cost-effective as possible, she said, and that
has allowed the state to eliminate waiting lists for community-based
services, which now serve nearly 13,000 people, up from 5,000, while keeping
the number of nursing home residents flat at 19,200.
Nationwide, publicly traded companies like UnitedHealthcare are replacing
nonprofits. There are trade-offs, said Michael J. McCue, a professor of
health administration at Virginia Commonwealth University, whose comparative
study found that publicly traded plans focusing primarily on Medicaid
enrollees reported the highest percentage of administrative expenses, and
received lower scores for quality of care.
â€śThey have to make sure that they meet earnings expectations to help improve
their stockholdersâ€™ wealth,â€ť Professor McCue said. â€śThey could argue that,
hey, maybe we have a more effective way of managing the care or cost. And
one can ask, hey, are they denying care?â€ť
Visit the New York Times for the story.
young stroke victims remain disabled years after: Study
One-third of people who suffer strokes before the age of 50 will have
trouble dealing with the challenges of daily life even several years later,
a new study finds. The finding suggests that younger age provides only
limited protection against the devastation of a stroke. While strokes are
much rarer in younger people, 10 percent of all strokes occur from age 18 to
50, the study authors noted.
Dr. Steven Levine, an attending neurologist at The Brooklyn Hospital Center
in New York City, agreed. "Stroke in young people is more common than most
people realize," he said. "Approximately 15 percent of all strokes due to
blocked arteries [called ischemic strokes] occur in young adults and
"Compared to stroke in older people, stroke in the young has significant
economic impact by leaving victims disabled prior to their most productive
years," he pointed out.
The new Dutch study was led by Frank-Erik de Leeuw, associate professor of
neurology at the Radboud University Nijmegen Medical Center. His team
tracked the progress of 722 people who first had a stroke at ages 18 to 50.
After an average of nine years, about one in three still required assistance
in some situations due to lingering disability that was at least at a
moderate level. Some were unable to independently accomplish household
chores and take care themselves, the study found.
Hemorrhagic strokes, which occur when there's bleeding in the brain,
resulted in the most disability, followed by ischemic strokes and the
"mini-strokes" known as transient ischemic attacks.
"Most doctors view young stroke patients as a group with great recovery
opportunities," de Leeuw said. "But our study is the first to show these
almost life-long effects of stroke on performance. This is important to
communicate right from the start to patients and families."
Dr. Aviva Lubin is associate stroke director at Lenox Hill Hospital in New
York City. She said the Dutch study "highlights the potential long-term
disability after stroke."
However, "stroke care has made strides in the past two decades, as shown in
the decreasing proportion of patients with poor functional outcome over the
time of the [Dutch] study," she added. "Such improvement is probably due to
intensive rehabilitation after stroke followed by continued exercise."
And Levine pointed out that support is out there for stroke patients and
"There are many websites addressing young stroke victims, and social media
networking can provide additional avenues for raising awareness and linking
individuals and families," (HealthDay)
Visit NIH for the study.
receives CE Mark for its hydrogen peroxide sterilizer technology
Sterilucent, Inc, announced that on March 6, 2014 the CE mark was issued for
the Sterilucent PSD-85 Hydrogen Peroxide Sterilizer and sterilant. This
low-temperature sterilization solution was recently exhibited at the MEDICA
Trade Fair in DĂĽsseldorf, Germany, and generated significant interest from
The Sterilucent PSD-85 sterilizer is a ruggedized low-temperature vaporized
hydrogen peroxide system designed specifically for use at civilian and
military facilities in austere environments, such as combat support
hospitals, world health organization clinics, and emergency response units.
This innovative system is designed to be easily and safely transported, and
is highly effective, efficient and safe for patients, staff, and most
reusable medical devices, when used as directed.
The specialized features that make the Sterilucent system ideal for austere
environments are: a ruggedized design that limits damage due to
transportation; expanded environmental operating conditions; low energy
requirements; Lumen and Non-Lumen cycles to broaden the types of devices
that can be processed; a long shelf life for the systemâ€™s related consumable
products; and the specific ability to process moisture and heat-sensitive
devices. In addition, Sterilucent offers a full line of sterility assurance
consumables and processing accessories to help assure that all necessary
components are available to users for consistent, productive low-temperature
The Sterilucent PSD-85 Hydrogen Peroxide Sterilizer and related accessories
are not available in the United States. Sale of these products in the U.S.
is pending FDA 510(k) clearance. For more information, please visit