Hospitals trying arsenal of superbug-fighting inventions
Mike Stobbe / The Associated Press
NEW YORK — They sweep. They swab. They sterilize. And still the germs persist.
In U.S. hospitals, an estimated 1 in 20 patients pick up infections they didn't have when they arrived, some caused by dangerous 'superbugs' that are hard to treat.
The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread:
Machines that resemble "Star Wars" robots and emit ultraviolet light or hydrogen peroxide vapors. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint.
While these products can help get a room clean, their true impact is still debatable. There is no widely accepted evidence that these inventions have prevented infections or deaths.
Meanwhile, insurers are pushing hospitals to do a better job and the government's Medicare program has moved to stop paying bills for certain infections caught in the hospital.
"We're seeing a culture change" in hospitals, said Jennie Mayfield, who tracks infections at Barnes-Jewish Hospital in St. Louis.
Those hospital infections are tied to an estimated 100,000 deaths each year and add as much as $30 billion a year in medical costs, according to the Centers for Disease Control and Prevention. The agency last month sounded an alarm about a "nightmare bacteria" resistant to one class of antibiotics. That kind is still rare but it showed up last year in at least 200 hospitals.
Hospitals started paying attention to infection control in the late 1880s, when mounting evidence showed unsanitary conditions were hurting patients. Hospital hygiene has been a concern in cycles ever since, with the latest spike triggered by the emergence a decade ago of a nasty strain of intestinal bug called Clostridium difficile, or C-diff.
How the 19-year-old brain can both awe and appall us
Posted April 25, 2013, at 12:04 p.m.
Among the most mysterious things on the planet is the brain of a male in his late teens. It has been designed by evolution for purpose without much perspective, passion without much reason, reproduction without much responsibility and performance without caution. If it was a car, it would be a Corvette convertible with 430 horsepower, no seat belts or brakes and a horn that blared, “Hey, babe, wanna go for a ride?”
That’s why we send their owners to goal lines and front lines, but don’t let them drink until they are 21. That’s why we love having them as sons but are reluctant to have them date our daughters. And as we were reminded last Monday in Boston’s marathon, it’s why we should not be surprised that among the millions of teen males growing up around us, one of them seems like a great kid one day and — under the influence of an influential, older ringleader — does something stupid, crazy or appalling the next.
Neuroscientists and other brain experts now know what the rest of us need to understand about brain biology: Those 19-year-old brains, while capable of doing things with some adult capability and many adult consequences, are not the same as fully developed adult brains. The typical brain of the late adolescent has at least three to five more years of development to go before judgment, impulse control, insight, good risk and consequence appreciation, consistent assumption of responsibility and emotional control are fully “wired” and fully functional. Neurons remain to be connected, frontal lobe nerve fibers remain to be coated with myelin so that judgment function routinely and effectively precedes decision function, and the brain wiring for full maturity is completed. (Some of you women would say all that never happens in men.)
Evidence of this incomplete development fills our living rooms with sprawled teenage males about to turn 20 with little sense of what they want to do when they grow up, and our parental lives with wonderful or painful chaos. It fills our legal systems with troubled teenagers on the verge of growing up too fast by being sentenced as adults, and our graveyards with premature deaths of 18- to 24-year-olds by the thousands in America each year. These young “boys-into-men” have among the highest crash, crime and chaos rates of our entire population.
At the same time, they go into battle for us, haul injured comrades out of harm’s way and fill our chests with pride and our eyes with tears because they can be so glorious to behold. Prince or pain; we are not certain which they will be, or when they will be whatever, because they often don’t know either and they often can be both for several difficult years.
Next Big Challenge for Health Law: Carrying It Out
By JOHN HARWOOD
WASHINGTON — This month, a political organization aligned with House Republicans sent an e-mail to reporters attacking President Obama’s health care law.
“Young adults on parents’ plan pay more,” said the organization, the YG Network, citing a new employee benefits study. The e-mail’s subject line read, “So Much for Popularity.”
Actually, the study did not show that those young adults were paying more. It showed that insurance companies were, because they had begun providing health coverage to those young adults, as called for under the law.
