Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Press Release] MyChart use skyrocketing among cancer patients, UT Southwestern study finds

From the 9-Jul-2014 EurkAlert

 

 IMAGE: From left to right are: Drs. David Gerber and Simon J. Craddock Lee.

Click here for more information. 

DALLAS – July 9, 2014 – There has been a sharp increase in the number of cancer patients at UT Southwestern Medical Center using MyChart, the online, interactive service that allows patients to view laboratory and radiology results, communicate with their healthcare providers, schedule appointments, and renew prescriptions.

Over a six-year period, the number of patients actively using MyChart each year increased five-fold, while the number of total logins each year increased more than 10-fold, according to a study by Dr. David Gerber, Associate Professor of Internal Medicine, and Dr. Simon J. Craddock Lee, Assistant Professor of Clinical Sciences.

“This pattern suggests that not only are far more patients using this technology, but also that they are using it more intensively,” Dr. Gerber said.

These findings, published in the Journal of Oncology Practice, are noteworthy because no prior study has systematically examined the use of electronic patient portals by patients with cancer, even though use of this technology is surging nationwide, creating new terrain in clinical care and doctor-patient relationships.

……

In 2009, Congress allotted $27 billion to support the adoption of Electronic Medical Records. The Department of Health and Human Services began allocating the funding in 2011. UT Southwestern started offering these services years earlier.

…..

“I was struck by the immediacy of the uptake and the volume of use,” Dr. Gerber said. “I suspected that the volume would be high. I did not think that it was going to be multi-fold higher than other patient populations.”

Use of MyChart was greater among cancer patients than among another other patient groups except for children with life threatening medical conditions, according to the study.

“We undertook this study because we suspected that the volume of electronic portal use might be greater among patients with cancer than in other populations,” Dr. Gerber said.

While the study did not directly compare use patterns with non-cancer groups, the average use in the current study was four to eight times greater than has been reported previously in primary care, pediatric, surgical subspecialty, and other populations.

Dr. Gerber explained that patient use of electronic portals to receive and convey information may have particular implications in cancer care. Laboratory and radiology results may be more likely to represent significant clinical findings, such as disease progression.

“I think we are still learning how patients understand and use the complex medical data, such as scan reports, that they increasingly receive first-hand electronically,” Dr. Gerber said.

Furthermore, symptoms reported by patients with cancer may be more likely to represent medical urgencies. Notably, the study found that 30 percent of medical advice requests from patients were sent after clinic hours.

 

July 11, 2014 Posted by | health care | , , , , , | Leave a comment

[News article] Pharmacists say collaboration bill will improve care | CJOnline.com

Pharmacists say collaboration bill will improve care | CJOnline.com.

From the 7 July 2014 article

Kansas pharmacists say a bill that went into effect this past week will improve patient care by allowing them to enter into agreements with physicians to do things like monitor and change medication levels without new orders.

Greg Burger, a pharmacist at Lawrence Memorial Hospital who helped push for the bill, said studies have shown reductions in cost and improvements in care when pharmacists have the authority to adjust medication levels, provide the right antibiotics for certain infections and adjust for drug allergies without waiting for a doctor’s say-so.

“There’s all kinds of things we do in hospitals now that we’re hoping to expand out to where pharmacists might be in clinics,” Burger said.

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English: Well Street Late Night Pharmacy This ...

English: Well Street Late Night Pharmacy This pharmacy is tucked in behind 1594903 making it very handy for getting prescriptions filled after visiting the Doctor’s surgery. The flat-roofed building to the left and behind is a Co-operative pharmacists, one would have thought that the competition would be quite high, but they seem to manage alright. (Photo credit: Wikipedia)

July 9, 2014 Posted by | health care | , , , | Leave a comment

[Reblog]Technology and the doctor-patient relationship

Technology and the doctor-patient relationship.

From the 1 July 2014 KevinMD article

I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient  relationship has degraded in our culture.

 

In large part, I believe this is due to technology.

The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit.  Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.

So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient?  In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.

Here’s the problem, though.  Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.

These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.

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July 9, 2014 Posted by | health care | , , , , , , | Leave a comment

[News Article] Large New Study Confirms That Childhood Vaccines Are Perfectly Safe

Large New Study Confirms That Childhood Vaccines Are Perfectly Safe | ThinkProgress.

From the 1 July 2014 Think Progress article

BY TARA CULP-RESSLER

vaccine

CREDIT: SHUTTERSTOCK

The vaccines that children receive when they’re young are quite safe, and the vast majority of them don’t lead to serious side effects, according to asweeping new review of 67 recent scientific studies on childhood vaccinations. The analysis, published on Tuesday in the journal Pediatrics, also found no link between vaccines and autism — effectively debunking a common myth that dissuades some parents from inoculating their children.

The new report is specifically intended to ease parents’ concerns about vaccines, as persistent misconceptions about vaccination have recently spurred a rise in infectious diseases. In order to reassure people who may be worried that their kids’ shots aren’t safe, the federal governmentcommissioned the RAND Corporation to review everything that scientists know about the 11 vaccines recommended for children under the age of six.

Like any medical intervention, vaccines are not without their potential risks. In some rare cases, certain shots can increase kids’ risk of fevers, seizures, and gastrointestinal problems. But the RAND researchers found that those adverse reactions are incredibly unlikely.

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July 8, 2014 Posted by | health care | , , , , , | 4 Comments

[News article] Proof Birth Control Access Is A Very, Very Big Deal To Women

Proof Birth Control Access Is A Very, Very Big Deal To Women.

Image of vaginal birth control device NuvaRing

Image of vaginal birth control device NuvaRing (Photo credit: Wikipedia)

From the 7 July 2014 Huffington Post article

On Monday, the Supreme Court ruled that corporations cannot be required to provide their employees with coverage for contraception, a decision that medical groups like the American College of Obstetricians and Gynecologists — this country’s leading group of professionals providing health care to women — have called “profoundly” disappointing.

“This decision inappropriately allows employers to interfere in women’s health care decisions,” the group said in a statement.

“Contraceptives are essential health care for women and should not be treated differently than other, equally important parts of comprehensive care for women, including well-woman visits, preconception care visits, cervical and breast cancer screenings and other needed health care services,” ACOG added.

Because that’s the thing about birth control. For many women across the United States, of all different religious, political and socioeconomic backgrounds, it’s an absolutely essential part of how they stay healthy. From pain management and menstrual cycle regulation to straight-up family planning, here are just some of the ways that birth control has been a very, very good thing in the lives of real women.

 

July 8, 2014 Posted by | health care | , | Leave a comment

[Magazine Article] Hospitals Are Mining Patients’ Credit Card Data to Predict Who Will Get Sick – Businessweek

Hospitals Are Mining Patients’ Credit Card Data to Predict Who Will Get Sick – Businessweek.

A patient having his blood pressure taken by a...

From the 3 July article

Imagine getting a call from your doctor if you let your gym membership lapse, make a habit of buying candy bars at the checkout counter, or begin shopping at plus-size clothing stores. For patients of Carolinas HealthCare System, which operates the largest group of medical centers in North and South Carolina, such a day could be sooner than they think. Carolinas HealthCare, which runs more than 900 care centers, including hospitals, nursing homes, doctors’ offices, and surgical centers, has begun plugging consumer data on 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick. The company purchases the data from brokers who cull public records, store loyalty program transactions, and credit card purchases.

Information on consumer spending can provide a more complete picture than the glimpse doctors get during an office visit or through lab results, says Michael Dulin, chief clinical officer for analytics and outcomes research at Carolinas HealthCare. The Charlotte-based hospital chain is placing its data into predictive models that give risk scores to patients. Within two years, Dulin plans to regularly distribute those scores to doctors and nurses who can then reach out to high-risk patients and suggest changes before they fall ill. “What we are looking to find are people before they end up in trouble,” says Dulin, who is a practicing physician.

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July 8, 2014 Posted by | health care | , , , | Leave a comment

[Article] BBC News – Do doctors understand test results?

BBC News – Do doctors understand test results?.

From the 6 July 2014 article

A confused doctor

Are doctors confused by statistics? A new book by one prominent statistician says they are – and that this makes it hard for patients to make informed decisions about treatment.

In 1992, shortly after Gerd Gigerenzer moved to Chicago, he took his six-year-old daughter to the dentist. She didn’t have toothache, but he thought it was about time she got acquainted with the routine of sitting in the big reclining chair and being prodded with pointy objects.

The clinic had other ideas. “The dentist wanted to X-ray her,” Gigerenzer recalls. “I told first the nurse, and then him, that she had no pains and I wanted him to do a clinical examination, not an X-ray.”

These words went down as well as a gulp of dental mouthwash. The dentist argued that he might miss something if he didn’t perform an X-ray, and Gigerenzer would be responsible.

But the advice of the US Food and Drug Administration is not to use X-rays to screen for problems before a regular examination. Gigerenzer asked him: “Could you please tell me what’s known about the potential harms of dental X-rays for children? For instance, thyroid and brain cancer? Or give me a reference so I can check the evidence?”

GigerenzerGerd Gigerenzer

The dentist stared at him blankly……

 

July 8, 2014 Posted by | health care | , , , , | 1 Comment

[Press release] Health, United States, 2013 includes special section on prescription drugs

From the 14 May 2014 press release

Most common prescription drugs among adults are those for cardiovascular disease and high cholesterol

Photo: Spilled bottle of pills.

About half of all Americans reported taking one or more prescription drugs in the past 30 days during 2007-2010, and 1 in 10 took five or more, according to Health, United States, 2013, the government’s annual, comprehensive report on the nation’s health.

This is the 37th annual report prepared for the Secretary of the Department of Health and Human Services by the Centers for Disease Control and Prevention’s National Center for Health Statistics.  The report includes a compilation of health data from state and federal health agencies and the private sector.

