Inflammation Byproduct Linked to Stress by Nicholas Bakalar. Well Blog. The New York Times. December 31, 2012.
Danish researchers, in a massive study, have noted an association of C-reactive protein and greater risk of psychological stress and clinical depression. Since CRP is a byproduct of inflammation, the lead author stated that treating inflammation may be one way of treating depression.
Monday, December 31, 2012
Global Cancer Drug Counterfeiting Operations Flourish
Counterfeit Cancer Medicines Multiply by Jeanne Whalen and Benoit Faucon. The Wallt Street Journal. December 31, 2012.
The web of manufacturing and distribution of fake cancer drugs is worldwide. China seems to be a center of manufacture with "thousands and thousands" of counterfeiting companies, some of whom operate are licensed as chemical manufacturers and therefore are not subject to Chinese government drug regulation.
The web of manufacturing and distribution of fake cancer drugs is worldwide. China seems to be a center of manufacture with "thousands and thousands" of counterfeiting companies, some of whom operate are licensed as chemical manufacturers and therefore are not subject to Chinese government drug regulation.
Estonia Shows the Way On TB Outbreak at Europe's Perimeter
At Europe's Doorstep, Fierce War Against TB by Gautam Naik. The Wall Street Journal. December 31, 2012.
Among the steps the article discusses in Estonia's efforts to limit the disease are isolation, banning the sale of TB drugs from pharmacies to prevent the spread of resistant strains, integrating drug treatment with TB screening efforts, and use of such equipment as GeneXpert to diagnosis if the strain of drug is regular or resistant. The Journal has been at the forefront of coverage of TB around the world.
Among the steps the article discusses in Estonia's efforts to limit the disease are isolation, banning the sale of TB drugs from pharmacies to prevent the spread of resistant strains, integrating drug treatment with TB screening efforts, and use of such equipment as GeneXpert to diagnosis if the strain of drug is regular or resistant. The Journal has been at the forefront of coverage of TB around the world.
ZocDoc Upends Traditional Medical Practice
Paging ZocDoc For the Future of Medicine by Michael Wolff. USA Today-Media. December 30, 2012.
ZocDoc allows a patient to identify doctors in an area who treat a particular malady as well as appointment availability. The writer recounts an experience using this service when his personal doctor was away. He identified a doctor 10 minutes from his house, established an appointment that day, and was treated in 15 minutes. He merely entered his ZIP code, malady, an insurance and was provided a list of available physicians. The writer envisions the time when all medical professions will join a ZocDoc-type service extending competition and resulting in price cuts. ZocDoc, the writer asserts, presents an opportunity to wring out profits from health care's "ridiculous inefficiencies."
ZocDoc allows a patient to identify doctors in an area who treat a particular malady as well as appointment availability. The writer recounts an experience using this service when his personal doctor was away. He identified a doctor 10 minutes from his house, established an appointment that day, and was treated in 15 minutes. He merely entered his ZIP code, malady, an insurance and was provided a list of available physicians. The writer envisions the time when all medical professions will join a ZocDoc-type service extending competition and resulting in price cuts. ZocDoc, the writer asserts, presents an opportunity to wring out profits from health care's "ridiculous inefficiencies."
Sunday, December 30, 2012
Sacks Illustrates Medicine As Art, Narrative, As Well As Science In New Book on Hallucinations
'Hallucinations,' by Oliver Sacks. A Book Review by Siri Hustvedt. Sunday Book Review. The New York Times. December 28, 2012.
Sacks method here is the narrative case study of a variety of hallucinations seeking always to preserves the part without losing the synthetic whole. He seeks, as much as possible, to unite the physiological and the psychological to paint a picture of complex human reality. The last sentence in the review is nice summary of the approach the reviewer sees in this book: "Learned, quietly passionate and always curious, Sacks is a physician who has long understood that medicine is an art as well as a science.
Sacks method here is the narrative case study of a variety of hallucinations seeking always to preserves the part without losing the synthetic whole. He seeks, as much as possible, to unite the physiological and the psychological to paint a picture of complex human reality. The last sentence in the review is nice summary of the approach the reviewer sees in this book: "Learned, quietly passionate and always curious, Sacks is a physician who has long understood that medicine is an art as well as a science.
Tracing The Marketing of A Drug from $40 to $28,000 a Vial
Finding Profits, At $28,000 A Vial by Andrew Pollack. The New York Times. December 30, 2012.
In this discussion of the evolution of the anti-inflammatory drug, H.P. Acthar Gel, from $40 to 28,000 a vial important issues are addressed including marketing practices, costs, insurance, orphan drugs, off-label prescriptions, efficacy research, drug licensing, and drug development. A rich case study.
In this discussion of the evolution of the anti-inflammatory drug, H.P. Acthar Gel, from $40 to 28,000 a vial important issues are addressed including marketing practices, costs, insurance, orphan drugs, off-label prescriptions, efficacy research, drug licensing, and drug development. A rich case study.
Saturday, December 29, 2012
The Evolutionary Link Between Exercise and Brain Size.
Exercise And The Ever-Smarter Human Brain by Gretchen Reynolds. Well Blog. The New York Times. December 26, 2012.
Our ancestors survived by becoming endurance athletes, the ability to outlast fleeing animals being crucial in acquiring food and hence mating success and propagation of endurance qualities. Now it is increasingly thought that BDNF, or brain-derived neurotrophic factor, are important for endurance and brain size and were transmitted by the evolutionary success of endurance-oriented humans. Intelligence and movement are linked. Hence the link between exercise and brain capacity--between a healthy body and a healthy mind.
Our ancestors survived by becoming endurance athletes, the ability to outlast fleeing animals being crucial in acquiring food and hence mating success and propagation of endurance qualities. Now it is increasingly thought that BDNF, or brain-derived neurotrophic factor, are important for endurance and brain size and were transmitted by the evolutionary success of endurance-oriented humans. Intelligence and movement are linked. Hence the link between exercise and brain capacity--between a healthy body and a healthy mind.
Businesses Prepare for the Affordable Care Act
Businesses Come Face-To-Face With Health Care Law by Carrie Teegardin. The Atlanta Journal-Constitution. December 29, 2012.
The impact of the health care law on individual firms largely depends on salary level of business employees. Those employers with many minimum-wage level employees will probably have more difficulty than those with higher salaries. Some employers have been surprised at how little the law will impact them, while others, such as nursing homes, are concerned due to the prevalence of low-wage jobs. Issues such as counting employees to determine applicability of the law and determining what employer offered plans are required to cover are presented.
The impact of the health care law on individual firms largely depends on salary level of business employees. Those employers with many minimum-wage level employees will probably have more difficulty than those with higher salaries. Some employers have been surprised at how little the law will impact them, while others, such as nursing homes, are concerned due to the prevalence of low-wage jobs. Issues such as counting employees to determine applicability of the law and determining what employer offered plans are required to cover are presented.
Six Transformative Trends in Medicine
The Future of Medicine Is Now. The Saturday Essay. The Wall Street Journal. December 28, 2012.
The trends discussed are (1) an innovative approach to hypoplastic left-heart syndrome by setting into motion a process that "grows" the left ventricle; (2) use of nanopore sequencing devices that are small, inexpensive, and powerful enough to allow DNA sequencing to be included in routine checkups; (3) the ability to match multiple genetic mutations to cancers that will allow precise matching of drugs to cancer type(s); (4) removing the obstacles in the immune system that prevent the body from attacking cancer; (5) Fully utilizing the smart phone in medical diagnosis and monitoring; (6) Gene therapy, with great hope for diseases that are caused by defects in single genes.
The trends discussed are (1) an innovative approach to hypoplastic left-heart syndrome by setting into motion a process that "grows" the left ventricle; (2) use of nanopore sequencing devices that are small, inexpensive, and powerful enough to allow DNA sequencing to be included in routine checkups; (3) the ability to match multiple genetic mutations to cancers that will allow precise matching of drugs to cancer type(s); (4) removing the obstacles in the immune system that prevent the body from attacking cancer; (5) Fully utilizing the smart phone in medical diagnosis and monitoring; (6) Gene therapy, with great hope for diseases that are caused by defects in single genes.
Friday, December 28, 2012
Genomic Data Converted to Medically Relevant Report by Firm's Software
Knome Software Makes Sense of the Genome by Susan Young. Technology Review. June 12, 2012.
While costs of sequencing technology has fallen sharply, effective medical use of genomic data is still limited by the vastness of the data generated. Knome has produced a way to cut through the data by considering disease type, the pattern of inheritance, and the effects of mutations while protecting patient privacy.
While costs of sequencing technology has fallen sharply, effective medical use of genomic data is still limited by the vastness of the data generated. Knome has produced a way to cut through the data by considering disease type, the pattern of inheritance, and the effects of mutations while protecting patient privacy.
Biological Food Clock: A Key to Weight Gain?
Holiday Overindulgence Got You Down? Blame Your 'Food Clock' by Melanie Haiken. Forbes. December 28, 2012.
This article discusses a study that, for the first time, pinpoints a mechanism by which schedule changes can affect how much you eat and how extra calories affect weight. This mechanism identified is a protein, PKCy.
This article discusses a study that, for the first time, pinpoints a mechanism by which schedule changes can affect how much you eat and how extra calories affect weight. This mechanism identified is a protein, PKCy.
Human Growth Hormone in Football: Differing Perspectives
Editorial: Why is NFL Union Fighting HGH Testing. The Editorial Board View. USA Today. December 27, 2012. NFL Players Association: We Want A Clean Game by George Atallah. Opposing View. USA Today. December 27, 2012.
The dueling editorials focus on testing for human growth hormone. The players question the scientific basis for tests used by the World Anti-Doping Agency, stating that they have proposed an alternative approach. The USA Today Board accuses the players of stalling the implementation of a widely used test, while pointing to the health risks of HGH.
