Over 1800 consecutive inpatients were enrolled in this randomized prospective clinical study. A total of 902 patients were managed with chemoprophylaxis alone and 901 patients received chemoprophylaxis augmented with [VenaFlow] intermittent pneumatic compression (IPC). All patients were Dopplered for evidence of symptomatic and nonsymptomatic deep vein thrombosis (DVT) at discharge. In the chemoprophylaxis-only group, fifteen patients (1.7%) were diagnosed with a DVT; three thromboses were symptomatic. In the IPC group, four patients (0.4%) were diagnosed with DVT; one thrombosis was symptomatic. The difference was significant. In addition, patients who wore the IPC device more than six hours per day had no deep vein thromboses. The results demonstrate that the multimodal approach of using a rapid inflation intermittent pneumatic compression device as an adjunct to low-molecular-weight heparin is significantly more effective in preventing DVTs than using low-molecular-weight heparin alone.

by Patty Cisco
Summer is the time for action! Unfortunately for senior care and living organizations, summer
typically represents sluggish census and occupancy results. The sales reps and marketing
directors who work in the trenches can certainly make a list of all the reasons why this occurs.
While there may be validity to some of those reasons, they also can be the excuse that creates a
barrier to productive activity. Taking a proactive approach to your marketing strategies and sales
tactics now will not only reap results in the summer months, but you’ll be surprised by what your
third and fourth quarters will yield.

1. Focus on quality, not quantity, in your sales calls. Analyze your referral list over a two-year
period. Categorize your referral sources as follows: A (represents top 15% of your referral
sources that make up 65% of your referrals); B (represents 20% of your referral sources that
make up 20% of your referrals; C (represents 65% of your remaining referrals sources that make
up 15% of your referrals; D (no referrals received but relationship worth maintaining). Compare
this referral analysis to current sales call activity. How much time are you spending on
non-referral related external sales calls?

2. Evaluate your marketing strategies. Compare how much time you spend on fun-oriented
marketing activities vs. educational activities and media buys vs. relationship-oriented. Your
time is precious and limited. Stop doing what’s not working and focus on target audience
activity.

3. Scrub lead lists. The cheapest leads are those you have. Set aside the time to review your lead
list and make a follow up. Contact is key to turning leads. Also, don’t forget to update your email
database list.

4. Break down barriers with education. If you or other decision makers in your organization
aren’t sure where to start with establishing a sales culture (people, systems and processes), or
haven’t engaged in an interactive website or have yet to initiate a social media strategy then
maybe it’s time to start strategizing. Plan to attend The Discovery to Sustainable Census
Workshop. Click here for more information on the Workshop.

5. Engage in a Just Ask Campaign. Yes, that’s right, it’s ok to ask for. Engage your staff, current
and past families, residents and network associates in a fun campaign designed to send prospects
of interest your way.

6. Stop all marketing activities for 30 days and just engage in a Summer Blitz! It’s a fun break
from the routine and creates a lot of buzz.

7. Engage in an online interactive campaign that focuses on one core service line. This strategy is
beneficial for special offerings, discounts, new services etc.

Senior care and living organizations can no longer stay in the comfort zone of past marketing
strategies and sales tactics. It’s time for a paradigm shift if you want to drive sustainable census
and occupancy. Starting a proactive action plan now for the summer months will pay in census
benefits later.

 
Bullying In Workplace Brings Devastation to the Company In The Long Run

Bullying in workplace is one of the types of abuse a particular employee or a group of employees
are subjected to at a workplace. It has many forms and comes in the form of verbal, physical or
emotional abuse. This is found in almost all the places like schools, churches and workplaces.
This can happen in many ways face to face, or in your absence, or online or with your friends and
relatives or even with strangers. Bullying is said to take place when a person is repeatedly
exposed over a period of time to any form of negative action from one or more of other persons
and he or she has difficulty in defending himself or herself from these actions.

Bullying in workplace is very common and it cannot be remedied by avoidance as in other cases
of bullying. Most of the times the workplace bullying makes the life of the person targeted more
difficult and unhappy and leads to constant mental strain. This has a very bad effect on his
morale and his productivity suffers much. Due to this, a hostile work environment develops that
leads to deterioration in the work values of the employees. But as per an estimate of the
Workplace Bullying Institute more than one third of the employees are subject to one form or
other of the bullying in workplace during some point of their work life.

The Bullying in a workplace can occur in many ways and some of them include:

Unjustified hypercritical judgment
Unnecessary or unfounded blame
Undue segregation
Isolation
Indifferent treatment from co-workers
Unnecessary yelling and humiliation in front of co-workers
Disproportionate monitoring of the work
Unnecessary verbal or written warnings etc
Vague or untrue claims of poor or underperformance

The bad effects of bulling in workplace

When there is bullying in workplace the employees who are subject to bullying are suffer more in
terms of physical and mental effects. They have very high stress levels, and suffer from extreme
bitterness in their attitude. They usually suffer from depression, and usually do not have any
motivation to excel in their jobs and exhibit greater levels of hostility towards other employees.
Due to the constant depression and stress they suffer from many physical illnesses like digestive
problems, sleeping disorders like insomnia and usually have high blood pressure.

