MRI Safety Still a Concern, But National Guidance Lacking

Published on the July 27, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

Last October, the U.S. Food and Drug Administration (FDA) held a meeting to examine the biggest MRI safety concerns and outline best practices to reduce injuries associated with the scans. So far, however, the industry has received no national guidance on how to accomplish this goal.

But the lack of official instruction at the federal level doesn’t mean the push toward greater MRI safety — being recognized this week during MRI Safety Week — has stalled. Advancements are underway at the state level and in the accreditation process to prevent another tragedy, such as the 2001 Colombini case when a 6-year-old boy died when an oxygen tank flew across the room and struck him during the imaging process.

“Any protection that is implemented will benefit the 30 million Americans who get MRIs on an annual basis,” said Tobias Gilk, president and MRI safety director at Mednovus and senior vice president at the design and architecture firm Rad-Planning. “People are beginning to look harder at MRI risk factors as the power of our magnets continue to increase.”

State Regulations

Many states and the Joint Commission have implemented new regulations that strictly govern the design and construction of new MRI suites. These requirements do not mandate retrofitting existing installations.

“There are a growing number of states that are adopting this building code,” Gilk said. “Anyone who does MRI suite work — renovation, upgrade, equipment replacements, anything with a building permit — in virtually every jurisdiction must follow these state standards.”

To conform to the building regulations, health care engineers must meet eight standards, Gilk said. They must follow the American College of Radiology’s (ACR) 4-Zone Principles that addresse integrated access controls and screening practices. There must also be a clear line-of-sight between the operator’s console and patient inside the MRI machine, and designers must include demarcation lines to keep individuals with implantable medical devices far enough away. The presence of ferromagnetic-only detectors is required, and new MRI suites must also have exhaust fans and other protective measures to eliminate any cryogen that escapes into the imaging area.They must include an always-illuminated sign to remind staff that the MRI magnetic field is always active even without a patient.

These new design codes also require a clearly marked safe zone in which staff can use MR conditional equipment. Most importantly, Gilk said, designers and engineers must remember there is no cookie-cutter model for MRI suites. Each site is different and requires individual planning.

Accreditation

In a switch from years past, Gilk said, the Joint Commission is requiring far more documentation to prove you are making your MRI suite as safe as possible for patients. As part of the ACR’s 4-Zone Principles, the Commission now requires proof that you have established access control and provide proper staff supervision. You must also produce documentation that you have adequately trained your MRI personnel in safety procedures and protocols, he said.

“The Joint Commission wants to see evidence of screening protocols for implants and devices, clinical contraindications, and physical screenings,” Gilk said. “They want to see what you’re doing to make sure visitors aren’t carrying objects that will become dangers in the magnet room and what processes or tools are in place that accidents don’t occur.”

Requiring these measures — from an accreditation standpoint — is a giant step forward, he said.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/mri/content/article/113619/2092918

Incomplete Documentation Shrinks Your Bottom Line

Published on the July 24, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

In the wake of the latest proposed radiology reimbursement cuts from CMS, documentation is more important than ever. And experts say your poor documentation may be to blame for your leaving rightfully-earned money unclaimed.

In fact, it’s common for radiologists to forego as much as 10 percent of overall legitimate revenue, according to Richard Duszak, MD, FACR, a radiologist with Mid-South Imaging and Therapeutics in Memphis and regular coding and billing columnist for the Journal of the American College of Radiology. While coders are your partners, they can only file for reimbursement based on the information you provide. It’s your responsibility, he said, to be vigilant.

“Each report must answer three questions: why, what, and how,” he said. “Not the clinical questions, but why did you do the exam, what is the clinical history of the body part imaged, and how was it imaged. Did you use plain films, was contrast present, how many views?”

Problem Areas to Watch

Incomplete documentation in three areas account for approximately 75 percent of unclaimed reimbursement, Duszak said. By addressing documentation problems with clinical history, the use of contrast, and ultrasound, you will likely see your revenue grow.