The dueling editorials focus on testing for human growth hormone. The players question the scientific basis for tests used by the World Anti-Doping Agency, stating that they have proposed an alternative approach. The USA Today Board accuses the players of stalling the implementation of a widely used test, while pointing to the health risks of HGH.
Pain-Pill Addiction Among Babies: Tragic, Costly, Difficult to Treat
Pain Pills' Littlest Victims by Arian Campo-Flores. The Wall Street Journal. December 28, 2012.
Between 2000 and 2009 the number of newborns showing withdrawal symptoms from opioids tripled according to the Journal of the American Medical Association. In terms of absolute numbers in 2009, more the 13,000 babies were diagnosed with neonatal abstinence syndrome. The cost for treating these babies comes in around a mean of $53,400. According to the article there seems to be some evidence that painkiller addiction in babies may be affecting babies physiologies more than cocaine in the "crack baby" outbreak of a few decades ago. No universal treatment protocol has been developed due to lack of research on the syndrome.
Between 2000 and 2009 the number of newborns showing withdrawal symptoms from opioids tripled according to the Journal of the American Medical Association. In terms of absolute numbers in 2009, more the 13,000 babies were diagnosed with neonatal abstinence syndrome. The cost for treating these babies comes in around a mean of $53,400. According to the article there seems to be some evidence that painkiller addiction in babies may be affecting babies physiologies more than cocaine in the "crack baby" outbreak of a few decades ago. No universal treatment protocol has been developed due to lack of research on the syndrome.
Thursday, December 27, 2012
Substitute Cancer Drugs Shown Not As Effective: Damage From Drug Shortages Demonstrated
Study: Cancer Drug Substitute Linked To Higher Rate of Relapse by Jonathan LaPook. December 26, 2012.
In 2010, there were shortages in 23 cancer drugs. This shortage spurred the search for substitutes. Now a study in the New England Journal of Medicine showed that 88 percent treated with the original drug were cancer-free after two years. However those treated with substitute drugs had only a 75 percent cancer-free rate.
In 2010, there were shortages in 23 cancer drugs. This shortage spurred the search for substitutes. Now a study in the New England Journal of Medicine showed that 88 percent treated with the original drug were cancer-free after two years. However those treated with substitute drugs had only a 75 percent cancer-free rate.
AMA Issues Principles For Physician Employment
AMA Principles for Physician Employment. The American Medical Association.
Doctors Warned on 'Divided Loyalty' by Robert Pear. The New York Times. December 28 2012.
The original source document of the policy and a news report about the report are linked above. The AMA addresses the potential conflicts of interest that can arise as medical practices are bought by hospitals. The purpose of the statement is to protect the professional autonomy of doctors. From 2000 to 2010 the American Hospital Association says that the number of doctors employed by hospitals grew by 32 percent, to 212,000. The AMA also addresses non-compete agreements which are sometimes required for situations when a doctor leaves the employ of a hospital.
Doctors Warned on 'Divided Loyalty' by Robert Pear. The New York Times. December 28 2012.
The original source document of the policy and a news report about the report are linked above. The AMA addresses the potential conflicts of interest that can arise as medical practices are bought by hospitals. The purpose of the statement is to protect the professional autonomy of doctors. From 2000 to 2010 the American Hospital Association says that the number of doctors employed by hospitals grew by 32 percent, to 212,000. The AMA also addresses non-compete agreements which are sometimes required for situations when a doctor leaves the employ of a hospital.
Apple Store Design Team Reconfigures Central Florida Walgreens
See Inside: Remodeling Walgreens Offer Sushi, New Technology by braham Aboraya. Orlando Business Journal. December 21, 2012.
40 Central Florida Walgreens are being renovated with new store features such as a kiosk for order and pick up of prescriptions, a pharmacy station out from behind the counter, and a nurses station. The market vice president for Walgreens stated that they same people who designed Apple stores designed the Walgreens pharmacy. An expanded grocery section is viewed as part of the health mission of the store.
40 Central Florida Walgreens are being renovated with new store features such as a kiosk for order and pick up of prescriptions, a pharmacy station out from behind the counter, and a nurses station. The market vice president for Walgreens stated that they same people who designed Apple stores designed the Walgreens pharmacy. An expanded grocery section is viewed as part of the health mission of the store.
Conservative Estimate: Over 150,000 People Victims of Unsafe Injection Practices Since 2001
Dirty Medical Needles Put Thousands at Risk by Peter Eisler. USA Today. December 27, 2012.
The article cites a 2010 anonymous survey of 5,446 clinical personnel where 6% stated that they sometimes used single-use medication vials to draw shots for more than one patient, a violation of CDC infection safety protocols. Shockingly, 1% reported that they used the same syringe on multiple patients. 80% of injection-related disease outbreaks occur in doctors' offices and outpatient clinics, such as pain management and endoscopy centers. There is a regulatory gap for such facilities. One expert offered the opinion that restaurants and pharmacies are subject to more regulation than some of these facilities.
The article cites a 2010 anonymous survey of 5,446 clinical personnel where 6% stated that they sometimes used single-use medication vials to draw shots for more than one patient, a violation of CDC infection safety protocols. Shockingly, 1% reported that they used the same syringe on multiple patients. 80% of injection-related disease outbreaks occur in doctors' offices and outpatient clinics, such as pain management and endoscopy centers. There is a regulatory gap for such facilities. One expert offered the opinion that restaurants and pharmacies are subject to more regulation than some of these facilities.
Wednesday, December 26, 2012
Food Allergy Related to Being Bullied
Almost Half of Children with Food Allergy Report Being Bullied. The Journal of the American Academy of Physician Assistants. December 26, 2012. Kids with Health Issues Target for Bullying. ABC News. December 26, 2012.
45.4% of children with food allergies reported bullying with 31.5% reported bullying specifically related to food.
45.4% of children with food allergies reported bullying with 31.5% reported bullying specifically related to food.
Better Data, Psychological Autopsies and Brain Examination Advocated for Murder/Suicide
Unlocking the Mystery of Murder-Suicide by Peter M. Marzuk. Opinion. The Wall Street Journal. December 25, 2012.
In this opinion piece, a psychiatry professor at Weill Cornell Medical College advocates what he calls "psychological autopsies" to help explain perpetrator's intentions before death. He also advocates detailed physical examination of the perpetrator's brain to spot anomalies. Also noted as a problem is the patchwork of data involving murder/suicides. Without a more comprehensive approach than what is currently available, it is difficult to conceive of an effective overall national strategy.
In this opinion piece, a psychiatry professor at Weill Cornell Medical College advocates what he calls "psychological autopsies" to help explain perpetrator's intentions before death. He also advocates detailed physical examination of the perpetrator's brain to spot anomalies. Also noted as a problem is the patchwork of data involving murder/suicides. Without a more comprehensive approach than what is currently available, it is difficult to conceive of an effective overall national strategy.
Crackdown in Florida Sends Pain Clinic Business to Georgia
Florida 'Pill Mill' Crackdown Sets Off a Rush to Georgia by Timothy W. Martin. The Wall Street Journal. December 25, 2012.
Georgia today is the home of 125 pain clinics, up from fewer than 20 in 2010. Per capita oxycodone prescriptions have tripled between 2000 and 2010. In 2010 Florida began a creating strike forces to close illicit pain clinics and track controlled-substances sales, an action that is directly relevant to some of the Georgia increase. Generally, pain clinics are subject nationally to at best a patchwork system of regulation, or non-regulation. This article highlights the focus on what is called the USA's No. 1 drug problem, painkillers.
Georgia today is the home of 125 pain clinics, up from fewer than 20 in 2010. Per capita oxycodone prescriptions have tripled between 2000 and 2010. In 2010 Florida began a creating strike forces to close illicit pain clinics and track controlled-substances sales, an action that is directly relevant to some of the Georgia increase. Generally, pain clinics are subject nationally to at best a patchwork system of regulation, or non-regulation. This article highlights the focus on what is called the USA's No. 1 drug problem, painkillers.
New Health Care Related Taxes Set To Take Effect
Partial List of Taxes and Fees In Health Overall. The Associated Press. December 25, 2012.
The biggest new tax is a 0.9 percent Medicare tax increase for individuals making more than $200,000 and couples making more than $250,000. This tax will tax effect on January 1, 2013. Also slated to take effect is an excise on medical devices such as coronary stents, pacemakers, and artificial hips.
The biggest new tax is a 0.9 percent Medicare tax increase for individuals making more than $200,000 and couples making more than $250,000. This tax will tax effect on January 1, 2013. Also slated to take effect is an excise on medical devices such as coronary stents, pacemakers, and artificial hips.
Process and Communications Improvement Focus of GM/WellStar Partnership
Metro Hospital Giant, GM Form Unlikely Team by Misty Williams. The Atlanta Journal-Constitution. December 26, 2012.
WellStar is seeking to improve its process flow and quality efforts by using a donated assembly line from GM to help doctors and nurses to visualize the patient care process, identifying potential bottlenecks and communications failures. Among the innovative approaches these two organizations have cultivated is a patented 3-D modeling application for tablets and smart phones to track progress in patient care.
WellStar is seeking to improve its process flow and quality efforts by using a donated assembly line from GM to help doctors and nurses to visualize the patient care process, identifying potential bottlenecks and communications failures. Among the innovative approaches these two organizations have cultivated is a patented 3-D modeling application for tablets and smart phones to track progress in patient care.
Tuesday, December 25, 2012
Multidisciplinary Institutes, Contracts for Doctors: Keys to Innovation at the Cleveland Clinic
Approaching Illness as a Team. Editorial, The New York Times. December 24, 2012.
Over the last five years The Cleveland Clinic has created 18 institutes for the multidisciplinary approach to illness of particular body systems. Physicians are salaried with one-year contracts and performance reviews with termination for some doctors who fall short. Data analysis of performance is a crucial part of the Cleveland clinic approach leading to decisions by doctors about treatment options.
