The Center for Dieses Control and Prevention reports that so far this year the United States has had 118 cases of measles. This is the highest year to date total since 1996.
The CDC on Tuesday released the count for January 1 through May 20. Cases were seen in 23 states. None of the patients died, but about 40 percent were hospitalized.
The U.S. normally sees about 50 cases of measles in a year, thanks to vaccinations. About 90 percent of the cases this year were unvaccinated.
Measles is highly contagious and up to 90 percent of people exposed to an infected person get sick. The virus spreads easily through the air, and in closed rooms, infected droplets can linger for up to two hours.
31 May 2011
DRUG SHORTAGES CAUSE CONCERN
Drug shortages have always been a part of the medical world, however the problem is growing. Hospitals and care givers are concerned that the drugs they desperately need to save lives is hard to get. There are already record cases where vital treatment has been delayed while doctors wait for the drugs they need.
The number of drugs listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah's Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists.
The vast majority involve injectable medications used mostly by medical centers in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren't always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions.
It's frightening for families.
At Miami Children's Hospital, doctors had to postpone for a month the last round of chemotherapy for 14-year-old girl, because of a months-long nationwide shortage of cytarabine, a drug considered key to curing a type of leukemia.
The parent commented that she is always fearful that if her child is going so long without chemo, that there may be a chance her cancer's going to come back. The mother says she'll be nervous until her daughter finishes her final treatments scheduled for this week. She can’t believe that in this day and age, we really shouldn't be having this kind of problem and putting children's lives at risk.
There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades.
Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble, or decides to quit making a particular drug, there are few others able to ramp up their own production to fill the gap.
The shortage that's made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:
-Thiotepa, used with bone marrow transplants.
-A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.
-Norepinephrine injections for septic shock.
-A cystic fibrosis drug named acetylcysteine.
-Injections used in the ER for certain types of cardiac arrest.
-Certain versions of pills for ADHD, attention deficit hyperactivity disorder.
-Some leuprolide hormone injections used in fertility treatment.
No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage.
Every pharmacist in every hospital across the country is working to make sure those things don't happen, but shortages create the perfect storm for a medication error to happen
What can be done?
The FDA has taken an unusual step, asking some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren't normally sold here. That eased shortages of propofol, a key anesthesia drug, and the transplant drug thiotepa.
Affected companies say they're working hard to eliminate backlogs. For instance, Hospira Inc., the largest maker of those injectable drugs, says it is increasing production capacity and working with FDA to address shortage situations as quickly as possible and to help prevent recurrence.
But the Generic Pharmaceutical Association says some shortages are beyond industry control, such as FDA inspections or stockpiling that can exacerbate a shortage.
Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders
Lawmakers are getting involved. Senator Herb Kohl of Wisconsin is urging the Federal Trade Commission to consider if any pending drug-company mergers would create or exacerbate shortages.
Also, pending legislation would require manufacturers to give FDA advance notice of problems such as manufacturing delays that might trigger a shortage. The FDA cannot force a company to make a drug, but was able to prevent 38 close calls from turning into shortages last year by speeding approval of manufacturing changes or urging competing companies to get ready to meet a shortfall.
With all things considered, everyone and every company is out to provide the best drugs as needed so as to not put anyone’s life at risk. If a drug shortage is foretasted steps are being taken, and have successfully been taken, to prevent the worst from happening.
The number of drugs listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah's Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists.
The vast majority involve injectable medications used mostly by medical centers in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren't always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions.
It's frightening for families.
At Miami Children's Hospital, doctors had to postpone for a month the last round of chemotherapy for 14-year-old girl, because of a months-long nationwide shortage of cytarabine, a drug considered key to curing a type of leukemia.
The parent commented that she is always fearful that if her child is going so long without chemo, that there may be a chance her cancer's going to come back. The mother says she'll be nervous until her daughter finishes her final treatments scheduled for this week. She can’t believe that in this day and age, we really shouldn't be having this kind of problem and putting children's lives at risk.
There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades.
Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble, or decides to quit making a particular drug, there are few others able to ramp up their own production to fill the gap.
The shortage that's made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:
-Thiotepa, used with bone marrow transplants.
-A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.
-Norepinephrine injections for septic shock.
-A cystic fibrosis drug named acetylcysteine.
-Injections used in the ER for certain types of cardiac arrest.
-Certain versions of pills for ADHD, attention deficit hyperactivity disorder.
-Some leuprolide hormone injections used in fertility treatment.
No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage.
Every pharmacist in every hospital across the country is working to make sure those things don't happen, but shortages create the perfect storm for a medication error to happen
What can be done?
The FDA has taken an unusual step, asking some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren't normally sold here. That eased shortages of propofol, a key anesthesia drug, and the transplant drug thiotepa.
Affected companies say they're working hard to eliminate backlogs. For instance, Hospira Inc., the largest maker of those injectable drugs, says it is increasing production capacity and working with FDA to address shortage situations as quickly as possible and to help prevent recurrence.
