Health & Fitness | Weight Loss

Morbidly Obese Sedentary most of the time

March 26, 2009 on 3:42 am | In Uncategorized | Comments Off

A newly released study appearing in Clinical Cardiology examines the average fitness level of the morbidly obese (body mass indexes between 40.0 and 49.9). The findings show that the tested population was sedentary for more than 99 percent of the day and, on average, walked less than 2,500 steps per day - far below healthy living guidelines of 10,000 steps per day. The results provide important links between obesity, poor fitness and cardiovascular disease.

The study used a precise body sensor to continually measure physical activity, caloric expenditure and movement minute-by-minute over a 72-hour period within their home environments. Following collection of the data, structured cardiorespiratory fitness testing waccording toformed on each subject.

Most morbidly obese participants in the study were markedly sedentary. On average, 23 hours and 51.6 min per day were spent sleeping or engaged in sedentary activity and the remaining 8.4 minutes were spent in moderate activity. On average, subjects took 3,763 ± 2,223 steps.

The highest level of activity attained by any single individual during one 24-hour period was 28 minutes of moderate activity. No length of time was spent at a high level of activity for any of the individuals while under observation. Two individuals in this study spent the entire monitoring period in sedentary activity.

Obesity contributes to five of the top 10 diseases with the highest mortality rates: cardiovascular disease, stroke, diabetes, high blood pressure and cancer. Increasingly, new technologic advances encourage individuals to move less and expend fewer calories.

However, it has been shown that, despite being obese, individuals with moderate-to-high levels of cardiorespiratory fitness have cardiovascular death rates that are 71 percent lower than their unfit counterparts. Moreover, low cardiorespiratory fitness is an independent predictor of mortality in normal weight, overweight and obese individuals alike. Morbidly obese individuals, however, have severely reduced cardiorespiratory fitness that is similar to those with established systolic heart failure.

Despite the lack of moderate or vigorous physical activity in the studied population, lighter amounts of physical activity may yield significant health benefits. Even light walking in speeds of 1 to 2 miles per hour shows significant health benefits. Over time, increasing amounts of light physical activity may improve aerobic capacity and ultimately reduce mortality.

"Our findings have important implications for the relationship between obesity and physical activity," say authors Thomas Vanhecke, Barry Franklin,Wendy Miller, Adam deJong, Catherine Coleman and Peter McCullough of William Beaumont Hospital. "Our findings will add incentive to increase physical fitness in this population and increase the awareness of healthcare professionals of the need for recommending physical activity in their patients".


Posted by: Evelyn    Source

Sweaty Betty - The best shop for your gym clothes

March 26, 2009 on 3:42 am | In Uncategorized | Comments Off

You can really enjoy your workouts if you slip into the Sweaty Betty attire before your sessions. You will be surprised if you find out the number of women who prefer Sweaty Betty for the gym clothes. My long lasting hunt for comfortable and trendy workout clothes ended when I came across the Sweaty Betty over the internet.

Sweaty Betty has surprisingly great and wide range of women's sports wear starting from yoga, sweat, snow and beach clothes. The website gives you an option to shop by the kind of activities you do, brands you prefer, collections they have, departments and new designs launched. You can be a regular customer of the Sweaty Betty website by creating your own account.

They provide excellent online services to their existing customers and the new customers. You can have all your questions answered online about delivery of goods, terms and conditions, the size guide and above all security and privacy without visiting the stores in person.

You can enjoy a lot of benefits once you are the member of the Sweaty Betty website like club card, updates on what to wear, latest survey on new trends and the running club. Sweaty Betty team can be contacted anytime online for the information on their boutiques, jobs and affiliates.

You will love the comfort and the latest trend Sweaty Betty offers. They have not only women's sports wear but other various accessories to go along with their clothes like bags, water bottles, shoes, sports bras and panties and handy workout equipments.

So, just log on to Sweaty Betty website and order the running clothes from the comfort of your home.



Posted by: Evelyn    Source

Practices paperless before 2012 could maximize Medicare bonuses

March 18, 2009 on 1:00 am | In Uncategorized | Comments Off Washington -- The recent economic stimulus package provides a significant investment in health information technology that could benefit many physicians. But the government is expecting doctors to do their part to implement health IT and is prepared to penalize those who don't.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

Doctors who wait until 2013 or 2014 to have EHRs in place will be eligible for smaller bonuses. The 2013 adopters can capture a maximum of $39,000 over four years, while the 2014 adopters can claim up to $24,000 over three years. Medicaid will have its own five-year bonus schedule that will offer as much as $64,000 to eligible physicians who don't claim Medicare bonus money.

