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Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived

Kaiser Health News - 6 hours 56 min ago

While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined. A Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention.  In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than average for at least one infection category, the KHN analysis found.

The missteps Texas Health Presbyterian Hospital made this month in handling an Ebola patient echo mistakes hospitals across the nation have made in dealing with homegrown infections. Dr. Kevin Kavanagh, a patient safety expert from Kentucky, said hospitals too often don't strictly follow protocols to deal with infectious diseases, and the government's standard responses are not specific enough. "Right now there are too many recommendations on how to handle infectious diseases, too much leeway," he said. 

A 2011 study in the New England Journal of Medicine underscored the problem, observing that while hospitals have reduced the frequency of many infections over the last decade, they could do better if staff complied with recommendations. Those include always washing their hands and using maximal barrier procedures when tubes are being inserted, such as covering patients from head to toe with a sterile drape and wearing sterile caps, masks gowns and gloves. 

"The percentage of time that health care providers do all of the things they are supposed to do when caring for a patient with a contagious disease can be pretty low," said one of the authors, Dr. Don Goldmann, chief medical and science officer at the Institute for Healthcare Improvement, a nonprofit in Cambridge, Mass. "There’s a lot of room for improvement."

Goldmann said that hospitals tend to become more focused on following procedures when facing novel, highly publicized outbreaks such as Ebola. "When [an infection risk has] been around for a long time, it kind of becomes part of the background," he said.

Since 2012 the federal government has been analyzing and publishing the CDC rates for specific hospitals on Medicare’s Hospital Compare website. Starting this fall, Medicare is considering infection rates when deciding how much to pay hospitals.

The CDC reports six categories of infections: those from flexible tubes inserted into veins to deliver medicines or nutrients; infections from catheters that drain bladders; two antibiotic resistant germs, Clostridium difficile (C. diff) and Methicillin-resistant Staphylococcus aureus (MRSA); and two surgical site infections after hysterectomies and colon operations. 

States with more than a quarter of hospitals having at least one high infection rate in the CDC data were Arizona, California, Colorado, Connecticut, Florida, Massachusetts, Montana, Nevada, New Jersey, New York, Rhode Island, South Carolina and Utah, according to the KHN analysis of the most current CDC records. 

Infections In Hospitals

Three highly regarded institutions—New York-Presbyterian Hospital in Manhattan, Geisinger Medical Center in Danville, Pa., and the University of Michigan Health System in Ann Arbor—were among seven hospitals the CDC rated as having worse than average rates for four of the six infections, KHN found.

The CDC data, based on reports hospitals submit, are considered the most reliable assessments that exist. Still, many hospitals the CDC judged as having worse than average rates disputed those verdicts. They said that they look bad because they are more vigilant in identifying and reporting infections, or because they handle very sick patients who are more prone to catching a bug. 

For instance, Dr. Darrell Campbell Jr., chief medical officer at the University of Michigan Health System, said hysterectomies are performed on cancer patients at four times the rate than at other Michigan hospitals that compare information with each other. Because cancer surgeries take longer than regular hysterectomies, often involving removal of pelvic lymph nodes, the chances of infection are greater, he said. 

"When you adjusted for the cancer, we don't look different from any of the hospitals," he said. Campbell said none of Michigan’s infection rates deserved being rated poorly.  "Eventually, we'll get where we are more comfortable with this data, but we’re not there now," he said.

New York-Presbyterian said in a statement it has made "significant improvements." Geisinger said in a statement that its infection rates have dropped since 2012 and that its MRSA rate appeared high because the hospital made a "data entry error" when it reported cases to the government. Geisinger also noted that many patients who test positive for C. diff never develop any symptoms, but hospitals still must report it as an infection.

Some major teaching hospitals, like Denver Health Medical Center, Duke University Hospital in Durham, N.C., and Mayo Clinic’s hospitals in Rochester, Minn., have been able to maintain low infection rates, the KHN analysis shows. 

Others are succeeding in controlling some infection types but not others, according to the CDC data. Yale-New Haven Hospital had lower than average rates of bloodstream infections caused by central lines, but higher than average rates of infections from catheters inserted into the bladder to remove urine. Since one of the main ways to avoid such infections is to remove the catheter as soon as it is not essential, the hospital now allows nurses to take them out without a physician’s order under certain conditions, said Dr. John Boyce, the hospital’s director of epidemiology and infection control. "Busy physicians sometimes forget their patient has a catheter in, but the nurses know," he said.

Nationally, surgical site infections dropped by a fifth and central-line infections decreased by 44 percent between 2008 and 2012. MRSA decreased by a third during that period. 

Battling C. diff is very different than fighting Ebola and in some ways harder, because it requires hospitals to restrain use of the antibiotics necessary for so many patients. When those drugs eliminate weaker bacteria from the intestines, C. diff is able to prosper. Patients can get massive diarrhea and, while C. diff can be treated, the worse cases may require surgery to remove the infected part of the intestines.

Other infections for which the CDC tracks but does not yet publish hospital-specific rates, known as gram negative, are impervious to nearly all antibiotics.

Reducing the frequency of C. diff and these kinds of infections requires hospitals to become more judicious in deploying antibiotics. But only about half of hospitals have established stewardship programs that help doctors use the appropriate antibiotics in the most effective doses without overdoing it, researchers say.

"We have increasing amounts of data that thirty to fifty percent of the antibiotics we are prescribing are inappropriate," said Dr. Kavita Trivedi, a consultant and former infection control official for California. "It sounds crazy to people who are not in medicine: Why would a patient be prescribed an antibiotic they don’t need? But it happens frequently because we don’t know what they need."

Data for individual hospitals is available as a Printable PDF and as a CSV spreadsheet, and you can also view infections rates by state.

jra@kff.org

Categories: Health Care

High Infection Rates Vary By State

Kaiser Health News - 6 hours 57 min ago

This chart shows what proportion of hospitals in each state had higher than average infection rates for at least one type of infection publicly reported by the Centers for Disease Control and Prevention. The rates are based on infections contracted in the first nine months of 2013 and, for some of the infections, also the last three months of 2012. KHN excluded from the calculations hospitals that did not report any infection rates to the CDC or did not have enough cases for the CDC to evaluate.

<< Back To Main Story: Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived

Categories: Health Care

Ebola Tipping Point? Dispelling Myths And, Possibly, Less Hysteria Over Virus

CommonHealth (WBUR) - 7 hours 15 min ago

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

Has the national hysteria over Ebola peaked? Who knows. Maybe. There seem to be fewer front page headlines screaming about it; a new national poll finds most Americans are “positive” about the response by public health authorities; and today’s news is that more than 40 Dallas residents (all who had been in contact with the Liberian man who died of Ebola) were declared virus free.

Still, education is the antidote to hysteria, so it’s worth reiterating some of the facts. Many of them can be found in this must-read commentary in the London Review of Books by Paul Farmer, the rock star Harvard infectious disease doctor and leading advocate for global health equity in the world’s most impoverished regions.  Farmer, who is also a co-founder of the Boston non-profit Partners in Health, writes that despite some of the truly scary aspects of the virus, an Ebola diagnosis is not necessarily a death sentence:

The Ebola virus is terrifying because it infects most of those who care for the afflicted and kills most of those who fall ill: at least, that’s the received wisdom. But it isn’t clear that the received wisdom is right….

…the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus. The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90 per cent, should survive.

And he adds this:

I’ve been asked more than once what the formula for effective action against Ebola might be. It’s often those reluctant to invest in a comprehensive model of prevention and care for the poor who ask for ready-made solutions. What’s the ‘model’ or the ‘minimum basic package’? What are the ‘metrics’ to evaluate ‘cost-effectiveness’? The desire for simple solutions and for proof of a high ‘return on investment’ will be encountered by anyone aiming to deliver comprehensive services (which will necessarily include both prevention and care, all too often pitted against each other) to the poor. Anyone whose metrics or proof are judged wanting is likely to receive a cool reception, even though the Ebola crisis should serve as an object lesson and rebuke to those who tolerate anaemic state funding of, or even cutbacks in, public health and healthcare delivery. Without staff, stuff, space and systems, nothing can be done.

If you want to become more educated on Ebola and find out what you can do to support the global effort, Partners In Health/Engage and Harvard are sponsoring an Ebola teach-in Wednesday night in Cambridge with a panel of practitioners and public health experts.

Jon Shaffer, Senior Strategist for Grassroots Organizing at PIH, says the goal of the event is to “help our broader community understand the social, political, biological and economic context in which this epidemic is situated.” Beyond fundraising, which is obviously important, Shaffer says the group is also advocating for a swifter and more aggressive response by the U.S. government to the Ebola epidemic and is also working to dispel myths about the virus.

