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Tuesday, April 23, 2013

Health Care Reform Articles - April 23, 2013


Boston Bombing Hero Who Identified Suspect Resorts To Online Fundraising To Pay His Medical Bills (UPDATED)

In the aftermath of the Boston Marathon bombings on Monday, Jeff Bauman’s image was seared into the American consciousness. An extremely graphic photo of Bauman being escorted in a wheelchair with most of his legs blown off quickly went viral. Bauman’s stock rose even further after reports surfaced that he had looked into the eyes of one of the bombing suspects minutes before the explosion, and that the moment he awoke from emergency care, he gave law enforcement critical information that substantially narrowed their field of suspects. But while police continue to scour the streets for at-large suspect Dzhokhar Tsarnaev, the 27-year-old Bauman isscouring the internet for donations to help pay for his outsized medical bills.
Bauman’s friends created the page “Bucks For Bauman!” on the gofundme.com crowdfunding service. The money raised through donations to the site are meant to help Jeff and his family pay the exorbitant costs of his surgeries, ongoing medical care, and physical therapy. Since Tuesday, when the site was launched, Americans from across the country have poured in $158,294 in donations — over half of the overall $300,000 goal.
Bauman has been fortunate enough to receive an impressive number of donations to help him pay his bills, and his uncle plans to buy him his first pair of prosthetic legs. But many other victims in the Boston bombings may not be as fortunate. The cost of treating the bombing survivors’ injuries is expected to exceed $9 million. The out-of-pocket costs associated with that treatment could bury many of the victims financially, even if they do have insurance — unless hospitals, insurers, and charitable foundations swoop in to help, as they did after the mass shooting in Aurora, Colorado.
You can donate to Jeff Bauman’s recovery fund here.

Raiding Grandma’s Medicine Cabinet




Last month, the chief medical officer of Britain called antibiotic resistance a “ticking time bomb” and a threat as dangerous as global warming. In Europe alone, 25,000 people die every year from antibiotic-resistant bacteria — and that’s only counting the infections that were picked up in supposedly sterile hospitals.
For more than 80 years, antibiotics have been nothing short of miraculous. Capable of killing bacteria without killing people, they’ve turned grave illnesses into mere annoyances, providing doctors with license to shoot first and ask questions later, and do so safely — or so we thought. Broad-spectrum antibiotics are powerful fighters with one flaw: unable to smite every bacterium, those immune to their wrath thrive. With every ear infection we treat, and every healthy cow prophylactically dosed with antibiotics (which also helps fatten the animals), we make these drugs less useful for future generations.
Scientists all over the globe are in a race with evolution, scrambling to understand the underlying mechanisms of antibiotic resistance and to discover new ways to fight bacteria. We must diversify our methods for treating bacterial infections and simultaneously reduce the amount of antibiotics we use, says Brad Spellberg, an infectious-disease specialist at U.C.L.A. This has led to a renewed interest in treatments from a world before penicillin.

Is It Time for Off-the-Shelf Birth-Control Pills?




WHEN a federal judge recently ordered the Food and Drug Administration to make the morning-after pill available to women of all ages without a prescription, the ruling was a political embarrassment for the Obama administration and unleashed protests from abortion foes and abstinence advocates. But that controversy may look like a tempest in a teapot compared with a broader and no less heated discussion that is roiling the medical community: should birth-control pills of any type require a doctor’s prescription? Or should they be available, like Tylenol, on pharmacy shelves?
Last December the American College of Obstetricians and Gynecologists released an official position paper concluding that the time had come for birth-control pills to be sold over the counter. It was the first time the group had endorsed such sales, concluding that scientific evidence suggested that the practice was safe and calling it “a potential way to improve contraceptive access and use, and possibly decrease the unintended pregnancy rate.”
After all, oral contraceptives have been available in the United States for more than half a century, and few medicines have been so thoroughly vetted. Despite some catchy new brand names, the pills I took 25 years ago are essentially the same as those my daughter takes today. If anything, pills have become safer because they contain lower doses of estrogen.
While oral contraceptives bring with them some tiny risks, especially if used improperly, they arguably pose fewer dangers than many other medicines bought freely at the pharmacy, experts say, including nonsteroidal pain pills like Motrin (which can cause stomach bleeding) and decongestants like Sudafed (which may raiseblood pressure). With a simple packaging insert about proper use and precautions, women would be fully capable of using them safely, the gynecologists’ group maintained.
“Nonsteroidal medicines kill far more people than birth-control pills,” said Dr. Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico, who was involved in writing the position paper. “For most women, the absolute risk of taking the pill is far less than the risks incurred in pregnancy.”

