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Sunday, May 11, 2014

Health Care Reform Articles - May 11, 2014

12 Questions About Single Payer Health Care
by Sarah Kliff - Washington Post

This is a link to 12 FAQs About Single Payer Health Care, formatted as index cards:

http://www.vox.com/cards/single-payer/what-is-single-payer-health-care

Terminal neglect? How some hospices decline to treat the dying


By  and , Published: May 3 E-mail the writers

TAMPA — The 85-year-old hospice patient was close to death.
Ying Tai Choi lay on a hospital bed arranged in the living room of her daughter’s house. A pulse oximeter pinged an intermittent warning about her oxygen levels. She heaved for breath sometimes and panted at others. Sounds of gurgling and congestion came from her throat. The skin behind her fingernails was turning dark.
“She is leaving soon,” the hospice nurse told Choi’s daughter.
Then the nurse left the house and drove away, even though the hospice had said it would provide Choi with “continuous care,” according to records.
“No relief arrived at this time,” the nurse wrote in her notes, according to state investigative documents. “Exiting the residence.”
Choi’s daughter Ching Cheung was stunned. She tried giving her mother a few drops of water, but she felt helpless.
“I kept calling hospice and they said no one is available,” Cheung said. “My mother was struggling. It was terrible.”
Her mother died within an hour.
For more than a million patients every year, the burgeoning U.S. hospice industry offers the possibility of a peaceful death, typically at home.
But that promise depends upon patients getting the medical attention they need in a crisis, and hundreds of hospices provide very little care to such patients, a Washington Post investigation has found.
To better understand the quality of services rendered to terminal patients, The Post analyzed the Medicare billing records for more than 2,500 outfits, obtained an internal Medicare tally of nursing care in patients near death and reviewed complaint records at hundreds of hospices.
The scarcity of care affects the patients most in need. While many home hospice patients require little more than weekly nursing visits, some encounter crises in which their symptoms — pain, breathing troubles, seizures and so on — flare up in ways that cannot be controlled without sustained attention. For those cases, hospices are supposed to be able to provide either “continuous” nursing care at home or inpatient care at a medical facility.
But about one in six U.S. hospice agencies, serving more than 50,000 of the terminally ill, did not provide either form of crisis care to any of their patients in 2012, according to an analysis of millions of Medicare billing records.

The former Obamacare czar wants to make single-payer happen

Updated by  on May 7, 2014, 4:20 p.m. ET 
Don Berwick's last job was running Obamacare's implementation at the Department of Health and Human Services, where Republicans berated the former doctor for supporting the British health service.
His next goal: bringing single-payer health care to Massachusetts.
The former Medicare administrator is the only candidate in the Massachusetts governor race running on a single-payer platform. He says he settled on the idea when he was thinking through the different goals he wanted to achieve — slower health care cost growth, better quality care — all seemed most attainable when the government was the one paying everybody's health care costs.
"I began to list the policies I wanted to pursue, and then I came to the payment side...and I started to talk to the people who helped shape Vermont, looked at Vermont, and I just said, 'oh my, there is just one straight shot here, it's going to single-payer,'" Berwick said in an interview Wednesday.
"At that point it was more about thinking about putting it on the table. Now it is the entire table."