Categories: Health Care

Direct Democracy: Ties between Switzerland and the U.S.

In Custodia Legis - 9 hours 25 min ago

The following is a guest post by Dr. Goran Seferovic. Goran is a senior research associate at the University of Zurich’s Institute of Law and has been our scholar in residence at the Law Library of Congress this past summer. Goran is conducting research on direct democracy and intends to publish a book on this subject. You can read more about Goran in his interview published in In Custodia Legis on October 1st, 2014.

There is a radical difference between a democracy and a representative government. In a democracy, the citizens themselves make the law and superintend its administration; in a representative government, the citizens empower legislators and executive officers to make the law and to carry it out.

James W. Sullivan (1848-1938) (The National Civic Federation Review, Dec. 1, 1913)

These sentences begin the book Direct Legislation by the Citizenship through the Initiative and Referendum, written in 1892 by James W. Sullivan.  Sullivan drew a strong distinction between the representative government and a “direct democracy”, by which he meant a form of government in which the citizens themselves make laws and oversee the administration of the laws. The mechanisms that would enable the citizens to do that, according to Sullivan, were the initiative and the referendum.

In a referendum citizens vote on a law or a constitutional amendment passed by the legislature. The referendum vote can either be mandatory (legislative referendum) or requested by the citizens by collecting a certain number of signatures of citizens (popular referendum). The initiative is the proposal of new laws or constitutional amendments placed on the ballot by collecting a certain number of signatures of citizens (See the National Council of State Legislators homepage).

Sullivan was a printer and editor from Pennsylvania but he was also a leader of the International Typographical Union. Sullivan learned as early as 1874 about direct democracy in Switzerland and about the writings of Karl Burkli from Zurich (Sullivan, supra at ii).

Burkli was one of the early Swiss Socialists. He moved to Texas in 1855 to take part in an endeavor to found a utopian self-sustaining community near a town in Texas called Utopia. However, the project didn’t succeed and Burkli moved back to Zurich. He took part in the movement to end the rule of the liberal majority in Zurich. In 1868 he was elected to the council for the revision of the constitution of Zurich. Being a strong advocate for direct democracy Burkli succeeded in introducing the initiative in its modern form in the constitution of Zurich, one of Switzerland’s cantons (a canton is a member state of the Swiss confederacy). The initiative provision in the constitution of Zurich enabled the citizens of this canton to draft laws and bring them to a public vote thereby circumventing the legislative procedures that are otherwise required to pass legislation by parliament.

Karl Burkli (1823-1901) (Samuel Zurlinden, Hundert Jahre: Bilder aus der Geschichte der Stadt Zürich in der Zeit von 1814-1914, Vol. II, Zurich 1915 at 70)

Burkli proposed a special form of a Swiss Socialism in which direct democracy would in the end lead to a popular government without the need of a parliament. This idea was rejected by the German socialist leaders Marx and Engels. The writings of Burkli were translated into English and distributed though the International Workingmen’s Association (Karl Bürkli, Direct Legislation by the People, Versus Representative Government, Translated from the original Swiss Pamphlets by Eugene Oswald, London 1869).

Sullivan probably became familiar with the Swiss system of direct democracy through his contacts with international labor unions. But Sullivan also travelled to Switzerland and met with Burkli himself. The Central Library of Zurich holds a copy of Sullivan’s book with a dedication for Karl Burkli.

Sullivan was not the only one to write about direct democracy in the United States at that time. Numerous books have been published on the Swiss political system and about direct democracy. But Sullivan’s book was by far the most popular. The publication of his book was timely since the United States changed at the end of the 19th century from an agrarian to an industrialized society. Scholars have noted that large parts of the society could not profit from that development. Accordingly, farmers became poor because their revenue decreased drastically. On the other hand, big industrial and financial companies formed at that time influencing politics to pass legislation favoring their position (see Steven L. Piott, Giving Voters a Voice: The Origins of the Initiative and Referendum in America, 2003). Sullivan’s book has been said to have inspired the movements against these special interests to campaign for the incorporation of direct democracy into the states constitutions (Piott, id. at 3).

Swiss Miss giving the referendum to Lady Liberty. (Dan Beard, Cosmopolitan Magazine, July 1893)

Sullivan argued that the goal of the direct democracy movement was to circumvent the legislators whom he considered “habitually” corrupt and non-responsive to the needs of the people in a society in the transition to an industrial country (Sullivan supra at 95).

However, the movement seems to have only succeeded in parts. While most states in the west incorporated direct democracy into their systems, in the east, the south and at the federal level direct democracy appears to have been largely rejected.

In Switzerland, however, all cantons have incorporated direct democracy into their political systems, and in 1891 the initiative was also introduced at the federal level.

Whether direct democracy achieved its goal of making the state legislators in the United States more responsive to the concerns of the people is a question still debated today (See, e.g., Richard J. Ellis, Democratic Delusions: The Initiative Process in America, 2002).

For further reading you may consult the following sources:

Thomas E. Cronin, Direct Democracy: The Politics of Initiative, Referendum, and Recall, 1989.

Thomas Goebel, A government by the people: Direct democracy in America, 1890-1940, 2002.

 

 

 

 

Categories: Research & Litigation

Few California Inmates With Hepatitis C Get Costly Sovaldi

Kaiser Health News - 13 hours 42 min ago

The drug is being given to fewer than 1 percent of the 17,000 inmates with the virus in California prisons, reports the San Francisco Chronicle. Meanwhile, a Senate Democrat plans a hearing on how VA hospitals are coping with its high cost.

San Francisco Chronicle: Prisons Balk At Sovaldi’s $84,000 Cost For Hepatitis C Treatment
In San Francisco’s jails, no inmates with hepatitis C are receiving Sovaldi, the breakthrough pill that can cure most patients in an unprecedented amount of time. In California’s prisons, the drug, made by Gilead Sciences of Foster City, is being given to less than 1 percent of the 17,000 inmates with the virus. Sovaldi could wipe out what has long been an intractable disease. But its $84,000 cost for a 12-week supply doesn’t fit into lean government budgets (Lee and Garofoli, 10/20).

The Wall Street Journal’s Pharmalot: Senate Lawmaker Eyes Hearing On The Cost Of Hepatitis C Treatments
Responding to the ongoing controversy over the prices for new hepatitis C treatments, U.S. Sen. Bernard Sanders (I-Vt.) will probably hold a hearing -- possibly before the year ends -- to examine how the cost is affecting the U.S. Department of Veterans Affairs, according to his spokesman. Sanders is chairman of the Senate Committee on Veterans’ Affairs (Silverman, 10/20).

Categories: Health Care

Just In Time For Open Enrollment, A New Physician Rating Site

Kaiser Health News - 13 hours 42 min ago

USA Today reports that the website uses about 500 million federal and private claims and patient reviews to rank doctors. Meanwhile, the failure of the $30 billion federal program to create interoperable electronic health record systems is examined by Politico.

USA Today: New Doctors Site Rates For Experience, Quality
The first comprehensive physician rating and comparison database launches Monday in time for open enrollment on federal and state health exchanges, as well as for many employer-provided plans. The new version of the website Healthgrades.com uses about 500 million claims from federal and private sources and patient reviews to rate and rank doctors based on their experience, complication rates at the hospitals where they practice and patient satisfaction (O’Donnell, 10/20).

Politico: Few Motives To Fix Busted Health Data
Someday, doctors will have our data at their fingertips and will use it to prevent drug reactions, nip diabetes and cancers in the bud and lengthen our lives while preventing unpleasant and costly hospital stays. But for most doctors, that free-flowing information highway is a beautiful dream that doesn’t pay the bills (Allen, 10/20).

The role of primary care doctors in lowering health care costs is also examined -

Milwaukee Journal-Sentinel: More Efficient Health Care Generates Savings
The potential to lower health care costs by focusing on primary care can be seen in the example of a patient with diabetes who had been to an emergency department or hospitalized 30 times in roughly a year. The patient then developed a relationship with a primary care physician who closely monitored his health. The next year, he didn't seek care at an emergency room and wasn't hospitalized once (Boulton, 10/20).

Categories: Health Care

Medicaid Expansion, Health Exchanges Dominate Gubernatorial Debates

Kaiser Health News - 13 hours 43 min ago

In Georgia, where a runoff is looming, Gov. Nathan Deal went on the offensive and criticized his conservative opponent's support for expanding Medicaid. In Maryland, Republican candidate Larry Hogan slammed Democratic Lt. Governor Anthony Brown for his role in the state's troubled health exchange launch.

