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Healthy Living: Remote Controlled Reconstruction Surgery

Coping with breast cancer surgery and treatment can be draining, but preparing for breast reconstruction can also be a painful process, until now.

See how new technology is making the journey easier on patients in Healthy Living.

Aeroform also allows patients to fully expand and be ready for reconstructive surgery in half the time as the traditional saline expanders, three weeks compared to almost two months.

The FDA-approved device is covered by insurance.



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Healthy Living: Don’t get sick in the office this holiday season – FOX 8 News WVUE


Between the candy that started showing up in your office after Halloween to the Thanksgiving desserts and all the sweets you’ll find at your holiday parties, the end of the year is a challenging time to stay healthy. Dr. Megan Butler, Family Medicine Physician at Ochsner Health Center – Belle Meade, shares some tips to keep you healthy, focused and on top of your game at work heading into the New Year.

Cold prevention
As we dive deeper into Fall, the temperature starts to lower, and the cooler weather moves in. Though a change in wardrobe may be exciting, the increased chance of catching a cold is not. However, if you do catch one, make sure to take your coworkers’ health and wellness into consideration when deciding whether to go in to the office that day.

Even when feeling well, in communal spaces like offices, it’s really important to wash your hands frequently to lessen the chances of germ spread.

Also, keeping a blanket at your desk is a great way to keep warm on chillier office days. Ergonomic studies have shown that warmer office temperatures improve accuracy and efficiency.

Don’t let neck and back pain slow your holidays down. When sitting at a computer, many people unknowingly draw their faces toward the screen, craning their necks forward. To combat this, arguably the most effective single exercise you can do for the neck and upper back is to do chin retractions, as if making a double chin, which keeps the neck and spine lined up.

It’s incredibly easy to indulge in the treats that circulate around offices approaching the holidays. Do your best to remain picky with these indulgences, though. Sticking to a weekend meal-prep plan for weekday lunches lends less of an excuse when eying those unanticipated holiday sweets in the office kitchen. 

Try to get up and move! Changing a task may help reset for the next round of work, but getting outside – even if for only a few minutes every day – can lower fatigue and increase your mental focus. If you can’t go outside, taking a movement break in between tasks is still beneficial. Stand during a phone call, take a lap around the office, or even stretch following a meeting.

Stress reduction
The year’s end is often accompanied by goals and project deadlines, and it’s easy to be stressed by work and personal obligations this time of year. All of the suggestions above can contribute to decreasing your stress level, but keeping a stress toy at your desk can serve as a great companion item. 

Copyright 2017 WVUE. All rights reserved.

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Healthy Living: FDA warns against herbal supplement, kratom

(CNN) — The Food and Drug Administration dealt another blow Tuesday to supporters of kratom, warning about “deadly risks” associated with the botanical supplement often used to treat pain, anxiety and depression. Kratom also has opioid-like effects — at low doses, it acts like a stimulant; at higher doses, it sedates, dulling pain — which has also made it popular as an over-the-counter remedy for opioid withdrawal.

“It’s very troubling to the FDA that patients believe they can use kratom to treat opioid withdrawal symptoms,” FDA Commissioner Scott Gottlieb said in a statement. “There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder.”

Instead, he said, the FDA is concerned that the use of kratom could actually “expand the opioid epidemic.”

“We’ve learned a tragic lesson from the opioid crisis: that we must pay early attention to the potential for new products to cause addiction and we must take strong, decisive measures to intervene,” Gottlieb said.

Gottlieb pointed to reports of 36 deaths associated with kratom, as well as a tenfold increase in calls to US poison control centers about the substance between 2010 and 2015.

Gottlieb said kratom has been associated with “serious side effects like seizures, liver damage and withdrawal symptoms.” In addition, he said, kratom can be laced with other pain medications, like hydrocodone, contributing to opioid addiction.

Used for centuries

Native to Southeast Asia, the kratom tree’s leaves have been used for centuries as an herbal drug by laborers and farmers. Today, leaves are ground into pills and powders and sold as a dietary supplement. It can be found in head shops and online. It’s even made into drinks in some bars.

