A Family Member HomeCare, A Pembroke Pines Home Health Care Agency, Notes Sun-Sentinel Report: Hospitals embrace high-tech security

Biometrics speed admissions and reduce mistakes while cutting fraud and ID theft



Yadira Suarez has her palm scanned during registration at Memorial Regional Hospital Miramar on Thursday. She was at the hospital with Jesus Gonzalez to deliver her twin babies. (Amy Beth Bennett, Sun Sentinel / September 1, 2011)












September 4, 2011
www.SunSentinel.com



The next time a hospital official asks to look into your eyes, it might not be your health he's checking.


In South Florida and across the nation, hospitals are implementing high tech biometrics technology to speed up the admission process, reduce errors and add a layer of security in an age where insurance fraud and identity theft is a serious problem.


They include such things as palm readers, iris scanners and voice recognition systems, which are methods to recognize a person based on unique biological characteristics and patterns, according to companies that create the technology.


These systems help locate patient records and log them into electronic files. It can also track who is looking at sensitive information stored in hospitals and cut down on patients pretending to be someone else to dodge a bill.


"The advantage is that it prevents some lunatic from walking in off the street with someone else's identity,'' said Dr. Fred Valdes, of Hollywood, whose palm was recently scanned at Memorial Hospital Miramar.


To prevent errors and enhance security, some hospitals, such as Bethesda Memorial Hospital in Boynton Beach, require new moms and their babies to wear bracelets with their photos attached to barcodes. When they leave, the bar codes must match so the family is "as safe as possible," said Lisa Kronhaus, director of public relations and marketing.


Others medical centers have finger scanners that only allow authorized workers to access certain records. The Veterans Affairs Medical Center in West Palm Beach is considering incorporating face recognition programs in the future.


"In the case of hospitals, there is a lot of private patient data that you don't want to fall in the wrong hands,'' said Dr. Anil Jain, distinguished professor in the computer science department at Michigan State University.


South Florida has had its share of medical fraud and identity theft. In April, a former emergency room clerk at Holy Cross Hospital in Fort Lauderdale was sentenced to two years in federal prison for selling patients' personal information to a South Florida identity-theft ring. She admitted copying documents containing patients' addresses, ages and Social Security numbers and passing them along for cash.


In February of last year, a man was charged with using a fake name to receive more than $106,000 in medical care at Boca Raton Community Hospital. Police later found the social security number he had provided belonged to an Arizona resident.


At Memorial patients have the right to decline having their palms scanned. But there is rarely any resistance from residents.


Bernadette Lopez, director of pre-services at Memorial, said the system has decreased the number of people looking to use someone else's insurance card or assume someone else's identity.


The system costs the tax-assisted hospital district about $150,000 annually to maintain.


"It's like airport security; we know it's part of our lives.'' said Kerting Baldwin, director of media relations.


Those who ask the most questions tend to be lawyers and police officers, Lopez said.


Experts say we can expect to see more of these and other high-tech gadgets, especially since they're becoming less expensive and easier to intergrate with existing security systems.


For example, In New York, the Urban Health Plan clinic in the Bronx began using iris scanners about two years ago to cut down on mistaken identities. The clinic is in a majority Hispanic area, where many of the clients didn't' speak English.


When a patient visits a clinic employee scans their eyes using a handheld camera. Within seconds, the camera reads the patient's iris patterns, and a computer locates their medical record.


But Jain said patients still have to warm up to the idea of having their eye scanned for record keeping reasons. Plus, he said, iris scanners tend to be more expensive and, "it takes longer. People have to get used to opening their eyes and standing in front of [it],'' he said.


In addition to cutting down on fraud, technology can be used to assist patients trying to access information remotely.


At the Veterans Affairs Medical Center in West Palm Beach, a veteran's voice can be used to access information over the phone about treatment. Now the center is researching how to use face recognition programs as it expands it services over the Internet and teleconferencing.


"A lot of the time patients have chronic diseases so they have travel limitation,'' said facilities coordinator Dan Dwyer. "These would make it easier for them to interact with their healthcare provider and health care team without having to travel great distances or even leave their homes.''


Still, some face recognition programs can be problematic, said Jain, because they can be very sensitive to changes in lighting and modified facial expressions.


"Matching can be difficult. It depends on the pose and the expression,'' he said.


Over at MD Now Urgent Care walk-in clinic, which has six locations in Palm Beach County, patients have their photo ID's scanned into the system which is attached to their electronic files. They don't use any biometrics yet and Dr. Peter Lamelas, CEO of the MD Now said there are no plans to do so in the near future.


