Tag Archives: american medical association

Rice University study: When physicians integrate with hospitals, costs go up

7 Sep

The American Medical Association wrote in 5 ways to improve access to health care:

Stabilize individual insurance marketplaces and retain ACA market reforms. The AMA advocates these actions to foster a stronger health insurance marketplace and ensure that low- and moderate-income patients are able to secure affordable and adequate coverage:
• Support expanding eligibility for premium tax credits up to 500% of the federal poverty level. Support providing young adults with enhanced premium tax credits while maintaining the current premium tax credit structure that is inversely related to income.
• Encourage state innovation, including considering state-level individual mandates, auto-enrollment and/or reinsurance, to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections.
• Support the establishment of a permanent federal reinsurance program.
• Oppose the sale of health insurance plans in the individual and small-group markets that do not guarantee pre-existing condition protections along with coverage of essential health benefits and their associated protections against annual and lifetime limits, and out-of-pocket expenses (with the exception of short-term, limited duration insurance offered for no more than three months).
Address physician shortages. Grow the clinical workforce by expanding the number of available graduate medical education residency slots, expand medical school loan-forgiveness programs, and remove barriers to physician immigration for foreign-trained physicians to practice in the U.S.
Telehealth and remote patient monitoring will become an essential, cost-effective and reliable means to expand capacity in a health system marked by significant and persistent specialty shortages and geographic disparities. Physicians should get assurances that digital health solutions are cost-effective and provide a path to payment.
Increase efficiency of the existing workforce by instituting common-sense medical liability reforms and reducing government and insurance industry regulatory burdens—such as prior authorization—that detract from patient care and increase costs. Also, there should be advancement of new physician-led payment models to achieve better outcomes at lower cost.

https://www.ama-assn.org/delivering-care/patient-support-advocacy/5-ways-improve-access-health-care

One model of health care is associated with higher costs.

Science Daily reported in When physicians integrate with hospitals, costs go up:

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study…. https://www.sciencedaily.com/releases/2019/09/190905161406.htm

Citation:

When physicians integrate with hospitals, costs go up

Date: September 5, 2019
Source: Rice University
Summary:
When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new article.

Journal Reference:
Vivian Ho, Leanne Metcalfe, Lan Vu, Marah Short, Robert Morrow. Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study. Journal of General Internal Medicine, 2019; DOI: 10.1007/s11606-019-05312-z

Here is the press release from Rice University:

When physicians integrate with hospitals, costs go up, Rice study says

JEFF FALK

– SEPTEMBER 4, 2019POSTED IN: CURRENT NEWS

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study.
“Centers for Medicare and Medicaid Services regulators should be wary of the burden that increasing reporting requirements place on physicians in small, independent practices,” Metcalfe said. “In the long run, these requirements may have the unintended consequence of raising health care costs.”
The paper, “Annual Spending per Patient and Quality in Hospital-Owned versus Physician-Owned Organizations: An Observational Study,” was also co-authored by Lan Vu, lead actuarial systems analyst at BCBSTX; Marah Short, associate director of the Center for Health and Biosciences at the Baker Institute; and Dr. Robert Morrow, Southeast Texas market president at BCBSTX.
TAGS: Baker Institute, Economics, Research, RNH, RNhome, Social Sciences
About Jeff Falk
Jeff Falk is associate director of national media relations in Rice University’s Office of Public Affairs.

The Healthcare Transformation Institute listed different models of healthcare.

According to Healthcare Transformation Institute, among models of healthcare are:

Healthcare Delivery Models
Please check back often for updates
ACO
• The ACO Model — A Three-Year Financial Loss?
• Accountable Care Organizations: The Case for Flexible Partnerships Between Health Plans and Providers
• The Collaborative Payer Model
• Continuous Innovation in Health Care: Implications of the Geisinger Experience
• Driving Population Health Through Accountable Care Organizations
• Growing an ACO-Easier Said Than Done
• Grand Junction, Colorado: A Health Community that Works
• Grand Junction, Colorado: How a Community Drew on its Values to Shape a Superior Health System
• Higher Health Care Quality and Bigger Savings Found at Large Multispecialty Medical Groups
• The Hot Spotters: Lower Costs and Better Care for Neediest Patients
• Improving The Coordination of Care for Medicaid Beneficiaries in Pennsylvania
• A National Strategy to Put Accountable Care into Practice
• Predictive Modeling and Team Care for High-Need Patients at HealthCare Partners
• How the Stars Aligned to Make Grand Junction a Success
Care Transitions
• Connected For Health – A Community-Based Care Transition Project
• Improving Care Transitions and Reducing Hospital Readmissions: Establishing the Evidence for Community-Based Implementation Strategies Through the Care Transitions Theme
• Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention
Disease Management
• ICC Asthma Program Evaluation 2007-2009
• German Diabetes Management Programs Improve Quality of Care and Curb Costs
• A Home-Based Diabetes Education Program and Its Approach to Disease Management
• How Direct Primary Care Reduces Primary Care Costs
• At Martin’s Point in Maine, Primary Care Teams for Chronic Disease Patients
• Primary Care Redesign: Delivering a Value Based Population Program for Chronic Disease
• Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine’s “Retooling for an Aging America” Report
• Taking Public Health Approaches to Care in Massachusetts
Medical Home
• American Medical Home Runs
• Changing the Conversation in California About Care Near the End of Life
• Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention
• The ‘GRACE’ Model: In-Home Assessments Lead to Better Care for Dual Eligibles
• The Group Health Medical Home at Year Two: Cost Savings, Higher Patient Satisfaction, and Less Burnout for Providers
• A Health Plan Spurs Transformation of Primary Care Practices Into Better-Paid Medical Homes
• Medical “Extensivists” Care for High-Acuity Patients Across Settings, Leading to Reduced Hospital Use
• A New Care Paradigm Slashes Hospital Use and Nursing Home Stays for the Elderly and the Physically and Mentally Disabled
• Restructuring Care in a Federally Qualified Health Center to Better Meet Patients’ Needs
• Transforming Physician Practices to Patient-Centered Medical Homes: Lessons from The National Demonstration Project
• Vermont’s Blueprint for Medical Homes, Community Health Teams, and Better Health at Lower Cost
Medication Management
• Medication Adherence Leads to Lower Health Care use and Costs Despite Increased Drug Spending
• Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform
• Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending
Elements of Healthcare Transformation
• Alignment of incentives
• Connectivity among caregivers and patients
• Leadership assessment and development
• Business plans and models
• Metrics and evaluation
• Medication management
• In-home care
ASU Healthcare Delivery and Policy Program
Read about our affiliated program at Arizona State University.
http://healthcaretransformationinstitute.org/page/healthcare-delivery-models

Faith Abubey of WFMY News reported on a healthcare delivery system outside the traditional insurance model.

Abubey reported in New Model: Triad Doctor Offers Unlimited Visits For $50 Monthly Fee:

But a growing number of family doctors say they have found a way to make routine doctor visits cheap and give you better care.
In some cases, you pay as low as $25 a month and still see a doctor whenever you want with no extra costs.
The idea is called Direct Primary Care (DPC).
Think of it like a gym membership.
You pay a monthly fee and you get to go as often as you want.
It’s the same idea.
In this case you get unlimited visits to your family doctor.
Access to that doctor by phone or a secure messaging system — 24/7.
You get same day or next-day appointments.
Discounts on things like labs and your prescription medicine.
All for a monthly fee of anywhere between $25 and $85 a month.
That’s it.
No extra costs. No co-pays. No insurance involved.
If you’re thinking this sounds too good to be true, even the Triad doctor who’s offering it agrees.
“It does sound too good to be true. And I think that that’s the hardest thing about selling people on this model. Because they just don’t understand how it could be that easy,” Dr. James Breen said.
Dr. Breen and his wife, Dr. Dayarmys Piloto de la Paz, who is also a doctor, opened their direct primary care practice just over a month ago in Greensboro.
It is called Vitral Family Medicine.
It is the only clinic of its kind we know of in the Triad.
But according to the Journal of Medical Economics, there are more than 300 doctors’ offices across the country using the same model.
“A lot of people describe direct primary care as do it yourself health care reform,” Dr. Breen said.
He explains that in this model, your doctor visits are longer, patients get better care and there is no red tape from insurance companies about what he can and can’t do…. https://www.wfmynews2.com/article/news/local/2-wants-to-know/new-model-triad-doctor-offers-unlimited-visits-for-50-monthly-fee/266503909

Access to healthcare for the greatest number is an important concept, but as with many things, the devil is in the details. What is the definition, cost and the population defined are questions that are political difficult to build a consensus.

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Journal of the American Medical Association special report: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

15 Mar

HELPGUIDE.ORG defines substance abuse and also describes some of the traits of a substance abuser.

