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Health Care

What’s Next If The Supreme Court Strikes Down Obamacare Aid?

Kaiser Health News - Mon, 05/11/2015 - 6:32pm

Millions of Americans get subsidized health insurance under the Affordable Care Act. But those subsidies are being challenged. And in the coming weeks the Supreme Court could rule that in more than 30 states, the subsidies are illegal.

To find out what federal and state lawmakers could do if the subsidies disappear, we spoke to Linda Blumberg, a senior fellow at the Urban Institute, an economic and social policy think tank. This is a lightly edited transcript of the conversation.

AUDIE CORNISH, NPR: Tell us who would be most affected if the subsidies stopped flowing.

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LINDA BLUMBERG, Urban Institute: These are not the poorest people, who were targeted to get help through the expansion of Medicaid.  What we’re talking about here, people who are vulnerable to losing their assistance, are really working people, low-income and middle-income workers.  The vast majority of them, over 80 percent , are the workers themselves. The rest are basically families of workers.  Over 60 percent of them are white, over 60 percent of them live in the South.  So we’re talking about a population that is working hard to make ends meet but can’t really do everything on their own.  They’re also a voting population which I think is really important, too.

AUDIE CORNISH: So help us understand for a state leader, a governor, who is faced with a potential ruling here, what are the options? If they have a federal marketplace, can they switch to a state-based one?

LINDA BLUMBERG: There should be some opportunity to switch to a state-based one.  The concern is we don’t know what’s going to be required in order to make that change. One of the big challenges, though, is if states have to take on a lot of new responsibilities then there may be a lot of costs for them to do that.  The states that made the decision to do state-based exchanges early on had a lot of federal grants to set them up. Those grants don’t exist anymore.  It’s also very time consuming.  It took years for states to get these up and running. So, if a lot is required of these states to switch over, then there’s a lot of logistical and financial challenges.

This copyrighted story comes from NPR’s Shots blog. All rights reserved.

AUDIE CORNISH: What about Congress? What options do they have to try and avoid potential chaos for some of these states?

LINDA BLUMBERG: Well, the most straightforward way to both avoid chaos and eliminate the problems of people losing their health insurance and premiums going up for everyone else is that they can extend the eligibility for the financial assistance to residents of all states, regardless of who’s administering their health insurance exchanges.  That’s really the best way to address this.

AUDIE CORNISH:  So they would just have to change the law, basically?

LINDA BLUMBERG: Right. Really, we’re talking about a couple of words in one sentence in the law that are in dispute here.  So all they would have to do is take out a couple of words in one sentence in a thousand-page-plus law.

AUDIE CORNISH:  Easy for you to say; what about the political will? Lawmakers have been fighting about this law for years.

LINDA BLUMBERG: I think the political will is the enormous challenge here.  There’s going to be a real tension because there’s the side that says, “Listen, we don’t want to do anything to support the Affordable Care Act.”  But the reality is that the folks in states that are likely to be affected are the ones that needed the most assistance.  These are the states that are most likely to have high rates of uninsurance. We’re talking about a very low income population in many of these states and a highly vulnerable population that’s going to be affected.

This story is part of a reporting partnership that includes NPR and Kaiser Health News.

Categories: Health Care

In Louisiana, Obamacare Subsidies Mean Financial Independence For Some

Kaiser Health News - Mon, 05/11/2015 - 4:50pm

The politics of the Affordable Care Act in the state of Louisiana are not subtle: It is not popular. The state was part of the lawsuit to strike down the law in 2012; it didn’t expand Medicaid and has no plans to, even as other Republican-led states have done so. And Louisiana didn’t set up its own marketplace to sell Obamacare insurance.

Nevertheless, about 186,000 people in Louisiana signed up for health insurance under the law and almost all of them got help from the federal government to pay their premiums.

The U.S. Supreme Court could soon rule illegal the insurance subsidies in Louisiana and more than 30 other states that use the federal website healthcare.gov. If the subsidies are eliminated, the number of uninsured people in the affected states would rise by 8.2 million in 2016, according to recent Senate testimony by Linda Blumberg, a senior fellow at the Urban Institute.

