Tagged: Healthcare

Ignore conservative whiners – Medicare improves your health

In a 15-year study of older Medicare patients, Yale School of Medicine researchers saw an estimated 20% drop in mortality, about 30% fewer hospitalizations, and 40% reduction in deaths after hospitalization…

Published in the July 28 JAMA theme issue on Medicare and Medicaid at 50, the study took a comprehensive look at national trends in mortality, hospitalizations, outcomes, and expenditures from all causes from 1999 to 2013. The team, from the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, analyzed data on 68,374,904 Medicare recipients 65 years of age or older from key demographic groups and geographic areas.

“We are in the midst of a remarkable era of improvements in health and health care in America,” said lead author Harlan M. Krumholz, M.D….co-director of the Clinical Scholars Program. “This decline represents millions of hospitalizations averted and hundreds of thousands of deaths delayed.”

“The news should give us reassurance about our current efforts, but not make us complacent. We should seek to continue our advances in technology, health behaviors and policies, and quality of care — and seek to continue this remarkable trend,” Krumholz added.

Krumholz and his team also found that the total number of hospitalizations for major surgery decreased over the course of the study. The average length of time spent in the hospital declined from 5 to 4 days, and the average inpatient costs per Medicare fee-for-service recipient declined from $3,290 to $2,801. The findings were consistent across geographic and demographic groups.

Now, imagine how much better this good news might be – if we kicked whiners and ideologues out of Congress and concentrated on solid science, best administrative practices and took as the single goal improving health and healthcare for all Americans.

That would really be good news.

5 years of wrong predictions about Obamacare in 1 video

John Oliver’s Last Week Tonight created a supercut of premature declarations about the “end of Obamacare.” It’s a telling look at the manner in which political promises fuse with the news cycle to exaggerate reality.

After the US Supreme Court upheld healthcare subsidies for 6.9 million Americans in its decision on King v. Burwell, momentum to repeal the Affordable Care Act is waning, as Sarah Kliff wrote late week:

If the challengers had won, it would have thrown the health-care law into chaos. But the White House prevailing marks something equally momentous: President Obama’s signature legislative accomplishment is actually, really, definitely here to stay

For more on Obamacare, make sure to read and share the comprehensive card stack at the bottom of the VOX article.

My opinion has been stated here and elsewhere often enough:

Expansion of Medicare to all citizens within a single-payer system reduces costs by cutting out the insurance industry slice of the pie. Congress isn’t likely to have the courage for that. But, the experience of Social Security – with operating costs at least 80% cheaper than anything the insurance industry offers – proves the possibility.

The same holds true for Medicaid. And I may as well throw in my favorite criticism of the provisions as designed by Congress. There is no legitimate reason preventing taxpayers in general from enjoying the same fixed, government-negotiated rates for prescription drugs that are guaranteed to members of the military.

How a cancer-fake hustler fooled folks – with lots of helpers


Belle Gibson, founder of The Whole Pantry app, and son Oliviersaid the caption at news.com.au

Boing Boing’s Xeni Jardin has a powerful post up about the news that Belle Gibson, a popular young Australian wellness blogger, has admitted to lying about having cancer. Gibson had convinced many people that she had “cured her terminal brain cancer by avoiding gluten and sugar,” as Jardin puts it — a claim that deserves to be treated with about as much merit as a report of a unicorn sighting. Gibson had used her story to help drum up her media profile and push her nutrition app, the Whole Pantry (the planned Apple Watch version of which disappeared from the app store about a month ago).

As Jardin, who has herself battled breast cancer, points out, we’ve entered the mass-shaming part of the story, with the predictable torrents of internet anger. It’s an understandable response, but it leaves out the complicity of many media outlets that should have known better.

Because sure, Gibson was embraced by many of the usual suspects — small health and wellness blogs with shaky-at-best understandings of science and bones to pick with processed foods and “Western medicine” — but a bigger part of the reason she was able to carve out a successful niche in the wellness world was that that mainstream outlets, particularly in her native Australia, offered her fawning coverage.

