JustCare

Tag: Infections

  • Is Medicare’s Hospital at Home program here to stay?

    Is Medicare’s Hospital at Home program here to stay?

    Since the Covid-19 pandemic, Medicare has been paying hospitals to treat patients at home, instead of in hospital, under its Hospital at Home program. Medicare pays hospitals the same rate for the care of these patients as it pays for hospital patients, including a facility fee. But, is the Hospital at Home program delivering benefits to patients?

    Under the Hospital at Home program or H@H, patients with 60 acute conditions, such as pneumonia, urinary tract infections or congestive heart failure can sometimes opt to get their hospital care at home, reports Richard Eisenberg for Fortune. The goal of H@H is to provide a more comfortable and safer care environment to patients. Patients are prone to fall in the hospital as well as to experience delirium.

    H@H has been around a long time both in and outside the United States, but it is only recently that Medicare has adopted it. Hospitals appear to value the hospital at home program for people with Medicare. After all, they are generating the same revenue through the program that they would receive if patients were in hospital, without the facility costs.

    But, unless Congress acts, the program will end in December of this year. The American Hospital Association is arguing for a five-year extension of the program. It offers little data to demonstrate the value of the program.

    Congress is likely to extend Medicare’s Hospital at Home program another five years even though there’s no good data to show better patient outcomes from the program and it is not saving the Medicare program any money, reports Jessie Hellmann for Roll Call.

    The Medicare Payment Advisory Commission reports that the program is not structured to deliver meaningful information on health outcomes and costs or to allow comparisons between patients treated at home and patients treated in a hospital facility. It wonders whether patients in the program are falling less frequently than patients in the hospital and whether they are experiencing fewer infections.

    How does the Hospital at Home program work? Hospitalized patients at participating hospitals can decide whether they want H@H. Generally, they are in need of four or five more days of hospital care. Participating hospitals are required to send clinicians to your home twice every day. A physician must “see” the patient each day as well, though the physician can do so remotely. Patients must be able to reach the hospital 24 hours a day. And hospitals must be able to respond to patient emergencies within 30 minutes,

    Among other things, H@H can provide IV antibiotics and infusions to patients at home. They can receive EKGs and X-rays. The hospital can monitor their blood pressure. And, they can get oxygen therapy.

    The program is still relatively small. Since its inception, just 328 hospitals in 37 states have participated, and 23,000 patients have been discharged from hospital into the program.

    National Nurses United does not support the H@H program. It calls it “Home All Alone.” Indeed, people can be sent home for their hospital care without a caregiver to be with them. That leaves them without the round-the- clock nursing care they receive in the hospital. And, what if the remote monitoring technology misfunctions or there’s an emergency and the patient can’t get the prompt attention that’s needed?

    Here’s more from Just Care:

  • Medicare seeks to stop disclosing hospital safety information

    Medicare seeks to stop disclosing hospital safety information

    It’s bad enough that hospitals can be dangerous places, yet most people check in to a hospital without knowing whether the hospital is safe for patients. For years now, Medicare has published some data on hospital safety and rated hospitals from one to five stars based on those ratings. Rachel Cohrs reports for Stat News that Medicare might stop doing so, although that information can help people avoid being admitted to an unsafe hospital.

    Hospital-acquired infections can literally kill patients, and each year thousands of people die from them. One in four people with Medicare are harmed in the hospital. They get sepsis, a life-threatening infection, or some other serious illness while being treated for something else in hospital.

    So, while Hospital Compare, Medicare’s online hospital quality comparison tool, is far from perfect, it’s worth checking out.  Medicare also has tools for comparing nursing homes and other health care providers. But, the government agency that compiles the care compare data lost a bunch of funding and is looking to cut back on the data it provides the public.

    Medicare wants to hide from public view 10 measures it has disclosed to promote patient safety and warn patients of poor quality. It wants to keep secret information on rates of hip fractures, sepsis post surgery and pressure ulcers in hospital. According to the Leapfrog Group, each year nearly 25,000 patients die from these hospital-acquired illnesses.

    Of course, the hospitals love the idea that Medicare would stop publishing this data. They argue that it is imperfect because it cannot capture the condition of patients before they are admitted, which could make them more prone to harm in hospital. While that is true, it’s true for all patients at all hospitals.

