Saturday, December 29, 2012

Health Care Reform Articles - December 29, 2012

Chronic MaineCare shortfalls — a symptom of a disease we can treat

Posted Dec. 27, 2012, at 1:35 p.m.
About a year ago, facing a budgetary shortfall, the Maine Legislature had a knock-down, drag-out fight over Gov. Paul LePage’s proposal to save $220 million by throwing 65,000 Maine residents off MaineCare.
At that time, I predicted that the Legislature “can look forward to a repeat performance in a year or two unless they have the courage, wisdom and bipartisanship to attack the fundamental flaws in the ways we finance and deliver [all] health care services.” Well, they didn’t. And now they are.
The recently announced “unexpected” cost overrun of more than $100 million attributable mostly to MaineCare will no doubt lead to a repeat of last year’s fight. At the same time, Maine hospitals are clamoring for almost $500 million in past-due MaineCare payments.
The Legislature is now under different management. Maybe the Democrats can succeed where the Republicans failed. But to do so they will have to finally be willing to look at the big picture.
At a national level, Congress and the Obama administration are contemplating cutbacks in Medicare eligibility as one way to reduce federal spending. Such cuts, like those in MaineCare, will simply shift those costs to the private sector.
That shift will only exacerbate existing private-sector health care cost problems. Out-of-control costs have had a dampening effect on employment, depressed wages and discouraged entrepreneurship by creating job lock. They have also encouraged employers to shift whatever costs they can to their workers and to public-sector programs such as MaineCare. Walmart is the poster child for this phenomenon, but it’s hardly alone.
MaineCare cost overruns are only a symptom of larger problems in our health care system as a whole. They cannot be solved in isolation. Trying to do so is a losing strategy.
The Legislature now has an opportunity to revisit a solution they have failed to embrace in the past under both Democratic and Republican leadership — movement toward a single, publicly managed health care system for all the people of Maine.

Doctors with financial conflicts influence drug treatment guidelines

Posted Dec. 28, 2012, at 10:00 a.m.
MILWAUKEE — Doctors with financial ties to drug companies have heavily influenced treatment guidelines that recommend the most lucrative drugs in American medicine, an analysis by the Milwaukee Journal Sentinel and MedPage Today has found.
The guidelines affect how doctors across the country treat patients for everything from diabetes to asthma, chronic pain, depression and high cholesterol.
Issued by leading medical associations and government institutions, treatment guidelines are supposed to be based on rigorous science. But the committees that write them have been dominated by doctors who have worked as paid speakers, consultants or advisers for companies selling the recommended drugs.
Critics say the financial relationships have corrupted medicine, resulting in cases where guidelines make dangerous or ineffective recommendations. Drug companies and some doctors counter that those with conflicts are often top experts in their field.
The Journal Sentinel examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the United States.
The drugs sit in the medicine cabinets of millions of Americans — Nexium for acid reflux, Lipitor for high cholesterol, Cymbalta for depression and OxyContin for pain. Their collective sales topped $94 billion in 2011, accounting for 30 percent of drug revenue in the United States.
An analysis of the guideline panels, which involved 293 doctors, found:
Nine guidelines were written by panels where more than 80 percent of doctors had financial ties to drug companies.
Four panels did not require members to disclose any conflicts of interest. Of the 16 that did, 66 percent of doctors on the panels had ties to drug companies.
Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing. Medical experts have raised such questions about guidelines for anemia, chronic pain and asthma.
Research funded by drug companies was not counted as a conflict in the Journal Sentinel analysis because experts disagree whether research poses as much of a conflict as speaking, consulting and advising.
The findings offer the latest glimpse into how pharmaceutical companies, with billions in sales at stake, exert a powerful but often unrecognized influence over the practice of American medicine.