First, work with your hospital partners to examine how information is documented in the emergency room. Often, referring physicians relay information verbally, and it isn’t recorded in the patient record. Without a properly recorded clinical history, coders must code for the lowest level of reimbursement, and radiologists won’t receive proper payment.

Second, pay close attention to documenting when you use intravenous contrast agents with a CT or MRI study. Failing to notate when you do use contrast reduces both technical and the professional reimbursement.

“Simply failing to mention the introduction of contrast in a CT scan will lead to a loss of legitimate revenue – often as much as 20 percent,” Duszak said. “That adds up over time. Radiologists, as a rule, do a lot of these, so it becomes very significant.”

Third, when performing a complete abdominal ultrasound, be sure to document the eight components required for full reimbursement — the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, abdominal aorta, and inferior vena cava. Missing one immediately downgrades the procedure to an incomplete ultrasound, and, based on the 2011 Medicare Physician Fee Schedule, your reimbursement drops by up to $25.

There are other areas where you could potentially be losing money, said Stacie Buck, president and senior consultant at Rad Rx, a coding consulting company that specializes in diagnostic and interventional radiology services. Fortunately, she said, the fixes are easy.

Always document the number and types of views in the body of the report to avoid having a claim down-coded. And, when documenting 3D reformatted images, note the medical necessity for obtaining them as 3D reformatting isn’t standard for MRI or CT exams.

The Coder’s Perspective

In most cases, Buck said, coders know radiologists are performing services that don’t appear in the documentation, but without written evidence, they can’t help you claim the revenue.

“It is very frustrating to coders when they receive conflicting documentation or incomplete documentation,” she said. “It forces coders to down-code encounters, which, of course, costs a practice or facility money.”

Although it can cause a delay in reimbursement, coders also have the option to come back to you for additional information, said Shirley Breslin, client education and coding training manager for AdvantEdge Healthcare Services, a leading radiology billing company. The length of the delay, however, is up to you.

“Delays in payment depend on how willing a physician is to help us. Having to go back to the radiologist can slow down payment anywhere from three days to a couple of weeks,” she said. “Some radiologists are very conscious of the fact that it’s important to get documentation done and done right. But it really comes down to how well the doctor receives hearing that additional information is necessary.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2092203

 

Genomics: A New Tool for Primary Care

Published in the Summer 2012 Duke University Nursing Magazine

By Whitney L.J. Howell

Nurses lead effort to evaluate, educate, and implement

Sitting in a genetic counseling session at Duke Primary Care’s Pickett Road Clinic, Sharon Graffagnino received news she never thought she’d hear. She was at high risk for diabetes. It was news that caught her completely by surprise.

“It was really shocking for me to get such strong and bad genetic information,” said Graffagnino, 51. “I always thought my numbers would be normal and in the middle.”

Graffagnino was familiar with diabetes and its serious health effects. Her brother weighs 400 pounds and takes insulin four times a day; her sister teeters on the border of full-blown diabetes; and her father battled against it until he passed away. But, as someone who always tried to eat well and exercise, she thought she was protected.

She learned she had a strong genetic risk for developing diabetes when she chose to participate in Effects of Type 2 Diabetes Genetic Risk Information on Health Behaviors and Outcome study through the Duke University School of Nursing. The result: Graffagnino now pays more attention to her food choices.

“I definitely hear the little voice in the back of my head if I’m overdoing it with sweets or starches or not getting enough exercise,” she said. “I’m totally aware and take it seriously. That doesn’t mean I always do really well, but I’m trying.”

This study, which tests whether identifying and relaying genetic risk factors can positively change health behaviors, is part of a larger push within the Duke University Health System (DUHS) toward personalized medicine. This emerging health care model fuses a patient’s genetic and genomic information with family history to provide tailored care. Nursing faculty are leading an interdisciplinary team focused on initiating a paradigm shift in patient care.