Once the chance for bonuses ends, Medicare starts penalizing physicians who have not responded to the incentives. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to their Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

Simply setting up any paperless system is not enough to earn bonuses and avoid penalties. The stimulus package stipulates that physicians must adopt a qualifying EHR and use it in a "meaningful way." Meaningful users are defined as physicians who demonstrate to the Health and Human Services Dept. that they are using electronic prescribing; that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care; and that they submit information to HHS on clinical quality measures.

No longer a question of "if"

Some physicians already have begun to move away from paper, and they would rather act sooner than later to avoid penalties down the road. "The question now isn't if, but how and when, because physicians are feeling a sense of inevitability," said Todd Rowland, MD, executive director of HealthLINC.org in Bloomington, Ind., a regional health information exchange that covers a multicounty area. "We need to figure out how to implement it in an economical, management-oriented approach that requires as few work-flow sacrifices as possible."

Dr. Rowland added that he doesn't expect physicians to like the implementation process -- or the possibility of penalties if they don't do it right -- but that it makes sense for physicians younger than 55 in particular to get on board. He estimates that more than 50% of physicians in Bloomington's metro area and more than 75% in the rural area have adopted EHR systems.

Early EHR adopters can get up to $44,000 in a Medicare bonus or $64,000 in a Medicaid bonus.

While the stimulus also provides Medicaid incentives, physicians can't have it both ways -- they must choose either Medicare or Medicaid bonuses, said Heidi Echols, a partner at the law firm McDermott, Will & Emery in Chicago.

In an effort to prevent additional "double-dipping," physicians who report using an EHR system that is also capable of e-prescribing no longer will be eligible for the e-prescribing bonuses that went into effect this year under the Medicare Improvements for Patients and Providers Act. On the other hand, Medicare penalties for those not e-prescribing by 2012 will sunset after 2014, so that no physician will be subject to double penalties for failing to e-prescribe and failing to use an EHR.

Now that Congress has set up the incentive structure for adoption, President Obama and his administration also must promote interoperability of EHR data so the records don't become information "islands," said David J. Brailer, MD, in an article published online as part of a series on health IT in Health Affairs' March/April issue.

Dr. Brailer was the first National Coordinator for Health Information Technology at HHS from 2004 to 2007 and is now chair of Health Evolution Partners, a health care investment firm based in San Francisco. He said physicians particularly need to be wary of vendors from which they purchase IT services, as systems that become obsolete could set back progress.

"What it boils down to is, are you buying EHRs that you can use and keep for a long time, or is it a system that in two or three years goes kaput?" he asked. "We're trying to avoid doctors having to start over again with electronic records during their career."

The next steps

The stimulus act requires HHS by Dec. 31 to develop an initial set of standards, implementation specifications and certification criteria for EHR system adoption. It also authorizes the department to provide competitive grants to states for implementation loans to health care entities.

The national health IT coordinator also will be authorized to make available a qualifying EHR system to physicians and others for a nominal fee. Doctors who do not purchase the government's system can purchase a qualifying system from a vendor of their choice as long as it meets certain standards, including interoperability requirements.

The American Medical Association will seek clarification from HHS on the cost of the government system and when it will be available. The department must determine more details on how it will spend the stimulus dollars and how doctors can access them.

Once those details are available, physicians must examine the cost-benefit breakdown. According to a May 2008 report from the Congressional Budget Office, estimated total costs for implementing a typical office-based EHR are about $25,000 to $45,000 per physician. Each physician would then need to spend about $3,000 to $9,000 per year to maintain the system.

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White House summit takes 1st step in health system reform discussion

March 18, 2009 on 1:00 am | In Uncategorized | Comments Off Washington -- Representatives of physicians, health plans, hospitals, patients, businesses, medical researchers, drug companies, the elderly and many others appear to agree on at least one thing: The nation's health system should work better.

President Obama invited more than 100 health care stakeholders and lawmakers to the White House on March 5 to begin an effort to craft legislation aimed at controlling health care costs, improving quality and providing better access for the nation's 46 million uninsured. The goal is to enact a comprehensive health system reform measure this year.