This story is part of a partnership that includes WNPR, NPR and Kaiser Health News. It can be republished for free. (details)

Jeff Cohen from member station WNPR spent three days driving around his home state of Louisiana speaking with people who got insurance under the law. Here are the stories of three people who say their financial independence is riding on the latest health law case before the Supreme Court.

Sheron Bazille

Sitting at her kitchen table in the Baton Rouge home she owns by herself, Sheron Bazille says she had a good job that offered benefits — like health insurance. But she got sick and had to stop working: “It was either me or my job. And my life and my health was more important.”

Sheron Bazille pays $219.01 for her health insurance. She knows the amount down to the penny. (Photo by Jeff Cohen/WNPR)

Bazille, 62, retired early, and she says leaving that job of 10 years meant losing her insurance – and some of her dignity, too.  Now, under Obamacare, she’s got subsidized insurance. She knows exactly how much her share is: “My monthly is 219. And one cent.”

The coverage has given her a sense of security, because she can take care of her health and her health care bills.

“Peace. I have peace now that I know I have hospitalization [coverage],” says Bazille. “If anything happens, I can go to the hospital.”

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She worries the Supreme Court justices could take away that peace and asked what she would tell the justices if she could, she says: “Think about your kids, your family. If they could not afford to pay for health insurance. Wouldn’t you want someone to help them?”

Jimmy See

At a coffee shop in Zachary, half an hour north of Bazille’s home in Baton Rouge, Jimmy See says he never felt like he needed health insurance – until he did. He’s 54, a self-employed housing and maintenance worker, and he’d always felt like health insurance was too expensive. But then he started having trouble breathing and he went to the hospital: “They said, ‘Well do you have any insurance? And I said, ‘No.’”

Rather than pay a lump sum up front, he went home and got worse.  Eventually, he collapsed and had to be hospitalized for close to two weeks for pneumonia. His remembers his bill being between $8,000 and $9,000. See negotiated with the hospital and received financial assistance to settle the bill.

Jimmy See has had medical debt in the past, and he hopes insurance means he won’t be in that position again. (Photo by Jeff Cohen/WNPR)

“If I hadn’t gotten that, I’d be looking for bill collectors after me,” See says. “And bill collectors don’t play. They come after you.”

See’s Obamacare subsidy covers all of his premium, and he says having insurance is a relief.

“If I had a big operation or whatever, you can’t afford no $70,000, $80,000, $90,000,” he says. “So, through the Affordable Care Act, the government’s going to help you out with all that.”

If the Supreme Court rules against subsidies, See says, for him it would be, “Back to square one. No insurance.”

James Marks

James Marks lives four hours north of Baton Rouge in Shreveport. He doesn’t want to go back to square one, either.

Marks is 36 and works as a freelance computer technician and an afterschool art teacher. Neither job provides insurance and being uninsured has been a blow to his self-esteem.

James Marks pays about $180 a month for his insurance and is happy he doesn’t have to depend on his parents for help with medical costs. (Photo by Jeff Cohen/WNPR)

“It made me feel lousy,” Marks says. “It made me feel like I was sponging off my parents. It made me feel like I wasn’t able to take care of myself.”

Marks lives with a mental health issue – and, for the better part of 10 years, his parents paid for both his psychiatrist and his expensive medications. Now, he pays about $180 a month for a subsidized insurance policy, and he says it makes him feel like an adult.

Asked what he would tell the justices, Marks says: “I know the Supreme Court tries to decide stuff based on the law and not based on the impact that it has on America.  But it’ll wind up making a lot of people who were insured, who had insurance, who were able to go to the doctor and pay for their pills, not be able to anymore. And that’s just pretty lousy.”

This story is part of a reporting partnership that includes WNPR, NPR and Kaiser Health News.

Categories: Health Care

Colleges Work To Prevent Suicide And Fight Stigma Around Mental Health On Campus

CommonHealth (WBUR) - Mon, 05/11/2015 - 3:06pm

A training session for Worcester Polytechnic Institute’s Student Support Network. The group’s more than 400 members are trained to intervene and help students dealing with mental health issues. (Jesse Costa/WBUR)

As another academic year winds down, many colleges are reviewing how they raise awareness of mental health issues on campus, and what additional steps they can take to try to prevent suicide among students.