    As you would expect, patient advocates strongly oppose it because it exposes patients to a lot of risk. Without public data, it’s hard to drive health care facilities to improve the quality of care they provide their patients.

    What’s super concerning is that Covid-19 has hurt patient safety in hospital significantly. In the first six months of 2021, US rates of central-line associated bloodstream infections in hospital were up 45 percent after having come down 31 percent in the five years before the Covid-19 pandemic. MRSA infection rates were up 39 percent. Yet, informing the public about patient safety appears to be low on the Biden administration’s agenda.

    To be clear, pre-pandemic, some hospitals performed extremely poorly from a quality perspective. The HHS Office of the Inspector General (OIG) found that, in 2018, 25 percent of Medicare patients who were hospitalized suffered from some time of harm while in hospital. In 2010, a similar OIG analysis found the same rate of harm to Medicare patients.

    As proposed, Medicare would still collect quality data. But, it would not impose fines on hospitals that performed poorly on the quality measures.

    Here’s more from Just Care:

  • Coronavirus: Biden administration fails to disclose hospital bad actors

    Coronavirus: Biden administration fails to disclose hospital bad actors

    The HHS Office of the Inspector General recently reported widespread and persistent denials of care in some Medicare Advantage plans but the Biden administration has yet to protect enrollees in those Medicare Advantage plans by disclosing the bad actors. Politico reports that the Biden administration is also choosing to protect the interests of hospital corporations over patients by not disclosing the names of the hospitals with high incidents of Covid-19 spread.

    If you’re heading to the hospital, you should keep in mind that some hospitals do a poor job of containing the spread of infections, including Covid-19. In the last month, there were 1,457 reported cases of people contracting Covid-19 in hospital. And, that’s an undercounting since it only counts individuals who have contracted the virus while in the hospital at least 14 days. Back in January, there were 3,000 reported Covid-19 cases while patients were in hospital each week.

    Patients have no warning as to which hospitals to avoid. The hospitals that did a poor job of containing the spread of Covid-19, in turn, are allowed to continue operations with little accountability for their poor behavior. Some of these hospitals could have done a lot more than they have to contain the spread of Covid-19 in hospital. The government has collected the data since the Trump administration, it just won’t share it.

    Even if people should take personal responsibility for protecting themselves against Covid-19, as the Biden administration says, knowing which hospitals to stay clear of is one piece of how people can take responsibility. Moreover, immunocompromised individuals put their health at extreme risk if they contract Covid-19.

    Patients can find some data on hospital-acquired infection rates at individual hospitals. Why isn’t a Covid-19 infection included in that data? Politico has filed a freedom of information act request for the data.

    Here’s more from Just Care:

  • Coronavirus: Copper kills bacteria quickly

    Coronavirus: Copper kills bacteria quickly

    Hospitals have struggled to stem the spread of the novel coronavirus infection inside their facilities. And, shortages of personal protective equipment early on were a grave problem, but they were not the only one. Many hospitals have historically done a poor job of preventing people from acquiring infections while inpatients. Now, Andrew Zaleski reports for Stat that replacing stainless steel surfaces with copper may be a key to reducing these infections. 

    Each year, about two million people develop hospital-acquired infections, What’s worse is that 90,000 people die from these infections. The use of copper materials, including copper surfaces instead of stainless steel could be a smart way to minimize infections.

    Copper has been found to kill bacteria that fall on its surface relatively quickly. It offers an antimicrobial surface that releases ions, which break into bacterial cell membranes, killing the DNA and proteins inside them. It neutralizes microbes. And, it does so in a matter of hours. Bacteria can live on stainless steel surfaces for days.

    Hospital executives dispute the science, sort of. They are not convinced that replacing stainless steel or plastic surfaces with a copper surface and reducing pathogens in a specific area will lower patients’ likelihood of infection. They acknowledge the correlation between use of copper in place of stainless steel and lower infection rates, but there is not evidence of causation.

    But, one researcher is convinced that switching to copper from stainless steel in a hospital room makes a big difference. A study that began in 2007 in hospital intensive care units found that if copper was used for bedrails, intravenous poles, visitors’ chair armrests, patients’ tray tables, and the nurses’ call button, infections dropped by more than half–58 percent. The researcher also found much lower rates of VRE and MRSA, which cause infections.

