story first appeared in Los Angeles Times
The Obama administration reaffirmed key requirements of the new healthcare law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits.
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law's requirements as the federal government races to implement the legislation by the end of next year.
But the proposed rules issued Tuesday hew closely to the Affordable Care Act that President Obama signed in 2010. At the same time, administration officials restated their commitment to move rapidly ahead, despite continued resistance from some Republican governors.
Health and Human Services Secretary Kathleen Sebelius said this means that beginning in October next year, families and small-business owners everywhere will be able to shop for affordable, quality health coverage and entrepreneurs won't have to give up their chance at affordable health coverage to start a new business.
Under the law, Americans who are not covered through work will be able to comparison shop for health insurance in online markets, also known as exchanges, designed to mimic the shopping experience of popular travel sites.
These exchanges will be run by state governments, except in states that elect to leave the job to the federal government or to partner with Washington.
More than 15 states, mostly with GOP governors, have said they will not operate an exchange. Some governors have complained the federal government has put too many requirements on the exchanges.
In state and federally run exchanges, insurance companies will be prohibited from denying coverage to sick Americans. Insurers will no longer be able to charge more from women or customers with medical conditions.
And for the first time, insurers will have to cover 10 basic benefits, including hospitalizations, emergency care, newborn and maternity care, and prescription drugs.
The Obama administration has allowed each state to detail this set of benefits, allowing for some variations of drugs that might be covered, for example.
That worries many consumer advocates who would like to see a national standard for health insurance. Carl Schmid, deputy executive director of the AIDS Institute fears that leaving the decision up to the states of which drugs insurance plans must cover, many patients, particularly those with complex medical conditions, may not have the coverage they need.
But several leading consumer groups, including AARP, which represents older residents, and the American Cancer Society's Cancer Action Network, applauded the administration for retaining key protections in the law, including a requirement that insurers charge elderly consumers no more than three times as much as they charge young customers.
Insurers had pushed for more leeway to vary rates based on age, arguing that this was necessary to keep premiums affordable for younger, healthier customers.
Gary Cohen, who oversees insurance regulations at the Department of Health and Human Services, said the administration did not believe this was necessary to attract younger consumers, who will have access to a lower-priced health plan to cover catastrophic illness and also may qualify for new subsidies to offset their premiums.
The administration adjusted several rules to accommodate industry concerns, including allowing insurance companies to institute higher deductibles in plans they sell to small businesses and setting enrollment periods to prevent consumers from signing up for insurance only when they get sick.
The proposed new rules drew cautious praise from several leading industry representatives. Karen Ignagni, head of America's Health Insurance Plans, reiterated concerns that requirements still may force consumers to purchase coverage that is more costly than they have today.
28 November 2012
25 November 2012
BCBS Overhauled
Story first appeared on freep.com.
A proposal that would end Blue Cross Blue Shield of Michigan's tax-exempt status and transform the organization from a charitable trust of the state to a customer-owned nonprofit is making headway in Lansing, but not without critics trying to step in the path of the legislation to overhaul Michigan's largest health insurer.
Competitors and advocates for consumers and the elderly — including the state attorney general — have been attempting to change or stop the legislation, which was proposed by Gov. Rick Snyder and enjoyed widespread support in the Michigan Senate. The voices for and against it now are setting their sights on the House, which is holding committee-level hearings that continue Monday and plans to bring the measures to a full and final vote by year's end.
Supporters, including the company, say the aim is to level the regulatory playing field for all health insurers. The proposed overhaul aims to modernize but not sell Blue Cross, which is governed by a separate state law from other insurers and typically waits much longer for its rate changes to be reviewed. Streamlining regulations, they say, is particularly important, as health insurers gear up for the implementation of the federal Affordable Care Act and try to meet a March deadline for getting its products and rates ready for an online health exchange where people can compare and buy their own insurance plans.
Blue Cross' special status is no accident. The insurer has been designated the state's insurer of last resort — meaning it must provide insurance coverage regardless of a customer's health status. Because of that, Blue Cross has been exempt from paying several local and state taxes. The measures proposed by Republican Gov. Rick Snyder, endorsed by Blue Cross and passed last month by the Senate, require the company to begin to pay those taxes, which Blue Cross estimates will average $100 million annually.
By transforming, Blue Cross also would shed its charitable "social mission" and contribute up to $1.5 billion to a nonprofit foundation that would carry on that work. Broadly speaking, the foundation would work to improve public health and health care access, particularly for children and the elderly. About 60% of the money is earmarked in the first four years to subsidize Medigap, which fills the gap in Medicare coverage for seniors, to prevent rates from significantly rising.
It would join 12 other Blue Cross Blue Shield companies nationwide structured as mutual insurers, which means they are owned by members. Those companies operate in 14 states.
Critics say it all doesn't add up. For starters, the contribution isn't set in stone and neither is the size of the tax bill after credits are taken into account. They fear that the social mission will be diminished because it doesn't cover the more than $300 million it contributes to social mission work.
