Closed Windows in Hospital Rooms May Raise Infection Risk

FRIDAY, April 19 (HealthDay News) -- Closed windows in large hospital wards may increase patients' risk of getting an infection, a new study suggests.

British researchers used carbon dioxide as a tracer gas to simulate how airborne infections spread in a traditional hospital ward, which typically includes two rows of up to 30 beds.

The carbon dioxide represented potentially infectious exhaled breath, and was released by popping carbon dioxide-filled balloons. Carbon dioxide detectors were placed where beds might be located in a functioning ward.

"By measuring the concentration of the gas over time, we were able to quantify the exposure at each bed and therefore the potential risk to a patient in that bed," study team member Laura Pickin said in a University of Leeds news release. "We were also able to use the same data to measure the overall ventilation rate in the ward."

When the windows were open, ventilation in the ward was generally good and the risk of airborne infection low. But the danger of infection increased fourfold when the windows were closed, according to the study in the current online issue of the Building and Environment Journal.

"These wards are still in operation and, although they have often been subdivided into smaller areas with six to eight beds, their ventilation and structure is still fundamentally the same," lead investigator Cath Noakes, from the University of Leeds' School of Civil Engineering, said in the news release.

With natural ventilation from windows, the wards are safe. But that changes when the windows are closed during the winter or permanently sealed to lower energy costs.

"Some of these wards were designed by the Victorians, and our results show that they knew what they were doing. But there is a danger that we could be adapting our buildings to improve efficiency without thinking how it might affect patients," Noakes said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Leeds, news release, April 16, 2013

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Charges Vary Widely From Hospital to Hospital: FAQ

May 31, 2013 -- Major joint replacement surgery costs $128,000 at a hospital in San Francisco and $59,000 at one in Chicago. Post-heart attack care ranges from $34,000 in a Little Rock facility to $81,000 in a Miami hospital.

The wide variation in pricing among U.S. hospitals became public when the federal government recently released prices charged by more than 3,000 hospitals. The Department of Health and Human Services (HHS) said it released the data to fulfill a mandate of the Affordable Care Act to bring more transparency to hospital pricing practices.

Yet, do these numbers really help people save money and make more informed health care choices?

WebMD went to a health care economist, the American Hospital Association (AHA), and the HHS for answers. 

What does the information on hospital pricing show?

The HHS data shows the prices hospitals in different markets charged in 2011 for the 100 most common inpatient services for Medicare patients. It also shows what the government paid to the hospitals for those services. The numbers are rarely the same.

Medicare sets a fixed payment rate for the overall type of service or treatment, such as joint replacement surgery, as opposed to the number of times a doctor sees a patient or the number of procedures a patient receives during one hospital stay. This is known as paying by episode. The rate it pays varies by hospital. Things affecting that rate include the number of low-income or sicker people the hospital serves and whether the hospital is an educational teaching facility.

Why is there such a big cost difference for the same services?

Hospital rates are based on a number of factors, according to the American Hospital Association, including:

Scope of services providedWhether the hospital serves a large portion of poorer and sicker patientsCommunity reputation of the hospital

The difference in costs between one hospital and another is a "byproduct" of the marketplace, says the AHA.

Caroline Steinberg, the AHA's vice president of trends analysis, believes the focus should shift from pricing to what hospitals actually collect for their services. Medicare and private insurer payments to hospitals are typically far lower than the stated cost. Medicare sets the rate of reimbursement, even though it adjusts the rates according to factors like the number of poorer people the hospital serves, Steinberg says.

But economist William Custer, PhD, director of health services research at the Institute of Health Administration at Georgia State University, says these factors can't explain the cost variations. 

"Hospitals have historically set prices based on their own methodology. One hospital can set prices three times greater than another; there's no real pattern," says Custer. "If we had a healthy health services market, you would expect those prices to be much closer aligned."

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How Much Does It Cost to Have a Baby? Hospital Costs, Baby Supplies, and More

The expenses you’ll face when you have your first baby, and tips for spending wisely on your newborn.

