Bausch & Lomb asks Europe: Do You have “The Winning Look”?

Bausch & Lomb announces the launch of an exciting campaign to drive consumers into opticians’ stores in celebration of the newest addition to the SofLens® daily disposable family: SofLens® daily disposable Toric for Astigmatism.

Crocs’ Compliance with OSHA Standards

In 2002, who would have thought a boating shoe would become the craze of the healthcare industry, particularly for nurses. Crocs (“Croslite^TM,) were originally designed for boaters, who loved the slip resistant soles and holes on the top with vents on the side for drainage. They are made of a plastic resin, a material that enables production of a soft and lightweight, non-marking, slip and odor-resistant shoe

Five years later and Crocs became the nursing shoe of choice. Their ergonomic design and shock absorbing properties benefited nurses, who were on their feet for long hours.  However, they failed OSHA’s requirements. Hospital members raised concerns that the Crocs with holes on the top did not comply with the “Protective Footwear”, which requires footwear that protects against “falling or rolling objects, or objects piercing the sole.” The second failure dealt with the “Bloodborne Standard, which required employees to wear foot wear that provides protection against needle sticks and splashing from blood or OPIM (Other Potentially Infectious Materials) spills.

To combat these matters, Crocs partnered with the American Nurses Association (“ANA”) in early 2007 to come up with a newly design “Nursing Croc” that met OSHA’s Bloodborne Standard.  They developed four models, three that was fully enclosed and one with a closed top and side ventilation that channeled liquids away from the feet. After communicating with OSHA, Crocs and ANA were informed that they only had to meet one of the two standards, i.e. OSHA’s Bloodborne Standard, 1910, 1030, section (d)(3(i).  OSHA stated it “does not qualify specific shoes or brands, but requires employees to wear shoes that protect from potential blood or OPIM splashing. Each hospital or healthcare facility should review the standard recommendation and decide if they will restrict brands or models. If shoes with ports or holes are allowed, shoe coverings are recommended” to be provided by employers.

Croc Corporation continues to work with healthcare associations and organizations to ensure OSHA compliance. Thanks to Crocs, many healthcare workers rely on their Crocs for comfort and relief of foot and back problems.

Diet Programs and Other Health News

Study Explores Whether Diet Programs Work

A new study published in the New England Journal of Medicine emphasizes that the mix of carbohydrates, fat, and protein in four diets to which people were assigned didn’t make a difference in whether they lost weight, Katherine Hobson reports. The findings point to behavioral factors rather than macronutrient metabolism as the main influences on weight loss. In other words, any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective. The bad news: Those pesky “behavioral factors,” i.e., our penchant for eating too much and exercising too little, seem to win out over the enthusiastic and persistent teaching. After two years, the average participant in the study had lost less than 9 pounds, and the trend was toward weight slowly creeping up again.

A study published in 2007 had similar findings. If you’re trying to lose weight, consider these 7 tips to shed pounds and try more traditional ways of eating.

A Quarter of Americans Suffer Food-Borne Illness Each Year

As many as 25 percent of Americans get a food-borne illness every year, and cases are not always tied to high-profile epidemics such as the recent salmonella and peanut product outbreak, the San Jose Mercury News reports. There are about 250 known types of food-related illnesses in all. Norwalk-like viruses are the most common; they comprise about two thirds of reported food poisoning cases. Campylobacter bacteria are the next most common culprit, accounting for 14 percent of food poisoning cases; salmonella falls next in line at 10 percent of cases. The Centers for Disease Control and Prevention estimated 10 years ago that there are about 76 million food poisoning illnesses annually, which cause 325,000 hospitalizations and 5,000 deaths each year, according to the Mercury News. Updated CDC numbers are not available, but the Associated Press estimates the current figure to be 87 million annual cases, resulting in 371,000 hospitalizations and 5,700 deaths.

This primer on common sources of food poisoning gives the lowdown on how to banish bad bugs from your kitchen. The recent salmonella outbreak may be the scariest one yet because it involves peanut butter and peanut paste that manufacturers bought by the tanker-load and mixed into hundreds of products on supermarket shelves. Here’s how to reduce your risk of becoming ill.

A Breakthrough Weapon to Fight Flu and Bird Flu?

U.S. News’s Nancy Shute recently talked about the latest influenza news with Wayne Marasco, an associate professor of medicine in the department of cancer immunology and AIDS at the Dana Farber Cancer Institute. Marasco is one of the developers of a new approach, which uses monoclonal antibodies, that’s being studied to treat and protect against influenza. If the research pans out, the approach could be used as a treatment for bird flu and seasonal flu and also as the basis for a vaccine against many different flu strains, including the H5N1 strain that has caused so much worry about a possible pandemic. Read Marasco’s explanation of how this approach would work if it were approved as a flu treatment.

