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February 22, 2013 Mystery disease kills dozens in Venezuela CARACAS, Venezuela — A mystery disease has killed dozens of Warao Indians in recent months in a remote area of northeastern Venezuela, according to indigenous leaders and researchers from the University of California at Berkeley, who informed health officials here of the outbreak on Wednesday. At least 38 people have died, including 16 since the start of June, said Charles Briggs, an anthropologist at Berkeley, and Dr. Clara Mantini-Briggs, a medical researcher there. They are a husband-and-wife team known for their research on a cholera outbreak that killed 500 people in Venezuela in the early 1990s. Preliminary studies of the latest outbreak indicate that it may be a type of infectious rabies transmitted by bites from bats, the researchers said. The symptoms, which last three to six weeks, include partial paralysis, convulsions and an extreme fear of water, they said, and those who die become rigid just before death. The disease is believed to be fatal in most cases. The disease is found in the swampy Delta Amacuro, near the border with Guyana. The state is inhabited largely by Warao Indians, a nomadic indigenous group said to number more than 20,000. Recently, many animals in the area have died, the researchers said, but no correlation has been established between those deaths and the disease. The group was allowed to meet with the government epidemiologists on Wednesday evening, and members said officials promised them that the disease would be investigated as soon as possible. (NY Times) http://www.nytimes.com/2008/08/07/world/americas/07venez.html?_r=1&ref=health&oref=slogin One-third of uninsured are chronically ill One out of every three working-age, uninsured Americans suffers from a chronic illness and isn't getting the medical care they need, a new report shows. Although the study didn't specifically look at the health consequences of lack of insurance and lack of access to medical care, it's reasonable to assume that these factors would lead to various medical complications, said the authors of a study published in the Aug. 5 issue of the Annals of Internal Medicine. Information on the number of Americans without health insurance (about 47 million in 2006, up from 31 million in 1987) is plentiful. Less clear has been how many of these individuals suffer from chronic medical conditions, although some, including policymakers, have suggested that many are healthy. Using data from interviews with almost 12,500 people aged 18 to 64 who had participated in the National Health and Nutritional Examination Survey (NHANES), the authors conclude that an estimated 11.4 million working-age Americans with at least one of seven chronic medical conditions do not have health insurance. This included 16.1 percent of the 7.8 million people with cardiovascular disease, 15.5 percent of the 38.2 million people with hypertension and 16.6 percent of the 8.5 million people with diabetes. Other conditions examined were asthma, high cholesterol, chronic obstructive pulmonary disease or a previous diagnosis of cancer. About 26 percent of uninsured people reported no standard site of care, versus only 6.2 percent of those who had insurance. More than 22 percent of uninsured individuals reported no visits to a health professional in the past year compared to 6.2 percent of insured people, and 7.1 percent of uninsured people with a chronic condition reported that the emergency room was their standard site of medical care, versus 1.1 percent of those carrying insurance. The new findings corroborate those from a study published July 22 in Health Affairs, which concluded that access to care among uninsured, nonelderly U.S. adults with chronic conditions actually got worse between 1997 and 2006. (HealthDay News) http://health.usnews.com/articles/health/healthday/2008/08/04/one-third-of-uninsured-are-chronically-ill.html New survey: 82 percent of Americans think healthcare system needs major overhaul Americans are dissatisfied with the U.S. healthcare system and 82 percent think it should be fundamentally changed or completely rebuilt, according to a new survey released by The Commonwealth Fund. The Commonwealth Fund Commission on A High Performance Health System released a report outlining what an ideally organized U.S. healthcare system would look like, and detailing strategies that could create that organized, efficient healthcare system while simultaneously improving care and cutting costs. The survey of more than 1,000 adults was conducted by Harris Interactive in May 2008; and the vast majority of those surveyed, nine out of ten, felt it was important that the two leading presidential candidates propose reform plans that would improve healthcare quality, ensure that all Americans can afford healthcare and insurance, and decrease the number of uninsured. One in three adults report their doctors ordered a test that had already been done or recommended unnecessary treatment or care in the past two years. Adults across all income groups reported experiencing inefficient care. And, eight in ten adults across income groups supported efforts to improve the health system's performance with respect to access, quality and cost. The survey, Public Views on U.S. Health Care System Organization: A Call for New Directions, found that, in addition to respondents' overall dissatisfaction with the healthcare system, people are frustrated with the way they currently get healthcare. In fact, 47 percent of patients experienced poorly coordinated medical care in the past two years, meaning that they were not informed about medical test results or had to call repeatedly to get them, important medical information wasn't shared between doctors and nurses, or communication between primary care doctors and specialists was poor. Respondents pointed out the need for a more cohesive care system. Nine of 10 surveyed believe that it is very important or important to have one place or doctor responsible for their primary care and for