Atlanta Journal-Constitution: Georgia Candidates Are Ready For A Runoff … But Not Happy About It
If you needed any proof that Republicans are worried about a looming runoff, look no further than Sunday’s gubernatorial debate. That’s when Gov. Nathan Deal, instead of lobbing a softball at his Libertarian rival, unloaded a double-barreled attack questioning his support for a Medicaid expansion and criticizing the millions of dollars in federal grants his technology firms accepted (Bluestein and Malloy, 10/20).

Baltimore Sun: Hogan Slams Brown, O’Malley Administration On Health Care Lawsuit Delay
Reppublican gubernatorial candidate Larry Hogan criticized the O'Malley administration Monday over its decision to delay a lawsuit against the contractor it has blamed for the failed launch of the state's health exchange web site.  Hogan, locked in a battle with Democratic Lt. Gov. Anthony G. Brown with two weeks to go before Election Day, accused the administration of putting politics ahead of the taxpayers by delaying court action against Noridian Healthcare Solutions. The state fired Noridian in April for poor performance and vowed to recover $55 million it spent on the web site, which crashed on its first day of operation last October. Maryland decided early this year to scrap the web site and develop a new one based on software used on the more successful Connecticut site (Dresser, 10/20).

Categories: Health Care

Medicare, Health Care Getting Attention In Senate, Congressional Races

Kaiser Health News - 13 hours 43 min ago

In Louisiana's Senate race, Medicare is grabbing the spotlight. The powerful issue is also popping up in North Carolina and Iowa. Meanwhile, Michigan's Senate race references to Medicare and the health law are checked for accuracy. And Obamacare is the subject of ads in an increasingly high-profile California House contest.   

The Associated Press: In Louisiana, Both Sides Claim Defense Of Medicare
An old political standby — the future of Medicare — is emerging as the go-to issue in Louisiana’s bitter Senate race as the candidates woo seniors who typically wield strong influence in midterm elections. The challenge for voters is to figure out which side, if either, is telling the whole truth about who would cut and who would protect the popular insurance program. Medicare serves more than 50 million people and accounts for about 15 percent of federal spending, with about 10,000 new beneficiaries added daily as baby boomers reach age 65. The issue is so powerful that it’s cropping up in North Carolina and Iowa, too, amid a national battle for control of the Senate (Barrow and Deslatte, 10/21).

Politico: Fact-Checking The Michigan Senate Race
The Michigan Senate race pits Democratic Rep. Gary Peters against Republican Terri Lynn Land, a former Michigan secretary of state, to replace the retiring Sen. Carl Levin. The two candidates have faced plenty of attacks from outside spending groups, who have poured enough money into the race to make it the seventh costliest in terms of outside dollars. In fact, those groups — not the candidates themselves — have so far been the focus of our fact-checking efforts. False and misleading claims have centered on taxes, equal pay for women, health care, outsourcing jobs, Medicare and energy (Factcheck.org, 10/21).

Sacramento Bee: Ad Watch: Democrats Use Obamacare Against Ose
House Majority PAC, a Democratic group, has criticized Republican congressional challenger Doug Ose for his stances on veterans and Social Security. Now, in a new television ad, the group is targeting the former congressman for his pledge to repeal the Affordable Care Act and replace it with a new plan (Cadelago, 10/20).

Categories: Health Care

ACA Knowledge Gap Greatest Among Uninsured

Kaiser Health News - 13 hours 44 min ago

Most of the uninsured know little about the online insurance marketplaces, or that financial help is available for those with low incomes, finds a poll. Meanwhile, a West Virginia Medicaid official says new enrollees "come in with baggage," such as a history of using free drug samples that aren't covered by the program and The Washington Post looks at continuing legal challenges to the law.

Politico Pro: ACA Knowledge Gaps Loom Before Second Enrollment Season
Here comes another bit of trouble for the Affordable Care Act: Most of the uninsured don’t know that open enrollment starts next month. And they don’t know much about the marketplaces. Or that financial assistance is available for low-income consumers, according to the Kaiser Family Foundation’s latest Tracking Poll, released Tuesday. The poll found that 89 percent of the uninsured don’t know that the second season of enrollment begins on Nov. 15. Two-thirds said they know “only a little” or “nothing at all” about the marketplaces or exchanges and over half (53 percent) of the uninsured don’t know about the subsidies (Villacorta, 10/21).

Kaiser Health News: Capsules: Uninsured Still Know Little About Health Law As 2nd Enrollment Period Draws Near
Health law? What health law? Almost nine of 10 uninsured Americans – the group most likely to benefit — don’t know that the law’s second open enrollment period begins Nov. 15, according to a poll released Tuesday. Two-thirds of the uninsured say they know “only a little” or “nothing at all” about the law’s online insurance marketplaces where they can buy coverage if they don’t get it through their jobs. Just over half are unaware the law might give them financial help to buy coverage, according to a new poll (Carey, 10/21).

Charleston (W.Va.) Gazette: New Medicaid Patients ‘Come In With Baggage’
With 155,000 people added to West Virginia’s Medicaid program following a major expansion, the state’s family practice doctors are seeing more patients whose medical care requires a complete overhaul, a state Medicaid official told lawmakers Monday. “The problem is patients who come from an uninsured status to a suddenly insured status frequently come in with baggage,” said Dr. James Becker, medical director for West Virginia’s Medicaid program. Some new Medicaid patients show up at doctors’ offices with medical treatment plans that don’t comply with program standards. Other patients are taking free drug samples not on the Medicaid program’s preferred medication list. Becker said primary care doctors are helping patients switch gradually to state-approved prescription drugs (Eyre, 10/20).

The Washington Post’s Wonkblog: How The Supreme Court Could Still Wreak Havoc On Obamacare
Obamacare may not be the political issue it was this time last year, when a faltering Web site threatened to derail the program, but that doesn't mean it's in the clear. Ongoing legal challenges to one aspect of the law could still put its coverage expansion in serious jeopardy. The dispute has to do with whether the subsidies can be provided through public health insurance marketplaces in states that refused to set up their own, instead leaving the job to the feds. The administration and Obamacare supporters say the law was designed to provide premium subsidies to all states, regardless of who runs the marketplace (Millman, 10/21).

Fiscal Times: Ebola: Obamacare’s Ultimate Pre-Existing Condition
With the new Obamacare enrollment period scheduled to begin on November 15, here’s an intriguing question: If you’re one of the rare Americans to have the misfortune of contracting Ebola, can you apply for a new insurance policy on one of the government-run health exchanges without being rejected (Pianin and Ehley, 10/21)?

Categories: Health Care

State Highlights: Calif. Ballot Measure Updates; Va. Prison Health Care Budget Shortfall

Kaiser Health News - 13 hours 48 min ago

A selection of health policy stories from California, Arizona, Maine, South Dakota, Virginia, Maryland, Louisiana, Pennsylvania, Massachusetts, North Carolina, Texas, Washington state and Missouri.

CQ Healthbeat: California Leads States In Ballot Measures That Could Influence Health Care
They’ll vote on whether to upend decades-old policies and give the state insurance commissioner the power to deny health insurer requests for rate increases. Another question on the ballot could significantly increase medical malpractice award caps set in 1975 and impose the first requirements in the nation that doctors get tested for illegal drug use. California’s measures stand out as the most significant health-related ballot initiatives in front of voters in the November elections. Elsewhere, Arizonans will vote on whether terminally ill people in the state can use drugs that aren’t yet approved by the Food and Drug Administration. In Maine, voters will decide whether to spend millions to encourage the development of a genomic industry, while South Dakotans will vote on whether to join at least 33 other states that require health insurers to have a contracting process that will consider requests to participate from all interested and licensed providers (Adams, 10/20).

Los Angeles Times: Health Insurers Boost No On 45 Funding
California insurers have pumped more than $12 million over the last five days into a campaign to defeat Proposition 45, an initiative on the Nov. 4 ballot that would regulate health insurance rates. Blue Shield gave $2.66 million, WellPoint $6 million, Kaiser Permanente $3.73 million and Health Net $350,000, according to late filings at the secretary of state's office (Lifsher, 10/20).

Richmond Times-Dispatch: Va. Prison System Faces $45 Million Shortfall In Inmate Health Care
Virginia’s prison system faces a $45 million shortfall in inmate health care through next year, even as the corrections department bears the brunt of the latest round of cuts in the two-year state budget. The shortfall emerged this year after a private company that had provided health care to inmates at 17 prisons in hard-to-serve areas ended its contract with the state at the end of September, according to Department of Corrections Director Harold W. Clarke in a presentation Monday to the House Appropriations Committee (Martz, 10/20). 

