Medicare Physicians Get Another Temporary Pay Cut Reprieve

While Medicare physicians could still be facing a 21.2 percent pay cut, they aren't facing it right now.

According to an article in McKnight's Long-Term Care News, the government has ordered that claims submitted on or after April 1 be held for an additional 10 days, until Congress returns from recess.

The pending physician pay cut was not covered in the recently passed healthcare reform law. However, there is legislation under debate in Congress that would have further delayed the pay cut - problem is, lawmakers adjourned for April recess before it could be passed.

This is the second time that Congress has delayed the physician pay cut.

The Embrace Magazine Site is Live!

The Web site designed to accompany Embrace, ProMed's brand-new magazine, is up and running! We hope you'll bookmark http://www.embracethemagazine.com/ and stop by often to see what's new.

On the site, we offer you a glimpse of all the exciting content packing Embrace's pages. Here are just a few of the articles at which you can sneak a peek:

• The ProMed Story
• Kathy Kelly: Championing a Compassionate Community
• Fighting the Flu at Your Facility
• Latex Gloves vs. Nitrile Gloves
  

If you like what you see, simply click on the Subscribe link! Subscriptions are free, and a copy of the debut issue of Embrace will soon be on its way to your facility.

Already have a copy of Embrace? We'd love to know what you think! Please send your thoughts and feedback to embrace@promedsupply.com or share them with your ProMed territory manager.

RUG-IV Now on the Back Burner Until 2011

The new healthcare reform package will push back the RUG-IV classification system's implementation until October 1, 2011.

RUG-IV, or Resource Utilization Group, Version Four, is a revised case-mix classification model. Medicare uses the case-mix classification system to assign nursing home residents to categories based on their medical conditions and the resources that are needed to care for them. Each category is tied to a specific Medicare payment rate.

A few of the changes that will be included in RUG-IV include:

• An increased number of RUG categories (from 53 to 66)
• The Special Care category will be split into Special Care High and Special Care Low
• The Impaired Cognition and Behavior categories will be combined to form one category: Behavioral Symptoms and Cognitive Performance
• Revisions to calculations of therapy minutes

To learn more about the changes that will come with RUG-IV, click here.

Healthcare reform will also retain the Medicare market basket, delay a "productivity adjustment" to provider reimbursements and extend the Medicare Part B therapy caps exceptions process through December 31 of 2010. It also establishes payment bundling pilot programs, requires disclosure of nursing home ownership, increases civil monetary penalties against nursing homes, establishes an independent Medicare payment advisory board and implements the CLASS (Community Living Assistance Services and Supports) Act.

Check Out Our LSN Pictures!

We have lots of great pictures from our booth at LSN! They're posted on our Facebook site. To view the pics, click here.

C. Diff Poised to Dethrone MRSA as Top Superbug

Just when the healthcare community had found a way to battle the top superbug - MRSA - C. diff is rising up to try and claim MRSA's throne.

According to new research from Duke University, C. diff is surpassing MRSA's infection rates in community hospitals. They also found that MRSA rates have actually been on the decline since 2005.

C. diff can cause diarrhea and, in some cases, colon inflammation that can be life-threatening. It is usually treated with antibiotics, but relapses are common and can occur despite treatment. A small percentage of patients with C. diff may die.

The researchers noted that many facilities have developed prevention methods around the goal of preventing the spread of MRSA. The goal should now be to develop prevention methods aimed at C. diff while simultaneously maintaining the success facilities have had with MRSA.

To learn more, click here.

You might also want to talk to your ProMed territory manager about CaviWipes, which are proven to kill C. diff (vegetative cells only) within two minutes.

How Full Is Your Glass? Optimism Can Boost Your Immunity!

Here's another reason to see the glass as half full - researchers have found that optimism can also strengthen your immune system, according to an article on MSNBC.com.

The authors of the study tracked changes in optimism and immune response among first-year law students. They discovered that when the students were more optimistic, they showed stronger cell-mediated immunity. Likewise, when their optimism dropped, so did their immunity.

The study's results could have implications for how mental health professionals handle counseling and treatment. Instead of focusing on reducing negative emotions and stress, for example, it could be beneficial to emphasize the positive.

