Healthcare Review

Approach will help ensure consumers have quality, affordable coverage starting in 2014

The Department of Health and Human Services today released a bulletin outlining proposed policies that will give states more flexibility and freedom to implement the Affordable Care Act.

The Affordable Care Act ensures all Americans have access to quality, affordable health insurance.  To achieve this goal, the law ensures that health insurance plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as “essential health benefits.”

The bulletin released today describes an inclusive, affordable and flexible proposal and informs stakeholders about the approach that HHS intends to pursue in rulemaking to define essential health benefits.  HHS is releasing this intended approach to give consumers, states, employers and issuers timely information as they work toward establishing Exchanges and making decisions for 2014.  This approach was developed with significant input from the public, as well as reports from the Department of Labor, the Institute of Medicine, and research conducted by HHS.

“Under the Affordable Care Act, consumers and small businesses can be confident that the insurance plans they choose and purchase will cover a comprehensive and affordable set of health services,” said HHS Secretary Kathleen Sebelius.  “Our approach will protect consumers and give states the flexibility to design coverage options that meet their unique needs.”

Under the Department’s intended approach announced today, states would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the essential health benefits package.  States would choose one of the following health insurance plans as a benchmark:

* One of the three largest small group plans in the state;
* One of the three largest state employee health plans;
* One of the three largest federal employee health plan options;
* The largest HMO plan offered in the state’s commercial market.

The benefits and services included in the health insurance plan selected by the state would be the essential health benefits package.  Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage.  Consistent with the law, states must ensure the essential health benefits package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs.  If a state selects a plan that does not cover all ten categories of care, the state will have the option to examine other benchmark insurance plans, including the Federal Employee Health Benefits Plan, to determine the type of benefits that will be included in the essential health benefits package.

The policy proposed today by HHS would give states the flexibility to select a plan that would be equal in scope to the services covered by a typical employer plan in their state.  States and insurers would retain the flexibility to evolve the benefits package with the market as innovative plan designs are developed and advancements in care become available, and meet the needs of their citizens.

“More than 30 million Americans who newly have insurance coverage in 2014 will have a comprehensive benefit package,” said Sherry Glied, PhD, assistant secretary for planning and evaluation.  “In addition to assuring comprehensive coverage for the newly insured, many millions of Americans buying their own insurance today will gain valuable new coverage, including more than 8 million Americans who currently do not have maternity coverage,  and more than 1 million who will gain prescription drug coverage.”

The bulletin issued today addresses only the services and items covered by a health plan, not the cost sharing, such as deductibles, co-payments, and coinsurance.  The cost-sharing features will be addressed in future bulletins and cost-sharing rules will determine the actuarial value of the plan.

New surgical approach is now available in Providence

Jennifer Gass, MD

Providence, RI – Jennifer Gass, MD, chief of surgery at Women & Infants Hospital of Rhode Island and a breast surgeon with the Breast Health Center in the hospital’s Program in Women’s Oncology, recently completed a one-month sabbatical in Paris with the world-renowned breast surgeon Krishna B. Clough, MD, medical director of the Paris Breast Center.

The sabbatical is key to making the novel surgical technique available to breast cancer patients through Women & Infants, which is the first facility in New England using this new approach to breast and cosmetic preservation.

Dr. Gass traveled to Paris to gain hands-on experience with Dr. Clough, who has been a pioneer in the field of oncoplastic surgery, a surgical approach that combines the best techniques from plastic surgery with oncologic surgery to remove breast cancer. The oncoplastic approach helps the breast surgeon reshape the remaining breast, either by redistributing the volume lost when the cancer is removed through the remaining breast, or by using other tissue to refill the space. The end result is a cancer-free breast that looks natural.

Dr. Clough, who trained in the United States and France, was chief of the Department of General and Breast Surgery at the Curie Institute when he resigned in 2005 to found the Paris Breast Center, the first facility in France dedicated to breast surgery and breast cancer. Continuing his research, Dr. Clough and a small group of European surgeons created the concept of oncoplastic surgery. At the Paris Breast Center, oncoplastic surgery was fully integrated as a multidisciplinary treatment and is now considered one of the main recent advances in breast cancer surgery.

“Many women with breast cancer know they need to have surgery to remove the disease but they are afraid of looking disfigured after surgery,” explained Dr. Gass, who is also who is also director of the Breast Fellowship at Women & Infants and an assistant professor of surgery at The Warren Alpert Medical School of Brown University. “Oncoplastic surgery includes tailoring the excision to minimize distortion, ultimately yielding a breast of optimal size and shape.”

Furthermore, the oncoplastic approach considers pre-existing breast diagnoses, as the surgeons plan to remove the cancer. A woman, therefore, may have ptosis (sagging breasts), macromastia (very large breasts) or asymmetry (breasts that are uneven in size) before her breast cancer diagnosis. The underlying condition, along with the cancer diagnosis, are addressed in surgery.

“The patient, at completion of therapy, has not only had treatment for her cancer but the underlying condition as well,” Dr. Gass noted. “She can be more confident in her self-image.”

The oncoplastic approach to breast surgery has greatly advanced the field from the traditional mastectomy to nipple sparing mastectomy. While mastectomy has been paired with immediate reconstruction in the past, women had to undergo additional surgery to achieve the final result. Now, with the preservation of the nipple areola complex, a truly one-staged immediate reconstruction is a reality. Oncoplastic surgeons use breast reduction techniques to contour the breast to have a smaller but rounder, more uplifted appearance. The unaffected breast is often exposed during the procedure to ensure the results are visually symmetrical. The unaffected breast may also undergo a procedure to create symmetry in some cases.

“Overall, the goal of oncoplastic surgery is to improve the patient’s journey through survivorship,” Gass said. “We want women to look at themselves with the pride they deserve, rather than looking at a scar as if it were a badge of courage.”

In addition to bringing these new procedures to Women & Infants, Dr. Gass will also be teaching them to the breast cancer fellows who study at the hospital, the only facility in New England to offer such a prestigious educational opportunity.

For more information on oncoplastic breast surgery or other treatment for breast cancer or breast diseases, call the Breast Health Center at (401) 453-7540.

PHOTO

EmSeeQ braclet

FRISCO, TX – For parents and caregivers of children with autism spectrum disorders (ASD), the risk of bolting (wandering away or elopement) is a source of constant worry. To help prevent a wandering event from becoming a tragedy, EmFinders, maker of the life-saving EmSeeQ(r) wearable locator device for children and adults with special needs, is urging parents, grandparents, school officials and other caregivers to take special precautions to prevent kids with ASD from wandering off to avoid potentially grave consequences.

