Story originally appeared on CNBC.
Health-care fraud costs taxpayers billions of dollars every year, with con artists constantly finding new ways to cheat the system. And while federal investigators report they are trying their best to crack down on crime, one scheme involving pharmacies and Medicaid is growing so quickly they said they can't work fast enough to keep up.
Here's how the scam works, according to Tom O'Donnell, special agent in charge with the Health and Human Services Office of Inspector General: An owner of a pharmacy asks customers to bring in prescription slips from doctors. But instead of filling the scripts and dispensing the drugs, the owner pays the customers a small fee and then bills Medicaid for the drugs that were never dispensed.
CNBC rode along with the Feds as they busted one pharmacy owner in Brooklyn, Aleksandr Ilyayev. Our cameras were rolling during the entire raid, from the early morning briefing session to the owner's ultimate arrest. Investigators had been keeping a close eye on the owner for a year, and said they already captured him on undercover video—allegedly pulling off a brazen scheme to rip off taxpayers.
The owner allegedly asked patients to bring prescription slips to his pharmacy in exchange for cash and New York Transit Authority MetroCards. The cash amounts weren't big—the owner allegedly dished out $20 to $40 for each prescription, according to investigators.
From there, O'Donnell said, the owner would bill Medicaid for drugs that were either partially filled, or never dispensed at all. O'Donnell said he also billed for refills.
According to federal agents, the owner focused on prescriptions for expensive HIV drugs like Atripla, Isentress, Prezista and Reyataz. Pharmacies are reimbursed by Medicaid for these drugs—often paying out as much as $1,500 for a 30-day supply.
All told, investigators allege the owner bilked Medicaid out of almost $1 million. Through his attorney, Ilyayev denies the charges.
This alleged scheme is just the tip of the iceberg, said O'Donnell, with other, similar schemes being played out at mom- and-pop pharmacies all over the country. He added that his department's caseload has quadrupled in the past five years.
It's a "drug trade subsidized by taxpayers," added Gary Cantrell, deputy inspector general in the Office of Investigations.
(Read more: Aphrodite girls: Inside an alleged high-end escort service)
According to Lauren Mack, executive assistant district attorney in Kings County, Brooklyn, between 3 percent and 10 percent of all Medicaid spending is fraudulent, or $184 million to $630 million worth of fraud.
19 August 2013
Paying for Obamacare: Some feel singled out
Story originally appeared on USA Today.
The Affordable Care Act generates revenue through a hodgepodge of new taxes, financial penalties and IRS rule changes.
NASHVILLE, Tenn. -- Johnny Drake's business is losing 2.3 percent of everything it makes because of the Affordable Care Act.
He's the president of Pathfinder Technologies, a small company in Nashville with fewer than 20 employees, that got hit with an excise tax this year because it makes medical devices.
Medical device manufacturers are among the federal health law losers, those that will have to pay up to cover the cost of implementing it. Others include high-wage earners, tanning salons and, in some cases, working parents and folks with big medical bills. The law generates revenue through a hodgepodge of new taxes, financial penalties and IRS rule changes.
"Every quarter, we're having to send the federal government a flat 2.3 percent of our revenue," Drake said. "I feel like it's double taxation because at the end of the year, we're sending them our federal income tax as well."
Tanning salon owners started having to pay a bigger tax three years ago. Lyvonn Reese, who owns the Hot Spot Tanning salons in the Nashville area, said the 10 percent tax ate away so much of her profit margin that she had no choice but to pass it along. She itemizes "tanning tax" on customer receipts.
Individuals won't be able to pass along taxes so easily. People making more than $200,000 annually and couples making more than $250,000 will have to pay a 3.8 percent tax on net investment income when they file next year — and that's not their only new tax.
"If you are in a high-income bracket with investment income and high wages, you might see something you might not have seen before," said Mark Steber, chief tax officer of Jackson Hewitt Tax Service Inc.
The federal health law could add up to a "triple whammy," he said. Besides the investment tax, people with these higher incomes also will have to pay an additional 0.9 percent in Medicare taxes, and many of them already fall into the highest tax bracket, he said.
There are legitimate reasons that some industries bear a bigger tax burden, said Sara Collins, an economist with The Commonwealth Fund, a foundation that supports improving health care and expanding access for the poor.
"Medical device manufacturers, pharmaceutical companies and insurance companies stand to gain an enormous increase in new customers because of the provisions in the law covering so many new people," she said. "What these fees and taxes do is essentially ask them to help support that major increase in their market.
"On net, they are really benefiting from health care reform. They will see a major increase in their revenues as a result of the reform law. These taxes and fees ask them to give back some of that."
But the 10 percent fee on tanning services is more of a sin tax for what the law's authors perceive as unhealthy habits. Reese said her businesses were unfairly singled out. The law assesses no new fees or penalties for tobacco or alcohol use.
Working parents
Companies and rich people aren't the only ones who will face higher tax bills. The law's quirks will put some working parents in a tight spot and make it harder for people with big medical bills to deduct those expenses.
The old 7.5 percent threshold to qualify for tax deductions on medical expenses is gone. The health law put the hurdle higher at 10 percent beginning this year. The law limits out-of-pocket costs for consumers, but the Obama administration gave some employer health plans a one-year grace period for complying with the limitations.
The tight spot for working parents occurs when an employer pays for their health coverage but not for their families'. The parents can't buy subsidized insurance on the federal exchange because it's not open to workers covered by an employer. Nevertheless, these parents will be penalized if their families go without coverage.
"The one that really gets the shaft in this whole thing is the guy making $25,000 or $30,000 or $35,000 a year where the company pays for part of his insurance but not for his dependents," said David Moore, a board member for the Tennessee Association of Health Insurance Underwriters.
"He is having to pay the whole family costs and the rest of his dependents. He can't afford it because it's expensive. But he can't send his wife and kids to the exchange to get insurance because he's got insurance available at work."
The Medicaid choice
Many of these families would qualify for Medicaid if states expanded their Medicaid programs. In Tennessee, a family of four with an income below $32,499 could get coverage.
Should Tennessee expand its Medicaid program, the decision would have no impact on income taxes. The money is already being collected in Tennessee by the federal government, but none of the funds allocated for Medicaid expansion would be coming back here unless Tennessee expands Medicaid.
The federal government will pick up 100 percent of the costs of insuring new people brought onto state Medicaid rolls through 2016 for those states that do expand their programs. It will then phase down to a permanent 90 percent matching rate in 2020.
Ron Pollack, executive director of Families USA, an advocacy organization for health consumers, said states that expand their Medicaid programs will save money because, otherwise, they will pay out more to support hospitals and other health providers that care for the uninsured.
"Any governor or state legislature that turns this down is really committing financial malpractice," Pollack said. "It just doesn't make sense."
Tennessee Gov. Bill Haslam has not completely ruled out an expansion of coverage, but he faces the double difficulties of getting a plan approved by a Republican-dominated legislature where "Obamacare" is disliked.
Industry impact
The medical device tax takes a big bite in Tennessee.
Tennessee ranks seventh among states for medical device manufacturing, accounting for about $275 million in wages in 2009, according to Life Science Tennessee, an advocacy organization that represents the industry.
The industry has a big foothold in Memphis, which is the nation's second-largest orthopedic device center and where Wright Medical Group Inc. is based.
"The medical device tax is particularly burdensome on smaller, innovative companies like Wright Medical," said Lance Berry, the chief financial officer for Wright. "Not only is the estimated $3 million to $4 million cost of this tax in 2013 for Wright's continuing operations significant — but both the cost and the effort required to comply with the tax consume resources that could otherwise be used to drive business growth, develop newer and better technology and hire new employees."
Business owners hit by the Affordable Care Act taxes feel singled out.
"Why not charge the tan tax everywhere?" asked Reese, noting that gyms that offer suntanning beds with memberships don't have to pay the 10 percent excise tax.
The Affordable Care Act brings the most change, however, for the health insurance industry. It limits their profits. The law requires insurance companies to spend at least 80 percent of the money they collect in premiums on either medical care or health care quality improvements. For large group plans, that requirement is 85 percent.
Whenever insurance companies don't meet the requirements, they have to issue rebates to the premium payers. That's only one of a myriad of regulations that health insurers must abide by. They will not be able to deny coverage due to pre-existing conditions and will no longer be allowed to set lifetime spending limits on individuals.
Indirect costs
The Affordable Care Act will make it possible for people to buy insurance who could not previously afford it, particularly those with chronic medical conditions. The average subsidy for a family to buy coverage on the exchange will be $2,672, which would reduce the cost of buying insurance by 32 percent, according to a report issued last week by the Henry J. Kaiser Family Foundation.
However, young people who do not qualify for subsidies, especially men, may end up paying more than they otherwise would have.
"Today men and women pay different rates in Tennessee," said Brian Haile, senior vice president for health care policy at Jackson Hewitt. "That will no longer be legal in 2014. Right now, a 27-year-old male is getting a real deal. He doesn't have to pay for labor and delivery costs because they segregate those. He will have to pay more if he wants to keep coverage."
Employers with healthy workers, who benefited with lower premiums under the old system, also may have to pay more as insurers spread the cost of having to cover people with pre-existing conditions.
A great deal of uncertainty remains about the Affordable Care Act as actuaries continue assessing costs, politicians debate the law and some provisions get delayed. Some of the rules for the tax provisions are still being written by the IRS.
Steber, the chief tax officer of Jackson Hewitt, said people who don't prepare in advance may get unexpected bills from the IRS.
"You can't hide these things," Steber said. "They are all traceable."
The Affordable Care Act generates revenue through a hodgepodge of new taxes, financial penalties and IRS rule changes.
NASHVILLE, Tenn. -- Johnny Drake's business is losing 2.3 percent of everything it makes because of the Affordable Care Act.
He's the president of Pathfinder Technologies, a small company in Nashville with fewer than 20 employees, that got hit with an excise tax this year because it makes medical devices.
Medical device manufacturers are among the federal health law losers, those that will have to pay up to cover the cost of implementing it. Others include high-wage earners, tanning salons and, in some cases, working parents and folks with big medical bills. The law generates revenue through a hodgepodge of new taxes, financial penalties and IRS rule changes.
"Every quarter, we're having to send the federal government a flat 2.3 percent of our revenue," Drake said. "I feel like it's double taxation because at the end of the year, we're sending them our federal income tax as well."
Tanning salon owners started having to pay a bigger tax three years ago. Lyvonn Reese, who owns the Hot Spot Tanning salons in the Nashville area, said the 10 percent tax ate away so much of her profit margin that she had no choice but to pass it along. She itemizes "tanning tax" on customer receipts.