Kratom has a narcotic effect because its active ingredients, the alkaloids mitragynine and 7-hydroxymitragynine, bind to the opioid receptors in our body, according to Dr. Ed Boyer, a professor of emergency medicine at the University of Massachusetts Medical School, who has studied the plant. But unlike opioid drugs such as hydrocodone or heroin, it doesn’t appear to slow breathing, he said.

Recent research has shown that one of the two active ingredients, 7-hydroxymitragynine, can be several times more potent than morphine, Boyer said.

But a study to be presented to the Society of Neuroscience shows the other alkaloid, mitragynine, isn’t addictive and may indeed have therapeutic effects, said medical chemist Chris McCurdy, a professor at the University of Florida and one of the authors of the new research who has been studying kratom for more than a decade.

“I share the public health concerns,” McCurdy said. “I’m not beating a drum to keep it legal and keep it the wild wild West. But I truly believe that it has medical potential.”

Scott Hemby, McCurdy’s research partner, was skeptical of kratom when they started their work but has since changed his mind. “I think it has the potential to be a pharmacotherapy, but we need to do more studies. “

Hemby, who studies the abuse potential of drugs at High Point University, said he hasn’t seen any data to prove that both active ingredients are as addictive as the FDA has stated.

“I’m concerned that we may be pushing the boat out of the harbor before we really know what’s going on,” he said. “The scientific community needs more time to definitively state one thing or another. I would hope public policy would be driven by scientific evidence.”

Regulatory ups and downs

Kratom has come under fire before. In 2014, the FDA issued an alert that allowed US officials to detain kratom without a physical examination. Between February 2014 and July 2016, the DEA said, nearly 247,000 pounds of kratom were seized.

In August 2016, the Drug Enforcement Agency moved to make kratom a Schedule I drug, a substance that has “no currently accepted medical use and a high potential for abuse.” After a public outcry, including letters from members of the House of Representatives and the Senate on the possible benefits of kratom, the DEA withdrew its intent to make it Schedule I. Instead, it opened a public comment period to react to possible scheduling, which closed in December 2016. Since that time, the DEA has taken no action and says they are still in the review process.

A call to science

In his statement, Gottlieb addressed the concerns of those interested in more science, saying that although the FDA remains open to the potential medicinal uses of kratom, “those uses must be backed by sound-science and weighed appropriately against the potential for abuse” and thoroughly evaluated by the DEA and the FDA.

“To those who believe in the proposed medicinal uses of kratom,” he wrote, “I encourage you to conduct the research that will help us better understand kratom’s risk and benefit profile, so that well studied and potentially beneficial products can be considered.”

At the request of the DEA, Gottlieb said, his agency has conducted a comprehensive scientific and medical evaluation of two compounds found in kratom and continues to actively prevent shipments from entering the country, and to destroy any that are seized.

“If they’ve been doing a review of the work for a year, who’s been doing the science? And why hasn’t anyone contacted us?” asked McCurdy, who has studied the plant for 13 years. Even though his name is frequently found as an author on kratom studies, he said, he was not approached by the FDA for its review.

“I realize there hasn’t been a huge amount of science, but that’s where we are now at: getting some of this science to the forefront,” McCurdy said. “Obviously, I agree with the need to regulate the marketplace, but I don’t want it to impede the research and potential for a treatment.”

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17 tips to pick the freshest veggies and ripest fruit

Refusing to eat broccoli or skipping the salad bar aren’t just habits exhibited by picky kids; turns out, most grown-ups aren’t eating their fruits and veggies, either. Federal guidelines recommend adults eat at least 1 and 1/2 to 2 cups of fruit and 2 to 3 cups of vegetables a day. But only 12 percent of adults meet the requirement for fruit and just 9 percent of adults eat enough vegetables, according to a new report from the U.S. Centers for Disease Control and Prevention.

