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Thursday, February 28, 2013

Health Care Reform Articles - February 28, 2013

PBS News Hour
Interview with Steven Brill, author of "Bitter Pill", this week's Time Magazine cover story
Transcript
JUDY WOODRUFF: Next: a big story on the big price tags attached to medical care.

Steven Brill spent months reporting his 26,000-word cover story in the latest issue of "TIME" magazine looking at what's behind our country's high cost of health care. What he found was startling: a few days of lab work that costs more than a car, a trip to an emergency room for indigestion that totaled more than a semester in college, and many more examples.

In response, the American Hospital Association released a statement that claimed the system is broken and that -- quote -- "Patients may look at a hospital bill and think the prices they see only reflect the direct care they received, when in fact what's reflected are all the resources to provide the care."

Steven Brill joins me now.

Welcome to the NewsHour.

STEVEN BRILL, TIME Magazine: Hi, Judy. How are you?

JUDY WOODRUFF: I'm well.

Let me just begin by, you paint a devastating picture of the American health care system, and you talk, of course, about a system that is based on private enterprise, the private marketplace in America. I guess my question is...


Portland forum to examine health-care access

Portland forum to examine health-care access

The group, Maine AllCare, is hosting an educational forum, "What If Everyone Had Health Care in Maine?" on Sunday, March 3. The event will also include a screening of a 2012 documentary film, "The Healthcare Movie," narrated by actor Kiefer Sutherland.
The movie contrasts the U.S. health-care system, with its patchwork of public and private services, and Canada's government-sponsored system, which guarantees care by hospitals, doctors and dentists for every citizen.
Sutherland is the grandson of Tommy Douglas, a former premier of the Canadian province of Saskatchewan, who pioneered the country's efforts to create a universal health-care system in the 1960s.
Critics of U.S. health care often point to Canada as an example of how care can be provided more effectively and more economically.
Research has shown that the United States spends more per capita on health care than any country in the world, while measurements of public health – such as average life expectancy and infant mortality rates – are consistently worse in the United States than in Canada and other developed countries.
"Health care is a human right, but it certainly doesn't seem to be in this country," Philip Caper, a founder of Maine AllCare who will be moderating Sunday's discussion, said last week.
Caper is a Brooklin physician who once served as a health-care staffer to former U.S. Sen. Edward Kennedy, D-Mass., and who writes a column about health care for the Bangor Daily News.

It’s the Sugar, Folks

By MARK BITTMAN
Sugar is indeed toxic. It may not be the only problem with the Standard American Diet, but it’s fast becoming clear that it’s the major one.
A study published in the Feb. 27 issue of the journal PLoS One links increased consumption of sugar with increased rates of diabetes by examining the data on sugar availability and the rate of diabetes in 175 countries over the past decade. And after accounting for many other factors, the researchers found that increased sugar in a population’s food supply was linked to higher diabetes rates independent of rates of obesity.

In other words, according to this study, obesity doesn’t cause diabetes: sugar does.
The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s. As Rob Lustig, one of the study’s authors and a pediatric endocrinologist at the University of California, San Francisco, said to me, “You could not enact a real-world study that would be more conclusive than this one.”
The study controlled for poverty, urbanization, aging, obesity and physical activity. It controlled for other foods and total calories. In short, it controlled for everything controllable, and it satisfied the longstanding “Bradford Hill” criteria for what’s called medical inference of causation by linking dose (the more sugar that’s available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don’t start consuming more sugar; people who consume more sugar are more likely to become diabetics).
The key point in the article is this: “Each 150 kilocalories/person/day increase in total calorie availability related to a 0.1 percent rise in diabetes prevalence (not significant), whereas a 150 kilocalories/person/day rise in sugar availability (one 12-ounce can of soft drink) was associated with a 1.1 percent rise in diabetes prevalence.” Thus: for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country’s food system, the rate of diabetes goes up 1 percent. (The study found no significant difference in results between those countries that rely more heavily on high-fructose corn syrup and those that rely primarily on cane sugar.)

Medicare paid $5.1B for poor nursing home care

The Associated Press
SAN FRANCISCO  — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

