Mayo Clinic researchers have found that cardiac patients who have skin allergies to metals commonly found in jewelry, such as nickel, are at no higher risk for complications if they receive a stent containing these metal components.
Mayo Clinic cardiologist Rajiv Gulati, M.D., Ph.D., and colleagues studied a total of 29 patients with a history of skin allergies to stent metal components who subsequently underwent coronary stent implantation. The research team compared clinical outcomes with a matched control group of 250 non- metal allergic patients who received similar stents. In addition to following the study patients’ outcomes in the long term, the team reviewed blood to look for signs of allergic reactions.
Steven R. Ytterberg, M.D., with the Department of Rheumatology at Mayo Clinic in Rochester, Minn., discusses a study that examined similarities and differences between two forms of vasculitis: giant cell arteritis and Takayasu’s arteritis. Findings suggest that TAK and GCA may exist on a spectrum within the same disease. The study was published online on Feb. 10, 2012 in the Annals of the Rheumatic Diseases.
ABSTRACT Objectives To compare patterns of arteriographic lesions of the aorta and primary branches in patients with Takayasu’s arteritis (TAK) and giant cell arteritis (GCA).
Methods Patients were selected from two North American cohorts of TAK and GCA. The frequency of arteriographic lesions was calculated for 15 large arteries. Cluster analysis was used to derive patterns of arterial disease in TAK versus GCA and in patients categorized by age at disease onset.
Using latent class analysis, computer derived classification models based upon patterns of arterial disease were compared with traditional classification.
Results Arteriographic lesions were identified in 145 patients with TAK and 62 patients with GCA. Cluster analysis demonstrated that arterial involvement was contiguous in the aorta and usually symmetric in paired branch vessels for TAK and GCA. There was significantly more left carotid (p=0.03) and mesenteric (p=0.02) artery disease in TAK and more left and right axillary (p<0.01) artery disease in GCA. Subclavian disease clustered asymmetrically in TAK and in patients ≤55 years at disease onset and clustered symmetrically in GCA and patients >55 years at disease onset.
Computer-derived classification models distinguished TAK from GCA in two subgroups, defining 26 percent and 18 percent of the study sample; however, 56 percent of patients were classified into a subgroup that did not strongly differentiate between TAK and GCA.
Conclusions Strong similarities and subtle differences in the distribution of arterial disease were observed between TAK and GCA. These findings suggest that TAK and GCA may exist on a spectrum within the same disease.
Authors Peter C. Grayson, Kathleen Maksimowicz-McKinnon,Tiffany M. Clark, Gunnar Tomasson, David Cuthbertson, Simon Carette, Nader A .Khalidi, Carol A. Langford, Paul A. Monach, Philip Seo, Kenneth J. Warrington, M.D., Steven R. Ytterberg, M.D., Gary S. Hoffman, and Peter A. Merkel, for the Vasculitis Clinical Research Consortium
When people are broached with the subject of fertility, one often associates it is to an individual family’s desire to have children. However, as Professor Nargund expresses in her paper “Declining birth rate in Developed Countries: A radical re-think is required”, the subject touches society much more widely as a whole for both the developed [...]
Randal J. Thomas, M.D., director of Mayo Clinic’s Cardiovascular Health Clinic, and colleagues found that patients who participate in cardiac rehabilitation after having heart interventions such as angioplasty, stents and clot-busting drugs have a 45 percent lower mortality rate.
The research team studied data from more than 2,300 patients between 1994 and 2008, and recently published the results inCirculation.
Only about 40 percent of patients in the study participated in cardiac rehabilitation. These findings are particularly important for interventional cardiologists, Dr. Thomas says, because encouraging patients to pursue cardiac rehab after their procedure can potentially save more lives than previously thought.
According to data collected by the American Medical Group Association’s and Cejka Search 2011 Physician Retention Survey, careers in the advanced health care field are growing rapidly. As such, employment in medical groups for nurse practitioners (“NPs”) and physician assistants (“PAs”) has increased significantly in the past five years. According to the data, 75% of the responses to the survey indicated more NPs and PAs will be hired in the next five years.
Growth in these advanced health care professions is due largely to economics, according to an article in U.S. News and World Report. NPs, for example, can provide patients with many primary health care services at a fraction of the cost of an internist. In addition, FiercePracticeManagement reports that due to physician shortages and the demand to create a medical “team” to care for patients (accountable care organizations, “ACO”), medical groups are employing the NP and PA at increasingly high rates. This gives NPs and PAs the advantage of choosing where to work, thus creating a high turnover rate for these positions. In addition, recruiting and retaining these professionals are challenges to medical groups.
Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues. If you need legal assistance or guidance on a matter regarding your practice, please call our office.
As we age, it’s not uncommon to face all different types of health concerns and challenges. And, when it comes to your eye health, there’s no exception.
Did you know that eye disorders are much more common among those of a certain age? We’re not just talking about needing a stronger eyeglass prescription, but rather diseases that can completely reduce your ability to see if left untreated. Want to know what to watch out for?
Here is our list of the Top 3 Age-Related Eye Conditions You Need to Be Thinking About:
Macular Degeneration: Age-related macular degeneration (AMD) can present itself in different ways – from a blurry area of vision to a dark blind spot. The condition occurs when arteries that nourish the retina harden. Now deprived of vital nutrients, these retinal tissues begin to weaken, which ultimately causes vision loss. As the number-one cause of vision loss in the US, any AMD symptoms need to be addressed as soon as possible. The best way is to schedule a Macular Degeneration Evaluation.
Cataracts: Cataracts are one of the most common eye concerns for those over the age of 65. The condition, which affects millions of people each year, causes a clouding of the eye’s natural lens. Often, the only good cataract treatment is surgery. During a typical Cataract Surgery, the eye is numbed and a small ultrasonic probe is inserted. This probe breaks up and removes the affected cloudy lens. A clear new artificial lens called an IOL is then implanted into the eye.
Glaucoma: Glaucoma is a common eye condition, commonly associated with an increased pressure in the eye. This increased pressure can damage the optic nerve and ultimately cause a gradual but serious loss of vision. Untreated, the disease often results in complete blindness. While not curable, modern medicine offers several advanced Glaucoma Treatments. These include medications, eye drops and sometimes, surgery.
Get Checked! Schedule an Appointment Today
To learn more about these or any of the age-related conditions you should be watching out for, contact us today and schedule an appointment. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Call us directly at (540) 722-6200. We look forward to meeting you.
This is National Health IT Week, and there are a host of activities planned to celebrate it in Washington, D.C.—summits and panels, webinars and receptions, workshops and even job fairs.You can see the full agenda for the week here.We’ll be sharing Health IT news, announcements and highlights from some of the events here on the Center for Total Health Blog.You can also follow the conversation on Twitter via hash tag #NHITWeek. Check back often for coverage.
Eye Consultants of Texas has always treated eye care as important as any other healthcare need. This may seem obvious, but LASIK, for example, tends to be marketed these days like a retail product. In other words, like the deal of the week with an amazingly low price, which often only applies to a small percentage of patients.
Whether it’s LASIK, cataracts with premium lens implants, or a more complex procedure, Dr. Labor, and his team of doctors and staff, treat post-surgery follow-up very seriously. At Eye Consultants of Texas, our follow-up actually begins before surgery. This is when we tell our patients what they will need to do, things they can and can’t do, and which medications to use. They know what to expect and when everything needs to happen.
Eye surgery isn’t different than any other surgery. There is a healing process involved, and sticking to a well-planned post-surgery routine can certainly yield the best outcomes.
Dr. Jay C. Grochmal, a laser eye surgeon in Baltimore, is launching an innovative website to enhance his ability to help his vision correction patients. In collaboration with Rosemont Media™, a medical website design firm in San Diego, CA, Dr. Grochmal’s new website is a comprehensive resource of information showcasing the range of procedures he offers, including vision correction procedures such as LASIK, and treatment for eye diseases such as glaucoma and cataract surgery in Baltimore, MD and the Washington, DC area.
Dr. Grochmal’s website features detailed descriptions of both corrective and cosmetic procedures such as eyelid surgery in Baltimore, as well as a doctor biography, patient testimonials, and financing options. In addition to the in-depth breakdown of the procedures and treatments Dr. Grochmal provides, his website also includes direct links to his social media sites, such as Facebook and Twitter to foster the growth of an online community centering around his practice and his patients’ experiences. Please welcome to the web, www.grochmaleye.com!
Vanda A. Lennon, M.D., Ph.D., with the Departments of Laboratory Medicine and Pathology and Neurology, discusses research that identifies critical properties of neuromyelitis optica, a potentially debilitating neurological disease that is often misdiagnosed as multiple sclerosis (MS).
Dr. Lennon’s team isolated and identified an antibody unique to NMO that may interfere with the transport of the water. In some areas of autopsied brain tissue studied, there was an accumulation of water in the myelin itself that the team believes may lead to the secondary destruction of the myelin in NMO and potential misdiagnosis of NMO as MS.