Making sure you’re getting your daily fill isn’t the only problem; finding the best, ripest and tastiest fruits and vegetables isn’t as intuitive as you might think. It’s a task that requires all five senses to decipher the quality of your supermarket produce. Regardless of what you’re shopping for, start with these three rules:

1. Beautiful doesn’t mean delicious

Sub-par conventional produce is bred to look waxy, glistening, and perfectly symmetrical, while prime fruits and vegetables are often irregularly shaped, with slight visual imperfections outside but a world of flavor waiting inside.

2. Use your hands

You can learn more about a fruit or vegetable from picking it up than you can from staring it down. Heavy, sturdy fruits and vegetables with taut skin and peels are telltale signs of freshness.

3. Shop with the seasons

In the Golden Age of the American supermarket, Chilean tomatoes and South African asparagus are an arm’s length away when our soil is blanketed in snow. Sure, sometimes you just need a tomato, but there are three persuasive reasons to shop in season: it’s cheaper, it’s better and it’s better for you.

To dig even deeper into our hunt for perfect produce, Eat This, Not That! asked Aliza Green, author of “Field Guide to Produce,” and Chef Ned Elliott of Portland’s Urban Farmer restaurant for the dirt on scoring the best of the bounty. Use the tips and tricks that follow and you’ll bring home the best fruits and vegetables every time, just like an Italian grandma. And while you’re at the store, check out these50 Best Supermarket Shopping Tips Ever.

1. Apples

Perfect pick: Firm and heavy for its size with smooth, matte, unbroken skin and no bruising. The odd blemish (read: wormhole) or brown “scald” streaks do not negatively impact flavor. The smaller the apple, the bigger the flavor wallop.

Peak season: September to May

Handle with care: Keep apples in a plastic bag in the crisper away from vegetables. Here, they should remain edible for several weeks.

The payoff: These fall and spring favorites are packed with quercetin, a flavonoid linked to better heart health, plus the soluble fiber pectin, which keeps cholesterol in check.

2. Artichokes

Perfect pick: An artichoke with deep green, heavyset, undamaged, tightly closed leaves is the best bet. The leaves should squeak when pinched together.

Peak season: March to May

Handle with care: Store in the fridge in a plastic bag for up to five days.

The payoff: Aside from being a good source of protein, artichokes have a higher total antioxidant capacity than any other common vegetable, according to USDA tests.

3. Asparagus

Perfect pick: Look for vibrant green spears with tight purple-tinged buds. Avoid spears that are fading in color or wilting. Thinner spears are sweeter and more tender.

Peak season: March to June

Handle with care: Trim the woody ends and stand the stalks upright in a small amount of water in a tall container. Cover the tops with a plastic bag and cook within a few days.

The payoff: Asparagus are potent sources of folate, a B-vitamin that protects the heart by helping to reduce inflammation.

4. Avocados

Perfect pick: Avocados should feel firm to the touch without any sunken, mushy spots. They should not rattle when shaken — that’s a sign the pit has pulled away from the flesh.

Peak season: Year-round

Handle with care: To ripen, place avocados in a paper bag and store at room temperature for two to four days. To speed up this process, add an apple to the bag, which emits ripening ethylene gas. Ripe avocados can be stored in the fridge for up to one week.

The payoff: The green berry (yes, we said berry!) packs plenty of cholesterol-lowering monounsaturated fat. Bonus: A diet rich in monounsaturated fat may prevent body fat distribution around the belly by down regulating the expression of certain fat genes. Simply put: It can whittle your waist by zapping away belly fat.

5. Bananas

Perfect pick: Ripe bananas have uniform yellow skins or small brown freckles indicating they are at their sweetest. Avoid any with evident bruising or split skins.

Peak season: Year-round

Handle with care: Store unripe bananas on the counter, away from direct heat and sunlight (speed things up by placing green bananas in an open paper bag). Once ripened, refrigerate; though the peel turns brown, the flavor and quality are unaffected.

The payoff: Bananas are a good source of vitamin B6, which helps prevent cognitive decline, according to scientists at the USDA.

6. Beets

Perfect pick: A beet that’s in its prime should have a smooth, deep-red surface that’s unyielding when pressed. Smaller roots are sweeter and more tender. Attached greens should be deep green and not withered.

