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Gregoire takes on superbug MRSA

By Carol M. Ostrom
Seattle Times health reporter

Gov. Christine Gregoire wants medical laboratories around the state to report cases of invasive MRSA infections caused by antibiotic-resistant strains of staph bacteria.

In a letter to Washington State Department of Health Secretary Mary Selecky, Gregoire directed that she use her authority to "request" that the labs cooperate.

In addition, Gregoire told Selecky to convene a panel of scientific experts to recommend the best, scientifically sound strategies to monitor and curb antibiotic-resistant organisms, including MRSA, which stands for methicillin-resistant Staphylococcus aureus.

Gregoire also instructed the Health Department to beef up efforts to help local health agencies, hospitals, health-care providers and other institutions educate the public, school officials and businesses about MRSA and how to prevent contracting the infection.

"While I appreciate the work of local public health, school districts and the Department of Health in getting information to our communities, we need to do more," Gregoire told Selecky in the letter received Wednesday.

Citing "increased media attention and public concern" over MRSA cases, the governor directed Selecky to take the actions immediately. Locally, several schools temporarily closed or canceled classes or athletic games to do extensive cleaning after students contracted MRSA infections.

Selecky, who has been known to pass around a bottle of alcohol hand-cleaning gel before sitting down to dinner with friends, said she didn't dispute the governor's orders.

She said her department already has contacted a sampling of the state's 90 medical laboratories to test their willingness to cooperate in the effort.

"The labs said it's not a problem," Selecky said. Such labs now routinely report other information to health authorities, but not all labs are capable of confirming invasive MRSA.

The Health Department already is scouting for members of the scientific panel, Selecky said. Gregoire asked for a report by Jan. 10 so the information can be used "as a sound basis for future action to prevent the spread of this infection."

In the meantime, Selecky said, it's important not to overreact. "One of the things that I think has gotten lost over the last couple of weeks is that it [MRSA] is treatable," she said. Penicillin-class antibiotics don't kill the organism, but other types of antibiotics do, she noted.

The department has recommended that schools contact local public-health agencies when they have MRSA cases rather than close immediately. "I think initially there was such concern that people reacted before consultation," she said.

Much of the concern occurred after a medical journal published a study estimating that the worst infections caused by the pathogen may kill as many as 19,000 people a year nationwide. These infections, called "invasive," can involve bloodstream or lung infections and are much more serious than the more common skin infections.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