ABSTRACT The astrocytic aquaporin-4 (AQP4) water channel is the target of pathogenic antibodies in a spectrum of relapsing autoimmune inflammatory central nervous system disorders of varying severity that is unified by detection of the serum biomarker neuromyelitis optica (NMO)-IgG. Neuromyelitis optica is the most severe of these disorders. The two major AQP4 isoforms, M1 and M23, have identical extracellular residues.
This report identifies two novel properties of NMO-IgG as determinants of pathogenicity:
The binding of NMO-IgG to the ectodomain of astrocytic AQP4 has isoform-specific outcomes. M1 is completely internalized, but M23 resists internalization and is aggregated into larger-order orthogonal arrays of particles that activate complement more effectively than M1 when bound by NMO-IgG.
NMO-IgG binding to either isoform impairs water flux directly, independently of antigen down-regulation.
We identified, in nondestructive central nervous system lesions of two NMO patients, two previously unappreciated histopathological correlates supporting the clinical relevance of our in vitro findings:
Reactive astrocytes with persistent foci of surface AQP4
Vacuolation in adjacent myelin consistent with edema
The multiple molecular outcomes identified as a consequence of NMO-IgG interaction with AQP4 plausibly account for the diverse pathological features of NMO: edema, iflammation, demyelination and necrosis.
Differences in the nature and anatomical distribution of NMO lesions, and in the clinical and imaging manifestations of disease documented in pediatric and adult patients, may be influenced by regional and maturational differences in the ratio of M1 to M23 proteins in astrocytic membranes.
For the spine patient with Failed Back Surgery Syndrome, the electrodiagnostic study helps the physician assess for nerve damage coming from the cervical or lumbar spine, as well as evaluate for other nerve-related problems in an extremity (such as peripheral neuropathy).
Because symptoms from a patient with Failed Back Surgery Syndrome can be complicated, additional electrodiagnostic tests can help the physician with accurate diagnosis of the origin(s) of the patient’s pain.
C. Daniel Smith, M.D. , chair of the Department of Surgery at Mayo Clinic in Florida, discusses minimally invasive surgical options for patients with gastroesophageal reflux disease (GERD). A novel device, a ring of tiny magnetic titanium beads that acts to keep stomach acid from leaking into the esophagus, is now offered at Mayo Clinic in Florida. Read more about the LINX Reflux Management System in the April 11, 2012, edition of MedCity News.
Mayo Clinic in Florida is one of the first health care institutions in the U.S. to offer a newly approved device to treat GERD. Mayo Clinic in Florida helped test the device in patients. The U.S. Food and Drug Administration (FDA) approved the device and treatment procedure on March 22, 2012, for patients with GERD who continue to have chronic reflux symptoms despite taking medication. Mayo Clinic in Florida was one of 14 centers nationally that participated in a clinical trial that led to the FDA’s approval of the device.
About GERD In patients with gastroesophageal reflux disease, liquid or food in the stomach flow back up into the esophagus due to the inability of a ring of muscle between the lower esophagus and the top of the stomach to close properly. If drugs aimed at neutralizing the acid in the stomach fails to prevent GERD, an operation designed to correct the mechanical defect is considered. Nearly 2 million patients of those patients could benefit from this treatment, which is much less complex than current surgical options, says Dr. Smith.
The results of the clinical study that led to approval of the device have not yet been published. “The data presented to the FDA, however, revealed striking results when compared to other GERD treatments that have been investigated over the past 20 years,” says Dr. Smith. “The system offers effective control of GERD with limited side effects and thus far an excellent safety record.”
The implanted device is a ring of tiny magnetic titanium beads that is wrapped around the junction between the stomach and esophagus, serving as a mechanical augmentation of the lower esophageal sphincter (the ring of muscle). The magnetic attraction between the beads is strong enough to keep the sphincter closed to refluxing acid, but weak enough so that food can pass through it into the stomach. The device can be implanted using minimally invasive surgery methods.
“I expect this device to be a game changer for the treatment of GERD in select patients who have failed management with drugs,” says Dr. Smith.
Kenneth R. DeVault, M.D. , chair of the Department of Internal Medicine at Mayo Clinic in Florida, also participated in the studies. “I have many patients who are searching for something more than medication for their reflux, but have been hesitant to undergo a traditional reflux surgery,” he says. “I think this procedure may well be a very attractive option for that group.”
Drs. Smith and DeVault were consultants to the company that developed the device and participated in the research study. Mayo Clinic licensed related technology to the company in exchange for equity.
Memphis Health Center, Inc. graduated from the Alliance’s Program for Nonprofit Excellence during a ceremony held at BRIDGES on February 16th, 2012 along with Delta Arts, Memphis Area Legal Services, & Synergy Treatment Centers. The Alliance Program for Nonprofit Excellence (PNE) is a nationally recognized initiative that transforms participating nonprofits into high-performance organizations through a rigorous multi-year curriculum.