But the Generic Pharmaceutical Association says some shortages are beyond industry control, such as FDA inspections or stockpiling that can exacerbate a shortage.
Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders
Lawmakers are getting involved. Senator Herb Kohl of Wisconsin is urging the Federal Trade Commission to consider if any pending drug-company mergers would create or exacerbate shortages.
Also, pending legislation would require manufacturers to give FDA advance notice of problems such as manufacturing delays that might trigger a shortage. The FDA cannot force a company to make a drug, but was able to prevent 38 close calls from turning into shortages last year by speeding approval of manufacturing changes or urging competing companies to get ready to meet a shortfall.
With all things considered, everyone and every company is out to provide the best drugs as needed so as to not put anyone’s life at risk. If a drug shortage is foretasted steps are being taken, and have successfully been taken, to prevent the worst from happening.
HEALTH FRAUD COULD HIT THE CEO’S POCKETBOOK AS WELL AS THE COMPANY
In the past large corporations were targeted in health care fraud cases. Now, the executives at these corporations are being sought out with their personal reputation and futures on the line. A Michigan Medical Malpractice Lawyer states that this can be a hard pill to swallow for executives.
The new tactic is raising the anxiety level and risks for corporate honchos at drug companies, medical device manufacturers, nursing home chains and other major health care enterprises that deal with Medicare and Medicaid.
Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.
Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career ending consequence.
Many in industry see the more aggressive strategy as government overkill, meting out radical punishment to individuals whose guilt prosecutors would be hard pressed to prove to a jury.
The feds say they got frustrated with repeat violations and decided to start using enforcement tools that were already on the books but had been allowed to languish. By some estimates, health care fraud costs taxpayers $60 billion a year, galling when Medicare faces insolvency.
When you look at the history of health care enforcement, there has been a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy.
The inspector general of the Health and Human Services Department stated that he feels that those in high ranking positions at these companies are not getting that what is happing is wrong. If writing a check for $200 million isn't enough to have a company change its ways, then maybe the individuals who are responsible for this be held accountable. The behavior of a company starts at the top.
Lawyers who represent drug companies say the change has definitely caused a stir, but the end result is far from certain. People are alarmed, and want to know what facts and circumstances would cause the Justice Department to indict someone who hadn't even known about the misconduct. The drug companies claim they are doing all they can to achieve compliance.
Others say high-powered corporate targets won't go meekly. If the government does continue to press its campaign against individuals, we may see the limits of the government's theories tested. There is a very important open question as to whether individuals can be held criminally culpable or lose their jobs simply by virtue of their status.
Although the Obama administration has increased scrutiny of corporate America generally, this shift in health care enforcement seems to have come up from the ranks, government and corporate attorneys say.
Investigators and lawyers at the HHS inspector general's office, the Justice Department and the Food and Drug Administration started moving more or less independently toward holding executives accountable. Morris outlined the inspector general's position in congressional testimony this spring, saying his office will use its power judiciously.
A test case is playing out with an 83-year-old drug company chief executive, Howard Solomon of New York City-based Forest Laboratories. Forest makes antidepressants, blood pressure drugs and other medications. Last month, the inspector general's office notified Forest that Solomon could potentially be banned from doing business with federal programs.
The power to ban or exclude an individual rests with the inspector general. It's routinely applied to low-level violators, but rarely to people of Solomon's rank. In the industry, they call it the "death penalty."
Last year, a Forest subsidiary pleaded guilty to criminal charges as part of a settlement with the Justice Department in which the company also agreed to pay $313 million to resolve long-running investigations. Prosecutors charged that Forest deliberately ignored an FDA warning to stop distributing an unapproved thyroid drug, promoted the use of an antidepressant in treating children although it was only approved for adults and misled FDA inspectors making a quality check at a manufacturing plant.
The company said it had considered the case closed. But then came the inspector general's letter.
A statement release said no one has ever alleged that Mr. Solomon has done anything wrong and excluding him would be completely unjustified. In prior cases where a senior executive has been excluded, that individual has been accused of wrongdoing and ultimately has either been convicted of or pleaded guilty to a crime.
Forest is fighting the move to ban Solomon. The inspector general's office refused to comment on the case, and no final decision has been made. In congressional testimony, it was said that when there is evidence an executive knew or should have known about misconduct, the inspector general "will operate with a presumption in favor of exclusion of that executive."
Separate from the inspector general's power to ban, the FDA has resurrected something called the "Park Doctrine," which makes it easier for prosecutors to bring criminal charges against an executive.
The doctrine, stemming from a 1970s Supreme Court case, allows the government to charge corporate officers in the chain of command with a criminal misdemeanor. They could face up to a year in prison and fines if they had the authority and responsibility to prevent, detect or resolve misconduct affecting the public welfare but failed to do so.
Although many details concerning the laws are still being discussed, the progress may already be making an impact on the industry. CEO’s and executives may think twice before making a questionable decision. Some companies already in fear of repercussions have changed their ways and began compliance.