This year’s report includes a special section on prescription drugs.  Key findings include:

  • About half of all Americans in 2007-2010 reported taking one or more prescription drugs in the past 30 days.  Use increased with age; 1 in 4 children took one or more prescription drugs in the past 30 days compared to 9 in 10 adults aged 65 and over.
  • Cardiovascular agents (used to treat high blood pressure, heart disease or kidney disease) and cholesterol-lowering drugs were two of the most commonly used classes of prescription drugs among adults aged 18-64 years and 65 and over in 2007-2010.  Nearly 18 percent (17.7) of adults aged 18-64 took at least one cardiovascular agent in the past 30 days.
  • The use of cholesterol-lowering drugs among those aged 18-64 has increased more than six-fold since 1988-1994, due in part to the introduction and acceptance of statin drugs to lower cholesterol.
  • Other commonly used prescription drugs among adults aged 18-64 years were analgesics to relieve pain and antidepressants.
  • The prescribing of antibiotics during medical visits for cold symptoms declined 39 percent between 1995-1996 and 2009-2010.
  • Among adults aged 65 and over, 70.2 percent took at least one cardiovascular agent and 46.7 percent took a cholesterol-lowering drug in the past 30 days in 2007-2010.  The use of cholesterol-lowering drugs in this age group has increased more than seven-fold since 1988-1994.
  • Other commonly used prescription drugs among those aged 65 and older included analgesics, blood thinners and diabetes medications.
  • In 2012, adults aged 18-64 years who were uninsured for all or part of the past year were more than four times as likely to report not getting needed prescription drugs due to cost as adults who were insured for the whole year (22.4 percent compared to 5.0 percent).
  • The use of antidepressants among adults aged 18 and over increased more than four-fold, from 2.4 percent to 10.8 percent between 1988-1994 and 2007-2010.
  • Drug poisoning deaths involving opioid analgesics among those aged 15 and over more than tripled in the past decade, from 1.9 deaths per 100,000 population in 1999-2000 to 6.6 in 2009-2010.
  • The annual growth in spending on retail prescription drugs slowed from 14.7 percent in 2001 to 2.9 percent in 2011.

Health, United States, 2013 features 135 tables on key health measures through 2012 from a number of sources within the federal government and in the private sector.  The tables cover a range of topics, including birth rates and reproductive health, life expectancy and leading causes of death, health risk behaviors, health care utilization, and insurance coverage and health expenditures.
The full report is available at www.cdc.gov/nchs

 

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May 17, 2014 Posted by | health care, Health Statistics | , , | 1 Comment

[News article] Strategies that reduce early hospital readmissions

From the 13 May 2014 ScienceDaily article

30-day readmissions can be reduced by almost 20 percent when specific efforts are taken to prevent them, a review has found. Key among these are interventions to help patients deal with the work passed on to them at discharge. “Effective approaches often are multifaceted and proactively seek to understand the complete patient context, often including in-person visits to the patient’s home after discharge,” says the lead author.

To put this problem into context, studies estimate that 1 in 5 Medicare beneficiaries is readmitted within 30 days of a hospitalization, at a cost of more than $26 billion a year. “Patients are sent home from hospitals because we have addressed their acute issues,” says Dr. Leppin. “They go home with a list of tasks that include what they were doing prior to the hospitalization and new self-care tasks prescribed on discharge. Some patients cannot handle all these requests, and it is not uncommon for them to be readmitted soon after they get home. Sometimes these readmissions can be prevented.”

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May 14, 2014 Posted by | health care | , | Leave a comment

[Reblog] The illegal ways patients buy drugs

The illegal ways patients buy drugs.

From the 27 March 2014 KevinMD article by Pamela Wible, MD

Tom is diabetic, asthmatic, and broke. He’s back for a checkup.

“I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.”

“How did you get extended release? They’re super expensive.”

Screen Shot 2014-05-13 at 5.16.10 AM

“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”

Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.

“Are you good on your inhalers?” I ask.

“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”

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And from one of the comments

Considering the high prices that pharmaceutical companies are allowed to legally charge in the US, this kind of thriving illegal underground market does not surprise me at all. It may be wrong and potentially dangerous, but it’s also wrong for Big Pharma to price millions of Americans out of being able to buy the drugs they need legally. Think of that huge segment of the population as “what the market can’t bear.”

Read the entire article here

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May 13, 2014 Posted by | health care | , | Leave a comment

[News article] mHealth still untapped resource for docs

From the 18 April article at Healthcare IT news

mHealth still untapped resource for docs
People cite privacy concerns for lack of adoption

For the most part, providers are still wary over the mHealth movement. And this caution just might be preventing them from big care improvement opportunities, say the findings of a new study.

The study, commissioned by mobile professional services firm Mobiquity, finds some 70 percent of consumers use mobile apps every day to track physical activity and calorie intake, but only 40 percent share that information with their doctor.

[See also: mHealth market scales to new heights.]

Privacy concerns and the need for a doctor’s recommendation are the two factors hindering the use of mobile and fitness apps for mHealth reasons, say officials with the Boston-based Mobiquity, which produced “Get Mobile, Get Healthy: The Appification of Health and Fitness.”

That, officials said, means the healthcare community has to take a more active role in promoting these types of apps and uses.

“Our study shows there’s a huge opportunity for medical professionals, pharmaceutical companies and health organizations to use mobile to drive positive behavior change and, as a result, better patient outcomes,” said Scott Snyder, Mobiquity’s president and chief strategy officer, in a press release. “The gap will be closed by those who design mobile health solutions that are indispensable and laser-focused on users’ goals, and that carefully balance data collection with user control and privacy.”

[See also: FCC creates mHealth task force.]

The study, conducted between March 5 and 11, focused on 1,000 consumers who use or plan to use health and fitness mobile apps.

According to the study:

  • 34 percent of mobile health and fitness app users say they would use their apps more often if their doctor recommended it
  • 61 percent say privacy concerns are hindering their adoption of mobile apps. Other concerns include time investment (24 percent), uncertainty on how to start (9 percent) and not wanting to know about health issues (6 percent).
  • 73 percent said they are more healthy because they use a smartphone and apps to track health and fitness
  • 53 percent discovered, through an app, that they were eating more calories than they realized
  • 63 percent intend to continue or increase their mobile health tracking over the next five years
  • 55 percent plan to try wearable devices like pedometers, wristbands or smartwatches
  • Using a smartphone to track health and fitness is more important than using the phone for social networking (69 percent), shopping (68 percent), listening to music (60 percent) or even making/receiving phone calls (30 percent).

“We believe 2014 is the year that mobile health will make the leap from early adopters to mainstream,” Mobiquity officials said in their introduction to the survey. “The writing is on the wall: from early rumors about a native health-tracking app in the next version of Apple’s iPhone operating system to speculation that Apple will finally launch the much-anticipated iWatch, joining Google, Samsung and Pebble in the race to own the emerging wearables market.”

[See also: Realizing the mHealth promise.]

 

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May 6, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] The Problem of Pain: When Best Medical Advice Doesn’t Equal Patient Satisfaction

From the 4 April 2014 post by Karen Sibert, MD at The Health Care Blog


The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.

The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.

If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.

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May 3, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Reblog] Fatal Error (in Health Care)

 

The VA Palo Alto Health Care System in Palo Al...

The VA Palo Alto Health Care System in Palo Alto, California. (Photo credit: Wikipedia)

From the 4 April 2014 post by Rob Lamberts, MD at The Health Care Blog

The janitor approached my office manager with a very worried expression.  ”Uh, Brenda…” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh…well…I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer….”  He cleared his throat nervously, “Uh…his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on the screen?” she asked, growing more curious.

“On the screen.  It said something about an ‘illegal operation.’  I was worried that he had done something illegal and thought you should know,” he finished rapidly, seeming grateful that this huge weight lifted.

Relieved, Brenda laughed out loud, reassuring him that this “illegal operation” was not the kind of thing that would warrant police intervention.

Unfortunately for me, these “illegal operation” errors weren’t without consequence.  It turned out that our system had something wrong at its core, eventually causing our entire computer network to crash, giving us no access to patient records for several days.

The reality of computer errors is that the deeper the error is — the closer it is to the core of the operating system — the wider the consequences when it causes trouble.  That’s when the “blue screen of death” or (on a mac) the “beach ball of death” show up on our screens.  That’s when the “illegal operation” progresses to a “fatal error.”

The Fatal Error in Health Care 

Yeah, this makes me nervous too.

We have such an error in our health care system.  It’s absolutely central to nearly all care that is given, at the very heart of the operating system.  It’s a problem that increased access to care won’t fix, that repealing the SGR, or forestalling ICD-10 won’t help.

It’s a problem with something that is starts at the very beginning of health care itself.

The health care system is not about health.

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For any solution to have a real effect, this core problem must be addressed.  The basic incentive has to change from sickness to health.  Doctors need to be rewarded for preventing disease and treating it early. Rewards for unnecessary tests, procedures, and medications need to be minimized or eliminated.  This can only happen if it is financially beneficial to doctors for their patients to be healthy.

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May 3, 2014 Posted by | health care | , , | Leave a comment

2m elderly will have no adult child to provide care by 2030

Originally posted on Empathic Urbanite:

66259-425x283-Woman_and_son Wow. 2 million of us without carers! When I started this enterprise I knew that we were an ageing population and there’d be a lot of need for care in the future. But I hadn’t considered that there’d be so many childless people, which basically DOUBLES the number of people who will need paid care workers.

“By 2030, 230,000 people who need more than 20 hours of care a week will not have a relative to provide it, the think tank said.”

This is an IPPR report, so it’s solid evidence that our society, culture and especially government needs to start supporting care agencies and offering much better individual training and organisational opportunities if we are to meet this massive challenge. And don’t forget, when we talk about older people in the future, it’s not a report about some vague ‘other’, this time, we are talking about ourselves!

Three Sisters…

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May 2, 2014 Posted by | health care | , , , , , | Leave a comment

[News Article] The Steep cost of Life Saving Drugs

Originally posted on Medication Health News:

ID-10057221 With many new drugs being brought to market, there has been increased talk about the pricing of many agents. Today, drugs in question include Evzio, a new naloxone auto-injector and  Sovaldi, a new antiviral for hepatitis C. These agents could save many lives, but their potential high costs could be a barrier to many of the patients of need. How should we solve this dilemma?  Should the subsidies be provided to those in need of these therapies?  What are your thoughts?

For additional information, please see the news analysis in the New York Times.

Image courtesy of [ddpavumba]/FreeDigitalPhotos.Net

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May 2, 2014 Posted by | health care | , , , | Leave a comment

[Reblog of an Alzheimer item] The 36-Hour Day Podcast: Getting Help

Originally posted on Johns Hopkins University Press Blog:

Today is the fifth and final in a series of brief podcast excerpts from The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss. This bestselling title by Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H., is in its fifth edition and is now available in an audio edition.