Seeing your child come home from school bending forward to handle the weight of a fully loaded school backpack is cause for concern. Backpacks that are too heavy for the child can cause back pain and spasms, shoulder pain, and neck pain, among other issues.
Learn a number of practical tips to significantly reduce the weight that your child is bearing on the way to and from school.
Whistleblowers, Lucas Matheny (“Matheny”) and Deborah Loveland (“Loveland”), brought an action against Medco Health Solutions (“Medco”) claiming that Medco and its subsidiaries failed to report and refund to the federal government $69 million in Medicare and Medicaid overpayments. The plaintiffs, former employees of Medco, used the authority of the False Claims Act to bring their lawsuit. The False Claims Act allows private individuals to sue an entity on their own and the government’s behalf. In doing so, the individuals receive compensation for being a “whistleblower”, which is usually between 15% and 25% of the funds recovered, including reasonable expenses, attorney fees and costs.
Matheny and Loveland knew of the overpayments to Medco, but were told that because of insufficient manpower to process the necessary forms, the overpayments would not be refunded to the government. Matheny and Loveland claimed the overpayments were transferred to fictitious patient accounts and perfect records with a zero percent error rate were created using a specific computer program. In addition, Medco filed a false certificate of compliance with the government, knowingly concealing millions of dollars in overpayments.
When the lawsuit was first heard by the court, it was dismissed, due to the court noting that the plaintiffs’ complaint had been amended three times and failed to state a claim. However, on appeal, the court concluded that Matheny and Loveland had sufficiently alleged the existence of a false record. Additionally, the court held that the defendants (Medco) knew the records were false and were to be used to avoid a financial obligation to the government.
The Matheny v. Medco Health Solutions matter is a prime example for healthcare providers to be careful with potential overpayments and how to handle those overpayments should they occur.
COHEN ANNOUNCES $3.1 MILLION IN NEW FEDERAL FUNDS FOR MEMPHIS HEALTH CENTER
MEMPHIS, TN – Congressman Steve Cohen (TN-09) today announced the Memphis Health Center will receive $3,133,617 in new federal funds from the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Division of Grants Management Operations so the facility can continue providing health services to the local community.
“The Memphis Health Center is a wonderful organization that provides invaluable health resources throughout Memphis,” said Congressman Cohen. “These new federal funds will help keep the Memphis Health Center going strong so more people throughout the city can receive the health care they need.”
The new federal funds are being awarded under the Health Center Cluster competing continuation grant program. The overall purpose of the health center continuation grant is to provide financial assistance to health centers to support the continued provision of comprehensive primary health care services to an underserved area or population.
The health center continuation grant supports the continued operation of a health center for the provision of required comprehensive primary, preventive, enabling and additional health care services including oral health care, mental health care and substance abuse services as appropriate, either directly on-site or through established arrangements without regard to ability to pay.
Failed Back Surgery Syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain, which occurs if spine surgery does not achieve the desired result. Contributing factors include recurrent disc herniation, compressed nerves, altered joint mobility, scar tissue, muscle deconditioning and degeneration of facet or sacroiliac joints.
To learn more about A Step Ahead and its free long-term birth control options, choose one of the two videos below. To schedule an appointment or to ask additional questions, please call A Step Ahead at (901) 320-STEP (7837).
Whistleblowers, Lucas Matheny (“Matheny”) and Deborah Loveland (“Loveland”), brought an action against Medco Health Solutions (“Medco”) claiming that Medco and its subsidiaries failed to report and refund to the federal government $69 million in Medicare and Medicaid overpayments. The plaintiffs, former employees of Medco, used the authority of the False Claims Act to bring their lawsuit. The False Claims Act allows private individuals to sue an entity on their own and the government’s behalf. In doing so, the individuals receive compensation for being a “whistleblower”, which is usually between 15% and 25% of the funds recovered, including reasonable expenses, attorney fees and costs.
Matheny and Loveland knew of the overpayments to Medco, but were told that because of insufficient manpower to process the necessary forms, the overpayments would not be refunded to the government. Matheny and Loveland claimed the overpayments were transferred to fictitious patient accounts and perfect records with a zero percent error rate were created using a specific computer program. In addition, Medco filed a false certificate of compliance with the government, knowingly concealing millions of dollars in overpayments.
When the lawsuit was first heard by the court, it was dismissed, due to the court noting that the plaintiffs’ complaint had been amended three times and failed to state a claim. However, on appeal, the court concluded that Matheny and Loveland had sufficiently alleged the existence of a false record. Additionally, the court held that the defendants (Medco) knew the records were false and were to be used to avoid a financial obligation to the government.
