Some rural hospitals used for big insurance reimbursements thanks to loophole

A CBS News investigation has uncovered a scheme that could make insurance premiums even higher. The scheme involves some rural hospitals that are being used to set up big paydays from providers. CBS News national correspondent Jim Axelrod explains.

From: http://www.cbsnews.com/video/some-rural-hospitals-used-for-big-insurance-reimbursements-thanks-to-loophole/

How some rural hospitals were used to score huge paydays

"I can tell you what was actually funneled through the facility, and that was over $120 million in about 14 months," an attorney says

From: http://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/

Global use of antibiotics soars as resistance crisis worsens

The change was largely driven by a dramatic increase in low-income and middle-income countries, researchers found

From: http://www.cbsnews.com/news/antibiotics-use-soars-as-resistance-crisis-worsens/

A Grand Moment for Doug Walsh - Proton Beam - Mayo Clinic

From: Mayo Clinic https://www.youtube.com/watch?v=FXRofJ6mfvU

So what is it that you do here? Featuring Barb Rechtzigel - New Employee Orientation -

From: Mayo Clinic https://www.youtube.com/watch?v=v-eNg_8XH8U

Hoverboard Injuries Speeding U.S. Kids to the ER

Nearly 27,000 kids landed in the emergency room from a hoverboard accident during the first two years the self-balancing, two-wheeled motorized scooters were sold in the United States, according to a new study.

From: https://www.webmd.com/children/news/20180326/hoverboard-injuries-speeding-us-kids-to-the-er?src=RSS_PUBLIC

Anti-Vaccine Movement Affecting Kids With Autism

Investigators tracked vaccination histories among all of the children through 2015. Vaccination records among younger siblings (born between 1997 and 2014) were also reviewed.

From: https://www.webmd.com/children/news/20180326/anti-vaccine-movement-affecting-kids-with-autism?src=RSS_PUBLIC

Study: Kids with autism, siblings at risk from skipping shots

More parents of children with autism forgo vaccines, putting kids at risk of preventable diseases, new research finds

From: http://www.cbsnews.com/news/vaccine-myth-persists-as-families-affected-by-autism-refuse-shots/

U.S. Opioid ODs Cluster in Centers of Poverty

Of the more than 515,000 Americans who have died from drug overdoses since 2006, most lived in poor areas where there were few job opportunities,  researchers discovered.

From: https://www.webmd.com/mental-health/addiction/news/20180326/us-opioid-ods-cluster-in-centers-of-poverty?src=RSS_PUBLIC

Most With Very High Cholesterol Missing Right Meds

The investigators also looked at a subgroup of patients with familial hypercholesterolemia, a genetic disorder that causes extremely high cholesterol that increases the risk of early heart disease.

From: https://www.webmd.com/cholesterol-management/news/20180326/most-with-very-high-cholesterol-missing-right-meds?src=RSS_PUBLIC

Accidental activist: life changes lead dentist to speak on opioid harms

The knock that changed Dr. Sharon Parsons life came early. It came around 3 a.m. on Sept. 21, 2015. There are no good knocks at 3 a.m. This one brought news that forever changed her life: her oldest son, Sean, overdosed on heroin and was dead at 27.

From: By Jennifer Garvin
https://www.ada.org/en/publications/ada-news/2018-archive/march/accidental-activist-life-changes-lead-dentist-to-speak-on-opioid-harms

New Moms Still Wary of Exposing Infants to Peanuts

For years, doctors instructed parents to delay exposing children to peanuts and other common food allergens, particularly those at high risk for peanut allergy. But this longstanding recommendation was reversed in 2017.

From: https://www.webmd.com/children/news/20180323/new-moms-still-wary-of-exposing-infants-to-peanuts?src=RSS_PUBLIC

Sports 'Sponsorships' Hawk Junk Food to Kids

Overall, 76 percent of foods were deemed unhealthy, and over half of beverages were sugar-sweetened.