The $1.5 billion represents half of Blue Cross' book value — the organization's assets minus liabilities. Some have been calling for a full financial valuation, saying it would provide a more accurate picture of its worth.
Michigan Attorney General Bill Schuette has opposed various parts of the legislation during the past two months and successfully lobbied to get the extended subsidies for eligible seniors, among other things, into the Senate bills. This past week, officials from his office argued for the first time publicly that the specific language creating the foundation needs to be much tighter and it should be set up so the Internal Revenue Service doesn't see it as self-dealing when Blue Cross — a major supplier of Medigap coverage — receives subsidies from the nonprofit.
Mark Cook, Blue Cross' vice president of governmental affairs, said at a hearing Tuesday that the intention of the legislation is clear to Blue Cross, which plans to make annual payments. He said the insurer is open to more language provided it's not forced to make that $1.5 billion payment at one time.
Also, he said, what some call "social assets" paid by Blue Cross in Michigan are viewed by the organization as losses. Blue Cross reported about $300 million in losses last year related to the subsidies it pays for Medigap and money it loses on individual insurance products because they tend to get the sicker folks.
Ultimately, Cook said the legislation is not what we would have proposed, but the company supports it. He said Snyder wanted to go larger and create uniformity in the insurance system, so he called for a review of the 32-year-old public act that pertains to Blue Cross, which led to the proposal he announced in September to do away with it.
Regardless, any large internal change to an insurer with 4.4 million customers representing 70% of the market is going to raise concerns and should be scrutinized.
A proposal that would end Blue Cross Blue Shield of Michigan's tax-exempt status and transform the organization from a charitable trust of the state to a customer-owned nonprofit is making headway in Lansing, but not without critics trying to step in the path of the legislation to overhaul Michigan's largest health insurer.
Competitors and advocates for consumers and the elderly — including the state attorney general — have been attempting to change or stop the legislation, which was proposed by Gov. Rick Snyder and enjoyed widespread support in the Michigan Senate. The voices for and against it now are setting their sights on the House, which is holding committee-level hearings that continue Monday and plans to bring the measures to a full and final vote by year's end.
Supporters, including the company, say the aim is to level the regulatory playing field for all health insurers. The proposed overhaul aims to modernize but not sell Blue Cross, which is governed by a separate state law from other insurers and typically waits much longer for its rate changes to be reviewed. Streamlining regulations, they say, is particularly important, as health insurers gear up for the implementation of the federal Affordable Care Act and try to meet a March deadline for getting its products and rates ready for an online health exchange where people can compare and buy their own insurance plans.
Blue Cross' special status is no accident. The insurer has been designated the state's insurer of last resort — meaning it must provide insurance coverage regardless of a customer's health status. Because of that, Blue Cross has been exempt from paying several local and state taxes. The measures proposed by Republican Gov. Rick Snyder, endorsed by Blue Cross and passed last month by the Senate, require the company to begin to pay those taxes, which Blue Cross estimates will average $100 million annually.
By transforming, Blue Cross also would shed its charitable "social mission" and contribute up to $1.5 billion to a nonprofit foundation that would carry on that work. Broadly speaking, the foundation would work to improve public health and health care access, particularly for children and the elderly. About 60% of the money is earmarked in the first four years to subsidize Medigap, which fills the gap in Medicare coverage for seniors, to prevent rates from significantly rising.
It would join 12 other Blue Cross Blue Shield companies nationwide structured as mutual insurers, which means they are owned by members. Those companies operate in 14 states.
Critics say it all doesn't add up. For starters, the contribution isn't set in stone and neither is the size of the tax bill after credits are taken into account. They fear that the social mission will be diminished because it doesn't cover the more than $300 million it contributes to social mission work.
The $1.5 billion represents half of Blue Cross' book value — the organization's assets minus liabilities. Some have been calling for a full financial valuation, saying it would provide a more accurate picture of its worth.
Michigan Attorney General Bill Schuette has opposed various parts of the legislation during the past two months and successfully lobbied to get the extended subsidies for eligible seniors, among other things, into the Senate bills. This past week, officials from his office argued for the first time publicly that the specific language creating the foundation needs to be much tighter and it should be set up so the Internal Revenue Service doesn't see it as self-dealing when Blue Cross — a major supplier of Medigap coverage — receives subsidies from the nonprofit.
Mark Cook, Blue Cross' vice president of governmental affairs, said at a hearing Tuesday that the intention of the legislation is clear to Blue Cross, which plans to make annual payments. He said the insurer is open to more language provided it's not forced to make that $1.5 billion payment at one time.
Also, he said, what some call "social assets" paid by Blue Cross in Michigan are viewed by the organization as losses. Blue Cross reported about $300 million in losses last year related to the subsidies it pays for Medigap and money it loses on individual insurance products because they tend to get the sicker folks.
Ultimately, Cook said the legislation is not what we would have proposed, but the company supports it. He said Snyder wanted to go larger and create uniformity in the insurance system, so he called for a review of the 32-year-old public act that pertains to Blue Cross, which led to the proposal he announced in September to do away with it.