Individuals won't be able to pass along taxes so easily. People making more than $200,000 annually and couples making more than $250,000 will have to pay a 3.8 percent tax on net investment income when they file next year — and that's not their only new tax.
"If you are in a high-income bracket with investment income and high wages, you might see something you might not have seen before," said Mark Steber, chief tax officer of Jackson Hewitt Tax Service Inc.
The federal health law could add up to a "triple whammy," he said. Besides the investment tax, people with these higher incomes also will have to pay an additional 0.9 percent in Medicare taxes, and many of them already fall into the highest tax bracket, he said.
There are legitimate reasons that some industries bear a bigger tax burden, said Sara Collins, an economist with The Commonwealth Fund, a foundation that supports improving health care and expanding access for the poor.
"Medical device manufacturers, pharmaceutical companies and insurance companies stand to gain an enormous increase in new customers because of the provisions in the law covering so many new people," she said. "What these fees and taxes do is essentially ask them to help support that major increase in their market.
"On net, they are really benefiting from health care reform. They will see a major increase in their revenues as a result of the reform law. These taxes and fees ask them to give back some of that."
But the 10 percent fee on tanning services is more of a sin tax for what the law's authors perceive as unhealthy habits. Reese said her businesses were unfairly singled out. The law assesses no new fees or penalties for tobacco or alcohol use.
Working parents
Companies and rich people aren't the only ones who will face higher tax bills. The law's quirks will put some working parents in a tight spot and make it harder for people with big medical bills to deduct those expenses.
The old 7.5 percent threshold to qualify for tax deductions on medical expenses is gone. The health law put the hurdle higher at 10 percent beginning this year. The law limits out-of-pocket costs for consumers, but the Obama administration gave some employer health plans a one-year grace period for complying with the limitations.
The tight spot for working parents occurs when an employer pays for their health coverage but not for their families'. The parents can't buy subsidized insurance on the federal exchange because it's not open to workers covered by an employer. Nevertheless, these parents will be penalized if their families go without coverage.
"The one that really gets the shaft in this whole thing is the guy making $25,000 or $30,000 or $35,000 a year where the company pays for part of his insurance but not for his dependents," said David Moore, a board member for the Tennessee Association of Health Insurance Underwriters.
"He is having to pay the whole family costs and the rest of his dependents. He can't afford it because it's expensive. But he can't send his wife and kids to the exchange to get insurance because he's got insurance available at work."
The Medicaid choice
Many of these families would qualify for Medicaid if states expanded their Medicaid programs. In Tennessee, a family of four with an income below $32,499 could get coverage.
Should Tennessee expand its Medicaid program, the decision would have no impact on income taxes. The money is already being collected in Tennessee by the federal government, but none of the funds allocated for Medicaid expansion would be coming back here unless Tennessee expands Medicaid.
The federal government will pick up 100 percent of the costs of insuring new people brought onto state Medicaid rolls through 2016 for those states that do expand their programs. It will then phase down to a permanent 90 percent matching rate in 2020.
Ron Pollack, executive director of Families USA, an advocacy organization for health consumers, said states that expand their Medicaid programs will save money because, otherwise, they will pay out more to support hospitals and other health providers that care for the uninsured.
"Any governor or state legislature that turns this down is really committing financial malpractice," Pollack said. "It just doesn't make sense."
Tennessee Gov. Bill Haslam has not completely ruled out an expansion of coverage, but he faces the double difficulties of getting a plan approved by a Republican-dominated legislature where "Obamacare" is disliked.
Industry impact
The medical device tax takes a big bite in Tennessee.
Tennessee ranks seventh among states for medical device manufacturing, accounting for about $275 million in wages in 2009, according to Life Science Tennessee, an advocacy organization that represents the industry.
The industry has a big foothold in Memphis, which is the nation's second-largest orthopedic device center and where Wright Medical Group Inc. is based.
"The medical device tax is particularly burdensome on smaller, innovative companies like Wright Medical," said Lance Berry, the chief financial officer for Wright. "Not only is the estimated $3 million to $4 million cost of this tax in 2013 for Wright's continuing operations significant — but both the cost and the effort required to comply with the tax consume resources that could otherwise be used to drive business growth, develop newer and better technology and hire new employees."
Business owners hit by the Affordable Care Act taxes feel singled out.
"Why not charge the tan tax everywhere?" asked Reese, noting that gyms that offer suntanning beds with memberships don't have to pay the 10 percent excise tax.
The Affordable Care Act brings the most change, however, for the health insurance industry. It limits their profits. The law requires insurance companies to spend at least 80 percent of the money they collect in premiums on either medical care or health care quality improvements. For large group plans, that requirement is 85 percent.
Whenever insurance companies don't meet the requirements, they have to issue rebates to the premium payers. That's only one of a myriad of regulations that health insurers must abide by. They will not be able to deny coverage due to pre-existing conditions and will no longer be allowed to set lifetime spending limits on individuals.
Indirect costs
The Affordable Care Act will make it possible for people to buy insurance who could not previously afford it, particularly those with chronic medical conditions. The average subsidy for a family to buy coverage on the exchange will be $2,672, which would reduce the cost of buying insurance by 32 percent, according to a report issued last week by the Henry J. Kaiser Family Foundation.
However, young people who do not qualify for subsidies, especially men, may end up paying more than they otherwise would have.
"Today men and women pay different rates in Tennessee," said Brian Haile, senior vice president for health care policy at Jackson Hewitt. "That will no longer be legal in 2014. Right now, a 27-year-old male is getting a real deal. He doesn't have to pay for labor and delivery costs because they segregate those. He will have to pay more if he wants to keep coverage."
Employers with healthy workers, who benefited with lower premiums under the old system, also may have to pay more as insurers spread the cost of having to cover people with pre-existing conditions.
A great deal of uncertainty remains about the Affordable Care Act as actuaries continue assessing costs, politicians debate the law and some provisions get delayed. Some of the rules for the tax provisions are still being written by the IRS.
Steber, the chief tax officer of Jackson Hewitt, said people who don't prepare in advance may get unexpected bills from the IRS.
"You can't hide these things," Steber said. "They are all traceable."
25 July 2013
Duchess Casts Midwife Tradition Aside for Royal Birth
Story Originally Appeared in Bloomberg News
Prince William’s wife, Kate, cast aside British tradition when she picked the team that helped her deliver her baby yesterday.
Instead of turning to a midwife, the method provided by the National Health Service and used by Queen Elizabeth II, the Duchess of Cambridge followed the U.S. practice of having doctors on hand for the birth of the boy who will be third in line to the British throne.
The royal birth was supervised by Marcus Setchell, 69, who serves as the queen’s gynecologist, and Guy Thorpe-Beeston, 53, an obstetrician who practices at St. Mary’s Hospital in Paddington, central London, where Kate’s son was born yesterday. The baby, weighing 8 pounds, 6 ounces (3.8 kilograms), is heavier than the average weight of boys born in the U.K., which has risen about 2 ounces to about 7 pounds, 8 ounces since 1971.
Kate, the first woman from outside royalty or the aristocracy to marry so close to the throne for 350 years, probably picked what seemed like the safest approach for the high-profile birth of her first child, said Nancy Chescheir, an obstetrician at the University of North Carolina’s School of Medicine in Chapel Hill. Yet scientific evidence suggests a hospital delivery under the care of an obstetrician isn’t necessarily best for routine births.
A 2008 Cochrane Collaboration review found women who used midwives have fewer interventions such as caesarean sections and episiotomies to widen the vagina during delivery, said Holly Powell Kennedy, a midwife and professor at Yale University’s School of Nursing.
Not America
“We are all baffled as to why Kate is having an obstetrician,” Sheena Byrom, a midwife based near Preston in northern England, said in an interview before the birth. “It’s not like America.”
The Duchess of Cambridge’s decision to pay for private care has hit a nerve in a country where almost two-thirds of births are supervised by midwives, the only option covered by the government-run health service for low-risk births. Queen Elizabeth II delivered her four children at home with midwives, said Louise Silverton, director of midwifery at the Royal College of Midwives.
“It’s a cultural thing,” Silverton said. “I don’t wait for doctors to tell me what to do, I make my own decisions.”
Midwives focus on high-touch, low-tech deliveries that can yield better results at a lower cost for healthy women, particularly because they’re less likely to use unnecessary medical equipment, said Angela Ferrari, a certified nurse midwife from Massachusetts General Hospital in Boston.
The role of midwives is so established in the country that it’s inspired the popular British Broadcasting Corp. television series entitled “Call the Midwife.” Obstetricians tend to step in for high-risk pregnancies or when complications develop.
Family Event
In the U.S., the system for prenatal care and delivery is based on the mother’s preference for a midwife or an obstetrician, according to the University of North Carolina’s Chescheir. Certified nurse midwives, the primary type of midwife in the U.S., care only for low-risk pregnancies and are supervised by an obstetrician.
Chescheir, herself an expert in complex, high-risk deliveries, is a fan of midwives, who she says tend to be more holistic, foster less of a medical environment and create a family event. Midwives delivered almost 12 percent of the 2.65 million infants born vaginally in 2011 in the U.S., the most recent statistics available, according to the National Center for Health Statistics.
No Slight
“I don’t think British women should feel they are being slighted as long as they have access to obstetrical specialists if a problem arises,” said Meg Berreth, a midwife and instructor at the University of North Carolina at Chapel Hill. “A very brief perusal of literature would show you the average woman is getting exceptional, if not better care, with a midwife in the U.S. and Britain.”
Women can also get epidurals and pain medicine even if they are delivering with a midwife, according to Berreth.
“I don’t envy Kate Middleton,” she said, referring to the Duchess of Cambridge by her maiden name. “Every decision she makes becomes a statement.”
Some experts said it made sense for Kate to rely on an obstetrician, given the high-profile pregnancy and its accompanying stress, and risks that can quickly spiral out of control if a delivery starts to go wrong.
High Stakes
“I don’t like to think of one birth being any more important than another’s, but the stakes are extraordinarily high in this case,” Chescheir said. “When there is that much pressure on, it probably makes sense to have a lot of people on board. In obstetrics, when things go bad, they can go bad extraordinarily quickly.”
In the end, Kate made a personal decision choosing obstetricians over midwives, just as her late mother-in-law, Diana, did when she delivered both her boys in the same London hospital in the 1980s under doctor supervision.
“It’s very important that women feel safe during labor,” Berreth said. “For some women that means a hospital and for others that means a home.”