Maine should have Medicaid conscience, too

Sometimes, politicians surprise you.
For years, Republican Florida Gov. Rick Scott railed against the president’s Affordable Care Act. And when the U.S. Supreme Court ruled the act constitutional in June, Scott, a former hospital executive, made clear he would not expand Medicaid, a health insurance program for the poor. He said increasing coverage would make the eventual costs to his state too high.
Gov. Paul LePage has used the same argument. In a Nov. 16 statement, the administration said it “will not expand Medicaid under the current structure that exists because it is not affordable.”
The health care law requires states to expand Medicaid access by raising income eligibility limits. The federal government originally said it would penalize any state that failed to comply with the expansion by withholding Medicaid funds, but the court ruled that penalty unconstitutional. So states can decline expansion without losing current federal funding.
Last week, Scott surprised the nation when he became the seventh Republican governor to support the expansion of Medicaid. He said he would agree to the expansion for the period the federal government would cover its costs entirely. Under the law, the federal government would fund 100 percent of the cost of “newly eligible adults” up to 133 percent of the federal poverty level for the first three budget years. Then it would cover 95 percent of the costs in 2017; 94 percent in 2018; 93 percent in 2019; and 90 percent in 2020 and future years.
We hope LePage listened to the reasoning Scott gave. “No mother or father should despair over whether they have access to high-quality health care for their sick child,” Scott said. Especially with the federal funding, “I cannot in good conscience deny Floridians that needed access to health care.”
That phrase, “in good conscience,” is missing from the debate in Maine. It has fallen into the minority of states — and the only one in New England — to reject or lean toward rejecting the Medicaid expansion. In doing so, Maine is closing its eyes to the possibility of improving public health and reducing health differences linked to economic disadvantages.
It’s also making other parts of the law hazardous. The Affordable Care Act reduces federal payments to hospitals over time, in expectation that more people on Medicaid and private insurance will reduce the amount of charity care hospitals have to provide. So in states that don’t expand Medicaid coverage, hospitals will face financial losses as they continue to treat the uninsured, according to the Harvard Law School Center for Health Law and Policy Innovation. The worry is that the costs will be passed onto patients with private insurance, increasing their premiums.
It’s reasonable for LePage to have concerns about how federal and state governments will pay for the Medicaid expansion. But the administration would be ill-advised to make such a large policy decision based on an as-yet unproven fear that the federal government won’t hold up its end of the deal. Maine Department of Health and Human Services Commissioner Mary Mayhew told Florida lawmakersearly this month that she had difficulty seeing how the federal government could afford the expansion amid consistent budget crises. However, not agreeing to the Medicaid expansion could make it more difficult for the federal government to carry out its overall health reform goals.

Saving on health care at the cost of people's health

Health care spending in the US has slowed because fewer people can afford health services

By Margaret Flowers, M.D.
Al-Jazeera, Feb. 27, 2013
In his recent State of the Union speech, President Obama remarked in one short sentence that "Already, the Affordable Care Act [ACA] is helping to slow the growth of health care costs". That was the extent of his comments on the historic health care bill he signed into law in March 2010 after more than a year of pushing health reform through Congress. It is true that total health care spending in the US has slowed, but it does not have much to do with the ACA. Instead, it is another symptom of the ailing market-based health system in the US which is causing poor health outcomes and growing inequality.
The US is unique among industrialised nations when it comes to health care. All other wealthy nations have some type of national universal health system that is publicly financed. The US relies primarily on a market-based health care system in which most private health insurance is tied to employment. There are public programmes, Medicaid, for those who are in extreme poverty, but these are subject to state-balanced budget pressures and struggle to meet the needs of their populations. And there is a public-private system for people 65 years of age and older, Medicare, that is financed through taxes at the Federal level. Overall, health coverage is private except for many people who do not qualify for public programmes and find private health insurance unaffordable.
Privatised health system: A failed experiment
The US health system is a failed experiment. Since the 1980s when the US moved aggressively to privatise the financing and delivery of health care, the cost of care, health disparities and the number of people without insurance have climbed. The US spends more per capita on health care than any other country and has excellent health facilities, but in the US, patients receive the amount of health services they can afford rather than what they need.
In fact, health care spending per capita in the US is two and a half times what the average OECD (Organisation for Economic Co-operation and Development) nation spends. Total health spending constitutes a greater piece of the Gross Domestic Product (GPD), currently at 17.9 percent, than the OECD average of 9.5 percent. Yet, nearly 50 million people in the US have no insurance at all. And tens of millions more are under-insured, meaning they have insurance but suffer significant financial barriers to care and face bankruptcy in the event of a serious accident or illness.

Market doesn't work for health

By James Binder, M.D.
The Charleston (W.Va.) Gazette, Feb. 27, 2013
A major shift is occurring in health and no one seems to be noticing. Computers have taken priority over patients. Wow! It doesn't matter whether the patient is seen in the emergency room, a physician's office or in a hospital, completing documentation on the computer is paramount. The patient better stay out of the way.
Is it impersonal? Of course. Is it a problem? Certainly. Over and over again, medical research has demonstrated that a physician's ability to engage with the patient and create a strong therapeutic relationship is the best predictor of positive health outcomes.
How did we come to this point in health care? My belief is that the answer is clear and simple. We have allowed health-care decisions to be made by a fragmented business conglomerate in which profit is the chief motive. The marketplace has never and will never work for health care.
Private insurance companies spend 31 percent of the health dollar on advertising and an excessive bureaucracy, instead of for patient care. The idea that competition will lower costs has not worked despite 50 years of trying. When we become ill and vulnerable, which we all will at some point in our lives, we are not in a position to be discriminatory consumers in the marketplace. Even if we were, 50 percent of us live in areas, most often rural, where there is no choice.
To foster the transformation to electronic records, proponents of the marketplace approach told us that digital electronic records would improve the quality of health care and save money. They lobbied very hard to get legislation passed in 2009 supporting the use of electronic records in health care.
It did not save money for consumers. The cost of health care continues to skyrocket. It did bring windfall profits to a few strategically placed companies in the medical-industrial complex. The New York Times reported Feb. 19 that AllScripts doubled its sales from $548 million in 2009 to $1.44 billion in 2012.
With time, we are likely to learn more flexible ways of using computers so they don't act as obstacles to a solid physician-patient alliance. The second problem may be more difficult to resolve. If we employ a fragmented, competitive marketplace model, companies will continue to create expensive electronic digital systems that do not communicate with each other. Their goal is to maximize the billing potential of hospital and other providers they serve. Solving this problem will require us to change our health-care financing method.