“The Whole Pantry founder inspires in the face of terminal cancer,” enthused a headline on news.com.au, a major outlet. “The Whole Pantry came out of Gibson’s determination not to be crushed by her illness and to find a way to help people like herself,” wrote the IT columnist at another. “The 25-year-old has turned her cancer diagnosis into a positive, believe it or not,” gushed an Australian Yahoo! TV host. Australian Women’s Health called her a “health game changer.” Thanks in part to all this attention, Gibson was able to expand her popularity to the States. As Jardin points out, Cosmopolitan even gave her a Fun Fearless Female award in the social media category.

It’s not reasonable to expect every single employee at every single outlet to be completely up to date on all the latest nutritional science, of course. But outlets do have at least some responsibility to not mislead their audiences. Gibson’s claims were, on their face, so outlandish that offering them a megaphone did real harm to readers and viewers: not just by encouraging them to follow a charlatan, but by potentially nudging them away from real, established treatments for diseases that can frequently be fatal. Gibson’s a liar, but she was only able to become a successful liar because so many people amplified her story without checking it first.

Bringing the question back to one we often confront: money-making journalism – the real deal – professionals who don’t do the rigorous fact-checking that is supposed to be required. Part incompetence; but, part laziness.

A PR release drops into your email inbox. Written well enough, the journalist and editor do their bit of tidying up and off it goes. I realize they’re conditioned by a fawning relationship with government and corporate overlords; but, that ain’t good enough. Cripes, at least look around, ask around online.

Surviving Vietnam Vets straining the VA system

absent friends

The struggles veterans face in accessing healthcare are a harbinger for all American medicine, and the problem won’t be resolved without adequate funding, said Department of Veterans Affairs Secretary Robert McDonald.

“VA is the canary in the coal mine. We learn about the problems in American medicine before American medicine,” McDonald told a roomful of reporters at the annual conference of the Association of Health Care Journalists…

McDonald joined the VA last summer in the wake of an exploding controversy. Earlier in 2014, staff at a Phoenix VA hospital were found to have falsified scheduling records in order to mask extended delays in appointments. Hundreds of veterans were waiting months for appointments and some deaths were blamed on the delays.

Since his confirmation, McDonald — formerly the CEO of Procter and Gamble — has tried to turn around the agency’s image as mired in bureaucracy and more responsive to administrative edicts than veterans’ economic and healthcare needs.

McDonald blamed last year’s failures in access primarily on the growth of the aging veteran population, specifically Vietnam veterans. He also cautioned that the agency hasn’t yet seen “peak demand” from the veterans of Middle Eastern wars.

“If we don’t get ready today for what could happen many years from now with Iraq and Afghanistan veterans, we’re going to have another crisis.”

The key to avoiding future problems is adequate funding now, said McDonald…

This puts him in a difficult place, as the department must provide legislatively mandated benefits to all eligible veterans on a budget that isn’t necessarily tied to their numbers or needs

The number of veterans is declining but that population is also getting older, said McDonald. Since older people have more health issues, the number of claims and issues per claim has dramatically increased…

Other factors creating strain on veterans health centers include: the number of veterans returning from Iraq and Afghanistan; new requirements to assess and treat exposure to Agent Orange during the Vietnam War; the lack of limits on the appeals process; and increased survival on the battlefield that leaves more veterans with severe disabilities…

Like every “good” American War, the Clown Show in Congress ran everything through as an unfunded mandate. Little or no provision was made for the survivors of our wars – whether they are veterans of the US Military or [perish the thought] civilian survivors of our pacification.

The latest iteration of Know-Nothing Republicans and Blue Dog Democrats in DC talk a great game about caring for our veterans while doing as little as possible.

Lowest-wage Aetna employees minimum wage now $16/hour + increased benefits

Bertolini, Keene, minimum wage

One CEO has taken a step that could help fend off Thomas Piketty’s nightmare vision of rising wealth inequality: He’s giving thousands of his workers a raise.

