Tuberculosis treatment requires medication and monitoring

Tuberculosis (TB) continues to be a problem in the United States, particularly among at-risk populations. The groups at highest risk for TB include people living with someone who has active disease, and those with a lowered immune response, such as HIV patients.

“Every medical center in our region has tuberculosis on its risk assessment list, that is, its list of potential issues to monitor on a continuing basis,” says Stephen Parodi, MD, chief of infectious disease for Kaiser Permanente, Northern California. “We make it a priority to ensure that patients at risk for infection with TB are screened for latent infections.”

The region includes 20 medical centers serving 3.1 million members. Dr. Parodi says the plan encourages screening for those who have been incarcerated or have a history of IV drug use and has educated primary care physicians and pediatricians to screen for TB.

“We saw a significant surge in TB cases when the HIV epidemic first hit; since then we’ve seen a leveling off,” he says. “In terms of epidemiology, it’s interesting to note that many cases we’re now seeing are in foreign-born individuals. We live in a global world, and we need to be aware that constant vigilance and aggressive, early recognition of latent and active disease will prevent further spread.”

Most people infected with tuberculosis don’t have any symptoms. When a patient is positive for latent TB, the clinician looks at the risk factors and determines (based on criteria from the Centers for Disease Control) whether the person is a candidate for preventive medicine.

“Preventive medicine is a lot easier than treating the active form of the disease,” Dr. Parodi says. “With latent disease we can treat with one drug, as opposed to active disease, where we typically have to use a minimum of four drugs initially.”

Patients who develop active TB experience symptoms such as weight loss, fever, night sweats, cough, chest pain and bloody sputum.

“Until susceptibility results are available, empiric initial treatment for active TB should include four drugs: isoniazid, rifampin, pyrazinamide and ethambutol,” says Mark Abramowicz, MD, editor-in-chief of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs. “When susceptibility to isoniazid, rifampin and pyrazinamide has been documented, ethambutol can be omitted.”

DIRECT PATIENT OBSERVATION NEEDED

One of the greatest problems in TB treatment today is the emergence of drug-resistant strains of the bacteria.

“Poor adherence to TB therapy is the most common cause of treatment failure, and can lead to drug resistance,” says Dr. Abramowicz. “Medical Letter consultants recommend that most patients, including those with disease due to drug-susceptible strains, take drugs for active TB under direct observation.”

At Kaiser, patients with active TB are monitored closely, typically with a monthly office visit. Kaiser physicians sign the orders for directly observed therapy, which is provided by the county public health department.

“We provide medications, lab testing to monitor potential side effects, symptom assessments, and imaging, x-rays or CT scans as needed,” Dr. Parodi says. “Protocols differ from jurisdiction to jurisdiction in terms of exactly who gets directly observed therapy, but in our experience, most counties are aggressive. If there is an identified case of active, potentially contagious TB, that person is receiving directly observed therapy.”

Extensively drug-resistant TB is a form of the disease caused by strains that are resistant to all the most effective anti-TB drugs. The World Health Organization reports that 41 countries have cases of extensively drug-resistant TB, including the United States.

“Confirmed multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis should be treated with directly observed therapy in collaboration with a clinician familiar with management of these conditions,” says Dr. Abramowicz. “Regimens for these conditions must include at least four drugs to which the organism is susceptible; the duration of therapy usually should be 18 to 24 months.”

In recent years, researchers have made considerable progress toward developing new medications that could treat tuberculosis more effectively. Eleven new medications from seven different drug classes are currently in clinical trials for tuberculosis.

“The medications that are farthest along are antibiotics called fluoroquinolones, which have the potential to shorten the duration of therapy,” says Eric Nuermberger, MD, associate professor of medicine and international health at Johns Hopkins School of Medicine, who is on the faculty of Hopkins’ Center for Tuberculosis Research. “Current medications require six to nine months; we hope fluoroquinolones will reduce that to four months. Four phase II studies of fluoroquinolones are currently underway, and we should have an answer in about two years.”

