25 hospital closures in 2024

https://www.beckershospitalreview.com/finance/5-hospital-closures-in-2024.html

Many hospitals and emergency departments have been forced to close in 2024 due to circumstances like high costs and shifts in care needs. 

Becker’s has reported on 25 hospital and emergency department closures in 2024:

Editor’s note: This article was updated Dec. 27 at 3:06 p.m. CT.

1. ShorePoint Health Punta Gorda (Fla.) hospital will remain closed after it sustained significant damage and suspended operations during Hurricanes Helene and Milton in September. Altamonte Springs, Fla.-based AdventHealth signed a definitive agreement to acquire ShorePoint Health Port Charlotte and “certain assets” of Punta Gorda in November. It is unclear if AdventHealth will repair structural damages and resume hospital services at the facility once the deal is finalized. 

2. Dallas-based Steward Health Care filed a closure notice for its Sharon (Pa.) Regional Medical Center after Meadville (Pa.) Medical Center withdrew its proposed transaction of the hospital. The notice proposed a Jan. 6 closure date.

3. Bryan, Texas-based CapRock Health System closed its Bryan-based CapRock Hospital and freestanding CapRock 24-Hour Emergency Care center in College Station, Texas, on Dec. 13. 

4. St. Louis-based Ascension and its joint venture partner, Emerus Holdings, will close a micro-hospital in Waukesha, Wis., on Jan. 13 and consolidate higher acuity-care services to fewer hospitals in southeast Wisconsin.

5. Dallas-based Steward Health Care filed an Oct. 7 notice of closure for its already nonoperational Norwood (Mass.) Hospital and four satellite facilities. 

6. Thomasville (Ala.) Regional Medical Center halted operations indefinitely amid staffing shortages.

7. Modesto, Calif.-based Stainslaus Surgical Hospital ended operations indefinitey Sept. 14 and laid off 160 employees.

8. Hicksville, Ohio-based Community Memorial Hospital permanently closed on Aug. 31 after temporarily shutting down in May due to financial challenges.

9. Des Moines, Iowa-based MercyOne closed its MercyOne Primghar (Iowa) Medical Center on Sept. 27. 

10. Steward closed Boston-based Carney Hospital on Aug. 31. 

11. Steward also shuttered its Ayer, Mass.-based Nashoba Valley Medical Center on Aug. 31. 

12. Norman (Okla.) Regional Health System closed its flagship Norman Regional Hospital and emergency department July 28 and relocating services to another location.

13. Columbia-based University of Missouri Health Care Women’s Hospital closed following its transitioning of all services to the new MU Health Care Children’s Hospital and Birthing Center. 

15. Prairieville (La.) Family Hospital closed April 29 after the Louisiana Department of Health determined that the hospital violated state hospital laws and regulations and revoked its license.

16. Family Hospital at Papillion (Neb.), part of Cedar Park, Texas-based Family Hospital Systems, abruptly shut down in late March.

17. Stoughton, Mass.-based New England Sinai Hospital, a 182-bed rehabilitation hospital owned by Dallas-based Steward Health Care, closed at the end of March. Steward shared plans to close the hospital in early December and cited “chronic low reimbursement rates” for Medicare and Medicaid services.

18. Regional Medical Center Health System is ending inpatient services at Anniston, Ala.-based Stringfellow Memorial Hospital. The hospital’s emergency department will transition to its main hospital campus about 1 mile away.

19. Springfield, Ill.-based Hospital Sisters Health System closed Chippewa Falls, Wis.-based St. Joseph’s Hospital on March 22, a spokesperson for HSHS confirmed with Becker’s. 

20. HSHS also closed its Eau Claire, Wis.-based Sacred Heart Hospital on March 22. Multiple regional health centers the health system operates in conjunction with Green Bay, Wis.-based Prevea Health were also set to close by April 21. 

21. Jellico (Tenn.) Regional Hospital closed March 9. The hospital will remain closed until Campbell County can secure another entity to assume management duties. 

22. Wausau, Wis.-based Aspirus Health shut down its Aspirus Ontonagon (Mich.) Hospital and turned it into a rural health clinic, effective April 20. 

23. Port Arthur-based the Medical Center of Southeast Texas, part of Dallas-based Steward Health Care, shuttered its Beaumont campus, including its emergency department and all hospital-related services, on Feb. 2.

24. Kettering (Ohio) Health closed its emergency department at Kettering Health Piqua (Ohio) on Feb. 1 due to a shift in care needs that led to fewer “true emergency cases.”

25. Family Hospital at Millard in Omaha, Neb., part of Cedar Park, Texas-based Family Hospital Systems, shut its doors in January. 

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Here is the “guidelines” for Ohio and prescribing opioids for Non-Terminal Pain. I did a “word search” for PHARMACOGENOMICS TESTING and it did not appear once in these guidelines. So these guidelines appears to be created by one or more people who is still functioning with a 20th century medical mind set/education.

Just take a pt who has been diagnosed with Complex regional pain syndrome (CRPS) https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome and is a ultra-fast metabolizer and will require high and frequent doses of a opiate, and they use the McGill Pain Scale and CRPS is known as the “suicide disease”

Notice this in Ohio’s guidelines,  No absolute maximum dose or duration of treatment is established for patients already being treated for chronic pain. Does this mean that “legacy pts” get a “free pass” to stay on the opioid dose they have been stable on for a long time. But here is a blog post that I made last week Did you every wonder how many new chronic pain patients are created everyday?       That number would be about 50,000 new chronic pain pts PER YEAR. I have never seen, but others may have – the number of chronic pain pts that die from a OD, suicide or premature death from under/untreated pain.