To view the MSNBC.com article and learn more, click here.

Captain Compliance Has Flown Into LSN!

Captain Compliance, savior from the dreaded F-tag violation, has arrived at LSN! Stop by and take a picture with a superhero!

Study: 94% of Certain Anti-Diabetic Drug Researchers Had Financial Relationships with Pharmaceutical Companies

Researchers at the Mayo Clinic discovered that 94 percent of scientific authors who provided positive results for an anti-diabetic drug, rosiglitazone, had financial relationships with pharmaceutical companies.

The study, published in the British Medical Journal, also found that 45 percent of the authors in question had financial conflicts of interest and that 23 percent of these authors did not disclose this information. In fact, three studies included in the latter group published statements declaring no financial conflicts of interest.

Rosiglitazone, the drug at the center of the 200 articles examined by the Mayo Clinic researchers, has been shown to lead a significant increased risk of heart attacks. This discovery prompted additional studies and commentaries about the safety of rosiglitazone, and policies were created to encourage disclosure of financial conflicts of interest.

The authors of the Mayo Clinic study arrived at this conclusion: "Disclosure rates for financial conflicts of interest were unexpectedly low, and there was a clear and strong link between the orientation of authors' expressed views on the rosiglitazone controversy and their financial conflicts of interest with pharmaceutical companies.

"These findings, while not necessarily causal, underscore the need for further progress in reporting in order for the scientific record to be trusted."

We're Ready for LSN!

Who's coming to LSN at Navy Pier today? If you're there, be sure to swing by Booth 1518 to meet members of Team ProMed and and our resident superhero, Captain Compliance!

Our team would love to introduce you to our education, resources and products designed to help you improve care, save time and reduce costs. We think you'll agree that our incontinence management products are top-of-the-line, that our skin care products would be a valuable addition to your facility and that our Compliance Blood Glucose Program is virtually pain-free. We'll also have copies of our brand-new magazine, Embrace!

We're also doing an amazing raffle for a trip for two to our Pre-Kentucky Derby Event! See you there!

Long-Term Care Community Has Mixed Feelings Over Illinois IMD Settlement

Over the next five years, thousands of Illinois psychiatric patients could leave nursing homes in favor of community-based settings, part of a landmark legal agreement.

According to the Chicago Tribune, approximately 4,500 mentally ill nursing home residents will be given the option of remaining in large nursing homes that are classified as "institutions for mental diseases" (IMDs) or moving into smaller settings that experts have heralded as more appropriate and less expensive.

The decision is the result of a lawsuit filed in 2005 by the ACLU of Illinois. The suit cited a 1999 Supreme Court ruling, known as the Olmstead decision, that requires states to place residents in the least restrictive setting appropriate to their disabilities.

The long-term care community has responded to the ruling with mixed feelings, according to an article in the online version McKnight's Long-Term Care News. Some groups applaud the decision. Others, like the Alliance for Living, which represents residential care facilities that are dedicated to treating patients with severe mental illness, caution that "Real choice in residential housing for the seriously mental ill means decisions are made jointly by the resident, their family and their doctors, not dictated by lawmakers."

While the decision only covers the 4,500 mentally ill residents in Illinois IMDs, there are at least 10,000 other mentally ill people in the state who live among elderly and disabled residents in nursing homes that are not classified as IMDs.

To learn more about the settlement, click here.

Historic Health Care Reform Bill Heads to Obama's Desk

Even with no support from the GOP, the historic $940 billion health care bill passed the House of Representatives late last night. It was approved by the Senate in December. President Obama is expected to sign off on the bill on Tuesday.