Lamelas said the current system in place works


"Sometimes science fiction is ahead of science fact,'' said Lamelas. "It takes a while for the real life application to catch up.''


Geast@tribune.com or 954-572-2078.

Miramar Home Health Care Agency Notes U.S. Government Accountability Office Report: Medicare Integrity Program: CMS Used Increased Funding for New Activities but Could Improve Measurement of Program Effectiveness



The U.S. Government Accountability Office ("GAO") issued report GAO-11-592 on August 29, 2011 entitled "Medicare Integrity Program: CMS Used Increased Funding for New Activities but Could Improve Measurement of Program Effectiveness."


A summary and hyperlinks to the complete report are reprinted below:


Highlights Page (PDF) Full Report (PDF, 37 pages) Accessible Text Recommendations (HTML)


Summary
The Medicare program makes about $500 billion in payments per year and continues to have a significant amount of improper payments--almost $48 billion in fiscal year 2010.


The Centers for Medicare & Medicaid Services' (CMS) Medicare Integrity Program (MIP) is designed to identify and address fraud, waste, and abuse, which are all causes of improper payments. MIP's authorizing legislation provided funding for its activities and subsequent legislation provided additional funding. GAO was asked to report on how effectively CMS is using MIP funding to address Medicare program integrity. GAO examined (1) how CMS used MIP funding to support the program's activities from fiscal years 2006 through 2010, (2) how CMS assesses the effectiveness of MIP, and (3) factors CMS considers when allocating MIP funding. GAO analyzed CMS budget and other documents, interviewed CMS officials, and examined the agency's method of calculating return on investment (ROI), a performance measure used by CMS to measure the effectiveness of MIP activities.


CMS used the increase in total MIP funding received, from $832 million in fiscal year 2006 to $1 billion in fiscal year 2010, to expand MIP's activities. The additional funding supported oversight of Medicare Part C (Medicare benefits managed through private plans) and Part D (the outpatient prescription drug benefit) and agency efforts to examine the claims of Medicare beneficiaries who also participate in Medicaid--a joint federal-state health care program for certain low-income individuals.


CMS officials also reported that CMS was able to move some funding from activities, such as provider audit, to other activities because of savings achieved from consolidating contractors. The largest percentage increase from this redistribution went to benefit integrity activities, which aim to deter and detect Medicare fraud through proactive data analysis and coordination with law enforcement.


Although CMS has reported that the agency measures MIP's performance with goals related to reductions in the improper payment rates for Medicare fee-forservice, Part C, and Part D, CMS officials with direct responsibility for MIP generally do not connect measurements of effectiveness of MIP activities with the CMS goals of reducing improper payments. These goals to reduce improper payments, which were reported as goals previously and for fiscal year 2012, are particularly important in light of the President's Accountable Government Initiative, which aims to reduce overall improper payments by $50 billion by the end of 2012.


In interviews with GAO, CMS officials with direct responsibility for implementing MIP activities generally did not connect the measurement of effectiveness of MIP activities with these CMS goals to reduce improper payments and instead cited other measures of effectiveness. This suggests that CMS has not clearly communicated to its staff the relationship between the daily work of conducting MIP activities and the agency's improper payment reduction performance goals. Because MIP will be central to CMS's efforts to reduce Medicare improper payments, MIP staff need to understand how their work supports these goals. In addition, the Patient Protection and Affordable Care Act requires CMS to report annually on the use of funds for MIP and the effectiveness of the use of those funds. One way that CMS already measures MIP effectiveness is ROI, which CMS calculates as savings from an activity in relation to expenditures.


CMS calculates ROI for most of its MIP activities, but the data it uses have two flaws. First, ROI calculations are not updated when program expenditure data, a key component in the ROI calculation, are updated, which may lead to an incorrect ROI. Second, CMS does not have reliable information to determine the amount of MIP spending by activity for one type of contractor that received about 22 percent of total MIP funding in fiscal year 2010.


It will be important for CMS to correct these flaws to ensure reliability in ROI reporting. CMS considers a variety of factors when allocating MIP funding. Based on a review of the documents submitted to justify funding of specific MIP activities, CMS may consider the prior year's funding level, the consequence of not funding, and the performance goal that the activity is intended to meet. GAO recommends that CMS communicate the linkage between MIP activities and the goals for reducing improper payments and that CMS expeditiously improve the reliability of data used to calculate ROI. The Department of Health and Human Services concurred with these recommendations.




Recommendations


Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.