I wonder if all this limiting of prescribing, dispensing opioids is just some sort of weird process/prgm to help create a balance between the number of new chronic pts and existing chronic pain pts?

what is the policies of Ohio in prescribing opioids/opiates for treating chronic pain and what mme/day – if any – are written in stone

Ohio has implemented several policies and guidelines for prescribing opioids to treat chronic pain. The state has established safety checkpoints and regulations to ensure appropriate prescribing while minimizing the risk of opioid misuse and addiction[4].

Key points of Ohio’s opioid prescribing policies for chronic pain include:

1. Morphine Equivalent Daily Dose (MED) checkpoints:
– 50 MED: Prescribers must re-evaluate the patient’s condition, assess functioning, look for signs of misuse, consider specialist consultation, and obtain written informed consent[4].
– 80 MED: Prescribers must look for signs of misuse, consult a specialist, obtain a written pain-management agreement, and offer a naloxone prescription[4].
– 120 MED: Prescribing above this level requires a recommendation from a board-certified pain medicine physician or hospice and palliative care physician, based on a face-to-face examination[4].

2. No absolute maximum dose or duration of treatment is established for patients already being treated for chronic pain[4].

3. Prescribers must consider and document non-medication and non-opioid treatments before prescribing opioids for chronic pain[8].

4. The Ohio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain use 80 mg MED as a “trigger threshold,” as the odds of an overdose are higher above that dose[7].

It’s important to note that while these guidelines and checkpoints exist, there is no specific MED/day that is absolutely “written in stone” for chronic pain treatment in Ohio. The regulations allow for clinical judgment and individualized patient care, particularly for those already on established treatment plans[4]. However, prescribers must follow the checkpoint requirements and document their decision-making process when prescribing higher doses.

Citations:
[1] https://doh.wa.gov/sites/default/files/legacy/Documents/2300/2017/OH-OK-OR-VermontPrescrib.pdf
[2] https://mha.ohio.gov/about-us/media-center/media-resources/opioid-prescribing-guidelines
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC9277518/
[4] https://med.ohio.gov/for-licensees/prescriber-resources/overview-regulations-for-chronic-and-subacute-opioid-prescriptions
[5] http://www.ooanet.org/aws/OOSA/page_template/show_detail/81290?model_name=news_article
[6] https://www.jpsmjournal.com/article/S0885-3924(22)00705-9/fulltext
[7] https://www.ohioafp.org/public-policy/state-legislative-regulatory-issues/opioid-prescribing-guidelines/
[8] https://www.mcmsoh.org/general/2021-12-19-safe-opioid-prescribing-in-ohio/
[9] https://spectrumnews1.com/oh/columbus/news/2023/09/22/prescription-opioids-pain-patients-

Ohio Governor Blocks Bill Allowing Doctors to Disagree with the Medical Opinions of State Officials

https://www.latintimes.com/ohio-governor-blocks-bill-allowing-doctors-disagree-medical-opinions-state-officials-571200

“Health professionals who give harmful medical care shouldn’t get a ‘legal shield’ to avoid accountability,'” Gov. Mike DeWine said.

Ohio Gov. Mike DeWine blocked a bill late Thursday that sought to protect medical professionals from disciplinary action for expressing opinions that contradict state health officials.

DeWine argued the measure in House Bill 315 would severely undermine the state’s ability to regulate medical misconduct and safeguard public health, AP reported.

“Ohio’s medical licensing boards exist to protect patients and the public from bad actors in the medical field,” DeWine wrote in his veto message. “Health professionals who give harmful medical care shouldn’t get a ‘legal shield’ to avoid accountability by claiming a difference of ‘medical opinion.'”

The provision, backed by Ohio Advocates for Medical Freedom, aimed to prohibit state health boards from disciplining licensed professionals for “publicly or privately expressing a medical opinion that does not align” with the “opinions” of health authorities at the city, county, or state level, AP reported.

Critics, including DeWine, warned it could have led to harmful consequences for patient care. The veto comes amid ongoing national debates over medical freedom and vaccine policies.

In 2021 an Ohio osteopathic doctor, Sherri Tenpenny, went viral for a testimony before state legislators where she claimed COVID-19 vaccines made people magnetic and could be interfering with women’s menstrual cycles and making people “interface” with cell towers.

In response to hundreds of complaints, the state medical board launched at inquiry and eventually suspended Tenpenny’s medical license when she refused to cooperate with the investigation. Ohio Advocates for Medical Freedom deny that Tenpenny’s case inspired the medical free speech proposal.

Despite vetoing the medical free speech provision, DeWine left other elements of the bill intact, including a declaration that Ohio is outside the jurisdiction of the World Health Organization (WHO).

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CMS Moved to Expand  Drug Coverage. Private Insurers Need to Step Up

https://www.medpagetoday.com/opinion/second-opinions/113572

In July 2024, Joseph Zucchi, PA-C, MPAS, wrote about how stigma and misconceptions   were creating barriers to GLP-1 obesity medication uptake, on top of systemic barriers like high costs and inadequate insurance coverage. As part of our review of the past year’s biggest events, Zucchi revisited this topic to share his perspective on the proposal from the Centers for Medicare & Medicaid Services (CMS) to expand coverage of these life-changing medications.

