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Family Medical Costs Still Rising

Editor - Health News — Sun, 26 May 2013 00:39:13 +0000

The good news is health care costs are going up more slowly. The bad news is that families continue to see larger medical bills.

The typical cost to cover a family of four now exceeds $22,000, including the amount paid in insurance premiums and out-of-pocket costs, according to the latest Milliman Medical Index for 2013. Milliman, an actuarial and benefits consultant, puts the cost at slightly less than the amount a family might pay to send a child to an in-state public college for a year.

This year’s increase over last was only 6.3 percent, according to the analysis from Milliman, having dropped steadily from the 7.8 increase it calculated for the year-over-year increase in 2010. But the total dollar increase is about $1,300, and families are paying several thousand dollars more than they were just a few years ago, increasing more than $5,000 since 2009. “The dollar amount is still significant,” said Chris Girod, an actuarial expert for Milliman.

Milliman calculates that employers pick up the bulk of the costs, paying nearly $13,000 of the overall tab.The employee pays the remaining $9,000, divided between the worker’s share of premiums and that worker’s out-of-pocket costs.

There has been vigorous debate over whether the slowing down in the rate of health care costs is because of the weak economy, efforts to bring costs under control or some other reason. The Milliman report does not predict whether families should expect the good news to continue. “There isn’t one single driver pushing this down right now,” said Mr. Girod.

Because the index reflects the costs for a family insured under an employer, which is representative of most people who have coverage, Milliman is fairly cautious about the impact of the Affordable Care Act on health care costs in the near future. The new marketplaces for health insurance, expected to make their debut in October to offer coverage in 2014, are largely aimed at people who have to buy insurance on their own. While there are provisions in the federal law aimed at reducing overall health care costs, it may take a while to see any proof that these steps are effective, Mr. Girod said. “The jury is out right now, and there are opportunities for improvement,” he said.

A version of this article appeared in print on 05/25/2013, on page B6 of the NewYork edition with the headline: Medical Costs Rise Further.

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We Don’t Feel So Good

Editor - Health News — Sun, 26 May 2013 00:39:05 +0000

According to rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, New Haven County—for the third year in a row—was found to be the least-healthy county in Connecticut.

Tolland was the healthiest, followed by Fairfield. Hartford was sixth. Counties were assessed in 25 categories, including teen birth rate, obesity, smoking, number of fast-food joints and excessive drinking.

Speaking of excessive drinking, The Daily Beast, with data from market researcher Experian Marketing Services and information from the Centers for Disease Control and Prevention, named Hartford-New Haven the sixth most drunken “city” in the country in 2012, with 16.5 percent of the population classified as binge drinkers and an average of 15.2 drinks consumed by adults each month.

We may not be the healthiest in the state, but we’re among the healthiest in the country. According to America’s Health Rankings, Connecticut is sixth in the nation for overall health. We’ll drink to that.

—Elaine X. Grant

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CDC to Doctors: Help Your Patients Quit Smoking!

Editor - Health News — Sun, 26 May 2013 00:38:37 +0000

The campaign – “Talk With Your Doctor” – also encourages clinicians to ask patients whether they smoke and to offer them assistance giving up cigarettes. The Centers for Disease Control and Prevention, in partnership with several national physicians’ organizations, unveiled the initiative Wednesday.

Though 70% of smokers see doctors regularly, most try to quit smoking without professional help, said CDC Director Thomas Frieden, himself a physician.

A doctor’s advice and assistance more than doubles the odds that a smoker will quit, Frieden said. Doctors can offer counseling, resources, prescription medication and nicotine replacement options.

“Every doctor should do everything possible to help their patients quit,” Frieden said. Unfortunately, he said, “it is still too often not part of the routine doctor visit.”

The initiative features national television and online advertisements that include tips from former smokers, each one ending with the statement: “You can quit. Talk with your doctor for help.” The ads will run from May 27 through June 2.

Doctors, who often underestimate the number of their patients who smoke, can get tips on the CDC website on how best to help patients. They can also attend training on tobacco interventions.

