Medicare and other payers urged to consider additional options with less-invasive virtual colonoscopy for screening and prevention of colorectal cancer.
People with health insurance policies that cover CT colonography for colorectal cancer screening are almost 50% more likely to get screened than those whose policies don't cover the procedure, according to a study in Radiology.
Colorectal cancer kills 50,000 people each year, despite screening methods that provide early detection and treatment of the disease. The American Cancer Society recommends CT colonography as one of the screening tests that can find both pre-cancerous polyps and cancer in people age 50 or older. Insurers have been slow to cover it. CT colonography, also known as virtual colonoscopy, uses CT imaging to provide fly-through views of the colon and is a less-invasive option than conventional colonoscopy.
Screening adherence rates have stalled at about two-thirds of the people who need to be screened, according to study lead author Maureen A. Smith, MD, of the University of Wisconsin-Madison School of Medicine and Public Health.
“CT colonography is a newer technology that can detect both pre-cancer and cancer, but because it's relatively new it isn't widely covered by insurance and isn't covered by Medicare,” Smith said.
Smith and her colleagues looked at overall colorectal cancer screening rates for 33,177 patients under age 65 who were eligible and due for colorectal cancer screening. About half of the people in the group were ultimately screened during the study period, and researchers compared screening rates between those with and without insurance coverage for CT colonography.
The people in the study who had insurance coverage for CT colonography had a 48% greater likelihood of being screened by any method compared with those without coverage who were due for screening.
“Our study suggests that when people are offered a greater choice of screening tests for colorectal cancer, including CT colonography, they are more likely to complete screening to prevent colorectal cancer,” Smith said.
"Policymakers should consider additional options for screening and prevention of colorectal cancer," Smith said. "CT colonography is potentially a powerful option, because there are people who will prefer it."
Some insurers have begun increasing coverage to include CT colonography, Smith said, but the lack of coverage by Medicare is unlikely to change soon.
"Locally, insurers have been open to including CT colonography in their coverage," she said. "Nationally, any change will probably rely on Medicare's decision-making process, which can take substantially more time."
The average additional cost in the six months following a fall for transfemoral amputee patients requiring an emergency department visit was $18,000. For patients who had to be hospitalized, this extra expense was more than $25,000.
Medicare and other insurers that pay for only basic mechanical artificial knees and legs instead of more sophisticated prosthetics with microprocessors could pay more in the long run because of falls associated with the low-tech appendages, a Mayo Clinic study has found.
In a new study published in Prosthetics and Orthotics International, Mayo researchers examined the direct medical costs of falls in adults with amputations above the knee in an effort to “provide a comparison for policymakers when evaluating the value of more expensive … technologies.”
Of the 185,000 transfemoral amputee patients each year, only 25%-30% receive a prosthetic leg and knee, and insurance policies for most only cover basic mechanical knees. Despite growing data that newer technology reduces falls and improves physical capabilities, only high-functioning patients are deemed eligible for a knee with microprocessor technology.
Mayo researchers said they are challenging that standard.
“We want to help provide the best quality of life and prosthesis for each individual,” said study lead author Benjamin Mundell, a health economist and a student at Mayo Clinic School of Medicine. “It is important to look beyond the initial cost differences of a microprocessor knee compared to a mechanical knee and understand what downstream costs might be avoided with a better prosthesis.”
“Microprocessor knees are designed to help improve balance and reduce falls,” he said. “The fear of falling for those with mechanical knees likely reduces their overall physical activity and if they do fall and require hospitalization, the cost of care is almost as expensive as a microprocessor knee.”
The team examined the medical records of 77 patients in Wisconsin and Minnesota who received a transfemoral amputation between 2000 and 2014. They found that 46 of these patients had received a prosthetic knee. Of these, 22 patients logged 31 falls that resulted in an ED visit or hospitalization.
Using standardized Medicare cost data, the researchers found that the average additional cost in the six months following a fall for patients requiring an ED visit was $18,000. For patients who had to be hospitalized, this extra cost was more than $25,000.
“Understanding the costs is part of basic health economics,” said study senior author Kenton Kaufman, a biomedical engineer and orthopedics researcher at Mayo. “This study quantifies the cost of falls that require medical attention – providing evidence that it may not be economical to withhold microprocessor knees from patients with moderate ambulatory capabilities.”
Kaufman said the costs to patients are much higher than the study shows because the study doesn’t reflect indirect costs such as lost wages, and transportation and caregiving expenses.
