Story first appeared in the Detroit Free Press.
Behold the thinking man's nose job.
Using skin and cartilage from a patient's ribs, Chinese doctors are growing a replacement nose on the forehead of a 22-year-old man injured in a car accident last year, according to a Reuters report picked up by news organizations.
The technique, reportedly a first, updates a common practice in reconstructive plastic surgery, doctors say.
The patient, nicknamed Xiaolian, received only basic treatment after the August 2012 wreck and could not afford surgery. His nose has become so badly infected that it cannot be saved.
Doctors in Fuzhou City, in Fujian province, decided to try the novel approach to growing a nose, which has taken about nine months.
LiveScience explains the procedure:
The man's doctors placed tissue expanders, which create space to stretch the skin, under the man's forehead, and created the rough shape of a nose, probably using screws and plates. They then harvested cartilage from his ribs to fill in the nose. Once the nose is ready, they will rotate the entire assemblage — skin, blood vessels, cartilage and all — and move the new nose to where his current nose sits.The lead plastic surgeon, Guo Zhihui, from Xiehe Hospital, said that the transplant would happen soon and that Xiaolian could lead a normal life afterward.
David Cangello, a plastic surgeon at Lenox Hill Hospital and Manhattan, Eye Ear and Throat Hospital in New York, told LiveScience that the procedure is "a different take on a principle that we commonly use in reconstruction." He was not involved in the surgery.
Last year, a British man who lost his nose to cancer had a replacement grown on one of his arms. His doctors said his appearance and sense of smell should be as they were before the transplant.
30 September 2013
18 September 2013
ARE YOU GETTING THE BEST CANCER CARE?
Story first appeared on CNCB.com.
Cancer may be the most feared diagnosis, but Americans are getting disorganized care and they're often not even getting treatment based on the best scientific evidence, a panel of experts reports.
It's often too expensive, and the most privileged are getting far better care than people with lower income, minorities, people who live away from big cities and the elderly. And most cancer patients who are doomed to die still wrongly believe they might be cured.
And as the baby boomer generation ages, the U.S. is going to be hit with a tsunami of new cancer cases. It's time to get organized, the Institute of Medicine committee says.
"As a nation we need to chart a new course for cancer care," says Dr. Patricia Ganz, chair of the committee that wrote the report and a professor at the University of California, Los Angeles, School of Medicine and School of Public Health. "We need to make the healthcare system better."
Read more from NBC News:
New Medicaid patients may be younger than states feared, study finds
'Severely obese:' 5 percent of US kids, teens fit risky new category
Graphic anti-smoking ads helped 100,000 kick the habit for good, CDC says
The Internet brings a unique opportunity to change this, with ways to make sure doctors follow the best protocols for treating patients, and making sure patients understand what they need and what is possible, the committee says.
Cancer is the No. 2 cause of death in the United States after heart disease, killing more than 500,000 Americans every year.
Because cancer becomes more likely as people get older, the numbers will go up exponentially. By 2030, the report projects, cancer rates will go up 45 percent, to 2.6 million cases a year.
Cancer is common, so a range of doctors and other specialists treat it. Often the care is very good, but too often it isn't.
"One would expect an entire system to snap into place that would ensure that this patient receives all the treatments he or she needs," Dr. Neil Wenger of UCLA, one of the committee members, says in a video released with the report.
"That is not the way that this system works. We have the most highly trained oncologists but because we don't have coordination among all clinicians, this care doesn't serve patients well. Sometimes it even harms patients."
So someone with colon cancer who goes to his community hospital maybe treated by a surgeon who doesn't know to take out certain lymph glands for testing to see if the cancer has spread, says Ganz. "They may do too many tests," she told NBC News.
(Read more: Studies support fast track for Roche breast cancer drug: FDA)
Often doctors order too many CT scans or unnecessary MRIs, Ganz said. "These kinds of variations lead to potential risk or harm to the patient," she said. "Obviously if you don't have good access, you won't get good care." Plus it can be costly -- and patients often must pay a large chunk of this pricey and unnecessary care.
But patients shouldn't have to rely on being able to get to big, famous cancer centers like MD Anderson in Houston, Memorial Sloan-Kettering Cancer Center in New York or Fred Hutchison Cancer Center in Seattle, says Ganz.
"The truth is, not everybody can travel," says Dr. Clifford Hudis, president of the American Society of Clinical Oncology, who was not on the panel. "We have a golden opportunity now that we are in the age of bioinformatics." Electronic communications can help doctors connect to one another and share expertise, and it needs to happen more often, Hudis and the panel agree.
"Why shouldn't any doctor who is using a computer and electronic records ultimately be able to gain from the experience of everyone? Then it won't matter quite so much if you wander into a one-person office in a rural center," Hudis says.