More than 1,000 college students die by suicide every year. Suicide is listed as the nation’s second-leading cause of death for people of college age, though people not enrolled in school take their own lives at a higher rate than those attending college. And research has found about 7 percent of undergraduate and graduate students seriously consider suicide.

‘Suicide: A Crisis In The Shadows’

Suicide prevention efforts vary greatly among schools. So does the rate of students seeking help from campus mental health services. According to the Association for University and College Counseling Center Directors, college mental health centers see on average about 10 percent of the student body, though mental health providers say the need is much greater. Smaller schools serve a greater percentage of their student body through campus mental health services than large colleges and universities do.

There’s also no consistency in how suicide is tracked in higher education. WBUR reached out to 10 Massachusetts colleges and universities to request information on their suicide rates and suicide prevention programs. Only two, Worcester Polytechnic Institute and Worcester State University, provided data. WPI has experienced one suicide since 2006 (in May 2011) and four in the last 18 years. Since implementing prevention programs several years ago, the school’s suicide rate has dropped below the national average. Worcester State University reports it has had one suicide in the last 10 years.

In the latest installment of our series, “Suicide: A Crisis in the Shadows,” several people involved in and affected by the issue of college suicide prevention joined WBUR to share their thoughts. Below find highlights from that conversation, and listen to it in full above.

Discussion Highlights

On college students hesitating to seek mental health care:

Dori Hutchinson, director of services at Boston University’s Center for Psychiatric Rehabilitation: “I really feel there’s a lot of stigma around those issues. There’s enormous shame when a student is diagnosed that I think comes from our society, comes from people’s families. Part of what we’re doing in our suicide prevention efforts on campuses is that we’re trying to promote this idea that help seeking is a positive adult behavior, and that everyone struggles.”

On what it means to ask ‘tough questions’ of fellow students:

Eric Schattschneider, senior at Worcester Polytechnic Institute and member of WPI’s Student Support Network: “Coming up and asking, ‘Are you having suicidal thoughts?’ When you hear from someone saying, ‘I’m having a really tough time with this workload or this project,’ being able to respond with empathy and say, ‘I understand that workload. And I understand how frustrating that can be.’ There’s definitely an expectation that you’ll watch out for your friends. If you notice they’re not eating right, or if they’re drinking too much, if they’re not sleeping enough, you’ll either intervene yourself or you’ll bring in the proper support.”

“I think having that first conversation, you might not always get a positive response. But it might plant the seed that, ‘Hey, maybe this isn’t normal.’ It might build the chance for conversation down the road.”

A training booklet for WPI’s Student Support Network features a section called “Helping a friend in crisis.” (Jesse Costa/WBUR)

On increasing communication about students who are struggling:

Harry Rockland-Miller, clinical psychologist and director of the Center for Counseling and Psychological Health at the UMass Amherst: “We have developed a 24-hour-a-day student affairs on-call system, which involves residence life, the dean of students, the counseling center … and the police, as well, are involved. We have a student of concern committee that meets every week, where we have representatives from around the campus. Are we worried about somebody? How do we reach out to that student … to support them? Every Monday morning we have a weekend review meeting. What happened over the weekend? And how, again, can we support students who are displaying some level of distress? We want to step in as early in the continuum as we can.”

On how college mental health providers deal with the issue of privacy:

Rockland-Miller: “Privacy is critical. If a student feels that they can come and speak with us in a confidential way, they’re much more likely to come talk to us. That said, there are those situations when we get to an imminent risk situation, when we do need to step in to protect safety. That might involve hospitalization. It may involve calling a parent. On a voluntary basis, we talk with students all the time about calling their parents with them in the room, and most often, they’re fine with it.”

On what memorable anecdotes they have related to suicide prevention:

Hutchinson: “I can think of a student that we were helping who was a student athlete, who was really struggling with some mental health issues that were interfering with her athletic and academic and social success on campus. And she was extremely distressed and sitting with hands over face, crying and saying, ‘I can’t believe I’m one of those people.’ And that perception, that self-stigma was really what had been holding her back in getting help. And so coaching her and supporting her and getting her connected to important resources ended up making the difference for her so that she was able to graduate successfully.”

