As the unofficial end of summer quickly approaches with Labor Day weekend, many Americans are planning one last hurrah by gathering with family and friends for cookouts and picnics. Essential ingredients for a successful party include sunny weather, good company and delicious – and safe – food. Food safety and quality testing company Intertek offers the following tips for packing the perfect cooler and advice for safe grilling to keep your party food at optimum temperatures during your outdoor celebration.

When packing for a cookout or picnic, it’s best to bring one cooler for beverages and a separate cooler for food. Because beverage coolers are opened more frequently, cold air can escape, causing the internal temperature to rise. Be sure to pack your food cooler with ice packs along with loose ice so it will remain below 40 F, reducing the risk for harmful bacteria to grow.

When grilling food, it is important to use a meat thermometer to ensure proper temperatures. To verify safe internal temperatures, beef and poultry should be grilled to 170 F, while hamburgers are best at 160 F. Additionally, to avoid cross contamination, do not use the same utensils for raw and cooked food.

If you have leftovers, immediately put perishable food away in a cooler containing ice or ice packs. Discard any leftovers that have been outside for more than two hours; however if the temperature exceeds 90 F, discard food left out only after one hour. When in doubt, throw it out.

The latest data from the Centers for Disease Control’s (CDC) National Health Statistics Reports shows continued use of the nation’s emergency rooms for conditions that could be treated in an urgent care setting.

Of the 116.8 million visits covered by the 2007 Emergency Department (ED) Summary, only 16.4% were actually admitted to a hospital or kept for observation, while the overwhelming majority (62%) were referred to their primary care provider or a specialist for follow up. Another 35% were referred back to the ED “as needed”, presumably because those patients did not have a regular doctor. Over one third of the patients categorized their pain levels as “none” or “mild”; the chief complaints continue to be (as they were in the 2006 data) upper respiratory issues, otitis media (earache), abdominal pain, wounds, and obstetrics complications.

While in the ED, 45.5% of the patients had a procedure, the majority of which were common procedures such as administration of IV fluids, splinting or wrapping, repair of a laceration, or a nebulizer treatment. Urgent care centers can treat the vast majority of these issues and others—issues that don’t require an inpatient stay and are not life or limb-threatening emergencies—at a lower cost and usually a much shorter wait time than the ED. Urgent care centers perform all of those common procedures and are set up to provide referrals back to primary care or specialists. Urgent care centers are open for extended hours, as well as on weekends, providing easy access.

While there will continue to be uncertainty about what seemingly minor conditions truly belong in the ED, and patients should always err on the side of caution, it is clear from the latest CDC data (based on the chief complaints, levels of pain, types of treatment and ultimate discharge plans for most patients) that many ED patients likely could have been treated in an urgent care center.

A team of Allegheny General Hospital (AGH) physicians led by neurosurgical pioneer Peter Jannetta, MD, has made an important new discovery linking the central nervous system to the onset and progression of type 2 diabetes mellitus. Reporting today in the journal Surgical Neurology International, Dr. Jannetta and his colleagues present evidence from a prospective clinical trial that vascular compression of a section of the brain called the medulla oblongata is a factor in some patients with type 2 diabetes and that microvascular decompression surgery (MVD) may be an effective treatment for the condition.

Recognized world-wide as one of the preeminent authorities on diseases associated with vascular compression of the cranial nerves, Dr. Jannetta is credited with developing the MVD technique, which is now generally considered the surgical standard of care for a host of debilitating cranial nerve diseases, including trigeminal neuralgia, hemifacial spasm, vertigo, Meniere’s disease and spasmodic torticollis.

Microvascular decompression is a procedure that involves repositioning compressive arteries in the brain and placing a protective pad between the nerve and artery.

Dr. Jannetta, who serves as Vice Chair of Academics in AGH’s Department of Neurosurgery, and his team have performed more than 6,000 such operations.

Over the past three decades, research by Dr. Jannetta and others has led to observations about the potential role of vascular compression in metabolic syndromes such as hypertension and diabetes.

A disease of epidemic proportions in the United States, type 2 diabetes mellitus is a chronic condition marked by high levels of sugar (glucose) in the blood. Although obesity is a primary risk factor for the disease, it can also develop in those who are not obese, especially among the elderly. Without medical intervention or aggressive lifestyle changes, type 2 diabetes often leads to serious cardiovascular, vision and renal problems.

