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Monday, February 4, 2013

Health Care Reform Articles - February 4, 2013


Drowned in a Stream of Prescriptions


By 

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.
It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”
It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.
The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.
Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.
Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.
Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Outpatient markups fuel outrage

A battle is brewing nationwide over billing by outpatient surgery centers.

By CHAD TERHUNE Los Angeles Times
A surgery center charged teacher Lynne Nielsen $87,500 for a routine 20-minute knee operation that normally costs about $3,000.
Despite the huge markup, her employer and its insurer, Blue Shield of California, paid virtually all of the bill from Advanced Surgical Partners in Costa Mesa, Calif. Blue Shield mailed the $84,800 check to the high school Spanish teacher in December and told her to sign it over to the surgery center.
Nielsen said she was outraged and refused to send the check. Instead, she asked the California attorney general's office to investigate the matter. "This is insane," she said.
The 61-year-old is one of the latest patients caught up in a growing battle nationwide over billing by outpatient surgery centers. Industry experts say some of these centers seek out well-insured patients such as Nielsen, sometimes by waiving their co-payments and deductibles, and then bill their insurers exorbitant amounts for out-of-network care.
All too often, critics say, insurers pay these large sums and then cite high medical bills for why insurance premiums keep rising for businesses and consumers.
"This bill is so outrageous it almost takes my breath away," said Gerald Kominski, director of the Center for Health Policy Research at the University of California-Los Angeles. "This is an example of what's wrong with our health-care system, and employees and taxpayers of the school district are paying the price here."

Steward reshapes Mass. health care business


For-profit hospital chain is growing fast; cutting costs with tough management, innovation

By Robert Weisman

 |  GLOBE STAFF  
  FEBRUARY 03, 2013
Ninety minutes into his shift, Dr. Gerard B. Hayes has visited six intensive care unit patients, conferred with nurses about 12, and reviewed the records of dozens more.
“Dottie, how are you?” he asks a woman in a purple robe who is suffering from obstructive lung disease. “I’m taking a look at your X-ray right now, and it looks pretty good.” She sits up in her bed, breathing through a tracheostomy tube. “I’ll check in with you later,” he promises.
Hayes’s pace might be called breakneck if he was moving from bed to bed. But he’s remotely monitoring patients at several hospitals from an “e-ICU’’ outpost in Westwood operated by Steward Health Care System. Caregivers at the site watch video screens showing patients in hospital ICUs from Methuen to Fall River. It brings extra sets of eyes to intensive care while letting Steward keep its staffing lean.
Like everything else about for-profit Steward — robotic surgery, fixed-rate insurance contracts, managers working with patients to prevent hospital readmissions — the e-ICU is focused on innovation, efficiency, and finding ways to save money.
It’s a formula that has been reshaping the way business is done in the state’s health care industry ever since Steward was formed by a New York buyout firm in 2010 to take over the struggling Caritas Christi Health Care chain. But whether the makeover will achieve its most important goals — making medical care less expensive in Massachusetts and making a profit for Steward — remains an open question. What is certain is that Steward has become a force in this critical industry.

Politicians strive to stay in hospitals' good graces

But the partisan tension over who gets credit for paying the state’s debt to medical institutions reveals that industry’s outsized clout.

By Steve Mistler smistler@pressherald.com
State House Bureau
The campaign rally for Paul LePage started at a Dunkin' Donuts parking lot, across the street from Central Maine Medical Center in Lewiston. The crowd, chanting "Pay your bills!" and sprinkled with children holding signs that read "Save our hospitals," eventually migrated to the sidewalk.
LePage, running for governor on a platform that included making a $248 million debt payment to Maine hospitals, hoped to get the rally onto the CMMC grounds.
But the sidewalk was as close to the hospital as he and his campaign operatives would get.
"We'd asked to do it on campus, but the hospital wouldn't allow it," said Dan Demeritt, then LePage's spokesman, of the 2010 event. "They are very careful not to engage in partisan activity."
Three years later, Maine's Republican governor has a much closer relationship with the state's hospitals. He delivered on the debt payment he called for at the CMMC rally. He hired Mary Mayhew, lead lobbyist for the industry's trade group, the Maine Hospital Association, as commissioner of health and human services -- which oversees hospital regulation in Maine.
And with a re-election campaign pending next year, LePage has made payment of another $484 million in hospital debt a centerpiece of his vision for how to order the state's finances.
The hospital association has reinforced LePage's message over the last few weeks with a flurry of paid advertisements and newspaper opinion columns.
It's an alignment that makes Democrats queasy. Party leaders agree that the hospital debt must be paid. But some are suspicious of what they view as the industry's apparent coziness with LePage. They say hospitals didn't acknowledge that the debt payment was largely made possible by leftover money from John Baldacci's Democratic administration, which had made payments that resulted in $3.7 billion going to hospitals since 2002.






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