The missive, inaccurate though it was, illustrates the immense challenge facing the Obama administration as it puts in place the most significant parts of the landmark 2010 law. Few government initiatives reach so many corners of the American economy and society — and have as much potential to generate trouble for the party in the White House.
Among the complex imperatives: pushing reluctant states to set up insurance marketplaces and expand Medicaid programs, keeping an eye on insurance companies as they issue new rate schedules, measuring the law’s effects on small-business hiring, and coaxing healthy young people to buy coverage so the system works economically for everyone else.
Gail Wilensky, who ran Medicare and Medicaid under President George Bush and supports the new law, said that 2014, when the law will make it mandatory to have insurance, “is going to be quite a bumpy year.”
Austan Goolsbee, a former chief economist to Mr. Obama, predicted “a big messaging headache the whole year.”
A fresh example popped up last week, to the delight of Republican opponents of the law. An article by Politico reported “high-level confidential talks about exempting lawmakers and Capitol Hill aides” from the health law.
In fact, lawmakers said, the talks that the article referred to concerned preserving the same kind of employer-subsidized health coverage for Congressional employees that workers at private companies can receive under the law. Yet the article, which quoted a spokesman for Speaker John A. Boehner as talking about “the ravages of the president’s health care law,” sent White House aides and other Democrats scrambling to avoid the appearance of special treatment.
The law poses some modest potential headaches for the overall economy.
Engaged or Detached?
By DAVID BROOKS
Let’s say you are a young person beginning to write about politics and policy. You probably have some idea of what you believe, but have you thought about how you believe it? That is to say, have you thought about where you will sit on the continuum that stretches from writers who are engaged to those who are detached?
Writers who are at the classic engaged position believe that social change is usually initiated by political parties. To have the most influence, the engaged writer wants to channel his efforts through a party.
The engaged writer closely and intimately aligns with a team. In his writing, he provides arguments for the party faithful and builds community by reminding everyone of the errors and villainy of the opposing side. For the engaged writer, the writing is often not about persuasion. (Realistically, how many times does a piece of writing persuade someone to switch sides?) It’s often about mobilization. It’s about energizing the people who already agree with you.
The engaged writer often criticizes his own party, but from a zone of trust inside it, and he is usually advising the party to return to its core creed. The engaged writer is willing to be repetitive because that’s how you make yourself an unavoidable pole in the debate. The goal is to have immediate political influence, to provide party leaders with advice, strategy and policy recommendations.
The detached writer also starts with a worldview. If you don’t have a philosophic worldview, your essays won’t even rise to the status of being wrong. They won’t be anything.
But the detached writer wants to be a few steps away from the partisans. She is progressive but not Democratic, conservative but not Republican. She fears the team mentality will blinker her views. She wants to remain mentally independent because she sees politics as a competition between partial truths, and she wants the liberty to find the proper balance between them, issue by issue.
The detached writer believes that writing is more like teaching than activism. Her essays are generally not about winning short-term influence. (Realistically, how many times can an outside writer shape the short-term strategies of the insider politicians?) She would rather have an impact upstream, shaping people’s perceptions of underlying reality and hoping that she can provide a context in which other people can think. She sometimes gets passionate about her views, but she distrusts her passions. She takes notes with emotion, but aims to write with a regulated sobriety.
Advocacy groups put pressure on Maine lawmakers to support Medicaid expansion
Posted April 29, 2013, at 1:07 p.m.
AUGUSTA, Maine — A coalition of advocacy groups, including AARP Maine, the American Cancer Society Cancer Action Network and the American Heart Association, will launch newspaper and radio advertisements Tuesday urging legislators to support a plan that would allow the state to expand Medicaid benefits under the Affordable Care Act.
The ad campaign comes after a weekend in which Republican Gov. Paul LePage and Democratic legislative leaders sparred over the proposal and whether it should be linked to a plan to repay the state’s Medicaid debt to Maine’s hospitals.
LePage and Republican legislative leaders remained more focused Monday on repaying the state’s $186 million share of an overall $484 million Medicaid debt to Maine’s 39 hospitals.