Those in the management must always be aware of the fact that bullying in workplace is not the
right way of running their business as a company with bullying becomes dysfunctional and
inefficient. You can see that the absenteeism and low productivity are the norms of any working
day and due to this the company suffers very strong negative growth factors in the long run. An
employee who is subject to bullying in workplace becomes totally against any form of innovation
at his workplace and he never expresses or develops his own ideas for the betterment of the
company.

Due to the hostile and unfavorable work environment even quality employees who are not bullied
also feel it necessary to leave the company at their earliest opportunities. When the bullying in
workplace is known to outside world new employees do not opt to come into the company for
fear of being bullied while working for the company.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in
stroke patients. The thigh-length sleeves promote blood flow by periodically filling with air and
gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor
of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s
president, commented on the study.

“Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have
already come to rely on this equipment for safe, effective, and affordable prevention of deep vein
thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to
give it a try.”

Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body.
It is common in stroke patients and immobile patients and can also occur in healthy people on
long flights where movement is restricted. When a clot detaches, it can then become lodged in
the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom.
Results showed 8.5 percent of patients treated with compression devices developed blood clots,
versus 12.1 percent of patients who received alternative treatments.

“Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these
drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to
bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke
patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed
the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s
guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients
at high risk of DVT. Currently, they only recommend it in cases where blood thinners are
unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and
another third result in permanent disability.

Vascular PRN may be reached at 800-886-4331.

by Patty Cisco
Summer is the time for action! Unfortunately for senior care and living organizations, summer
typically represents sluggish census and occupancy results. The sales reps and marketing
directors who work in the trenches can certainly make a list of all the reasons why this occurs.
While there may be validity to some of those reasons, they also can be the excuse that creates a
barrier to productive activity. Taking a proactive approach to your marketing strategies and sales
tactics now will not only reap results in the summer months, but you’ll be surprised by what your
third and fourth quarters will yield.

1. Focus on quality, not quantity, in your sales calls. Analyze your referral list over a two-year
period. Categorize your referral sources as follows: A (represents top 15% of your referral
sources that make up 65% of your referrals); B (represents 20% of your referral sources that
make up 20% of your referrals; C (represents 65% of your remaining referrals sources that make
up 15% of your referrals; D (no referrals received but relationship worth maintaining). Compare
this referral analysis to current sales call activity. How much time are you spending on
non-referral related external sales calls?

2. Evaluate your marketing strategies. Compare how much time you spend on fun-oriented
marketing activities vs. educational activities and media buys vs. relationship-oriented. Your
time is precious and limited. Stop doing what’s not working and focus on target audience
activity.

3. Scrub lead lists. The cheapest leads are those you have. Set aside the time to review your lead
list and make a follow up. Contact is key to turning leads. Also, don’t forget to update your email
database list.

4. Break down barriers with education. If you or other decision makers in your organization
aren’t sure where to start with establishing a sales culture (people, systems and processes), or
haven’t engaged in an interactive website or have yet to initiate a social media strategy then
maybe it’s time to start strategizing. Plan to attend The Discovery to Sustainable Census
Workshop. Click here for more information on the Workshop.

5. Engage in a Just Ask Campaign. Yes, that’s right, it’s ok to ask for. Engage your staff, current
and past families, residents and network associates in a fun campaign designed to send prospects
of interest your way.

6. Stop all marketing activities for 30 days and just engage in a Summer Blitz! It’s a fun break
from the routine and creates a lot of buzz.

7. Engage in an online interactive campaign that focuses on one core service line. This strategy is
beneficial for special offerings, discounts, new services etc.

Senior care and living organizations can no longer stay in the comfort zone of past marketing
strategies and sales tactics. It’s time for a paradigm shift if you want to drive sustainable census
and occupancy. Starting a proactive action plan now for the summer months will pay in census
benefits later.

 
Bullying In Workplace Brings Devastation to the Company In The Long Run

Bullying in workplace is one of the types of abuse a particular employee or a group of employees
are subjected to at a workplace. It has many forms and comes in the form of verbal, physical or
emotional abuse. This is found in almost all the places like schools, churches and workplaces.
This can happen in many ways face to face, or in your absence, or online or with your friends and
relatives or even with strangers. Bullying is said to take place when a person is repeatedly
exposed over a period of time to any form of negative action from one or more of other persons
and he or she has difficulty in defending himself or herself from these actions.

Bullying in workplace is very common and it cannot be remedied by avoidance as in other cases
of bullying. Most of the times the workplace bullying makes the life of the person targeted more
difficult and unhappy and leads to constant mental strain. This has a very bad effect on his
morale and his productivity suffers much. Due to this, a hostile work environment develops that
leads to deterioration in the work values of the employees. But as per an estimate of the
Workplace Bullying Institute more than one third of the employees are subject to one form or
other of the bullying in workplace during some point of their work life.