“Bolting is very common in kids with autism: about half of parents of children with ASD deal with elopement. Among those who do, two-thirds say their child has had a ‘close call’ with traffic, while one-third say they’ve had a ‘close call’ with a possible drowning,” said Jim Nalley, co- founder of EmFinders, citing recent research from the Interactive Autism Network (IAN). “Certainly there are steps you can take to prevent a child from bolting, but it’s also critical to have a plan in place to bring them home quickly and safely if they do get away. That’s where EmSeeQ can help.”

EmSeeQ Speeds Rescue in Spokane
When 9-year-old Jakob Lund failed to return home from Whitman Elementary School in Spokane, Wash. one Friday afternoon in May, his mother, Stephanie, knew exactly what to do: she first called 911 and then alerted EmFinders, who activated Jakob’s EmSeeQ bracelet. Jakob has Asperger’s syndrome, a form of autism, and had a history of wandering off for hours at a time. His mother purchased the EmSeeQ bracelet the previous fall as a way to quickly locate Jakob and bring him home safely should this situation occur.

Thanks to the EmSeeQ bracelet, police were able to locate Jakob 15 blocks away from the school in just 10 minutes. “I think it’s really important for any parent who has a child with disabilities or even just a regular child because this device is just incredible,” Lund said of the EmSeeQ system. “I think it will end a lot of Amber Alerts.”

The EmSeeQ system uses the nationwide TruePosition U-TDOA cellular technology to quickly locate the individual wearing the device anywhere in the U.S. where cellular coverage exists. Once activated, the bracelet places a call to 911, providing its location to dispatchers, who can then direct responders to the individual’ specific location, as they do every day for thousands of wireless 911 calls. The system can accurately locate the wearer to within meters, typically within 30 minutes.

Affordable Peace of Mind
In addition to virtually eliminating time-consuming search and rescue operations that can jeopardize the lost individual’s safety and cost taxpayers thousands of dollars, EmSeeQ provides a valuable peace of mind to parents and caregivers who know they have a tool for quick rescue in the event their child escapes their careful supervision.

“We are so glad to have such an effective and accessible safety tool available that can relieve some of the anxiety parents may have about their child wandering away,” said Emily Iland, chairperson of the Santa Clarita Autism Asperger Network’s (SCAAN) Community Law Enforcement Aware Response (CLEAR) Committee. The mother of an autistic child herself, Iland spearheads SCAAN’s nationally recognized programs to train local law enforcement officials in the signs and symptoms of ASD and how to approach and handle children with ASD who are unresponsive or nonverbal. “EmSeeQ offers an affordable option for parents to help prevent a tragedy, which is the smartest thing you can do.

“Think about it: If your child went missing, what would you pay to get them back? The fact that EmSeeQ offers inexpensive peace of mind is incredibly valuable for parents who live a state of constant worry,” Iland said.

An Ounce of Prevention
In addition to taking preventative measures to retrieve a child with ASD if they do wander or become lost, keeping kids with ASD safe takes a combination of careful planning and creativity on the part of parents, grandparents and other caregivers. In addition to the Safety in the Home tips offered by the Autism Society of America, EmFinders and Iland recommend parents take the following precautions:

• Talk to neighbors about the child’s ASD and his or her tendency to elope-and this goes for parents, grandparents and anywhere else the child might stay or visit. Having those extra sets of eyes can help bring a safe and speedy end to a wandering situation.
• Many children have a favorite place they go to if they do bolt, a particular store, for example. Talk with the people who work there (door greeters, cashiers, or other attendants), and explain how they can contact parents if they should see the child there without a parent or guardian. Iland even suggests creating business cards with emergency contact information and handing them out to everyone who might encounter the child if he or she should show up unsupervised.
• Have the child wear a medical ID bracelet to identify their ASD and help police and other responders recognize the special circumstances that may surround an encounter with the child
• Introduce the child to police officers, sheriff’s deputies and other emergency personnel. Not only will help the child feel more comfortable if he or she were to encounter a uniformed officer during a wandering emergency but it will also make these first responders  aware of the child’s ASD, behaviors they might display and how best to approach him or her in the event the child does need to be rescued.
• “Despite the best efforts of vigilant parents and caregivers, no amount of planning and prevention can completely eliminate the risk of a determined child with ASD wandering into harm’s way,” Iland said. “And, while EmSeeQ is certainly no substitute for careful supervision, it does provide a very effective rescue tool that can dramatically reduce the risk of a wandering emergency turning into a tragedy.”

Available in two models, a buckle-style band or a secure clasp-style that requires two hands for removal, the EmSeeQ system costs less than a typical cell phone. Unlike other locator systems, EmSeeQ can locate a missing person anywhere in the U.S. where cellular coverage exists, and it even works indoors and in other areas where GPS satellite signals may be obstructed.

For more information about EmFinders’ EmSeeQ emergency locator system, please visit www.emfinders.com.

PORTLAND, ME – Veteran healthcare industry executives Hud Connery, Tom Day, LeeAnne Denney, and John R. Morrow today announced that they have combined their respective companies (Performance Management Institute, LLC, of Portland, ME; The Healthcare Management Council, Inc., of Needham, MA; Health InfoTechnics, LLC, of Nashville, TN; and The Ratings Guy, LLC, of Belfast, ME) under the umbrella of a common parent company to provide a single source of business intelligence solutions to help providers address the complex requirements of managing under the new healthcare. Although the existing companies will continue certain operations, all new business opportunities will be pursued by the newly formed parent entity, and ultimately all consolidated into the single entity.

Named iVantage Health Analytics, Inc.(tm), the privately held company provides comprehensive and objective business information products to help hospitals and health systems strategically manage their growth during a period of significant health reform.
“Hundreds of billions of dollars are at stake for healthcare providers. We know that healthcare executives say that they are extremely concerned about the increased regulatory mandates and oversight of the Affordable Care Act (PPACA). Providers are also worried that they may be paid less than the cost of providing the care,” explained Hud Connery, president of iVantage Health.