On Monday, the governor issued a statement challenging Democratic legislative leaders to schedule an up-or-down vote on his proposal to use revenue bonds derived from renegotiating the state’s wholesale liquor contract to repay the hospitals.
House Republican Leader Ken Fredette of Newport followed with a statement echoing LePage’s call. “Paying our bills to Maine’s hospitals is the one big issue we’re all in agreement on at the State House and indeed throughout the state,” Fredette said. “It deserves a clean, up-or-down vote.”
“Maine has an opportunity to expand access to health care to thousands of people, while also reducing health care costs and providing a boost to our economy,” Becky Smith, director of government relations for the American Heart Association in Maine, said Monday in a prepared statement. “Our goal is to raise awareness about this important issue and encourage Mainers to let their voices be heard.”
The ads provide a toll-free phone number that Mainers can call to urge their legislators to support the Medicaid expansion. The release announcing the ads cites a Maine People’s Resource Center pollshowing that 68 percent of respondents support the expansion. The Maine People’s Resource Center is affiliated with the Maine People’s Alliance, a liberal advocacy group that opposes many of LePage’s policies.
The group, called the Cover Maine Now! Coalition, also has begun collecting signatures on a petition encouraging legislators to support the Medicaid expansion, according to the release.
Under the Affordable Care Act, President Barack Obama’s 2010 health care reform law, Maine has the option of expanding Medicaid. Under the law, the federal government will cover 100 percent of costs for newly eligible Medicaid recipients for three years. The 100 percent funding will gradually drop to 90 percent in 2020, and states will have to make up the remaining share.
Rep. Linda Sanborn, D-Gorham, has introduced legislation calling for Maine to participate in the expansion. The LePage administration has generally opposed expanding Medicaid, but his administrationbegan discussing the possibility with federal officials after a number of other Republican governors said they would accept the federal Medicaid funds in their states.
Health and Human Services Commissioner Mary Mayhew last month sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius requesting more flexibility and more funding — 10 years of full federal expansion funding rather than the three prescribed in law — as a condition for Maine to expand Medicaid.
LePage said Saturday that Mayhew is traveling to Washington, D.C., this week discuss details with federal officials.
Paying off the hospital debt and expanding Medicaid eligibility would be good policy.
Gov. LePage has made paying Maine's debt to hospitals his top policy priority. He says that paying for services already rendered is not only the right thing to do, it would be good for the state's economy.
Raising $186 million in state money through the revenue of liquor sales would release $298 million from the federal government. Since hospitals are among the state's biggest employers and economic actors, these funds would reverberate through communities still struggling to recover from the recession.
He's right, but the same arguments can be made for another health care policy that he has chosen to oppose -- accepting federal funds to enroll more people in MaineCare, the state's version of Medicaid.
Expanding access to health care is the right thing to do: People with health insurance live longer and lead healthier lives than those without. And with 69,000 more Mainers insured -- all on the federal government's tab -- millions more dollars would be delivered to Maine hospitals and have the same positive effect on local economies.
And expanding Medicaid would attack one of the biggest cost drivers in Maine's high health insurance costs -- uncompensated charity care, usually in emergency departments.
LePage: Health law to send U.S. 'into a spiral'
Speaking to a crowd of business leaders, he also criticizes President Obama and Maine's wind-energy industry.
WASHINGTON — Maine Gov. Paul LePage lashed out against President Obama's health care initiative Monday, predicting the law "is going to put this country into a spiral" and that Obama "is going to ruin the American Dream as we know it."
Speaking to several hundred business owners from across the country, LePage also once again blamed Maine's high energy costs on the growing wind power industry in the state.
LePage, a Republican, said the Obama administration's Affordable Care Act -- commonly referred to as "Obamacare" -- would result in higher health care costs in Maine and is undercutting his own administration's efforts to increase competition in the insurance market.
"I think the ACA is going to put this country into a spiral," said LePage, one of three governors speaking as part of a U.S. Chamber of Commerce panel discussion. "I think the country is partly in a spiral now, but I think this president ... is going to ruin the American Dream as we know it.
