Terminal patients would still need care, but in more expensive settings; other states reject similar proposals

The State of Florida’s proposed elimination of the Medicaid benefit that provides hospice care to some of the state’s most fragile individuals actually would cost Florida millions more than the state currently spends – adding to the state’s budget deficit rather than reducing it – according to a newly released study commissioned by Florida Hospices and Palliative Care (FHPC), the statewide group representing all of the state’s hospice providers.

FHPC engaged The Moran Company, a Washington-based health care research and consulting firm, to examine the state’s financial assumptions and develop an independent evaluation of the impact of eliminating the Medicaid Hospice Benefit, as recommended by Florida’s Agency for Health Care Administration (AHCA). The study reviewed actual state data for fiscal year 2007 and concluded that if the cut had been in place at that time, the state’s health care budget would have been $3.7 million more. In contrast to the findings of the Moran Company report, AHCA claims cutting the benefit for fiscal year 2009 would save the state $343 million in Medicaid payments.

FHPC Executive Director Paul Ledford said, “This report reinforces our view that Florida can’t afford to take this misguided approach to dealing with its budget difficulties, especially since it will only make the budget situation worse. Cutting the Medicaid Hospice Benefit doesn’t mean the needs of the terminal patient change; it just shifts those costs to more expensive ways of delivering those vital services.

“We appreciate the financial challenges that Florida’s government faces, but cutting the Medicaid Hospice Benefit simply isn’t the answer – or even a part of the answer,” Ledford added.

The report contained the following major findings:

  • Eliminating the Medicaid Hospice Benefit will not save the state money, and likely will result in increased spending for mandatory services. The report conservatively estimates an additional $3.7 million in state Medicaid costs, as patients needing end-of-life care would end up in more expensive settings, such as hospital emergency rooms.
  • Such action also will likely increase the burden on Florida counties to provide indigent care through already financially stressed indigent care programs.
  • The loss of the service coordination, care management, and supportive services offered by hospice will increase fragmentation of care for terminally ill patients, limit their access to palliative care, and burden families and caregivers, potentially limiting their employment and educational options.
  • The beneficiaries in Florida’s Medicaid hospice program are different from the Medicare population that dominates hospice services. Florida Medicaid-only hospice patients are younger and more likely to be in the terminal stages of cancer or have HIV/AIDS related conditions than Medicare or dual Medicare/Medicaid patients. Their average length of stay in hospice is shorter, and their care is more likely to be complex and involve management of severe symptoms that, unmanaged, trigger emergency room visits and/or hospitalization.
  • The cut also would mean that Florida will lose revenue. For every dollar Florida cuts in the hospice benefit, the state will lose $1.25 in matching Federal Medicaid support.

The research study also noted that, until now, every other state that has studied wiping out the Medicaid Hospice Benefit has rejected that approach for precisely the same reason – it ends up costing more money than would be “saved.” In fact, Connecticut recently added the benefit, and now only two states do not offer it.

“Hospice has a vital place in health care,” noted Anthony J. Palumbo, FHPC President and CEO of Hospice of Citrus County and Hospice of the Nature Coast. “In addition to the compassionate, hands-on medical care we provide, we also take care of our patients’ psychosocial and spiritual needs. We care for patients as well as their loved ones.”

“Hospice is an all-inclusive benefit,” Palumbo added. “Every visit by our nurses, hospice aides, social workers, chaplains, physicians and community-based volunteers is covered by a per diem payment that is widely recognized as cost-effective. And, from that same small per diem payment, hospices provide patients – without charge – all of the prescription drugs, over-the-counter medications, medical equipment and medical supplies associated with a patient’s primary diagnosis. Hospices also offer bereavement care to each patient’s loved ones for up to a year after the patient has died, all at no additional cost to the health care payment system.”

Source: Florida Hospices and Palliative Care


The Children’s Hospital of Philadelphia is named the nation’s best pediatric hospital by Parents magazine.

“Children’s Hospital employees work tirelessly everyday to ensure every family has the ideal patient experience and we are truly grateful to our dedicated and talented staff,” said Steven M. Altschuler, M.D., president and chief executive officer of The Children’s Hospital of Philadelphia. “We recognize our responsibility to provide excellent patient care, to conduct innovative research and to train tomorrow’s pediatric specialists; our ultimate goal is to eradicate pediatric disease worldwide.”