If you're thinking about having a baby, you're probably thinking of the joy of holding your newborn in your arms -- not the financial costs.

But sooner or later, you run into the expenses involved with a pregnancy. And although the experience of becoming a parent is priceless, you'll also want to make sure your money is well spent.

From the price of diapers to the going rate for a cesarean section, here's the bottom line on what it costs to have a baby, as well as how to save wisely on those costs.

It's easy to get excited about buying baby supplies. But your top priority for pregnancy spending should be on health -- of mother and baby.

"Early and continuous prenatal care is essential both before and throughout your pregnancy to help ensure a healthy delivery and healthy baby," says Jeanne Conry, MD, an obstetrician with Kaiser Permanente in Sacramento, Calif.

If you have health insurance, prenatal visits and any diagnostic tests (such as ultrasounds) will likely be covered. They are generally considered "preventive" care.

If you don't have health insurance, the average cost of prenatal care is about $2,000.

One of the most important parts of prenatal care is a prenatal vitamin. You need one that contains at least 400 micrograms (mcg) of folic acid to help prevent neural tube birth defects.

This is one cost you should start paying even before you get pregnant. About half of all pregnancies are surprises. So all women of childbearing age should take a multivitamin that contains folic acid, Conry says.

For an over-the-counter option, the cost ranges from $10 to $20. If it's prescribed by your doctor and covered by your insurance you'll pay whatever the co-pay price is. Either way, this could be one of the most important pregnancy investments you make.

Shopping for a newborn baby can be overwhelming. You don't want to go overboard on expensive baby luxuries that aren't must-haves.

"There are thousands of baby products on the market for new moms to consider, but frankly speaking, most are nice-to-haves," says Lori Hill, a certified doula in Williamsburg, Va.

You should first focus on what you and your baby must have, she says. Then figure out how much you have left over to spend on accessories.

Some basic supplies to consider buying include:

Car seatCribDiapers and wipesChanging tableA few baby clothes to get you startedBaby monitor

A thrifty parent can buy these for about $450 by shopping for bargains.

But don't sacrifice safety to save a buck, especially on the car seat and crib. The American Academy of Pediatrics recommends that you avoid older, used car seats to get maximum protection for your child. Use cribs certified by the Juvenile Products Manufacturers Association (JPMA).

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New public database shows hospital billing charges all over the map

Posted May 10, 2013, 8:27 am

Most reputable companies that provide services tell you what you’ll get for your money. Hospitals are an exception. They haven’t traditionally made public the cost of operations and other procedures. This secrecy has let hospitals set widely different prices for the same procedure. It’s also made it impossible to do any comparison shopping.

Yesterday’s release to the public of a once very private database shows just how big the differences can be from hospital to hospital.

On the South Side of Chicago, where I grew up, one hospital’s charge for implanting a pacemaker to keep the heart beating at a steady rhythm was $49,601, while another hospital charged $63,979 to do it. In Boston, a hospital not far from where I work charged $76,121 to implant a pacemaker while another hospital less than three miles away charged $55,687.

According to The New York Times, the Keck Hospital of the University of Southern California charged an average of $123,885 for a major artificial joint replacement (six times the average amount that Medicare reimbursed for the procedure) while Centinela Hospital Medical Center, also in Los Angeles, charged $220,881 for the same type of joint replacement surgery.

The database, released by the Centers for Medicare and Medicaid Services, details what 3,300 hospitals charged for the 100 most common treatments and procedures in 2011.

The data reinforce the big differences in charges from one part of the U.S. to another. What’s new and surprising are the huge differences sometimes seen between hospitals in the same city, or even the same neighborhood.

Keep in mind that these “charges” aren’t hard and fast. Medicare doesn’t pay the full charge. Insurers don’t either, as many of them negotiate lower charges. As NPR’s Robert Siegel said about the database, “it sounds like what you’ve got is a survey of the sticker prices in car lots all around America, but every deal is a special deal.”