Aetna Chairman and CEO Mark Bertolini announced…that the health-insurance company will be raising wages for its lowest-paid employees. Starting in April, the minimum hourly base pay for Aetna’s American workers will be $16 an hour, according to a company press release.

The 5,700 workers affected by the change will see an average pay raise of about 11 percent. The lowest-paid workers, who currently make $12 an hour, will get a 33-percent raise.

The Wall Street Journal reported that Bertolini recently requested that Aetna executives read Capital In The Twenty-First Century, by the French economist Piketty. The book, which has been hailed as the “most important book of the twenty-first century,” warns that the gap between the haves and the have-nots is heading toward Gilded Age levels of inequality and calls on the world’s largest economies to fix the problem.

The U.S. government, which last raised the federal minimum wage to $7.25 an hour in 2009, has not exactly scrambled to respond. Aetna’s move is one way companies could help close the gap

Other factors may have influenced Aetna’s decision to boost pay. The Affordable Care Act is helping millions of Americans get insured, which means insurance companies have to beef up their consumer services to stay competitive.

“Health care decisions are increasingly consumer driven,” Bertolini said in a statement emailed to The Huffington Post. “We are making an investment in the future of health-care service.”

The job market is healing, as well, which should eventually push wages higher. Last month capped the best year for hiring since 1999, as the unemployment rate fell to 5.6 percent. That said, even though the job market has improved, wages have been slow to grow.

Still, some large employers, including Aetna, Starbucks and the Gap, have raised wages in the past year.

In the interview, Tom Keene makes the point that wages have been stagnant for years. Bertolini describes the segment that most influenced his decision were single moms who needed food stamps to get by in Connecticut’s capitol. Their kids often were on Medicaid because they couldn’t even afford the company’s healthcare plan.

60% of the increase dedicated to benefits. 40% of the budget increase went to the wages – raised to $16/hour minimum. Doing it this way produced the best possible increase in personal disposable income. Not that any of this means crap to Republicans and other tightwads pretending to be conservatives.

Bertolini’s cogent point is that healthcare is a growing segment in our service economy. Workers who are well-paid always perform better than folks treated like serfs. As much as today’s conservatives prefer the latter. Something not noted in this article are the changes in workplace life, as well. More advanced sectors in the American economy – like the tech sector – long ago proved that a small portion of time away from necessary work reduces tedium, makes for increased acuity in all tasks. That should include physical changes, exercise – as well a bit of time to rest your brain.

Aetna now brings in a bit of yoga, a little meditation time to their workplace. Something else, fundamentalist curmudgeons will also hate.

Health care is getting more affordable — see that on the local news, yet?

Every two years, the Commonwealth Fund surveys Americans on how difficult it is to afford medical care. The 2014 survey showed something new: for the first time in a decade, the number of Americans who say they can afford the health care they need went up.

The Commonwealth Fund fielded the survey during the second half of 2014, meaning they captured the people who signed up for Obamacare during the open enrollment period earlier in the year. And it showed, for the first time in the survey’s 10-year history, a decline in the number of Americans who reported having difficulty paying medical bills or who carried medical debt.

The Commonwealth Fund also looked at Americans who said they put off care because it was too expensive. And there, too, they saw a decline: 36 percent of Americans reported delaying care because of the price, an all-time low in the survey’s history.

This also coincided with an increase in the number of Americans who reported having health insurance, a finding that lines up with other national surveys on coverage.

In a way, it seems obvious that more people with health insurance would mean more Americans able to afford care. But that notion hasn’t always been taken for granted with Obamacare. Some of the plans sold on the new marketplaces have had especially narrow networks that limit coverage to a smaller set of doctors. These plans have also had particularly high deductibles, often over $2,000.

So it hasn’t been totally clear whether these plans would make it easier for Americans to afford coverage: would enrollees with a $2,000 deductible, for example, still find it too expensive to go to the doctor?

The Commonwealth Fund survey suggests that the answer is no: that the plans sold on the marketplace are making it easier for the people who buy them to see the doctor — which is one of the main points of having health insurance to begin with.