(Read more: Rare disease at hospital raises concerns about VA health care)
Patients also need to get more informed, and they can't be left to the mercy of misinformation on the Internet, adds Ganz. "We do recommend there be good quality information available in both written and social media," she said. "What is out there and what is on blogs can be very distressing."
The report points out that Americans often don't understand a cancer diagnosis. Up to 80 percent given a diagnosis of incurable cancer don't fully get it — they think they can still be cured, the panel points out.
"Part of this has to do with human nature and the belief that you will be the exception," Hudis says. But many oncologists are also reluctant to deliver the bad news that a patient will never be cured.
Americans often emphasize fighting cancer, characterizing patients as courageous survivors who either beat the odds, or went down after a good fight. But evidence suggests that so-called palliative care — designed to ease pain and other symptoms -- not only makes patients more comfortable, but can help them live longer than intense chemotherapy.
And people shouldn't die of cancer in an intensive care unit, the report says — even though this is still happening far too often. Quality hospice care provides a better alternative.
On the other side, people often panic when they get a cancer diagnosis and may rush into treatment, says Ganz. "We don't want to frighten patients," she says. "I think the quality of care in many places around the country is really high and of a high standard. Patients need to understand that once they are told they have cancer, it is rarely an emergency."
With the exception of an unusual brain tumor or some forms of leukemia, there is usually not a hurry. "Most of the time you can make up your mind over several weeks," Ganz says.
"It will take training of professionals and it will take big changes at a policy level including how care is reimbursed," says Betty Ferrell, an oncology nurse researcher at the City of Hope cancer center in California who was on the IOM panel. "But everything that we are advocating for is ultimately extremely possible."
Cancer may be the most feared diagnosis, but Americans are getting disorganized care and they're often not even getting treatment based on the best scientific evidence, a panel of experts reports.
It's often too expensive, and the most privileged are getting far better care than people with lower income, minorities, people who live away from big cities and the elderly. And most cancer patients who are doomed to die still wrongly believe they might be cured.
And as the baby boomer generation ages, the U.S. is going to be hit with a tsunami of new cancer cases. It's time to get organized, the Institute of Medicine committee says.
"As a nation we need to chart a new course for cancer care," says Dr. Patricia Ganz, chair of the committee that wrote the report and a professor at the University of California, Los Angeles, School of Medicine and School of Public Health. "We need to make the healthcare system better."
Read more from NBC News:
New Medicaid patients may be younger than states feared, study finds
'Severely obese:' 5 percent of US kids, teens fit risky new category
Graphic anti-smoking ads helped 100,000 kick the habit for good, CDC says
The Internet brings a unique opportunity to change this, with ways to make sure doctors follow the best protocols for treating patients, and making sure patients understand what they need and what is possible, the committee says.
Cancer is the No. 2 cause of death in the United States after heart disease, killing more than 500,000 Americans every year.
Because cancer becomes more likely as people get older, the numbers will go up exponentially. By 2030, the report projects, cancer rates will go up 45 percent, to 2.6 million cases a year.
Cancer is common, so a range of doctors and other specialists treat it. Often the care is very good, but too often it isn't.
"One would expect an entire system to snap into place that would ensure that this patient receives all the treatments he or she needs," Dr. Neil Wenger of UCLA, one of the committee members, says in a video released with the report.
"That is not the way that this system works. We have the most highly trained oncologists but because we don't have coordination among all clinicians, this care doesn't serve patients well. Sometimes it even harms patients."
So someone with colon cancer who goes to his community hospital maybe treated by a surgeon who doesn't know to take out certain lymph glands for testing to see if the cancer has spread, says Ganz. "They may do too many tests," she told NBC News.
(Read more: Studies support fast track for Roche breast cancer drug: FDA)
Often doctors order too many CT scans or unnecessary MRIs, Ganz said. "These kinds of variations lead to potential risk or harm to the patient," she said. "Obviously if you don't have good access, you won't get good care." Plus it can be costly -- and patients often must pay a large chunk of this pricey and unnecessary care.
But patients shouldn't have to rely on being able to get to big, famous cancer centers like MD Anderson in Houston, Memorial Sloan-Kettering Cancer Center in New York or Fred Hutchison Cancer Center in Seattle, says Ganz.
"The truth is, not everybody can travel," says Dr. Clifford Hudis, president of the American Society of Clinical Oncology, who was not on the panel. "We have a golden opportunity now that we are in the age of bioinformatics." Electronic communications can help doctors connect to one another and share expertise, and it needs to happen more often, Hudis and the panel agree.
"Why shouldn't any doctor who is using a computer and electronic records ultimately be able to gain from the experience of everyone? Then it won't matter quite so much if you wander into a one-person office in a rural center," Hudis says.