The Washington Post: Booz Allen Buys Baltimore-Based Health Division Of Genova Technologies
Booz Allen Hamilton has acquired the health care division of Genova Technologies, an Iowa-based government contractor, for an undisclosed sum. The health care group, made up of about 40 employees, is based in Baltimore. The office has already been integrated into Booz Allen, said Susan Penfield, executive vice president of Booz’s health business (Jayakumar, 10/20).

The Associated Press: La. Health Dept. Seeks End To Billing Rape Victims
Sexual assault victims in Louisiana should not have to pay for their treatment in emergency rooms, the health department said Monday, announcing a proposal that would have a state victims’ assistance board finance the exams (10/20).

The Wall Street Journal: Judge Blocks Cancellation Of Philadelphia Teachers Contract
A judge on Monday temporarily blocked the Philadelphia public-school system from canceling the teachers union contract and requiring educators to pay a share of their health insurance premiums starting in December. The union, the Philadelphia Federation of Teachers, sought the injunction, claiming the five-member School Reform Commission that governs the district lacked legal authority to impose the changes. The school district said it would appeal Monday’s ruling (Calvert, 10/20).

Boston Globe: Mental Health Record May Be Predictor For Baker
[Charlie] Baker’s blueprint saved Massachusetts millions of dollars at a time when the state was staring at a nearly $2 billion deficit, but it left thousands of mental health patients often waiting weeks for treatments. The controversial approach became his template for rescuing financially ailing Harvard Pilgrim Health Care a decade later. The aftershocks of both initiatives are still being felt as the now 57-year-old Republican runs for governor, and those experiences, say Baker supporters and critics, provide a window into how he might handle similarly fraught and costly issues if elected (Lazar, 10/21).

Arizona Central-Republic: Phoenix VA Hospital Fails Outside Compliance Review
The Department of Veterans Affairs health-care system in Phoenix does not comply with U.S. standards for safety, patient care and management, according to a non-profit organization that reviews medical facilities nationwide. In findings published online, The Joint Commission says Carl T. Hayden VA Medical Center failed a July inspection in 13 quality-control categories (Wagner, 10/21).

California Healthline: New Los Angeles Program Working To Divert Mentally Ill, Homeless From Jail
Court. Jail. Homelessness. Repeat. That cycle so familiar to many Californians with mental illnesses may soon be interrupted thanks to the new Third District Diversion and Alternative Sentencing Program in Los Angeles County. Designed for adults who are chronically homeless, seriously mentally ill, and who commit specific misdemeanor and low-level felony crimes, the demonstration project could help reduce recidivism by as much as two-thirds, Third District Supervisor Zev Yaroslavsky said (Stephens, 10/20).

North Carolina Health News: A Rural Practice Fights To Stay Solvent
By many measures this is a pediatric practice that shouldn’t exist. Ahoskie is home to 5,000 people, only 1,200 of whom are under 18. The median income of the town hovers right around the federal poverty level, and the bulk of the young residents qualify for Medicaid or the state’s children’s health insurance program, free school lunch, and other services. Beverly Edwards, MD, is one of only two pediatricians within a 2-hour drive of Ahoskie, and never has a shortage of patients. Despite the challenging environment, and state bureaucratic changes that have nearly bankrupted her practice, Ahoskie Pediatrics’ sole doctor, Edwards says she’s been living the dream (Ferris, 10/21).

The Associated Press: Texas Selects Company To Run Psychiatric Facility
Texas leaders are closer to privatizing a much maligned North Texas psychiatric facility despite concerns from mental health care advocates. The Austin American-Statesman reports state officials announced Monday that Tennessee-based Correct Care Solutions has the winning bid to operate Terrell State Hospital, which employs 980 staffers and serves more than 250 patients. The state and company are negotiating the deal and a decision on whether to move forward with the privatization should be made by the year's end. State health officials said privatization might be the best way to improve the hospital, which was scrutinized following a patient death. A 62-year-old Pittsburg woman died at the facility in 2013 after being restrained for 55 hours. The Centers for Medicare and Medicaid Services shortly thereafter cut off federal funding because of poor conditions at the hospital (10/21).

Houston Chronicle: Riverside Hospital Ex-CEO, 3 Others Convicted In Medicare Fraud Case
The former president of historic Riverside Hospital -- along with his son and two other people affiliated with the facility -- were convicted in federal court Monday for their roles in a Medicare scheme to steal $158 million from the U.S. government. The convictions are a hefty blow to the hospital, which has been teetering on financial collapse. Prosecutors said the facility's psychiatric care was a "sham," and that the four convicted - ex-hospital chief Earnest Gibson III; his son Earnest Gibson IV; Regina Askew and Robert Crane - reaped taxpayer money for services that were not provided. Assistant U.S. Attorney General Leslie Caldwell said the defendants treated mentally ill and disabled people "like chits to be traded and cashed out to pad their own pockets (Chiller, 10/20).

Seattle Times: Washington Insurance Commissioner, Court Bolster Mental Health Coverage
Washington residents will be able to recover some of their medical costs for certain mental health services. Insurance Commissioner Mike Kreidler is sending letters instructing insurance companies to identify and inform policyholders whose insurance claims were denied for mental-health care that they have a right to have those claims re-evaluated, provided that they were denied under a blanket or categorical exclusion. The letters from Kreidler are being sent in response to a ruling earlier this month by the state Supreme Court. The court determined that insurance companies are required to cover medically necessary neurodevelopmental therapies for patients with mental illness including autism (Stiffler, 10/20).

St. Louis Post-Dispatch: Home Health Workers In Missouri Fight For Higher Minimum Wage
For home health attendants and their patients, a push to raise the workers’ hourly minimum wage is a no-brainer. “The people that take care of me deserve a living wage,” said Kyle Auxier, of St. James, Mo., who receives five hours of care at home every day from a home health attendant. “They don’t get what they deserve in my opinion. They can help someone disabled, like me, live their life normally.” But the proposal for an $11 hourly pay floor for those workers in a Medicaid-funded consumer-led health program has been met with skepticism and silence from some state policy makers. Auxier has Duchenne muscular dystrophy, a condition that has progressed as he’s gotten older. He has had a home health care attendant each day for the last four years but said his current worker was considering leaving because she makes only $7.75 an hour (Shapiro, 10/20).

Categories: Health Care

Viewpoints: Health Care Opponent's Legal Strategy; The Challenge For This Open Enrollment

Kaiser Health News - 13 hours 49 min ago

The Wall Street Journal: Carvin's ObamaCare Tour De Force
In 2011 after the first appeals circuit struck down the Affordable Care Act’s individual mandate, the White House asked the Supreme Court to take the case as soon as possible and "put these challenges to rest." There was no value in waiting on the merits to percolate in other courts, liberals argued then, given the grave practical consequences for this landmark social legislation. So observes Jones Day attorney Michael Carvin in his corker of a reply brief asking the High Court to accept King v. Burwell, an equally consequential challenge to ObamaCare. Yet now the White House is asking the Court to wait, and wait, and wait, which Mr. Carvin calls "irresponsible" and "out of touch with reality." The 12-page document is a master class in legal persuasion and deserves more readers (10/20). 

The New York Times' The Upshot: Next Open Enrollment For A.C.A. Approaches, But Few Notice
This year, the big challenge for officials behind the Affordable Care Act may not be making the website work but getting customers to come shop in the first place. A new survey of people without health insurance highlights the challenge: It found that 89 percent of the people surveyed were unaware that open enrollment begins in November, or any time soon (Margot Sanger-Katz, 10/21). 

The New York Times' Letter From America: Obamacare Losing Power As A Campaign Weapon
Then there was the disastrous rollout in late 2013, caused by computer glitches that cost the program precious credibility at a critical time. That's what most people remember — which might explain why some Republicans seeking election next month are still running attack ads against the health care law. The problem with that narrative is the program is proving to be a success, and yet the health care initiative — arguably the most significant piece of social legislation in decades — is no longer a prominent part of the Democratic agenda (Celestine Bohlen, 10/20). 

Los Angeles Times: To Govs. Jindal, Perry: A Travel Ban Won't Save Lives, But Medicaid Will
For Bobby Jindal of Louisiana and Rick Perry of Texas, two Republican governors thinking about running for president, the Ebola virus has been a heaven-sent opportunity. It has allowed them to swank around as protectors of public health, distracting their audiences from policies they've implemented that really are threats to public health (Michael Hiltzik, 10/20). 