Doctors can be a guide and partner for patients who are ready to quit, but they have to understand that giving up smoking can be a process, said Dr. Jeffrey Cain, president of the American Academy of Family Physicians.

“The door is open,” he said. “America’s family physicians are ready, willing, trained and able to help you quit smoking.”

Surgeon Gen. Regina Benjamin said the U.S. had reduced tobacco use by half since 1964, but there was still a long way to go. About 1,200 people die each day from smoking, and one-fifth of the adult population continues to smoke, she said. Benjamin said part of the reason doctors can help is because their patients trust them.

Smokers can read the stories of successful quitters, learn about smoking-related health conditions and more on the CDC website.

anna.gorman@latimes.com

@annagorman

Return to Science Now.

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VIDEO: Man plays guitar during brain surgery

Editor - Health News — Sun, 26 May 2013 00:38:27 +0000

In a medical first, a patient has played the guitar while undergoing brain surgery in the US.

The aim was to help surgeons pinpoint exactly where to place electrodes to treat the effects of his Parkinson’s disease, as Janey Mitchell explains.

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Chemical ‘makes us scratch itches’

Editor - Health News — Sun, 26 May 2013 00:38:18 +0000

24 May 2013
Last updated at 04:34 ET

Researchers have found a chemical that is necessary in order to feel the urge to scratch an itch.

They were able to turn off the urge in mice while leaving the animals’ other senses, such as touch and temperature, intact.

It is hoped that a deeper understanding of itching could eventually lead to therapies for patients with debilitating, chronic itch.

The study was published in the journal Science.

The team at the National Institute of Dental and Craniofacial Research, part of the US National Institutes of Health, bred mice that were unable to produce a chemical called Nppb.

It is a small signalling chemical that allows brain cells to communicate with each other.

Mice without the chemical looked and acted like other mice, said Dr Santosh Mishra, except “when we exposed the mice to several itch-inducing substances, it was amazing to watch, nothing happened, the mice wouldn’t scratch”.

Injections of Nppb into a mouse’s spinal cord made them scratch.

‘Landline to the brain’

The group of researchers said the chemical was involved in taking itching sensations in the skin and passing them up the spinal cord and into the brain.

Dr Mark Hood said: “Our work shows that itch, once thought to be a low-level form of pain, is a distinct sensation that is uniquely hardwired into the nervous system with the biochemical equivalent of its own dedicated landline to the brain.”

He told the BBC: “I’d be extremely surprised if it didn’t work the same way in people.”

Insect bites, psoriasis and eczema can all result in a strong itch. Some people develop a profound urge to itch with no obvious cause.

Dr Hood said this could be “devastating” and lead to a “poor quality of life when people just keep scratching”. The only treatment is to sever the nerves in the affected region, but this also damages other sensations.

Researchers are keen to find a way to selectively turn off the need to itch in people with these conditions.

However, Nppb looks unlikely to be the immediate answer as it also has an important role in the heart so any drug could have serious side effects.

Prof Malcolm Rustin, from the British Association of Dermatologists, said it was “desperately important” that drugs to combat itch were developed.

“In patients with eczema, the first symptom is itch. There is debate if you have itch, damage the skin barrier and let allergens in, it becomes a vicious circle.”

He said this was an “interesting study” and that developing blockers for the chemical pathway in which Nppb was involved might treat itch.

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60,000 get MMR jab after outbreak

Editor - Health News — Sun, 26 May 2013 00:38:13 +0000

23 May 2013
Last updated at 08:23 ET

MMR drop-in clinics finish this weekend, but jabs will be available from GPs

Over 60,000 measles vaccinations have now been given which will help to reduce the length and severity of the outbreak in Swansea and Powys, says Public Health Wales.

However, another 33,000 youngsters between 10 and 18 have still not had the jab, say officials.

The number of cases in the outbreak has now reached 1,136 since November 2012, up 10 cases in the last few days.

There were only 19 measles cases in Wales in the whole of 2011.