Fighting for health care that doesn’t leave you broke & naked

A profile of Dr. Elizabeth Frost

By Jacob Wheeler
Together with her friend, Dr. Ann Settgast, Frost co-founded the Minnesota Chapter of Physicians for a National Health Program (PNHP) five years ago. The group holds rallies and speaks at hospitals across the state to recruit new members to its cause — and now boasts more than 1,000 members in Minnesota. Frost also has the ear of state lawmakers such as Sen. John Marty and Rep. David Bly, who hope to expand health care access in Minnesota.

“Single-payer” health care would make health care universal and ensure equal access to best treatment, expanding President Obama’s Affordable Care Act. Under single-payer, everyone would be entitled to the best available care, no matter the size of their wallet. Citizens could keep their health insurance coverage even if they lost or changed jobs, and be allowed to retain their preferred doctor or caregiver. By encouraging preventative care, proponents say a single-payer system would significantly lower costs (as much as $350 billion a year, they estimate). Perhaps most importantly, a single-payer system would end health insurance industry meddling. Patients could make decisions based on health needs, not on what a billing department dictates.

Frost, 39, is a Washington, D.C., native who went to medical school at Case Western Reserve in Cleveland and serves as a family physician at the Hennepin County Medical Center’s East Lake Clinic. She came to Minneapolis 11 years ago to live near her sister and her niece and nephew. One of the reasons she has stayed here is Minnesota’s focus on improving health care services which, while far from ideal, offer better access to care than many other states do. Frost, who refers to herself as “something of a do-gooder,” believes that her work as a physician extends beyond diagnosing defects or prescribing medicine.

Her tireless advocacy for single payer stems from her experience caring for her patients, and her concern that the present health system doesn’t offer adequate care.

“I had a patient who came to see me who was 64 years old and had chest pains,” Frost says when asked to illustrate the problem. “I recommended he go to the emergency room to get evaluated for his chest pains, and he refused because he didn’t have health insurance. He said ‘I’m gonna wait until I’m 65 to have this evaluated.’

“About a week later he went to the ER after having a massive heart attack. He died a few weeks later. If the Medicare age limit was 64 instead of 65, then that patient would be alive today.”
http://www.pnhp.org/print/news/2013/february/fighting-for-health-care-that-doesn’t-leave-you-broke-naked



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Wednesday, February 27, 2013

Health Care Reform Articles - February 27, 2013


Getting Patients to Think About Costs

By PAULINE W. CHEN, M.D.
A colleague and I recently got into a heated discussion over health care spending. It wasn’t that he disagreed with me about the need to rein in costs; but he said he was frustrated every time he tried to do so.
Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a patient who had been suffering from headaches. After a thorough examination, my colleague was convinced the headaches were the result of stress.
But the patient was not.
“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained his conclusions several times, proposed a return visit in a month to reassess the situation and ran so far overtime that his office nurse knocked on the door to make sure nothing had gone awry, the patient continued to insist on getting the expensive study.
When my colleague finally invoked cost – telling the woman that while an M.R.I. might ferret out rare causes, it didn’t make sense to spend the enormous fee on something of such marginal benefit – the woman became belligerent. “She yelled that this was her head we were talking about,” he recalled. “And expensive tests like this were the reason she had health insurance.”
Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he finally said. “But are our patients?”
According to a new study in the journal Health Affairs, his concern about patients may not be far off the mark.
A growing number of initiatives aimed at controlling spiraling health care costs have been championed in recent years, aiming to replace the current model in which doctors are reimbursed for every office visit, test or procedure performed. These programs range from pay-for-performance, where doctors can earn more money by meeting predetermined quality “goals” like controlling patients’ blood sugar or high blood pressure, to accountable care organizations, where clinicians and hospitals in partnership are paid a lump sum to cover all care.
Their uninspired monikers aside, all of these plans share one defining feature: doctors are to be the key agents of change. Whether linked with quality measures, bundled payments or satisfaction scores, it is the doctors’ behavior and choice of treatments that result in savings, goes the thinking.

