Category Archives: Valley Medical Center

Making hard decisions: WSU President Elson Floyd on splitting up with UW – Puget Sound Business Journal

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elson-floyd-wsu-president*304xx2996-4494-299-0Q: What brought about the decision to split up?

A: It was the view of the UW that in order to continue our participation in the WWAMI program we had to be “100 percent in,” and that was the term that was used by UW. And by that they meant we could not continue in the WWAMI program while pursuing aspirations to have a second medical school in the state.

via Making hard decisions: WSU President Elson Floyd on splitting up with UW – Puget Sound Business Journal.

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UW snaps back against WSU over med school – Puget Sound Business Journal

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UW WashingtonStateCougarsUW officials say the study wildly over-estimated the cost per student to attend medical school at UW.

They also claim a new medical school would suck resources from the existing medical program known as WWAMI, which is named for the five states it operates in: Washington, Wyoming, Alaska, Montana and Idaho. Washington State University is part of the program.

via UW snaps back against WSU over med school – Puget Sound Business Journal.

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WSU: Community health services key to economic development – Puget Sound Business Journal

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WashingtonStateCougarsDoctor shortages and economic development: Those were the two major issues Washington State University officials emphasized Monday after last week’s release of a feasibility study that examined the prospects for a new medical school in Spokane.

via WSU: Community health services key to economic development – Puget Sound Business Journal.

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Valley Medical Center CEO gets pay cut – but package will still top $1 million

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H for hospitalBy Lewis Kamb, The Seattle Time
This story was produced in partnership with 

Washington’s highest-paid public-hospital executive has won a new two-year employment contract that will pay him more than $1 million a year in salary and bonuses.

But for longtime Valley Medical Center Chief Executive Rich Roodman, the deal amounts to a pay cut.

Roodman’s contract was the focus of a Kaiser Health News story last June, which looked at how incentives for hospital CEOS were driving the kind of hospital profits and expansion that many say are no longer affordable for patients, employers and taxpayers.

The 30-year CEO of the Renton hospital — whose soaring pay has stirred local controversy for years — won unanimous approval for the contract extension Tuesday from the Valley Medical board of trustees.

“We need strong leadership during this period of health-care change,” trustee Bernie Dochnahl said before the vote. Other trustees said the contract represented a good compromise that recognized Roodman’s service but paved the way for new leadership.

Dr. Paul Joos, an outspoken critic of Roodman’s, said the negotiation process revealed possible past errors and “struck a good compromise for the future.”

He noted the search for Roodman’s successor will begin immediately.

Roodman, who attended Tuesday’s board meeting, slipped out without comment after it concluded.

Tuesday’s approval ensures Roodman, 65, will continue working as the top executive of taxpayer-funded Valley Medical Center —- the centerpiece of King County Public Hospital District No. 1 — through at least Jan. 1, 2016. It also signals that his time is coming to an end.

The current contract for Roodman, who earned $1.3 million in total pay last year, expires at month’s end.

Under the new contract, Roodman’s current base salary of about $769,000 will be frozen. He will still get up to $238,341 in annual incentives, but contributions to his supplemental retirement plans stop, as do “retention” bonuses that have recently garnered him more than $235,000 per year.

The contract includes five weeks of annual vacation, standard health benefits provided to hospital executives and physicians, and a car allowance. It also offers Roodman the possibility to work for another year.

Once Roodman retires, he’ll walk away with a $7.5 million retirement package, records show. The amount includes a standard hospital-executive retirement plan valued at $1.6 million, plus supplemental retirement plans worth $3.4 million and two life-insurance policies valued at $2.5 million.

Valley Medical Center, a 303-bed acute-care hospital, serves more than 400,000 South King County residents as part of the state’s largest public hospital district, which encompasses the cities of Kent and Renton and includes parts of Tukwila, Auburn, Black Diamond, Covington, Federal Way, Maple Valley, Newcastle and Seattle.

In 2013, the owner of a typical home in the district assessed at $210,000 paid about $105 in property taxes under the district’s tax rate of 50 cents per $1,000 of assessed value, according to the King County Assessor’s Office.

Seattle Times reporter Christine Clarridge contributed.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Nearly 1,500 hospitals penalized under Medicare quality program

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hospital magnify 300By Jordan Rau
KHN Staff Writer

More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.

Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates.

Another 1,451 hospitals are being paid less for each Medicare patient they treat.

For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings.

Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.

The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.

“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.

Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms.

Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.

“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”

Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis.

Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.

How A Hospital Is Rated

Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers.

The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.

To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals.

A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement.

It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.

This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.

Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.

The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations.

Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.

Will Penalties Bring Change?

Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.

“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health.  Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods.

“The fiscal penalties are nominal, frankly, in the scheme of things,” she said.

Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”

The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates.

“They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”

The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent.  Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements.

The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.

The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.

“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”

Many Past Winners Continue To Get Bonuses

Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores.

Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.

A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.

This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money.

Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.

The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.

For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent.

As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country.

Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.

Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.

Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.

Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.

Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010.

For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.

The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.

Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.

In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.

Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.

“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”

Read More:

jrau@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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How much should hospital executives be paid? – Viewpoint

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H for hospitalBy Kathleen O’Connor
Publisher of the O’Connor Report

This year was the first year that hospitals in Washington State were required to report their executives’ compensation.  I did not conduct this research independently.

The figures below are what the hospitals themselves reported to the Department of Health.  The complete list of executive pay in not-for-profit hospitals can be found on The Department of Health website here.

For profit hospitals were not required to report their executive compensation, presumably for proprietary reasons. Some hospitals and hospital systems apparently chose not to report. See the list of non-responders at the end of this article.

These salaries raise more questions than answers.  The differences between hospitals are staggering and incomprehensible. I offer questions for Boards of Directors and consumers at the end of the article.

We have several millionaires. Some in places I would not have predicted. In order of magnitude:

  • Gary Kaplan, MDVirginia Mason Medical Center, Seattle                   $3,737,678
  • John Evans, Jr., Central Washington Medical Center, Wenatchee   $1,766,084
  • Rich Roodman, Valley Medical Center, Renton                                          $1,285,860
                                               
  • Elaine Couture, Providence Sacred Heart, Spokane                                $1,034,994
  • Medrice Caluccio, Providence St. Peter, Olympia                                     $1,010,027

 

Top Seattle Hospitals

The following is the compensation details only for the top administrator at the four top Seattle hospitals.  Swedish has several sites.

