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Study Finds More Chemical Causes For Concern In E-Cigarette Vapor

CommonHealth (WBUR) - Wed, 07/27/2016 - 12:52pm
A study finds two probable carcinogens in e-cigarettes, at levels that vary depending on the heat and age (and gunk level) of the device.
Categories: Health Care

Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings

Kaiser Health News - Wed, 07/27/2016 - 11:26am

The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to many unheralded ones.

The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.

Just 102 hospitals received the top rating of five stars, and few are those considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession.

Medicare awarded five stars to relatively obscure hospitals and a notable number of hospitals that specialized in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the only nationally known hospitals getting five stars.

Use Our Content This KHN story can be republished for free (details).

Medicare awarded the lowest rating of one star to 129 hospitals. Five hospitals in Washington, D.C., received just one star, including George Washington University Hospital and Georgetown University Hospital, both of which teach medical residents. Nine hospitals in Brooklyn, four hospitals in Las Vegas and three hospitals in Miami received only one star.

Some premiere medical centers received the second highest rating of four stars, including Stanford Health Care in California, Massachusetts General Hospital in Boston, Duke University Hospital in Durham, N.C., New York-Presbyterian Hospital and NYU Langone Medical Center in Manhattan, the Cleveland Clinic in Ohio, and Penn Presbyterian Medical Center in Philadelphia. In total, 927 hospitals received four stars.

Medicare gave its below average score of two-star ratings to 707 hospitals. They included the University of Virginia Medical Center in Charlottesville, Beth Israel Medical Center in Manhattan, North Shore University Hospital (now known as Northwell Health) in Manhasset, N.Y., Barnes-Jewish Hospital in St. Louis, Tufts Medical Center in Boston and Washington Hospital Center in D.C. Geisinger Medical Center in Danville, which is a favorite example for national health policy experts of a quality hospital, also received two stars.

Nearly half the hospitals — 1,752 — received an average rating of three stars. Another 1,042 hospitals were not rated, including all hospitals in Maryland.

Medicare based the star ratings on 64 individual measures that are published on its Hospital Compare website, including death and infection rates and patient reviews. Medicare noted that specialized and “cutting-edge care,” such as the latest techniques to battle cancer, are not reflected in the ratings.

The government said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and found them useful to consumers and patients. Those ratings have shown, Medicare said, “that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries.”

In a statement, Rick Pollack, president of the American Hospital Association, called the new ratings confusing for patients and families. “Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers,” he said. “We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor.”

A preliminary analysis Medicare released last week found hospitals that treated large numbers of low-income patients tended to do worse, as did teaching hospitals.

Categories: Health Care

Medicaid Works: 10 Key Facts

Center on Budget and Policy Priorities - Wed, 07/27/2016 - 10:50am

This is the next in our “Medicaid Works” blog series, which aims to inform the debate over Medicaid’s future by providing the latest facts and figures on this essential and popular part of the nation’s health care system.

Categories: Benefits, Poverty

An Interview with Quinn Smith, Metadata Technician

In Custodia Legis - Wed, 07/27/2016 - 10:00am

Today’s interview is with Quinn Smith, who is working with Julie McVey as a metadata technician on our digital projects this summer.

Describe your background.

I grew up on the Eastern Shore. I lived in Delmar, Maryland, but attended school in Delmar, Delaware (Delmar: The town too big for one state). I have 2 sisters and 4 brothers. I now live in Washington, D.C. with my husband, and 6-year-old daughter, Eleanor (named after Eleanor Roosevelt).

What is your academic/professional history?

I have Bachelor’s degrees in humanities and English. I have a Master’s degree in Library Science with an e-government concentration. I am currently contemplating my next educational goal (law school, library science, or some combination). I worked at the World Digital Library, the Internet Archive, the Congressional Research Service, the University of Maryland – Hornbake Library, and now at the Law Library of Congress. Most of my experience has been in taking physical objects and digitally preserving them, metadata management, and quality assurance of audiovisual and digital objects.

How would you describe your job to other people?

Quinn Smith / Photo by Andrew Weber

I create and manage information about information. I create an information index for an item and then parse out as much information as possible to make searching for the object easier for researchers.  The record should be as robust as possible; the more correct information, the better.

I think of myself as an “information miner.” I take an original object (pamphlet, book, manuscript, photograph, newspaper, yearbook, letter and correspondence, map, artwork, graph, etc.) and “mine” it for information.  I look for answers to the following questions: Who created the original object–an individual or organization? Where was it created? What is it about (topics/keywords)? What is the title? Who owns the copyright or is it in the public domain? What is the unique identifier for the object? Who published the original? Where was it published, etc.?