Personalized Medicine and Nurses
Nurses have a longstanding reputation as being effective in identifying and managing illness and treatment-related symptoms. Knowledge of genetic factors that put some patients at higher risk for intense symptom experiences is rapidly developing. Nurse researchers are working on studies that help build this knowledge.

“If nurses are aware of genetic markers that make adults or children more or less susceptible to symptom distress, they are
better prepared to make decisions and recommendations that will greatly benefit the patient,” said associate professor Sharron
Docherty, PhD, CPNP-AC/PC, RN. “Understanding individual patients’ genetic risk for key symptomatology, such as cognitive
dysfunction or fatigue, will allow them to more efficiently and accurately assess patients and intervene during treatment.”

It’s also critical to study the use of personalized genetic information to increase knowledge about the impact of whole genome sequencing results on patients and families.

“The role of nurses is to help broker information to the patient and help families understand the difficult concepts that come with this information,” she said. “Nurses today and in the future must be able to understand whole genome sequencing, risk levels, and be able to help families interpret results.”

Researching the impact of Genetic Knowledge
Interest in how personalized medicine can touch clinical care sparked at Duke in 2010 with the creation of the Duke Center for Personalized Medicine. This group, led by genomics clinical director Geoffrey Ginsburg, MD, PhD, fuses resources and expertise from a broad array of players, including the Institute for Genome Sciences & Policy (IGSP), the schools of medicine and nursing, the Sanford School of Public Policy, and the Fuqua School of Business. Through these partnerships, faculty and students are searching for the best ways to bring personalized medicine to all aspects of health care.

The Center for Personalized Medicine (CPM) is also pursuing a policy agenda that will consider reimbursement, legal, and ethical issues related to genomic testing when assessing potential research projects, said assistant professor Allison Vorderstrasse, DNSc, APRN, CNE.

While these multidisciplinary investigations are complex and must be deftly designed, nurses are, in many ways, the keystones in these projects.

“Clinically, nurses tend to take a personalized, holistic approach with patients without even realizing it. They’re all well trained to provide a lot of patient interaction and education,” said Vorderstrasse, who serves on several personalized medicine working groups. “It’s a goal, through CPM’s educational, clinical and research initiatives, to ensure that nurses, as providers, are up-to-date on health
care advances and that they can translate what it all means to patients.”

But there’s not much existing evidence to validate the proposed benefits of the individualized approach to health care. This flimsy body of research is why studies, such as the previously mentioned diabetes study, are critical, said assistant professor Michael Scott, DNP, FNP-BC. This work provides valuable information about how genetic factors can be used clinically.

“With this study, we wanted to explore the value of genetic testing as it pertains to the predisposition to chronic diseases, in this case Type 2 diabetes, and how feasible it is to do this type of testing in a primary care clinic,” said Scott, who provided risk counseling to study participants. “We wanted to see if personal genomic information is likely to benefit patients through motivation of lifestyle behavioral change.”

Scott’s colleagues from the IGSP recruited participants from the Pickett Road Clinic and Pickens Family Medicine who had no reported history of diabetes and had never been genetically tested. Overall, 317 participants completed the full study.

To gather genetic material, researchers scraped the inside of each participant’s cheek with a tongue blade, and a genetic testing company analyzed samples for certain genes associated with a risk for Type 2 diabetes. Investigators also collected information about other factors influencing diabetes risk, such as family history, blood sugar, body mass index, age, and ethnicity. All participants had the opportunity to meet with Scott for risk counseling, and those who were randomly selected for testing received counseling rooted in their individual genetic results.

Based on study results, 26 percent of participants were pre-diabetic with blood sugar levels between 100 and 125; 68 percent were either overweight or obese; and 57 percent had a family history of diabetes. In addition, 92 percent returned for counseling sessions. Preliminary analysis is ongoing, but early results have shown both groups—those who were genetically tested and those who weren’t—made minimal improvement in overall health status, especially with weight loss.

