Bausch & Lomb Launches Instrument CE Programs

Bausch & Lomb Japan Names Mitsuo Hirose as Chairman

Bausch & Lomb Japan has named Mitsuo (Mike) Hirose as chairman, effective immediately. Mr. Hirose has served on the subsidiary’s Board of Directors since January 2009.

State Report: Wisconsin

In his january state of the state speech, Wisconsin Governor Jim Doyle described his success in making health insurance premiums tax deductible. He also praised the BadgerCare Plus program, through which “any child in Wisconsin can get health insurance.” The program gained 100,000 new enrollees in 2008, two-thirds of whom were children. Wisconsin ranked second nationally for health insurance coverage, Doyle said.

In addition, he urged private insurers to cover treatments for autism and said he plans to make all public places in the state smoke-free.

 He has endorsed a plan to tax revenue of most hospitals in the state to garner about $393.5 million more in federal aid. Officials at the state Department of Health Services say every $1 of tax revenue would generate $1.65 from the federal government for Wisconsin hospitals. The majority of the money would be returned to hospitals that treat Medicaid patients. Some of the funding would pay healthcare costs for 41,000 low-income, childless adults. If the hospital tax is enacted, the state could use tax dollars originally planned for healthcare to help relieve the state budget deficit.

The Wisconsin Hospital Assn. endorsed the proposal noting “it has been more than a decade since hospitals received an increase in what they are paid to care for Medicaid patients.” Wisconsin hospitals experience an annual shortfall of more than $600 million between what it costs to treat patients and what the Medicaid program pays, according to the WHA, which urged legislators to act quickly on the plan so it can be applied retroactively beginning fiscal year 2009.

 PILOT LAUNCHED

Humana Inc. has partnered with the Wisconsin Health Information Exchange to ensure clinicians have access to the most comprehensive community-wide data available for emergency department patients. WHIE uses information technology to provide secure authorized access to clinical data, improving communication and reducing duplication. Humana has agreed to provide a WHIE-administered incentive to providers for utilization. WHIE launched the ED Linking Project in 2007, with clinical use beginning in 2008.

As of February, WHIE had 13 hospitals across four delivery networks contributing data to the exchange, and five emergency departments using the exchange in regular patient care. During 2009, it plans to expand the number of participating organizations and the types of data available to participants, including lab results, pharmacy information, and imaging results.

PHYSICIAN SHORTAGE

Wisconsin has a shortage of 374 primary care physicians, primarily in rural areas and some inner-city neighborhoods, according to a new report by the Wisconsin Council on Medical Education and Workforce. The shortage, which is expected to increase as more primary care physicians retire and fewer medical school students enter primary care, coincides with an increase in demand for primary care physicians due to an aging population. The number of Wisconsin residents age 65 and older is projected to double by 2030.

To address the problem, the report recommends enrolling students from rural areas; increasing tuition reimbursement programs for physicians who practice in underserved areas; recruiting out-of-state physicians; and increasing the roles of nurse practitioners and physician assistants.

INFANT MORTALITY ADDRESSED

The Wisconsin Partnership Program recently announced a five-year, $10-million initiative designed to reduce infant mortality in the state, which has the highest African-American infant mortality rate in the country, according to the Milwaukee Journal Sentinel.

One of the goals is to help coordinate existing infant mortality programs in Beloit, Kenosha, Milwaukee and Racine, the four cities that account for 92% of the deaths, and to increase public awareness. A co-chair of the steering committee forecasts the initiative will last 10 to 15 years.

MHE Sources: Centers for Medicare & Medicaid Services; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The Commonwealth Fund. 

Protect Your Windows PC from the Conficker Worm

The Conficker worm has infected millions of Windows computers—and is set to be unleashed on April 1st, 2009. Here’s what you need to know to keep yourself safe.

What is the Conficker Worm?

Microsoft released an update in October to resolve a critical security hole in the Windows “Server” service. Since people were not as diligent about patching as they should be, hackers created a new worm that spread like wildfire, leaving systems completely under their control. Security researchers have determined that the virus is expected to go “live” on April 1st, 2009, causing your computer to do bad things—but since the worm uses a P2P protocol it’s nearly impossible to identify the source.