coordinating all of their care. Similarly, there was substantial public support for wider adoption of health information technology, like computerized medical records and sharing information electronically with other doctors as a means of improving patient care. Nine of 10 adults wanted easy access to their own medical records, and thought it was important that all their doctors have such access as well. Those surveyed also reported problems with access to healthcare, nearly three out of four (73%) had a difficult time getting timely doctors' appointments, phone advice, or after-hours care without having to go to the emergency room. Although the uninsured were the most likely to report problems getting timely care without going to the emergency room, 26 percent of adults with health insurance also said it was difficult to get same- or next- day appointments when they were sick. And 39 percent of insured adults said it was hard to get through to their doctors on the phone when they needed them. The Commission report, outlines strategies that could help lead to a better healthcare system with higher quality and better efficiency such as the recommendation to move away from traditional fee-for-service payments to a system in which providers and hospitals are paid for high quality, patient-centered, coordinated health care, and that providers should be required to implement and use electronic health records within five years. Report authors analyzed healthcare systems around the country that are successfully employing these strategies and examined how positive gains could be achieved for the entire U.S. healthcare system. The report concludes that in order for the U.S. health care system to truly be higher-performing, reorganization will be needed at the practice, community, state and national levels. http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=698139 Alcohol consumption declining, according to results of new study Overall alcohol use, particularly consumption of beer, is declining in the US, according to a new study published in the August 2008 issue of The American Journal of Medicine. Researchers examined 50 years of data and found several changes in alcohol intake but no change in alcohol use disorders. Americans are drinking significantly less beer and more wine, while hard liquor use has remained fairly constant. More people now report that they are non-drinkers. People born later in the 20th century drink more moderately than older people. As we age, our individual alcohol consumption goes down. Researchers examined 8,000 records of the Framingham Heart Study, the longest population-based study of American adults ever conducted, to measure alcohol consumption over 50 years. Because the Framingham study recruited subjects that were born before 1900 until 1959, it gives insights into behavior and medical histories through most of the 20th Century. Subjects, both from the original cohort and from the children of the original cohort, have been interviewed every 4 years, from 1948 until 2003. Since each individual was followed directly, a set of histories of lifetime alcohol use could be captured. While heavy alcohol use is associated with numerous bad outcomes, moderate consumption has been linked to improved cardiovascular health and to improved morbidity and mortality in the elderly. This study shows that, on the whole, the American population is moving in a healthier direction. Despite more favorable patterns of drinking, risk of alcohol dependence did not show a decrease. The proportion of people who developed alcohol-related disorders, such as alcoholic cardiomyopathy or alcoholic cirrhosis remained nearly constant across all age groups. Writing in the article, Yuqing Zhang, DSc, Boston University School of Medicine, and his co-investigators state, “The findings in this study may be considered encouraging in many ways: the average amount of alcohol has decreased in more recently born cohorts, the percentage of the population exhibiting 'moderate' alcohol intake has been increasing steadily, and the percentage reporting 'heavy' drinking has decreased over time.” Anaheim General Hospital hit with dozens of citations over staffing, care An Anaheim, CA, hospital that treats a large share of poor patients in the region has been slapped with dozens of citations by two independent sets of regulators for inadequate staffing and poor medical care. The findings have placed the hospital's public and private funding at risk. Although the hospital is not expected to close down and is currently appealing the decisions, it must correct the extensive problems that regulators found to ensure that it remains open. The unusually harsh rebukes preceded by several months a lawsuit filed Wednesday against the owner of Anaheim General Hospital, Tustin-based Pacific Health Corp. Los Angeles City Atty. Rocky Delgadillo filed the suit contending that the company and two of its hospitals were part of a "scheme to defraud the Medi-Cal and Medicare programs out of millions of dollars." The findings by regulators and the lawsuit come as the company also wages a fight to buy Anaheim Memorial Medical Center, a larger hospital six miles across town. California Atty. Gen. Jerry Brown, who has to approve the sale, is expected to announce a decision this month. Pacific Health issued a statement Wednesday saying it has been cooperating with authorities and it believes that it will be cleared of any illegal actions. President Jim Young, asked previously about the Anaheim General findings by regulators, said the hospital had corrected all the issues that regulators had cited. The hospital's "current state is excellent," he said. According to one report by the federal Centers for Medicare and Medicaid Services, Anaheim General put patients "at immediate jeopardy" by not having life-saving medications available, having insufficient food and water for patients in the event of an emergency and failing to ensure the safety of its psychiatric patients. The hospital said it corrected those problems as soon as they were