Lewiston woman sickened by ground beef rallies against antibiotics in meat

Posted April 16, 2013, at 3:12 p.m.
Danielle Wadsworth vividly recalls the night in late 2011 when she awoke with agonizing stomach pain. Lying on the couch in her Lewiston home, Wadsworth was violently ill for several days with what she assumed was the flu.
She’d been discharged from the emergency room at a local hospital earlier that day after undergoing some tests. She decided to sleep downstairs during what she now calls “the most horrible night of my life” to avoid waking her boyfriend.
“I kept going back and forth to the bathroom every 15 minutes and finally, I said, ‘This isn’t normal. I’m not OK,’” Wadsworth said. “So I crawled upstairs, literally on my hands and knees.”
Her boyfriend brought her back to the hospital. Three days later — hooked up to intravenous drips in both arms and losing so much blood through diarrhea that doctors considered giving her a transfusion — Wadsworth received a diagnosis: salmonella.
“I was really scared … it was excruciating,” she said.
She would later learn that she was one of 16 people in seven states known to have been sickened by an antibiotic-resistant strain of the bacteria, which was linked to ground beef sold in Hannaford supermarkets in late 2011. Wadsworth, 32, suspects that tacos she ate the night before Halloween led to her illness. She’d pinched an undercooked piece of meat from the pan as she was preparing the meal, she said.
Wadsworth is now pursuing a legal claim against Hannaford.

Cancer Centers Racing to Map Patients’ Genes



Electric fans growl like airplanes taking off and banks of green lights wink in a basement at Mount Sinai’s medical school, where a new $3 million supercomputer makes quick work of huge amounts of genetic and other biological information.
Just a couple of miles away, a competitor, Weill Cornell Medical College and NewYork-Presbyterian Hospital/Weill Cornell hospital are building a $650 million research tower. Across the street is a newly completed $550 million tower housing labs for another competitor, Memorial Sloan-Kettering Cancer Center.
Major academic medical centers in New York and around the country are spending and recruiting heavily in what has become an arms race within the war on cancer. The investments are based on the belief that the medical establishment is moving toward the routine sequencing of every patient’s genome in the quest for “precision medicine,” a course for prevention and treatment based on the special, even unique characteristics of the patient’s genes.
Among other projects, Harvard Medical School has its Center for Biomedical Informatics, which among a broad array of approaches uses mathematical modeling to predict when genetic information could lead to more effective treatment. Phoenix Children’s Hospital opened the Ronald A. Matricaria Institute of Molecular Medicine in December, recruiting researchers from Los Angeles and Baltimore and planning to sequence the genomes of 30 percent of their childhood cancer patients in their search for better therapies.
Johns Hopkins, with its focus on public health, wants to develop a “systematic genomic sequencing program” over the next two years that will combine genomic analysis with a patient’s environmental exposure, family history and other factors to support preventive medicine, said Scott Zeger, vice provost for research.
“There will be a moment in time when whole genome sequencing becomes ubiquitous throughout health care,” said Peter Tonellato, director of the Harvard personalized medicine lab and a clinical investigator in pathology at Beth Israel Deaconess Medical Center in Boston. “Let’s say we figure out all the individuals who might have a cancer, and we can predict that with a relatively high level of accuracy. Then presumably we can take steps to avoid those, let’s say, decades of treatment.”

Biopharmaceutical industry faces a shift in dynamics

Changes in health care breed uncertainty

As more than 15,000 executives and economic development officials gathered in Chicago Monday for the opening day of the annual Biotechnology Industry Organization convention, the talk was less about bringing safe and effective drugs to market than about improving health, keeping patients out of the hospital, and reining in costs in the US and globally.
http://www.bostonglobe.com/business/2013/04/22/biotechnology-executives-from-around-world-gather-chicago-amid-changing-times/Rzvxhh2ZMWW42yh1El3TNJ/story.html