Director: Kathleen M. King
Team: Government Accountability Office: Health Care
Phone: (202) 512-5154






Recommendations for Executive Action


Recommendation: To enhance accountability and sharpen the focus of the agency on reducing improper payments, the Administrator of CMS should clearly communicate to staff the linkage between Government Performance and Results Act (GPRA) and Patient Protection and Affordable Care Act (PPACA) performance measures related to the reduction in improper payments and other measures used to determine the performance of Medicare Integrity Program (MIP) activities.


Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services


Status: Open


Comments: In its comments on our draft report, CMS concurred with our recommendation to clearly communicate to staff the linkage between GPRA and PPACA performance measures related to the reduction in improper payments and other measures used to determine the performance of MIP activities. CMS stated that the agency recently established the position of the Chief Performance Officer to provide leadership, technical direction, and guidance in the development, implementation, communication, and operation of a comprehensive, CMS-wide performance management program. CMS also summarized other agency activities under way to assess program effectiveness, such as developing a new online data tool to report on the progress of key performance indicators, including those related to program integrity.
Recommendation: To enhance the reliability of data used to calculate the MIP ROI, the Administrator of CMS should periodically update ROI calculations after contractor expenses have been audited to account for changes in expenditure data reported to CMS and publish a final ROI after data are complete.


Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services


Status: Open


Comments: In its comments on the draft report, CMS concurred with our recommendation to periodically update ROI calculations after contractor expenses have been audited to account for changes in expenditure data reported to CMS and publish a final ROI after data are complete. According to CMS, the agency will update the ROI when there has been a material change in the data used in the calculation and, at a minimum, will revisit the ROI annually to account for revisions in contractor cost reports and updated savings information. CMS also highlighted the complexities of estimating cost data for the MACs for purposes of the ROI.
Recommendation: To enhance the reliability of data used to calculate the MIP ROI, the Administrator of CMS should expeditiously complete the implementation of data system changes that will permit CMS to capture accurate Medicare administrative contractor (MAC) spending data, thereby helping to ensure an accurate ROI.


Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services


Status: Open


Comments: In its comments on our draft report, CMS concurred with our recommendation to complete the implementation of data systems changes that will permit CMS to capture accurate MAC spending data, thus helping to ensure the accuracy of the ROI. CMS stated that the agency will convene an internal work group consisting of staff from several components to explore more efficient ways to accumulate MAC cost data and calculate ROI performance statistics. CMS also noted that some changes to the cost reporting system for contractor cost submissions have already been completed, particularly in the area of medical review cost reporting. However, the agency plans to pursue a full assessment of the costs reported across all of the MIP functions performed by the MACs to ensure that any additional changes are identified and implemented.



For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach.

Pompano Beach Home Health Care Agency Notes: Florida Board of Nursing Home Administrators Meets September 12, 2011 at 1 p.m.



The Florida Board of Nursing Home Administrators will hold a public teleconference on Monday, September 12, 2011 at 1:00 p.m.


To participate, call (888) 808-6959, conference code 9849329103. (Participants in this public meeting should be aware that these proceedings are being recorded and that an audio file of the meeting will be posted to the Board’s Web site.)


SEPTEMBER 12 AGENDA


I. CALL TO ORDER (Roll Call):


Jeri Francoeur, Chair Patricia Freeman, Vice-Chair


Carolyn Moore Robert Rosenthal


II. PETITION FOR VARIANCE/WAIVER and APPLICANT PRESENTED FOR BOARD


REVIEW – Shea M. Nicosia – Nursing Home Administrators – Rule 64B10-11.007(1),


F.A.C. – College Training in Health Administration


(Book I of the August 19, 2011 meeting agenda – page 00349)


III. APPLICANT PRESENTED FOR BOARD REVIEW – Christopher M. Sefjack –


Nursing Home Administrators


(Book II of the August 19, 2011 meeting agenda – page 00054)




The Board's September 23 agenda is reprinted below:


The Florida Board of Nursing Home Administrators will hold a duly noticed telephone conference call meeting on Friday, September 23, 2011, commencing at 9:00 a.m. This meeting will be held at meet me number (888) 808-6959, conference code 9849329103, to which all persons are invited to attend. Participants in this public meeting should be aware that these  proceedings are being recorded and that an audio file of the meeting will be posted to the board’s website.


