DAILY UPDATE

Cheaper surgery sends Lowe’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, Lowe’s covers the full cost of surgery, as well as travel and lodging for the worker and a relative. The company health plan won’t cover thousands of dollars of unbundled costs at local hospitals.

“It’s a win-win-win” for patients, employers and the hospital, said Michael McMillan, Cleveland Clinic’s executive director of market and network services. “The patient has no out-of-pocket responsibility, employers have a better long-term financial result and we get patients.”

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, it’s been joined by other centers, including Johns Hopkins Bayview Medical Center in Baltimore, that see the same opportunities.

“It’s new volume that we wouldn’t have otherwise, which means new revenue for us,” Trisha Frick, assistant director of managed-care contracting at Johns Hopkins, said in a telephone interview. “It also gives us predictability in reimbursement rates.”

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 reimbursement.

Providers are “very interested in extending their market share nationally,” said Susan Connolly, a partner at Mercer LLC who specializes in clinical consulting. Contracting with Lowe’s or Wal-Mart Stores Inc., “you know you’re going to get a lot of volume because they’re so big.”

Lowe’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 world’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.

Lowe’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 Lowe’s has saved in this time.

Wal-Mart instituted its own program last year. More than a million of the retailer’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 Lowe’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 aren’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 use.

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 (6” x 6.75” wipe), extra-large canister (7.5” X 15” wipe), large individual packets (5” x 8” wipe) and extra-large individual packets (11.5” x 11.75” 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 PDI’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 situational use. Visit here for the release.

Maternity units 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, Crain’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 York’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 integrity."

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.

Emerging 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.

“It’s a success story,” 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 — including care that people would have received under the old system.

“The notion of prevention saving money in the long run only works if you actually provide care in the long run,” said Gordon Bonnyman, former director of the Tennessee Justice Center, a patient advocacy group. “Tennessee is probably as good as it gets in terms of oversight and financial regulation, and thus I think it is a cautionary tale.”

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 — 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.

McClanahan’s case illustrates both the appeal and the perils of the new system. Once a high school quarterback, a successful car salesman and a ladies’ 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 — $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 “spent down” their “countable” assets — the primary home is the major exclusion — 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 way.

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, “difficult 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.”

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.

“They have to make sure that they meet earnings expectations to help improve their stockholders’ wealth,” Professor McCue said. “They 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?” Visit the New York Times for the story.

One-third of 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 adolescents."

"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 their caregivers.

"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.

Sterilucent, Inc. 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 Düsseldorf, Germany, and generated significant interest from attendees.

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 system’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 sterilization

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 www.sterilucent.com.