Fluoroquinolone drugs are already on the market in the United States for acute conditions such as community-acquired respiratory tract infections and urinary tract infections.

Of the medications that are being developed solely for tuberculosis, the one that’s furthest along is TMC207, developed by Tibotec.

According to a recent study in The New England Journal of Medicine, when researchers added TMC207 to a standard regimen for multidrug-resistant tuberculosis, a significantly higher proportion of patients had negative sputum cultures at two months.

Elaine Zablocki has been reporting on healthcare for more than 20 years. She is based in Oregon.

This article is based on information supplied by The Medical Letter (www.medicalletter.org), a non-profit organization that publishes newsletters offering critical appraisals of new drugs and comparative reviews of older drugs. The Medical Letter is independent of the pharmaceutical industry and supported entirely by subscription sales. Institutional site license inquiries can be sent to info@medicalletter.org [info@medicalletter.org]

California Doctors Agree on Need for Health Reform, Disagree on Which Version

A recent survey of members of the California Medical Association found that although almost all of them would like to see some sort of health reform, they are evenly divided over which kind, according to a report by California Physician.
While 97 percent favored either incremental or fundamental health reform rather than no reform at all, 44 percent supported the Democrats’ stalled health reform legislation and 44 percent opposed it.

Asked what kind of healthcare system they would prefer, 19 percent wanted a single-payer system, 13 percent wanted a free market system without public insurance and 66 percent wanted a pluralistic system with government and private payors.

CMA members showed significant support for the following reform measures:

• 94 percent favor protecting California’s unusual state cap on noneconomic damages in medical liability cases.
• 89 percent wanted to bar health insurers from denying coverage based on pre-existing conditions or changes in health status.
• 88 percent favored providing tax credits and subsidies to low-income families and small employers to purchase coverage.
• 82 percent wanted to expand health insurance coverage to 95 percent of the uninsured.
• 76 percent favored funding the development of best practices and quality measures.

Read California Physician’s report on health reform.

Anthem Blue Cross of California Raises Individual Premiums by 30-39%

Anthem Blue Cross, California’s largest for-profit health insurer, is raising premiums for individual insurance policies by 30-39 percent on March 1, according to a report by the Los Angeles Times.

Individual policies, which already tend to be more expensive than group policies, are a refuge for people who are uninsured, self-employed or have recently lost employer-based coverage.

Word of the increase, the largest in policyholders’ memory, has prompted the California Insurance Commissioner to order an actuarial study to determine if Anthem spends at least 70 percent of individual premiums on medical care, as required by state law.

The company, which provides individual coverage for 800,000 customers, said the increases “are merely the symptoms of a larger underlying problem in California’s individual market — rising healthcare costs.”

Read the Los Angeles Times’ report on insurance premiums.

5 Best Specialties for ASCs Now

1. Orthopedics. Rising ASC reimbursement for orthopedic surgery is transforming a sometimes break-even field into a money-making one, says William G. Southwick, president and CEO of HealthMark Partners in Nashville. For example, shoulder surgery used to be so underfunded it needed to be supplemented by income from other procedures, he says. Now, under Medicare’s ambulatory payment classification system, reimbursement for orthopedic ASCs is expected to increase 100 percent.

Orthopedics, along with otolaryngology and general surgery, is on Mr. Southwick’s list of specialties with enhanced value for ASCs. “These specialties are good for Medicare patients and are saving the healthcare system significant dollars,” he says.

Jerry Ippolito, director of perioperative services business development at Southeast Anesthesiology, Charlotte, N.C., also puts orthopedics at or near the top of his list. “Orthopedics is a big winner under APCs,” he says. “It has some lucrative cases, such as knee arthroscopies and it is not isolated to one payor population.” For example, while total joint procedures focus on Medicare patients, “some of the most severe joint injuries happen to younger people who are on private insurance,” Mr. Ippolito says.