The company provides a single source of business intelligence to hospital executives allowing them to confidently manage under the new healthcare. iVantage Health brings together all of the different and new measurements required under the PPACA into a single source. Market supply conditions are integrated with measures of patient safety, quality, efficiency, affordability, patient satisfaction, and population demand which are delivered through a comprehensive dashboard platform. “Our company provides comprehensive and objective information to help hospitals improve their performance so they can be successful. Bringing this disparate information together for the industry is a big deal in today’s healthcare environment,” said Tom Day, a company co-founder.

“The Affordable Care Act is in essence about increasing access to care for the uninsured. Hospitals and other providers must plan for this fundamental shift in care delivery and the enormous associated costs,” explained John R. Morrow, a company co-founder. This additional burden comes at a time when industry trends such as transparency, accountable care and reduced reimbursement have added stress to an already strained system. “The new rules are different and equally as complex as the old rules, yet they have economic consequences which can be punitive,” added Morrow. “Managing under the new healthcare will require expanded competencies for assimilating information in order to maintain a sustainable organization. Our company makes executives better prepared to manage in this complex environment.”

The combined companies are already delivering its products to more than 550 hospitals across the country to help hospitals and ACOs plan for a formerly uninsured population and its demands, prepare for the value-based purchasing rules, and remove the unnecessary costs associated with off-quality care.

“Ultimately, those who will most benefit from the combined expertise are hospitals struggling with too many silos of data and not enough integrated information. The new healthcare needs new intelligence to effectively manage in this era of health reform. And we have that intelligence,” said LeeAnne Denney, another company co-founder.

When someone is diagnosed with Alzheimer’s disease or dementia, his or her behavior will change, seemingly without reason or explanation. Nataly Rubinstein explains ten common behaviors that baffle and frustrate caregivers-and shares a wealth of practical advice on how to handle them.

Miami Beach, FL – No doubt about it: when someone you love is diagnosed with Alzheimer’s disease or some other cause of dementia, it’s a crushing blow. Not only must you face the fact that your loved one has a degenerative (and ultimately fatal) condition, you also have to deal with a plethora of increasingly strange behaviors. Mother tells the same story fifty times a day and wanders the house all night. Or Dad compulsively loads and then unloads the dishwasher. Or your devoted spouse of thirty years is suddenly convinced you’re cheating on him with the next-door neighbor.

If you feel confused, worried, frustrated, or even angry about the bewildering behaviors exhibited by your family member, congratulations. You’re normal. And now, says Nataly Rubinstein, it’s time to come to terms with a hard truth: the real source of your negative reaction is not necessarily the patient. It’s you.

“One big reason these behaviors are ‘unwanted’ is because they disrupt your life,” points out Rubinstein, author of the new book Alzheimer’s Disease and Other Dementias: The Caregiver’s Complete Survival Guide (Two Harbors Press, 2011, ISBN: 978-1-9361981-3-9, $17.95, www.AlzheimersCareConsultants.com). “Sure, many behaviors are unhealthy and dangerous for you and your loved one. Other times, though, it’s not the actual behavior that’s causing so much trouble-it’s our reaction to that behavior, based on the mindset we’ve locked ourselves into.”

In short, she says, we believe that the way we think things should be is the only way (or at least the only right way). Thus, we limit our own options when it comes to dealing with the patient. What’s more, we don’t want our relationship with the person to change-and these behaviors are 24/7 evidence that it has changed…dramatically and forever.

Rubinstein speaks from firsthand knowledge. As a licensed clinical social worker and geriatric care manager, she has over twenty-six years of professional and personal experience. (Visit www.AlzheimersCareConsultants.com for more.) Besides her professional work in dementia care, she served as a primary caregiver for sixteen years after her own mother was diagnosed with dementia.

“Being a caregiver for someone with any form of dementia, whether you live with the patient or not, will change your life,” Rubinstein asserts. “And sometimes, the new normal is more a problem for you than for the patient. For instance, you-not your loved one-are the person who tends to get upset when the same question is asked over and over again. I’m not saying it’s easy, but the best thing to do is get into the patient’s world and provide the answer over and over again.”

While every case of Alzheimer’s disease and dementia is different, Rubinstein says there are practical ways for caregivers to successfully deal with the behavioral changes that result from a patient’s memory loss. Read on to learn about ten “problem” behaviors that caregivers often have to deal with-and how you can best respond to these changes if they crop up in your relationship with your loved one:

PROBLEM: Compulsive Behaviors (Dad keeps taking everything out of his wallet and putting it back in.) Your loved one with Alzheimer’s may constantly check to see if the door is locked, empty or rearrange wallets or purses, pack and repack clothing, etc. These things are all manifestations of anxiety. The patient knows he has something important to remember but has forgotten what it was…and this causes his repetitive behaviors. The “big four in anxiety” are the basics for all of us: food, shelter, clothing, and family, and it’s not surprising that many compulsive behaviors revolve around these issues. (A man’s wallet signals to him that he is still a provider, for instance, so he may seem obsessed with going through its contents.)

SOLUTIONS: First, ignore the behavior and remember that although it seems strange to you, it’s probably not doing any real harm. Giving cease-and-desist advice to your loved one will only spark stress and arguments. Plus, if a behavior isn’t reinforced, it may stop. In general, do all you can to help the patient cope with his anxiety. Speak in a calm, gentle voice, and don’t be afraid to touch or hug. Remember, the person is seeking reassurance. Your job is to show him that he is safe, loved, and respected.

PROBLEM: Repeating (My wife asks me the same question over and over again, even though I answered it-yet again-not five minutes ago.) At their cores, Alzheimer’s and dementia are diseases of forgetting. As these illnesses progress, patients live increasingly “in the moment,” and they lose the ability to think and process information. For someone in this situation, repetition-whether it’s asking a question, stating a fact, or telling a story-is comforting.

SOLUTIONS: It will take patience on your part, but it’s usually best for everyone if you answer the same question or listen to the same story again and again. Handling repetitiveness in this manner doesn’t hurt you, it helps your loved one, and it can prevent much more serious episodes of agitation, confusion, or aggression. Also, when dealing with an Alzheimer’s or dementia patient, it’s always best to keep your conversation as simple and direct as possible in order to avoid miscommunications that might spark confusion and repetitive questions.

PROBLEM: Toileting Problems (Dad has started peeing on the couch, in the bathtub, and even out in the yard!) It’s common for Alzheimer’s patients to struggle with incontinence. Sometimes they simply don’t realize they need to use the bathroom or can’t make it there in time. And other times, they may have forgotten the location of the bathroom or what its purpose is. Nobody has accidents on purpose, and patients will often offer alternative explanations as to why, for instance, the bed or couch is wet-such as spilled drinks or leaky roofs.