The Matheny v. Medco Health Solutions matter is a prime example for healthcare providers to be careful with potential overpayments and how to handle those overpayments should they occur.
For the second year in a row there have been cases of Plasmosium vivax malaria reported in Greece.
There is no history of travel to malarious area in the affected patients, so the cases have been acquired locally.
These cases were in agricultural areas, and there are no reports of malaria occurring in resort areas of Greece.
It is however, recommended that travellers do take precautions against getting insect bites – West Nile virus (not as serious as malaria, but nevertheless unpleasant) is also spread by infected mosquitos and cases have been reported recently.
Source: European Centre for Disease Prevention and Control
For further advice, contact the Globe Travel Health Centre on 01603 667323
Recently, Phillips Kirk Labor, MD implanted Crystalens intraocular lenses in both eyes of a very important person: his wife. A respected physician herself, Dr. Penny Labor expected nothing less than excellence, and knew exactly who to trust. Here is her own firsthand account:
“Many people may think I’m biased since my husband, Dr. Labor, was my eye surgeon. But like so many of his patients, my Crystalens procedure was a life-changing experience not unlike theirs. You see, I’ve worn glasses or contact lenses since I was 5 years old, and had 20/400 vision in my left eye, and 20/200 vision in my right eye. As a radiologist, clear vision is crucial to what I do, so having eye surgery was a big decision, even though the person I trust most in the world was doing the procedure. Recently, I completed two eye surgeries over a 4-week period and my vision without glasses or contacts is better than it’s been my entire life! I now have better than 20/20 vision in both eyes, and the colors I see through my new Crystalens are unbelievable.”
“I may need reading glasses only for very small print, but I know my near vision will improve over 12 months; and, over time, my Crystalens will work better for me every day. I’m definitely going to do everything Dr. Labor says – including my reading exercises – to get the absolute best results. As he does with all of his patients, Dr. Labor ensured I knew everything that was going to happen and what I could expect. I was literally shedding tears of joy at how great I could see right after surgery! Without a doubt, this has truly changed my life.”
If you’d like to know more about Crystalens, or any of our Premium Smart Lenses, call us locally in Grapevine at 877-516-4364. Or email us at info@eyecontx.com.
COHEN ANNOUNCES $3.1 MILLION IN NEW FEDERAL FUNDS FOR MEMPHIS HEALTH CENTER
MEMPHIS, TN – Congressman Steve Cohen (TN-09) today announced the Memphis Health Center will receive $3,133,617 in new federal funds from the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Division of Grants Management Operations so the facility can continue providing health services to the local community.
“The Memphis Health Center is a wonderful organization that provides invaluable health resources throughout Memphis,” said Congressman Cohen. “These new federal funds will help keep the Memphis Health Center going strong so more people throughout the city can receive the health care they need.”
The new federal funds are being awarded under the Health Center Cluster competing continuation grant program. The overall purpose of the health center continuation grant is to provide financial assistance to health centers to support the continued provision of comprehensive primary health care services to an underserved area or population.
The health center continuation grant supports the continued operation of a health center for the provision of required comprehensive primary, preventive, enabling and additional health care services including oral health care, mental health care and substance abuse services as appropriate, either directly on-site or through established arrangements without regard to ability to pay.
Baltimore, MD – According to the Administration on Aging (AOA), persons 65 and older represented nearly 13% of the U.S. population in 2009, and are expected to represent 19% by 2030. The Bureau of Labor Statistics finds that the number of older Americans in the workforce is growing as well. As the population and workforce ages, Baltimore eye surgeon Jay C. Grochmal, MD says his patients that are late stage baby-boomers are under extreme pressure to maintain a high level of performance in the workplace, and portraying a vivacious and youthful appearance is essential to continued success.
While helping patients improve their vision with procedures such as LASIK and cataract surgery is important to success in the workplace, Dr. Grochmal says the desire to help his patients enhance their aesthetic appearance has become an important part of his practice as well. He says this growing demand for increased confidence and a natural-looking enhancement is what led him to the decision to add cosmetic eyelid surgery to his list of procedures: “Our society places such a high value on appearance and equates a youthful look with the likelihood of business and social success. Baby boomers are still very active and productive and a refreshed look can eliminate unwarranted bias in career choices.”