Copyright © 2007 The Seattle Times Company

By A. Chris Gajilan
CNN

(CNN) -- Michael Moore's "Sicko," which opened nationwide
Friday, is filled with horror stories of people who are deprived of
medical service because they can't afford it or haven't been able
to navigate the murky waters of managed care in the United
States.
A couple featured in Michael Moore's "Sicko" leave a London
hospital with their newborn.
It compares American health care with the universal coverage
systems in Canada, France, the United Kingdom and Cuba.
Moore covers a lot of ground. Our team investigated some of
the claims put forth in his film. We found that his numbers were
mostly right, but his arguments could use a little more context.
As we dug deep to uncover the numbers, we found surprisingly
few inaccuracies in the film. In fact, most pundits or health-care
experts we spoke to spent more time on errors of omission
rather than disputing the actual claims in the film.
Whether it's dollars spent, group coverage or Medicaid income
cutoffs, health care goes hand in hand with numbers. Moore
opens his film by giving these statistics, "Fifty million uninsured
Americans ... 18,000 people die because they are uninsured."
For the most part, that's true. The latest numbers from the
Centers for Disease Control and Prevention say 43.6 million, or
about 15 percent of Americans, were uninsured in 2006. For the
past five years, the overall count has fluctuated between 41
million and 44 million people. According to the Institute of
Medicine, 18,000 people do die each year mainly because they
are less likely to receive screening and preventive care for
chronic diseases.
Moore says that the U.S. spends more of its gross domestic
product on health care than any other country.
Again, that's true. The United States spends more than 15
percent of its GDP on health care -- no other nation even
comes close to that number. France spends about 11 percent,
and Canadians spend 10 percent.
Like Moore, we also found that more money does not equal
better care. Both the French and Canadian systems rank in the
Top 10 of the world's best health-care systems, according to the
World Health Organization. The United States comes in at No.
37. The rankings are based on general health of the population,
access, patient satisfaction and how the care's paid for.
So, if Americans are paying so much and they're not getting as
good or as much care, where is all the money going? "Overhead
for most private health insurance plans range between 10
percent to 30 percent," says Deloitte health-care analyst Paul
Keckley. Overhead includes profit and administrative costs.
"Compare that to Medicare, which only has an overhead rate of
1 percent. Medicare is an extremely efficient health-care delivery
system," says Mark Meaney, a health-care ethicist for the
National Institute for Patient Rights.
Moore spends about half his film detailing the wonders and the
benefits of the government-funded universal health-care
systems in Canada, France, Cuba and the United Kingdom. He
shows calm, content people in waiting rooms and people getting
care in hospitals hassle free. People laugh and smile as he asks
about billing departments and cost of stay.
Not surprisingly, it's not that simple. In most other countries,
there are quotas and planned waiting times. Everyone does
have access to basic levels of care. That care plan is formulated
by teams of government physicians and officials who determine
what's to be included in the universal basic coverage and how a
specific condition is treated. If you want treatment outside of
that standard plan, then you have to pay for it yourself.
"In most developed health systems in the world, 15 percent to
20 percent of the population buys medical services outside of
the system of care run by the government. They do it through
supplemental insurance, or they buy services out of pocket,"
Keckley says.
The people who pay more tend to be in the upper income or
have special, more complicated conditions.
Moore focuses on the private insurance companies and makes
no mention of the U.S. government-funded health-care systems
such as Medicare, Medicaid, the State Children's Health
Insurance Program and the Veterans Affairs health-care
systems. About 50 percent of all health-care dollars spent in the
United States flows through these government systems.
"Sicko" also ignores a handful of good things about the
American system. Believe it or not, the United States does rank
highest in the patient satisfaction category. Americans do have
shorter wait times than everyone but Germans when it comes to
nonemergency elective surgery such as hip replacements,
cataract removal or knee repair.
That's no surprise given the number of U.S. specialists. In U.S.
medical schools, students training to become primary-care
physicians have dwindled to 10 percent. The overwhelming
majority choose far more profitable specialties in the medical
field. In other countries, more than one out of three aspiring
doctors chooses primary care in part because there's less of an
income gap with specialists. In those nations, becoming a
specialist means making 30 percent more than a primary-care
physician. In the United States, the gap is around 300 percent,
according to Keckley.
As Americans continue to spend $2 trillion a year on health
care, everyone agrees on one point: Things need to change,
and it will take more than a movie to figure out how to get there.

UPMC Presbyterian Shadyside leads state in hospital profits
Wednesday, June 27, 2007

By Dan Fitzpatrick, Pittsburgh Post-Gazette

For the fourth year in a row, UPMC Presbyterian Shadyside is the most profitable hospital in the state, as measured by operating income, earning $177 million in fiscal year 2006.

Its closest competitor, according to figures released today by the Pennsylvania Health Care Cost Containment Council, is the Hospital of the University of Pennsylvania, with $141.6 million.

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The results are proof, said UPMC Chief Financial Officer Robert DeMichiei, that "volume matters."

UPMC operates a local network of 19 hospitals, and the nonprofit argues its size is key to increases in volume and lowering of costs, with functions such as billing, collection and legal services performed at one location instead of 19 and the profits paying for the "best" doctors, the "best" equipment and the "best" buildings, Mr. DeMichiei said.

At UPMC Presbyterian Shadyside, profits were up 18 percent in fiscal 2006 but volume was up as well, with 829 more patients admitted than the year before.

"It is sort of like a cycle," said Mr. DeMichiei. "For us it is a good cycle, a good snowball running down the hill. For small hospitals, it is a vicious cycle." While UPMC is able to "leverage that volume and economies of scale," smaller hospitals are "waging an uphill battle all the time."

UPMC last year released its full financial results for fiscal 2006, with profits of $512 million on revenue of nearly $6 billion.