I am currently working with databases that include the U.S. Reports (Supreme Court cases) and the United States Treaties Collection.

Why did you want to work at the Library of Congress?

I have always loved books and libraries. Working at this particular library has been a lifelong dream of mine. As a child, I was amazed that there was a library with every book in the world in its collection (I now know that isn’t true).

As an adult, I realize and understand the role of the Library of Congress as one of the greatest cultural heritage sites in the world. People come from all over the world to visit and research, and I have the access and opportunity to be here every day.

What is the most interesting fact you’ve learned about the Law Library of Congress?

The first thing I found interesting about the Law Library was the global aspect. While waiting to be interviewed, I noticed reports on Abortion Legislation in Europe and Foreign Intelligence Gathering Laws. Both reports contained smaller reports written by foreign law experts. It is interesting to see how different countries approach and legislate on the same topic.

I was also unaware the Law Library prepared reports for members of Congress.

The most interesting thing I have seen is the stacks – that’s a privilege that not many people will ever get; viewing the stacks puts into perspective just how many books there are!

What’s something your coworkers don’t know about you?

I don’t know how to drive. I’ve had three permits, but driving terrifies me. I do plan on learning. Also, I love Barbra Streisand, musicals, logic puzzles.

 

 

Categories: Research & Litigation

Clinton Veep Pick Tim Kaine Bolstered Mental Health System After Va. Tech Shooting

Kaiser Health News - Wed, 07/27/2016 - 8:21am

Tim Kaine is in Hillary Clinton’s camp — and his party’s — on the big health care issues, with a defining moment in his tenure as governor coming in 2007 after the mass shooting at Virginia Tech. His response to the shooting was a $42 million legislative package to reform the state’s mental health system.

As a U.S. senator who was elected in 2012, he’s backed the Affordable Care Act and has pushed for expanded Medicaid eligibility in his state and others. A Catholic, he’s said he opposes abortion personally, but supports a woman’s right to choose for herself.

Kaine did not mark himself as a health care reformer when he was Virginia’s governor, but his 2006-2010 term overlapped the recession when little reform was happening anywhere at state or national levels, said Peter Cunningham, a professor of health behavior and policy at Virginia Commonwealth University.

“He was probably pretty typical of the middle of the road Democratic governors in sort of purple states,” Cunningham said. “When the recession hit, that precluded any other major health reform effort that he might have contemplated.”

This KHN story also ran on NPR. It can be republished for free (details).

Kaine has occasionally incited controversy, however, as in 2007 when Virginia became the first state to require all girls get the human papillomavirus vaccine, protection against a virus that can cause cervical cancer, before enrolling in high school. In 2009, he backed a bill that banned smoking in bars and restaurants in the tobacco-producing commonwealth.

Mental Health

At 32 fatalities excluding the gunman, the Virginia Tech massacre at the hands of a student with mental illness was the deadliest mass shooting in U.S. history at the time.

Almost exactly one year later, Kaine signed a reform package into law bolstering funding for emergency mental health services, children’s mental health services, increased case managers and doctors and jail diversion projects, according to the Virginia Office of the Attorney General.

“Somebody shouldn’t be imprisoned because we won’t provide funding for community mental health,” Kaine said at a mental health conference in 2008, shortly after the bills were signed, according to the Virginian-Pilot in Norfolk, Va.

The package made it easier for authorities to commit someone having a mental health crisis into treatment involuntarily. They no longer had to prove the patient was in “imminent danger,” instead, the new standard required they show a “substantial likelihood” that the person could cause serious harm to themselves or others.

Together, Kaine and the state’s General Assembly made a down payment on longer-term reforms for the delivery of mental health and behavioral health services in Virginia, Cunningham said.

Opioids

Since his election to the Senate four years ago, Kaine has cosponsored bills to establish an advisory committee to help the FDA approve new opioids, reform guidelines for the VA to prescribe opioids, protect first responders from lawsuits when they administer emergency overdose drugs and create a drug monitoring program for Medicare.

Many of those bills were rolled into CARA — the Comprehensive Addiction and Recovery Act of 2016 signed by President Obama in July — which also bore Kaine’s name as a cosponsor.

Affordable Care Act

Though he wasn’t in office while the ACA was being implemented and debated, Kaine supported Obamacare when he ran for Senate and has since cosponsored bills to improve the law.

Kaine has advocated for Medicaid expansion in Virginia and cosponsored legislation to incentivize expansion in other states as well. Like Clinton, Kaine has proposed adjusting the ACA to include some low-income families that aren’t currently covered, fixing the so-called “family glitch.” This year, he cosponsored a bill to require more businesses to provide benefits under the ACA.

Abortion

Kaine, who worked with Jesuit missionaries in Honduras in 1980, follows the Catholic Church’s stand on abortion. His stance has drawn criticism over the years.