Regardless, any large internal change to an insurer with 4.4 million customers representing 70% of the market is going to raise concerns and should be scrutinized.
19 November 2012
Study Shows Health Benefits of Reflexology
story first appeared on freep.com
Reflexology -- the method of massaging the feet to stimulate parts of the body -- can help cancer patients perform daily tasks better.
That's the conclusion of a new study led by Michigan State University researcher Gwen Wyatt, a professor in the College of Nursing.
The study, funded by the National Cancer Institute, is believed to be the first large-scale study to put hard science behind the benefits of reflexology as a complement to standard cancer care,
"It's always been assumed that it's a nice comfort measure, but to this point we really have not, in a rigorous way, documented the benefits," Wyatt said in a report released by the MSU today. "This is the first step toward moving a complementary therapy from fringe care to mainstream care."
People who received the reflexology treatment had significantly less shortness of breath and were able to more easily perform such tasks as climbing stairs, getting dressed and going grocery shopping, according to the MSU report.
Over an 11-week period, they compared the reflexology group with a group that had regular foot massage and a group that had neither foot massage nor reflexology. The study involved 385 women undergoing chemotherapy or hormonal therapy for advanced-stage breast cancer that had spread beyond the breast. The women were assigned randomly to three groups: Some received treatment by a certified reflexologist, others got a foot massage meant to act like a placebo, and the rest had only standard medical treatment and no foot manipulation.
Wyatt is now researching whether massage similar to reflexology performed by cancer patients' friends and family, as opposed to certified reflexologists, might be a simple and inexpensive treatment option.
Reflexology -- the method of massaging the feet to stimulate parts of the body -- can help cancer patients perform daily tasks better.
That's the conclusion of a new study led by Michigan State University researcher Gwen Wyatt, a professor in the College of Nursing.
The study, funded by the National Cancer Institute, is believed to be the first large-scale study to put hard science behind the benefits of reflexology as a complement to standard cancer care,
"It's always been assumed that it's a nice comfort measure, but to this point we really have not, in a rigorous way, documented the benefits," Wyatt said in a report released by the MSU today. "This is the first step toward moving a complementary therapy from fringe care to mainstream care."
People who received the reflexology treatment had significantly less shortness of breath and were able to more easily perform such tasks as climbing stairs, getting dressed and going grocery shopping, according to the MSU report.
Over an 11-week period, they compared the reflexology group with a group that had regular foot massage and a group that had neither foot massage nor reflexology. The study involved 385 women undergoing chemotherapy or hormonal therapy for advanced-stage breast cancer that had spread beyond the breast. The women were assigned randomly to three groups: Some received treatment by a certified reflexologist, others got a foot massage meant to act like a placebo, and the rest had only standard medical treatment and no foot manipulation.
Wyatt is now researching whether massage similar to reflexology performed by cancer patients' friends and family, as opposed to certified reflexologists, might be a simple and inexpensive treatment option.
Republican States Delaying Health Care Law Deadine
story first appeared on nytimes.com
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week, said there had been a total blackout of information, and they they are behind schedule and at a disadvantage.
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week, said there had been a total blackout of information, and they they are behind schedule and at a disadvantage.
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.
Experimental Breast Cancer Treatment Proving Beneficial
story first appeared on usatoday.com
Vickie Baker did not have time for breast cancer.
The 49-year-old Hazard resident knew she needed radiation therapy, but she couldn't imagine how she could get to University Hospital in Louisville for treatments five days a week. Not when she lives more than three hours away and babysits eight grandchildren.
But a University of Louisville study allowed her to receive radiation treatment just once a week in March and April, after a lumpectomy in January.
Baker, who is doing well today, said the experimental treatment for people with early stage breast cancer made her life easier and offered hope for the future.
Dr. Anthony Dragun, a radiation oncologist at the University of Louisville's James Graham Brown Cancer Center who is overseeing the study, hopes it will make radiation treatment more accessible to women facing such obstacles as distance, transportation problems and time constraints — while also cutting treatment costs by more than half.
Research subjects get higher doses of radiation once weekly than they would receive during each daily treatment, but less radiation during the overall five-week course of treatment. Traditional daily radiation schedules are also usually five weeks, but in some cases may be six or seven weeks.
Vickie Baker did not have time for breast cancer.
The 49-year-old Hazard resident knew she needed radiation therapy, but she couldn't imagine how she could get to University Hospital in Louisville for treatments five days a week. Not when she lives more than three hours away and babysits eight grandchildren.
But a University of Louisville study allowed her to receive radiation treatment just once a week in March and April, after a lumpectomy in January.
Baker, who is doing well today, said the experimental treatment for people with early stage breast cancer made her life easier and offered hope for the future.
Dr. Anthony Dragun, a radiation oncologist at the University of Louisville's James Graham Brown Cancer Center who is overseeing the study, hopes it will make radiation treatment more accessible to women facing such obstacles as distance, transportation problems and time constraints — while also cutting treatment costs by more than half.
Research subjects get higher doses of radiation once weekly than they would receive during each daily treatment, but less radiation during the overall five-week course of treatment. Traditional daily radiation schedules are also usually five weeks, but in some cases may be six or seven weeks.