SOLUTIONS: Right off the bat, realize that it’s okay to feel extremely reluctant to take on this particular cleaning task. When an adult can no longer control his bladder or bowels, it’s natural for caregivers to feel distressed. If you’re experiencing toileting problems, the first step is to make a doctor’s appointment to ensure that another medical condition or medication isn’t the cause. Establish a regular bathroom routine and encourage the patient to go instead of asking whether or not he needs to.

You may also find it helpful to place signs indicating where the bathroom is, make the toilet seat a different color, provide clothes without complicated zippers or buttons, or buy pads for beds, furniture, and cars. Ultimately, don’t beat yourself up if you feel too overwhelmed by toileting problems. It might be better for all involved to call in outside help rather than force yourself to face changing a parent’s diaper.

PROBLEM: Refusal to Bathe (Mom insists that she took a shower this morning, but I know she hasn’t bathed in several days.) An Alzheimer’s or dementia patient who once paid scrupulous attention to her grooming and beauty rituals may gradually begin to “let herself go.” In the beginning, you may not notice small changes, but it’s impossible to ignore when someone to whom you’re close wears the same clothes for days at a time or hasn’t cleaned herself in awhile. Some patients actually believe that they have bathed recently; others may have forgotten the steps it takes to clean oneself, think that there’s no need to bathe if they haven’t perspired, be afraid of water or showers, or not want to ruin a hairdo. No matter the reason (even if it is somewhat logical), refusal to bathe is a major issue for those who live in close proximity with the patient.

SOLUTIONS: Know that forcing someone to bathe when she doesn’t want to isn’t an easy or one-size-fits-all task-and also acknowledge that you aren’t being unreasonable in insisting that this happen. Your own physical and emotional well-being are in play here, too. If appropriate, try to reason with your loved one by telling her that you’ll have visitors or must go to a doctor’s appointment and that you know she’ll want to look her best. Also, you can make showering easier by pre-measuring shampoo, setting water and room temperatures to the patient’s desired level, playing music, etc. Above all, keep in mind that a person with memory problems needs to feel safe and secure, so do everything possible to prevent her from feeling threatened or humiliated in this intimate setting.

PROBLEM: Wandering (My husband walked out the door and was halfway down the street before I noticed!) When people wander-whether they’re experiencing memory loss or not-it’s usually because they’re looking for a safe or comfortable place. Your loved one might be seeking a bathroom, a person or place from his past, or relief from boredom or pain. (Or he may have simply become confused while getting the mail.) When they’re seeking something in particular, Alzheimer’s and dementia patients can be very adept at slipping away-even if they’re wheelchair bound!

SOLUTIONS: Wandering is a behavior change that is imperative to address, because becoming lost or being unaware of surroundings can have dire consequences for those suffering from memory loss. Whether your loved one has a history of wandering or not, buy him a Safe Return necklace or bracelet through the Alzheimer’s Association. You might also change locks, install a security system in the patient’s home, or make use of baby gates. Again, making your loved one feel secure is paramount, so don’t call attention to any changes you may make in the living environment. And pay special attention to making sure that he doesn’t wander away during outings.

PROBLEM: Paranoia (My mother thinks that I’m trying to poison her.) Paranoia boils down to fear. And people who are suffering from memory loss have a lot to be afraid of. As time goes on, Alzheimer’s patients lose the ability to recognize their homes, their friends, their family, and even their own reflections in the mirror. In the midst of this unfamiliarity, they’ll struggle to make some sense of their situations, and they can hold on to the ideas they form for quite some time. Even though your loved one’s belief that you’re trying to steal her jewelry may seem irrational to you, it’s nothing short of reality to her. (In this situation, you may have asked to borrow a certain necklace years ago. Mom can’t find it now, so-clearly-you must have taken it!)

SOLUTIONS: Dealing with paranoia is tricky. The best things you can do are to remember that your loved one isn’t trying to hurt you, and to try not to take things personally. Know beforehand that rational explanations and clarifications probably won’t work, so don’t pin your hopes of returning to “normal” on them. And while there may be nothing you can do to help the patient return to reality, it’s always a good idea to schedule medical appointments to check for other illnesses, sensory deficits, or side effects from medications.

PROBLEM: Hallucinations (My father keeps talking to someone who isn’t there.) Hallucinations are closely related to paranoia. A hallucination is a misperception of reality, often sparked by changes in the brain that cause the patient to see, hear, feel, or smell something that no one else does. Rubinstein recalls a client, Max, who loved his cat, Morris. Max enjoyed playing with Morris, grooming him, and watching TV with him. The only problem was, Morris didn’t exist…and Max’s hallucination was driving his wife, Alice, over the edge!

SOLUTIONS: In the case of Max and Morris, Rubinstein advised Alice to change her attitude about the imaginary cat. Instead of letting Morris upset her, Alice realized that the cat wasn’t hurting anyone and was making Max happy-plus, he was the perfect pet since he didn’t shed, make noise, or make a mess. Like Alice, if your loved one’s hallucinations aren’t doing any harm, do your best to live with them and not allow them to become a bone of contention. Keep in mind, too, that changes in environment or medication can trigger hallucinations. If your loved one is hallucinating (or experiencing paranoia, for that matter), warn visitors in advance so that they don’t inadvertently exacerbate the situation.

PROBLEM: Sundowning (My wife gets agitated and starts trying to find her own mother every day in the late afternoon.) Many Alzheimer’s and dementia patients perceive their environments differently as the light begins to fade toward sundown-and this sensory confusion can cause them to become anxious, paranoid, or aggressive. Understandably, sundowning is frightening for the person whose world seems to be becoming more menacing by the minute. In her eyes, the light pole outside the living room might become a threatening intruder, and she will begin to look for a safe place.

SOLUTIONS: First, realize that once sundowning begins, the most you can do is provide a secure place for the patient and tell yourself that tomorrow is another day. As is the case with paranoia, there’s very little you can do to convince your loved one that the reality she’s experiencing isn’t accurate once she has worked herself into an agitated state. However, you can take steps to decrease or avert sundowning’s effects. Stick closely to a daily routine, and start turning on lights mid-afternoon. You can also encourage your loved one to be as active as possible during the day (and thus tired toward evening) and to sit in the sunlight for at least 20 minutes to reset circadian rhythms.