2. Spine. Naya Kehayes, CEO of Eveia Health Consulting & Management in Issaquah, Wash., sees a great deal of promise for this specialty. “Spine is probably the newest, biggest most costly surgery done in the hospital that can be done outpatient,” she says, but she cautions that ASCs should contact payors before deciding to add any specialty. “The biggest mistake an ASC can make is to buy all the equipment and then talk to the insurer,” she says. Ms. Kehayes also sees great potential for ASCs that add cochlear implants, vaginal hysterectomies and some of the larger urology cases to their list of procedures..

Robert S. Bray Jr., MD, a neurosurgeon who runs a spine ASC in California, believes that “the future of spine surgery is in the ASC. “Spine will literally be a game-changer for ASCs in the next 10 years.” He warns that ORs have to be larger than at the average ASC to accommodate spine surgery equipment and ORs have to be “ultra clean,” so they cannot be shared with specialties like gastroenterology. And it takes a while to convince insurers that spine can be performed safely in an outpatient setting, he says.

3. Bariatrics. Along with spine and retina, bariatrics is on Mr. Southwick’s list of specialties with growing value for ASCs because they have been slowly moving out of the hospital setting. Laparoscopic gastric band procedures, or lap-bands, are the only bariatic procedures that are typically performed in an ASC, he says. In contrast, he says gastric bypass surgery requires two or three days of hospitalization and costs a great deal more.

Mr. Southwick notes that the recession has dampened demand for lap-bands, which cost $10,000-$15,000 and are often paid by the patient out of pocket. But popularity is expected to rebound, because an estimated 5-7 percent of the population is eligible for bariatric surgery.

However, “keep in mind that bariatrics needs the whole array of services [for the ASC] to be a bariatric center of excellence,” warns Ms. Kehayes. These include patient support services and features such as patient-lifting equipment, wide doorways, floor-supported toilets and sensitivity training for the staff.

4. Retina. Many ophthalmology ASCs limited to cataract surgery are adding retina surgery, which is usually handled by a separate subspecialty of some 1,300 ophthalmologists. These procedures are longer and more complicated and, until recently, were almost always done in the hospital.

While retina is now safe to do in ASCs, ophthalmology surgeons were discouraged from moving out of the hospital by low reimbursements that didn’t cover costs in the ASC. However, under the new Medicare APC system, retina payments will rise 100 percent, according to Leo T. Neu III, MD, a retina surgeon who runs an ASC in Springfield, Mo. He says the average payment for a standard pars plana vitrectomy, the most common retina procedure, will rise 145 percent by 2011, to $1,540.

On the professional fee side, Dr. Neu adds that declining reimbursement for some retinal procedures will lure retinal surgeons out of the hospital and into the ASC. For example, Dr. Neu reports that the Medicare professional fee for a vitrectomy with epiretinal membrane peeling fell by 24 percent in 2008.

5. Pain management. Along with gastroenterology and ophthalmology, pain management is on Mr. Southwick’s list of specialties with continued value for ASCs. “These specialties continue to be successful in ASCs, if expenses are managed carefully, even as reimbursements for them are cut,” he says. While most of the cutting has been due to Medicare APCs, “private payors are beginning to reflect those cuts,” he says.

Even though reimbursement to ASCs for pain management will fall 2 percent under APCs, volume is rising. A study conducted last year by KNG Health Consulting found that pain management was one of the few ASC-based specialties where most of the new procedures in centers were not simply moving out of the hospital. While 77-95 percent of new volume in orthopedics, ophthalmology and other specialties came from hospitals, the figure for pain cases was 15 percent. The new volume represents “significant changes in insurance coverage and advancement in the pain management clinical treatments [that] have evolved in the past seven years,” the study said.