“We’re thinking just the possibility of sitting down with me to talk about risk in the way a clinician doesn’t have time to do may have made an impact. Weight loss in both groups doesn’t mean genetic testing isn’t necessary,” Scott said. “These are just the early results, but whether the participant was genetically tested, it’s clear simple involvement with a health care professional gets people motivated.”

The Center for Personalized Medicine has other ongoing medicine studies, as well. Vorderstrasse, who sits on the center’s leadership team charged with creating criteria that will determine which future studies win funding, is also a co-principal investigator on a pilot study. This study is currently recruiting patients and is led by co-principal investigators Ruth Wolever, PhD, of Duke Integrative Medicine and Alex Cho, MD. It is designed to determine whether genomic risk assessment can be effectively added to standard risk assessments for heart disease. The goal, she said, is to develop risk assessment tools and behavioral support interventions (health
coaching) for implementation in primary care.

Educating Nurses to Play Their Role
Determining the efficacy of discussing genetic results with individual patients could drastically change the health care delivery model, and all providers must be ready to implement such a strategy. This spring, the School of Nursing introduced an interdisciplinary pilot elective class focused on genomic fundamentals and how they apply to personalized medicine.

Having a solid understanding of how genomics can impact patients’ response to treatments and medications could greatly
enhance the quality of care, said assistant professor Jennifer Dungan, PhD, RN.

“If nurses truly understand how genomics impacts health risk at the forefront and know how to evaluate it, they can be much better at approaching these topics with patients,” said Dungan, who co-teaches the course with Sara Katsanis, MS, an associate in research in the Duke IGSP. “Rather than being reactive to patients, they can proactively reach out and determine if this information is important to patients, what it all means, and what to focus on.”

During the first seven weeks of the seven-student class, the curriculum focused on fundamental genomic principles, such as human genetic variation, bioinformatics, ethical and social issues, and the principles of genomic testing. But it’s the second half of the semester where students saw how genomic test results can directly impact health care.

In addition to hearing clinical and research experts discuss these topics, students had the option, but weren’t required, to complete a free, anonymous 23andMe genetic testing panel. After receiving the results, they used skills they mastered during earlier weeks to evaluate their own genetic risk through the Web site of the direct-to-consumer company that analyzed the tests. Students who didn’t submit samples used data from mock patients.

This activity gave students the opportunity to experience what it would be like to learn about genetic risk from the patient’s perspective. They discussed how to convey genetic results and how to put them into proper context. It’s the knowledge of how
and where to find additional information in existing literature, however, that is one of the class’s most valuable lessons.

“I think getting the resources is one of the biggest take aways from the class. It’s having the knowledge of where to turn,” said Ann Miller, an accelerated BSN student in Dungan’s class. “A lot of physicians and nurses don’t know about this stuff. Being the only person or one of a few that know and understand is a huge asset.”

Tailoring health services to the individual patient is the next phase of medical care, she said, and a nursing workforce well-educated in genetics and genomics will be better prepared to advocate for their patients’ needs.

This type of class also introduces nurses and nursing students to more scientific aspects of health care, said Sarah Timberlake, an accelerated BSN student who has a microbiology and biomedical research background. The more exposure nursing students have to genetics and genomics in the classroom, she said, the greater opportunities they will have to influence how this knowledge is integrated into personalizing health care.

Educational efforts aren’t solely focusing on students, however. According to Dungan, the School of Nursing is investigating ways to provide genetics and genomics education for practicing nurses, physical therapists, and other health professionals through short courses, workshops, or continuing education modules. The Center for Personalized Medicine leadership group is also discussing a similar educational model for physicians, including online modules and webinars.

Next Steps in Personalized Medicine

Although much has been done over the past two years, work still remains before personalized medicine can be effectively implemented across the Duke University Health System. In the coming year, Vorderstrasse said, working groups intend to establish an official agenda and priorities. The long-term goal is to develop partnerships both within and outside of Duke.