Parents surveyed more than 100 children’s hospitals, to determine where the more than three million children hospitalized each year can get the best care possible. The results of the survey will appear in the February 2009 issue of Parents magazine on newsstands nationwide January 13, 2009.

“Every parent wants to make the most informed decisions about their child’s health, and that’s especially important when a child is facing a serious illness,” says Dana Points, editor in chief of Parents. “We created this guide with the hope of making the difficult process of choosing the right hospital a little easier.”

The Parents 10 Best Children’s Hospital survey provides the most extensive data-driven comparison of children’s hospitals to date. All surveyed hospitals are members of the National Association of Children’s Hospitals and Related Institutions. Hospitals are ranked on their responses to detailed questions in the following areas: survival rates for childhood cancer, pediatric heart disease, and other critical conditions; their experience in performing certain complex procedures; the depth of the research program; safeguards to prevent medical errors; staffing ratios and quality; waiting times in the emergency department; community outreach; and services that address the emotional needs of sick children and their families.

Parents, published monthly by Meredith Corporation, (also former publishers of the now defunct Child magazine) has been America’s #1 family magazine for more than 80 years. Since its inception in 1926, it has been a trusted source by every generation of parents.

In addition to the overall ranking, Parents magazine also ranked Children’s Hospital’s emergency medicine, neonatology and pulmonology divisions number one in the nation and the Cardiac Center, Cancer Center and orthopaedics division ranked second.

Facts about the six ranked divisions:
Cardiac Center

The Cardiac Center at The Children’s Hospital of Philadelphia is one of the world’s largest and most experienced programs, with more than 24,000 outpatient visits and 1,500 admissions, more than 1,000 surgeries, 1,000 catheterizations and 53,000 diagnostic studies each year; patients are referred to the Center from across the nation and around the world. The program’s high volumes of complex cases, along with the dedicated team of 500 professionals, correlate directly with its consistently exceptional record of outcomes. The Cardiac Center provides comprehensive services across the full continuum of care, from diagnosing a fetus with congenital heart disease to caring for them through adulthood.

Thanks to advances in care, many pioneered at CHOP, the first generation of children with previously fatal congenital heart disease are surviving – and thriving – into adulthood. In 2005, the Cardiac Center created the Philadelphia Adult Congenital Heart Center, in partnership with the University of Pennsylvania Health System. Uniting the resources of a renowned pediatric heart program with a national leader in adult cardiac care, the Center offers comprehensive care to meet the unique needs of this rapidly growing population.

The Fetal Heart Program, one of only a few and the largest – of its kind in the U.S., attracting referrals from across the nation, has performed more than 2,000 fetal heart studies annually as it provides diagnoses, education and treatment plans. The newest addition to the Cardiac Center is the Garbose Family Special Delivery Unit (SDU), the first birth facility in the world exclusively for babies with birth defects. It includes eight labor-delivery rooms and two operating rooms for c-section deliveries and fetal surgery. Congenital heart disease is the most common birth defect; approximately half the babies born in the SDU will be Fetal Heart Program babies. The newborns are evaluated by cardiologists and, if necessary, transported to the Evelyn and Daniel M. Tabas Cardiac Intensive Care Unit just down the hall.

Emergency Medicine

The CHOP Emergency Department (ED) provides safe and efficient, family-centered, high quality care to more than 80,000 critically ill, injured, or sick children each year. The ED is a 75-bed, state of the art facility; each patient room is private, designed for families’ comfort and equipped with TVs and VCRs for education or entertainment. No patient is ever treated in a hallway and patients are never diverted. The ED has been designed to safeguard patients in the event of a bio-terrorism attack; it is equipped with three decontamination quarters to allow the team to care for whole families or critically ill children.

Emergency Medicine at the Children’s Hospital of Philadelphia is multi-faceted and includes not just the care provided by the Emergency Department, but the life-saving interventions of the Poison Control Center, Trauma Team and Medical Transport Team. The ED team’s commitment extends beyond delivery of care to injury prevention efforts and advocacy for all children.