Imagine a disease so prevalent it affects more than two-fifths of the adult population and one-fifth of children, yet its most effective treatments remain out of reach for those who need them most. This is the reality of obesity, a condition that drives chronic disease but is met with barriers to care at every turn. Obesity isn’t a mere lifestyle choice or lack of willpower; it’s a complex, chronic disease that heightens the risk of many of the most common chronic conditions: diabetes, heart disease, hypertension, osteoarthritis, and more.

Yet, despite the power of GLP-1 anti-obesity medications to reduce these risks, many insurers continue to deny coverage, leaving millions of Americans to fend for themselves.

Obesity: The Most Costly and Preventable Health Risk Factor

Obesity affects over 40% of American adults,   making it one of the most prevalent chronic diseases in the U.S. This disease carries more than just physical weight — it costs us in quality of life, productivity, and billions of dollars in healthcare expenses. It burdens our hospitals and our health system, and, most importantly, it leads to unnecessary suffering and premature death. Obesity-related conditions cost the U.S. over $170 billion annually and that number is only growing.

Obesity medications, particularly GLP-1 receptor agonists like semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro), have changed the landscape of obesity treatment. These drugs address the physiological drivers of obesity by curbing appetite, reducing food cravings, and improving insulin sensitivity. Beyond only helping people lose weight, these drugs are approved for type 2 diabetes       and sleep apnea, and can reduce the risk of heart disease   and possibly obesity-related cancers.

Yet, despite the health benefits, less than half   of private and public insurance plans currently offer coverage for anti-obesity medications.

A Promising Step Forward

A potential turning point came in November, when the White House announced a proposal to expand Medicare and Medicaid coverage for obesity medications. This long-overdue change could provide access to life-changing medications for an estimated 7.4 million Americans  

Historically, Medicare has excluded drugs used for weight-loss from its coverage, leaving millions of older Americans without affordable options for treatment. This exclusion has also made these drugs an optional drug benefit for Medicaid programs, leading to variation by state.

Under this new proposal, CMS would permit coverage of anti-obesity medications for the treatment of obesity when such drugs are indicated to reduce excess body weight and maintain weight reduction long-term for individuals with obesity.” This would not apply to patients who are overweight but who don’t have obesity. The plan could save about 75% of the cost for Medicaid beneficiaries, and up to 95% of the out-of-pocket costs for Medicare enrollees, reducing financial barriers to treatment.

This proposed rule signals an important shift in the federal approach to obesity management, aligning with the medical community’s consensus that obesity is a chronic disease requiring long-term care. It also highlights the economic and ethical imperative of addressing obesity proactively, rather than reactively.

The Double Standard of Coverage

Even with this encouraging progress, the private insurance landscape remains inconsistent. Insurers readily cover medications for high blood pressure, diabetes, and high cholesterol — diseases often linked to obesity — but frequently balk at covering treatments for obesity itself. This double standard is akin to offering treatment for a heart attack but denying preventive care to avoid it.

Why does a medication become “worthy” of coverage only after someone’s health has declined to the point of needing multiple drugs to manage preventable diseases?

The reluctance to cover obesity medications has consequences that extend far beyond individual patients. Untreated obesity costs employers billions in reduced productivity and contributes to rising rates of chronic diseases. Worse, the lack of coverage drives some patients to seek cheaper, unregulated alternatives, such as compounded or counterfeit drugs. These risky options    lack FDA oversight and can lead to overdose and severe side effects. By denying coverage, insurers are not only failing their members but also exacerbating public health risks. Finally, denying coverage reinforces harmful stereotypes. One of the most damaging misconceptions about obesity is that it’s merely the result of poor personal choices, and critics label these medications as a “quick fix.” By expanding private insurance coverage of GLP-1 medications, insurers can align with the medical societies and federal agencies that recognize obesity as a disease.

A Path Forward

The White House’s proposal is a major step in the right direction, but it also underscores the need for broader systemic change.

Beyond insurance plans, pharmaceutical companies must also work to make these medications more affordable, helping to ensure that access isn’t limited by cost. Failing to promote affordability across the board perpetuates our reactive, expensive healthcare model that treats symptoms rather than root causes.

This is a pivotal moment for healthcare in America. The proposed rule from the White House offers hope for millions struggling with obesity, but it must be matched by action from private insurers. Obesity is a disease, and it’s time everyone treats it as one. Our healthcare system cannot afford to turn a blind eye to the preventive power of anti-obesity medications.

Filed under: General Problems | 1 Comment »

 

 

 

 

 

 

 

 

 

 

Back  in the day, when I was in pharmacy school we were taught that we were an IMPORTANT PART OF THE SYSTEM. We were to make sure that the pt was not allergic to a new medication(s), the new medication(s) could cause some serious drug to drug interaction – especially a level 1 interaction, or the dose was too HIGH or too LOW!  Back in the day, if I was not sure about the pt’s new medication(s) and the three major “don’t go there”.  I had my best luck with trying to get the prescriber to make some changes/adjustments to what he/she had prescribed, was to tell the prescriber that the FDA professional literature did not support whatever I had a question about.  I found that more prescribers would reconsider their choices. As I matured, I changed my tactics. I would ask the prescriber, if the could help me understand why I shouldn’t be concerned about whatever he/she was prescribing for this pt?