In addition, there are extensive curricular revisions underway that will thread genetic and genomic information through bachelor’s, master’s, and doctoral tracks in nursing, Dungan said. Weaving instruction through all programs would eliminate the need for an elective class and would turn nursing graduates into some of the most knowledgeable and effective providers in their communities, she said.

Nursing faculty and students view these efforts as necessary in order to provide the highest quality care possible, and support for the personalized medicine model continues to grow throughout the health system. But, most importantly, patients are beginning to grasp the importance of having health care providers who understand how genetics and genomics can directly impact individual health outcomes.

“When you look at American culture, having a doctor or nurse who can explain genetic risk is extremely important. We see so many people innocently unaware of the lifestyle choice they’re actually making as they pull up for fast food, for example,” Graffagnino said. “Most people don’t know that their genetics are a big part of how your health will play out over the years. They don’t understand how medically tied in everything is.”

To read the story at its original location, pg. 8: https://nursing.duke.edu/sites/default/files/alumni/magazine/summer_2012_issue.pdf

The time is ripe for tomato genetics

Published in the July 16, 2012, Raleigh News & Observer and Charlotte Observer

By Whitney L.J. Howell

There’s no doubt humans top the evolutionary food chain. But people are, by no means, the most genetically hefty beings on Earth.

Recent research from a North Carolina site of a global plant-development company revealed the tomato has at least 7,000 more genes than humans. And, decoding that genome could make picture-perfect, grocery-store tomatoes taste as good as deformed, homegrown ones.

Since 2008, researchers at Syngenta’s biotechnology hub in Research Triangle Park, along with other scientists worldwide, have analyzed the genetic sequence for two tomato varieties – Heinz 1706, the tomato used in ketchup production, and its closest wild relative, Solanum pimpinellifolium, found in Peru. These investigations revealed tomatoes boast 31,760 genes, many of which scientists are analyzing to determine how they control the fruit’s growth.

“Tomatoes are a model crop that, in many ways, is well understood,” said Bob Dietrich, Ph.D., senior research scientist at Syngenta. “Our main reason for conducting this research is so we have enough information to develop the tomatoes we want.”

Why the tomato?

Although the genetic structures are different, tomatoes are closely

Becky Cade prepares tomato leaf samples for testing at Syngenta’s Research Triangle Park laboratory. PHOTO CREDIT: Syngenta

related to potatoes, tobacco plants, peppers, eggplant and nightshade – a toxic member of the potato family. According to Rebecca Cade, a Syngenta research scientist, studying the tomato genome can increase the knowledge base around these and many other plants.

“The tomato is an excellent archetype for fruiting plants,” she said. “There’s been lots of research on how it grows, and scientists and breeders will be able to apply the knowledge gained from studying its DNA to other fruiting crops.”

Syngenta’s team has a multifocused goal with this research, looking for genetic answers to the tomato’s shelf-life, size and firmness. However, the company’s chief concern is helping farmers bring a better-tasting product to market.

“Once we have the finished genome sequence, we’ll be able to tell the differences between a beefsteak tomato and a cherry tomato,” Dietrich said. “With that information, we’ll be able to make a beefsteak with a cherry flavor or vice versa.”

Ultimately, Cade said, the goal is to allow breeders to do predictive breeding.

“In this scenario, someone would say, ‘I need a tomato with this maturity date, this sugar content, and resistant to this pathogen,’” she said. “By looking at our tomato genomes, you can take various seed lines, cross them, and get this type of desired outcome.”

Sequencing the code

According to Dietrich, efforts to decode the tomato genome began in 2009. The work was initially geared toward creating a rough draft of the genetic map that would eventually help breeders create more marketable versions of the fruit. In 2010, Syngenta and its partners teamed up to use different technologies that build upon each other’s strengths and weaknesses, he said.

