Medicare patients treated at top-rated hospitals nationwide across the most common Medicare diagnoses and procedures are 27 percent less likely to die, on average, than those admitted to all other hospitals, according to a study released today by HealthGrades. Patients who undergo surgery at these high-performing hospitals also have an average eight percent lower risk of complications during their stay.

The study identifies hospitals in the top five percent nationally in terms of mortality and complication rates across 26 procedures and diagnoses, from heart attacks to total knee replacement. Hospitals achieving this level of care are designated as Distinguished Hospitals for Clinical Excellence™ by HealthGrades and are identified on the organization’s consumer Web site, HealthGrades.com. Many hospitals excel in a given service line, but what differentiates these top hospitals is their quality achievement across a broad range of procedures and treatments.

The 2009 study of Medicare patients found that 152,666 lives may have been saved and 11,772 major complications avoided during the three years studied, had the quality of care at all hospitals matched the level of those in the top five percent. The difference between these top hospitals and the rest of the pack highlights a distinct gap between them.

We all new that with the new political regime coming into place that there would be sizable changes in the health care industry.  However, I’m not sure if anyone was prepared for massive alterations that would be proposed so soon in the beginning.  Aftern reviewing the new HITECH Act, I was both pleasantly surprised and dismayed at the new Houst Stimulus bill.  With a proposed $20 billion dollars to be distributed for economic and clinical health, this would be one of the largest health care centric bills that has come through Washington in some time.  First, here are the positives that the bill entails:

• ONCHIT budget to increase 3x to $250 million dollars for 2009, this is up from the $61 million spent in 2008.
• HITSP and NeHC become key advising entities to ONCHIT, HITSP on standards and NeHC on HIT policy.
• National Institute of Standards & Technology to take a leadership role in testing standards and implementation specifications.
• Substantial amount of writing on privacy, particulary consumer notification process should their health information be compromised.
• Bill also instructs ONC chief to appoint a CPO, a Chief Privacy Officer.
• $300 million on RHIOs.
• An extension program for HIT.

Now for the controversy.  The Bill has included the term ‘Certified EHR’, and states:

“The National Coordinator, in consultation with the Director of the National Institute of Standards and Technology, shall develop a program (either directly or by contract) for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle…’

What does this mean?  Simply said this would mean that any reimbursements, payments and anything coming out of the $20 billion will only be supplied when a ‘certified’ EHR has been utilized.  This would result in a slowdown in innovation.  Anytime the Government places funding prerequisites like this it forces the industry to follow unnecessary guidelines as opposed to moving forward with developing new technology to enhance the medical market.

To battle this portion of the Bill, make sure to contact your local representative ASAP.

In response to a recent announcement by Director Cindy Ehnes from the Department of Managed Health Care about new rules requiring California HMOs to provide translation services for patients with limited English ability, Donald Crane, President and CEO of the California Association of Physician Groups (CAPG), issued the following statement:

“We applaud Director Ehnes and DMHC for their leadership on this issue. California is the most diverse state in the nation and it is only fitting that our health care providers can communicate effectively with their patients. As California’s largest network of healthcare providers, CAPG’s doctors have provided translation assistance and other culturally competent healthcare services to their patients since their inception in 2003. In addition, California’s physician groups constantly strive to provide the highest quality care to their patients. CAPG works with their physician groups’ key strength — coordinated approaches to population care — to overcome the clinical, economic, and community consequences of health disparities. The organization promotes expanded education of healthcare professionals in cultural responsiveness, engagement of practitioners with special knowledge, development of expanded community networks, and collaboration with government, academic, and professional organizations with similar interests. We look forward to sharing our experiences and established practices with DMHC and other healthcare leaders in order to ensure that language and cultural differences are never barriers to quality care.”

Popular osteoporosis drugs such as Merck’s Fosamax and other similar drugs might carry a risk of causing esophageal cancer, reported the U.S. Food and Drug Administration. The FDA’s division of drug risk assessment states researchers should check into potential links between so-called bisphosphonate drugs and cancer.

