Health Care Reform Articles - December 9, 2015

Officials Rally for an Extension of a 9/11 Health Bill

By LISA W. FODERARO and TATIANA SCHLOSSBERGDEC. 6, 2015

Standing in the shadow of the towering rebuilt World Trade Center, scores of firefighters and police officers, led by Mayor Bill de Blasio and two United States senators from New York, rallied on Sunday to press Congress to extend a 9/11 health bill.

The bill would pay for medical care for emergency medical workers and others, including police officers, firefighters and construction workers who risked their lives on Sept. 11, 2001, or in the weeks and months after to recover bodies and begin the cleanup. They were exposed to toxic chemicals that have sickened or killed many of them.

The bill would extend the World Trade Center Health Program, which is part of the James Zadroga 9/11 Health and Compensation Act. The program expired on Oct. 1; another part of the act, the Victim Compensation Fund, is set to expire next October.

“We have been on the cusp of passing this bill for weeks and months,” said Senator Kirsten E. Gillibrand, who was joined at the rally by Senator Chuck Schumer, a fellow Democrat. “But somehow it hasn’t gotten done. It isn’t a controversial issue.”

Lawmakers, city officials and advocates say the bill, which has broad bipartisan support, must emerge from a few important congressional committees, where some Republicans have tried to water it down. It was meant to be voted on with a transportation bill recently, but it was removed at the last minute. In order to pass before the end of the year, it must be voted on as part of the omnibus spending bill or be attached to a tax-extending bill.

http://www.nytimes.com/2015/12/07/nyregion/officials-rally-for-an-extension-of-a-9-11-health-bill.html?hpw&rref=nyregion&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Learning From Ebola: Was Quarantine Too Extreme a Response?

By SHERI FINKDEC. 4, 2015

Sometimes journalists take a hard look at questions that survive after an immediate crisis has passed. In that spirit, my most recent article for The Times was about Ebola — yes, Ebola, last year’s frightful threat.

I focused on the discovery that quarantines were imposed within the United States during the epidemic on a much wider scale than previously known.

Here’s the big question: Were officials justified in restricting people’s liberties for up to three weeks? There was much public fear and confusion about Ebola at the time, but less restrictive measures — arguably equally or more effective than quarantine — were available.

A bit of back story: I reported extensively from West Africa during the epidemic, including three weeks in an Ebola treatment unit in Liberia in October 2014 for a series of articles. American staff members there regularly spoke about their fear — not of the virus, but of what might happen to them when they flew home to America, which was then in a height of what some called Ebolanoia.

Thomas Eric Duncan, a traveler from Liberia, had fallen sick and died in Dallas; two nurses who treated him also contracted the dreadful disease (both survived). Some children traveling from unaffected parts of the African continent — far from any known cases of Ebola — were told to stay out of school.

Political leaders announced tough new measures that would be imposed on people coming to the United States from Liberia, Sierra Leone and Guinea. Special attention would be paid to medical workers after a Doctors Without Borders physician, Craig Spencer, developed Ebola in New York City. Senior Defense Department officials announced that members of the American military serving in Ebola-affected countries would be quarantined for 21 days.

http://www.nytimes.com/2015/12/04/insider/learning-from-ebola-was-quarantine-too-extreme-a-response.html

Your New Medical Team: Algorithms and Physicians

DEC. 7, 2015

by Austin Fract

Can machines outperform doctors? Not yet. But in some areas of medicine, they can make the care doctors deliver better.

Humans repeatedly fail where computers — or humans behaving a little bit more like computers — can help. Even doctors, some of the smartest and best-trained professionals, can be forgetful, fallible and prone to distraction. These statistics might be disquieting for anyone scheduled for surgery: One in about 100,000 operations is on the wrong body part. In one in 10,000, a foreign object — like a surgical tool — is accidentally left inside the body.

Something as simple as a checklist — a very low tech-type of automation — can reduce such errors. For example, in a wide range of settings, surgical complications and mortality fell after implementation of a basic checklist including verification of patient identity and body part for surgery, confirmation of sterility of the surgical environment and equipment, and post-surgical accounting for all medical tools. Though simple procedures would all but eliminate certain sources of infections in hospitals, thousands of patients suffer from them in American hospitals every year.