It's been through many rounds of changes - so what's in the bill now? Here are a few highlights, according to CNN.com:

• New health insurance subsidies for families of four who make up to $88,000 a year
• Small businesses, the self-employed and the unemployed will be able to pool their resources to purchase less expensive coverage
• Total out-of-pocket expenses would be limited and insurance companies cannot deny coverage based on pre-existing conditions. Insurers also can't cancel coverage for sick people or charge higher premiums based on gender or medical history.
• Non-dependent children can be covered up until age 26
• The Medicare prescription drug "doughnut hole" will be closed by 2020
• Starting in 2018, a 40 percent tax will be imposed on insurance companies that provide health plans valued at more than $10,200 for individuals and $27,500 for families.
• The Medicare tax will be imposed on investment income for individuals making more than $200,000 and couples making more than $250,000
• The federal government will pick up 100 percent of the costs of expanded Medicaid coverage between 2014 and 2016 and 90 percent beginning in 2020
• Individuals will be required to purchase coverage or face a fine of $695 or 2.5 percent of their income, whichever is greater, starting in 2016. However, there will be a hardship exemption for poorer Americans.
• Companies that have more than 50 employees will be required to pay $2,000 per worker if they don't provide coverage and any of the company's workers receive federal health care subsidies.
• States can choose whether to ban abortion coverage in plans offered in health insurance exchanges. If individuals purchase plans through health insurance exchanges, they will have to pay for abortion coverage from their own funds.
• Illegal immigrants will not be allowed to buy health insurance in the health insurance exchanges.

To view more information on the health care bill as it becomes available, click here.

CMS Reorganization on the Horizon

The Centers for Medicare & Medicaid Services (CMS) is planning an organizational restructuring in the next 60 days, according to an internal agency email obtain by the National Association for the Support of Long Term Care.

Changes will primarily be concentrated in three areas - beneficiary services, program integrity and strategic planning. The email, authored by Acting Administrator and Chief Operating Office Charlene Frizzera, explains that the changes are necessary in order to ensure that CMS is most effectively meeting current requirements as well as preparing for the future.

The proposed new structure establishes the following:

• The position of Principial Deputy Administrator
• The Office of External Affairs and Beneficiary Services
• Four Centers, each led by a Deputy Administrator (Center for Medicare; Center for Medicaid, CHIP and Survey & Certification; Center for Program Integrity and the Center for Strategic Planning)

The email also announced the addition of two new CMS team members - Principal Deputy Administrator Marilyn Tavenner and Deputy Administrator for Program Integrity Peter Budetti.

The proposed realignment has not yet been through the clearance process and has not been signed off on by the Secretary of Health and Human Services, Kathleen Sebelius, but Frizzera noted in the email that she expects the approval and effective date to occur within the next 60 days.

To view the email in its entirety, click here.

AHRQ Reveals Top Five Drug Expenditures by the Elderly

The Agency for Healthcare Research and Quality (AHRQ) has released information on the top five categories of prescription drugs for Medicare beneficiaries age 65 and older. The data is part of the Medical Expenditure Panel Survey, Statistical Brief #280.

The categories, and the total expenses associated with each, are:

1. Metabolic agents ($18.6 billion)
2. Cardiovascular agents ($14.7 billion)
3. Central nervous system agents ($8.4 billion)
4. Gastrointestinal agents ($7 billion)
5. Hormones ($5.4 billion)

According to the brief, just over three-quarters of Medicare beneficiaries with a prescribed drug expense purchased cardiovascular agents (77.3 percent). Metabolic agents were purchased by 57.9 percent, 48.5 percent purchased central nervous system agents, 36.2 percent purchased hormones and 29.8 percent purchased gastrointestinal agents.

Of the top five categories, gastrointestinal agents had the highest price per prescription ($114). Metabolic agents came in at an average of $94, central nervous system agents were $65, hormones were $62 and cardiovascular agents were $40.

To view the statistical brief in its entirety, click here.

Sebelius: Criticisms of Five-Star Quality Rating System Need to Be Addressed

Kathleen Sebelius, Secretary of the Department of Health and Human Services, acknowledged yesterday that although the Five-Star Quality Rating System is an important tool for consumers, criticisms about its shortcomings need to be addressed.

Speaking at the National Council on Aging and The American Society on Aging annual conference in Chicago, Sebelius said "We need to have some standards; they need to be clear, need to be accurately measured and if everyone ends up being excellent or everyone ends up being failing, so be it. But somehow this sort of bell curve seems to have some inherent flaws."

Critics of the rating system have complained about regulators assigning predetermined percentages of facilities either "excellent" or "failing" grades. Sebelius commented, "The last thing we want to do is have an arbitrary bell curve just for the sake of having a system."

To learn more, click here.