As the number of cosmetic procedures performed in the U.S. continues to increase, Dr. Grochmal says the desire to look younger longer is obvious, adding that a tough economy and high unemployment rate further contribute to the stress his older patients must endure. Because he constantly strives to improve patient care while providing the latest and safest procedures, Dr. Grochmal says providing cosmetic treatments for his patients is a result of his original commitment to provide the most effective treatments available to meet any and all needs of his patients: “As the cliche goes now, 50 is the new 40 and 60 is the new 50, and so on. My patients want to look as young as they feel and be able to see well too. Ultimately, we believe providing cosmetic eyelid surgery will improve their chances of success in the workplace.”
About Jay C. Grochmal, MD
After earning his medical degree from the University of Maryland, Dr. Jay C. Grochmal completed his residency while achieving the rank of Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology. In addition to being on staff at some of the leading hospitals in the Baltimore area, Dr. Grochmal has traveled on a number of missions dedicated to improving eye care around the world.
Grochmal Eye Center is located in the Catonsville Professional Center at 405 Frederick Rd., Ste. 102, Baltimore, MD 21228, and can be reached at (410) 697-4090. Dr. Grochmal and his team can also be reached at grochmaleye.com or their Baltimore Eye Care Facebook page.
Dr. Jay C. Grochmal, a laser eye surgeon in Baltimore, is launching an innovative website to enhance his ability to help his vision correction patients. In collaboration with Rosemont Media™, a medical website design firm in San Diego, CA, Dr. Grochmal’s new website is a comprehensive resource of information showcasing the range of procedures he offers, including vision correction procedures such as LASIK, and treatment for eye diseases such as glaucoma and cataract surgery in Baltimore, MD and the Washington, DC area.
Dr. Grochmal’s website features detailed descriptions of both corrective and cosmetic procedures such as eyelid surgery in Baltimore, as well as a doctor biography, patient testimonials, and financing options. In addition to the in-depth breakdown of the procedures and treatments Dr. Grochmal provides, his website also includes direct links to his social media sites, such as Facebook and Twitter to foster the growth of an online community centering around his practice and his patients’ experiences. Please welcome to the web, www.grochmaleye.com!
Recently, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued an advisory opinion regarding two types of Proposed Arrangements between an anesthesia provider (AP) and physician-owned ambulatory surgery centers (ASCs). This came as a result of a request for an opinion from an AP who, because of competitive market pressures, was considering one of two new business relationship models. Under the AP’s current professional arrangement, the ap offers exclusive anesthesia services to ASCs, employs personnel to meet the anesthesia needs of the ASCs, and independently bills patients and third party payors, including Medicare, for professional fees. The ASCs bill the same parties for professional services plus a facility fee for materials and ancillary staff.
Under Proposed Arrangement A, the AP would continue to provide exclusive anesthesia services to the ASC and to bill independently. Additionally, the AP would pay a market value “management services” fee to the ASC for each non-Federally funded patient. The ASC would both collect this fee and continue to charge a facility fee to Federal and third party payors.
Under Proposed Arrangement B, the ASC physician-owners would set up a separate subsidiary to exclusively provide anesthesia services to their patients. The subsidiary then would hire the AP as the exclusive independent anesthesia services contractor, handle all billing with the assistance of the AP and its staff, pay the AP out of fees collected, and retain any profits.
In analyzing the legality of the two arrangements, the OIG considered two questions: 1. Does either arrangement violate the Federal anti-kickback statute, and, 2. Would any safe harbor protection apply?
Under the anti-kickback statute, it is a criminal offense to offer, pay, solicit, or receive any remuneration for referrals reimbursable by a Federal health care program. This statute seeks to ensure that referrals are based on sound medical judgment and not financial or other incentives. Regarding Proposed Arrangement A, although the AP would pay a management services fee only for non-Federal health care program patients, this does not reduce the risk that the fee might be paid by the AP to induce referrals from the ASC of all types of patients. Additionally, the arrangement allows the ASC to be paid twice for the same services, and this could unduly influence the ASC to select the AP as the exclusive provider. The OIG concluded that Proposed Arrangement A could violate the anti-kickback statute. No safe harbor protections apply.
Safe harbor protections for ASCs, employment, and personal services and management contracts were determined to not apply to Proposed Arrangement B. The Subsidiary does not qualify as a Medicare-certified ASC because it would not provide surgical services, only anesthesia services. As such, its income and the profits distributed to the ASC physician-owners would not be protected by any safe harbor provisions. Additionally, the OIG is concerned about exclusive arrangements between those who refer business (the ASC physician-owners), and those who furnish goods or services reimbursed by a Federal health care program (the AP). The AP and the ASC physician-owners both would benefit financially in Proposed Arrangement B, with the AP receiving its negotiated rate and the physician-owners receiving residual profits from the subsidiary after expenses and payment to the AP. The OIG concluded that Proposed Arrangement B would permit the physician-owners to receive compensation in the form of profits from the subsidiary from referring patients to the AP; this payment would be for services that they themselves could not provide. The more than minimal risk of fraud and abuse and the prohibited remuneration both would be in violation of the Federal anti-kickback statute.
