Re: Prime Healthcare response to allegations

[Guest guest]

Great article! Thank you,

Sent from my iPhone

On Mar 11, 2011, at 7:57 PM, Vajda

wrote:

> Prime Healthcare Services Responds to Allegations Re: Malnutrition.

> Article from:

> Science Letter

> Article date:

> March 8, 2011

> The February 19, 2011 article written by reporters from California

> Watch repeats

> SEIU's allegation that Prime Healthcare hospitals use a diagnosis of

> malnutrition to increase reimbursement. This allegation is baseless

> and nothing

> more than another example of SEIU distorting the facts in order to

> mislead the

> public and extort concessions from Prime Healthcare (see also

> Malnutrition).

>

> First, Prime Healthcare hospitals do not use a diagnosis of

> malnutrition to

> increase reimbursement. Indeed, the relevant (i.e., where the

> diagnosis affected

> reimbursement) malnutrition rate at all Prime Healthcare hospitals

> was 3.6%,

> which is much less than the rates referenced in the article. For

> example, the

> relevant malnutrition rate at Huntington Beach Hospital was 5.3%

> rather than the

> 39% reported by California Watch.

>

> In addition, the higher than average malnutrition rates at Prime

> Healthcare

> hospitals are the result of Prime Healthcare's commitment to

> providing high

> quality healthcare for all of its patients for which Prime

> Healthcare should be

> applauded rather than criticized. Published studies estimate that up

> to 15% of

> ambulatory elderly patients, up to 44% of homebound elderly

> patients, up to 65%

> of hospitalized elderly patients, and up to 85% of nursing home

> patients are

> malnourished. Hajjar, R.R., Kamel, H.K., Denson, K., Malnutrition In

> Aging, The

> Internet Journal of Geriatrics and Gerontology, Volume 1, Number 1

> (2004);

> Chen, C.C-H, Schilling, L.S., Lyder, C.H., A Concept Analysis of

> Malnutrition

> In The Elderly, Journal of Advanced Nursing, Volume 36(1) (2001).

> Given these

> statistics and the morbidity and mortality rates associated with

> undetected and

> untreated malnutrition, Prime Healthcare hospitals have implemented a

> nutritional screening program in order to improve patient care

> outcomes and

> decrease mortality and morbidity. This program includes policies and

> procedures

> designed to ensure that each elderly patient admitted to the

> hospital receives

> a nutritional screening. Physicians also routinely order serum

> albumin tests

> and promptly assess patients based on the serum albumin levels and

> other

> malnutrition indicators. While this initiative has undoubtedly

> improved patient

> care outcomes and decreased mortality and morbidity, it has also

> resulted in

> more Medicare patients being properly diagnosed with malnutrition

> and the

> average malnutrition rates being higher at Prime Healthcare

> hospitals than other

> hospitals. However, the increase in malnutrition diagnoses has not

> lead to a

> similar increase in reimbursement as a substantial majority of the

> malnutrition

> diagnoses did not lead to enhanced reimbursement. Rather, these

> quality measures

> and Prime Healthcare's commitment to providing the highest quality

> of patient

> care lead to Prime Healthcare being ranked as one of the Top 10

> Health Systems

> in the Nation by Thomson Reuters, the only for profit hospital

> system to be so

> recognized.

>

> Like SEIU's earlier allegations concerning septicemia rates, which

> were

> repeated by California Watch in an October 2010 article, the most

> recent

> allegations concerning malnutrition rates are part of SEIU's

> concerted corporate

> campaign of extortion against Prime Healthcare. Prime Healthcare has

> and will

> continue to stand up to SEIU's extortion tactics so as to protect

> the interests

> of its 9,000 employees and the hundreds of thousands of patients it

> serves.

>

> Keywords: Acute-Phase Proteins, Albumins, Blood Proteins, Hospital,

> Malnutrition, Nutrition Disorders, Nutritional and Metabolic

> Diseases, Prime

> Healthcare Services, Serum Albumin.

>

> This article was prepared by Science Letter editors from staff and

> other

> reports. Copyright 2011, Science Letter via NewsRx.com.

