That's because NYS stinks at their rules and regs....the state and the feds aren't even on the same page.......not to mention this state is all about "The Consumer" and pratices obfuscation and compensation rather than truth and justice.......a sad state we are in, the word accountability has been thrown all over like a dirty washcloth.....and the large amount of immigrants-legal and illegal are not from the history and/or traditions that the 3rd and 4th generations are from,,,however they are willing to work for small wages--until they learn 'the truth' about better paying or even less stressful jobs........like those lucrative state jobs......

JMHO

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New York’s nursing homes just want the easy patients

    I’m writing to empathize with Janice Mix, who wrote that local nursing homes shut out her husband because he suffers from a mental illness [May 6 Gazette].
    My mother passed away last November; she suffered from senile dementia and heart failure. She had spent all of her life living in the Capital Region, attending local schools, raising a family, going to church, paying taxes. When her dementia started to progress, she moved into assisted living. That was fine until she started to wander. We moved her to a facility that advertises itself as being a “memory care residence.” They should add in parentheses to their advertising that they are a memory care residence as long as the individual is easy to control (i.e., is in a wheelchair, uses a walker or is slowmoving) and not mobile, determined and/or stubborn.
    When Mom would try to leave the residence because she was confused (she had dementia!) or would be combative or difficult to handle, the staff would call 911 so that the paramedics or emergency responders would have to deal with her behavior, because they didn’t seem capable.
    After a short time in this facility, we were told that she needed to be placed in a nursing home. She stayed in the geriatric psychiatric wing of the Troy Samaritan Hospital for two months until we could find a nursing home that would admit her. And where did she spend the last two years of her life? In Massachusetts, over an hour away from where she had spent the previous 81 years of her life; away from her children, her only grandchild, everyone and everything that was near and dear to her — because New York nursing homes do not have to accept patients and don’t have to give any reason for denying admission.
    When she left the hospital to go to Massachusetts, she could still communicate and still walk on her own; shortly after moving into the nursing home, she was no longer able to communicate with us and her mobility diminished and she was soon confi ned to a wheelchair. I’m sure we could have found placement for her back in New York because she was no longer a “behavior problem” or a “flight risk,” but by that time her health was fragile, and we had no way of knowing how such a move would affect her.
    As far as I’m concerned, New York cheated my family out of two years that we could have spent closer to my mother. Janice Mix should keep fighting for her husband — why are New York’s nursing homes allowed to turn people away and not give them a valid reason, or any reason at all?
    VIRGINIA KIRBY
    Schenectady

The help isn't there.....and if the 'proper' help was there---WE COULDN'T AFFORD IT........and we think gas is expensive----

THERE IS NO WAY OUR 'HEALTHCARE SYSTEM' WILL BE ABLE TO COPE WITH NUMBER OF AGED BOOMERS, MUCH LESS DEMETIA(DEMENTED) BOOMERS,,,,,,SOME OF WHICH HAVE A LARGE AMOUNT OF DRUG ABUSE, ILLEGAL AND LEGAL(MOTHERS LITTLE HELPER, ETC).......

society is UPSIDE DOWN----the aged in our society have 'no value'----they are trumped ALL the time by the ignorant, pompas, self serving youth of today.....we reap what we sow.......

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For cancer patient, wait for miracle drug was too long
BY ROBIN PENICHTER For The Sunday Gazette

Robin M. Penichter lives in Broadalbin. The Gazette encourages readers to submit material on local issues for the Sunday Opinion section.