The new tactic is raising the anxiety level and risks for corporate honchos at drug companies, medical device manufacturers, nursing home chains and other major health care enterprises that deal with Medicare and Medicaid.
Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.
Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career ending consequence.
Many in industry see the more aggressive strategy as government overkill, meting out radical punishment to individuals whose guilt prosecutors would be hard pressed to prove to a jury.
The feds say they got frustrated with repeat violations and decided to start using enforcement tools that were already on the books but had been allowed to languish. By some estimates, health care fraud costs taxpayers $60 billion a year, galling when Medicare faces insolvency.
When you look at the history of health care enforcement, there has been a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy.
The inspector general of the Health and Human Services Department stated that he feels that those in high ranking positions at these companies are not getting that what is happing is wrong. If writing a check for $200 million isn't enough to have a company change its ways, then maybe the individuals who are responsible for this be held accountable. The behavior of a company starts at the top.
Lawyers who represent drug companies say the change has definitely caused a stir, but the end result is far from certain. People are alarmed, and want to know what facts and circumstances would cause the Justice Department to indict someone who hadn't even known about the misconduct. The drug companies claim they are doing all they can to achieve compliance.
Others say high-powered corporate targets won't go meekly. If the government does continue to press its campaign against individuals, we may see the limits of the government's theories tested. There is a very important open question as to whether individuals can be held criminally culpable or lose their jobs simply by virtue of their status.
Although the Obama administration has increased scrutiny of corporate America generally, this shift in health care enforcement seems to have come up from the ranks, government and corporate attorneys say.
Investigators and lawyers at the HHS inspector general's office, the Justice Department and the Food and Drug Administration started moving more or less independently toward holding executives accountable. Morris outlined the inspector general's position in congressional testimony this spring, saying his office will use its power judiciously.
A test case is playing out with an 83-year-old drug company chief executive, Howard Solomon of New York City-based Forest Laboratories. Forest makes antidepressants, blood pressure drugs and other medications. Last month, the inspector general's office notified Forest that Solomon could potentially be banned from doing business with federal programs.
The power to ban or exclude an individual rests with the inspector general. It's routinely applied to low-level violators, but rarely to people of Solomon's rank. In the industry, they call it the "death penalty."
Last year, a Forest subsidiary pleaded guilty to criminal charges as part of a settlement with the Justice Department in which the company also agreed to pay $313 million to resolve long-running investigations. Prosecutors charged that Forest deliberately ignored an FDA warning to stop distributing an unapproved thyroid drug, promoted the use of an antidepressant in treating children although it was only approved for adults and misled FDA inspectors making a quality check at a manufacturing plant.
The company said it had considered the case closed. But then came the inspector general's letter.
A statement release said no one has ever alleged that Mr. Solomon has done anything wrong and excluding him would be completely unjustified. In prior cases where a senior executive has been excluded, that individual has been accused of wrongdoing and ultimately has either been convicted of or pleaded guilty to a crime.
Forest is fighting the move to ban Solomon. The inspector general's office refused to comment on the case, and no final decision has been made. In congressional testimony, it was said that when there is evidence an executive knew or should have known about misconduct, the inspector general "will operate with a presumption in favor of exclusion of that executive."
Separate from the inspector general's power to ban, the FDA has resurrected something called the "Park Doctrine," which makes it easier for prosecutors to bring criminal charges against an executive.
The doctrine, stemming from a 1970s Supreme Court case, allows the government to charge corporate officers in the chain of command with a criminal misdemeanor. They could face up to a year in prison and fines if they had the authority and responsibility to prevent, detect or resolve misconduct affecting the public welfare but failed to do so.
Although many details concerning the laws are still being discussed, the progress may already be making an impact on the industry. CEO’s and executives may think twice before making a questionable decision. Some companies already in fear of repercussions have changed their ways and began compliance.
24 May 2011
DMC ASKS FOR FEDERAL AID
The Detroit Medical Center was among one of the first hospitals nationally to apply for federal incentive dollars. The money, if received will go towards paying for an expensive Michigan emr system, also known as electronic medical records.
The Detroit Medical Center said they have sent proof to the Centers for Medicare & Medicaid Services (CMS) that they have achieved "meaningful use" of several electronic health record objectives that qualifies them for the aid.
The DMC will get an estimated $16 million to $17 million this year, helping to cover some of the $35 million it spent in 2006 and 2007 to upgrade its computerized physician order entry and nursing documentation systems. The DMC expects to receive a total of $40 million in incentives.
The federal funding is aimed at expediting the conversion of paper medical records to electronic systems that can move with patients, which experts say could drive down health care costs.
Many hospitals nationwide haven't installed much electronic record technology and are looking for meaningful use consultation. About 1.6 percent of hospitals surveyed in January by the American Hospital Association said they meet "meaningful use" requirements and have certified electronic health record technology.
The DMC is ahead of some competitors in using electronic record systems. The DMC hospitals are rated six out of seven for using the technology by the Healthcare Information Management Systems (a seven is paperless).