‘Gaping security holes’ expose health systems’ data, researchers reveal

Posted Dec. 26, 2012, at 6:04 p.m.
As the health care industry rushed onto the Internet in search of efficiencies and improved care in recent years, it has exposed a wide array of vulnerable hospital computers and medical devices to hacking, according to documents and interviews.
Security researchers warn that intruders could exploit known gaps to steal patients’ records for use in identity theft schemes and even launch disruptive attacks that could shut down critical hospital systems.
A yearlong examination of cybersecurity by The Washington Post has found that health care is among the most vulnerable industries in the country, in part because it lags behind in addressing known problems.
“I have never seen an industry with more gaping security holes,” said Avi Rubin, a computer scientist and technical director of the Information Security Institute at Johns Hopkins University. “If our financial industry regarded security the way the health care sector does, I would stuff my cash in a mattress under my bed.”
Compared with financial, corporate and military networks, relatively few hacks have been directed at hospitals and other medical facilities. But in recent months, officials with the Department of Homeland Security have expressed growing fear that health care presents an inviting target to activist hackers, cyberwarriors, criminals and terrorists.
“These vulnerabilities may result in possible risks to patient safety and theft or loss of medical information,” a DHS intelligence bulletin said in May.
Security researchers are starting to turn up the same kinds of trivial-seeming flaws that earlier opened the way for hackers to penetrate financial services networks, Pentagon systems and computers at firms such as Google.
Rubin has documented the routine failure to fix known software flaws in aging technology and a culture in which physicians, nurses and other health care workers sidestep basic security measures, such as passwords, in favor of convenience.
Another researcher found that a system used to operate an electronic medicine cabinet for hospital prescriptions in Oklahoma could be easily taken over by unauthorized users because of weaknesses in the software interface.
OpenEMR, an open-source electronic medical records management system that is about to be adopted worldwide by the Peace Corps, has scores of security flaws that make it easy prey for hackers.
The University of Chicago medical center operated an unsecure Dropbox site for new residents managing patient care through their iPads, using a single user name and password published in a manual online.

The Smart Money: Entitlement Reform

by Gina Hamilton
Out of every dollar spent by the federal government, 47 cents is spent on entitlements. 
Entitlements are things that people paid taxes specifically to support, such as Social Security and Medicare, and low-income supports, such as Medicaid, as well as interest on the national debt.  Because people are living longer, combined with a blip in the demographics that we call the Baby Boom, the funding for these programs isn't keeping up with the costs.
It's not surprising that Congress turns its eyes to entitlements when it is trying to solve a fiscal problem; it's a huge part of the budget, and entitlements are guaranteed.  But there are options for reform that won't hurt the neediest and seniors, if Congress can just get its collective head around a few points.

Maine officials acting amid a surge in gonorrhea

The 441 infections in 2012, many involving people in their 20s, is quadruple the number reported in 2008.

By Kelley Bouchard
Staff Writer
The annual incidence of gonorrhea in Maine has more than quadrupled since 2008, when the state had the nation's second-lowest infection rate, according to the Maine Center for Disease Control and Prevention.

Service providers taking stock of mental health, substance abuse cuts

Posted Dec. 28, 2012, at 6:55 p.m.
AUGUSTA, Maine — Agencies that provide services to people with mental health and substance abuse problems started to assess the impact Friday of $13.4 million in cuts to the state’s health and human services budget as part of a $35.5 million curtailment order issued this week by Gov. Paul LePage.
The cuts hit health and human services and local school aid — the two areas that account for the largest portion of state spending — hardest. The curtailment is a temporary measure designed to keep the state budget in balance amid revenue collections that have fallen short of earlier projections.
The $13.4 million in Department of Health and Human Services cuts include $2.2 million in funding reductions for state contracts with providers that serve people with substance abuse problems and mental illness.
Bonnie Smith, DHHS’ deputy commissioner for programs, said the department tried to find as many areas to cut as possible without eliminating services.
“That process went on in depth for many, many long days and nights. None of this was taken lightly,” she said. “We’re doing everything we can to make sure that services are not interrupted, that we’re not having people without services who are in need.”