    Tiny spiders crawled all along the stems of the unruly, fragrant lilacs as they splayed out in the back of my vehicle, a memory of a gift from my father a few springtimes before his confinement to a wheelchair.
    My father had a penchant for flowers. I thought of this as I tried to distract my brain from the reality of what the oncologist was saying as he confirmed the results of my father’s liver biopsy: primary liver cancer.
    The liver is one of the body’s largest organs. It helps metabolize food and medicine absorbed from the intestines into the blood stream, produces bile to aid in the digestion of fats, and stores energy-producing glycogen (sugar).
    Primary liver cancer is a relatively rare form of cancer in the United States and, in its advanced form, a diagnosis was historically a definitive and quick death sentence. The disease is curable by surgical intervention or a liver transplant, but only if the tumor is small.
FDA APPROVAL
    For my father, as for almost all patients diagnosed with an advanced case, surgery or liver transplantation was not a viable option. So when the doctor announced, in his upbeat and no-punches-pulled manner, that there was an option, a so-called “miracle drug” on the recently (three months) approved Federal Drug Administration (FDA) list of cancer treatment drugs, rays of light began to break through the darkness of the knowledge that my father had a terminal illness.
    The miracle drug, Nexavar, was approved by the FDA in 2005 for the treatment of advanced renal cancer. The statistics for a prolonged life of quality for patients was astounding, especially since at the time there were no other drugs to treat it. Approximately three months before my father’s diagnosis (October 2007), the FDA had also approved Nexavar for the treatment of primary liver cancer.
    In layman’s terms, the drug targets and destroys only the cancerous cells within the affected organ without harming healthy cells, such as the case with radiation and/or chemotherapy. It was a revolutionary and much-needed pharmaceutical breakthrough for a particular group of cancer patients already in a state of compromised immunity.
    The process of red tape and paperwork began for the life-saving drug that my father needed. My parents, living on a fixed income of Social Security and various small pensions, were advised that for $6,000 a month, my father would be given a real chance to fight this cancer. Fortunately, they were also advised of an organization that assists people who cannot afford $6,000 a month for life-saving medication. The National Organization of Rare Diseases is a notfor-profit organization that offers financial assistance to people such as my father.
    So, my family began our journey. It took several weeks, due to paperwork, proof of eligibility for financial assistance, telephone calls, more paperwork, more proof of eligibility, mailing and faxing of forms, before my father’s HMO and National Organization of Rare Diseases reached an agreement. Finally, one Tuesday afternoon, a package containing a 30-day supply of the miracle drug arrived via Federal Express.
    Unfortunately, the time it took for this medication to find its way to my parents’ doorstep was just too long. During these weeks, my father’s health rapidly deteriorated. His body was now rejecting food and certain fluids. He had an appointment to see the oncologist for an examination to see if he was strong enough to undergo this pharmaceutical therapy.
    The day of my father’s scheduled appointment with the oncologist, my parents came to a mutual, difficult and painful decision. My father was not even strong enough to travel to the doctor’s offi ce.
TIME TO DECIDE
    It was clear that it was now time for our family to accept death on my father’s terms.
    For two more weeks my family would care for my father, assisting him in eating popsicles and with pain medication. No more doctors, no more trips to the emergency room. He was in control of his own destiny now.
    My father died peacefully with his family and a close friend by his side. The miracle drug remained unopened in its Federal Express box, until it was donated to the oncologist with the hopes that it could save another cancer patient three weeks of excruciating anticipation.

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So when the doctor announced, in his upbeat and no-punches-pulled manner, that there was an option, a so-called “miracle drug” on the recently (three months) approved Federal Drug Administration (FDA) list of cancer treatment drugs, rays of light began to break through the darkness of the knowledge that my father had a terminal illness.

I find diseases that take away a persons life, light and hope to be an 'enemy' in a sense....although I feel them to be opponents on the enemy's side....I find it very disheartening to have the medical profession tout "miracle drugs/therapys" to someone who just had a bomb dropped in the middle of their 'home country/life' to be very shortsighted.....although I have never been diagnosed with a terminal disease, I have taken care of many folks who have....and as a nurse or MD more than 1/2 the battle lies in the conversations had with family/loved ones/patient about the NOW...not the drugs, effects etc....it is very easy for most of use to make our conversation about 'the disease'....and now it has been divided further into Hospice...I respect hospice and what they do, but, there is a disconnect and a switch is turned off when a patient is 'passed' from life to death while still breathing....this is also true of us when we age and become old---it seems to be considered a disease of some sort.....

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NEW YORK STATE
Hospitals get mixed review Infections up but survival rate from procedures better
BY VALERIE BAUMAN The Associated Press