15 States That Opted-Out of Federal Supervision Requirement for CRNAs

Fifteen states have opted out of the physician supervision requirement for certified registered nurse anesthetists. Note: States listed in alphabetical order.

1. Alaska opted out in October 2003.
2. California opted out in July 2009.
3. Iowa opted out in December 2001.
4. Idaho opted out in March 2002.
5. Kansas opted out in March 2003.
6. Minnesota opted out in April 2002.
7. Montana opted out in January 2004. Note: The opt-out was briefly reversed in 2005.
8. Nebraska opted out in February 2002.
9. New Hampshire opted out in June 2002.
10. New Mexico opted out in November 2002.
11. North Dakota opted out in October 2003.
12. Oregon opted out in December 2003.
13. South Dakota opted out in March 2005.
14. Washington opted out in October 2003.
15. Wisconsin opted out in June 2005.

Source: American Association of Nurse Anesthetists, last updated July 2009.

WellPoint Explains High Rate Increases for Individual Insurance

WellPoint explained why it wants to increase rates as much as 39 percent for individual insurance at its California subsidiary, Anthem Blue Cross, in a letter to HHS Secretary Kathleen Sebelius.

Squeeze out waste

Understandably, the painstaking scrutiny of healthcare costs has reached a fever pitch. While administration is a relatively small percentage of the overall costs in the system, the pressure is on payers to trim as much waste from their operations as possible.

Administrative costs—or any outlays that are not specifically tied to medical care—are a political hot button. Insurers defend what they spend on tasks such as case management and disease management as well as investments in technology as necessary spending that results in net savings and improved health. Some critics of the insurance industry characterize administrative costs as nothing more than profits and executive compensation and seek legislation to control how premium dollars are spent.

In fact, 15 states have implemented laws dictating minimum medical loss ratios (MLRs), ranging from 50% to 80%. In 2008, California Governor Arnold Schwarzenegger vetoed a bill that would have forced insurers to maintain an MLR of 85%.

According to America’s Health Insurance Plans, in a 2008 study conducted by PricewaterhouseCoopers (PwC), 87 cents of every premium dollar goes to healthcare and medical services, and just 3 cents goes toward profits.

PASSING THE BLAME

Governments are taking some steps that could eventually result in lower healthcare costs, such as smoking bans in public places and removing soda and sugary snacks from school vending machines. On Jan. 1, 2010, California became the first state to ban the use of trans fats in restaurants and bakeries. New York City adopted a similar ban several years ago.

Nonetheless, it was inevitable that scrutiny would intensify on payers and their efforts to reduce costs and minimize wasted resources in the system, and now that it has, they’re possibly receiving more blame than is fair.

“When people look at waste in claims processing, for example, they assume [all of the money is being wasted] by insurers, when a lot of it is wasted by providers,” says Mark Merlis, a health policy consultant who has written several papers on the topic of healthcare waste. “But in fairness to providers, they have to comply with many different insurers’ administrative processes, so we should be doing as much as we can to promote uniform transactions.”

Merlis says the more uniformity that can be achieved among payers, the more money the system overall is going to save. Market complexity makes it difficult to identify who is “committing” the waste. Furthermore, cutting waste from one area might simply shift costs to another. For example, in an attempt to fight losses from fraud, payers could investigate more claims in detail, but that will delay payments to providers, damaging relations and potentially resulting in legal action under prompt payment laws.

TECHNOLOGY TO THE RESCUE

The siloed yet sprawling nature of the U.S. healthcare system—payers, physicians, pharmaceutical companies, hospitals, government agencies and consumers—means that waste elimination isn’t as easy as making an individual organization operate more efficiently.

Some Americans, including some physicians, believe a shift to a single payer system would simplify healthcare administration, but the large majority is firmly opposed to such a change. As Merlis points out in his paper, “Simplifying Administration of Health Insurance” (January 2009), complexity is not just a byproduct of the insurance system—it is what insurers are selling.