I took the position, that if the prescriber justified his beliefs, I documented that I spoke with the prescriber and prescriber has no interest in changing the pt’s prescription. I would also consult with the pt to my concerns of what the prescriber had written for them and whatever adverse events that they need to be on the lookout for.  If things “went off the rails” for the pt. The prescriber and the pt made their own decisions and I had CYA myself.

Below is a email that Dr Ibsen sent me and asked me to share!

---

Kirsten was fired from her job.

I spent several hours of my time, finagling faxes and emails and FMLA forms.

I am beyond upset about this.

Kirsten has allowed me to share this story
I am sending it to Steve Ariens
For his blog to publish

This is a sickening situation. She came to me for help because her pain was untreated due to her severe inflammatory illness: ankylosing spondylitis.

Her previous doctor would only give her 10 mg of oxycodone four days a day.

At her request, I put her on 15 mg of oxycodone four times a day.

Her most recent prescription the pharmacist refused to Phil saying “I don’t know why she has to come to this Pharmacy”

This was very upsetting and destabilizing for Kirsten.

Eventually, she was fired from her job because of it.

A
Ankylosing spondylitis

P
Because of an interruption in her care, she lost her job. So now we have a person instead of working for a living and supporting her six-year-old daughter she now has to either look for work or take unemployment or file for disability. She was stable until this incident happened with her pharmacist.

I’m not sure what legal options Kirsten has, but I’m suggesting she talked to the insurance commissioner in the state of Montana. I thought it would also be a good idea for her to file a complaint against this pharmacist with the board of pharmacy because the pharmacist got her fired from her job. Whether or not she has a torque case or confined representation that will be up to Kirsten and her legal advisor.

Right now, I can categorically say she’s without work as a single mother because of the actions of her pharmacist.

 

Kirsten was fired from her job.

I spent several hours of my time, finagling faxes and emails and FMLA forms.

I am beyond upset about this.

Kirsten has allowed me to share this story
I am sending it to Steve Ariens
For his blog to publish

This is a sickening situation. She came to me for help because her pain was untreated due to her severe inflammatory illness: ankylosing spondylitis.

Her previous doctor would only give her 10 mg of oxycodone four days a week.

At her request, I put her on 15 mg of oxycodone four times a day.

Her most recent prescription the pharmacist refused to Phil saying “I don’t know why she has to come to this Pharmacy”

This was very upsetting and destabilizing for Kirsten.

Eventually, she was fired from her job because of it.

A
Ankylosing spondylitis

P
Because of an interruption in her care, she lost her job. So now we have a person instead of working for a living and supporting her six-year-old daughter she now has to either look for work or take unemployment or file for disability. She was stable until this incident happened with her pharmacist.

I’m not sure what legal options Kirsten has, but I’m suggesting she talked to the insurance commissioner in the state of Montana. I thought it would also be a good idea for her to file a complaint against this pharmacist with the board of pharmacy because the pharmacist got her fired from her job. Whether or not she has a torque case or confined representation that will be up to Kirsten and her legal advisor.

Right now, I can categorically say she’s without work as a single mother because of the actions of her pharmacist.

Filed under: General Problems | 3 Comments »

I am writing this on Saturday night @ 6PM (EST)

UPDATE Sunday 6:50 PM (EST): Our outside cameras around our house, it looks like it just started raining and the ambient temp is 26F.  Educated guess is that it is FREEZING RAIN. To point, we still have electricity from Duke Energy.

They are forecasting a major weather event for our area.  Because of the Ohio river near us, that is a “huge heat sink” and since Barb & I have lived in the area all our life, it can help shift a weather front a mile or so to 10s of miles.

The weather is now scheduled to encroach our area around 7 AM tomorrow ( Sunday) and continue on until late on Monday.

They tell us that we are on the edge of snow/ice line. South of us may get up to 0.75″ of ICE and we may get up to 0.5″ of ice. We are suppose to get some snow first, then the freezing rain, and then some more snow – up to 6″, and somewhere along the way we may get some sleet.   North of us – up towards Indianapolis may get up to 12″ of snow.

Regardless of what happens, we will be fine. We have a 20Kw whole house generator and abt 300 gal of propane in a buried tank in our yard to feed our generator and our central furnace.

Our generator is a auto-start, if Duke Energy’s system fails because of the ice, it will start automatically after abt 15 second. It automatically “exercises” itself every week – on Wednesday – and runs for 12 minutes. I checked the “log” on the generator a couple of days ago and it ran for its scheduled 12 minutes on Wednesday.

If/when the electricity fails, I am not sure if we will have cable/internet and/or cell service. So I am writing this now and when/if it all starts tomorrow, I will be able to just hit SEND.

Filed under: General Problems | 3 Comments »

UPDATE –This Pt posted a updated last night that SHE IS OK!

State Attorney Generals have sued the 3 major drug wholesalers and major chain pharmacies and getting them to agree to pay millions/billions in fines because – according the DOJ/DEA – they were accused of contributing to our fabricated Rx opioid/opiates crisis. They also agreed to sell/dispense fewer controlled Rx meds to pharmacies and pharmacies dispense fewer Rx controlled meds to pts.  Totally disregarding the valid medical necessity of any pts.

Here is a 8 page synopsis of the nearly 600 page agreement with the three major drug wholesalers – that control abt 85% of the market.