“We are delighted to see that thanks to the efforts of health board staff and the efforts of parents, the number vaccinated with MMR has now passed 60,000,” said health protection director Dr Marion Lyons from Public Health Wales (PHW).

Final drop-in clinics

Continue reading the main story

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…we remain concerned for the 33,000 children aged 10 to 18 who remain unvaccinated”

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Dr Marion Lyons
Public Health Wales

“This will undoubtedly have helped to reduce the length and severity of the current outbreak – but we remain concerned for the 33,000 children aged 10 to 18 who remain unvaccinated.

“There will always be the possibility of measles outbreaks elsewhere in Wales until we reduce the numbers of unvaccinated people.”

In all, almost 61,500 non-routine vaccinations have been given since 1 March.

This includes 17,440 people aged 10 to 18 who are said to be the group hardest hit by the measles outbreak centred on the Swansea area.

This week sees the final opportunities for people to be vaccinated at drop-in clinics and in school sessions, although jabs will still be available through GP surgeries.

There will be a final drop-in session at the Princess of Wales Hospital, Bridgend on Thursday from 18:00 to 21:00 BST.

In Powys, two drop-in sessions will be held at the outpatients’ departments of Brecon Hospital and Newtown Hospital on Saturday between 10:30 to 14:30 BST.

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Clock Ticking on Full Medicaid Expansion Funds

Editor - Health News — Sat, 25 May 2013 16:47:08 +0000

States still mired in the fight over the Obamacare Medicaid expansion are starting to give up on their first year of full funding — and it’s unclear whether they would be able to tap into the money before 2015.

Expansion remains an open question in about a dozen states after months of legislative fights. As more states continue to wrap up their budgets, some are already looking to next year’s legislative sessions as their next shot at the expansion, even amid calls for state legislatures to return for special sessions.

“Most of these conversations are going to be over by June,” said Judy Solomon, vice president for health policy at the left-leaning Center on Budget and Policy Priorities.

(PHOTOS: The eight GOP governors who said yes to Medicaid expansion)

Though the Obama administration is allowing states to sign up for the Medicaid expansion at any time, even a one-year delay could mean lost federal funds totaling hundreds of millions of dollars — and in some larger states, billions — to cover low-income residents.

Some undecided states have recently signaled there will be little chance of expansion taking effect before 2015, if at all. Pennsylvania Gov. Tom Corbett’s top health official reportedly said she doesn’t think the state would be able to expand before January 2015. And a consulting firm advising Oklahoma Gov. Mary Fallin didn’t offer expansion as an option until 2015.

In Utah, Gov. Gary Herbert has convened a work group this summer to study Medicaid expansion options, ranging from the straight-up expansion to making Utah less reliant on federal dollars. Herbert’s not expected to make a decision until September, and even if he were to opt for the expansion envisioned under the health law, advocates in the state think they would miss out on at least the first six months of funding in a best-case scenario.

But those closely watching the health law’s implementation said states, under the right circumstances, could still sign up for the expansion early in 2014 and receive full federal funding.

Clouding matters a bit is the fact that federal Medicaid officials haven’t actually given states a deadline to sign up for the expansion. And in some states — depending on the level of preparedness — implementing the expansion wouldn’t be all that challenging, experts say.

A spokesman for the Centers for Medicare Medicaid Services didn’t respond to a question about the timing for states to opt in to the expansion by 2014. CMS Medicaid director Cindy Mann, who is overseeing negotiations with the states, refused to speak to a POLITICO reporter when approached after an industry event late last week.

Compared to the herculean effort of setting up new health insurance exchanges — which just 16 states and Washington, D.C., are doing — the Medicaid expansion isn’t nearly as large of an undertaking.

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Incentives Push Doctors to Electronic Medical Records

Editor - Health News — Sat, 25 May 2013 16:46:59 +0000

WASHINGTON — More than half of doctors’ offices and 80% of hospitals that provide Medicare or Medicaid will have electronic health records by the end of the year, the Department of Health and Human Services announced Wednesday.