Massachusetts waves off the Chicago Way as ObamaCare beckons

Imagine for a moment that you could take any one of your biggest debts — be it a home loan, credit card balance or student loan — and announce that (a.) you plan to never pay off this obligation, and (b.) you plan instead to have all of your neighbors dig into their own pockets and make good on this hefty IOU.
That’s essentially what the city of Chicago is considering as it hashes out a plan to potentially erase around $800 million in unfunded retiree health care liabilities. The vehicle that makes this potential trip possible is the Affordable Care Act, forever known as ObamaCare. The proverbial “neighbors” who could be left holding the bag are the nation’s taxpayers, from Boston to San Bernardino.
The prospect of a cash-strapped Chicago spreading its retiree health care liabilities thinner than a Downton Abbey plot is a disturbing scenario, given the hundreds of billions in additional unfunded liabilities owed by states, cities and towns throughout the country. Should Chicago go the easy route, it is foreseeable that most state and local governments would follow suit by effectively eliminating retiree health care benefits and pushing tens of thousands of former public workers into ObamaCare’s subsidized safety net. The hit to the national fisc would be astronomical.

Christie Says He’ll Take U.S. Money to Expand Medicaid


By 

TRENTON — Gov. Chris Christie, one of the most strident Republican critics of President Obama’s health care overhaul, announced on Tuesday that he would accept federal money to expand the Medicaid program in New Jersey.
The expansion, which the governor described in his annual budget address to the Legislature, would provide health insurance to 104,000 of the poorest 1.3 million residents currently living without it, though some groups say the number could be higher.
Mr. Christie emphasized that it was a financial decision, not a philosophical shift; if New Jersey did not take the money, he said, the federal government would give it to other states.
“Let me be clear: I am no fan of the Affordable Care Act,” the governor said. “I think it is wrong for New Jersey and for America. I fought against it and believe, in the long run, it will not achieve what it promises. However, it is now the law of the land. I will make all my judgments as governor based on what is best for New Jerseyans.”
Mr. Christie’s budget speech, delivered less than a year before he will be up for re-election, at times sounded like a campaign pitch to the voters of this overwhelmingly Democratic state. Advocacy groups had lobbied hard for the Medicaid expansion, and Democrats in the Legislature applauded it.
But it also reflected Mr. Christie’s national ambitions and his continued push to present himself as a different kind of Republican — one who could teach Washington a thing or two about bipartisanship. He talked about how he had “turned Trenton upside down” in his first three years, ending what he described as the tax-and-spend ways of his Democratic predecessors. His proposed budget of $32.9 billion is an increase of about 4 percent over the one approved last year, but he emphasized that the state will spend less than it did in the 2008 fiscal year.
Accepting federal money for Medicaid, he said, would save the state $227 million in the fiscal year that begins in July. Earlier this month, the governor showed his opposition to the health care law when he declined to establish a state-run exchange to allow people to buy health insurance, insisting that the federal government would have to do it.

Our View: Federal health-care grant targets the right problem

The money to find new ways to pay for health care could change the system for the better.

Every once in a while, we get some good news from Washington.
That was certainly the case last week, when the LePage administration announced that Maine would be one of only six states to get a federal grant to implement new programs to lower health care costs through reforming the ways we pay for services.
Maine will receive $33 million over the next 3½ years to expand its experiment with payment reform, including accountable care organizations, group practices that receive incentives to improve their patients' health instead of simply being paid for tests and procedures.
The model is designed to lower costs and improve outcomes at the same time. That's exactly the right place for the state and federal governments to be directing their efforts.
With all the strong words and posturing from Augusta and Washington, it's easy to lose sight of the fact that both capitols are struggling with the same issue.

A few weeks before our long-awaited trip to Italy in 2011, my husband, Jim, received a disconcerting phone call about one of the results of his annual physical. Jim’s PSA, a blood test that screens for early-stage prostate cancer, had been rising over the past couple of years. His internist was becoming concerned, and he suggested that Jim get another PSA when he returned from Europe.
I didn’t think much about this while we were away. I assumed my healthy, youthful husband, in his early 60s, couldn’t possibly be one of the almost 2.5 million American men living with prostate cancer. So I was surprised when the PSA test Jim had after our trip showed a continued increase. With this latest information, Jim’s internist thought it was time for him to see a urologist.
We made an appointment and unknowingly entered into the contentious arena of how to respond to potentially worrisome prostate cancer tests.
Originally used to track the progress of cancer treatment, the PSA test is now widely used to detect possible signs of early-stage prostate cancer. But it is an imperfect tool — so imperfect, in fact, that recently the U.S. Preventive Services Task Force, which is charged with tracking medical practices and treatments, said the test should no longer be part of routine standard of care.The test does more harm, through unnecessary surgery, than good, the group said. The recommendation, which reversed the task force’s previous position, has been extremely controversial, with many urologists, cancer doctors and prostate cancer survivors decrying it, saying the PSA test had saved lives.
All of this, though, was well in the future. For now, all we knew was that his PSA was elevated. The question was what to do. In trying to answer that, we felt as though we’d fallen down a medical rabbit hole.
— — —
The medical consensus has been that if the PSA number is above 4.0 and this is confirmed in a second test, a biopsy should be done. Clinicians also get concerned when the PSA number rises too quickly; a two-point rise — say, from 1.5 to 3.5 over a two- or three-year period — can be a red flag. My husband fell into the latter category. But as the urologist took great pains to tell us, the rise could mean nothing. Some men who have prostate cancer fall below 4.0, and others whose number is above 4.0 do not have cancer.
We found the doctor’s realistic assessment of the PSA reassuring, and we were sure he wouldn’t recommend a biopsy unless Jim’s third PSA, done through the urologist’s own lab, showed an increase. When the result came back, Jim’s PSA number had stabilized, but the doctor nonetheless recommended a biopsy. When Jim asked why, the doctor expressed concern about the PSA numbers and thought that a biopsy was warranted.