Peak season: June to October

Handle with care: Remove the leaves (which are great sautéed in olive oil) and store in a plastic bag in the fridge for no more than two days. The beets will last in the crisper for up to 2 weeks.

The payoff: Beets serve up a hefty dose of folate, which may help regulate cholesterol levels and boost heart health.

Salad of Roasted Heirloom Beets with Capers and Pistachios

Roasted Red and Golden Beet Salad with Pistacchios

Renee Comet / The New Jewish Tab

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Will County Health Department Offers Holiday Food Safety Tips

JOLIET, IL – From the Will County Health Department: As we have reached the time for holiday meals and parties, it is once again a good practice to review both the practical things, as well as the “sometimes hidden and forgotten secrets,” when it comes to keeping our food safe.

Some of the common items, such as washing hands with warm water and soap for 20 seconds before handling food, and rewashing them when any change of tasks takes place while preparing food (such as handling garbage, touching the dog or cat, picking up something that fell on the floor), are common instinct for many.

But there may be some other tips that make people say, “Oh, I never thought of that!”

The Food and Drug Administration likes to highlight four major categories, or should we say four specific verbs, when it comes to preparing food: clean, separate, cook, and chill.

The “clean” category includes the part about 20 second hand washing, but it also reminds us to clean all surfaces that will have contact with the food: such as countertops, cutting boards, dishes, and utensils. They should be washed with hot,soapy water as well.

But here’s an important thing to distinguish: while it is wise to rinse fruits and vegetables thoroughly under cool, running water (with perhaps a produce brush to remove stubborn surface dirt), it is not wise to rinse raw meat and poultry before cooking, as this can cause bacteria to spread to areas around the sink, such as countertops.

“Some people rinse out the cavity of the turkey or of a chicken, or even rinse their steaks,” says Will County Health Department Environmental Director Tom Casey. “But when you do that you are literally splashing the raw meat juices all over; in addition to on your hands, arms, and body.”

For “separate,” this is where you do not allow raw food that will be cooked to touch foods that will not be cooked until they are served. For example; raw eggs, meat, and poultry; as well as their juices; should be kept away from vegetables, salads, and other ready to eat items. It is best to keep all of this in mind through the entire process: from the purchase at the store, to the storing in the refrigerator, to the preparation and serving of the meal.

There should also be separate cutting boards for foods that are raw and for ready to eat foods. And another thing that could be an “oops, I forgot” moment: cooked meat, or anything that is ready to be served, should not be placed on an unwashed plate that has already held raw eggs, meat, poultry, or their juices. This will avoid cross-contamination.

For the “cook” category, temperature is extremely critical, especially when preparing a holiday turkey. A turkey should never be judged to be “done” or “not done” depending upon its color. Instead, a food thermometer should be used, and should be inserted into the innermost part of the thigh and wing away from the bone, as well as the thickest part of the breast. The temperature for both the turkey and stuffing (if the turkey is stuffed) should be a minimum of 165 degrees Fahrenheit.

And speaking of stuffing, there’s another important area of caution that is often forgotten. Not only should the stuffing be the same temperature as the turkey when done cooking, but the turkey should be stuffed just prior to being placed in the oven. In addition, it should be stuffed rather loosely, at about ¾ cup of stuffing for each pound of the turkey.

Other “cook” items include bringing sauces, soups, and gravies to a rolling boil when heating or reheating. And if you are making your own eggnog, or if you need raw eggs for a certain recipe; you should use pasteurized shell eggs, liquid or frozen pasteurized egg products, or powered egg whites. “The pasteurized shell eggs are where the eggs are heated up while still in the shell according to FDA regulation, and then preserved at 41 degrees Fahrenheit or less,” Casey explained. “You need to ask your grocer if they carry these products.”

And while on the topic of raw eggs: although this is a favorite of many kids, eating uncooked cookie dough is not safe, as it may contain raw eggs. “Yes, a lot of us did that,” Casey admits. “But it’s just not safe. And this goes for stuffing as well. Some people like to taste their stuffing after all the flavorings are added before it goes into the bird. But you are consuming raw stuffing, which commonly means you are eating raw eggs.”