In a previous, retrospective study of 15 patients with type 2 diabetes who were operated on by Dr. Jannetta for an unrelated right-sided cranial nerve disease, arterial compression of the right anterolateral medulla oblongata was documented in every single case (Stroke 1999:30:1707-10).

The medulla oblongata is the lowermost portion of the brain, continuous with the spinal cord, that is responsible for respiration, circulation and the body’s autonomic reflexes, including function of the pancreas.

“Insulin resistance, or hyperinsulinemia, is central to the development of type 2 diabetes mellitus. We have documented previously that pulsatile arterial compression of the right anterolateral medulla oblongata is associated with autonomic dysfunction that adversely impacts the pancreas and increases insulin resistance. Building upon that knowledge, we hypothesized that decompressing the right cranial nerve X – or the vagus nerve – and the medulla oblongata could result in better glycemic control for patients with this disease,” said Dr. Jannetta.

Ten patients with steadily progressive type 2 diabetes mellitus and visible right lateral medullary compression by arterial loops on MRI were enrolled in the team’s follow up study. Each patient in the trial underwent right retromastoid craniectomy and microvascular decompression. At intraoperative visual evaluation, the vascular compression was even more severe than seen on MRI scans in 9 of the 10 patients, Dr. Jannetta said.

Patients in the study were followed for 12 months post-operatively, during which time no changes in diet, weight or activity level were permitted. In addition to blood glucose monitoring, studies of glycemic control, pancreatic function and insulin metabolism were performed regularly by the team.

Study participants whose glycemic control either improved or did not worsen during the course of the trial were considered “good” responders, while “failed” responders had no slowing in the natural progression of the disease.

Results of the trial showed that seven of the ten patients who underwent MVD experienced significant improvement in their glucose control, based on measurement of diabetes markers (changes in hemoglobin A1c, fasting blood glucose and serum insulin levels) and decrease of diabetes medication dosages. One patient was able to discontinue his diabetic medications entirely.

Dr. Jannetta said body mass index also appeared to be an important factor in who responded well to surgery. Those in the study who had the best outcome from MVD had BMIs classified as overweight while those who did not respond had BMIs in the obese category.

“Diabetes is a tremendously difficult condition to manage and, for patients, to live with. Though our study involves a relatively small sampling of patients, we believe that it represents a major breakthrough in our understanding about the central nervous system etiology of the disease and the potential of surgical intervention as an alternative therapy for a significant subset of patients. The next step is a much larger prospective clinical investigation to further corroborate what we have found,” Dr. Jannetta said.

Commenting on the study in an accompanying editorial, Sunil Patel, MD, Chair of the Department of Neurosciences at the Medical University of South Carolina and Joyce Nicholas, Ph.D., Associate Professor in MUSC’s Department of Biostatistics and Epidemiology, concur on the importance of the AGH team’s work and the need for continued investigation:

“These observations point the way to further questions that need to be answered to conclude definitively that pulsatile arterial compression of the right antrolateral medulla is an independent risk factor for type 2 diabetes mellitus. Like Dr. Jannetta’s earlier observations on essential hypertension, the observations presented [in the current study] are valuable starting points for questions related to the exact location of arterial compression relevant to type 2 diabetes mellitus, the best experimental measure of response, and the subset of patients most likely to benefit from microvascular decompression surgery. We encourage their continued efforts and those of other researchers in addressing the questions raised by this valuable contribution to our understanding of the disease and its treatment.”

In addition to Dr. Jannetta, other AGH physicians who participated in the study include neurosurgeon Ray Sekula, MD, endocrinologist Peter Grondzioski, MD, and research coordinator Lynn Fletcher, RN.

The U.S. Department of Health and Human Services (HHS) announced two key steps in the process of partnering with states and other stakeholders to begin establishing health insurance Exchanges. HHS announced the availability of up to $1 million in grants per state to help states begin work to establish Exchanges and published a request for comment calling for public input as HHS develops standards for the Exchanges.

Starting in 2014, health insurance Exchanges – new, competitive, consumer-centered health insurance marketplaces – will put greater control and greater choice in the hands of individuals and small businesses. The Exchanges will make purchasing health insurance easier by providing eligible consumers and businesses with “one-stop-shopping” where they can compare and purchase health insurance coverage. The Affordable Care Act authorized grants to the states to help them design and establish Exchanges in time for millions of Americans to choose their coverage for 2014.