Details on other executives’ compensation are included in the compensation data on the DOH website referenced above.

Harborview Medical Center: 

Eileen Whalen, base salary $485,000, bonus incentive -0-, other $1,692, retirement/deferred compensation $61,550non-taxable benefits, $19, 268 Total:  $567,599

Swedish Medical Center: First Hill

Todd Strumwasser, base $435,848, bonus incentive $2500, other $71,000, retirement/deferred $76,928, nontaxable benefits $21,928 Total:  $607,702

Swedish Medical Center:  Cherry Hill

 Rayburn Lewis, base $303,584, bonus incentive $24, other $51,875, retire/deferred $51,194, non taxable $17,713 Total: $424,390

 Swedish Medical Center: Ballard

 Jennifer Graves, base $241,620, other -0-, bonus incentive $37,500 retire/deferred $12,882, nontaxable $11,245 Total: $303,187

 University of Washington Medical Center: 

 Stephen Zieniewicz, base $518,405, bonus -0-, other $1692, retire/deferred $61,793, non taxable $23,942, Total:  $605,832

 Virginia Mason Medical Center

Gary Kaplan, MD base $1,039,978, bonus incentive $449,871, other $17,788, retire/deferred $2,199,932, non-taxable $30,109 Total: $3,737,678

 Other State Hospitals and Medical Centers

Valley Medical Center, Renton, Washington

 Rich Roodman, base $706,575, bonus incentive $487,105, other $33,306, retire/deferred $32,201, nontaxable $26,471. Total:  $1,285,860

Evergreen Medical Center, Bellevue

Robert Malte, base $592,423, bonus incentive -0-, other $51,581, retire/deferred $194,960, nontaxable $4,272, Total:  $843,236

Providence Sacred Heart, Spokane

Elaine Couture, base $360,667, bonus incentive $592,708, other $17,901, retire/deferred $46,618, nontaxable $17,100 Total: $1,034,994

Providence St. Peter, Olympia

Medrice Caluccio base $417, bonus incentive $141,498, other $17,577, retire/deferred $419,464, non taxable $15,710 Total:  $1,010,027

Central Washington Medical Center, Wenatchee

John Evans, Jr. base $141,598, bonus incentive -0-, other $1,491,778, retire/deferred $127,110 nontaxable $5,597 Total:  $1,766,084

Smaller Hospitals: Top Administrators Total Salaries

Lake Chelan                                                       $177,242

Forks                                                                     $217,892

Lourdes Medical Center, Pasco                 $823,668

Skagit County Hospital, Anacortes           $378,386

Yakima Valley Memorial Hospital            $565,441

Kittitas Valley Hospital, Ellensburg         $277,674

Kadlac Medical Center, Richland              $879,058

Walla Walla General Hospital                   $393,221

Shriners’ Hospital for Children                  $144,910 (Spokane)

Mid-Valley Hospital, Omak                        $159,972

Hospitals Not Reporting

For profit hospitals were not required to report, presumably for proprietary reasons.  Other hospital and health systems apparently chose not to report.  All these hospitals accept public money in the form of Medicaid and Medicare money.

There were some health systems that were not abundantly clear about who made what at which hospital, such as Multicare Health System out of Tacoma.

It was not clear what was Multicare, Mary Bridge Children’s Hospital and their other hospitals, so they were not included here. You can check them online at the DOH website.

Not reporting: 

Overlake Medical Center, Bellevue

Seattle Children’s Hospital

Seattle Cancer Care Alliance

Peace Health Hospitals

Franciscan Health System Hospitals

It’s Time for Accountability

Each of these organizations has a Board of Directors, Trustees or Commissioners.  You can go to each hospital website. If you do not easily find the list of their Boards of Directors/Trustees/Commissioners, you can type in “Board of Directors” in the search function on their website and the information will come up.

For example, here is the list of the Board of Trustees for Virginia Mason.https://www.virginiamason.org/BoardMembers

Swedish:  http://www.swedish.org/About/Overview/Leadership—Governance/Community-Board#axzz2WpWdCSEa

University of Washington Medical Center: http://www.uwmedicine.org/Global/About/Pages/UWMedicineBoard.aspx

Harborview:  http://www.uwmedicine.org/Patient-Care/Locations/HMC/About/Pages/Board-of-Trustees.aspx

Central Washington Medical Center:  http://www.cwhs.com/Content.aspx?id=71&terms=board%20of%20directors

Valley Medical Center:  https://www.valleymed.org/About-Us/Meet-the-Board/

Providence Health System:  This is more difficult since it is a health system, and there is a system board, as well as a local board, but here is Spokane:http://washington.providence.org/donate/providence-health-care-foundation-eastern-wa/board-of-directors/

Mid Valley Medical Center, Omak http://www.mvhealth.org/leadership

Forks Community Hospital, Forks, http://www.forkshospital.org/board-minutes

What We Need to Do

As members of Boards of Trustees, Commissioners, you need to ask the hard questions:

  • What value and outcomes are you getting in your community for the salaries you are paying your executives?
  • Are they improving patient care?
  • What are patient outcomes?
  • How many readmissions do you have that may have been avoided?
  • How are you doing in managing hospital infections?
  • How much uncompensated care does the hospital provide as compared to other hospitals in the community?

This last question, of course, would not apply to communities such as Omak or Forks where they are the only hospital.

Certainly the choices in Omak and Forks are different than the ones in Tacoma and Seattle, but the question is, how do we hold our health care institutions accountable?

I believe, but I do not know for certain, that many Boards of Trustees are paid to serve on these Boards.  If you are paid to serve, who is going to ask the hard questions?  Who is going to ask about outcomes, readmission rates, infection control, necessary or unnecessary surgeries?

Certainly the problems in Forks, Omak and other disproportionate share rural hospitals are different from an urban Swedish or Evergreen.  But we all need to be smarter about health care.

