Happy 2017

Happy New Year...welcome 2017

Wishing peace and God's blessings to all my family and friends. Especially to my sister and brother-in-law. May 2017 bring them closer to good health so they can resume and enjoy their lives. Hoping in the new year relationships can be re-kindled, holding current ones close to my heart, and looking forward to creating new ones with friends I haven't met yet. Happy New Year!

Mommy & Emma

Daddy & Emma.
Emma sitting in Aunt Laura's Cabbage Patch doll cradle.
The cradle has to be close to 30 years old.

Gram loves Emma

Uncle Alfie & Emma

Emma & cousin Shawn

Emma & her grandpa

Latest Hospital Injury Penalties Include Crackdown On Antibiotic Resistant Germs

Reprinted from KHN / Kaiser Health News

By Jordan Rau December 21, 2016

http://www.khn.org/

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria impervious to drugs.

Based on rates of all these complications, the hospitals identified by federal officials this week will lose 1 percent of all Medicare payments for a year — with that time frame beginning this past October.  While the government did not release the dollar amount of the penalties, they will exceed a million dollars for many larger hospitals. In total, hospitals will lose about $430 million, 18 percent more than they lost last year, according to an estimate from the Association of American Medical Colleges.

The reductions apply not only to patient stays but also will reduce the amount of money hospitals get to teach medical residents and care for low-income people.

Forty percent of the hospitals penalized this year escaped punishment in the first two years of the program, a Kaiser Health News analysis shows. Those 306 hospitals include the University of Miami Hospital in Florida, Cambridge Health Alliance in Massachusetts, the University of Michigan Health System in Ann Arbor and Mount Sinai Hospital in New York City.

Nationally, hospital-acquired conditions declined by 21 percent between 2010 and 2015, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The biggest reductions were for bad reactions to medicines, catheter infections and post-surgical blood clots.

Still, hospital harm remains a threat. AHRQ estimates there were 3.8 million hospital injuries last year, which translates to 115 injuries during every 1,000 patient hospital stays during that period.

Each year, at least 2 million people become infected with bacteria that are resistant to antibiotics, including nearly a quarter million cases in hospitals. The Centers for Disease Control and Prevention estimates 23,000 people die from them.

Infection experts fear that soon patients may face new strains of germs that are resistant to all existing antibiotics. Between 20 and 50 percent of all antibiotics prescribed in hospitals are either not needed or inappropriate, studies have found. Their proliferation — inside the hospital, in doctor’s prescriptions and in farm animals sold for food — have hastened new strains of bacteria that are resistant to many drugs.

One resistant bacteria that Medicare included into its formula for determining financial penalties for hospitals is methicillin-resistant Staphylococcus aureus, or MRSA, which can cause pneumonia and bloodstream and skin infections. MRSA is prevalent outside of hospitals and sometimes people with it show no signs of disease. But these people can bring the germ into a hospital, where it can be spread by health care providers and be especially dangerous for older or sick patients whose immune system cannot fight the infection.

Hospitals have had some success in reducing MRSA infections, which dropped by 13 percent between 2011 and 2014, according to the CDC. AHRQ estimates there were 6,300 cases in hospitals last year.

The second bacteria measured for the penalties is Clostridium difficile, known as C. diff, a germ that can multiply in the gut and colon when patients take some antibiotics to kill off other germs. It can also spread through contaminated surfaces or hands.

While it can be treated by antibiotics, C. diff can also become so serious that some patients need to have part of their intestines surgically removed. C. diff can cause diarrhea and can be deadly for the elderly and other vulnerable patients.

C. diff has challenged infection control efforts. While hospital infections dropped 8 percent from 2008 to 2014, there was a “significant increase” in C. diff that final year, the CDC says. AHRQ estimated there were 100,000 hospital cases last year.

“The reality is we don’t know how to prevent all these infections,” said Dr. Louise Dembry, a professor at the Yale School of Medicine and president of the Society for Healthcare Epidemiology of America.

The Hospital-Acquired Condition Reduction Program also factors in rates of infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubs. Those infections carry the most weight in determining penalties, but the formula also takes into account the frequency of bed sores, hip fractures, blood clots and four other complications.

Specialized hospitals, such as those that treat psychiatric patients, veterans and children, are exempted from the penalties, as are hospitals with the “critical access” designation for being the only provider in an area. Of the remaining hospitals, the Affordable Care Act requires that Medicare penalize the 25 percent that perform the worst on these measures, even if they have reduced infection rates from previous years.

That inflexible quota is one objection the hospital industry has with the penalties. In addition, many hospitals complain that they are penalized because of their vigilance in detecting infections, even ones that do not cause any symptoms in patients. Academic medical centers in particular have been frequently punished.

“The HAC penalty payment program is regarded as rather arbitrary, so other than people getting upset when they incur a penalty, it is not in and of itself changing behavior,” said Nancy Foster, vice president for quality and patient safety at the American Hospital Association.

Federal records show that 347 hospitals penalized last year will not have payments reduced because their performance was better than others. Those include Harbor-UCLA Medical Center in Los Angeles, the Johns Hopkins Hospital in Baltimore and the University of Tennessee Medical Center in Knoxville.