Rockland-Miller: “I’m thinking of a student I work with, an international student, who came in grossly distressed, drinking, preoccupied with suicide, unable to focus on his academics, which were so important to him. And via a series of interventions — both psychotherapy, community, some medication — things started to shift. He went home. He called me up a year or so later just to tell me how much the work that started here at UMass had changed his life and how he continued to be on that trajectory.”

Schattschneider: “I’ve had a number of personal experiences. Unfortunately, I lost a friend from high school when I was a sophomore in college. As I’ve become more active and just an active listener, just the number of friends who have come to me, just talking about what they’ve been through, the challenges they’ve faced, it gives me the strength when I’m having a rough day, or when I’m stressed out. I know with the right tools and with the right support, I’ll definitely not only make it through, but succeed and excel.”

For more on research priorities and immediate action steps some are calling for to reduce suicide, read our conversation with the director of NIMH, Dr. Tom Insel.

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673)

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Categories: Health Care

‘Free’ Contraception Means ‘Free,’ Obama Administration Tells Insurers

Kaiser Health News - Mon, 05/11/2015 - 2:23pm

Free means free.

The Obama administration said Monday that health plans must offer for free at least one of every type of prescription birth control — clarifying regulations that left some insurers misinterpreting the Affordable Care Act’s contraceptive mandate.

A NuvaRing contraceptive (Photo by Sandy Huffaker/Getty Images)

“Today’s guidance seeks to eliminate any ambiguity,” the Health and Human Services Department said. “Insurers must cover without cost-sharing at least one form of contraception in each of the methods that the Food and Drug Administration has identified … including the ring, the patch and intrauterine devices.

The ruling comes after reports by the Kaiser Family Foundation and the National Women’s Law Center, an advocacy group, found many insurers were not providing no-cost birth control for all prescription methods. (KHN is an editorially independent project of the Kaiser Family Foundation.)

Gretchen Borchelt, a vice president with the women’s law center, applauded the guidance.

“Insurance companies have been breaking the law and, today, the Obama Administration underscored that it will not tolerate these violations,” she said. “It is now absolutely clear that ‘all’ means ‘all’— ‘all’ unique birth control methods for women must be covered.”

The law requires that preventive services, such as contraception and well-woman visits, be covered without out-of-pocket expenses, such as a co-pay or deductible.

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

While HHS said insurers must offer for free at least one version of all 18 FDA approved contraceptives, the plans may still charge fees to encourage individuals to use a particular brand or generic. For example, a generic form might be free, while a brand name version of the drug can include cost sharing, HHS said.

The administration Monday said insurers could have misinterpreted prior rules to mean they only had to offer certain types of contraception without cost-sharing. Plans have until July to implement the policy, which will generally not take effect until a new plan year begins. That means for most people the new rule will start in January.

Cecile Richards, president of Planned Parenthood Action Fund, the political arm of Planned Parenthood of America, thanked the administration.

“This is a victory for women and the more than 30,000 Planned Parenthood supporters who spoke out to ensure all women, no matter what insurance they have, can access the full range of birth control methods without a copay or other barriers,” she said. “We know that increased access to birth control has helped bring teen pregnancy rates to a 40-year low and we must continue to drive forward policies that build on this progress.”

The Kaiser study  — which looked at a sample of 20 insurers in five states — found one that simply didn’t cover the birth control ring (NuvaRing) at all and four that “couldn’t ascertain” whether they covered such birth control implants. More commonly, insurers would restrict access to certain contraceptives when they believed a cheaper, equally effective way for patients to get the same treatment was available.

The report by the health law center, which analyzed coverage from 100 insurance companies during 2014 and 2015, found that 15 plans in seven states failed to cover all FDA-approved methods of birth control. Among the companies named as not complying with the law’s requirements in some states are Aetna, Cigna, Physicians Plus and Anthem Blue Cross Blue Shield.