Here’s advice for how to keep your family safe from flu and bird flu. Also, learn how bird flu infected an Indonesian family.

MCOs see value in personalized medicine

Plan sponsors are concerned with rising prescription costs but are willing to adapt to medical and scientific innovations, according to experts.

“More plan sponsors are seeing value in measures to ensure patients get more precise pharmacy care, such as gene testing,” says Janine Nowatzky, senior director, market strategy, Medco’s Systemed. “Or they attempt to better manage patient care either through wellness or disease management.”

A study conducted on behalf of Medco by Haldy McIntosh and Associates polled 295 pharmacy benefit decision makers from leading corporations, as well as nonprofit, labor, and public sector groups with at least 500 eligibles. The study assessed perceptions regarding the pharmacy benefit and understand current and future approaches plan sponsors are relying on to control prescription drug costs.

Specialty drug costs are becoming a larger driver of pharmaceutical spending, since these treatments are gaining greater use.

“With some drug regimens costing thousands of dollars annually for a patient, it is a growing concern for any plan sponsor,” says Nowatzky. “An aging population is also a big factor in driving of demand for pharmacy care.

However, health plan sponsors are not helpless to mitigate some of these dynamics either through plan design or utilization management.”

Additionally, adverse drug events result in 100,000 deaths and more than 2 million hospitalizations in the United States each year, according to the Mayo Clinic, so drug use must be approached with care.

“The promise of personalized medicine or pharmacogenomics offer opportunities to reduce these risks, thereby reducing healthcare costs and improving the quality of life for patients,” says Nowatzky.

Managed care executives should be aware of medical innovations that can help improve safety and reduce wasteful spending, according to Nowatzky. “Gaining a clear understanding of how genetic tests—or personalized medicine—can help physicians prescribe the right drug at the right dose for the right duration early in a patients treatment regime, will lower overall healthcare costs for the payer,” she says.

Medco has enrolled 100 clients in its Personalized Medicine Program.

Individual insurance reform dies in Michigan

A vocal minority of Michigan Senate Republicans prevented compromise health insurance legislation from being reported out of a bipartisan legislative committee on December 18.Blue Cross Blue Shield of Michigan (BCBSM) asked state lawmakers to reform the state’s individual insurance market because it is “broken” and “financially unsustainable.”

Losses in BCBSM’s individual lines of business are projected to be $264 million in 2009 and it reported financial losses over the first nine months of 2008 of $111 million for these individual lines of business.

“Losses in Blue Cross’ guaranteed-coverage individual pool are driven by the practices of for-profit insurance carriers who continue to reject people with medical histories and send them to the Michigan Blues,” says Andrew Hetzel, BCBSM vice president of corporate communications.

Because of commercial “cherry picking,” Hetzel says that Blue Cross covers 84% of all the unhealthy people in the individual market.

Over the last 14 months, the Michigan legislature has studied reforming the individual insurance market in the state to update laws that date back to 1980.

“The legislation would make changes in rate setting and regulatory practices in the individual health insurance market in Michigan,” says BCBSM spokeswoman Helen Stojic. “The individual purchase of health insurance is growing.”

The proposed changes would have changed the law covering the individual insurance market in Michigan, but would not affect laws in other states, according to Stojic, who adds that other states have already reformed their individual insurance markets.

“Most states do not regulate health insurance premiums in the way other insurance might be regulated where they set rates or rate bands,” says MHE Letter of the Law columnist Barry Senterfitt, managing shareholder in the insurance industry practice of Greenberg Traurig, Austin, Texas. “Some states however limit the amount by which rates may be increased upon renewal.”

“Nineteen states have enacted rate bands. In Michigan, we have two separate regulatory environments—a highly regulated Blue Cross and virtually no or very little regulation of for-profit commercial insurers,” says Stojic. “This type of environment is unsustainable in the long-run.”

Under the proposed compromise legislation in the committee report, BCBSM would have remained nonprofit and an insurer of last resort.

Opponents of the legislation feared premium hikes for Michigan consumers, which could mean an increase the number of uninsured.

“It sounds like [Michigan consumers] could be staring at significant premium increases soon,” Senterfitt says.Stojic says that the changes would have stabilized the individual market in the long-run by encouraging a better mix of healthy people and those who need medical services.

“Until the legislature acts to create a fair and balanced regulatory system that holds for-profit insurers more accountable for rejecting the sick and allow Blue Cross to better compete for younger and healthier individual subscribers, Blue Cross financial losses on individual insurance lines will continue to mount,” Hetzel says.