The 3-4 major PBMs are financially straggling community pharmacies – both chains and independent pharmacies.  I have read where for the first time in nearly 10 years the DEA is not going to reduce pharma production quotas in 2025.  Which suggests to me, that the state AGs agreement with the three major wholesalers and the major chain pharmacy, along with what appears that all the Rx controlled meds that have been allocated/rationed to all those pharmacies that are closing their doors for good. Are not being reallocated to the community pharmacies that are still open, but are just dropped out of the distribution channels.

About a third of America’s pharmacies have closed since 2010 – abt 20,000 pharmacies. https://www.usnews.com/news/health-news/articles/2024-12-04/almost-a-third-of-u-s-retail-pharmacies-have-closed-since-2010. Just imagine the number of controlled Rxs meds are no longer available for pharmacies to order from their drug wholesaler. It appears that more and more chronic pain pts have been pushed to the “end of their rope” with few or no pain management meds. As the woman who made the post below.

I’m done. I’ll can’t take this anymore. Love you all and please take care.

 

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Worse Outcomes After Esophagectomy at Private Equity-Owned Hospitals

Structural elements of private equity ownership linked to higher mortality, complication rates

https://www.medpagetoday.com/hematologyoncology/othercancers/113623

Esophagectomy outcomes trended in the wrong direction at hospitals owned by private-equity companies, a review of more than 9,000 cases showed.

Statistically significant differences existed for 30-day mortality, any complication, serious complications, and failure to rescue, all favoring non-equity hospitals. Private-equity ownership was associated with lower procedural volume, although only 5.5% of all cases came from private-equity hospitals.

Additional studies are required to identify drivers of the outcome disparities, improve performance, and inform policy decisions involving allocation of care for select surgical procedures, reported Jonathan Williams, MD, of the University of Michigan in Ann Arbor, and co-authors in JAMA Surgeryopens in a new tab or window.

“These findings suggest that poorer postoperative outcomes at private equity-acquired health centers may be attributed to characteristic structural differences associated with private equity acquisition,” the authors stated.

“Our sensitivity analysis, which analyzed comparative outcomes for similarly low-volume non-acquired and private equity-acquired health centers, showed a persistence in worse 30-day mortality and any complication rates for patients undergoing esophagectomy at private equity-acquired centers,” they added. “This finding suggests that there are additional contributing institutional factors at play at private equity-acquired health centers than simply a volume-outcome association for esophagectomy care.”

Structural elements potentially contributing to the outcome disparities might include intensive care unit organization and multidisciplinary care teams, which have been linked to fewer adverse events, as well as failure to rescue, nurse-to-patient ratio, and teaching hospital status.

Failure to rescue has received increased attention in surgical outcomes research, particularly for high-complexity procedures, Williams and colleagues noted. The outcome is based on the theory that the incidence of complications is not the primary driver of postoperative mortality, but instead delays or omissions in recognition and treatment of complications.

“The results of this study both confirm this association and show an association between hospital acquisition status and failure to rescue,” the authors stated.

The study was limited to Medicare patients, and older patients have an increased risk of complications, noted Aaron R. Dezube, MD, and Virginia Litle, MD, both of St. Elizabeth’s Medical Center in Brighton, Massachusetts, in an accompanying commentaryopens in a new tab or window. Additionally, the complication rates were low. As such, the findings might have limited generalizability to younger patients and high-volume academic centers.

Despite the limitations, the sensitivity analysis showed that non-acquired hospitals outperformed private equity-acquired facilities.

“The message from this article is the necessity to keep an eye not only on esophagectomy outcomes, but also on all complex surgical procedures among hospital types, and to raise the alarm if needed,” Dezube and Litle wrote. “Either private equity-acquired hospitals need to invest in quality databases, hire more staff, and educate staff on perioperative care, or they need to recognize the private inequity they are providing for complex cases.”

Private equity acquisition of health systems has increased involvement in the management of acute-care hospitals, Williams and co-authors noted in their introduction.

“The impetus of private equity acquisition of a healthcare institution is to directly manage and modify care delivery operations with a central goal of maximizing profit and limiting costly inefficiencies,” they continued. “As private equity acquisition of health systems has become more prevalent, both professional physician societies and governmental agencies have called for further investigationopens in a new tab or window of the association of these practices with care quality.”

MedPage Today took a closer lookopens in a new tab or window at some of the concerns about private-equity ownership in a recent end-of-year review of the topic.

Growing involvement of private-equity interests in hospital management has created a need to examine associations between private-equity acquisition and the quality of care for complex surgical procedures, such as esophagectomy.

Toward that end, the authors analyzed data from the Medicare Provider Analysis and Review to identify beneficiaries 65 or older who underwent elective esophagectomy from January 2016 through December 2020. They searched the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems to identify centers acquired by a private-equity entity. Finally, they linked the American Hospital Association Annual Survey to the AHRQ compendium by means of facilities’ unique CMS Certification Number.

During the study period, 954 centers performed esophagectomy, consisting of 132 private equity-acquired and 822 non-acquired centers. The number of hospitals performing esophagectomy declined over the study period. As compared with non-acquired centers, private equity-acquired hospitals had a lower annual esophagectomy case volume (2 vs 7, P<0.001), lower nurse-to-patient ratio (7.9 vs 9.6, P<0.001), were less likely to be a teaching institution (3.8% vs 24.5%, P<0.001), and more likely to be concentrated in the South (60.2% vs 32.8%) and West (27.8% vs 22.5%, P<0.001).