In southwestern Pennsylvania, UPMC controls four of the five most profitable hospitals, as measured by operating income. After UPMC Presbyterian Shadyside, two separate campuses run as one corporation, there is Magee-Women's Hospital ($35.4 million), UPMC Passavant ($23.6 million) and Children's Hospital ($17.4 million). The other hospital in the top five belongs to the West Penn Allegheny Health System, UPMC's No. 2 rival. West Penn Hospital in Bloomfield made $20.2 million.

The local hospital to lose the most money last year was Aliquippa Community Hospital, with losses of $10.8 million. UPMC Braddock, one of UPMC's 19 hospitals, lost $3.3 million.

Across Pennsylvania, just 10 hospitals accounted for 62 percent of all statewide operating income, with higher margins driven primarily by reimbursements from commercial health insurers rather than Medicare, a trend that has prompted questions in the field about whether employers are paying more than their fair share of the health-care tab.

Fewer hospitals reported losses than the year before -- "a reflection of the fact that the tide is rising everywhere," said Marc Volavka, executive director of the cost containment council. But "the tide is not necessarily raising all boats the same. The report clearly indicates a very small number of Pennsylvania hospitals are doing exceedingly well."



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(Dan Fitzpatrick can be reached at dfitzpatrick@post-gazette.com or 412-263-1752.)

Social Security Numbers Displayed On UPMC Mailers

POSTED: 4:18 pm EDT May 22, 2007
UPDATED: 4:27 pm EDT May 22, 2007

The region's largest health care provider is accused of sending out mailers with recipients' Social Security numbers in plain view through the window on the envelopes.

The University of Pittsburgh Medical Center mailers were sent to 6,000 former patients. The letters inside asked for donations.

The mailing used a tracking code for each recipient, but the tracking code included the person's Social Security number.


A UPMC spokesman said anyone looking at the envelope would not have recognized the numbers as Social Security numbers and said the risk of identity theft due to the problem is very low.

UPMC officials said they know of no identity theft tied to the mailing so far.

The health care giant sent letters to those affected, apologizing for the oversight, and offered to pay for credit-monitoring services.

The latest incident comes a month after it was discovered that dozens of patients' Social Security numbers and other personal information were posted on the Web site for the UPMC Radiology Department for as long as two years.


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UPMC chief's payout hits $3.3 million
Wednesday, May 23, 2007

By Dan Fitzpatrick, Pittsburgh Post-Gazette

On paper, it looks large -- and is. University of Pittsburgh Medical Center Chief Executive Officer Jeffrey Romoff collected $3.3 million in compensation in fiscal 2006, up 17 percent from the year before.

But the nonprofit that derives one-third of its revenue from for-profit ventures argued that Mr. Romoff's pay was appropriate given the "size, complexity and accomplishments" of UPMC, a $6 billion organization with 43,000 employees and 19 hospitals. And a compensation expert didn't necessarily disagree, though he noted Mr. Romoff's overall payout was larger than that of CEOs at most hospital systems.

For the fiscal year that ended last June, Mr. Romoff received a base amount of $958,482 and "incentive compensation" of $2.3 million , according to the Oakland hospital conglomerate's annual filing with the Internal Revenue Service. Mr. Romoff also received pension plan contributions of $32,915 and an additional $36,995 for taxable expenses such as a car allowance, spousal travel, legal and financial counseling.

When compared with 47 other hospital systems across the United States with more than $1.5 billion in revenue, Mr. Romoff's base salary of $958,482 is slightly higher than the $902,000 average, according to Tom Pavlik, managing principal of compensation consulting firm Sullivan, Cotter & Associates Inc. in Chicago.

But his total compensation of $3.3 million -- which includes an incentive bonus and is tied to such benchmarks as profits and revenue increases -- is considerably higher than the $1.3 million average for hospital system CEOs surveyed by Sullivan, Cotter. But Mr. Pavlik acknowledged that UPMC, because it is so large and "complex," is tough to match against other health-care systems in the country .

UPMC general counsel Robert Cindrich said Mr. Romoff's compensation is "mid to high" when compared with other hospital CEOs.