Prince William’s wife, Kate, cast aside British tradition when she picked the team that helped her deliver her baby yesterday.
Instead of turning to a midwife, the method provided by the National Health Service and used by Queen Elizabeth II, the Duchess of Cambridge followed the U.S. practice of having doctors on hand for the birth of the boy who will be third in line to the British throne.
The royal birth was supervised by Marcus Setchell, 69, who serves as the queen’s gynecologist, and Guy Thorpe-Beeston, 53, an obstetrician who practices at St. Mary’s Hospital in Paddington, central London, where Kate’s son was born yesterday. The baby, weighing 8 pounds, 6 ounces (3.8 kilograms), is heavier than the average weight of boys born in the U.K., which has risen about 2 ounces to about 7 pounds, 8 ounces since 1971.
Kate, the first woman from outside royalty or the aristocracy to marry so close to the throne for 350 years, probably picked what seemed like the safest approach for the high-profile birth of her first child, said Nancy Chescheir, an obstetrician at the University of North Carolina’s School of Medicine in Chapel Hill. Yet scientific evidence suggests a hospital delivery under the care of an obstetrician isn’t necessarily best for routine births.
A 2008 Cochrane Collaboration review found women who used midwives have fewer interventions such as caesarean sections and episiotomies to widen the vagina during delivery, said Holly Powell Kennedy, a midwife and professor at Yale University’s School of Nursing.
Not America
“We are all baffled as to why Kate is having an obstetrician,” Sheena Byrom, a midwife based near Preston in northern England, said in an interview before the birth. “It’s not like America.”
The Duchess of Cambridge’s decision to pay for private care has hit a nerve in a country where almost two-thirds of births are supervised by midwives, the only option covered by the government-run health service for low-risk births. Queen Elizabeth II delivered her four children at home with midwives, said Louise Silverton, director of midwifery at the Royal College of Midwives.
“It’s a cultural thing,” Silverton said. “I don’t wait for doctors to tell me what to do, I make my own decisions.”
Midwives focus on high-touch, low-tech deliveries that can yield better results at a lower cost for healthy women, particularly because they’re less likely to use unnecessary medical equipment, said Angela Ferrari, a certified nurse midwife from Massachusetts General Hospital in Boston.
The role of midwives is so established in the country that it’s inspired the popular British Broadcasting Corp. television series entitled “Call the Midwife.” Obstetricians tend to step in for high-risk pregnancies or when complications develop.
Family Event
In the U.S., the system for prenatal care and delivery is based on the mother’s preference for a midwife or an obstetrician, according to the University of North Carolina’s Chescheir. Certified nurse midwives, the primary type of midwife in the U.S., care only for low-risk pregnancies and are supervised by an obstetrician.
Chescheir, herself an expert in complex, high-risk deliveries, is a fan of midwives, who she says tend to be more holistic, foster less of a medical environment and create a family event. Midwives delivered almost 12 percent of the 2.65 million infants born vaginally in 2011 in the U.S., the most recent statistics available, according to the National Center for Health Statistics.
No Slight
“I don’t think British women should feel they are being slighted as long as they have access to obstetrical specialists if a problem arises,” said Meg Berreth, a midwife and instructor at the University of North Carolina at Chapel Hill. “A very brief perusal of literature would show you the average woman is getting exceptional, if not better care, with a midwife in the U.S. and Britain.”
Women can also get epidurals and pain medicine even if they are delivering with a midwife, according to Berreth.
“I don’t envy Kate Middleton,” she said, referring to the Duchess of Cambridge by her maiden name. “Every decision she makes becomes a statement.”
Some experts said it made sense for Kate to rely on an obstetrician, given the high-profile pregnancy and its accompanying stress, and risks that can quickly spiral out of control if a delivery starts to go wrong.
High Stakes
“I don’t like to think of one birth being any more important than another’s, but the stakes are extraordinarily high in this case,” Chescheir said. “When there is that much pressure on, it probably makes sense to have a lot of people on board. In obstetrics, when things go bad, they can go bad extraordinarily quickly.”
In the end, Kate made a personal decision choosing obstetricians over midwives, just as her late mother-in-law, Diana, did when she delivered both her boys in the same London hospital in the 1980s under doctor supervision.
“It’s very important that women feel safe during labor,” Berreth said. “For some women that means a hospital and for others that means a home.”
17 July 2013
Most health care records now are electronic
Originally Appeared in USA TODAY
An ever-expanding amount of the nation's medical records — millions of prescriptions, medical reports and appointment reminders — are now computerized and part of an ambitious electronic medical records program, the Obama administration reports.
Since the start of a 2011 program in which the government helps finance new health records systems, doctors or their assistants have filled more than 190 million prescriptions electronically, according to data provided by the Centers for Medicare & Medicaid Services.
Providers have also shared more than 4.3 million health care summaries with colleagues when patients change doctors, according to the data.
More than half of the nation's health care providers and more than 80% of hospitals now have electronic records.
"It has real-world implications for real-life patients," said Farzad Mostashari, a physician and national coordinator for health information technology with the Department of Health and Human Services.
The goals of electronic medical records include better and faster exchanges of information between doctors who share a patient, reducing duplication of tests and procedures, eliminating errors on prescriptions, and providing patients with quicker access to their own records.
The data also says that health care providers have delivered:
• More then 4.6 million electronic copies of health information to patients;
• More than 13 million reminders about appointments, required tests, or check-ups;
• More than 40 million checks on drug and medication interactions.
To date, the Obama administration has provided $15.5 billion to nearly 310,000 health care providers that have moved to "EHR," the government's term for electronic health records. The program was part of the 2009 stimulus bill.
The law also includes financial penalties for Medicare providers that do not move to electronic records, starting in 2015.
The transition to electronic medical records has not always been a smooth one.
Margret Amatayakul,a health information systems consultant in the Chicago area, said some providers have had a hard time deciding what kind of computer system might work best for them. She said installing and learning how to use new electronic systems take time, and some providers have had to use "a trial and error" approach.
"Overall, it's been a good thing," she said. "But we have to look at the lessons we're learning."
Mostashari said switching to electronic records is "a big change," and health care officials are willing to work with providers by supplying data and other forms of assistance.
"I can tell you one thing," Mostashari said. "Once they make the change, they'll never go back to paper."
A June report from the Centers for Medicare & Medicaid Services said that 4,024 hospitals — 80.3% of those eligible — have adopted an EHR system.
So have more than 305,000 health care professionals, 55.3% of the total.
An ever-expanding amount of the nation's medical records — millions of prescriptions, medical reports and appointment reminders — are now computerized and part of an ambitious electronic medical records program, the Obama administration reports.
Since the start of a 2011 program in which the government helps finance new health records systems, doctors or their assistants have filled more than 190 million prescriptions electronically, according to data provided by the Centers for Medicare & Medicaid Services.
Providers have also shared more than 4.3 million health care summaries with colleagues when patients change doctors, according to the data.
More than half of the nation's health care providers and more than 80% of hospitals now have electronic records.
"It has real-world implications for real-life patients," said Farzad Mostashari, a physician and national coordinator for health information technology with the Department of Health and Human Services.
The goals of electronic medical records include better and faster exchanges of information between doctors who share a patient, reducing duplication of tests and procedures, eliminating errors on prescriptions, and providing patients with quicker access to their own records.
The data also says that health care providers have delivered:
• More then 4.6 million electronic copies of health information to patients;
• More than 13 million reminders about appointments, required tests, or check-ups;
• More than 40 million checks on drug and medication interactions.
To date, the Obama administration has provided $15.5 billion to nearly 310,000 health care providers that have moved to "EHR," the government's term for electronic health records. The program was part of the 2009 stimulus bill.
The law also includes financial penalties for Medicare providers that do not move to electronic records, starting in 2015.
The transition to electronic medical records has not always been a smooth one.
Margret Amatayakul,a health information systems consultant in the Chicago area, said some providers have had a hard time deciding what kind of computer system might work best for them. She said installing and learning how to use new electronic systems take time, and some providers have had to use "a trial and error" approach.
"Overall, it's been a good thing," she said. "But we have to look at the lessons we're learning."
Mostashari said switching to electronic records is "a big change," and health care officials are willing to work with providers by supplying data and other forms of assistance.
"I can tell you one thing," Mostashari said. "Once they make the change, they'll never go back to paper."
A June report from the Centers for Medicare & Medicaid Services said that 4,024 hospitals — 80.3% of those eligible — have adopted an EHR system.
So have more than 305,000 health care professionals, 55.3% of the total.
16 July 2013
Four Drugmakers Face China Probes as Glaxo Woes Widen
Originally Appeared on Bloomberg
China is investigating at least four multinational drugmakers as it widens its probe of GlaxoSmithKline Plc (GSK), according to a lawyer in Hong Kong whose firm advises companies on cross-border anti-corruption.
The investigations point to an increased targeting of the pharmaceutical industry in corruption probes as the world’s most populous country faces rising health-care costs and seeks to lower drug prices. While the drugmakers are being examined by local regulators, the results may draw added questions from officials in Beijing and scrutiny by the U.S. government under the Foreign Corrupt Practices Act.
“We are aware of four pharmaceutical companies who are facing” investigation by local anti-corruption units, said the lawyer, Wendy Wysong, the head of anti-corruption practice in Asia-Pacific at law firm Clifford Chance. Wysong declined to identify the companies. Yesterday, Chinese officials said Glaxo used travel agencies as a conduit for bribes, that company executives received “sexual bribes,” and that other drugmakers have transferred money to the agencies.
“As to whether these companies are also involved in illegal dealings, you can go and ask them,” said Gao Feng, head of the economic crimes investigations unit at China’s Public Security Ministry. “Of course they won’t answer. But you can ask them one question: ‘Can you sleep well at night?’”
Gao didn’t identify the other companies linked financially to the travel agencies at a news conference yesterday. His comments were unusual, given that Chinese police rarely speak publicly to foreign media about ongoing investigations. The Glaxo case, Gao said, included bribes that went to “government officials, medical associations, hospitals and doctors.”
Drugmaker Target
China, the world’s fastest-growing market for medicines, has become an important target for the pharmaceutical industry as more and more best-selling therapies have gone off patent.
Glaxo’s revenue from China increased 17 percent last year to 759 million pounds ($1.1 billion), while product sales for London-based AstraZeneca rose 20 percent in China to $1.5 billion. Pfizer Inc. and Merck & Co., the two biggest U.S. drugmakers, together employ about 14,000 people in China. AstraZeneca, Pfizer and Merck haven’t been identified by China as targets of their probe.