A letter to the New England Journal of Medicine noted that since the initial marketing of Fosamax, known generically as alendronate, the FDA has received twenty-three reports in which patients developed esophageal tumors. The report has now been expanded to include more than forty reported cases of esophageal cancer and fourteen deaths.

Esophagitis, which is an inflammation of the lining of the tube carrying food to the stomach, is already a known side effect of the drugs, which is why patients are instructed to remain upright for at least a half hour after taking them. The ever-expanding list of side effects linked to bisphosphonates includes osteonecrosis, severe bone and joint pain, sudden low energy leg fractures, and irregular heart rhythms.

“The fact that these drugs deposit in the bone suggests that patients may risk experiencing one or more of these conditions many years after bisphosphonate therapy is stopped,” says Warren Levy, PhD, CEO of Unigene Laboratories, a biopharmaceutical company focused on peptide-based nasally and orally delivered osteoporosis treatments.

“For the millions of people who have taken or are considering taking these drugs, it is essential that patients are made aware of new potential long-term safety issues before selecting an osteoporosis treatment,” said Dr. Levy.

Michael Law MD Aesthetic Plastic Surgery in Raleigh, NC is seeing an increase in demand for fat transfer, fat injections and microfat grafting. Dr. Law, a board certified plastic surgeon, explains this increase in demand due to the natural looking results these fat grafting procedures provide.

Facial plastic surgery has been undergoing a paradigm shift in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older subtractive techniques to newer restorative techniques. Natural looking plastic surgery is in demand.

Surgery which consists mainly of removing (subtracting) skin and fat, and pulling tissues tight will lead in many instances to a skeletonized and therefore more aged (or done) appearance. This approach to plastic surgery often results in the “wind tunnel” look that screams, “I’ve had a facelift!” Facial soft tissues (and even the facial bones) actually lose volume and projection with age, and it is thus inevitable that surgery which focuses only on removing tissue will in some fashion age the face.

The contemporary approach to surgical rejuvenation of the face consists more and more of restoring facial volume and contour in an attempt to emulate youthful facial features. Specialists in plastic surgery will first maximize repositioning and recontouring of facial aesthetic areas and remove only as much tissue as necessary.

Structural fat grafting, using a patient’s own fat from the abdomen or hips, is an extremely effective means to help restore the facial volume associated with a youthful appearance. Structural fat grafting does not require incisions or sutures and is applicable to more and more patients. It involves carefully and painstakingly grafting (by micro-injection) a patient’s own fat into areas which benefit from volume restoration. In selected patients, this is a powerful but minimally invasive means of permanently restoring cheek volume and projection.

The goal of aesthetic plastic surgery today is to provide a natural, not “done” result. When performed expertly, friends and family of an aesthetic surgery patient will often comment that a patient looks great, but can’t put their finger on what the change is. According to Dr. Law, “Great plastic surgery doesn’t look like surgery, it just makes people look great.”

Patients from all parts of the country choose Dr. Law as their plastic surgeon to ensure beautiful, natural looking results. Dr. Michael Law has moved his Beverly Hills plastic surgery practice back to his hometown of Raleigh, NC. “I have always loved Raleigh,” says Dr. Law. “Now that I have a family of my own, I wanted them to be here. I want my sons to experience all the wonderful things I experienced growing up here. I miss my practice and patients from Beverly Hills, but it is wonderful to be back home.”

Two previously identified pathways associated with aging in mice are connected, say researchers at the Stanford University School of Medicine. The finding reinforces what researchers have recently begun to suspect: that the age-related degeneration of tissues, organs and, yes, even facial skin with which we all struggle is an active, deliberate process rather than a gradual failure of tired cells. Derailing or slowing this molecular betrayal, although still far in the future, may enable us to one day tack years onto our lives — or at least delay the appearance of that next wrinkle.