Drug abuse, also known as substance abuse, involves the repeated and excessive use of chemical substances to achieve a certain effect. These substances may be “street” or “illicit” drugs, illegal due to their high potential for addiction and abuse. They also may be drugs obtained with a prescription, used for pleasure rather than for medical reasons.
Different drugs have different effects. Some, such as cocaine or methamphetamine, may produce an intense “rush” and initial feelings of boundless energy. Others, such as heroin, benzodiazepines or the prescription oxycontin, may produce excessive feelings of relaxation and calm. What most drugs have in common, though, is overstimulation of the pleasure center of the brain. With time, the brain’s chemistry is actually altered to the point where not having the drug becomes extremely uncomfortable and even painful. This compelling urge to use, addiction, becomes more and more powerful, disrupting work, relationships, and health. http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

In a 2014 article the National Institute on Drug Abuse took a cautious approach in linking pain killers and drug abuse.

The National Institute on Drug Abuse wrote in Abuse of Prescription Pain Medications Risks Heroin Use:

Text Description of Infographic

In 2010 almost 1 in 20 adolescents and adults – 12 million people – used prescription pain medication when it was not prescribed for them or only for the feeling it caused.  While many believe these drugs are not dangerous because they can be prescribed by a doctor, abuse often leads to dependence.  And eventually, for some, pain medication abuse leads to heroin.

Top Figure: 1 in 15 people who take non medical prescription pain relievers will try heroin within 10 years.

Left  Graph: Number of people who abused or were dependent on pain medications and percentage of them that use heroin.  Pie charts show in 2004 1.4 million people abused or were dependent on pain medications and 5% used heroin. In 2010, 1.9 million people abused or were dependent on pain medications and 14% used heroin.

Right Top Graph:  Heroin users are 3 times as likely to be dependent.  14% of non medical prescription pain reliever users are dependent. Yet, 54% of heroin users are dependent.

Right Bottom Graph:  Heroin emergency room admissions are increasing.  In 2005 there were less than 200,000 emergency room visits related to heroin. By 2011 this number had increased to almost 260,000….https://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use

The CDC issued new recommendations regarding prescribing pain medication.

Kimberly Leonard of U.S. News wrote in Getting a Painkiller from a Doctor Is About to Get Harder:

Government health officials on Tuesday provided strategies for primary care doctors who treat patients suffering from chronic pain. Among the recommendations: to use urine drug testing before prescribing highly addictive painkillers like oxycontin, codeine and morphine.

The guidance, put forth by the Centers for Disease Control and Prevention, is part of the government’s response to the epidemic of people dying from opioid overdoses, which include prescription painkillers but also the drug’s cheaper alternative, heroin. Data from the CDC show that in 2014 these deaths surpassed car accidents as the No. 1 cause of injury-related death.

For the most part, the CDC recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. Primary care doctors have been in part responsible for the surge in addiction: Since 1999, the prescribing and sales of opioids has quadrupled, and primary care doctors account for nearly half of these prescriptions….                                                                                                           http://www.usnews.com/news/articles/2016-03-15/cdc-issues-guidance-on-prescription-painkillers

Citation:

Special Communication | March 15, 2016

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 FREE ONLINE FIRST

Deborah Dowell, MD, MPH1; Tamara M. Haegerich, PhD1; Roger Chou, MD1

[+] Author Affiliations

JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.1464

Text Size: A A A

Article

Tables

Supplemental Content

References

ABSTRACT

ABSTRACT | INTRODUCTION | GUIDELINE DEVELOPMENT PROCESS | RECOMMENDATIONS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.

Objective  To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Process  The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.

Evidence Synthesis  Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.

Recommendations  There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.

Conclusions and Relevance  The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Here is the recommendation for patients from LeShaundra Cordier Scott, MPH, CHES; Sarah Lewis, MPH, CHES:

RECOMMENDATIONS FOR SAFER AND MORE EFFECTIVE PAIN MANAGEMENT

A JAMA article was published online on March 15, 2016, describing a new Centers for Disease Control and Prevention opioid prescribing guideline for chronic pain. The guideline provides recommendations based on available science for safer, more effective treatment of chronic pain outside of active cancer, palliative care, and end-of-life care.