The analysis included 9,462 esophagectomy procedures, 517 (5.5%) of which were performed at private equity-acquired hospitals. Comparison of outcomes for non-acquired versus private equity-acquired hospitals produced the following results:

• 30-day mortality: 4.9% vs 8.1%, OR 1.82, P=0.002
• Serious complication: 14.3% vs 17.5%, OR 1.35, P=0.03
• Any complication: 30.1% vs 36.6%, OR 1.46, P=0.001
• Failure to rescue: 3.4% vs 5.9%, OR 1.86, P=0.004
• Readmission: 19.2% vs 21.1%, OR 1.13, P=0.28

“Our findings suggest that center-level factors outside of case volume alone may influence outcomes for patients undergoing high-complexity operations, which may better inform center designations by advocacy groups who have historically been focused on case volume alone,” the authors stated in their conclusions. “Further investigations into structural drivers of outcome differences at private equity-acquired health centers are necessary to inform potential regulations for esophagectomy care and other similar high-complexity surgical conditions.”

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I got a phone call yesterday. Actually this young woman was trying to send me a text message, pushed the wrong button(s) and ended up calling me.

She was probably in her 30’s, she said she had a 12 y/o who had developmental issues. She told me that she had been diagnosed with a STAGE 4 CANCER. She was being treated at one of those very large very recognizable MAJOR Health care system – east of the Mississippi.

She told me that she was told a few months ago that her cancer WAS CURED and they would start to reduce her pain management. Then a month or so ago, they told her that they were wrong, but they were going to continue reducing her pain management meds and her prognosis was MAYBE – ONE YEAR!

Maybe the doctors are more concerned about the $$ that are going to be expended on a terminal pts. So I asked www.perplexity.ai:  how much money is typically spent on healthcare in a person last two years of life.
I referred her to a physician who I know is very emphatic and taking on pts who he refers to as “pain refuges”. By referring, I mean that I gave her the doc’s two phone numbers & email and after I got off the phone with her… and call this doc and gave him a “heads-up” and the Cliff’s notes of what her health issues were!

how much money is typically spent on healthcare in a person last two years of life

Healthcare spending in the last two years of life is substantial and varies across countries, but generally represents a significant portion of lifetime healthcare expenditure. Here’s an overview of the typical costs:

## United States

In the US, healthcare spending in the final years of life is particularly high:

– The average healthcare cost in the last 12 months of life is approximately $80,000[4].
– For the last 3 years of life, the total healthcare expenditure averages around $155,000[4].
– A more detailed study found that the mean total healthcare cost in the last 2 years of life was $316,579 in 2000 dollars[1].

Citations:
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC1361028/
[2] https://www.rbcwealthmanagement.com/en-us/insights/the-real-cost-of-health-care-in-retirement
[3] https://trustees.aha.org/articles/852-health-care-costs-and-choices-in-the-last-years-of-life
[4] https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00176-4/fulltext
[5] https://www.nber.org/bah/2010no2/out-pocket-health-care-expenditures-end-life
[6] https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174

I remember when we had the pharmacy and Home Medical Equipment business and a female – who was a nurse – had come into town because her Father was dying of Lung Cancer. She was wanting to get her Father home Oxygen and she had talked to her Father’s pulmonologist about home oxygen and she said that the pulmonologist response to her was “.. he is dying, there is really no need “.   I don’t remember what we did, but I know my home care staff would do just about anything to get a pt’s needs taken care of.

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I asked www.perplexity.ai this:

how many people become chronic pain patients every day from accidents, injuries or new diagnosis of a painful disease

Based on the search results, approximately 52.4 new cases of chronic pain occur per 1,000 persons per year in the United States[4][6]. This translates to about 143 new cases of chronic pain per day per million people. The USA has abt 340 million population- translates to abt 50,000 new chronic pts every year.

To put this in perspective:

1. The incidence rate of chronic pain (52.4 cases per 1,000 person-years) is higher than that of other common chronic conditions:
– Diabetes: 7.1 cases per 1,000 person-years
– Depression: 15.9 cases per 1,000 person-years
– Hypertension: 45.3 cases per 1,000 person-years[4]

2. Among those who reported non-chronic pain in 2019, about 14.9% developed chronic pain by 2020, highlighting the importance of early pain management[4].

3. Chronic pain is highly persistent, with 61.4% of those reporting chronic pain in 2019 still experiencing it a year later[4].

4. For high-impact chronic pain (HICP), which limits life or work activities, the incidence rate is 12.0 cases per 1,000 person-years[6].

5. Motor vehicle accidents and work-related injuries are common causes of chronic pain[5]. A study found that 44% of individuals who had sustained severe accidental injuries reported accident-related pain 3 years after the incident[5].

These statistics underscore the significant burden of chronic pain in the U.S. population and emphasize the need for effective early interventions and pain management strategies[4][6].