I offer two sites in Washington State that are dealing with documented health care outcomes as determined voluntarily by community practicing doctors:  http://www.qualityhealth.org and its respective programs and the Bree collaborative:  http://www.hta.hca.wa.gov/bree.html

As patients and consumers, we need to hold the Boards of Directors/Trustees accountable.  Your doctor determines where you go, because of admitting privileges and insurance contracts.  Ask him or her why they chose to work with the hospital they use.  Talk to the hospital board of director members.  Look at the outcomes from facility to facility.

I don’t know how many states require hospitals to report their compensation.  But it is time we had community conversations about what we expect from these institutions in return for our community investments.

I am not the only person looking into this.  

Here is an article by Kaiser Health News: Hospitals reward CEOs for growth that increase costs.

Kathleen O’Connor, MA: O’Connor, publisher of the O’ConnorReport, has nearly 30 years experience in health care reform publishing and consulting, reform strategies, and consumer advocacy locally and nationally.  She is a member of the Association of Health Care Journalists.

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Sign for an emergency room.

Hospitals reward CEOs for growth that increases costs

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By Jay Hancock
KHN Staff Writer 

This KHN story was produced in collaboration with 

Sign for an emergency room.Like hospital leaders everywhere, the people running Valley Medical Center in Renton, Wash., talk frequently about the need to control soaring medical costs.

“We are working to reduce the overall cost of health care and to transfor

m health care delivery,” Lisa Jensen, chairwoman of the hospital’s board of trustees, said last year.

Experts believe that’s a good prescription for the entire U.S. health industry, which costs the economy far more than systems in other developed countries, delivers mediocre results and is widely seen as unsustainable at its current growth rate.

But even as Valley officials talk about change, they’re paying hospital CEO Richard Roodman tens of thousands of dollars in bonuses for driving the kind of profits and expansion many say are no longer affordable for patients, employers and taxpayers.

Across the nation, boards at nonprofit hospitals such as Valley are often paying bosses much more for boosting volume rather than delivering value, according to interviews with compensation consultants and an examination of CEOs’ employment contracts and bonus packages.

Such deals undermine measures in the 2010 health law that aim to cut unnecessary treatment and control costs, say economists and policy authorities.

Story Components

KHN, in collaboration with ABC News, investigates hospital leader pay at nonprofit hospital systems.

Hospital CEO Bonuses Reward Volume And Growth

“Boards of trustees in health care are oriented around top-line, revenue goals,” said Dr. Donald Berwick, a longtime reform advocate who ran Medicare and Medicaid for President Barack Obama until December 2011. “They celebrate the CEO when the hospital is full instead of rewarding business models that improve patients’ care.”

Thirty percent of what’s spent on U.S. health care is unnecessary, studies have estimated. U.S. hospitals spend twice as much per discharged patient as those in other developed nations without delivering much better results, according to research financed by the Commonwealth Fund.

As public and private budget pressures prompt sharper questions about how the system got so bloated, here is one answer: Hospital CEOs are paid to make it that way.

Kaiser Health News obtained compensation details for CEOs at dozens of top nonprofit and government-supported hospital systems for 2011 or 2012 via public information requests and tax filings. As many bosses noted, their incentives for growth and profits are often part of a package that also promotes clinical quality, patient satisfaction or other goals.

“More than 60 percent of my performance incentives were either in academic missions or quality measures,” said Dr. Sheldon Retchin, CEO of the Virginia Commonwealth University Health System in Richmond.  “To say that I’m only interested in profits misses the entire mission.” Read Retchin’s full response.

Retchin’s goals for earning a bonus of $205,885 (plus a salary of $864,700) included boosting profits, surgeries, admissions and outpatient visits. For all the talk about reform, CEO incentives for traditional financial goals of boosting revenue and the bottom line still far outweigh those for rigorous quality and efficiency targets, experts say.

“What you’re seeing is incentive plans that look pretty similar to what they looked like five years ago or ten years ago,” said James Guthrie, a hospital compensation consultant for Integrated Healthcare Strategies. “They’re changing, but they’re changing fairly slowly.”

Along with those of smaller hospitals such as Valley, KHN examined CEO pay records from 30 of the largest private and public nonprofit hospital systems. Nonprofits deliver the large majority of hospital care. KHN did not query for-profit hospitals, whose leaders have long focused on growth and the bottom line.

Examples of CEO pay linked to finance and growth include:

Feinberg

Incentive targets for UCLA Hospital System CEO Dr. David Feinberg included increased profits, revenues and “further hospital system growth,” such as completing a $572 million rebuilding of the system’s Santa Monica campus. Feinberg earned a 2012 bonus of $262,534.

Growth accounts for “only a fraction” of Feinberg’s bonus, a systemspokeswoman said.

Fine

At Banner Health, a large, nonprofit system based in Arizona, CEO Peter Fine speaks of “an unwavering commitment to improve clinical quality and efficiency.” But Fine’s long-term incentive goals included profits and revenue growth, the organization’s most recent filings with the Internal Revenue Service show.

Banner has been shifting incentive goals away from profits, and “the gap between financial and clinical quality is dramatically closing for us,” a spokesman said. Read Banner’s full response.

Gabbe

Goals for the $84,394 bonus earned in fiscal 2012 by Dr. Steven Gabbe, CEO of Ohio State University’s Wexner Medical Center, included profits, cash, and growth in admissions, according to internal documents. Read OSU’s response.

 

Tarwater

Michael Tarwater, CEO of fast-growing, Charlotte-based Carolinas HealthCare System, earned a $2.8 million bonus last year that included $1.6 million tied to targets including undisclosed financial goals. His total pay of $4.8 million that year reflects the “growth in scope and scale” of the organization, according to the system. Read Carolinas’ response.

 

Migoya

In Miami, the more profit Jackson Health System records, the bigger the bonus CEO Carlos Migoya can earn. For raising net assets past a certain point last year, he was eligible to receive a portion of the increase up to about $295,000, according to his employment contract. In March, Migoya donated the bonus — it came to $160,000 — to charity. Read Jackson’s response.

 

Dean

Incentive goals for Lloyd Dean, CEO of Dignity Health, a large Catholic system based in San Francisco, include unspecified “annual and long-term financial performance,” according to its most recent IRS filing. Dean’s bonus for 2011 was $2.1 million. Read Dignity’s response.