Over the lifetime of the penalty program, 241 hospitals have been punished in all three years, including the Cleveland Clinic; Intermountain Medical Center in Murray, Utah; Ronald Reagan UCLA Medical Center in Los Angeles; Grady Memorial Hospital in Atlanta; Northwestern Memorial Hospital in Chicago; and Brigham & Women’s Hospital in Boston.

The penalties come as the Centers for Medicare & Medicaid Services also launches new requirements for hospitals to ensure that the use of antibiotics is limited to cases where they are necessary and be circumspect in determining which of the drugs are most likely to work for a given infection. Hospitals will have to establish these antibiotic stewardship programs as a condition of receiving Medicare funding under a regulation the government drafted last summer.

Lisa McGiffert, who directs Consumers Union’s Safe Patient Project, said that as a result of Medicare’s penalties and other efforts, “more hospitals are thinking more about appropriate use of antibiotics.” However, she said, “I think most hospitals do not have effective antibiotic stewardship programs yet.”

I has been 3 years...

since Danielle rescued Zoey and brought her to us to foster. Fred still believes we are fostering her and no one has come to adopt her. I guess we should let him in on the truth--Zoey found her fur-ever home 3 years ago.  (Although, sometimes it feels like 30 years!) She has come a long way in the time she has been with us. 

Arrival Dec 10, 2013

2013

2013

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2015

2015

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2016

Congress Passes Bill with Billions for Cancer Research

But some consumer groups say new standards for drug approvals could put patients at risk

Consumer Reports / Teresa Carr / December 7, 2016

Congress has passed the most expensive and far-reaching health reform bill since the Affordable Care Act in 2010.

The 21st Century Cures Act, which garnered widespread, bipartisan support in both the House and Senate, is expected to be signed into law by President Obama soon.

The bill signifies an investment of billions of dollars over the next decade to fight cancer, prevent and treat brain disorders, and harness enormous amounts of data to develop individualized treatments based on person’s environment, genes, and lifestyle.

But the bill also lowers the bar for the kind of scientific evidence companies must provide to gain the Food and Drug Administration’s (FDA) approval for their products. It would mean, for instance, that in some circumstances the FDA could rely in part on individual patient experiences with a drug or device, instead of evidence from large-scale, randomized controlled clinical trials.

Rep. Fred Upton, the Republican from Michigan who chairs the House Energy and Commerce Committee and co-sponsored the bill, says the Cures Act "expedites the approval of drugs and devices and includes literally billions of dollars in additional spending for health research so that we can find a cure and the answers to what patients are demanding today.”

Consumer groups, including Consumers Union, the policy and moblization arm of Consumer Reports, have deep concerns that this effort to speed medical innovation comes with a potentially harmful tradeoff for consumers.

“The unfortunate consequence of 21st Century Cures is that less thoroughly tested medications and medical devices will reach the market,” says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. “And that means that consumers will have less assurance that a new treatment will help and not harm them.”

More Research Dollars

The bill directs $4.8 billion over the next decade to research, in part, to fight cancer.

“Considering that one in two men and one in three women will be diagnosed with cancer in their lifetime, cancer research funding is an investment in yours, mine, and everyone’s health,” says David Pugach, vice president of federal relations at the American Cancer Society Cancer Action Network, the advocacy arm of the ACS.

Pugach says 21st Century Cures represents a “historic opportunity” to accelerate cancer research. “This includes devoting more resources to improve and use new treatments like immunotherapy,” he says, “where the body’s own defenses are used against cancer—as well as creating ways for researchers to more easily share data so they can see patterns across studies more quickly.”

The bill also allocates funds to treat brain disorders, combat opioid abuse, improve suicide prevention programs, and provide mental health care to children. It establishes a task force for research on women who are pregnant or breastfeeding because these women are typically excluded from medical studies.

Faster Drug Approvals, But Lower Standards

The Cures Act loosens requirements for how drugs are studied and approved that have been in place since 1962.

Here's how it usually works: A company submits evidence from studies done under controlled conditions, comparing patients who received the treatment with those who didn't. The studies typically have to show that people who were given the new drug lived longer or felt better than those who didn't get it.

This kind of research can be expensive and time-consuming for drug companies to collect, says Diana Zuckerman, Ph.D., president of the National Center for Health Research, a nonprofit think tank focused on health research. Cancer drugs, for example, can take several years to show that a drug improves survival.

The Cures Act calls on the FDA to approve some drugs more quickly, based on less thorough testing. The problem with this, says Zuckerman, is that “getting drugs to market faster doesn’t help consumers at all if they turn out not to work or causes them harm.”

What Consumers Should Know

Once the Cures Act takes effect, consumers must be especially careful when considering a new medication or medical device, says Orly Avitzur, M.D., Consumer Reports’ medical director.

"When you have a choice, you may want to consider treatments with a proven track record, as you'll have more assurance that they work and are safe," Avitzur says. "Always make sure someone has taken the time to thoroughly explain all the options to you, and the possible risks and benefits of each."

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).