Over the last five years The Cleveland Clinic has created 18 institutes for the multidisciplinary approach to illness of particular body systems. Physicians are salaried with one-year contracts and performance reviews with termination for some doctors who fall short. Data analysis of performance is a crucial part of the Cleveland clinic approach leading to decisions by doctors about treatment options.
Monday, December 24, 2012
Psychopathic Characteristics of Occupations Compared
Wisdom From Psychopaths by Kevin Dutton. Scientific American. December 31, 2012.
Kevin Dutton is a distinguished academic researcher of the psychopathic condition. His basic approach is summarized in this quote: "Psychopathy is like a medicine for modern times. In moderation, it can prove extremely beneficial. But if you overdose, then as is he case with all medicines, there can be some rather unpleasant side effects.: In this article he examines the decision making style of patients at Broadmoor, a high-security psychiatric hospital in England, obviously people who had "overdosed" to use Dutton's phrase. In the print edition of Scientific American he includes an occupational survey os psychopathic characteristics. While he found nurses, therapists, and doctors low in psychopathic characteristics, surgeons were quite high. The highest of all occupations was CEO and lawyer. Fascinating and controversial perspective!
Kevin Dutton is a distinguished academic researcher of the psychopathic condition. His basic approach is summarized in this quote: "Psychopathy is like a medicine for modern times. In moderation, it can prove extremely beneficial. But if you overdose, then as is he case with all medicines, there can be some rather unpleasant side effects.: In this article he examines the decision making style of patients at Broadmoor, a high-security psychiatric hospital in England, obviously people who had "overdosed" to use Dutton's phrase. In the print edition of Scientific American he includes an occupational survey os psychopathic characteristics. While he found nurses, therapists, and doctors low in psychopathic characteristics, surgeons were quite high. The highest of all occupations was CEO and lawyer. Fascinating and controversial perspective!
Hospice and Palliative Care: Different and Complementary
Evolving Roles of Hospice and Palliative Care. Science Daily. November 14, 2012.
While hospice care is generally understood as coming at the end of life, palliative care can also be useful at any point of recovery from serious illnesses in addition to end of life situations. Palliative care seeks to improve quality of life, provide pain management and symptom control, provide emotional support and spiritual care. Each role is discussed in the article.
While hospice care is generally understood as coming at the end of life, palliative care can also be useful at any point of recovery from serious illnesses in addition to end of life situations. Palliative care seeks to improve quality of life, provide pain management and symptom control, provide emotional support and spiritual care. Each role is discussed in the article.
Last Hurdle for Obamacare Could Be Republican Governors
Georgia Puts Health Effort on Feds by Greg Bluestein and Misty Williams. The Atlanta Journal-Constitution. December 24, 2012.
The opposition of Georgia Governor Nathan Deal to health care exchanges is put into context of decisions by 30 states, with mostly GOP leadership, to decline participation in the exchanges. Governor Deal states that while he does not want to thwart Obamacare, he does not have enough information and questions whether the exchange will meet Georgia needs. An interesting observation quoted in the article is from Georgians for a Healthy Future. She believes that it is probably better for HHS to implement the exchange in Georgia since it is committed to the goals of the law. Roughly 900,000 Georgians could participate in the exchanges scheduled to come online in 2014.
The opposition of Georgia Governor Nathan Deal to health care exchanges is put into context of decisions by 30 states, with mostly GOP leadership, to decline participation in the exchanges. Governor Deal states that while he does not want to thwart Obamacare, he does not have enough information and questions whether the exchange will meet Georgia needs. An interesting observation quoted in the article is from Georgians for a Healthy Future. She believes that it is probably better for HHS to implement the exchange in Georgia since it is committed to the goals of the law. Roughly 900,000 Georgians could participate in the exchanges scheduled to come online in 2014.
Saturday, December 22, 2012
80,000 Major Surgical Errors Occurred Between 1990-2010--Study
Study: "Never" Surgery Mistakes Still Happening to Patients by Bob Holt. Newjerserynewsroom.com. December 22, 2012.
Researchers at Johns Hopkins University used the National Practitioner Data Bank to arrive at the 80,000 estimate of errors based upon malpractice claims. A study author estimates that the number is likely to be low since many patients filed no claim after a medical mistake.
Researchers at Johns Hopkins University used the National Practitioner Data Bank to arrive at the 80,000 estimate of errors based upon malpractice claims. A study author estimates that the number is likely to be low since many patients filed no claim after a medical mistake.
Technology Opportunities in Medicaid Expansion
Health Law May Boost Tech Firms' Revenue by Phil Gatewitz, Kaiser Health News. December 20, 2012.
Firms set to profit from the possible expansion of up to 17 million new enrollees in Medicaid include Hewlett-Packard, Xerox, and smaller firms such as CNSI. Among the services these firms may offer include cost control, program operations, health insurance exchanges, claims processing, verification of eligibility, fraud detection, and call center operation.
An Idea Returns: Physicians Working for Insurance Companies
When The Doctor Works For the Insurance Company by Tracey Samuelson. NPR Planet Money. December 21, 2012.
The potential advantages of such an arrangement is cost control resulting in superior care. A potential disadvantage is that patient care will be shortchanged in order to improve profitability.
The potential advantages of such an arrangement is cost control resulting in superior care. A potential disadvantage is that patient care will be shortchanged in order to improve profitability.
Video Consultations: Insurers, Employers, Patients, And Physicians See Potential and Problems
Doctors Move To Webcams by Anna Wilde Mathews. The Wall Street Journal. December 20, 2012.
Several perspectives on video and phone consultations are explored. Insurers, patients, state regulators, administrators and policy makers concerned with costs, employee benefits managers at companies, state health insurance program managers, telemedicine companies, professional boards, and family practitioners are among those whose concerns are addressed.
Several perspectives on video and phone consultations are explored. Insurers, patients, state regulators, administrators and policy makers concerned with costs, employee benefits managers at companies, state health insurance program managers, telemedicine companies, professional boards, and family practitioners are among those whose concerns are addressed.
Medicare Bonuses and Penalties: Part of Effort to Reshape U.S. Medical System
Interactive Chart: Bonuses and Penalties For U.S. Hospitals. Kaiser Health News. December 20, 2012.
Medicare Discloses Hospitals' Bonuses, Penalties Based Upon Quality by Jordan Rau. December 20, 2012.
These bonuses and penalties are part of an effort to increasingly base reimbursements through Medicare on the quality of care instead of the quantity of care. Quality is 70 percent based upon 12 basic standards of clinical care and 30 percent based upon survey ratings of former patient. 1,557 hospitals are receiving more money while 1,427 receive less as a result of the program called Hospital Value-Based Purchasing Program.
Medicare Discloses Hospitals' Bonuses, Penalties Based Upon Quality by Jordan Rau. December 20, 2012.
These bonuses and penalties are part of an effort to increasingly base reimbursements through Medicare on the quality of care instead of the quantity of care. Quality is 70 percent based upon 12 basic standards of clinical care and 30 percent based upon survey ratings of former patient. 1,557 hospitals are receiving more money while 1,427 receive less as a result of the program called Hospital Value-Based Purchasing Program.
Friday, December 21, 2012
Sepsis, A Leading Cause of Hospital Deaths, Is Focus of New York Regulations
One Boy's Death Moves State to Action to Prevent Others By Jim Dwyer. The New York Times. December 20, 2012.
Sepsis, according to an expert cited in the article, is the most common killer in intensive care units, killing more than breast cnancer, lung cancer, and stroke combined. While sepsis treatment guidelines have been developed, the condition in its early stages is easily confused with the flu or common cold. Early treatment with antibiotics and fluids can lessen the relative risk mortality by 40 percent. New York's pioneering approach to sepsis and the story of the advocacy of a victim's family provide provide the human and scientific context.
Sepsis, according to an expert cited in the article, is the most common killer in intensive care units, killing more than breast cnancer, lung cancer, and stroke combined. While sepsis treatment guidelines have been developed, the condition in its early stages is easily confused with the flu or common cold. Early treatment with antibiotics and fluids can lessen the relative risk mortality by 40 percent. New York's pioneering approach to sepsis and the story of the advocacy of a victim's family provide provide the human and scientific context.
Thursday, December 20, 2012
Improvement and Problems In Georgia Mental Health
Mental Health Professionals Say Georgia Care Needs More Improvement by Tracey McManus. The Augusta Chronicle. December 18, 2012.
While professionals noted improvements since the 2010 settlement between the Justic Department and the State of Georgia areas of concern remain. Among the areas of concern are funding, housing, transportation and children and adolescent services. At present the Department of Corrections is the largest provider of child mental care in the state, according to the Executive Director of the National Alliance on Mental Illness Georgia. Also noted was a shortage of 422 mental health professionals in the state.
While professionals noted improvements since the 2010 settlement between the Justic Department and the State of Georgia areas of concern remain. Among the areas of concern are funding, housing, transportation and children and adolescent services. At present the Department of Corrections is the largest provider of child mental care in the state, according to the Executive Director of the National Alliance on Mental Illness Georgia. Also noted was a shortage of 422 mental health professionals in the state.
Difference Between Supplier Cost and Medicare Reimbursement Points to Problem
Heavy Price: Medicare Overpaying for Back Brace. by Ricardo Alonso-Zaldivar. Associated Press. December 19, 2012.
Medicare paid $919 for back braces which costs suppliers an average of $191 each. This is according to a report released by the inspector general of the Department of Health and Human Services. Such discrepancies may lead to more competitive bidding for medical equipment as a result of negotiations for the so-called "fiscal cliff."
Medicare paid $919 for back braces which costs suppliers an average of $191 each. This is according to a report released by the inspector general of the Department of Health and Human Services. Such discrepancies may lead to more competitive bidding for medical equipment as a result of negotiations for the so-called "fiscal cliff."
Lady Health Workers Speak Out After Attacks on Polio Eradication Team in Pakistan
Polio Workers Speak Out On Pakistan Attacks. BBC News. December 20, 2012.
Two lady health workers (LHW) in Pakistan offer their personal perspectives after an attack blamed on the Taliban killed nine workers in a UN-backed anti-polio campaign.