(Read more: Rare disease at hospital raises concerns about VA health care)
Patients also need to get more informed, and they can't be left to the mercy of misinformation on the Internet, adds Ganz. "We do recommend there be good quality information available in both written and social media," she said. "What is out there and what is on blogs can be very distressing."
The report points out that Americans often don't understand a cancer diagnosis. Up to 80 percent given a diagnosis of incurable cancer don't fully get it — they think they can still be cured, the panel points out.
"Part of this has to do with human nature and the belief that you will be the exception," Hudis says. But many oncologists are also reluctant to deliver the bad news that a patient will never be cured.
Americans often emphasize fighting cancer, characterizing patients as courageous survivors who either beat the odds, or went down after a good fight. But evidence suggests that so-called palliative care — designed to ease pain and other symptoms -- not only makes patients more comfortable, but can help them live longer than intense chemotherapy.
And people shouldn't die of cancer in an intensive care unit, the report says — even though this is still happening far too often. Quality hospice care provides a better alternative.
On the other side, people often panic when they get a cancer diagnosis and may rush into treatment, says Ganz. "We don't want to frighten patients," she says. "I think the quality of care in many places around the country is really high and of a high standard. Patients need to understand that once they are told they have cancer, it is rarely an emergency."
With the exception of an unusual brain tumor or some forms of leukemia, there is usually not a hurry. "Most of the time you can make up your mind over several weeks," Ganz says.
"It will take training of professionals and it will take big changes at a policy level including how care is reimbursed," says Betty Ferrell, an oncology nurse researcher at the City of Hope cancer center in California who was on the IOM panel. "But everything that we are advocating for is ultimately extremely possible."
09 September 2013
Cancer Battle
Story first appeared in the Detroit News.
At the same time Diana Nyad, 64, was celebrating her successful 110-mile swim from Cuba to Florida, I was with my 65-year-old brother during his five-hour chemotherapy infusion at the University of Michigan Cancer Center.
The New York Times said Nyad’s fifth attempt came “after four years of grueling training, precision planning and single-minded determination.”
I think the same could be said of Peter. Diagnosed in September of 2007 with stage four inoperable prostate cancer, the average survival time back then was 2½years. That was six years ago.
For most people, an infusion room is the least happiest place on Earth. Save the supremely accommodating nurses and staff, no one is expected to be pleasant here. No one is in a good mood. Except my brother.
Escorting us to the infusion room on the upper floor, a nurse asked: “How are you today, Mr. Rich?”
“Wonderful, just wonderful.“
As Peter took his place in the chair he gestured with one arm like a concierge. “So what do you think?” he said. “I call this ‘The Penthouse.” And “How ’bout that view? You should be here when the storms roll in. Magnificent!”
I was there for four hours. The man never shut up. In fact, after three tries, his blood pressure was still too high to start the IV. The nurses had to ask me to leave for a few minutes to get him to stop talking. Later he explained: “Early on, I didn’t want to forge any relationships. I didn’t want to join any cancer club. I was going to get in and get out. I was tough, you know. Then I decided to let my guard down and you know what? I’ve made a whole lot of friends.”
Out of the gate, Peter has been pragmatic. He asked his oncologist: “Will I die from this?” From the moment she said yes, he determined he would do everything in his power to increase his time left, to outlive the statistics. He has.
In all, he’s been through almost two years of hormone therapy, several rounds of chemo and radiation. He is now in his third clinical trial. A diligent researcher, he stays one step ahead of the clinical trials and keeps track of the maze of eligibility requirements.
The challenge in buying time is that each drug is only effective for the length of time it takes for the cancer to outwit the treatment.
With hormone therapy Peter got 22 months, with conventional chemotherapy he got 18 months. With one clinical trial, he got 46 weeks. With another clinical trial, he got nothing. In fact, the cancer advanced.
Then there are the side effects. He gained 32 pounds, only to lose almost twice that. All his hair fell out, including his eyebrows. He’s fought off pneumonia, flus and urinary tract infections. One drug turned him ghost white and blew up his face: He looked like the man in the moon. At one low point, his prostate swelled so much from the cancer he had to have stent put in his ureter.
But he’s also walked a daughter down the aisle. He completed a triathlon. He was there in the labor and delivery room when his first grandchild was born. He and his wife, Carol, welcomed another daughter home after a long absence. And too, this year’s harvest of apples, pears and pumpkins on the several acres of farmland he owns in South Lyon is the most plentiful in years.
He says his job and that of his “team” — meaning the coterie of doctors that a teaching hospital accords him — is to get “as much quality and quantity of life as possible.” Judging from the number of clinical trials being fast-tracked and the advances in gene therapy and molecular biology, he says, “I’m adding more tools to my toolbox all the time.”