Podcast #5: Excerpt from Chapter 10: Getting Help

In this excerpt from Chapter 10, Dr. Rabins focuses on the need for caregivers to have outside help and have time away from the responsibilities of caregiving. He describes how to find good information on available services, how to seek and accept help from friends and neighbors,  and how to address problems you may encounter.

You can find this podcast and the rest of the series of podcasts here.

mace

These podcasts are excerpted from a Johns Hopkins University Press audio…

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May 2, 2014 Posted by | health care, Health Education (General Public) | , , , , | Leave a comment

[Reblog] ‘Inherently dangerous’ drugs routinely prescribed to seniors: Report

Originally posted on Metro News:

Thousands of seniors in Ontario nursing homes are on a powerful mix of antipsychotics and sedatives, according to a new provincial Health Ministry report that surfaced after a recent Torstar News Service investigation.

The report, commissioned by the ministry and co-authored by a leading doctor and scientist, sheds new light on the widespread use of powerful prescription drugs among the vulnerable elderly.

“These drugs are prescribed so commonly because they are perceived to be benign. That’s not true,” said Dr. David Juurlink, a drug safety expert who co-authored the report. “These drugs are inherently dangerous.”

Last week, Torstar revealed that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.

At close to 300 homes, Torstar found, more than a third of the residents are on the drugs, despite warnings that the medications can kill elderly patients…

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April 29, 2014 Posted by | Consumer Health, Consumer Safety, health care | , , , , | Leave a comment

[News Article] New AARP report looks at onus on spousal caregivers

From the 24 April 2014 article at Covering Health

A new report from the The United Hospital Fund and AARP Public Policy Institute finds that spouses who act as the primary family caregiver routinely perform complex medical and nursing tasks without adequate in-home support from health care professionals, especially when compared with non-spousal family caregivers.

Screen Shot 2014-04-29 at 4.34.05 AM

“Wedding vows include the promise to be there “in sickness and in health”, but we should not expect spouses to do things that can make nursing students tremble without offering them instructions and support. They should not have to do this important work at home alone. They need and deserve support from professionals, other family members, and the community,” Reinhard said.

It’s unclear why spouses receive less help, but Reinhard and co-authors Carol Levine and Sarah Samis of the United Hospital Fund theorize that choice, lack of awareness about resources, financial limitations, or fear of losing independence play a role. The report calls for additional research to help tailor interventions that support but do not supplant the primary bond between spouses.

 

Read the entire article here

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April 29, 2014 Posted by | health care | , , | Leave a comment

[Press release] Stigmas, once evolutionarily sound, are now bad health strategies

Cannot but think of the New Testament headings, especially of lepers.

Stigmas, once evolutionarily sound, are now bad health strategies.

Stigmatization may have once served to protect early humans from infectious diseases, but that strategy may do more harm than good for modern humans, according to Penn State researchers.

“The things that made stigmas a more functional strategy thousands of years ago rarely exist,” said Rachel Smith, associate professor of communication arts and sciences and human development and family studies. “Now, it won’t promote positive health behavior and, in many cases, it could actually make the situation worse.”

Stigmatizing and ostracizing members stricken with infectious diseases may have helped groups of early humans survive, said Smith, who worked with David Hughes, assistant professor of entomology and biology. Infectious agents thrive by spreading through populations, according to Smith and Hughes, who published an essay in the current issue of Communication Studies.

For early humans, a person who was stigmatized by the group typically suffered a quick death, often from a lack of food or from falling prey to a predator. Groups did not mix on a regular basis, so another group was unlikely to adopt an ostracized person. Infectious disease stigmas may have evolved as a social defense for group-living species, and had adaptive functions when early humans had these interaction patterns.

However, modern society is much larger, more mobile and safer from predators, eliminating the effectiveness of this strategy, according to Smith.

“In modern times, we mix more regularly, travel more widely, and also there are so many people now,” Smith said. “These modern interaction patterns make stigmatization unproductive and often create more problems.”

Hughes studies disease in another successful society, the ants, which have strong stigma and ostracism strategies that serve group interests at the cost to individuals.

“Ants are often held up as paragons of society and efficiency but we certainly do not want to emulate how they treat their sick members, which can be brutal,” said Hughes.

Stigmatization could actually make infectious disease management worse. The threat of ostracization may make people less likely to seek out medical treatment. If people refuse to seek treatment and go about their daily routines, they may cause the disease to spread farther and faster, according to the researchers, who are both investigators in the Center of Infectious Disease Dynamics in Penn State Huck Institutes of the Life Sciences.

Stigmatization may harm a person’s ability to survive a disease. Ostracization may increase stress, lessening the body’s ability to fight off diseases and infections.

“People are very sensitive to rejection and humans worry about being ostracized,” said Smith. “These worries and experiences with rejection can cause problematic levels of stress and, unfortunately, stress can compromise the immune system’s ability to fight off an infection, accelerating disease progression.”

Once applied, a stigma is difficult to remove, even when there are obvious signs that the person was never infected or is cured. Health communicators should make sure they intentionally monitor if their public communication or intervention materials create or bolster stigmas before using them, Smith said.

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March 31, 2014 Posted by | health care, Medical and Health Research News | , , , , , | Leave a comment

Top 100 Selling Drugs of 2013

Top 100 Selling Drugs of 2013.

Hypothyroid medication levothyroxine (Synthroid, AbbVie) was the nation’s most prescribed drug in 2013, whereas the antipsychotic aripiprazole (Abilify, Otsuka Pharmaceutical) had the highest sales, at nearly $6.5 billion, according to a new report from research firm IMS Health on the top 100 selling drugs in the United States.

Following levothyroxine as most prescribed were the cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca), the proton-pump inhibitor esomeprazole (Nexium, AstraZeneca), and the antidepressant duloxetine (Cymbalta, Eli Lilly).

Rounding out the top 10 most prescribed drugs in 2013 (in order) were the asthma drugs albuterol (Ventolin, HFA) and fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), the antihypertensive valsartan (Diovan, Novartis), the attention deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), the antiepileptic pregabalin (Lyrica, Pfizer), and the chronic obstructive pulmonary disease drug tiotropium bromide (Spiriva, Boehringer Ingelheim).
Table 1. Top 100 Drugs by Sales
Rank Drug (brand name) Sales, 2013
1 Abilify $6,460,215,394
2 Nexium $6,135,667,614
3 Humira $5,549,996,855
4 Crestor $5,310,818,889
5 Cymbalta $5,219,860,418
6 Advair Diskus $5,121,312,668
7 Enbrel $4,681,201,645
8 Remicade $4,098,233,242
9 Copaxone $3,697,182,238
10 Neulasta $3,580,364,758
11 Rituxan $3,288,614,045
12 Lantus Solostar $3,005,681,663
13 Spiriva Handihaler $2,998,207,542
14 Atripla $2,856,818,557
15 Januvia $2,843,496,907
16 Avastin $2,688,414,938
17 Lantus $2,556,825,619
18 Oxycontin $2,534,909,675
19 Lyrica $2,415,254,835
20 Epogen $2,280,696,834
21 Celebrex $2,237,658,764
22 Truvada $2,235,712,145
23 Diovan $2,169,819,482
24 Herceptin $1,938,804,857
25 Gleevec $1,896,982,614
26 Lucentis $1,859,463,484
27 Namenda $1,856,822,750
28 Vyvanse $1,743,115,521
29 Zetia $1,710,526,476
30 Symbicort $1,563,242,161
31 Levemir $1,547,629,745
32 Suboxone $1,450,554,130
33 Novolog Flexpen $1,377,221,614
34 Novolog $1,349,403,122
35 Avonex $1,240,754,136
36 Seroquel Xr $1,226,532,019
37 Viagra $1,196,812,385
38 Alimta $1,192,134,813
39 Humalog $1,184,189,487
40 Nasonex $1,137,402,455
41 Victoza 3-Pak $1,104,811,637
42 Cialis $1,086,355,583
43 Gilenya $1,059,346,323
44 Flovent Hfa $1,050,009,900
45 Procrit $1,030,419,958
46 Isentress $1,014,678,055
47 Xarelto $996,441,091
48 Prezista $992,087,940
49 Janumet $987,663,598
50 Stelara $965,072,892
51 Neupogen $958,807,372
52 Orencia $957,680,500
53 Renvela $955,330,199
54 Reyataz $934,879,388
55 Vesicare $933,311,254
56 Dexilant $916,401,204
57 Tecfidera $879,673,483
58 Humalog Kwikpen $879,632,962
59 Synthroid $858,725,708
60 Vytorin $858,576,112
61 Lunesta $851,791,226
62 Pradaxa $836,573,805
63 Benicar $832,276,970
64 Evista $823,647,433
65 Xolair $821,783,471
66 Aranesp $809,245,700
67 Prevnar 13 $806,129,346
68 Sensipar $786,320,942
69 Xgeva $785,725,436
70 Invega Sustenna $779,834,172
71 Zytiga $775,269,249
72 Avonex Pen $768,655,140
73 Synagis $767,786,422
74 Betaseron $767,648,290
75 Xeloda $754,133,787
76 Ventolin Hfa $745,629,470
77 Zyvox $726,184,205
78 Afinitor $721,629,719
79 Gardasil $710,208,856
80 Zostavax $705,140,729
81 Incivek $701,317,408
82 Sandostatin Lar $697,961,265
83 Aciphex $683,359,951
84 Benicar Hct $681,353,719
85 Bystolic $681,318,227
86 Treanda $679,052,250
87 Focalin Xr $660,161,202
88 Erbitux $648,984,405
89 Tamiflu $641,134,799
90 Tarceva $640,597,157
91 Pristiq $632,619,542
92 Complera $630,039,312
93 Cubicin $628,034,439
94 Velcade $621,800,823
95 Strattera $616,604,042
96 Viread $599,074,197
97 Stribild $598,844,153
98 Welchol $573,939,710
99 Combivent Respimat $573,179,772
100 Xifaxan $569,762,570
Source: IMS National Prescription Audit, IMS Healt

March 28, 2014 Posted by | health care | | Leave a comment

[Report] Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014

Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014.

