February 8th, 2010
In the wake of the devastating Haiti earthquake, Florida Governor Charlie Crist has signed a temporary order allowing nurses licensed in other states to practice in the Sunshine State. The move allows Florida nurses leeway to travel to Haiti to assist in earthquake-relief efforts. Unless extended, the order expires in 90 days.
Before coming to Florida, nurses must prove they have a valid license in their home states, and have no health complications, history of disciplinary actions or criminal history. Once cleared, the nurses will receive a practice letter from the Florida Board of Nursing. Out-of-state nurses with practice letters will be paid for their work, a change from the past.
According to U.S. Census Bureau Statistics, Florida has the highest percentage of Haitian-Americans in the country, many of whom are nurses who are volunteering to work on earthquake relief. The Service Employees International Union reports that at least 600 of its members have volunteered to travel to Haiti, many of them nurses and physicians who are originally from Haiti and speak Creole. National Nurses United has a list of 8,000 members who have volunteered for disaster relief.
February 4th, 2010
Are physicians ready for virtual visits with their patients? This issue was examined recently in the New York Times by Pauline W. Chen, M.D., a liver transplant and liver cancer surgeon and the author of “Final Exam: A Surgeon’s Reflections on Mortality”. Virtual physician visits would allow clinicians in a “control center” to remotely monitor, consult and even care for and perform procedures. A rural primary-care physician, for example, whose patient has a rare skin lesion could get expert consultation from a dermatologist who might be hundreds of miles away.
According to Dr. Chen, “Despite its promise, telemedicine has failed to take hold in the same way that other, newer, technologies have. Not because of technical challenges, expense or insufficient need. On the contrary, the most daunting obstacle to date has been a deeply entrenched resistance on the part of providers.” Although most physicians believe that technology can strengthen their bonds with their patients, Dr. Chen says this is not the case in telemedicine. “Indeed, for many doctors, telemedicine seems to depersonalize the relationship and sabotage trust.”
Dr. Chen references a recent study performed at the University of Texas Medical School in Houston that examined the impact of telemedicine on patients in I.C.U.s. “Every I.C.U. patient in the study received the usual on-site care, as well as all the additional audiovisual and vital signs monitoring offered by a remote critical care specialist 24 hours a day. In addition, each patient’s physician could choose the degree to which the remote specialists would be involved in delivering direct care - that is, giving orders and intervening from afar.”
The majority of doctors in the study elected to limit remote involvement for their patients, fearing telemedicine might adversely affect their relationship with the patient. “Certainly some of the doctors were just skeptical,” said Dr. Eric J. Thomas, one of the study’s authors and director of the University of Texas - Memorial Hermann Center for Health Care Quality and Safety. “Others were hesitant because of how they felt about their relationship with their patients.
February 3rd, 2010
President Barack Obama used his first State of the Union Address to tell members of the House and Senate to continue their efforts to enact healthcare reform. “As temperatures cool, I want everyone to take another look at the plan we’ve proposed,” the president said. “Not now. Not when we are so close. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. I will not walk away from these Americans and neither should the people in this chamber.” The president’s comments won applause and ovations from both sides of the aisle.
Richard Umbdenstock, president and CEO of the American Hospital Association said “I think it’s the right approach.” Umbdenstock, who worked closely with the Obama administration to shape elements of healthcare reform legislation, said it was “important work” and “there is a real need to continue.” He also linked healthcare reform to the crucial issue of job creation, noting that “Hospitals are the second largest source of private sector jobs.”
Senator Bill Nelson (D-FL) said “I think the House should just pass the Senate bill,” although he agreed that there likely will be efforts to amend the legislation through a procedure that allows passage on a simple majority vote. “But clearly the House can pass the Senate bill and the Senate’s bill is a good bill.”
“We all know we’ve been trying to get healthcare done since Teddy Roosevelt,” Senator Barbara Boxer (D-CA) commented on Wednesday. “So a few more weeks isn’t a long period of time in the context of how tough a fight this is when you go up against the special interest. We’ll do it and we’ll do it the right way.”
Posted by: John Driscoll
Categories: Healthcare
Tags: American Hospital Association, Chris Van Hollen, Democrats, healthcare reform, House of Representatives, President Barack Obama, Republicans, Richard Umbdenstock, Senate, Senator Barbara Boxer, Senator Bill Nelson, Senator Max Baucus, State of the Union Address, Teddy Roosevelt
February 2nd, 2010
Americans spent an average of $7,681 per person on healthcare during 2008, just a 3.5 percent rise over the previous year - the slowest growth rate in 48 years. According to a report issued by the Department of Health and Human Services, healthcare spending totaled $2.3 trillion in 2008 and accounted for 16.2 percent of the GDP.
