Published on the June 21, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Purchasing a refurbished CT or MRI machine could be a good option, particularly if your budget is tight. But practices should proceed with caution, said Joyce Bates, RT, director of imaging and radiation oncology at Carolinas Medical Center-Union in Charlotte, N.C., who offered a few considerations.
First, be sure to select a company with a strong reputation for quality products and service. If possible, she said, purchase a refurbished machine from a vendor with whom you have an existing relationship, and be sure to secure a warranty. Next, be sure the vendor fully updates their machines, including replacing parts, installing new software, and painting the equipment. Everything should look new, she said.
Second, she said, only consider purchasing refurbished machines that are less than three years old. Technology changes so rapidly in the industry that older equipment cannot give you the same clinical capabilities.
Lastly, it’s also important to remember, Bates said, that refurbished equipment isn’t suited for every modality. Machines that approach $1 million in price, such as CTs and MRIs, can be refurbished and provide the same level of performance as a new machine would. Nuclear medicine cameras, although their price tag hovers around $300,000 to $400,000 dollars, can also offer suitable refurbished options. However, Bates recommended avoiding refurbished equipment of less than $100,000, such as ultrasound machines, because the technology becomes obsolete much more quickly.
Above all else, she said, consider the current health care landscape when making your purchasing decisions.
“We don’t know what’s going to happen to affect our capital equipment choices,” she said. “Budgets will be tighter, and health care economics will be really tough. It could very well be that refurbished equipment will be the standard within the next five years.”
To read the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2085255
Published on the June 21, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
If you’re looking to add another CT or MRI machine to your imaging suite or you need to replace one that will no longer pass muster under accreditation, you’re likely juggling the question of whether to buy a refurbished machine.
Acquiring refurbished versions of these machines is a growing trend as practices and facilities grapple with concerns over decreasing reimbursement or consider the possibility of future consolidations. Technology advancements over the past five years — and the desire of some larger facilities to purchase the most up-to-date machines — have made CT and MRI machines increasingly available for refurbishment. These machines are best suited for refurbishment, although some less-expensive equipment — mainly ultrasounds — account for solid portion of pre-owned equipment purchases.
“You can get really high-end, latest-technology equipment for refurbishment after five years,” said Sabine Duffy-Sandstrom, vice president of Refurbished Systems (U.S.) at Siemens Healthcare. “That’s why CTs and MRIs are the leading modalities in refurbishment. Facilities tend to keep other machines, such as angiography, for a much longer time.”
An Increase in Demand
If health care reform passes U.S. Supreme Court scrutiny this month, the industry anticipates approximately 37 million new patients will have access to clinical services. It’s possible this uptick will translate into a 14 percent jump in diagnostic imaging utilization, according to a recent study based on Kaiser Permanente data from imaging consultant firm Regents Health Resources in Tennessee.
As a result, Regents president Brian Baker predicted imaging centers could run an additional half-million scans during the next decade, meaning you must find a way to meet the increase in demand. The good news, he said, is that you don’t always have to purchase a new, $1.5 million machine.
“You have to take a look at the entire market. The most advanced technology might be a 3T MRI machine, but you don’t necessary need it to accommodate your patient base or the kinds of exams your referring physicians are ordering,” Baker said. “Often, we recommend refurbished equipment because it’s so much better and faster than what they already have and it will help them better meet the standards of care without carrying the larger price.”
The Refurbishing Process
It could be tempting to think of a refurbished machine simply as a used one with a proverbial new paint job. But that’s not accurate, Siemens’ Duffy-Sandstrom said.
“Everyone tends to use the word refurbished,” she said. “So, when facilities are looking to buy not-new equipment, it’s very important to understand the differences between refurbished and used, especially with the concerns about lowest dose and CT scanners.”
According to Duffy-Sandstrom, Siemens follows a five-step process when refurbishing equipment. First, the refurbishment team considers the machine’s age, performance, and service history. They also check whether the machine’s software and hardware can be upgraded and if service parts will be available for the next five years. Next, the team de-installs the machine and ships it back to a Siemens factory in its original packaging.
Machines are cleaned, disinfected, and painted; worn parts are replaced; hardware and software updates are installed; and the machine is reset to new customer specifications, she said. After passing a final check, refurbished machines receive a quality seal.
The same Siemens team re-installs the machine, which carries the same warranty as a new machine, with the new customer and provides standard training.