For the “chill” category, the number one rule is to refrigerate leftovers and takeout foods within two hours of the meal’s conclusion. It is important to remember that room temperature falls right in the middle of the “danger zone” for bacteria to begin rapidly growing on food that’s left out. That danger zone is identified as anywhere between 41 and 135 degrees Fahrenheit. Although we often love to leave leftovers and desserts out for a while as the evening at home moves into relaxation time, this includes pumpkin pie as well.

And getting back to the start of the process, food should not be defrosted at room temperature. You should defrost in the refrigerator, under cold running water, or in the microwave as part of the cooking process. “The reason to use cold constantly running water,” Casey explained. “is to make sure particles are rinsed off and going down the drain. This is much safer than having something, like a turkey, thawing in stagnant water.”

And if you are using the fridge to defrost, it’s important to remember to not wait until the night before your meal. For example, a 20-pound turkey often takes four or five days of refrigeration to completely defrost.

What’s something else that is often not thought of? Always thaw raw meat, small or large, on the bottom shelf of your refrigerator. This avoids the dripping of raw meat juices on to food that would be stored below.

For more advice on holiday food safety, you can go to the Food and Drug Administration or Centers for Disease Control websites.

Image via Unsplash

This Face-Recognition App Could Potentially Identify Diseases

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3 Thanksgiving Health and Safety Tips

Thanksgiving represents a great opportunity for pharmacists to play an important role in patient education. From medication safety to the prevention of foodborne illnesses, pharmacists can provide great resources and support. 

Check out these 3 Thanksgiving health and safety tips:

1. Encourage patients to get their annual influenza vaccines. Influenza activity is low in the United States, but it is increasing.1 Vaccination is the best way for patients to protect themselves and family members from the flu. Let patients know that it takes about 2 weeks for the vaccine to become effective. The most frequently reported influenza virus type so far this season has been influenza A.

2. Educate patients to poison-proof their homes. Poison prevention is extremely important, especially for families with children and pets. Medications should be stored out of the reach of children and pets, preferably in a locked area. Those who are hosting Thanksgiving celebrations in their homes should be sure to keep guests’ handbags and suitcases, which may contain medications, out of the reach of children. Tell families to assign an adult to keep an eye on children, as poisoning can happen in the blink of an eye. Families should keep the Poison Help Line number (1-800-222-1222) on hand, which is a great free resource available 24/7 for poison emergencies.

Keep chocolate, coffee, and caffeine products away from pets. These products contain methylxanthines, which can cause vomiting, diarrhea, panting, excessive thirst and urination, hyperactivity, arrhythmias, tremors, seizures, and even death.Products containing the sweetener xylitol (eg, gum, candy, baked goods, and toothpaste) should also be kept out of reach. Xylitol can cause insulin release, which can lead to liver failure and hypoglycemia. Tell families that they can contact their veterinarians or the Animal Poison Control Center (1-888-426-4435) in an emergency.2 There may be a $65 fee applied for a consultation with the Animal Poison Control Center.

3. Prevent foodborne illness during the Thanksgiving meal. Advise patients to purchase a food thermometer to make sure that the turkey is cooked and reaches a temperature of 165°F.3 The preferred method of thawing a turkey is in the refrigerator. It is important to plan ahead to allow about 24 hours for every 4 to 5 pounds in a refrigerator set at 40°F or below.3 

It is important to wash one’s hands with soap and water for at least 20 seconds before preparing food. The turkey should not be washed, as this can spread pathogens onto kitchen surfaces. Additionally, raw turkey should be separated from all other foods.  Separate cutting boards, plates, and utensils should be used when handling raw turkey to prevent cross-contamination. The turkey’s temperature should be checked by inserting the thermometer in the thickest part of the breast, the innermost part of the thigh, and the innermost part of the wing. Leftovers should be refrigerated within 2 hours to prevent Clostridium perfringens, which are bacteria that grow in cooked foods left at room temperature.4 Symptoms include vomiting and abdominal cramps within 6 to 24 hours of consuming the affected food. This is the second-most-common bacterial cause of food poisoning, with most outbreaks occurring in November and December.4


1.  1. Centers for Disease Control and Prevention. Weekly US influenza surveillance report. Updated November 9, 2017. Accessed November 14, 2017.
2. ASPCA. People foods to avoid feeding your pets. Accessed November 14, 2017.
3. Thanksgiving.  Accessed November 14, 2017.
4. Centers for Disease Control and Prevention. Food safety tips for your holiday turkey. Updated November 13, 2017. Accessed November 14, 2017.




