Monthly Archives: February 2014

One Tough Little Bugger

Almost two years ago, our daughter Alexandria developed a serious infection. Not knowing how to relieve her pain and crying, my wife and I decided that we needed to take her to the Emergency Room. After a blood culture, we found out that she had contracted MRSA.

What is it? MRSA or Methicillin-Resistant Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. This virulent bacterium is a strain of Staphylococcus aureus that, through the process of natural selection, has developed resistance to certain types of antibiotics, including penicillins, and Human_neutrophil_ingesting_MRSAcephalosporins. Although MRSA isn’t typically more aggressive than a regular strain of staph, the antibiotic resistance makes it more difficult to treat. The majority of staph and MRSA infections occur in hospitals or other health care settings among patients with weakened immune systems. Following a recent trend, our daughter’s case is just one of an increasing number of community based infections.

Statistics: Unfortunately, there is no data showing the total number of people who get MRSA skin infections within the general community. However, the table below gives us an idea of its prevalence in the form of estimated incidence rates of invasive MRSA in dialysis patients. An estimated 10,800 deaths in the U.S. each year are caused by staph, 5,500 of which are linked to MRSA. The economic cost created by hospital-acquired infections including those caused by MRSA is estimated to be as much as $45 billion. The increased incidence of these infections and the longer hospital stays and worse patient outcomes associated with them are the key drivers behind the proliferation of costs. The drastic rise in hospitalizations in the past 15 years has mirrored the increase in antibiotic resistance. With nearly 5% of hospitalized patients contracting an infection, the problem may not be given the attention it deserves.  MRSA

According to the CDC website, studies show that about one in three people carry staph in their nose, usually without any illness. Also, two in 100 people carry MRSA. Although MRSA is still a major patient threat, a CDC study published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011.

What are the signs? Our daughter’s case started in typical fashion with a red bump that looked like a pimple. This lesion quickly became painful and inflamed and ultimately developed into an abscess that required surgical drainage. Infection sites can also resemble a spider bite and can cause serious infections in surgical wounds. Infections such as those caused by MRSA are most dangerous when they get into the bloodstream and bones. Healthy individuals may carry MRSA asymptomatically for periods ranging from a few weeks to many years.

How do I contract it? Risk factors for healthcare-associated MRSA infections (HA-MRSA) include the following:

–          Current or recent hospitalization

–          Living in a nursing home

–          Long-term antibiotic use.

Risk factors for a community-associated (CA) MRSA Infection include:

–          Having an underdeveloped or weakened immune system

–          Playing contact sports

–          Association with healthcare workers (family, friends, etc.)

–          Living in crowded or unsanitary conditions.

Diagnosis: In most patients, MRSA can be detected by swabbing the nostrils and isolating the bacteria found inside on an agar plate. Tests such as quantitative PCR, that can detect staph DNA, and latex agglutination can yield faster results than growing the bacteria in a lab.

How is it treated? Both CA- and HA-MRSA are usually treated differently. CA-MRSA typically has a greater spectrum of antimicrobial susceptibility including sulfa drugs, tetracyclines, and clindamycin. HA-MRSA can be resistant to these antibiotics and often is susceptible to only vancomycin. A bit disconcerting is the fact that there are several newly discovered strains of MRSA that show antibiotic resistance to vancomycin and can only be treated with more powerful antibiotics.

How can I prevent infection? Similar to other infections, hands should be washed often with warm water and soap or with an alcohol-based hand sanitizer. Open wounds should be covered and kept clean and sharing personal hygiene items such as towels, sheets, clothing, and toiletries should be avoided. Small children or infants still in diapers have underdeveloped immune systems. Due to this, care should be taken to wash or sterilize your hands before and after changing them. Finally, surfaces can be sanitized using alcohol or a mixture of ammonium and alcohol which can extend the longevity of the sanitation. Combined with these sanitary measures, screening patients admitted to hospitals has also been found to be effective at stopping the spread of MRSA. In addition to personal preventive measures, each state offers HAI (Healthcare Acquired Infection) Prevention Activities. Please visit the following website to see what’s available in your area.  

(Photo Credit 1)

(Photo Credit 2)

A Royal Pain?

 

While recently watching and episode of the USA Network television show, “Royal Pains” I became intrigued about the true nature of concierge medicine and so I decided to devote a blog piece to the concept.

Concierge medicine, also known as direct care, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer [1]. Widely believed to have been started in 1996 by Dr. Howard Maron, as of 2012, there were 4,400 private physicians; a number that continues to grow.

