Hospital Study: Greater spending linked to higher mortality

An extensive study of Medicare patients in California hospitals found that the more money spent on the care of the patients, the lower the mortality rate, according to Health Leaders Media.

The study, which was limited to patients with six common medical conditions, was published in this month’s Annals of Internal Medicine.

The study found that higher patient survival was linked with higher spending for each of the diagnoses.

Data was analyzed from Medicare patients who suffered from stroke, pneumonia, hip fracture, congestive hearth failure, gastrointestinal hemorrhage and acute myocardial infarction. The scope of the study included spending data from 208 hospitals over 9 years.

According to the study, during 1999 to 2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than did those admitted to hospitals in the lowest. The prediction of inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. 

John Romley, of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, is lead author of the study. He says he and his colleagues worked to control factors like patient health status and hospital teaching affiliation.

The study contradicts findings from a previous Dartmouth Atlas of Health Care that spearheaded much of what is being looked at in healthcare reform regulations, that expensive care is not necessarily better care, and may in fact be worse care.

“If the results are real … that would suggest these reductions across the board in hospital spending might lead to worse outcomes for some patients,” Romley told Reuters Health. That doesn’t mean cuts wouldn’t still be cost-effective, if money elsewhere could better improve public health. But, he added, “it is important to understand the trade-offs.”

Do You Know the Difference Between Medigap and Medicare Advantage?

Both “Medigap” and Medicare Advantage plans are often referred to as “supplemental insurance” plans in Medicare articles and literature.  This language is confusing and somewhat misleading. Do you understand the difference?

Nicknamed “Medigap,” it is technically the only real “supplemental insurance”; its formal name is Medicare Supplemental Insurance. Only people enrolled in traditional Medicare can use a supplemental insurance plan.

Medigap is NOT a government run plan. Medigap is private insurance. You can buy it to defray some or most of your out-of-pocket costs. These might include:

• The hospital deductible for Part A, which is currently $1,100 for each hospital benefit period.
• Part B costs such as the percentage you pay for doctor’s visits and outpatient services.
• The costs of emergencies up to plan limits you incur when traveling overseas.
• Other costs as defined by the plan.

There are 10 types of medigap policies, and they are legally standardized, which means that the benefits you get are the same, regardless of who sells them to you.

However, that does not mean you will receive the same price from each insurer so it’s a good idea to check around. To compare the benefits in each Medigap plan, enter your zip code at Medicare Solutions.com to get started.

Medicare Advantage is an umbrella name for a VARIETY of private health plans which include HMOs, PPOs, PFFS (Private Fee For Service plan.)

Medicare Advantage, called “Medicare Part C” is an alternative to the traditional Medicare program. Those who enroll in Medicare Advantage may NOT purchase a Medigap plan or a stand-alone prescription drug plan.

Each Medicare Advantage plan covers all the same benefits as traditional Medicare (called “Part A” and “Part B”), but the plans operate on the copayment system and may offer extra benefits. Sometimes the copayments are lower than traditional Medicare, and sometimes not. Each plan is different.

For example, some plans may include vision and hearing services, and include prescription drug coverage at no additional cost. However, most plans will require you to go to in-network doctors, or to pay high co-pays if you go out of network.

To compare Medicare Advantage plans, go to Medicare Solutions.com and enter your zip code to begin.

Practicing “Mindfulness” Can Teach Us to Pay Attention

Practicing “Mindfulness” Can Teach Us to Pay Attention

You don’t have to be a yogi to know that meditation is more than just sitting like a pretzel and chanting. Now scientists are finding that practicing meditation not only affects our psychological life: it physically alters the structure of the brain.

The findings support the growing hypothesis in the scientific community: that the brain is a far more pliable system than believed even a decade ago. In fact, the choices we make in the way we think and act affect the health and growth of our body’s most vital organ.

The study on brain growth, completed at the Massachusetts General Hospital and Harvard Medical School, had participants doing 30 minutes of “mindfulness meditation” for eight weeks.

The study participants were given MRI to measure changes in the grey matter growth during the study. Increased grey matter was found in the area of the brain the controls learning and memory with decreased grey matter in the brain where stress is controlled. The control group showed no changes in growth in these areas.

Adding meditation practice to your retirement plans might just lengthen your life and make you more healthy. In 2009, a study found that people who meditate may have lower blood pressure, a leading factor in heart disease Another study found links between meditation and ability to “pay attention” – a critical skill in a world where we are being exhausted by sensory inputs.

Meditation – along with its fraternal twin, yoga — has blossomed in Western culture in the last four decades and is now a fairly common practice in the United States.

Meditation is often connected to Eastern religions such as Buddhism or Hinduism, but the practice of meditation is not a religious act.  It is the practice of quieting the body and the mind from the many external stimuli, moving through concentration to a place of “unbroken attention.”

Those who meditate often say the goal is to achieve the same kind of “mindfulness” in their conscious lives as they do in their meditation practice.