Medicare K levels are used to determine which prosthetic device is medically necessary for a patient. To be considered eligible for the microprocessor knee, a patient needs extensive documentation that he would use the leg more than the normal day-to-day walking, stairs, etc.
“For many, the default may be a mechanical knee, because it is easier to prove basic necessity than to ensure the rigorous documentation requirements for one with advanced – and more costly – technology,” Kaufman said. “One of the reasons we work on improving technology in prosthetic knees is to help individuals become more agile, more balanced and less likely to fall, but if people aren’t able to access this technology, they may become more vulnerable and less active than their condition would normally indicate.”
The most common errors were taking or giving the wrong medication or incorrect dosage, and inadvertently taking or giving a medication twice, researchers have found.
The frequency of serious medication errors by patients or their caregivers outside of a healthcare setting more than doubled from 2000 to 2012, according to a study in Clinical Toxicology.
Researchers from the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital analyzed calls to poison control centers across the country over the 13-year period about medication errors that resulted in serious medical problems.
The rate of serious medication errors per 100,000 people more than doubled from 1.09 in 2000 to 2.28 in 2012. These errors occurred mostly in the home, affected people of all ages, and were associated with a wide variety of medications.
“Drug manufacturers and pharmacists have a role to play when it comes to reducing medication errors,” said Henry Spiller, a co-author of the study, and director of the Central Ohio Poison Center at Nationwide Children’s. “There is room for improvement in product packaging and labeling. Dosing instructions could be made clearer, especially for patients and caregivers with limited literacy or numeracy.”
The most common errors were taking or giving the wrong medication or incorrect dosage, and inadvertently taking or giving the medication twice. Among children, dosing errors and inadvertently taking or giving someone else’s medication were also common errors. One-third of medication errors resulted in hospital admission.
The medication categories most frequently associated with serious outcomes were cardiovascular drugs (21%), analgesics (12%), and hormones/hormone antagonists (11%). Most analgesic exposures were related to products containing acetaminophen (44%) or opioids (34%), and nearly two-thirds of hormone/hormone antagonist exposures were associated with insulin. Cardiovascular and analgesic medications combined accounted for 66% of all fatalities in this study.
Among children younger than six years, the rate of medication errors increased early in the study and then decreased after 2005, which was associated with a decrease in the use of cough and cold medicines attributable to the Food and Drug Administration’s 2007 warning against giving these drugs to children.
“Managing medications is an important skill for everyone, but parents and caregivers have the additional responsibility of managing others’ medications,” said study lead author Nichole Hodges, a researcher at the Center for Injury Research and Policy at Nationwide Children’s.
“When a child needs medication, one of the best things to do is keep a written log of the day and time each medication is given to ensure the child stays on schedule and does not get extra doses.”
Data for the study were obtained from the National Poison Data System, which is maintained by the American Association of Poison Control Centers.
The sector’s 37,000 new jobs accounted for nearly 17% of all new jobs in the economy in June. Despite the strong growth, healthcare job creation is trending about 20% slower than in 2016, a record year.
Halfway through 2017, healthcare job growth remains strong, but it’s running nearly 20% below last year’s record pace, according to the Bureau of Labor Statistics
In June, healthcare added 37,000 jobs, including 26,000 in ambulatory services and 12,000 in hospitals. So far this year, healthcare has created an average of 24,000 jobs each month, compared with a monthly average of 32,000 jobs in 2016, BLS data show.
In the larger economy, total nonfarm payroll employment increased by 222,000 in June, and the healthcare sector accounted for nearly 17% of those new jobs. The unemployment rate was little changed at 4.4%, BLS data show.
The latest Conference Board Help Wanted OnLinedata series for May shows that healthcare job growth is robust, with nearly five job openings for every clinician and healthcare technologist searching for a job, with an average hourly wage of $38.06. The news is not so good for healthcare support workers, of whom there are 1.4 people searching for every advertised job, paying an average hourly wage of $14.65.
Healthcare job growth has continued at a torrid pace for most of the new century. The sector set a record pace for job growth in 2016, which broke the record set in 2015. However, 2017 is trending slower.Nicole Smith, chief economist at Georgetown University Center on Education and the Workforce, told HealthLeaders Media that the slowdown could be linked to churn and uncertainty around the Affordable Care Act.
"Maybe hospitals are being pre-emptive and not hiring workers at the same pace as in the past in anticipation that this repeal and replace is actually going to go through,” Smith said. “We can expect hospital hiring to really slow down until people get a handle on what is going to happen.”