AGENDA


I. CALL TO ORDER (Roll Call):


Jeri Francoeur, Chair Patricia Freeman, Vice-Chair


Carolyn Moore Robert Rosenthal


II. FINAL ORDER ACTIONS:


1. Motion for Final Order after Hearing not Involving Disputed Issues of Material


Facts and Determination of Respondent’s Waiver of Right to Request a Formal


Hearing:


a. William J. Hackett, N.H.A. – Case Number 10-22732


PCP: Freeman/Goodman


(Book I of the August 19, 2011 meeting agenda – page 00014)


2. Motion for Final Order Based Upon a Voluntary Relinquishment of License:


a. Chester V. Cole, N.H.A. – Case Number 11-03942


PCP: Waived


(Book I of the August 19, 2011 meeting agenda – page 00118)


III. COMMITTEE REPORTS:


1. Continuing Education – Ms. Freeman


a. Marlene D. Hunter A.L.F. Consultant, Inc. – Recommended for Denial


(Book II of the August 19, 2011 meeting agenda – page 00612)


VI. APPLICANT PRESENTED FOR BOARD REVIEW – Diana R. Darona – Nursing


Home Administrators 00001


VII. ADJOURNMENT




To view more about recent laws impacting nursing homes, click on the hyperlinks below:






Laws passed impacting Florida's Health care regulation include:


2011
2010


2011
SB 146 - Criminal Justice; Cites this act as the "Jim King Keep Florida Working Act." Requires state agencies to prepare reports that identify and evaluate restrictions on licensing and employment for ex-offenders. Prohibits state agencies from denying an application for a license, permit, certificate, or employment based solely on a person's lack of civil rights. Provides an exception, etc. (Section 112.011, Florida Statutes).


HB 155


HB 155 Clarification Letter to Medical Doctors, dated July 18, 2011
HB 155 Clarification Letter to Osteopathic Physicians, dated July 18, 2011
HB 155 Clarification Letter to Podiatric Physicians, dated July 18, 2011
HB 155 - Enrolled (Bill Text)






HB 479 - Medical Malpractice; Requires DOH to issue expert witness certificates to certain physicians & dentists licensed outside of state; provides application & certification requirements & exemptions for physicians & dentists issued certifications from certain licensure & fee requirements; provides additional grounds for disciplinary actions; requires Board of Medicine & Board of Osteopathic Medicine to adopt certain patient forms specifying cataract surgery risks; provides for execution & admissibility of patient forms in civil & administrative proceedings, etc. (Sections 458.3175, 459.0066, 466.005, 458.331, 459.015, 466.028, 458.351, 459.026, 627.4147, 766.102, 766.106, 766.1065, 766.110, 766.206 and 768.135, Florida Statutes). More Information…


HB 935 - Health Care Price Transparency; Authorizes primary care provider to publish & post schedule of certain charges for medical services offered to patients; requires schedule to include certain information regarding medical services offered; provides that schedule may group provider's services by price levels & list services in each price level; provides exemption from license fee & continuing education requirements for provider who posts schedule of charges; requires primary care provider's estimates of charges for medical services to be consistent with posted schedule, etc. (Sections 381.026, 395.002, 395.107and 400.9935381.026, 395.002, 395.107 and 400.9935, Florida Statutes).


HB 1127 – Abortions; Requires that ultrasound be performed on woman obtaining abortion; failure to comply with the statute constitutes grounds for discipline (Section 390.0111, Florida Statutes).


HB 1319 - FAQs Certificates/Licenses/Health Care Practitioners; Provides for issuance of temporary license to specified health care practitioners who are spouses of active duty members of Armed Forces under certain circumstances; revises scope & area of practice for dental hygienists; adopts American Dental Licensing Examination as clinical or practical licensure examination used for licensure as dentist in this state, providing specified conditions are maintained; authorizes applicants to submit American Dental Licensing Examination scores from jurisdiction outside state, etc. (Sections 456.024, 458.315, 459.0076, 466.003, 466.023, 466.0235, 466.024, 466.00672(2), 466.006, 466.0065(1), 466.0067, 466.00671, 466.007, 466.009(1), 466.011, 468.701, 468.703, 468.707 and 468.711, Florida Statutes). More Information…


HB 7095 - Controlled Substances; Makes failure to comply with requirements of s. 456.44, F.S., grounds for disciplinary action; provides mandatory administrative penalties for certain violations related to prescribing; requires prescriptions for controlled substances to be written on counterfeit-resistant pad produced by approved vendor or electronically prescribed; provides conditions for being approved vendor; requires certain physicians to designate themselves as controlled substance prescribing practitioners on their practitioner profiles, etc. (Sections 456.072, 456.42, 456.44, 458.3265, 458.327, 458.331, 459.0137, 459.013, 459.015, 465.015, 465.016, 465.018, 465.022, 465.0276, 499.0051, 499.012, 499.0121, 499.05, 499.067, 810.02, 812.014, 893.055, 893.065, 893.07, 893.13, 893.138, Florida Statutes). More Information…