PROBLEM: Aggression and Violence (My once-loving husband is increasingly nasty to me when I talk to him and try to help him complete tasks.) For individuals suffering from a form of memory loss, many actions, requests, and events can trigger a volcanic moment (one that you probably didn’t see coming). Since Alzheimer’s and dementia cause the brain’s pathways to work differently, communication doesn’t “work” the way it used to. Things that seem normal to the caregiver (like getting out of bed after a nap, needing to bathe, or eating a meal) may seem threatening to the patient, thus sparking belligerence, arguments, or even combativeness. Plus, since politeness is a learned behavior, it (along with other social mechanisms) can be stripped away by memory loss.

SOLUTIONS: As with paranoia, try not to take aggression personally. People suffering from dementia are often frightened and in survival mode, and they lack other outlets for relieving stress. Of course, it’s always a good idea to consult a doctor and check to make sure that the correct medications are being taken. However, an educated caregiver is often the best medicine of all for patients who are aggressive. Your behavior can either fuel the fire or help extinguish the flames. It’s important to remain calm and reassuring, and to approach reality as your loved one sees it. (In other words, trying to reason probably won’t have a positive effect.) If you feel that you’re in danger or can’t handle the situation, though, leave the room, get to a phone, and call for support.

PROBLEM: Sleep Problems (Mom wakes up frequently at night, and as a result we’re both tired and cranky all day.) As we age-whether we’re suffering from Alzheimer’s or not-the quality of our sleep tends to change. Individuals can wake up frequently due to the need to go to the bathroom, pain, anxiety, restless leg syndrome, or even a confusing environment. And when you’re a caregiver, your loved one’s sleep problems become your sleep problems. Obviously, consistent sleep deprivation won’t help either of you to function or cope well. On the other hand, it’s also possible for patients to sleep too much.

SOLUTIONS: First, make sure that your loved one is physically comfortable in terms of her clothing, temperature, lighting, mattress, pillows, etc. Helping her to be mentally comfortable so that she can rest well might be a bit trickier. Try to minimize stress around the clock, stick to a routine, and provide reassurance rather than giving orders. For instance, you might tell your mom that you know everyone in the house is safe at night because she’s so careful about checking the doors instead of suggesting she go to bed because she’s already checked the locks twelve times. If your loved one sleeps too much, limit daytime naps and try to get outside so that the sun can influence circadian rhythms. If your initial efforts don’t work well enough, consider hiring a nighttime aide to give yourself a break.

“Ultimately, while you can’t change the progression of the disease from which your loved one is suffering-or even greatly influence his or her behaviors-you can take steps to minimize the stress both of you feel as a result of behavior changes,” says Rubinstein. “Remember that educating yourself is one of the smartest things you can do-and never be afraid to ask for help and support if you feel that you’re having trouble handling things yourself.

“Also, keep in mind that while many of the behaviors that result from memory loss can be difficult to deal with, it doesn’t mean all the joy is gone from your life and that of the patient,” she adds. “Caring for my mother wasn’t always easy or enjoyable, but I can assure you that we did share plenty of smiles, laughs, and yes, love. You, too, can have a positive impact on the patient’s quality of life-and you can definitely still enjoy special moments with your loved one.”

K. Gabriel Heiser, J.D.

It’s the conversation people don’t have until they have to, but by then, it’s too late.

The fact is that in 2010, more than 7,000 people turned 65 years old or older every single day, a figure that is predicted to rise in 2011. Further, an AARP survey revealed that only 4 in 10 of those people feel they will be financially secure for their golden years.

For many, that lack of financial stability will transform from being a worry to becoming a crisis if they discover they’ll need any kind of assisted living. That’s why Gabriel Heiser, an attorney with more than 25 years of experience in nursing home law, believes that people should start planning now, even if they aren’t close to their 65th birthdays.

“The average monthly cost of a nursing home today is $6,917 per month, and a typical Alzheimer’s patient will spend $395,000 for their nursing home care after diagnosis,” said Heiser, author of How to Protect Your Family’s Assets from Devastating Nursing Home Costs: Medicaid Secrets www.MedicaidSecrets.com). “Those costs are only going to rise, so it’s important to plan now. One important benefit to consider is Medicaid, which can help offset a good amount of those costs, but only if you know what it takes to qualify for those benefits.”

The mistake a lot of people make is thinking that they can’t qualify for Medicaid, according to Heiser.

“Many feel that because they own a home or have some assets that they can’t qualify for Medicaid help with their nursing home and doctor’s bills,” he said. “The truth is there are a variety of assets people can own and still qualify. It’s just a matter of knowing the rules, and making a plan to meet those requirements.”

Heiser listed the asset limits for those applying for Medicaid. They include:

• Cash - You can possess $2,000 cash that will not be counted as an asset in determining your Medicaid eligibility.
• Home - There is a $500,000 exclusion toward your home, meaning that if your home is valued at $500,000 or less at the time of your application, it is excluded as an asset. Some states use the higher permitted exemption of $750,000.
• Car - Up until recently, you could exclude only one car at a value of $4,500 or less, however that law has been changed. Now, one automobile of ANY current market value is excluded on your application.
• Funeral and Burial Funds - If you have a pre-planned funeral or memorial arrangement, the entire value of that plan is excluded. If you do not, a separate bank account that contains $1,500 toward funeral expenses can be excluded. If you have pre-purchased burial plots, you can exclude not only the costs of the plot for the applicant, but for the entire family, and still be eligible for Medicaid.
• Property – According to federal law, any real or personal property that is essential to self-support, regardless of value or rate of return, is excluded. That could include farms, rental properties and other real estate investments that generate income necessary for self-support. For rental income, however, the property must generate at least 6 percent of its value annually in order to qualify for the exclusion.
• Life Insurance - Only the cash value of a life insurance policy owned by the applicant is counted, thus, all term policies are ignored.

“There are so many other rules that can benefit those who aren’t sure they’ll have enough when the time comes,” Heiser added. “The key is to plan now and act now. These laws exist for your protection, and avoiding the discussion and the planning necessary to take care of the potential complications just because it is an unpleasant topic will only result in a more unpleasant conversation when you realize you’re not ready when the worst happens. That can be a very expensive dilemma. Peace of mind right now, however, won’t cost a dime, and could save you hundreds of thousands of dimes later.”

About Gabriel Heiser

K. Gabriel Heiser, J.D., has focused exclusively on estate planning and Medicaid eligibility planning, including trusts, estates, gifts, and related tax issues, since graduating from Boston University School of Law in 1983.