….
More than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. In total, sponsors reported identifying 64,135 incidents of potential fraud and abuse between 2010 and 2012. Sponsors’ identification of such incidents varied significantly, from 0 to almost 14,000 incidents a year.

CMS requires sponsors to conduct inquiries and implement corrective actions in response to incidents of potential fraud and abuse; however, 28 percent of Part D plan sponsors reported performing none of these actions between 2010 and 2012. Although CMS reported that it conducted basic summary analyses of the data on potential fraud and abuse, it did not perform quality assurance checks on the data or use them to monitor or oversee the Part D program.
WHAT WE RECOMMEND
We recommend that CMS (1) amend regulations to require sponsors to report to CMS their identification of and response to potential fraud and abuse; (2) provide sponsors with specific guidelines on how to define and count incidents, related inquiries, and corrective actions; (3) review data to determine why certain sponsors reported especially high or low numbers of incidents, related inquiries, and corrective actions; and (4) share sponsors’ data on potential fraud and abuse with all sponsors and law enforcement. CMS did not concur with the first recommendation, partially concurred with the second and fourth recommendations, and concurred with the third recommendation.

 

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March 28, 2014 Posted by | health care | , , | Leave a comment

Ethics: A Patient’s Right to Not Know

Ethics: A Patient’s Right to Not Know.

Excerpt

Writing in Science, the chair of the Presidential Commission for the Study of Bioethical Issues notes it is increasingly common for physicians and medical researchers to discover a disease that was not the original target of a medical test or screening.

Amy Guttman Ph.D. notes these surprise clinical test results are called incidental and secondary findings. Guttman explains the surprise discovery of an unexpected illness from screening and similar tests is called an ‘incidental’ finding. Guttman adds when clinicians deliberately seek to discover a second or third disease in addition to the primary target, these results are called ‘secondary’ findings.

Guttman, who is the president of the University of Pennsylvania, writes (and we quote): ‘Improved technologies are making incidental and secondary findings increasingly common. They are becoming a growing certainty in clinical practice as well as in the distinct contexts of research and direct-to-consumer testing’ (end of quote). For example, Guttman notes an array of unexpected clinical findings may be generated by new CT scans intended to detect lung cancer in heavy smokers. The increased screening will occur because of recent recommendations from the U.S. Preventive Services Task Force, which we discussed in last week’s podcast.

Guttman writes before CT scans or other medical tests, clinicians should alert patients about the possibility of surprise findings regardless whether screening deliberately seeks (or accidentally finds) new, unexpected illnesses.

Guttman notes while some persons will ask a physician to tell them about whatever clinical tests discover, some patients do not want to learn about incidental or secondary findings.

As a result, the Presidential Bioethics Commission recommends physicians and medical practitioners need to know a patient’s health priorities and tolerance to manage surprising results prior to clinical testing. Guttman writes (and we quote) ‘A patient who does not wish to learn about information related to the primary purpose of the test should not undergo the test. If a patient wishes to opt out of receiving incidental or secondary findings that are clinically significant and actionable, then clinicians should exercise their discretion whether to proceed with testing’ (end of quote).

Guttman notes health care providers should explain both the risks and rewards of finding unexpected illnesses that can occur from a new generation of sophisticated clinical tests, such as human genome screenings. While false positive findings are among the risks, Guttman explains the rewards include the detection of diseases and illness that could be clinically actionable.

In terms of biomedical ethics, Guttman concludes (and we quote):’ In keeping with shared decision-making, clinicians live up to their highest calling when they discuss how they will handle incidental findings with their patients’ (end of quote). While the Presidential Bioethics Commission provides more specific recommendations in their report, their overall intent is to improve patient-provider disclosure and communication as well as help patients anticipate the possibility of unexpected findings from routine testing.

The Commission’s report is available at bioethics.gov.

Meanwhile, a link to a website that explains some of the ethical issues associated with patient and provider health decision making (from Beth Israel Medical Center) is available in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.

Similarly, a link to a website that explains some of the ethical issues associated with patient and provider treatment decisions (also from Beth Israel Medical Center) can be found in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.

MedlinePlus.gov’s medical ethics health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s medical ethics health topic page type ‘medical ethics’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘medical ethics (National Library of Medicine).’ MedlinePlus.gov additionally contains a health topic page on talking with your doctor, which provides tips to enhance provider and patient communication.

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March 26, 2014 Posted by | health care | , , , , , , , , , | Leave a comment

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline

Surely, as one of the wealthiest countries in the world, we can find a way to provide basic health care for all.
And this includes prisoners, they too are human beings.

 

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline.

If used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States. But the high price of the drugs might prevent their use in prisons, which house as many as one-third of those who are infected.

The drugs cost anywhere from about $65,000 to $170,000 for a single course of treatment—between three and nine times more than earlier treatments. Ronald Shansky, former medical director of the Illinois prison system and founder of the Society of Correctional Physicians, described that price as “extortionarily high, criminal.”

HIV Precedent
States and municipalities typically pay for prisoner health care out of their corrections budgets. When effective HIV treatments emerged in the late 1990s, those budgets grew to accommodate the cost of the drugs, said Edward Harrison, president of National Commission on Correctional Health Care, which sets standards for prisoner health care.

But the new hepatitis C medications present a much bigger challenge. “The prevalence of HCV [hepatitis C) is 10 times greater than HIV and the cost of treatment is probably 10 times greater than a year’s worth of treating HIV,” said Anne Spaulding of Emory University, one of the leading researchers on hepatitis C in prisons.

 

The new hepatitis C drugs and others in the pipeline could be the “straw that breaks the back of corrections” and force large-scale changes in penal systems. Already, as a result of a U.S. Supreme Court decision, California has had to reduce its prison population by tens of thousands because of inadequate health care. Spaulding said she can foresee the high costs of medicine could force cuts in prison populations across the United States.

Another possibility, she said, would be to create a different mechanism for paying for prison health care, perhaps by extending Medicaid to jail and prison populations.

One thing is clear: The goal of eradicating hepatitis C won’t be achieved unless the campaign involves prisons.

“Because of these new drugs, the conversation about eliminating hepatitis C is finally happening,” said Ninburg of the Hepatitis Education Project. “But if it’s going to be eliminated, we are going to have to address hep C in the correctional setting.”

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March 26, 2014 Posted by | health care | , , , , , | Leave a comment

[News item' The patient from the future, here today

Two thoughts on disparities highlighted in the article
What about folks who do not have the background and access to resources to self diagnose? In all countries, “developed” (as USA, most of Europe) and “developing” (asmuch of Africa, parts of Asia…)

Is it ethical for some health information to be physician/research access only?

 

From the 5 March 2014 UT-San Diego article

By 1997, those irregular heartbeats became common, leading to “hundreds and hundreds” of serious episodes, capable of causing death. She eventually received an ICD, an implanted cardioverter-defibrillator, which would shock her heart back into the proper rhythm.

Goodsell began studying her condition, drawing back on her own education. While she has no medical degree, Goodsell had been a pre-med student at UC San Diego, where she met Charles, who was studying chemistry. She dropped out after falling in love with nature during a trip to Peru.

Looking for that unifying theory, Goodsell delved into genomics, searching for mutations that could encompass her symptoms. She found it with a gene called LMNA, that codes for making proteins called lamins that stabilize cells. Defects in these proteins can cause a form of Charcot-Marie-Tooth disease, damaging nerves in the extremities and causing muscle wasting, including in the hands.

Symptom after symptom checked with the mutation. But to be sure, she needed a genetic test, and her Mayo doctors resisted.

Taking the research into self-therapy, Goodsell researched risk factors associated with the disease, examining what goes on at a molecular level. She changed her diet: Out went sugars, out went gluten and any food with additives. And out went a beloved snack.

“I used to eat bowls of jalapeño peppers. I discontinued.”

But she added certain fats she had previously avoided, such as omega-3 fatty acids and nuts, which are rich in fats.

“Cell membranes are fat, and we need fat — good fat,” she said. “I was advised to start eating fat.”

Goodsell said her symptoms improved. Control over her hands improved enough to allow her to eat with chopsticks and to resume kitesurfing.

Goodsell’s doctor wrote up her case history, listing her as co-author “because he said I had done the lion’s share of the work.” The study is to be presented at an upcoming meeting of the Heart Rhythm Society.

 

Read the entire article here

Epatients: The hackers of the healthcare world [O'Reilly Radar]

Meet e-patient Dave – a voice of patient engagement (and related resources)

 

 

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March 21, 2014 Posted by | health care | , , , , , , , | Leave a comment

[News item] British hospital to become first in Europe to use Skype for consultations

From the 21 March 2014 Daily Telegraph article

 

A hospital in Staffordshire is set to become the first in Europe where doctors consult with their patients via Skype

A hospital is set to become the first in Europe to tackle waiting times by getting overworked doctors to consult with their patients via Skype.

Managers at the University Hospital of North Staffordshire claim using the online video calling service could reduce outpatient appointments by up to 35 per cent.

They argue that using Skype will help free up consultants’ time and car parking spaces – while also helping patients who are unable to take time off work.

If approved, they would become the first UK hospital to use Skype to consult with patients.

The proposals, by Staffordshire’s biggest hospital, also include doctors treating patients via email consultations……..

“The key issue for doctors will be to recognise when this mode of consultation is not sufficient to properly assess the patient and address the problem, and to arrange a face-to-face consultation instead.”

…….

Skype

Skype (Photo credit: Wikipedia)

 

 

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March 21, 2014 Posted by | health care, Health News Items | , , , , , | Leave a comment

Explore causes of regional variations in premiums | Association of Health Care Journalists

 Explore causes of regional variations in premiums | Association of Health Care Journalists

Excerpts from the 4 March 2014 blog item

The regional variations are more complicated. It’s not as simple as labor costs in New York being higher than those in Arkansas.

Competition is a big factor. The highest prices aren’t necessarily in a big city. Some of the highest rates are in rural areas with few health care providers and scant competition to drive prices down.

Narrow networks, where there are fewer doctors and hospitals, or at least fewer name-brand hospitals, are also a factor. Not all consumers want these – although some are willing to make that tradeoff to save money.

