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 kbouchard@mainetoday.com
Staff Writer
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.”
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