Cedars-Sinai Medical Center of Los Angeles said Monday that in reviewing the cases of patients who received eight times normal doses of radiation during CT brain perfusion scans, it appears some patients have an enhanced risk of developing cataracts.
In making that statement yesterday, Cedars-Sinai officials say they are offering to pay bills for future medical care if needed "should the CT brain perfusion scans cause any specific health problem."
Also, hospital officials acknowledged, "260 patients were affected, up from the initial finding of 206," over the course of an 18-month period that ended in August.
In letters sent yesterday, Cedars-Sinai officials told patients that approximately 20% of affected patients had exposure directly to the lens of their eyes from the radiation.
In a statement, Cedars-Sinai officials said that those letters "told those patients of the finding (of risk to the lens) and informed them that they may be at risk for developing cataracts sooner than they would have normally, had the scan delivered the appropriate amount of X-ray radiation."
The statement continued: "Cedars-Sinai said it will pay for treatment if there are cataracts caused by the unexpected X-ray levels of the scan."
The letter, signed by Cedars-Sinai Medical Center's chief operating officer and chief medical officer, apologized to the patients, and offered the medical center's "ongoing commitment" to being available to the patients "now and at any time in the future to answer any questions or concerns about your healthcare." It also noted the incident was "completely unacceptable to all of us."
It continued, "We have a responsibility to do right by our patients, so we are committed to addressing their needs by providing information and resources as we continue to investigate the scanning equipment issues," wrote Mark Gavens, Cedars-Sinai's COO.
The U.S. Food and Drug Administration and officials for the state Department of Public Health are investigating the incident. In October, the FDA issued an interim alert to hospitals throughout the country saying the overexposure "may not be isolated to this particular facility or this imaging procedure."
Cedars-Sinai has since changed its scanning procedures.
The overdose came to light after one patient who received an excessive dose of radiation during a 64-slice CT brain perfusion scan for a suspected stroke reported reddening of the skin and a loss of hair in August.
A later review of other patients who had undergone the scan determined that as many as 40% of the patients who received the scans reported experiencing symptoms, such as the loss of patches of hair, from the overexposure.
In turn, Cedars-Sinai CEO Tom Priselac sent a number of recommendations to the FDA suggesting changes in the scanner's design to prevent a recurrence.
The scanner was manufactured by General Electric, which issued this statement on Oct. 20: "Although GE Healthcare continues its internal investigation, we confirm that there were no malfunctions or defects in any of the GE Healthcare equipment involved."
Pay for performance may be the rage, and the future of physician reimbursement—but it doesn't come cheap.
Responding to all those requests for data, proper planning, training, coding, data entry, and modification of electronic systems cost physician practices between $1,000 to $11,100 in implementation costs per doctor, and from about $100 to $4,300 per year per clinician after the program was launched, according to a survey of eight physician practices participating in four quality reporting programs in North Carolina.
"One thing is clear," wrote Jacqueline R. Halladay, MD, the study's author and a UNC researcher. "Participation in quality-reporting programs requires resources that have measurable costs. The costs appear high, especially when compared with the modest reimbursement offered by many programs."
The report added, "To date, the question of whether participation in quality-reporting is worth the time, effort and expense is largely unresolved."
The study was published Monday in the Annals of Family Medicine.
The UNC report found substantial variation in the resources used by four reporting programs. There was a wide variation in the "amount of work shouldered by the quality improvement program staff, the intensity of a program's quality focus, and the time required for quality improvement work beyond data collecting and reporting."
Small practices appeared especially hard hit by the program participation costs, she said.
The researchers examined costs of four incentive programs: Medicare's Physician Quality Reporting Initiative (PQRI); Improving Performance in Practice in North Carolina and Colorado (IPIP); Bridges To Excellence, (BTE), implemented by Blue Cross/Blue Shield of North Carolina; and Community Care of North Carolina (CCNC).
Practices selected included four for-profit practices, three non-profit practices, and one teaching practice and represented variation in size, ownership, specialty, location, and medical record formats.
The major costs included planning meetings, clinician time required to gather and code data, information technology system modification, and staff time to verify the accuracy of the clinicians' coding.
"Despite the enthusiasm for quality improvement, reporting activities have occurred with relatively little regard to the challenges primary care practices face in collecting and reporting requested data," according to the report.