Two lady health workers (LHW) in Pakistan offer their personal perspectives after an attack blamed on the Taliban killed nine workers in a UN-backed anti-polio campaign.
2013 In Healthcare Reform
5 Health Care Reform Changes Coming in 2013 by Jay MacDonald. Bankrate.com
Excellent brief presentation of 5 trends and events for 2013: (1) Increasing physician pay by equalizing reimbursements for Medicaid and Medicare patients, (2) Expanding preventive care under Medicaid, (3) Bolstering the CHIP program, (4) Streamlining medical billing under Medicare by moving away from the pay-for-service system, (5) Continued certification of state health care exchanges.
Excellent brief presentation of 5 trends and events for 2013: (1) Increasing physician pay by equalizing reimbursements for Medicaid and Medicare patients, (2) Expanding preventive care under Medicaid, (3) Bolstering the CHIP program, (4) Streamlining medical billing under Medicare by moving away from the pay-for-service system, (5) Continued certification of state health care exchanges.
Costs Of Gun Violence: A Public Health Concern?
Gun Deaths Cost U.S. Billions Each Year While Firearms Makers Thrive by Jeffrey Young. Huffingtonpost.com. December 19, 2012.
Relevant facts cited: 30,000 gun-related deaths a year (CDC); Gun-related deaths are on pace to surpass deaths from automobiles in 2015 (Bloomberg); 37 billion in costs for 2005 for fatal firearm-related deaths (CDC); 3.7 billion in addition for non-fatal injuries in 2005 (CDC); Gun manufacturer estimated sales in 2012 $11.7 billion with profits of $993 million; Estimated domestic economic impact of the firearm and ammunition industry is $31.8 billion. These facts are placed in the context of the controversy about guns as a public health concern.
Relevant facts cited: 30,000 gun-related deaths a year (CDC); Gun-related deaths are on pace to surpass deaths from automobiles in 2015 (Bloomberg); 37 billion in costs for 2005 for fatal firearm-related deaths (CDC); 3.7 billion in addition for non-fatal injuries in 2005 (CDC); Gun manufacturer estimated sales in 2012 $11.7 billion with profits of $993 million; Estimated domestic economic impact of the firearm and ammunition industry is $31.8 billion. These facts are placed in the context of the controversy about guns as a public health concern.
Wednesday, December 19, 2012
Antibiotic No Better Than Nothing for Coughs--Study Asserts
Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication. Medical News Today. December 19, 2012.
This study from the UK was the largest randomized placebo controlled trial of antibiotics for lower respiratory tracts infections done to date.
This study from the UK was the largest randomized placebo controlled trial of antibiotics for lower respiratory tracts infections done to date.
Medicare Cuts: Alternatives and Impacts
Hospitals Fear They'll Bear Brun of Medicare Cuts by Robert Pear and Reed Abelson. The New York Times. December 18, 2012.
Higher premiums, provider cuts, raising the eligibility age, opportunities for increased efficiency and effectiveness, access to the most vulnerable, rural hospitals, and effects on hospital mergers are some of the topics covered.
Higher premiums, provider cuts, raising the eligibility age, opportunities for increased efficiency and effectiveness, access to the most vulnerable, rural hospitals, and effects on hospital mergers are some of the topics covered.
Healthcare Innovations: Beyond Drugs and Devices
Ten Ways Patients Get Treated Better. The Informed Patient from The Wall Street Journal. December 17, 2012.
Excellent sampling of changes in patient care. Bedside manners in physicians, observation rooms in ER's, and new tests for colon cancer are a few of the innovations examined.
Excellent sampling of changes in patient care. Bedside manners in physicians, observation rooms in ER's, and new tests for colon cancer are a few of the innovations examined.
Political Impact on Public Health Research on Guns
CDC: Politics Affected Gun Research by Craig Schneider and Ernie Suggs. The Atlanta Journal-Constitution. December 19, 2012.
In the aftermath of Sandy Hook, The Atlanta Journal-Constitution looks at the political pressures impacting gun violence research at the CDC. The CDC considers matters beyond infectious disease as part of its mandate. Opponents of CDC research have taken the view that research into guns has been politically motivate, methodologically flawed, and lacking in objectivity. The bottom line now is that it is almost impossible to get federal funding for firearm injury prevention research.
In the aftermath of Sandy Hook, The Atlanta Journal-Constitution looks at the political pressures impacting gun violence research at the CDC. The CDC considers matters beyond infectious disease as part of its mandate. Opponents of CDC research have taken the view that research into guns has been politically motivate, methodologically flawed, and lacking in objectivity. The bottom line now is that it is almost impossible to get federal funding for firearm injury prevention research.
Monday, December 17, 2012
In National Trend, Atlanta Hospital Chains Piedmont and WellStar Start An Insurance Company
Hospital Systems to Form Their Own Insurance Company by Carrie Teegardin. The Atlanta Journal-Constitution. December 17, 2012.
In an effort to control costs, information, and quality of care, Atlanta hospitals, the Piedmont and WellStar hospital systems in Atlanta are forming an insurance company. The ultimate aim is lowering the cost of health care by making it better. The effect on the Georgia insurance market could be significant, expanding competition, especially if the insurance offerings are presented on the new health law's exchanges slated to begin in 2014. The new system of insurance and patient care is to be modeled on a system at the University of Pittsburgh.
Seven Facts About America's Mental Health-Care System
Seven Facts About America's Mental Health-Care System by Sarah Kliff. Wonkblog. The Washington Post. December 17, 2012.
Among the facts cited are: Access to mental health care is worse than other types of medical services, and states cut 1.8 billion from their mental health budgets during the recession. Mental health services have come under scrutiny since Newtown.
Among the facts cited are: Access to mental health care is worse than other types of medical services, and states cut 1.8 billion from their mental health budgets during the recession. Mental health services have come under scrutiny since Newtown.
Error from Outsourced Medical Transcription Leads to $140 Million Award Against Hospital
Fatal Outsourcing? Thomas Hospital Hit with $140 Million Verdict in Death of Daphne Woman by Brendan Kirby. Al.com December 14, 2012.
An error by an Indian medical transcription firm resulted in an Alabama woman receiving 10 times the insulin dose prescribed by her doctor. For her death a Baldwin County Alabama Circuit Court handed down a $140 million judgement.
An error by an Indian medical transcription firm resulted in an Alabama woman receiving 10 times the insulin dose prescribed by her doctor. For her death a Baldwin County Alabama Circuit Court handed down a $140 million judgement.
Sunday, December 16, 2012
Virus Rebuilds Heart's Own Pacemaker in Animal Tests
Virus Rebuilds Heart's Own Pacemaker in Animal Tests by James Gallagher. BBC News. December 16, 2012.
In animal tests, researchers used a virus to insert a gene normally active during embryonic development to stimulate the heart to form new natural pacemaker cells. While scientifically intriguing and potentially of great clinical value, the innovation requires much more testing.
In animal tests, researchers used a virus to insert a gene normally active during embryonic development to stimulate the heart to form new natural pacemaker cells. While scientifically intriguing and potentially of great clinical value, the innovation requires much more testing.
Needed: Alternatives to Doctors in Age of Obamacare
When The Doctor Is Not Needed. Editorial. The New York Times. December 16, 2012.
Among the alternatives explored are pharmacists, nurse practitioners, retail clinics, community aides, and self-care at home. Physician assistant is mentioned briefly. Also mentioned is the funding provided by the Affordable Care Act for increases in medical residents, nurse practititoners, and physician assistants trained in primary care.
Among the alternatives explored are pharmacists, nurse practitioners, retail clinics, community aides, and self-care at home. Physician assistant is mentioned briefly. Also mentioned is the funding provided by the Affordable Care Act for increases in medical residents, nurse practititoners, and physician assistants trained in primary care.
Georgia Hospitals Rated for Safety by Washington Non-Profit
'A' Through 'F': Group Rates Georgia Hospitals by Andy Miller. Georgia Health News. November 28, 2012.
This rating used a scoring system of 26 measures of publicly available hospital safety data, including Medicare's Hospital Compare figures. 15% of Georgia Hospitals receive an A grade as compared with 30 percent of the nation's hospitals.
This rating used a scoring system of 26 measures of publicly available hospital safety data, including Medicare's Hospital Compare figures. 15% of Georgia Hospitals receive an A grade as compared with 30 percent of the nation's hospitals.
Saturday, December 15, 2012
Halve Food Waste, Feed an Additional Billion
Halving Food Losses Would Feed An Additional Billion People, Finnish Study Finds. Science Daily. October 10, 2012.
A quarter of the amount of calories in produced food is lost or wasted during production. If waste were stemmed 8 billion people could be fed with the currently used resources. The present estimated population is 7 billion.
A quarter of the amount of calories in produced food is lost or wasted during production. If waste were stemmed 8 billion people could be fed with the currently used resources. The present estimated population is 7 billion.
Women Physicians Grow in Number
Women Notch Progress by Josh Mitchell. The Wall Street Journal. December 4, 2012.
Tracing the progress of women in law and medicine, this article notes that women now constitute 32.4 or physicians and surgeons in 2010 up from 26.8 in 2000. The rise of women in medicine coincides with the rise of corporate owned medical practices and hospitals which makes it easier for women to balance work and family.
Tracing the progress of women in law and medicine, this article notes that women now constitute 32.4 or physicians and surgeons in 2010 up from 26.8 in 2000. The rise of women in medicine coincides with the rise of corporate owned medical practices and hospitals which makes it easier for women to balance work and family.
The Inevitability of Debt in Medical Education Questioned
Tackling the Problem of Medical Student Debt by Pauline Chen. M.D. Well Blog. The New York Times. December 13, 2012.
Institutions including the Geffen School of Medicine at U.C.L.A, the new medical school at the University of Central Florida, and the Cleveland Clinic Lerner College of Medicine have, through philanthropic donations, taken steps to lessen or eliminate the extent of medical student debt. Medical debt may deter many students from medical careers, deter them from family practice and toward lucrative specialities, lessen idealist commitment to service in order to retire debt.