 

Howell

At the University of Virginia Medical Center, CEO R. Edward Howell proposed that his 2012 incentive bonus be tied partly to profits, new clinical initiatives and “expansion of the UVA Health System,” according to internal documents. His performance bonus paid in 2012 came to $199,002. Read UVA’s response.

 

But constant expansion at the UVA Health System and elsewhere, sought by trustees and prized as a source of jobs by community leaders, drives up insurance premiums and government spending.

As health care takes up larger and larger portions of the economy, it consumes resources that might be better spent on schools, roads, corporate investment or raises for American workers, economists say.

“If the creation of jobs comes when you have overpaying systems … then growth is a reflection of screwy incentives and misalignment of payments,” said Barak Richman, a Duke University law professor who specializes in health and economics. “Ultimately we’re all paying for it. It’s coming right out of our pockets.”

Richard Umbdenstock, CEO of the American Hospital Association, defended financial goals in executive bonus packages.

“They have to include profitability or you are out of business tomorrow,” he said.

And while targets for revenue and admissions growth reflect a system that has traditionally rewarded volume, CEO incentive goals “are changing,” he added. “They are moving toward a greater balance toward quality and safety, patient satisfaction, employee satisfaction and finances.”

Growth has been the theme at Valley Medical Center almost since CEO Richard Roodman took over in 1983. Valley is a 300-bed community hospital in suburban Seattle that gets a cut of local property taxes.

In a story matched at hospitals across the country, the institution has repeatedly added space, programs, amenities and technology once reserved for top teaching hospitals to become Renton’s second-biggest employer, after aircraft maker Boeing.

Patient revenue doubled over the decade ending in 2012, to $406 million, as Valley added a new surgery center; a $115 million tower that included an expanded emergency department and a joint and spine center; a birthing center with whirlpool tubs and reclining chairs for dads; and a “soothing, light-filled lobby” with pyramid skylights and waterfalls.

Roodman had extra reason to celebrate the ribbon-cutting ceremonies and expansion milestones. Often, they were tied to rewards in his paycheck.

Kaiser Health News focused on Roodman’s incentives not because they are unusual but rather the contrary; experts say they are typical. Washington’s public record laws ensure that more detail is available on executive pay at Valley than at hospitals in other states.

Roodman declined to be interviewed, but he answered questions via email, noting that Valley delivers millions in uncompensated care each year and stating that the best treatment and care for lower-income patients can be delivered only when hospitals are financially strong.

“Improving the health of our patients through the highest quality, safest and most effective care cannot occur in a vacuum,” he said. “For us, growth is necessary as long as the demand remains, and we are growing as responsibly as possible.”

In 2012 Roodman’s pay was $1.2 million. That included a $213,000 bonus, about a third of which was related to financial goals and expansion.

Over several years his pay repeatedly included rewards triggered by specific achievements in building the hospital’s business. For example, when Valley exceeded profit goals for three consecutive years, Roodman earned a bonus each time.

When patient volume increased at the hospital’s primary and specialty care clinics in 2009, he got a bonus. When urgent-care center visits grew the same year, he got another bonus.

While reformers focus on changing the “pay per procedure” incentives that induce physicians to perform excessive treatment, few seem to have noticed that incentives for the bosses like Roodman who run the hospitals and supervise the doctors point in the same direction. 

Because hospital officials feel obligated to put expensive equipment to use, many analysts believe the mere existence of new programs increases treatment and spending whether they are needed or not.  

In 2011, Valley’s board offered Roodman a reward if the hospital increased the number of angioplasties, a procedure to clear coronary arteries that many experts believe is overprescribed.

The hospital missed that target but achieved another goal on the CEO bonus menu: increasing surgeries using its da Vinci robot, a system questioned for costing much more than other methods without adding any proven benefits.

“Wow,” said Dr. Martin Makary, a surgeon at Johns Hopkins Medicine and author who has criticized hospitals’ promotion of robotic surgery. “It’s almost a story of what’s wrong with American medicine. You have an expensive technology with no advantage over standard surgery and we’re rewarding based on pure volume. The metrics should not be the number of procedures but how well the patients do.”

Other bonus targets included expanding Valley’s chemotherapy infusion center and recruiting doctors — a common way for hospitals to boost admissions. Valley’s incentives goals for 2013 do not include increasing robotic cases.

A high point in Roodman’s career was Valley’s 2011 alliance with UW Medicine, the health services wing of the University of Washington in nearby Seattle. The deal mimics mergers across the country blamed for giving hospitals monopoly-like power to raise prices.

The purpose of the UW marriage was “to align services so they can be provided in a more efficient manner,” Roodman told local newspapers.

Not really, said Dr. Paul Joos, an ophthalmologist and member of Valley’s board who has clashed with Roodman and other trustees.

“It’s nothing about affordable health care. It’s just about negotiating power with the insurance companies,” Joos said in an interview. “All these hospitals, they talk about quality and how to make things more affordable. But in the board meetings I’m at, they’re always talking about how to charge you more.”

Roodman’s recent incentives, like those of many CEOs, included categories for quality, patient satisfaction and charity care in addition to expansion and financial targets.

“Quality is as important as financials and really more so,” said Jensen, the head of Valley’s board of trustees. “We’re very focused on how health care in our organization is going to transition from fee for service to focusing more on value.”

Hospitals, however, tend to see satisfaction and quality scores in the same light as concierge service and luxury sheets — another way to attract patients and boost revenue.

A few years ago, Integrated Healthcare Strategies asked hospitals why they pay executives quality and safety bonuses. “Way to grow service volumes” through publicity was one of the top reasons, along with “it’s the right thing to do.”

Valley’s quality scores as compiled by federal regulators and the Washington Hospital Association are similar to those of other hospitals in the area. It got a “B” in the latest safety ratings by the Leapfrog Group, an employer consortium, compared with grades of “C” and “B” in reports last year. It was one of the most-penalized hospitals in the state (eighth out of 48) for high readmission rates of Medicare patients. 

“Boards tend to be comfortable with kind of average performance” in quality, Berwick said. “Whereas they might demand very aggressive performance in terms of volume and expansion, they tend to fall silent when the report shows average levels of care.”