House Bill 479
This bill requires medical doctors, osteopathic physicians, or dentists who provide expert testimony concerning the prevailing professional standard of care of a medical doctor, osteopathic physician or dentist, to be licensed in this state or possess an expert witness certificate issued by the department. Disciplinary action can be taken by the board for offering false or misleading information as an expert witness. The bill also makes modifications regarding insurance policy or self-insurance policy for medical malpractice coverage.


House Bill 1319


Frequently Asked Questions


This bill takes effect upon becoming law. It authorizes the department to issue a temporary license to a health care practitioner whose spouse is stationed in Florida on active duty with the Armed Forces if the applicant meets the eligibility requirements for a full license and is qualified to take the licensure examination. It also requires the applicant for a temporary license to pay for fingerprint processing for a criminal history check in addition to the application fee.


The bill generally expands the scope and area of practice of dental hygienists by authorizing dental hygienists to perform certain duties unsupervised in health access settings which include school-based prevention programs and accredited dental hygiene programs. It allows dental hygienists to apply fluorides, instruct on the oral hygiene of a patient, and supervise the oral hygiene of a patient, without the supervision of a dentist. It further requires dental hygienists who perform remediable tasks without supervision to provide a dental referral in compliance with federal and state patient referral, anti-kickback, and patient brokering laws; encourages the establishment of a dental home; and requires the dental hygienists to maintain a certain amount of professional malpractice insurance coverage. The bill also clarifies that the authorization for dental hygienists to perform some duties does not prevent a program operated by one of the health access settings for a nonprofit organization from billing and obtaining reimbursement for the services provided by a dental hygienist.


This bill replaces the current dental exam, administered through the department of Health, with a national exam, the American Dental Licensing Examination (ADLEX). The bill provides that if an individual who is relocating to Florida took the ADLEX more than a year ago, he or she must meet additional criteria for licensure, including engaging in the full-time practice of dentistry in the 5 years preceding the date of application to practice dentistry in Florida or since initial licensure if he or she has practiced less than 5 years. The bill requires the Board of Dentistry to develop rules for the full-time dentistry practice required for an individual who is relocating to Florida to practice dentistry. It provides for the expiration of licenses if the full-time practice requirements are not fulfilled and makes it a 3rd degree felony to use or attempt to use a license that is expired or has been revoked.


This bill defines "Board of Certification" to mean the nationally accredited certifying body for athletic trainers. It requires the five licensed athletic trainer members of the Board of Athletic Training be certified by the Board of Certification. It revises requirements for licensure as an athletic trainer. It requires that anyone who graduated after 2004 must have completed a curriculum from a program recognized by the Board of Certification. It provides that current certifications for athletic trainers include the use of automated external defibrillators. It removes the requirement for a course in HIV/AIDS at initial licensure.


This bill also revises provisions relating to renewal of a license. It requires licensed athletic trainers to hold a current certification in cardiovascular pulmonary resuscitation with an automated external defibrillator as a requirement of renewal. It recognizes courses given by the American Heart Association. It requires athletic trainers licensed after January 1, 1998, to be currently certified by the Board of Certification or its successor agency. It removes the HIV/AIDS requirement at time of renewal.


2010
HB 573 - Deletes requirements that physician assistants file evidence of certain clinical experience before prescribing or dispensing medication (Sections 458.347 and 459.022, Florida Statutes). It also authorizes electronic submission of physician assistant license applications and other required documentation (Sections 458.347 and 459.022, Florida Statutes).


HB 1143 - Amends the provision relating to the Drug-Free Workplace Act. Is also directs the DOH to accept funds from counties, municipalities, and certain other entities for purchase of certain products made available under contract with U.S. Department of Health & Human Services for manufacture and delivery of products in response to public health emergencies (Sections 318.21, 318.18 and 381.00315 Florida Statutes). More Information…


SB 2272 - Creates new pain management provisions and criminal penalties for certain violations, and amends DOH’s regulatory provisions for obtaining patient records (Sections 456.037, 456.057, 458.3265, 458.327, 458.331, 459.0137, 459.013, 465.0276, 893.055, and 893.0551, Florida Statutes).