Thursday, December 27, 2012

Health Care Reform Articles - December 27, 2012

7-Eleven Shifts Focus to Healthier Food Options

The chain that is home of the Slurpee, Big Gulp and self-serve nachos with chili and cheese is betting that consumers will stop in for yogurt parfaits, crudité and lean turkey on whole wheat bread.
7-Eleven, the convenience store chain, is restocking its shelves with an eye toward health. Over the last year, the retailer has introduced a line of fresh foods for the calorie conscious and trimmed down its more indulgent fare by creating portion-size items.
The change is as much about consumers’ expanding waistlines as the company’s bottom line. By 2015, the retailer aims to have 20 percent of sales come from fresh foods in its American and Canadian stores, up from about 10 percent currently, according to a company spokesman.
“We’re aspiring to be more of a food and beverage company, and that aligns with what the consumer now wants, which is more tasty, healthy, fresh food choices,” said Joseph M. DePinto, the chief executive of 7-Eleven, a subsidiary of the Japanese company, Seven & i Holdings.
Convenience stores have typically been among the most nimble of retailers. In the 1980s, they added Pac-Man arcade games as a way to keep customers in stores longer and to buy more merchandise. They installed A.T.M.’s a decade later, taking a slice of the transaction fees. More recently, they built refrigerated dairy cases, with milk, eggs, cheese and other staples.
But just as they have taken business from traditional supermarkets, convenience stores have faced increased competition from the likes of Dunkin’ Donuts and Starbucks, which offer a basic menu of fresh foods for consumers on the go.
At the same time, a major profit driver for convenience stores — cigarettes — has been in steady decline over the last decade as the rate of smoking has dropped in the United States.
Fresh foods can help offset some of those losses. The markup on such merchandise can be significant, bolstering a store’s overall profits. It’s also a fast-growing category.

Health care tax hikes for 2013 may be just start

Monday, December 24, 2012

Health Care Reform Articles - December 24, 2012

Happy Holidays All!

German Health Care Attracts Foreign Patients

BERLIN — When Jalal Talabani, the president of Iraq, needed advanced medical care for a stroke suffered this week, he flew not to the United States or Britain but to Germany, for treatment here in the capital.
For many Americans, Germany is known as a way station where soldiers wounded in Iraq and Afghanistan received immediate medical care on United States military bases. But it is also a popular destination for wealthy and prominent patients from the Middle East, Russia and beyond, experts say.
Before the Arab Spring uprisings, the Egyptian president Hosni Mubarak traveled to Munich in 2004 for back treatment and to Heidelberg in 2010 to have his gallbladder removed. Last year, President Nursultan Nazarbayev of Kazakhstan reportedly had a surgical procedure on his prostate at the University Medical Center Hamburg-Eppendorf.
According to German government statistics, the number of hospital patients from the United Arab Emirates rose to 1,754 from 339 between 2000 and 2010, the most recent year available. From Saudi Arabia, the figure climbed to 712 from 143. The numbers from Iraq were smaller but still rose to 176 from 95. Over the same period, the number of Russians jumped to 4,873 from 842.
“We have one of the worldwide best health care systems and people from abroad know that,” said Isabella Beyer, research associate in medical tourism at the Bonn-Rhein-Sieg University of Applied Sciences. Mr. Talabani, 79, is among them; he was treated in Germany before for back trouble.
Mr. Talabani is now being cared for at Berlin’s Charité hospital, which is more than 300 years old and is one of Europe’s largest university hospitals. The storied institution was home to several Nobel Prize winners, including Robert Koch and Paul Ehrlich. A spokeswoman for Charité, Manuela Zingl, confirmed that Mr. Talabani was being treated there but said that she could not disclose any information on his condition because of rules on medical privacy.

When The Doctor Works For The Insurance Company

Some insurance companies are taking a page out of their own history books: running their own doctors' offices and clinics. Though the strategy previously had mixed results, insurers think that by providing primary care for patients, they might reduce costly diseases and hospital stays in the long run.

Dr. Michael Byrne spent eight years working for a Brooklyn hospital and he saw firsthand why the United States spends more on healthcare than any other country in the world.

"I would regularly see patients who were admitted to the hospital, I took care of, who got better and we'd discharge with plan of care," he said. "And they'd come back either to the E.R. sick or to the floor. It's a common occurrence."
Roughly 25 percent of patients hospitalized in Brooklyn were back in the hospital within a month, according to Byrne. They wouldn't fill their prescriptions or take their medications; they'd miss appointments for follow-up tests or consultations with specialists.