The recommendations ask health care practitioners to

  • Use nonopioid medications and other therapies such as physical therapy instead of or in combination with opioids.
  • Prescribe the lowest effective dosage of opioids to reduce risks of opioid use disorder and overdose.
  • Discuss potential benefits and harms of opioids with patients.
  • Assess improvements in pain and function regularly.
  • Use tools such as urine drug tests and prescription drug monitoring programs to inform themselves about patients’ other medications that increase risk.
  • Monitor patients for signs of whether opioid use disorder might be developing and arrange treatment if needed

 

WHAT YOU CAN DO

 

If you have chronic pain, be sure to

  • Consider ways to manage your pain that do not include opioids, such as physical therapy, exercise, nonopioid medications, and cognitive behavioral therapy.
  • Make the most informed decision with your doctor.
  • Never take opioids in greater amounts or more often than prescribed.
  • Avoid taking opioids with alcohol and other substances or medications you have not discussed with your doctor.

If you or someone close to you has an addiction to pain medication, talk to your doctor or contact the Substance Abuse and Mental Health Services Administration’s treatment help line at (800) 662-HELP.

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Published Online: March 15, 2016. doi:10.1001/jama.2016.3224.

Here is the press release from the American Medical Association:

March 15, 2016

AMA Responds to CDC Guidelines on Opioids

For immediate release:
March 15, 2016

CHICAGO – In response to the Centers for Disease Control and Prevention (CDC) guidelines issued today, the American Medical Association (AMA) noted its shared goal of reducing harm from opioid abuse and seeking solutions to end this public health epidemic and applauds the agency for making the issue a high priority. As with any guideline development of this magnitude, we appreciated the opportunity to add the voice of patients and physicians.

“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care,” said Patrice A. Harris, MD, the AMA board chair-elect and chair of the AMA Task Force to Reduce Opioid Abuse.

“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”

###

Media Contact:
Jack Deutsch
AMA Media & Editorial
202-789-7442
Jack.Deutsch@ama-assn.org

If you or a member of your family is prescribed pain medication, the course of treatment should follow CDC recommendations.

Where information leads to Hope. © Dr. Wilda.com

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Virginia Mason Hospital study: Carbon monoxide can pass through dry wall

21 Aug

Carbon monoxide poisoning can kill. Marijke Vroomen Durning wrote in the Forbes article, Carbon Monoxide, A Silent Killer: Are You Safe At Home?

Every year, 20,000 to 30,000 people in the United States are sickened by accidental carbon monoxide poisoning and approximately 500 people die, many in their own home. Carbon monoxide is colorless, odorless, and tasteless. It cannot be detected by humans without the help of a detector.
A new study, released today in the Journal of the American Medical Association (JAMA), has found that carbon monoxide easily passes through gypsum wallboards (also called drywall), the material used to finish walls and ceilings in most residential homes. The porous material does nothing to stop the gas from seeping through.
Here’s where the problem gets worse: Twenty-five states require that residents have a carbon monoxide alarm in their homes but in December 2012, 10 states exempted residences that don’t have an internal carbon monoxide-producing source, such as a gas stove or fireplace, or an attached garage in which a car could be left idling. This move worries toxicologists who fear that these exemptions may give people a false sense of security. It’s believed that removing the requirement for all homes to have such alarms will lead to an increased number of accidental carbon monoxide poisonings, particularly in multi-unit buildings.
http://www.forbes.com/sites/marijkevroomendurning/2013/08/20/carbon-monoxide-a-silent-killer-are-you-safe/

Here is the press release from Virginia Mason Hospital:

News Releases
Researchers Prove Carbon Monoxide Penetrates Gypsum Wallboard
SEATTLE – (Aug. 21, 2013) — Carbon monoxide (CO) from external sources can easily penetrate gypsum wallboard (drywall) commonly used in apartments and houses, potentially exposing people indoors to the toxic, odorless, tasteless gas within minutes, concludes a study conducted at Virginia Mason Medical Center.
These findings, which underscore the importance of CO alarms in single-family and multi-family homes, are published in today’s edition of the Journal of the American Medical Association. Authors of the study are Neil B. Hampson, MD; James R. Holm, MD; and engineer Todd G. Courtney, of the Virginia Mason Center for Hyperbaric Medicine.
Their research casts doubt on the assumption that the risk for CO poisoning inside a residence is eliminated if there is no apparent internal source of the gas. They determined that carbon monoxide from an external source, such as an electrical generator operating in an adjacent apartment or an automobile engine running in an attached garage, can pass through drywall ceilings and walls because gypsum wallboard is highly porous. CO also penetrates painted drywall, albeit more slowly, the researchers determined.
Their study is believed to be the first to examine the ability of carbon monoxide to diffuse through gypsum wallboard. Gypsum particles contain microscopic pores that are many times larger than CO molecules, allowing these dangerous molecules to easily penetrate drywall.
“There are numerous media reports describing simultaneous CO poisonings in different units of multifamily dwellings,” the authors note. Even though carbon monoxide might have traveled through ventilation ducts, hallways, elevator shafts or stairways in some cases, this was not possible in every case due to configurations of the buildings, they add. This raised the question whether CO could pass through drywall.
Many states are enacting legislation mandating residential CO alarms, although some have exempted structures if there is no apparent indoor carbon monoxide source (i.e., fuel-burning appliances, fireplaces, etc.). This action is dangerous, authors of the study caution, because occupants of multifamily dwellings, for example, can bring sources of CO production into their units and put themselves and people in neighboring units in harm’s way.
Since January 2013, Washington state law has required carbon monoxide alarms be installed in most existing single-family homes, as well as hotels, motels and apartments. The alarms must be located outside, and near, each separate sleeping area.
Carbon monoxide poisoning causes about 500 accidental deaths annually in the U.S.
About Virginia Mason Medical Center
Virginia Mason Medical Center, founded in 1920, is a nonprofit regional health care system in Seattle that serves the Pacific Northwest. Virginia Mason employs more than 5,300 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians; satellite locations throughout the Puget Sound area; and Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the U.S. designed and built specifically to meet the needs of people with HIV/AIDS. Benaroya Research Institute at Virginia Mason is internationally recognized for its breakthrough autoimmune disease research. Virginia Mason was the first health system to apply lean manufacturing principles to health care delivery to eliminate waste and improve quality and patient safety.
To learn more about Virginia Mason Medical Center, please visit Facebook.com/VMcares or follow @VirginiaMason on Twitter. To learn how Virginia Mason is transforming health care and to join the conversation, visit our blog at VirginiaMasonBlog.org.
Media Contact:
Gale Robinette
Virginia Mason Media Relations
(206) 341-1509
gale.robinette@vmmc.org

See:

Drywall No Barrier Against CO Poisoning http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/41091

The Centers for Disease Control and Prevention posted information about Carbon Monoxide Poisoning:
Frequently Asked Questions

What is carbon monoxide?

Carbon monoxide, or CO, is an odorless, colorless gas that can cause sudden illness and death.
Where is CO found?
CO is found in combustion fumes, such as those produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, and gas ranges and heating systems. CO from these sources can build up in enclosed or semi-enclosed spaces. People and animals in these spaces can be poisoned by breathing it.
What are the symptoms of CO poisoning?
The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. High levels of CO inhalation can cause loss of consciousness and death. Unless suspected, CO poisoning can be difficult to diagnose because the symptoms mimic other illnesses. People who are sleeping or intoxicated can die from CO poisoning before ever experiencing symptoms.
How does CO poisoning work?
Red blood cells pick up CO quicker than they pick up oxygen. If there is a lot of CO in the air, the body may replace oxygen in blood with CO. This blocks oxygen from getting into the body, which can damage tissues and result in death. CO can also combine with proteins in tissues, destroying the tissues and causing injury and death.

Who is at risk from CO poisoning?

All people and animals are at risk for CO poisoning. Certain groups — unborn babies, infants, and people with chronic heart disease, anemia, or respiratory problems — are more susceptible to its effects. Each year, more than 400 Americans die from unintentional CO poisoning, more than 20,000 visit the emergency room and more than 4,000 are hospitalized due to CO poisoning. Fatality is highest among Americans 65 and older.
How can I prevent CO poisoning from my home appliances?
• Have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do not use portable flameless chemical heaters (catalytic) indoors. Although these heaters don’t have a flame, they burn gas and can cause CO to build up inside your home, cabin, or camper.
• If you smell an odor from your gas refrigerator’s cooling unit have an expert service it. An odor from the cooling unit of your gas refrigerator can mean you have a defect in the cooling unit. It could also be giving off CO.
• When purchasing gas equipment, buy only equipment carrying the seal of a national testing agency, such as the CSA Group .
• Install a battery-operated or battery back-up CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall.

How do I vent my gas appliances properly?

• All gas appliances must be vented so that CO will not build up in your home, cabin, or camper.
• Never burn anything in a stove or fireplace that isn’t vented.
• Have your chimney checked or cleaned every year. Chimneys can be blocked by debris. This can cause CO to build up inside your home or cabin.
• Never patch a vent pipe with tape, gum, or something else. This kind of patch can make CO build up in your home, cabin, or camper.
• Horizontal vent pipes to fuel appliances should not be perfectly level. Indoor vent pipes should go up slightly as they go toward outdoors. This helps prevent CO or other gases from leaking if the joints or pipes aren’t fitted tightly.