How Does It Spread?

The worm originally started spreading using a network attack against the file sharing services in Windows, but since it can automatically update itself, it adapted to spread through the autoplay feature on removable media like USB thumb drives, by adding a new option to open where you see “publisher not specified”. This allows the worm to spread to systems already patched against the original vulnerability, so using anti-virus software is even more important, because once it’s on your computer it can spread further.

Is My Computer Affected?

Most anti-virus software has already been able to detect and remove the Conficker worm for a while now, so you are probably not at risk as long as you keep up with your updates and have real-time scanning enabled.

To actually detect and remove the worm, you can use the freely available Microsoft Windows Malicious Software Removal Tool that can remove a large number of viruses for a full guide, I’ve also written an article on how to scan and remove malicious viruses.

How Do I Stay Safe?

Staying safe from this, and many other viruses and worms, requires a combination of keeping your computer updated and using anti-virus software. Here’s a couple of quick tips to follow:

• Make sure your system is fully patched using Windows Update, and update MS08-067 has been applied.
• Make sure your anti-virus is fully updated, enabled, and you’ve run a full scan.
• Make sure you are using strong passwords (see our guide to choosing great passwords).
• Disable the AutoPlay feature—which Conficker uses to infect systems.
• Make sure your firewall is enabled when you are on untrusted networks.
• Make sure your data is backed up—if you aren’t sure what to use, see our five best Windows backup tools.

Keeping your system and your data safe is extremely important, so make sure to take some time out of your day to keep your system patched, updated, and virus-free. Hit the link for Microsoft’s explanation of the situation, or check out my article on scanning and removing malicious viruses for the walk-through approach.

Protect yourself from the Conficker computer worm

Digital Integrating Your Operating Room

During research of Operating Room Integration, one thing stood out, that all of the elements involve extensive planning with facility planning, architects, general and specialized building contractors, and the makers of all of the apparatus.  All systems generally will require some custom-built elements.  

In general, the components of a system fall into the category of equipment and infrastructure the equipment is likely to be replaced or upgraded several times during the projected life of an installation.  The infrastructure should be adaptable, within reason, to the anticipated replacement life cycle of the equipment.  Specialist claim that cabling should be placed in open wireways where additional cables or fibers can be added or replaced as needed.  Installations that use the available wireways and conduits to capacity should be avoided wherever possible, as this will impede system adaptation, thereby impairing its continued usefulness.

So the Integration process of an Operating Room could require and army of people to complete your project.  Your need may be to integrate one room or many and is your team ready for this complexity?  Your team will need to research, so before we begin, where can we look and become better educated in this process.  I give just a few sites to start on your massive undertaking. 

http://www.healthcaredesignmagazine.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=7F034F46E2384341977552D9ED1E97B1

http://blog.medting.com/2008/12/21/video-in-operating-room/

http://www.compviewmedical.com/site/home/

http://www.medtronicnavigation.com/procedures/integrated_operating_room.jsp

http://www.networkworld.com/news/2007/050207-data-integration-medical.html

Crestor’s Effect on Blood Clots and Other Health News

Study: Crestor Reduced Risk of Blood Clots in Veins

The statin Crestor may help cut the risk of blood clots in the veins, suggests a new study, which was presented Sunday during the American College of Cardiology’s annual meeting. The study, which involved more than 17,000 relatively healthy participants, saw 94 cases of venous thromboembolism, or blood clots in patients’ veins. Thirty-four of those cases occurred in people taking Crestor, while 60 took place in those taking a placebo, resulting in a 43 percent relative risk reduction for those taking the cholesterol-lowering medication. This reduction was observed in people with and without blood-clot risk factors such as hospitalization, surgery, or cancer, HealthDay reports. “We’re very pleased that the drug seems to have this beneficial effect,” study author Robert J. Glynn, a biostatistician at Brigham and Women’s Hospital in Boston, told HealthDay. This reduction in risk for blood clots would probably be seen with other statins, too, he added. The study is based on data from the JUPITER clinical trial, which is sponsored by AstraZeneca, the drug maker that markets Crestor.

