Prime Healthcare response to allegations

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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