Sunday, July 28, 2013

Easton Hospital emergency department remodeling aims to improve patient satisfaction

Easton Hospital emergency department remodeling aims to improve patient satisfaction
Easton Hospital Emergency Department Director Dr. David Ligor, center, seated Thursday at a nursing station, says the remodeling that began this week aims to improve patient satisfaction and outcome at the Wilson Borough facility. sits and talks to colleague about the upcoming changes the emergence center of Easton hospital will be going threw the next few months. Express-Times Photo | CORINNE HEFT (Express-Times Photo | CORINNE HEFT)
Special to The Express-TimesBy Special to The Express-Times 
on July 27, 2013 at 5:30 AM, updated July 27, 2013 at 5:32 AM
For The Express-Times
Easton Hospital this week began a $1 million-plus remodeling of its emergency department that is expected to wrap up in December.
Geared partly toward improving care for senior citizens, the changes will help increase overall patient satisfaction and care, officials at the Wilson Borough facility said.
The work will occur in three phases. The first phase, completion of a new entrance and registration area, is expected to be completed in mid-August. The second phase of the project should begin and end in September and will involve improving the ambulance entrance.
The renovations coincide with the hospital pursuing Nurses Improving Care for Health System Elders, or NICHE, certification. The New York University College of Nursing program aims to help hospitals improve the care of the elderly population.
The third phase of the remodeling is specific to compliance with the certification. It involves the installation of nonglare lighting, easy-to-read signs, thick mattress padding on stretchers to prevent pressure wounds, and nonskid, nonglare floor surfaces to avoid falls.
“Looking at the demographics, there’s a lot of people 65 and older in the area,” said Christine Biege, the hospital’s vice president of quality and support services. “That’s the population we primarily serve and it’s important to tailor to their needs.”
Dawn Marie Tuers, the hospital’s NICHE coordinator, said the certification effort aims to improve the hospital staff’s understanding of health issues in the elderly population and create positive outcomes for the patients and their family.
“It improves the staff competence in geriatric care specifically, tending to the elderly and their specific issues,” Tuers said.
Both Tuers and the hospital’s chief nursing officer, Karen Vadyak, who is overseeing the NICHE certification, said NICHE is about allowing older patients to maintain their independence.
“Really what we’re trying to ensure is that patients over the age of 65 maintain their independence and that they’re able to return home and function independently in their (home) environments,” Vadyak said.
Other improvements being made as part of the remodeling include installing opaque glass doors on the critical care rooms, a new counter top for the nurses’ station and new furniture in the waiting room.
Director of the Emergency Department Terry Ciccarone said the addition of the doors in particular will allow for more privacy, which research has shown leads to a better outcome for the patient.
“There are many things that have been identified throughout the country as patient satisfiers, mainly the privacy piece of it,” Ciccarone said. The doors “will allow for a lot more privacy, a lot more quiet.”
David Ligor, chairman of emergency medicine at Easton Hospital, said he hopes the remodeling will create a warmer environment.
“We’re a community hospital and our patients are like family for us, so we want to make sure we have a nice environment to receive their care,” Ligor said.

Tri-county health assessment points to chronic disease, obesity, mental health issues plaguing region

By Michelle Caffrey / South Jersey Times 
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on July 28, 2013 at 7:00 AM, updated July 28, 2013 at 7:10 AM