There also may be fewer insurers offering coverage in the exchanges in some areas. Even where competition is minimal, the medical loss ratio in the Affordable Care Act limits how much profit an insurer can make or at least limits how much of the premium people pay can be used for nonmedical purposes – including profit. They have to rebate the money if they don’t meet MLR.

Local health care history and how it has affected incentives and efficiency is a factor. For instance, Minnesota, which has some of the lowest premiums, has been working on delivery system, integrated care and managed care for years.

Also, regional oddities – such as a mountainous section of Colorado that has to medevac people by helicopter – can play a role in why one section of a state pays more than others.

Jordan Rau of Kaiser Health News has written about the cheapest and most expensive markets nationally. Katie Kerwin McCrimmon of Health News Colorado has written about the controversy in Colorado about why people in one community pay more than people in an adjacent community. (Here and here).

 

 

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March 14, 2014 Posted by | health care | , | Leave a comment

Explore how changing nursing home culture affects care

From the 28 January 2014 article at Covering Health

 

Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.

English: Nursing Home in Goldthorn Hill. This ...

English: Nursing Home in Goldthorn Hill. This area of Wolverhampton has a cluster of nursing homes. (Photo credit: Wikipedia)

For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes.  Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.

Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Are there nursing homes in your community that are doing things differently? Have any instituted policies or processes that show improvements in care coordination, outcomes, quality, or other key measures? Are there homes that are resisting change? Why? Which one(s) best exemplify person-centered care? How do these changes affect the workforce?

Nursing Home Compare from CMS provides the data behind complaints, violations, quality, and cost, among other metrics. This article in The Philadelphia Inquirer is a great example of interweaving research with personal narrative. Another approach might be to look at trends in the city, state, or region. How are nursing homes marketing themselves to consumers? To referral sources? Have their business models changed?

Experts on all sides have been talking about culture change for more than a decade. And in 2008, a Commonwealth Fund report explored culture change in nursing homes. Has the time finally come, for real?

 

Read the entire article here

 

Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.

 

Articles referred to above

 

  • Transforming Nursing Home Culture: Evidence for Practice and Policy

     

  • What Does the Evidence Really Say About Culture Change in Nursing Homes?
  • A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters
  • High-Performance Workplace Practices in Nursing Homes: An Economic Perspective
  • Medicaid Capital Reimbursement Policy and Environmental Artifacts of Nursing Home Culture Change
  • Building a State Coalition for Nursing Home Excellence
  • Implications for Policy: The Nursing Home as Least Restrictive Setting

     

 

 

 

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March 14, 2014 Posted by | health care | , , , , | Leave a comment

What do we know about health care determinants?

Originally posted on healthcareinfonomics:

Image As a nation, we only spend 9% of national health expenditures in embracing healthy behavior. On the other hand, only 6% of health determinates are related to access to services, although 90% of national health expenditures is spent on medical services. [1] Therefore, presumably, providing primary care providers the tools and the means to change and educate patients about their health determinate will have a significant impact on overall spending on medical services.

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March 13, 2014 Posted by | health care | , , | Leave a comment

Drugs For Life; Subcultural Identity

Originally posted on The Kente Weaver:

Watch: http://www.bbc.co.uk/programmes/b01r0h4r

BY: BBC Video Documentary, Think Aloud.

Here’s a short video interview with anthropologist Joseph Dummit, author of the book “Drugs For Life” in which he tackles  the pervasiveness of America’s pharmaceutical market in its economy and society. Dummit explores in detail, America’s increasing medicalization and the emergence of the ‘expert patient’ who shifts the dynamic of the patient-doctor relationship because this ‘expert patient’ is now equipped with ‘knowledge’ about his own health, what kind of lifestyle is healthy and to some extent the ‘medical know-how’ of how to treat certain conditions ‘off-the-counter’.

Dummit argues that Pharmaceutical companies have come to occupy a predominant role in American society, changing the discourse about what is “healthy” and what isn’t through their huge marketing campaigns and their capitalistic drive. What I find most interesting in his argument is the fact that he shows how these direct-to-consumer advertising mechanisms not only affect patients…

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March 13, 2014 Posted by | health care | , , | Leave a comment

Vaccine-preventable outbreaks

Originally posted on Eideard:

vaccine preventable
Click for interactive map

In what medical century does your nation reside?

Thanks, Mike

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March 13, 2014 Posted by | health care | , , , , , , | Leave a comment

[Reblog] The disturbing confessions of a medical scribe

From the 9 March 2014 KevinMD article

Screen Shot 2014-03-13 at 7.16.13 AM

As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a pre-medical student working next to several other doctor-hopefuls in a high stress environment, being a scribe frustrates me on an ethical level.

 

 

 

Let’s examine the structure and reasoning that has made medical scribe programs so successful. When EMR systems were first introduced, there was resistance, but it gave way to the push for efficiency. The biggest benefit of EMRs is easy: risk management. By allowing for documentation of every little part of a patient’s care, EMRs significantly decrease the risk of mistakes slipping through the cracks. It allows for better defense of the physician’s medical decisions, even months down the line.

 

For example, a physician I worked with was asked to go to court for a patient who had been assaulted by her boyfriend. The patient had been seen several months ago in the ED. Few physicians would be able to remember all the details of an encounter so long ago. His testimony was therefore entirely based on the medical chart, written by me and approved by him. The EMR allowed for comprehensive, detailed documentation of test results, discussions with the patient, and interactions with the police.

 

Unfortunately, such comprehensive medical records take time and effort to write. Physicians complain that they were becoming little more than data entry specialists, dedicating large portions of the time they should be spending with patients to clicking buttons. In comes the scribe. Usually students or recent graduates interested in becoming a medical provider, we become the physician’s right hand. Scribes are purported to decrease physician burnout considerably and increase ED efficiency. Better documentation also leads to better billing, so hospitals make more money. The physicians I work with, in a hospital who has been using scribes for over 3 years now, have all been grateful for the program.

 

Sounds great, right? The winning combination of EMRs and scribes. The road to increased efficiency, increased Press-Ganey scores, increased billing accuracy, increased fraud, increased profits for the administration. Happiness abounds.

 

How many of you missed the “increased fraud”?

 

…..

 

Read the entire article here

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March 13, 2014 Posted by | health care | , , , | Leave a comment

IT maybe be helpful for your health! – Clinical decision support, CPOE get thumbs up from academics

Clinical decision support, CPOE get thumbs up from academics 

From the 22 January 2014 news article at EHRIntelligence

Formal academic studies about the implementation of clinical decision support (CDS) and computerized provider order entry (CPOE) are generally positive, according to a study of studies targeting the meaningful use of EHRs and associated technologies.  The report, published in the Annals of Internal Medicine, found that for the most part, health IT implementations were successful in reducing adverse events and increasing efficient and effective processes of care.  However, many key aspects of IT adoption have been underreported, including the reasons why implementations go awry, leading to significant gaps in the ability to study the industry’s progress.

Funded by the ONC, the research team found that at least 78% of studies focused on medication safety found positive effects from CPOE use.  The automated dose calculation features of the software helped reduce dosage errors anywhere between 37% and 80%.
Fifty-eight of the articles reviewed by the researchers addressed efficiency questions, and found that health IT was able to reduce costs in 85% of cases, even though a large number of studies also reported increased time and effort spent on electronic documentation.  Clinical decision support was associated with a 30% increase in adherence to infection prevention guidelines in one study, and a “substantial decline” in venous thromboembolism for patients in another.
Overall, positive findings from CDS and CPOE projects included shorter emergency department turnaround times, more time for clinicians to interact with patients, and better chronic disease management.  However, when individual studies reported negative or mixed findings, there were few clues in the literature as to why the problems manifested themselves or how to correct them.
Read the entire article here

 

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March 13, 2014 Posted by | health care | , , , , , | Leave a comment

Order or Download Your Free Patient Packet – Tips on How to Talk with your Health Care Provider

Order or Download Your Free Patient Packet | NCCAM

From the Web page

Order or Download Your Free Patient Packet

As part of the Time To Talk campaign, NCCAM has developed a packet of helpful materials to help you begin a dialogue with your health care providers. Order your packet online or call 1-888-644-6226 and use reference code D393.

Each packet contains:

  • Backgrounder PDFBackgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF

 

Order your packet online or call 1-888-644-6226 and use reference code D393.

 

Related Resources

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March 13, 2014 Posted by | health care, Uncategorized | , , , , , , , , , , | Leave a comment

Pill Nation

Pill Nation.

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Screen Shot 2014-02-13 at 5.36.17 AMScreen Shot 2014-02-13 at 5.37.04 AM

 

February 13, 2014 Posted by | health care | | 4 Comments

[News article] The Rise of Medical Identity Theft

From the 7 February 2014 Stateline news article 

By Michael Ollove, Staff Writer

A young woman retrieves a patient’s medical records at the Family Health Center in Louisville, Ky. The theft of personal medical information, whether paper-based or electronic, is a large and growing problem. (Getty)

If modern technology has ushered in a plague of identity theft, one particular strain of the disease has emerged as most virulent: medical identity theft.

Last month the Identity Theft Resource Centerproduced a surveyshowing that breaches of medical records involving personal information accounted for 43 percent of all records breaches involving personal information reported in the United States in 2013. That is a far greater chunk of record breaches than those involving banking and finance, the government and the military or education.

The definition of medical identity theft is the fraudulent acquisition of someone’s personal information – name, Social Security number, health insurance number – for the purpose of illegally obtaining medical services or devices, insurance reimbursements or prescription drugs.

“Medical identity theft is a growing and dangerous crime that leaves its victims with little to no recourse for recovery,” said Pam Dixon, the founder and executive director of World Privacy Forum. “Victims often experience financial repercussions and worse yet, they frequently discover erroneous information has been added to their personal medical files due to the thief’s activities.”

The Affordable Care Act has raised the stakes. One of the main concerns swirling around the disastrous rollout of federal and state health insurance exchanges last fall was whether the malfunctioning online marketplaces were compromising the confidentiality of Americans’ medical information.  Meanwhile, the law’s emphasis on digitizing medical records, touted as a way to boost efficiency and cut costs, comes amid intensifying concerns over the security of computer networks.

Edward Snowden, the former National Security Agency contractor who has disclosed the agency’s activities to the media, says the NSA has cracked the encryption used to protect the medical records of millions of Americans.