"I'm confident if we come together and work together, we will finally achieve what generations of Americans have fought for and fulfill the promise of health care in our time," Obama said.

Representatives from several physician organizations, including the American Medical Association, attended the White House meeting. AMA President Nancy H. Nielsen, MD, PhD, said after the event that the attendees seemed to agree that every American ought to have health insurance and that the summit was a good start. "The devil is going to be in the details of what happens next."

Dr. Nielsen and other physicians also met again with the Obama administration on March 6. "We've actually had relatively unprecedented access" at the White House, she said.

That same day, Obama announced regional health reform gatherings scheduled for March and early April in California, Iowa, Michigan, North Carolina and Vermont. The governors of each state will host the events, which will include physicians, patients, policy experts and others. The Obama transition team in December 2008 asked Americans to hold community discussions on health care and report the results. More than 30,000 people attended 3,000 meetings in all 50 states and Washington, D.C.

Meanwhile, on Capitol Hill, two key Senate panels have been holding health reform hearings for months. Their House counterparts more recently began hearings on overhauling the health system.

Working group discussion

The White House summit opened with remarks by Obama, broke into five working groups moderated by White House staff, then ended with participants asking Obama questions and offering comments. Dr. Nielsen said her group met for 75 minutes.

The groups, according to press pool reports, avoided heated discussions. Instead, many participants stated their concerns and goals for reform legislation, including the urgency for quick action. Sen. Sheldon Whitehouse (D, R.I.) referred to the series of television advertisements that the health insurance industry used to help derail the Clinton-era health reform efforts. "This isn't a 'Harry and Louise' moment; it's a 'Thelma & Louise' moment. We're in the car, headed towards a cliff, and we must act."

Sen. Edward Kennedy (D, Mass.), who attended the summit despite his poor health, said he was as optimistic as he's ever been about finishing comprehensive health system reform legislation because everyone is involved this time. "You have the insurance companies, you have the medical professions, all represented in one form or another. That has not been the case over the history of the past, going all the way back to [President] Harry Truman's time," said Kennedy, who chairs the Senate Health, Education, Labor and Pensions Committee.

Sen. Mike Enzi (Wyo.), the highest-ranking Republican on the Senate HELP panel, said he agreed with Kennedy on 80% of his proposals for health system reform. The tough work will be finding common ground on the other 20%, Enzi said.

Strange bedfellows

Summit participants mentioned physicians in both critical and sympathetic terms. Sen. Jay Rockefeller (D, W.Va.), chair of the Senate Finance health subcommittee, said physicians stand in the way of nurses taking on greater responsibility in treating patients. Obama said he has close friends who are doctors and that he understands they are feeling tremendous strains from many sides. In addition, he said he recognizes that the cost of medical education is keeping medical students from choosing primary care as a profession.

Many attendees also spoke about the need for true bipartisanship and open-mindedness to different ideas. But advocates for single-payer health plans -- including Physicians for a National Health Plan -- were not invited until the last minute, said PNHP Director Oliver Fein, MD. The organization canceled planned protests once the invitation came through.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said she understands that her organization, which fought health system reform when President Clinton spearheaded it in the early 1990s, must now fight to "earn a seat at the table."

Obama signaled some flexibility in his policy position. He said he would consider legislation that includes more private or public involvement in the health system than outlined in his campaign proposal, which calls for creating a national public health plan with competition from national private plans. Sen. Chuck Grassley (Iowa), the ranking Republican on the Senate Finance Committee, said he fears that a national public plan will erode private insurance coverage.

The president closed the event by addressing worries that Congress and the White House are taking on too much work at one time. "When times were good, we didn't get [reform] done. When we had mild recessions, we didn't get it done. When we were in peacetime, we did not get it done. When we were at war, we did not get it done. There is always a reason not to do it. And it strikes me that now is exactly the time for us to deal with this problem."

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Texas hospital settles charges of boycotting physician-owned hospital

March 18, 2009 on 1:00 am | In Uncategorized | Comments Off Community hospitals may think twice before attempting to stifle competition from physician-owned hospitals, experts say, after a recent antitrust action by a state government official that is believed to be among the first of its kind.