In November, U.S. News’s Bernadine Healy explored whether, based on earlier JUPITER findings, statins should be prescribed for many apparently healthy people. Also, consider these 6 statin-free ways to reduce inflammation.

Bioidentical Hormones: Safer for Hot Flashes Than HRT?

To take hormones or not to take them? That question plagues womensuffering from menopausal symptoms—like hot flashes and night sweats and the severe sleep deprivation and crankiness that come with them, Deborah Kotz reports. Some women still opt for traditional hormone therapy, like Prempro, which combines estrogen and progesterone. (The latter hormone is included in order to protect women against endometrial cancer, which can be triggered by using estrogen alone.) Other women have turned to what they believe to be a safer alternative: bioidentical hormones. These compounds are identical in molecular structure to the sex hormones produced in a woman’s ovaries.

Here’s a user’s guide to bioidentical hormones. And learn why actress Suzanne Somers loves bioidentical hormones.

How to Get a Cheap Workout: 8 Ideas for Building a $100 Home Gym

If you’re unable—or simply unwilling—to pay a thousand dollars a year or more for a high-end gym membership, never fear. You don’t need to be cashed up to get a good workout. In fact, you don’t need to join a gym at all. U.S. News’s Katherine Hobson asked four fitness pros for 8 tips for putting together a home gym for $100 or less. Among the advice she got: Start by looking at what you already own, and don’t buy anything you’re sure not to use.

For more on saving money on your fitness routine, try these 5 ways your workout can weather the recession. Also, find out how you can spend less time exercising.

Under the Microscope

Ambulatory surgery centers (ASCs) face a long, rigorous process to receive both state licensure and/or Medicare certification. So SurgiStrategies asked Patsy Powers, attorney at Waller Landsden Dortch and Davis, LLP, and Joshua Kaye and Jerry Sokol from McDermott Will and Emery, LLP, to answer some questions on the entire process. Below are their responses.

Are you seeing a great discrepancy in the time it takes for your clients to apply for and then secure a state license and/or a Medicare provider number? What factors are coming into play with each of these?

The time factor with new surgery centers getting enrolled in Medicare is really a function of the time it takes the Medicare carrier to process the Form 855 enrollment application. Some carriers are reasonably fast (20 to 30 days) and others take much longer. Usually the delay is a function of carrier workloads and sometimes a function of new personnel unfamiliar with the process.

KAYE & SOKOL: There are a number of variables involved. With respect to Medicare, it depends whether the provider number arises in the context of developing a new surgical facility vs. acquiring an existing surgical facility, and if it is the latter, whether the acquisition is structured in a manner that allows the buyer to continue to operate under the same Medicare provider number. With that said, ASC acquisitions by strategic buyers and private equity investors have continued at a robust pace (notwithstanding the economic downturn) and so the Medicare provider number is not typically a significant issue assuming the transaction is structured carefully to allow the facility to continue to operate under the same Medicare number. Obtaining a new Medicare provider number, particularly in the case of a start-up facility, can be a lengthy process and it is not unheard of for a start-up facility to have to wait four to six months from the date it submits the appropriate application to obtain its provider number. This can result in major cash flow issues since Medicare will not pay claims until a Medicare number is assigned to the facility although it may pay retroactively in certain instances or claims submitted after the date that the appropriate paperwork was submitted. State licenses are even more of a dice roll because it really depends on the specific state’s regulations. For example, due to some recent case law and guidance in California, it has now become much easier to operate an ambulatory surgical facility. Texas is also a fairly simple process. By contrast, New York has a very complicated and lengthy vetting certificate of need process that can easily take over a year and it is not unheard of to take multiple years.

If the application process becomes problematic, is it a matter of clients not doing their due diligence, or does it come down to specific parameters within the state licensure or Medicare certification, such as grandfathering, etc.?

KAYE & SOKOL: Both. Often, a client is unwilling to bring in the appropriate consultants until it’s too late and then a lot of additional time is spent undoing the errors and omissions previously submitted to federal or state regulators. Submitting forms with improper information or not working with architects, developers and other advisors experienced in the surgical center industry can create a lot of unnecessary issues. But regulators can unfortunately hold up the process as well, and so depending on their work load, the number of applications pending and/or specific guidance or changes established by their federal or state agency, an application can find itself in a regulatory lock-up.