Limits on how much information we can process and manipulate make it hard or impossible for even the smartest and most adept doctors to keep up with new evidence. In 2014 alone, more than 750,000 additional medical studies were published. Granted, a physician might need to keep up only with the evidence in her specialty, but even at a fraction of this rate, it is unrealistic to expect even the best physicians to assimilate every new development in their fields. In cancer alone, 150,000 studies are published annually.

Computers, on the other hand, excel at searching and combining vastly more data than a human. I.B.M.’s Watson — the computer that won Jeopardy! — is among the best at doing so. Teams of physicians at Memorial Sloan Kettering Cancer Center in New York, the University of Texas MD Anderson Cancer Center in Houston, and the Cleveland Clinic are helping to train Watson to apply humanity’s huge store of cancer knowledge to the delivery of more personalized treatment.

At Boston Children’s Hospital, Watson will help diagnose and treat a type of kidney disease. It will team up with Apple to collect health care data; with Johnson & Johnson to improve care for knee and hip replacements; with medical equipment manufacturer Medtronic to detect when diabetes patients require adjustments to insulin doses; and with CVS to improve services for patients with chronic conditions. Another computer-assisted approach to cancer treatment is already in place in the vast majority of oncology practices. Other automated systems check for medication prescribing errors.

To many patients, the very idea of receiving a medical diagnosis or treatment from a machine is probably off-putting. Apart from the sense that it just doesn’t feel right to some, there’s a fundamental question of whether medicine is or can be purely data driven. If the only thing between your illness and its diagnosis and cure is the manipulation of evidence, then, in principle, a computer should one day be able to deliver care as well or better than a human.

But healing may rely on more than the mere processing of data. In some cases, we may lack data, and a physician’s judgment might be the best available guide. A good deal of health care’s benefits may also be in the human interaction between doctor and patient. Placebo effects can be real and strong. Many people engage the health system for reassurance and hope, even when no cure is available. Studies show that patients with close, personal bonds with their doctors and shared engagement with their care are more likely to follow their prescribed treatments. To the extent medical treatment relies on the human touch, on the trust of patients in their doctors and on physicians’ embodiment of authority, a computer-delivered cure may never feel complete.

http://www.nytimes.com/2015/12/08/upshot/your-new-medical-team-algorithms-and-physicians.html?em_pos=small&emc=edit_up_20151207&nl=upshot&nlid=1311158&ref=headline

Health care, banking stocks lead a recovery in U.S. markets

Associated Press

http://www.latimes.com/business/la-fi-wall-street-stocks-20151201-story.html

Pulse of Longwood takes you inside one of the nation’s largest hubs of hospitals and biomedical research.

by Melissa Bailey - Boston Globe

Brigham and Women’s Hospital has posted its first budget shortfall in over 15 years, hospital president Dr. Betsy Nabel announced at a recent town hall-style meeting. To blame, in part, was the expense of switching to new electronic health records, a cost that has led to overruns at a number of hospitals in recent years.

The hospital fell $53 million short of its budget in the fiscal year that ended Sept. 30, in large part due to unexpected costs associated with switching to electronic health records in June, according to hospital spokeswoman Erin McDonough.

Wisconsin-based Epic is the dominant provider of electronic health records in the country, and its products are also among the priciest. In addition to the Brigham, two other Massachusetts health systems and one in the UK reported financial losses after making the switch to Epic.

The budget overruns and complications are a setback for executives at the Brigham and other hospitals who have argued that implementing new software systems will help contain costs and improve medical care.

Nabel said the Epic-related losses were temporary, and expecting the Brigham to meet its budget every year “is sort of like you expect the Patriots always to win.”

The Brigham, a 79by 3-bed hospital in Boston that ranks among the top 10 in the nation, brought in $3.3 billion in revenue in FY2015, according to McDonough. It had expected a $121 million surplus, which would be reinvested into capital projects and other costs such as pay increases. But it came up $53 million shy of that number, she said.

