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Protecting Older, Vulnerable Patients From the Flu

People aged 65 and older account for more than 60% of the estimated 226,000 flu-related hospitalizations and 90% of the 3,000 to 49,000 flu-related deaths in the United States each year. This age group is at highest risk for contracting influenza and developing its potentially serious complications, including pneumonia, bronchitis, sinus and ear infections, and coronary problems. Flu symptoms can even exacerbate other comorbid conditions. This puts patients at greater risk for complications and reduces quality of life. Collectively, these health issues can result in hospitalization and even death in older patients. Be Vigilant of Those at Higher Risk for Flu As the 2012-2013 influenza season continues and we look ahead to the next, it’s important to improve community-wide vaccination rates so that we can protect public health, especially when treating adults aged 65 and up. Seniors are at higher risk for influenza because the immune system weakens with age. In turn, the body’s ability to produce a sufficient amount of protective antibodies is reduced. When considering influenza vaccine resources for the season, it’s important to offer a variety of vaccine options and newer delivery systems. Merle C. Turner, DO A few years ago, the healthcare world received good news when a higher dose of the influenza vaccine was approved by the FDA for older patients. Designed for those aged 65 and older, the vaccine generates a stronger immune response because it contains four times the amount of antigen as the standard dose. While the high-dose vaccine has shown a higher risk for side effects at the injection site, there is no greater risk of a systemic reaction than...

How to Lower 30-Day Hospital Readmission Rates

As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%. Investigators at the Skeptical Scalpel Institute for Evidence-Based Outcomes and Advanced Research (SSIEBOAR, catchy acronym, don’t you think?) have come up with a plan that is certain to lower readmission rates across the board. Some have said the idea should be patented, but the institute is not-for-profit and thus is willing to share. The solution is quite simple — let the patients die. Yes, death reduces readmission rates for all diseases, not just MI, CHF and pneumonia. Oh, there may be some resistance and relatives of the patients may complain, but at least Medicare will be satisfied and after all, isn’t that why we became doctors? Another outcome measure, hospital length of stay, is also positively impacted by death. For example, if the average length of stay for a patient with a heart attack is 4 days, a patient who dies on hospital day #2 would lower the hospital’s average. Death also results in fewer resources being utilized, which saves the hospital money for patients whose reimbursement is based on the DRG. I confess. I’m not serious, and the idea is not original. There are many issues. In most cases, as length of stay is ratcheted down, readmission rates will rise. One way to reduce readmissions is to keep patients in the hospital longer. And what about the things the hospitals and doctors can’t control? A recent study found that only 63% of...

Post-Acute Care for Medicare Beneficiaries

The quality of care coordination is important to the United States healthcare system as hospital readmission rates are being further scrutinized. When hospital readmission rates are high, it is often the result of poorly coordinated care across the full continuum of care settings, from EDs and ICUs to primary care and outpatient settings. As care is better coordinated, it is more likely that these rates will be reduced. “Improving the coordination of care for patients is also important to Medicare and to hospitals,” says David C. Goodman, MD, MS. “Medicare patients who return to hospitals shortly after they’ve been discharged add substantial costs to Medicare that could be avoided with better post-discharge care.” CMS estimates that the cost of avoidable readmissions is more than $17 billion per year. In the coming months, there are plans in place to reduce Medicare payments for readmissions if hospitals have higher-than-expected 30-day readmission rates for patients with acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia. In 2013, hospitals face a penalty equal to 1% of their total Medicare billings if an excessive number of patients are readmitted. The penalty rises to 2% in 2014 and 3% in 2015. Hospitals Currently Struggling In September 2011, the Dartmouth Institute for Health Policy & Clinical Practice released the Dartmouth Atlas report, which analyzed readmission rates among Medicare patients for AMI, CHF, pneumonia, and other hospital discharges between 2003 and 2009. Researchers examined the records of 10.7 million Medicare patient hospital discharges and found little progress during the study period. Patients hospitalized for CHF, pneumonia, surgery, hip fractures, or other medical conditions had 2009 readmission...
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