The insurance industry disputes the reports’ conclusions that the problem is widespread. “This report presents a distorted picture of reality,” Karen Ignagni, president and CEO of America’s Health Insurance Plans, the industry’s primary trade group, said when the report came out.

AHIP did not have an immediate comment Monday on the federal guidance.

Categories: Health Care

The Checkup: How Patients Can Try To Take The Power Back

CommonHealth (WBUR) - Mon, 05/11/2015 - 2:21pm

(Photo: MTSO Fan/Flickr Creative Commons)

It doesn’t help, of course, to be half-naked or in a bottom-baring johnny. But even when fully clothed, we patients — and we’re pretty much all patients at some point — often feel powerless or uncharacteristically passive in our encounters with the health care system.

In the latest episode of our WBUR/Slate podcast, The Checkup, we explore three strategies to help you take charge of your medical experience:

• How to be a better medical shopper in terms of both cost and quality: Tips and insights from Dr. Don Goldmann of the Institute for Healthcare Improvement.

• Telling your own medical story can help you heal, say Dr. Annie Brewster and Prof. Jonathan Adler of Health Story Collaborative.

• Also, medical informatics whiz Dr. Isaac Kohane talks about pushing the “blue button” to gain real control of your own medical data.

The Checkup: a WBUR/Slate health podcast Subscribe on iTunes | The Checkup on Slate

In case you missed other recent episodes: “High Anxiety” looked at hormones, parenting and fear of flying; “Sexual Reality Checks” examined penis size, female desire and aging;  and “Grossology” included a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal. )

But lists get tedious — why not just subscribe?

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at podcasts@slate.com.

Categories: Health Care

Report: Officials ‘Misled’ Public About Connector Failures

CommonHealth (WBUR) - Mon, 05/11/2015 - 11:51am

A new report on the botched rollout of the state’s revamped health insurance website alleges Massachusetts officials “misled” the public and federal officials about the site’s woes.

“State officials knew that development of a federal Affordable Care Act (ACA) website was off track for more than a year before the October 1, 2013 launch date,” the Pioneer Institute, a right-leaning think tank, said in a press release about its report. “Instead of raising concerns about the project, they misled the public by minimizing the shortcomings of the contractor hired to build the website, asked state workers to approve shoddy work and appear to have covered up the project’s abysmal progress in a presentation to federal officials.”

The report out Monday from the Pioneer Institute — a persistent critic of the Patrick administration’s handling of the Health Connector’s redesign — is based on “third-party audits and hours of interviews with multiple whistleblowers with first-hand knowledge of the project.”

The 2013 website, built in conjunction with the federal health law, was eventually scrapped, costing the state millions, and a rebuilt health exchange was launched in November.

“Citizens should demand accountability of public officials that left us with this mess, and try to prevent this from becoming an IT version of the Big Dig,” Josh Archambault, the author of the Pioneer report, said in the press release.

Archambault’s report finds state officials failed “to commit sufficient resources to the project,” “failed to hold CGI [the contractor] accountable for shoddy work” and attempted to conceal shortcomings from the public and federal officials.

The report comes days after it was made public that federal authorities earlier this year had subpoenaed records related to the Health Connector, including a period covering the breakdown of the health exchange’s website.

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After Cluster Of Suicides, MIT Works To Relieve Student Pressure, Raise Awareness

CommonHealth (WBUR) - Mon, 05/11/2015 - 6:20am

Students climb the steps of the Rogers building at MIT. (Robin Lubbock/WBUR)

On a recent sunny spring day, MIT students were lined up at a table grabbing ice cream sundaes, milk and cookies, and, if they were interested, an embrace.

“Yes, giving away ice cream and now hugs,” explained MIT parent Sonal Patel, of Cambridge, as she embraced Miguel Mendez, a native of Mexico who is doing post-doctoral research at MIT.

“It’s always good to know that people around the campus actually care about you as a person,” Mendez said. “This being an institution that expects a lot from you, it can really pass a toll on you sometimes.”

The event was billed as “Stress Less Day,” a chance for people at the university that churns out many of the world’s top engineers and scientists to take a break from problem sets, exams and research.

The snack break was sponsored by the student group Active Minds, which promotes mental health awareness. Volunteers handed out flyers with facts on depression and anxiety, as well mental health resources at MIT.