“The value-added of the managed care industry consists of the very features that make insurance complicated: different coverage rules and formularies, authorization requirements and careful scrutiny of claims, and so on,” he writes. “The variations are what differentiate one plan from another, and competition and uniformity may be conflicting goals.”

Still, that doesn’t mean plans can’t improve their internal operations and their relationships with other healthcare stakeholders. There are also high hopes that technology can eliminate some waste in the system, and at least one project is proving that to be true.

In 2008, Blue Shield of California (BSC) created its Partnership in Operational Excellence and Transparency (POET) transactions-tracking tool to improve payment accuracy and dispute resolution, speed claims turnaround, and increase operational transparency. The program is available online for 90 of the hospitals Blue Shield of California contracts with across the state.

“POET has been enhancing our working relationships with network hospitals by providing opportunities for data-driven discussions that directly improve operational efficiencies,” says Juan Davila, the plan’s senior vice president for network management. “Using key claims performance indicators and transparent claims data, we work jointly with our facilities to target and prioritize impactful process improvements.”

Davila says the claims-processing related improvements have been impressive, and the benefits of improved relations with network providers are even more so.

“We wanted to show that we were really trying to get at the root of the problem,” he says. “We paid for the system up-front, and we were increasing our transparency to them, as opposed to trying to cover up our errors. We genuinely wanted to develop a more collaborative relationship with our network hospitals, and that’s changed the way we think of each other in a very positive way.”

The hospital association of Southern California recently approached BSC to help the association with another large-scale project.

“I have been in this business for 20 years and have never gotten a phone call like that before,” Davila says.

Within administrative functions, such as those BSC is addressing, it’s hard to know exactly what is waste. A 2008 study by PwC’s Health Research Institute, “The Price of Excess: Identifying Waste in Healthcare Spending,” points out that “inefficiency” and “waste” are not interchangeable terms; the former is merely one component of the latter.

Authors define waste as costs that could have been avoided without a negative impact on quality, which is similar to the definition used by the Institute of Medicine and the authors of another watershed study conducted by Thomson Reuters in October 2009: expenses that don’t add value.

WHERE TO FIND WASTE

The PwC research estimates that slightly more than half of all healthcare spending ($1.2 trillion of the annual $2.2 trillion spent) is wasteful and breaks it into three categories:

• Behavioral waste, which accounts for $303 billion to $493 billion each year;
• Clinical waste, accounting for $312 billion annually; and
• Operational waste, which consumes $126 billion to $315 billion.

The study further breaks the operational waste segment down into four subsets:

• Claims processing, which accounts for $21 billion to $210 billion in waste;
• Inefficient use of technology ($81 billion to $88 billion);
• Staff turnover ($21 billion); and
• Paper prescriptions ($4 billion).

The research by New York-based Thomson Reuters Healthcare Analytics (October 2009) is slightly less pessimistic, estimating that each year, between $600 billion and $850 billion of healthcare spending is wasted.

The study, “Where Can $700 Billion in Waste Be Cut Annually from the U.S. Healthcare System?” identifies six primary culprits:

• Unnecessary care (40% of waste), accounting for $250 billion to $325 billion;
• Fraud (19%), $125 billion to $175 billion;
• Administrative inefficiency (17%), $100 billion to $150 billion;
• Healthcare provider errors (12%), $75 billion to $100 billion;
• Preventable conditions (6%), $25 billion to $50 billion; and
• Lack of care coordination (6%), $25 billion to $50 billion.

Those figures are so staggering that the system can’t expect to “cut” its way out of them, according to Bob Kelley, Thomson Reuters’ vice president of healthcare analytics and author of the report.

“Simple external controls on cost and utilization will not work, and any effort to control costs by eliminating waste must be careful to consider possible unintended impact on access to appropriate and necessary care,” he says. “We should expect that any change to the system of care that improves its performance will require a realignment of the types and levels of professional and facility resources and the relationships among these resources.”