"And the reason why is the American Dream is based on earned success. You earn it," LePage said. "Whereas he believes in learned dependency. He believes very, very strongly that every American's American Dream is provided by the government. And it doesn't work that way."
A simple way to improve Maine’s health care delivery
Posted April 29, 2013, at 2:23 p.m.
Maine officials and health care professionals know of ways to make the delivery of health care more efficient and reduce costs, but political agreement is difficult. One preventive approach, however — where health care providers focus on the underlying reason for an illness instead of only treating the illness — should not be a difficult political lift and deserves greater recognition and implementation in health care circles.
The spending problem could rightfully be called a crisis. Maine is fifth in the nation for health care spending per person. Its health care costs per capita exceed the national average and continue to increase at a faster-than average rate. The Maine Economic Growth Council’s “ Measures of Growth in Focus” 2013 report identifies health care spending as having an “enormous impact on Maine’s economy.” Maine businesses identified the cost of health care as being the top obstacle to investment in a 2010 Maine Development Foundation survey.
The state, unfortunately, does not have a long-term strategy to reduce health care costs, though some good efforts are being carried out in parts of Maine. The “ Accountable Care Organization” model has propelled some doctors, hospitals and other providers to work together to avoid the duplication of services under Medicare, for example, and prevention efforts have expanded under the Affordable Care Act.
Another approach worth pursuing more is trauma-informed care. Studies have shown that when doctors identify a patient’s childhood abuse or emotional trauma and recognize that it contributed to the patient’s health concern, patients end up not needing their doctors as frequently. The approach requires physicians to make a change in the way they practice medicine.
In some cases the correlation between childhood trauma and disease is profound, as Vincent Felitti and Robert Anda learned in their Adverse Childhood Experiences Study, which was carried out in Kaiser Permanente’s Department of Preventive Medicine in San Diego, together with the U.S. Centers for Disease Control and Prevention. They studied 17,000 individuals to record the effect that traumatic childhood experiences had later in life.
Two-thirds of the middle-class population surveyed had experienced at least one adverse childhood experience, such as abuse, neglect or growing up with an alcoholic or drug-addicted parent. The researchers found a proportionate relationship between the number of trauma-related categories that people experienced and the following: self-acknowledged chronic depression, hallucinations, smoking, alcoholism, impaired worker performance, drug use, liver disease and chronic obstructive pulmonary disease — all conditions that require expensive treatments and that are partially responsible for continually rising health care costs.
It turned out what was often presenting as the person’s health problem, such as obesity or an addiction, was, in fact, sometimes the person’s attempted solution for dealing with the long-term effects of trauma. As one study subject, who was beaten as a child and later turned to alcohol, cigarettes and drugs, said, “I found a way to block the emotions and the memories.”
Hospitals that pay no taxes must tend to community health
Posted April 28, 2013, at 1:23 p.m.
Consider the tax-exempt hospital.
Traditionally, these hospitals have offered free or subsidized medical treatment for poor patients. Over the past half-century, however, as the federal government has taken to paying for health care — via Medicare, Medicaid and, now, the Affordable Care Act — policymakers have tried to steer the nation’s 2,900 tax-exempt hospitals away from charity medical treatment for individuals and toward the kinds of preventive public-health services that are believed to lower health care costs generally: community blood-pressure and mammography screening, clinics for weight loss and smoking cessation, and so on.
To push this shift, the Internal Revenue Service has required tax-exempt hospitals to report annually on the community benefits they provide. Now, under the Affordable Care Act, they also have to formally assess, every three years, the health needs of their communities and adopt strategies to meet those needs. The idea is to hold the hospitals accountable for the estimated $13 billion in federal, state and local tax breaks they receive.
It’s too soon to tell whether the latest reporting requirement will accomplish the shift policy makers are looking for. What is known is that hospitals have a long way to go to live up to their mandate.
According to a study published last week in the New England Journal of Medicine, only 5 percent of the money that tax-exempt hospitals spent on behalf of their communities in fiscal year 2009 went to public-health programs. The lion’s share went to free and subsidized patient care.