Glaxo said in an e-mailed statement it is “deeply concerned and disappointed” and will stop using agencies identified in the probe. The drugmaker is reviewing all third-party agency relationships and will cooperate with Chinese authorities, according to the statement.
U.S. Act
The U.S. Foreign Corrupt Practices Act bars corporate employees or their agents from paying bribes to government officials to obtain or retain business or to secure an improper advantage. Glaxo is among several drugmakers that have already been contacted by U.S. authorities in an ongoing industrywide probe into possible violations of the act. That Glaxo probe, begun in 2010, covers practices in countries that include China, according to the company’s 2012 annual report.
AstraZeneca, in its 2012 annual report, also said it is investigating indications of inappropriate conduct in countries that include China. The company said it received inquiries from U.S. authorities related to “among other things, sales practices, internal controls, certain distributors and interactions with health-care providers and other government officials in several countries.”
“This is an ongoing matter and AstraZeneca is co-operating with the inquiries,” Esra Erkal-Paler, a spokeswoman for London-based AstraZeneca said in an e-mail, referring to the U.S. inquiry. “We have no update to provide at this time.”
China President
In China, President Xi Jinping has vowed to combat official corruption since becoming head of the Communist Party in November. At the same time the country has been moving aggressively to get drugmakers to lower prices as it prepares to widen health coverage, with the top economic planning agency probing the costs and prices of 60 drugmakers including Glaxo, Merck, Novartis AG and Baxter International Inc.
Foreign drugmakers in regular contact with Chinese officials overseeing the health system are an obvious target for anti-corruption probes, said Willy Wo-Lap Lam, an adjunct professor at the Chinese University of Hong Kong who studies the politics of that country.
“The medical system is a disaster zone when it comes to high-level corruption,” Lam said in a telephone interview. “Since they instituted the anti-corruption campaign, areas of abuse within the medical system could be targets.”
Regulatory Agencies
In China, every province and city have local agencies that regulate commercial activity. These units, formally known as the Administration for Industry and Commerce, or AIC, hold broad powers to investigate possible malfeasance, seize evidence and impose financial penalties without a warrant, according to a note from consulting firm Control Risks. They also have the authority to order the disgorgement of profits earned through unfair commercial practices.
In some cases, if a company operates in more than one community, a probe can begin in one jurisdiction and spread to others, with the different AIC branches exchanging information, said Wysong, who wasn’t commenting specifically on Glaxo.
Finding by these local agencies could trigger further scrutiny under the U.S. foreign practices act, said Sam Williamson, a partner who specializes in anti-corruption law at the Shanghai offices of Kirkland & Ellis LLP.
The settlement of AIC corruption charges “could have significant implications back in the U.S.,” said Williamson, a former U.S. prosecutor. The Justice Department is “familiar with the AICs and often ask companies questions about this -- for example what AIC investigations a company has had and how did they play out.”
‘Most Shocked’
China may also take its cues from the U.S. At yesterday’s press conference, the Chinese investigator Gao mentioned Glaxo’s 2011 agreement to pay $3 billion to settle U.S. claims the company marketed drugs for unapproved uses and other matters.
“We were most shocked” by the settlement, Gao said. “At the time, we were very puzzled as to what actually happened at the company and, through our investigations, we have found the answer.”
Whistle-blowers can also drive investigations by anti-corruption agencies, said Kelly Austin, partner-in-charge of the Hong Kong offices of law firm Gibson, Dunn & Crutcher.
“Sometimes they’re started by a whistle-blower, sometimes by a disgruntled competitor, and sometimes it can be a result of their own enforcement action,” Austin said in an interview.
Police Investigation
The Glaxo probe is a result of police investigations, not a whistle-blower’s complaint, Gao said at the press conference.
Half of all the overseas bribery cases settled last year involved activity conducted in Asia Pacific, according to the U.S. Securities and Exchange Commission’s website.
Glaxo’s troubles in China began surfacing last month. The company spent four months investigating a whistleblower’s claims of corruption and bribery at its China business. Glaxo said that it found no evidence of wrongdoing. That same week, Glaxo fired its head of Chinese research and development after finding that a paper he helped write for a medical journal contained data that had been misrepresented, according to the company.
A police investigation followed. China detained four senior Glaxo executives on suspicion of economic crimes involving 3 billion yuan ($489 million) of spurious travel and meeting expenses, and receiving sexual favors.
The alleged offenses date to 2007 and involved 700 travel agencies, Gao said at yesterday’s briefing. The ministry has been handling the Glaxo case for more than half a year following police investigations, Gao said.
China’s probe of drugmakers will probably continue to expand, said Lam of the Chinese University of Hong Kong.
“We are only at the beginning of an anti-corruption campaign which will last for at least one year,” Lam said.
China is investigating at least four multinational drugmakers as it widens its probe of GlaxoSmithKline Plc (GSK), according to a lawyer in Hong Kong whose firm advises companies on cross-border anti-corruption.
The investigations point to an increased targeting of the pharmaceutical industry in corruption probes as the world’s most populous country faces rising health-care costs and seeks to lower drug prices. While the drugmakers are being examined by local regulators, the results may draw added questions from officials in Beijing and scrutiny by the U.S. government under the Foreign Corrupt Practices Act.
“We are aware of four pharmaceutical companies who are facing” investigation by local anti-corruption units, said the lawyer, Wendy Wysong, the head of anti-corruption practice in Asia-Pacific at law firm Clifford Chance. Wysong declined to identify the companies. Yesterday, Chinese officials said Glaxo used travel agencies as a conduit for bribes, that company executives received “sexual bribes,” and that other drugmakers have transferred money to the agencies.
“As to whether these companies are also involved in illegal dealings, you can go and ask them,” said Gao Feng, head of the economic crimes investigations unit at China’s Public Security Ministry. “Of course they won’t answer. But you can ask them one question: ‘Can you sleep well at night?’”
Gao didn’t identify the other companies linked financially to the travel agencies at a news conference yesterday. His comments were unusual, given that Chinese police rarely speak publicly to foreign media about ongoing investigations. The Glaxo case, Gao said, included bribes that went to “government officials, medical associations, hospitals and doctors.”
Drugmaker Target
China, the world’s fastest-growing market for medicines, has become an important target for the pharmaceutical industry as more and more best-selling therapies have gone off patent.
Glaxo’s revenue from China increased 17 percent last year to 759 million pounds ($1.1 billion), while product sales for London-based AstraZeneca rose 20 percent in China to $1.5 billion. Pfizer Inc. and Merck & Co., the two biggest U.S. drugmakers, together employ about 14,000 people in China. AstraZeneca, Pfizer and Merck haven’t been identified by China as targets of their probe.
Glaxo said in an e-mailed statement it is “deeply concerned and disappointed” and will stop using agencies identified in the probe. The drugmaker is reviewing all third-party agency relationships and will cooperate with Chinese authorities, according to the statement.
U.S. Act
The U.S. Foreign Corrupt Practices Act bars corporate employees or their agents from paying bribes to government officials to obtain or retain business or to secure an improper advantage. Glaxo is among several drugmakers that have already been contacted by U.S. authorities in an ongoing industrywide probe into possible violations of the act. That Glaxo probe, begun in 2010, covers practices in countries that include China, according to the company’s 2012 annual report.
AstraZeneca, in its 2012 annual report, also said it is investigating indications of inappropriate conduct in countries that include China. The company said it received inquiries from U.S. authorities related to “among other things, sales practices, internal controls, certain distributors and interactions with health-care providers and other government officials in several countries.”
“This is an ongoing matter and AstraZeneca is co-operating with the inquiries,” Esra Erkal-Paler, a spokeswoman for London-based AstraZeneca said in an e-mail, referring to the U.S. inquiry. “We have no update to provide at this time.”
China President
In China, President Xi Jinping has vowed to combat official corruption since becoming head of the Communist Party in November. At the same time the country has been moving aggressively to get drugmakers to lower prices as it prepares to widen health coverage, with the top economic planning agency probing the costs and prices of 60 drugmakers including Glaxo, Merck, Novartis AG and Baxter International Inc.
Foreign drugmakers in regular contact with Chinese officials overseeing the health system are an obvious target for anti-corruption probes, said Willy Wo-Lap Lam, an adjunct professor at the Chinese University of Hong Kong who studies the politics of that country.
“The medical system is a disaster zone when it comes to high-level corruption,” Lam said in a telephone interview. “Since they instituted the anti-corruption campaign, areas of abuse within the medical system could be targets.”
Regulatory Agencies
In China, every province and city have local agencies that regulate commercial activity. These units, formally known as the Administration for Industry and Commerce, or AIC, hold broad powers to investigate possible malfeasance, seize evidence and impose financial penalties without a warrant, according to a note from consulting firm Control Risks. They also have the authority to order the disgorgement of profits earned through unfair commercial practices.
In some cases, if a company operates in more than one community, a probe can begin in one jurisdiction and spread to others, with the different AIC branches exchanging information, said Wysong, who wasn’t commenting specifically on Glaxo.
Finding by these local agencies could trigger further scrutiny under the U.S. foreign practices act, said Sam Williamson, a partner who specializes in anti-corruption law at the Shanghai offices of Kirkland & Ellis LLP.
The settlement of AIC corruption charges “could have significant implications back in the U.S.,” said Williamson, a former U.S. prosecutor. The Justice Department is “familiar with the AICs and often ask companies questions about this -- for example what AIC investigations a company has had and how did they play out.”
‘Most Shocked’
China may also take its cues from the U.S. At yesterday’s press conference, the Chinese investigator Gao mentioned Glaxo’s 2011 agreement to pay $3 billion to settle U.S. claims the company marketed drugs for unapproved uses and other matters.
“We were most shocked” by the settlement, Gao said. “At the time, we were very puzzled as to what actually happened at the company and, through our investigations, we have found the answer.”
Whistle-blowers can also drive investigations by anti-corruption agencies, said Kelly Austin, partner-in-charge of the Hong Kong offices of law firm Gibson, Dunn & Crutcher.
“Sometimes they’re started by a whistle-blower, sometimes by a disgruntled competitor, and sometimes it can be a result of their own enforcement action,” Austin said in an interview.
Police Investigation
The Glaxo probe is a result of police investigations, not a whistle-blower’s complaint, Gao said at the press conference.
Half of all the overseas bribery cases settled last year involved activity conducted in Asia Pacific, according to the U.S. Securities and Exchange Commission’s website.