“With most states struggling to keep their budgets in balance, these grants will give them the resources to conduct the research and planning needed to build the health insurance marketplace of the future,” said HHS Secretary Kathleen Sebelius. “We are working hand-in-hand with states as we carefully implement the Exchanges to make sure they best meet people’s health insurance needs.”

This first round of Exchange grants will give states resources to conduct the research and planning needed to build a better health insurance marketplace and determine how their Exchanges will be operated and governed.

Each state has the option to establish and operate its own Exchange or partner with another state or states to operate a regional Exchange. If a state decides not to create an Exchange for its residents, HHS will help establish one on their behalf. Grant applications are available at http://www.healthcare.gov/center/grants and are due by September 1, 2010.

Keeping with President Obama’s commitment to transparency and open government, HHS also today issued a request for comment asking states, consumer advocates, employers, insurers, and other interested stakeholders to provide input as HHS develops the rules and standards Exchanges should be required to meet. Comments are due by October 4, 2010. Read the complete request for comment at http://www.healthcare.gov/center/regulations.

Despite the fact that the US pays more per individual for healthcare costs, it continues to score the lowest in overall healthcare benefits.

According to the latest Commonwealth Fund comparison of the US Healthcare system, the US scored either last or second to last in each major category. The competition this year was from: Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. The US finished last overall, and practically last in each major criteria test.

Julie Rovner, from NPR News had this to say about the test, “To come up with the rankings, researchers surveyed both doctors and patients. The criteria comprised quality, access, efficiency, equity, whether people in each country lived long and productive lives, and how much each country spent per person on care.” She continues with her perspective of the results, “About the only good news for America, said Commonwealth Fund President Karen Davis, who was also the study’s lead author, is that the new health law could put the U.S. on a path towards improvement.”

A new study by the Institute for Women’s Policy Research (IWPR) and the Center for Economic and Policy Research (CEPR) reveals some bad news for men: they are a majority of non-elderly adults in the United States who lack health insurance, according to an analysis of the 2009 March Current Population Survey.

One in five men ages 18-64 – about 21.2 million –are uninsured, compared with 17.2 million women in the same age group. This gap in coverage is consistent across various demographic groups.

The group most likely to lack health insurance is younger, unmarried men—but men are less likely to have health insurance than women at every age range.

Married men lack health insurance in greater numbers than married women before the age of 65, with 18.4 percent of married men between the ages of 26 and 34 lacking insurance.

“This disparity in health insurance between men and women is a serious problem for families,” said Dr. Heidi Hartmann, President of IWPR. “With so many men lacking health insurance, I can think of no greater gift for fathers this year than the security of knowing that they will have coverage in case of illness. Men are often bread-winners for their families, and family members often depend on them for access to health insurance.”

The data show that men stand to gain the most from health-insurance reform, with 4 million more men than women ages 18 to 64 uninsured in the United States across age and marital status.

View the Fact Sheet here: http://www.iwpr.org/pdf/A142.pdf

U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder today sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer. The outreach campaign is another step in the ongoing work of the Health Care Fraud Prevention Enforcement Action Team (HEAT), a cabinet-level initiative launch by HHS and DOJ in May 2009.

“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” said Secretary Sebelius and Attorney General Holder in the letter. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”

In the letter, the Secretary and Attorney General outline education and outreach efforts where state attorneys general could make a big difference. These include efforts to cut the cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012; a series of regional fraud prevention summits around the country over the next few months; regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort; HHS’s plans to double the size of the Senior Medicare Patrol and to put more boots on the ground in the fight against Medicare fraud; and a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud.

The full letter follows.

June 8, 2010

Dear Attorney General:

It was a pleasure to have the opportunity to speak with you and your staff a few weeks ago. We wanted to send you a letter summarizing our discussions and following up with some suggestions of ways we can work together to protect the American people from health care fraud.

In the two months since the Affordable Care Act was signed into law, we have made substantial progress on providing better choices for consumers, tackling health care costs, and holding insurance companies accountable. But while we have been hard at work, scam artists and criminals continue to profit from misinformation about the Affordable Care Act.

Since early April, we have heard increasing reports about seniors being asked to provide their Social Security numbers in order to receive a “donut hole” check under the new law, raising concerns about potential identity theft scams. We have fielded consumer complaints about phony insurance policies, and our Senior Medicare Patrols have been receiving a growing number of calls from people across the country reporting potential fraud schemes.