“Personally, I’m opposed to abortion and I’m opposed to the death penalty,” he said on Meet the Press in June.

“The right thing for government is to let women make their own decisions,” he continued.

That was a change from Kaine’s position in 2005, when he supported parental consent laws and bans on “partial birth” abortions, causing the Virginia chapter of NARAL Pro-Choice America to withhold an endorsement in his gubernatorial campaign. As governor, he signed a bill creating “Choose Life” license plates in Virginia, which he said was an issue of free speech.

Since then, Kaine has advocated for Planned Parenthood and opposed abortion restrictions.

In 2013, Kaine cosponsored legislation to improve access to contraception.

Categories: Health Care

First Edition: July 27, 2016

Kaiser Health News - Wed, 07/27/2016 - 6:39am
Categories: Health Care

Congressman Decries Olympus’ Failure To Warn U.S. Hospitals About Tainted Scopes

Kaiser Health News - Wed, 07/27/2016 - 6:05am

A U.S. lawmaker is renewing his push for Congress to toughen requirements on medical-device warnings, calling Olympus Corp.’s 2013 decision against issuing a broad alert to U.S. hospitals about scope-related superbug outbreaks “despicable.”

Rep. Ted Lieu (D-Torrance) said internal Olympus emails about that decision, detailed for the first time in a Los Angeles Times/Kaiser Health News article on Sunday, were “incredibly disturbing” and the company officials involved should face questions at a Congressional hearing. At least 35 patients in American hospitals have died since 2013 after developing infections tied to tainted duodenoscopes.

In company emails from February 2013, a senior executive at Olympus’ Tokyo headquarters told its U.S. managers not to issue a broad warning to American hospitals despite reports of scope-related infections in Dutch, French and U.S. hospitals. The executive added that they could respond to questions from a customer.

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The company had issued an alert to European customers a month earlier but chose not to do so in the U.S. until last year.

The emails were filed in a Pennsylvania court this month as part of a patient lawsuit and obtained by Kaiser Health News working in collaboration with the Los Angeles Times.

This story also ran in the Los Angeles Times. It can be republished for free (details).

“Olympus’ actions in this case were despicable,” Lieu said. “They knowingly failed to warn hospitals and patients of their defective scopes.”

After the company opted against a U.S. alert in early 2013, Virginia Mason Medical Center in Seattle discovered an outbreak involving contaminated gastrointestinal scopes manufactured by Olympus. The hospital said 39 patients eventually became infected and at least 18 of them died. The hospital acknowledged that the patients who died had other underlying illnesses.

Hospital patients in Los Angeles, Charlotte, Denver and other cities were also sickened by antibiotic-resistant bacteria, known as superbugs, after being treated with Olympus duodenoscopes.

“We are very troubled by the now very clear facts that Olympus in Japan knew of the infection problems with their duodenoscopes long before the outbreaks we saw in America, and chose not to warn physicians,” said Dr. Andrew Ross, section chief of gastroenterology at Virginia Mason Medical Center.

Related Stories

Follow past coverage of superbug outbreak caused by tainted scopes:

“If they had done so, physicians could then determine what is best in how to treat and advise their patients,” Ross said.

Virginia Mason is suing Olympus for fraud and misrepresentation in Washington state court. In court documents, Olympus denies the allegations and contends that the hospital failed to follow the instructions for cleaning the scopes.

Lieu filed a bill in April, known as the Device Act, which would make it mandatory for device makers to share safety alerts more widely, including those issued abroad.

Under the proposed legislation, companies would have to notify the Food and Drug Administration when they issue safety warnings in other countries related to the design and cleaning of their devices. The legislation also would require manufacturers to notify the FDA when they change the design or cleaning instructions of their devices, regardless of whether those changes warrant new government approval.

Lieu said he will press lawmakers to take up the bill in September when Congress reconvenes.

“This is why Congress needs to act and pass legislation to make sure this doesn’t happen again as well as hold a hearing,” Lieu said. “I believe it is now time for the decision-makers at Olympus to be held accountable and for Congress to hear what they have to say.”

Olympus didn’t have an immediate comment when reached Tuesday. The company has said previously that patient safety is a top priority and it is “working with the proper authorities and our stakeholders to understand and address the potential root causes” of contamination and infection tied to duodenoscopes.

Federal prosecutors are investigating Olympus and two other smaller scope manufacturers over their role in the superbug outbreaks at U.S. hospitals. In California, UCLA’s Ronald Reagan Medical Center, Cedars-Sinai Medical Center and Pasadena’s Huntington Hospital all have reported infections linked to Olympus scopes.