But he also suggested that UPMC, the region's largest employer that is moving its headquarters to the top of the 64-story U.S. Steel Tower, is closer in size and complexity to Pittsburgh's top for-profit corporations.

He noted that the 50 highest-paid CEOs in the Pittsburgh area, as measured by the Post-Gazette, earned an average of $6.7 million in 2006, twice what Mr. Romoff made. By comparison, Mr. Romoff's pay is "paltry," Mr. Cindrich said.

The inclusion of Mr. Romoff's salary in the annual IRS form is new for UPMC -- in the past, it was not fully disclosed because Mr. Romoff technically worked for "Managed Care Advisory Services," a management company under contract with UPMC to provide Mr. Romoff's services, Mr. Cindrich said. But the hospital giant has decided to be more transparent in reporting its finances and pay, much like public companies do, he said. " We didn't like the idea that you couldn't find it easily."

In all, UPMC paid seven people more than $1 million last year, including Senior Vice President Elizabeth Concordia ( $1.08 million); Ron Forsythe, the former vice president of facilities ($1.2 million); and clinicians James Luketich ($1.4 million), Amin Kassam ($1.07 million), Michael Horowitz ($1.07 million), and James Kang ($1.03 million).

Nonprofit insurer Highmark Inc. had six people top $1 million in 2006, including Chief Executive Officer Kenneth Melani, who collected $3.2 million. UPMC's No. 2 hospital rival, West Penn Allegheny Health System, paid three doctors more than $1 million. Its president, Jerry Fedele, was paid $843,752.



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(Dan Fitzpatrick can be reached at dfitzpatrick@post-gazette.com or 412-263-1752.)

Study: iPods Can Make Pacemakers Malfunction
By Debra Sherman, Reuters
May 11, 2007


CHICAGO (Reuters) iPods can cause cardiac implantable pacemakers to malfunction by interfering with the electromagnetic equipment monitoring the heart, according to a study presented by a 17-year-old high school student to a meeting of heart specialists on Thursday.

The study tested the effect of the portable music devices on 100 patients, whose mean age was 77, outfitted with pacemakers. Electrical interference was detected half of the time when the iPod was held just 2 inches from the patient's chest for 5 to 10 seconds.

The study did not examine any portable music devices other than iPods, which are made by Apple Inc.

In some cases, the iPods caused interference when held 18 inches from the chest. Interfering with the telemetry equipment caused the device to misread the heart's pacing and in one case caused the pacemaker to stop functioning altogether.

The study was held at the Thoracic and Cardiovascular Institute at Michigan State University. The results were presented at the Heart Rhythm Society annual meeting in Denver.

Jay Thaker, lead author of the study and a student at Okemos High School in Okemos, Michigan, concluded that iPod interference can lead physicians to misdiagnose actual heart function.

Thaker, whose father is an electrophysiologist and whose mother is a rheumatologist, said he asked his dad about a potential interaction between pacemakers and iPods.

"We looked online but didn't see anything. Then, one of his patients asked him if there would be a problem, so (my father) put me in touch with Dr. Krit (Jongnarangsin)," Thaker said in a telephone interview.

Jongnarangsin, a long-time friend of Thaker's father, is the senior author of the study and an assistant professor in the Division of Cardiovascular Medicine at the University of Michigan.

"Most pacemaker patients are not iPod users," Jongnarangsin said. For that reason, he said, it is unclear how often iPods cause misdiagnosis.

"This needs to be studied more," Jongnarangsin added.

Thaker said he is interested in doing a similar study about how implantable cardioverter defibrillators, known as ICDs, are affected by iPods.

Labels: cardiac, ipod, pacemakers

Gabcast! HonestMED #1

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Once again patients rights have been violated by the health care system
refer: UPMC patients' personal data left on Web
(http://www.post-gazette.com/pg/07102/777281-114.stm)
What can a patient do to prevent health care providers from accessing
Social Security Numbers? HonestMed is offically launching a fact finding
investigation into how to safe guard SS# and your confidental information
from use at will by health care insurance providers and hospital
organizations.
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