The Bullying in a workplace can occur in many ways and some of them include:

Unjustified hypercritical judgment
Unnecessary or unfounded blame
Undue segregation
Isolation
Indifferent treatment from co-workers
Unnecessary yelling and humiliation in front of co-workers
Disproportionate monitoring of the work
Unnecessary verbal or written warnings etc
Vague or untrue claims of poor or underperformance

The bad effects of bulling in workplace

When there is bullying in workplace the employees who are subject to bullying are suffer more in
terms of physical and mental effects. They have very high stress levels, and suffer from extreme
bitterness in their attitude. They usually suffer from depression, and usually do not have any
motivation to excel in their jobs and exhibit greater levels of hostility towards other employees.
Due to the constant depression and stress they suffer from many physical illnesses like digestive
problems, sleeping disorders like insomnia and usually have high blood pressure.

Those in the management must always be aware of the fact that bullying in workplace is not the
right way of running their business as a company with bullying becomes dysfunctional and
inefficient. You can see that the absenteeism and low productivity are the norms of any working
day and due to this the company suffers very strong negative growth factors in the long run. An
employee who is subject to bullying in workplace becomes totally against any form of innovation
at his workplace and he never expresses or develops his own ideas for the betterment of the
company.

Due to the hostile and unfavorable work environment even quality employees who are not bullied
also feel it necessary to leave the company at their earliest opportunities. When the bullying in
workplace is known to outside world new employees do not opt to come into the company for
fear of being bullied while working for the company.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in
stroke patients. The thigh-length sleeves promote blood flow by periodically filling with air and
gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor
of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s
president, commented on the study.

“Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have
already come to rely on this equipment for safe, effective, and affordable prevention of deep vein
thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to
give it a try.”

Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body.
It is common in stroke patients and immobile patients and can also occur in healthy people on
long flights where movement is restricted. When a clot detaches, it can then become lodged in
the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom.
Results showed 8.5 percent of patients treated with compression devices developed blood clots,
versus 12.1 percent of patients who received alternative treatments.

“Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these
drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to
bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke
patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed
the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s
guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients
at high risk of DVT. Currently, they only recommend it in cases where blood thinners are
unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and
another third result in permanent disability.

Vascular PRN may be reached at 800-886-4331.

Dabigatran, better known as Pradaxa, marketed by Boehringer Ingelheim, is an anti-coagulant prescribed to millions of patients since its release in 2010. Now patients are coming forward with claims of life-threatening and other serious side effects.

An FDA MedWatch report states that Pradaxa caused at least 542 known deaths in 2011, the year after it was introduced to the public. Other reports include more than 2,350 cases of internal hemorrhaging, 644 strokes and almost 300 cases of acute renal failure. The most often cited side affects patients are claiming were caused by Pradaxa include gastrointestinal bleeding, brain hemorrhage, stroke, and heart attack.

The maker of Pradaxa, Boehringer Ingelheim, has been accused of concealment of risk, negligence, and strict product liability. The company has also been accused of failing to establish an internal bleeding protocol, failing to warn consumers of the high risks associated with taking Pradaxa, and failing to adequately research the medication’s safety and proper dosage.

Pradaxa has been a popular substitute for Warfarin, an anti-coagulant on the market for more than 50 years. Warfarin also increases the risk of internal bleeding, but the bleeding can be stopped with vitamin K. Pradaxa does not have a comparable antidote and there is no standard method to measure its anticoagulant effects.

Pradaxa lawsuits were consolidated in August 2012 to allow multiple litigants; four bellwether trials are scheduled for August 2014. Meanwhile, Pradaxa is still on the market and is considered a viable treatment option for those who need an anticoagulant. Anticoagulants are designed to reduce blood clotting or prevent blood clots. Anticoagulants are commonly prescribed to treat superficial venous thrombosis (SVT), deep vein clots, and deep venous thrombosis DVT. Anticoagulants are also commonly given when there is a risk of stroke.

As of April 2013, the label for Pradaxa contains a boxed warning which advises that discontinuing the medication may increase the risk of stroke.

If you or a loved one has been prescribed Pradaxa and have had any incidences of an adverse reaction, your experience should be immediately reported to the FDA.

At The Hale Law Firm, we have helped thousands of clients successfully prosecute their personal injury claims including auto accidents, wrongful death, dangerous products, brain injuries, burn injuries, and defective medical devices. Clients depend on their personal injury lawyers for guidance and legal advice across a broad range of personal injury accidents. To learn more, visit http://www.hale911.com/ or call 972.351.0000.

By Jordan Rau
Kaiser Health News
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by
the government starting in October because many of their patients are readmitted soon after
discharge, new records show.