For Wounded, Daunting Cost; for Aid Fund, Tough Decisions

WASHINGTON — For victims of the Boston Marathon bombings, the terrible physical cost may come with a daunting financial cost as well.
Many of the wounded could face staggering bills not just for the trauma care they received in the days after the bombings, but for prosthetic limbs, lengthy rehabilitation and the equipment they will need to negotiate daily life with crippling injuries. Even those with health insurance may find that their plan places limits on specific services, like physical therapy or psychological counseling.
Kenneth R. Feinberg, the lawyer who has overseen compensation funds for victims of the Sept. 11 terrorist attacks, the shootings at Virginia Tech and other disasters, arrived in Boston on Monday to start the difficult work of deciding who will be eligible for payouts from a new compensation fund and how much each person wounded in the bombings and family of the dead deserves.
The One Fund Boston, which Mayor Thomas M. Menino of Boston and Gov. Deval Patrick of Massachusetts created a day after the bombings, has already raised more than $10 million for victims and their families. At the same time, friends and relatives have set up dozens of smaller funds for individual victims.
For at least 13 victims who lost limbs, including William White of Bolton, Mass., expenses may also include renovations to their homes that make it easier for them to get around.
“What if his stairs are at the wrong incline, or he needs a ramp, or the cobblestones in his backyard are uneven?” said Benjamin Coutu, a friend of the White family who helped create a donation page on a fund-raising Web site for Mr. White and his wife and son, who were also wounded in the blasts. “People who are insured in these situations think, ‘Wow, I’m O.K., I’m covered.’ It’s not until a month or two later that they realize, ‘I’m covered for the bare bones.’ ”

Day Centers Sprout Up, Luring Fit Elders and Costing Medicaid

Scores of elderly Russian immigrants played bingo under the chandeliers of a former funeral parlor in Brooklyn on a recent Monday, with a free dinner and door-to-door transportation from anywhere in the city.
Nearby, older people speaking Chinese filled a supermarket-size storefront with vigorous games of table tennis, billiards and mah-jongg, and ordered free lunch from a takeout menu featuring minced pork, beef and salty fish.
In Bensonhurst, Brooklyn, at the new R & G Social Adult Day Care Center, known locally among elderly immigrants for luring clients with cash and grocery vouchers, most people there for lunch did not stay to eat. Instead, many walked briskly toward the subway carrying bags stuffed with takeout containers, and two elderly men rode away on bicycles with the free food.
Not a wheelchair or walker was in sight at these so-called social adult day care centers. Yet the cost of attendance was indirectly being paid by Medicaid, under Gov.Andrew M. Cuomo’s sweeping redesign of $2 billion in spending on long-term care meant for the impaired elderly and those with disabilities.
Such centers have mushroomed, from storefronts and basements to a new development in the Bronx that recently figured in a corruption scandal. With little regulation and less oversight, they grew in two years from eight tiny programs for people with dementia to at least 192 businesses across the city.
Managed care companies, financed by Medicaid, pay the centers to provide services to members. But the door swings both ways: Centers also refer new clients to the companies.
Managed care became mandatory last year for people receiving home services who are eligible for both Medicaid and Medicare. The idea is to try to control spending, but about a third of the 92,000 people so far enrolled in the system statewide are newcomers to such services, many responding to aggressive marketing by social day care centers.
Centers collected over $25 million from managed care plans in the first nine months of 2012, at roughly $93 per person per session, according to state figures. The managed care companies are paid by Medicaid; in New York City, the rate is about $3,800 a month per member.
“The whole thing is going to end up costing the state much more money,” said Valerie Bogart, a lawyer with New York Legal Assistance Group who specializes in advocacy for frail elderly and disabled people. “It’s really up to the managed care plans to be the watchdogs now, and it’s like the fox watching the chicken coop, because they have an incentive to make money from these centers, too.”

How Therapy Can Help in the Golden Years

Marvin Tolkin was 83 when he decided that the unexamined life wasn’t worth living. Until then, it had never occurred to him that there might be emotional “issues” he wanted to explore with a counselor.
“I don’t think I ever needed therapy,” said Mr. Tolkin, a retired manufacturer of women’s undergarments who lives in Manhattan and Hewlett Harbor, N.Y.
Though he wasn’t clinically depressed, Mr. Tolkin did suffer from migraines and “struggled through a lot of things in my life” — the demise of a long-term business partnership, the sudden death of his first wife 18 years ago. He worried about his children and grandchildren, and his relationship with his current wife, Carole.
“When I hit my 80s I thought, ‘The hell with this.’ I don’t know how long I’m going to live, I want to make it easier,” said Mr. Tolkin, now 86. “Everybody needs help, and everybody makes mistakes. I needed to reach outside my own capabilities.”

Optometrists Seek Negotiating Power With Insurers

A group of Texas optometrists is lobbying the State Legislature for more power to negotiate contracts with health insurance companies, and the measure they are supporting could hit consumers’ wallets, some business advocates say.
“The problem is that optometrists are just getting eaten up by insurance companies,” said Dr. Thomas A. Lucas Jr., an optometrist and legislative chairman for the Texas Optometric Association. “It’s very rare that the small-business optometrist has any say in what’s actually in the contract.”
Senate Bill 632, by Senator John Carona, Republican of Dallas, would prohibit a common practice among insurers: contractually obligating optometrists to offer discounts on services and products that are not covered by the health plan, like a spare pair of glasses or cosmetic contact lenses that change eye color.
The Senate approved the bill this month, and Representative J. M. Lozano, Republican of Kingsville, has agreed to sponsor the bill in the House.
Kandice Sanaie, a lobbyist for the Texas Association of Business, argued that the restriction would mean that consumers would pay more for uncovered items. It could also raise insurance premiums, she said, if insurers began including uncovered services that were previously discounted in a health plan.
“There’s nothing forcing providers to sign contracts with health insurance carriers in the first place,” Ms. Sanaie testified last month at a legislative hearing on the bill.
Optometrists who sign contracts with insurance networks, she added, receive client referrals from the insurer.