Physicians should be aware of this development, as it may affect current and future professional relationships. A health care attorney can offer assistance in interpreting the potential impact of the OIG decision and evaluating the need to restructure business arrangements.
This is National Health IT Week, and there are a host of activities planned to celebrate it in Washington, D.C.—summits and panels, webinars and receptions, workshops and even job fairs.You can see the full agenda for the week here.We’ll be sharing Health IT news, announcements and highlights from some of the events here on the Center for Total Health Blog.You can also follow the conversation on Twitter via hash tag #NHITWeek. Check back often for coverage.
If you’re in your 40s, 50s or 60s, you may think you’re too old to undergo LASIK surgery. Think again! WebMD, a leading source in medical news, reports on one study demonstrating the effectiveness of laser eye surgery in older patients. Citing research from the Massachusetts Eye and Ear Infirmary, the article suggests that “laser surgery corrects vision for patients in [their] 40s, 50s and 60s.”
The study looked at 424 LASIK patients between the ages of 40 and 69. According to the article, following their surgery, “20/30 vision … was restored in 86% to 100% of eyes corrected for nearsightedness and 80% to 84% of eyes corrected for farsightedness.” Even those in their 60s? Yes, WebMD goes on to explain that “Patients in their 60s were just as likely to have good outcomes as those in their 40s and 50s.”
Is LASIK Right for You?
This study brings up an interesting question: Who is a good candidate for LASIK surgery? While there is no single formula for determining a good LASIK candidate, here are some general guidelines.
A good LASIK candidate:
…is in good general health.
…has good eye health and is free of eye conditions such as cataracts, chronic corneal infections or keratoconus.
…is of a certain age, typically 21 years old.
…has a cornea of appropriate shape and thickness.
There are several other factors that need to be discussed before choosing laser vision correction. The only way to do that is to schedule a consultation with a qualified LASIK surgeon.
Considering LASIK? Learn More Today
To learn more about Laser Eye Surgery, contact us today. Together, we can find the best treatment options for you. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200.
When is the last time that you took off your shoes and yours socks and you walked barefoot on the grass. If you’re older than twelve I’m guessing it has been quite some time. It’s funny, when we’re kids, if we see a mud puddle we JUMP right in it. When we become adults we walk around the mud puddle. Not only do we walk around the mud puddle…we complain about it!
Stop complaining. It’s not really serving you. Start living. Get outside and re-connect with our planet. This isn’t some hippy dippy statement. We (human beings) are electrical beings. That’s right, we are electrical beings. Electricity is constantly flowing through our bodies. In fact, without electricity you wouldn’t be reading this post right now. Without electricity running through your body your brain would cease to function.
Sometimes we need to re-charge. We need to “ground” ourselves. One of the ways to do this is by getting outside and walking barefoot on the grass. While you’re walking (barefoot of course) do some deep breathing – you’ll be accomplishing two things at the same time (there is nothing like multi-tasking when it comes to your health). Walking barefoot on the grass will “ground” you, literally. Doing this will help you release built up electrical energy that’s in your body.
As stated above, your entire nervous system is run on electrical energy. Get walking, ground yourself, do your deep breathing, and make some positive changes in your life. This doesn’t cost you a dime. What have you got to lose?
Today, Kaiser Permanente published its E-Quality Update—a quarterly e-newsletter that covers industry news on issues of technology-enabled health care quality and service. It is distributed to more than 20,000 industry stakeholders, and each issue features a guest column from someone outside of Kaiser Permanente. Today’s issue features a column by Marc Probst, chief information officer and vice president at Intermountain Healthcare, as well as articles highlighting recent research findings about EHR adoption and use, stages 2 and 3 of the Meaningful Use incentive program, and much more.
Grochmal Eye Center Adds Hi-Def Cirrus Laser Eye Surgery Technology
The Grochmal Eye Center is a Baltimore LASIK surgery practice, offering complete and comprehensive eyecare for the entire family. Dr. Jay C. Grochmal is announcing the addition of the Cirrus™ HD-OCT by Zeiss, which he says helps him visualize and analyze the status and health of the retina. In particular, the Cirrus™ technology allows him to assess the health of his patients’ eyes prior to performing a number of procedures, including traditional cataract surgery and refractive lens exchange.