The Rise of Antibiotic Resistance

By 
The World Health Organization has surveyed the growth of antibiotic-resistant germs around the world — the first such survey it has ever conducted — and come up with disturbing findings. In a report issued late last month, the organization found that antimicrobial resistance in bacteria (the main focus of the report), fungi, viruses and parasites is an increasingly serious threat in every part of the world. “A problem so serious that it threatens the achievements of modern medicine,” the organization said. “A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”
The growth of antibiotic-resistant pathogens means that in ever more cases, standard treatments no longer work, infections are harder or impossible to control, the risk of spreading infections to others is increased, and illnesses and hospital stays are prolonged.
All of these drive up the costs of illnesses and the risk of death. The survey sought to determine the scope of the problem by asking countries to submit their most recent surveillance data (114 did so). Unfortunately, the data was glaringly incomplete because few countries track and monitor antibiotic resistance comprehensively, and there is no standard methodology for doing so.
Still, it is clear that major resistance problems have already developed, both for antibiotics that are used routinely and for those deemed “last resort” treatments to cure people when all else has failed.
Carbapenem antibiotics, a class of drugs used as a last resort to treat life-threatening infections caused by a common intestinal bacterium, have failed to work in more than half the people treated in some countries. The bacterium is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, and infections in newborns and intensive-care patients. Similarly, the failure of a last-resort treatment for gonorrhea has been confirmed in 10 countries, including many with advanced health care systems, such as Australia, Canada, France, Sweden and Britain. And resistance to a class of antibiotics that is routinely used to treat urinary tract infections caused by E. coli is widespread; in some countries the drugs are now ineffective in more than half of the patients treated. This sobering report is intended to kick-start a global campaign to develop tools and standards to track drug resistance, measure its health and economic impact, and design solutions.
The most urgent need is to minimize the overuse of antibiotics in medicine and agriculture, which accelerates the development of resistant strains. In the United States, the Food and Drug Administration has issued voluntary guidelines calling on drug companies, animal producers and veterinarians to stop indiscriminately using antibiotics that are important for treating humans on livestock; the drug companies have said they will comply. But the agency, shortsightedly, has appealed a court order requiring it to ban the use of penicillin and two forms of tetracycline by animal producers to promote growth unless they provide proof that it will not promote drug-resistant microbes.
The pharmaceutical industry needs to be encouraged to develop new antibiotics to supplement those that are losing their effectiveness. The Royal Pharmaceutical Society, which represents pharmacists in Britain,called this month for stronger financial incentives. It said that no new class of antibiotics has been discovered since 1987, largely because the financial returns for finding new classes of antibiotics are too low. Unlike lucrative drugs to treat chronic diseases like cancer and cardiovascular ailments, antibiotics are typically taken for a short period of time, and any new drug is apt to be used sparingly and held in reserve to treat patients resistant to existing drugs.
Antibiotics have transformed medicine and saved countless lives over the past seven decades. Now, rampant overuse and the lack of new drugs in the pipeline threatens to undermine their effectiveness.
http://www.nytimes.com/2014/05/11/opinion/sunday/the-rise-of-antibiotic-resistance.html?hpw&rref=opinion&_r=0

Pain and gain: An Alabama clinic stands out amid data on Medicare payments


By ,  and , Published: May 10 E-mail the writers


Nearly 20 patients packed the waiting lobby of the Alabama Pain Center before 10 a.m. on a warm April day. Crosses and biblical passages adorned the walls. In a hallway, a painting titled “The Great Physician” depicted Jesus assisting a doctor in the operating room.
Afflicted by pain from spinal injuries, botched surgeries or rare nerve conditions, patients from Tennessee, Georgia and Florida have flocked across state lines to see K. Dean Willis, a tanned anesthesiologist with salt-and-pepper hair who says he is among the top 30 experts on the use of pain pumps.
mplanted under the skin, the pump looks like a titanium hockey puck. High-powered drugs are custom-mixed on site, injected into the pump and carried by catheter into the spinal fluid. When the pump runs low, the patient returns to have it refilled, like a gas tank.
Although some experts consider the implanted pain pump to be an unusual and controversial last resort of pain management, it has become a signature treatment at the Alabama Pain Center.
Willis is now garnering national attention and new scrutiny. For the first time, newly released Medicare data has identified the costs associated with specific doctors performing procedures or administering drugs. The data allows for the identification of “hotspots” for particular treatments. The Washington Post found that the Huntsville area ranked fourth in the nation in Medicare spending per enrollee for drugs administered by doctors in 2012, the only year for which data has been released.
The procedures driving much of the cost were injections of “unclassified” drugs, a catchall category used by Medicare that includes drugs mixed at compounding operations, such as the one inside Willis’s clinic. Huntsville ranks No. 1 in that category.
“We see the worst of the worst,” Willis said in the hallway of his clinic. “It’s usually more expensive. Maybe that explains why our payments are so high.”
Nationwide, about $4 out of the $299 in total drug treatments by doctors per Medicare beneficiary is spent on unclassified drug injections. In Huntsville, the amount spent is $152 per enrollee — 38 times the national average — out of $766 in total drug treatments.
About 98 percent of the $11.4 million in Medicare’s payments for unclassified injections in Huntsville went to three doctors, all at the Alabama Pain Center: O. Jameson Stokes, Norman McCoomer and Willis were responsible for reimbursements in the amounts of $5.7 million, $3.3 million and $2.2 million, respectively, in 2012 and ranked first, second and third in the nation for Medicare payments for unclassified injections.
But the once-booming practice has hit hard times.