Active Minds raised awareness about their group during MIT’s campus preview weekend for incoming freshman last month. (Robin Lubbock/WBUR)

Following six student suicides since March 2014, Active Minds and other student groups have seen increased interest in their events designed to reduce stress, promote a sense of community and reduce stigma.

MIT is not the only higher education institution to struggle with suicide clusters. But the school and its students, widely considered among the world’s most elite, are taking some very open steps to confront the problem.

‘Everyone’s Used To Being A Perfectionist’

Some at MIT say a lot of the pressure that exists is self-imposed by ultracompetitive and successful students.

“There’s no way to avoid stress in a place like this, where most kids were like the valedictorians of their school,” said sophomore mechanical engineering major Matt Ossa. “So there’s really no way, because everyone’s used to being a perfectionist and all that.”

‘Suicide: A Crisis In The Shadows’

Ossa, who’s from San Antonio, says at one point when he was feeling overwhelmed he went to Student Support Services, known as “S3″ or “S Cubed.” That’s where academic deans help students with a range of issues, from deciding whether they should seek mental health care, to looking for some leeway from professors during a particularly jam-packed week — which Ossa got.

“I was able to get, like, a few tests pushed back a couple days, stuff like that,” Ossa said. “They’re really willing to work with people as long as they reach out. That’s the hardest thing, is getting people to reach out.”

Academic Pressure Not Always A Factor 

But one thing often overlooked when an elite college has a cluster of suicides is that academic pressure may not have played a role in some of the deaths. Mental health professionals say a combination of factors — including mental illness — is usually to blame for suicide.

“There’s actually no empirical evidence at this point that schools that are more competitive or more pressured actually have higher rates of suicide deaths than other colleges,” explained Dr. Victor Schwartz, medical director of the Jed Foundation, which helps colleges improve their suicide prevention and mental health programming.

But MIT has gone through periods when its suicide rate is higher than the national average, including last year and this year.

A flyer pinned to a board in an MIT hallway asks: “Have you been feeling sad, blue or down?” (Robin Lubbock/WBUR)

“We should be careful about not reaching conclusions that we really don’t have evidence to support,” Schwartz said. “In fact, with undergraduates the information we have suggests more that suicidal behavior is more often associated with relationship or family problems.”

The father of late 18-year-old MIT freshman Matthew Nehring, who killed himself March 1, says he learned after his son’s death that he had sought help from an MIT psychiatrist in January because he was “preoccupied with thoughts of life and death” he had had since childhood — thoughts he never revealed to his family. Nehring indicated to the doctor he was not suicidal, according to his father. He wrote a letter saying his suicide had nothing to do with the stress of school work.

Four days after Nehring’s death, another MIT freshman, Christina Tournant, died by suicide while home in Florida. According to published reports, she suffered from a physical disease that caused debilitating chronic pain, and she left behind messages to her family that she “couldn’t keep fighting.”

The father of Eliana Hechter, a student in the joint MIT/Harvard graduate program in health sciences and technology, tells us Hechter took her life last spring a month after being devastated by her mother’s sudden death from cancer.

Though every suicide is unique, Schwartz says MIT has some specific challenges.

“It’s a very, very disparate population. You have a large population of of grad students, of international students,” Schwartz said. “So I think one of the challenges there is creating a sense of connectedness and community.”

That would help reduce isolation, which can contribute to suicide. And Schwartz says the Jed Foundation is working with MIT and other schools to improve communication between residence hall leaders, academic advisers and campus mental health counselors about specific students who are struggling — to the extent it’s legal under privacy laws.

But these aren’t new issues for MIT. In 2001, then-President Charles Vest commissioned a mental health task force following a series of suicides over the previous decade. The group issued a report and detailed recommendations for improving mental health care and awareness on campus. MIT says “nearly all” of the recommendations were adopted.

In 2006, the university settled a wrongful death lawsuit stemming from one of those earlier deaths, and it faces another suit related to a suicide in 2009. In both cases, the families claimed people at MIT knew of their children’s mental health issues and didn’t respond properly.