“We have reached a tipping point in adoption of electronic health records,” said HHS Secretary Kathleen Sebelius, and they “are critical to modernizing our health care system.”

The announcement comes as a key part of the 2010 health care law: Doctors with have can better track errors and prevent future problems. The government can track organizations for quality, as the law requires. And electronic records allow each of a patient’s doctors to see what tests have been performed and what medications have been administered, which could prevent duplicated prescriptions and procedures and bad drug interactions.

About 17% of physicians used electronic records in 2008, but now 50% “have demonstrated meaningful use and received an incentive payment,” according to HHS. About 9% of hospitals had electronic records in 2008, but HHS found that 80% have now demonstrated use.

The federal government gave health providers grants to buy technology as part of the Recovery Act in 2009 but also required that they show “meaningful use” to get incentive payments. They are now in the stage in which they must show they can store data and track it, report quality measures and begin to engage patients electronically, among other things.

“In four years, they’ve made more progress than in the previous 20 years,” said Farzad Mostashari, national coordinator for health information technology at HHS. Some of those changes, he said, were “painfully obvious,” but people have been afraid to take on what can seem like an enormous task.

STORY:: Electronic records companies to benefit from law

Incentive money has encouraged use of the records, he said. But providers also understood that to move away from fee-for-service payment programs and toward team-based healthcare, they needed to be able to share information easily. Medicare also began charging penalties for people readmitted to hospitals for certain conditions, such as heart attacks and pneumonia. Without electronic records, doctors didn’t always know when their patients were released — or even that they were in the hospital to begin with.

“I think a lot of what seems like resistance was uncertainty,” Mostashari said. To help address that, HHS created 62 resource centers to help providers pick software based on their needs, or to plan a new program’s implementation. About 140,000 doctors worked with those extension services, and they were 2.5 times more likely to be successful in reaching meaningful-use goals than providers who did not seek help, he said.

So far, more than 291,000 providers and 3,800 hospitals have received incentive payments.

Some of the changes are already paying off, Mostashari said. For example, in the past, doctors would write down medical recommendations in a person’s medical record, then it would be transcribed to a prescription, but the person’s last prescription might not be in the record, or it might be illegible, or it might be in a record at another doctor’s office. If the person went to the emergency room, no one knew his medical history.

“There were hundreds of thousands of medical errors,” Mostashari said. “Electronic records cut errors by half.”

Next year, providers will be expected to have their medical records systems talking to other systems so they can easily shoot a prescription to the pharmacy and share patient records with patients and other providers. In 2016, they’ll be expected to use the data to determine what works best, what’s the safest, and what is the most cost-effective when it comes to care. Some providers are already in those stages, Mostashari said.

Despite the gains in use, problems remain. Systems don’t always talk to each other, which requires more guidance from the government, he said.

“We want a single standard for lab results,” Mostashari said. That way, providers can receive results from any lab without worrying about whether the software matches.

They’ve also worked on standardizing language and making sure it can all be sent securely, he said.

There have been other difficulties. The sequestration has cut the incentive payments by 2%, he said, as well as cutting his office’s budget.

“It definitely makes it harder,” he said.

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Governors Team Up for Healthcare Sustainability, Innovation

Editor - Health News — Sat, 25 May 2013 16:46:50 +0000

Heeding healthcare industry calls for payment reform, Govs. John Kitzhaber of Oregon and Bill Haslam of Tennessee will lead the new Health Care Sustainability Task Force to help governors innovate their Medicaid programs and achieve low-cost, high-quality healthcare for their constituents.

Using shared experiences and best practices from states, the task force will focus on federal legislative or regulatory efforts that could help states reform healthcare payment and delivery models to improve care and lower costs, the National Governors Association (NGA) announced Tuesday.

The task force membership includes California Gov. Jerry Brown, whose state has accepted Medicaid expansion and who earlier this year asked the Obama administration for broader leeway to control costs for the Medicaid program–a call for flexibility that was echoed by other governors.