Neonatology Division

The Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU) at Children’s Hospital continues to make significant advances in the field of neonatal medicine and the care of the most fragile infants. To meet rapidly growing demand, the N/IICU facility is expanding to a 75-bed unit, equipped with the latest technology and advances in neonatal medicine to care for neonates with all types of diseases. The team’s clinical expertise has been recognized by regional providers as Children’s Hospital operates NICUs at seven community hospitals. The board-certified N/IICU faculty are leaders in the field, clinically and in research. Patient volume at the main campus has grown to more than 1,000 admissions; about 20 percent of neonatal admissions come from beyond the metropolitan Philadelphia region. Children’s Hospital is nationally recognized as a leader in the repair of congenital anomalies during the neonatal period.

The Neonatal Follow-Up Program monitors the physical and cognitive development of high-risk premature patients well into their childhood years, providing information, education and support for families. This program links with other clinics, provides referrals for early intervention and includes a program to promote early literacy.

Cancer Center

The mission of the Cancer Center at Children’s Hospital is to provide the most skilled, compassionate care available. State-of-the-art facilities enable us to focus on the needs of both children and their families. The Cancer Center offers comprehensive, family-centered care with more than 40 pediatric oncologists with expertise spanning every form of childhood cancer, enabling us to provide more breadth and depth than any other pediatric cancer program in the country. Each year, we treat more than 500 new patients and follow more than 4,000 patients previously treated for childhood cancer.

In addition, Children’s Hospital has launched a new Center for Childhood Cancer Research, bringing together the diverse talents of investigators from multiple disciplines with the goal of eradicating the problem of cancer in children. The Center pursues this goal through both basic and clinical research with the goal of incorporating research advancements into routine clinical care for children with cancer.

The Children’s Hospital of Philadelphia also supports cancer survivors. The Cancer Survivorship Program cares for and tracks long-term survivors of childhood cancer, and conducts research to understand how cancer treatment can affect a patient many years later, making recommendations about how to mitigate harmful side effects.

Orthopaedic Division

The Children’s Hospital of Philadelphia is internationally recognized for its pioneering work in pediatric orthopaedic patient care, education, and basic and clinical research; in fact, CHOP physicians have pioneered 16 orthopaedic surgical procedures and are internationally renowned for their skill in limb-sparing surgery, tumors, spines, hand, sports and trauma. The orthopaedic team provides a full-range of services from caring for children with common conditions such as sports injuries to those with the most complex musculoskeletal disorders such as cerebral palsy and bone tumors.

Each year, the team provides more than 62,000 outpatient visits in our orthopaedic and musculoskeletal programs, receives over 1,300 admissions and performs nearly 2,600 surgical cases. In addition to Main Campus, outpatient care is available at six Specialty Care Centers, and surgical procedures are offered at three Ambulatory Surgery Centers throughout the region. We have a broad referral network, with 16 percent of surgical cases coming from outside the Philadelphia region. The orthopaedics team has also expanded programs in neuromuscular, spine and cerebral palsy and established a world-class hand surgery program and are one of a handful of institutions that treat children with complex spine and chest wall deformities.

With orthopaedics at its core, Children’s Hospital’s unique Musculoskeletal Center, believed to be the only one of its kind in the nation, brings together a multidisciplinary team representing 10 pediatric subspecialties to provide seamless and comprehensive care for infants, children and young adults with congenital or acquired musculoskeletal conditions. This Center treats nearly 24,000 outpatients with the most complex musculoskeletal conditions such as limb deformities, spina bifida, and scoliosis.

Pulmonology Division

The Division of Pulmonology at The Children’s Hospital of Philadelphia is internationally known for being at the forefront of patient care and research into causes and treatments for the entire range of diseases affecting the lung, chest wall and control of respiration in children. These disorders include asthma, cystic fibrosis, sleep disorders, congenital lung disorders and chronic respiratory failure requiring home mechanical ventilation or other forms of technology. The Division has extensive expertise in managing complex end-stage lung diseases and in lung transplantation. The team believes in a holistic, multidisciplinary approach that utilizes the talents of many healthcare professionals, including physicians, nurse practitioners, social workers, nutritionists, respiratory therapists and physical therapists. These professionals work together to educate families and patients about their disorders, which in turn allows the team to partner with patients to achieve the best possible outcomes.

About The Children’s Hospital of Philadelphia: The Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu/.