Hospitals will use the federal money, made available through 2009's American Recovery and Reinvestment Act, to help pay for the transition from paper records to electronic systems that cost some health systems upwards of $100 million to deploy. Physicians also can apply for funding through CMS, which began taking applications in the middle of April.
Electronic medical records help reduce medical errors and lower health care costs by reducing duplication of tests and unnecessary procedures, eliminate transcription costs and can reduce a patient's stay. Electronic records also help assure patients that there won't be problems misreading handwriting or paperwork being lost or unseen.
CMS hasn't made any incentive payments yet to hospitals nationwide, but expects before the end of May to release information on incentive payments.
The state of Michigan has yet to issue any Medicaid incentive payments to the 13 hospitals that have applied because it is reviewing paperwork.
Medicare's first phase required compliance with 15 core measures and five of 10 other objectives. Goals included having at least 30 percent of patients get a computerized order entry for medications. Hospitals that don't achieve CMS goals by 2015 will be subject to significant financial penalties by Medicare.
Some Detroit hospital systems such as the University of Michigan Health System are working to upgrade electronic medical record systems before they apply. U-M has a more than $100 million upgrade under way, while Dearborn-based Oakwood Healthcare Inc. also is spending $60 million on a new system and plans to apply for its first incentive in 2013.
Botsford Hospital in Farmington Hills will apply for the Medicare incentive early next year after it deploys an $8 million electronic medical record system hospital wide this fall.
Other area hospital systems say they plan to apply for incentives later, including the Henry Ford Health System and St. John Providence Health System. Novi-based Trinity Health, which owns the Saint Joseph Mercy Health System in southeast Michigan, plans in July to apply for incentives at 20 sites, including hospitals in the Saint Joseph system.
The federal aid would definitely keep the DMC and other Michigan hospitals moving forward to inprove customer service, satisfaction, and care all while streamlining internal systems and saving a considerable amount of time and money.
INCREASE IN SURGERIES FOR BABY BOOMERS
Baby boomers are more active than past generations at this age. This activity has put extra strain on hips, knees, and shoulder joints, causing many to look into joint replacement surgery such as hip arthroscopy.
Those receiving a knee replacement surgery has doubled over the last decade and more than tripled in the 45-to-64 age group, new research shows. Hips are trending that way, too.
In the past replacement surgeries had a lot to do with obesity. Ironically, trying to stay fit and avoid extra pounds is taking a toll on a generation that expects bad joints can be replaced routinely.
Joint replacements have enabled millions of people to lead better lives by reducing joint pain, and surgeons are increasingly offering them to younger people. The problem is that no one really knows how well these implants will perform in the active baby boomers getting them now. Most studies were done on older people whose expectations were to be able to go watch a grandchild's soccer game - not play the sport themselves.
A 55-year-old retiree in San Diego plans to have a hip replacement surgery in September. She can't exercise the way she wants to. She has to go slow, which she finds really aggravating. She claims she is not worried about how she is going to feel when she is 75.
Being active is viewed as the closest thing to the fountain of youth, however, most people need to modify their exercise habits because they're overdoing one sport, not stretching, or doing something else that puts their joints at risk.
Experts recommend:
Cross training. Multiple activities prevent overuse.
Balance your routines to build strength, flexibility, core muscles and cardiovascular health.
Lose weight. Every extra pound you carry registers as 5 extra pounds on your knees.
Spend more time warming up.
Let muscles and joints recover, and rest between workouts.
If you've had a joint replacement, take part in the rehabilitation services that's recommended.
01 April 2011
Accountable Care Act Causes Doctors To Be Concerned
It has been a year since the Accountable Care Act was adopted. Many are out crying over the lack of control on the act. Never before has a president needed to go around the country to defend and sell a bill that he signed into law. America has been subjected to a law that over 1000 groups, representing 2.4 million people has been exempted from because they discovered that they could not afford the increased costs associated with it. This is before the law has even gone into effect. The bitter irony is that many of these groups who have received waivers were the most vocal proponents for this law, including the SEIU. This is cronyism at its worst and just a taste of things to come when the Federal Government, under the watchful eye of the Secretary of HHS decides what treatments doctors may deliver to their patients.
Physicians are already beginning to see the profoundly adverse effects of the Accountable Care Act (ACA) on them and their patients.
This year, the Medicare SGR (sustainable growth rate), which required a 23% reduction in physician reimbursement, was postponed 5 times. The final reprieve, resulted in Congress moving forward until January 2012, when the reduction becomes 29%. Meanwhile, the new Medicare fee schedule goes into effect in October, with across the board cuts of approximately 7%. During 2011, CMS (Centers for Medicare and Medicaid) withheld payments to physicians on two occasions, for as long as 45 days. This presented tremendous hardships for doctors whose practices are largely made up of patients on Medicare and where these payments represent a large portion of their income.