At many hospitals, simply passing a basic accreditation survey is enough to earn the CEO a quality bonus.

Valley and its new UW Medicine partner are trying to improve. Roodman’s 2013 quality goals — reducing hospital-acquired infections and achieving other safety objectives — are “state of the art” and a big advance over his previous quality targets, said Dr. David Nash, the dean of Thomas Jefferson University’s School of Population Health in Philadelphia who also advises hospitals on incentive design.

But they still account for only 15 percent of Roodman’s potential 2013 bonus. Financial goals, construction and starting or expanding half a dozen programs such as neurosciences and a sports and spine clinic, on the other hand, make up a much bigger portion.  

Compensation specialists expect hospital boards to increase quality expectations and deemphasize growth and the bottom line in future CEO bonus plans, especially as insurers and Medicare reward quality and efficiency more highly. But they predict it will take years.

“I’d say we’re just starting down that road,” said James Otto, a health care pay consultant for the Hay Group. “Until there’s more of that transition from volume to value, you’ll see [incentive] plans that aren’t dramatically different on a year-over-year basis. But if you and I had this conversation in say, eight years, what plans are measuring will be significantly different.”

For his part, Roodman is focused on expansion.

“You can look at growth purely for the sake of growth, or you can look at who the growth is intended to serve and why,” he said via email. “We plan to continue to grow and expand our clinical services because it meets the needs of our constituents.”

The problem, Berwick said, is that almost every other hospital CEO thinks the same way. Executives who talk about streamlining the industry are rarely the ones to volunteer, he said.

“We want to have growing market share and let our competitors die,” is their attitude, Berwick said. “When you’re in a market where that’s the case, guess what happens? They all continue to stand and grow — and costs go up without value.”

Kaiser Health News staff writer Sarah Barr contributed to this report.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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UW Medicine to “affiliate” with PeaceHealth – Seattle Times

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seattle-times-logo-squareUW Medicine and PeaceHealth have agreed to create a “strategic affiliation,” with details to be spelled out by the end of September, Seattle Times health write Carol Ostrom reports.

PeaceHealth, a not-for-profit system based in Clark County and founded by the Sisters of St. Joseph of Peace, operates nine hospitals and physician groups in Alaska, Washington and Oregon, and a Medicaid health plan.

Ostrom writes:

The two organizations said they will remain legally separate and independent, but critics of such affiliations noted that after Swedish Medical Center used such language in an affiliation with Providence Health & Services last year, it stopped doing elective abortions and closed its hospice service.

The U.S. Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services restrict such services as abortion, birth control, sterilization and patients’ rights regarding end-of-life treatment.

Seattle Times staff columnist Danny Westneat questions the growing role of the Catholic church in healthcare in Washington state.

By the end of this year, half of our state’s medical system will be Catholic-run, as measured by number of hospital beds. That’s the highest share in the nation, and rising fast — up from about 30 percent just last year. Somehow our godless state has become Ground Zero for faith-based medicine.

He asks:

We’d never turn our education system over to one church to run. Why are we doing it with health care?

To learn more:

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New online database reveals thousands of hospital violation reports

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Sign for an emergency room.By Christine Vestal
Stateline Staff Writer

Hospitals make mistakes, sometimes deadly mistakes.  A patient may get the wrong medication or even undergo surgery intended for another person.  When errors like these are reported, state and federal officials inspect the hospital in question and file a detailed report.

Now, for the first time, this vital information on the quality and safety of the nation’s hospitals has been made available to the public online.

A new website, www.hospitalinspections.org, includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word.

Previously, these reports were filed with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid (CMS), and released only through a Freedom of Information Act request, an arduous, time-consuming process.

Even then, the reports were provided in paper format only, making them cumbersome to analyze.

Release of this critical electronic information by CMS is the result of years of advocacy by the Association of Health Care Journalists, with funding from the Ethics and Excellence in Journalism Foundation.

The new database makes full inspection reports for acute care hospitals and rural critical access hospitals instantly available to journalists and consumers interested in the quality of their local hospitals.

The database also reveals national trends in hospital errors. For example, key word searches yield the incidence of certain violations across all hospitals.  A search on the word “abuse,” for example, yields 862 violations at 204 hospitals since 2011.

Once they receive a complaint, federal and state inspectors attempt to discover the cause of a hospital error or violation. For example, poor safety procedures result in thousands of patients slipping and falling each year in U.S. hospitals, and poor sterilization methods cause thousands more to contract infections. Poor administrative procedures can result in patients receiving wrong treatments.

Once the causes of specific problems are determined, federal and state authorities require hospitals to file a plan to correct them.  These plans still remain under wraps, as do inspection reports on psychiatric hospitals and long-term care hospitals.

Also unavailable are the results of complaint-based and routine inspections by the nation’s largest private hospital accreditation organization, The Joint Commission.

Because the commission is a private entity, it is not subject to the Freedom of Information Act.  For this reason, the health care journalism association has launched a new effort to gain the release of these reports on hospital quality and safety.

The commission has rejected two previous requests by the journalism group saying disclosure of the information would hamper its efforts to improve hospital quality.

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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My doctor is taking payments from drug companies – what should I do?

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Dollars for Docs: How to Evaluate Drug Payment Data

by Nicholas Kusnetz
ProPublica

Update: This story has been revised to reflect updated Dollars for Docs data on March 11, 2013.

Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But 15 companies have now made some of that information public.

pills-spill-out-of-bottle

ProPublica’s Dollars for Docs pulls their disclosures into a single database so patients can easily search for their doctor. We created Dollars for Docs database partly as an educational tool. How can patients use it? Here are some suggestions.

Q. My doctor is on this list. Should I care?

A. If your doctor is listed, it’s because he or she received money from one of the drug companies for promotional activities or consulting.

Payments are legal, so it doesn’t mean your doctor has done anything wrong. But research has shown that drug company marketing can influence what a doctor prescribes, and some experts say it is cause for concern.

Others say the information should carry less weight. They say the amount of money a doctor receives is less important than personal recommendations and the doctor’s training and experience.

One word of caution: Some doctors in our database have the same or similar names, so be sure to confirm with your doctor that he or she is actually the one on the list. Names and addresses on the data are as disclosed by the companies, and they sometimes use variations.