Together, these hospitals will forfeit more than $280 million in Medicare funds over the next
year as the government begins a wide-ranging push to start paying health care providers based on
the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge,
the government considers readmissions a prime symptom of an overly expensive and
uncoordinated health system. Hospitals have had little financial incentive to ensure patients get
the care they need once they leave, and in fact they benefit financially when patients don’t
recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year,
costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate
has remained steady at around 19 percent for several years, even as many hospitals have worked
harder to lower theirs.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by
Medicare to use its financial muscle to force improvements in hospital quality. In a few months,
hospitals also will be penalized or rewarded based on how well they adhere to basic standards of
care and how patients rated their experiences. Overall, Medicare has decided to penalize 71
percent of the hospitals whose readmission rates it evaluated, the records show.

The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia,
Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of
the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 307 hospitals nationally will lose the maximum amount allowed under the health care
law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked
institutions, including Hackensack University Medical Center in New Jersey, North Shore
University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a
teaching hospital of Harvard Medical School.

“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands,
senior vice president for quality at Beth Israel. “It is not completely understood what goes into an
institution having a high readmission rate and what goes into improving” it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has
unusually low mortality rates for its patients, which he says may reflect that the hospital does a
good job at swiftly getting ailing patients back and preventing deaths.

Penalties Will Increase Next Year

The maximum penalty will increase after this year, to 2 percent of regular payments starting in
October 2013 and then to 3 percent the following year. This year, the $280 million in penalties
comprise about 0.3 percent of the total amount hospitals are paid by Medicare.

According to Medicare records, 1,910 hospitals will receive penalties less than 1 percent; the
total number of hospitals receiving penalties is 2,217. Massachusetts General Hospital in Boston,
which U.S. News last month ranked as the best hospital in the country, will lose 0.53 percent of
its Medicare payments because of its readmission rates, the records show. The smallest penalties
are one hundredth of a percent, which 49 hospitals will receive.

Dr. Eric Coleman, a national expert on readmissions at the University of Colorado School of
Medicine, said the looming penalties have captured the attention of many hospital executives.
“I’m not sure penalties alone are going to move the needle, but they have raised awareness and
moved many hospitals to action,” Coleman said.

The penalties have been intensely debated. Studies have found that African-Americans are more
likely to be readmitted than other patients, leading some experts to be concerned that hospitals
that treat many blacks will end up being unfairly punished.

Hospitals have been complaining that Medicare is applying the rule more stringently than
Congress intended by holding them accountable for returning patients no matter the reason they
come back.

Hospitals That Serve Poor Are Hit Harder Than Others

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher
readmission rates, which the hospitals attribute to the lack of access to doctors and medication
these patients often experience after discharge. The analysis of the penalties shows that 80
percent of the hospitals that have a lot of low-income patients will lose Medicare funds in the
fiscal year starting in October. Sixty-seven percent of the hospitals treating few poor patients are
going to be penalized, the analysis shows.

“It’s our mission, it’s good, it’s what we want to do, but to be penalized because we care for
those folks doesn’t seem right,” said Dr. John Lynch, chief medical officer at Barnes-Jewish
Hospital in St. Louis, which is receiving the maximum penalty.

“We have worked on this for over four years,” Lynch said, but those efforts have not substantially
reduced the hospital’s readmissions. He said Barnes-Jewish has tried sending nurses to patients’
homes within a week of discharge to check up on them, and also scheduled appointments with a
doctor at a clinic, but half the patients never showed. This spring, the hospital established a team
of nurses, social workers and a pharmacist to monitor patients for 60 days after discharge.

“Some of the hospitals that are going to pay penalties are not going to be able to afford these
types of interventions,” said Lynch, who estimated the penalty would cost Barnes-Jewish $1
million.

Atul Grover, chief public policy officer for the Association of American Medical Colleges, called
Medicare’s new penalties “a total disregard for underserved patients and the hospitals that care
for them.” Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: “It’s
really ironic that you penalize the hospitals that need the funds to manage a particularly difficult
population.”

Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or
better on the measures than hospitals without substantial numbers of patients of low
socioeconomic status.” Safety-net hospitals that are not being penalized include the University of
Mississippi Medical Center in Jackson and Denver Health Medical Center in Colorado, the
records show.

Bill Kramer, an executive with the Pacific Business Group on Health, a California-based
coalition of employers, said the penalties provide “an appropriate financial incentive for hospitals
to do the right thing in terms of preventing avoidable readmissions.”

The government’s penalties are based on the frequency that Medicare heart failure, heart attack
and pneumonia patients were readmitted within 30 days between July 2008 and June 2011.
Medicare took into account the sickness of the patients when calculating whether the rates were
higher than those of the average hospital, but not their racial or socio-economic background.

The penalty will be deducted from reimbursements each time a hospital submits a claim starting
Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted
a claim for $20,000 for a stay, Medicare would reimburse it $19,800.