Many doctors needed to take personal loans to meet payroll. Many doctors did not take home a paycheck even though they had provided services. Some doctors needed to down size, which meant layoffs of employees, and still others needed to close their practices. And thousands of doctors, who have been caring for Medicare patients for over 40 years, simply had enough and either stopped taking new Medicare patients or left the Medicare system entirely. Any business needs to have some degree of predictability in order to survive, and Medicare has become too unpredictable to base future decisions upon.
The losers are not so much the doctors as are the seniors. They have paid into a system during their working lives, and now many struggle to find a doctor. With $500 billion slated to be cut away from Medicare, the benefits that seniors will receive will diminish as well.
The care that these seniors and others receive will not be as good as the care that patients currently get. One reason is that the ACA makes it easier for non- physicians to deliver healthcare. The new law emphasizes the concept of “medical homes”, which will be the gatekeeper in future healthcare delivery models. Nurse practitioners and physician assistants are elevated to physician status by virtue of this law. It is the attempt on the part of the federal government to convince the public that there is equivalency between all healthcare providers. It is the beginning of the attempt on the part of the government to condition the public for a lower standard of healthcare because they are not doctors; they are physician extenders.
Unfortunately effects are being seen around the country. Clinical psychologists in California are being giving hospital admitting and prescription writing privileges, optometrists in some states are given eye surgery privileges, including laser surgery privileges in Oklahoma, and nurse anesthetists are designated as equals to board certified anesthesiologists. Pharmacists are lobbying for the ability to change prescriptions written by physicians not to generics, but to entirely different drugs, if they think that it is warranted. And nurse practitioners are now able to do an extra year of training and come out with a doctorate degree in nurse practice, so that they can call themselves “doctor” as they populate primary care clinics and medical homes.
The HITECH Act which was actually in the Stimulus Bill of 2009, was essentially activated by passage of ACA, so that now, all doctors who wish to receive the highest levels of reimbursement for the services that they will have already provided, will need to have a health information system in place that meets federal standards. This is not an entirely bad concept, were it not for the fact that the systems currently available are not yet ready to accomplish the integration of clinical information between doctors, hospitals, pharmacies and other sectors of the healthcare spectrum.
The systems are pricey, and the costs cannot be passed along, so doctors have to assume them all themselves. Consequently, less money will be available to spend on patients whether that means fewer personnel in doctors’ offices to care for them or less sophisticated tools available for the doctors. The systems that doctors are being forced to adopt will soon be surpassed by better systems that will be developed that can do what we expect from them, and then doctors will have to incur the costs to retool their offices once again. The problem is that when the technology is developed, every doctor will want to adopt it and not before, just because it has been decreed. The money that is supposedly available to doctors who implement these systems and who demonstrate “meaningful use” will barely cover the incurred costs, assuming that there is money available to begin with.
The government and insurance companies are looking for alternative healthcare delivery models and the ACA supports one such model- the Accountable Care Organization (ACO). This organization is intended to be a vertically integrated healthcare delivery system consisting of physicians of all specialties working together, by following clinical protocols and best practice models, so that care can be coordinated and waste can be eliminated, while delivering improved care. This medical utopia would work with the hospitals as partners, but what is instead happening around the country is that hospitals are buying up physician practices at a record pace so that they can control as many patients as possible and hence control the medical market in their community.
The physicians in this HMO are employees and they then have to choose between doing what is right for their patients and what their employers instruct them to do. This is already happening in hospitals across the country, but will escalate as more physicians, especially specialists, leave private practice because they fear that their practices will have no value if the hospitals control the flow of patients to them.
Besides encouraging the formation of ASOs, the ACA has other provisions which are aimed directly at doctors, in an attempt to destroy the private practice of medicine; a necessary first step to get to a single payer, government run healthcare system. Working with a willing accomplice, the American Hospital Association (AHA), provisions were put into the ACA that eliminates future physician owned hospitals and surgery centers, imaging centers and laboratories. The exemptions to these ventures occur when they are connected to and are a part of the physicians’ direct practice, but these exemptions are being challenged as well. The AHA is a very powerful lobby and as we have come to see, doctors have no effective lobbying group and are easy targets for every group that wants to push us around.
Finally, the worst part of the ACA lies in the limitless power granted to the Secretary of HHS when it comes to healthcare matters. The Secretary determines what the clinical protocols are which doctors must follow if they wish to see patients who have insurance that is offered through the healthcare exchange. According to the ACA, there will be no insurance offered outside of the exchange. So if you want to see insured patients, you must follow the protocols approved by the HHS Secretary.
Unfortunately, the board appointed by Obama call the Federal Coordinating Council for Comparative Effectiveness, does not have any Congressional management. This board will decide the treatment that doctors will be allowed or not allowed to do.
Physicians are already beginning to see the profoundly adverse effects of the Accountable Care Act (ACA) on them and their patients.