From: https://www.webmd.com/fitness-exercise/news/20180326/sports-sponsorships-hawk-junk-food-to-kids?src=RSS_PUBLIC

These are the healthiest communities in the U.S.

Seven of the top 10 counties were located in just two states

From: http://www.cbsnews.com/news/the-healthiest-communities-in-the-united-states/

Outcry after 144 psychiatric patients die during transfer to other facilities

Patients were transferred from a private health care provider to other facilities, and some were not properly licensed

From: http://www.cbsnews.com/news/south-africa-shocked-by-deaths-of-144-psychiatric-patients/

A barber shop where customers get their medical checkups

A visit to the barber usually means a trim, maybe a shave -- and some conversation. CBS News chief medical correspondent Dr. Jon LaPook takes us to a barber shop where costumers also get much needed medical checkups.

From: http://www.cbsnews.com/video/a-barber-shop-where-customers-get-their-medical-checkups/

Many Doctors Don't Push HPV Shots To Boys

HPV is a sexually transmitted virus that can cause cervical, vulvar, vaginal, penile, anal, mouth and throat cancers. The HPV vaccine is recommended as a routine childhood vaccination.

From: https://teens.webmd.com/news/20180326/many-doctors-dont-push-hpv-shots-equally-to-boys?src=RSS_PUBLIC

Dentists say they support limits on opioid prescriptions

New study showing dentist opioid prescriptions rose from 2010-2015 while national trend declined

From: http://www.cbsnews.com/news/dentists-say-they-support-7-day-limits-on-opioid-prescriptions/

Rethinking A1C goals for type 2 diabetes

“Treat the patient, not the number.” This is a very old and sound medical school teaching. However, when it comes to blood sugar control in diabetes, we have tended to treat the number, thinking that a lower number would equal better health.

Uncontrolled type 2 diabetes (also known as adult-onset diabetes) is associated with all sorts of very bad things: infections, angry nerve endings causing chronic pain, damaged kidneys, vision loss and blindness, blocked arteries causing heart attacks, strokes, and amputations… So of course, it made good sense that the lower the blood sugar, the lower the chances of bad things happening to our patients.

Tracking blood sugar control over time

One easy, accurate way for us to measure a person’s blood sugar over time is the hemoglobin A1c (HbA1c) level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months.

Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people (not necessarily including the elderly or very ill), with a lower goal — closer to normal, or under 6.5% — for younger people.

We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didn’t meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still weren’t at goal, then it was time to start insulin injections.

While all this sounds very orderly and clinically rational, in practice it hasn’t worked very well. I have seen firsthand how enthusiastic attention to the A1c can be helpful as well as harmful for patients.

And so have experts from the Clinical Guidelines Committee of the American College of Physicians, a well-established academic medical organization. They examined findings from four large diabetes studies that included almost 30,000 people, and made four very important (and welcome!) new guidelines around blood sugar control. Here’s the big picture.

Doctors and patients should discuss goals of treatment together and come up with an individual plan

Blood sugar goals should take into account a patient’s life expectancy and general health, as well as personal preferences, and include a frank discussion of the risks, benefits, and costs of medications. This is a big deal because it reflects a change in how we think about blood sugar control. It’s not a simply number to aim for; it’s a discussion. Diabetes medications have many potential side effects, including dangerously low blood sugar (hypoglycemia) and weight gain (insulin can cause substantial weight gain). Yes, uncontrolled blood sugars can lead to very bad things, but patients should get all the information they need to balance the risks and benefits of any blood sugar control plan.