Glaxo’s troubles in China began surfacing last month. The company spent four months investigating a whistleblower’s claims of corruption and bribery at its China business. Glaxo said that it found no evidence of wrongdoing. That same week, Glaxo fired its head of Chinese research and development after finding that a paper he helped write for a medical journal contained data that had been misrepresented, according to the company.
A police investigation followed. China detained four senior Glaxo executives on suspicion of economic crimes involving 3 billion yuan ($489 million) of spurious travel and meeting expenses, and receiving sexual favors.
The alleged offenses date to 2007 and involved 700 travel agencies, Gao said at yesterday’s briefing. The ministry has been handling the Glaxo case for more than half a year following police investigations, Gao said.
China’s probe of drugmakers will probably continue to expand, said Lam of the Chinese University of Hong Kong.
“We are only at the beginning of an anti-corruption campaign which will last for at least one year,” Lam said.
01 July 2013
Prognosis varies for self-insured under health law
Originally Appeared in USA TODAY
Gail Harriman's health insurance costs rose four times in slightly more than two years, from $550 a month to $1,171, an amount "more than my mortgage." But when the self-employed San Francisco resident tried to switch insurers, she was rejected because of a minor health problem.
Harriman, 60, is among the estimated 15 million Americans who buy their own insurance and face far bigger hurdles getting and keeping it than those with job-based coverage.
"Most people who work for a company have absolutely no clue about what goes on with people who buy their own insurance," said Harriman. "I would never consider going without. But there have been moments when I feel it's the bane of my existence."
Most of the debate on how the law will change the individual market has centered on whether consumers will experience "rate shock" from higher premiums when key changes go into effect next year. But there's a flip side: New rules that broaden benefits prohibit discrimination against those with health issues and cap consumers' out-of-pocket costs, which can cut far deeper than premiums.
Currently, about one in five plans sold to consumers makes them responsible for at least half their medical costs after they've paid premiums and met deductibles, according to an analysis of government data by U.S. News & World Report and Kaiser Health News. It could not be determined how many consumers have such plans.
"The individual market before and after Jan. 1 will be fundamentally different places," said Robert Laszewski, a former insurance executive who now consults for the industry.
Get a break or pay more
The new rules bar insurers from rejecting applicants with health problems, set limits on how much more they can charge older residents and require most Americans to carry coverage or face a fine.
Whether individuals will be better or worse off under those rules depends on their age, health status, where they live — and perhaps most important, whether they end up needing substantial medical care in the coming year.
Generally speaking, those who are younger and healthier will pay more than they would have in the old market, while older and sicker people are likely to be better off.
Coverage under the health law will still require cost-sharing, potentially running into thousands of dollars. But those amounts will be clearly laid out — helping those who now "might buy insurance that looks cheap, but when they get sick, they realize they didn't read all the fine print, and it doesn't cover what they thought it did," said Uwe Reinhardt, a Princeton economics professor.
The single biggest change is that insurers will no longer be able to reject people with health problems or charge them more based solely on their health history — a practice that has effectively barred some people from the market, and prevented others from being able to switch plans.
Insurers were already forbidden from doing that to enrollees in group health plans, such as those sold to employers.
The change will be a huge relief for Maureen Mitchell, 58, of St. Augustine, Fla., who has spent most of the past decade uninsured after being rejected for coverage because of a heart rhythm abnormality.
Last September, Mitchell awoke with a stabbing pain in her chest and did a mental calculation: If she called for help, she would face large bills for hospital care and the ambulance ride. If she didn't call, she might die. "I just didn't have that money," said Mitchell, who did not call 911.
Deductions from deductibles
The law will also put limits on high-deductible policies such as those chosen by Laurie Simons, 62, and Mary McVey, 50 — meaning they pay significant sums out of their own pockets before their coverage kicks in.
Starting in January, new policies must cap annual "out-of-pocket" costs, which include deductibles and co-insurance payments, to about $6,350 for an individual, or $12,700 for a family — amounts that could still be a stretch for many consumers.
"There aren't that many Americans who have that kind of cash just sitting around," said Karen Pollitz of the Kaiser Family Foundation.
Nonetheless, the law's caps will reduce the cost-sharing in many plans currently sold, including those purchased by Simons and McVey.
Almost a third of plans currently offered to consumers exceed those caps, according to the U.S. News/Kaiser Health News analysis.
When Simons, a self-employed mental health counselor in Portland, Maine, switched to a high-deductible plan to reduce her monthly costs, she was healthy. But earlier this year, she was diagnosed with melanoma. Now, she must find $11,000 to pay for her surgery.
"If you don't have money, I don't know what you do," Simons said.
She hopes that next year, she can buy coverage that would protect her against five-figure medical bills
McVey, on the other hand, wants to keep her current policy, saying she is not willing to pay much more than her current $500 per month premium for a family of five. The self-employed accountant in Cape Elizabeth, Maine, has a policy that carries a $15,000 deductible, which could rise to $30,000 if two or more family members fall seriously ill in the same year.
McVey acknowledges she's been lucky that no one in her family has ever faced serious medical problems. She hardly ever goes to the doctor, she said, and offers cash when she does, hoping for a discount. While she would love "a health policy where I don't have to pay $700 to get a checkup for my kids," she said she would not like it if the trade-off is higher premiums.
"Paying $1,200 or more a month for health insurance seems like craziness," she said.
Steve Sternberg and Chris Young of U.S. News & World Report contributed to this report by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.
Gail Harriman's health insurance costs rose four times in slightly more than two years, from $550 a month to $1,171, an amount "more than my mortgage." But when the self-employed San Francisco resident tried to switch insurers, she was rejected because of a minor health problem.
Harriman, 60, is among the estimated 15 million Americans who buy their own insurance and face far bigger hurdles getting and keeping it than those with job-based coverage.
"Most people who work for a company have absolutely no clue about what goes on with people who buy their own insurance," said Harriman. "I would never consider going without. But there have been moments when I feel it's the bane of my existence."
Most of the debate on how the law will change the individual market has centered on whether consumers will experience "rate shock" from higher premiums when key changes go into effect next year. But there's a flip side: New rules that broaden benefits prohibit discrimination against those with health issues and cap consumers' out-of-pocket costs, which can cut far deeper than premiums.
Currently, about one in five plans sold to consumers makes them responsible for at least half their medical costs after they've paid premiums and met deductibles, according to an analysis of government data by U.S. News & World Report and Kaiser Health News. It could not be determined how many consumers have such plans.
"The individual market before and after Jan. 1 will be fundamentally different places," said Robert Laszewski, a former insurance executive who now consults for the industry.
Get a break or pay more
The new rules bar insurers from rejecting applicants with health problems, set limits on how much more they can charge older residents and require most Americans to carry coverage or face a fine.
Whether individuals will be better or worse off under those rules depends on their age, health status, where they live — and perhaps most important, whether they end up needing substantial medical care in the coming year.
Generally speaking, those who are younger and healthier will pay more than they would have in the old market, while older and sicker people are likely to be better off.
Coverage under the health law will still require cost-sharing, potentially running into thousands of dollars. But those amounts will be clearly laid out — helping those who now "might buy insurance that looks cheap, but when they get sick, they realize they didn't read all the fine print, and it doesn't cover what they thought it did," said Uwe Reinhardt, a Princeton economics professor.
The single biggest change is that insurers will no longer be able to reject people with health problems or charge them more based solely on their health history — a practice that has effectively barred some people from the market, and prevented others from being able to switch plans.
Insurers were already forbidden from doing that to enrollees in group health plans, such as those sold to employers.
The change will be a huge relief for Maureen Mitchell, 58, of St. Augustine, Fla., who has spent most of the past decade uninsured after being rejected for coverage because of a heart rhythm abnormality.
Last September, Mitchell awoke with a stabbing pain in her chest and did a mental calculation: If she called for help, she would face large bills for hospital care and the ambulance ride. If she didn't call, she might die. "I just didn't have that money," said Mitchell, who did not call 911.
Deductions from deductibles
The law will also put limits on high-deductible policies such as those chosen by Laurie Simons, 62, and Mary McVey, 50 — meaning they pay significant sums out of their own pockets before their coverage kicks in.
Starting in January, new policies must cap annual "out-of-pocket" costs, which include deductibles and co-insurance payments, to about $6,350 for an individual, or $12,700 for a family — amounts that could still be a stretch for many consumers.
"There aren't that many Americans who have that kind of cash just sitting around," said Karen Pollitz of the Kaiser Family Foundation.
Nonetheless, the law's caps will reduce the cost-sharing in many plans currently sold, including those purchased by Simons and McVey.
Almost a third of plans currently offered to consumers exceed those caps, according to the U.S. News/Kaiser Health News analysis.
When Simons, a self-employed mental health counselor in Portland, Maine, switched to a high-deductible plan to reduce her monthly costs, she was healthy. But earlier this year, she was diagnosed with melanoma. Now, she must find $11,000 to pay for her surgery.
"If you don't have money, I don't know what you do," Simons said.
She hopes that next year, she can buy coverage that would protect her against five-figure medical bills
McVey, on the other hand, wants to keep her current policy, saying she is not willing to pay much more than her current $500 per month premium for a family of five. The self-employed accountant in Cape Elizabeth, Maine, has a policy that carries a $15,000 deductible, which could rise to $30,000 if two or more family members fall seriously ill in the same year.
McVey acknowledges she's been lucky that no one in her family has ever faced serious medical problems. She hardly ever goes to the doctor, she said, and offers cash when she does, hoping for a discount. While she would love "a health policy where I don't have to pay $700 to get a checkup for my kids," she said she would not like it if the trade-off is higher premiums.
"Paying $1,200 or more a month for health insurance seems like craziness," she said.
Steve Sternberg and Chris Young of U.S. News & World Report contributed to this report by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.
27 June 2013
Six common surgeries often done unnecessarily
Story originally appeared on USA Today.
Caution: Six common surgeries are often done unnecessarily, including stents, pacemakers and spinal fusions, according to medical research and government databases
Here are six common surgeries that carry significant risks of being done without medical necessity, according to federal data and independent studies.
Cardiac angioplasty, stents:
A 2011 study in the Journal of the American Medical Association looked at angioplasty procedures, which often include insertion of stents. In cases where patients were not suffering acute heart attack symptoms, 12% of all angioplasty procedures were found to lack medical necessity.
"This procedure (angioplasty), along with stenting, has been proved to protect the heart or prolong life only in people highly susceptible to heart attack," Consumer Reports wrote in 2005. "In everyone else, it appears only to ease angina. Further, the procedure has risks, including, in two to six percent of patients, heart attack, stroke or death."