discovered. The report also found that the hospital kept too low a number of nurses on staff and failed to maintain adequate levels of doctors available on site at all times. Both reports came after regulators made surprise visits in February and March. The Medicare report singled out two patient deaths early this year that the agency said might have been linked to inadequate patient care. In addition, it highlighted a third death that occurred after a patient in renal failure did not receive adequate dialysis treatment for more than 16 hours. The report said the death occurred after an unresolved mechanical breakdown, which the hospital said was the fault of a subcontractor. Regulators did not conclude that the hospital was responsible in the case. In a second report, the Joint Commission found 47 safety deficiencies at the hospital, an unusually high number for such surveys, say local hospital experts. Hospitals must have fewer than 18 deficiencies to keep their full accreditation, according to the group's guidelines. Among the safety issues Joint Commission surveyors found: inadequate procedures for preventing the development of healthcare-associated infections within the hospital, poorly inspected medical equipment, fire safety violations and improperly stored medications. Young said the hospital held an in-person meeting in Chicago with the Joint Commission last month to appeal its accreditation status and is awaiting a decision. If a hospital loses its Joint Commission accreditation, which happens only a few times each year across the country, a hospital "could lose its ability to treat commercially insured patients," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. The chain also owns Buena Park Medical Center, Bellflower Medical Center and two others, Los Angeles Metropolitan Medical Center and Tustin Hospital and Medical Center, swarmed by agents Wednesday in connection with the legal action filed. The suit said the hospitals used unfair practices to fill empty beds by paying people on skid row to stay in the hospitals. (LA Times) http://www.latimes.com/features/health/la-fi-anaheim7-2008aug07,0,2278911.story 3 Southern California hospitals accused of fraud On a Sunday afternoon two years ago, five homeless people being dropped off on Los Angeles' skid row by an ambulance caught the attention of police officers. The officers videotaped what they thought was a case of hospitals dumping patients in a section of the city where few would notice or care. But as investigators began to unravel the incident, they say they found something far different: a massive scheme to defraud taxpayer-funded healthcare programs of millions of dollars by recruiting homeless patients for unnecessary medical services. The elaborate enterprise churned thousands of indigents through hospitals over the last four years and billed Medicare and Medi-Cal for costly and unjustified medical procedures, federal, state and local investigators said Wednesday. Those involved in the alleged conspiracy “ranged from street-level operatives to the chief executive of a hospital,” U.S. Atty. Thomas P. O'Brien said. After raids on three hospitals in Los Angeles and Orange counties Wednesday, one hospital chief executive faces criminal charges and executives at two other facilities were accused of fraudulent business practices in a related civil lawsuit filed by Los Angeles City Atty. Rocky Delgadillo. Some of the homeless patients involved received tests or treatments that were potentially harmful, authorities said. The “depravity” of the alleged scheme startled authorities, said Salvador Hernandez, assistant director in charge of the FBI's Los Angeles office. Arrested on federal charges were Dr. Rudra Sabaratnam, an owner and chief executive of City of Angels Medical Center, and Estill Mitts, an alleged patient recruiter who operated a storefront facility called the Assessment Center in the heart of skid row. A 21-count grand jury indictment accuses the pair of healthcare fraud and receiving illegal kickbacks. In addition to City of Angels, agents earlier Wednesday swarmed Los Angeles Metropolitan Medical Center and Tustin Hospital and Medical Center in Orange County. Pacific Health Corp., which owns both hospitals, said in a statement that it had cooperated with authorities and believed it would be cleared of any illegal conduct. Officials said the investigation was continuing and additional defendants were expected to be charged. The total amount of the fraud was still being tallied, but prosecutors said Mitts' operation could have cost the government $11 million in improper payments and that City of Angels collected $5 million in federal healthcare reimbursements. Delgadillo sued the three hospitals, their operators and several others. The hospitals used unfair business practices to fill empty beds in a bid to boost their finances, the suit claims. The privately owned medical centers allegedly worked with patient recruiting operations on skid row that plucked homeless people from the streets and delivered them, with fake medical diagnoses, to the hospitals. According to court filings, “runners” or “stringers” on skid row looked for homeless recruits. Prospects were offered small sums of money, typically $20 or $30, to be paid upon completion of a hospital stay of one to three days. The street recruiter typically received $40 for each homeless recruit with Medicare eligibility and $20 for each recruit with Medi-Cal benefits, according to the city attorney's lawsuit. Some solicitations were direct, but others were coded, according to the city attorney's lawsuit. One alleged street pitch referred to the color scheme of the Medi-Cal eligibility card: “Red, white and blue, just make it do what it do, for me and you.” A person familiar with the workings of the alleged scheme told The Times last year that employees at the Assessment Center would recruit people on skid row to reach out to potential patients, who may or may not have needed medical treatment. The source, who spoke on the condition that he not be named, said some patients