The Centers for Medicare & Medicaid Services has been trying to help hospitals and community
organizations by giving grants to help them coordinate patients’ care after they’re discharged.
Leaders at many hospitals say they are devoting increased attention to readmissions in concert
with other changes created by the health law.

Sally Boemer, senior vice president of finance at Mass General, said she expected readmissions
will drop as the hospital develops new methods of arranging and paying for care that emphasize
prevention. Readmissions “is a big focus of ours right now,” she said.

Gundersen Lutheran Health System in La Crosse, Wis., and Intermountain Medical Center in
Murray, Utah, were among 887 hospitals where Medicare determined the readmission rates were
acceptable. Those hospitals will not lose any money, nor will another 346 hospitals that had too
few cases for Medicare to evaluate. On average, the readmissions penalties were lightest on
hospitals in Utah, South Dakota, Vermont, Wyoming and Oregon, the analysis shows. Idaho was
the only state where Medicare did not penalize any hospital.

Even some hospitals that won’t be penalized are struggling to get a handle on readmissions.
Michael Baumann, chief quality officer at the University of Mississippi Medical Center, said
in-house doctors had made headway against heart failure readmissions by calling patients at
home shortly after discharge. “It’s a fairly simple approach, but it’s very labor intensive,” he said.

The problems afflicting many of the center’s patients—including obesity and poverty that makes
it hard to afford medications—make it more challenging. “It’s a tough group to prevent
readmissions with,” he said.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in stroke patients.

The thigh-length sleeves promote blood flow by periodically filling with air and gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s president, commented on the study.  “Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have already come to rely on this equipment for safe, effective, and affordable prevention of deep vein thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to give it a try.”  Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body. It is common in stroke patients and immobile patients and can also occur in healthy people on long flights where movement is restricted. When a clot detaches, it can then become lodged in the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom. Results showed 8.5 percent of patients treated with compression devices developed blood clots, versus 12.1 percent of patients who received alternative treatments.  “Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients at high risk of DVT. Currently, they only recommend it in cases where blood thinners are unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and another third result in permanent disability.

By Jordan Rau
Kaiser Health News
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by
the government starting in October because many of their patients are readmitted soon after
discharge, new records show.

Together, these hospitals will forfeit more than $280 million in Medicare funds over the next
year as the government begins a wide-ranging push to start paying health care providers based on
the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge,
the government considers readmissions a prime symptom of an overly expensive and
uncoordinated health system. Hospitals have had little financial incentive to ensure patients get
the care they need once they leave, and in fact they benefit financially when patients don’t
recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year,
costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate
has remained steady at around 19 percent for several years, even as many hospitals have worked
harder to lower theirs.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by
Medicare to use its financial muscle to force improvements in hospital quality. In a few months,
hospitals also will be penalized or rewarded based on how well they adhere to basic standards of
care and how patients rated their experiences. Overall, Medicare has decided to penalize 71
percent of the hospitals whose readmission rates it evaluated, the records show.

The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia,
Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of
the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 307 hospitals nationally will lose the maximum amount allowed under the health care
law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked
institutions, including Hackensack University Medical Center in New Jersey, North Shore
University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a
teaching hospital of Harvard Medical School.

“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands,
senior vice president for quality at Beth Israel. “It is not completely understood what goes into an
institution having a high readmission rate and what goes into improving” it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has
unusually low mortality rates for its patients, which he says may reflect that the hospital does a
good job at swiftly getting ailing patients back and preventing deaths.

Penalties Will Increase Next Year

The maximum penalty will increase after this year, to 2 percent of regular payments starting in
October 2013 and then to 3 percent the following year. This year, the $280 million in penalties
comprise about 0.3 percent of the total amount hospitals are paid by Medicare.

According to Medicare records, 1,910 hospitals will receive penalties less than 1 percent; the
total number of hospitals receiving penalties is 2,217. Massachusetts General Hospital in Boston,
which U.S. News last month ranked as the best hospital in the country, will lose 0.53 percent of
its Medicare payments because of its readmission rates, the records show. The smallest penalties
are one hundredth of a percent, which 49 hospitals will receive.

Dr. Eric Coleman, a national expert on readmissions at the University of Colorado School of
Medicine, said the looming penalties have captured the attention of many hospital executives.
“I’m not sure penalties alone are going to move the needle, but they have raised awareness and
moved many hospitals to action,” Coleman said.

The penalties have been intensely debated. Studies have found that African-Americans are more
likely to be readmitted than other patients, leading some experts to be concerned that hospitals
that treat many blacks will end up being unfairly punished.

Hospitals have been complaining that Medicare is applying the rule more stringently than
Congress intended by holding them accountable for returning patients no matter the reason they
come back.

Hospitals That Serve Poor Are Hit Harder Than Others

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher
readmission rates, which the hospitals attribute to the lack of access to doctors and medication
these patients often experience after discharge. The analysis of the penalties shows that 80
percent of the hospitals that have a lot of low-income patients will lose Medicare funds in the
fiscal year starting in October. Sixty-seven percent of the hospitals treating few poor patients are
going to be penalized, the analysis shows.