SB 2386 - Makes each agency responsible for exercising due diligence in securing payment for all accounts receivable and other claims due the state. Is also authorizes the CFO to adopt rules requiring that payments made by the state for goods, services, or anything of value be made by electronic means, and revises contractual services and commodities that are not subject to competitive-solicitation requirements (Florida Statutes).


HB 5311 - Calls for a type-2 transfer of the Drug, Devises and Cosmetics Program (DDC) to the Department of Business and Professional Regulation (Chapters 465 and 499, Florida Statutes).


HB 7069 - Revises background screening requirements for Certified Nursing Assistant applicants and all licensees employed in long-term care facilities (Section 464.203 and 408.809; and Chapter 435, Florida Statutes).


House Bill 1143Revisions have been made to Section 395.0193, Florida Statute regarding the transfer of review of facility peer review agendas and minutes and receipt of facility peer review discipline reports from the Division of Health Quality Assurance within the Agency for Health Care Administration to the Division of Medical Quality Assurance within the Department of Health.


Sections499.003 and 499.01212, Florida Statute has been amended to include a definition of "Medical Convenience Kit" and to remove the requirement for certain medical convenience kits to have pedigree papers.


In addition, sections 318. 21, 318.18 and 381.00315 Florida Statutes amends the provision relating to the Drug-Free Workplace Act; and directs the DOH to accept funds from counties, municipalities, and certain other entities for purchase of certain products made available under contract with U.S. Department of Health & Human Services for manufacture and delivery of products in response to public health emergencies.
Florida Association of Homes and Services for the Aging
(850) 671-3700
Florida Health Care Association
(850) 224-3907
National Association of Long Term Care Administrator Boards (NAB):
(202) 712-9040 or nab@nabweb.org


For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach.

Ft. Lauderdale Home Health Care Agency Notes New York Times Story: Along the Spine, Women Buckle at Breaking Points Due to Bone Loss Vertebral Compression Fractures



Along the Spine, Women Buckle at Breaking Points
By JANE E. BRODY
Published: June 27, 2011
http://www.nytimes.com/



Enlarge This Image
Yvetta Fedorova

An 80-year-old friend was lifting a corner of the mattress while making her bed when, as she put it, “I broke my back.”

In fact, she suffered a vertebral fracture — a compression, or crushing, of the front of a vertebra, one of the 33 bones that form the spinal column. This injury is very common, affecting a quarter of postmenopausal women and accounting for half of the 1.5 million fractures due to bone loss that occur each year in the United States.

By age 80, two in every five women have had one or more vertebral compression fractures. They often result in chronic back pain and impair the ability to function and enjoy life. They are one reason so many people shrink in height as they age.

Multiple vertebral fractures, found in 20 percent to 30 percent of cases, often result in a hunched posture, a condition called kyphosis that impairs breathing and compresses the abdomen, leading to a protruding stomach with limited capacity.

But while vertebral fractures are a telltale sign of bone loss among women over age 50 and men over age 60, most who suffer them are unaware of the problem and receive no treatment to prevent future fractures in vertebrae, hips or wrists, the bones most likely to break under minor stress when weakened.

Yet, if a vertebral fracture is diagnosed and properly treated, the risk of future fractures, including hip fractures, is reduced by half or more, studies have shown.

“Most vertebral fractures do not come to medical attention at the time of their occurrence,” Dr. Kristine E. Ensrud and Dr. John T. Schousboe wrote recently in The New England Journal of Medicine. One reason is that the pain may be minimal at first or, if more severe, attributed to a strain that subsides over a few weeks.

Indeed, patients or their physicians are made aware of these fractures in just one-fourth to one-third of the instances in which they are discovered on X-rays, according to the doctors.

“The patient may have had a chest or back X-ray for some other reason, perhaps to rule out pneumonia, but the focus is on why the test was ordered, and an incidental finding of a vertebral fracture is ignored,” Dr. Ensrud said in an interview. “Doctors need to be more aware of this problem, and maybe patients should ask to see the report.”

Dr. Ensrud, an internist and epidemiologist who researches osteoporosis at the University of Minnesota and the Veterans Affairs Medical Center in Minneapolis, noted that in a person with severe osteoporosis, a vertebral fracture can be caused by something as mundane as coughing, sneezing, turning over in bed or stepping out of a bathtub.

In patients whose bone loss is less advanced, a fracture may occur when lifting something heavy, tripping or falling out of a chair.

“A lot of the time, people don’t recall the incident,” Dr. Ensrud said. “They just report that their back has been bothering them.” Patients also may mistakenly assume that their chronic discomfort is a result of arthritis or a normal consequence of age, and never mention it to their doctors.

