Growing hospice care brings concerns about misuse
United States (KaiserHealth) – As she surveyed patients’ charts, Nancy Romeo, a medical review auditor at a hospice company, was surprised by the resilience of those supposedly near death.
One patient admitted to hospice care in 2002 was still healthy enough in 2007 to stroll around his yard at home, she found. Another patient received hospice care for four years before the company for which Romeo worked, SouthernCare, determined she was not dying. “I looked at charts every day, and almost every chart was inappropriate,” said Romeo, a nurse.
Nancy Romeo looks over files in the office of her lawyer Henry Frohsin on Thursday, Feb. 17, 2011, in Birmingham, AL.
In 2007, she filed a whistleblower lawsuit against SouthernCare claiming that the company had fraudulently enrolled patients in hospice. Eventually, the government obtained a $24.7 million settlement in the case. SouthernCare, based in Birmingham, AL, and one of the nation’s largest for-profit hospice companies, admitted no wrongdoing, and officials declined comment for this article.
Over the 28 years that Medicare has reimbursed providers for hospice services, it has been praised for giving critical medical and emotional support to dying patients and their families. When properly used – that is, at the very end of life – hospice care also has saved the government money. Providing dying patients with palliative care in their own homes, or in a hospice facility or nursing home, is far less expensive than continuing to order up futile medical treatments, studies have shown.
Indeed, advocates say more patients should be receiving hospice services earlier in the course of their illness. The median time spent in hospice care now is just 17 days.
But as hospice has moved into the mainstream – it is now serving 1.1 million Medicare patients a year – concerns about excessive costs and misuse have mounted.
Four in 10 Medicare beneficiaries now use the hospice benefit before they die. Patients agree to forgo treatments aimed at prolonging their lives, but can receive pain-relieving medication to ease the symptoms of a terminal illness, as well as attention from nurses, social workers and others.
Medicare’s bill for hospice care rose to more than $12 billion in 2009 from $2.9 billion in 2000. Although the benefit is intended for patients who have no more than six months to live,’ percent now receive hospice services for longer, according to the Medicare Payment Advisory Commission, or MedPAC, an independent congressional oversight panel. In 2009, 10 percent of patients remained in hospice beyond seven months. Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not.
Financial Incentives
A primary concern of MedPAC is that this payment method encourages hospices to seek out patients likely to live longer. For-profit hospices in particular tend to have longer-staying patients, studies have shown.
“The financial incentives do in fact dictate behavior,” said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. “It’s a lucrative business, at least under the current reimbursement system.”
In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash.
Hospice operators say sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. Presently, most hospices rely on registered nurses to see patients and then relay information back to the office.
“This face-to-face visit is a way to limit the length of people staying on hospice, and it probably will increase the number of people who get discharged,” said Dr. David Casarett, an associate professor of medicine at the University of Pennsylvania and chief medical officer at the university’s Philadelphia-based hospice. “But will we be discharging the right people? I’m not sure.”
But given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment – hospice patients in nursing homes – and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled. The inspector general is now investigating unusual patterns of hospice stays.
Evidence produced in a series of lawsuits, too, suggests that hospices may need more careful oversight.
A regional vice president at Trinity Hospice, a now-defunct chain based in Texas, “strongly encouraged” employees to “find a way” to keep patients as long as possible, according to a 2005 internal report uncovered in a whistleblower lawsuit.
In 2006, the government obtained a $12.9 million settlement from another national chain, Odyssey Healthcare, after a former manager there said she was fired for trying to get the company to discharge patients who did not meet Medicare’s eligibility rules.
Both companies settled the cases out of court and did not admit wrongdoing. Odyssey was subsequently bought by Gentiva Health Services, and a company spokesman had no comment on the settlement.
Dementia’s Unpredictability
One of the main reasons for longer hospice stays is the increasing prevalence of patients with diseases, like dementia, that follow sometimes unpredictable paths. For instance, Alzheimer’s patients are three times more likely than cancer patients to stay in hospice beyond six months, MedPAC data show.
In 2009, Duane Chirhart, a retired airline pilot, questioned the cost of his aunt’s hospice care while she was in a nursing home in Minnesota. For more than two years, the nursing home had been taking care of most of her needs. At the same time, a hospice company billed Medicare $4,252 a month for its services, which included short visits by outside nurses.
“The employees who visited her were really caring people,” he said, “but there only were four or five hours a month when they were actually there.” Chirhart canceled the hospice service. His aunt, who has Alzheimer’s, is now 88 and still alive.