This ongoing robust job growth in healthcare was not unforeseen. In 2009, the President’s Council of Economic Advisors correctly predicted that healthcare would be the largest source of job growth in the decade ahead, with 3.5 million new jobs expected by 2016.
"Healthcare practitioners and technicians, which include physicians, registered nurses, and other health professionals and technicians, are expected to be in increasing demand," the report stated. “Investments in health information technology will bolster job growth in that area, while the healthcare support sector–including physical therapists, medical social workers, and home healthcare aides–is projected to see even faster job growth as the nation's population ages.”
Risk factors associated with adverse events within six months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.
More than half patients age 65 and older who visited an emergency department for injuries sustained in a fall suffered adverse events – including additional falls, hospitalization and death – within six months, according to a small sample study this week in the Annals of Emergency Medicine.
“Our study shows an even higher rate of adverse events than previous studies have,” said lead author Jiraporn Sri-on, MD, of Navamindradhiraj University in Bangkok, Thailand. “Patients taking psychiatric and/or sedative medications had even more adverse events. This is concerning because these types of drugs are commonly prescribed for elderly patients in community and residential care settings.”
The findings rely upon an analysis of 350 elderly fall patients who presented to the ED at one urban teaching hospital in 2012. Of patients who visited the ED for injuries sustained in a fall, 7.7% developed adverse events within 7 days, 21.4% developed adverse events within 30 days and 50.3% developed adverse events within six months. Within six months, 22.6% had at least one additional fall, 42.6% revisited the emergency department, 31% had subsequent hospitalization and 2.6% had died.
Risk factors associated with adverse events within six months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.
"Emergency physicians have a tremendous opportunity to reduce the very high adverse event rate among older emergency patients who have fallen,” Sri-on said. "Fall guidelines exist and work needs to be done to increase their implementation in emergency departments so patients can be educated on how not to fall again once they have been discharged from the emergency department."
The American College of Emergency Physicians recently produced a public education video to help prevent falls.
Across all patient subgroups and payers, hospital stays decreased or held stable between 2005 and 2014, while the inflation-adjusted mean cost per inpatient stay increased by 12.7%, from $9,500 to $10,900.
Hospital inpatient stays dropped from 37.8 million in 2005, to 35.4 million in 2014, a decrease of 6.6%, according to a statistical brief from the Healthcare Cost and Utilization Project.
And the demographic trends show that more affluent people are spending 15%-20% less time in the hospital, while people living in poorer communities experienced the smallest decrease in hospitalization rates. Medicaid-covered inpatient stays increased by 15.7%, while the proportion paid by private insurance and that were uninsured decreased by 12.5% and 13%, respectively.
The decreased held for several patient demographic subgroups, including patients younger than 45 years and older than 74 years, patients with private insurance or no insurance, and patients in the two highest income quartiles. For patients aged 45-64 and 65-74 years, the number of hospital stays did not change substantially during the 10-year time period, HCUP’s analysis found.
The only hospitalization type that changed substantially from 2005 to 2014 was mental health/substance use. Between 2005 and 2014, the proportion of inpatient stays for mental health/substance use increased from 4.9% to 5.9% of all hospital stays, a 20% increase. The proportion of stays for other hospitalization types held steady.
The HCUP analysis also found that:
The overall average cost per hospital stay increased by 12.7% from 2005 to 2014, adjusting for inflation. Inflation-adjusted cost per stay for patients covered by private insurance or Medicaid increased 16%-18%. Cost per stay for Medicare-covered patients and the uninsured changed minimally. Other subgroups with large increases in mean cost per stay were patients aged 0-17 years (up 15.3%) and patients hospitalized for neonatal care (up 19.2%), injuries (up 17%), and surgery (up 16.4%).
In both 2005 and 2014, medical hospitalizations constituted the highest proportion of stays (46%), followed by surgical (20%), maternal (12%), neonatal (11%), mental health/substance use (6%), and injury (5%).
Medicare was the most common expected payer for hospital care and together with Medicaid paid for 61.6% of all hospital stays in 2014.
The proportion of Medicaid-covered inpatient stays increased by 15.7%, whereas the proportion paid by private insurance and that were uninsured decreased by 12.5% and 13%, respectively.
Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled. Septicemia and complication of device/implant/graft rose to top 10 conditions in 2014 but were not on the top 10 list a decade earlier. Nonspecific chest pain and coronary atherosclerosis decreased by more than 60% from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.
The incidence of Clostridium difficile infections rose by 43% from 2001 to 2012, while the incidence of multiple recurring CDI rose by 189% over the same period.