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U.S. Health Policy Idea Gets Rave Reviews From Canadians : Shots …

The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.

Jay Mallin/Bloomberg via Getty Images

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Jay Mallin/Bloomberg via Getty Images

The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.

Jay Mallin/Bloomberg via Getty Images

Ask people in Canada what they make of U.S. health care, and the answer typically falls between bewilderment and outrage.

Canada, after all, prides itself on a health system that guarantees government insurance for everyone. And many Canadians find it baffling that there’s anybody in the United States who can’t afford a visit to the doctor.

So even as Canadians throw shade at the American hodgepodge of public plans, private insurance, deductibles and copays, they hold in high esteem a little-known Affordable Care Act initiative: the federal Center for Medicare Medicaid Innovation.

Obamacare's Test Kitchen For Payment Experiments Faces An Uncertain Future

CMMI was a hot topic on a reporter’s recent visit to Toronto to study the single-payer health care system.

Wonky as it seems, the center’s mission — testing innovations to hold down health care costs while increasing quality — is drawing praise from many policy analysts. Researchers and clinicians talk about its potential to foster experimentation and how it has led the United States to think creatively about payment and reimbursement models.

“It is gaining traction in many circles here,” says Dr. Robert Reid, who researches health care quality at the University of Toronto.

Thanks to the ACA, the center for innovation is equipped with $10 billion each decade and sponsors on-the-ground experiments with doctors, health systems and payers. The idea is to devise and implement payment approaches for health care services that reward quality and efficiency, rather than the number of procedures performed.

“There have been some good efforts — they have tried more things than we have,” agrees Dr. Kaveh Shojania, an internist at same university who studies health care quality and safety.

Still, despite the praise emanating from north of the border, the U.S. program doesn’t get the same love on the homefront. Since taking office, President Donald Trump has moved to roll back the center’s reach.

Canada has its own reasons for seeing potential in this sort of systemic test kitchen.

Hospitals Worry Repeal Of Obamacare Would Jeopardize Innovations In Care

Health care’s growing price tag — and a payment system that doesn’t always reward keeping people healthy — is not just an American problem. The vast majority of Canadian doctors are paid through what Americans call the “fee-for-service” model. And Canadian policymakers are also looking for strategies to curb health care costs — which are a big part of federal and provincial budgets in Canada, too.

“The whole world is confronting the same issue, which is, ‘How do you pay and incentivize doctors to keep people out of the hospital and keep them healthy?’ ” says Dr. Ezekiel Emanuel, a former adviser to President Barack Obama, who pushed for the center’s initial development.

“Different places are looking at how to break out of that system, because everyone knows its perversions,” Emanuel says. “This is one place where … we are in the world among the most innovative groups.”

Emanuel says he’s not surprised to hear of the center’s appeal in Canada. He has received similar feedback from health ministers in Belgium and France, he says.

Even so, U.S. critics say CMMI’s work is a waste of money or a federal overreach.

And, so far, the Trump administration has taken steps to reduce by half the size of one high-profile Obama administration project that bundles payments for hip and knee replacements. Under the bundling program, the hospitals performing those are paid a set amount, rather than for individual services. The administration has also canceled other scheduled “bundling” projects that target payment for cardiac care and other joint replacements.

Seema Verma, Trump’s administrator of the Centers for Medicare and Medicaid Services, wrote in The Wall Street Journal in September that the innovation center was going to begin moving “in a new direction.”