Makes sense to me. My Medicare Advantage has gone up a very small percentage; but, I’m entering the second year with a new provider – and all the insurance companies seem to play the same game of lowballing the first year.

The few other folks and family members I chatted with on the topic – admittedly a short sample – all agree with the article.

Marijuana revenue helping schools on projects political hacks won’t fund

image

As marijuana revenues trickle into the state, slow to meet projections, a few Colorado school districts are among the first to see some impact from the state’s new funds.

The state Department of Education’s program to fund capital projects — known as Building Excellent Schools Today, or BEST, grants — had received more than $1.1 million from marijuana taxes in May when it made the annual award recommendations.

The state also is readying another $2.5 million from pot taxes so interested schools can hire health professionals.

The additional capital project money has been welcomed as the state fund for the BEST grants has been declining and the program reached a cap for the financed grants it could issue through bonds…

The marijuana excise tax — which is 15 percent on unprocessed recreational pot sales on its first sale – — netted about $3 million from January through June 30. The education department receives the funds monthly and will dole out the awards recommendations every May.

Next year, officials estimate the pot contribution to the BEST grants will be about $10 million. But some school officials say there’s a misconception about where the pot money is going.

“I feel like the word on the streets is marijuana funding is going to schools, but certainly it’s not going to schools for operating costs,” said Ryan Elarton, director of business services for the Pueblo district. “And not every district gets it.”

Besides the new marijuana funds, BEST grants have been funded by sources including money from the state land trust and spillover from Powerball profits after funding the Great Outdoors Colorado fund…

From other marijuana revenue appropriated by the legislature, $2.5 million has been set aside to increase the presence of health professionals in schools.

Schools that apply for those grants and win could have that money by January.

It’s hilarious that schools may get back some of the necessities cut by conservative politicians — and they’ll be getting it from profits generated by legal ganja.

The sad part remains that folks trapped in the two-party belief system can’t get any results from simply going to the polls on election day. Frankly, issues like school safety, healthcare for the student population, reasonable curricula dedicated to learning and all that entails — are a natural for independent political organizing. Yes, just like legalizing marijuana.

Then, you’re not required to shove a natural local response to problems into a cookie cutter mold designed by seventeen lobbyists employed by a Congressional action committee.

Anti-vaccination nutballs now refusing Vitamin K for their children, as well

Over a single 8-month period, seven infants were admitted to Monroe Carell Jr. Children’s Hospital at Vanderbilt for treatment of either cranial or intestinal hemorrhaging due to vitamin K deficiency bleeding (VKDB)…

That report prompted researchers in Canada to investigate local vitamin K refusal rates and predictors.

Of the 214,061 children born in Alberta, Canada, from 2006 to 2011, 0.3% had parents who declined the vitamin K injection after birth, Shannon E. MacDonald, PhD…and colleagues wrote in Pediatrics.

In 2006, the vitamin K refusal rate was 0.21%, but by 2012, that rate increased to 0.39% (P<0.001) of live births.

The highest rates of vitamin K refusal occurred in parents who also refused recommended vaccines throughout the first 15 months of life…

The vitamin K refusal rate for parents who delivered in a hospital was very low, 0.2%, compared with parents who had planned home deliveries, 14.5%…and parents who delivered at a birthing center, 10.7%…

The study authors suggested parental decisions to refuse vitamin K were linked to lack of education and misinformation based on two studies from the 1990s (Golding et al.), which suggested vitamin K injections could increase the chances of developing childhood cancer. Those study results, the Canadians said, were since found to be inaccurate…

Refusal rates have increased in Texas, too. At Texas Children’s Pavilion for Women, Tiffany McKee-Garrett said that when parents refuse, they team up with the parents’ primary care provider to counsel the family extensively and provide the parents with written materials to educate them about vitamin K.

RTFA for details of other regional studies.

I know I get too cranky for some folks; but, what kind of parent is so dedicated to 14th Century dogma that they’re ready and willing to accept the prattle from long-discredited studies – generally from some 3rd or 4th-hand source – instead of taking the time to read a little science about disease prevention, proven health maintenance.