Institutions including the Geffen School of Medicine at U.C.L.A, the new medical school at the University of Central Florida, and the Cleveland Clinic Lerner College of Medicine have, through philanthropic donations, taken steps to lessen or eliminate the extent of medical student debt. Medical debt may deter many students from medical careers, deter them from family practice and toward lucrative specialities, lessen idealist commitment to service in order to retire debt.
Two Global Health Diplomacy Offices Created
New Office in U.S. To Fight AIDS by Donald G. McNeil. The New York Times. December 15, 2012.
The new offices are the Office of Global Health Diplomacy in the State Department and the assistant secretary for global affairs in the department of Health and Human Services. The State Department office will be focused on persuading countries to spend more on their epidemics and to focus on disease victims who may be politically unpopular such as gays.
The new offices are the Office of Global Health Diplomacy in the State Department and the assistant secretary for global affairs in the department of Health and Human Services. The State Department office will be focused on persuading countries to spend more on their epidemics and to focus on disease victims who may be politically unpopular such as gays.
Friday, December 14, 2012
Fatty/Sugary Diet Linked to Brain Chemicals Associated With Depression
This Is Your Brain On Fatty Foods by Briana Rognlin. Blisstree.com. December 14, 2012.
Could Ending Your Fatty Habit Cause Withdrawal Symptoms and Depression. Public release by William Raillant-Clark. December 11, 2012.
Adaptations In Brain Reward Circuitry Underlie Palatable Food Cravings and Anxiety Induced by High-Fat Diet Withdrawal by S. Sharma, M.F. Fernandes, and S. Fulton. International Journal of Obesity. December 11, 2012.
In this study mice fed a high-fat diet were more anxious than mice fed a lower-fat diet supporting the conclusion that diet affects brain chemistry. The study looked particularly at dopamine and CREB which is activated in high-fat diet mice who also have corticosterone, a hormone also associated with stress. These chemical changes occur before obesity.
Could Ending Your Fatty Habit Cause Withdrawal Symptoms and Depression. Public release by William Raillant-Clark. December 11, 2012.
Adaptations In Brain Reward Circuitry Underlie Palatable Food Cravings and Anxiety Induced by High-Fat Diet Withdrawal by S. Sharma, M.F. Fernandes, and S. Fulton. International Journal of Obesity. December 11, 2012.
In this study mice fed a high-fat diet were more anxious than mice fed a lower-fat diet supporting the conclusion that diet affects brain chemistry. The study looked particularly at dopamine and CREB which is activated in high-fat diet mice who also have corticosterone, a hormone also associated with stress. These chemical changes occur before obesity.
Global Disease Patterns Described in New Report
Global Burden of Disease Study 2010. Coordinated by the Institute of Health Metrics and Evaluation. Published in The Lancet. December 13, 2012. Online access to The Lancet is free with registration.
This is the first systematic and comprehensive assessment of data on disease, injuries, and risk since 1990.
The report is summarized by The New York Times article: Life Expectancy Rises Around the World, Study Finds. December 13, 2012
This is the first systematic and comprehensive assessment of data on disease, injuries, and risk since 1990.
The report is summarized by The New York Times article: Life Expectancy Rises Around the World, Study Finds. December 13, 2012
Thursday, December 13, 2012
Georgia Chapter American College of Physicians Addresses Medicaid Expansion
Medicaid Expansion Should Go Forward By Jacqueline Fincher, Governor, Georgia chapter of the American College of Physicians. December 12, 2012. A report submitted to Georgia Governor Nathan Deal from an organization representing 2,676 internal medicine specialists and medical students.
How Will The Medicaid Expansion Benefit Georgia? by the Georgia chapter of the American College of Physicians. Report Included Below.
How Will The Medicaid Expansion Benefit Georgia? by the Georgia chapter of the American College of Physicians. Report Included Below.
A Report from Georgia’s Internal Medicine Physician Specialists:
How Will the Medicaid Expansion Benefit Georgia?
Introduction
In light of the Supreme Court’s ruling on the Affordable Care Act’s Medicaid expansion, states now have the option of expanding their Medicaid programs to all individuals with incomes up to 133% of the federal poverty level (FPL), which is equal to $14,856 for an individual or $30,656 for a family of 4 in 2012.
The federal government will finance most of the expansion’s cost. From 2014 to 2016, the federal government will pay for 100% of the coverage expansion. States will gradually assume a portion of the cost, providing 10% of expenses starting in 2020.
Now that the Medicaid expansion is optional, it’s estimated that fewer uninsured people will be able to access Medicaid. The Congressional Budget Office (CBO) originally estimated that 16 million people would be covered by the ACA Medicaid expansion. As a result, the CBO predicts that 6 million fewer individuals will be covered by Medicaid, although 3 million of these will be eligible for exchange-based private insurance.
The Georgia chapter of the American College of Physicians believes that it is imperative that the state of Georgia accept the unique opportunity that is now available to use federal dollars to expand Medicaid to everyone who has an income up to 133% of the federal poverty level. The report explains why it is in the best interests of the residents of this state, the physicians and hospitals who deliver care to them, and the state itself to agree to do so.
Our organization represents 2,676 internal medicine specialists and medical student members who live, study, teach and practice in the state of Georgia. We are a chapter of the American College of Physicians, which represents 133,000 internal medicine and medical student members nationwide. ACP is the largest physician specialty society and second largest physician-membership organization in the United States.
No matter where one stands on the Affordable Care Act itself, the evidence is clear: Georgia will greatly benefit by accepting federal dollars to extend Medicaid, and Georgians will be harmed it if does not:
- ¬ Extending Medicaid coverage to Georgia’s low-income uninsured will improve health status and quality of life.
Numerous studies show that individuals who enroll in Medicaid benefit significantly compared with the uninsured.
- • For instance, a study comparing Oregon Medicaid enrollees with uninsured people found that 35% of Medicaid enrollees were more likely to receive outpatient care compared to the uninsured. Seventy percent of Medicaid enrollees reported having access to a regular source of primary care, and 55% were more likely to have a doctor they usually see, compared with the uninsured.
- • Medicaid coverage also reduces mortality. One study concluded that mortality declined after states expanded their Medicaid programs, particularly among those aged 35 to 64 years, minorities, and people living in poorer areas.
- • Medicaid coverage may also help curb racial and ethnic health care disparities that are exasperated by lack of insurance, such as lack of usual source of care or receipt of preventative screenings. About 54% of adult Georgians newly-eligible for Medicaid are people of color, a population that is more likely to be uninsured than whites.
- ¬ Extending Medicaid coverage will reduce the numbers of uninsured Georgians by as much as 42 percent.
Source: Kenney GM, Zuckerman S, Dubay L, Huntress M, Lynch V, Haley J, Anderson N.
- • Twenty-two percent of Georgians - nearly two million people – were uninsured between 2009 and 2010. According to one estimate, 843,000 adult Georgians would be eligible for Medicaid coverage, including 684,000 who would be newly eligible under the health reform law.4
- • This is a significant expansion, as childless, non-disabled adults are currently ineligible for Georgia’s Medicaid program. The state currently restricts eligibility to working parents with incomes up to $9,080 (for a family of three) and non-working parents with incomes up to $5,003.
- ¬ Medicaid expansion will help the “safety net” of physicians, hospitals, and academic medical centers better serve their low-income patients and reduce cost-shifting to the rest of us.
In anticipation of the Medicaid expansion, the health reform law increases Medicaid primary care payments to Medicare levels in 2013 and 2014, paid for entirely by the federal government at no cost to Georgia. In addition, a reduction in uncompensated care will help the “bottom line” of Georgia’s hospitals and physician clinics that take care of Medicaid patients, and the state and local governments that help fund indigent care.
- • In 2008, the last year for which information is available, Georgia’s Medicaid primary care payment rates were 86% of Medicare rates. While Medicaid physician participation lags behind Medicare and private insurance, evidence shows that physicians are more likely to accept new Medicaid patients in states that pay closer to Medicare rates.
- • Hospitals will benefit from reduced uncompensated care costs, as the newly-insured will no longer be forced to seek free care provided by hospitals. Uncompensated care costs are shared across the public and private sectors.
- • It’s estimated that state and local governments provide 30% of the cost of uncompensated care. By expanding Medicaid to cover the previously uninsured, Georgia would benefit from a portion of uncompensated care savings.10
- • If Georgia chooses to opt-out of the expansion, the state’s hospitals and clinics will have to provide roughly $36 billion in uncompensated care over the next 10 years to those who would’ve been eligible for Medicaid coverage.
- • The Medicaid expansion is especially crucial for hospitals, since the health care reform law cut the federal share of uncompensated care payments because lawmakers assumed the Medicaid expansion would heavily reduce the need for uncompensated care. In 2010, Georgia hospitals received about $269 million in Medicaid federal funds to help offset the cost of covering the uninsured.
In addition, everyone in Georgia pays for the care that is provided on an uncompensated basis by hospitals and physicians, because those costs are shifted to the rest of us through higher premiums for our health insurance and higher taxes for government safety-net programs. And every one of us will benefit when there is less uncompensated care because more Georgians will be covered by Medicaid.
- ¬ The state will benefit fiscally by accepting this unprecedented offer by the federal government to pay almost all of the costs of extending Medicaid to more Georgians.
Medicaid’s rising costs are a growing burden for Georgia, mainly because the federal government does not pay a fair share of Medicaid costs while imposing costly federal mandates on the state. But this new program is different, because the federal government pays almost the entire cost.
- • Right now, the federal government pays about 66% of the cost for Georgians enrolled in Medicaid; our state pays the other 34%.
- • But starting in 2014, the federal government will pay 100% of the cost—yes, all of it!—for the first two years of extending Medicaid to all Georgians with incomes below 133% of the federal poverty level. Gradually, the federal government’s share will go down to 95% and then 90% over the next ten years. Still, the federal contribution would be the most ever offered to Georgia to cover more of our residents.