When the humorist Art Buchwald went into a hospice in February 2006, he expected to die within weeks of kidney failure. But his kidneys kept working, and Buchwald made national news when he quit hospice after five months. He died the following year.
To allow for greater flexibility, Congress ended the strict seven-month time limit imposed when the benefit was created. Now hospice care can continue indefinitely so long as the hospice said the patient is still likely to die within six months.
“To some degree, the growth in the number of beneficiaries and the duration of stays is the result of conscious policy changes,” said Jonathan Blum, deputy administrator of the Centers for Medicare & Medicaid Services.
Alexander Horvath, who is 85 and has dementia, is in his eighth month of care provided by the Jewish Social Service Agency Hospice, a nonprofit in Rockville, MD. His wife, Jacqueline, believes that he is receiving excellent, cost-effective care. The hospice has taken steps to prevent bedsores, for instance, by replacing his mattresses with special ones that help keep lesions from developing. “I want him to be as happy and comfortable as long as he possibly can be,” she said.
But the profit motive in hospice has become a greater concern as for-profits hospices have expanded. They now account for half of Medicare certified hospices. A study in the Journal of the American Medical Association published in February found 6.9 percent of patients tended by for-profit hospice providers remained for more than a year, while 2 percent of those in nonprofits did.
“Objectively if patients are in hospice more than a year, it kind of suggests that based on current hospice eligibility criteria they have been enrolled too early in the course of their terminal illness,” said Dr. Melissa Wachterman, the study’s lead author.
J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, based in Alexandria, VA., said longer stays are a good development, because the full benefit of hospice can’t be realized in just the final days of life. He said a hospice’s ownership type does not influence the nature of care provided, and credits hospices for enrolling patients earlier in their declines. “Hospices have gotten better and more sophisticated in marketing their services to patients whose illness are moving from chronic disease into terminal illness,” Schumacher said.
But some fear that hospice companies have become too aggressive. “There are rival companies trying to get people to sign up for who will care for them until they die,” said Lloyd Peeples, an assistant U.S. attorney who led the government’s case against SouthernCare. “I had no idea there were companies fighting over patients, just like telephone companies fighting over whether to sell you an iPhone or a Blackberry.”
jrau@kff.org
– Provided by Kaiser Health News.
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Oxfam warns about rising global food prices as one-sixth of all people go hungry
Washington, D.C., United States (AHN) – Oxfam warns that as global food prices continue to increase the resultant hardship caused to people who were already struggling to obtain adequate amounts of food is increasing demands for a major reform in global food prices.
When world food prices reached a new historic peak in January, it left over a billion people, or one-sixth of the world’s population, hungry and millions of people under threat of starvation, with the situation expected to worsen, Oxfam officials say.
Oxfam is calling on world leaders to act to improve the regulation of food markets. In addition, it is asking for investment in a global climate fund.
World food prices have more than doubled since 1990, but the incomes of the poor have not.
“Poor people in developing countries spend between 50-80% of their income on food, making higher prices, as well as unpredictable prices, a serious threat to their ability to eat – let alone continue spending on other basic needs such as health, or education,” Oxfam officials say in a statement posted on the website.
The key drivers of rising food prices are reduced production caused by bad weather that might be linked to climate change; export restrictions and panic buying mostly caused by weather related problems; increased demand for food and for biofuels, which removes land from food production; financial disruptions, including low interest rates, depreciation of the dollar and speculation in commodity markets; and increased oil prices that increased the costs of fertilizer for crops and transportation to get food to market or stores.
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New study raises doubts about benefits of ezetimibe in patients suffering from high LDL cholesterol
More than 42 million Americans suffer from high cholesterol, and 63 million more have borderline high cholesterol. Over time, high levels of LDL cholesterol, often called “bad cholesterol,” build up along the walls of arteries and blood vessels, a process called atherosclerosis, which can lead to a high risk of heart disease, stroke and heart attack.
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Catherine Zeta-Jones opens up about bipolar illness
Los Angeles, CA, United States (AHN Entertainment) – Catherine Zeta-Jones has opened up about her bipolar disorder. The 41-year-old actress, who was recently admitted to a mental health facility, said going public with her illness is worth it, saying she hopes she has encouraged a person suffering from a similar disorder to seek out help.
The Academy Award-winning actress was diagnosed with bipolar II disorder earlier this month. The mental illness is marked by prolonged periods of depression alternating with episodes of mild mania.
She said in a statement to People magazine, “This is a disorder that affects millions of people and I am one of them. If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it.”
“There is no need to suffer silently and there is no shame in seeking help.”