Source: The Children’s Hospital of Philadelphia


NovaRx Corporation announced the opening of the company’s pivotal Phase 3 clinical trial of Lucanix(R) (belagenpumatucel-L) in the treatment of advanced non-small cell lung cancer (NSCLC) in Serbia. Serbian oncology centers participating in the trial include the Clinical Hospital Center Benzanijska Kosa in Belgrade, the Clinic for Pulmonary Diseases and TB “Knez Selo” in Nis, and the Institute for Pulmonary Disease of Vojvodina in Sremska Kamenica.

Serbia is the first European country to open the Lucanix(R) study for enrollment. The study is an international, multicenter, randomized, double-blind study involving up to 700 individuals with advanced stage NSCLC, and will be conducted at approximately 90 clinical sites in the U.S., Canada, Europe, and India. Treatment of patients in the Phase 3 Lucanix(R) trial at multiple clinical centers began in the United States in August 2008.

“For my team and Institution, the Lucanix(R) trial will be a challenge and also an affirmation of innovation in the development of lung cancer treatments,” stated Dr. Vladimir Kovcin, Head of Oncology at the Clinical Hospital Center Bezanijska Kosa in Belgrade, Serbia. “Given the expense of current therapies for NSCLC, many advanced-stage Serbian lung cancer patients do not have many treatment options for their disease. Lucanix(R) is unique from other therapies because it enhances the immune system in a natural way. It is a great pleasure to participate in this clinical trial.”

In a previous Phase 2 clinical trial, survival ranges among advanced-stage non-small cell lung cancer patients who received Lucanix(R) after receiving chemotherapy were more than double the survival ranges of individuals being treated with the current standard of care. Patients on Lucanix(R) demonstrated a one-year survival of 61% and a median survival of 16 months. Late-stage NSCLC patients typically demonstrate a less than 30% one-year survival. A second, investigator-initiated Phase 2 study supported these results.

Importantly, there were no significant toxicities related to Lucanix(R) in these trials. Side effects have been generally mild and similar to brief influenza symptoms.

“The safety and side effect profile of Lucanix(R) seems to be acceptable for patients’ quality of life, which is very important,” Kovcin stated. “If the Phase 3 clinical trial is successful, Lucanix(R) could change lung cancer treatment strategy in Serbia and the rest of the world.”

According to the WHO-Europe, lung cancer represents one of the leading causes of death for males and females in Serbia. In 2006, there were 5,400 new cases of lung cancer diagnosed in Serbia, and 4839 deaths from the disease. Lung cancer represents the number one cause of cancer death throughout the world.

“We are aggressively expanding the reach of our international Phase 3 trial of Lucanix(R) and we are pleased Serbia is the first of many countries in Europe where this experimental treatment will be available for patients.” said Dr Norrie Russell, President and Chief Operating Officer of NovaRx. “We are grateful to those centers and those patients who are helping establish whether, one day, Lucanix(R) will provide a much-needed option for lung cancer patients worldwide.”

About Lucanix(R):

In contrast to conventional cancer therapies, where systemic chemotherapeutic drugs nonspecifically kill normal cells as well as tumor cells, Lucanix(R) induces the patient’s immune system to specifically target the cancer.

Lucanix(R) consists of four non-small cell lung cancer cell lines that have been gene-modified to block a molecule called transforming growth factor-beta (TGF-beta), which is commonly produced by cancer cells. The molecule allows cancer to hide from the body’s natural immune system. When TGF-beta is blocked, the immune system can see, find, and destroy the cancer naturally.

United States Food & Drug Administration granted NovaRx Fast-Track approval for the Phase 3 Lucanix(R) trial in March of 2007, and Special Protocol Assessment approval in January of 2008.

Lucanix(R) currently is under clinical investigation and has not been approved for use in the United States, Canada, Europe or elsewhere. The product has not been proved to be safe or effective, and any claims of safety and effectiveness can be made only after regulatory review of the data and approval of the labeled claims.

Source: NovaRx Corporation


According to the latest science, resveratrol pill users are best advised to consume modest doses of resveratrol plus an array of antioxidant molecules as typically provided in 3 to 5 glasses of aged, red wine, rather than resveratrol alone.

The most recent study shows mega-dose resveratrol alone fails to prolong the life of laboratory mice. In fact, mega-doses shortened the life of animals compared to a standard calorie diet with no resveratrol. [Cell Metabolism. 2008 Aug; 8:157-68]

“While resveratrol (rez-vair-ah-trol), an antioxidant molecule concentrated in red wine (about 1 milligram per glass), is touted for its health properties, partially explaining the French Paradox (why French wine drinkers have cardiac mortality rates 30% lower than North Americans despite their high-calorie, high-fat diets), it is not the sole molecule responsible for longevity,” says Bill Sardi, spokesperson for Longevinex(R), a leading brand of resveratrol dietary supplement.