The school denied our requests for interviews with Chancellor Cynthia Barnhart and the head of the mental health service, saying those people are engaged in the work at hand and can’t be pulled away from it.

The Issue Of ‘Impostor Syndrome’

After the two most recent suicides in March, the MIT administration organized gatherings to remember the students and foster conversation.

Freshman Annamarie Bair was one of hundreds of students who attended.

“I think just the idea that someone in our grade was feeling such pain to go through something like this, it’s just really hard,” she said.

The chancellor and provost also emailed faculty urging them to be flexible with students, to give them a break on tests and assignments, and talk with them about their feelings.

“I think you can always do more. But I think MIT does a good job at what they do,” said John Belcher, who has taught physics at MIT for 44 years.

Belcher applauds the institute for making Student Support Services easily accessible and unintimidating. He says he’s referred many students there because they were struggling academically or emotionally.

MIT professor John Belcher, pictured here with president of the Active Minds student group, Ariella Yosafat, is working with Active Minds to organize a campus-wide awareness campaign. (Robin Lubbock/WBUR)

Belcher and other professors are now particularly attuned to the issue of “impostor syndrome” — a feeling that students, or even professors, can have that they must be at MIT by mistake.

“I think impostor syndrome is a real effect here at MIT. The students come in and they tend to think that they’re the dumbest student here and everybody else is brighter,” Belcher said. “And when they get into trouble, they don’t realize that other people are struggling with the same thing.”

And Belcher can speak from experience about mental illness. He openly tells students and colleagues of having had clinical depression 25 years ago, and the fact that the anti-depressant Prozac has stabilized him since then.

“I was very depressed, but it was a minor blip in my medical history,” he said. “I’ve had cancer twice. Those were major blips.”

The professor is helping Active Minds organize a campus-wide awareness campaign to launch in the fall, centered on the theme that struggling is part of life and it’s OK to ask for help.

The group also promotes simple steps students can take to care for themselves and set limits.

“I have found that I love sleep and I need sleep and I need some restful awake time,” says MIT junior Ariella Yosafat, the president of Active Minds. “And I think a lot of MIT students come to that point where they realize that, ‘Oh, I don’t need to be taking six classes and I don’t need to be doing five extra-curriculars to fit in at MIT. I can take four classes. I can be really, you know, heavily into this one thing and that’s OK.'”

It’s the students who don’t get that message and don’t reach out for help who worry her.

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673)

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How One Hospital Brought Its C-Sections Down In A Hurry

Kaiser Health News - Mon, 05/11/2015 - 5:00am

NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.

A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.

“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.

The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.

Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.

In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average. The Newport Beach hospital has been working to lower the amount of c-sections by stepping up data analysis and patient education. (Photo by Heidi de Marco/Kaiser Health News)

In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.

Decreasing C-sections results in “better health to mothers and better health to babies and lower costs,” said Stephanie Teleki, senior program officer at the California HealthCare Foundation, which helped fund the data collection and analysis by the California Maternal Quality Care Collaborative. “That’s like a nirvana moment in health care.”

Experts have long been troubled by the wide variation of C-sections among hospitals nationally. (In California, the rates range from 18 percent to 56 percent.)  Certainly there are instances in which C-sections are typically recommended – such as a baby in breech position. But the disparities suggest that decisions are being driven by factors other than medical necessity – such as doctors’ time constraints and malpractice concerns.

This KHN story also ran in U.S. News & World Report. It can be republished for free (details).

Over the past few years, there has been a coordinated push to cut C-section rates in other states and in births covered by Medicaid, the health coverage program for low-income Americans.

Across California, data publicly released by the California HealthCare Foundation, the Pacific Business Group on Health and others in the past few years have underscored the differences in how hospitals handle maternity care. http://www.chcf.org/publications/2014/11/tale-two-births  http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf

Despite the increased transparency, however, many hospitals don’t act until dollars are at stake, said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. That’s what happened with Hoag, which Main said is now becoming a model for others.

“In quality improvement, we call it ‘the burning bridge,’” he said. “You can’t just stay still. You’ve got to move.”