Other companies, such as Philips and GE Healthcare, also refurbish their machines. Philips’ five-step process is similar to what Siemens offers, and it focuses on bringing a wide range of modalities to customers looking to purchase updated machines on a budget, said Jim Moran, director of equipment remarketing for Philips Healthcare for North America.
On the other hand, purchasing a used machine from a third-party retailer is an option. There is no hazard to doing so, Moran said, but all updating processes are not created equal. It’s akin to purchasing a used car — you must choose from what the dealer has on the lot.
“Not everyone can access the proper software and safety upgrades for all machines,” he said. “This is a big investment so you want to make sure the refurbisher has sound processes. My guidance to clients is to go to the facility, oversee the process, and be mindful of whether the equipment looks new and has been brought up to current industry specifications.”
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2085269?pageNumber=1
Published in the June 25, 2012, Raleigh News & Observer and Charlotte Observer
By Whitney L.J. Howell
“Cat Scratch Fever” might be best known as a catchy song, but the infection of the same name, scientifically known as Bartonella – is an easy-to-catch infection caused by a common, hard-to-detect microbe. But a test developed by N.C. State researchers could make it simpler to pinpoint the pathogen and treat the resulting symptoms.
Using a patented insect medium and a sensitive, sophisticated DNA analysis tool, N.C. State investigators have developed a Bartonella diagnostic test for humans. The goal is to identify Bartonella infections faster and more accurately, and a partnership with Research Triangle Park-based company Galaxy Diagnostics, Inc. could make the test widely available.
“This microbe is one of a handful that physicians who specialize in chronic disease
look at now, but a lot of doctors don’t test for it because of the high false-negative rates. If you don’t know exactly what to look for or if you don’t have the tools, why look for it?” said Amanda Elam, Galaxy Diagnostics president. “We think we’ve found a way to identify the bacteria, and we’re helping to find it in patients with this test.”
Currently, there are more than 25 known Bartonella strains, and roughly nine have been linked to disease development in humans.
However, diagnosis is challenging because it only takes a few Bartonella particles to prompt an infection. Small amounts mean even highly sensitive tests, such as DNA analysis with the help of polymerase chain reactions (PCR), often yield false negatives.
“Locating Bartonella is like finding a needle in a haystack with the infection being the needle and the haystack being the patient,” said Ed Breitschwerdt, internal medicine professor at N.C. State’s College of Veterinary Medicine. “If the haystack is too big and there are only a few needles, PCR will miss the infection more often than not.”
How the test works
Getting a Bartonella diagnosis faster means relying on the bugs that carry it, said Breitschwerdt, who led the test’s development team.
“During our 15 years of research, it became obvious many different insects – sand flies, lice, fleas, biting flies on cattle, and ticks – were confirmed Bartonella carriers,” Breitschwerdt said. What made his research different was finding the way to grow Bartonella more quickly in a Petrie dish.
“We asked whether Bartonella would be happier in an insect-growth medium compared to mammal-growth. It’s not too sophisticated a question, but it proved important because the answer was yes.”
To identify an infection, scientists kick-start Bartonella growth by putting a small ( 4 milliliter) blood sample into an insect growth medium called Bartonella alpha Proteobacteria Growth Medium that stimulates bacteria production. Within 10 days, there are enough bacteria present in the blood for a PCR test to yield an accurate diagnosis. Through a series of up to 40 temperature changes, PCR produces multiple copies of any bacteria DNA present, allowing scientists to definitively determine whether Bartonella is present.
The entire process – from petrie dish to verified results – takes between two to three weeks, said Galaxy’s Elam. Scientists can also run the test using non-blood bodily fluids or tissue samples.
Testing teams at Galaxy Diagnostics run PCR analyses on patient samples before inserting it into the insect growth medium in order to accurately gauge the bacteria’s growth. They also determine which Bartonella strain is present by running DNA sequence verification.
According to company data, the enhanced PCR analysis is four to five times more sensitive than the traditional PCR technique used to pinpoint the bacteria in the bloodstream, Elam said. With this extra sensitivity, Breitschwerdt estimated the tests will accurately diagnose between 80 percent to 90 percent of tested individuals who have Bartonella infections.
But identifying the pathogen is only part of the battle, he said.
“Our major contribution is that we’ve gone from thinking this bacterium only occurs in immuno-compromised patients or people with cat scratch disease to knowing there are quite a few people out there in specific populations who have this bacterium in their blood,” he said. “Now, we need research to find out what it means for patients to have this bacterium in their bloodstream.”