The culprit is the recession, which achieved what a generation of public officials attempted without success. Federal officials said the slowdown in health spending resulted from the soft economy, people delaying elective procedures, for example, and did not cite any factors that will alter the long-term outlook for continued increases as baby boomers age and physicians rely more on new technologies to treat patients.
According to Micah Hartman, a government statistician who contributed to the report, federal spending for health services and supplies grew 10.4 percent in 2008 and equaled 36 percent of federal receipts, up from 28 percent in 2007. “In 2008, federal Medicaid spending increased 8.4 percent - the highest rate of growth since 2003 - while state spending declined by 0.1 percent, the first decline in these expenditures in program history,” Hartman said. “Spending for healthcare by private businesses grew just 1.2 percent in 2008, in part because of a drop in the proportion of employer-sponsored insurance paid by employers. Private business’ health spending remained relatively flat as a share of compensation at 7.9 percent.”
In other findings, the report noted that “private health insurance premiums and benefits grew in 2008 at their slowest rate since 1967, 3.1 percent and 3.9 percent respectively.” The slowdown reflects a drop in the number of Americans with private health insurance. That fell to 195.4 million in 2008, compared with 196.4 percent in 2007.
February 1st, 2010
Some Democrats think legislating in baby steps to achieve healthcare reform is their best option now that the party has lost its 60-vote super majority with Scott Brown’s upset victory in Massachusetts to fill Senator Ted Kennedy’s seat.
According to Representative Bill Pascrell, Jr., (D-NJ), some House Democrats are proposing an incremental approach to fix the healthcare system via multiple pieces of legislation instead of a single all-encompassing bill. The goal would remain to reform insurance coverage, assure patients’ rights and improve the way that healthcare is delivered. Pascrell envisions introducing three or four bills in quick succession. The legislation would encompass the least controversial elements of the broader reform package now stalled in Congress.
Pascrell believes that his measures might garner some Republican support because they would eliminate the public option, individual insurance mandates and entitlement programs. Pascrell notes that “You can blame the Senate all you want, but we are our own worst enemy. We do everything in mega-fashion. We need to do it in mini-fashion.”
Posted by: John Driscoll
Categories: Healthcare
Tags: 60 vote super majority, Bill Pascrell Jr, Democrats, entitlement programs, filibuster, healthcare reform, House of Representatives, individual insurance mandates, public option, Republicans, Scott Brown, Ted Kennedy
January 28th, 2010
In 2011, physicians will be eligible for extra payments from federal health insurance programs if they implement electronic medical record systems. The extra money is courtesy of President Obama’s American Recovery and Reinvestment Act stimulus bill signed into law early last year. To help physicians - especially those in small practices - pay for the several thousand dollar systems, private insurers are also offering financing incentives of their own.
UnitedHealth Group, for example, is offering interest-free loans to small practices that start using Ingenix CareTracker, an internet-based system. Chicago-headquartered Allscripts-Misys Healthcare Solutions, Inc., is offering a six-month, no-payment program for qualified buyers of its electronic healthcare records software.
Under the federal legislation, physicians who start using electronic medical records can receive more than $40,000 in Medicare payments over a five-year period. At present, the Obama administration is soliciting comments on new regulations to “lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record technology.” Although electronic records keeping will cut paperwork, control costs and create a more efficient system, physicians have been slow to adopt the technology because of the high cost of purchasing the equipment.
Even though 75 percent of Americans patronize doctors in small practices, less than 15 percent of physicians now use electronic records systems. UnitedHealth, which says its CareTracker system can cost less than $7,000 annually, is “helping physicians overcome the challenge of funding their upfront investment - the biggest barrier in implementing health information technology,” said Bill Miller, executive vice president of Ingenix, the firm’s health information technology subsidiary.
January 27th, 2010
Illinois medical providers rank among the nation’s most ineffectual when it comes to providing cost-effective treatment and avoiding unnecessary hospitalizations.
According to the nonprofit Commonwealth Fund’s report, Illinois ranks 49th among 50 states and the District of Columbia in terms of “avoidable hospital use and costs.” The study measures how often Medicare patients with chronic conditions such as heart disease are admitted to the hospital or how frequently nursing home patients shuttle in and out of hospitals. New York came in 50th, with Louisiana occupying the last place.