Cardiac pacemakers:
A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support the installation.
A 1988 study in the New England Journal of Medicine reviewed 382 pacemaker implants at 30 Philadelphia-area hospitals and found that 20% of the procedures were not medically warranted.
Back surgery, spinal fusion:
A 2011 study, in the journal Surgical Neurology International, assessed the medical records of 274 patients who were told they needed spinal surgery. More than 17% had no abnormal neurological or radiographic findings in their case histories.
"Since the 1980s, operations for low-back pain have increased from about 190,000 to more than 300,000 per year," Consumer Reports noted in 2005. "Many of those operations are probably unnecessary."
Hysterectomy (surgical removal of the uterus):
In a 2000 study for the American College of Obstetricians and Gynecologists, researchers assessed hysterectomies on 497 women in Southern California. They found the surgery was recommended inappropriately in about 70% of cases, often because doctors did not try non-surgical approaches.
"The conditions that most often cause pelvic pain or abnormal bleeding — fibroids, or benign tumors; endometriosis, or growth of uterine-like tissue on abdominal or pelvic organs; and hormonal imbalances — can all be treated less aggressively," Consumer Reports reported. Other potential options: therapy to reduce estrogen levels or surgery to remove fibroids but retain the uterus.
Knee and hip replacement:
In a 2012 study in Health Affairs, researchers provided patients in a Washington state health system with "decision aids," which included information on joint replacements and alternative treatments. The researchers found that patients who got the information had 26% fewer hip replacements and 38% fewer knee replacements.
Cesarean section:
In a 2013 study in Health Affairs using data from 593 hospitals nationwide, researchers found that cesarean rates varied tenfold across hospitals, from 7.1% to 69.9%. Among women with lower-risk pregnancies, where researchers expected less variation, cesarean rates varied by a factor of 15, from 2.4% to 36.5%. "Vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many U.S. hospitals," the study concluded.
Caution: Six common surgeries are often done unnecessarily, including stents, pacemakers and spinal fusions, according to medical research and government databases
Here are six common surgeries that carry significant risks of being done without medical necessity, according to federal data and independent studies.
Cardiac angioplasty, stents:
A 2011 study in the Journal of the American Medical Association looked at angioplasty procedures, which often include insertion of stents. In cases where patients were not suffering acute heart attack symptoms, 12% of all angioplasty procedures were found to lack medical necessity.
"This procedure (angioplasty), along with stenting, has been proved to protect the heart or prolong life only in people highly susceptible to heart attack," Consumer Reports wrote in 2005. "In everyone else, it appears only to ease angina. Further, the procedure has risks, including, in two to six percent of patients, heart attack, stroke or death."
Cardiac pacemakers:
A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support the installation.
A 1988 study in the New England Journal of Medicine reviewed 382 pacemaker implants at 30 Philadelphia-area hospitals and found that 20% of the procedures were not medically warranted.
Back surgery, spinal fusion:
A 2011 study, in the journal Surgical Neurology International, assessed the medical records of 274 patients who were told they needed spinal surgery. More than 17% had no abnormal neurological or radiographic findings in their case histories.
"Since the 1980s, operations for low-back pain have increased from about 190,000 to more than 300,000 per year," Consumer Reports noted in 2005. "Many of those operations are probably unnecessary."
Hysterectomy (surgical removal of the uterus):
In a 2000 study for the American College of Obstetricians and Gynecologists, researchers assessed hysterectomies on 497 women in Southern California. They found the surgery was recommended inappropriately in about 70% of cases, often because doctors did not try non-surgical approaches.
"The conditions that most often cause pelvic pain or abnormal bleeding — fibroids, or benign tumors; endometriosis, or growth of uterine-like tissue on abdominal or pelvic organs; and hormonal imbalances — can all be treated less aggressively," Consumer Reports reported. Other potential options: therapy to reduce estrogen levels or surgery to remove fibroids but retain the uterus.
Knee and hip replacement:
In a 2012 study in Health Affairs, researchers provided patients in a Washington state health system with "decision aids," which included information on joint replacements and alternative treatments. The researchers found that patients who got the information had 26% fewer hip replacements and 38% fewer knee replacements.
Cesarean section:
In a 2013 study in Health Affairs using data from 593 hospitals nationwide, researchers found that cesarean rates varied tenfold across hospitals, from 7.1% to 69.9%. Among women with lower-risk pregnancies, where researchers expected less variation, cesarean rates varied by a factor of 15, from 2.4% to 36.5%. "Vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many U.S. hospitals," the study concluded.
24 June 2013
Men Over 40 Should Think Twice Before Running Triathlons
Story Originally Appeared in Bloomberg News
For men competing in triathlons past the age of 40, the grueling slog to the finish line could be their last.
As the average age of competitors in endurance sports rises, a spate of deaths during races or intense workouts highlights the risks of excessive strain on the heart through vigorous exercise in middle age. Among the recent casualties: Michael McClintock, senior managing director of Macquarie Group Ltd. and a triathlete, who died at age 55 of cardiac arrest earlier this month after training.
The 40-to-60-year age bracket, often referred to as middle aged men in Lycra, or Mamils, now holds 32 percent of the membership in USA Triathlon, the sport’s official governing body in the U.S. More fitness conscious than previous generations, their numbers in competitive races are swelling, along with their risk of cardiac arrest. Triathlons, the most robust of endurance races requiring swimming, biking and running, are also believed to be the most risky.
“People need to understand that they’re not necessarily gaining more health by doing more exercise,” said David Prior, a cardiologist and associate professor of medicine at the University of Melbourne. “The attributes to push through the barriers and push through the pain are common in competitive sport, but that’s also dangerous when it comes to ignoring warning signs.”
While benefits of exercise are well-known, researchers now suspect that there may be a point at which exertion becomes dangerous, especially for middle aged men who, because of gender and changes that accompany aging, are more susceptible to cardiac arrest caused by vigorous exercise.
Cardiac Arrest
Cardiac arrest, which occurs when the heart suddenly stops beating, can be caused by almost any heart condition, including abnormal heart rhythm, thickening heart muscle and arteries -- changes that can occur silently as healthy people age. The risk of sudden cardiac arrest, which can be brought on with physical stress, increases with age, and men are two to three times more likely to suffer from it than women, according to the National Institutes of Health.
McClintock, the Macquarie Bank executive who died on June 2 at his home in Larchmont, New York, was an avid skier, biker and golfer. The previous September, he completed the Jarden Westchester Triathlon, his first Olympic-length event, taking less than 4 hours to swim 0.9-miles (1.4 kilometers), cycle 25 miles and run 6.2 miles.
While McClintock’s death can’t be directly linked to the race, USA Triathlon has noted an increase in race-related fatalities, with the highest number occurring in the 40-to-49-year age group.
Triathlon Risk
The death rate for triathlons is about twice that of marathons because of increased intensity of the competition and the initial swimming leg of the events, according to a 2012 study published last year in the journal Mayo Clinic Proceedings.
“The swim seems to be a particularly dangerous time,” said Andre La Gerche, a cardiologist at Melbourne’s St Vincent’s Hospital and marathoner. “Paradoxically, in the marathon, it’s the opposite: it’s the last mile of the event where the vast majority of fatalities occur.” Researchers speculate that sprinting to the finish produces a rush of adrenalin that may trigger an abnormal rhythm in runners with susceptible hearts.
‘Fighting to Breathe’
The swim leg of the triathlon, often held in open water, can be “extraordinarily stressful,” said La Gerche, who has also competed in more than 100 triathlons. “You have people climbing all over you. Sometimes you’re fighting to breathe, and that’s not something the body is used to.”
Open-water racing triggers a clash of two mechanisms of the involuntary nervous system, according to researchers at England’s University of Portsmouth. A “fight or flight” response activated by physical exertion, cold water temperature or anxiety tries to speed up the heart rate and causes hyperventilation, just as the body tries to slow the heart rate to conserve oxygen in response to facial wetting, water entering the mouth, nose and throat, and extended breath-holding, the scientists said.
“Normally the two responses don’t happen at the same time, but when they do, the heart can go into abnormal rhythms, which can cause sudden cardiac death,” Mike Tipton, who runs the university’s Extreme Environments Laboratory, wrote in a commentary for the British Journal of Sports Medicine in February.
Train to Sprint
Runners should maintain their pace or slowdown in the last mile and not sprint unless they have trained for it, the International Marathon Medical Director’s Association, a doctor’s group, said in 2010 in a list of recommendations in response to race-related sudden deaths.
Running appears to lower the risk for mortality when an athlete doesn’t exceed more than 20 miles a week, log more than five to seven miles per hour, or run more than two to five times a week, researchers at the Ochsner Health System of New Orleans and the University of South Carolina found in a study last year.
More than 2 million people participate in long-distance running races in the U.S. each year -- a number that has doubled since 2000. Even though the risk of death from marathon-running is small, increased participation has resulted in a higher incidence of sudden death at the events, according to a study published in the New England Journal of Medicine in January 2012. Out of 11 million long-distance runners, 59 people suffered cardiac arrest, 51 of them men.
Causes of cardiac events in athletes vary depending on age. For those under 35, cardiovascular conditions are usually inherited. Heart incidents in older athletes can be due to coronary artery disease that they don’t know they have, Melbourne cardiologist Prior said.
Vessel Disease
By middle age, most people have developed some underlying early stage vessel disease, such as hardening or plaque buildup in their coronary arteries, said Kade Davison, who teaches clinical exercise science at the University of South Australia in Adelaide.
“If anyone is going to have a cardiac event they’re far more likely to have one during exercise,” said Davison. A person is seven times more likely to have a heart incident while exercising than at rest, he said, citing a 1984 New England Journal of Medicine study.
A person’s electrolyte balance changes while doing long distance endurance events like marathons or long cycle rides, Davison said. People might also suffer potassium or sodium depletion, or become dehydrated, which also contributes to extra stress on the heart.
Heart Tears
Intense exercise for periods longer than one to two hours can cause over-stretching and tiny tears of the heart’s tissue, said James O’Keefe, a sports cardiologist and head of preventative cardiology at the Mid America Heart Institute in Kansas City, Missouri. This type of repeated injury over years can cause irregular heart rhythms, increased inflammation, scarring and stiffening of the arteries, he said.
Athletic over-achievers tend to think that “more is better,” though when it comes to health, “moderation is almost always best,” said Mid America Heart Institute’s O’Keefe.
As a precaution, getting a computerized tomography, or CT, scan of the heart to look for calcified plaque is a good way for endurance athletes to check if their workouts are putting their heart at risk, O’Keefe said. Yet there is no agreement on what the best strategy is for testing.
