Elevated homocysteine is a risk factor for premature vascular disease. This substance is measured by HPLC. Scientific studies in 1995 demonstrated that individuals with elevated homocysteine levels and suboptimal intake of vitamins B6 and B12 and folic acid had an increased risk of carotid artery stenosis. Supplementation of the diet with these vitamins results in a reduction in the circulating homocysteine concentration. Also, in 1995 patients with elevated homocysteine levels were demonstrated to have recurrent venous thrombosis. Not only are high homocysteine levels associated with myocardial infarctions and death, but a graded risk of these cardiovascular diseases exists through the entire normal range of homocysteine levels. Therefore, even a mildly elevated homocysteine level can increase the risk of cardiovascular disease. Studies suggest that homocysteine is about as important a risk factor for the development of vascular events as hypercholesterolemia. For patients with elevated homocysteine, the level of vitamins B6, Bl 2 and folic acid are measured, and deficient vitamins are replaced. In patients with no deficiency, it has been noted that treatment with folic acid can reduce homocysteine levels.

Quantitative plasma homocysteine can be measured in EDTA plasma. At this time, it is not recommended to use this test as a screening test without a complete cardiac evaluation or a laboratory evaluation for disorders of hemostasis and thrombosis.

Back to Top
Return to Index

NEW OSHA ERGONOMICS STANDARD PROPOSED.
The Occupational Safety and Health Administration posted the working version of its new ergonomics standard on its website in March 1999. In its current form, the Ergonomics Standard would apply immediately only to manufacturing operations, manual handling jobs and other general industry. In other workplaces an employee would first have to suffer musculoskeletal disorder (MSD) for the standard to be triggered. There are six elements to the ergonomics program.

1. Management leadership and employee participation. OSHA expects the employer to set up an ergonomics program and keep managers and employees informed.
2. Hazard Identification and Information. If there is a problem, find the cause and inform employees about it. Employers would be expected to offer a means of reporting signs and symptoms of MSDS, and a way of investigating any problems.
3. Job hazard analysis and hazard control.
4. Training. Employers would be expected to offer training about the ergonomic program and workplace hazards at least every 3 years.
5. Medical Management. Any employee reporting a possible MSD should be promptly examined by a doctor for a written diagnosis. The employer would be required to follow the doctor's recommendations for recovery, including any work restrictions.
6. Program evaluation. Ergonomics programs would be reevaluated at least every 3 years that ensure compliance.

A formal proposed version of the standard may be published in the Federal Registry this September, after OSHA has assessed the impact of such a standard on small businesses. Enforcement isn't expected until at least 2000.

Back to Top
Return to Index

CHANGES AT AVERA SACRED HEART HOSPITAL BLOOD BANK.
Previously, Avera Sacred Heart Hospital (ASHH) has operated its own hospital-based blood bank with supplementation of its supply by Siouxland Community Blood Bank. Due to additional testing of donor blood required by the FDA and an increased laboratory workload, Siouxland Community Blood Bank from Sioux City, IA will now furnish ASHH with all of its blood products, as well as provide other services. ASHH will still do autologous blood donations (donation of one's own blood).

The Siouxland Community Blood Bank will be at ASHH in Yankton on the fourth Tuesday of each month from 11:00 a.m. - 5:00 p.m. Each blood drive is open to the community. To be eligible to donate you must be at least 17 years old and weigh 1 00 pounds. You must be feeling well and healthy on the day of donation. Please eat a good meal prior to donation, and bring a list of current medications. You can donate blood every 56 days. The entire donation process takes 30-45 minutes.

Because a unit of blood is separated into three different components, your one donation can save up to three lives. Red blood cells have a shelf life of 42 days and are used to treat patients with low blood counts. Plasma is frozen for up to a year and helps treat patients with a large blood volume loss. Platelets have a shelf life of 5 days and are used to treat patients with bleeding disorders.

Back to Top
Return to Index

UNBUNDLE FOR CLIA COUNTING.
Counting tests for calculating CLIA certificate fees must be done by counting total billable tests. Here are some guidelines from HCFA:

Histocompatibility: Count each HLA typing, HLA antibody screen, or HLA crossmatch as one test.