The New Orleans' Times-Picayune: The Political Gamesmanship Of Opposing Medicaid Expansion
Sen. David Vitter, who has never been mistaken for a liberal, said in a June speech to the Baton Rouge Press Club that if he's elected governor, he wouldn't rule out Medicaid expansion the way that Gov. Bobby Jindal has. This is noteworthy because the Medicaid expansion is a major component of the Affordable Care Act, also known as Obamacare, and Rep. Bill Cassidy is just about basing his entire campaign on Sen. Mary Landrieu's support of that legislation. ... If Jindal had agreed to an expansion of Medicaid, then Cassidy's argument that the Affordable Care Act has been bad for Louisiana would be more difficult to make. If there were 242,000 people who were granted access to medical coverage, Landrieu could rightly claim credit for that. And what self-respecting Republican is going to let a Democrat claim credit for something as monumental as bring health care access to the masses? (Jarvis DeBerry, 10/20).

The Hill: ObamaCare — Why, Sure, It's 'Paid For'
Republican Senate Budget Committee analysts reported last week that the Patient Protection and Affordable Care Act (ACA) — a.k.a. ObamaCare — would increase the federal deficit by $131 billion over the period from 2015 to 2024. Drew Hammill, a senior aide to House Minority Leader Nancy Pelosi (D-Calif.), dismissed the report as "complete garbage." Name-calling is no substitute for analysis. The Senate budget analysts' work is fully transparent. Based on Congressional Budget Office (CBO) data on medical spending and labor market effects, it is quite easy to check out (Robert E. Moffit, 10/20).

The Wall Street Journal: ObamaCare Shunts My Patients Into Medicaid
Thirty years of experience in private medical practice uncovers many ironies. For example, recently several of my patients who had been paying for their own individual health insurance informed me that they were forced off private insurance and placed into Medicaid when they signed up for health care at Healthcare.gov. This unwanted change—built into ObamaCare with the intention of helping patients—has harmed them by taking away their freedom to choose a health-care plan that works best for them (Jeffrey A. Singer, 10/20).

The Washington Post's Volokh Conspiracy: A Recent Poll Shows That Most Doctors Give Obamacare Low Grades – But Should This Influence Voters’ Evaluation Of The Program?
A recent survey of doctors by the Physicians Foundation finds that most give low grades to Obamacare. Some 46% of the doctors polled gave Obamacare a grade of "D" or "F" and 29% gave it a "C." Only 25 percent give it an "A" or a "B," including just 4% who gave it the highest grade. It’s possible that some of the doctors who chose C really meant to say that it was at least reasonably good. But in modern America, thanks to grade inflation, a C is generally considered a very bad grade. Thus, it seems likely that a large majority of doctors have strongly negative view of the program (Ilya Somin, 10/20).

Los Angeles Times: What's Behind The Huge Price Jump For Some Generic Drugs?
Why are the prices of some generic drugs so darn high? That's a question many consumers have been asking lately. And now, a pair of prominent congressmen are demanding an answer from the drug industry. In letters to 14 pharmaceutical companies, the congressmen said they're investigating "the recent staggering price increases for generic drugs used to treat everything from common medical conditions to life-threatening illnesses" (David Lazarus, 10/20). 

Categories: Health Care

Views On Ebola: America Needs To 'Calm Down'; Political Criticism Is Off Base

Kaiser Health News - 13 hours 49 min ago

Los Angeles Times: Calm Down, America, Ebola Isn't About To Kill Us All
A Texas university refuses to accept students from Nigeria, where there were a couple dozen Ebola cases before the disease was quickly stopped. Louisiana refuses to allow incinerated trash from the treatment of Texas' first Ebola victim, Thomas Eric Duncan, into its landfills, as though the virus would survive immolation. A passenger on a cruise ship to Mexico who may have been exposed to lab samples from Duncan, but who appears to be healthy, is given a blood screening for Ebola even though the test isn't reliable in people without symptoms (10/20). 

The Wall Street Journal: Reasons To Calm Down About Ebola
The Ebola epidemic ravaging Liberia, Sierra Leone and Guinea is unlikely to become a global pandemic, though an international response is critical. The isolated cases in the U.S., Spain and elsewhere are to be expected, but as long as public-health systems act with alacrity, this should not lead to new outbreaks (F. Landis MacKellar and Jose G. Siri, 10/20).

The Washington Post: A Public Dispute Between NIH Officials Over Ebola
Foes of medical research spending by the National Institutes of Health got a boost Sunday from an unlikely source: Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. Fauci, a media-friendly scientist, was asked on "Meet the Press" on Sunday about remarks on the Ebola outbreak made by Francis Collins, head of the National Institutes of Health. ... I spoke Sunday night with Fauci, a longtime advocate for higher levels of medical research funding, to see why he had opened this public dispute with Collins. He said he agrees that "budget cuts have a lot to do with the slowing down of research" on Ebola and most everything else, but it’s possible that even with full funding, NIH might have encountered difficulty with the vaccine and couldn't persuade a corporate partner to make it (Dana Milbank, 10/20). 

The Washington Post: Beating Ebola Through A National Plan
The appointment of Ebola czar Ron Klain is an important initial step in mobilizing a coordinated national effort to confront this deadly virus. As the first U.S. hospital to successfully treat Ebola patients, Emory University Hospital has a unique perspective on the scope of the effort and skill required to care for such patients while also protecting the staff and public. One key lesson learned has been that training and strictly following protocol are paramount. Although that may sound simple, it takes an enormous amount of dedication, resources and planning (John T. Fox, 10/20). 

USA Today: Obama Critics Off-Base On Ebola
Sen. Ted Cruz, the Tea Party Republican who has little experience running anything bigger than his mouth, showed up Sunday on national television to hawk his call for President Obama to ban people in Ebola-plagued African countries from traveling to the United States. "For over two weeks, I've been calling on the (Obama) administration to take the common-sense stand of suspending commercial air travel" out of the three West African countries that are hard hit by the Ebola virus, the Texas senator said on CNN. When asked why the president should ignore the advice against the travel ban he received from the director of the Centers for Disease Control and Prevention and other medical experts, Cruz's responded by, in essence, calling them political hacks (DeWayne Wickham, 10/20). 

Politico: No, A Surgeon General Couldn't Stop Ebola
I appreciate the question "where is the surgeon general on this?" And I understand the public desire for a more neutral medical voice to talk to them about Ebola—one who is also appointed by the president but not as directly involved in the government’s response as [CDC Director Thomas] Frieden, Fauci or the politicos giving them orders. But what we’re talking about here is a wish, not a reasonable expectation. What commentators have failed to acknowledge is the surgeon general is crippled—permanently, in my estimation—and in no position to rescue us from either Ebola or the hysteria that has accompanied it. It didn’t used to be that way, but that's how it is today (Mike Stobbe, 10/20).

Bloomberg: Will Ebola Be Good For The CDC?
Don't get me wrong: Fighting infection is still one of the things that the public health infrastructure does, and though I hope it doesn’t come to that, I expect that our system will do a much better job next time. But the CDC did not botch the job because there’s something wrong with Barack Obama, or government, or the state of Texas, or private hospitals. They dropped the ball because the public health system no longer needs to work so many miracles, and consequently hasn’t had much practice. We shouldn’t have let public health give us such an inflated belief in the power of government. But we also shouldn't forget that with the right task and the right tools, government is still capable of doing some wondrous things (Megan McArdle, 10/20).

The Wall Street Journal: Poll: Most Americans Positive About Ebola Response
For days now marathon media coverage of Ebola has been turning even the tiniest developments into "breaking news." ... But the American people have remained levelheaded. And with just a small number of cases reported in one city, the public seems far calmer about Ebola in the U.S. than either cable news or the debate inside the Beltway suggests (Drew Altman, 10/21).

The Washington Post: Ebola Caregivers Deserve A Parade
A man my age grows up wondering: Could I have hit the beach at Normandy? How would I have handled being trapped near the Chosin Reservoir in North Korea, thousands of Chinese pouring over the border and a bitter winter coming on fast? What about Vietnam, or later Iraq and then Afghanistan and Iraq again? I come not from the Greatest Generation but the Wondering One — lucky, a reaper of what others have sown, and now, jaw agape, I wonder about health workers who leave the comforts and certainties of the United States and go to Africa to treat Ebola patients. Who are these people? (Richard Cohen, 10/20).

Journal of the American Medical Association: Ebola In The United States: EHRs As A Public Health Tool At The Point Of Care
The readiness of the health care system for Ebola was challenged by the very first case. When Thomas E. Duncan went to the Texas Health Presbyterian Hospital in Dallas in September, health care workers reportedly obtained and recorded his travel history, but the patient was nonetheless discharged home without being diagnosed as having Ebola. The press in part focused on whether the electronic health record (EHR) contributed to the missed diagnosis, but the right question to be asking is how a modern computer system should perform in this circumstance. The EHR appears to have performed exactly as expected. ... For many patients, travel history is not especially relevant. However, for Duncan, it was the single most important aspect of the case (Dr. Kenneth D. Mandl, 10/20).