‘No Good Test’
“The throwaway line is to consult your doctor to make sure you’re fit to race,” said Melbourne cardiologist La Gerche. “The only good tests depend on people having symptoms and telling their doctors. In healthy asymptomatic people, there is no good test to see if someone is at risk of sudden death.”
Those who experience a bit of chest pain or become breathless should see a doctor to check it out, especially if the discomfort occurs during training, said University of South Australia’s Davison. Sudden events that occur in people who have had no previous sign of heart disease usually indicate a build-up of plaque.
When plaque ruptures, it can cause a clot in an artery, which often doesn’t show up in typical stress tests of ECG monitoring of the heart’s electrical activity. Clots aren’t often detected until the heart becomes stressed enough to cause a rupture, causing sudden onset of chest pain, Davison said.
Screening typically would have more value in people who are new to exercise and don’t know whether they have developed a disease. People who regularly exercise without any symptoms aren’t likely to show any signs in a stress test, Davison said.
Competition Changes
World Triathlon Corp., the owner of the sport’s Ironman-branded events, made changes to the swim portion of select races after an increase in competitor deaths in recent years, the company announced last month.
Events in Coeur d’Alene, Idaho; Lake Placid, New York; and Mont-Tremblant, Quebec, no longer feature a mass swim start, eliminating a long-standing Ironman tradition. Athletes at those races will either enter the water in a continuous stream through an access point, with their time starting when they cross a timing mat, or in staggered waves based on their age group.
The changes came two months after Ross Ehlinger, a 46-year-old man from Austin, Texas, died during the swim portion of the Escape from Alcatraz Triathlon and nine months after Andy Naylor, a 43-year-old member of the Hong Kong Police Force, died near the conclusion of the 2.4-mile swim portion of the New York City Ironman. In 2011, two competitors died during the swim portion of the Olympic-distance New York City Triathlon.
MetaMan Iron
Other organizers are also taking precautions. On the last day of August, triathletes will gather on the beach of Bintan, Indonesia and participate in the MetaMan Iron Distance race. Two speedboats will be on hand to help racers in the event of a medical emergency, said organizer spokeswoman Hollie Avil.
O’Keefe advises his patients, especially those over 45, to run no more than 20 miles a week, spread out over three to four days.
“That’s not to say you can’t get problems when you’re under 45,” said O’Keefe. “But you’re much more susceptible when you’re over 45 because it just takes longer for your body to recover and when you hammer it day in and day out, it just takes a toll on your body.”
For men competing in triathlons past the age of 40, the grueling slog to the finish line could be their last.
As the average age of competitors in endurance sports rises, a spate of deaths during races or intense workouts highlights the risks of excessive strain on the heart through vigorous exercise in middle age. Among the recent casualties: Michael McClintock, senior managing director of Macquarie Group Ltd. and a triathlete, who died at age 55 of cardiac arrest earlier this month after training.
The 40-to-60-year age bracket, often referred to as middle aged men in Lycra, or Mamils, now holds 32 percent of the membership in USA Triathlon, the sport’s official governing body in the U.S. More fitness conscious than previous generations, their numbers in competitive races are swelling, along with their risk of cardiac arrest. Triathlons, the most robust of endurance races requiring swimming, biking and running, are also believed to be the most risky.
“People need to understand that they’re not necessarily gaining more health by doing more exercise,” said David Prior, a cardiologist and associate professor of medicine at the University of Melbourne. “The attributes to push through the barriers and push through the pain are common in competitive sport, but that’s also dangerous when it comes to ignoring warning signs.”
While benefits of exercise are well-known, researchers now suspect that there may be a point at which exertion becomes dangerous, especially for middle aged men who, because of gender and changes that accompany aging, are more susceptible to cardiac arrest caused by vigorous exercise.
Cardiac Arrest
Cardiac arrest, which occurs when the heart suddenly stops beating, can be caused by almost any heart condition, including abnormal heart rhythm, thickening heart muscle and arteries -- changes that can occur silently as healthy people age. The risk of sudden cardiac arrest, which can be brought on with physical stress, increases with age, and men are two to three times more likely to suffer from it than women, according to the National Institutes of Health.
McClintock, the Macquarie Bank executive who died on June 2 at his home in Larchmont, New York, was an avid skier, biker and golfer. The previous September, he completed the Jarden Westchester Triathlon, his first Olympic-length event, taking less than 4 hours to swim 0.9-miles (1.4 kilometers), cycle 25 miles and run 6.2 miles.
While McClintock’s death can’t be directly linked to the race, USA Triathlon has noted an increase in race-related fatalities, with the highest number occurring in the 40-to-49-year age group.
Triathlon Risk
The death rate for triathlons is about twice that of marathons because of increased intensity of the competition and the initial swimming leg of the events, according to a 2012 study published last year in the journal Mayo Clinic Proceedings.
“The swim seems to be a particularly dangerous time,” said Andre La Gerche, a cardiologist at Melbourne’s St Vincent’s Hospital and marathoner. “Paradoxically, in the marathon, it’s the opposite: it’s the last mile of the event where the vast majority of fatalities occur.” Researchers speculate that sprinting to the finish produces a rush of adrenalin that may trigger an abnormal rhythm in runners with susceptible hearts.
‘Fighting to Breathe’
The swim leg of the triathlon, often held in open water, can be “extraordinarily stressful,” said La Gerche, who has also competed in more than 100 triathlons. “You have people climbing all over you. Sometimes you’re fighting to breathe, and that’s not something the body is used to.”
Open-water racing triggers a clash of two mechanisms of the involuntary nervous system, according to researchers at England’s University of Portsmouth. A “fight or flight” response activated by physical exertion, cold water temperature or anxiety tries to speed up the heart rate and causes hyperventilation, just as the body tries to slow the heart rate to conserve oxygen in response to facial wetting, water entering the mouth, nose and throat, and extended breath-holding, the scientists said.
“Normally the two responses don’t happen at the same time, but when they do, the heart can go into abnormal rhythms, which can cause sudden cardiac death,” Mike Tipton, who runs the university’s Extreme Environments Laboratory, wrote in a commentary for the British Journal of Sports Medicine in February.
Train to Sprint
Runners should maintain their pace or slowdown in the last mile and not sprint unless they have trained for it, the International Marathon Medical Director’s Association, a doctor’s group, said in 2010 in a list of recommendations in response to race-related sudden deaths.
Running appears to lower the risk for mortality when an athlete doesn’t exceed more than 20 miles a week, log more than five to seven miles per hour, or run more than two to five times a week, researchers at the Ochsner Health System of New Orleans and the University of South Carolina found in a study last year.
More than 2 million people participate in long-distance running races in the U.S. each year -- a number that has doubled since 2000. Even though the risk of death from marathon-running is small, increased participation has resulted in a higher incidence of sudden death at the events, according to a study published in the New England Journal of Medicine in January 2012. Out of 11 million long-distance runners, 59 people suffered cardiac arrest, 51 of them men.
Causes of cardiac events in athletes vary depending on age. For those under 35, cardiovascular conditions are usually inherited. Heart incidents in older athletes can be due to coronary artery disease that they don’t know they have, Melbourne cardiologist Prior said.
Vessel Disease
By middle age, most people have developed some underlying early stage vessel disease, such as hardening or plaque buildup in their coronary arteries, said Kade Davison, who teaches clinical exercise science at the University of South Australia in Adelaide.
“If anyone is going to have a cardiac event they’re far more likely to have one during exercise,” said Davison. A person is seven times more likely to have a heart incident while exercising than at rest, he said, citing a 1984 New England Journal of Medicine study.
A person’s electrolyte balance changes while doing long distance endurance events like marathons or long cycle rides, Davison said. People might also suffer potassium or sodium depletion, or become dehydrated, which also contributes to extra stress on the heart.
Heart Tears
Intense exercise for periods longer than one to two hours can cause over-stretching and tiny tears of the heart’s tissue, said James O’Keefe, a sports cardiologist and head of preventative cardiology at the Mid America Heart Institute in Kansas City, Missouri. This type of repeated injury over years can cause irregular heart rhythms, increased inflammation, scarring and stiffening of the arteries, he said.
Athletic over-achievers tend to think that “more is better,” though when it comes to health, “moderation is almost always best,” said Mid America Heart Institute’s O’Keefe.
As a precaution, getting a computerized tomography, or CT, scan of the heart to look for calcified plaque is a good way for endurance athletes to check if their workouts are putting their heart at risk, O’Keefe said. Yet there is no agreement on what the best strategy is for testing.
‘No Good Test’
“The throwaway line is to consult your doctor to make sure you’re fit to race,” said Melbourne cardiologist La Gerche. “The only good tests depend on people having symptoms and telling their doctors. In healthy asymptomatic people, there is no good test to see if someone is at risk of sudden death.”
Those who experience a bit of chest pain or become breathless should see a doctor to check it out, especially if the discomfort occurs during training, said University of South Australia’s Davison. Sudden events that occur in people who have had no previous sign of heart disease usually indicate a build-up of plaque.
When plaque ruptures, it can cause a clot in an artery, which often doesn’t show up in typical stress tests of ECG monitoring of the heart’s electrical activity. Clots aren’t often detected until the heart becomes stressed enough to cause a rupture, causing sudden onset of chest pain, Davison said.
Screening typically would have more value in people who are new to exercise and don’t know whether they have developed a disease. People who regularly exercise without any symptoms aren’t likely to show any signs in a stress test, Davison said.
Competition Changes
World Triathlon Corp., the owner of the sport’s Ironman-branded events, made changes to the swim portion of select races after an increase in competitor deaths in recent years, the company announced last month.
Events in Coeur d’Alene, Idaho; Lake Placid, New York; and Mont-Tremblant, Quebec, no longer feature a mass swim start, eliminating a long-standing Ironman tradition. Athletes at those races will either enter the water in a continuous stream through an access point, with their time starting when they cross a timing mat, or in staggered waves based on their age group.
The changes came two months after Ross Ehlinger, a 46-year-old man from Austin, Texas, died during the swim portion of the Escape from Alcatraz Triathlon and nine months after Andy Naylor, a 43-year-old member of the Hong Kong Police Force, died near the conclusion of the 2.4-mile swim portion of the New York City Ironman. In 2011, two competitors died during the swim portion of the Olympic-distance New York City Triathlon.