BRATTLEBORO, VT – The Brattleboro Retreat supports National Post Traumatic Stress Disorder (PTSD) Awareness Day, held annually on June 27th.  PTSD can occur in people who have witnessed or experienced traumatic events such as combat, auto crashes, etc. Their response often includes intense fear, helplessness or horror. Memories of the event then often interfere with their ability to function and lead a meaningful life. National PTSD Awareness Day was started by Sen. Kent Conrad of North Dakota after he learned of the North Dakota National Guard’s efforts to raise awareness of PTSD and honor one of their members who took his own life after returning from a second tour of duty in Iraq.

“We see in the Brattleboro Retreat’s Uniformed Service Program many veterans and first responders who showed early warning signs of PTSD but often waited to get help,” says Frederick Engstrom, MD, medical director of the Brattleboro Retreat.

Engstrom explains that PTSD sufferers and the people around them, often do not know the warnings signs or the serious effects the disorder can have on person’s health and well being.  “We hope this day helps more people become familiar with the warning signs,” he says. “Help is out there. If you are concerned about yourself, or someone you know, please seek professional help.”

The Brattleboro Retreat has compiled “Ten Warning Signs for PTSD” that can help more people seek help and further raise awareness of this serious condition.  Many people with PTSD experience two or more of the following warning signs, usually for a period of at least a month and often times for years if not treated, according to Engstrom.

Ten Warning Signs for Post Traumatic Stress Disorder (PTSD):

• Dreams and recurrent and intrusive distressing recollections of the     event, including images, thoughts, or perceptions.
• Acting or feeling as if the traumatic event were recurring, including a     sense of reliving the experience, illusions, and flashback episodes.
• Intense psychological distress over actions or things that symbolize or     resemble an aspect of the traumatic event.
• Feelings of detachment or estrangement from others.
• Inability to express loving feelings.
• Sense of a foreshortened future (e.g., does not expect to have a career,     marriage, children, or a normal life span).
• Difficulty falling or staying asleep.
• Irritability or outbursts of anger.
• Difficulty concentrating.
• Efforts to avoid thoughts, feelings, or conversations associated with the trauma or activities, places, or people that arouse recollection of the trauma.

Robert McAfee M.D.

Former president of the American Medical Association, surgeon, member of the Board of Medical Advisors for Avvo.com, and advocate for family/national healthcare

In the following feature piece, Dr. McAfee provides an overview of the most salient issues affecting the healthcare industry today as it relates to physicians’ use of the Internet and social media tools to advance their professional reputation and attract new, prospective patients.

The Internet is transforming the healthcare arena – and no one in the medical industry has been more impacted by this than the physician community.  Doctors have been traditional late bloomers with regard to embracing digital age practices primarily due to two factors – 1) a busy profession that is centralized by nature and lacking the layers of marketing and operations support that accompany other businesses, and 2) skepticism – even fear – about how to properly use the Internet to manage reputation, while navigating privacy and liability concerns in the era of malpractice and HIPPA regulations.

But having a clear understanding of the Internet and its many abilities to enhance reputation and attract prospective patients is now crucial for private physicians.  With a little guidance about the basic tenets of commanding and strategically using the Internet, today’s doctors can assimilate into the digital culture and become more in-tune with both their patients and the information being pushed to those patients.

To obtain a clearer picture of how leaders in the physician community perceive the Internet’s risks and rewards, we recently spoke to Dr. Robert McAfee, former president of the American Medical Association, and a current medical Board Advisor for Avvo (www.avvo.com), the world’s largest online ratings directory and peer review collection and management source for doctors and lawyers.

In the following exclusive Question and Answer interview, Dr. McAfee debunks some common myths and shares key insights about the role of the Internet for the physician community.

Q: How do you see the role of the Internet impacting the way physicians manage their practice growth?
A: The Internet has become “sluggishly” important to the physician community – and let me explain the context of “sluggish.”  While its importance is clearly perceived by the majority of working doctors today, there are a lot of negative factors that doctors associate with the Internet that have hindered its fast adoption.  First, there is a general wariness among physicians with regard to information technology in general.  For example, many doctors have been slow to adopt EMR (electronic medical records) because their primary focus has been on serving their practice – and technology operations are not their core expertise.

Similarly, there has just been a hesitancy to embrace the Internet.  But the Internet also has a challenging history as it relates to the medical community for other reasons.  Some of its earliest adopters were not the most esteemed doctors.  There was a clear perception that the best and most respected doctors simply had patients walking through the door based on local reputation.  This sentiment muddied early opinions about doctors and Internet usage – and even though the landscape is now transformed, old attitudes still linger and it has made some physicians wary of Internet marketing.  Unfortunately, this wariness now translates to naivety – and doctors are really missing the next generation of patient relations and reputation management by ignoring (or fearing) the Internet.  Doctors need to tell their story – and the Internet is challenging them to become better marketers.

Q: What do you believe are the biggest opportunities offered by the Internet (including their use of social media venues and applications)?
A: Marketing.  Hands down, it is the number one tool.  But doctors hear “marketing” and they associate it only with money.  Marketing for physicians is much bigger than that.  It helps doctors establish their identity and develop good, marketable practice habits, plus it also gives them autonomy-a commodity cherished by many private physicians who are really struggling to maintain their independence.

I’m concerned that, as many doctors move toward employment relationships with big hospitals and clinics, they will give up on “holistic” marketing – deliver on fewer of the critical attributes mentioned above (identity, autonomy, good practice habits, etc.).  In Maine, where I’m located, I’ve seen MDs migrate out of independent practice and into the hospital employment model at . . . let’s call it an alarming rate.  The employment statistic in this state was roughly 7 percent a decade ago – now, it is somewhere in the ballpark of 70 percent.  A startling increase.

Q: Can you speak to the increasingly important role of accuracy in online reporting of a doctor’s professional record, credentials and merits (or falsely reported demerits)?
A: It is absolutely critical. Online reputation management is a big part of the marketing equation – be it proactive or reactive.  A large portion of “word-of-mouth” has moved online . . . doctors need to know how to play in that arena if their practice and reputation are going to flourish.  Plus, physicians need to police the Internet for accuracy.  They need to understand the dynamics of online rankings and peer ratings, in particular, and take charge to make informed decisions and establish the proper alliances to safeguard their professional reputation.