POWERS: There are many reasons a Form 855 might not get approved. The applications take time and the provider enrollment department of a carrier often rejects an application for peculiar, unexpected reasons. In the 20 years I have been working in the surgery center industry, I have only seen one case where a facility license was not issued because the state determined that the facility could not be grandfathered into a new requirement, and in that case it was a life safety issue.

What, if any, new rules or regulations have the Centers for Medicare and Medicaid Services (CMS) added to certification?

POWERS: The main thrust of the changes in the Conditions for Coverage, not surprisingly, relate to ensuring ASCs provide high quality of care. From a business perspective, ASCs are now defined as entities that perform procedures in which the expected time for the procedure and recovery is less than 24 hours. The other changes to the conditions relate to quality improvement, patient rights, infection control and physician disclosure of ownership in the facility prior to admission.

The CMS also proposed seemingly cumbersome new rules governing patient admission, assessment and discharge. However, CMS ultimately tempered many of the more controversial proposals. For example, rather than adopting CMS’s proposal that ASCs ensure that each patient has a safe transition home — which would have implied that ASCs ensure that patients have adequate transportation, and actually make it home safely — ASCs now must merely ensure that “all patients are discharged in the company of a responsible adult with limited exception.”

KAYE & SOKOL: On Oct. 30, 2008, CMS published a long anticipated final rule substantially revising the Medicare ambulatory surgery center (ASC) Conditions for Coverage (CfCs) and updating 2009 payment rates. Perhaps the most controversial and widely opposed CfC that had been proposed by CMS in August involved redefining ASCs in a manner that would have limited the range of services that could be offered by ASCs by changing the rule that prohibits a stay of anything exceeding 24 hours to prohibiting an overnight stay (meaning anything beyond 11:59 p.m.) Additionally, CMS proposed prohibiting ASCs from furnishing procedures that require “active monitoring by qualified medical personnel, regardless of whether it is provided in the ASC,” which again departs from current policy that allows a facility to transfer non-Medicare patients to non-hospital settings (e.g., skilled nursing facilities, recovery care centers) for extended recovery. Finally, the proposed restrictions would apply to all patients regardless of payment source. After consideration of the public comments, CMS revised the proposed definition of “ASC” to retain much of the current flexibility towards patient discharge schedules, including allowing surgical services for Medicare patients that do not require hospitalization and in which the expected duration of services would not exceed 24 hours following admission. Consequently, Medicare patients may stay at an ASC for 23 hours, 59 minutes starting at the time of admission without constituting an overnight stay. Non-Medicare patients seemingly could be allowed to recover longer in a setting other than the ASC or a hospital. Beginning in 2009, surveyors will examine ASC patient records to ensure that ASCs do not, as a matter of routine, recover patients for more than 24 hours.

How do ASCs maintain compliance for certification when many government agencies usually do not give specific criteria?

KAYE & SOKOL: It’s not a matter that the guidance is not given, but rather knowing how to access such guidance. Compliance guidance takes on many forms including federal and state laws and regulations, agency rule-making, conditions of participation, advisory opinions, position statements and more. Additionally, complying with one set of rules doesn’t mean that the ASC is complying with other applicable sets of rules. For example, an ASC could be in compliance with the Medicare conditions of participation by allowing overnight stays as long as a patient is discharged in less than 24 hours from admission. However, certain states may still prohibit overnight stays under its licensing statutes. Here too, having experienced ASC health law advisors and consultants who have familiarity with the various rules and work regularly with regulators are the best source of ensuring continued compliance.

POWERS: Between the CMS Conditions of Coverage, the accreditation standards, licensure standards, and general standards of surgical practice, ASCs have plenty of regulatory guidance.

Important: How To Scan and Remove Malicious Viruses

Every so often, we hear about a new and horrible virus spreading across the internet, infecting millions of Windows computers. Today we’ll show you the steps to remove those threats and (hopefully) prevent them from happening in the future.