The best solutions will effect positive changes and recognize that the healthcare market dynamic is much different from other product or service markets. Most consumers believe that their access to all potentially useful services is a right.

“We need to shift the public’s perception and expectation [of quality] away from ‘more services is better’ to ‘the care that will most likely result in the outcomes that are best for me,’” he says. “Simultaneously, we must begin to reward physicians for providing this type of care, and recognize and pay for the required time and effort.”

CONSUMER BAD HABITS

Shifting public perception is critical, because for many Americans, “waste in healthcare” brings to mind images of bloated, lethargic mega-plans with outdated technologies and overpaid, fat-cat executives. Although the U.S. Centers for Disease Control and Prevention estimate that fully half of the nation’s deaths each year are the result of bad and avoidable habits, most Americans, rather than look in the mirror, latch onto headlines about excessive health plan profits and executive bonuses.

When consumers learned that former UnitedHealth Group CEO William McGuire received more than $124 million in total compensation in 2005, it’s understandable that many of them reacted with indignation. While the public’s sensitivity to what they perceive as excessive income is at an all-time high, salaries and bonuses paid to health plan executives are a very small number in a very large sum, according to Dan Munro, principal with The DMM Group.

“If you added up all of the executive bonuses and salaries for the entire healthcare industry, it would just be a drop in the bucket compared to the other costs,” he says. “Healthcare is nothing at all like Wall Street, where firms are racing to pay back their Troubled Asset Relief Program funds because they want to go back to handing out those huge bonuses again.”

Merlis agrees, saying executive compensation “might look ugly when you see how much money certain people are being paid, but it’s really not a driver of healthcare expenses.”

It’s clear that politicians are doing what they can to foster greater use of technology in healthcare, particularly with federal funding included in the stimulus package to spur greater adoption of electronic medical records, which are not yet widely adopted.

“The government is trying to encourage the meaningful use of electronic health records,” Munro says. “For the first time, the government is mandating that EHR applications engage the consumer. If you tell most EHR vendors that you’re going to develop a patient-focused system, they’ll laugh at you. They have always been provider-focused, because that’s where the money is.”

An EHR system can cost millions of dollars, so small providers are less likely to adopt them simply because of the cost. The government has realized that use of health IT won’t progress if it doesn’t engage the consumer, Munro says.

THE OPPORTUNITIES ARE REAL

To further explore IT’s opportunities to improve healthcare, Kelley and Thomson Reuters are working on a follow-up whitepaper highlighting specific initiatives that have been successful in eliminating waste, or that show the potential to do so.

“There are certainly high expectations for the contributions of IT to both improved quality and reduced waste,” he says. “Many of these initiatives are either directly related to new or enhanced IT applications or require IT system support to enable new relationships between providers, or between providers and patients.”

Examples of the first type include electronic medical records, health information exchanges, and clinical registries. Examples of the second type include patient-centered medical homes and bundled or episode-based payment systems.

“I think that these opportunities are real, but changes in the systems of care and the relationships among providers and patients will be required if the great potential for these solutions is to be ultimately realized,” he says.

According to Davila, BSC’s POET program is improving efficiencies at the larger system level.

“Historically, when we would show up to renegotiate a contract, the hospital representative would say, ‘My people are telling me that you don’t pay your claims right, you don’t handle appeals well, and you owe us X million dollars. Before we recontract, I need you to fix that.’ The result, inevitably, was a lot of negative energy.”

To solve the problem, BSC worked with a third-party vendor to develop a system that enables participating hospitals to review 24 months of processed claims information and performance metrics on the POET Hospital Dashboard, an online performance analytics portal specifically designed for those hospitals.

Those facilities routinely receive quarterly claim summary reports that provide information on key indicators such as cycle time; submission type; denial volume and reasons for denial; appeal volume, outcomes, and reasons; and claim volume for patients with Bluecard, a national program that allows any Blue member to receive care from another Blue company when traveling or living outside of their usual service area.