A recent Forbes article entitled, “Is Concierge Medicine Right for You?” outlines some of the benefits that a patient might see from joining a concierge medicine practice.

–        Concierge medicine can be surprisingly affordable

  • Once thought to be something only the wealthy can afford, a yearly fee can now average out to be approximately $4-5 dollars per day.

–        The Choice is good, meaning that patients have the right to pay for a more comprehensive doctor’s appointment.

–        Concierge medicine benefits both physician and patients.

  • These physicians routinely report greater job satisfaction, because they can practice the way that they were trained – taking the time to really talk to their patients and use their skills to their fullest extent – rather than being handcuffed by increasing overhead costs and decreasing insurance reimbursement.

While the concept of concierge medicine may sound enticing, detractors have accused the practice of promoting a two-tiered health system that favors the wealthy. It also limits the number of physicians to care for those who cannot afford it, and burdens the middle and lower class with a higher cost of insurance. As more and more physicians retire every year in a “silent exodus”, losing physicians to concierge practices cannot be easily tolerated by the general public.

Upon doing some further research, my local area offers a number of options for patients seeking these services. The most surprising resource that I found was a service provided by a local hospital. My challenge to you this week is to do a quick google search for concierge physician services in your area.

Thank You for Reading!

 

To Vax or Not to Vax?

Like it or not, the flu season is in full swing and along with it the great debate over whether or not to receive the flu vaccine rages on. While perusing my twitter feed today, I came across a number of tweets by Dr. Tom Frieden (@DrFriedenCDC), the Director of the CDC in which he exhorts the general public to receive the vaccine. In this blog post I will present both sides of the argument and encourage you to make the best decision for yourself and your loved ones.

In the United States, annual vaccination against seasonal influenza is recommended for all persons aged >/= 6 months [1].  Every year, the flu season is particularly hard on younger- and middle-aged adults and this year is no different. People age 18-64 represented 61% of all hospitalizations from influenza [2]. This statistic hits especially close to home due to the fact that my wife and I both fall into that demographic. As evidence for receiving the flu vaccine, the CDC cites statistical analysis of each season’s vaccine. During each flu season since 2004-2005, the CDC has estimated the effectiveness of that season’s vaccine at preventing influenza- associated, medically attended acute respiratory illness (ARI) [3]. As of February 21st, 2014 the CDC estimates an effectiveness of 61% against the major flu virus strain detected, the 2009 H1N1.

Compelling arguments against receiving the vaccine can be found in a 2013 NY Times article entitled, “Myths About the Flu Vaccine” by Jane E. Brody as well as in the comments section. First, the flu virus in circulation changes from year to year and there is no guarantee that the virus that the vaccine is designed to prevent will be effective against a new

While I have made the personal choice to receive the vaccine, ultimately it is up to you to make the best educated decision that you can  regarding whether or not to be vaccinated. The internet is a treasure trove of information which I encourage you to utilize along with your  health care provider, whether homeopath or allopath, before you come to a conclusion.

Affordable Care Act Part 2

10-things-2014-under-affordable-care-act

 

A little over four months ago, I began working at a locally owned, not-for-profit health insurance company. Although the patient-care centered aspects of this business  weren’t foreign to me, there has been a pretty steep learning curve with regards to the health insurance side of things. I touched on a few of the upcoming ACA changes in  my last blog post; however, there are a few additional topics that I would like to discuss. These subjects include Nevada Health Link, Grandfathered Plans, The Patient Bill  of Rights, Medical Loss Ratios, and Cost-Sharing.

 

Nevada Health Link is Nevada’s version of the Health Insurance Marketplace. The ACA requires a new Health Insurance Exchange be established in every state beginning  January 2, 1014. These online portals are a new way for individuals and small businesses to purchase health insurance. As of February 12th, the Nevada exchange has  enrolled only 23, 686 members which are well short of its goal of 118,000 by March 31st [1].

 

Prior to beginning my current employment, the term Grandfathered Plans was a complete mystery to me. A Grandfathered plan is any plan in effect on March 23, 2010, the date that the ACA became law. These plans do not have to follow some health insurance reform provisions, such as the requirement to cover all preventive care services without cost sharing, for as long as they remain grandfathered.

 

On the surface, the Patient Bill of Rights helps children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all Americans’ choice of doctors, and end lifetime limits on the care consumers receive [2].