Multiple Motives

Thieves have used stolen medical information for all sorts of nefarious reasons, according to information collected by World Privacy Forum, a research group that seeks to educate consumers about privacy risks. For example:

  • A Massachusetts psychiatrist created false diagnoses of drug addiction and severe depression for people who were not his patients in order to submit medical insurance claims for psychiatric sessions that never occurred. One man discovered the false diagnoses when he applied for a job. He hadn’t even been a patient.
  • An identity thief in Missouri used the information of actual people to create false driver’s licenses in their names. Using one of them, she was able to enter a regional health center, obtain the health records of a woman she was impersonating, and leave with a prescription in the woman’s name.
  • An Ohio woman working in a dental office gained access to protected information of Medicaid patients in order to illegally obtain prescription drugs.
  • A Pennsylvania man found that an imposter had used his identity at five different hospitals in order to receive more than $100,000 in treatment. At each spot, the imposter left behind a medical history in his victim’s name.
  • A Colorado man whose Social Security number, name and address had been stolen received a bill for $44,000 for a surgery he not undergone.

 

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February 9, 2014 Posted by | health care | , , , | 2 Comments

[Press release] Are you big pharma’s new target market?

From the 3 February 2014 EurekAlert

Taking a cue from Apple and Coca-Cola, pharmaceutical firms are humanizing their brands

This news release is available in French.

Montreal, February 4, 2014 — By 2018, it is estimated that the global pharmaceutical market will be worth more than $1.3 trillion USD. To corner their share of profits, established drug companies have to fight fierce competition from generic products, adhere to stringent government regulations and sway a consumer base that is better informed than ever before.

New research from Concordia University’s John Molson School of Business shows that Big Pharma has begun these efforts by embracing “brand personality,” a marketing strategy traditionally employed by consumer-focused companies like Apple, Coca-Cola and Harley-Davidson.

By imbuing their brands with human characteristics, pharmaceutical companies can boost sales by developing direct relationships with their consumers. The result: patients are more likely to ask their physician to prescribe specific brand-name medication.

Screen Shot 2014-02-05 at 8.35.25 AM

“Brand personalities can transform products from being merely functional to having emotional value in the eyes of the consumer,” says marketing professor Lea Katsanis, a co-author of the study that recently appeared in the Journal of Consumer Marketing.

“Pharmaceutical companies give their brands personality traits by relying on physical attributes, practical functions, user imagery and usage contexts. As a result, brand names like Viagra, Lipitor and Prozac become shorthand for the drugs themselves.”

To carry out the study, Katsanis and co-author Erica Leonard, a recent graduate of Concordia’s Master of Science in Marketing program, used an online survey to poll a total of 483 U.S. respondents. They rated 15 well-known prescription medications based on 22 different personality traits, such as dependability, optimism, anxiousness and elegance. The study included blockbuster drugs from Big Pharma companies such as Pfizer, Eli Lilly and GlaxoSmithKline.

The results show that prescription drug brand personality, as perceived by consumers, has two distinct dimensions: competence and innovativeness. Consumers typically applied terms such as dependable, reliable, responsible, successful, stable, practical and solution-oriented” to branded drugs, thus showing a preference for overall competence. Words like unique, innovative and original related to the “innovativeness” of the drug in question.

“Our findings can help marketers better understand how competing brands are positioned and act accordingly to ensure their products remain distinctive. One way of achieving this could be to appropriately focus more on either the competence or innovativeness dimensions,” says Katsanis.

“From a consumer perspective, prescription drug brand personality may make health-related issues more approachable and less intimidating, facilitating physician-patient interactions by making patients more familiar with the medications used to treat what ails them.”

###

Related links:

 

 

Media contact:

Cléa Desjardins
Senior advisor, media relations
University Communications Services
Concordia University
Phone: 514-848-2424, ext. 5068
Email: clea.desjardins@concordia.ca
Web: concordia.ca/now/media-relations
Twitter: twitter.com/CleaDesjardins

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February 5, 2014 Posted by | health care, Health News Items | , , , , | Leave a comment

[Press release] Taking statins to lower cholesterol? New guidelines

From the 4 February 2014 Mayo Clinic Press Release

ROCHESTER, Minn. — Feb. 4, 2014 — Clinicians and patients should use shared decision-making to select individualized treatments based on the new guidelines to prevent cardiovascular disease, according to a commentary by three Mayo Clinic physicians published in this week’s Journal of the American Medical Association.

Journalists:  Sound bites with Dr. Montori are available in the downloads.

Shared decision-making is a collaborative process that allows patients and their clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.

In 2013, the American College of Cardiology and the American Heart Association issued new cholesterol guidelines, replacing previous guidelines that had been in place for more than a decade. The new guidelines recommend that caregivers prescribe statins to healthy patients if their 10-year cardiovascular risk is 7.5 percent or higher.

“The new cholesterol guidelines are a major improvement from the old ones, which lacked scientific rigor,” says primary author Victor Montori, M.D., Mayo Clinic endocrinologist and lead researcher in the Knowledge and Evaluation Research Unit. “The new guidelines are based upon calculating a patient’s 10-year cardiovascular risk and prescribing proven cholesterol-lowering drugs — statins — if that risk is high.”

However, Dr. Montori cautions that the risk threshold established by the guideline panel is somewhat arbitrary. Instead he recommends that patients and their clinicians use a decision-making tool to discuss the risks and benefits of treatment with statins.

“Rather than routinely prescribing statins to the millions of adults who have at least a 7.5 percent risk of having a heart attack or stroke within 10 years, there is an opportunity for clinicians and patients to discuss the potential benefits, harm and burdens of statins in order to arrive at a choice that reflects the existing research and the values and context of each patient,” he says.

“We’re creating a much more sophisticated, patient-centered practice of medicine in which we move the decision-making from the scientist to the patient who is going to experience the consequences of these treatments and the burdens of these interventions,” Dr. Montori explains. “Decision-making tools can democratize this approach and put it in the hands of millions of Americans who have their own goals front and center in the decision-making process.”

Additional authors of the commentary include Henry Ting, M.D., and Juan Pablo Brito Campana, M.B.B.S., both of Mayo Clinic.

 

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February 5, 2014 Posted by | health care | , , , , , , , , | Leave a comment

[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

 

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February 5, 2014 Posted by | health care | , , , , , , | Leave a comment

[Reblog] Are you a victim of patient profiling?

Very controversial, this posting has 113 comments as of Feb 4, 2014.
Two (or more! ) sides to this.
On a personal level, my medical record very boldly on the first page states two conditions
– Anxiety/Depression (have not needed medication for these conditions in 5 years)
– High Cholesterol ( have disputed the doctor on this, based on how I have read the scientific literature)

So, yes…I feel profiled!

Yet, the doctor is doing the best he can. He can only see patients for 15 minutes. His electronic records are
basically, well, dictated by the group he is in.

On another note, just as I am not defined by my job or resume…
I am also not defined by my medical record!

Screen Shot 2014-02-04 at 5.31.34 AM

From the 4 February 2014 Kevin MD article by Pamela Wible, MD

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

 

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences.

For the first time, people share their stories:

I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider

 

Read the entire article (with 113+ comments) here

 

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February 4, 2014 Posted by | health care | , , , , , | Leave a comment

US Government Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices

New to me!

From the US Health Resources and Services Program Web page -  340B Drug Pricing Program & Pharmacy Affairs

The 340B Drug Pricing Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices.

The 340B Program enables covered entities to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Eligible health care organizations/covered entities are defined in statute and include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers. See the full list of eligible organizations/covered entities.

To participate in the 340B Program, eligible organizations/covered entities must register and be enrolled with the 340B program and comply with all 340B Program requirements. Once enrolled, covered entities are assigned a 340B identification number that vendors verify before allowing an organization to purchase 340B discounted drugs.

New registrations are accepted October 1-15, January 1-15, April 1-15 and July 1-15.

Update here, which includes..

HRSA is currently working to formalize existing program guidance through regulation, designed to cover a number of aspects of the 340B Program. The regulation currently under development will address the definition of an eligible patient, compliance requirements for contract pharmacy arrangements, hospital eligibility criteria, and eligibility of off-site facilities. We expect to publish this proposed regulation, which will be open for public comment, by June 2014. In order to ensure that covered entities retain flexibility based on their size, structure, and patient population, HRSA will continue to hold covered entities accountable for implementing those requirements as appropriate for their specific circumstances.

…..

Implemenation page includes

Once a covered equity is enrolled in the 340B Program and included in the covered entities database, it is the covered entity’s responsibility to inform wholesalers and manufacturers of enrollment in order to purchase drugs at the 340B discounted price.

Covered entities may continue to work directly with individual wholesalers and manufacturers and may participate in the 340B Prime Vendor Program (PVP). As the government’s awarded 340B Prime Vendor, Apexus is responsible for securing sub-ceiling discounts on outpatient drug purchases and discounts on other pharmacy related products and services for covered entities electing to join the PVP. For complete information, see the Prime Vendor Program .

Implementation Options

HRSA does not specify how participants should implement the 340B Program. As long as participants comply with all 340B Program requirements, they have flexibility in implementing the 340B Program.

Most covered entities choose one or more of the following options:

  • In-House Pharmacy, in which the covered entity owns drugs, pharmacy and license; purchases drugs; is fiscally responsible for the pharmacy; and pays pharmacy staff.
  • Contract Pharmacy Services, in which the covered entity owns drugs; purchases drugs; pays (or arranges for patients to pay) dispensing fees to one or more contract pharmacies; and contracts with pharmacy to provide pharmacy services.
  • Provider/In-House Dispensing, in which the covered entity owns drugs; employs providers licensed in the state to dispense; holds a license for dispensing for the participating providers; and is fiscally responsible for operating and dispensing costs.
  • Alternative Methods Demonstration Project, in which HRSA Office of Pharmacy Affairs approves a model proposed by the covered entity, such as a network of 340B covered entities.

The 340B Database includes links to

 

 

 

 

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February 2, 2014 Posted by | health care | , , , , , , | Leave a comment

Parents unclear about process for specialist care for kids

Parents unclear about process for specialist care for kids.

No recommendations, but an interesting survey.