Microbiology: Count each group of antibiotics used in susceptibility testing as one test. Cultures count as one test per specimen.

Allergy testing: Count each allergen as one test.

Chemistry profiles: Count each analyte as one test.

Urinalysis: Count microscopic and macroscopic exams as one test each.

Complete blood counts: Count each measured individual analyte ordered and reported as one test. Differentials are counted as one test.

lmmunohematology: Count each ABO, Rh, antibody screen, crossmatch and antibody ID as one test.

Histopathology: Count each block as one test.

Cytology: Count each slide as one test for Pap smears and non-gynecologic cytology.

Cytogenetics: Count is determined by the number of specimen types processed on each patient.

DO NOT COUNT- Calculations (eg. A/G ratio, MCH and T7), quality control, quality assurance and proficiency testing assays.

Back to Top
Return to Index

MEDICARE B UPDATE: REASONABLE AND NECESSARY.
This applies to the following states: Alaska, Arizona, Colorado, Hawaii, Iowa, Nevada, North Dakota, Oregon, South Dakota, Washington, and Wyoming.

Reasonable and necessary takes into account the medical condition, the patient, the doctor, the family, medical support services, and a host of other things. This article discusses four areas of medical necessity: frequency of laboratory tests, frequency of patient visits, coding level of patient visits, and multiple tests for the same diagnosis.

Frequency of laboratory tests: A lab test may not be reasonable and necessary when it is frequently repeated and always normal, when it is normal with no change in symptoms, diagnoses, orders, or medications, and when there is no relationship to acute care.

Frequency of patient visits: Visits may not be reasonable and necessary if they occur frequently with no change in the diagnoses or disease state; no change in orders or decision making; no change in the medications taken or procedures planned.

Coding level of patient encounters: Reimbursement for patient visits is reimbursement for physician work, overhead, and liability, which is based on the RBRVS (resource based relative value system) designed and frequently revised by physicians representing organized medicine and specialty societies. For evaluation and management services, work involves the areas of history, physical exam, and clinical decision making. When reviewing documentation to determine whether a visit is reasonable and necessary, Medicare assesses whether the patient is stable or unstable; the presenting problems are acute or chronic; new decisions, orders or tests were ordered; and what was actually done that visit to determine a diagnosis or effect a therapy.

Multiple tests for the same diagnosis: Once a disorder is diagnosed, are more tests needed to reconfirm it each visit?

Source: MedB Issue 171

Medications: There are thousands of medications, from aspirin and antacids to birth control pills and other prescription drugs that, taken by patients undergoing tests, can affect the results. Proper timing is critical in therapeutic drug monitoring.

Food and drink: Instructions about eating and drinking should be carefully explained. Some tests require a special diet for several days prior to testing, others require a 10-12 hour fast.

Mood: Nervousness and anxiety can affect certain measurements. Prolonged crying in children can falsely elevate white blood cell counts.

Exercise: Even moderate muscular activity will elevate levels of lactic acid, creatinine, protein, and certain enzymes.

Altitude: The decreased oxygen content of air at higher altitudes causes the body to produce more red blood cells to fulfill the body's oxygen needs.

AVERA ST. LUKE'S MED TECH PROGRAM CELEBRATES ANNIVERSARY.
The Medical Technology program at Avera St. Luke's celebrated 50 years of education July 17th. Forty-three alumni and thirty-eight guests attended a dinner at the Ramada in Aberdeen. Many stories were shared of the "good old days". Prizes were given out with everyone receiving something. A video was made of some of t he memories from the lab staff and past students. Many of the alumni wrote articles about their families and what they were doing. These were put into a booklet along with pictures of the graduates, and given to each alumni.

In 1948, Sr. Veronica Ogden submitted an application to start a MT program and in 1949 the 1st two students were accepted. Since that time 210 have graduated from the program. Avera St. Luke's will be closing its program after the graduation of the current class. Etta Bassinger will be retiring after 22 years as education coordinator/program director. Etta received a plaque at the reunion, honoring her many years of service.