Citations:
[1] https://uspainfoundation.org/news/the-impact-of-pain-in-america/
[2] https://www.gaspineortho.com/chronic-pain-after-a-car-accident/
[3] https://www.npr.org/sections/health-shots/2022/11/03/1133908157/new-opioid-prescribing-guidelines-give-doctors-more-leeway-to-treat-pain
[4] https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults
[5] https://pubmed.ncbi.nlm.nih.gov/19154854/
[6] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804995
[7] https://parris.com/news/personal-injury/types-of-pain-after-a-car-accident-acute-vs-chronic-pain
[8] https://pubmed.ncbi.nlm.nih.gov/33990113/
[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC4942849/
[10] https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm

 

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It is a fairly well accepted theory that under/untreated pain can/may cause elevated blood pressure and also that the 4 or 5 different categories of Pharma produced blood pressure meds will not do little/nothing to lower the pt’s blood pressure, because there is a separate biological pathway that is used to elevate blood pressure that the pharma meds do not address.

Here is the current levels and how they are categorized by the American Heart Assoc https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

It is a known fact that high blood pressure can cause kidney damage. IF a pt has been told that their pain meds are going to be lowered. Would it be a good idea for the pt to request lab test for these substances that are generated by the kidneys – to establish a base line – and when the pt’s blood pressure goes up – especially to HYPERTENSIVE CRISIS LEVEL to ask that they be run again and if they have changed dramatically and especially if they are outside of the normal range, would it suggest that the pt is/could be experiencing kidney damage because of their under/untreated pain. There is a number of damage to a pt’s body caused by elevated blood pressure, and the higher the blood pressure the more likely the damage will progress at a more rapid rate.  The DEA has always “hung their hat” on the claim that there is no way to document that a pt is dealing with pain and/or the intensity of their pain.  If the pt has had their pain meds reduced and their blood pressure has gone up – especially to  HYPERTENSIVE CRISIS LEVEL and their lab values from substance created by the kidney are now outside of normal values, could we back the DEA down? Would it be a good idea to put the pt back on their pain meds for 30 to 60 days and see if the pt’s blood pressure goes back down.  Then  perhaps it is time for some clinical trials to establish the relationship between under/untreated pain, high blood pressure and the lab values of those specific substances created by the kidneys being out of range.  All practitioners  are  suppose  be healers and allowing a pt to be at risk of all the potential damages of high blood pressure because of the failure to treat the pt’s chronic pain. The same theory should apply to Pharmacist who claim that they are “not comfortable” to fill pain meds for a pt.  Could some clinical trials turn the CDC dosing guidelines UPSIDE DOWN and be justification to have those guidelines and the MME system TOSSED IN THE TRASH?

Are there any substances produced by the kidneys that will affect or control blood pressure

Yes, the kidneys produce several substances that affect and control blood pressure:

1. Renin: This enzyme is produced by special cells in the kidneys and released into the bloodstream when blood pressure drops too low[2]. Renin plays a crucial role in activating the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure[3].

2. Angiotensin: While not directly produced by the kidneys, angiotensin is part of the RAAS. Renin from the kidneys acts on angiotensinogen (produced by the liver) to form angiotensin I, which is then converted to angiotensin II. Angiotensin II causes blood vessel constriction, increasing blood pressure[6].

3. Urotensin: The kidneys produce urotensin, which causes blood vessels to constrict and helps raise blood pressure[7].

4. Nitric oxide and prostaglandins: These substances, produced by the kidneys, help regulate blood flow and pressure within the kidneys and can influence overall blood pressure[1].

The kidneys also play a crucial role in regulating blood pressure by controlling sodium excretion. When too little sodium is excreted, blood pressure is likely to increase[7]. Additionally, the kidneys’ ability to excrete sodium in response to elevated blood pressure (pressure natriuresis) is a major factor in long-term blood pressure regulation[1][3].

Citations:
[1] https://www.jci.org/articles/view/72274
[2] https://my.clevelandclinic.org/health/body/22506-renin
[3] https://www.clinhypertensionjournal.com/articles/ach-aid1011.php
[4] https://newsroom.uvahealth.com/2022/01/11/blood-pressure-drugs-may-cause-kidney-damage-study-suggests/
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC5515225/
[6] https://my.clevelandclinic.org/health/articles/23359-angiotensin
[7] https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/biology-of-the-kidneys-and-urinary-tract/kidneys
[8] https://newsroom.uvahealth.com/2024/11/18/blood-pressure-kidney-damage/

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Is there a way to detect those substances in the patient’s blood

Yes, there are several ways to detect kidney-produced substances that affect blood pressure in a patient’s blood:

## Renin Test

A renin test, often performed alongside an aldosterone test, can measure the levels of renin in the blood[1][5]. This test is particularly useful for:

– Diagnosing the cause of high blood pressure, especially in younger patients
– Determining if high blood pressure is related to salt sensitivity
– Identifying potential adrenal gland issues

The test involves taking a blood sample, typically in the morning when renin levels are highest[1].

## Angiotensin II and Angiotensin (1-7) Test

This test directly measures the levels of Angiotensin II and Angiotensin (1-7) in plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS)[3]. It can be used as:

– An adjunct to plasma renin activity and aldosterone measurements
– A tool for investigating potential associations with outcomes of coronavirus infection

## Urotensin II Test

While less common, urotensin II levels can be measured in blood serum. This test has been used in research settings to study conditions like inflammatory bowel disease and may have implications for blood pressure regulation[4].

## ACE (Angiotensin-Converting Enzyme) Test

The ACE test measures the level of angiotensin-converting enzyme in the blood[7]. This enzyme plays a crucial role in the renin-angiotensin-aldosterone system, which regulates blood pressure.