Q. My doctor is not on the list. What does that mean?

A. ProPublica included payments only from the drug companies that have made these relationships public so far. Many doctors do not do promotional work or consulting for drug companies.

Others may receive such payments from companies that haven’t yet disclosed them. So even if your doctor isn’t on the list, experts say it’s worth asking about the issue.

Q. What’s the best way to bring up the issue with my doctor?

A. Although it can feel awkward, some experts say it’s important to ask about potential conflicts of interest. Others say patients should trust their doctors to do what’s right for them.

If you do raise the issue, tell your doctor you want to feel confident the drugs he is prescribing for you are best for the job.

According to a 2010 national survey by Consumer Reports, conducted for this project, 70 percent of adults say doctors should tell their patients about payments they’ve taken from a drug company whose drugs they are about to prescribe.

Ask first if your doctor has any financial relationships with drug companies. If so, ask about what companies are involved, the nature of each relationship and the duration.

Most often, doctors are paid for promotional activities, such as speaking to other doctors about a drug, or for consulting or research.

It’s important to ask whether medications you are taking are made by the companies. If the answer is yes, it’s not necessarily a problem but is worth discussing further.

Q. How can I be sure my doctor is offering unbiased advice about a drug?

A. If your doctor has prescribed you medication made by a company he or she receives payments from, you should ask whether there are any cheaper generic alternatives. How does the drug compare to others in its class? What are the side effects? Are there alternatives with fewer side effects? And importantly, are there non-drug alternatives, such as diet, watchful waiting or physical therapy?

It may be that the drug you are on is the best option. But sometimes a drug company will market a new, more expensive version of an established drug even when the older one is cheaper and effective.

Asking these questions will show your doctor you’re aware of these issues.

Q. Where can I learn more about drugs my doctor prescribes?

A. Searching the Web will bring up a wealth of links and literature. One site that has comprehensive drug and supplement information is MedlinePlus.

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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Iyer_Glowblog

The ups & downs of blood pressure

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Anusha Iyer, MD

By Anusha Iyer, MD
Valley Medical Center Fairwood Clinic

Is my blood pressure high?

I get asked this question time and again: what is considered normal blood pressure and what is high?

Generally speaking, in healthy adults a normal blood pressure (BP) is less than 120 systolic (the pressure on the arteries as the heart contracts (squeezes)), and less than 90 diastolic (the pressure on the vessels as the heart relaxes).

In common terms this BP would be expressed as 120 over 90. We call it high blood pressure or hypertension if the BP is greater than 140 systolic and greater than 90 diastolic.

What causes high blood pressure?

Genetics plays an important role. Obesity, weight gain, excessive alcohol use, high cholesterol, excessive use of salt (sodium), not enough activity and a sedentary lifestyle, and type A or having an aggressive personality have all been linked to high blood pressure.

Medications such as oral contraceptive pills, certain cold remedies, anti-inflammatory drugs and many other common medications can increase blood pressure.

Also certain medical conditions such as kidney disease, thyroid and adrenal gland disorders, and sleep apnea can lead to secondary hypertension.

Why is knowing my blood pressure important?

High blood pressure is a major risk factor for heart disease and stroke. Also, untreated hypertension can lead to damage to the eyes and kidneys.

What should I do if my blood pressure is high?

Eat less salt. Most patients don’t realize the high salt content of common foods like certain types of breads and canned soups. Be sure to read labels and choose items with lower sodium content.

Eat more servings of vegetables and fruits. Limit the amount of alcohol you consume. Try to get some cardio-exercise into your weekly schedule. And try to decrease your stress level. (Yeah right! That’s easier said than done!)

If you can you set aside 15 minutes in your day here is a simple meditation exercise to relax your mind and reduce your stress: sit in a quiet place, close your eyes and take slow deep breaths in and out; meditate on peace (choose a person, place or object that makes you feel calm and happy).

I believe that a peaceful and strong internal environment is as essential to a woman’s survival and success as is her external environment.

Keep track of your BP numbers and follow your doctor’s recommendations. You can check your BP with your own blood pressure cuff if you have one, or you can check it by using the free automatic blood pressure monitor available at many large pharmacies. Write down your numbers in a log book and show it to your doctor when you go for your appointment.

Discuss your blood pressure goals with your doctor and write it down. If you are taking medication to lower your BP, don’t forget to take your medication and report any side effects or concerns to your doctor.

Almost 30% of the US population is reported to have high blood pressure. Take control of your blood pressure and work towards a healthier you by adopting healthy habits and setting the right goals.

Dr. Iyer is a Internal Medicine physician in VMC’s Kent Clinic, located at 24920 104th Ave SE in Kent. Phone: 253.395.2000.

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q

What you need to know about your kidneys, chronic kidney disease and its prevention

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By Vilma Quijada, MD
Valley Medical Center, Nephrology Services

The incidence of chronic kidney disease (CKD) in our country has increased significantly over the past 20 years.

In analyzing national data from NHANES (National Health and Nutritional Examination Survey), the Centers for Disease Control (CDC) indicates that 16.4% of the population age 20 years and older have this condition.

The incidence of obesity and diabetes has also increased in what seems to be epidemic proportions during this same period. Is there a connection?

First: What is the function of our kidneys?

Before I discuss CKD it’s important to understand what our kidneys do in our bodies. You might know that kidneys filter waste products and excess fluid out of our blood and eliminate them as urine.

What you probably don’t know is that our kidneys filter 172 liters (over 45 gallons) of blood each day. Our bodies contain about 5 liters (1.3 gallons) of blood that circulates through the kidneys at a rate of 120 ml (about ½ cup) per minute.

Another important function of the kidneys is they help to regulate our electrolyte* levels by filtering out excess minerals and keeping a very tight balance of the most important ones, including potassium and sodium.

In addition, the kidneys produce several very important hormones, including erythropoietin (also called EPO), that stimulate your bone marrow to produce red blood cells** and calcitriol, the most active form of vitamin D.

What is chronic kidney disease and what causes it?

When our kidneys become damaged as a consequence of chronic inflammation, infections, exposure to toxins, excessive use of non-steroidal anti-inflammatory drugs (over the counter pain medications), illicit drug use, or from a genetic condition, we call this chronic kidney disease.