A federal document recently issued by CMS suggests that the center for innovation will now emphasize cutting health care costs through strategies like market competition, eliminating fraud and helping consumers actually shop for care. It also says the innovation center will favor smaller-scale projects.

At least for now, it’s hard to interpret exactly what this means, says Jack Hoadley, a health policy analyst at Georgetown University who has previously worked at the Department of Health and Human Services.

Limiting CMMI’s footprint in the U.S. would be problematic, Emanuel says.

Meanwhile, the center’s influence in Canada, seems to be growing.

“We definitely looked to it as a model as something we can do. Like look, this happened, and why can’t we do the same thing here?” says Dr. Tara Kiran, a Toronto-based primary care doctor who also researches health care quality.

The nonprofit health newsroom Kaiser Health News is an editorially independent part of the Kaiser Family Foundation. Shefali Luthra covers health care for KHN. She’s on Twitter @shefalil.

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Madison Latino Health Fair to offer free screenings and information Saturday

Whenever Lisa Speckhard posts new content, you’ll get an email delivered to your inbox with a link.

Email notifications are only sent once a day, and only if there are new matching items.

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Health giant Sutter destroyed evidence in crucial antitrust case over high prices, judge says

Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.

In a ruling this week, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”

Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.

Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.

Sabra Health Care Vs. Omega Healthcare: Side-By-Side


I hold small positions in Sabra Health Care (SBRA) and Omega Healthcare (OHI). Both are REITs leasing to the healthcare industry with a focus on skilled nursing facilities. In fact, both companies share several common operator-tenants.

Both OHI and SBRA share prices declined heavily since the quarter ended September 30, 2017. Readers may be aware that Sabra issued 16 million common shares on September 28, 2017 at $21 per share (source: NASDAQ Globe Newswire). As of November 16, 2017, SBRA shares closed at $19.05. Omega shares have shared a similar trend.

In this article, I wanted to review the two healthcare REITs side-by-side to evaluate whether one is particularly stronger investment candidate relative to the other. Among others, I independently computed several operating metrics and liquidity measures. Read on for the calculations and my conclusion.

Show Me The Dividend

Without further ado, let me start bombarding you with the metrics. First of all, I recognize that there’s a good chance you, the reader, is a dividend investor. Me, too! So, here is how the two companies stack up side-by-side.

Dividend Yield

Basically, both companies yield a relatively high 9%+, with a slight edge going to Omega Healthcare (which mainly is following the recent sell-off). Also, worth noting is that Omega had the stronger absolute dividend growth over prior year in the high single-digit %.

(As an aside, Sabra shares jumped so much since 2016 year-end, because of the merger with Care Capital Properties.)

Winner: Omega. But, not by much.

Reference Financial Info

The following reference financial info was mostly keyed in using 2017 Q3 10-Q (for the quarter ended 9/30/2017). These base figures will set the stage for the computations to follow and I wanted to share these with you for reference.

Source: Author’s data entry. [Original worksheet: sbra_vs_ohi_side-by-side.xlsx]

I need to make a quick explanation about the column labeled “Omega w/out imp.” That refers to what Omega’s financials would look like if I exclude the non-cash impairment charge for direct financing lease of $198 million.

In this article, I won’t debate the merits of whether or not the figure should be deemed reflective of on-going operations. Rather, I want to present the metrics both with and without that particular impairment charge. Okay, back to metrics.

Operating Metrics

Based on the financial table shared above, one can re-compute the following metrics.

Recognize that these are neither GAAP measures nor conventionally disclosed REIT measures. However, these made sense to me as operating metrics I’d like to know if I were running the business.

For instance, Both Omega and Sabra derive over 80% of their total revenues from renting. That helps me understand that both are mostly in the business of being a landlord. Clearly, Omega is more involved in “other” activities.

OpEx ratio is simply total operating expense (including interest expense) divided by total revenues. You can see how these were computed in the source spreadsheet. Here, I find that Sabra is the more frugal spender. That’s important for me to know as an investor.

With respect to distributions made relative to FFO, both come out in the low 80%-range if you exclude the impact of the aforesaid $198 million impairment charge. On a NAREIT FFO basis, Omega’s distributions exceeded its FFO for the 9-months ended September 30, 2017.