About one-third of the postmenopausal women found to have vertebral fractures do not have osteoporosis as defined by bone mineral density testing, according to Dr. Ensrud and Dr. Schousboe. Rather, test scores indicate that these women are suffering from a lesser form of bone loss called osteopenia.

Yet the occurrence of vertebral fractures means that the situation is worse than bone density testing would suggest. “The identification of a vertebral fracture indicates a diagnosis of osteoporosis,” Dr. Ensrud and Dr. Schousboe concluded in their article.

Asked if such women should receive bone-preserving medication, Dr. Ensrud said emphatically, “Yes!” One major study found that a vertebral fracture raises the risk of further vertebral fractures by five times in just one year.

A vertebral fracture can be seen on an ordinary X-ray of the spine. But there is a more practical approach involving much less radiation: a scan of the spine called a lateral DEXA, an acronym for dual energy X-ray absorptiometry, as part of a routine bone density exam.

The scan requires special computer software. Patients must ask whether a particular clinic or hospital is able to perform a lateral DEXA.

If a postmenopausal woman whose bone density measures in the osteopenic range (suggesting bone loss, but not yet full-blown osteoporosis) is found to have a vertebral fracture, her doctor may decide to prescribe medication that increases bone strength. Often the drug will be a bisphosphonate like alendronate (brand name Fosamax), which is now available in an inexpensive generic form.

Future fractures can often be prevented if a bisphosphonate is taken by someone found to have one or more vertebral fractures, even if these fractures cause no discomfort. There are many other bone-building options, too, including a once-a-year injection.

In addition, patients should consume adequate amounts of calcium and vitamin D, the critical nutrients for strong bones: a total of 1,200 milligrams of calcium daily from food and supplements, and 1,000 international units daily of vitamin D.

Initially, a painful vertebral fracture may be treated with a short period of bed rest and pain medication like a nonsteroidal anti-inflammatory drug, narcotic, pain patch or an injection or nasal spray of calcitonin. But if too much time is spent in bed, the resulting weakness can increase the risk of further fractures.

Whatever is done, or not done, to treat the injury, the pain of a vertebral fracture usually subsides over the course of several weeks.

Dr. Ensrud and Dr. Schousboe cautioned in their article against rushing into two invasive procedures that have become increasingly common in this country: vertebroplasty and kyphoplasty. During these procedures, a kind of cement is injected into the compressed vertebra to stabilize it.

The operations are performed by interventional radiologists who, naturally, endorse them enthusiastically. However, two scientifically conducted studies of vertebroplasty using sham procedures as a control found no benefit with respect to pain, disability or quality of life.

Nor are these procedures completely free of risk. Although rarely, they can sometimes injure nerves or cause pulmonary embolisms. They also may result in fractures of adjacent vertebrae by increasing the mechanical stress on them.

Exercises to improve posture, strengthen back muscles and enhance mobility are less costly and likely to be more effective in the long run, the doctors wrote.

A version of this article appeared in print on June 28, 2011, on page D7 of the New York edition with the headline: Along the Spine, Women Buckle at Breaking Points.

Health Guide: Nonspecific Back Pain


For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach.

Miramar Home Health Care Agency Notes Sun-Sentinel/Reuters Report: Many seniors leave the hospital without their meds


By Frederik Joelving
Reuters
August 23, 2011


NEW YORK (Reuters Health) - Seniors with chronic disease often leave the hospital without prescriptions for the medicine they were getting when they arrived, Canadian researchers said Tuesday.

In some cases, that may have upped their risk of landing in the emergency room over the following year, or even dying, the team reports in the Journal of the American Medical Association.

"These are people that have been identified to have a disease and have been appropriately treated with evidence-based treatment for that disease," said Dr. Chaim Bell of St. Michael's Hospital in Toronto, who worked on the study. "So these are success stories."

"After hospitalizations they are no longer on these medications, and that's a shame," he told Reuters Health.

Bell and his colleagues used medical records for nearly 400,000 elderly people in Ontario to see how often those people left the hospital without renewed prescriptions for five long-term medications -- including the cholesterol-lowering statins, blood thinners and similar drugs, as well as asthma inhalers.

The researchers then compared those who'd been admitted to a hospital with those who hadn't.

For the blood thinners, which include aspirin, as many as 19 percent of the seniors who had been hospitalized failed to get a renewed prescription within three months.

By contrast, that number was less than 12 percent for people who hadn't been admitted to the hospital between 1997 and 2009.