“It’s our mission, it’s good, it’s what we want to do, but to be penalized because we care for
those folks doesn’t seem right,” said Dr. John Lynch, chief medical officer at Barnes-Jewish
Hospital in St. Louis, which is receiving the maximum penalty.

“We have worked on this for over four years,” Lynch said, but those efforts have not substantially
reduced the hospital’s readmissions. He said Barnes-Jewish has tried sending nurses to patients’
homes within a week of discharge to check up on them, and also scheduled appointments with a
doctor at a clinic, but half the patients never showed. This spring, the hospital established a team
of nurses, social workers and a pharmacist to monitor patients for 60 days after discharge.

“Some of the hospitals that are going to pay penalties are not going to be able to afford these
types of interventions,” said Lynch, who estimated the penalty would cost Barnes-Jewish $1
million.

Atul Grover, chief public policy officer for the Association of American Medical Colleges, called
Medicare’s new penalties “a total disregard for underserved patients and the hospitals that care
for them.” Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: “It’s
really ironic that you penalize the hospitals that need the funds to manage a particularly difficult
population.”

Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or
better on the measures than hospitals without substantial numbers of patients of low
socioeconomic status.” Safety-net hospitals that are not being penalized include the University of
Mississippi Medical Center in Jackson and Denver Health Medical Center in Colorado, the
records show.

Bill Kramer, an executive with the Pacific Business Group on Health, a California-based
coalition of employers, said the penalties provide “an appropriate financial incentive for hospitals
to do the right thing in terms of preventing avoidable readmissions.”

The government’s penalties are based on the frequency that Medicare heart failure, heart attack
and pneumonia patients were readmitted within 30 days between July 2008 and June 2011.
Medicare took into account the sickness of the patients when calculating whether the rates were
higher than those of the average hospital, but not their racial or socio-economic background.

The penalty will be deducted from reimbursements each time a hospital submits a claim starting
Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted
a claim for $20,000 for a stay, Medicare would reimburse it $19,800.

The Centers for Medicare & Medicaid Services has been trying to help hospitals and community
organizations by giving grants to help them coordinate patients’ care after they’re discharged.
Leaders at many hospitals say they are devoting increased attention to readmissions in concert
with other changes created by the health law.

Sally Boemer, senior vice president of finance at Mass General, said she expected readmissions
will drop as the hospital develops new methods of arranging and paying for care that emphasize
prevention. Readmissions “is a big focus of ours right now,” she said.

Gundersen Lutheran Health System in La Crosse, Wis., and Intermountain Medical Center in
Murray, Utah, were among 887 hospitals where Medicare determined the readmission rates were
acceptable. Those hospitals will not lose any money, nor will another 346 hospitals that had too
few cases for Medicare to evaluate. On average, the readmissions penalties were lightest on
hospitals in Utah, South Dakota, Vermont, Wyoming and Oregon, the analysis shows. Idaho was
the only state where Medicare did not penalize any hospital.

Even some hospitals that won’t be penalized are struggling to get a handle on readmissions.
Michael Baumann, chief quality officer at the University of Mississippi Medical Center, said
in-house doctors had made headway against heart failure readmissions by calling patients at
home shortly after discharge. “It’s a fairly simple approach, but it’s very labor intensive,” he said.

The problems afflicting many of the center’s patients—including obesity and poverty that makes
it hard to afford medications—make it more challenging. “It’s a tough group to prevent
readmissions with,” he said.

Compression Therapy Reduces Blood Clots in Stoke Patients, Study Finds

New research shows that inexpensive leg compression devices help prevent fatal blood clots in stroke patients.

The thigh-length sleeves promote blood flow by periodically filling with air and gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company’s president, commented on the study.  “Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have already come to rely on this equipment for safe, effective, and affordable prevention of deep vein thrombosis. I’m glad this new research was done, and I hope it will help convince more doctors to give it a try.”  Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body. It is common in stroke patients and immobile patients and can also occur in healthy people on long flights where movement is restricted. When a clot detaches, it can then become lodged in the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom. Results showed 8.5 percent of patients treated with compression devices developed blood clots, versus 12.1 percent of patients who received alternative treatments.  “Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed the study’s findings. Professor Martin Dennis of the University of Edinburgh said that the UK’s guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients at high risk of DVT. Currently, they only recommend it in cases where blood thinners are unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and another third result in permanent disability.