“It’s all right there in black and white for everyone to see,” Davila says. “One national hospital system was upset because they thought we weren’t paying as quickly as we should, until POET revealed the problem: We were paying the claim in 12 days, but it was taking them 25 days to get the claim to us. The system showed them exactly where the process was broken so they could fix it.”

PHYSICIANS’ WEIGH THEIR COSTS

The need for such transparency is significant, according to research from the American Medical Assn. Its second annual National Insurer Report Card study attempts to diagnose the strengths and weaknesses of the claims processing systems used by eight of the nation’s largest health insurers. Five of the eight plans showed improvements in the median amount of time necessary to respond to providers’ claims, but the report estimates that providers still divert as much as 14% of their revenue to ensure they are receiving accurate payments.

Physicians reported spending three hours weekly interacting with plans in 2006, according to a Web Exclusive produced by Health Affairs in May 2009. When time is converted to dollars, the cost to practices is estimated at $23 billion to $31 billion annually, or 6.9% of all U.S. expenditures for physician and clinical services. Further, 45.9% of physicians surveyed for the report said the cost of dealing with health plans had “increased a lot.”

The report goes on to note that administrative cost cannot be reduced to zero dollars and that interactions that cost money also can produce benefit, such as prior authorization, which can reduce inappropriate use.

Anthem Delays Individual Insurance Rate Hike, Pending Study; Other States Also See Large Rate Hikes

Anthem Blue Cross of California has agreed to postpone big rate increases for individual policyholders from March 1 to May 1 so outside actuaries can review its rate proposal, according to a report by the Los Angeles Times.

Making Infection Control Central to an ASC’s Operations

In my parallel life, I also edit one of our company’s sister publications, Infection Control Today (ICT) magazine, so as you can imagine, infection prevention in all healthcare environments is dear to my heart. I have been following closely the new conditions for coverage (CfCs) issued last year by the Centers for Medicare and Medicaid Services (CMS) addressing infection control in ambulatory surgery centers (ASCs), and the sense of panic that these CfCs have triggered. ASCs have traditionally enjoyed a very low infection rate, but some rather high-profile infectious outbreaks at outpatient facilities prompted a greater investigation by the government into the state of infection control at surgery centers and a few bad apples have forced a new regime. But perhaps that’s a very good thing in disguise. It’s true that human nature being what it is, people don’t always do what they are supposed to do, and so rules are made to enforce mandatory compliance. It’s always a shame when doing the right thing must be legislated instead of met voluntarily, but the bright spot in the new CfCs relating to infection control is the hope for even better patient outcomes — a distinct hallmark of the ASC industry in the first place.

In this issue you’ll meet Bruce Wallace and Anthony Pings, two people who have made infection control the focus of every decision they have made in the design and development of Renaissance Surgical Arts at Newport Harbor, LLC, a brand new multi-specialty ASC that will surely be a destination for healthcare in the Orange County, California region. Central to the center’s long list of innovations is the numerous concessions made to making infection control an imperative, from the multi-chamber sterile and substerile areas in between the operating rooms, to the extensively automated surgical device and instrument sterilization systems, to the use of touchless scrub sinks and surfaces impervious to bacteria.

10 States With the Highest Hourly Wages for LPNs

Here are the ten states with highest average hourly wages for licensed practical nurses and licensed vocational nurses, according to the U.S. Bureau of Labor Statistics’ Occupational Employment Statistics survey.

1. Connecticut — $24.90
2. District of Columbia — $23.96
3. Massachusetts — $23.89
4. New Jersey — $23.83
5. California —$23.27
6. Rhode Island — $23.23
7. Maryland — $23.09
8. New Mexico — $23.02
9. Alaska — $23.01
10. Nevada — $22.41

Source: U.S. Bureau of Labor Statistics.

Note: Data does not included self-employed workers.

Next Page »