Missed diagnoses common in the doctor’s office

Reuters
Posted Feb. 26, 2013, at 9:42 a.m.
Missed or wrong diagnoses are common in primary care and may put some patients at risk of serious complications, according to a U.S. study.
Mistakes in surgery and medication prescribing have been at the center of patient safety efforts, but researchers whose findings appeared in JAMA Internal Medicine said less attention has been paid to missed diagnoses in the doctor’s office.
Because of how common they are, those errors may lead to more patient injuries and deaths than other mistakes, according to David Newman-Toker from Johns Hopkins University School of Medicine in Baltimore, who co-wrote a commentary on the study.
“We have every reason to believe that diagnostic errors are a major, major public health problem,” Newman-Toker told Reuters Health. “You’re really talking about at least 150,000 people per year, deaths or disabilities that are resulting from this problem.”
For the study, researchers used electronic health records to track 190 diagnostic errors made during primary care visits at one of two healthcare facilities. In each of those cases, the misdiagnosed patient was hospitalized or turned up back at the office or emergency room within two weeks.
The study team found the type of missed diagnosis varied widely. Pneumonia, heart failure, kidney failure and cancer each accounted for between five and seven percent of conditions doctors initially diagnosed as something else.
Most diagnostic errors could have caused moderate or severe harm to the patient, the researchers determined. Of the 190 patients with diagnostic errors, 36 could potentially have had serious permanent damage and 27 could have died.
One of the difficulties in making an accurate diagnosis is that certain common symptoms, such as stomach ache or shortness of breath, could be signs of a range of illnesses, both serious and not, researchers said.
“If you look at the types of chief complaints that these things occur with, they’re fairly common chief complaints,” said Hardeep Singh, who led the study at the Houston VA Health Services Research and Development Center of Excellence.
“If somebody would come in with mild shortness of breath and a little bit of cough, people would think you might have bronchitis, you might have phlegm… and lo and behold they would come back two days later with heart failure,” he told Reuters Health.


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Monday, February 25, 2013

Health Care Reform Articles - February 25, 2013

Note:

I am re-sending the following article titled "Bitter Pill", by Time Magazine journalist Steven Brill because of its importance in laying out a pervasive problem in healthcare that has heretofore received little attention - massive overpricing of many healthcare goods and services.

This post is followed by a link to an interview with Brill by The Daily Show's Jon Stewart, that adds additional insights and punch to the 20,000 word Time article. The interview begins about 15 minutes into the show. You may have to sit through one, two, or three commercials before you get to the interview, but it is well worth the wait, even if you don't especially like Burger King!


Bitter Pill: Why Medical Bills Are Killing Us

By Feb. 20, 2013

1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.
Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.
About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

The Daily Show with Jon Stewart 

http://www.thedailyshow.com/full-episodes/thu-february-21-2013-steven-brill


44,000 to lose Medicaid coverage in Maine

By Tracy Jan

LEWISTON, Maine — Louis Bourgoin seems an unlikely symbol of the latest battle over health care spending. The 68-year-old retired shipyard worker is undergoing chemotherapy for liver cancer. He lives in a state once renowned for its efforts to insure the poor, and Mainers stood to benefit even more under President Obama’s health care plan.
Then the letter from the administration of Governor Paul LePage arrived. Bourgoin and his wife were told last month they were about to lose thousands of dollars in annual Medicaid benefits starting in March.
“It’s going to hurt,” Bourgoin said, looking across the spartan living room at his wife. “The government doesn’t care. It means we’re just going to not eat very much.”
By the end of the year, more than 44,000 Mainers — seniors, the disabled, parents, and childless adults — will be dropped from the government-subsidized health insurance program. They represent roughly 13 percent of the state’s Medicaid population, and include the very group that national health reform sought to insure through the Medicaid expansion the Supreme Court has deemed optional.
LePage, meanwhile, seems an unlikely politician to wield such power. The oldest son of 18 children, he ran away from home at age 11, lived on the streets of this once-thriving mill town, and eventually was elected as a Tea Party-backed candidate in 2010
Now the paths of Bourgoin and LePage have crossed because the governor is among more than a dozen Republicans rejecting billions of federal dollars in Obamacare funding for Medicaid expansion. LePage is even going further, cutting benefits available before national health reform passed.