Although few would plan for the years after retirement to be spent in a nursing home, unforeseen illness and declining mobility could render dreams of traveling the country by RV or perfecting agolf swing unlikely. According to a 2004 report compiled by the Centers for Disease Control(CDC), 27 percent of Americans over the age of 65—1.3 million—were residing in nursing homes.  What’s more, the Census Bureau predicts that the population of people 65 and over willmore than double to 86.7 million in 2050 from 36.3 million in 2004, a number that reveals the potential rise in health issues as a result of an aging population whose life span has become increasingly higher than in previous years.  But with many elderly people stubbornly resisting the transition to a nursing home—stereotypes of loneliness, isolation and stifled independence abounding—is there any alternative other than home health care for people requiring day to day care? Based on the teachings of Dr. Bill Thomas, a geriatrician whose Eden Alternative philosophy teaches that “aging should be a continued state of development and growth, rather than a period of decline,” the Sarah Neuman nursing home in Mamaroneck plans to build a freestanding set of buildings modeled after Thomas’ Green House project, which will address what Thomas says are the basic problems affecting nursing home residents: loneliness, boredom and helplessness.  In a poignant quote from a National Public Radio (NPR) interview in 2005, Thomas said, “I believe that in the nursing home every year, thousands and thousands of people die of a broken heart. They die not so much because their organs fail, but because their grip on life has failed.”  Please continue reading at:http://nanuet.patch.com/articles/nursing-home-of-the-future-mamaroneck-s-sarah-neuman-pioneering-resident-centered-care

Former CMS administrator scolds long-term care providers — but he has it all wrong!
By Steve Moran, Senior Housing Forum

McKnight’s Long-Term Care published an article titled “Former top Medicare official scalds long-term care leaders”  on September 26. According to this article, Tom Scully, the former chief of the Medicare & Medicaid Services Administration, brutally chastised the long-term care industry for exploiting a change in the Medicare reimbursement rules that allowed providers to extract an extra $5 billion from the system in less than a year.His proposition was that the long-term care providers should have known that it would not last and would damage their lobbying efforts for the foreseeable future. He has it wrong on so many counts. Last year, I pointed out:
The system, as designed by the government, is adversarial in nature, meaning that the government works to pay out as little possible and the providers work to get paid as much as possible while not breaking the rules, which is exactly what they did.The government is that stupid! If they had thought out the rule change it would have been easy to  figure out how the providers would react. This was an easily predictable outcome.You could even make a case that if the providers had not taken advantage of the rule change, they would have been violating their responsibility to their investors.The providers did nothing that was illegal or even against the rules. It is hard to even figure out how to apply morality to this particular situation. At the end of the day, even with the “take backs”, the long-term care providers who were the most aggressive in taking advantage of the system ended up financially better off than if they had not. At least some of those providers who”did the right thing” ended being penalized for not taking advantage of the system.The blame for this colossal waste of tax money, my money and your money, lies squarely at the feet of the CMS.

Simple Products That Can Make Mobility Easier
by Lynda Shrager, The Organized Caregiver

After 33 years of practicing in the field of occupational therapy, it still never ceases to amaze me how a simple piece of adaptive equipment can so highly impact how a person completes a task.Whether they have joint limitations, decreased strength, loss of the use of one extremity, poor balance, or difficulty mobilizing, a simple modification can often turn an impossible task into an achievable one. One of my principles of health organizing is to gather all of the equipment you need ahead of time before undertaking a task:The Organized Caregiver’s Top Ten Choices for Products That Will Make Life Easier and Safer:
1. Elastic shoe laces: Lace in shoes, pull to desired tension, tie a bow and then never have to tie your shoes again! It turns tie shoes into slip-ons.
2. Button hook/Zipper pull: The button hook is inserted through the button hole, hooks the buttonand easily pulls it back through. The zipper pull easily grabs hard to grasp zippers. This is a greattool for people with decreased fine coordination or arthritis.
3. Rocker knife: Simultaneously stabilizes and cuts food. The knife has a sharp, curved blade thateasily cuts when rocked back and forth over food. For one handed use, decreased coordination orweakness.
4. Spike board: A cutting board with several long nails protruding up to stab meats, vegetablesand fruits for cutting or peeling. Look for suction cup legs and a raised corner against which apiece of bread can be placed for buttering. This is a good product for people with weakness, onehanded use, a lack of coordination or low vision.
5. Bed rail: Available in many types and sizes, this small rail provides support to help people safely get in and out of bed. Many have a base that fits between the mattress and box spring with no assembly required!
6. Sock aide: An incredible gadget that helps you put on socks without bending over. An inexpensive tool that is helpful for those with limited mobility or recovering from hip replacement surgery.
7. Raised toilet seat with handles: If you have decreased mobility in the hips, knees or back your toilet can seem very low. This product raises it about four inches and has armrests for added safety and support.
8. Reacher: Helps you pick up things more than an arm’s length away for people with limited reach or strength. Various types have different “jaws” depending on what type of objects you need to grab.
9. Bathtub transfer bench: Two legs sit outside of the tub and two are in. The person sits down and slides in without needing to step over the wall of the tub.
10. Grab bars: I saved the best for last. Place them in the shower, on the way into the tub, by the toilet, or near the door jam on the way out of the house. Be sure they are installed properly and have a textured surface making them easier to grasp. This simple bar will increase safety and make transfers easier.
You may purchase most of these items in your neighborhood home medical supply store. Many drugstores or big box stores also carry them. For more information, pictures of the products and where to purchase, go online to “Home Health Care Equipment and Supplies” or Google the name of the item.