Some areas of the country have better access to this type of treatment. A Cancer Specialist Detroit procedure might be available in areas less rural than in Appalachia.
Dragun led a study two years ago showing that about a third of Kentucky women with early stage breast cancer didn't get recommended radiation treatments after lumpectomy surgeries.
Among those least likely to get radiation were the elderly, African Americans and women in rural areas, including the Appalachian region of the state.
Women who did not get recommended radiation were 60% more likely to die during the time they were studied.
Dragun said that many times studies like these are published but never followed through to the next step, but made sure that wasn't the case here.
He said he's hopeful about the new regimen. In his study and previous European studies, women getting weekly radiation report similar levels of side effects as those getting radiation five days a week.
Some outside experts say the approach seems promising, but one pointed to research that found drawbacks in terms of breast appearance after once-a-week treatments.
Baker, who is scheduled for a follow-up doctor visit later this month, said she's glad to play a part in advancing the science.
Dragun's study targets women with breast cancer in Stages 0-II who have undergone lumpectomies and who may be getting chemotherapy or hormonal therapy.
He said the experimental regimen not only improves access to care, but also significantly reduces treatment costs as measured by Medicare reimbursement. Five weekly treatments total $2,901, compared with $6,884 for 25 daily treatments over five weeks.
And that doesn't count such costs as increased medical staff time for the more frequent treatments, and wear-and-tear on the linear accelerator that provides the radiation.
Dragun said it is less costly for the health care system, and added that it also saves patients money on transportation and potential expenses such as overnight stays near cancer centers.
But Dragun said the biggest benefit is improving access to care — which can potentially save lives, while also giving patients more time with their families and less time off of work.
Baker said distance was a big obstacle for her after doctors found a lump in her right breast on a mammogram in 2011 and her family physician referred her to University.
After the lumpectomy in January, she didn't hesitate to join Dragun's research.
Baker said she and family members drove to Louisville each week, returning to Hazard the same day. Noting that she frequently takes care of her grandchildren, she predicted that, if the only option were daily radiation treatments, she would simply have skipped some.
Baker is one of 90 patients who have joined the study, which opened in January 2011 and aims to enroll 250 patients.
An article on the results among the first 42 patients has been accepted for publication in the International Journal of Radiation Oncology, and it concludes that women's tolerance of the weekly radiation compares well with recent reports of daily schedules, and the new regimen appears feasible and cost-effective.
Dr. Bruce Haffty, associate director of the Cancer Institute of New Jersey and president-elect of the American Society for Radiation Oncology, said he's aware of Dragun's research, which is one of several alternatives to daily, five-week radiation regimens being studied right now.
Haffty said radiation technology has grown more sophisticated, and such pared-down treatment schedules may someday help patients with long distances to travel.
If weekly regimens do become common, Dragun said they could be particularly helpful in such places as Kentucky, a largely rural state beset by doctor shortages, high levels of poverty and cancer disparities.
In his previous study, he and his colleagues analyzed the radiation rates for 11,914 women who underwent lumpectomies for early breast cancer, and found the percentages who didn't get radiation were 47.5% for women 70 or older, compared with 28.9% for those under 50; 43.8% for Appalachian women, compared with 30.4 for non-Appalachian women, and 35.4% for black women, compared with 33.6% for white women.
The study found that women without private health insurance fared worse. Among uninsured women, 34.4% didn't get radiation, compared with 27.8% for those with insurance, 34.5% for those with Medicaid and 42.1% for those with Medicare.
Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness, said some people believe that breast-cancer disparities could be eliminated simply by making screenings more available.
But she said the problem is much more complicated, considering big issues with access to care, timeliness of care and quality of treatment for cancer.
She said even the issue of transportation isn't as simple as it seems. In rural areas, public transportation is often scarce.
Nesbitt said new treatment schedules such as the one Dragun is studying could help — not only by reducing the number of commutes but also by improving women's quality of life.
Dragun said if his results hold up, the new treatment regimen eventually could help all early stage breast cancer patients who need radiation because less frequent treatments would be a boon to any woman juggling work and child-rearing.
Dragun led a study two years ago showing that about a third of Kentucky women with early stage breast cancer didn't get recommended radiation treatments after lumpectomy surgeries.
Among those least likely to get radiation were the elderly, African Americans and women in rural areas, including the Appalachian region of the state.
Women who did not get recommended radiation were 60% more likely to die during the time they were studied.
Dragun said that many times studies like these are published but never followed through to the next step, but made sure that wasn't the case here.
He said he's hopeful about the new regimen. In his study and previous European studies, women getting weekly radiation report similar levels of side effects as those getting radiation five days a week.
Some outside experts say the approach seems promising, but one pointed to research that found drawbacks in terms of breast appearance after once-a-week treatments.
Baker, who is scheduled for a follow-up doctor visit later this month, said she's glad to play a part in advancing the science.
Less trips, money
Dragun's study targets women with breast cancer in Stages 0-II who have undergone lumpectomies and who may be getting chemotherapy or hormonal therapy.