This year, the Medicare SGR (sustainable growth rate), which required a 23% reduction in physician reimbursement, was postponed 5 times. The final reprieve, resulted in Congress moving forward until January 2012, when the reduction becomes 29%. Meanwhile, the new Medicare fee schedule goes into effect in October, with across the board cuts of approximately 7%. During 2011, CMS (Centers for Medicare and Medicaid) withheld payments to physicians on two occasions, for as long as 45 days. This presented tremendous hardships for doctors whose practices are largely made up of patients on Medicare and where these payments represent a large portion of their income.
Many doctors needed to take personal loans to meet payroll. Many doctors did not take home a paycheck even though they had provided services. Some doctors needed to down size, which meant layoffs of employees, and still others needed to close their practices. And thousands of doctors, who have been caring for Medicare patients for over 40 years, simply had enough and either stopped taking new Medicare patients or left the Medicare system entirely. Any business needs to have some degree of predictability in order to survive, and Medicare has become too unpredictable to base future decisions upon.
The losers are not so much the doctors as are the seniors. They have paid into a system during their working lives, and now many struggle to find a doctor. With $500 billion slated to be cut away from Medicare, the benefits that seniors will receive will diminish as well.
The care that these seniors and others receive will not be as good as the care that patients currently get. One reason is that the ACA makes it easier for non- physicians to deliver healthcare. The new law emphasizes the concept of “medical homes”, which will be the gatekeeper in future healthcare delivery models. Nurse practitioners and physician assistants are elevated to physician status by virtue of this law. It is the attempt on the part of the federal government to convince the public that there is equivalency between all healthcare providers. It is the beginning of the attempt on the part of the government to condition the public for a lower standard of healthcare because they are not doctors; they are physician extenders.
Unfortunately effects are being seen around the country. Clinical psychologists in California are being giving hospital admitting and prescription writing privileges, optometrists in some states are given eye surgery privileges, including laser surgery privileges in Oklahoma, and nurse anesthetists are designated as equals to board certified anesthesiologists. Pharmacists are lobbying for the ability to change prescriptions written by physicians not to generics, but to entirely different drugs, if they think that it is warranted. And nurse practitioners are now able to do an extra year of training and come out with a doctorate degree in nurse practice, so that they can call themselves “doctor” as they populate primary care clinics and medical homes.
The HITECH Act which was actually in the Stimulus Bill of 2009, was essentially activated by passage of ACA, so that now, all doctors who wish to receive the highest levels of reimbursement for the services that they will have already provided, will need to have a health information system in place that meets federal standards. This is not an entirely bad concept, were it not for the fact that the systems currently available are not yet ready to accomplish the integration of clinical information between doctors, hospitals, pharmacies and other sectors of the healthcare spectrum.
The systems are pricey, and the costs cannot be passed along, so doctors have to assume them all themselves. Consequently, less money will be available to spend on patients whether that means fewer personnel in doctors’ offices to care for them or less sophisticated tools available for the doctors. The systems that doctors are being forced to adopt will soon be surpassed by better systems that will be developed that can do what we expect from them, and then doctors will have to incur the costs to retool their offices once again. The problem is that when the technology is developed, every doctor will want to adopt it and not before, just because it has been decreed. The money that is supposedly available to doctors who implement these systems and who demonstrate “meaningful use” will barely cover the incurred costs, assuming that there is money available to begin with.
The government and insurance companies are looking for alternative healthcare delivery models and the ACA supports one such model- the Accountable Care Organization (ACO). This organization is intended to be a vertically integrated healthcare delivery system consisting of physicians of all specialties working together, by following clinical protocols and best practice models, so that care can be coordinated and waste can be eliminated, while delivering improved care. This medical utopia would work with the hospitals as partners, but what is instead happening around the country is that hospitals are buying up physician practices at a record pace so that they can control as many patients as possible and hence control the medical market in their community.
The physicians in this HMO are employees and they then have to choose between doing what is right for their patients and what their employers instruct them to do. This is already happening in hospitals across the country, but will escalate as more physicians, especially specialists, leave private practice because they fear that their practices will have no value if the hospitals control the flow of patients to them.
Besides encouraging the formation of ASOs, the ACA has other provisions which are aimed directly at doctors, in an attempt to destroy the private practice of medicine; a necessary first step to get to a single payer, government run healthcare system. Working with a willing accomplice, the American Hospital Association (AHA), provisions were put into the ACA that eliminates future physician owned hospitals and surgery centers, imaging centers and laboratories. The exemptions to these ventures occur when they are connected to and are a part of the physicians’ direct practice, but these exemptions are being challenged as well. The AHA is a very powerful lobby and as we have come to see, doctors have no effective lobbying group and are easy targets for every group that wants to push us around.
Finally, the worst part of the ACA lies in the limitless power granted to the Secretary of HHS when it comes to healthcare matters. The Secretary determines what the clinical protocols are which doctors must follow if they wish to see patients who have insurance that is offered through the healthcare exchange. According to the ACA, there will be no insurance offered outside of the exchange. So if you want to see insured patients, you must follow the protocols approved by the HHS Secretary.