Q: What are the three biggest challenges – as it relates specifically to reputation management – facing doctors today?
A: That’s an easy question to answer because the issues are crystal clear:

1. Accuracy.  This is essential because there are a plethora of credentials/peer ratings reporting sources out there and doctors need to police those sources for accuracy because current and prospective patients are reading them.
2. Flexibility.  As the Internet changes the rules of the game, doctors must be flexible and nimble in their response.  Sadly, the medical profession – and physician practices, in particular – are not evolving quickly enough.
3. The role of third-party endorsements.  This is a factor that is still evolving – but, at its simplest, other people saying you are great means more than you saying you are great.  The issue is defining the best system and methodology to objectively assess a doctor’s performance.

Q: When you mention third-party endorsements, what do you believe to be the essential practices for the collection and management of online peer reviews and ratings?
A: They have to be accurate and represent a responsible system of evaluation.  There are a lot of fly-by-night players out there who are feeding patients inaccurate information.  I’ve seen a number of these sites come and go – and there is a legitimate fear among doctors about how to distinguish between the good and bad review sites.   In my opinion, Avvo is a reliable site for doctors who, especially, are just getting their feet wet with the online environment.  I like Avvo because they have strict community guidelines for their reviews, requiring every review be factual and without personal attacks – and they don’t allow anonymous reviews.  Everyone must register with the site – which helps Avvo police for any non-legitimate contributions.  They use proprietary software that examines every client and patient review to flag inauthentic entries, plus a human looks at every review before it goes up.  That’s a big game changer with regard to accuracy in a category previously plagued with abuse and inaccuracies.  Physicians also can respond to any review about them and have the opportunity to thoughtfully address readers with a positive counter perspective – and they also have a process whereby doctors can dispute reviews.

Doctors won’t turn to the Internet if they feel they can’t trust the intermediaries, so it’s really important that the community as a whole continues to demand review practices that are trustworthy.

Q: What is the biggest factor that private physicians need to take into account when managing their operational bottom-line?
A: They need to be focused on cost in this environment because it is extremely difficult to drive higher fees.  Downward pricing pressure from insurance and public assistance makes it challenging especially for private physicians to even stay solvent.  Let’s face it – no one is doing better financially than they were 10 years ago.  That’s really a disappointing statement about the state of the medical profession.  To survive, I think it’s critical that physicians look for good tools at no great extra cost.  This is where the Internet can really play a positive and impactful role.  Many marketing opportunities online are free – or available at relatively low cost – and many offer highly effective tools to help drive practice growth.

Q: If you could offer one piece of advice to today’s physician community as it relates to specifically attracting and growing their prospective patient base (especially in a highly competitive medical marketplace), what might that be?
A: It would revolve around building visibility.  Doctors need to command every appropriate tool to enhance their presence and visibility with the patient base.  This is essential, coupled with availability.  As so many physicians move to the employment model, they’re knocking off at 5 p.m.  In the old days, it used to be that you were in the hospital because you had to be – and this can still be an important point of distinction for doctors.

Q: And, lastly, what advice do you have for doctors on how they can better preserve and maintain the loyalty of their retained base – in an era when doctors are turning to increasingly aggressive marketing tactics to lure away prospects?
A: Think through the full cycle of care – everything that touches the patient experience and make sure that you are giving proper attention to each of these elements.  This is part of the “holistic” marketing I was talking about.  An easy example here is having a receptive office setting so that when a patient walks out the door and asks “Was that office clean?” – the answer is an unequivocal “yes.”  Are patients received in a polite fashion? If your staff doesn’t care, patients will not return.  In many cases, it’s as simple as that.

Outcomes are also very important, but so much of so-called “outcomes” are based on a patient’s very personal view of the outcome.  If patients were coming through my door regularly saying positive things about another physician, chances are that their opinion was based on many more factors than just that person’s technical prowess and ability.  Still, it enhanced my professional opinion of that doctor.  Ironically, the American Medical Association has spent millions trying to define an objective, outcome-based measurement for physician quality, but these efforts ultimately stalled in part because even the professional medical community couldn’t agree upon what was an appropriate measure for a good “outcome.”

So, it all comes back to the patient’s opinion.  It may not be expertly formed, but it is one of the most effective measures we currently have.  This just again underscores the influence and power of opinion sharing by patients, as well as peers, and further points to the fact that, in today’s climate, many fundamental discussions reside online.  This is just another reason why doctors need to heed and harness the power of the Internet to their best advantage and be informed about their options.

Roslyn, NY. – Skin cancer is on the rise, with more incidents being identified in younger people. There are more than one million cases of skin cancer diagnosed annually and The American Cancer Society estimates that one in five Americans will develop skin cancer in their lifetime. A study recently published in the American Medical Association’s Archives of Dermatology combined multiple government databases to calculate that 3.5 million cases of nonmelanoma skin cancers are diagnosed annually in the U.S., prompting its authors to declare skin cancer an “under-recognized epidemic.”

The most common type of skin cancer is basal cell carcinoma, which affects at least one million Americans a year. While rarely fatal, it’s important to treat early because basal cell carcinomas can grow, ultimately requiring larger-scale surgeries and resulting in larger scars. Squamous cell carcinoma is also common: More than 250,000 cases are diagnosed annually, resulting in about 2,500 deaths.

According to Dr. Maya Thosani, who specializes in Mohs surgery at Advanced Dermatology, P.C. in New Jersey, “both of these carcinomas can be easily treated, and one type of surgery offers patients the best odds. Mohs surgery has the highest cure rate, 99%, for these common types of skin cancer. The main difference between this micrographic surgery and other methods of removing skin lesions is microscopic control. The procedure allows the board certified dermatologic surgeon to precisely remove skin cancers without removing large amounts of normal skin.”

What happens during Mohs surgery?

During this fresh tissue technique, layers of skin which contain the skin cancer are progressively removed and examined until only cancer-free tissue remains. Doctors mark the area of clinically recognizable tumor and numb the area to be excised with local anesthetic. The tissue is surgically removed, divided, and marked with reference points on the patient. Specimens are then labeled with dyes that allow the surgeon to correlate the tissue seen on microscopic slides.

“Specialized technicians at the surgery site then produce frozen section slides of the removed tissue that is microscopically analyzed by the surgeon,” explains Dr. Aza Lefkowitz, who also specializes in Mohs micrographic surgery at Advanced Dermatology, P.C. in New York. “If any tumor remains in the resection tissue, the surgeon knows that the tumor is still in the patient. The patient then returns to the operating room for removal of another thin segment of tissue which saves the patient from getting a big scar.”