Multiple recurring Clostridium difficile infections are becoming more common in the nation’s hospitals and researchers aren’t sure why.
In an analysis of a large, nationwide health insurance database, researcher’s at the University of Pennsylvania’s Perelman School of Medicine found that the annual incidence of multiple recurring C. difficile (mrCDI) increased by almost 200% from 2001 to 2012. During the same period the incidence of ordinary CDI increased by only about 40%. The study results were published this week in the Annals of Internal Medicine.
The reasons for the sharp rise in mrCDI incidence is unknown. Researchers said the finding points to an increased burden on the healthcare system, including increased demand for new treatments for recurrent CDI. The most promising of these new treatments, fecal microbiota transplantation—the infusion of beneficial intestinal bacteria into patients to compete with C. difficile—has shown good results in small studies, but hasn’t yet been thoroughly evaluated.
“The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” said study senior author James D. Lewis, MD, professor of gastroenterology and senior scholar in the Center for Clinical Epidemiology and Biostatistics.
“While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.”
In their analysis of CDI trends, the researchers examined records on more than 40 million patients enrolled in private health insurance plans. Cases of CDI were considered to have multiple recurrences when doctors treated them with at least three closely spaced courses of CDI antibiotics.
According to the analysis, the incidence of CDI rose by 43% percent from 2001 to 2012, while the incidence of mrCDI rose by 189% over the same period.
Compared to CDI patients whose infections cleared up after just one or two courses of therapy, patients with mrCDI were older (median age 56 vs. 49), more likely to be female (64% vs. 59%), and more likely to have been exposed, before their CDI, to medications such as corticosteroids, proton-pump inhibitors, and antibiotics, the researchers found.
The rapid rise in the incidence of mrCDI may be due in part to Americans’ increasing use of such drugs. However, according to Lewis, it is likely that other causes are also involved.
“An additional driver of this rise in incidence could be the recent emergence of new strains of C. difficile, such as NAP1, which has been shown to be a risk factor for recurrent CDI,” he said.
C. difficile can encapsulate itself within hardy spores, making it relatively resistant to normal sterilizing procedures. It is notorious for spreading among vulnerable patients within hospitals. Infection causes diarrhea and severe gut inflammation, and can lead to sepsis, especially among the elderly.
The antibiotics metronidazole, vancomycin, and fidoxamicin are commonly used to treat CDI, but recurrence after initial treatment happens in roughly a third of cases.
Because C. difficile appears to thrive in people whose normal, healthy gut bacteria have been killed off or diminished, gastroenterologists recently have begun using fecal microbiota transplantation (FMT) as an alternative to antibiotics for recurrent CDI. Long used in veterinary medicine, FMT involves infusions of fecal matter from healthy intestines. The aim is to help restore a normal gut bacteria population in the patient.
A small study in 2013 found that a single FMT infusion cleared up C. difficile diarrhea in 81% of the recurrent-CDI patients who received it, whereas a standard treatment with the antibiotic vancomycin worked for just 31% of patients. Lewis said more needs to be known about FMT’s long-term safety.
The American Gastroenterological Association recently set up a formal registry for doctors to report their results with FMT procedures. “It’s a way in which practitioners who are performing fecal microbiota transplantation can contribute data to help answer these critical questions,” Lewis said.
CareSpot says deal provides more resources when follow-up care is needed. Orlando Health seeks to expand care access points in its service area.
Orlando Health and CareSpot Urgent Care have formed a partnership.
Under the deal, CareSpot’s eight urgent centers in the Orlando area, and all future centers, will continue to be managed by CareSpot and co-branded CareSpot Urgent Care | Orlando Health, according to a joint media release.
The deal is expected to be finalized by the end of the summer. Financial terms were not disclosed.
“Orlando Health is a widely respected healthcare system in Central Florida,” CareSpot CEO Eric Enderle said. “This partnership will allow us to seamlessly connect our patients in the greater Orlando area to the broader resources in the Orlando Health network when follow-up care is deemed necessary and if the patient chooses.”
“Additionally, it gives us a strong partner as we grow throughout the area,” he said. “We are excited to be aligned with Orlando Health and anticipate opening more centers to better serve the needs of the greater Orlando Health community.”
Orlando Health CEO David Strong said the partnership “position(s) both parties to offer our community many access points for a high-quality, full continuum of care serving all levels of acuity for a wide range of conditions.”