The Grochmal Eye Center was founded in 1978, and continues to provide state-of-the-art eye care and laser eye surgery procedures, such as PRK and LASIK in Maryland under the leadership of Dr. Jay C. Grochmal. As part of their commitment to the cutting-edge of ophthalmic technology, Dr. Grochmal is announcing the latest addition to the practice: the Cirrus™ HD-OCT by Zeiss. He says the new technology will help him and his staff diagnose any changes in the macula caused by different diseases, such as macular degeneration, diabetic retinopathy, or glaucoma. He adds that early detection of these diseases will enable him to start treatment before permanent vision loss occurs.
Zeiss is one of the world’s leading medical technology companies. Founder Carl Zeiss was the first to commercialize the OCT technology, and the first to deliver the high definition 3D maps created by the Cirrus™ HD-OCT. Dr. Grochmal says the new technology not only helps him detect potentially damaging eye conditions, but also helps him improve the overall level of care he can offer his patients. The printouts from the OCT are very helpful, according to Dr. Grochmal, as they aid in educating his patients and help them gain a better understanding of the disease and procedure.
Whether he is performing refractive or cataract surgery, LASIK or PRK, Dr. Grochmal says he and his team tirelessly pursue the latest advancements in eye care and laser eye surgery to ensure their patients receive the best care available. “The advancements in ophthalmology in just the last ten years are astounding; staying on top of these developments is essential to our continued dedication to providing state-of-the art treatment. Our patients deserve only the best, and that is what we constantly strive to offer.”
About Dr. Grochmal
Dr. Jay Grochmal earned his medical degree from the University of Maryland. He then completed a rotating internship with the U. S. Public Health Hospital in Baltimore, MD. After becoming the Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology, he completed his residency and established the Grochmal Eye Center. Dr. Grochmal is currently on staff at some of the top hospitals in Baltimore, and continues to offer his expertise and skill to medical missionary trips around the globe.
The Grochmal Eye Center is located at 405 Frederick Rd., Ste. 102 in Baltimore, MD 21228, and can be reached at (410) 697-4090, or found online at www.grochmaleye.com or the Grochmal Eye Center Facebook page.
Vanda A. Lennon, M.D., Ph.D., with the Departments of Laboratory Medicine and Pathology and Neurology, discusses research that identifies critical properties of neuromyelitis optica, a potentially debilitating neurological disease that is often misdiagnosed as multiple sclerosis (MS).
Dr. Lennon’s team isolated and identified an antibody unique to NMO that may interfere with the transport of the water. In some areas of autopsied brain tissue studied, there was an accumulation of water in the myelin itself that the team believes may lead to the secondary destruction of the myelin in NMO and potential misdiagnosis of NMO as MS.
ABSTRACT The astrocytic aquaporin-4 (AQP4) water channel is the target of pathogenic antibodies in a spectrum of relapsing autoimmune inflammatory central nervous system disorders of varying severity that is unified by detection of the serum biomarker neuromyelitis optica (NMO)-IgG. Neuromyelitis optica is the most severe of these disorders. The two major AQP4 isoforms, M1 and M23, have identical extracellular residues.
This report identifies two novel properties of NMO-IgG as determinants of pathogenicity:
The binding of NMO-IgG to the ectodomain of astrocytic AQP4 has isoform-specific outcomes. M1 is completely internalized, but M23 resists internalization and is aggregated into larger-order orthogonal arrays of particles that activate complement more effectively than M1 when bound by NMO-IgG.
NMO-IgG binding to either isoform impairs water flux directly, independently of antigen down-regulation.
We identified, in nondestructive central nervous system lesions of two NMO patients, two previously unappreciated histopathological correlates supporting the clinical relevance of our in vitro findings:
Reactive astrocytes with persistent foci of surface AQP4
Vacuolation in adjacent myelin consistent with edema
The multiple molecular outcomes identified as a consequence of NMO-IgG interaction with AQP4 plausibly account for the diverse pathological features of NMO: edema, iflammation, demyelination and necrosis.
Differences in the nature and anatomical distribution of NMO lesions, and in the clinical and imaging manifestations of disease documented in pediatric and adult patients, may be influenced by regional and maturational differences in the ratio of M1 to M23 proteins in astrocytic membranes.
As we age, it’s not uncommon to face all different types of health concerns and challenges. And, when it comes to your eye health, there’s no exception.
If you’re in your 40s, 50s or 60s, you may think you’re too old to undergo LASIK surgery. Think again! WebMD, a leading source in medical news, reports on one study demonstrating the effectiveness of laser eye surgery in older patients. Citing research from the Massachusetts Eye and Ear Infirmary, the article suggests that “laser surgery corrects vision for patients in [their] 40s, 50s and 60s.”