Hospitals cut back on dangerous early elective deliveries

By Phil Galewitz, KHN Staff Writer
Posted Feb. 21, 2013, at 2:05 p.m.
For decades, doctors have been warned about the dangers of delivering babies early without a medical reason. But the practice remained stubbornly persistent.
Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to latest hospital survey from The Leapfrog Group, a coalition of some of the nation’s largest corporations that buy health benefits for their employees.
The national average of elective early deliveries fell to 11.2 percent last year from 14 percent in 2011 and 17 percent in 2010. Nearly 800 U.S. hospitals report their data to Leapfrog, about a third of U.S. facilities offering maternity services.
“This data shows more hospitals are responding to the evidence,” said Cindy Pellegrini, senior vice president of the March of Dimes, which has been educating women and working with hospitals and doctors to lower early delivery rates. “This means babies are being born healthier and having a better start in life, and have a much greater likelihood of avoiding health consequences later on in life.”
Babies born before 39 weeks are more likely to have feeding and breathing problems and infections that can result in admissions to neonatal intensive care units than those who are born later, studies show. The elective deliveries can also cause developmental problems that show up years after birth.
Inducing labor early also carries risks for mothers because it increases the chances they will need Cesarean sections.
Since 1979, the American College of Obstetricians and Gynecologists has recommended against deliveries or induced labor before 39 weeks unless there is a medical indication, such as the mother’s high blood pressure or diabetes or signs that the fetus may be in distress.
Still, an estimated 10-15 percent of U.S. babies continued to be delivered early without medical cause, according to a report last year by the Department of Health and Human Services.
Leapfrog CEO Leah Binder said she’s encouraged by the latest figures, but says rates are still too high at many hospitals — with some as high as 40 percent. “This is a move in right direction, but more needs to be done,” Binder said.

Mediterranean Diet Can Cut Heart Disease, Study Finds


By 


About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study found.
The findings, published on the New England Journal of Medicine’s Web site on Monday, were based on the first major clinical trial to measure the diet’s effect on heart risks. The magnitude of the diet’s benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue.
The diet helped those following it even though they did not lose weight and most of them were already taking statins, or blood pressure or diabetes drugs to lower their heart disease risk.
“Really impressive,” said Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association. “And the really important thing — the coolest thing — is that they used very meaningful end points. They did not look at risk factors like cholesterol of hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”
Until now, evidence that the Mediterranean diet reduced the risk of heart disease was weak, based mostly on studies showing that people from Mediterranean countries seemed to have lower rates of heart disease — a pattern that could have been attributed to factors other than diet.
And some experts had been skeptical that the effect of diet could be detected, if it existed at all, because so many people are already taking powerful drugs to reduce heart disease risk, while other experts hesitated to recommend the diet to people who already had weight problems, since oils and nuts have a lot of calories.
Heart disease experts said the study was a triumph because it showed that a diet is powerful in reducing heart disease risk, and it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.
Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality born out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.
“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”

A Complex Role for Medicare in the Standoff in Washington


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WASHINGTON — In some ways, the partisan standoff over looming budget cuts resembles earlier links in the chain of fiscal battles that began two years ago.
But the politics of one core dispute between Democrats and Republicans — what to do about Medicare — are changing. And some of those changes complicate President Obama’s agenda, even as he continues to flex his postelection muscle.
One shift is the shrinking magnitude of the Medicare spending problem — a consequence, at least for now, of a recent slowdown in the rise of health care costs. That diminishes the willingness of Congressional Democrats, and perhaps the administration, too, to accept the sort of Medicare curbs that Mr. Obama has indicated that he favors.
Another is a moderation in the public stance of Republican leaders. In recent weeks, they have advocated smaller changes to Medicare than the “premium support” or voucher plan that Mitt Romney advocated and that Mr. Obama denounced in last year’s presidential campaign.
As a result, Mr. Obama’s ability to deliver a bipartisan compromise on entitlement spending may be waning even as Republicans edge closer to one.
The reduction in Medicare spending levels is the more drastic change.
In August 2010, the Congressional Budget Office estimated that Medicare would cost $6.5 trillion from 2012 to 2020. A few months later, a deficit reduction panel appointed by Mr. Obama called those spending levels unsustainable.
But the budget office’s latest projections have pegged Medicare spending over the same period at $6.1 trillion. That $400 billion decline exceeds the $303 billion in savings over that period recommended in 2010 by the panel, which was led by former Senator Alan K. Simpson, a Republican, and Erskine B. Bowles, who served as a chief of staff under President Bill Clinton.
The causes of the decline, which could include the impact of a weak economy as well as adjustments by doctors and hospitals to policy changes in the 2010 health care law, remain unclear. As does the decline’s duration.
Even so, Harold M. Ickes, a longtime Democratic strategist and a veteran of Mr. Clinton’s White House, said that “it’s going to be a hard case to make among Democrats that entitlements should be cut” as long as that trend persisted.
Yet no one argues that the deceleration in health costs has resolved the looming fiscal squeeze caused by the aging of the baby boom generation. Among the more optimistic liberal economists, Dean Baker of the Center for Economic and Policy Research argues that the trend, if it continues, will eventually resolve 75 percent of the long-term budget challenge posed by Medicare.