“There is a genetic process that has to be on, and enforced, in order for aging to happen,” said Howard Chang, MD, PhD, associate professor of dermatology at the school and a member of Stanford’s Cancer Center. “It’s possible that those rare individuals who live beyond 100 years have a less-efficient version of this master pathway, just as children with progeria — a genetic aging disease — may have components of this pathway that are more active.”

The study, which will be published in the Jan. 9 issue of Cell, grew out of a three-year collaboration between Chang and Katrin Chua, MD, PhD, assistant professor of endocrinology, gerontology and metabolism at Stanford and member of the Stanford Cancer Center and the Veterans Affairs Palo Alto Health Care System. Chang and Chua are co-senior authors of the research.

The researchers focused their investigation on two seemingly separate pathways linked to aging. One involved a molecule known as SIRT6 — a member of the sirtuin family of proteins that modulate life span in organisms such as yeast and worms — that Chua’s laboratory has been studying for several years. She and her lab members have previously shown that SIRT6 is involved in genomic stability and the protection of chromosomal ends called telomeres. Telomeres, which grow shorter with each cell division, are thought to function as a kind of internal molecular clock associated with aging. Furthermore, mice lacking SIRT6 are born normally but die within a few weeks because of a rapid, multi-organ degeneration that somewhat resembles premature aging.

“Sirtuin family members have been implicated in aging and age-related diseases,” said Chua, “but very little was known about how SIRT6 worked on a molecular level until recently. Our new study reveals that SIRT6, in addition to its role in genomic stability and telomere protection, also regulates gene expression.”

The other pathway involved a more well-known protein called NF-kappa B, or NF-kB, that binds to and regulates the expression of many genes, including those involved in aging. The expression of many of these genes increases with age, and blocking the activity of NF-kB in the skin cells of elderly mice causes them to look and act like younger cells.

The researchers wondered if NF-kB and SIRT6 somehow work together to help cells age appropriately. They found that, in human and mouse cells, SIRT6 binds to a subunit of NF-kB and modifies components of a nearby DNA packaging center, called histones. This modification makes it more difficult for NF-kB to trigger the expression of the downstream gene — perhaps by causing the DNA to twist in such a way to boot off the protein.

“It seems that an important job of SIRT6 is to restrain NF-kB and limit the expression of genes associated with aging,” said Chang. “We’ve been interested in the activity of regulatory genes such as NF-kB during aging for several years now, and we were quite happy to find this very clear biochemical connection between these two pathways.”

Young mice lacking the SIRT6 protein displayed elevated levels of NF-kB-dependent genes involved in immune response, cell signaling and metabolism — all potentially involved in the uniformly fatal aging-like condition that killed them within four weeks of birth. Tamping down the expression of the gene for NF-kB’s SIRT-binding subunit allowed some of the mice to escape this fate.

“Mice lacking SIRT6 seem to hit some kind of a wall at around four weeks of age,” said Chua, “when their blood sugar drops to a level barely compatible with life. Reducing NF-kB activity somehow allows the mice to get over this critical period and to live much longer. These mice provide a great new tool to study the effect of SIRT6-deficiency in much older animals than was possible before.”

The researchers are now working to understand how NF-kB knows when and to what extent during an organism’s lifetime to initiate the degenerative process and what role SIRT6 may play.

“It’s a very provocative question,” said Chang. “We’ve tied together two previously separate pathways in aging. Now we’d like to better understand what regulates that pathway.”

It’s another new year, and once again people have resolved to get active, lose weight, quit smoking or make other healthy changes in their lives. While it’s fairly easy to make New Year’s resolutions, for many of us it’s a lot harder to keep them. For some, earning rewards — like a gift card at a major retailer in return for completing an online coaching program, or merchandise, such as clothing, jewelry or electronics, for completing a series of health screenings — is just what’s needed to turn the best of intentions into everyday action.

That’s why people who are covered by a CIGNA health plan now have the opportunity to earn points that are redeemable for gift cards, merchandise and other rewards, such as travel packages, as part of the new CIGNA Incentive Points Program, which became available January 1 to CIGNA’s employer customers who choose to offer it to their employees.