He said the experimental regimen not only improves access to care, but also significantly reduces treatment costs as measured by Medicare reimbursement. Five weekly treatments total $2,901, compared with $6,884 for 25 daily treatments over five weeks.
And that doesn't count such costs as increased medical staff time for the more frequent treatments, and wear-and-tear on the linear accelerator that provides the radiation.
Dragun said it is less costly for the health care system, and added that it also saves patients money on transportation and potential expenses such as overnight stays near cancer centers.
But Dragun said the biggest benefit is improving access to care — which can potentially save lives, while also giving patients more time with their families and less time off of work.
Baker said distance was a big obstacle for her after doctors found a lump in her right breast on a mammogram in 2011 and her family physician referred her to University.
After the lumpectomy in January, she didn't hesitate to join Dragun's research.
Baker said she and family members drove to Louisville each week, returning to Hazard the same day. Noting that she frequently takes care of her grandchildren, she predicted that, if the only option were daily radiation treatments, she would simply have skipped some.
Baker is one of 90 patients who have joined the study, which opened in January 2011 and aims to enroll 250 patients.
An article on the results among the first 42 patients has been accepted for publication in the International Journal of Radiation Oncology, and it concludes that women's tolerance of the weekly radiation compares well with recent reports of daily schedules, and the new regimen appears feasible and cost-effective.
Dr. Bruce Haffty, associate director of the Cancer Institute of New Jersey and president-elect of the American Society for Radiation Oncology, said he's aware of Dragun's research, which is one of several alternatives to daily, five-week radiation regimens being studied right now.
Haffty said radiation technology has grown more sophisticated, and such pared-down treatment schedules may someday help patients with long distances to travel.
Unequal treatment
If weekly regimens do become common, Dragun said they could be particularly helpful in such places as Kentucky, a largely rural state beset by doctor shortages, high levels of poverty and cancer disparities.
In his previous study, he and his colleagues analyzed the radiation rates for 11,914 women who underwent lumpectomies for early breast cancer, and found the percentages who didn't get radiation were 47.5% for women 70 or older, compared with 28.9% for those under 50; 43.8% for Appalachian women, compared with 30.4 for non-Appalachian women, and 35.4% for black women, compared with 33.6% for white women.
The study found that women without private health insurance fared worse. Among uninsured women, 34.4% didn't get radiation, compared with 27.8% for those with insurance, 34.5% for those with Medicaid and 42.1% for those with Medicare.
Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness, said some people believe that breast-cancer disparities could be eliminated simply by making screenings more available.
But she said the problem is much more complicated, considering big issues with access to care, timeliness of care and quality of treatment for cancer.
She said even the issue of transportation isn't as simple as it seems. In rural areas, public transportation is often scarce.
Nesbitt said new treatment schedules such as the one Dragun is studying could help — not only by reducing the number of commutes but also by improving women's quality of life.
Dragun said if his results hold up, the new treatment regimen eventually could help all early stage breast cancer patients who need radiation because less frequent treatments would be a boon to any woman juggling work and child-rearing.
15 November 2012
New Affordable Care Act Has State Tense Over Deadline
Story first appeared in the New York Times.
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
“There has been a total blackout of information,” said State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week. “We’re behind schedule, we’re at a disadvantage, and I don’t know what our governor’s plan is to reposition Iowa.”
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
“States are struggling with many unanswered questions and are not able to make comprehensive, far-reaching decisions prudently,” Gov. Bob McDonnell of Virginia, the chairman of the association, and Gov. Bobby Jindal of Louisiana, its next chairman, wrote.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help provide Prescription Drug Assistance pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
“The election is over, and President Obama won,” Mr. Scott told The Associated Press. “If I can get to yes, I want to get to yes.”
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
“I’d much prefer control at the state level,” Mr. Walker said, “but the problem is, I don’t think they are really state-run.”
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.
The Affordable Care Act is a federal program, it’s primarily designed to give federal premium tax subsidies, and it’s all tied up in federal regulations,” said Tony Keck, director of the Department of Health and Human Services in South Carolina, which has rejected the idea of running its own exchange. “So to ask states to get involved is like asking states to run the post office. It doesn’t make sense.”
Setting up an insurance exchange is no simple task. Among other things, states have to set up a governance board, decide what kinds of health plans to offer through the exchange and build sophisticated information technology systems.
lthough many Republican governors delayed planning, some have quietly prepared. Gov. Brian Sandoval of Nevada and Gov. Susana Martinez of New Mexico have spent months laying the groundwork for exchanges; so has Mike Chaney, the Mississippi insurance commissioner.
Creating a state-based exchange will “allow us to retain some flexibility,” said Matt Kennicott, a spokesman for the New Mexico Human Services Department, and allow people there to buy insurance in an exchange “developed by New Mexicans, for New Mexicans.”
Other states, like Alaska, South Carolina, South Dakota and Texas, had already decided to let the federal government run an insurance exchange for them instead of building one themselves. A handful of additional states — Alabama, Kansas, Ohio, Wyoming and Missouri, whose governor, Jay Nixon, is a Democrat — announced this week that they, too, would opt for a federally run exchange.