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Friday, February 22, 2013

Health Care Reform Articles - February 22, 2013


Medical Waste: 90 More Don'ts For Your Doctor


Doctors do stuff — tests, procedures, drug regimens and operations. It's what they're trained to do, what they're paid to do and often what they fear not doing.
So it's pretty significant that a broad array of medical specialty groups is issuing an expanding list of don'ts for physicians.
Don't induce labor or perform a cesarean section for a baby who's less than full-term unless there's a valid medical reason, say the American College of Obstetrics and Gynecology and the American Academy of Family Physicians. (It can increase the risk of learning disabilities and respiratory problems.)
Don't automatically do a CT scan on a child with a minor head injury, warns the American Academy of Pediatrics. (Currently half of all such children get them, when simple observation is just as good and spares radiation risk.)


Bitter Pill: Why Medical Bills Are Killing Us

By Feb. 20, 2013


Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LdaDmWzz

1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.
Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.
About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”
Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/



Governors Fall Away in G.O.P. Opposition to More Medicaid

By  and 
Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.
The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.
The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budgetdeficit. Some flatly declared they would not consider it.
In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.
The shift has delighted supporters of the law.
“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”
 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

GOP governors make peace with Obamacare

By , Friday, February 22, 10:01 AM

“It is not a white flag of surrender,” Florida Gov. Rick Scott said.
This was technically true: Scott did not wave a banner of any color when he announced Wednesday that he wants Florida to expand Medicaid, a key piece of Obamacare.
But make no mistake: Scott, a tea party Republican and outspoken critic of the law, was laying down arms in defeat. The former hospital executive won his gubernatorial race in 2010 by campaigning against Obamacare, and as governor he fought the law in court.  Even when the Supreme Court ruled against his position last year, he vowed defiance.
“We’re not going to implement Obamacare in Florida,” he said then. “We’re not going to expand Medicaid.”
The about-face by Scott, the seventh Republican governor to accept Obama’s expansion of government-funded health care for the poor, is a crucial validation of the president’s signature initiative. In his announcement, Scott made a moral case for the Medicaid expansion as compelling as the law’s proponents ever made.
“This country is the greatest in the world, and it’s the greatest largely because of how we value the weakest among us,” said Scott, in a blazer and open-collar oxford, said in his announcement. “It shouldn’t depend on your Zip code or your tax bracket. No mother or father should despair over whether they have access to high-quality health care for their sick child.” With federal funds covering the cost, “I cannot in good conscience deny Floridians that needed access to health care.”
Conscience is trumping politics elsewhere, too, even as the tea party maintains its grip on Republicans in Washington. Thirteen states, mostly in the South, have so far opted out of the Medicaid expansion, according to the Advisory Board Co.  Twenty-three and the District have opted in, accepting federal funds (100 percent for three years and at least 90 percent after that) to extend Medicaid to those with incomes up to about $31,000 for a family of four. “States are deciding this deal is simply too good to pass up,” Health and Human Services Secretary Kathleen Sebelius told reporters Thursday.

LePage says mental health care best remedy for gun violence

But Maine's annual spending on mental health care has dropped by $27 million since 2008.

By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
Gov. Paul LePage is pointing to his record on mental health care spending as he lobbies the Obama administration and Maine's congressional delegation to follow his lead rather than support increased gun control in response to the shootings in Newtown, Conn.
But the governor's record is mixed when it comes to supporting programs that serve people with mental and behavioral health problems, say advocates who monitor Maine's mental health care programs.
LePage released letters Wednesday that he sent to Vice President Joe Biden on Jan. 16 and to Maine's congressional delegation on Feb. 1, each saying that "the problem we face has little to do with firearm ownership and nearly everything to do with mental health issues."
LePage noted that he has increased funding for mental health services required under a consent decree by $2 million, and that he has increased funding for people with developmental disabilities by $6.7 million.
While mental illnesses differ from developmental disabilities, LePage wrote that he is "confident these initiatives will mean much more to the individuals receiving these services – and will provide more public safety – than simply enacting unnecessary gun laws."
LePage noted in an accompanying news release that Maine recently got a notable B grade from the National Alliance on Mental Illness and that the state increased its mental health budget 15 percent from 2009 to 2012.

Democrat proposes alternative to LePage liquor plan without hospital debt payoff

By Matthew Stone, BDN Staff
Posted Feb. 21, 2013, at 6:15 p.m.
AUGUSTA, Maine — The Democratic leader in the Maine Senate on Thursday put forth a liquor contract proposal of his own as a legislative committee prepares to take up a competing bill from Gov. Paul LePage to renegotiate the state’s wholesale liquor contract and use the proceeds to pay off a $484 million debt the state owes to hospitals.
Republicans immediately slammed the proposal from Sen. Seth Goodall, D-Richmond, and accused Democrats of stalling on the hospital debt repayment. A newly formed company that plans to bid on the state’s wholesale liquor contract also slammed the proposal.
Goodall’s legislation sets out an alternative for putting the state’s wholesale liquor business out to bid. The legislation, however, doesn’t attach the wholesale liquor contract to a plan for paying off the hospital debt.
“That discussion needs to be separate from making sure we have a process in place to make sure we get the best value for the state of Maine,” Goodall said, echoing comments earlier this month from Democratic leaders.
Goodall’s bill, LD 644, would require a company vying to operate the state’s wholesale liquor business to pay the state either $20 million or $200 million up front at the start of the 10-year contract. The legislation also would require a fixed annual payment from the company and a slice of annual profits based on the size of the initial payment.
In addition, Goodall’s bill would require that any company competing for the wholesale liquor contract pay a nonrefundable $25,000 application fee. And if the state can’t find a new wholesale liquor contractor in time for the current contract’s July 1, 2014, expiration, Goodall’s bill would allow the state to extend the current contract — held by Maine Beverage Co. — for another year in exchange for at least $34 million from the company.
Goodall said his plan would guarantee that a private sector company with adequate financial and operational wherewithal would end up with the contract.
“We need to make sure they have experience in the industry, that they have the knowledge, that they have the warehousing and delivery capacity,” he said. “This is a contract that’s worth hundreds of millions of dollars, and it requires significant service.”
Goodall said the LePage administration hasn’t laid out sufficient detail about its plans for bidding out the contract.