Illinois also placed 44th in terms of how effectively hospitals deliver basic care that avoids complications. Healthcare costs and volumes of tests and treatments were found to be unusually high, especially in metropolitan Chicago.
There was some good news for Illinois in the Commonwealth Fund’s study. The state ranked 20th in access to care, quality in terms of income, race and ethnic background; 29th in quality-of-life measures such as infant mortality; and 32nd in death rates for colon and breast cancer. The study places Illinois in 42nd place in terms of the quality of overall healthcare delivery.
Cathy Schoen, Senior Vice President of the Commonwealth Fund and a co-author of the study, noted that the findings underscore the need for wide-ranging healthcare reform. “We need payment reforms with incentives to do well on outcomes and efficiency of care,” she said.
January 26th, 2010
A Glendale, AZ, family clinic operated by the non-profit Mayo Clinic is no longer accepting Medicare patients, saying government payments are too low. The more than 3,000 Medicare-eligible patients who use the facility will be forced to pay cash or find a physician at another location. The decision, which doesn’t impact other Mayo facilities in Arizona, Minnesota and Florida, is a two-year pilot project, according to spokesman Michael Yardley.
Mayo’s move may lead additional family physicians to drop Medicare patients, according to Lori Heim, president of the National Association of Family Physicians. “Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” Heim said. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”
Mayo’s Yardley defended his organization, noting that “We firmly believe that Medicare needs to be reformed. It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.” Nationally, physicians were reimbursed approximately 20 percent less for treating Medicare patients vs. privately insured patients in 2007. That payment gap has not changed over the last 10 years, says a report from the Medicare Payment Advisory Commission, a group that advises Congress on Medicare. At the end of 2008, approximately 45 million Americans were covered by Medicare, according to statistics from the Centers for Medicare & Medicaid Services. Although 92 percent of family physicians participate in Medicare, just 73 percent are accepting new patients under the program.
Medicare patients who opt to stay with their physician at Mayo’s Glendale clinic will pay $1,500 annually for a physical and three additional visits. Additionally, they will pay a $250 annual administrative fee.
January 25th, 2010
Normal isn’t necessarily 98.6° anymore. Scientists have learned that the normal resting body temperature may actually be 98.2° Fahrenheit, rising from morning to evening. Other studies have shown that the normal temperature declines slightly as people age. That’s not necessarily good news, because a drop of even a few degrees could mean that serious fevers go unnoticed because low temperature readings can be misleading.
A study in The Journal of the American Geriatric Society found that half of nursing home patients who had infections registered temperatures below 101 degrees. Some had temperature increases of 2.4 degrees or more, symptoms of potentially serious fevers.
Fever is a natural part of the body’s defense mechanism against infections, and this immune response appears to be diminished in many older people. Some studies suggest that up to 30 percent of the elderly register a low normal, making bacterial or viral infections all the more serious.
January 21st, 2010
“The Terminator” thinks it is time for the federal government to take care of California - especially when it comes to healthcare reform legislation. At a time when Congress is poised to pass sweeping healthcare reform, Governor Arnold Schwarzenegger (R-CA) thinks that President Obama should rethink the legislation. In fact, Schwarzenegger thinks that healthcare reform is “something that ultimately would beat up on California,” as moderator David Gregory remarked during a recent “Meet the Press” interview.
According to Schwarzenegger, “Right now it is. And I just cannot imagine why we would have, like I said, our senators and congressional people, how they would vote for something like that where they’re representing Nebraska and not us. And, by the way, as I said in my State of the State, that’s the biggest rip-off. That is against the law to buy a vote.”
Schwarzenegger is referring to the Equitable Support for Certain States, which will provide Nebraska — as well as Massachusetts and Vermont — support in paying its share of additional costs to Medicaid in the health legislation. The provision, which Republicans have mocked as the “Cornhusker Kickback,” actually provides Nebraska the least of the three states. Vermont will receive $600 million over 10 years, while Massachusetts will receive $500 million. The money to Nebraska is expected to total $100 million.
The Congressional Budget Office (CBO) disagrees with Schwarzenegger - who says it will cost $3 to $ billion over 10 years — on the total cost of the Equitable Support for Certain States program. According to CBO statistics, the section of the manager’s amendment to the Senate’s health bill would cost $1.2 billion over 10 years.