Zeta-Jones privately struggled with husband Michael Douglas’ battle with throat cancer. And while Douglas, 66, recovered, she didn’t. She realized that she needed help in the face of her mounting depression.
A close friend said, “The simple things would just seem overwhelming, like going out to dinner. There was just a little piece of her chipped away. It was hard to watch because I knew how hard she was trying.”
Zeta-Jones checked into Silver Hill Hospital in Canaan, CT, in early April. She and Douglas are both parents to 10-year-old son Dylan and 8-year-old daughter Carys.
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What Is The Big Deal About Free Range Meats?
You are standing in the meat section of your local grocery store. You have the option of choosing between commercial meat and free range meat. Now, you may be asking yourself, “Why the free range meat when it’s more expensive?” Well the free range meats are richer in antioxidants; including vitamins E, beta-carotene, and vitamin C. Furthermore, they do not contain traces of added hormones, antibiotics or other drugs. You are getting more “good” fats (Omega 3) and less “bad” fats (Omega 6). Free range meats can also be called grass fed. Grass fed beef tends to be much lower in total fat than grain fed products. For example, a sirloin steak from a grass fed steer has about one half to one third the amount of fat as a similar cut from a grain fed steer. In fact, grass fed meat has about the same amount of fat as skinless chicken or wild deer or elk. When meat is this lean, it actually lowers your LDL cholesterol levels. The effects of grass fed beef and the nutritional benefits to the human body range from a lower risk of cancer to better circulation of the cardiovascular system. Free range and grass fed meats can be found in cows, lamb, bison, poultry, and pork.
Aside from the great health benefits, there are also benefits for the animals being used. Free range meat production involves providing open air access to animals instead of confining them to barns. They should be free to roam in open fields along with other animals and should receive natural light. Open pasture access is an important criterion for organic meat production. Grass fed animals live low-stress lives and is so healthy there is no reason to treat them with antibiotics or other drugs. When they are switched from pasture to grain, they can become afflicted with a number of disorders, including a common but painful condition called “subacute acidosis.” Cattle with subacute acidosis kick at their bellies, go off their feed, and eat dirt. Grass fed and pasteurized animals are in a much healthier environment, which in turn makes the meat healthier.
The environment also receives benefits from all this. Many studies show that appropriate grazing by ruminant animals on native pastureland increases the biodiversity of species of grasses. When pastureland is left ungrazed, a single species tends to take over, creating a ‘monoculture’ of that particular grass species. The United States loses about three billion tons of nutrient-rich topsoil each year. Growing corn and soy for animal feed using conventional methods causes a significant amount of this soil loss. Well-managed grazing returns nutrients to the soil as moderate amounts of manure act as natural fertilizers for the soil. When manure is recycled into the landscape through good pasture management, the nutrient balance in waterways is maintained. Ranchers who protect riparian areas see improvement in water flow: creeks begin to run sooner and remain wet longer, and the grass season is extended.
Overall, free range and grass fed meats are better for your health, the animals, and the environment.
About Hypothyroidism – a Common Health Problem
By hypothyroidism, the thyroid gland is producing too less hormones to stimulate the metabolism, or the body is not able to utilize the hormones. The lack of thyroid hormones slows down the metabolism and thus all the activities in the body, giving a combination of many symptoms related to slowness of bodily processes.
Hypothyroidism is common, but the frequency of the condition is not well determined. Some authorities estimate that 0.5% of the total American population have the disease to some degree. The frequency is much greater among people over 50 years of age than among young people.
THE SYMPTOMS AND COMPLICATIONS OF HYPOTHYROIDISM
The most common early symptoms are: Mental and physical fatigue, weakness, weight gain or over-weight, and depression.
One or more of these symptoms also use to appear early: Constipation, sensitivity to coldness, cold hands and feet, thick tongue, decreased sweating, dry hair, thin brittle hair, thin brittle nails, muscle and joint pain, pale or yellowish skin, rashes and itching.
One or more of these symptoms usually appear later: Poor memory, slow thought process, drowsiness, slow speech, thinning of eyebrows, hoarseness, low blood pressure, poor circulation, dry and flaky skin, decreased taste and smell, menstrual irregularities, skin thickening, puffy face, puffy hands and feet, swelling of extremities, overall swelling, muscle spasms, muscle atrophy, joint stiffness.
In children or young persons hypothyroidism may give developmental problems, like disturbed tooth development and short stature.
Hypothyroidism increases the risk of elevated cholesterol levels, heart disease and diabetes (diabetes mellitus). This occurs even by moderately decreased thyroid production.