MetaMan Iron
Other organizers are also taking precautions. On the last day of August, triathletes will gather on the beach of Bintan, Indonesia and participate in the MetaMan Iron Distance race. Two speedboats will be on hand to help racers in the event of a medical emergency, said organizer spokeswoman Hollie Avil.
O’Keefe advises his patients, especially those over 45, to run no more than 20 miles a week, spread out over three to four days.
“That’s not to say you can’t get problems when you’re under 45,” said O’Keefe. “But you’re much more susceptible when you’re over 45 because it just takes longer for your body to recover and when you hammer it day in and day out, it just takes a toll on your body.”
21 June 2013
Cardiac deaths like James Gandolfini's are too common
Story Appeared in USA TODAY
The American Heart Association's president talks about how heart attacks can be avoided.
The news that James Gandolfini, 51, star of The Sopranos, died of cardiac arrest stunned his fans, but for medical experts, it was a reminder of the thousands who remain at risk of a similar fate all the time.
Claudio Modini, head of the emergency room at the Policlinic Umberto I hospital in Rome, said Gandolfini suffered a cardiac arrest and was pronounced dead at 11 p.m. Wednesday after resuscitation efforts in the ambulance and hospital failed. An autopsy will be performed. Originally, it was reported that Gandolfini died of a heart attack.
A heart attack may cause cardiac arrest and sudden death. Heart attacks are caused by a blockage that stops blood flow to the heart. Cardiac arrest is an abrupt loss of heart function caused when the heart's electrical system malfunctions. About 360,000 cardiac arrests are assessed by emergency medical services in the USA annually.
About 715,000 people in the USA will have a new or recurrent heart attack this year, according to the American Heart Association. The average age of the first heart attack is 64.7 years for men and 72.2 years for women.
USA TODAY talked to Donna Arnett, the president of the American Heart Association and the American Stroke Association, about the risk of having a heart attack and ways to avoid it. Arnett is chairman of the department of epidemiology in the School of Public Health at the University of Alabama at Birmingham.
The answers below are from both Arnett and the American Heart Association website:
Q: What is a cardiac arrest? Is it the same as a heart attack?
A: No. The term heart attack is often mistakenly used to describe cardiac arrest. Though a heart attack may cause cardiac arrest and sudden death, the terms don't mean the same thing. Heart attacks are caused by a blockage that stops blood flow to the heart. A heart attack refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim.
Cardiac arrest is caused when the heart's electrical system malfunctions. In cardiac arrest, death results when the heart suddenly stops working properly. This may be caused by abnormal, or irregular, heart rhythms called arrhythmias. A common arrhythmia in cardiac arrest is ventricular fibrillation. This is when the heart's lower chambers suddenly start beating chaotically and don't pump blood. Death occurs within minutes after the heart stops.
Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed and a defibrillator is used to shock the heart and restore a normal heart rhythm within a few minutes.
Q: How common is it for someone in their 50s to have a heart attack?
A: Though risk for heart attacks increases with age, it is not uncommon for a heart attack to occur in the early 50s. Data from one study show that for every 1,000 men, ages 45-54, three will have heart attacks every year. This is why it is important for men and women to visit their health professional to be screened for conditions that increase heart disease risk, such as high blood pressure, high blood cholesterol and type 2 diabetes.
Q: Could Gandolfini's weight have contributed to heart troubles?
A: Obesity is a contributor to the risk of heart attack. We know that excess body weight raises blood cholesterol and blood pressure and can induce type 2 diabetes.
Q: What is a heart attack?
A: A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.
When plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). About every 34 seconds, someone in the USA has a myocardial infarction or heart attack.
The American Heart Association's president talks about how heart attacks can be avoided.
The news that James Gandolfini, 51, star of The Sopranos, died of cardiac arrest stunned his fans, but for medical experts, it was a reminder of the thousands who remain at risk of a similar fate all the time.
Claudio Modini, head of the emergency room at the Policlinic Umberto I hospital in Rome, said Gandolfini suffered a cardiac arrest and was pronounced dead at 11 p.m. Wednesday after resuscitation efforts in the ambulance and hospital failed. An autopsy will be performed. Originally, it was reported that Gandolfini died of a heart attack.
A heart attack may cause cardiac arrest and sudden death. Heart attacks are caused by a blockage that stops blood flow to the heart. Cardiac arrest is an abrupt loss of heart function caused when the heart's electrical system malfunctions. About 360,000 cardiac arrests are assessed by emergency medical services in the USA annually.
About 715,000 people in the USA will have a new or recurrent heart attack this year, according to the American Heart Association. The average age of the first heart attack is 64.7 years for men and 72.2 years for women.
USA TODAY talked to Donna Arnett, the president of the American Heart Association and the American Stroke Association, about the risk of having a heart attack and ways to avoid it. Arnett is chairman of the department of epidemiology in the School of Public Health at the University of Alabama at Birmingham.
The answers below are from both Arnett and the American Heart Association website:
Q: What is a cardiac arrest? Is it the same as a heart attack?
A: No. The term heart attack is often mistakenly used to describe cardiac arrest. Though a heart attack may cause cardiac arrest and sudden death, the terms don't mean the same thing. Heart attacks are caused by a blockage that stops blood flow to the heart. A heart attack refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim.
Cardiac arrest is caused when the heart's electrical system malfunctions. In cardiac arrest, death results when the heart suddenly stops working properly. This may be caused by abnormal, or irregular, heart rhythms called arrhythmias. A common arrhythmia in cardiac arrest is ventricular fibrillation. This is when the heart's lower chambers suddenly start beating chaotically and don't pump blood. Death occurs within minutes after the heart stops.
Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed and a defibrillator is used to shock the heart and restore a normal heart rhythm within a few minutes.
Q: How common is it for someone in their 50s to have a heart attack?
A: Though risk for heart attacks increases with age, it is not uncommon for a heart attack to occur in the early 50s. Data from one study show that for every 1,000 men, ages 45-54, three will have heart attacks every year. This is why it is important for men and women to visit their health professional to be screened for conditions that increase heart disease risk, such as high blood pressure, high blood cholesterol and type 2 diabetes.
Q: Could Gandolfini's weight have contributed to heart troubles?
A: Obesity is a contributor to the risk of heart attack. We know that excess body weight raises blood cholesterol and blood pressure and can induce type 2 diabetes.
Q: What is a heart attack?
A: A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.
When plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). About every 34 seconds, someone in the USA has a myocardial infarction or heart attack.
18 June 2013
Hospitals and doctors should be required to carry medical malpractice insurance
Story Originally Appeared in the Chicago Tribune
Corporations, hospitals and insurance companies have fought for more than two decades to chip away at Americans' right to enter a courtroom and seek damages for medical negligence. The most publicized of these efforts has taken the form of capping the damages that patients can collect.
Now there's another effort to limit medical negligence claims. It has the effect of preventing an injured patient from filing a lawsuit at all.
Hospitals and doctors are simply "going bare" — in other words, not carrying medical malpractice insurance. Hospitals and doctors will often set up a corporation, forgo the purchase of malpractice insurance, and if the corporation is sued, file for bankruptcy and set up a new corporation.
In Illinois, although a driver must have insurance to get behind the wheel, a hospital that cares for thousands of patients is not required to have insurance.
In one case, in 2007, a 21-year-old woman had a baby at a South Side hospital, St. Bernard. Due to a lack of oxygenated blood, the baby's brain was damaged. We sued St. Bernard on behalf of the child, alleging negligence. The hospital said that it had no malpractice insurance to cover the claim. Now, the young mother and her baby must go through life without enough money for proper care. (St. Bernard says the infant was treated appropriately and it has done what it can to resolve the matter.)
Hospitals and doctors that choose to go bare often claim they cannot afford to pay high insurance premiums while at the same time caring for their patients. Insurance companies blame the high premiums on large verdicts that they allegedly pay out. Yet, the blame for the inflation of premiums in Illinois must be placed on the insurance companies. It has been proved that even where insurance companies have had to pay out large jury verdicts or settlements, increased premiums do not correlate with the increase or decrease in payouts during any given year.
Every hospital in Illinois should be required to carry a minimum of $5 million in liability coverage. A small tax could be charged on those hospitals that can afford the coverage, which could be used to supplement the payments of hospitals that cannot afford it. This would allow all hospitals to have some insurance coverage while motivating hospitals to press insurance companies to lower premiums.
The solutions are not complicated, yet they require action soon. This reform will not come without pressure from all parties — the doctors and hospitals that buy insurance, the Illinois legislature and trial lawyers.
Deratany and MacIver are lawyers at the Deratany Firm in downtown Chicago.
Corporations, hospitals and insurance companies have fought for more than two decades to chip away at Americans' right to enter a courtroom and seek damages for medical negligence. The most publicized of these efforts has taken the form of capping the damages that patients can collect.
Now there's another effort to limit medical negligence claims. It has the effect of preventing an injured patient from filing a lawsuit at all.
Hospitals and doctors are simply "going bare" — in other words, not carrying medical malpractice insurance. Hospitals and doctors will often set up a corporation, forgo the purchase of malpractice insurance, and if the corporation is sued, file for bankruptcy and set up a new corporation.
In Illinois, although a driver must have insurance to get behind the wheel, a hospital that cares for thousands of patients is not required to have insurance.
In one case, in 2007, a 21-year-old woman had a baby at a South Side hospital, St. Bernard. Due to a lack of oxygenated blood, the baby's brain was damaged. We sued St. Bernard on behalf of the child, alleging negligence. The hospital said that it had no malpractice insurance to cover the claim. Now, the young mother and her baby must go through life without enough money for proper care. (St. Bernard says the infant was treated appropriately and it has done what it can to resolve the matter.)
Hospitals and doctors that choose to go bare often claim they cannot afford to pay high insurance premiums while at the same time caring for their patients. Insurance companies blame the high premiums on large verdicts that they allegedly pay out. Yet, the blame for the inflation of premiums in Illinois must be placed on the insurance companies. It has been proved that even where insurance companies have had to pay out large jury verdicts or settlements, increased premiums do not correlate with the increase or decrease in payouts during any given year.
Every hospital in Illinois should be required to carry a minimum of $5 million in liability coverage. A small tax could be charged on those hospitals that can afford the coverage, which could be used to supplement the payments of hospitals that cannot afford it. This would allow all hospitals to have some insurance coverage while motivating hospitals to press insurance companies to lower premiums.
The solutions are not complicated, yet they require action soon. This reform will not come without pressure from all parties — the doctors and hospitals that buy insurance, the Illinois legislature and trial lawyers.
Deratany and MacIver are lawyers at the Deratany Firm in downtown Chicago.
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