The White House is facing a growing revolt from some Democrats and analysts who say the health reform bills Congress is considering do not fulfill President Obama's promise to slow the runaway rise in healthcare spending. President Obama has made cost containment a centerpiece of his health reform agenda, and in May industry groups pledged voluntary efforts to trim the growth of healthcare spending by 1.5%, or $2 trillion, over the next decade. But health economists say it is impossible to know whether the bills, including one passed by the House, would meet that goal, and many are skeptical that they even come close, the New York Times reports.
A provision in the House healthcare bill would limit how much insurers can vary premiums based on the age of the person buying the policy. The narrower the range, the lower the premiums for older people, a help to those who currently pay some of the highest rates for insurance and often need coverage the most. But such a limitation tends to raise premiums for younger people, who are sometimes reluctant to buy coverage, the Wall Street Journal reports.
In further moves to reduce ever-mounting losses, Miami-based Jackson Health System announced plans to close six units in January and lay off 93 employees. Jackson officials said it will close two transplant units, two other units at Jackson North and Jackson South, as well as two primary care clinics. Because the financial situation keeps getting worse, Jackson officials say the system is still looking for other areas to save money.
Complaining about lousy, dangerous, and illegal healthcare practices in Florida just got a little easier with word today that the state has launched an online healthcare facility complaint form.
"We are always looking for ways to empower Floridians to be more involved in their healthcare and the care of their loved ones," said Thomas Arnold, the newly appointed secretary of the Florida Agency for Health Care Administration.
"The new online healthcare facility complaint form will give Floridians direct access to our agency when they feel a violation has occurred, allowing us to act quickly and efficiently to help correct the issue."
Healthcare consumers can search www.FloridaHealthFinder.gov to see if a healthcare facility is regulated by AHCA. If a consumer has a complaint or would like to report a suspicious activity, they can anonymously complete AHCA's online complaint form at FloridaHealthFinder.gov and click on File a Complaint or click here.
The only information needed to file a complaint is the name of the facility, address, date of the incident, and the patient/resident's name and date of birth, if available. Floridians without Internet access can call AHCA toll-free at (888) 419-3456.
AHCA regulates 41 types of healthcare service providers, including hospitals, nursing homes, assisted living facilities, and home health agencies, administers Florida's Medicaid program, licenses and regulates more than 40,000 healthcare facilities and 43 HMOs, and publishes healthcare data and statistics. In 2008, AHCA received 7,788 complaints through phone calls and written correspondence.
Officials at Los Angeles-based Cedars-Sinai Medical Center said that 260 patients had been exposed to high doses of radiation during CT brain scans during an 18-month period, up from the hospital's original estimate of 206 in September. A review by the hospital also found that about 20% of the patients received exposure directly to the lenses of their eyes, which puts them at a higher risk for cataracts, said a spokeswoman for the hospital. Of the newly identified cases, 47 patients had died by the time the hospital began contacting victims. This was a reflection, officials said, of their serious illnesses, not the radiation exposure. Seven more patients were identified as a result of the ongoing investigation.
A key Democratic senator said he will follow House colleagues in insisting on tough antiabortion language before he votes for a health overhaul bill, the Wall Street Journal reports. Leading Senate Democrats are seeking to prevent the abortion issue, which almost capsized the healthcare debate in the House, from engulfing the Senate.
The American Medical Association rebuffed dissident members and voted to stick with support for ongoing health reform efforts. The action at the group's semiannual meeting in Houston could be seen as a vote of confidence for AMA leaders who voiced support for the $1.2-trillion, 10-year bill the U.S. House passed. Several dissident doctor organizations within the AMA had urged the group to reverse its position and come out with a strong statement opposing Democrat-led reform efforts.
After faciing criticism for proposing to eliminate a state healthcare program for the indigent, Minnesota Gov. Tim Pawlenty's administration has decided to transfer most of those recipients to a subsidized insurance plan for the working poor. The General Assistance Medicare Program program for adults making less than $7,800 a year is scheduled to go away March 1, potentially leaving some 36,000 recipients without regular access to medical care. Now some 28,000 will be automatically enrolled in MinnesotaCare, a subsidized health insurance plan. The remainder are those whose GAMC eligibility is running out or who already are applying for MinnesotaCare.