- • The CBO estimates that states will incur an additional 2.8% increase in Medicaid costs compared with what they would have spent in absence of the health care law, an estimate that includes those currently eligible for Medicaid coverage.
- • A 2011 Urban Institute report estimated that Georgia’s Medicaid program expenditures would increase by only $1.5 billion over 2014-2019. The federal government would spend an extra $21.2 billion for Georgia’s Medicaid program during the period. Similarly, a Kaiser Family Foundation study predicts a 2.7% increase in state Medicaid spending from 2014-2019.
- • If Georgia waits to accept the federal offer to pay for the Medicaid extension, it will get less help from the federal government. 100% federal funding is available only in 2014-15, so if Georgia waits until 2016, the federal government’s initial contribution will be 95% of the cost. If Georgia waits until 2020, the federal government’s annual contribution will be 90% of the cost. Delay now means Georgia taxpayers will pay more later to cover the same people under Medicaid.
- • Should Georgia accept the federal dollars now, the state is not locked in if the federal government reneges in the future on the commitment to pay for most of the Medicaid expansion. If the federal payments are reduced, then Georgia could revisit its decision to expand Medicaid.
What would happen to the uninsured if Georgia chose not to expand Medicaid?
The Urban Institute estimates that about 792,000 uninsured Georgians with incomes under 100% FPL would be denied coverage if Georgia chooses not to expand its Medicaid program.5 And, under the health reform law, they would not be eligible to get the subsidies to help pay for health insurance available to people who earn more than the federal poverty level, because Congress had expected that they would be covered by Medicaid.
Think about that: if Georgia turns down or delays accepting the federal money to extend Medicaid, we will be leaving our poorest residents with no other way to get coverage—resulting in poorer health outcomes for them, more uncompensated care for hospitals and physicians who take care of them., more cost-shifting for the rest of us, and ultimately, higher cost to the state.
As an organization representing Georgia’s internal medicine physicians and medical students, our greatest concern is for the working people—our patients—who will be left behind without any access to health insurance coverage if Georgia declines the federal money to expand Medicaid. We are speaking for them when we ask Governor Deal and the Georgia legislature to do the right thing and accept this unprecedented opportunity to provide coverage to our poorest patients, at minimal cost to the state.
Additional Resources:
Kaiser Family Foundation: Medicaid: A Primer.
Urban Institute: Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage?
Center on Budget and Policy Priorities: How Health Reform's Medicaid Expansion Will Impact State Budgets.
Urban Institute: Considerations in Assessing State-Specific Fiscal Effects of the ACA's Medicaid Expansion.
Urban Institute: Consider Savings as Well as Costs: State Governments Would Spend at Least $90 Billion Less With the ACA than Without It from 2014 to 2019.
Kaiser Family Foundation. Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL.
State Health Facts: Health Reform Information by State.
Kaiser Family Foundation: Visualizing Health Policy – Medicaid: Its Role Today and Under the Affordable Care Act.
Georgia Budget and Policy Institute. Affordable Care Act Benefits Georgia: Health Care Law Expands Coverage, Saves State Money.
Wednesday, December 12, 2012
'Smart Stethoscope' Monitors Kidney Stone Treatment
'Smart Stethoscope' Advance in Monitoring Treatment of Kidney Stones. Science Daily. December 12, 2012.
It is sometimes difficult to determine if lithotripsy has adequately broken kidney stones. This new device measures the reverberated sound produced around the body by the shock waves as they hit the stone. The British researchers who developed the device employ principles of computational fluid dynamics to develop the instrument.
It is sometimes difficult to determine if lithotripsy has adequately broken kidney stones. This new device measures the reverberated sound produced around the body by the shock waves as they hit the stone. The British researchers who developed the device employ principles of computational fluid dynamics to develop the instrument.
Significance of Declines in Youth Obesity--A Trend?
Obesity In Young Is Seen As Falling In Several Cities by Sabrina Tavernise. The New York Times. December 10, 2012.
Researchers are puzzling over what to make of declines in youth obesity rates in diverse cities including major population centers such as New York and Los Angeles as well as smaller communities like Kearney Nebraska. The consensus seems to be that while this hopeful sign could be the start of a decline in the obesity epidemic it is too early to know for certain. The results are uneven. For example in Mississippi, a decline has isolated to white youth. However in Philadelphia, the declines in youth obesity are widely spread among several ethnic groups. Following the approach advocated by the Institute of Medicine, officials are increasingly presenting comprehensive and multifaceted approaches to the problem. The long-term costs of childhood obesity are tremendous.
Researchers are puzzling over what to make of declines in youth obesity rates in diverse cities including major population centers such as New York and Los Angeles as well as smaller communities like Kearney Nebraska. The consensus seems to be that while this hopeful sign could be the start of a decline in the obesity epidemic it is too early to know for certain. The results are uneven. For example in Mississippi, a decline has isolated to white youth. However in Philadelphia, the declines in youth obesity are widely spread among several ethnic groups. Following the approach advocated by the Institute of Medicine, officials are increasingly presenting comprehensive and multifaceted approaches to the problem. The long-term costs of childhood obesity are tremendous.
Aspirin: Ancient, Effective, Cheap Preventative Medicine
The 2,000-Year-Old Wonder Drug by David B. Agus. The New York Times Op-Ed Page. December 11, 2011.
Making a compelling case for public health policies that encourage middle-aged people to use aspirin, Agus cites research indicating the effectiveness of aspirin for cardiovascular disease and cancer. He puts aspirin forward as a cost-effective strategy of prevention instead of a costly strategy of treatment. He points to behavior-shaping and modification strategies, such as those advocated by Mayor Bloomberg, as vital for public health. He raises the question of the public consequences of private health decisions.
Making a compelling case for public health policies that encourage middle-aged people to use aspirin, Agus cites research indicating the effectiveness of aspirin for cardiovascular disease and cancer. He puts aspirin forward as a cost-effective strategy of prevention instead of a costly strategy of treatment. He points to behavior-shaping and modification strategies, such as those advocated by Mayor Bloomberg, as vital for public health. He raises the question of the public consequences of private health decisions.
Tuesday, December 11, 2012
Obesity, Smoking, Diabetes, Sedentary Lifestyle: A State Ranking
America's Health Rankings. United Health Foundation. Released December 11, 2012
This resource ranks the states in obesity, smoking, diabetes, and sedentary lifestyle with infographics, timelines and other reference tools.
This resource ranks the states in obesity, smoking, diabetes, and sedentary lifestyle with infographics, timelines and other reference tools.
Forensic Microbiology Identifies Source of Major Hospital Infection: North America
Cause Of The Global Epidemic Of Clostridium Difficle Identified. MNT--Medical News Today. December 10, 2012.
Researchers from the Wellcome Trust Sanger Institute and the London School of Hygiene and Tropical Medicine have established a database for researchers to trace the genomic changes in C. difficile outbreaks. They have traced C. difficile betwen 2002 and 2006 to two epidemic strains that emerged in North American and spread rapidly between hospitals around the world. By using techniques of forensic microbiology researchers hope to trace the evolution of drug resistance in hospital and clinical settings.
Researchers from the Wellcome Trust Sanger Institute and the London School of Hygiene and Tropical Medicine have established a database for researchers to trace the genomic changes in C. difficile outbreaks. They have traced C. difficile betwen 2002 and 2006 to two epidemic strains that emerged in North American and spread rapidly between hospitals around the world. By using techniques of forensic microbiology researchers hope to trace the evolution of drug resistance in hospital and clinical settings.
Monday, December 10, 2012
Reprogrammed Immune Cells Offer Powerful Tool Against Leukemia
In Girl's Last Hope, Altered Immune Cells Beat Leukemia by Denise Grady. The New York Times. December 9, 2012.
In an inspiring story of the successful treatment a young leukemia patient, scientists have found success in using a disabled form of H.I.V to insert new genes into T-cells programming them to attack B-cells, a part of the immune system that turns malignant in leukemia. The method has shown success in other cases, though not all. Cost advantages, as compared with bone marrow transplants, are significant. The ramifications for the pharmaceutical industry could be profound. For example, Novartis is modifying its approach to cancer drugs, focusing on unmistakable impact on a small number of patients as opposed to broad-use drugs for many.
In an inspiring story of the successful treatment a young leukemia patient, scientists have found success in using a disabled form of H.I.V to insert new genes into T-cells programming them to attack B-cells, a part of the immune system that turns malignant in leukemia. The method has shown success in other cases, though not all. Cost advantages, as compared with bone marrow transplants, are significant. The ramifications for the pharmaceutical industry could be profound. For example, Novartis is modifying its approach to cancer drugs, focusing on unmistakable impact on a small number of patients as opposed to broad-use drugs for many.
Economic and Scientific Challenges Demand Collaborative Approaches to Antibiotics
Let's Gang Up on Killer Bugs by Carl F. Nathan, Op-Ed Contributor. The New York Times. December 10, 2012.
Problems of financial viability confront antibiotics targeted toward one type of bacterium as well as those that are "broad spectrum." Antibiotics also must deal with independent mutations of bacteria that make them more adept at evading antibiotics. The author, the chairman of the department of microbiology and immunology at Weill Cornell Medical School, advocates an "open lab" style of doing science that deemphasizes secrecy. He also advocates a new reward mechanism for drug discovery.
Problems of financial viability confront antibiotics targeted toward one type of bacterium as well as those that are "broad spectrum." Antibiotics also must deal with independent mutations of bacteria that make them more adept at evading antibiotics. The author, the chairman of the department of microbiology and immunology at Weill Cornell Medical School, advocates an "open lab" style of doing science that deemphasizes secrecy. He also advocates a new reward mechanism for drug discovery.
Sunday, December 9, 2012
Cat Litter Parasite Linked to Behavior Changes, Mental Illness
How Cat Litter Parasite Toxoplasma Gondii Influences The Brain. Medical News Today. December 9, 2012.