Proceeding with caution
Terry Yamauchi, M.D., an Arkansas Children’s Hospital pediatrician with infectious disease expertise, agreed with Breitschwerdt. While the insect growth medium-enhanced PCR is a valid method of identifying Bartonella, the analysis should not be a stand-alone clinical tool.
“The test itself seems to be scientifically very sound – growing more of the organism you’re searching for to improve test sensitivity will be helpful,” he said. “However, I worry about putting all our treatment-plan bets on this test because there’s little hard-core evidence indicating Bartonella is responsible for the chronic effects attributed to these infections.”
Until additional investigations into Bartonella yield a more definitive link between the bacteria and long-term symptoms, he said, physicians should opt to pair the test with traditional clinical observation and assessment.
WHAT IS BARTONELLA?
Bartonella, also called cat scratch fever, is a difficult-to-detect pathogen transmitted by blood-sucking insects, such as fleas, lice, or ticks. Individuals with frequent animal exposure, especially to cats, are also at high risk.
Many clinicians view Bartonella as a common culprit in chronic Lyme disease, arthritis, and multiple sclerosis-like neurological disorders, and is suspected to contribute to swollen lymph nodes, joint and muscle pain, inflammation, headaches, memory loss, and numbness in the hands and feet.
Once believed to only induce disease in animals, more recent research reveals this bacteria is also a threat to humans. According to the American Veterinary Medicine Association, nearly 60 percent of the 1,500 diseases recognized in humans can make the leap from animals to people. And, the phenomenon is growing. The Centers for Disease Control and Prevention estimates 70 percent of newly-identified human infections spring from animals.
To read the story at its Raleigh News & Observer location: http://www.newsobserver.com/2012/06/25/2151203/sharper-infection-detection.html#storylink=cpy
To read the story at its Charlotte Observer location: http://www.charlotteobserver.com/2012/06/24/3332959/sharper-infection-detection.html#storylink=misearch
Published on the June 14, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Changes to Medicare reimbursement and other financial incentives designed to control the use of diagnostic imaging services aren’t working as expected, even in clinical settings without a fee-for-service payment model, according to a study published earlier this week in the Journal of the American Medical Association. However, not all industry leaders agree that imaging utilization is on the rise.
A retrospective study of up to 2 million electronic health records from 1996 to 2010 from six health systems with health maintenance organizations (HMOs) revealed the number of diagnostic imaging studies performed increased between nearly 8 percent to 57 percent during that time period.
The findings, compiled by researchers at the University of California-San Francisco (UCSF), showed the number of ultrasounds doubled, CTs tripled, and MRIs quadrupled during those 15 years. These results indicate that financial disincentives, such as lowered reimbursement or added cost to the patient, aren’t enough to eliminate unnecessary testing, as once was the hope, researchers said.
“Some people are just unrealistically enamored with diagnostic tests. There’s a perception that there’s no harm to these tests, so we can do them and think about the results later,” Rebecca Smith-Bindman, MD, UCSF radiology and biomedical imaging professor and lead study author, said in an interview. “The pictures are extraordinary, and some patients receive enormous benefits from having these tests. But others receive no help at all — they face high radiation doses, false positives, and more unnecessary downstream testing.”
Fear of facing malpractice suits and of missing a malignancy also pushes providers to order diagnostic studies for which there is no true medical indication, she said. If these problems were resolved, she said, radiologists and referring physicians could likely avoid 30 percent to 50 percent of diagnostic studies.
Even an industry-wide shift to an accountable care organization (ACO) or bundled payment model is unlikely to be enough to drive down imaging utilization, she said. Instead, medical imaging should invest in comparative effectiveness studies to better understand when imaging is appropriate. Industry leaders can, then, use that information to create clinical guidelines.
However, several groups, including the American College of Radiology (ACR), the Medical Imaging and Technology Alliance (MITA), and the Access to Medical Imaging Coalition (AMIC) said the study’s findings actually supported existing evidence that imaging use is decreasing.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/low-dose/content/article/113619/2083399
Published in the June 2012 AAMC Reporter
By Whitney L.J. Howell
At Mississippi’s Jackson State University campus, roughly 160 undergraduate students gathered last February to learn about the ins and outs of medical school—applying, financing, and navigating the curricula. Most important however, they discovered that becoming a doctor is within reach.
The experience was part of a five-day campaign, known as the Tour for Diversity in Medicine (T4D), a bus tour that brings information about academic medicine and clinical practice to students attending historically black colleges and universities (HBCUs). The tour also includes information for students interested in dentistry.