THE THYROID GLAND AND ITS HORMONES
To understand the hypothyroidism, some knowledge about the thyroid gland and its hormones is essential.
The thyroid gland produces hormones that accelerate and in other wise regulate metabolism. A part of metabolism is the process of breaking down energy containing nutrients, and using the energy to produce molecules that all the processes and activities in the body use as fuel. Another part is the production of molecules that the body use as building materials.
The thyroid makes four hormones: Thyroxin (T4), triiodothyronine (T3), diiodothyronine (T2) and monoiodothyronine (T1). The hormones contain iodine, and the figures tell about the number of iodine atoms in each hormone molecule. T3 is not made directly, but is produced from T4. T3 is a more efficient hormone than T4. Therefore this conversion is important.
The pituitary, a gland under the brain, produces a hormone called thyrotropin or thyroid stimulating hormone (TSH) that enhances the activity of the thyroid gland. If the body has too less thyroid hormone in the blood, the pituitary produces more thyrotropin. This makes the thyroid gland speed up its own production. By a too heavy thyroid hormone concentration, less thyrotropin is produced by the pituitary, and the thyroid gland slows down. This feed-back mechanism regulates the metabolism of the whole body.
THE MECHANISMS AND CAUSES OF HYPOTHYROIDISM
By hypothyroidism the body does not get enough thyroid hormone, or the hormones do not work effectively in the body. This causes the metabolism to slow down. When the metabolism decreases, the processes in the body do not get enough fuel and building materials, and all the body activities will therefore slow down. Energy containing nutrient will also be stored as fat, since they are not broken down.
Serious variants of hypothyroidism are called myxedema. This is a rare condition. However, less serious, but painful variants are common. There are several reasons for hypothyroidism, each giving a variant of the disease:
*An autoimmune reaction against the thyroid tissue can destroy the capability of the thyroid gland to produce hormones (for example Hashimoto’s disease).
*Sometimes the production of T3 by conversion from T4 is impaired. The total amount of hormones may be normal in these cases, but the body is still lacking T3, and gets the symptoms of hypothyroidism.
*Iodine deficiency can cause hypothyroidism, since the thyroid hormones contain iodine. In Europe and America the food is seldom short in iodine, but bad nutrition may result in iodine deficiency.
*Surgery or radiation at the thyroid area can destroy enough tissue to cause hypothyroidism.
*Injury or disease in the pituitary or of the part of the brain controlling the pituitary may cause a decrease in secreted thyrotropin, and then the thyroid will respond by producing less of its own hormones with hypothyroidism as a result.
*Some people have symptoms of hypothyroidism even though the amount of thyroid hormone in the blood is normal. One of the symptoms is raised levels of thyrotropin, indicating that the body signals need for more thyroid hormones. This variant may be caused by conditions elsewhere in the body that make it difficult for the hormone to reach their destination in the cells. In many of these cases the immune system produces anti-bodies against the thyroid hormones. This variant is called sub-clinical hypothyroidism, and responds to the same treatment as ordinary hypothyroidism.
*Some types of food can contribute to a depressed thyroid function or aggravate hypothyroidism when eaten raw in great amounts: Brussel sprouts, broccoli, corn oil, cabbage, cauliflower, kale, kohlrabi, radishes, rutabaga, soy and turnips. By cooking these vegetables, the depressing effect is decreased
*Factors suspected for causing hypothyroidism are: The artificial sweetener aspartame, mercury pollution, dental fillings containing mercury, fluoride and heavy metal pollution.
HOW CAN HYPOTHYROIDISM BE TREATED
For serious hypothyroidism caused by tissue destruction, external supplement of thyroid hormones is necessary.
When the condition is caused by lack of iodine in the diet, dietary changes and iodine supplements will be a part of the treatment.
Less serious, but painful hypothyroidism is sometimes also treated with hormone supplements. In these cases it is difficult to find the right dose, and treatment may result in hormone poisoning.
You can sometimes alleviate hypothyroidism by reducing the amount of food suspected for depressing the thyroid function: Brussel sprouts, broccoli, corn oil, cabbage, cauliflower, kale, kohlrabi, radishes, rutabaga, soy, soy products and turnips. However, these food types are valuable in many ways, so it is probably not wise to cut them out totally. Also try to avoid artificial ingredients like the sweetener aspartame, conserving additives and fluoride.
Changing out mercury dental fillings and avoiding mercury or heavy metal exposure may help to ameliorate the condition.
You may also alleviate the condition by eating food that stimulates the thyroid function according to practical experience: Chia seed, dulse, fish from the ocean, flax seed, pumpkin seed, seaweed, coconut and brewer yeast.