Unfortunately, the board appointed by Obama call the Federal Coordinating Council for Comparative Effectiveness, does not have any Congressional management. This board will decide the treatment that doctors will be allowed or not allowed to do.
GREECE HAS MORE PROBLEMS WITH SPENDING CUTS
Greece has had its share of financial woes. Less than a year ago it was close to bankruptcy but was able to make it by with loans from other European countries and the International Monetary Fund. Now, in an effort to cut costs they have hit the nerve of teachers and doctors.
State school teachers and hospital doctors in debt-ridden Greece have walked off the job to protest planned education and health spending cuts.
Doctors in the social security fund system were also on strike for the second day Wednesday, demanding that their fixed-term contracts be made permanent.
Health and education unions are planning demonstrations in central Athens to protest planned school and hospital mergers.
This is not the first time the government cutbacks have caused strikes and protests. Whenever cuts are made that effect peoples livelihoods, there is anticipation that there will be push-backs.
State school teachers and hospital doctors in debt-ridden Greece have walked off the job to protest planned education and health spending cuts.
Doctors in the social security fund system were also on strike for the second day Wednesday, demanding that their fixed-term contracts be made permanent.
Health and education unions are planning demonstrations in central Athens to protest planned school and hospital mergers.
This is not the first time the government cutbacks have caused strikes and protests. Whenever cuts are made that effect peoples livelihoods, there is anticipation that there will be push-backs.
15 March 2011
Advances Made With Cancer Infertility
New Hope For Men Deemed Sterile Due to Childhood Cancer Treatments
New research shows a painstaking surgical technique can help some men deemed infertile because of childhood cancer treatment to become fathers after all.
Many of the cancer treatments that can save lives also leave survivors infertile. Young men can bank sperm if they're told in time, but many aren't. And experiments to find options for children diagnosed before puberty are only now beginning.
Researchers at New York-Presbyterian Hospital and Weill Cornell Medical Center pioneered an option a decade ago for men deemed sterile for a number of reasons.
Now they have long-term data showing the technique can work in some childhood cancer survivors whose only other options would have been adoption or using donor sperm.
Surgeons essentially perform tiny biopsies of testicular tissue to hunt any pockets of hidden sperm, which then are used in standard in vitro fertilization to attempt a partner's pregnancy.
In cancer survivors, they were able to extract small amounts of sperm from more than a third of the men - 27 of 73. Doctors then attempted injecting the sperm into a partner's eggs in hopes of pregnancy. The result: 20 children were born, including five pairs of twins, the researchers reported Monday in the Journal of Clinical Oncology.
Being able to find what are essentially stray sperm cells is dramatic but doesn't mean the technique will help everyone.
The new study found that the best chance for sperm retrieval was among men who'd been treated for testicular cancer, while survivors of sarcoma had the lowest chance. That's because of varying treatments for different types of cancer.
Sperm is made in tiny tubes inside the testicles, which can be seen under an operating-room microscope. Flat tubes probably contain no sperm, while larger ones are removed to see if they do.
The surgery costs about $10,000 to $12,000, in addition to the costs of IVF, he said. It's already offered at various medical centers around the country.
03 March 2011
Compensation for BCBS CEO jumped to $2.75 million in 2010
Blue Cross Blue Shield CEO of Michigan operations, Dan Loepp, earned a total of $2.75 million in compensation for 2010, according to the BCBS' financial report, filed with the state Office of Financial and Insurance Regulation. His earnings marked an increase of 56 percent from $1.76 million in 2009.
Those figures, however, are on the deceptive side because Loepp, along with other senior executives of the company, took a 5% base pay cut in 2009. The CEO also voluntarily reduced his performance-based compensation by $340,000, said vice president of corporate communications Andy Hetzel.
"It looks like a $1 million increase, but he really got a $660,000" pay increase after the 2009 reductions, Hetzel added.
Loepp's total compensation in 2010 includes his base salary of $1.27 million and performance incentives totaling $1.27 million. The value of Loepp's non-cash earnings amounted to roughly $207,000, which includes life and automobile insurance benefits.
Compared to other BCBS plan CEOs, Loepp's compensation ranked at the lower end, Hetzel said. When viewed from a per-member perspective, his total compensation was in fact the second-lowest. On total compensation, Loepp ranked 18th highest on the list of CEOs, added Hetzel.
The insurance giant also reported its financials to OFIR based on statutory accounting principles (SAP).
In 2010, BCBS claimed to have earned $205.3 million in net income for 2010. In 2009, its net income was $12.6 million.
The accounting methods of SAP differ from that of GAAP or "generally accepted accounting principles," which was the financial statement the provider reported earlier in the week.
A primary reason SAP and GAAP figures are different is that OFIR is mostly interested in BCBS' insured business, which includes sales from HMO (health maintenance organization) and (PPO) preferred provider organization products. An overwhelming majority of the Blue's business stems from large, self-insured employer accounts.