“We wanted to make sure these events had a personal component to them. We, as physicians and medical students, go to campuses, sit with students, and have conversations about their personal and academic lives,” said Alden Landry, M.D., M.P.H., T4D co-founder. “It’s more personal than a webinar, Web site, or newsletter. We wanted to meet the students where they are comfortable so they could see us as examples in front of them.”
Landry is an emergency medicine instructor and associate director for the office of multicultural affairs at Beth Israel Deaconess Medical Center in Massachusetts. Along with Kameron Matthews, M.D., J.D., an attending physician at Cermak Health Services of Cook County in Chicago, Landry created the tour to introduce health and medical careers to minority students with the goal of increasing the number of doctors and dentists from groups that are underrepresented in medicine and other health professions.
Academic medicine continues to make progress toward growing a more diverse student body, but programs like T4D still are important, said Norma Poll-Hunter, Ph.D., director for diversity programs and policies at the AAMC.
“It’s critical to take this innovative approach to reach out to underserved communities. Despite concerted efforts from medical schools, associations, and foundations, the overall percentage of racial and ethnic minorities matriculating to M.D.-granting institutions hasn’t changed significantly in the past 10 years,” Poll-Hunter said.
T4D completed its first tour in February, visiting five HBCUs: Jackson State, Tuskegee University in Alabama, South Carolina State University, Johnson C. Smith University in North Carolina, and Hampton University in Virginia. All told, the tour reached approximately 500 students and provided information on how to prepare for and take the Medical College Admission Test®, which undergraduate courses to take to strengthen medical school applications, and how to finance medical education.
But the most significant information, according to Matthews, came from the nine mentors she and Landry recruited. The group of practicing physicians representing minority groups traveled with the tour and offered students first-hand experiences from both school and practice.
“They hammered home that there’s a sense of delayed gratification with medical school. It’s a marathon in terms of the steps from application to becoming a physician or dentist,” Matthews said. “You need to look at this as a long-term career and not be swayed so much by what it takes to get through school. The students got the hint that we did it, and they could persevere to do it, too.”
The information students gathered and the skills they learned through T4D undoubtedly will contribute to increasing the number of minority students who enter medicine, said Michael Druitt, who coordinates pre-health programs and a medical science master’s degree program at Hampton University. The mentors offered tips on how students can improve their interview performances and how they can build rapport with practicing health care professionals, he said. These relationships could lead to shadowing experiences that bolster medical school applications.
Bridget Rideau, M.D., Jackson State’s pre-med and pre-nursing coordinator, said the T4D inspired several of her students to begin actively taking the path toward medical school.
“Many of our students latched onto information about the National Health Service Scholarship. I’ve already filled out five recommendation letters to accompany applications,” Rideau said. “This is especially significant for our students coming from lower-income families who are fearful of how to pay for additional education.”
Student feedback from this year’s tour has been overwhelmingly positive, Landry said, and the program has already scheduled a Midwest tour for this fall and another tour across Texas in spring 2013. HBCUs will continue to be a focus, but upcoming tours also will concentrate on Hispanic-serving institutions, tribal colleges and universities, and regions that have few minority physicians and dentists.
To read the story at its original location: https://www.aamc.org/newsroom/reporter/june2012/285340/diversity.html
Published in the June 7, 2012, Billian’s HealthDATA/Porter Research Hub e-Newsletter
By Whitney L.J. Howell
Across the United States, more than 7.5 million people need daily health services, but they aren’t getting the help they require in a hospital or outpatient facility. Instead, they’re receiving necessary treatments at home from healthcare providers trained to meet patient needs outside of a clinical environment. This is the home healthcare industry, a more than $60 billion sector of the healthcare system that is ballooning rapidly.
Overall, home healthcare is designed to alleviate the stresses placed on outpatient clinics by moving treatment for injuries and some illnesses to the patient’s residence. Providers, usually licensed practical nurses, therapists or home health aides, make routine visits with the goal of helping individuals regain their independence and self-sufficiency.
Meeting this objective often means fusing traditional home healthcare, such as assistance with daily living activities (often known as companion care), with services provided in skilled nursing facilities. For example, home healthcare aides can also tend to wound care needs, physician or occupational therapy, diabetes care, nutrition therapy, injections, or offering patient and caregiver education.
The Bureau of Labor Statistics has estimated that employment in home healthcare agencies will spike by 51 percent between 2006 and 2016. The reason is clear, according to Michael Hicks, Ph.D., Director of Ball State’s Center for Business and Economic Research.