>

> Cite this article

>

> " Prime Healthcare Services Responds to Allegations Re:

> Malnutrition. " Science

> Letter. NewsRX. 2011. HighBeam Research.11 Mar. 2011 <http://www.highbeam.com/

> >.

>

> ** May be a good place for RD's to work after all.

> I was just reading about albumin on RD411 today. I learned that low

> albumin is

> not to be considered useful to tell us if they are malnourished but

> at the same

> time that it is associated with increased mortality and morbidity -

> so the

> elderly person with an albumin of 7 or 8 shouldn't be considered

> 'malnourished'

> but just be considered at increased risk of morbidity and mortality

> and to

> continue calculating everything as usual? Instead of pouring another

> Health

> Shake in to add to the malabsorbtion mess I would rather consider

> what is

> causing the shift in fluid and what might be better absorbed.

>

> Based on the sensitivity of the autoimmune gut and the kwashiorkor

> research, I

> would surmise that a gluten free, lactose free, lower calcium to

> magnesium ratio

> with an increase in glucosamine and other essential sugars (super

> starches) and

> plenty of B vitamins, C, A, zinc, selenium might help the catabolic

> patient with

> edema. We need to provide building blocks that readily make a strong

> glycocalcyx

> to reduce the leakiness. (and no excess vitamin D is needed - test

> the 1,25 D

> levels - the chronically ill have more than enough of the active

> hormone - it is

> part of the stress response. An active D level above 45 means the

> bones are

> losing stores not gaining stores. My five year 1,25-D average while

> actively

> avoiding vitamin D foods, supplements and much time in the sun was

> 59 pg/ml and

> my five year average 25-D was 20 ng/ml. The range was 51-71 pg/ml,

> 1-25-D and

> 8.0-26.7 ng/ml for 25D. Ex: 3-31-2009 25-D of 9.0 and 1-25D of 53 pg/

> ml. If I

> spend a day on the beach I am hurting in two days from the calcium

> that is drawn

> out of storage - muscle spasms & fatigue primarily but there are other

> symptoms.)

>

> From those BMI search terms/limits Pam suggested last week I

> gathered that:

> 1. a BMI up to 29.9 might be considered healthy for elderly - " the

> body weight

> assoc with inc survival increases with inc age " " After adjusting for

> all

> relevant covariates, all-cause mortality risk was 11% lower in the

> overweight

> group (p<0.05). " pre-surgery study

> 2. weight loss greater than 5% or weight gain more than 5% is assoc

> with

> decreased lower body function

>

> 3. assessing frailty factors seems more correlated with a variety of

> quality of

> life factors and surgical risk than BMI- 3 of 5 of the following -

> unintentional

> weight loss, weakness, self-reported poor energy, slow walking

> speed, and low

> physical activity -hand grip strength, calf muscle to fat area, mid

> arm

> circumference, sarcopenia were also mentioned

>

> 4. mid arm circumference changes were mentioned in a few studies so

> may be

> useful tool for busy nurses/aides compared to weighing uncooperative

> or

> disabled individuals

>

> Lack of adaptation to severe malnutrition in elderly

> patients.Schneider et al

> Clin Nutr 2002 Dec;21(6):499-504 was a good one. I collected 12

> others on the

> theme.

>

> So is frail a more 'nice' label for our elderly patients than

> starving - reduced

> fat free mass equals muscle catabolized to feed infection or cancer

> or simply

> the brain and heart. Frail or starved - I know that my father in law

> was frail

> at Christmas but minor elective eye surgery and two months of ICU

> and nursing

> home type intensive care has left him cachexic. At Christmas I was

> thinking he

> didn't have too many more Christmases but now I'm thinking not too

> many more

> weeks. Nice isn't working -health care or care of death- honesty is

> a better

> policy. I think it actually cheered him up a bit when I explained

> what I thought

> was happening to him (starvation due to malabsorption) versus his

> statement

> ' " the doctor's don't know what is wrong with me " . He knows he is

> dieing but

> denial and trust in authority is the family approach and his older

> sons don't

> want me disturbing his doctors.