We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it.

The President has asked us to reach out to you and to other federal, state, and local law enforcement officials across the country to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. Some important components of these outreach and education efforts, where you and your staff could make a big difference, are described below.

First, the President has directed the Department of Health and Human Services (HHS) to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.

Second, following on the National Health Care Fraud Summit we co-hosted in Washington earlier this year, the President has asked both our Departments to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.

These summits will bring together top federal and state officials; representatives of federal, state, and local law enforcement; representatives of our agencies; the health care provider community, such as hospitals and doctors; local businesses; the Senior Medicare Patrol; caregivers; and seniors, for a day of panels and training sessions. Your expertise and experience will be instrumental to the success of these events.

Third, at the Attorney General’s request, the Acting Deputy Attorney General has sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud efforts. Most of these meetings will be held quarterly, with some exceptions for smaller districts. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010. We hope that you and your office will take part in these regular exchanges on effective fraud fighting strategies.

Fourth, HHS will be doubling the size of the Senior Medicare Patrol and putting more boots on the ground in the fight against Medicare fraud. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to three million Medicare beneficiaries have been educated since the start of the program, and more than one million one-on-one counseling sessions have taken place with seniors or their caregivers. Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.

Fifth, the Centers for Medicare & Medicaid Services, in conjunction with the Administration on Aging, will be launching an educational media campaign this summer to educate Medicare beneficiaries about the importance of staying vigilant with their personal Medicare information and getting the facts out about the new law so that scam artists are not able to prey on seniors.

The more we can educate the American people about fraud prevention, the better chance we have to protect taxpayer dollars and the Medicare trust fund. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud.

As you are well aware, fraud schemes have plagued public and private health care plans for decades. Fraudsters have been stealing billions of dollars a year from Medicare, Medicaid, and private health insurers. A year ago, our Departments joined forces to combat fraud in federal health programs. Through the establishment of the Health Care Fraud Prevention Enforcement Action Team (HEAT), we have expanded special anti-fraud Medicare Fraud Strike Forces into seven cities, developed sophisticated new techniques of fraud prevention data analysis, and redirected program integrity resources to fraud hot spots.

Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud. These include new criminal and civil penalties, enhanced information technology to track and prevent fraud in the first place, and new authorities to prevent bad actors from billing Medicare and Medicaid. HHS has already issued the first set of fraud prevention regulations required under the new health law. These regulations strengthen provider enrollment requirements to ensure we have the ability to better identify, screen, and audit providers and claims.

As we do our part in Washington, we want to work closely with you and other state officials to fight fraud. In that vein, the Affordable Care Act also strengthens state officials’ ability to detect and root out Medicaid fraud. For example, the law provides new access to Medicaid data for the Secretary of HHS that will help both states and the Administration to coordinate anti-fraud activities and gives states greater incentives and flexibility in identifying and collecting Medicaid overpayments. It also helps to promote enhanced information technology to track and prevent fraud, including predictive modeling techniques that can identify abusive or fraudulent billing patterns, audits, and a shared provider database for pre-enrollment screening and post-enrollment anomaly monitoring.

Securing health care coverage, affordability, and choices for Americans requires hard work and vigilance. We stand ready to serve as a resource and partner for you as we work together to fight fraud, implement the provisions of the new health reform law, and strengthen our health care system.

Sincerely,
Eric Holder
Kathleen Sebelius
Attorney General
Secretary of Health and Human Services

A serious long-term illness or disability can have devastating, often irreversible, effects on a family’s financial well-being, according to Allsup, a nationwide provider of Social Security disability representation and Medicare plan selection services. In fact, the support of friends and family members are the most relied on financial support resources, according to a recently completed poll Allsup conducted among people with disabilities.

Specifically, the poll found that during the time people were awaiting their Social Security Disability Insurance (SSDI) benefits, they relied on the following resources for support:

The low reliance on personal savings may be in part because most people are not financially prepared to have their employment interrupted, even briefly. For example, studies have found that more than 60 percent of workers live paycheck to paycheck, and the U.S. Department of Commerce reports that the personal savings rate in March was just 2.7 percent of after-tax income.

So, what can someone do to ease the financial risks if they are one of the millions of people who must stop working each year because of a serious health condition?

“First, have hope because there are things you can do to take control,” said Paul Gada, personal finance director for the Allsup Disability Life Planning Center.