AMA Releases New Safety Guide for Older Drivers

It's not an easy conversation, but it's one that needs to happen - it's the discussion about when it's time for senior citizens to hang up their car keys. While a drivers license can symbolize independence, the fatality rate for drivers 85 years and older is nine times higher than the rate for drivers 25 to 69 years old. This rate is higher for two reasons: drivers age 75 and older are involved in significantly more crashes per mile driven, and they're considerably more fragile and likely to suffer a fatal injury in a crash than their younger counterparts.

Fortunately, the American Medical Association (AMA) has released a new Physician's Guide to Assessing and Counseling Older Drivers. The AMA encourages physicians to use the guide to make road safety a routine part of office visits for their senior patients.

The guide covers topics including screening, assessing functional abilities, handling evaluations and referrals, conditions and medications that may impact driving, addressing safer driving and counseling those who are no longer able to drive. Worksheets and resources for older patients and caregivers are also included.

To view the guide, click here.

FDA Slaps Boxed Warning on Plavix

The FDA has slapped a boxed warning - its most severe - on the popular blood thinner Plavix. It warns that some patients may not effectively metabolize the drug (these patients are referred to as "poor metabolizers") and therefore may not receive its full benefits. The FDA estimates that between 2 and 14 percent of the population are poor metabolizers and that the rate varies based on racial background.

The warning also advises healthcare professionals to consider prescribing other anti-platelet medications to poor metabolizers or consider alternative dosing strategies. In addition, the warning alerts healthcare professionals that tests are available to identify poor metabolizers.

Plavix is prescribed to help reduce the risk of heart attacks, unstoppable angina, strokes and cardiovascular death in patients who have cardiovascular disease. The drug works by decreasing platelet activity, making them less likely to form blood clots. In order for the drug to work, a patient's liver must convert, or metabolize, the drug to its active form. Poor metabolizers do not effectively convert Plavix to its active form, making the drug less effective.

The FDA advises patients not to stop taking Plavix unless directed to do so. If you have any concerns about Plavix, or if you want to find out if you are a poor metabolizer, please speak to your healthcare professional.

For more information, please click here.

NPUAP: Not All Pressure Ulcers are Avoidable

The National Pressure Ulcer Advisory Panel's recent consensus conference panelists agreed that unavoidable pressure ulcers may occur with patients who choose not to participate in their own pressure ulcer prevention. To reflect this, the panel issued a new definition of "unavoidable pressure ulcer":

Unavoidable - means that the individual developed a pressure ulcer even though the provider had evaluated the individual's clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with individual needs, goals and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as necessary.

To view the NPUAP's press release on the revised definition in its entirety, click here.

Study: Expensive, Invasive Heart Test May Be Overused

A new study reveals that nearly two-thirds of all people who undergo cardiac catheterization who have not been diagnosed with heart disease receive a clean bill of health. That's troubling, considering that the test is expensive and exposes patients to substantial amounts of radiation.

During the test, a catheter is inserted through the groin and threaded through blood vessels in an effort to examine coronary arteries.

The study's authors concluded that "Better strategies for risk stratification are needed to inform decisions and to increase the diagnostic yield of cardiac catheterization of routine clinical practice."

However, experts noted that just becacuse patients who undergo testing don't have a severe artery obstruction, that doesn't mean they don't need therapy. The test results could still lead to doctors recommending medical treatment or lifestyle modifications. For many, the test can also provide peace of mind and the freedom to be more active.

The study was published in the March 11, 2010 issue of the The New England Journal of Medicine.

"Shocking" News on Defibrillators in End-of-Life Care

There's no denying that implantable cardioverter-defibrillators (ICDs) perform a valuable and life-saving service - but could they be doing more harm than good for patients near the end of life?

According to Dr. Nathan Goldstein, the study's author, it makes no sense for ICDs to continue shocking patients when it does not fix the underlying condition. These shocks may result in unnecessary discomfort for patients and unneeded stress and anxiety for family members.

A study published in March 2 edition of Annals of Internal Medicine found that while 97 percent of hospices admitted patients with ICDs, only 10 percent had a policy that addressed deactivation. An average of 42 percent of hospice patients with ICDs had the shocking function deactivated. Fifty-eight percent of hospices surveyed reported that a patient had been shocked within the year prior to the study.