But most Republican-led states are somewhere in the middle — still vexing over whether to build an exchange on their own, do it in partnership with the federal government or let the federal government do it for them. In Iowa, Mr. Branstad has been consulting with officials from his administration on how to move forward and help consumers get Prescription Savings, his spokesman said.
But their discussions have been private, and unlike some other governors, Mr. Branstad has not held public hearings or meetings to gather opinions. A coalition of health care advocacy groups circulated a list of “principles for success” for a state-run exchange and sent e-mails to Mr. Branstad’s staff in the days after the election, pleading for clarity.
The best response they got was at a health care conference in Des Moines on Tuesday, when several state officials said they were trying their best to prepare but were hampered by a lack of guidance. Asked by an audience member about “the current thought in Iowa on the health exchange,” Jennifer Vermeer, the state’s Medicaid director, paused for several long seconds before saying state officials had been “focusing our energies” on planning a partnership exchange.
Even if Iowa opts for a partnership with the federal government, it will be “without a totally clear understanding of who needs to do what,” said Charles M. Palmer, director of the state’s Department of Human Services.
Walking down a hallway during the Republican governors meeting on Wednesday, Mr. Branstad said that Iowa was working on its letter to send the administration by the Friday deadline, but that officials did not feel they had gotten all the information they needed from the federal government.
“There’s a whole lot of questions we have,” he said. “We have a whole lot of questions.”
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
“There has been a total blackout of information,” said State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week. “We’re behind schedule, we’re at a disadvantage, and I don’t know what our governor’s plan is to reposition Iowa.”
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
“States are struggling with many unanswered questions and are not able to make comprehensive, far-reaching decisions prudently,” Gov. Bob McDonnell of Virginia, the chairman of the association, and Gov. Bobby Jindal of Louisiana, its next chairman, wrote.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help provide Prescription Drug Assistance pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
“The election is over, and President Obama won,” Mr. Scott told The Associated Press. “If I can get to yes, I want to get to yes.”
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
“I’d much prefer control at the state level,” Mr. Walker said, “but the problem is, I don’t think they are really state-run.”
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.
The Affordable Care Act is a federal program, it’s primarily designed to give federal premium tax subsidies, and it’s all tied up in federal regulations,” said Tony Keck, director of the Department of Health and Human Services in South Carolina, which has rejected the idea of running its own exchange. “So to ask states to get involved is like asking states to run the post office. It doesn’t make sense.”
Setting up an insurance exchange is no simple task. Among other things, states have to set up a governance board, decide what kinds of health plans to offer through the exchange and build sophisticated information technology systems.
lthough many Republican governors delayed planning, some have quietly prepared. Gov. Brian Sandoval of Nevada and Gov. Susana Martinez of New Mexico have spent months laying the groundwork for exchanges; so has Mike Chaney, the Mississippi insurance commissioner.
Creating a state-based exchange will “allow us to retain some flexibility,” said Matt Kennicott, a spokesman for the New Mexico Human Services Department, and allow people there to buy insurance in an exchange “developed by New Mexicans, for New Mexicans.”
Other states, like Alaska, South Carolina, South Dakota and Texas, had already decided to let the federal government run an insurance exchange for them instead of building one themselves. A handful of additional states — Alabama, Kansas, Ohio, Wyoming and Missouri, whose governor, Jay Nixon, is a Democrat — announced this week that they, too, would opt for a federally run exchange.
But most Republican-led states are somewhere in the middle — still vexing over whether to build an exchange on their own, do it in partnership with the federal government or let the federal government do it for them. In Iowa, Mr. Branstad has been consulting with officials from his administration on how to move forward and help consumers get Prescription Savings, his spokesman said.
But their discussions have been private, and unlike some other governors, Mr. Branstad has not held public hearings or meetings to gather opinions. A coalition of health care advocacy groups circulated a list of “principles for success” for a state-run exchange and sent e-mails to Mr. Branstad’s staff in the days after the election, pleading for clarity.
The best response they got was at a health care conference in Des Moines on Tuesday, when several state officials said they were trying their best to prepare but were hampered by a lack of guidance. Asked by an audience member about “the current thought in Iowa on the health exchange,” Jennifer Vermeer, the state’s Medicaid director, paused for several long seconds before saying state officials had been “focusing our energies” on planning a partnership exchange.
Even if Iowa opts for a partnership with the federal government, it will be “without a totally clear understanding of who needs to do what,” said Charles M. Palmer, director of the state’s Department of Human Services.
Walking down a hallway during the Republican governors meeting on Wednesday, Mr. Branstad said that Iowa was working on its letter to send the administration by the Friday deadline, but that officials did not feel they had gotten all the information they needed from the federal government.
“There’s a whole lot of questions we have,” he said. “We have a whole lot of questions.”