At least for now, the database isn’t especially easy to use. It’s just an Excel spreadsheet listing the hospitals by state along their charges for the 100 procedures. The Washington Post created a nifty interactive tool that you can use to look at charges in your state for 10 conditions. Choose your state and the tool shows how its hospitals stack up against the national average, as well as the highest and lowest charges for these ten procedures. Expect other creative apps incorporating this information to be coming along soon.

If you decide to dive into the data, be aware—especially if you have private insurance (not Medicare)—that appearances can be deceiving. It may look like Hospital A charges more than Hospital B, but that may not be so. Your insurer and Hospital may have actually agreed on a lower payment. So the data don’t necessarily say what your insurance company is actually going to pay.

A few weeks ago, I finally finished reading “Bitter Pill,” Steven Brill’s extraordinary Time magazine article on the crazy cost of healthcare in America. I say “crazy” because, according to Brill, how hospitals set their prices has little rhyme or reason. The database from the Centers for Medicare and Medicaid Services reinforces that notion.

Publishing this information is one small step toward making the cost of healthcare more transparent. While it will be a long time before most of us will be able to figure out how much an operation or a hospital stay costs, the database could nudge hospitals with exorbitant charges to bring them in line.

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Little-Known Respiratory Infection Sends Many Kids to Hospital

Title: Little-Known Respiratory Infection Sends Many Kids to Hospital
Category: Health News
Created: 2/13/2013 6:36:00 PM
Last Editorial Review: 2/14/2013 12:00:00 AM

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Little-Known Virus Sends Many Kids to Hospital

By Serena Gordon

HealthDay Reporter

WEDNESDAY, Feb. 13 (HealthDay News) -- Chances are you've never heard of human metapneumovirus. But, it's quite possible that you've been sick with this respiratory germ at some point in your life.

Discovered only 12 years ago, human metapneumovirus (HMPV) shares many symptoms with the flu. And, like the flu, most people who get it are miserable for a short time and then get better with no complications.

But the virus can cause serious illness, and in a recent study in U.S. children, researchers found that 6 percent of children who were hospitalized had HPMV, while 7 percent of pediatric emergency room visits were due to the virus.

"It turns out that human metapneumovirus is one of the most common causes of acute respiratory infections," said study senior author Dr. John Williams, an associate professor of pediatrics at the Vanderbilt University School of Medicine in Nashville, Tenn.

"Everyone knows about flu and RSV [respiratory syncytial virus], but it's just in the last couple of years that HPMV is making it into the medical school textbooks. For otherwise healthy children and adults, it tends to be a minor illness, like a cold, but populations that are vulnerable to one of these viruses are vulnerable to all of them," said Williams, who added that this generally includes the very young, the very old and people with underlying health problems, such as asthma or chronic heart disease.

"Now, that we've discovered this leading cause of respiratory infections in kids, it gives us a target for a vaccine," he noted.

The study was supported by a grant from the New Vaccine Surveillance Network of the U.S. Centers for Disease Control and Prevention. It was published in the Feb. 14 issue of the New England Journal of Medicine.

Human metapneumovirus was only discovered in 2001, though it was likely causing disease for many years before it was identified, according to background information in the study. And, although it's been a dozen years since the disease was discovered, it was still unclear how often people were infected, and how severe the illness could be.

To track down these answers, Williams and his Vanderbilt colleague Dr. Kathryn Edwards, along with other researchers, collected data on the virus from hospitals in three U.S. counties from 2003 through 2009.

They found the virus in 200 of 3,490 children (6 percent) hospitalized during that time period. Of 3,257 outpatient clinic visits, they found 7 percent of children had HPMV. And, of 3,001 children seen in emergency rooms, 7 percent had the virus. The researchers also tested 770 children who weren't having any symptoms, and found the virus in 1 percent.

Annually, one out of every 1,000 hospitalizations in children less than 5 years old was due to human metapneumovirus. In those less than 6 months of age, the rate of hospitalization due to HPMV was three per 1,000. In children aged 6 months to 1 year, that number was two per 1,000, according to the study.

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