 

Under the health care reform law, health insurers are required to spend at least 80% (for individuals and small groups) or 85% (for large groups) of their policy premiums in a given state on claims. This percentage is called their Medical Loss Ratio or MLR. If their MLR (claims over premiums) is less than the required percentage, the difference has to be paid to individual and group policyholders as a rebate.

 

Finally, cost-sharing. Some cost-sharing limits that apply to non-grandfathered plans beginning with 2014 plan years are outlined below:

 

–        In-network out-of-pocket (OOP) maximums cannot exceed $6,350/individual and $12,700/family. All copays, deductibles and coinsurance for EHBs must count toward the OOP maximum.

 

–        Mental health/substance abuse benefits must count toward the medical plan’s OOP maximum, even if the benefits are provided by a different vendor.

 

–        For insured small group plans only, (no more than 50 employees), in-network deductibles cannot exceed $2,000 individual and $4,000 family.

 

This blog series, by no means is intended to be comprehensive. However, as we can see, there is a lot more to the ACA than we may read or hear about from local media members. I encourage all of you to examine your health insurance plan documents and see if you can tell where the Affordable Care Act has taken effect.

 

 

Affordable Care Act Part 1

In my last blog post, I mentioned the Affordable Care Act (ACA). Despite how you may feel personally or politically about this piece of legislation, it affects all of us whether or not we have health insurance. In 2010, the ACA was passed by Congress and then signed into law by President Obama. However, it wasn’t until two years later that the Supreme Court reached a final decision to uphold this law.

While this law, in its entirety, is extremely lengthy and complicated I will only highlight some of the basic features that I find interesting and potentially beneficial. First, the topic of coverage. No longer do the parents of children under the age of 19 have to be worried about their child being denied for pre-existing conditions nor do they have to be concerned about limits to their coverage. Children will also continue to be covered up to age 26. Second, costs. Lifetime limits on coverage are no longer allowed and insurance companies must now “publicly justify any unreasonable rate hikes.” Third, care. Beginning January 1, 2014 all fully insured small group and individual health plans must cover essential health benefits. These benefits, otherwise known as EHB’s include the following categories:

–        Ambulatory patient services

–        Emergency services

–        Hospitalization

–        Maternity and newborn care

–        Mental health and substance abuse disorder services (including behavioral health treatment)

–        Prescription drugs

–        Rehabilitative and habilitative services and devices

–        Laboratory services

–        Preventive and wellness services and chronic disease management

–        Pediatric services, including oral and vision care

In part two of my ACA blog, I will dive a little deeper into the ACA including a discussion on such topics as the Health Insurance Marketplace (especially Nevada HealthLink), Grandfathered Plans, The Patient Bill of Rights, Medical Loss Ratios, and Cost-Sharing. In the meantime, please feel free to visit the following links:

–        U.S. Department of Health and Human Services

–        Nevada Health Link

–        Hometown Health

Thank You for Reading!

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It’s an Exciting Time for Healthcare!

This is an exciting time for healthcare! Not only are people living longer, they’re living happier and healthier lives. Modern healthcare research indicates that patient mortality is at the lowest rate it’s ever been. Millions of people every day benefit from access to well-trained healthcare practitioners all over the world. From Chiropractors to Physical Therapists, Acupuncturists to Homeopaths, and Physicians to Nurse Practitioners, our medical knowledge base is perpetually expanding and we’re releasing better trained clinicians into the field every year.

While there is a lot to look forward to regarding healthcare, I am also aware that there is a lot of anxiety and confusion surrounding the Affordable Care Act and its associated policies. One of the purposes of this blog is to help alleviate any concerns that there might be by providing an un-biased picture of legislation and how it affects all of us. I also hope to bring to light some of the more exciting aspects of healthcare which includes new pharmaceuticals, technologies, and techniques.

As a preview to tone and contents of my blog, I would like to introduce an amazing example of recent medical technology that I feel could be poised to revolutionize the way that life-threatening internal bleeding can be treated.  XStat™ is a syringe-like device that has been developed to deliver small sponges to the site of internal bleeding. If cleared by the FDA, XStat™ will be used to treat gunshot and other wounds that before may have been life-threatening. It works by delivering tiny sponges internally to a lacerated artery where before field medics would have to try to apply large sponges manually. These sponges expand rapidly and have proven to hold in place even under the enormous pressure of large arteries. Not only could it benefit military personnel, but could be adapted to meet the needs of EMTs and potentially ER/OR personnel. It is developments such as these that make me anxious to see what else the field of healthcare has in store.

Sponge-filled syringe called XStat is a quicker way to treat combat wounds