    A different clinical trial found that when copper oxide surfaces were used instead of stainless steel, there was a 78 percent drop in drug-resistant microbes. And, yet another trial had similar results.

    A 2019 study found that copper beds in an ICU led to an almost total reduction of bacteria. Ninety-five percent of bacteria were wiped out. That said, funding for that project was from a company that makes copper beds.

    It’s not clear whether hospitals have a financial incentive to replace stainless steel with copper. Right now, they see longer hospital stays and possibly more revenue from higher infection rates. When people contract an infection in hospital, they stay longer, at an average additional cost of $43,000.

    Moreover, people cannot find information on a hospital’s infection rates easily. And, if they knew the hospital’s infection rate, they likely wouldn’t consider it before electing to use a particular hospital.

    For hospitals, switching to copper surfaces is very expensive. It is far less expensive to hire people to assiduously clean surfaces.

    Here’s more from Just Care:

  • Beware of researchers with conflicts of interest

    Beware of researchers with conflicts of interest

    When reading about health care, it’s sometimes hard to know who’s telling the truth and who’s burying it. That’s why I try to base all JustCare posts on findings from independent researchers, information from consumer organizations and government agencies and other generally trustworthy sources. But, when things get technical, even seasoned reporters at the New York Times fail to beware of researchers with conflicts of interest and bury the lede.

    Josh Freeman writes on Medicine and Social Justice that Denise Grady at the New York Times promotes a Novartis-funded study published in the New England Journal of Medicine on the effect of canakinumab (Ilaris) on heart attack survivors. The findings, he says, and cardiologist Michael Gilson, M.D., agrees, are not surprising and unremarkable–fewer heart attacks and strokes for patients taking the drug. But, overall, the people taking the drug died at the same rate as the people not taking the drug because the drug “decreases the body’s immune response,” leading to sometimes lethal infections.

    Freeman and Gilson’s conclusion: The drug offers no clinical advance. For $200,000 a year–the cost of the drug–fewer people die of heart attack and stroke but, because of the drug’s side effects, they have the same likelihood of dying as people who don’t take the drug. Moreover, an unknown number of people who take the drug do not die from it but suffer significantly from the infections caused by the drug, including tuberculosis, sepsis, pneumonia and cellulitis.

    In short, contrary to the New York Times article, this drug is “no major milestone.” It costs a fortune, does not decrease people’s risk of death, and it increases their risk of serious infections. In the second half of her NYT article, Grady does cover these issues, but the article headline, “Drug Aimed at Inflammation May Lower Risk of Heart Disease and Cancer,” and its opening paragraphs are terribly misleading.

    N.B. Also beware of doctors with conflicts of interest. Stat News recently published a Pharma puff piece by Dr. Robert Yapundich, who, according to Pro Publica, has received $215,000 from Pharma. If Stat was not aware of the Pro Publica database revealing which doctors take money from Pharma, it should be. If it was aware and still thought the piece offered value for its readers–which is hard to understand–it owes its readers a prominent note about the author’s conflict of interest.

    Here’s more from Just Care:

  • Live longer after a heart attack, choose your hospital carefully

    Live longer after a heart attack, choose your hospital carefully

    There’s no question that some hospitals are far better than others, so it’s important to choose your hospital carefully. Some hospitals have lower hospital-acquired infection rates, meaning that you’re less likely to get sick while you’re in those hospitals than in other hospitals. And, new data published in the New England Journal of Medicine reveals that some hospitals are better at having their patients live longer after a heart attack than others.

    Researchers found that choosing the right hospital to treat your heart attack can extend your life a full year. They looked at patients who received hospital care for their heart attacks over a 17-year period. Those patients who were treated at hospitals with high quality ratings lived between nine and 14 months longer than patients who were treated at hospitals with low quality ratings.

    Most noteworthy, the researchers found that the hospitals that received high scores for keeping heart attack patients from dying at 30 days actually were successful at extending the lives of their patients over the long term. They studied nearly 120,000 Medicare patients at 1,824 hospitals.

    What should you do? Plan ahead and know which hospital or hospitals in your community have the best quality ratings. Medicare and other groups help you do so. Also, take advantage of Medicare’s preventive care benefits, including annual cardiovascular screening.  Talk to your doctor about getting them.