Rent income yield was computed as annualized rental income divided by gross real estate assets. It was a way of seeing for a given amount of asset, how much income is that asset producing in rent? In that measure, Omega was the winner. But, then unlike Sabra, Omega was recognizing quite a bit of impairment activity. That means both you and I need to dig a little deeper into the quality of Omega’s assets and drivers of the impairment charges. Sadly, that deep dive is out of scope here and will have to be done in a separate analysis.

Winner: Sabra. But Maybe.

Liquidity/Credit Quality

Both companies issue investment grade debt as measured by your rating agencies (I excluded Fitch rating for simplicity). Ba1 is one grade lower than Baa3, so Omega’s unsecured debt is rated slightly higher.

Also, note that a greater portion of Omega’s debt is unsecured. That gives some strength to Omega’s case relative to Sabra.

(For those unfamiliar with debt, unsecured is better in this case. Secured debt basically means that the Bank has secured a specific lien on some hard asset of the business, most likely a real estate property. An unsecured debt would be made based on the creditworthiness and enterprise value of the overall business.)

That said, I find that Sabra has the lower overall debt burden relative to equity, but higher debt burden relative to its annualized FFO (for Omega, using the FFO excluding impairment).

In terms of servicing current interest expenses, I find both companies similar. (Here, note that this coverage calculation is my proforma, as it is simply FFO over interest expense from the income statement.)

As for upcoming maturities, I actually like Sabra’s maturity schedule much more. It will have very little payments until 2019, but the maturing payments should be manageable through 2020. Omega has one big balloon maturity in 2021. That’s good for the next few years, but it means management will be busy restructuring or refinancing the debt in a few years’ time.

Winner: Mixed. It’s a tie.


We can’t end an article like this without looking at tenants; these are landlords, after all!

I was surprised to see that Sabra has a better occupancy ratio in the upper 80%-range. I was surprised because I’ve read many articles asserting how Omega was best in class in the skilled nursing category.

It also struck me how much lower the occupancy rate is for these two REITs relative to high performing retail REITs like Realty Income (O) and Tanger Factory Outlets (SKT), whose occupancy rates will be in the high 90%-range. For example, see my post on Tanger and Retail REITs for those occupancy rates.

Digging little more, we find that Omega has little less concentration from top 5 tenant-operators. But, both share some operators that many readers will recognize as distressed. Note below the EBITDAR coverage as shared by Sabra Health Care in its 2017 Q3 supplemental presentation.

Omega and Sabra both share top tenants Genesis and Signature, and neither have a very strong income coverage of debt obligations.

In fact, in its November 8, 2017 8-K filing, Genesis Healthcare announced plans to restructure its obligations with counterparties Welltower Master Lease and Sabra Master Leases, among others.

I feel like this last comparison is like seeing who has the stinkier feet. There are no winners in that game. This last aspect of the business model is a little bit disappointing. The conservative investor should require a healthy margin of safety. If you step back and consider a business model lending to or leasing to those with limited (or shaky) ability to payback your money, then you have a business model with little margin of safety. It is my hope – and I’m sure the management’s hope as well – that the parties can work out a payment plan that works, and that the operating health of these tenants will improve over time. As for Sabra, its management already has announced plans to dispose of Genesis-related assets.

Loser: Both. Though a slight edge to Sabra.

Here again, the source file: sbra_vs_ohi_side-by-side.xlsx


I compared Sabra Health Care and Omega Healthcare because I have small positions in both companies. Further, both have a material skilled nursing facility exposure and share top common tenants.

Specifically, I independently computed several operating metrics and liquidity measures. My conclusion is that on the whole, Sabra appears to be the better operator with the stronger overall business mix (e.g. higher occupancy, higher interest coverage).

That said, it is clear that both REITs are operating under some market distress. So, I likely will not be adding to my positions in spite of the appealing dividends.

Disclosure: I am/we are long OHI, SBRA.

I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

Additional disclosure: I am not a financial advisor. The research was done for myself, and I am sharing it with the readers.

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