Agents played key role in California's Obamacare enrollment

As enrollment neared under the Affordable Care Act, both President Obama and California officials boasted that signing up for health insurance would be as easy as ordering a book from Amazon.com or buying a plane ticket online.
With that in mind, Covered California's executive director, Peter Lee, predicted a bleak future for insurance agents selling individual policies, saying they could easily go the way of travel agents.
As it turns out, reports of their demise were greatly exaggerated. Insurance agents played a major role in California's larger-than-expected enrollment of 1.4 million people in private health plans.
They personally signed up 525,000 Californians — nearly 40% of the state's total, new data show. About the same number signed up on their own using the Covered California website.
"Agents deserve credit. They brought in big numbers," said Betsy Imholz, special projects director at Consumers Union. "They are sort of the Rodney Dangerfield of the enrollment world."
And agents did it without much help from the state-run exchange early on.
They were slowed by many of the same glitches on the Covered California website that flummoxed consumers. The exchange's call center initially refused to help agents with customer applications, and clinics and nonprofit groups were discouraged from working with agents at enrollment events. State officials didn't promote free, in-person assistance from agents until late in enrollment.
Covered California acknowledges that mistakes were made, and it's conducting a comprehensive review of enrollment efforts so problems can be addressed going forward. But the state insists agents were never deliberately shunned.
"Any idea that we weren't invested in agents on Day One is flat-out wrong," Lee said. "Agents were embraced all along."
Like many agents, Edmond Haronian said it didn't feel that way.
Soon after enrollment began in October, the Canoga Park agent started calling the state's service center to resolve issues with the website or his customer applications. First, it often took more than 30 minutes to get through. Then state workers refused to even take his call because they were instructed to only assist consumers.
Covered California said it reversed that policy in December and told call-center workers to help agents.
Meanwhile on his website, Haronian began touting his office as the alternative with "no wait time, no operator, in other words, no headaches like Covered California." He hung a huge "Got Obamacare?" banner on his two-story building and he said he enrolled more than 1,000 people in the exchange.

Steve Robinson: Michaud's support for Obamacare certain to haunt his bid for governor

The law is anticipated to deliver a steady stream of bad news for Democrats for the foreseeable future.

Mike Michaud has an Obamacare problem.
No, he’s not one of more than 10,000 Mainers whose insurance plans – which they liked – were outlawed because of it. No, he’s not a private-practice physician about to be forced out of business by it. And, no, he’s not a business owner struggling with its regulatory uncertainty, skyrocketing premiums and painful taxes.
But he is an original supporter of the Affordable Care Act, and he happens to be running for governor in a state where that controversial law is unpopular.
A TOUGH VOTE TO JUSTIFY
Michaud voted for the health care law and has voted to defend it on dozens of occasions. Outside of the D.C. swamp, back here in Maine, Michaud will have to defend the amorphous bureaucratic monstrosity that is Obamacare.
Remarkably, Michaud claims to have read the bill. In a statement explaining his vote March 23, 2010, Michaud said he was voting after “thoroughly reading and reviewing” the entire bill.
If you believe Michaud read thousands of pages of bureaucratic gobbledygook before casting his vote, there’s some oceanfront property in Penobscot County I’d like to sell you.
None of the promises Michaud made about the law has come to fruition.
He said his vote would “help us move closer to more affordable and stable health care coverage.” However, premiums are increasing with no end in sight, folks are losing their insurance left and right and businesses and medical professionals face a more uncertain future than ever.
In his statement, Michaud said he had “already started” work on improvements.
All right, Mike, where are those improvements you promised four years ago? Point us to the bill you co-sponsored. Surely voters will hear about it on the campaign trail, right?
BAD NEWS WILL CONTINUE




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