At those three hospitals, 28 infections have been reported and 14 of the patients later died. Some of the patients who died were seriously ill and the role of the infection in their deaths is unclear.

Lieu has introduced an additional bill, a companion to legislation that Sen. Patty Murray (D-Wash.) has filed, requiring that the cleaning instructions for medical devices be scientifically validated to ensure they work.

The duodenoscopes are long, flexible devices that are put down a patient’s throat during a procedure known as ERCP, or endoscopic retrograde cholangiopancreatography. Nearly 700,000 such procedures are performed annually in the U.S.

Olympus holds an 85 percent share of the U.S. market for these devices and other specialty endoscopes. Pentax and Fujifilm are two other manufacturers.

Overall, as many as 350 patients at 41 medical centers worldwide were infected or exposed to contaminated scopes made by the three manufacturers from January 2010 to October 2015, according to the FDA.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans

Kaiser Health News - Wed, 07/27/2016 - 5:00am

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, New Mexico, at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

This KHN story also ran in The Washington Post. It can be republished for free (details).

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days.

Medicare officials refused recently to name the companies that have sought or received such approval or even to say how long the Centers for Medicare & Medicaid Services has allowed the practice. Numerous insurers, including Cigna, Anthem and other Blue Cross Blue Shield subsidiaries, also declined to discuss whether they are automatically enrolling beneficiaries as they turn 65.

But others say they’re moving ahead.

Aetna will begin the process soon for its marketplace members in 17 Florida counties. The effort will kick off with individuals who qualify for Medicare in November, spokesman Matthew Clyburn said. They’ll receive 90 days advance notice instead of the required 60 and a postcard they can mail back, he said, and the company will follow up by phone to make sure they understand the change.

In November, UnitedHealthcare will start to automatically enroll members of its Medicaid plans in Tennessee and Arizona into its Medicare Advantage plans, a spokeswoman said.

And Humana, the nation’s second largest Medicare Advantage provider, has asked for federal permission to also do auto-enrollment. The process “will benefit people who want to stay with the same insurance company,” said Mark Mathis, director of Humana’s corporate communications. “It would simplify administration, eliminating a step in the process, and help maintain continuity with the same company.”

Medicare officials are developing a procedure for reviewing seamless conversion requests as well as a system to monitor implementation, spokesman Raymond Thorn said. A company given approval must automatically enroll all Medicare-eligible beneficiaries. But because federal law prohibits marketplace insurers from dropping a member who qualifies for Medicare, both marketplace and Medicare Advantage coverage continue until the person cancels the marketplace plan, Thorn explained.

Sally Thomphsen, who lives outside Chicago and had an individual health policy from Blue Cross Blue Shield last year, was more than surprised when she received her member card for a Medicare Advantage plan shortly before turning 65. Printed on the card was the name of her new primary care physician, someone she didn’t know.

“I almost hit the ceiling,” said Thomphsen, who had already enrolled in traditional Medicare.

She demanded that Blue Cross cancel her enrollment and reported the situation to Erin Weir, health care access manager at the local advocacy group AgeOptions. Weir heard a similar story from another local woman, who’d received a letter from her insurer saying a Medicare Advantage plan was “selected for you because it is similar to your current plan. Unless you contact us, you will be automatically enrolled.”

After learning about the problem both from constituents and health care advocates, Rep. Jan Schakowsky, D-Ill., wants stronger consumer protections. “I am exploring the option of requiring an ‘opt-in’ so that Medicare beneficiaries are adequately informed and able to make the choices that work best for them,” said Schakowsky, whose district includes the Chicago area.

The Lovelace Medicare Advantage plan in which Hanttula found herself is run by Health Care Service Corp., which administers Blue Cross Blue Shield plans covering 15 million beneficiaries in Illinois, Montana, New Mexico, Oklahoma and Texas. A Health Care Service spokeswoman said it “offers seamless conversion enrollment on a limited basis.” She would not provide details.

Hanttula finally solved her problem with help from a Medicare counselor at New Mexico’s Aging and Disability Resource Center, who contacted David Lipschutz, a senior attorney at the Center for Medicare Advocacy in Washington. He advised the counselor to tell Medicare officials that the retiree was enrolled in Medicare Advantage without her knowledge even though enrollment must be voluntary.

Eventually, officials disenrolled Hanttula from her unwanted plan, restored her traditional Medicare coverage and agreed to cover her medical bills.

Lipschutz said giving beneficiaries the chance to opt out doesn’t adequately safeguard consumers. An insurer’s notification letter can easily be mistaken or overlooked in the deluge of marketing materials seniors receive.

“The right to opt out doesn’t exist if they didn’t get the notice or if they did get the notice but didn’t understand it,” he said.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Categories: Health Care

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