Toxoplasma gondii has been linked with risk-taking in humans as well as schizophrenia, depression, anxiety. The parasite is spread by poorly cooked meat or contact with cat feces. Hence the warning that pregnant women should not come in contact with cat litter since fetuses can be vulnerable. This article focuses on impact of the parasite on the dendritic secretion of GABA, a chemical messenger of the brain.
Toxoplasma gondii has been linked with risk-taking in humans as well as schizophrenia, depression, anxiety. The parasite is spread by poorly cooked meat or contact with cat feces. Hence the warning that pregnant women should not come in contact with cat litter since fetuses can be vulnerable. This article focuses on impact of the parasite on the dendritic secretion of GABA, a chemical messenger of the brain.
Tax For Financing Georgia Hospitals Expires Next Year
The Power Of A Name At the Center of Medicaid Debate by Jim Galloway. The Atlanta Journal-Constitution. December 5, 2012.
The so-called "bed tax" is set to expire next year. This tax is vital to financing many Georgia rural hospitals and hospitals serving poor people generally. Extension of the tax will be a important focus of the Georgia General Assembly when it meets in January. Some argue for extension of tax while others, particularly anti-tax activists, are skeptical.
The so-called "bed tax" is set to expire next year. This tax is vital to financing many Georgia rural hospitals and hospitals serving poor people generally. Extension of the tax will be a important focus of the Georgia General Assembly when it meets in January. Some argue for extension of tax while others, particularly anti-tax activists, are skeptical.
Thursday, December 6, 2012
Program Tests New Approach to Treating Medicare/Medicaid Eligible Poor
Medicare-Medicaid Experiment Aims To Save On Care by Mary Agnes Carey and Sarah Varney/Kaiser Health News. USA Today. December 5, 2012.
California is experimenting with moving a large group of Medicaid enrollees from traditional fee-for-service programs into managed care to see if good care can be delivered at lower cost. This program foreshadows the roll-out of a program under the Affordable Care Act for managed care for dual-eligible people i.e. those eligible for both Medicare and Medicaid. These dual-eligibles face some of the most complex medical cases from both programs. The challenge is for better coordination to eliminate costs and deliver better service. Critics site concerns regarding the speed of implementation and scope of the new program. While there is an opt-out provision in the national program, critics wonder how that would work when a significant number of the affected patients have cognitive impairment.
California is experimenting with moving a large group of Medicaid enrollees from traditional fee-for-service programs into managed care to see if good care can be delivered at lower cost. This program foreshadows the roll-out of a program under the Affordable Care Act for managed care for dual-eligible people i.e. those eligible for both Medicare and Medicaid. These dual-eligibles face some of the most complex medical cases from both programs. The challenge is for better coordination to eliminate costs and deliver better service. Critics site concerns regarding the speed of implementation and scope of the new program. While there is an opt-out provision in the national program, critics wonder how that would work when a significant number of the affected patients have cognitive impairment.
Scope of Practice Laws Impact Nurse Practitioners
In Many Communities, Nurse Practitioners Fill An Important Void by Chrisine Vestal, Stateline/Kaiser Health News. December 6, 2012.
Using Buckingham County, Virginia as a case study, this article explores one aspect of the difficulties posed by the fact that there are 5,800 communities with a shortage of primary care physicians. With extended coverage to 30 million more people in 2014, the problem is only going to get worse. Additional physicians can only provide part of the solution. Increasingly states are seeing nurse practitioners as a resource to address this physician supply problem. However, scope of practice laws limit the independence of these nurses and therefore their ability to address the shortage. Political tensions with doctors groups impact regulatory rules concerning the independence of nurses. In Virginia in 2011 a new law was passed aimed at improving patient access to primary care cross that state. The issues raised by this law, especially doctor supervision and required consultation in "complex" case, are a major concerns addressed in this article.
Using Buckingham County, Virginia as a case study, this article explores one aspect of the difficulties posed by the fact that there are 5,800 communities with a shortage of primary care physicians. With extended coverage to 30 million more people in 2014, the problem is only going to get worse. Additional physicians can only provide part of the solution. Increasingly states are seeing nurse practitioners as a resource to address this physician supply problem. However, scope of practice laws limit the independence of these nurses and therefore their ability to address the shortage. Political tensions with doctors groups impact regulatory rules concerning the independence of nurses. In Virginia in 2011 a new law was passed aimed at improving patient access to primary care cross that state. The issues raised by this law, especially doctor supervision and required consultation in "complex" case, are a major concerns addressed in this article.
Wednesday, December 5, 2012
Georgia Physician Assistant/Nurse Practitioner Roles Defined In Proposed Rule
Telemedicine Rule Draws Fire by Misty Williams. The Atlanta Journal-Constitution. December 4, 2012.
The Georgia Composite Medical Board is slated to consider a rule that would require that a telemedicine patient be seen or examined by a physician in person or via electronic means before a registered nurse or physician assistant can provide care. Advocates of the rule cite patient safety and taking a conservative approach with new technology. Opponents of the rule are concerned about barriers to access. Issues of telemedicine are certain to become more important as Georgia's doctor shortage grows. 5,000 additional doctors are needed in Georgia before 2030. There are now roughly 20,000 doctors in Georgia.
The Georgia Composite Medical Board is slated to consider a rule that would require that a telemedicine patient be seen or examined by a physician in person or via electronic means before a registered nurse or physician assistant can provide care. Advocates of the rule cite patient safety and taking a conservative approach with new technology. Opponents of the rule are concerned about barriers to access. Issues of telemedicine are certain to become more important as Georgia's doctor shortage grows. 5,000 additional doctors are needed in Georgia before 2030. There are now roughly 20,000 doctors in Georgia.
Training More Internal Medicine Residents May Not Solve Doc Shortage
Most Internists Don't Plan To Stay in Primary Care by Genevra Pittman. Reuters. December 4, 2012.
A survey by the Mayo Clinic of 17,000 internal medicine residents found that only 22 percent said that they were planning to become general internal medicine physicians. As a result the article suggests that the strategy of training more internal medicine residents in order to address the general practice physician shortage may be flawed. An alternative may be to pay current physicians in underserved areas more to work longer and see more patients. The need to revitalize and reform internal medicine and primary care as viable career options is crucial.
A survey by the Mayo Clinic of 17,000 internal medicine residents found that only 22 percent said that they were planning to become general internal medicine physicians. As a result the article suggests that the strategy of training more internal medicine residents in order to address the general practice physician shortage may be flawed. An alternative may be to pay current physicians in underserved areas more to work longer and see more patients. The need to revitalize and reform internal medicine and primary care as viable career options is crucial.
Drug Promotion Ruling Could Be Major Landmark
Off-Label Drug Marketing Is 'Free Speech,' Court Rules by John Fauber. Milkaukee Journal Sentinel/MedPage Today. ABC News. December 5, 2012.
The FDA rules governing pharmaceutical company promotion of drugs may have been significantly changed. The broad impact of the decision by the Second Circuit Court of Appeals in New York awaits determination by the U.S. Supreme Court.
Under FDA rules, pharmaceutical companies can only promote a drug for an FDA-approved use. As a result of the Second Circuit decision, the limited focus of pharmaceutical companies' promotion effort has greatly broadened, encompassing promotion of "off-label" uses of the drug. The article addresses the "free-speech" rationale for the decision as well as the public health, and safety implications of the ruling.
The FDA rules governing pharmaceutical company promotion of drugs may have been significantly changed. The broad impact of the decision by the Second Circuit Court of Appeals in New York awaits determination by the U.S. Supreme Court.
Under FDA rules, pharmaceutical companies can only promote a drug for an FDA-approved use. As a result of the Second Circuit decision, the limited focus of pharmaceutical companies' promotion effort has greatly broadened, encompassing promotion of "off-label" uses of the drug. The article addresses the "free-speech" rationale for the decision as well as the public health, and safety implications of the ruling.
Tuesday, December 4, 2012
The Future of Diagnosis: Knowledge Versus Intuition? Human Versus Computer?
For Second Opinion, Consult a Computer? by Katie Hapner. The New York Times. December 3, 2012.
The breathtaking diagnostic skill of Dr. Gurpreet Dhaliwal, an associate professor of clinical medicine at the University of California, San Francisco is highlighted to raise questions about the source of diagnostic skill and the present and future roles of computers in diagnosis.
The breathtaking diagnostic skill of Dr. Gurpreet Dhaliwal, an associate professor of clinical medicine at the University of California, San Francisco is highlighted to raise questions about the source of diagnostic skill and the present and future roles of computers in diagnosis.
Weight Watchers Adds Behavioral Strategies
New Weight Watchers 360 Plan Unveiled by Nanci Hellmich. USA Today. December 2, 2012.
One study cited by the article indicates that people, either consciously or unconsciously, make more than 200 food-related decisions a day. With the behavioral aspects of food firmly established, Weight Watchers is supplementing its strategy of tracking of food intake by facilitating monitoring of physical activity, interactive and app-based group meetings, establishing eating and sleep habits, and managing food environments
One study cited by the article indicates that people, either consciously or unconsciously, make more than 200 food-related decisions a day. With the behavioral aspects of food firmly established, Weight Watchers is supplementing its strategy of tracking of food intake by facilitating monitoring of physical activity, interactive and app-based group meetings, establishing eating and sleep habits, and managing food environments
DSM-5 Identifies and Classifies Mental Conditions for Psychiatric Profession
Psychiatrists Approves Vast Changes To Diagnosis Manual by Sharon Jayson. USA Today. December 2, 2012.
Culminating the work of over a decade, the board of the American Psychiatric Association approved the latest version of the Diagnostic and Statistical Manual of Mental Disorders, which will be published in detail in May. The Manual has tremendous significance for insurance coverage and school special services.
Among the several controversial changes addressed by this article is the elimination of a mild form of autism known as Asperger's syndrome and folding it in as a part of autism spectrum disorder.