Memorial Hermann Healthcare System on Jan. 26 settled allegations by Texas Attorney General Greg Abbott that the hospital systematically discouraged health insurers from doing business with a competing physician-owned hospital. Memorial Hermann, Houston's largest hospital system, allegedly used its leverage to punish -- with threats of contract terminations or rate increases -- insurers that signed on with what used to be Town & Country Hospital. The physician-owned facility went out of business in 2007.

Memorial Hermann denied any wrongdoing but agreed to pay the state $700,000 to reimburse the cost of the two-year investigation. The hospital also agreed to a five-year injunction prohibiting certain contracting practices, though the hospital said they are "practices Memorial Hermann has never employed."

"This is an instance where you have the government actually getting on board for the argument that physician-owned facilities cannot be frozen out of the managed care market," said Lorin E. Patterson, a health care regulatory expert and partner with law firm Reed Smith in Falls Church, Va. "The outcome is that it really should be a level playing field for all facilities."

The case also may offer physicians an alternate course of action against anticompetitive behavior other than pursuing what often are expensive private antitrust claims, he said.

The settlement is one of several legal battles across the country, sparked by doctors who allege that dominant hospitals are trying to protect themselves from competition at the expense of patient care. A separate lawsuit brought by the physician owners of Town & Country Hospital is pending in Harris County District Court and is set for trial in September. The doctors claim that Memorial Hermann's conduct drove their facility to close.

On the other hand, general hospitals argue that physician-owned facilities often choose more profitable treatments and patients, leaving the community facilities with the cost of emergency and uninsured care.

A trend at play?

Unlike more limited specialty hospitals, Town & Country was a general acute-care facility, noted Texas Assistant Attorney General Mark Tobey. "That was a fairly important distinction for us," he said, noting that Town & Country had an emergency department and had plans to offer a full range of patient services.

Competition is key to ensuring patient choice, and physician-owned hospitals have shown reduced costs and improved quality over community facilities, Tobey said.

Hospitals can contract exclusively with insurers without disobeying antitrust laws.

The case also signals that stronger state scrutiny is to come, he said. "The injunction in place should make it clear to Memorial Hermann and to the health care community at large that the attorney general is going to be watching this situation."

The attorney general's office also launched an early-stage inquiry into the possibility of similar antitrust violations in the Amarillo area. As part of the probe, state officials in November 2008 requested what they considered relevant information from Baptist St. Anthony's Health System. That included documents related to the hospital network's managed care contracts and communications, as well as a list of any competing physician-run facilities, legal records show.

Baptist was the subject of an earlier antitrust lawsuit brought by a group of Texas orthopedic surgeons who owned a competing surgical hospital. The Texas Medical Assn. and the Litigation Center of the American Medical Association and State Medical Societies contributed financially to the doctors in that case, Higgins v. Baptist, which ultimately settled.

Baptist spokeswoman Mary Barlow said the hospital complied with the request, but she had no further comment.

Tobey also declined to comment on the matter, but he said the attorney general's office was aware of the previous physician actions. Texas law requires parties to notify the attorney general's office upon filing any antitrust claim.

Policy questions

While antitrust laws generally favor competition, government officials and payers have kept a close eye out for overutilization and excessive costs when doctors refer patients to their own facilities, said John J. Miles, a former Justice Dept. attorney and partner at Ober Kaler in Washington, D.C. "The policy questions are very important in antitrust litigation" and are likely to be taken into account by courts, he said.

In addition, hospitals are able to contract exclusively with insurers without necessarily running afoul of antitrust laws. "There is no antitrust problem if a big hospital goes to a third-party payer to express concern [about a competing entity] and says, 'You decide,' " said Miles, who represents Baptist Health, a separate facility in Arkansas in a similar dispute brought by a physician-owned heart hospital. Little Rock Cardiology Clinic v. Baptist is headed to the 8th U.S. Circuit Court of Appeals after a trial court initially dismissed the case.

Memorial Hermann President and CEO Dan Wolterman said in a statement that his hospital had complied with the law, noting that nothing in the settlement prevents it from entering into exclusive contracts or negotiating appropriate rates and terms.

But Tobey said the hospital crossed the line when it imposed a significant rate increase on an insurer that included Town & Country in its network and when it pressured other payers. He said Memorial Hermann is permitted to seek rate increases under certain circumstances, but it first would need to show that it lost business because of any proposed changes by a managed care plan.

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