Now, more than halfway through a 30-week clinical trial, he’s sick about four days a month. On those days he says he “makes adjustments.” In Peter’s world, that means it may take twice as long to finish painting the barn or he won’t be able to run as fast chasing Sage, his 2-year-old granddaughter. “And that’s just fine with me,” he says, smiling at the very thought of that special little girl.
When Nyad finished her swim on Monday after nearly 53 hours in an ocean brimming with sharks, jelly fish and squalls, she said “I have three messages. One is we should never, ever give up. Two is you never are too old to chase your dreams. Three is it looks like a solitary sport, but it takes a team.”
If I didn’t know better, I’d say my brother and this endurance swimmer were reading the same playbook.
From The Detroit News: http://www.detroitnews.com/article/20130906/LIFESTYLE01/309060015#ixzz2eQtcT6Ps
At the same time Diana Nyad, 64, was celebrating her successful 110-mile swim from Cuba to Florida, I was with my 65-year-old brother during his five-hour chemotherapy infusion at the University of Michigan Cancer Center.
The New York Times said Nyad’s fifth attempt came “after four years of grueling training, precision planning and single-minded determination.”
I think the same could be said of Peter. Diagnosed in September of 2007 with stage four inoperable prostate cancer, the average survival time back then was 2½years. That was six years ago.
For most people, an infusion room is the least happiest place on Earth. Save the supremely accommodating nurses and staff, no one is expected to be pleasant here. No one is in a good mood. Except my brother.
Escorting us to the infusion room on the upper floor, a nurse asked: “How are you today, Mr. Rich?”
“Wonderful, just wonderful.“
As Peter took his place in the chair he gestured with one arm like a concierge. “So what do you think?” he said. “I call this ‘The Penthouse.” And “How ’bout that view? You should be here when the storms roll in. Magnificent!”
I was there for four hours. The man never shut up. In fact, after three tries, his blood pressure was still too high to start the IV. The nurses had to ask me to leave for a few minutes to get him to stop talking. Later he explained: “Early on, I didn’t want to forge any relationships. I didn’t want to join any cancer club. I was going to get in and get out. I was tough, you know. Then I decided to let my guard down and you know what? I’ve made a whole lot of friends.”
Out of the gate, Peter has been pragmatic. He asked his oncologist: “Will I die from this?” From the moment she said yes, he determined he would do everything in his power to increase his time left, to outlive the statistics. He has.
In all, he’s been through almost two years of hormone therapy, several rounds of chemo and radiation. He is now in his third clinical trial. A diligent researcher, he stays one step ahead of the clinical trials and keeps track of the maze of eligibility requirements.
The challenge in buying time is that each drug is only effective for the length of time it takes for the cancer to outwit the treatment.
With hormone therapy Peter got 22 months, with conventional chemotherapy he got 18 months. With one clinical trial, he got 46 weeks. With another clinical trial, he got nothing. In fact, the cancer advanced.
Then there are the side effects. He gained 32 pounds, only to lose almost twice that. All his hair fell out, including his eyebrows. He’s fought off pneumonia, flus and urinary tract infections. One drug turned him ghost white and blew up his face: He looked like the man in the moon. At one low point, his prostate swelled so much from the cancer he had to have stent put in his ureter.
But he’s also walked a daughter down the aisle. He completed a triathlon. He was there in the labor and delivery room when his first grandchild was born. He and his wife, Carol, welcomed another daughter home after a long absence. And too, this year’s harvest of apples, pears and pumpkins on the several acres of farmland he owns in South Lyon is the most plentiful in years.
He says his job and that of his “team” — meaning the coterie of doctors that a teaching hospital accords him — is to get “as much quality and quantity of life as possible.” Judging from the number of clinical trials being fast-tracked and the advances in gene therapy and molecular biology, he says, “I’m adding more tools to my toolbox all the time.”
Now, more than halfway through a 30-week clinical trial, he’s sick about four days a month. On those days he says he “makes adjustments.” In Peter’s world, that means it may take twice as long to finish painting the barn or he won’t be able to run as fast chasing Sage, his 2-year-old granddaughter. “And that’s just fine with me,” he says, smiling at the very thought of that special little girl.
When Nyad finished her swim on Monday after nearly 53 hours in an ocean brimming with sharks, jelly fish and squalls, she said “I have three messages. One is we should never, ever give up. Two is you never are too old to chase your dreams. Three is it looks like a solitary sport, but it takes a team.”
If I didn’t know better, I’d say my brother and this endurance swimmer were reading the same playbook.
From The Detroit News: http://www.detroitnews.com/article/20130906/LIFESTYLE01/309060015#ixzz2eQtcT6Ps
30 August 2013
The new health-care scam that's ripping off taxpayers
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.
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.
Subscribe to:
Posts (Atom)