Nabel cited three factors: The hospital lost patient volume in February when Boston got slammed by snow; it paid more than expected into its employee pension fund; and it lost money transitioning to Epic.

http://www.statnews.com/2015/12/07/brigham-budget-electronic-health-records/

Anthem to end individual health plans that don’t comply with Affordable Care Act

by Joe Lawlor

Anthem Blue Cross Blue Shield aims to phase out its “grandfathered” individual insurance plans that are not compliant with Affordable Care Act standards, company officials said Monday.

The move is expected to ultimately save consumers money as they transition to more affordable plans, while at the same time allowing Anthem to discontinue a coverage option that has become increasingly expensive and subject to steep premium increases.

People with grandfathered individual plans would be automatically switched to a similar one by Jan. 1, 2017, if they don’t purchase another plan.

The insurer filed a request with the Maine Bureau of Insurance last week that would affect about 3,800 people who still have grandfathered policies – plans that were purchased before the ACA went into effect in March 2010. The vast majority of all grandfathered plans sold in Maine were Anthem plans, according to bureau filings.

In most cases, the new plans will be less expensive than the grandfathered policies, said Anthem spokesman Rory Sheehan. Switching to the ACA plans will save the 3,800 on grandfathered plans a total of about $7.5 million in premiums, he said.

“For many legacy policyholders, they can already get an ACA plan that is less expensive and has richer benefits,” Sheehan said. That’s because those few remaining on the grandfathered plans tend to be sicker, older and in smaller risk pools. Insurers were prohibited from selling non-ACA plans starting in 2010.

The cost of the grandfathered plans also has been increasing – by 18 percent for 2016, on top of 13 percent for 2015.

http://www.pressherald.com/2015/12/07/anthem-to-end-individual-health-plans-that-dont-comply-with-aca/

From Doctors and Lawyers: ‘A Call to Action’ on Guns

DEC. 8, 2015

From Doctors and Lawyers: ‘A Call to Action’ on Guns

To the Editor:

We applaud The Times for its rare action of publishing a front-page editorial, stressing the importance of addressing the never-ending, tragic loss of life related to firearms violence (“The Gun Epidemic,” Dec. 5).

Allowing unrestricted access to firearms without universal background checks, including military-style assault weapons and high-capacity magazines, is unconscionable for a civilized society that prides itself on valuing life, liberty and the pursuit of happiness.

Additionally, laws that prevent medical professionals from speaking with their patients about firearms constitute inappropriate interference in the patient-clinician relationship.

Our organizations, the American College of Physicians and the American Bar Association, joined with seven other major national medical and public health professional organizations to publish a “call to action” about firearms violence earlier this year in Annals of Internal Medicine.

We advocated adoption of a number of reasonable and sensible gun control regulations that are consistent with the Second Amendment and do not go against any Supreme Court decisions. The recommendations in that paper have been endorsed by 52 national and other major organizations that recognize how critical it is to address this major public health problem.

All our organizations call upon our elected legislators at both state and federal levels to recognize their obligation to protect the American public and stop this tragic and senseless epidemic of firearms violence.

WAYNE J. RILEY

PAULETTE BROWN

Philadelphia

The writers are presidents of the American College of Physicians and the American Bar Association, respectively.

http://www.nytimes.com/2015/12/09/opinion/from-doctors-and-lawyers-a-call-to-action-on-guns.html?emc=edit_tnt_20151208&nlid=1311158&tntemail0=y

Americans Who Don’t Buy Health Coverage Face Heftier Fine in ’16, Analysis Finds 

By ABBY GOODNOUGHDEC. 9, 2015

WASHINGTON — Americans who remain uninsured in 2016 despite having the option of buying health coverage through an Affordable Care Act marketplace will owe an average tax penalty of $969 per household, a new analysis has found.

That amount is substantially higher than the average estimated penalty of $661 for those who went uninsured in 2015, according to the analysis by the Kaiser Family Foundation. But it remains to be seen how effective the rising fine will be in persuading the roughly 10.5 million uninsured Americans who are eligible for marketplace coverage to buy it.