An A1c goal of between 7% and 8% is reasonable and beneficial for most patients with type 2 diabetes…

…though if lifestyle changes can get that number lower, then go for it. For patients who want to live a long and healthy life and try to avoid the complications of diabetes, they will need to keep their blood sugars as normal as possible — that means an A1c under 6.5%. However, studies show that using medications to achieve that goal significantly increases the risk of harmful side effects like hypoglycemia and weight gain. To live longer and healthier and avoid both the complications of diabetes as well as the risks of medications, there’s this amazing thing called lifestyle change. This involves exercise, healthy diet, weight loss, and not smoking. It is very effective. Lifestyle change also can help achieve healthy blood pressure and cholesterol levels, which in turn reduce the risk for heart disease. And heart disease is a serious and common complication of diabetes.

Lifestyle change should be the cornerstone of treatment for type 2 diabetes. The recommendations go on to say that for patients who achieve an A1c below 6.5% with medications, we should decrease or even discontinue those drugs. Doing so requires careful monitoring to ensure that the person stays at the goal set with his or her doctor, which should be no lower than 7%, for the reasons stated above.

We don’t even need to follow the A1c for some patients

Elderly patients, and those with serious medical conditions, will benefit from simply controlling the symptoms they have from high blood sugars, like frequent urination and incontinence, rather than aiming for any particular A1c level. Who would be included in this group? People with a life expectancy of less than 10 years, or those who have advanced forms of dementia, emphysema, or cancer; or end-stage kidney, liver, or heart failure. There is little to no evidence for any meaningful benefit of intervening to achieve a target A1c in these populations; there is plenty of evidence for harm. In particular, diabetes medications can cause low blood sugars, leading to weakness, dizziness, and falls. There is the added consideration that elderly and sick patients often end up on a long list of medications that can (and do) interact, causing even more side effects.

The bottom line

There is no question that type 2 diabetes needs to be taken seriously and treated. But common sense should rule the day. Lifestyle changes are very effective, and the side effects of eating more healthfully and staying more active are positive ones. Every person with type 2 diabetes is an individual. No single goal is right for everyone, and each patient should have a say in how to manage their blood sugars and manage risk. That means an informed discussion, and thoughtful consideration to the number.

Sources

Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: A guidance statement update from the American College of Physicians. Annals of Internal Medicine, March 2018.

An overview of the management of diabetes in non-pregnant adults. MGH Primary Care Office Insite, updated June 2016.

Management of persistent hyperglycemia in type 2 diabetes mellitus. UpToDate, updated April 2017.

The post Rethinking A1C goals for type 2 diabetes appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH https://www.health.harvard.edu/blog/rethinking-a1c-goals-for-type-2-diabetes-2018032613452

Infectious Diseases A-Z: Prevent norovirus with good hand hygiene

From: Mayo Clinic https://www.youtube.com/watch?v=BY461Lgfwvc

Mayo Clinic Minute: 3 tips to reduce food waste

From: Mayo Clinic https://www.youtube.com/watch?v=cg5TTNrtJ7U

ADA adopts interim opioids policy

The Association on March 26 announced a new interim policy on opioids that supports prescription limits and mandatory continuing education for dentists.

From: By Jennifer Garvin
https://www.ada.org/en/publications/ada-news/2018-archive/march/ada-adopts-interim-opioids-policy

April JADA examines opioids and dentistry

The April issue of The Journal of the American Dental Association focuses on the subject of opioids and dentistry.

From: https://www.ada.org/en/publications/ada-news/2018-archive/march/april-jada-examines-opioids-and-dentistry

WHO - Contingency Fund for Emergencies - Enabling quick action to save lives

From: World Health Organization https://www.youtube.com/watch?v=qUoJAAMOuIs

Some rural hospitals used for big insurance reimbursements -- and profit

CBS News investigation finds some hospitals have become gold mines for enterprising health care executives looking for a way to quietly make a quick buck

From: http://www.cbsnews.com/news/rural-hospitals-big-insurance-reimbursements-chestatee-regional/

Thousands of kids injured by hoverboards

Hoverboards got bad publicity for bursting into flames – but that wasn't the reason more than 26,000 children ended up in the E.R.

From: http://www.cbsnews.com/news/hoverboard-injuries-26000-children-hurt-in-first-2-years-of-sale/