According to Gada, seeking help is essential. “Many people are afraid and overwhelmed. Asking for help is a sign of strength and being your own best advocate can help you feel more in control.”

Among the first steps people with serious health conditions or their caregivers should take quickly are:

• Create a financial plan. The plan should focus on establishing a budget and making certain you are spending down your assets in the least harmful way. Generally, this means using your savings or other resources before withdrawing from retirement accounts that could trigger a penalty or using high interest rate credit, which will have you paying off interest for years.

  “Sometimes it is unavoidable to use these higher cost resources, but before doing so people should actively pursue other types of public or private assistance that may be available to them,” said Gada.

• Contact your mortgage company or landlord. As part of this, identify housing assistance programs. For example, the U.S. Department of Housing and Urban Development (HUD) has programs to assist with mortgage modifications, as well as rental assistance that can lower housing costs drastically. However, there are waiting lists, so it’s important to sign up as soon as possible.

  “People are often reluctant to reach out to their mortgage company or their landlord, they start missing payments, and the foreclosure or eviction process starts before they finally explain the situation,” says Gada. “By that time, it may be too late.”

• Seek assistance with utilities, food and other necessities. Conserve your resources by finding assistance to help you cope. There are hundreds of federal, local and private resources available in most communities. These can range from neighborhood food pantries to federally funded programs, such as Low Income Home Energy Assistance Program (LIHEAP). Local phone companies provide reduced-rate support for home phone service. Associations such as the American Cancer Society and the National Family Caregiver Association also offer guidance.

  Many more people indicate they are considering assistance than are actually securing this assistance, according to the Allsup Disability Finance poll. Specifically, respondents reported that they had considered or attempted to get assistance from many types of programs, including:

“These findings indicate that people may not understand the various programs that are available and how to apply, or they may not meet the income thresholds initially for programs with these requirements, but could later on as they spend down their assets,” said Gada. “It can be overwhelming and people too often give up. Unfortunately, this can take an even greater toll on their finances as they turn to credit cards or retirement savings because they don’t understand what programs are available to assist them.”

Allsup offers information and links to many of these resources on its website.

• Secure healthcare coverage. Continuing medical treatment is vital. Among the options are COBRA through your former employer, a spouse’s plan or other private coverage, such as through the health insurance exchanges being established as part of the healthcare legislation enacted earlier this year. Compare plans closely to make sure you are getting the coverage needed and that you understand the costs. Additionally, if you must take expensive prescription drugs, check if the pharmaceutical company offers a prescription-drug assistance program.
• Pursue income sources, including SSDI. If you have paid into the Social Security Disability Insurance program, you may be eligible for benefits. If you are eligible, it’s essential to apply quickly as it can take up to two years or more to be approved. Gada advises seeking help with your SSDI application to speed the process. For example, people with disabilities represented by Allsup are significantly more likely to receive SSDI benefits at the initial level.

“It’s heartbreaking to hear of people with serious illnesses and disabilities unable to work and struggling month after month to pay for food or medical costs until they’re financially wiped out,” Gada said. “It shouldn’t be that way. There are steps people can take, but they need to ask for help and know how to get it.”

A synthetic version of a naturally occurring peptide promoted the creation of new blood vessels and repaired damaged nerve cells in lab animals, according to researchers at Henry Ford Hospital in Detroit.

“This successful experiment holds promise for treating clot-induced strokes in humans,” says study lead author Daniel C. Morris, M.D., senior staff physician in the Department of Emergency Medicine at Henry Ford Hospital. “Neurorestorative therapy is the next frontier in the treatment of stroke.”

He will present the findings June 3 at the Annual Meeting of the Society for Academic Emergency Medicine in Phoenix.

Dr. Morris explains that the researchers added the synthetic peptide Thymosin beta 4 to a group of drug treatments – including statins – used for neurorestorative therapy to activate repair mechanisms which mimic cellular changes that occur in the early stages of brain development.

This research follows an earlier study, reported by the same team in March, which found that Thymosin beta 4 improved neurological function after stroke in adult rats by increasing the formation of protective myelin around nerve fibers in brain cells.

These experiments conclude that the peptide repairs and regenerates stroke-injured brain tissue.

The results of the first study also were similar to other research using the peptide to regenerate damaged heart, corneal tissue and wound repair.

In the latest study, adult rats were dosed with Thymosin beta 4 one day after they were subjected to a blockage in the cerebral artery, then given four more doses, once every three days. Rats treated only with saline were used as a control group.