Lawsuit Filed Over Negligence In DVT Prevention and Treatment
Tampa, FL (Law Firm Newswire) October 10, 2012 –

A lawsuit has been filed against an Illinois nursing home over negligence in the prevention and treatment of deep vein thrombosis (DVT). Carol Harrison, 63, was admitted to Maple Ridge Care Centre for rehabilitation and ventilator care following complications from surgery. As with many patients in long-term care, Harrison was at risk for blood clots. According to the lawsuit, medical staff failed to detect the fact that Harrison had developed DVT. Her leg had to be amputated, which allegedly hastened her death. DVT is a potentially fatal condition that staff at hospitals and nursing homes must be alert to, as anyone with limited mobility may be at risk due to compromised blood circulation. DVT happens when a blood clot is created in the veins of the legs or pelvis. If the clot breaks free and travels through the bloodstream, it becomes an embolism. Common symptoms of DVT include discoloration and swelling of the limb, usually the leg. Patients at risk may be prescribed blood thinners like Warfarin, but pneumatic compression therapy is another alternative. “Some doctors prescribe blood thinners like Warfarin to reduce the chance of blood clots, but these drugs are expensive, and have potentially dangerous side effects, which can be as serious as the clots themselves,” said Greg Grambor, owner of VascularPRN, a distributor of DVT prevention devices. “Pneumatic compression therapy is a far less expensive alternative, which is every bit as effective as the drugs, with absolutely no dangerous side effects.”Maple Ridge Care Centre is a nursing home in Lincoln, Illinois specializing in wound care,pulmonary diseases and physical therapy. The facility provides respiratory care through a partnership with the Springfield Clinic and Southern Illinois University Pulmonology. The nursing home lawsuit was filed in Macon County Circuit Court by Harrison’s husband. To learn more about a Sequential Compression Device, SCD boots, visit www.vascularprn.com or call 800-886-4331.

There has been significant discussion regarding hospital readmissions and the impact tocompensation. CMS has just begun a study looking at readmissions from nursing homes.
by Candyce Henry

A 79 year old woman had advanced heart failure, chronic lung disease and diabetes. She recently had signed a D.N.R., “do not resuscitate” order and there was nothing more that could be done to care for her at the hospital. The cardiologist called her doctor and they agreed that they would respect her wishes to be kept out of the hospital. Within a few hours after being placed in long term care, the staff noticed her very low oxygen levels and contacted another doctor who was not familiar with the woman’s medical history who gave the order to send her back to the hospital.The situation highlights problems with long-term care that frequently frustrate caregivers and that are receiving fresh attention from medical providers and Medicare. The nursing home staff had no knowledge of the woman’s D.N.R. and the patient was unable to provide information. This might not have happened if the woman’s D.N.R. order had traveled with her when she was discharged from the hospital. It is a common problem that results in the default option being to send the individual back to the hospital. When the patient goes to the hospital, she will be seen by a physician who doesn’t know her, usually for only a few minutes. Because the medical history is not readily available for nursing home patients, the doctor will order a number of tests which will likely show abnormalities because of the patient’s age and medical conditions. Then ext step is to readmit the woman to the hospital for more evaluation and observation. The patient will become afraid and disoriented because of the unknown situation, little sleep, and noise. She then will receive aggressive medications and be confined to her bed.
Few caregivers realize this is a likely chain of events. Rarely do nursing home doctors or nursessit down and explain the risks of hospitalizing a frail older person who is profoundly physicallyand mentally compromised. This is the set of problems that a new pilot program of the Centersfor Medicare and Medicaid Services (CMS) hopes to address in Alabama, Indiana, Missouri,Nebraska, Nevada, New York and Pennsylvania later this year. Seven organizations arepartnering with 145 Nursing Facilities to reduce avoidable hospitalizations. CMS will fundorganizations that provide enhanced on site services to support nursing facility residents. Nearlytwo-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled inMedicare. These Medicare-Medicaid enrollees are among the most fragile and chronically illindividuals served by the programs. Research found that approximately 45 percent ofhospitalizations among Medicare-Medicaid enrollees receiving skilled nursing facility servicescould have been avoided. Total costs for these potentially avoidable hospitalizations forMedicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion. Allselected organizations will have on-site staff to partner with the existing nursing facility staff toprovide preventive services as well as improve assessments and management of medicalconditions. Participants will also work toward more seamless beneficiary transitions of care, andleverage use of emerging technologies, among many other activities. Each model will be subjectto a rigorous external evaluation.  The Initiative will be run collaboratively by the CMSMedicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation,both created by the Affordable Care Act to improve health care quality and reduce costs in theMedicare and Medicaid programs. http://innovations.cms.gov/initiatives/rahnfr/.