The health law requires people without health insurance to either pay a penalty when they file taxes or to claim an exemption. Last year, the penalty was $95 per adult or 1 percent of household income, whichever was greater. This year it is rising to $325 per adult or 2 percent of household income, and for 2016, it will increase to $695 per adult or 2.5 percent of household income.

Open enrollment for 2016 started on Nov. 1, and this week the Obama administration began stepping up efforts to draw attention to the growing penalty for those remaining uninsured. In a blog post on Monday, Kevin Counihan, chief executive of the federal insurance marketplace, stressed that the penalty was increasing.

“I believe your best option is to learn about the tax credits that are available and to visit Healthcare.gov to enroll in a plan,” Mr. Counihan wrote.

He also announced that a special enrollment period around the April 15 tax filing deadline would not be offered in 2016, as it was this year.

http://www.nytimes.com/2015/12/09/us/americans-who-dont-buy-health-coverage-face-heftier-fine-in-16-analysis-finds.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news&_r=0

 

THE END

Imagine a Medicare ‘Part Q’ for Quality at the End of Life

By KATY BUTLER

 DECEMBER 9, 2015

I spent the last Sunday of my father’s life sitting by his bed on the hospice unit in a small Connecticut hospital. He was dying of pneumonia, once called “the old man’s friend.” There was a nondenominational chapel down the hall, and a sheet cake in the kitchen. His hand was warm. Reassured by the quiet presence of the hospice nurses and feeling the mysterious quickening of life through his veins, I gave over to being his daughter and letting him be my father one last time.

It had been six and a half years since I’d felt purely like his daughter. When he was 79, a bad stroke (followed by a succession of mini-strokes, vascular dementia and creeping blindness) ended my father’s role as paterfamilias and transformed my mother and me from wife and daughter to exhausted caregiver and untrained medical advocate. We soon found ourselves in the maw of America’s fragmented fee-for-service medical system, a notoriously bad fit for the frail elderly. Ours is a story familiar to many families: shuttling my aged father to specialist after specialist, each focused on a single crumbling organ — his brain, his heart, his bladder, his colon, his eyes. Each ordered tests, carried out Medicare-reimbursed procedures, and rarely, if ever, talked to one another. If it hadn’t been for my mother’s nonstop caregiving and my parents’ stoic medical minimalism, I have no doubt my father would have joined the sickest 5 percent of Medicare’s patients who run up almost half of its costs.

My father, and others like him, suffered because, at the tail end of life, Medicare continues to pay well for fix-it treatments focused unrealistically on cure and underpays for care and desperately needed home support. In his last six years, it paid more than $80,000, all told, for treatments that included a hernia repair, a pacemaker, and $24,000 for the injectable drug Lucentis which, sadly, failed to arrest the macular degeneration that was robbing him of sight. It covered a series of ambulance rides, emergency room visits and a hospital stay after he fell repeatedly on throw rugs and down the stairs, once breaking his wrist, falling on my mother, and leaving her black and blue from toe to hip.

But it paid very little for home health aides to give my mother respite and cut off, far too soon, the speech and physical therapies that helped maintain his ability to function and take pleasure in life. Under fee-for-service medicine, Medicare paid to patch him up after he fell but not to keep him from falling.                

http://opinionator.blogs.nytimes.com/2015/12/09/imagine-a-medicare-part-q-for-quality-at-the-end-of-life/?action=click&pgtype=Homepage&version=Moth-Visible&moduleDetail=inside-nyt-region-2&module=inside-nyt-region&region=inside-nyt-region&WT.nav=inside-nyt-region

California's 3 largest health insurers among few to show Obamacare profit in 2014

by Chad Terhune

In the first year of the massive coverage expansion, California's three largest health insurers bucked the national trend of heavy losses and accounted for half of the gains reported under the Affordable Care Act in 2014.

Blue Shield of California led the country with $107 million in profit on Obamacare policies sold to individuals. Kaiser Permanente was second with $66 million, and Anthem Blue Cross ranked seventh nationally with a $9-million surplus in the Covered California exchange.

Nationwide, insurers reported just $362 million in total profit under a federal rate-stabilization program, while most insurers recorded big losses — a total of $2.87 billion.