Central Maine Healthcare pulls bid to manage Brunswick hospital

By Beth Brogan, BDN Staff
Posted Feb. 21, 2013, at 7:51 p.m.
BRUNSWICK, Maine — Central Maine Healthcare in Lewiston announced Thursday that it has requested that the state suspend for one year the hospital’s bid to acquire Parkview Adventist Medical Center in Brunswick.
The Maine Department of Health and Human Services was reviewing a Certificate of Need application filed by CHMC and Parkview in August 2012 seeking approval for the merger.
But at a meeting in January, DHHS suggested that Central Maine Healthcare conduct a feasibility study “about the future of Parkview,” Chuck Gill, vice president for public affairs at CMHC, said Thursday.
“We looked at what they requested and realized it would take quite a bit of time to put the information together,” he said.
Gill said the department requested information “about the future of Parkview and what the organizations will be doing to make sure Parkview can thrive in the future.”
According to a release issued Thursday by CMHC and Parkview, “The leadership of both Central Maine Healthcare and Parkview remain upbeat about Parkview’s continued important role as a healthcare provider. Although this delay is unfortunate, Parkview still expects to become part of Central Maine Healthcare in the future. In the interim, Parkview will continue to serve the people of the mid-coast region with compassion and distinction.”
Parkview spokesperson Tory Ryden on Thursday referred calls to Gill.
After CMHC filed its Certificate of Need application, Mid Coast Hospital in Brunswick sought to block the plan and filed its own competing Certificate of Need application in an attempt to absorb all of Parkview’s operations and create a single hospital in Brunswick.
In October, hundreds of people attended a public hearing in Brunswick to weigh in on the proposal. Many that night spoke of loyalty to faith-based Parkview, while others argued that the midcoast region could not support two hospitals.

Maine wins $33 million to test health care innovations

By Jackie Farwell, BDN Staff
Posted Feb. 21, 2013, at 4:48 p.m.
Maine will receive up to $33 million from the federal government over the next three and a half years to test a plan to improve residents’ health care while cutting costs.
Maine and five other states are the first recipients of more than $250 million in funding awards made under the federal Affordable Care Act, the U.S. Department of Health and Human Services announced Thursday. The money is designed to help states find new ways of paying for and delivering health care that could ultimately lower costs for Medicare, Medicaid and the Children’s Health Insurance Program while making those programs’ beneficiaries healthier.
HHS hopes to foster state-level innovations that could eventually stem the tide of rising costs in Medicaid, the state-federal health insurance program for the poor, and the Medicare program for the elderly and disabled. Maine’s Medicaid program, known as MaineCare, accounts for about a third of the total state budget. Like Medicaid programs in other states, it faces critical funding shortages.
In a conference call on Thursday with reporters, HHS Secretary Kathleen Sebelius acknowledged the burden of mounting health care costs on the economy, states, businesses and consumers.
“Too many Americans receive care that’s fragmented, unreliable and generates poor health outcomes,” she said. “The good news is that we have numerous examples from across the country of how improvements in care delivery can both lower costs and improve health.”
Maine’s plan is a broad effort that includes expanding the creation of “accountable care organizations,” or groups of health providers that are promised incentives for better coordinating each patient’s care while also trimming costs. The model, which ties payments to health care quality metrics, stresses patient safety, better management of chronic diseases, and preventive health services.
The accountable care organization model was formalized under President Barack Obama’s health reform law, upheld in late June by the U.S. Supreme Court. It’s being tested in regions across the country.
HHS was impressed with work done by Maine health providers in recent years to collaborate with other stakeholders to improve health care, and then broaden those efforts statewide, Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation at HHS, said in the conference call.
“Many providers in Maine had come together with private entities and with payers and the state government and have been thinking about planning specific initiatives to address transforming care in their local communities,” he said.
Maine’s plan also calls for strengthening coordination among primary care providers and public health, behavioral health and long-term care organizations. The federal funding will allow the state to continue work to facilitate better partnerships between patients and their families and their primary care physicians.
The state additionally seeks to make better use of health data for more transparent and detailed reporting of health care costs and quality.




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