Democrats oppose LePage budget cuts to prescription drug aid, hospital payments

Posted April 22, 2013, at 5:34 p.m.
AUGUSTA, Maine — Democrats on the Legislature’s Health and Human Services Committee have joined their colleagues on other committees in opposing a number of contentious portions of Gov. Paul LePage’s two-year budget proposal.
In a series of largely party-line votes, Democrats on the panel have opposed millions of dollars in cuts the LePage administration has proposed that would scale back prescription drug assistance for seniors, hospital Medicaid reimbursements, and general assistance payments to towns and cities. The administration has proposed the cuts in an effort to rein in Department of Health and Human Services spending and balance the budget.
The committee votes are part of a set of recommendations the Health and Human Services Committee made to the budget-writing Appropriations Committee on Monday. The Appropriations Committee is now charged with crafting a final budget for the two-year cycle that begins July 1.
Many of the cuts Democrats opposed in the Health and Human Services budget were similar to reductions the LePage administration proposed as part of a budget-balancing supplemental budget package passed earlier this year. Democrats in the Legislature removed many of those cuts from the final budget package.
Health and Human Services Committee members voted 7-5 against eliminating the state’s “Drugs for the Elderly” program, which aids some low-income seniors. The elimination would have cut $6.1 million from the budget over the next two years. Republicans, in the minority on the committee, proposed restricting eligibility for drug assistance to those who earn 100 percent of the federal poverty level or less — $15,510 for a two-person household — down from the current 185 percent eligibility level.
Democrats also opposed scaling back another drug assistance program for seniors, the Medicare Savings Program, which is available to seniors who receive Medicare but also qualify for some Medicaid benefits. The opposition to scaling back the program means budget writers will have to find an alternative means for filling a $16 million budget hole.
Democratic members of the committee said Monday they opposed the cuts in order to preserve needed services while Republicans said they supported some reductions as a way to meet savings targets.
On general assistance, Democrats opposed a measure that would cut state reimbursements to municipalities to 50 percent of costs from the current two-thirds level. General assistance is an aid program for low-income people that’s administered by local governments.

Maine CDC workers claim harassment, threats

Posted April 21, 2013, at 12:13 p.m.
Sun Journal interviews with a handful of current and former workers from the Maine Center for Disease Control echoed allegations of harassment, threats and poor management filed in a complaint a little over two weeks ago by a current CDC director.
Employees paint a picture of an ineffectual leader who lets upper management run wild. They tell of threats and intimidation, of screaming bosses, of demands that are, at best, unethical, and at worst, illegal.
They talk of promotions for workers who don’t question the way things are run and intra-office spying on those who do.
They call the CDC “The Third Reich,” “a reign of terror” and, plainly, “hell.”
Since the director of the CDC’s Division of Local Public Health filed a complaint of discrimination with the Maine Human Rights Commission a little more than two weeks ago, a number of her CDC co-workers have come forward to support her allegations.
They are current and former workers and supervisors from at least four divisions within the CDC. Some worked directly with the woman who filed the complaint; others barely know her. Many have advanced degrees and years of experience, both in the CDC and out.
A couple of the employees spoke on the record. One former worker wrote a detailed letter to state Sen. Margaret Craven, D-Lewiston, and the Legislature’s Government Oversight Committee. He called his new workplace, The Jackson Laboratory, “a welcome relief.”
Others, concerned about retaliation, spoke on the condition of anonymity. As much as they loathe the atmosphere at the CDC, they said, they need their jobs.
“It gets very, very scary if people know we’re talking,” one employee said.
But some people — community leaders, CDC grant recipients and health advocates — say there’s no way any of that can be true. They have worked with the two CDC officials at the heart of the allegations and say they are kind, compassionate and professional. They believe the women are getting a bad rap, and they can’t imagine why.
“Maybe there were misunderstandings. Happens all the time in business,” said Ron Deprez, director of the Center for Community and Public Health at the University of New England. “But all I know is these two women are two of the best people I’ve ever worked with in the state.”

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