Employees enrolled in the program can monitor the accumulation and redemption of their points through myCigna.com, much as they can monitor their accounts in airline, hotel and other rewards programs. The standard plan allows individuals to earn up to 200 points in a calendar year, but the employer has flexibility to set the cap.

They can earn points for participating in a variety of health-related activities, such as completing a health assessment or biometric screenings; reaching milestones in any of CIGNA’s eight disease management programs, such as programs for diabetes, heart disease or depression; or actively participating in a lifestyle management program such as CIGNA’s Quit Today^SM tobacco cessation program.

“The concept is simple,” says Tom Richards, senior vice president of product for CIGNA. “The more activities you participate in, the more points you earn; and the more you participate, the more opportunities you have to stay healthy or to improve your health.”

With a point equal to $1, employees enrolled in some health plans will also be able to convert their points to a cash contribution to a health reimbursement account or use them to defray health care premiums once the program is fully rolled out later this year.

Midwest health care startups attracted $1.1 Billion in new investments across 166 companies in 2008, ranking the region 3^rd among US regions and maintaining a multi-year growth trend for Midwest health care investing. Minnesota and Ohio companies collectively attracted the most investment dollars within the Midwest. All findings are reported in the Midwest Health Care Venture Report 2008 released today by BioEnterprise and the Mid-America Healthcare Investors Network (MHIN).

“The continued momentum seen in Midwest health care investments is the result of a concerted effort by the public sector, venture firms, accelerators, and research institutions to develop high-caliber health care startups,” said Dan Broderick, President of MHIN and Managing Director of Prolog Ventures. “Midwest institutions are responsible for nearly one-quarter of the nation’s NIH-funded research. This research is at the core of the startups that have spawned venture-backed companies, making the region home to over 300,000 bioscience employees.”

Minnesota ($331 million) and Ohio ($189 million) led all Midwestern states in dollars of investment attracted, followed by Michigan ($105 million) and Illinois ($97 million). The leading regions were Minneapolis ($331 million), Cleveland ($164 million), and Pittsburgh ($151 million). Major financings were reported in each area.

“Midwest health care deals continue to mature and attract greater levels of investment both from Midwest-based venture firms as well as coastal investors,” said Baiju R. Shah, President & CEO of BioEnterprise, the Cleveland-based biomedical venture developer. “In addition, the Midwest health care pipeline has matured to the point where the region is seeing numerous high-profile acquisitions each year of venture-backed companies.”

The Midwest report notes that over the past two years, there have been several high-profile Midwest acquisitions in all health care sectors:

• Medical Devices: Renal Solutions by Fresenius (Pittsburgh); Theken by Integra (Ohio)
• BioPharmaceuticals: NimbleGen by Roche (Wisconsin); Nanosphere; AppTec by WuXi (Minnesota)
• Software and Services: HealthMedia by Johnson & Johnson (Michigan); CMS by Elekta (Missouri); MemberHealth by Universal American (Ohio)

By sector, the 2008 equity funding was allocated as follows:

• Medical device companies: $524 million (48%)
• Biopharmaceutical companies: $380 million (35%)
• Health care software and service companies: $183 million (17%)

The success of the Midwest health care sector is due to the convergence of several forces:

• Excellent academic, research and clinical institutions performing over one-quarter of all NIH and University-funded research;
• Professional technology transfer offices yielding a substantial percentage of total US licensing revenues and university-based startups;
• Numerous leading health care companies employing over 300,000 individuals; and
• Progressive Midwest state economic stimulus and investment initiatives providing billions in funding to develop health care innovations.

The California Health Insurance provider, The HealthCare Solution, today announced the company is radically changing the way high risk baby boomers obtain health insurance. Taking a new approach, the California health insurance provider has partnered with top UK neurosurgeon, Dr. Sim Farar, to provide education to baby boomers to reduce their risk of memory loss that often times affects health insurance eligibility.