MedPAC Recommends Surgery Center Payment Rate Increase of 0.6%

The Medicare Payment Advisory Commission (MedPAC) has recommended that Congress should increase payment rates for ASC services in 2010 by 0.6 percent, according to a transcript of a public MedPAC meeting held Jan. 8.

MedPAC also recommended that ASCs should be required to submit cost and quality data.

MedPAC recommended 0.6 percent because “that is the difference between the most recent published estimates of input price increases, which is measured by the CPI-U (Consumer Price Index for All Urban Consumers), as required by law, and the Commission’s productivity goal,” said Dr. Dan Zabinski, according to the transcript.

Dr. Zabinski also said noted that MedPAC will discuss whether the CPI-U is an appropriate measure of input price increase.

Dr. Zabinski ended his presentation by stating that the recommendations would have no impact on beneficiaries access to ASC services, which is “especially important because beneficiaries typically have lower cost sharing if they receive a procedure in an ASC rather than an HOPD,” according to the transcript.

Glenn Hackbarth, JD, chair of MedPAC, followed Dr. Zabinski’s presentation with a suggestion that MedPAC, in the future, “take up what would be a more appropriate market basket for the ASC Payment System,” a change that the ASC Association has long advocated and was recently recommended to MedPAC in a Dec. letter from the ASC Association (pdf).

Read the Jan. 8 MedPAC transcript (pdf). The discussion on ASCs begins on p. 117.

UnitedHealth Group to Pay $50M to Settle NY Reimbursement Probe

Minneapolis-based UnitedHealth Group has agreed to pay $50 million to settle allegations from N.Y. Attorney General Andrew Cuomo that the health plan and its wholly owned subsidiary, Ingenix, manipulated out-of-network insurance payment rates for physician fees, according to a news release from the attorney general’s office.

United and other health plans use information gleaned from databases provided by Ingenix, the nation’s largest private provider of healthcare billing information, to set their ‘usual and customary rates’ for paying doctors. In Feb. 2008, Mr. Cuomo launched an investigation into what he alleged was a scheme to manipulate the Ingenix databases and issued subpoenas to Ingenix and 16 health insurers, including United, Aetna, Cigna and several Blue Cross and Blue Shield plans.

Mr. Cuomo found that “by distorting the ‘reasonable and customary’ rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs,” the attorney general’s office said in a news release. Mr. Cuomo alleged the practice was industry-wide.

“For the past 10 years, American patients have suffered from unfair reimbursements for critical medical services due to a conflict-ridden system that has been owned, operated and manipulated by the health insurance industry,” Mr. Cuomo said. “This agreement marks the end of that flawed system.”

Mr. Cuomo said Ingenix’s ‘reasonable and customary’ rates were lower than actual cost of medical expenses, which compelled individual beneficiaries to pay more out of pocket than necessary for out of network visits. Ingenix and United, the nation’s second largest health insurer, agreed to close Ingenix’s Prevailing Health Charges System and Medical Data Research data bases. United also agreed to pay $50 million to fund a not-for-profit organization to create and own a new, independent healthcare billing database to replace the two insurer-owned databases. That not-for-profit organization will also develop a Web site to inform consumers around the country how much they will be reimbursed for common out of network services in their area and make rate information available to health plans.

“Today, patients and physicians prevailed over health insurance giant UnitedHealth Group when New York Attorney General Andrew Cuomo stopped the insurer from using a rigged Ingenix database that increased insurer profits at the expense of patients and physicians,” said American Medical Association President Nancy Nielsen, MD, in a news release. “For far too long health insurers using the flawed Ingenix databases have been able to increase revenue by underpaying patients’ medical bills.”

United said the agreement will enhance the transparency of information related to physician fees for out of network services.

“We are committed to increasing the amount of useful information available in the health care marketplace so that people can make informed decisions, and this agreement is consistent with that approach and philosophy,” said Thomas Strickland, UnitedHealth Group executive vice president and chief legal officer, in a statement.

Read the attorney general’s news release about the UnitedHealth Group settlement.

CMS Outlines Roadmap to Reshape Fee-For-Service Program

In anticipation of a new presidential administration, CMS has recapped its roadmap for reshaping Medicare’s traditional fee-for-service program through market-based and value-purchasing initiatives intended to improve quality and reduce costs.

CMS began launching quality initiatives in 2001 under former CMS Administrator Thomas Scully and has continued to introduce new programs to improve the quality of healthcare delivered to Medicare beneficiaries.