Syngenta’s global collaborators sequenced 70 percent to 80 percent of the tomato’s DNA using technology that focused on longer reads – segments of DNA long enough to identify when gene components (the bases adenine, guanine, cytosine and thymine) begin to repeat. Scientists were able to identify significant differences among cultivated tomato lines with this amount of data.

But the gaps in the genome still left unanswered questions about which genes could control a plethora of tomato characteristics, he said. Using technology from the genetic-analysis company Illumina, Syngenta analyzed the final one-third of tomato genes using a technique that looks at smaller segments of DNA. In this case, Cade said, this short-read sequencing examined DNA strips with up to 800 bases.

“DNA sequencing is really like a puzzle – it takes a lot of work to make sense of it,” she said. “If you have short reads, you can have billions of pieces and maybe 1,000 of them look exactly the same. With longer-read technologies, you can have bigger pieces that show repeat and unique sequences. So, you need long reads to complement the short reads to get a full picture.”

This long/short sequencing technique is beneficial, Dietrich said, because it opens the door for other tomato varieties to be sequenced more easily. Researchers will now be able to analyze the DNA many other types of tomatoes in far less time and for less money.

While knowing which genes could improve the taste and appearance of tomatoes in the grocery store, understanding the fruit’s DNA and how to manipulate it could impact the global food supply, said Jim Giovannoni, Ph.D., plant geneticist at the Boyce Thompson Institute for Plant Research associated with Cornell University. The majority of Giovannoni’s work is also focused on decoding what part of the tomato genome is responsible for ripening.

Toward a ripe future

“Understanding and potentially controlling the ripening process genetically could increase food security for people in other countries who, at certain times, have a lot of food available but can’t eat it due to rot,” he said. “They don’t have the infrastructure and money to store food like we do, so a genetic solution could have a real effect on food security in the developing world. It would also make our First World issue of shipping food around a less expensive process.”

Specifically choosing certain traits that alter taste, color, texture, and ripening does present trade-offs, however, he said. For instance, a tomato bred to last longer on the shelves might not taste as good. Or one bred for a more home-grown flavor might not have a uniformly-colored skin.

“The reality is that, with this research, we understand more about what genes are responsible for what characteristics, and we can give breeders the tools for selecting certain traits,” Giovannoni said. “There can still be negative outcomes, no matter how small, but breeders can now take the selection of characteristics in their traditional breeding programs to a different level.”

To read the story at its Raleigh News & Observer location:  http://www.newsobserver.com/2012/07/15/2197089/ripe-time-for-tomato-genetics.html#dsq-content

To read the story at its Charlotte Observer location: http://www.charlotteobserver.com/2012/07/15/3381234/ripe-time-for-tomato-genetics.html

 

Radiology Leadership: Proposed Reimbursement Cuts “Arbitrary”

Published on the July 12, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

A new round of potential cuts to radiology reimbursement has many in the industry expressing anger and frustration. Radiology leaders have called the proposals “arbitrary” and “unfounded,” and all agree the reductions will negatively impact practice management and patient care.

CMS this week released its proposed Medicare Physician Fee Schedule for 2013, calling for a 4 percent to 19 percent drop in radiology reimbursement rates. The proposal would also extend a contentious policy that governs imaging conducted by a single physician during one patient encounter.

“The most important thing to remember is these are the latest in a series of arbitrary cuts to radiology reimbursement that started with provisions back in 2006,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors. “We’ve long argued that CMS has flawed data, and they continue to single out radiology based on the perception that imaging is a growing market with run-away costs. That’s simply not the case. Imaging and the associated spending levels are back to early 2000s levels.”

According to the proposed rule, many radiology services would see reimbursement levels drop: 19 percent in radiation therapy centers, 15 percent in radiation oncology, 8 percent in diagnostic testing facilities, and 4 percent in nuclear medicine. These cuts would be reallocated as 7 percent reimbursement increases to family medicine physicians and other primary care providers.