Categories: Health Care

Hill Republicans Refine Their Strategy On Foreign Travelers As CDC Tightens Ebola Guidelines

Kaiser Health News - 13 hours 49 min ago

The GOP are now pressing to suspend visas for some travelers since the administration has so far rejected calls for a flight ban. Also Monday, the Centers for Disease Control and Prevention beefed-up its guidelines to protect health care workers.

The New York Times: On Ebola Response, Congressional Republicans Put New Focus On Visa Suspensions
Republican leaders, conceding the futility of a flight ban from Ebola-afflicted West Africa, are refining their response to the outbreak, pressing to suspend visas for travelers and create "no boarding" lists. But a supercharged political atmosphere is making legislative nuance difficult two weeks before midterm elections and days before a hearing on Friday on the Ebola response called by the House Oversight and Government Reform Committee, a panel riven by partisan division. Republicans on the campaign trail continue to goad Democrats to embrace a broad travel ban, although no direct flights to the United States from Liberia, Sierra Leone or Guinea exist (Weisman, 10/20).

The Washington Post: CDC Issues Formal Guidelines Giving Workers More Protection Against Ebola
Federal health officials Monday tightened infection-control guidelines for health-care workers caring for Ebola patients, explicitly recommending that no skin be exposed. The beefed-up guidelines also call for health-care workers to undergo rigorous training, and to be supervised by trained monitors when putting on and taking off personal protective equipment. The government will issue step-by-step instructions for workers to follow in doing that (Sun and Berman, 10/20).

Los Angeles Times: New Ebola Protection Guidelines Leave No Bare Skin
After pointed criticism from healthcare workers and relatives of an Ebola-infected nurse, the U.S. Centers for Disease Control and Prevention announced new guidelines Monday for hospital protective gear. The guidelines, which were scheduled to be posted on the CDC's website late Monday night, were described by CDC Director Thomas Frieden during a telephone news conference (Morin, 10/20).

Politico: Dude, Where's My Czar?
The White House announced Friday that Ron Klain would be the country’s public point-person on Ebola, but so far what the "Ebola czar" isn’t doing has been clearer than what he is. Klain won’t be testifying this Friday on the Hill. He didn’t participate in a Saturday meeting of top officials on Ebola. And administration officials haven't yet confirmed that he’s talked with the president since their conversation the day his selection was made public (Epstein, 10/20).

Categories: Health Care

Kasich Retreats From Politically Charged Health Law Comments

Kaiser Health News - 13 hours 50 min ago

After telling the Associated Press that he didn't think a repeal of the health law was going to happen, Ohio Gov. John Kasich, a Republican, took aggressive steps to attempt to correct the record. His statement, he said, was meant only about attempts to repeal the Medicaid expansion, which Ohio has implemented. 

Politico: Gov. John Kasich: Repeal Obamacare, But Not All Of It
A political firestorm broke out Monday when The Associated Press quoted Kasich as saying that Obamacare repeal was “not gonna happen.” That view is almost unheard of — at least in public — among most Republicans, let alone those who might run for the White House in 2016. Kasich said AP got it wrong, and he called POLITICO Monday night to correct the record. He said he was talking specifically about repeal of the expansion of Medicaid — which Ohio has implemented — and not of the Affordable Care Act more broadly (Wheaton, 10/21).

The New York Times: Ohio Governor Backpedals On Repeal Of Health Law
Wait, that’s not what I really meant. Gov. John Kasich of Ohio said his comments about a Republican-led Congress being unlikely to repeal the Affordable Care Act — which commentators on the right and left pounced upon Monday — were taken out of context. Mr. Kasich, a Republican mentioned as a 2016 presidential hopeful, in an interview distanced himself from the notion that he had accepted the health care law as a fait accompli. The idea is anathema to almost all Republican officials, and especially the party’s base (Gabriel, 10/20).

The Washington Post: Kasich: I ‘Don’t Back Obamacare’ And I ‘Want It To Be Repealed’
Ohio Gov. John Kasich (R) is pushing back on reports that he'd said Obamacare was here to stay, saying Monday night that he opposes the federal health care law and believes it could be repealed and replaced under a Republican president and GOP-controlled Congress. "I don't back Obamacare. I never have. I want it to be repealed," he told The Washington Post in a telephone interview (Sullivan, 10/20).

CNN: Kasich In Interview: Obamacare Has To Stay
A repeal of President Barack Obama's signature health care law is "not gonna happen" even if the GOP takes the Senate, Ohio Gov. John Kasich said. The Republican governor's comments, in an interview with The Associated Press published Monday, are a major departure from the rest of his party -- and stunning for a potential 2016 presidential contender (Bradner, 10/20).

Cleveland Plain Dealer: Does John Kasich Still Want To Repeal Obamacare?
So it was surprising Monday to see Kasich quoted in an Associated Press story that characterizes his position as shifting even farther to the left. "That's not gonna happen," Kasich reportedly told the AP when asked about a repeal of Obamacare, something many GOP candidates for president and Congress favor. ... But when it comes to the Affordable Care Act in its entirety, Kasich has in the past expressed support for "repeal and replace" -- a standard Republican stance. What's changed? Nothing, said Kasich press secretary Rob Nichols. "He's for repeal and replace," Nichols said Monday afternoon. "He always has been." Nichols said Kasich was speaking specifically about Medicaid expansion when interviewed by the AP (Gomez, 10/20).

In related news, many GOP governors face a similar pull between their choice to expand Medicaid and their positions on the overall health law -

The Associated Press: GOP Governors Don’t See ‘Obamacare’ Going Away
While Republicans in Congress shout, “Repeal Obamacare,” GOP governors in many states have quietly accepted the law’s major Medicaid expansion. Even if their party wins control of the Senate in the upcoming elections, they just don’t see the law going away. Nine Republican governors have expanded Medicaid for low-income people in their states, despite their own misgivings and adamant opposition from conservative legislators. Three more governors are negotiating with the Democratic administration in Washington (Alonso-Zaldivar, 10/20).

Categories: Health Care

Political Cartoon: 'Line In The Sand?'

Kaiser Health News - 13 hours 50 min ago

Kaiser Health News provides a fresh take on health policy developments "Line In The Sand?" by John Darkow.

And here's today's health policy haiku:

KASICH: REPEAL, REPLACE... REVISE?

The health law's repeal?
Not happening, he said... But
that's not what he meant.
-Anonymous 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

The importance of the civil action cover sheet

A recent superior court decision has underlined the importance of a full and accurate reporting of the injuries on the Civil Action Cover Sheet.  The form requires a listing of expenses as well as a description of the injury, including the nature and extent.
In Stankiewicz v. DiStefano, Judge Curran admonished counsel to comply with Superior Court rule 29.  The case was dismissed since the cover sheet did not include a detailed listing of injuries that were caused by the defendant.  Plaintiffs must meet the burden of showing that they have a reasonable likelihood of recovery of over $25,000 to proceed in Superior Court.
Categories: Research & Litigation

The True Cost Of A Mother’s Death: Calculating The Toll On Children

CommonHealth (WBUR) - 15 hours 48 min ago

A health worker interviews a client at a health care facility in Tharaka, Kenya. (Photo: Family Care International)

By Emily Maistrellis
Guest contributor

Walif was only 16 and his younger sister, Nassim, just 11 when their mother died in childbirth in Butajira, Ethiopia.

Both Walif and Nassim had been promising students, especially Walif, who had hoped to score high on the national civil service exam after completing secondary school. But following the death of their mother, their father left them to go live with a second wife in the countryside. Walif dropped out of school to care for his younger siblings, as did Nassim and two other sisters, who had taken jobs as house girls in Addis Ababa and Saudi Arabia.

Nassim was married at 15, to a man for whom she bore no affection, so that she would no longer be an economic burden to the family. By the age of 17, she already had her first child. Seven years after his mother died, Walif was still caring for his younger siblings, piecing together odd jobs to pay for their food, although he could not afford the school fees.

In all, with one maternal death, four children’s lives were derailed, not just emotionally but economically.

More than 1,000 miles away, in the rural Nyanzo province of Kenya, a woman in the prime of her life died while giving birth to her seventh child, leaving a void that her surviving husband struggled to fill. He juggled tending the family farm, maintaining his household, raising his children and keeping his languishing newborn son alive.

But he didn’t know how to feed his son, so he gave him cow’s milk mixed with water. At three months old, the baby was severely malnourished. A local health worker visited the father and showed him how to feed and care for the baby. That visit saved the baby’s life.