The Medicare Payment Advisory Commission wants a copayment to discourage misuse of home health care services.

The congressionally appointed commission voted 13-1 to recommend that lawmakers impose the new charge. Two commissioners abstained and one was absent.

According to the Associated Press, home health services, which are currently covered under Medicare, cost taxpayers approximately $20 billion a year.

The co-pays, commission chairman Glenn Hackbarth said, would help avoid the benefit turning into a “long-term care social support system.”

Concerns with Medicare fraud and a tight budget have motivated the commission to look for cuts. Home health care was originally considered a “cost saver.” Now increasing costs and big differences in how communities around the country use the benefit have given lawmakers reason to make changes.

Exemption from the recommendation would include low-income patients covered by Medicaid, as well as those just discharged from the hospital. According to the AP, more than 30 million beneficiaries in traditional Medicare would be directly subject to the fee.

The recommendation was strongly opposed by AARP lobbyists who support a strong network of home providers to assist the more than 3 million seniors and disabled people on Medicare who are not able to easily leave home.

In September, AARP strongly supported The Home Health Care Planning Improvement Act of 2010, House Bill 4993 and Senate Bill 2814, which was a bi-partisan effort to expand the roles of nurse practitioners and physician assistant to allow them to certify home healthcare plans for Medicare patients.

In rural parts of the country, areas where the nation suffers from shortages of physicians, many Americans see nurse practitioners as their primary care provider.

A long-term study in the American Journal of Clinical Nutrition tested thousands of Chicago residents 65 and older, starting back in 1993. The study looked at the mental acuity, as it followed the seniors based on their adherence to a diet recognized as the “Mediterranean diet”: fish, vegetables, olive oil, and moderate amounts of wine.

Those who scores for adhering to the diet where higher were associated with slower rates of cognitive decline, even after controlling for smoking, education, obesity, hypertension and other factors. The study’s author said that the conclusions of the study showed a large difference in those who stuck to the diet.

The Mediterranean diet has long been recognized for its healthful qualities: It’s is the basis of recommendations by experts for a heart-healthy eating plan as well.

According to the Mayo Clinic, the key components of the diet are:

• Getting plenty of exercise
• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats such as olive oil and canola oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Drinking red wine in moderation (optional)

The diet also recognizes the importance of enjoying meals with family and friends.

The Mediterranean diet has long been recognized for its healthful qualities

Your kidneys are workin' it!

New Medicare payment rules for kidney dialysis are making it easier for patients to have their treatment at home.

The changes, which just went into effect, are motivating more clinics to teach the do-it-yourself form of dialysis using specially designed portable equipment.

Some patients may be nervous or intimated at the thought of home dialysis. Currently, only 8 percent of kidney patients do dialysis at home and many patients do not know that have that option.

Home dialysis includes an intensive training program. People who prefer the home program, according to physorg.com, cite the convenience as a major factor in choosing home dialysis. The possibility of traveling with the machine gives them more freedom, as well as setting a more flexible schedule.

Despite concerns about infection and control in the home environment, a study published last year in The Archives of Internal Medicine found that patients “with end-stage kidney disease who have dialysis at home fare just as well as their counterparts who do hemodialysis,” traditionally performed at a dialysis center.

One additional key factor that is boosting home treatment is that new Medicare rules also pay physician reimbursement for patient education. This means that the home care training is no longer a burden to the system, but a covered cost.

As for the patients, Dr. Leslie Spry of the National Kidney Foundation says, once they “experience the difference between home and in-center dialysis most will not return to in-center treatment.”

Spry is a consulting physician for the National Kidney Foundation. In 2003, he also established at the first home hemodialysis program in the Midwest at his home clinic, the Dialysis Center of Lincoln in Nebraska.

To learn more about home kidney dialysis, check out this handy, downloadable comparison chart.

New to dialysis and Medicare? For a checklist of questions for your treatment plan and physician, click here.

Avastin still covered regionally on Medicare during appeal

One regional Medicare provider has decided to continue to cover Avastin, a breast cancer drug, reversing their decision from last week’s announcement to refuse coverage.

Questions about coverage of the pricey drug were sparked by the Food and Drug Administration (FDA)’s12-1 ruling in July to revoke approval of the drug for use to treat breast cancer. Genentech, the manufacturer of the drug, is appealing the decision.

A spokesperson for Medicare contractor Palmetto GB, a subsidiary of Blue Cross Blue Shield of South Carolina, reported in the New York Times that Palmetto “has suspended consideration of changes in its reimbursement policy for Avastin as a treatment for breast cancer” while the appeal process continues.

Last week, in a notice posted on its website, Palmetto GB, a regional company that determines Medicare coverage for South Carolina, Ohio, West Virginia, California, Nevada and Hawaii had said that it would stop paying for the use of Avastin for breast cancer treatment as of Jan. 29. That notice was updated this week to state it will “continue coverage of Avastin under current policy.”

In July, the F.D.A. decided to revoke approval of Avastin, also called bevacizumab, because the F.D.A. said follow up studies had found the drug was not effective and had dangerous side effects.