    The rate of hospital infections has increased in New York, and it’s a trend that could indicate many more infections are occurring than can be tracked, according to the lead author of a statewide hospital report.
    An association of health care plans in a new report found that about 3,200 of 1.45 million cases resulted in a hospital-acquired infection in New York, up from about 2,900 out of 1.48 million the year before.
    The number appears small, but “that’s just the tip of the iceberg,” said Bruce Boissonnault, the lead author of the study and president of the Niagara Health Quality Coalition.
    “I would say it’s a small fraction of the infections,” he said. “For example, many people do not show symptoms of an infection until they’re discharged, and those patients would not be in that sample [used in the study].”
    The risk of infection is also a growing concern because it’s the first time a health trend has worsened since the Niagara Health Quality Coalition started conducting the study six years ago.
    Overall, state hospitals are improving: New Yorkers are less likely to die from having a hospital procedure than they were a few years ago. In 2002, hospitals had a mortality rate of 8.5 percent for eight inpatient procedures the study evaluated. That dropped to 7.4 percent in 2006.
    State Health Department spokesman Jeffrey Hammond said that since 2007, all New York’s acute care hospitals have been required to report certain hospital-acquired infections, including central line and colon and cardiac surgical site infections. This year, hip replacement surgery was added to the list. He said they will review the coalition’s findings.
    “While it may be possible that infec- tion rates are getting worse, it may also be true that hospitals are more vigilant at reporting infections, and that’s good news for patients,” Hammond said. The department plans to use its information to educate providers and patients about problems and identify quality control improvements to replicate statewide, he said.
    The 2008 New York State Hospital Report Card is a consumer tool for comparing hospital performance on specific procedures and specialties.
    The card rated all the state’s 243 acute care hospitals on 31 common procedures, treatments and ailments. In many cases, it evaluated the likelihood of death depending on what procedure was conducted at which hospital.
    “The kind of information that they [the coalition] put out is the kind of information that consumers need and the state should be doing it,” said Blair Horner of the New York Public Interest Research Group.
    The ratings use a star system, with one star indicating a hospital has below-average performance and three stars above-average performance. The system uses federal measures for hospitals as a benchmark.
    Just because a hospital has a stellar reputation for one procedure doesn’t mean it will excel in other areas, Boissonnault said. A one-star rating doesn’t mean New Yorkers should start changing doctors, either, he said.
    “Just because you go to a hospital that’s a three-star hospital, that doesn’t mean you’re going to have a good outcome,” Boissonnault said. “You know about the outcomes of other people. So a one-star rating does not mean this is a bad hospital. In fact, a two-star hospital in New York state is pretty good.”
    The report card described the volume of procedures handled by a facility, which Boissonnault says is an indicator of experience. For example, patients having a hip transplant may want to use the site to determine which nearby hospital tends to perform that procedure regularly.
    The study included abdominal aortic aneurysm repair, hip replacement, coronary artery bypass grafts, esophageal resections and the success of vaginal births after Caesarean section delivery.

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Brain pacemakers may ease depression
BY LAURAN NEERGAARD The Associated Press

    WASHINGTON — It’s a new frontier for psychiatric illness: Brain pacemakers that promise to act as antidepressants by changing how patients’ nerve circuitry fires.
    Scientists already know the power of these devices to block the tremors of Parkinson’s disease and related illnesses; more than 40,000 such patients worldwide have the implants.
    But psychiatric illnesses are much more complex and the new experiments with so-called deep brain stimulation, or DBS, are in their infancy.
    Only a few dozen patients with severe depression or obsessivecompulsive disorder so far have been treated in closely monitored studies.
    Still, the early results are promising. Dramatic video shows one patient visibly brightening as doctors turn on her brain pacemaker and she says in surprise: “I’m starting to smile.”
    And new reports this month show that some worst-case patients — whose depression wasn’t relieved by medication, psychotherapy, even controversial shock treatment — are finding lasting relief.
    Six of 17 severely depressed patients were in remission a year after undergoing DBS and four more markedly improved, and more than half of 26 obsessive-compulsive patients showed substantial improvement over three years, say studies from a team at the Cleveland Clinic, Brown University, and Belgium’s University of Leuven.
    “Not all patients get better, but when patients respond, it’s signifi - cant,” says Dr. Helen Mayberg of Emory University, who has implanted about 50 depression patients.
    Her first remains in remission after five years; she estimates that four of every six show enough improvement to be classified “responders.”
    “We’re rewiring the brain in many ways,” says Dr. Ali Rezai, chief of the Cleveland Clinic’s Center for Neurologic Restoration.
    There’s a need for innovative therapies. Up to 20 percent of depression patients and 10 percent of those with obsessive-compulsive disorder are treatment-resistant — several million people in the U.S. alone.
    The rationale behind DBS is credible, says Dr. Wayne Goodman of the National Institute for Mental Health: Surgery sometimes helps worst-case patients by destroying misfiring patches of brain tissue. The electrodes are placed into similar spots, but don’t destroy tissue — the electrical signals can be adjusted and turned off.
    But it’s not yet ready for primetime, Goodman cautions. He worries that because the electrodes already are widely available, centers without proper training will start offering the $40,000 implant surgeries to psychiatric patients before science proves if they’re really valuable.
    “It is an invasive, experimental procedure,” he warns, with risks including bleeding in the brain and infections. He calls DBS “the last resort for stringently selected patients.”
    Earlier this month, federal health officials and the Cleveland Clinic brought together the field’s leading researchers to highlight progress so far and debate if it’s time for much larger studies — even whether DBS might be tweaked to help people with traumatic brain injuries, such as Iraq war veterans.
    “There’s not enough awareness of what the potential is of this kind of stimulation,” says meeting cochair Dr. Margaret Giannini, who heads the government’s Office on
Disability.
    In deep brain stimulation for Parkinson’s, a wire is implanted within a walnut-sized area known as the thalamus, a hub of sensory information.
    That electrode is connected by a cable running through the neck to a pulse generated under the collarbone. Tiny electrical zaps disable overactive nerve cells, blocking tremors.
    Scientists don’t have nearly as much understanding of what goes awry to cause depression or other psychiatric illnesses — but they do know the thalamus isn’t the right spot for those patients.
    They’re focusing instead on two regions with names only a neurologist could love — the ventral capsule/ventral striatum and socalled Brodmann Area 25. Ignore the names; the point is that these are regions where brain circuitry involved in mood and anxiety intersect.
    It’s not yet clear who should have DBS in which spot, or if there are still other target areas.
    Much of the research to date has been funded by electrode manufacturers, with some paid for by the government — and consists of measuring patients’ disability before and after DBS, not more rigorous studies that randomly assign patients to treatment.
    Still, Diane Hire of Cleveland, the patient whose first smile was recorded, illustrates the hope.
    The 12-year Navy veteran was medically discharged for depression and spent a decade on disability, unable to function.
    “I basically felt like a dead person walking. I had no feelings, no emotions,” she told the scientists’ meeting.
    Her DBS was switched on in January 2007, and “my whole world changed,” says Hire, 54. She’s not back to work yet: “It is a real challenge to learn how to live as a healthy person again,” she adds, saying she doesn’t handle stress or multitasking well.
    But, “I wake up every day looking forward to what’s ahead.”