Dr. Thosani explains that traditional sectioning can sometimes leave “nests” of cancer cells behind, allowing the cancer to remain and grow. With Mohs’ mapping, the cancer would be detected and cured. According to studies by the Mayo Clinic and other institutions, Mohs surgery provides five-year cure rates exceeding 99 percent for new cancers, and 95 percent for recurrent cancers.
When is Mohs the best treatment option?

• When the patient wants/needs to have the smallest scar, highest cure rate and a stress reliever because the results are  given the same day.
• The cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes, genitals
• The cancer was treated previously and recurred
• Scar tissue exists in the area of the cancer
• The cancer is large
• The edges of the cancer cannot be clearly defined
• The cancer is growing rapidly or uncontrollably
• When the cancer Is likely to return. Mohs micrographic surgery is more effective in obtaining cancer-free margins for cancers that have irregular borders and a history of removal and recurrence.
• Has a high risk of spreading to other parts of the body, such as in some squamous cell carcinomas.
• Occurs in children.

What are the cost benefits?

Studies cited in Journal Watch Dermatology comparing the costs of Mohs Surgery with those of traditional surgical methods show that Mohs is no costlier than standard excision and is less expensive than radiation therapy or excision in an ambulatory surgery center. The research also determined that non-Mohs treatments carry 5-year recurrence rates of up to 10-12% for common skin cancers and up to 50% recurrence rates for rarer skin cancers.

“Additional procedures for removal of recurrent cancers or for re-excision (in cases where part of the cancer is missed in the first excision) can be expensive,” says Dr. Lefkowitz. “Because this procedure minimizes the risk of recurrence, Mohs surgery reduces and frequently eliminates the costs and severe patient anxiety, trauma and complication of larger, more serious surgery for recurrent skin cancers.”

Dr. Lefkowitz is a summa cum laude graduate of the State University of New York (SUNY) Downstate College of Medicine in Brooklyn, where he earned his Medical Degree. Dr. Lefkowitz’s practice is primarily surgical. With his precision and expertise, he is especially well regarded for the exceptional and cosmetically elegant way in which he repairs his patients’ Mohs defects. Board certified in both Dermatology and Mohs Microsurgery, Dr. Lefkowitz has been a member of Advanced Dermatology and the Center for Laser and Cosmetic Surgery since 2001. www.advancedd.com

A graduate of Columbia University, Dr. Thosani completed a fellowship in Mohs Micrographic Surgery at the Skin Cancer Center in Cincinnati, under the mentorship of Dr. Brett Coldiron, president-elect of the Mohs College and Board member of the American Academy of Dermatology. Dr. Thosani’s research interests involve cutaneous oncology and the use of dermoscopy as a non-invasive tool for early detection of skin cancer.  She is a member of the American Academy of Dermatology, and an associate fellow of the Mohs College of Micrographic Surgery. http://www.advancedd.com/

Statewide commitment will make hospitals in N.H. even safer

CONCORD, NH  – New Hampshire is the first state in the country where the governing boards of all hospitals have signed a resolution to work collaboratively to deliver safe care to everyone who walks through their hospitals’ doors. In their continuing effort to promote better and safer care to patients, hospitals across the state have committed to work together on ways to help eliminate harm to patients. To accomplish this goal, they pledge to consistently follow the processes of care that have been proven to increase patient safety.

“Hospitals in our state have made tremendous strides in making improvements to quality of care,” said Greg Walker, chairman of the Foundation for Healthy Communities and CEO of Wentworth-Douglass Hospital in Dover. “With their commitment to participate in the New Hampshire Eliminate Harm Initiative, they will continue that work with an even more ambitious purpose.”

For the better part of the last ten years, New Hampshire’s hospitals have ranked number one in the country for providing the appropriate evidence-based processes of care for patients being treated for heart attacks, heart failure, and pneumonia, and those undergoing surgery.  But there is more to be done to ensure that every patient receives the right care every time.

“The Eliminate Harm Initiative’s goal is to remove those instances of patient harm that could have been prevented if the processes and systems known to improve patient safety had been implemented and followed,” said David Green, MD, chief medical officer at Concord Hospital and member of the N.H. Eliminate Harm steering committee. The committee, made up of representatives of several hospitals, identifies which aspects of harm hospitals will target for elimination.

While there are no uniformly accepted definitions, “harm” in this initiative refers to an injury associated with medical care which requires or prolongs hospitalization and/or results in permanent disability or death.

Hospitals in New Hampshire already have been working for several years on improving patient care, including efforts to decrease infection rates through a campaign to promote hand washing among health care providers.  Hospitals also are decreasing harm in the operating room by using a patient safety checklist before and during all procedures.  Another statewide effort among hospitals is working to eliminate central line bloodstream infections.  More detailed information about all of the hospital patient safety projects related to the Eliminate Harm Initiative is available online at http://www.healthynh.com/ and http://www.nhha.org/.

“Working together as a group, our hospitals have proven over time that they can make a significant positive impact on the quality of care they provide in all of the areas they focus on,” said Michelle McEwen, chair of the New Hampshire Hospital Association board of trustees and CEO of Speare Memorial Hospital in Plymouth. “Their collaboration, willingness to share, and ability to learn from each other are keys to the success in making care better and safer.”

The newest strategy adopted in 2011 is to prevent cases of hospital-acquired venous thromboembolic (VTE) disease over the next 12-18 months.

“VTE can be deadly to hospitalized patients,” said Carl DeMatteo, MD, chief quality and compliance officer at Dartmouth-Hitchcock Medical Center, who also serves on the steering committee.  “Pulmonary embolism, in particular, is a dangerous condition with an exceeding high mortality rate. Multiple clinical trials have provided irrefutable evidence that VTE can be prevented.”

Hospitals in New Hampshire are working hard to ensure that the appropriate protocols are used to prevent VTE in every patient at risk.

“Our hospitals are poised to deliver the best health care in the country,” said Steve Ahnen, president of the New Hampshire Hospital Association. “The residents of New Hampshire are counting on us.”

The Foundation for Healthy Communities is a nonprofit corporation that exists to improve health and health care in New Hampshire. It’s the leading organization in the state facilitating hospitals’ quality and safety programs. The Foundation’s partnerships include hospitals, health plans, clinicians, home care agencies, public policy leaders, and other health and social service organizations. Learn more about the Foundation at http://www.healthynh.com/.