For the other medications, the difference was less pronounced, but still there -- especially for those patients who landed in the intensive care unit.

While their study can't prove that hospital stays caused patients to drop their medications, Bell said he had taken measures to ensure that in most cases the discontinuation was unintentional.

The researchers also found that patients who discontinued statins and blood thinners -- both of which are often used to treat heart disease -- had a slightly higher risk of dying or landing in the emergency room over the next year.

Bell said that many seniors are on multiple drugs and simply may not notice that a prescription hasn't been renewed after they leave the hospital.

"There needs to be better communication" at the hospital, said Bell, adding that it could be hard to get a complete list of the medicine patients are on when they get admitted.

"Everybody is calling for the electronic patient record," he told Reuters Health.

In an editorial in the journal, Dr. Jeremy Kahn and Dr. Derek Angus of the University of Pittsburgh note that landing in the hospital can be a chance to adjust people's drugs and help them change their lifestyle.

"However, transitions of care are also a threat, especially for patients with chronic diseases and complex treatment regimens," they add. "Either because of miscommunication or simple error, patients may experience unwarranted changes in treatment with potentially deleterious effects on their health."

SOURCE: http://bit.ly/4HWZ7 Journal of the American Medical Association, August 24, 2011.

Copyright © 2011, Reuters



For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach.

Brian Gauthier's A Family Member HomeCare, a Pembroke Pines HomeCare Agency, Notes HealthDay report: Some Older Americans Overwhelmed by Medicare Options, Study Says

Healthday



Those experiencing mental decline may have the most trouble sorting through the options

By Mary Elizabeth Dallas



MONDAY, Aug. 29 (HealthDay News) -- Although older Americans have many Medicare options to choose from, they may not be making good decisions about their coverage, according to a new study.

Some seniors -- particularly those with impaired brain function -- can become overwhelmed by the variety of complex Medicare Advantage plans available to them, preventing them from finding the best plan to fit their needs, according to researchers from Harvard Medical School's department of health care policy.

"We are providing the most complex insurance choices to the very population that is least equipped to make these high-stakes decisions," said Dr. J. Michael McWilliams, assistant professor of health care policy and medicine at Harvard Medical School and a general internist at Brigham and Women's Hospital, in a university news release.

"Most other Americans choose from just a few health plans, but elderly Medicare beneficiaries often have to sift through dozens of options," McWilliams said.

The Medicare Modernization Act of 2003 increased the number of private plans participating in the Medicare Advantage program, which purports to usher in more competition, lower premiums and result in better benefits, including prescription drug coverage.

In assessing how these changes affected enrollment in Medicare Advantage compared to traditional Medicare, researchers examined nearly 22,000 enrollment decisions made by more than 6,600 participants over the course of four years, taking into account their mental status and the plans available to them.

The study, published online and in the September print issue of Health Affairs, found that enrollment in Medicare Advantage increased when the number of Medicare Advantage plans available to seniors was fewer than 15.

When there were more than 30 plans available, however, enrollment dropped. The researchers pointed out that 25 percent of U.S. counties offer more than 30 Medicare Advantage options.

Elderly people with impaired brain function were much less likely to understand and take advantage of the wide array of benefits offered by Medicare Advantage plans and instead were more likely to choose the traditional Medicare program by default, according to the report.

Given the increasing numbers of older Americans with Alzheimer's and other forms of dementia, the findings should prompt policymakers to establish better ways to assist seniors in making the right choice for them, researchers said. That could include offering fewer choices or helping them make better decisions based on those options.

"Efforts to limit choice and guide seniors to the most valuable options could especially benefit those with cognitive impairments, who without more help appear to be leaving money on the table," said McWilliams. "Better enrollment decisions could in turn strengthen competition by rewarding high-value plans with more enrollees."

Not all experts would agree that the seniors who chose Medicare over Medicare Advantage were making the wrong choice, however.

Medicare Advantage plans have serious drawbacks compared to the original Medicare, according to the Medicare Rights Center (MRC), a non-profit consumer advocacy group.

Among the problems with Medicare Advantage the MRC cites are higher costs for skilled nursing care, home health care and in-patient hospital costs; unstable private plans that may suddenly stop coverage; restrictions in the choice of doctors, hospitals and other providers members can choose; and problems getting urgent or emergency care.

More information

The U.S. National Institutes of Health provides more information on
Medicare.

SOURCE: Harvard Medical School, news release, August 2011


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@2011 HealthDay. All Rights Reserved.



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