As these stories illustrate, the impact of a woman’s death in pregnancy or childbirth goes far beyond the loss of a woman in her prime, and can cause lasting damage to her children — consequences now documented in new research findings from two groups: Harvard’s FXB Center for Health and Human Rights, and a collaboration among Family Care International, the International Center for Research on Women and the KEMRI-CDC Research Collaboration.

The causes and high number of maternal deaths in Ethiopia, Malawi, Tanzania, South Africa, and Kenya — the five countries explored in the research — are well documented, but this is the first time research has catalogued the consequences of those deaths to children, families, and communities.

The studies found stark differences between the wellbeing of children whose mothers did and did not survive childbirth:

• Out of 59 maternal deaths, only 15 infants survived to two months, according to a study in Kenya.
• In Tanzania, researchers found that most newborn orphans weren’t breastfed. Fathers rarely provided emotional or financial support to their children following a maternal death, affecting their nutrition, health care, and education.
• Across the settings studied, children were called upon to help fill a mother’s role within the household following her death, which often led to their dropping out of school to take on difficult farm and household tasks beyond their age and abilities.

How to use these new research findings to advocate for greater international investment in women’s health?At a webcast presentation earlier this month, a panel of researchers, reproductive and maternal health program implementers, advocates and development specialists discussed that question.

Central to the discussion was the belief that the death of a woman during pregnancy and childbirth is a terrible injustice in and of itself. The vast majority of these deaths are preventable, and physicians and public health practitioners have long known the tools needed to prevent them. And yet, every 90 seconds a woman dies from maternal causes, most often in a developing country.

The panelists expressed hope that these new data, which show that the true toll of these deaths is far greater than previously understood, can help translate advocacy into action.

“It’s important to recognize that, beyond the personal tragedy and the enormous human suffering that these numbers reflect — some hundreds of thousands of women die needlessly every year — there are enormous costs involved as well,” said panelist Jeni Klugman, a senior adviser to the World Bank Group and a fellow at the Harvard Kennedy School of Government.

“So quantifying those effects in terms of [children’s] lower likelihood of surviving, the enormous financial and health costs involved and the repercussions down the line in terms of poverty, dropping out of school, bad nutrition and future life prospects are all tremendously powerful as additional information to take to the ministries of finance, to take to the donors, to take to stakeholders, to help mobilize action,” she said.

Just what does “action” mean? Currently, the countries of the world are debating the new global development agenda to succeed the eight Millennium Development Goals, an ambitious global movement to end poverty. Advocates can use this research to make the case that reproductive, maternal, newborn, and child health should play a central role in this agenda, given that it reveals the linkages between the health of mothers, stable families, and ultimately, more able communities, according to Amy Boldosser-Boesch, Interim President and CEO of FCI.

Panelists also called for more aggressive implementation of the strategies known to prevent maternal mortality in the first place; as well as for the provision of social, educational, and financial support to children who have lost their mothers; and for continued research that outlines the direct and indirect financial costs of a woman’s contributions to her household, and what her absence does to her family’s social and economic well-being.

But action is also required outside of the realm of health care, said Alicia Ely Yamin, lecturer in Global Health and Population at the Harvard School of Public Health and policy director of the FXB Center.

In fact, the cascade of ill effects for children and families documented by this research doesn’t begin with a maternal death. The plight of the women captured in these studies begins when they are experience discrimination and marginalization in their societies: “It [maternal death] is not a technical problem. It’s because women lack voice and agency at household, community, and societal levels; and because their lives are not valued,” she said.

Klugman added that this research adds to work on gender discrimination, including issues like gender-based violence, which affects one in three women worldwide.

It’s a tall order: advancing gender equality, preventing maternal, newborn, and child death, and improving the overall well-being of families. But panelists were hopeful that this research can show policy makers, and the public, that these issues are intertwined, and must be addressed as parts of a whole.

As Aslihan Kes, an economist and gender specialist at ICRW and one of the researchers on the Kenya study concluded, this research is “making visible the central role women have in sustaining their households.”

“This is an opportunity to really put women front and center,” she said, “making all of the arguments for addressing the discrimination and constraints they face across their lives.”

Emily Maistrellis is a policy coordinator at the FXB Center for Health and Human Rights and a research study coordinator at Boston Children’s Hospital.

Categories: Health Care

First Edition: October 21, 2014

Kaiser Health News - 15 hours 50 min ago

Today's headlines include reports about health law positions taken by Republican governors -- including Ohio Gov. John Kasich.

Kaiser Health News: More Plans Setting Spending Limits For Some Medical Services
Kaiser Health News consumer columnist Michelle Andrews writes: “Aiming to contain health care costs, a growing number of employers and insurers are adopting a strategy that limits how much they’ll pay for certain medical services such as knee replacements, lab tests and complex imaging. A recent study found that savings from such moves may be modest, however, and some experts question whether “reference pricing,” as it’s called, is good for consumers” (Andrews, 10/21). Read the story.

The Associated Press: In Louisiana, Both Sides Claim Defense Of Medicare
An old political standby — the future of Medicare — is emerging as the go-to issue in Louisiana’s bitter Senate race as the candidates woo seniors who typically wield strong influence in midterm elections. The challenge for voters is to figure out which side, if either, is telling the whole truth about who would cut and who would protect the popular insurance program. Medicare serves more than 50 million people and accounts for about 15 percent of federal spending, with about 10,000 new beneficiaries added daily as baby boomers reach age 65. The issue is so powerful that it’s cropping up in North Carolina and Iowa, too, amid a national battle for control of the Senate (10/21).

The Associated Press: GOP Governors Don’t See ‘Obamacare’ Going Away
While Republicans in Congress shout, “Repeal Obamacare,” GOP governors in many states have quietly accepted the law’s major Medicaid expansion. Even if their party wins control of the Senate in the upcoming elections, they just don’t see the law going away. Nine Republican governors have expanded Medicaid for low-income people in their states, despite their own misgivings and adamant opposition from conservative legislators. Three more governors are negotiating with the Democratic administration in Washington (10/20).

Politico: Gov. John Kasich: Repeal Obamacare, But Not All Of It
A political firestorm broke out Monday when The Associated Press quoted Kasich as saying that Obamacare repeal was “not gonna happen.” That view is almost unheard of — at least in public — among most Republicans, let alone those who might run for the White House in 2016. Kasich said AP got it wrong, and he called POLITICO Monday night to correct the record. He said he was talking specifically about repeal of the expansion of Medicaid — which Ohio has implemented — and not of the Affordable Care Act more broadly (Wheaton, 10/21).

The New York Times: Ohio Governor Backpedals On Repeal Of Health Law
Wait, that’s not what I really meant. Gov. John Kasich of Ohio said his comments about a Republican-led Congress being unlikely to repeal the Affordable Care Act — which commentators on the right and left pounced upon Monday — were taken out of context. Mr. Kasich, a Republican mentioned as a 2016 presidential hopeful, in an interview distanced himself from the notion that he had accepted the health care law as a fait accompli. The idea is anathema to almost all Republican officials, and especially the party’s base (Gabriel, 10/20).

The Washington Post: Kasich: I ‘Don’t Back Obamacare’ And I ‘Want It To Be Repealed’
Ohio Gov. John Kasich (R) is pushing back on reports that he'd said Obamacare was here to stay, saying Monday night that he opposes the federal health care law and believes it could be repealed and replaced under a Republican president and GOP-controlled Congress. "I don't back Obamacare. I never have. I want it to be repealed," he told The Washington Post in a telephone interview (Sullivan, 10/20).

The Washington Post’s Wonkblog: How The Supreme Court Could Still Wreak Havoc On Obamacare
Obamacare may not be the political issue it was this time last year, when a faltering Web site threatened to derail the program, but that doesn't mean it's in the clear. Ongoing legal challenges to one aspect of the law could still put its coverage expansion in serious jeopardy. The dispute has to do with whether the subsidies can be provided through public health insurance marketplaces in states that refused to set up their own, instead leaving the job to the feds. The administration and Obamacare supporters say the law was designed to provide premium subsidies to all states, regardless of who runs the marketplace (Millman, 10/21).

USA Today: New Doctors Site Rates For Experience, Quality
The first comprehensive physician rating and comparison database launches Monday in time for open enrollment on federal and state health exchanges, as well as for many employer-provided plans. The new version of the website Healthgrades.com uses about 500 million claims from federal and private sources and patient reviews to rate and rank doctors based on their experience, complication rates at the hospitals where they practice and patient satisfaction (O’Donnell, 10/20).

