NEWSHOSPITALS & HEALTH SYSTEMS

A recent Canadian study found that hospital patients who are homeless end up costing hospitals more money. Really, it took a study to find this out?

Please excuse the sarcasm; this just seems to be obvious. Obvious to those of us advocating for the health and wellbeing of those living in poverty and homelessness. Not so obvious to those who enforce inhumane laws against those living in poverty and homelessness. Like Gainesville, Florida officials who impose a 130-meal-limit on area soup kitchens. We'll get back to that in a minute -- first, the research.

The study was conducted by a Canadian physician at St. Michael's Hospital in Toronto. The study found that overall, homeless patients cost hospitals an additional $2,500 each. The reasons for this extra cost are most often related to housing issues. Specifically, a homeless patient often does not have a place to go upon discharge and therefore the hospital keeps them for additional time. Often homeless shelters will not accept a person if they are recently discharged from the hospital or are still ill, which can further complicate the issue. The study team found similar findings from a study conducted in New York City in 1998.

A hospital is usually where you go to get well. But with the rise of hospital-acquired bacterial infections, a visit can leave you worse off than when you came in.

Take, for example, the case of Katie Roche. A healthy 19-year-old, Katie went into the hospital for corrective spine surgery. The surgery went well, but unfortunately for Katie she shared a room with a six-year-old child with a fever. Katie contracted a bacterial infection that left her fighting for her life. The infection was so bad she lost 30 pounds in a few weeks. She had to have three surgeries to clear up the bacterial infections, which almost took her life.

The bacterial infection Katie contracted is one that plagues many hospitals and long-term care facilities -- Clostridium difficil, or C. diff. Though usually a problem with older adults, the bacteria has started to affect hospitalized children. A recent study found that infection rates have increased 15 percent per year in U.S. hospitals since 1997. Children who acquire the infection are much more likely to die or require surgery to fight off the infection than adults.

Over 7,000 children contracted C. diff infections from hospitals in 2006 alone.

By now you've probably heard of the antimicrobial triclosan and the health concerns associated with it. But for those consumers looking to stringently avoid exposure to it, good luck. The chemical is so widely used -- in everything from toys and toothpaste to cutting boards and soaps -- that it's hard to know where, exactly, it lurks. But that could change, as both the Environmental Protection Agency and the Food and Drug Administration are reviewing the science to determine just how safe (or unsafe) the chemical is.

The increased attention has made industry a tad nervous. In a January 10th article, the American Cleaning Institute (formerly known as the Soap and Detergent Association, in case you were confused) issued a response to the increased investigations by reminding lawmakers that anti-microbial products like triclosan are "used daily in hospitals and health care establishments" and  "are globally accepted as safe for daily use." The latter is not exactly true, since some countries have taken the precautionary principle and banned triclosan.

And by pointing out their warranted use in health care facilities, the ACI makes the case even stronger for curbing the widespread but largely useless addition of antimicrobials consumer products. The FDA has already recognized that triclosan can lead to the development of drug-resistant bacteria, a huge problem plauging hospitals and the medical establishments.

It's a seemingly nonpartisan piece of legislation -- giving health benefits to Ground Zero first responders and survivors, many of whom were exposed to toxic smoke and dust after the twin towers collapsed. But, as the final days of the congressional session near, it's not clear that a new version of the bill will pass, as members of the GOP continue their opposition to the critical piece of legislation.

Yesterday, first responders joined with New York Mayor Michael Bloomberg at City Hall to urge Congressional Republicans to approve the new version.  The bill had already passed the House and a scaled-back version was re-introduced in the Senate in order to win further support. But the House would have to approve changes to the legislation before Congress ends in early January, a move that will only come if senators have enough support to overcome a Republican filibuster.

Even though the GOP lauded the 9/11 responder efforts, they're now holding up health care for the those that need it most -- and facing criticism for it. Prominent members of the GOP, including former mayor Rudolph Giuliani and former Arkansas Gov. Mick Huckabee, have criticized members of their party for denying ailing firefighters and police officers medical treatment, according to the LA Times. Last week, Jon Stewart told the story of sick World Trade Center survivors on "The Daily Show" and yesterday, Shep Smith of Fox News called out every single GOP member that wouldn't come on his show to talk about the bill.