CMS estimated that by 2017 the United States would spend more than $4 trillion on healthcare, twice what it spends now and an increase from roughly 14.5 percent to 21 percent of the total economy. The Medicare Trust Fund is predicted to go bankrupt by 2019, but that could occur as soon as 2016, according to federal actuaries.

“It is incumbent on us to use the lessons we’ve learned with many of the tools we have implemented to help the nation’s health care leaders as they look to improve the health care system in a time that’s even more critical because the projected rate of growth in health care costs is climbing at an unsustainable rate,” said Acting CMS Administrator Kerry Weems.

Learn more about these CMS quality initiatives.

Transitional care lacking in elderly

The most vulnerable population in the United States is the elderly, and the highest-risk phase of care for these patients is at discharge.

However, in most cases, hospitals provide no coordination in transitional care for elderly patients. Information doesn’t transfer from one point to the next in the delivery of care, leaving elderly patients discharged from hospitals with unresolved issues and with care needs too complex for themselves and their caregivers to handle.

For example, in the course of an acute exacerbation of an illness, a patient might receive care from a primary care physician or specialist in an outpatient setting, then move to a hospital physician and nursing team during an inpatient admission before moving on to another care team at a skilled nursing facility. Finally, the patient might return home, where he/she would receive care from a visiting nurse. Each of these shifts is defined as a transition.

“The physical movement of an elderly patient from location to location is certainly achievable and happens every day” says Kate O’Malley, RN, senior program officer for the California Healthcare Foundation in Oakland, Calif. “The real challenge is taking the sum total of knowledge of that elderly patient’s condition and making sure that it transfers from one healthcare setting to another.”

Part of the problem is the “silo” effect of healthcare. A hospital physician is focused on the acute event that brings the patient into the hospital, while the next physician is focused on rehabilitation or other post-hospital care.

“We may give fantastic care at a hospital and at a nursing home,” says James E. Lett, MD, senior medical director for health process improvement for Lumetra, a San Francisco-based healthcare consulting company. “But if they [the hospital and nursing home] aren’t in sync, then the patient is not well-served.”

Perhaps the most serious issue in the lack of transitional care has to do with prescription medications. In one clinical study by the University of Pennsylvania, 70% of patients experienced some form of medication reconciliation error during care transition.

Eric Coleman, MD, director of Care Transition Programs at the University of Colorado Health Sciences Center in Aurora, Colo ., says that it is important for elderly patients and their caregivers to become more active participants in their transitional care.

A lack of transitional care directly leads to a high readmission rate within 30 days of discharge, which leads to higher healthcare costs.

Many of these readmissions could be prevented by improved transitional care, says Mary Naylor, RN, professor in the School of Nursing at the University of Pennsylvania. Naylor and her staff have done numerous studies analyzing the cost and outcomes of transition care.

One of the most common reasons for the hospitalization of elderly patients is heart failure, and patients with heart failure typically have multiple chronic conditions.

In 2005, according to Naylor, there were 600,000 indexed hospitalizations for elderly patients being admitted to hospitals for heart failure. The readmission rate within 30 days was 27% and by 90 days, the rate was nearly 40%.

CMS is taking a hard look at the issue. It has begun a three-year pilot project that will examine readmission rates of elderly patients to hospitals, especially within 30 days, from the same diagnosis. The agency will seriously consider not paying hospitals that readmit patients for the same diagnosis within 30 days or substantially reduce payments, according to a spokeswoman.

GHN-Online Launches Online User Forum for Surgery Centers and Hospitals

GHN-Online, a leading provider of real-time, revenue-cycle management solutions, has announced the launch of its new Client Advocacy Group, a GHN-Online user forum for ASCs, hospitals and laboratories, according to a company news release.

Shannon Smith, founder of the RUSH GROUP, a strategic consulting and training firm specializing in healthcare financial operations, was named president of the GHN Client Advocacy Group.

“We want to engage with our clients at all levels and delight them beyond their service expectations,” said Azadeh Farahmand, president and CEO of GHN-Online, according to the news release. “During these turbulent economic times, our Client Advocacy Group will increase meaningful dialogue with our user community to introduce succinct strategies for cash flow improvements, best practices in claims management, and the day-to-day workflow. This service-centric forum is an open invitation for all players to participate in GHN’s product roadmap strategy and version enhancements so that we can deliver the best bottom-line value to every stakeholder.

“We’re confident that our valued clients will be well-served by Shannon, a GHN user of several years, who has in-depth industry knowledge, intellectual curiosity, and personal integrity,” Mr. Farahmand said.

Learn more about the GHN-Online Client Advocacy Group.

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