“It’s not especially complicated – as with most of the developed world, we have a higher population of elderly people for whom the demands of healthcare is rising,” Hicks said. “Many more older people value home healthcare because they wish to remain at home. And, as more want to have these services, we’ll continue to see employment grow in these agencies.”
For example, Partners in Care (PiC), a nonprofit home healthcare services provider under the Visiting Nurse Service of New York, has nearly doubled its workforce in the past six years, prompting the need for a second training facility. The number of aides grew from 5,800 in 2006 to approximately 9,200 in 2011. In fact, according to PiC data, the company hired its second-largest group of new employees – 374 aides – in June 2011.
In addition to allowing older patients to maintain a level of independence, home health care is also attractive because of its affordability, Hicks said. For individuals, the cost for 20 hours of weekly home healthcare is approximately $1,500 per month, totaling roughly $18,000 annually, according to the National Private Duty Association. Based on 2011 MetLife statistics, assisted living or nursing home care can cost between $36,000 and $70,000 a year.
These savings can be substantial at a national level. In 2007, the Centers for Disease Control and Prevention reported approximately 1.5 million people received home healthcare services for an average of 315 days.
Fortunately, as home healthcare’s customer base has grown, so have the technologies its providers use to meet patient needs in the home, said Sherl Brand, RN, BSN, President and CEO of the Home Care Association of New Jersey. These tools and the ability to use them in virtually any setting make home healthcare and its providers the epitome of mobile health.
“Technology has far surpassed what we had when I first started as a home health nurse in the early 1990s,” said Brand, who also serves as the chair for the National Association of Home Care and Hospice Forum of State Associations. “Today, we have telehealth, hand-held devices, and electronic health records. Data is real time, and we can communicate easily with physicians and quickly intervene when appropriate to manage care needs in any situation.”
For example, Brand witnessed this type of intervention several years ago with a patient who had severe cardiac disease and had been hospitalized multiple times. With the help of a telehealth system that monitored him closely between clinic appointments, he went 18 months without an emergency room visit or hospital admission.
“We were able to help him stay at home with his lovely wife of over 50 years,” Brand said. “It’s a great story, but it’s not a unique story. We see this stuff all the time.”
These technology improvements have also saved considerable federal healthcare dollars, making home healthcare highly cost-effective. According to an Avalere Health LLC study conducted from 2006 to 2009, in-home care for diabetes, chronic obstructive pulmonary disease, and congestive heart failure prevented 20,426 hospital readmissions. The total savings to Medicare during that time: $670 million.
Long-Term Care Connection
There are also other, less obvious, cost savings associated with the use of home health care services. Patients living at home cover the cost of their own food and housing. Once they move to a skilled nursing facility or nursing home, the federal government assumes those costs, placing greater monetary stress on the overall healthcare system.
While patients view home healthcare as a lower-cost, more comfortable alternative to a hospital admission, these agencies also view themselves as collaborative partners with long-term care facilities.
Many patients do eventually need a higher level of care than home healthcare providers can offer, but these nurses and therapists work with patients, their families and their physicians to keep them at home for as long as possible. Their work alleviates the demand patients have for securing a spot as residents in long-term care facilities.
However, home healthcare does face challenges. Despite its proven benefits, Medicare does not reimburse for telehealth. Consequently, agencies must foot the bill for these services, covering the capital expenditures for all equipment and taking on responsibility for communicating with physicians. The result: an increasing number of entities are abandoning telehealth.
“Today, the home healthcare world is being hit from all angles, and we’re facing a barrage of reimbursement cuts,” Brand said. “I’ve seen some agencies close their doors but others are doing whatever they can to maintain services like telehealth because they are proven to produce such wonderful outcomes for patients.”
Here to Stay
But even with the financial challenges and its already significant growth over the past decade, home healthcare shows no real signs of slowing. There is still has room to expand, Hicks said.
“We’re not really at the point yet where electronic health records are so fully integrated into home healthcare that visiting social workers or home healthcare nurses can take vitals in the home and receive diagnostic analysis from a physician or nurse practitioner located elsewhere. But those days are coming,” he said. “This could mean the suite of services nurse practitioners provide will increase or we could see physicians beginning to look into expanding their practices to link with home health agencies. We will see health networks become far more successful.”
To read the story at its original location: http://www.billianshealthdata.com/news/SiteNews/news_items/2012/June/Home_Health.html