>

> Sorry if I have disturbed anyone here but nutrition is our job. I am

> glad that

> Prime Healthcare has had to stand up for malnourished patient's

> rights - the

> right to a diagnosis that is accurate. An albumin of 7 or 8 is

> tragic and just

> because it is from excessive dilution due to malabsorption/

> malretention and not

> due to lack of protein in the diet - doesn't mean it isn't cell

> starvation. Just

> because we don't quite understand it doesn't mean that it doesn't

> exist and

> isn't killing people in a very costly and agonizingly slow way.

>

> Names matter and the tropical kwashiorkor is simply where the

> problem was

> studied most. Edematous malnutrition is a better name, not protein

> calorie

> malnutrition. Long term edema means the cells aren't being well fed

> or well

> detoxified - movement of fluid is reduced and movement of nutrients

> and toxins

> is slowed - long term edema is dysfunction and malnourishment. If

> the fluid in

> our toilets backed up regularly we would expect the plumber to

> repair not just

> measure the dysfunction. Puffy abdomen/ankles = overflowing waste =

> better call

> a doctor on the Prime Healthcare team; maybe repair is still in the

> future but

> recognition is at least a first step.

>

> R Vajda, R.D.

> www.GingerJens.com

>

>

[Guest guest]

I turned it into a blog minus the part about my father-in-law. I told the story

of Alp Luachra instead.. and proof of my improved Zotero skill - the BMI/

frailty articles Bib is there (proof that I stay up to late).

From #8: Consistent with this hypothetical pathway is our

finding that indicates physical inactivity as the frailty domain most strongly

associated with body composition indexes. By stimulating

muscle protein synthesis, physical activity may prevent the age-related decline

in muscle energy efficiency and contractile functions (21) and through this

mechanism may prevent the development of frailty. Moreover, physical activity

mediates strong antiinflammatory mechanisms with sufficient

power to reduce proinflammatory activity in vitro and in vivo (22). In a

previous study, Walston et al (23) showed that the frailty syndrome is

characterized by increased amounts of inflammation, which, in themselves, have

shown a direct effect on skeletal muscle in animal

(24–26)

and human (27) models.

*this study looked at muscle mass loss - fat mass ratio increases as does

morbidity and mortality.

*what if fatigue from the increased inflammation leads to the reduced activity.

What if part of inflammation is wasting energy poroducing non-useful proteins -

harvesting materials from other body stores.

-->anti-inflammation diet plus exercise and hydration - to help prevent the

slide into no appetite left to coax.

R Vajda, R.D.

www.GingerJens.Com

________________________________

To: " rd-usa " <rd-usa >

Sent: Fri, March 11, 2011 11:53:13 PM

Subject: Re: Prime Healthcare response to allegations

Great article! Thank you,

Sent from my iPhone

On Mar 11, 2011, at 7:57 PM, Vajda

wrote:

> Prime Healthcare Services Responds to Allegations Re: Malnutrition.

> Article from:

> Science Letter

> Article date:

> March 8, 2011

> The February 19, 2011 article written by reporters from California

> Watch repeats

> SEIU's allegation that Prime Healthcare hospitals use a diagnosis of

> malnutrition to increase reimbursement. This allegation is baseless

> and nothing

> more than another example of SEIU distorting the facts in order to

> mislead the

> public and extort concessions from Prime Healthcare (see also

> Malnutrition).

>

> First, Prime Healthcare hospitals do not use a diagnosis of

> malnutrition to

> increase reimbursement. Indeed, the relevant (i.e., where the

> diagnosis affected

> reimbursement) malnutrition rate at all Prime Healthcare hospitals

> was 3.6%,

> which is much less than the rates referenced in the article. For

> example, the

> relevant malnutrition rate at Huntington Beach Hospital was 5.3%

> rather than the

> 39% reported by California Watch.