From this new partnership, The HealthCare Solution will tap into Dr. Sim Farar’s vast knowledge of aging and memory loss. Together, Dr. Sim Farar and The Healthcare Solution will create useful and practical educational literature to hand out to the California Health Insurance provider’s potential clients. The goal of this educational component is to provide tips and tools which will help baby boomers improve their health and, in turn, eligibility for insurance coverage.

“Partnering with a world renowned neurosurgeon such as Dr. Sim Farar is a wonderful addition to our company’s education component. As a California Health Insurance provider, we see the great numbers of baby boomers who are struggling to obtain proper health coverage,” commented Fred Wiener, President of The HealthCare Solution.

“The HealthCare Solution is committed to not only providing great insurance products, but to the educational side and our social responsibility. The tools we will be able to create with Dr. Sim Farar will be able to be used by boomers to improve their health. The better their health, the more easily they become insured,” continued Wiener.

Well known in the UK for working with alternative medicine, Dr. Sim Farar has been conducting studies on the effects of Ginkgo Biloba on men and women ranging from ages 40-60. The Healthcare Solution expects the partnership with Dr. Sim Farar to yield additional tools to achieve optimal health. To learn more about Dr. Sim Farar’s research and career, please visit www.simfarar.com.

There are hard dollars-and-cents costs to being overweight or obese,  Specifically, the health care specialists at Humana estimates these costs at the following for 2009:

• $19.39 in added health care costs for every overweight pound;
• $1,037.64 for every overweight individual;
• $127 billion added to the national health care bill.

Overweight people are more prone to heart disease, stroke, diabetes — even some kinds of cancers. Chronic diseases that are a result of weighing too much are an ever-increasing part of America’s health care bill.

Carol McCall — a research actuary at Humana — culled through national health care data and the data from Humana’s members, and here is what she found.

Like butter and sugar, obesity has a cost per pound

On average, the annual per-pound cost of being overweight — that is, the added cost per added pound of the overweight and the obese — is $19.39. The cost increases with age.

For 25-year-olds, it averages $10.25 for every overweight pound. By age 64, it increases to $26.32. (On average, overweight people are 29 pounds overweight; the obese are 82 pounds overweight.)

For someone age 25, the added annual health care cost is $209 for the overweight and $960 for the obese. By age 64, this grows to $610 extra for the overweight and $2,300 for the obese.

Why this impacts the national healthcare crisis

There are more than 122 million overweight and obese Americans between the ages of 20 and 65. On average, their additional health care costs are $534 per year for an overweight person and $1,614 for an obese person. Those costs add up to a $127 billion crisis. The increase in obesity prevalence – going from 23 percent to 33 percent between 1994 and 2004 – added $34 billion to the annual health care bill.

A person who is 25 and obese today, and remains obese until they’re 65, will average $179,000 more in health care costs (in 2009 dollars, assuming health care inflation of 4 percent a year) over those 40 years.

A new way to look at and to count calories

Maintaining all of those extra pounds requires Americans to take in 23 trillion calories a year. That’s the equivalent of 46 billion Big Macs, 114 billion Krispy Kreme donuts or 152 billion bags of chips.

These calories have the same energy as the following:

• 10 1,000-megawatt power stations generating for a year
• 788 million gallons of gasoline
• 10 million tons of coal
• 96 trillion AA alkaline batteries

There is a way to get out of this national problem

The good news is that Humana’s data also indicates that just a small change – a reduction of 276 calories a day for the overweight – makes a big difference. Cutting that little from each day’s intake would start moving millions of Americans from the category of overweight to healthy. That means people don’t have to re-engineer their lives to get on a healthier path. Incremental change — giving up one soft drink and walking an extra 2,500 steps each day, for example — will do the job.

“If obesity were eliminated, or even significantly reduced,” says McCall, “the money saved would be significant. It could pay for food for the poor, health insurance for the uninsured or millions of college educations every year.”