How can I heat my house safely or cook when the power is out?

• Never use a gas range or oven for heating. Using a gas range or oven for heating can cause a build up of CO inside your home, cabin, or camper.
• Never use a charcoal grill or a barbecue grill indoors. Using a grill indoors will cause a build up of CO inside your home, cabin, or camper unless you use it inside a vented fireplace.
• Never burn charcoal indoors. Burning charcoal — red, gray, black, or white — gives off CO.
• Never use a portable gas camp stove indoors. Using a gas camp stove indoors can cause CO to build up inside your home, cabin, or camper.
• Never use a generator inside your home, basement, or garage or near a window, door, or vent.
How can I avoid CO poisoning from my vehicle?
• Have a mechanic check the exhaust system of my car every year. A small leak in your car’s exhaust system can lead to a build up of CO inside the car.
• Never run a car or truck in the garage with the garage door shut. CO can build up quickly while your car or truck is running in a closed garage. Never run your car or truck inside a garage that is attached to a house and always open the door to any garage to let in fresh air when running a car or truck inside the garage.
• If you drive a vehicle with a tailgate, when you open the tailgate, you also need to open vents or windows to make sure air is moving through your car. If only the tailgate is open CO from the exhaust will be pulled into the car.
http://www.cdc.gov/co/faqs.htm

It is more important than ever for those living in multi-unit homes to have carbon monoxide detectors in each unit.

Consumer Search offers tips about buying a carbon monoxide monitor in How to Buy a Carbon Monoxide Detector:

What the best carbon monoxide detector has
• Audio alarm. Devices certified by Underwriters Laboratories (UL) have a minimum 85-decibel horn that can be heard within 10 feet.
• Interconnectivity. Interconnecting units are helpful in large homes because they communicate with one another; when one alarm detects a hazard, it triggers them all to sound an alarm. To work properly, all units must be made by the same manufacturer. While traditionally hardwired, battery-operated wireless interconnecting units are now available.
• Five-year sensor lifespan. The sensors on carbon monoxide detectors do wear away over time. Expect your unit to last at least five years. The better models have an end-of-life timer to alert you when the unit needs to be replaced. Kidde’s newest CO detectors, released in March, last for 10 years.
• Long warranty. Carbon monoxide detectors can malfunction, and the best units come with a warranty of at least five to seven years.
• Digital display. UL-certified carbon monoxide detectors are designed to sound an alarm if they sense CO levels of 70 parts per million (ppm) or higher. Exposure of 100 ppm for 20 minutes may not affect healthy adults. However, people with cardiac or respiratory problems, infants, pregnant women and the elderly may be harmed by lower concentrations. A device with a digital display can show these concentrations and give you the peace of mind.
• Testing functionality. CO detectors should be tested once a month. The best detectors have a test/silence button to test the device and also silence the alarm in the event of a false alarm.
Know before you go
What are the regulations in your state or municipality? Most states require a carbon monoxide detector to be installed in new homes or before the sale of a home. Some require hardwired or plug-in units to have battery backup in the case of a power outage. The National Conference of State Legislatures is a good resource for determining what regulations apply to you.
How are your current carbon monoxide detectors installed? Detectors may be hardwired, plugged into an outlet or battery operated, depending on the model. Some plug-in and hardwired units use batteries as a backup during a power failure and will not operate if they are not installed. If your current carbon monoxide detectors are hardwired, you will most likely want to keep that system. Otherwise, battery-operated and plug-in models are the easiest to install.
Do you need a smoke alarm, too? If you also need a smoke alarm, a combination smoke and carbon monoxide alarm might be best. Decide whether you need the smoke alarm to use ionization or photoelectric technology. The U.S. Fire Administration provides background on the different technologies.
How many alarms do you need? CO alarms should be installed in a central location outside each sleeping area and on every level of the home, according to the National Fire Protection Association, which also recommends interconnecting all alarms.
Does your unit meet safety standards? Check to see that the detector is certified by an independent testing agency such as Underwriters Laboratories or Canadian Standards Association.
http://www.consumersearch.com/carbon-monoxide-detectors/how-to-buy-a-carbon-monoxide-detector

The Virginia Mason study shows how important carbon monoxide detectors are.

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