The quality of patient care, particularly in outpatient radiation therapy centers, could decrease if these proposed reimbursement cuts take effect as-is, McGinty said. Many of these centers would likely close their doors, limiting patient access to this type of high-quality, cost-effective care.

The industry’s strongest outcry, however, stems from a measure to expand the current 25 percent multiple procedure payment reduction (MPPR) on provider services for CT, MRI, and ultrasound. Currently, the MPPR applies to imaging services rendered by the same physician to the same patient during the same encounter. The new proposal would extend the MPPR to other physicians within the same group practice who performed subsequent procedures in those same patient encounters.

If this proposal becomes permanent, it will have a chilling effect of how providers work together, said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors.“These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives,” he said in a written statement.

There’s also a chance expanding the MPPR will have a significant, negative impact on work flow, said Mike Mabry, executive director of the Radiology Business Management Association. It’s unclear whether smaller or more rural radiology practices would be able to effectively and efficiently change their billing strategies.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/news/display/article/113619/2090032

No unnecessary early-term deliveries is goal for hospitals

Published in the July 2012 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

Risks rise for moms, newborns with elective deliveries

Evidence is mounting that both mothers and newborns are at heightened risk of health problems following nonmedically necessary early-term deliveries. In response, hospitals nationwide are instituting policies to eliminate the procedure.

In late June, the American Hospital Association board of trustees issued a policy supporting those efforts.

Babies are considered full term between 37 and 41 weeks of gestation. Early-term deliveries occur during the first two weeks of this period. The number of elective early-term deliveries — either by induction or cesarean — nearly doubled to 22.5 percent in 2006, up from 9.5 percent in 1990, according to the most recent data available from the Centers for Disease Control and Prevention.

“Women who are induced in the 37th to 38th week have a significantly higher risk of having a cesarean section than mothers who have spontaneous labor,” according to the Leapfrog Group. “And, given low rates of vaginal births after cesarean sections, these mothers are likely to have additional cesarean sections with increasing risks.”

Citing other studies, the patient safety group goes on to note that babies induced during these early weeks are at higher risk of neonatal mortality and morbidity, including respiratory problems. Length of stay also typically increases for both moms and newborns, who are put in neonatal intensive care units.

To control inductions, Utah’s Intermountain Healthcare educates doctors and patients. A team of nurses, physicians and administrators designed a data-rich program to explain the risks of the procedure, says Teri Kiehn, R.N., operations director of Intermoutain’s women and newborns clinical programs.

They’re succeeding.

“Our elective induction rate dropped from more than 30 percent to 2 percent,” she says. “We’ve made significant inroads, and it’s improving. We were at 1.2 percent, and we’d love to reach zero. It’s a work in progress.”

Physicians who ignore the policy meet with Intermountain’s medical director to review existing best practices and clinical evidence. The goal, Kiehn says, is to reinforce that pre-determining times is risky.

Health officials in Minnesota targeted unnecessary inductions in 2009, according to Jeff Schiff, M.D., medical director, Minnesota Health Care Programs, Department of Human Services. The state has a multistep plan to identify necessary inductions, and 70 out of Minnesota’s 90 hospitals participate.

Proposed inductions are reviewed to decide whether they’re necessary. Providers and patients are informed and talk about the risks of an early-term delivery.

“It’s important to stop thinking birth at 37 weeks is OK,” Schiff says. “Our goal is getting people thinking more than 39 weeks.”

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2012/0712HHN_Inbox_birthday&domain=HHNMAG

Good (and healthy) eats!

Published in the July 2012 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

With an eye toward improving population health and combating the obesity epidemic, clinicians at Indiana University Health are bringing an oasis to food deserts in Indianapolis.

“We wanted to increase access to affordable fruits and vegetables in low-income populations because they face challenges to acquiring healthy foods doctors prescribe to patients,” says Lisa Cole, R.N., creator of Garden on the Go and IUH’s Indianapolis Community Outreach manager. “We wanted to be part of the solution and provide access in those neighborhoods.”