    Here’s more from Just Care:

  • Cranberry juice won’t treat urinary tract infections

    Cranberry juice won’t treat urinary tract infections

    Did your mother ever advise you drink cranberry juice to treat a urinary tract infection(UTI)? It turns out that it doesn’t work. A new study reported in JAMA finds that cranberries and cranberry products–specifically cranberry pills–are not effective in treating or preventing UTIs. It’s time we put the old wives’ tale to bed once and for all.

    Millions of Americans get UTIs each year, including between a quarter and a half of all women in nursing homes. According to the National Institutes on Health, bacteria living in the digestive tract, in the vagina, or around the urethra are the most common cause of UTIs. Symptoms include a burning sensation when you urinate and the need to urinate frequently. While most UTIs are not serious, they sometimes can lead to chronic kidney infections, which can cause permanent damage to the kidney and high blood pressure.

    Researchers tested whether cranberry pills containing the equivalent of 72mg proanthocyanidins in 20 ounces of cranberry juice could cure or prevent UTIs in nursing home residents. They gave a group of 147 nursing home residents two cranberry pills a day for more than a year to see if they would prevent bacteriuria and pyuria, two conditions that are present in people with urinary tract infections. They found that the people receiving these pills had “no significant difference” in bacteriuria and pyuria from the residents who did not receive the pills. They concluded that these cranberry pills have no clinical benefit and are not cost effective.

    Here’s more from Just Care:

  • A medical device may make heart surgery even riskier

    A medical device may make heart surgery even riskier

    Every year, more than half a million Americans have heart bypass surgery to get blood flowing to the heart. As we all know, heart surgery can be risky. What most of us don’t know is that a new infection associated with a medical device used in heart surgery may make heart surgery even riskier. While the Centers for Disease Control (CDC) is alerting hospitals to this risk and asking them to alert patients, neither the FDA nor the CDC has required hospitals to warn heart bypass patients about the risk nor does either have the authority to do so.

    Consumer Reports writes about a patient who died after experiencing chest pain and fever post heart bypass surgery. He had been discharged from the hospital and then rehospitalized. The doctors found that his wound had opened and was oozing pus. He had non-tuberculosis mycobacteria (NTM), a rare microbial infection that can be deadly in the chest cavity or prosthetic heart valve but is otherwise generally harmless. While the infection can be treated in healthy patients, the patient was not healthy enough to tolerate the drug cocktail treatment and the hospital could do nothing to save him.

    As it turns out, several other patients who have had heart surgery have also developed NTM infections, sometimes many months after surgery. In the past six years, at least 45 patients have been infected during surgery and at least nine have died. We do not know how many more cases have gone undiagnosed or unreported.

    It appears that heater-cooler devices (HCDs), which regulate patients’ body temperatures during surgery are likely to be responsible. Hospitals use these HCDs in about 250,000 heart bypass surgeries each year. Many think that the HCDs spray the NTM bacteria into patients’ bodies during surgery through their exhaust fans. In most instances where infections were reported, the hospitals used a particular HCD, the Sorin Stockert 3T Heating-Cooling System, manufactured by the European company LivaNova.

    The FDA and CDC have sent notices to hospitals warning them about the HCD risks for heart surgery patients, asking them to clean the HCDs in a particular way and recommending they turn the HCD exhaust fans away from the operating tables. But, believe it or not, it is up to individual state health departments to require hospitals to notify patients about the risks.

    Some hospitals have addressed the possible problem by moving the HCDs outside the operating room in a way that allows them to regulate patients’ body temperature but keeps their exhaust vents away. But, many hospitals have not, and many hospitals do not have the ability to adopt this solution.

    If you or someone you love is getting heart bypass surgery, Consumer Reports recommends you ask whether the hospital is using an HCD, whether it has been tested for NTM and other bacteria and whether any of their heart bypass patients have gotten NTM or other infections.

    Here’s more from Just Care:

     

  • Pay attention when someone you love leaves the hospital

    Pay attention when someone you love leaves the hospital

    It’s not something most of us would instinctively believe, but hospitals can be dangerous places and leaving the hospital can be equally or more dangerous. According to the U.S. Agency for Health Care Research and Quality, AHRQ, almost one out of five patients who leave the hospital end up experiencing some harmful effect within 21 days. Yet, most of these events are preventable.  So, pay attention when someone you love leaves the hospital.