Five health systems, 12 hospitals, three county health departments and a range of community partners in South Jersey got a check-up, last week when the results of a tri-county community health assessment were presented at Camden County College.
The study involved the Kennedy, Lourdes and Virtua health systems as well as Inspira Medical Center of Woodbury and Cooper University Health Care in Camden along with health departments from Gloucester, Camden and Burlington.
The purpose of the study, which is mandated by the Affordable Care Act, is to identify key health issues affecting consumers in the region.
Topping the list of pressing concerns in the three counties is access to health care as well as chronic health conditions like diabetes, heart disease and cancer along with mental health, substance abuse and obesity.
To complete the intensive 10-month study, the five health systems called on Pennsylvania-based research and consulting company Holleran. 
They tapped secondary data from the Health Research & Educational Trust of New Jersey on a range of health statistics, combining that with a telephone survey of nearly 2,500 tri-county residents and interviews with 165 Camden City residents of diverse populations.
Researchers also conducted focus group discussions and interviews with 154 local community leaders.
While collaboration wasn't mandated, the director of communications for Inspira Medical Center of Woodbury said it made sense.
“We all serve the same communities, we overlap," said Molly Tritt. "There’s always strength in numbers ... There’s a competitive nature among hospitals, but this was very much a collaborative project.” 
The data revealed various levels of health issues faced by each county, such as the percentage of respondents surveyed who said they needed to see a doctor in the past year but couldn’t due to cost.
Only 12.8 percent of respondents in Gloucester County said that was an issue, compared to 16.2 percent in Camden County, 15.9 percent in Burlington County and 38 percent in Camden City, which is consistently an outlier in the data.
Gloucester also ranked highest in insurance coverage, with 92.3 percent of residents surveyed reporting coverage by private health insurance or government-issued plans like Medicare. That compares to 87.9 percent in Camden County, 76 percent in Camden City and 90 percent in Burlington County. The average in New Jersey is 88.5, but just 84.9 percent nationwide.
For illness, diabetes, is a significant issue in all three counties, with reported rates slightly higher than the national and state averages of 9.3 and 9.2, respectively. Gloucester County has the highest rate of respondents reporting high blood cholesterol, coming in at 42.3 percent. That compares to 41.1 percent in Burlington County, 37.3 percent in Camden County, 37 percent statewide and 38.5 percent nationwide.
The survey found that Camden County has more high blood pressure, though, with 43.3 percent of respondents reporting a diagnosis, compared to 37.1 percent in Gloucester County, 32.3 percent in Burlington County, and 30.6 percent statewide.
Among the three counties studied, Gloucester has the lowest rate of asthma at 14.1 percent, but that number is higher than the state average of 13.3 percent and the national average of 13.5 percent. Camden City has the highest asthma rate with 27.7 percent, followed by Burlington County with 18.5 percent and Camden County with 17.8 percent.
Skin cancer rates were the lowest in Camden City, with just .6 percent of respondents reporting a previous diagnosis of skin cancer, compared to 7.3 in Burlington County, 6.6 in Gloucester County and 5.5 in Camden County. The national average is 5.7 and state average is 4.8 percent.
For all types of cancer, however, Gloucester County has the highest rates with 8.3 percent of respondents reporting a cancer diagnosis. In Camden County, that number of cancer diagnoses drops to 6.1 percent, compared to the state average of 5.5 percent and national average of 6.5 percent.
The survey also measured risk factors that contribute to chronic disease, including exercise, obesity and smoking.
In Gloucester County, 70.4 percent of respondents said they participated in physical activities in the past month, compared to 70.2 in Camden County, 60 in Camden City and 72.9 in Burlington County. The entire region comes under the state average of 73.4 percent and national average of 75.6 percent.
Gloucester County’s consumption of sugared soda was far below the national average, however, with just 11.3 percent of respondents replying they drank full-sugar soda on a daily basis in the past month. That compares to a 17.3 percent national average, 11.5 percent in Burlington County and 14.6 percent in Camden County.
The tri-county region was nearly equal in the percentage of fast food consumed, with 23.8 percent of respondents reporting consumption of fast food one to seven times a week. The same percentage applied to Camden County, but Burlington County came in slightly lower at 23.1 percent.
Smoking, a significant contributor toward cancers, breathing issues and a variety of health conditions, saw the highest rate in Camden City with 57.5 respondents reporting that they smoked every day. That number dropped to 31.3 for all of Camden County, 29.5 percent for Gloucester and 27.1 for Burlington.
In addition to the household surveys, researchers interviewed local leaders in health and human services, government agencies and community groups. The interviews identified five key health issues that applied to all three counties: access to care, diabetes, obesity, substance and alcohol abuse, plus mental health and suicide.
The interviewees pointed to a lack of health insurance for residents, the inability to pay out-of-pocket expenses, inability to navigate the health care system, lack of transportation, and lack of provider availability as the highest barriers to getting proper health care.
Focus groups, six in total with two per county, pointed to similar needs in the community, adding to the need for community awareness of available programs, a need for more mental and behavioral health services as well as a need for a centralized place to get information along with a listing of resources. These respondents suggested a range of improvements including transportation assistance, patient navigation services, nutrition and exercise programs, support groups, and chronic disease management programs among others
With survey results in hand, the health systems and county agencies will now establish a prioritization process to look closer at the areas of need and come up with collaborative ways to match the needs of the community with the ability and reach of each entity.
“Our next step for the whole collaborative is to get together and look at all of this and prioritize what issues we can effectively address and decide what organizations will address what,” said Frances Atkinson, vice president of marketing for the Kennedy Health System 
For example, Kennedy could decide to tackle chronic disease, specifically diabetes, and put together an outreach program. Community organizations could offer venues to reach the community, and a county health department could address the need for better transportation.
The Gloucester County Board of Health has a community health plan in place to address some of the problems put forward in the survey, according to county Public Health Officer Annmarie Ruiz.
“Some of the issues that came out were already aligned with that,” Ruiz said. She added that the county board meets twice a year with hospitals and local boards of health to inform them about the available county programs including free flu shots to county residents, free screenings for various chronic diseases at the County Store in the Deptford Mall, and community resource guides provided to local medical practices.
“They’re all important topics,” said Ruiz. “We now have to work together, prioritize the topics and areas we’re going to focus on, and move forward.”