In co-chair Kitzhaber’s home state, an experiment to expand Medicaid coverage improved healthcare utilization, but not outcomes, according to a May study published in the New England Journal of Medicine. Meanwhile, co-chair Haslam hails from one of the nine Medicaid expansion holdouts, which maintain they can’t afford to expand the program.

“Governors are working in their states to find ways to cut costs when it comes to healthcare,” Haslam said in a statement. “It is our responsibility to examine every possible option in an effort to make sure promising new initiatives can be fully utilized.”

With similar payment reform goals, a recently formed coalition, supported by the Robert Wood Johnson Foundation, calls for incentivizing states to help control healthcare costs by allowing states that slow spending growth to share a percentage of Medicare and Medicaid savings.

For more:
- here’s the NGA statement

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Jabs and 999 calls in NHS priorities

Editor - Health News — Sat, 25 May 2013 16:46:43 +0000

24 May 2013
Last updated at 01:46 ET

The framework outlines the priorities for the NHS in Wales

Immediate action is needed by the NHS in Wales to increase vaccinations of young children, reduce AE waiting times and to get to grips with bed blocking, health chiefs say.

The NHS Delivery Framework priorities for 2013/14 also include spot-checks relating to patients’ dignity of care.

NHS Wales chief executive David Sissling said the focus was “quality, patient experience and outcome”.

Opposition parties say cancer care and doctor training also needs to improve.

The priorities outlined are:

spot checks and patient surveys to see if dignity in care is improving
ensuring improvements in ambulance response times, patient waiting times in AE departments and access to planned care
vaccinating 95% of children up to the age of four with scheduled jabs such as the triple vaccine MMR
closer working with social care agencies to reduce emergency hospital admissions

Mr Sissling said: “It will ensure the NHS can drive up standards in key areas. During the course of the next few months we will be looking to further improve our targets.

“We will be working with our staff, stakeholders and service users to ensure we are monitoring and measuring the things which will really make a difference.”

In a move to ease pressure on hospitals, Health Minister Mark Drakeford last month said patients should leave as soon as they can and not continue to occupy a ward bed.

Measles crackdown

This month a review of the ambulance service ordered by former Health Minister Lesley Griffiths recommended a revamp of its performance targets and said crews should concentrate on emergency patients with routine transfers to hospitals becoming the responsibility of local health boards.

The focus on vaccination rates comes as Wales is tackling its largest measles outbreak in a generation, with 1,136 suspected cases since November 2012.

MMR drop-in clinics finish this weekend, but jabs will be available from GPs

More than 60,000 unscheduled MMR vaccinations have been given aimed at reducing the length and severity of the outbreak but Public Health Wales says another 33,000 youngsters between 10 and 18 still have not had the jab.

A spokesman said: “Our MMR uptake in small children has been rising over the last few years but we are still short of hitting the 95% target for both doses of MMR that would eradicate measles in Wales.”

The issue of dignity in care follows concerns highlighted by the public inquiry into Stafford Hospital which uncovered neglect and abuse of patients leading to hundreds of unnecessary deaths between 2005 and 2008.

It was also raised in December by Cynon Valley MP Ann Clwyd who complained that her husband Owen Roberts had died “like a battery hen” at the University Hospital of Wales in Cardiff.

She is now advising Prime Minister David Cameron on how NHS hospitals handle complaints.

Opposition parties in Wales have responded to the publication of the priorities by highlighting other issues they want tackled.

Welsh Conservatives health spokesman Darren Millar said: “There is nothing here to suggest the cancer delivery plan will be dusted off and implemented, no guarantees on abysmal cancer waiting times, and nothing to address the unfair divide in access to cancer drugs.”

Plaid Cymru health spokesperson Elin Jones said there was a need to “train more doctors in Wales, and ensure that more doctors that train in Wales stay in Wales to work”.

Welsh Lib Dem leader Kirsty Williams said the priorities were “hardly surprising” and the party would use them to ensure “the Welsh Labour government learns from its mistakes and starts to actually improve our health service, rather than sitting back and continuing to allow our NHS to deteriorate”.

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