Rather, they risk the lives of their newborn in pursuit of purity of their soul. No sense or balance IMHO.

States are losing billions by not expanding Medicaid

States that aren’t expanding Medicaid are leaving a total of $423 billion in federal funds on the table over the next decade.

Leaving money on the table

States do have to spend a bit of their own money to get the federal dollars. While the federal government covers the full cost of Medicaid expansion through 2016, states have to kick in a small portion (5 percent) beginning in 2017. The state’s contribution ultimately rises to 10 percent by 2020.

The Urban Institute, who crunched the numbers behind this map, finds that the states currently not expanding Medicaid would have to spend $31.6 billion over the next decade if they opt-in. That is definitely real money — but also less than a tenth of the amount they’re losing out on by passing up the expansion.

Almost all these states have Republican governors and Republican-conrolled legislatures. Proving once again idjits elect idjits – or liars.

As for sloganeering — it’s obvious Republicans have as much concern for people needing healthcare as they do for people needing jobs. Lots of talk – but, won’t do a damned thing to help out.

Thanks, Mike

Hospitals could face penalties for missing electronic health record deadline

More than half of U.S. hospitals were on the hook to meet a new set of “meaningful use” of electronic health records criteria — known as the stage 2 criteria — by the end of the fiscal year that ended in July. The new study’s data, which was gathered in late 2013, suggests that many may have missed the milestone. At the time, only 5.8 percent of those hospitals were on track to adopt all 16 of the stage 2 meaningful use goals.

Hospitals that bill the Medicare program and didn’t meet the criteria in fiscal year 2014 will be subject to financial penalties in fiscal year 2015…

The criteria, set forth by the Centers for Medicare and Medicaid, include relatively easy items such as using electronic health records to enter orders for medication as well as lab and radiology tests, to chart patients’ vital signs and to record patient demographics. More difficult activities include sharing electronic health record data with patients online, sharing electronic data with other providers who care for the same patients and submitting electronic data to vaccine registries…

The criteria are the second tier of compliance with the 2009 Health Information Technology for Economic and Clinical Health Act, also known as HITECH. The act requires hospitals to move from paper to electronic recordkeeping. At first, only a basic set of criteria is required, but once a hospital starts down the path, it must meet higher benchmarks at scheduled dates. The more than half of hospitals that were scheduled to meet the stage 2 meaningful use criteria in 2014 were the first wave to begin adopting digital medical records.

The study determined that the number of hospitals adopting electronic health records continues to rise steeply. Nearly 60 percent of hospitals now have at least a basic system. And 90 percent of those were on track to achieve many of the 16 core criteria.

The study suggests that, where hospitals are not able to meet criteria, they aren’t always to blame. Vendors must upgrade their products to make necessary functions available to meet the criteria. These challenges, however, appear to be concentrated in specific types of hospitals.

“Policymakers may want to consider new targeted strategies to ensure that all hospitals move toward meaningful use of electronic health records,” Adler-Milstein said. “We found that rural and small hospitals lag behind, suggesting a need to expand federal efforts to help these institutions select, purchase, implement and successfully use electronic health records in ways that earn them incentive payments and enable them to engage in new care delivery and payment models.”

Overdue. Way overdue. One of the best things we can thank Obama for – at two levels.

I really enjoy being able to access my medical records, diagnoses and communications – and love seeing them available between my physicians. Two of the four physicians on my Medicare chart are there: my GP and my eye doctor. Mostly just annual checkups; but, I’m glad they can see other’s work. The other two have just as perfunctory a relationship – and I’m confident they’ll soon be on board.

The best reason in the world to get hospitals into the mix makes me feel great – as a cynical geek. Because computational analysis is turning up crooked hospitals, administrators and healthcare conglomerates all over the country. And I love it.

When a hospital’s billing practices distort general rules of practice – it shows up. When a hospital is requesting ten times the national/regional average of one kind of profit center test – it shows up. Etc.

Like I said. Overdue.