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Brain pacemakers may ease depression

would that be a TV/computer hardwired into the brain??? A Clockwork Orange anyone????

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Medicare won’t pay for hospital-acquired injuries
BY JAMES SCHLETT Gazette Reporter

    All of those people with red socks shuffling down the corridors of Albany Medical Center are not early harbingers of the holiday season.
    Instead, they are the early signs of a Medicare payment policy change that is threatening hospitals’ bottom line and commercial health plan rates.
    Albany Med last year starting issuing the red footwear to patients deemed at high risk of falling. The socks have rubber bottoms and provide visual cues to hospital staff that the patients wearing them are a little wobbly.
    The apparel is one of many new tools medical professionals are adding to their arsenal for the fight against hospital-acquired conditions. HACs, as they are called, are injuries or ailments patients receive after admission.
    Starting this Wednesday, the Centers for Medicare and Medicaid Services will cease paying hospitals for the extra care they have to provide to treat HACs, such as falls, pressure ulcers and catheter-associated infections.
    Many CMS-defined HACs are often considered “never events” — things that should never happen in a hospital.
    “They’re telling us this list is just going to get longer every year. They’re just going to stop paying for our mistakes,” said Louis Filhour, Albany Med’s senior vice president of clinical quality.
    And those mistakes are costly. According to a 2002 Institute of Medicine report, medical errors, including those that result in HACs, are behind 98,000 deaths annually and up to $29 billion in billings.
SWALLOWING COSTS
    After Wednesday, hospitals will have to swallow costs stemming from errors in care for Medicare patients — a move that could chip away at already thin profit margins and limit their ability to invest in workers or technology. CMS estimates the HAC provisions will save Medicare $21 million during the federal government’s 2009 fiscal year, which starts Wednesday.
    “It’s going to start limiting the resources to provide the care,” Filhour said.
    However, area hospitals in recent months have implemented a series of preventative measures to make sure it does not come to that. To further address the problem of patient falls, Albany Med also altered its rounding practices, which involves nurses periodically checking on patients.
    Not wanting patients to put themselves at risk of falling by getting out of bed without assistance to go to the bathroom, Albany Med now requires nurses to check in on patients every two to three hours. The nurses see if patients have to go to the bathroom “rather than wait for the patient to get to that point,” Filhour said.
    Also concerned about falls, Ellis Hospital has installed several beds with sensors that alert nurses when patients are getting up. The Schenectady hospital also installed low-rise beds that are easier to get out of than regular beds, and it placed cushioned matting around beds.
    “I don’t think it’s going to be a burden for hospitals,” said Cindee McGuire, Ellis’ vice president of quality care.
    Under the policy change, CMS will only pay for the treatment of conditions that were present when a patient was admitted into the hospital. For example, if a patient has a stroke and dislocates his kneecap, CMS will fully reimburse the hospital the estimated $6,177 it costs to treat both conditions. But if that stroke patient broke his leg after being admitted to the hospital, its Medicare payment would be only $5,348, according to CMS.
    With the Medicare policy change hinging on conditions that are “present on admission,” Northeast Health in Troy has intensifi ed its screening of patients as they enter its hospitals. Northeast, which owns Albany Memorial Hospital and Samaritan Hospital in Troy, in March upgraded its electronic medical records system by rolling out a nursing documentation module.
    The module enables nurses to electronically note any minor conditions that are present on admission but can worsen during a patient’s stay at the hospital. The electronic notes help ensure Northeast will not get stuck with the bill if a red rash that was present on admission turns into a pressure ulcer.
    “We did it all the time, but it was on paper. But now it’s on the computer and can be used at the time of discharge,” said Dr. John Collins, Northeast’s chief medical officer.