The two most prevalent causes of CKD are thought to be diabetes (Type I and Type II) and high blood pressure. CKD can also be a strong indicator of vascular disease.

It has been reported that amongst people with kidney disease, it’s likely that more than 80% may die of serious complications such as stroke or heart attack without even knowing their kidneys are damaged.

This is unfortunate because the diagnosis is relatively simple:  A blood test for creatinine (a naturally occurring substance in our blood) and a urine test to detect proteins is all that is needed to evaluate the presence and severity of kidney disease.

You’ve been diagnosed with chronic kidney disease – how can you prevent its progression?

When faced with a diagnosis of CKD, people often and understandably feel overwhelmed because it can lead to end-stage renal failure requiring dialysis or a kidney transplant for the patient to survive.

But it’s very important to remember that there are ways to prevent the progression of CKD once an initial diagnosis has been made:

  • Maintain a healthy weight to avoid obesity-related diabetes (Type II)
  • Treat hypertension (high blood pressure)
  • Avoid cigarette smoking
  • Avoid excessive use of anti-inflammatory drugs (over-the-counter drugs with analgesic and fever-reducing effects such as aspirin, ibuprofen and naproxen)
  • Avoid excessive use of alcohol
  • Avoid using illicit drugs
  • Keep your cholesterol low
  • Stay physically active and well hydrated

It’s important to note that no matter what stage your CKD has progressed to, short of renal failure, these simple preventive steps can help significantly.

Genetic kidney disease

Some causes of CKD, such as genetic or familial causes, we unfortunately cannot control. However, keeping healthy habits will make a big difference between a rapid or slow decline of kidney function.

If you have a family history of kidney disease, diabetes or hypertension, consult with your doctor. They can order tests that will gauge whether or not you have healthy kidneys. Use this information as a platform to educate yourself and to take charge of the long-term health of your kidneys.

*Electrolytes are essential minerals in your body that are necessary for nerve and muscle function, the body-fluid balance, and other critical processes.

**A single drop of blood contains millions of red blood cells which are constantly traveling through your body delivering oxygen and removing waste. Without red blood cells performing this function, your body would slowly die. 

About Dr. Quijada

Dr. Vilma Quijada is board certified in both Nephrology and Internal Medicine, and practices in VMC’s Nephrology Clinic in Kent (nephrology concerns the diagnosis and treatment of kidney diseases). She is also the Medical Director of the Renton Kidney Center. Originally from Panama, Dr. Quijada graduated from the University of Panama in 1977 and has been practicing in Nephrology since 1983. When she came to the U.S. in the late 1980s she trained in Internal Medicine and Nephrology at Georgetown University in Washington DC. Dr. Quijada is a Fellow of the American Society of Nephrology (FASN) and also holds “Hypertension Specialist” certification from the American Society of Hypertension. Passionate about helping people, Dr. Quijada truly loves educating her patients in a way that is meaningful to them. Married with two children and one grand-daughter that she is crazy about, Dr. Quijada enjoys hiking, sailing, and reading mysteries. And, she says, “I just love the rain.”

Nephrology Services is located at 24920 104th Ave SE in Kent. Phone: 425.227.0231

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White Bread by Ricardo Perina

What you need to know about gluten and celiac disease

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By Lola O’Rourke, MS, RD
Valley Medical Center 

Celiac Disease (CD) is the result of an immune system response to the ingestion of gluten, a protein found in wheat, rye and barley.

When people with CD ingest gluten, this auto-immune response causes damage to the small intestine, reducing the body’s ability to absorb nutrients, leading to many of the most common symptoms of CD.

If left untreated, CD can have serious long term health consequences.

The symptoms of CD are extremely varied, and mirror symptoms for other conditions too. This is, in part, why it often takes a long time for CD to be diagnosed – the average length of time it takes for a diagnosis is about four years.

To complicate matters, many people with CD do not have obvious symptoms at all – they may have anemia or low bone density, conditions which may present during a routine medical exam.

Some of the most common symptoms include diarrhea, constipation, bloating, weight loss, anemia, chronic fatigue, infertility, migraines, bone pain and muscle cramps.

It’s estimated that about 1 percent of the U.S. population has Celiac Disease; the vast majority of these cases are undiagnosed. To develop CD, it’s necessary to have a genetic predisposition, to be consuming gluten and to have the disease activated by a triggering event such as surgery, illness, or even stress.

The first step to diagnosing CD is a blood test ordered by your physician which will look for the presence of antibodies that are indicative of CD. If these tests suggest CD, a biopsy of the small intestine is recommended to determine if the intestinal cells show damage consistent with this condition.

The biopsy is considered the “gold standard” for a CD diagnosis. If the biopsy does indicate CD, a gluten-free diet is warranted. Part two of the “gold standard” CD diagnosis is if the patient experiences improvement on a gluten-free diet.

People who experience adverse reactions to gluten but test negative for celiac disease may have a condition called non-celiac gluten sensitivity (NCGS). Symptoms tend to overlap with those of CD, however, in the case of NCGS an intestinal biopsy would be negative.

Treatment for NCGS is also a gluten-free diet. The recognition and classification of NCGS is quite new and more research is needed, but estimates claim the incidence of NCGS is up to 6 or 7 times higher than that of CD.

The “good” news about CD (and NCGS) compared with many other medical conditions is that it can be treated by diet. (Note: In some cases, especially the newly diagnosed, nutritional supplements and/or other medications may be required to treat related conditions: consult with your primary care physician and dietitian.)

What’s sometimes viewed as “bad” news (often for the newly diagnosed) is that it MUST be treated by diet. The only known treatment is a strict gluten-free diet. Although a gluten-free diet may seem restrictive at first, you can still enjoy a wide range of delicious foods, and in time, it will seem second nature.

There is a wealth of good information available to help people live a healthy and satisfying gluten-free life. The Gluten Intolerance Group (GIG) is a non-profit organization that provides an extensive range of educational information on numerous aspects of celiac disease and other gluten-related disorders, including how to eat safely in restaurants, what to do about gluten in medications, and how to use gluten-free grains.