Most people would rather have a cold or flu than a nasty bacterial infection that's incurable. Unfortunately, this is kind of the choice we're forced to make these days, as more and more research shows our overuse of antibacterial agents -- in consumer products, it's most commonly the ingredient triclosan -- contributes to the development of new "super bugs" that are resistant to antibiotics and antibacterials.

Triclosan is found in everything from Clearasil face wash and Colgate toothpaste to Playskool children's toys. Do we really need that much sterility? It makes sense to keep everything germ-free in a hospital setting where patients have compromised immune systems, but in our daily lives, according to the CDC, antibacterial products can lead to drug resistance, lower immunity and allergies. A recent study by the CDC detected triclosan in the urine of 75 percent of the people they tested.

In April, the FDA issued a statement regarding triclosan's health effects. In it, they note that triclosan alters hormone regulation in laboratory animals and may contribute antibiotic resistant bacteria. Although they state that the chemical does not currently present a health hazard, it does merit "further review" and they are currently reviewing the scientific evidence to determine its safety in consumer products. Some countries have already banned or limited the use of the chemical.

Perhaps most perplexing is why we use the chemical in the first place. Although it's been found to be useful to prevent gingivitis, overall, the FDA statement concludes that it "does not have evidence that triclosan in antibacterial soaps and body washes provides any benefit over washing with regular soap and water."

After the 9/11 attacks, tens of thousands of first responders flooded Lower Manhattan in hopes of rescuing attack victims. The responders came from all 50 states and worked long hours on a massive pile of burning rubble, searching for victims' remains. Numerous toxins filled the air after the attacks, including pulverized concrete, burning plastics, asbestos, heavy metals and irritating gases.

These toxins affected responders and volunteers, as well as local residents, area workers and students, who were brought back to a dust-coated war zone within days of the attacks after the the federal government assured them that the "air was safe to breath." Though the responders' work is long accomplished, health effects of time spent at Ground Zero and the area surrounding it continue to linger.

Doctors initially identified a "World Trade Center Cough," a persistent cough that can require at least four consecutive weeks of medical leave, according to the World Trade Center Medical Monitoring and Treatment Program. As time passed, the cough improved for some responders and residents. For others, it blossomed into asthma, reactive airway disease, recurring bronchitis and a range of respiratory and sinus problems.  A study by the Mount Sinai Medical Center shows that about one quarter of responders had impaired lung function years after their exposures.

A lung doctor that carries a pack of Camels. An infusion nurse that smells of cigarettes. A cloud of smoke outside a cancer center. These will be scenes of the past for the Massachusetts Hospital Association (MHA), a not-for-profit organization, that announced this month that it will no longer hire individuals who use tobacco products.

"MHA and its members hospitals have long been committed to initiatives that promote the health and welfare of our patients and communities. The negative impact of tobacco use on health is well documented. In Massachusetts alone, smoking is the leading cause of preventable death and disease," they said in a statement on their website.

The move could set a precedent for hospitals -- an other organizations -- nationwide. And Lynn Nicholas, the CEO of the Association, which consists of more than 100 of hospitals in the state, wanted it that way. She decided to take the ban public as a way to raise awareness about the tobacco use, the number one cause of preventable death in the United States.

The hiring ban makes sense for a hospital, whose employees are meant to care for sick and serve, at least in some capacity, as role models for healthy living. In addition, not hiring tobacco users is a savvy way to reduce healthcare costs.

Smokers are not a protected class of workers, so the ban doesn't violate federal law. Police and fire departments in the state stopped hiring smokers in 1997 as part of a change in their pension system. But while MA state law permits the ban, 29 states do have laws discriminating against hiring smokers.