Critics have seized on the industry losses as a sign that the health law is failing. Those concerns were amplified when the nation's largest insurer, UnitedHealth, warned that it may quit selling Obamacare policies because the business was so unprofitable.

Now some experts point to California's experience as a sign that this can be an attractive business for insurers — so much so that it has raised questions about whether state officials should have pushed harder for lower rates.

"The data show insurers did not do well nationally," said Larry Levitt, a senior vice president at the nonprofit Kaiser Family Foundation. "But in parts of the country where things were working smoothly, like California, insurers were making money."

http://www.latimes.com/business/la-fi-obamacare-profits-20151209-story.html

Maine health insurer for small businesses to close down

BY WHIT RICHARDSON STAFF WRITER

An experiment to help small Maine companies pool their resources to better control health insurance costs is ending at the end of this year.

MaineSense, an employer-owned health insurance nonprofit, is winding down and will close on Dec. 31, according to Joe Edwards, president of the Maine Wellness Association, which created the program.

MaineSense was plagued by a high claim frequency that wasn’t sustainable, according to Edwards, a former superintendent of Maine’s Bureau of Insurance.

“We had much higher frequency and larger claims than we could have predicted,” Edwards said.

When it was created in 2011, MaineSense was the nation’s first group health insurance captive, according to Eric Cioppa, superintendent of Maine’s Bureau of Insurance. A captive is an insurance company that operates like a co-op to cover the risks of a group of employers. While captive insurance companies are common with other types of insurance, such as general liability and workers’ compensation, it’s not a typical model for health insurance.

Edwards declined to provide any more on-the-record comments about MaineSense or its members.

Although Maine’s Bureau of Insurance regulates MaineSense, Cioppa said any information about the nonprofit, including the number of member companies or covered employees, is confidential per Maine law. Justin Ward, executive vice president of Patient Advocates, a health insurance plan administrator in Gray that administered MaineSense, confirmed that the program is shutting down, but said he was unable to provide details about its members.

In a 2014 interview, Edwards told BusinessInsurance.com that MaineSense had 50 member companies that covered 4,500 employees and their dependents. That article also called MaineSense the “nation’s first group health insurance captive.” Cioppa said MaineSense is the only such organization in the country he knows of.

Cioppa said MaineSense was trying to take an innovative approach to alter the health insurance market for small companies. Most of the member companies were employers with years of experience running successful workers’ comp insurance programs, Cioppa said.

“They were hoping to take that experience and leverage it in health insurance,” he said. “They were committed. They really wanted to make a difference in the health insurance market.”

http://www.pressherald.com/2015/12/08/innovative-health-insurer-closes-down/

Burnout increasing among U.S. doctors

by Lena Sun - Washington Post

Burnout among U.S. doctors is getting worse, according to a study that shows physicians are worse off today than just three years earlier.

Mayo Clinic researchers, working with the American Medical Association, compared data from 2014 to measures they collected in 2011 and found higher measures on the classic signs of professional burnout. More than half of physicians felt emotionally exhausted and ineffective. More than half also said that work was less meaningful.

The data dovetail with a recent JAMA study, which found much greater prevalence of depression among doctors in training than in the general population.

Taken together, experts say the problems require solutions that offer a systemic approach. All health care organizations have a shared responsibility to address the situation, they add.

"What we found is that more physicians in almost every specialty are feeling this way and that's not good for them, their families, the medical profession or patients," said Tait Shanafelt, an author of the Mayo study and director of the clinic's Department of Medicine Program on Physician Well-being. The study was published in Mayo Clinic Proceedings.

The results were based on survey responses from 6,880 physicians across the United States. In the 2011 survey, 45 percent of doctors met the burnout criteria, with highest rates occurring in the fields considered the "front lines," such as general internal medicine, family medicine and emergency medicine.

In 2014, 54 percent of responding physicians had at least one symptom of burnout.

https://www.washingtonpost.com/news/to-your-health/wp/2015/12/08/burnout-increasing-among-u-s-doctors/?hpid=hp_hp-cards_hp-card-national%3Ahomepage%2Fcard