Visit www.gluten.net for information, recipes and listings of certified gluten-free products. GIG also has a network of support groups around the country.

Getting involved with a support group can be very helpful in terms of learning about local gluten-free resources (grocery stores, products, restaurants), as well as for sharing stories and getting support, especially during the early stages of learning about the gluten-free diet.

PHOTO: White bread by Ricardo Perina

A local GIG Branch meets at Valley Medical Center the third Tuesday of every month from 7:00 to 9:00pm. For more information contact Lynn Jameson: Southseattlegfgroup@yahoo.com.

About Lola O’Rourke, MS, RD

Lola O’Rourke is a registered dietitian who specializes in gluten-free eating, weight management and family meal planning. During her twenty-five year career in food and nutrition she has provided nutrition expertise to public health agencies, food businesses, school districts and individuals. Lola is bilingual in Spanish and has lived and worked in Mexico and Latin America. She recently served as a national media spokesperson for the American Dietetic Association and conducted over 300 interviews with venues including The New York Times, MSNBC, USA Today and Latina magazine. She’s been an avid baker and dessert fan since her teens, became gluten-free as an adult and now integrates these interests into healthful and delicious eating plans for her clients.

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HPV

What you need to know about HPV

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By Monica Richter, MD, PhD

One of the most important recent advances in women’s health is a vaccine against human papillomavirus (HPV). The HPV vaccine protects against serious health problems such as cervical cancer and other less common cancers.

The first HPV vaccine was approved in June of 2006 after testing in thousands of people around the world.

Two HPV vaccines are currently licensed by the FDA and recommended by the Centers for Disease Control and Prevention (CDC): Gardacil is approved for girls or boys ages 9 to 26, and Cervarix is approved for girls 10 through 25 years of age.

HPV is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with the virus at some time in their lives.

In addition to causing cervical cancer, HPV can cause vaginal and vulvar cancer in women, and other types of cancers in both men and women. It can also cause genital warts and warts in the throat.

But good news! The HPV vaccine can prevent most cases of cervical cancer in women. It can also prevent vaginal and vulvar cancer in women and genital warts and anal cancer in both men and women. Protection from the vaccine is long-lasting.

While we all hope that young teens are abstaining from sexual activity, it is important to vaccinate girls long before their first sexual contact.

In addition, the response to the vaccine is stronger in younger girls and for this reason, we recommend vaccinating girls at age 11 or 12 years. The vaccine is given as a 3-dose series over 6 months.

Both vaccines are available for women, but only one of them can be given to men also.

Vaccines have undergone a lot of scrutiny in recent years, but all of the available scientific evidence confirms their safety and efficacy.

In spite of this, many false rumors are circulating and I continue to be confused by the number of parents who decline the vaccine for their daughters. As a mother and a pediatrician,

I gave my daughter the HPV vaccine as soon as it became available and I urge all parents to do the same.

For more information on the HPV vaccine, visit www.cdc.gov/vaccines.

About Monica Richter, MD, PhD

Dr. Monica Richter is a board certified pediatrician with Valley Children’s Clinic. Over the past 18+ years Dr. Richter has helped hundreds of pubescent girls navigate the physical and emotional aspects of their changing bodies and psyches, including menstruation, body changes, sexuality and how babies are conceived, through her free seminar, As Girls Grow Up. She also teaches BodyWorks, an eight-week health education program developed by the Dept. of Health & Human Services. Bodyworks is designed to provide parents and caregivers of teenage girls and boys ages 9 to 16 with tools to improve family eating and activity habits. Originally from Manhattan, Dr. Richter is married with two grown children. In her spare time she enjoys reading and knitting.

Valley Children’s Clinic is located at 4011 Talbot Road S., Suite 220, in Renton. Phone: 425.656.5300; www.valleychildrensclinic.org

 

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Barbara Mitchell

Valley Medical Center’s Barbara Mitchell to be remembered Wednesday, Aug. 29th

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A Celebration of Life will held Wednesday, August 29th at the Valley Medical Center’s Healing Garden for Barbara Mitchell, who passed away August 8th at the age of 66.

Mitchell, who had been Valley Medical Center’s senior vice president of Human Resources & Marketing, was known for her vivacious spirit and love for her family and career, colleagues said.

Mitchell spent 35 years in corporate business management, with a primary emphasis and focus on human resource leadership, serving in a spectrum of industries spanning healthcare, broadcasting, and insurance in both union and non-union, for profit and not for profit, private sector and public sector arenas.

Mitchell came to Valley Medical Center in 1999 to serve as Director of Human Resources. She was promoted to Vice President of Human Resources, and then to Senior VP Human Resources and Marketing.

Consistent with her prior work as Vice President Human Resources and Corporate Services for KIRO, Inc., and her consulting work throughout the Puget Sound, she was focused on strengthening workforces through management development, effective labor relations, strategic organizational development, and the fostering of energized, productive, responsive teams that readily achieved corporate goals.

Under her leadership, Mitchell secured “Best Workplace” recognition for VMC for ten consecutive years, saluting a high level of excellence in staff training and involvement, benefit enhancement and recruitment in a competitive industry.

“Barbara has always been an incredibly valuable member of Valley’s management team. She was smart, insightful, compassionate and a friend, and will be missed by so many on both a professional and personal level,” said Valley Medical Center CEO Rich Roodman.

Mitchell was acknowledged throughout her career as a person with exceptional mentoring and coaching skills. She designed effective career ladder programs and developed systems to identify potential talent through non-traditional methods, resulting in strong and ethnically diverse candidates for promotion.

Her ability to build trust throughout all levels of the corporate environment enabled the implementation of progressive programs that have become best practice.

Mitchell grew up in Alaska, attended Marylhurst University, served as Chairman of the Board for First Choice Health, and was active in fundraising with American Cancer Society, Washington Women in Need and Lake Washington Technical College.

She also participated in community involvement with Renton Community Foundation, Rotary International, Renton Technical College, various Chambers of Commerce and community organizations.

Mitchell is survived by her husband, Robb; son, Jordan Miller; daughter-in-law, Mistilyn Miller; grandson, Zayden; and granddaughter, Adel.

In lieu of flowers, the family requests donations be made to the American Cancer Society or VMC’s Healing Garden.

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