Contact staff writer Michelle Caffrey at

Accountable Care Organizations And Innovation: A Changing Landscape

June 28th, 2013 

As Accountable Care Organizations take the country by storm, too little attention is being paid to how the new incentive structure of ACOs is sharply altering the landscape of health care innovation.
ACOs, even at this early stage, are changing the innovation paradigm, creating new opportunities for some sectors and new challenges for others. For payers and providers, ACOs have opened the door for innovative new payment and care delivery models. But at the same time, there are new pressures on the biopharmaceutical and medtech industries to demonstrate the value of their innovations in ways not required in the past.
Here are some of the emerging lessons and concerns about ACOs and innovation that were raised during a series of multi-stakeholder roundtables hosted by NEHI in Massachusetts and Washington, DC.
Transitioning From Broad-Based Innovations to Targeted Solutions
The use of global budgets has allowed providers to shift their focus from volume and intensity of service to a broader more comprehensive view of health. As a result, ACOs have begun to invest in innovations and services that were previously under-reimbursed or not reimbursed at all: prevention and wellness, chronic disease management, and behavioral and mental health. This shift towards patient-centered care is driving industry to develop solutions that help ACOs achieve these new population-health goals. They are doing this by developing tailored solutions that incorporate prevention strategies, behavioral changes, genomic factors, and home-based or community-based interventions that get to the underlying factors of a patient’s health.
Interestingly, in many cases it is clinicians who are driving these changes from the bottom up, rather than ACO leadership dictating practice reforms from the top down. Once physicians become part of an ACO model, they typically look for ways to redesign the way care is delivered in order to stay within their global budget. As a result, clinicians are now taking the lead in creating new clinical protocols, developing ways to track patient outcomes, measuring cost savings, and leveraging other practitioners as part of the care team.
Emerging Patient Engagement Technologies
With patient engagement a new focus of ACOs, industry innovators are actively investing in new ways to help ACOs achieve this goal.   For instance, there has been a marked increase in the adoption of telehealth and mobile health technologies that can bridge the communication gap between patients and providers outside of the doctor’s office or the hospital room. There is now a real business case to invest in many of these technologies when considering their cost relative to the total medical expense for a patient, rather than relying on fee-for-service reimbursement. Home telemonitoring for heart disease patients, for example, can seem expensive to purchase — costing as much as $1,000 per device — but if it can help avoid a $10,000 hospital readmission, the investment may make financial sense for an ACO.
Similarly, the biopharmaceutical industry is striving to extend its reach and its value by offering consumer-based tools that help educate and engage patients across the continuum of care. For instance, Johnson & Johnson recently purchased the consumer-based business HealthMedia to create coaching tools to help patients navigate the health care system, better engage with their providers, and learn what symptoms they should be looking out for.
Payers are also exploring technologies that can help patients seek appropriate care for their symptoms. Aetna, a national health plan, recently invested in the mobile application iTriage that allows patients to query their symptoms, identify appropriate providers and care settings for their treatment, and determine what services are covered by their insurance plan. This mobile technology even allows patients to print out directions to see their provider of choice. Aetna has shown that when patients are empowered with this information, they are much more likely to seek appropriate care and choose an in-network provider.
Increasing Use Of Evidence Based Medicine And Clinical Guidelines