Cesarean sections are on the rise throughout the country, but the exact reason for this trend isn't clear. However, a recent report by the investigative team at California Watch indicates that money may be a motivating factor.

The analysis found that after controlling for other factors, women in California were at least 17 percent more likely to have a C-section at a for-profit hospital than at a non-profit hospital. According to report, a surgical birth can bring in twice the revenue of a vaginal delivery.

California Watch looked at those births not likely to require a C-section -- moms without a previous C-section, a single fetus, head positioned down and at full-term. After adjusting for the women's age, they found that at non-profits the surgical rate was 16 percent, while for-profits it was 19 percent.

The strikingly different rates between hospital throughout California indicates having a C-section has more to do with what hospital a woman chooses than her medical condition. For instance, women with low-risk pregnancies had a 9 percent chance of having a C-section at the nonprofit Kaiser Permanente Redwood City, but a 47 percent chance of having surgery at the for-profit Los Angeles Community Hospital.

Although C-sections can save a baby or mother in distress, they are a variety of reason why they are now performed. This includes an increase in obesity, older mothers, increases in induction and litigation fears. The report also found that some hospitals perform C-sections because of impatient doctors and scheduling conflicts. Now it seems that profit may be another reason.

Nationally, the cesarean section rate has steadily risen from 1996 to 2007, reaching 32 percent in 2007, the highest rate in U.S. history, according to the National Center for Disease Statistics. It is the most common surgical procedure performed in the United States.

Generally considered very safe, C-sections can result in surgical complications like infections and maternal injuries. Many hospitals will not perform vaginal deliveries after a woman has had a C-section, though regulations are changing.

The California Watch report provides evidence to those who have long proposed that the rise in C-sections has nothing to do with medical necessity and has lots to do with profit. According to the report, a 2007 analysis by the Pacific Business Group on Health found that hospitals can increase their revenue by 82 percents by performing a C-section instead of a vaginal birth.

One way to circumvent the question of profit -- for the doctor or hospital -- is to get rid of any financial incentives and payment structures that favor unnecessary surgical intervention.  C-sections can help some women and their babies -- but not when they are abused for profit.

Photo credit: bluekdesign

I’ve just this very moment gotten my head above the surface after spending the better part of the last week and a half navigating the waters of the federal grant process.  The good news is that I think programs like mine are particularly well-suited to the grant for which we’re applying, and I’m quite optimistic about the outcome.  The bad news is that the process, and in the case of this grant the incredibly short turn-around time, may dissuade from applying the very programs that it’s meant to benefit.

The grant to which I refer is HRSA-10-277, the Affordable Care Act Primary Care Residency Expansion Program.  Announced June 17, 2010 and due July 19, 2010, this program offers $168 million to increase the number of primary care physicians by expanding enrollment in primary care residency programs.  Priority will be given to those programs who offer a minimum of six months of the residents’ training in a rural health clinic, community health center, community hospital, critical access hospital, or other community based settings.

Which sounds great, but I can’t help but wonder how programs so heavily invested in such priority areas could have the resources to come up with a 35-page grant in such a short period of time.  Do these places have grant writers?  Because there’s no way on earth I could have completed this grant application without my grant writer Donna.  Just none.  And most community health centers that I know of are so overextended and understaffed, the mere suggestion of adding a project of this size with such a precipitous deadline would probably be met with no small measure of laughter.

I received a call yesterday not unlike several calls I get at least yearly.  It was from a resident in an internal medicine residency program in another city—it seems his residency program is closing down and now he is in search of another.

I wince when I get these calls, not because I get them so frequently, but because a) this is an internal medicine residency that’s going down at precisely the time that we need more of them, b) given the caller’s clipped foreign accent, I’d wager he sacrificed body and soul to get that position, and c) the chances are good that he won’t find another spot.

But there is some good news. The U. S. Department of Health and Human Services recently announced federal funding for expansion of primary care residency programs.  The July 17th deadline for the grant is optimistic, if not unrealistic, but at least it’s an opportunity to make up for lost programs.  Our program is going to apply.  I can sleep in August.