After eight weeks, the Thymosin beta 4 group showed significant overall improvement compared to the control group.

The researchers concluded that the peptide improved blood vessel density as well as promoted a certain type of immature brain cells called oligodendrocyte progenitor cells to differentiate into mature oligodendrocytes, which produces myelin to protect axons in nerve cells.

In addition to Dr. Morris, the Henry Ford research team included Michael Chopp, Ph.D.; Li Zhang, M.D.; and Zheng Gang Zhang.

Thymosin beta 4 is produced by RegeneRx Biopharmaceuticals.

The study was funded by the National Institutes of Health.

The number of bariatric surgeries in the U.S. skyrocketed from 13,386 in 1998 to 220,000 in 2008, but a new study released this past week by HealthGrades, finds that the nation’s hospitals have wide variances in both complication rates and lengths of stay, which largely correlate with the number of times the hospital performs bariatric procedures.

According to the study, patients undergoing bariatric surgery at hospitals rated with 5 stars by HealthGrades experienced, on average, 43% fewer complications and 10% less time in the hospitals than patients at average hospitals.

“Bariatric surgery has been proven to reduce caloric intake and control obesity, but the HealthGrades study demonstrates that where patients have this type of surgery matters – a great deal,” said Rick May, M.D., a vice president with HealthGrades and a co-author of the study. “There is a subset of U.S. hospitals whose patients, the data show, routinely have fewer complications and leave the hospital earlier.”

Hospitals receiving a 5-star rating in bariatric surgery have complication rates that are, to a statistically significant degree, lower than expected based on their patient population. Hospitals receiving a 3-star rating performed as expected, and those receiving a 1-star rating have complication rates that are higher than expected to a statistically significant degree. Hospitals with patient outcomes in the top 10% in the nation received the 2010/2011 HealthGrades Bariatric Surgery Excellence Award™.

The study found that:

• Patients having bariatric surgery at 5-star rated hospitals are 42.66% less likely to experience inhospital complications than patients at 3-star rated programs, and 66.55% less likely compared to 1-star rated programs.
• Five-star rated hospitals had an average case volume of 646 surgeries performed over three years, while 1-star rated hospitals averaged 384 cases.
• While inhospital mortality is generally an uncommon complication, patients had, on average, a four times higher risk of dying if they had a bariatric surgery performed at 1-star rated hospitals compared to 5-star rated hospitals.
• If all bariatric programs from 2006 through 2008 had performed at the level of 5-star rated hospitals, 5,046 patients could have potentially avoided a major inhospital complication across the 19 states studied.
• Patients having surgery at 5-star rated hospitals spent, on average, less time in the hospital (2.00 days) compared to patients treated in 3-star rated hospitals (2.21 days), and almost a half a day less than patients having surgery in 1-star rated hospitals (2.48 days).
• Bariatric Centers of Excellence (COE) programs were more likely to receive a 5-star rating than non-COE programs (25.6% of COE programs were 5-star rated while only 10.9% of non-COE programs received a 5-star rating).

Other findings from HealthGrades study include:

• Over the three years studied, 2006, 2007 and 2008, the number of bariatric surgeries in the 19 states analyzed increased 16%.
• In 2006, less-invasive laparoscopic procedures represented 83.18% of all procedures, and by 2008 they represented 88.93% of all bariatric procedures. On average, laparoscopic procedures had a complication rate of 5.49%, while gastric bypass procedures had a complication rate of 11.64%, and malabsorptive procedures had a complication rate of 7.01%.
• Of the 19 states studied, 63.33% of all procedures were performed in five states: California, New York, Texas, Pennsylvania and Florida.
• Overall, bariatric surgery patients were charged, on average, $38,254 for a laparoscopic procedure, while the average charge for an open procedure (e.g., gastric bypass or malabsorptive) was $38,323.
• Of all patients, 6.57% paid for their surgery out-of-pocket (self-pay) and did not utilize any type of insurance. There was a 5.42% decrease in the number of self-pay patients from 2006 through 2008.

Bariatric surgery is recognized as an effective treatment for obesity, especially in those patients noted to have extreme obesity, also referred to as “morbid obesity.” Morbid obesity carries an extensive risk of life-threatening complications such as heart disease, diabetes and high blood pressure. Morbid obesity affects approximately 4.7% of the U.S. population, according to the Centers for Disease Control.