Surgical study cites objects left in patients, other errors that should ‘never’ occur

Posted Dec. 21, 2012, at 8:57 a.m.
They sound like some of the worst mistakes a surgeon could make: Leaving an instrument inside a patient. Operating on the wrong body part — or the wrong person. They’re aptly named “never” events, the errors that should never, ever occur.
Turns out, however, these “never” events happen quite frequently, about 500 times a year. Between September 1990 and September 2010, new research in the journal Surgery found evidence of 9,744 paid malpractice claims for never events.
About half of those cases were ones in which surgeons left an object inside the patient (separate research suggests that the most frequently forgotten items are sponges). The other half were cases where the surgeon operated on the wrong part of the body or performed the wrong procedure. A small number, 17, involved surgeons operating on the wrong person altogether.
These events are dangerous: When the researchers analyzed a smaller cohort of data, from 2004 through 2010, they found that 6.6 percent of patients experiencing a never event subsequently died. A third had a permanent injury and 59 percent had a temporary injury.
Patients who received the wrong procedure were at highest odds of death or permanent injury. The research also found that younger patients had significantly better odds of surviving a never event than did patients over 60.
Keep in mind, these data only draw from malpractice claims that were paid. The data would not capture a never event where a patient did not experience harm.
It’s hard to know whether this study even captures the full breadth of never events. As the study’s lead author Winta Mehtsun, a surgeon at Johns Hopkins University School of Medicine, points out, their data only cover malpractice claims. They don’t touch cases never filed.
“Although the data we utilized captured surgical never events resulting in malpractice claims, many do not reach legal process and are then only voluntarily disclosed, with little coordination among reporting bodies,” he writes in the Surgery article.
What the data do suggest is that we do know a bit about which doctors are most likely to experience never events. They are, perhaps unsurprisingly, doctors who had already experienced malpractice claims. Younger doctors also had higher odds of settling malpractice claims for never events.

Walking the Tightrope on Mental Health Coverage

Insurance covers more mental health care than many people may realize, and more people will soon have the kind of health insurance that does so. But coverage goes only so far when there aren’t enough practitioners who accept it — or there aren’t any nearby, or they aren’t taking any new patients.
In the days after the Newtown, Conn., school shooting, parents and politicians took to the airwaves to make broad-based proclamations about the sorry state of mental health care in America. But a closer look reveals a more nuanced view, with a great deal of recent legislative progress as well as plenty of infuriating coverage gaps.
The stakes in any census of mental health insurance coverage are high given how many people are suffering. Twenty-six percent of adults experience a diagnosable mental disorder in any given year, and 6 percent of all adults experience a seriously debilitating mental illness, according to the National Institute of Mental Health. Twenty-one percent of teenagers experience a severe emotional disturbance between the ages of 13 and 18.
According to this year’s Society for Human Resource Management survey of 550 employers of all sizes, including nonprofits and government entities, 85 percent offer at least some mental health insurance coverage. A 2009 Mercer survey found that 84 percent of employers with more than 500 employees covered both in-network and out-of-network mental health and substance abuse treatments.
For now, some people who have no health insurance or who buy it on their own may avoid purchasing mental health coverage too, or may avoid seeking treatment for things like addiction or depression. This happens for many of the same reasons that there has historically been less mental health coverage than there has been for other illnesses. The earliest objections among insurance providers and employers had to do with whether mental disorders existed at all, according to Howard Goldman, a professor of psychiatry at the University of Maryland school of medicine. Then there were questions about whether treatment actually worked. Next, concerns arose over cost and how often people would avail themselves of costly mental health treatments.

N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition

Training to become a doctor takes so long that just the time invested has become, to many, emblematic of the gravity and prestige of the profession.
But now one of the nation’s premier medical schoolsNew York University, and a few others around the United States are challenging that equation by offering a small percentage of students the chance to finish early, in three years instead of the traditional four.
Administrators at N.Y.U. say they can make the change without compromising quality, by eliminating redundancies in their science curriculum, getting students into clinical training more quickly and adding some extra class time in the summer.
Not only, they say, will those doctors be able to hang out their shingles to practice earlier, but they will save a quarter of the cost of medical school — $49,560 a year in tuition and fees at N.Y.U., and even more when room, board, books, supplies and other expenses are added in.
“We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.
At this point, the effort involves a small number of students at three medical schools: about 16 incoming students at N.Y.U., or about 10 percent of next year’s entering class; 9 at Texas Tech Health Science Center School of Medicine; and even fewer, for now, at Mercer University School of Medicine’s campus in Savannah, Ga. A similar trial at Louisiana State University has been delayed because of budget constraints.
But Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing, and the deans of all three schools say that if the approach works, they will extend the option to larger numbers of students.