Digital Integration in your Operating Room

Facilitating in surgical procedures in today’s surgical environment is catapulting the surgeon and attending surgical team into the new realm of audio-visual technology.  The new environment can include high-resolution video displays, touch screen controls, and digital information archived for later surgeon review.  However, are we researching enough before we leap into the digital world?

Many facilities look to improve efficiencies via connectivity by allowing multiple team members to view from afar for better patient flow.  Institutions gather live data that provide dashboards of information of surgical images, X-Rays for better patient safety.

Unfortunately, the well-intended goal often runs short and the Operating Room becomes an isolated island.  The excitement of great technology pushes forth with uncharted plans that often lead to disappointment and expensive equipment sitting idle on walls and inside cabinets collecting dust.

Examples are Operating Rooms with high definition video, but technology down line that cannot display the data.  The healthcare facility network maybe antiquated and budget restraints keep the information from passing outside the Operating Room. 

The cost of not preparing for your new digital Operating Room could provide a room housing extremely expensive audio, visual devices, which benefit no one.  Today’s technology moves rapidly and an extremely well thought out plan for your digital Operating Room today may already be outdated.

Even in the fast world of internet technology research the amount of information floating in our cyber world is minimal with integrating your operating room to audio/visual and data.  There are companies available but you will need to investigate those to match your budget as well.

http://www.vtsmedical.com/integration/infrastructure_services.php

http://www.rgb.com/

http://www.mechdyne.com/corporate/overview.htm

Hot Tea and Throat Cancer, and Other Health News

Study: Hot Tea May Increase Risk of Throat Cancer

Drinking tea that is too hot may increase your risk of throat cancer, suggests a new study published online in the British medical journal BMJ. A team of researchers traveled to Iran’s Golestan province, where residents tend to drink mostly very hot tea and water and where there’s an unusually high rate of esophageal cancer, ABCNews.com reports. The researchers studied the tea, alcohol, and smoking habits of 871 people, 300 of whom had been diagnosed with esophageal cancer. They found that those who regularly drank “very hot” tea were eight times as likely to have been diagnosed with esophageal cancer, compared with those who drank warm or lukewarm tea, WebMD reports. Those who preferred “hot” tea had twice the risk of esophageal cancer, compared to those drank warm or lukewarm tea. Other contributing factors included socioeconomic status, a diet lacking in fruits and vegetables, and poor oral health habits. 

In the United States, many loyal tea drinkers believe the beverage is good for your health. And it may indeed offer some benefits, such as helping you to focus.

Circumcision’s Effect on the Spread of Sexually Transmitted Diseases

A study of 5,000 initially uncircumcised Ugandan men in this week’s New England Journal of Medicine found that once the men underwent circumcision, their rate of acquiring herpes virus infection plunged by 28 percent and they were 35 percent less likely to get infected with human papillomavirus (HPV), which is responsible for genital warts and, in women, cervical cancer, U.S. News’s Deborah Kotz reports. Previous research has shown that circumcision reduces infection with HIV by 60 percent. Other studies, however, have shown no difference in rates of certain sexually transmitted diseases between circumcised and uncircumcised men. And circumcision may be beside the point when it comes to making a decision on whether to have safe sex, which is known to reduce the rates of transmission of STDs.

The Slow Progression of Electronic Health Records

A study published in the New England Journal of Medicine found that just 1.5 percent of hospitals have equipped all of their major medical services with comprehensive electronic health records, U.S. News’s Avery Comarow reports. Add 7.6 percent for hospitals with EHRs in as few as one clinical unit. Computerized physician order entry (CPOE) of prescriptions is in use at 17 percent of hospitals. Those figures are “abysmally low,” Ashish Jha of the Harvard School of Public Health, the report’s lead author, said at a press conference Tuesday. The main reasons identified by the thousands of hospitals that responded to a massive survey: not enough money to buy the systems (which can cost $20 million to $100 million), not enough money to maintain them, physician resistance, and unclear return on their investment.

Consider these 6 ways electronic medical records could make your life safer and easier, and read about how they can help keep your family healthy, too.

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