“The total array of red wine molecules found in the best red wine, about 60 milligrams per 5-ounce glass, or 180-300 milligrams in 3 to 5 glasses, is the suggested healthy dosage range,” says Sardi.

Consistently, studies show modest doses of red wine lower mortality rates over abstention or over-consumption. [American Journal Epidemiology 1986 Sep; 124(3):481-9] Red wine pills offer the advantage of no alcohol, no calories or sulfite preservatives.

Cause of shortened lifespan

The negative effect upon lifespan with mega-dose resveratrol may emanate from over-inhibition of tumor necrosis factor (TNF), an inflammatory factor. Excessive TNF leads to inflammation, while too little impairs the immune system, says Sardi.

“We know that over-inhibition of TNF in humans increases the risk for lymphoma (cancer that originates in lymphocytes, a type of white blood cell),” says Sardi. [Therapeutics Clinical Risk Management 2007 Jun; 3(2):245-58] “When laboratory mice were given mega-dose resveratrol they did not live as long and largely succumbed to lymphoma. Resveratrol is a known TNF inhibitor,” adds Sardi. [Biochemical and Biophysical Research Communications 2008 May 2; 369(2):471-7]

Confusing dosage advice

While longevity seekers have been hearing a lot about resveratrol in the past four years, since an Ivy League university discovered it activated a longevity gene known as Sirtuin 1, advice concerning dosage has been confusing at times.

A 2006 mouse study suggested consumers would have to drink about 750 to 1500 bottles of red wine a day to live longer (24 milligrams per kilogram of body weight), but the longevity effect was only demonstrated among mice engorged with a fat-laden diet (60% fat calories vs. 35% for the typical human diet), which isn’t a real-world example.

When the data on mice fed a standard calorie diet were analyzed and published in 2008 [Cell Metabolism. 2008 Aug; 8(2):157-68], ultra-high dose resveratrol (360 mg and 1565 mg, human equivalent dosage) actually stunted the lifespan of mice. So the public has been misled concerning dosage since 2006 [Nature 2006 Nov 16; 444:337-42], and may have never heard about the 2008 report, says Sardi.

Lower dose resveratrol accompanied by an array of other small molecules may be superior to resveratrol alone. According to a mouse study conducted by Longevinex(R), published in the September 2008 issue of Experimental Gerontology [2008 Sept; 43(9):859-66], far more longevity genes were activated in heart tissue by Longevinex (9-fold more) than plain resveratrol, at a dose that was 17-320 times lower than doses used in prior studies.

Synergism found

“A synergistic effect has been demonstrated with the array of antioxidant molecules provided in Longevinex(R), compared to resveratrol alone,” says Sardi. Other studies also corroborate that resveratrol works better when accompanied by other molecules, at lower doses. [Journal Medicinal Food 2008 Dec; 11:773-83; Translational Oncology 2008 March; 1:19-27; Life Science 2008 May 7; 82: 1032-9]

Sardi says longevity seekers often demand human lifespan studies, not realizing such a study would be impractical, taking 100 years to complete. Mouse longevity studies take about 3-4 years and cost more than a million dollars, so more economical gene array studies are performed and compared against a calorie restricted diet, which is a known intervention that prolongs life in all life forms. Longevinex(R) also sponsored an unpublished study showing it activated far more genes in brain tissue than plain resveratrol.

Longevinex(R) is a patent-applied-for matrix providing 250 milligrams of gene-controlling molecules (resveratrol, quercetin, rice bran IP6, ferulic acid, vitamin D), and is currently the only resveratrol-based dietary supplement to have been successfully studied in humans. Researchers at Appalachian State University found Longevinex(R) had superior antioxidant and anti-inflammatory action among endurance athletes compared to green tea molecules or quercetin alone.

Longevinex(R) is microencapsulated for stability and long-term shelf life, and is micronized to enhance absorption. Longevinex(R) contains no alcohol. Longevity seekers are invited to visit the website at www.longevinex.com

Source: Longevinex


Categories

Archives

Blogroll

Meta