From the University of Michigan Press Release

Answers vary about the roles of parents and care providers in referral process, according to U-M’s National Poll on Children’s Health

ANN ARBOR, Mich. – Parents vary widely in views about their responsibilities in getting specialty care for their children, according to a new University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health.

Most children get their health care from a primary care provider, known as a PCP, but when there are signs or symptoms of a more serious illness, the PCP often refer kids to a specialist.

According to this month’s poll, it’s a common occurrence. Among the 1,232 parents surveyed in this poll, 46 percent report that at least one of their children has been referred to a specialist.

But when asked about the process of getting specialist care for their child, parents had a wide range of views, says Sarah J. Clark, M.P.H. , associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics.

Parents are divided over who is responsible for choosing the specialist: 52 percent say the PCP and 48 percent say the parent. They also differed in who should verify insurance coverage: 55 percent say the PCP and 45 percent say the parent.

Forty percent of parents say the PCP should make sure the wait time isn’t too long for a specialist appointment, but 60 percent say that’s the parents’ responsibility.

“This poll shows a wide range of views about who is supposed to do what, so it’s not unexpected that sometimes the process doesn’t work well,” says Clark. “If a referral is delayed or it doesn’t happen at all, a child’s health can be put at risk.”

The poll also found that parents of children with Medicaid insurance coverage are more likely than parents of privately-insured children to say PCPs should be responsible for choosing the specialist, calling to set up the appointment, and verifying that insurance will cover the specialist care. Clark says this indicates that PCPs should understand that their Medicaid patients may have different expectations about their roles.

Parents also were asked to rank the importance of different characteristics of specialists, and rated the following as very important:

  • knowing how to take care of the child’s specific condition (89%)
  • having training in pediatrics (80%)
  • being affiliated with a highly-rated hospital (62%)
  • being involved in research so child has access to latest treatment (50%)
  • appointment time convenient for the family schedule (43%)
  • drive time to the specialist (38%)
  • other parents recommending the specialist (38%)

“For a parent, hearing that a child needs to see a specialist is often cause for concern. Confusion about their responsibilities for arranging specialty care can add to parents’ anxiety,” says Clark, who also is associate director of the Child Health Evaluation and Research (CHEAR) Unit.

“Primary care providers cannot assume that parents understand their responsibilities around making specialty appointments.  Clear communication — ideally, with instructions written in plain language — will help parents ensure their kids get the care they need.”

Broadcast-quality video is available on request. See the video here:http://www.youtube.com/watch?v=uif7xpr5iy8&feature=youtu.be

Full report: C.S. Mott Children’s Hospital National Poll on Children’s Health

http://mottnpch.org/reports-surveys/seeing-specialists-roles-parents-providers-unclear

 

Website: Check out the Poll’s website: MottNPCH.org. You can search and browse over 80 NPCH Reports, suggest topics for future polls, share your opinion in a quick poll, and view information on popular topics. The National Poll on Children’s Health team welcomes feedback on the website, including features you’d like to see added. To share feedback, e-mailNPCH@med.umich.edu.

Facebook: http://www.facebook.com/mottnpch

Twitter: @MottNPCH

 

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February 1, 2014 Posted by | health care | , , , , , , | Leave a comment

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily.

Date:  January 29, 2014
Source:  Elsevier
Summary:  U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study.

From the news article

U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

“Establishing policies does not ensure clinician adherence at the bedside,” state the authors. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”

The survey also assessed structure and resources of infection prevention and control programs, evaluating characteristics such as staffing, use of electronic surveillance systems, and proportion of infection preventionists with certification.

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. Many of these infections occur in the ICU setting and are associated with an invasive device such as central line, ventilator, or indwelling urinary catheter. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. The estimated annual costs associated with HAIs in the U.S. are up to $33 billion.

 

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February 1, 2014 Posted by | health care | , , , , , , , , | Leave a comment

Things Physicians and Patients Should Question – With Lists From Choosing Wisely

Screen Shot 2014-02-01 at 5.27.47 AMThings Physicians and Patients Should Question | Choosing Wisely.

Ever wonder if a medical test or procedure was right for you?
Maybe you read about it, hear it on the news, or came across it on the Internet.

Here’s Web site that just might help in discussions with your health care provider.

From the Choosing Wisely site

Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

This concept was originally conceived and piloted by the National Physicians Alliance, which, through an ABIM Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were first published inArchives of Internal Medicine. 

Recognizing that patients need better information about what care they truly need to have these conversations with their physicians, Consumer Reports is developing patient-friendly materials and is working with consumer groups to disseminate them widely.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

From the List at Choosing Wisely, by the ABIM Foundation

United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.

In collaboration with the societies, Consumer Reports has created resources for consumers and physicians to engage in these important conversations about the overuse of medical tests and procedures that provide little benefit and in some cases harm.

Specialty Society Lists of Five Things Physicians and Patients Should Question (for physicians):

Patient-Friendly Resources from Specialty Societies and Consumer Reports:

and more!

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February 1, 2014 Posted by | health care | , , , , , , , , | Leave a comment

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution.

From the 27 January 2014 Brookings Institute post
The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

January 30, 2014 Posted by | health care | , , , , | Leave a comment

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution.

From the 27 January 2013 post at Health care and the digital revolution – A graduate student’s take on health care going digital – Claudia Paz

Something we have been hearing a lot of lately is how this is the moment for the healthcare consumer (see, Bloomberg Review videoMedCity Article, Forbes article on trends to be excited about).  Basically, people are noting that EMR’s and patient portals, the proliferation of health and wellness related mobile apps, and greater transparency across the system, will all lead to a new age of health care where patients have the information and tools to savvily navigate a streamlined healthcare delivery system oiled by customer reviews, online tools, and digital gadgets. Think Yelp and MenuPages meets healthcare.

While all of the trends listed above are exciting leaps forward, not enough attention is being paid to the patient’s needs at the point of care. Research on patient activation andshared or participatory decision making all points to the following:

Empowered patients who actively participate in decisions about their health and treatment options are more likely to be compliant with their medications, make less risky and more cost effective decisions, and are more confident in the management of their health outcomes.

For the purposes of this blog, I am focusing on the concept of a patient as an active participant at the point of care. From my own personal experience, it seems that “doctor knows best” remains the dominant paradigm. Instead of having a conversation about treatment options, the pros and cons of alternatives, variations in costs and side affects, I am more often than not prescribed a medication or treatment option and sent about my day. If I feel like knowing more about the medication (that I have already agreed to take), I usually conduct research after the appointment.

,,,,,

 

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January 30, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Journalist explains what to expect from new mental health parity rules

From the 27 January 2014 post at Covering Health – Monitoring the pulse of health care journalism

by | January 27, 2014

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Michelle AndrewsMichelle Andrews

Later this year, health plans will be under new mental health parity rules affecting how insurers should cover patients with mental health and substance abuse disorders.

Michelle Andrews, a health policy reporter and columnist for Kaiser Health News, explains the issue in a new tip sheet,  “Mental health parity rule clarifies standards for treatment limits, coverage of intermediate care.”

These rules, governing the limits that health insurers can place on coverage for patients needing mental health and substance abuse care, will be important to consumers for several reasons. One reason involves what services health plans must provide when covering mental health benefits –keep in mind that health plans do not need to offer mental health care. But if they do, they need to cover inpatient and outpatient services, emergency room care and prescription drugs, Andrews reports. Also, the rules prohibit health insurers from setting limits on treatment that are more restrictive than the limits set on a plan’s medical-surgical coverage, she adds.

In addition, intermediate-level mental health services, such as residential treatment and intensive outpatient services for patients needing substance abuse treatment or mental health care, should be covered at the same level as the insurer covers residential and intensive outpatient services for medical-surgical patients, Andrews adds. Often patients needing mental health and substance abuse care require residential or intensive outpatient treatment.

The new parity rules also do not allow health insurers to charge higher co-payments, deductibles, or out-of-pocket maximums for mental health and substance abuse treatment without setting similar co-payment, deductibles, and out-of-pocket limits for medical-surgical coverage.

 

 

Read the entire article here

January 28, 2014 Posted by | health care | , , , , | Leave a comment

[Reblog] Healthstyles: Pre-operative Fasting–Too Long?

Fasting instructions for healthy pre surgical patients should be based on the known differences in gastric transit times of clear liquids, full liquids, and other foods.

Screen Shot 2014-01-26 at 6.44.46 AM

From the 23 January 2014 post at HealthCetera – CHMP’s Blog
     Center for Health Media & Policy at Hunter College (CHMP): advancing public conversations about health & health
policy

This week on Healthstyles, I'm rebroadcasting an important interview that I did with Dr. Jeannette Crenshaw, RN, DNP, two years ago about what the evidence suggests is appropriate for pre-operative fasting--what should you not eat or drink and for how long before surgery.
Unfortunately, little attention is paid to this topic. Most people are told to fast for much longer periods of time than is necessary, and this can lead to dehydration and other adverse effects.
Tune in tonight on WBAI (www.wbai.org; 99.5 FM), or click here to listen anytime: Crenshaw

[The broadcast is about 22 minutes long, but very informative]

For those interested, the broadcast is based on her article Pre-operative Fasting – Will the Evidence Ever be put into Practice? 

Highlights from the article

  • Overview: Decades of research support the safety and health benefits of consuming clear liquids, including those that are carbohydrate rich, until a few hours before elective surgery or other procedures requiring sedation or anesthesia.
    Still, U.S. clinicians routinely instruct patients to fast for excessively long preoperative periods. Evidence-based guidelines, published over the past 25 years in the United States, Canada, and throughout Europe, recommend liberalizing preoperative fasting policies.
    To improve patient safety and health care quality, it’s essential that health care professionals abandon outdated preoperative fast- ing policies and allow available evidence to guide preanesthetic practices.

Preoperative fasting practices in the United States often disregard both the guidelines of the American Society of Anesthesiologists (ASA)1, 2 and the most current available evidence on the subject.

A PRACTICE BASED ON MYTH

The U.S. practice of requiring an extended fast before scheduled anesthesia or sedation is based primarily on the following three myths8-12:

• Myth: Overnight fasting from all solids and liquids is the optimal approach to reduce the risk of pul- monary aspiration during anesthesia.