02 November 2012
Tigers' Pitcher Doug Fister Appears to Avoid Concussion
story first appeared in Detroit Free Press
The line drive Tigers pitcher Doug Fister took to the head in Thursday’s World Series game certainly looked painful. But how badly was he injured?
Dr. Daniel B. Michael, a neurosurgeon and Chief of Neurotrauma at Beaumont Hospital in Royal Oak said a hit like that would obviously be painful.
Both Michael and Dr. Sadiq Haque, a sports medicine specialist at the Detroit Medical Center, watched the game on TV Thursday night. They said it didn’t appear that Fister suffered a concussion.
The line drive Tigers pitcher Doug Fister took to the head in Thursday’s World Series game certainly looked painful. But how badly was he injured?
Dr. Daniel B. Michael, a neurosurgeon and Chief of Neurotrauma at Beaumont Hospital in Royal Oak said a hit like that would obviously be painful.
Both Michael and Dr. Sadiq Haque, a sports medicine specialist at the Detroit Medical Center, watched the game on TV Thursday night. They said it didn’t appear that Fister suffered a concussion.
Michael said it it was good to see the ball hit him at a glancing blow, and the energy with which it went from his skull was a good sign, because that energy wasn't imparted to Fister's head.
Tigers Manager Jim Leyland, a pitching coach and a trainer immediately went to check on Fister. Michael noted that Fister was asked various questions, including where he was and which inning the game was in. Short term memory problems are among the symptoms of a concussion, an injury to the brain that results in a transient deficit in function.
Fister was able to answer the questions correctly. He went back in the game.
Tigers Manager Jim Leyland, a pitching coach and a trainer immediately went to check on Fister. Michael noted that Fister was asked various questions, including where he was and which inning the game was in. Short term memory problems are among the symptoms of a concussion, an injury to the brain that results in a transient deficit in function.
Fister was able to answer the questions correctly. He went back in the game.
Dr. Sadiq Haque said the impact looked serious, but the trainer would have done the appropriate evaluations to make sure it wasn't a concussion and that Fister could safely return to play.
Michael said if Fister has any memory problems, headaches or other concerning symptoms Friday, he should get checked out again, because sometimes in a moment like that the adrenaline will compensate for a mild concussion. If Doug demonstrated symptoms of a concussion within a few days of the game, he should be taken out of harm's way and watched closely. According to Michael, a head injury can be lethal even within a week or two.
Michael said he is in favor of having additional protective headgear for pitchers. He said even more protection built into the pitcher's cap could help prevent a serious head injury.
Michael said if Fister has any memory problems, headaches or other concerning symptoms Friday, he should get checked out again, because sometimes in a moment like that the adrenaline will compensate for a mild concussion. If Doug demonstrated symptoms of a concussion within a few days of the game, he should be taken out of harm's way and watched closely. According to Michael, a head injury can be lethal even within a week or two.
Michael said he is in favor of having additional protective headgear for pitchers. He said even more protection built into the pitcher's cap could help prevent a serious head injury.
01 November 2012
Hundreds of Patients Evacuated from New York Hospital for Hurricane Sandy
story first appeared on apnews.com
A backup generator failed at a New York City hospital Monday night, forcing it to move out more than 200 patients, including 20 babies from neonatal intensive care.
Dozens of ambulances lined up around the block outside New York University Tisch Hospital as doctors and nurses began the slow process of evacuation. They started with the sickest and youngest. Some were on respirators operating on battery power.
NYU Medical Dean Robert Grossman told WCBS-TV said this challenging situation is the kind of thing they drill for all the time.
Much of New York was plunged into darkness by superstorm Sandy, a monstrous hybrid system that swept across a huge swath of the East.
Most of the power outages in lower Manhattan, where Tisch is located, were due to an explosion at an electrical substation, officials at Consolidated Edison said. It wasn't clear whether flooding or flying debris caused the explosion, said John Miksad, senior vice president for electric operations at Con Edison.
Without power, there are no elevators, meaning patients - some of whom are being treated for cancer and other serious illnesses - must be carefully carried down staircases, Grossman said.
As the patients were evacuated, gusts of wind blew their blankets. Nurses and staff huddled around the patients, some holding IVs and other equipment.
Ambulances came from around the city to help transport the sick. Patients will be taken to other hospitals including Mount Sinai and the Memorial Sloan-Kettering Cancer.
A backup generator failed at a New York City hospital Monday night, forcing it to move out more than 200 patients, including 20 babies from neonatal intensive care.
Dozens of ambulances lined up around the block outside New York University Tisch Hospital as doctors and nurses began the slow process of evacuation. They started with the sickest and youngest. Some were on respirators operating on battery power.
NYU Medical Dean Robert Grossman told WCBS-TV said this challenging situation is the kind of thing they drill for all the time.
Much of New York was plunged into darkness by superstorm Sandy, a monstrous hybrid system that swept across a huge swath of the East.
Most of the power outages in lower Manhattan, where Tisch is located, were due to an explosion at an electrical substation, officials at Consolidated Edison said. It wasn't clear whether flooding or flying debris caused the explosion, said John Miksad, senior vice president for electric operations at Con Edison.