Because ACOs are taking on whole or partial financial risk for their patient populations, they are now looking more closely at which drugs, devices, technologies, procedures, and patients require the most resources and are reviewing the clinical evidence to determine appropriate care. In some cases, global payment models have already shown a change in the utilization of some therapies and technologies on the market today. For example, early results from Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract, a commercial ACO-like payment model, show that the use of high-tech radiology and imaging services has declined significantly while preventive care has improved overall,  including some forms of cancer screening, when compared to fee-for-service payment models.
Steward Health Care System, a pioneer ACO in Massachusetts, streamlined the use of anesthetic agents across their chain of hospitals after recognizing that one of three anesthetic agents being used was four-times more expensive than the others. After reviewing the evidence, Steward decided to use the more costly drug only in instances where the evidence supported its use.
Paying closer attention to the evidence also applies to the adoption of new innovations. Many ACOs have created committees and review boards to assess the evidence and ultimately decide if and when new drugs or devices should be used. These review boards are evaluating new products and writing clinical guidelines based on safety, effectiveness, patient-centeredness, regulatory compliance and cost-effectiveness. Partners HealthCare System, another pioneer ACO in Massachusetts, has a “Center for Drug Policy” where physician leaders review newly FDA-approved therapies and write clinical guidelines for appropriate use.
Due to these changes in the marketplace, the biopharmaceutical and medtech industries are adjusting by generating evidence earlier in the product development process. Not only are they generating clinical and sometimes cost-effectiveness data earlier, they are also exploring partnerships with payers and providers to better understand the long term impact and outcomes of their products. These partnerships allow manufacturers to gain better feedback data on their products in real time rather than having to conduct additional clinical studies that can be costly and time consuming.
The Challenge for Innovators
Despite the new opportunities offered by ACOs, many questions remain about the impact of ACOs on innovation, including:
  • Will ACOs disincentivize the use of new technologies in cases where the clinical or financial benefits accrue outside of the window in which an ACO would calculate savings?   Innovators are understandably concerned that an ACO may favor a less expensive therapy over a more costly alternative despite its potential long-term benefits that may be unclear when a product first enters the market.
  • Will ACOs incentivize the use of Part D therapies that are excluded from the ACO’s global budget over Part B therapies that aren’t? What will this mean for patients and their access to innovative and appropriate therapies?
  • How will academic research be supported and subsidized in the new ACO environment?  If academic medical centers are forced to compete with other providers on cost alone, the fear is that the funding stream for academic research may decrease significantly.
These questions deserve close attention by health care leaders, policymakers, patient groups and innovators so that all sectors can better work together to make ACOs a success. In the meantime, the continuing challenge for biopharmaceutical and medtech innovators is to develop products that help reduce the total medical expense for patients and/or improve quality as defined by ACO quality measures.
A simple formula for how innovators can best survive in the new ACO world comes from Health Economist David Cutler of Harvard University: “In any industry that works well, the firms that do extremely well are the one that create value. They’re not the ones that are the cheapest or the highest quality at all cost. They are the ones that focus on how do I create value. Do that and you win.”

Hospital for Specialty Care, Inc. to Pay U.s. $8 Million to Resolve False Claims Act Allegations