• Myth: Gastric emptying time is the same for clear liquids as for full liquids (those that are not transpar- ent, such as milk, creamed soup, and nonstrained fruit juice) and solids.

• Myth: Clear liquids ingested up to two hours be- fore surgery increase the risk of vomiting and pul- monary aspiration.

 

The ASA (American Society of Anesthesiologists) recommends that healthy patients

 

  • consume clear liquids up to two hours before elective surgery or conscious sedation but cautions that their guidelines aren’t intended for women in labor and may need to be modified for patients with conditions that affect gastric emptying or fluid volume and those in whom airway management may be difficult.3-5
  • Evidence gathered throughout the world over the past 25 years not only supports the ASA guidelines, but establishes the health benefits of preoperative carbohydrate loading (through the consumption of carbohydrate-rich clear liquids) the evening before and the morning of surgery.6, 7

Clear liquids leave the stomach almost immediately, while full liquids and solids remain for significantly longer periods. It’s long been established that patients who drink clear liquids a few hours before surgery have significantly lower gastric volumes and similar or higher pH values compared with those who fast overnight, suggesting that drinking clear liquids may stimulate gastric emptying and dilute acidic gastric secretions, thereby lowering the risk of pulmo- nary aspiration and increasing patient safety.15-1 

Screen Shot 2014-01-26 at 6.36.06 AM

  • In addition to discomforts such as thirst, hunger, anxiety, drowsiness, and dizziness, excessive preoperative

    fasting may have adverse physiologic effects, including dehydration, insulin resistance, postoperative hy- perglycemia, muscle wasting, and a weakened immune response.18, 23-25 Clear liquids, taken alone, may be in-sufficient to ward off such effects. Emerging evidence suggests that, in addition to offering clear liquids up until two hours before anesthesia or sedation, the best way to avert the harmful consequences of preoperative fasting is to prescribe a carbohydraterich clear bev-erage to be consumed two to three hours before the scheduled procedure

  • The author also details reasons for resistance by the medical community and research needs (as for patients who are not healthy and/ or have stomach and breathing issues).

 

So, does one take the law into one’s hands, so to speak? The radio interview seems to suggest be careful if you drink clear liquids up to two hours before the surgery and/or drink a carbohydrate beverage.  Best not to tell the health care providers, perhaps on the day of surgery.

 

 

 

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January 26, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] Measuring Quality of Care for Older Adults With Serious Illness

From he 22 January 2014 post at HealthAffairsBlog

by Laura Hanson, Anna Schenck, and Helen Burstin

Editor’s Note: This post is the third in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. 

In the United States, value is the new health care imperative – improving quality while controlling costs.  We spend nearly twice the rate of comparable nations, yet have poorer health outcomes.  In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), mandating a new emphasis on paying for value, not volume.

Our greatest opportunity to enhance value in US health care is to improve quality of care for older adults with serious illness – the group who uses the most health care services. Serious illness, in which patients are unlikely to recover, stabilize, or be cured, is life-altering for patients and family caregivers.  It includes advanced, symptomatic stages of diseases such as congestive heart failure, chronic lung disease, cancer, kidney failure, and dementia. Serious illness may also refer to the cumulative consequences of multiple conditions progressing over time, causing functional decline or frailty.

We’ve made important progress in understanding high quality care for this population of patients.  Researchers have asked patients with serious illness and their families how they define high quality care.  Especially in serious illness, patients want control over treatment through shared decision-making.   Even when there is no cure, most patients still want health care that helps them live longer – but only if they can also get help with function, physical comfort, and attention to family, emotional and spiritual needs.

We know what types of health care help patients and families cope with serious illness.  A 2012 report to the Agency for Healthcare Research and Quality finds evidence for three types of care to improve health outcomes:

  1. Expert pain and symptom treatment
  2. Communication to engage patient preferences for treatment decisions
  3. Interdisciplinary palliative care

We’ve developed quality measures to understand how often real-world care lives up to these ideals.

……

 

Read the entire article here

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January 26, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog] Saying No to “Know Your Numbers” campaigns – Health News Watchdog blog

Saying No to “Know Your Numbers” campaigns – Health News Watchdog blog.

Saying No to “Know Your Numbers” campaigns

Posted by Gary Schwitzer in Health care journalismRisk communication

4 COMMENTS

“Know Your Numbers” campaigns can serve a useful purpose.

But they can also be guilty of non-evidence-based fear-mongering.  They can fuel obsessions with numbers that fully-informed people might just as soon not know anything about. There can be harm living our lives worrying about numbers, test results – making ourselves sick when we are, in fact, healthy.

Here’s a screenshot of just a tiny part of a Google search result of “Know Your Numbers” campaigns.  The list goes on and on and on.

The most recent that I saw was in the January 2014 edition of Prevention magazine.  It’s entitled, “Know Your Numbers: The 5 Health Stats You Should Know.”

While we acknowledge the prestige of the Cleveland Clinic and its chief wellness officer, we point out that there is a lot of debate in medical science circles about what is laid out in this Preventionmagazine piece. For example:

“There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion”

So if 140/90 is where this group starts thinking about treatment, and if even the American Heart Association says normal is “less than 120/80,” what we have with an announcement that 115/75 is “ideal” is mission creep, medicalizing normal blood pressure, or disease-mongering. Where does this “ideal” come from?  It may only be a few points of difference, but with a few points, thousands of Americans suddenly become “less than ideal”…or, as we often call them, patients. One minute they’re healthy.  And then – voila – with a prestigious organization’s spokesman proclaiming a new “ideal” – they’re sick, abnormal, patients.

  • Cholesterol.  Hmmm.  Let’s see what the Cleveland Clinic website says about LDL and HDL. The Clinic’s own website says the LDL goal value should be less than 130 for people who don’t have heart or blood vessel disease or high risk.  And since a Prevention magazine article reaches a broad audience, that’s the crowd we’re talking about. And the Clinic website says HDL goal value should be greater than 45.  So the Prevention magazine targets of LDL under 100 and HDL over 50 are again mission creep, medicalizing normal blood tests, or disease-mongering.  Please note:  we could (but won’t herein) write volumes about much broader questions about being obsessed over LDL or HDL numbers, which are surrogate markers that don’t tell people everything they need to know.
  • This is the one that bugs me the most.  The article lists C-reactive protein as one of the “5 health stats you should know.”  What you should know is that the US Preventive Services Task Force does not share in that endorsement.  The USPSTF states that “the current evidence is insufficient to assess the balance of benefits and harms of using the (the test) to screen asymptomatic men and women with no history of coronary heart disease (CHD) to prevent CHD events.” Even a brief look at other guidelines by other groups shows that the promotion of this test as a “stat you should know” is not as simple and uncomplicated as the Prevention magazine article makes it out to be.

Please note that almost exactly 2 years ago we wrote, “Cleveland Clinic’s Top 5 Tests for 2012 clash with many guidelines.” C-reactive protein was on that list as well.

And you may be interested in some of my past articles about “Know Your Numbers” campaigns:

Comments

Laurence Alter posted on January 13, 2014 at 10:00 am

Dear Gary & Staff:

1. “Live by the numbers; die by the numbers”
2. “The facts speak for themselves”

Live by the first expression or idiom; die by the second one.

Fine physicians give subtlety and nuance behind “the numbers.”

Laurence Alter

Reply

Gary Schwitzer posted on January 13, 2014 at 12:06 pm

Laurence,

Thanks for your note, but for the umpteenth time, there is no staff.

There wasn’t even any staff when we had funding. So there certainly isn’t any staff in the unfunded era.

Whereas I once had help from as many as almost 40 different part-time contributors, they were not staff, just very limited part-time contributors.

It’s just me, flying solo these days.

Reply

Gwyneth Olwyn posted on January 14, 2014 at 10:50 pm

Dear Gary By Himself:

1. Live by the numbers, die anyway.
2. Unequivocally one death per person.

There is no subtlety or nuance to be had for fine physicians in an era of standard of care and fear of litigation from failing to screen aggressively for potential disease.

Therefore a person needs to know ahead of getting his or her numbers checked whether he or she is ready to inadvertently become a patient based on numbers and that the treatments to change those numbers may have little to no evidence to support them.

Reply

shaun nerbas posted on January 20, 2014 at 3:01 pm

It seems that the patient must look out for themselves, ask questions, and not just accept the standard script of medical people. I had an MI 4 years ago (stent placed in the LAD which was nearly 100% blocked ) , but in the 2.5 months before that I saw 4 different doctors who told me nothing was wrong. I had normal LDL and total cholesterol,but I did have low HDL, which I had recently raised up to a ” nearly normal ” value using niacin. I walked for 1.5 hours a day, but in that 2.5 month period before the MI, while walking, I started to get increasing shortness of breath, indigestion, and a pain in my upper back, between the shoulder blades. My doctor gave me Nexium . My doctor didn’t think it was my heart. He based that on having two relatives of his with heart disease, my normal ECG, and my normal cholesterol numbers. I saw other doctors, as my shortness of breath got worse, but again, they didn’t think it was my heart. Then one day I got the symptoms while eating lunch. I went to the local hospital,who after being in communication with a larger specialized hospital, sent me to that larger center, which put the stent in. I eventually learned that over 62% of MIs happen to people with ” normal cholesterol ” . How is it possible that the cholesterol numbers used by lay doctors are so useless for diagnosis ? Does heart disease have multiple causes or do we just not have a good understanding of how do diagnose and track it ? I almost never see this inadequacy discussed by the experts ! Subsequent to my MI I became a vegan to improve my diet to remove saturated fat, which along with a grandmother who had a heart problem, were, in my mind, the reasons for my heart disease. My cardiologist acted as if I was misguided with the vegan approach, which he felt was a path almost nobody could follow.. ….. just take the statins. Maybe Cardiology is a very lucrative occupation that keeps us coming back…..see you next time ! Sorry for being so cynical, but that’s how I feel.

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January 24, 2014 Posted by | health care, Health News Items | , , , , , | Leave a comment

[News article] Little-known aspect of Medicaid now causing people to avoid coverage

From the 23 January 2014 Washington Post article

Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house.

The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-
income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets.

after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

..

after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.

“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.

Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.

It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.

“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”

Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.

,,,,

 

Read the entire article here

 

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January 24, 2014 Posted by | health care | , , , , | Leave a comment

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