Goldstein and his team recommend that hospices have policies in place to address situations where ICD deactivation may improve the care for patients with these devices. His team also drafted a provided a sample deactivation policy.

Know Someone Who Needs a Gentle Reminder about Handwashing? Try a CDC E-Card!

Handwashing is the number one way to prevent the spread of germs - but we all know someone who occasionally needs a gentle reminder. The CDC has just the solution - an animated e-card!

The e-card shows a cat washing his hands - er, paws? - and singing a song set to the tune of "Happy Birthday." Individuals are encouraged to keep washing their hands through two refrains of the song to make sure their hands are free of bacteria and grime.

After the e-card plays, recipients can click on links to learn more about proper handwashing technique.

To view and send the e-card, click here. The CDC also has e-cards on other topics ranging from appointment reminders to vaccinations.

Alzheimer's Association: Minorities at Greater Risk

A new report from the Alzheimer's Association revealed that African Americans and Hispanics are at an increased risk of developing the disease. African Americans are about twice as likely to develop Alzheimer's than whites, and Hispanics are about 1.5 times more likely.

The report notes there is no known genetic factor that accounts for these differences. However, health conditions such as high blood pressure, which are prevalent in African American and Hispanic communities, are known to increase Alzheimer's risk.

Interestingly, although African Americans and Hispanics have a higher Alzheimer's rate, they are less likely than whites to have a diagnosis.

The report also includes updated key facts about Alzheimer's disease, including the following:

• 5.3 million people in the United States have Alzheimer's disease
• Alzheimer's in the seventh leading cause of death in the U.S.
• $172 billion is spent annually on Alzheimer's-related costs
• There are 10.9 million unpaid caregivers tending to people with Alzheimer's
• Between 2000 and 2006, Alzheimer's disease deaths increased by 46.1 percent while other causes of death (including stroke, prostate cancer, breast cancer, heart disease and HIV) decreased

To view the report in its entirety, please click here.

RIP, Mary Josephine Ray

Today we bid farewell to Mary Josephine Ray, a woman nobody here at ProMed knew - but that shouldn't stop us all from being inspired by her zest for life.

Ray was the U.S.'s oldest living person. She passed away on Sunday at a Westmoreland, NH nursing home at the age of 114 years and 294 days. She was also the oldest person to ever live in New Hampshire.

What was her secret to longevity? According to her granddaughter, "She just enjoyed life. She never thought of dying at all. She was planning for her birthday party." May would have turned 115 on May 17. Her granddaughter said that Ray remained active and spry up until about two weeks before her death.

Ray is survived by her two sons, eight grandchildren, 13 great-grandchildren and five great-great grandchildren.

Following May's death, the oldest living American is now Neva Morris of Ames, Iowa. Morris is 114 years, 216 days old.

UPDATE: MSNBC.com is reporting that Ray died just hours before Daisy Bailey, who was 113 years, 342 days old. Bailey lived in Detroit, and her family reported that she suffered from dementia.

Have You Checked Out Our Amazon Storefront Yet?

Have you had a chance to visit our Amazon.com storefront? We're currently offering briefs, wipes, barrier cream and hand sanitizer - and everything ships for free! Check it out by clicking here.

Promising Alzheimer's Drug Falls Flat in Clinical Trials

During early testing, the drug Dimebon showed great promise for halting cognitive decline associated with Alzheimer's disease - but in clinical trials, the drug failed.

The drug, developed by Medivation and Pfizer, showed virtually no effect after six months, according to an article in the New York Times. Dimebon showed no difference in treating cognitive decline or behavioral problems associated with Alzheimer's when compared with a placebo.

The results were especially disappointing because in previous testing, Dimebon had performed better than any drug already approved to treat Alzheimer's disease. Results seemed to indicate that it improved cognitive function or staved off mental decline for about 18 months. Current treatments can only stave off decline for about six months.

In the wake of the testing results, shares of Medivation lost two thirds of their value, dropping to $13.10. Shares of Pfizer fell 28 cents, about 1.6 percent, to $17.32.