You can find nutritional supplements to help for hypothyroidism. The compositions of these products vary:
*They may contain building materials that the thyroid uses to make its hormones, for example: iodine, acetyl-L-tyrosine or L-phenylalanine.
*They may also contain vitamins and minerals that stimulate the mechanism of hormone production by being a part of necessary enzymes, or by helping the absorption of the ingredients that hormones are made from, like: Magnesium, zinc, selenium, copper and vitamin E.
*They may furthermore contain constituents that stimulate tissue regeneration by being part of tissue building enzymes, and thus helping to restore a degraded thyroid, for example: Folic acid or folate, vitamin B2 (riboflavin), B3 (niacin), B5 (pantothenic acid or pantothenate), B6 (pyridoxine), B12 (cyanocobalamin) and molybdenum.
About Author Knut Holt is an internet consultant and marketer focusing on health items. To find more advices and natural products to help against hypothyroidism and other health problems please visit:
Some Facts About Whey Protein Isolate
Whey protein is one of the best sources of protein. Because it is divided up between whey isolate and concentrate, it is crucial that you decide on the right powder. Whey Protein Isolate is the healthiest, most pure form of whey protein. It has a high biological value for quicker absorption and it doesn’t have a lot of filler items in it like concentrate does. It is best to get the protein that is low in carbs, fat and cholesterol. While some amounts of fat and cholesterol are good, it’s not good if it’s combined with other sources of fat like milk. This only compounds the problem.
Protein does a number of things for your body like boosting the immune system, helping with fat loss and muscle gain, and repairing of the body cells. In these ways it is really helpful. There are high amounts of protein in sources like eggs, chicken and beef, but it’s important to note that they also have high amounts of fat and cholesterol. Even if you trimmed the fat on the beef and chicken, there are still amounts of fat that concealed within the flesh. We can’t escape that fact, but isolate is a pure source.
You can conveniently make it into a shake or make a delicious drink out of it. No matter what it is, you’ll quickly feel the benefits of protein in your body. Whether you use it as a meal replacement (which happens more often than people think) or take it in the middle of the day, it is the perfect protein supplement for us.
People’s Pharmacy: Clearing up confusion about vitamin D intake
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Comedian Jon Lovitz Serious About Joking On Skin Condition
Horsham, PA, United States (AHN) – Comedian and actor Jon Lovitz has revealed he suffers from psoriasis and for the first time is talking candidly about living with the disease. He’s part of a national disease awareness campaign titled “Are You Serious.”
Psoriasis is a chronic autoimmune condition that causes red, scaly plaques on the skin and affects nearly 7.5 million Americans. Lovitz said he struggled with severe plaque psoriasis for 10 years before getting its symptoms under control.
“A large portion of my body was covered in psoriasis – I had plaques on my arms, back, stomach and scalp. It was embarrassing, painful and emotionally difficult to deal with until, finally, I got serious about my psoriasis and worked with a dermatologist to find an effective treatment,” remembers Lovitz. “I decided to use my comedy to raise awareness about psoriasis, without making fun of having the disease. I hope that through hearing my story, people with psoriasis will feel inspired to talk with a dermatologist and get their symptoms under control.”
“Are You Serious” was launched by Centocor Ortho Biotech Inc. and the National Psoriasis Foundation (NPF) and uses Lovitz’s personal experiences and signature humor in an effort to educate the condition.
“Our findings about the impact of psoriasis, along with the stories we hear from people coping with the disease, underscore the importance of working with a dermatologist to find a treatment that effectively manages your disease symptoms,” said Randy Beranek, president and CEO of the National Psoriasis Foundation. “The NPF is grateful to Jon for taking a different approach to share his story, using humor as a means to motivate patients and educate the public about a disease that’s often misunderstood.”
Medical professionals estimate that approximately 7.5 million Americans and nearly 3 percent of the world’s population are living with psoriasis and nearly one-quarter of those people have cases that are considered moderate to severe.
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Progresso® Soup Cooks Up “Soup Worth Talking About” for Coming Soup Season
MINNEAPOLIS–(BUSINESS WIRE)–Consumers will find a lot to talk about in the soup aisle this fall as Progresso launches a line of ethnic-inspired soups, adds cholesterol-lowering benefits to some soups and introduces two “firsts”, including the first cream-based Light soup in the ready-to-serve category, and Progresso’s first chili soup as part of its High Fiber lineup. “We have worked hard to develop exciting new flavors and health enhancements to many of our soups to deliver the taste, quality
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