Without power, there are no elevators, meaning patients - some of whom are being treated for cancer and other serious illnesses - must be carefully carried down staircases, Grossman said.
As the patients were evacuated, gusts of wind blew their blankets. Nurses and staff huddled around the patients, some holding IVs and other equipment.
Ambulances came from around the city to help transport the sick. Patients will be taken to other hospitals including Mount Sinai and the Memorial Sloan-Kettering Cancer.
Quality of Heath Care Varies by Region According to Study
story first appeared on usatoday.com
Where you live – and where your doctors did their training – has a lot to do with whether you'll be operated on, get an infection or have other potentially risky medical tests, a report out Tuesday said.
And we're not talking about small-town vs. big-city medicine. The report by Dartmouth Medical School's Atlas Project looked closely at 23 medical centers, including many of the top-rated hospitals for clinical excellence by U.S. News and World Report and other leading hospitals affiliated with universities. New Atlas data that include nearly all the teaching hospitals in the U.S. were also released.
The study was done to help medical students decide where to do their residencies, but it also helps consumers better understand how their local hospitals differ from the norm.
Among the findings: If you're in Salt Lake City, you're twice as likely to get knee-replacement surgery than if you're in New York City. Lubbock, Texas, had the highest rate of knee replacements -- 13.2 per 1,000 Medicare beneficiaries.
Arthritis in the knee is "not a dependably progressive disorder" that nearly always requires surgery, says David Goodman, a doctor who is co-principal investigator for the Atlas Project.
The report uses new 2010 Medicare data to update previous reports on regional variations in the treatment of patients at the end of life, trends in surgical procedures and trends in quality of care as it relates to patient experience and safety.
There is an emphasis on more aggressive treatment over preventive care at some hospitals, Goodman says. The report includes a "hospital care intensity index" when it comes to treatment of people at the "end of life."
Goodman says some hospitals may have a lot of capacity in their intensive care units and not enough in primary care.
Patients at NYU Langone Medical Center were 47 times less likely to get an infection from a urinary catheter than patients at the University of Michigan Health System, for example. Mount Sinai Medical Center had the second lowest. Goodman says such infections are "largely preventable."
David Muller, dean for medical education at the Mount Sinai School of Medicine, says the population of patients a hospital treats -- that is, whether they are low income and already in poor health -- can have a lot to do with whether a patient contracts an infection and can recover fully from it. The report's rates were adjusted for age, race and gender using the U.S. Medicare population as the standard.
Muller says the Dartmouth report can be valuable for both medical students and patients, but he notes that the Atlas Project's research is sometimes practically considered a bible, but he says any measures of quality of care in hospitals, varies widely and the subject is controversial.
This list ranks 23 teaching hospitals by the Hospital Care Intensity (HCI) index, which is a measure that combines the number of days patients spent in the hospital and the average number of inpatient physician visits during the last two years of life.
Hospital (ranked by Hospital Care Intensity (HCI) index):
Patients at NYU Langone Medical Center were 47 times less likely to get an infection from a urinary catheter than patients at the University of Michigan Health System, for example. Mount Sinai Medical Center had the second lowest. Goodman says such infections are "largely preventable."
David Muller, dean for medical education at the Mount Sinai School of Medicine, says the population of patients a hospital treats -- that is, whether they are low income and already in poor health -- can have a lot to do with whether a patient contracts an infection and can recover fully from it. The report's rates were adjusted for age, race and gender using the U.S. Medicare population as the standard.
Muller says the Dartmouth report can be valuable for both medical students and patients, but he notes that the Atlas Project's research is sometimes practically considered a bible, but he says any measures of quality of care in hospitals, varies widely and the subject is controversial.
This list ranks 23 teaching hospitals by the Hospital Care Intensity (HCI) index, which is a measure that combines the number of days patients spent in the hospital and the average number of inpatient physician visits during the last two years of life.
Hospital (ranked by Hospital Care Intensity (HCI) index):
- Cedars-Sinai Medical Center 2.06
- NYU Langone Medical Center 1.73
- Mount Sinai Medical Center 1.50
- Ronald Reagan UCLA Medical Center 1.48
- New York-Presbyterian Hospital 1.37
- University of Pittsburgh Medical Center 1.28
- Northwestern Memorial Hospital 1.28
- Massachusetts General Hospital 1.19
- Cleveland Clinic 1.12
- Hospital of the Univ. of Pennsylvania 1.08
- University of Michigan Health System 1.07
- Brigham and Women's Hospital 1.06
- Johns Hopkins Hospital 1.01
- United States average 1.00
- Indiana Univ. Health (Clarian Health) 0.96
- Barnes-Jewish Hospital/Washington Univ. 0.95
- UCSF Medical Center 0.92
- Duke University Medical Center 0.87
- Vanderbilt Univ. Medical Center 0.80
- University of Washington Medical Center 0.78
- Stanford Hospital and Clinics 0.78
- St. Mary's Hospital, Mayo Clinic 0.70
- Scott & White Memorial Hospital 0.62
- University of Utah Health Care 0.62
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