Bringing in healthy food meant partnering with a Green B.E.A.N. Delivery, a food delivery service committed to providing fresh, local, organic produce. Since its launch last year, GOTG has grown to 16 weekly stops in community centers, libraries, neighborhood health centers and senior centers where workers select produce for customers with mobility issues, Cole says.

So far, the initiative has been successful. As of late June, GOTG had processed 15,700 transactions with roughly 400 repeat customers. Each $7 purchase, for which customers can use cash, credit, debit or food stamps, includes 1 pound each of bananas, green beans and tomatoes, 3 pounds of potatoes, and a large bunch of greens.

“The food smells and looks good. The bunches of greens are big. The peppers aren’t shriveled,” Cole says. “It’s an important message for the community — they deserve the same quality food you and I purchase. It gives them a better value for their dollar.”

Having easy access to fresh foods has positively impacted community members. For example, after Sandra Bailey began shopping with GOTG last year, her blood sugar levels dropped, making her diabetes more manageable. In addition, as an employee of the Indianapolis Housing Agency, which hosts several GOTG stops, she’s seen similar effects on low-income groups.

IUH researchers recruited 120 shoppers and are tracking their blood sugar, blood pressure, body mass index and food patterns for six months. Twenty of the shoppers will receive specific food-choice guidance from dietitians.

The program also fits with the nonprofit health system’s effort to provide a community benefit, Cole says. Clinicians can monitor what people are buying and provide guidance for improving their health status.

Cole says hospitals can learn from IUH’s experience. Working with for-profit produce companies and using operational dollars makes it easier for initiatives to benefit communities. It’s also important to determine how communities prefer to access produce, such as in trucks or community buildings, to ensure greatest participation.

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2012/0712HHN_Inbox_fooddeserts&domain=HHNMAG

Radiology Job Market: 6 Steps To Greater Employment Success

Published on the July 5, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

It’s no mystery that today’s radiology job market is tight. Many recent graduates chose radiology before the economic collapse when jobs were plentiful, and now they’re struggling to get their foot in the door either in a hospital or a private practice. And, they’re not alone. Older job seekers are also struggling as practices are forced to downsize in an effort to cope with dwindling reimbursement. A recent informal Diagnostic Imaging poll found that only a quarter of groups are hiring, and 53 percent are still thinning the ranks.

At this point, it’s unclear how – or if – Thursday’s U.S. Supreme Court decision on the Affordable Care Act will impact the industry and its job pool, but there are a few tactics job seekers can use now to improve their chances of securing employment.

1. Create a detailed narrative for yourself. It isn’t enough to simply reply to a job posting with your CV and contact information, said Patrick Moore, president of Smart Physician Recruiting. Employers receive at least 20 to 30 applications per job, so you must tell your story to stand out from the crowd.

“Cover letters are a must when applying for a new position,” Moore said. “Tell your story about who you are, what your training was like, and why you are unique. Otherwise, you’re not likely to receive a phone call.”

2. Be willing to work outside your subspecialty. Many practices hire radiologists because of their training in a particular area. But in a growing number of cases, radiologists are being called upon to work outside their wheelhouse, said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors.

“Indeed, there are some practices looking for someone to work entirely within their subspecialty,” McGinty said. “But, there are many who need someone flexible – someone who will do something other than what they learned during fellowship. Job seekers must have a willingness to pitch in.”

3. Pick your desired location wisely: If you’re applying for a job in a different geographic location, have and share the specific reasons why you chose it. It isn’t uncommon in this tight job market to see graduates from New England schools applying for jobs in the Southwest without any clear ties to that region, Moore said, and it’s easy for employers to spot someone who is applying wildly in the hopes of finding a job.

“If you do want to choose a different geographic region, seek out practices in that area while you’re in residency or during fellowship,” Moore said. “Make phone calls. Connect with them at conferences. Explain your reasons for wanting to come to their region because they’re looking to find people who will be long-term hires.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2088125