Politico: Few Motives To Fix Busted Health Data
Someday, doctors will have our data at their fingertips and will use it to prevent drug reactions, nip diabetes and cancers in the bud and lengthen our lives while preventing unpleasant and costly hospital stays. But for most doctors, that free-flowing information highway is a beautiful dream that doesn’t pay the bills (Allen, 10/20).

The Wall Street Journal’s Pharmalot: Senate Lawmaker Eyes Hearing On The Cost Of Hepatitis C Treatments
Responding to the ongoing controversy over the prices for new hepatitis C treatments, U.S. Sen. Bernard Sanders (I-Vt.) will probably hold a hearing – possibly before the year ends – to examine how the cost is affecting the U.S. Department of Veterans Affairs, according to his spokesman. Sanders is chairman of the Senate Committee on Veterans’ Affairs (Silverman, 10/20).

The New York Times: On Ebola Response, Congressional Republicans Put New Focus On Visa Suspensions
But a supercharged political atmosphere is making legislative nuance difficult two weeks before midterm elections and days before a hearing on Friday on the Ebola response called by the House Oversight and Government Reform Committee, a panel riven by partisan division. Republicans on the campaign trail continue to goad Democrats to embrace a broad travel ban, although no direct flights to the United States from Liberia, Sierra Leone or Guinea exist (Weisman, 10/20).

The Washington Post: CDC Issues Formal Guidelines Giving Workers More Protection Against Ebola
Federal health officials Monday tightened infection-control guidelines for health-care workers caring for Ebola patients, explicitly recommending that no skin be exposed. The beefed-up guidelines also call for health-care workers to undergo rigorous training, and to be supervised by trained monitors when putting on and taking off personal protective equipment. The government will issue step-by-step instructions for workers to follow in doing that (Sun and Berman, 10/20).

Los Angeles Times: New Ebola Protection Guidelines Leave No Bare Skin
After pointed criticism from healthcare workers and relatives of an Ebola-infected nurse, the U.S. Centers for Disease Control and Prevention announced new guidelines Monday for hospital protective gear. The guidelines, which were scheduled to be posted on the CDC's website late Monday night, were described by CDC Director Thomas Frieden during a telephone news conference (Morin, 10/20).

Politico: Dude, Where's My Czar?
The White House announced Friday that Ron Klain would be the country’s public point-person on Ebola, but so far what the “Ebola czar” isn’t doing has been clearer than what he is. Klain won’t be testifying this Friday on the Hill. He didn’t participate in a Saturday meeting of top officials on Ebola. And administration officials haven’t yet confirmed that he’s talked with the president since their conversation the day his selection was made public. Klain will be starting work on Wednesday, White House principal deputy press secretary Eric Schultz said Monday, but he won’t be testifying before the House Oversight and Government Reform Committee at the end of the week as Chairman Darrell Issa (R-California) had requested (Epstein, 10/20).

Los Angeles Times: Health Insurers Boost No On 45 Funding
California insurers have pumped more than $12 million over the last five days into a campaign to defeat Proposition 45, an initiative on the Nov. 4 ballot that would regulate health insurance rates. Blue Shield gave $2.66 million, WellPoint $6 million, Kaiser Permanente $3.73 million and Health Net $350,000, according to late filings at the secretary of state's office (Lifsher, 10/20).

The Washington Post: Booz Allen Buys Baltimore-Based Health Division Of Genova Technologies
Booz Allen Hamilton has acquired the health care division of Genova Technologies, an Iowa-based government contractor, for an undisclosed sum. The health care group, made up of about 40 employees, is based in Baltimore. The office has already been integrated into Booz Allen, said Susan Penfield, executive vice president of Booz’s health business (Jayakumar, 10/20).

The Associated Press: La. Health Dept. Seeks End To Billing Rape Victims
Sexual assault victims in Louisiana should not have to pay for their treatment in emergency rooms, the health department said Monday, announcing a proposal that would have a state victims’ assistance board finance the exams (10/20).

The Wall Street Journal: Judge Blocks Cancellation Of Philadelphia Teachers Contract
A judge on Monday temporarily blocked the Philadelphia public-school system from canceling the teachers union contract and requiring educators to pay a share of their health insurance premiums starting in December. The union, the Philadelphia Federation of Teachers, sought the injunction, claiming the five-member School Reform Commission that governs the district lacked legal authority to impose the changes. The school district said it would appeal Monday’s ruling (Calvert, 10/20).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

Categories: Health Care

More Plans Setting Spending Limits For Some Medical Services

Kaiser Health News - 17 hours 6 min ago

Aiming to contain health care costs, a growing number of employers and insurers are adopting a strategy that limits how much they’ll pay for certain medical services such as knee replacements, lab tests and complex imaging. A recent study found that savings from such moves may be modest, however, and some experts question whether “reference pricing,” as it’s called, is good for consumers.

The California Public Employees’ Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems. More than three years ago, the agency began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, CalPERS’ deputy executive officer for Benefit Programs Policy and Planning.

Working with Anthem Blue Cross, the agency set $30,000 as the reference price for those two surgeries in its preferred provider organization plan. Members who get surgery at one of the 52 hospitals that charge $30,000 or less pay only their plan’s regular cost-sharing. If a member chooses to use an in-network hospital that charges more than the reference price, however, they’re on the hook for the entire amount over $30,000, and the extra spending doesn’t count toward their annual maximum out-of-pocket limit, Boynton says.

“We’re not worried about people not getting the care they need,” says Boynton. “They have access to good hospitals, they’re just getting it at a reasonable price.”

In two years, CalPERS saved nearly $6 million on those two procedures, and members saved $600,000 in lower cost sharing, according to research published last year by James C. Robinson, a professor of health economics at the University of California, Berkeley, and director of the Berkeley Center for Health Technology. Most of the savings came from price reductions at expensive hospitals.

The agency recently set caps on how much it would spend for cataract surgery, colonoscopies and arthroscopic surgery, Boynton says. 

Experts say that reference pricing is most appropriate for common, non-emergency procedures or tests that vary widely in price but are generally comparable in quality. Research has generally shown that higher prices for medical services don’t equate with higher quality. Setting a reference price steers consumers to high-quality doctors, hospitals, labs and imaging centers that perform well for the price, proponents say.

Others point out that reference pricing doesn’t necessarily save employers a lot of money, however. A study released earlier this month by the National Institute for Health Care Reform examined the 2011 claims data for 528,000 autoworkers and their dependents, both active and retired. It analyzed roughly 350 high-volume and/or high-priced inpatient and ambulatory medical services that reference pricing might reasonably be applied to.

The overall potential savings was 5 percent, the study found.

“It was surprising that even with all that pricing variation, reference pricing doesn’t have a more dramatic impact on spending,” says Chapin White, a senior policy researcher at RAND and lead author of the study.

Even though the results may be modest, a growing number of very large companies are incorporating reference pricing, according to benefits consultant Mercer’s annual employer health insurance survey. The percentage of employers with 10,000 or more employees that used reference pricing grew from 10 percent in 2012 to 15 percent in 2013, the survey found. Thirty percent said they were considering adding reference pricing, the survey found. Among employers with 500 or fewer workers, adoption was flat at 10 percent in 2013, compared with 11 percent in 2012.

The approach is consistent with employers’ general interest in encouraging employees to make cost-effective choices on the job, whether for health care or business supplies, says Sander Domaszewicz, a principal in Mercer’s health and benefits practice.

This spring, the Obama administration said that large group and self-insured health plans could use reference pricing.

The health law sets limits on how much consumers have to pay out of pocket annually for in-network care before insurance picks up the whole tab—in 2015, it’s $6,600 for an individual and $13,200 for a family plan. But if consumers choose providers whose prices are higher than a plan’s reference price, those amounts don’t count toward the out-of-pocket maximum, the administration guidance said.

Leaving consumers on the hook for amounts over the reference price needlessly drags them into the battle between providers and health plans over prices, says White.

“You expect the health plan to do a few things: negotiate reasonable prices with providers, and not to enter into network contracts with providers who provide bad quality care,” White says. “Reference pricing is kind of an admission that health plans have failed on one or both of those fronts.”

Some experts, however, say the strategy can work for consumers. 

“What I think is that reference pricing is a choice-preserving strategy, when you look at the alternative, which is a narrow network,” says Robinson.

That may be a question of semantics, if relatively few providers meet the reference price.

Recent guidance from the administration spells out some of the requirements that health plans must meet in order to ensure that there are adequate numbers of high-quality providers if reference-based pricing is used. Among other things, it suggests that plans consider geographic distance from providers or patient wait times.

Like so much about reference pricing, it remains a work in progress. The administration says it will continue to monitor the practice, and may provide additional guidance in the future.

Categories: Health Care

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