>

> In addition, the higher than average malnutrition rates at Prime

> Healthcare

> hospitals are the result of Prime Healthcare's commitment to

> providing high

> quality healthcare for all of its patients for which Prime

> Healthcare should be

> applauded rather than criticized. Published studies estimate that up

> to 15% of

> ambulatory elderly patients, up to 44% of homebound elderly

> patients, up to 65%

> of hospitalized elderly patients, and up to 85% of nursing home

> patients are

> malnourished. Hajjar, R.R., Kamel, H.K., Denson, K., Malnutrition In

> Aging, The

> Internet Journal of Geriatrics and Gerontology, Volume 1, Number 1

> (2004);

> Chen, C.C-H, Schilling, L.S., Lyder, C.H., A Concept Analysis of

> Malnutrition

> In The Elderly, Journal of Advanced Nursing, Volume 36(1) (2001).

> Given these

> statistics and the morbidity and mortality rates associated with

> undetected and

> untreated malnutrition, Prime Healthcare hospitals have implemented a

> nutritional screening program in order to improve patient care

> outcomes and

> decrease mortality and morbidity. This program includes policies and

> procedures

> designed to ensure that each elderly patient admitted to the

> hospital receives

> a nutritional screening. Physicians also routinely order serum

> albumin tests

> and promptly assess patients based on the serum albumin levels and

> other

> malnutrition indicators. While this initiative has undoubtedly

> improved patient

> care outcomes and decreased mortality and morbidity, it has also

> resulted in

> more Medicare patients being properly diagnosed with malnutrition

> and the

> average malnutrition rates being higher at Prime Healthcare

> hospitals than other

> hospitals. However, the increase in malnutrition diagnoses has not

> lead to a

> similar increase in reimbursement as a substantial majority of the

> malnutrition

> diagnoses did not lead to enhanced reimbursement. Rather, these

> quality measures

> and Prime Healthcare's commitment to providing the highest quality

> of patient

> care lead to Prime Healthcare being ranked as one of the Top 10

> Health Systems

> in the Nation by Thomson Reuters, the only for profit hospital

> system to be so

> recognized.

>

> Like SEIU's earlier allegations concerning septicemia rates, which

> were

> repeated by California Watch in an October 2010 article, the most

> recent

> allegations concerning malnutrition rates are part of SEIU's

> concerted corporate

> campaign of extortion against Prime Healthcare. Prime Healthcare has

> and will

> continue to stand up to SEIU's extortion tactics so as to protect

> the interests

> of its 9,000 employees and the hundreds of thousands of patients it

> serves.

>

> Keywords: Acute-Phase Proteins, Albumins, Blood Proteins, Hospital,

> Malnutrition, Nutrition Disorders, Nutritional and Metabolic

> Diseases, Prime

> Healthcare Services, Serum Albumin.

>

> This article was prepared by Science Letter editors from staff and

> other

> reports. Copyright 2011, Science Letter via NewsRx.com.

>

> Cite this article

>

> " Prime Healthcare Services Responds to Allegations Re:

> Malnutrition. " Science

> Letter. NewsRX. 2011. HighBeam Research.11 Mar. 2011 <http://www.highbeam.com/

> >.

>

> ** May be a good place for RD's to work after all.

> I was just reading about albumin on RD411 today. I learned that low

> albumin is

> not to be considered useful to tell us if they are malnourished but

> at the same

> time that it is associated with increased mortality and morbidity -

> so the

> elderly person with an albumin of 7 or 8 shouldn't be considered

> 'malnourished'

> but just be considered at increased risk of morbidity and mortality

> and to

> continue calculating everything as usual? Instead of pouring another

> Health

> Shake in to add to the malabsorbtion mess I would rather consider

> what is

> causing the shift in fluid and what might be better absorbed.