CareSpot Urgent Care, a division of United Surgical Partners International, Inc., is operated and managed with MedPost Urgent Care at 91 locations nationwide. Core services include urgent care, wellness, in-house lab work and x-rays, seasonal care, and occupational health.
Orlando Health is a six-hospital, not-for-profit teaching hospital system that includes a level-one trauma center, a cancer center, two pediatric hospitals and three community hospitals serving Central Florida.
CHRISTUS will be the majority owner of the not-for-profit entity and will manage the joint venture, including CHRISTUS St. Patrick Hospital and Lake Area Medical Center.
CHRISTUS Health and Ochsner Health System have signed a letter of intent to pursue a joint venture of CHRISTUS operations in the Lake Charles region of southwest Louisiana, the two health systems announced Wednesday.
The joint venture will have responsibility for all healthcare facilities and services operated by the two health systems in the region. In a joint media release, the health systems said the agreement will improve and expand local access to healthcare and specialties such as maternal fetal medicine, pediatric subspecialties, neurosciences and oncology.
Financial terms of the deal were not disclosed.
“With today’s announcement we are sharing our intentions of bringing together two vital, not-for-profit organizations,” said Ernie Sadau, president and CEO of CHRISTUS. “We’re also reinforcing our deep commitment to continue to provide high quality care and improve the health of the communities we serve.”
Ochsner President and CEO Warner Thomas said the two health systems have an “opportunity and in fact (a) responsibility to work even more closely together and do more to expand, innovate and improve healthcare in our region.”
Ochsner will assume management of the clinics and employed physicians in the CHRISTUS Physician Group and Lake Area Medical Group. A new joint board of directors will oversee strategic decisions for the integrated system in the Lake Charles area.
When the transaction is completed, CHRISTUS will be the majority owner of the not-for-profit entity and will continue to manage all other parts of the joint venture, including CHRISTUS St. Patrick Hospital and soon to be acquired Lake Area Medical Center.
Until then, Lake Area Medical Center will be called CHRISTUS Lake Area Hospital.
The deal is expected to be finalized by fall 2017 including the new structure, an anticipated name change and co-branding. When the deal is finalized, the new entity will expand specialized healthcare services in the Lake Charles area that are currently unavailable.
CHRISTUS Health, a Catholic, faith-based, not-for-profit health system, is headquartered in Dallas, TX and includes more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers and dozens of other health ministries and ventures in the U.S., Mexico, Chile and Colombia.
Ochsner Health System is Louisiana’s largest non-profit, academic, healthcare system and includes 29 affiliated hospitals and more than 80 health centers and urgent care centers.
The widely read list ranks hospitals on how they performed in three key areas: clinical outcomes, care coordination, and providing care-related resources.
U.S. News on Tuesday unveiled its 11th annual list of the nation’s Best Children’s Hospitals, and it bears a striking resemblance to the magazine’s 10th annual list.
The top four hospitals in 2016-17 held their rankings in 2017-18, led by Boston Children’s Hospital, which is a perennial list topper. Only one hospital on the 2017-18 list, Johns Hopkins Children’s Center in Baltimore at No. 5, was not on the Top 10 list the previous year.
In the 2017-18 rankings, 82 hospitals ranked among the top 50 in at least one specialty. Ten of those hospitals earned a place on the Best Children's Hospitals 2017-18 Honor Roll by racking up points for being highly ranked in many specialties.
U.S. News said the 2017-18 rankings were created from data collected through a clinical survey sent to nearly 200 hospitals and a reputational survey sent to about 11,000 doctors who are pediatric specialists. RTI International, a North Carolina-based research and consulting firm that also generates the Best Hospitals rankings, administered both surveys and analyzed the results.
Data collected and analyzed included survival rates for children who underwent surgery for serious congenital heart defects, infection rates in neonatal intensive care units, complications from kidney biopsies and other care outcomes. Data about the adequacy of each hospital's nurse staffing and infection-prevention programs were among many other factors also considered, U.S. News said.
Rankings also depended on how well a hospital performed in three broad respects: clinical outcomes, such as maximizing cancer survival and minimizing rates of various infections; efficient coordination of care as demonstrated, for example, by complying with accepted "best practices"; and providing sufficient care-related resources such as nursing staff and outpatient programs tailored to particular conditions. Each of these three major areas determined up to one-third of a hospital's score, U.S. News said.
The rankings also considered responses to a survey of more than 3,000 pediatric specialists, who were asked to name up to 10 hospitals they consider best in their specialty for children with serious or difficult medical problems, U.S. News said.