Focus on Physicians

At Hoag, where more than 6,000 babies are born each year, Brooks and other administrators knew that they had to focus on changing the mindset and behavior of physicians. “Hospitals don’t do C-sections, doctors do,” she said.

Holly Grim’s son was born by cesarean after a long and painful labor. The Huntington Beach resident said she knew she wanted to attempt a vaginal birth with her second child. (Photo by Heidi de Marco/Kaiser Health News)

So they took some aggressive steps. First, they shared the data with all the physicians in the department without names — then decided to reveal the names. Suddenly, everyone knew who had exceeded or come in under the average.

“There was a lot of upheaval,” Dr. Jeffrey Illeck, a community OB-GYN and the hospital’s obstetrics department chair. “None of us want to look bad in front of our peers. … And some looked horrible.”

Some physicians reacted with surprise and frustration. Initially, many attributed the high rates to the patients, saying they were older, had more complicated pregnancies or demanded scheduled C-sections.

Dr. Amy VanBlaricom, an OB-GYN who delivers about 25 to 30 babies a month, said she wasn’t opposed to sharing the data. But she said doctors were worried that the rates would be used to penalize them rather than to drive improvement.

“It’s very heated,” she said. “We should use this data as an opportunity rather than a polarizing topic.”

VanBlaricom already tracked her own rates, which she said fell in the middle of the pack, and has only seen a small drop since. But she said being aware that Hoag is monitoring the C-sections has changed how she thinks about her practice and has encouraged her to let women remain in labor longer.

That’s what Hoag administrators were aiming for – a realization among doctors that C-sections should not be undertaken lightly. They carry surgical risks, including serious infection and blood clots, and require longer hospital stays.

“Doctors and patients look at cesareans as an easy way to time the birth,” said Dr. Marlin Mills, chief of perinatology at the hospital. “But a C-section is not benign. It’s a big surgery.”

The costs are also well-documented. Surgical births cost nearly $19,000, compared to about $11,500 for vaginal births, according to the Pacific Business Group on Health, an organization of employers that is also working to bring down C-section rates around the state.

The business group worked with the hospital on the financial side. It enlisted the help of some of the biggest local employers, including Disney, and another insurer, Blue Shield, to adjust payments so the hospital didn’t earn more from elective C-sections than vaginal births.

In addition, the hospital set new scheduling rules. In the past, doctors could simply call in with the woman’s due date and schedule the birth. Now, they would have to fill out a detailed form, with some requests needing special approval.

The hospital also stepped up its patient education, encouraging women to wait for labor to come naturally.  If patients did want an elective C-section, they would have to sign an easy-to-understand consent form in the doctor’s office that detailed the risks.

The nurses received end-of-year bonuses if they helped the hospital reach certain goals on reducing surgical births.

The hospital opened an obstetrics emergency department and gave more responsibility to “laborists,” doctors who were there around the clock to respond to emergencies, monitor women in labor and deliver babies.

Dr. Alex Deyan, who delivered more than 500 babies at the hospital last year, used to turn away patients who wanted vaginal births after cesarean sections. With a busy private practice, Deyan said he couldn’t always be immediately available if labor didn’t go as expected and a woman needed a C-section. That changed with the laborist program.

“Having in-house doctors 24/7 is a huge benefit,” Deyan said. “I can be a little more patient.”

Good for Patients Too

Holly Grim appreciated Hoag’s approach. She knew she didn’t want a C-section with her second baby. Her first labor at another hospital in December 2013 was long and painful and ended with a cesarean section that kept her in the hospital for days. Her son was healthy, but she said, “this wasn’t exactly how I had it planned – not even close.”

This time, she needed to get back on her feet quickly so she could chase after her 16-month-old. She decided to switch doctors and hospitals. And in early April, she got her wish — giving birth naturally to an 8-pound girl, Agnes, at Hoag.

The day after Agnes was born, the family was packing up to go home. She didn’t have any restrictions on lifting or driving, and she wasn’t in severe pain. This, she said, is how childbirth is supposed to be.

“I’m feeling really good,” she said as she nursed Agnes, wrapped in a blanket decorated with pastel footprints. “I’m relieved I’ll be able to run around after my son.”

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