For example, BCBS specializes in offering insurance packages for broad scope of employers, such as Detroit doctors and their staff members, large commercial manufacturing and production companies, and even vehicle logistics providers that offer express services for freight, automobile transport, and highly complex car shipping.
As a result, the total revenue in 2010 for BCBS was $6.57 billion, compared with $6.98 billion the previous year, according to SAP reporting. When company factors in its self-insured market based on GAAP financial reporting, its revenue plummeted to $19.2 billion in 2010, 11 percent lower than the $21.6 billion in 2009.
Those figures, however, are on the deceptive side because Loepp, along with other senior executives of the company, took a 5% base pay cut in 2009. The CEO also voluntarily reduced his performance-based compensation by $340,000, said vice president of corporate communications Andy Hetzel.
"It looks like a $1 million increase, but he really got a $660,000" pay increase after the 2009 reductions, Hetzel added.
Loepp's total compensation in 2010 includes his base salary of $1.27 million and performance incentives totaling $1.27 million. The value of Loepp's non-cash earnings amounted to roughly $207,000, which includes life and automobile insurance benefits.
Compared to other BCBS plan CEOs, Loepp's compensation ranked at the lower end, Hetzel said. When viewed from a per-member perspective, his total compensation was in fact the second-lowest. On total compensation, Loepp ranked 18th highest on the list of CEOs, added Hetzel.
The insurance giant also reported its financials to OFIR based on statutory accounting principles (SAP).
In 2010, BCBS claimed to have earned $205.3 million in net income for 2010. In 2009, its net income was $12.6 million.
The accounting methods of SAP differ from that of GAAP or "generally accepted accounting principles," which was the financial statement the provider reported earlier in the week.
A primary reason SAP and GAAP figures are different is that OFIR is mostly interested in BCBS' insured business, which includes sales from HMO (health maintenance organization) and (PPO) preferred provider organization products. An overwhelming majority of the Blue's business stems from large, self-insured employer accounts.
For example, BCBS specializes in offering insurance packages for broad scope of employers, such as Detroit doctors and their staff members, large commercial manufacturing and production companies, and even vehicle logistics providers that offer express services for freight, automobile transport, and highly complex car shipping.
As a result, the total revenue in 2010 for BCBS was $6.57 billion, compared with $6.98 billion the previous year, according to SAP reporting. When company factors in its self-insured market based on GAAP financial reporting, its revenue plummeted to $19.2 billion in 2010, 11 percent lower than the $21.6 billion in 2009.
11 November 2010
Study: Obesity Rates to reach 42 Percent
Reuters
Americans will keep growing fatter until 42 percent of the nation is considered obese, and having fat friends is part of the problem, researchers said on Thursday.
The prediction by a team of researchers at Harvard University contradicts other experts who say the nation's obesity rate has peaked at 34 percent of the U.S. population.
The finding is from the same group, led by Nicholas Christakis, that reported in 2007 that if someone's friend becomes obese, that person's chances of becoming obese increase by more than half.
They now think this same phenomenon is driving the obesity epidemic, which will climb slowly but steadily for the next 40 years.
Alison Hill, a graduate student at Harvard and the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, said the study is based on the idea that obesity can spread like an infectious disease and people can catch it from their friends.
For the study, she and colleagues applied a mathematical model to four decades of data from the long-running Framingham study -- a study of the health and habits of nearly an entire town in Massachusetts.
"We looked at the probability of becoming obese and what that was influenced by," Hill said in a telephone interview.
"We found there is some baseline risk of becoming obese based on the friends you have," Hill said.
Hill said that based on their calculations and looking at the influence of social interactions on obesity in the Framingham study, they think the U.S. obesity rates will top out at 42 percent of the population.
Over the long-running study, the rate of weight gain caused by social interaction -- a person's contact with friends who are obese -- has grown quite rapidly since 1971, Hill said.
"It looks like obesity is becoming more infectious," said Hill. The findings are reported in the Public Library of Science journal PLoS Computational Biology.
MULTIPLE SOCIAL CONTACTS
In the study, the team found that an American adult has a 2 percent chance of becoming obese in any given year, and each obese social contact increases the risk of becoming obese by 0.5 percent per year.
And while having fat friends increases the odds that you will become fat, befriending thin people does not appear to help you lose weight.
"We didn't find having more healthy-weight friends made it more likely to help people lose weight. It fits in with this idea of thinking about it as an infectious disease. You don't really catch healthiness," she said.
Hill said the findings are the best-case scenario based on current assumptions, but changes in public policy could make a difference.
U.S. government researchers in January said 68 percent of U.S. adults are considered overweight, having a body mass index or BMI of 25 or higher, and a third are obese, having a body mass index of 30 or higher.
BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall is classified as overweight at 150 pounds (68 kg) and obese at 180 pounds (82 kg).
Being overweight or obese raises the risk of heart disease, diabetes, some cancers, arthritis and other conditions.
Obesity-related diseases account for nearly 10 percent of medical spending in the United States or an estimated $147 billion a year.
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