Culminating the work of over a decade, the board of the American Psychiatric Association approved the latest version of the Diagnostic and Statistical Manual of Mental Disorders, which will be published in detail in May. The Manual has tremendous significance for insurance coverage and school special services.
Among the several controversial changes addressed by this article is the elimination of a mild form of autism known as Asperger's syndrome and folding it in as a part of autism spectrum disorder.
Monday, December 3, 2012
CBO: Obamacare Drug Savings Produce Medicare Savings
Medicare Beneficiaries Reach $5 Billion In Drug Savings by Kelly Kennedy. USA Today. December 3, 2012.
Drug discounts from pharmaceutical firms obtained under Obamacare have resulted in more people taking their medication which, in turn, has resulted in long-term medical costs reductions according to the Congressional Budget Office. The CBO has quantified the savings: 1% increase in Medicare prescription has caused Medicare spending to drop by one-fifth of 1%. A critic of the new health care law questions the reliability of this "attractive story." Such assertions are "almost never true." he stated.
Drug discounts from pharmaceutical firms obtained under Obamacare have resulted in more people taking their medication which, in turn, has resulted in long-term medical costs reductions according to the Congressional Budget Office. The CBO has quantified the savings: 1% increase in Medicare prescription has caused Medicare spending to drop by one-fifth of 1%. A critic of the new health care law questions the reliability of this "attractive story." Such assertions are "almost never true." he stated.
Sunday, December 2, 2012
The Immortal Jellyfish: Cancer and the Human Future
Can A Jellyfish Unlock the Secret of Immortality by Nathaniel Rich. The New York Times Magazine. November 28 2012.
In Japan, the country with the world's oldest population, a scientist, Sin Kubota with the Seto Marine Biological Laboratory. looks for the keys to immortality in an obscure species known as Turritonsis dohrnij, the immortal jellyfish.
In 1988 it was discovered that Turritonsis dohrnij could at any stage of development could transform itself back to a polyp, in essence becoming younger and younger until a new life cycle would begin again. In addition to Kubota, other scientists are studying hydrozoans, invertebrates that depending on life cycle stage will resemble a jellyfish or soft coral. For example, the hydra is composed almost completely of stem cells that allow continuous regeneration.
The capacity for regeneration has potentially profound implications for cancer research and longevity. microRNAs regulate cell differentiation by the process of gene expression. These simple organisms may have, in effect, eschewed cell differentiation for cancer prevention and immortality.
Sin Kubota, scientist, is also a songwriter. His songwriting is not merely a hobby but a tool for spiritual change. He worries that needed spiritual changes in the human heart will not be adequate to deal with the potential that he sees from his research. Song is the way he seeks to expand man's vision for change and love of nature.
In Japan, the country with the world's oldest population, a scientist, Sin Kubota with the Seto Marine Biological Laboratory. looks for the keys to immortality in an obscure species known as Turritonsis dohrnij, the immortal jellyfish.
In 1988 it was discovered that Turritonsis dohrnij could at any stage of development could transform itself back to a polyp, in essence becoming younger and younger until a new life cycle would begin again. In addition to Kubota, other scientists are studying hydrozoans, invertebrates that depending on life cycle stage will resemble a jellyfish or soft coral. For example, the hydra is composed almost completely of stem cells that allow continuous regeneration.
The capacity for regeneration has potentially profound implications for cancer research and longevity. microRNAs regulate cell differentiation by the process of gene expression. These simple organisms may have, in effect, eschewed cell differentiation for cancer prevention and immortality.
Sin Kubota, scientist, is also a songwriter. His songwriting is not merely a hobby but a tool for spiritual change. He worries that needed spiritual changes in the human heart will not be adequate to deal with the potential that he sees from his research. Song is the way he seeks to expand man's vision for change and love of nature.
Saturday, December 1, 2012
Greece Hammered by HIV, Drugs, Financial Collapse, Austerity
Health Officials: Athens Has Spiraling HIV Crisis by Elena Becatoros. Bloomberg Businessweek. November 30, 2012.
HIV infections among drug users in Greece have skyrocketed by 15-fold last year and 35-fold so far this year compared to a 2008-2010 baseline. During the economic calamity drug users have turned from smoking to injecting in order to get the same effect from smaller amounts of drugs. Austerity measures have impacted hospitals and charities who work with drug users, crippling efforts to deal with the HIV crisis. Efforts to distribute clean needles do no match the extent of the problem.
HIV infections among drug users in Greece have skyrocketed by 15-fold last year and 35-fold so far this year compared to a 2008-2010 baseline. During the economic calamity drug users have turned from smoking to injecting in order to get the same effect from smaller amounts of drugs. Austerity measures have impacted hospitals and charities who work with drug users, crippling efforts to deal with the HIV crisis. Efforts to distribute clean needles do no match the extent of the problem.
ACA: Fear and Opportunity for Small Employers
Small Employers Weigh Impact of Providing Health Insurance by Steven Greenhouse and Reed Abelson. The New York Times. November 30, 2012.
Some small employers are deciding if they should be fearful about the Affordable Care Act or can view it as an opportunity. Most employers, including small businesses, already offer health coverage and will not be significantly impacted by the requirement in the next year or so. However, among firms in the retail and hospitality industries where employees often cannot afford their share of insurance premiums there is great concern. By 2014, firms employing more than 50 employees will be expected to offer affordable--as yet undefined--coverage or pay a fine of 2,000 per employee, excluding the first 30 employees. Some small employers suggest that they may lower the number of hours worked to fall outside the requirement for coverage. This course of action however, experts in the article suggest, will put those employers at a competitive disadvantage. Definitions are key as employers await clarification of key concepts such as "full-time employee" and approved coverage.
Some small employers however view the ACA as an opportunity. With tax credits, they are able to offer health insurance for the first time. These businesses had 15 and 5 employees.
Some small employers are deciding if they should be fearful about the Affordable Care Act or can view it as an opportunity. Most employers, including small businesses, already offer health coverage and will not be significantly impacted by the requirement in the next year or so. However, among firms in the retail and hospitality industries where employees often cannot afford their share of insurance premiums there is great concern. By 2014, firms employing more than 50 employees will be expected to offer affordable--as yet undefined--coverage or pay a fine of 2,000 per employee, excluding the first 30 employees. Some small employers suggest that they may lower the number of hours worked to fall outside the requirement for coverage. This course of action however, experts in the article suggest, will put those employers at a competitive disadvantage. Definitions are key as employers await clarification of key concepts such as "full-time employee" and approved coverage.
Some small employers however view the ACA as an opportunity. With tax credits, they are able to offer health insurance for the first time. These businesses had 15 and 5 employees.
Overall Birth Rate The Lowest Since 1920
U.S. Birth Rate Falls To A Record Low; Decline Is Greatest Among Immigrants by Gretchen Livingston and D'Vera Cohn. Pew Research Center. November 29, 2012.
Comparative figures: Overall U.S. birth rate--8% decline from 2007-2010; U.S.-born women birth rate-- 6% decline; Foreign-born women birth rate--14% decline; Mexican immigrant women--23% decline.
Preliminary figures for 2011 indicate a birth rate of 63.2 per 1,000 rate compared with 122.7 in 1957.
The advent of the Great Recession in 2007 marked the end of an increase in U.S. births that had begun in 2002.
Foreign born mothers give birth to a disproportionate share of U.S. newborns: 23% share of all births as compared with the 13% share of the U.S. population.
Comparative figures: Overall U.S. birth rate--8% decline from 2007-2010; U.S.-born women birth rate-- 6% decline; Foreign-born women birth rate--14% decline; Mexican immigrant women--23% decline.
Preliminary figures for 2011 indicate a birth rate of 63.2 per 1,000 rate compared with 122.7 in 1957.
The advent of the Great Recession in 2007 marked the end of an increase in U.S. births that had begun in 2002.
Foreign born mothers give birth to a disproportionate share of U.S. newborns: 23% share of all births as compared with the 13% share of the U.S. population.
Healthcare Consolidation: Changing Medical Practice
A Hospital War Reflects A Bind For U.S. Doctors by Julie Creswell and Reed Abelson. The New York Times. November 30, 2012.
Using Boise, Idaho as a springboard case for a larger discussion of health care consolidation, this article suggests several contributing factors including shrinking Medicare reimbursements, higher costs due to the implementation of technology including electronic medical records, the changing environment of health care delivery, and certain aspects of Obamacare. Buyers driving the consolidation trend include hospitals and hospital chains, insurance companies, and private equity firms as well as individual doctors who choose to band together.
The patient-care rationale for consolidation is the belief that coordination of care is key to good care. However cited are indications that prices are rising relative to pre-consolidation. e.g. services performed in a doctor's office are sometimes cheaper that the same service performed in hospital which now owns the referring physician group. Also cited by some physicians in the article are perceived difficulties in referral outside the consolidated health care entity. Other problems cited are pressure on doctors to meet financial targets and admissions goals in addition to the structure of physician contracts. Federal and state officials, including the Federal Trade Commission, are investigating some instances of anticompetitive consolidation.
Using Boise, Idaho as a springboard case for a larger discussion of health care consolidation, this article suggests several contributing factors including shrinking Medicare reimbursements, higher costs due to the implementation of technology including electronic medical records, the changing environment of health care delivery, and certain aspects of Obamacare. Buyers driving the consolidation trend include hospitals and hospital chains, insurance companies, and private equity firms as well as individual doctors who choose to band together.
The patient-care rationale for consolidation is the belief that coordination of care is key to good care. However cited are indications that prices are rising relative to pre-consolidation. e.g. services performed in a doctor's office are sometimes cheaper that the same service performed in hospital which now owns the referring physician group. Also cited by some physicians in the article are perceived difficulties in referral outside the consolidated health care entity. Other problems cited are pressure on doctors to meet financial targets and admissions goals in addition to the structure of physician contracts. Federal and state officials, including the Federal Trade Commission, are investigating some instances of anticompetitive consolidation.
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