    Here’s Just Care’s checklist of seven things to do before you or someone you love leaves the hospital.

    What are the worst things that can happen to a patient upon hospital discharge? The AHRQ’s Patient Safety Network reports that the most serious complication comes from a bad reaction to a new prescription or medical regimen.  But, people also often pick up infections from antibiotic resistant bacteria in the hospital. And, some suffer procedural complications. Still others leave the hospital without lab results or with a need for follow-up tests, but do not follow through in a timely way or as warranted.

    The risks upon hospital discharge in part stem from a lack of care coordination between the in-hospital doctors and the patients’ primary care doctors and specialists. In addition, there are usually an overwhelming array of directives on discharge from the hospital. Without a “health care buddy,” someone whom you trust at your side as an extra pair of eyes and ears, who can ask questions on your behalf and make sure everything is in order for a safe transfer out of the hospital, there is a high likelihood of mixup.

    Keep in mind that it also can be extremely hard for a health care buddy or family member who is not a professional to appreciate the patients’ full range of care needs and how well patients can care for themselves once out of the hospital. Not surprisingly, one in five Medicare patients are rehospitalized in the 30 days after they are discharged.

    Here’s more from Just Care:

  • Could your hospital make you sick? How to protect yourself against hospital-acquired infections

    Could your hospital make you sick? How to protect yourself against hospital-acquired infections

    The hospital is a place that’s supposed to make us well. However, it can also make us very sick. Individuals who go to the hospital too often end up with severe—and sometimes fatal—infections simply from being there. For aging Americans, the risk is even higher.

    Hospital-acquired infections are a major concern for patients, their families, health care administrators—and all personnel who are associated with patient care. Here are some practical tips to better protect both you and your family against hospital-acquired infections.

    Officially known as healthcare-associated infections (HAIs), hospital-acquired infections fall into a broader category of infections that patients get while receiving treatment in a health care setting. They can be associated with procedures (like surgery), or devices that are used for treatment—such as invasive catheters.

    The overuse of antibiotics greatly contributes to both the existence of HAIs, as well as the inability to treat them effectively. Indeed, the effectiveness of many antibiotics is at serious risk because of their overuse and the consequent emergence of antibiotic-resistant bacteria.

    If you receive care in health care settings other than hospitals, you also can get these infections. These include places like outpatient surgery centers, dialysis centers, physician offices, and long-term care facilities.

    Two of the most common infections are Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile). C. difficile caused almost half a million infections among patients in the U.S. in just one year. More than 80 percent of the deaths associated with C. difficile occurred in patients 65 years or older, and many were in nursing homes. Aging Americans are more vulnerable to HAIs because they often have multiple medical conditions and their systems are more fragile and less able to fight off disease.

    The problem has become so serious that the White House has developed a strategy to combat antibiotic-resistant bacteria and the U.S. Department of Health and Human Services has developed a national action plan to prevent health care-associated infections.

    The good news is that there are a number of steps you can take in the hospital or other health care setting to help protect yourself and your family from getting one of these—or other—infections:

    • If possible, choose your hospital carefully; Consumer Reports offers hospital safety ratings on its web site by state at not charge. Medicare also has a web site comparing hospitals that provides information on healthcare-associated infections.
    • Ask health care workers to wash their hands before they touch you.
    • Ask if equipment has been properly sterilized before it’s used on you.
    • Ask questions about antibiotics, including what they are and if you really need them.
    • Know how to recognize an infection and ask about suspicious symptoms—such as diarrhea, fever, chills, and redness or drainage at a site.
    • Get vaccinated for common ailments that make your body susceptible to infection—according to your doctor’s guidance. (Medicare covers the flu shot, as well as the pneumonia vaccine, and the shingles vaccine.)
    • Consider having a health care buddy who can stay with you and advocate for you.
    • Stay away from health care settings, if at all possible. Talk to your doctor about whether receiving care at home may be a better option. 

    For more information on topics related to hospital and health care administration, check out the blog by MHA@GW, the online Master of Health Administration program offered by The Milken Institute School of Public Health at the George Washington University.

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