    The impetus behind CMS’ new stance on HACs came from the Deficit Reduction Act of 2005. The law authorized the secretary of the Department of Health and Human Services to draw up a list of HACs deemed “reasonably preventable.” The federal agency developed a list of preventable HAC categories and last year required hospitals to begin reporting whether certain conditions listed on claims were present on admission.
    The American Medical Association in July voiced “strong over-arching concerns” about the Medicare policy changes and its “all or nothing” approach toward HACs.
    The Chicago physicians organization disagreed with CMS that certain medical conditions and complications are “reasonably preventable.” It also argued that some conditions lie dormant and are not detectable during admission.
    “Under an ‘all or nothing’ approach, hospitals may have an incentive not to treat high-risk patients that are likely to develop an HAC even though evidence-based guidelines are followed,” AMA Executive Vice President and Chief Executive Officer Dr. Michael Maves said in a July 13 letter to CMS’ acting director.
    Hospitals were initially required to report on 30 quality measures, but CMS in July increased that fi gure to 42. CMS will shave 2 percent from scheduled reimbursement rate increases for hospitals that fail to properly report the quality measures. Many New York hospitals have profit margins of about 2 percent.
    “If they’re losing money in the Medicare business, they will probably try to get it out of the commercial business,” Laurel Pickering, executive director New York Business Group on Health, a New York nonprofit coalition of 150 businesses that advocates a market-driven health care system.
FIRST STEP
    Pickering called the Medicare policy change a “good first step because we have to start paying for results and outcomes, as opposed to the current system where we pay for volume.” But she also warned that hospitals might try to shift costs incurred from HAC care not covered by Medicare onto commercial health plans by raising rates for other treatments.
    “Obviously, we’re always concerned about cost shifting, but I think our feeling is we hope it does not happen here,” said Leslie Moran, president of the New York State Health Plan Association, an Albany trade organization that represents health insurers statewide.
    Following CMS’ lead, a growing number of private health insurers have recently established policies against paying for certain HACs. They include Aetna in Hartford, Cigna in Bloomfield, Conn., and WellPoint in Indianapolis, the parent of Empire Blue Cross Blue Shield in New York.
    Capital District Physicians’ Health Plan spokeswoman Kristin Marshal said the Albany health plan will monitor the impacts of the Medicare policy change: “We haven’t made any decisions on whether we will follow suit on the present on admission issue.”
    MVP Health Care in Schenectady is working on the issue of billing practices for HACs with the Healthcare Association of New York State, or HANYS, an Albany trade organization that represents hospitals statewide. MVP spokesman Gary Hughes said many New York hospitals have agreed not to bill for HACs because of Medicare’s decision to not pay for them.
    “We decided to do it cooperatively rather than contentiously by working with the hospital association,” Hughes said.
PREPARING FOR CHANGE
    HANYS has been advising its member hospitals on ways they can prepare for the Medicare policy change. And the changes hospitals are implementing are coming at their own expense.
    “We’ve just had to get smarter at what we’re doing,” Filhour said.
    Albany Med last year started using silver-tipped catheters that are four times more expensive than their all-plastic counterparts. But Filhour said the more sterile silver catheters deliver a payoff in the form of reduced usage of antibiotics for infections.
    Ellis in May installed 36 hydraulic beds in its intensive care unit. The expensive beds automatically move patients lying in them to reduce the risk of pressure ulcers.
    To cut down on infections caused by catheters running into vascular arteries near the jugular vein or the collar bone, Ellis six months ago also began applying Biopatch dressing to those injection sites. The antiseptic skin patches provide an extra layer of protection against infectious microbes.
    “It does add to the cost of patient care, but that’s not the focus,” Mc-Guire said.