Washington, DC--(ENEWSPF)--July 26, 2013.  Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent) have agreed to pay the United States $8,000,000 to settle allegations that they submitted false claims to Medicare, the Justice Department announced today.  Dubuis Health System manages long-term acute care hospitals in multiple states, including Southern Crescent.  Southern Crescent is a long-term acute care hospital located in Riverdale, GA and is part of the CHRISTUS Health System. 
Long term acute care hospitals are similar to typical acute care hospitals except that they are certified to focus on patients with more complex medical needs who, on average, remain in the hospital more than 25 days.  Long term acute care hospitals receive a higher rate of Medicare reimbursement than do typical acute care hospitals.  This settlement resolves allegations that between 2003 and 2009, Dubuis Health System and Southern Crescent knowingly kept patients hospitalized beyond the time considered to be medically necessary, to increase their Medicare reimbursement and to maintain Southern Crescent’s classification as a long-term acute care facility.
"Billing Medicare for patient care that is not necessary or appropriate contributes to the soaring costs of health care.  This settlement demonstrates the Department of Justice’s commitment to protect public funds and guard against abuse of the Medicare system,” said Stuart F. Delery, the Acting Assistant Attorney General of the Justice Department’s Civil Division.
“Hospitals that violate the public trust by keeping patients hospitalized beyond what is medically necessary will not be tolerated.  Our office will continue to bring cases that enforce our health care laws,” said Kenneth Magidson, United States Attorney for the Southern District of Texas.
This matter was initiated by the filing of a whistleblower complaint under the False Claims Act (FCA).  Under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the Government.  The whistleblower in this matter, Darlene Tucker, was a former administrator at Southern Crescent.  As a result of this settlement, Ms. Tucker will receive $2,160,000 of the United States’ recovery.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.7 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14.7 billion.
The case was jointly handled by the U.S. Attorney’s Office for the Southern District of Texas, the Justice Department’s Civil Division, and the Office of the Inspector General of the Department of Health and Human Services.  The claims resolved by this settlement are allegations only, and there has been no determination of liability.
The case is captioned United States ex rel. Tucker v. Christus Health and Dubuis Health System, Inc., et al, No. 09-cv-1819 (S.D. Tex.).

Blood Pressure and Atrial Fibrillation

An epidemiological study shows that pulse pressure is an important risk factor for atrial fibrillation – a 20 mm Hg increase in pulse pressure was associated with a 24% increase in the risk for developing atrial fibrillation.
Atrial fibrillation (previously called auricular fibrillation) is what cardiologists once described as an “irregular irregularity” of the heartbeat – in other words, the perceived rhythm from the ventricles is rapid but totally irregular. There are about 2½ million people in the USA with atrial fibrillation; it’s more common in old age, along with higher systolic pressure, diabetes, obesity, and conditions affecting the left heart ventricle.
As people age, the likelihood of increased pulse pressure also rises. This is attributed to age-related increase in aortic stiffness. It’s been suggested that the subsequent increased load on the heart’s work may be responsible for an increase in atrial fibrillation.
Data from the Framingham Heart Study were analyzed. Over 5,300 participants aged 35 and older and free of atrial fibrillation provided the necessary information. Their average age was 57, with 55% of them women and 45% men.
Medical history, physical exam, and electrocardiography were done at baseline. Subsequent diagnosis of atrial fibrillation was based on electrocardiograms from a hospital or physical exam, or done at one of the routine 2-4 yearly Framingham clinic exams.
Statistical analyses sought an association between pulse pressure and newly-developed atrial fibrillation, the relationships between atrial fibrillation and other blood pressure components, and whether the relationship with pulse pressure was influenced by changes in the left ventricular structure and function.
At baseline the average pulse pressures in the whole collective were 51 mm Hg in the men and 53 mm Hg in the women. As expected, individual pulse pressure was linked closely to the systolic pressure, and only weakly to the diastolic pressure.
During the follow-up period, which averaged 16 years, there were 363 new cases of atrial fibrillation in the men, and 335 in the women. The probability of developing atrial fibrillation over time increased with increasing pulse pressure; thus the incidence was 5.6% for people with pulse pressures of 40 mm Hg or less, and 23.3% for those with pressures above 70 mm Hg.
After adjusting for age, sex, body mass index (BMI), smoking, diabetes, and heart disease, a 20 mm Hg increase in pulse pressure was found to be associated with a 24% increase in the risk for developing atrial fibrillation.
Adding left ventricle structure and function factors (obtained from the electrocardiogram) to the analysis failed to alter the association, showing that elevated pulse pressure (representing arterial stiffness) remains a modifiable risk factor for atrial fibrillation; it cannot be explained fully by left ventricle enlargement.
This study shows that pulse pressure is the single blood pressure component most predictive of future atrial fibrillation. This association remains after adjustment for age, diabetes, obesity, left ventricle enlargement, and smoking. This means that older people must check their pulse pressure, and not concentrate exclusively on systolic or even diastolic pressures. The good news is that it’s possible to reduce aortic and arterial stiffness, as shown in a smoking/non-smoking study. With values over 40 mm Hg, initial steps should be lifestyle modifications – those that address high blood pressure, chiefly – followed by antihypertensive medication, if necessary. Atrial fibrillation is to be avoided, if possible.

Blood Pressure and Atrial Fibrillation -