In 2008, the expensive drug was a part of the F.D.A.’s accelerated approval program, according to the FDA’s website. The approval was based on a trial of patients who had not received chemotherapy for mestatic breast cancer.

“Under the accelerated approval program, a drug may be approved based on clinical data that suggest the drug has a meaningful clinical benefit, with more information being needed to confirm this.  The program provides earlier patient access to promising new drugs to treat serious or life-threatening conditions while confirmatory clinical trials are conducted.”

According to the F.D.A., follow-up trial results submitted by Genentech only showed a small effect on “progression-free survival.”

The F.D.A.’s decision to revoke approval for use of the drug for breast cancer treatment will not affect its approval for use for treating other cancers.

Seniors and retirees often have flexible schedules and are able to make and keep regular appointments with their local blood bank. These simple appointments—which take on average 8 to 10 minutes — make that donor an everyday hero.

“Every 12 seconds someone in the United States needs some sort of blood transfusion,” says Colleen O’Callaghan, a donor recruitment representative for the American Red Cross. “One donation can help up to three people.”

And no better time than in January, when the reserve of blood is critically low, O’Callaghan says.

Monica Stoneking, communications director for the American Red Cross, said she strongly encourages individuals with Type O blood to donate. Since O Negative blood type is the universal blood type, it becomes extremely important in an incidence where doctors don’t have time to test a patient for their blood type.

But do you think you are too old or a bit ill for the Red Cross to take your pint? Think again.

On the American Red Cross’s “Top 10 Reasons People Don’t Give Blood,” number 9 is “The won’t want my blood (I am too old/I’ve had an illness).”

If you’ve been putting off giving a pint or two because you think you aren’t “qualified,” it’s as easy as checking with your doctor. Also, the staff at the blood centers will review your medical history.

According to the Red Cross site: “There is no upper age limit to donate blood with the American Red Cross, and a great many medical conditions do not prevent you from donating blood, or may have done so only temporarily in the past.”

And, should you discover you can’t give blood, there are dozens of opportunities for volunteering with the Red Cross to help.

To find the closest location to donate, simply click here and enter your zip code in the box.

January Bonus for those living in The Red Cross’s Northeast Division! Give a pint, get a pound of Dunkin Donuts coffee! All eligible donors will also be entered for a chance to win Free Dunkin’ Donuts Coffee for a Year.

In our diets, Vitamin B-12 is found most commonly in meats, fish, fortified cereals, and dairy. Experts from the Mayo Clinic note that elderly are most at risk of diseases as a side effect of B-12 deficiency.

The Oxford study found that people who had higher vitamin B12 levels were six times less likely to experience brain shrinkage compared with those who had lower levels of the vitamin in their blood. None of the people in the study had vitamin B12 deficiency. The study was conducted over five years and published in the journal of Neurology.

Studies found that deficiencies themselves can lead to anemia and abnormal neurological and psychiatric symptoms, with the elderly and strict vegetarians most at risk. Patients with Alzheimer’s disease have been found with abnormally low B12 levels, the Mayo Clinic reports.

It isn’t clear whether vitamin supplements are metabolized as successfully as the vitamin found naturally in food. Thus, recommendations are to increase intake of healthy foods where B12 is found: low-fat yogurt, low-fat milk, shellfish, chicken breast, turkey, hard-boiled eggs, salmon, and raisin bran.

The Oxford study’s author, Anna Vogiatzoglou, noted that vitamin B12 deficiencies are “a public health problem, especially among the elderly” and that consumption of the vitamin could help to reduce the risk of brain shrinkage.

“Many factors that affect brain health are thought to be out of our control,” she said, “but this study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory.”

One of the leading reasons the elderly become sick with cold (and pneumonia) is they are often undernourished. And without the proper nutrients, they lack the ability to fight off illness.

Chicken soup provides both preventative nutrition, and relief for symptoms.

Dr. Stephen Rennard of The University of Nebraska Medical Center studied the impact of chicken soup on a body suffering from the common cold.

Rennard looked at the role of white blood cells, in particular the neutrophil, a white blood cell. The cell’s movement was impacted by the body’s consumption of Grandma’s chicken soup. He found that the soup had “a kind of anti-inflammatory activity.”

Rennard’s study was published in 2000 in the International Journal CHEST, the Cardiopulmonary and Critical Care Journal, and has since been cited in more than 1,200 further studies and research.

Rennard and his wife, Barbara, share their recipe via Youtube, though they noted that further research showed the specifics of the recipe didn’t impact the results.

Other Cultures, Other Soups.

Another chicken soup, congee (also called okaku, jook, or juk), has long been recognized for its healing benefits in traditional Chinese, Japanese, and Korean cultures.

Congee, a rice and chicken broth-based porridge, is easy on the digestive track. Recipes for congee often include ginger, which is widely known in Asia for its healing properties.

A printable version of the Rennard’s recipe is available here.