were reimbursed for their time with money, food or a pack of cigarettes, what was called an “incentive.” Delgadillo said patients received treatment for conditions including dehydration, a yeast infection and a cardiopulmonary disorder that “didn't exist.” One patient, referred to in the city attorney's lawsuit as "Recruit X," suffered from a mental disorder and was sent by the Assessment Center to all three of the medical centers. At one of the hospitals, the lawsuit says, the patient was given a nitroglycerin patch for a nonexistent cardiopulmonary condition, causing a precipitous drop in her blood pressure. The treatment, said Delgadillo “put her in peril.” Wednesday's crackdown sends a message that “those who would seek to defraud our healthcare system, and those who would callously exploit mentally impaired and drug-addicted homeless men and women to turn a profit will be prosecuted to the fullest extent of the law,” Delgadillo said. In addition to Mitts and Sabaratnam, the city attorney's civil lawsuit names Pacific Health Corp.; Los Angeles Doctors Hospital Corp., which operates Los Angeles Metropolitan Medical Center, corporation Chief Executive John Fenton and admitting physician Frederick Rundall; and Tustin Hospital and Medical Center, Chief Executive Daniel Davis, Chief Financial Officer Vincent Rubio and admitting physicians Kenneth Thaler and Al-Reza Tajik. Also named are Intercare Health Systems Inc., which owns and operates City of Angels Medical Center, and Robert Borseau, who, like Sabaratnam, was an owner/officer. The Tustin hospital was allegedly guaranteed 40 to 50 patients a month; City of Angels got 25 to 30. Metropolitan Medical Center received patients whenever beds were available, according to the suit. City attorneys allege that the admitting Drs. Rundall, Thaler and Tajik did not see the patients until shortly before their discharge. City attorneys allege that for patient referrals, Mitts' group was paid $20,000 per month each from Metropolitan Medical Center and Tustin, while City of Angels paid between $400 to $1,000 a week to the recruiting group. The suit also alleges that Rubio, the Tustin hospital's chief financial officer, personally received a $3,500-a-month kickback from Mitts' group to ensure that Tustin continued to take homeless patients from the skid row center. (LA Times) http://www.latimes.com/features/health/la-me- skidrow7-2008aug07,0,5921372.story Meeting on mastering the CMS regulations The Association for Professionals in Infection Control and Epidemiology (APIC) with support from Premier, is offering a unique program to address the clinical and financial impact of the new CMS policies for reduced Medicare reimbursement related to hospital-acquired conditions. The program, Mastering the new CMS regulation: Implications for infection prevention and control, will be held September 22-23, 2008, in Arlington VA. Thomas Valuck, MD, JD, Medical Officer and Senior Advisor, Center for Medicare Management, is the keynote presenter for the two-day conference and will be joined by other national experts and thought leaders. Program details, registration, and lodging information are available at www.apic.org. Americans made over 1 billion hospital and doctor visits in 2006 Patients in the United States made an estimated 1.1 billion visits to physician offices and hospital outpatient and emergency departments in 2006, an average of four visits per person per year, according to new healthcare statistics released today by the Centers for Disease Control and Prevention. The data come from various components of CDC’s National Center for Health Statistics National Health Care Survey and are featured in a series of new National Health Statistics Reports. Some of the findings include: The number of visits to physician offices and hospital outpatient and emergency departments increased by 26 percent from 1996 to 2006, faster than the growth of the U.S. population, which rose by 11 percent. The rise in visits can be linked to both the aging of the population, as older people have higher visit rates than younger people in general. In 2006, seven out of 10 visits had at least one medication provided, prescribed, or continued, for a total of 2.6 billion medications overall. Analgesics (pain relievers) were the most common, accounting for 13.6 percent of all drugs prescribed, and were most often used during primary care and emergency department visits. The emergency department served as the route of admission to hospital inpatient services for roughly 50 percent of non-obstetric hospital patients in 2006, up from 36 percent in 1996. Patients with Medicaid use the emergency department more frequently than patients with private insurance, 82 per 100 persons for Medicaid vs. 21 per 100 for private insurance. Most emergency department visits occurred after business hours (defined as 8 a.m. to 5 p.m. on weekdays), when 63 percent of adults and 73 percent of children younger than age 15 arrived. The overall average waiting time to see a physician in the Emergency Department was nearly 56 minutes. Over the past 36 years, the percent of hospital inpatients who were 65 years of age and older grew from 20 percent in 1970 to 38 percent in 2006. Over the same time period, the percent of inpatients who were 75 years of age and older grew from 9 percent to over 24 percent. The rate of knee replacement for those aged 65 years old and over increased 46 percent between 2000 and 2006, and the rate doubled among those aged 45-64 years during the same time period. The rate of coronary atherosclerosis (clogged heart arteries) more than doubled during the 1990s but since 2002 declined for all age groups, particularly for those 65 years and over. Between 1996 and 2006, the percentage of visits to hospital outpatient departments made by adults 18 years and over with chronic diabetes increased by 43 percent and visits with chronic high blood pressure increased by 51 percent. The new series of healthcare reports can be accessed at www.cdc.gov/nchs.
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