A Medical Device Daily

Lung cancer is still the most deadly of all cancers, and America’s military veterans are more likely to suffer and die from lung cancer than civilians. As a result, an alliance of veterans groups and a medical society has issued a plea for the second consecutive year for a lung cancer screening program for veterans.

The Lung Cancer Alliance (LCA; Washington) issued a statement last week to make that case, with a board member who is also a retired U.S. Navy rear admiral explaining the need.

Rear Admiral Philip Coady, the chairman of the LCA’s board, said, “Lung cancer continues to kill more men and women every year than all the other major cancers – breast, prostate, and colon – combined, and our veterans are at even higher risk, especially those whose active duty service exposed them to Agent Orange, asbestos, spent nuclear fuels, propellant gases and other carcinogens.”

Coady, a 34-year veteran of the Navy, is among these, and he never smoked.

“Because there are usually no specific symptoms, most people are diagnosed so late they die within a year,” Coady said, and he bemoaned the fact that “high-risk veterans [are] not benefiting from the new technologies that detect lung cancer earlier.

The statement points out that the insidious nature of lung cancer puts extra pressure on the Veteran’s Health Administration because many patients are retired from civilian work – and coverage – by the time they are diagnosed. Treatment at the late stages of the disease in can double the cost of treatment, and survival is much higher in early-stage treatment. CT scanning, the statement says, can catch up to 85% of all lung cancer cases in this early stage.

The LCA statement provided a hefty roster of co-signers, including Vietnam Veterans of America (Silver Spring, Maryland) and the Association of American Medical Colleges (Washington).

Coady said “LCA is deeply grateful to the leadership and foresight of these organizations for speaking out about the No. 1 cancer killer.”

According to the statement, a lung cancer screening program was included in the Independent Budget for FY09, presented by a coalition of military veteran organizations.

“This highly regarded comprehensive alternative budget, which addresses the most urgent needs of veterans, is being presented to Congress this week,” the statement says, with co-signers including Disabled American Veterans (Cold Spring, Kentucky) and the Veterans of Foreign Wars (Kansas City, Missouri).

Under-performing nursing homes list grows

The Centers for Medicare & Medicaid Services said last week that it has built upon “historic” action it took last November by making public more names of underperforming nursing homes across the country.

At that time the agency began publishing the names of Special Focus Facility (SFF) nursing homes that had failed to improve significantly after being given the opportunity to do so (Medical Device Daily, Dec. 3, 2007). The poor-performance list consists of more than 50 nursing homes in 33 states and the District of Columbia.

There are currently about 131 active facilities identified as an SFF. This number varies as nursing homes are graduating or leaving Medicare and Medicaid and new nursing homes are added to the SFF list.

The CMS data indicate that about 50% of the nursing homes identified as SFFs significantly improve their quality of care within 24-30 months, while about 16% are terminated from Medicare and Medicaid.

Once a facility is selected as an SFF, state survey agencies are responsible for conducting twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves, (b) is granted additional time due to meet standards, or (c) is terminated from Medicare and/or Medicaid.

The release includes a broader list of all nursing homes identified in the SFF initiative. This updated and expanded list identifies facilities by the category they fall within, such as:

• New Additions: nursing homes added within about the past six months;

• Not Improved: nursing homes that have failed to improve significantly in at least one survey after being named as a SFF nursing home;

• Improving: nursing homes that significantly improved on the most recent survey, including no findings of harm to any resident and no systemic potential for harm;

• Recently Graduated: nursing homes showing significant improvement for about 12 months, indicating a trend in quality improvement compared to the nursing home’s prior history ;

• And No Longer in Medicare and Medicaid: nursing homes either terminated by CMS from participation in Medicare within the past few months or voluntarily chosing not to continue participation.

The SFF initiative was created by CMS in 1998 in response to the number of facilities that were consistently providing poor quality of care. Those facilities were periodically instituting enough improvement so that they would pass one survey, only to fail the next (for many of the same problems as before). Facilities with this compliance history rarely addressed underlying systemic problems giving leading to repeated serious deficiencies.

Serious deficiencies include such things as failing to give residents their medications in the correct dose at the correct time, prevention of abuse or neglect, inappropriate use of restraints and failure to prevent, or properly treat, bed sores.