>

> Based on the sensitivity of the autoimmune gut and the kwashiorkor

> research, I

> would surmise that a gluten free, lactose free, lower calcium to

> magnesium ratio

> with an increase in glucosamine and other essential sugars (super

> starches) and

> plenty of B vitamins, C, A, zinc, selenium might help the catabolic

> patient with

> edema. We need to provide building blocks that readily make a strong

> glycocalcyx

> to reduce the leakiness. (and no excess vitamin D is needed - test

> the 1,25 D

> levels - the chronically ill have more than enough of the active

> hormone - it is

> part of the stress response. An active D level above 45 means the

> bones are

> losing stores not gaining stores. My five year 1,25-D average while

> actively

> avoiding vitamin D foods, supplements and much time in the sun was

> 59 pg/ml and

> my five year average 25-D was 20 ng/ml. The range was 51-71 pg/ml,

> 1-25-D and

> 8.0-26.7 ng/ml for 25D. Ex: 3-31-2009 25-D of 9.0 and 1-25D of 53 pg/

> ml. If I

> spend a day on the beach I am hurting in two days from the calcium

> that is drawn

> out of storage - muscle spasms & fatigue primarily but there are other

> symptoms.)

>

> From those BMI search terms/limits Pam suggested last week I

> gathered that:

> 1. a BMI up to 29.9 might be considered healthy for elderly - " the

> body weight

> assoc with inc survival increases with inc age " " After adjusting for

> all

> relevant covariates, all-cause mortality risk was 11% lower in the

> overweight

> group (p<0.05). " pre-surgery study

> 2. weight loss greater than 5% or weight gain more than 5% is assoc

> with

> decreased lower body function

>

> 3. assessing frailty factors seems more correlated with a variety of

> quality of

> life factors and surgical risk than BMI- 3 of 5 of the following -

> unintentional

> weight loss, weakness, self-reported poor energy, slow walking

> speed, and low

> physical activity -hand grip strength, calf muscle to fat area, mid

> arm

> circumference, sarcopenia were also mentioned

>

> 4. mid arm circumference changes were mentioned in a few studies so

> may be

> useful tool for busy nurses/aides compared to weighing uncooperative

> or

> disabled individuals

>

> Lack of adaptation to severe malnutrition in elderly

> patients.Schneider et al

> Clin Nutr 2002 Dec;21(6):499-504 was a good one. I collected 12

> others on the

> theme.

>

> So is frail a more 'nice' label for our elderly patients than

> starving - reduced

> fat free mass equals muscle catabolized to feed infection or cancer

> or simply

> the brain and heart. Frail or starved - I know that my father in law

> was frail

> at Christmas but minor elective eye surgery and two months of ICU

> and nursing

> home type intensive care has left him cachexic. At Christmas I was

> thinking he

> didn't have too many more Christmases but now I'm thinking not too

> many more

> weeks. Nice isn't working -health care or care of death- honesty is

> a better

> policy. I think it actually cheered him up a bit when I explained

> what I thought

> was happening to him (starvation due to malabsorption) versus his

> statement

> ' " the doctor's don't know what is wrong with me " . He knows he is

> dieing but

> denial and trust in authority is the family approach and his older

> sons don't

> want me disturbing his doctors.

>

> Sorry if I have disturbed anyone here but nutrition is our job. I am

> glad that

> Prime Healthcare has had to stand up for malnourished patient's

> rights - the

> right to a diagnosis that is accurate. An albumin of 7 or 8 is

> tragic and just

> because it is from excessive dilution due to malabsorption/

> malretention and not

> due to lack of protein in the diet - doesn't mean it isn't cell

> starvation. Just

> because we don't quite understand it doesn't mean that it doesn't

> exist and

> isn't killing people in a very costly and agonizingly slow way.

>

> Names matter and the tropical kwashiorkor is simply where the

> problem was

> studied most. Edematous malnutrition is a better name, not protein

> calorie

> malnutrition. Long term edema means the cells aren't being well fed

> or well

> detoxified - movement of fluid is reduced and movement of nutrients

> and toxins

> is slowed - long term edema is dysfunction and malnourishment. If

> the fluid in

> our toilets backed up regularly we would expect the plumber to

> repair not just

> measure the dysfunction. Puffy abdomen/ankles = overflowing waste =

> better call

> a doctor on the Prime Healthcare team; maybe repair is still in the

> future but

> recognition is at least a first step.

>

> R Vajda, R.D.

> www.GingerJens.com

>

>