Need Another Culprit for Flu Outbreaks? Blame Dry Air

The same dry air that wreaks havoc with your skin and causes your hair to stand on end might also make you more susceptible to the flu.

Researchers have found that extremely low humidity levels, such as in those seen in the winter, can fuel influenza outbreaks. Particularly dry spells can also make outbreaks worse.

The researchers found that influenza outbreaks are more likely to occur when absolute humidity levels are low. Absolute humidity is the measure of how much moisture is in the air, regardless of temperature. Progressively drier air leads to a progressively higher likelihood that an influenza outbreak will occur.

However, humidity isn't the only explanation for outbreaks. The virus still needs to be hanging around and people still need to come into contact with it to spread it.

While the study's researchers suggest that humidifying your home might be helpful, they caution that it isn't a replacement for getting vaccinated.

To learn more, click here.

CaviWipes Ideal for Disinfecting Glucometers Between Residents

Since we've had a few questions about CaviWipes' suitability for disinfecting glucometers between residents, we thought we'd clear things up for everyone!

Revised guidance on Tag F441 from CMS now specifies that caregivers need to disinfect glucometers in between residents. After reviewing manufacturer specifications and relevant guidelines, ProMed is confident that CaviWipes are appropriate for disinfecting glucometers as well as other non-porous substances. CaviWipes are the chosen disinfectant for the Compliance BG System.

It is recommended that facilities clean equipment used with residents with a 1:10 dilution of sodium hypochlorite (bleach) or an EPA-registered tuberculocidal disinfectant to reduce the spread of harmful organisms, including HIV, MRSA, VRE and Hepatitis A, B and C. CaviWipes are effective against all of these organisms, plus the following:

• Mycobacterium tuberculosis var: bovis (BCG)
• Pseudomonas aeruginosa
• Salmonella choleraesuis
• Trichophyton mentagrophytes
• Staphylococcus aureus
• Clostridium difficle (C. diff) (vegetative cells only)
• Staphylococcus aureus with reduced susceptibility to vancomycin
• Herpes simplex types 1 and 2
• Influenza A2 virus

CaviWipes kill all of the above-listed organisms within a maximum kill time of three minutes. Surveyors are looking for caregivers to allow a three-minute dwell time for glucometer disinfection between residents. It is suggested that caregivers have at least two glucometers available during glucose testing so that one is always available for use while the other one is drying.

To learn more about CaviWipes and view our statement paper on their suitability for disinfecting glucometers in between residents, please contact your ProMed sales rep.

BD Introduces Microtube Designed with Fragile Veins in Mind

BD Diagnostics has introduced the BD Microtainer MAP Microtube, which was designed to improve the safety, accuracy and turnaround time of collecting blood in patients with fragile veins, such as infants, children, oncology patients and the elderly.

According to the product's press release, the microtube is the first to be totally compatible with most hematology instruments, which reduces the turnaround time and costs associated with blood sample transfer and relabeling. The microtube can also accommodate standard, full-size patient ID labels, helping to reduce the risk of labeling errors and potential misdiagnosis.

The MAP Microtube enables automated processing with 81 percent less blood than venous systems, a critical improvement for patients from whom it is difficult to obtain a sufficient amount of blood to perform crucial diagnostic tests.

To learn more, click here.

CMS Delays Medicare Physician Pay Cut for 10 Days

As of today, Medicare physicians were to begin facing a 21.2% pay cut - but CMS has stepped in and ordered contractors to hold claims for 10 days in the hopes that a solution can be reached in that time.

CMS was compelled to action after the Senate failed to pass legislation that would have extended a number of expiring unemployment benefits and delayed the Medicare pay cut. Last Thursday, the House passed a bill that would delay the pay cut until March 28.

If Congress and the White House are able to enact a delay of the pay cut by the end of the 10-day period and make it retroactive to March 1, physicians shouldn't see any checks come back with the 21.2% cut applied.

The bill's passing is currently being held up by Sen. Jim Bunning (R-Kentucky), who objects to it on the basis that its total cost (about $10 billion) would add to the federal deficit. Roughly $1 billion of the total cost would go toward the physicians' pay freeze. If Bunning doesn't change his vote, the bill will need to go through the regular order, a process that takes more time than a unanimous consent approval.

To learn more, click here.