When conducting these tests, it’s important to consider factors that may affect the results, such as:

– Time of day
– Patient’s body position
– Medications (especially blood pressure medications)
– Salt intake
– Stress levels
– Pregnancy

Healthcare providers may need to adjust a patient’s medications or diet before conducting these tests to ensure accurate results[1][6].

Citations:
[1] https://www.webmd.com/hypertension-high-blood-pressure/renin-test
[2] https://www.columbiadoctors.org/health-library/test/renin-blood-test/
[3] https://www.mayocliniclabs.com/test-notifications/attachment.php?id=64257
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC8476337/
[5] https://www.labcorp.com/tests/002006/renin-activity-plasma
[6] https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Genetics/Renin-and-aldosterone-test-2433-PIL.pdf
[7] https://www.ucsfhealth.org/medical-tests/ace-blood-test
[8] https://www.nature.com/articles/pr2017183
[9] https://medlineplus.gov/lab-tests/renin-test/
[10] https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=167&contentid=angiotensin_converting_enzyme_blood
[11] https://www.mayocliniclabs.com/test-catalog/overview/8060

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would those substances be higher or lower in the pt’s blood if the pt’s blood pressure in higher

In patients with higher blood pressure, the levels of substances produced by the kidneys that affect blood pressure can vary:

## Renin

Renin levels can be either high or low in patients with high blood pressure, depending on the underlying cause:

– High renin: This may indicate salt sensitivity or kidney problems[3][5].
– Low renin: This could suggest a condition called low renin hypertension (LRH) or primary aldosteronism[7][3].

## Angiotensin II

Angiotensin II levels are typically higher in patients with hypertension:

– Higher than normal angiotensin II levels cause excess fluid retention and high blood pressure[6].
– Elevated angiotensin II can contribute to heart enlargement in hypertensive patients[6].

## Aldosterone

Aldosterone levels can also be elevated in some forms of hypertension:

– High aldosterone with low renin may indicate primary aldosteronism, a cause of high blood pressure[3][5].
– Elevated aldosterone causes the kidneys to retain more water and salt, increasing blood volume and pressure[5].

## Angiotensinogen

Recent research has shown a positive association between angiotensinogen levels and blood pressure:

– Higher angiotensinogen levels are associated with higher odds of prevalent hypertension[2].
– The relationship between angiotensinogen and blood pressure appears to be stronger in males compared to females[2].

It’s important to note that the relationship between these substances and blood pressure is complex and can vary depending on the specific cause of hypertension. Measuring these substances, particularly through tests like the renin activity test and aldosterone levels, can help healthcare providers determine the underlying cause of high blood pressure and guide appropriate treatment.

Citations:
[1] https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/renin-test
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10352958/
[3] https://www.webmd.com/hypertension-high-blood-pressure/renin-test
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC1693859/
[5] https://my.clevelandclinic.org/health/body/22506-renin
[6] https://my.clevelandclinic.org/health/articles/23359-angiotensin
[7] https://www.healthline.com/health/high-blood-pressure-hypertension/low-renin-hypertension
[8] https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16514
[9] https://www.healthcentral.com/condition/hypertension/renin-activity-test

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what are the normal lab values for these substances Renin, Angiotensin, Urotensin, renin-angiotensin system activity, Nitric oxide and prostaglandins

Based on the provided search results, here are the normal lab values for some of the substances you inquired about:

## Renin

The normal range for Plasma Renin Activity (PRA) in adults varies slightly depending on the source:

– 0.7 to 3.3 ng/mL/hr (or 0.7 to 3.3 mcg/L/hr in SI units)[1]
– 0.2 to 1.6 ng/mL/hour while lying down and 0.5 to 4.0 ng/mL/hour while standing[4]

## Nitric Oxide

For serum nitric oxide metabolites (NOx):

– Men: 11.5 to 76.4 micromol/L
– Women: 10.1 to 65.6 micromol/L[3]

For exhaled nitric oxide (FeNO):

• Values below 25 parts per billion (ppb) are considered low
• Values above 50 ppb are considered high and consistent with type 2 inflammation

It’s worth noting that nitric oxide levels can vary based on factors such as age, height, gender, and certain medical conditions.

## Prostaglandin D2

For adults:

– 35-115 pg/mL[7]

## Angiotensin, Urotensin, and Renin-Angiotensin System Activity

The search results do not provide specific normal values for angiotensin, urotensin, or direct measurements of renin-angiotensin system activity.

It’s important to note that “normal” values can vary depending on the specific laboratory, testing method, and patient factors such as age, sex, and medical conditions. Additionally, some tests, like the aldosterone-renin ratio (ARR), use combinations of these values for diagnostic purposes. For example, an ARR greater than or equal to 20 with serum aldosterone greater than or equal to 15 ng/dL may indicate probable primary aldosteronism[2].

Citations:
[1] https://www.primaryaldosteronism.org/step-1-aldosterone-renin-ratio-arr/
[2] https://pediatric.testcatalog.org/show/PRA
[3] https://pubmed.ncbi.nlm.nih.gov/19782059/
[4] https://www.ucsfhealth.org/medical-tests/renin-blood-test
[5] https://pubmed.ncbi.nlm.nih.gov/8662293/
[6] https://journals.physiology.org/doi/full/10.1152/ajpregu.1999.276.4.R1125
[7] https://www.mayocliniclabs.com/test-notifications/attachment.php?id=58887

 

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