More Answers To Your Questions About The Health Care Law

Adam Cole/NPR

The Affordable Care Act remains pretty much intact after its review by the Supreme Court. So what's in it anyway?

Now that the Supreme Court has upheld almost all of the Affordable Care Act, many Americans are scrambling to remember � or learn for the first time � what's in the law and how it works.

We asked for questions from our audiences online and on air. Here's are some, edited for clarity and length, and the answers:

 

Q: Will the penalty for not having health insurance affect people at all income levels, or will low-income people be spared?

A: The short answer is no, if you can't afford insurance you don't have to buy it.

Here is the slightly longer answer.

For starters, if you don't earn enough to have to file a federal tax return, you're exempt. In 2010 that was $9,350 for an individual, or $18,700 for a married couple.

You're also exempt if you would have to pay more than 8 percent of your household's income for health insurance, after whatever help you might get from an employer or subsidies from the federal government.

Q: If someone is only insured for six or seven months a year, will there still be a fine?

A: Possibly, but it would be prorated for only the months you didn't have insurance.

There is one exception. There's no penalty in the law for a single gap of less than three months in a year. That's because many employers impose a waiting period. There's also a separate provision in the health law that forbids employers from imposing waiting periods of longer than three months. So no one will have to pay a penalty specifically because a new employer makes them wait to qualify for coverage.

Q: I understand that businesses above a certain size have to provide a health care insurance option, but do they have to pay for it? Does the law require a certain contribution from the employer, or can the employer make the employees just pay, say, 99 percent of the premiums?

A: This is where the law seems a little bit tricky. It doesn't stipulate how much of the premiums employers have to pay, but it does say that overall, employers with more than 50 workers have to provide a plan that covers 60 percent of the covered expenses for a typical population. And that plan can't cost more than 9.5 percent of family income.

Q: How does the law affect Medicare recipients? I heard it cuts billions of dollars from the program. Does it have other effects?

A: Let's take these one at a time. Yes, the law does reduce Medicare spending by roughly $500 billion less than it would have been without the law. That's over 10 years, by the way, and Medicare will cost a little under $500 billion this year. But none of that comes out of benefits guaranteed under the law.

The biggest single chunk comes from reducing what had been overpayments to private HMOs and other health plans that serve about 20 percent of Medicare patients.

The next biggest chunk comes from hospitals and other providers of health care that hope to get that money back because more people will have insurance.

As to other changes to Medicare, there are actually some new benefits. The doughnut hole, that gap in coverage for prescription drugs, is being gradually closed. And Medicare patients are now getting new preventive screenings, like mammograms, without having to pay a deductible.

Q: My son lives overseas, where he is covered by the national health insurance plan. As an American citizen, would he be required to pay the fee for not being covered under an American plan?

A: No, only residents of the U.S. and its territories are subject to the insurance requirements.

Q: I am a veteran getting my medical care from Veterans Affairs. Am I correct that this counts as having insurance, when it comes to the requirement that everyone be covered or pay a penalty?

A: Yes, the VA counts. So does TRICARE and other military health plans. In fact, just about all government health care program, including Medicare and Medicaid, count as well. That's why the Urban Institute estimates that come 2014, only about 7 million people out of the U.S. population of well over 300 million will have to either purchase insurance or be subject to paying the penalty.

Q: If my current insurance policy does not meet the minimum requirements in the Affordable Care Act, and my insurer must raise the standards of my policy, can my insurer raise the premiums I pay?

A: In a word, yes. That was part of the goal of the law, not just to get people without insurance to have it, but to get people with what was considered substandard insurance up to par. This is controversial, and it's the part that leads to claims that the government is interfering in the private insurance market, which in this case it is. But it's in the law because Congress heard about lots and lots and lots of cases where people who had insurance nevertheless ended up bankrupt because the insurance didn't cover what they thought it did. So will this make healthy people who have to spend more unhappy? Yes. But will it protect people better when they do get sick? Yes, it will do that, too. And will the arguments about it continue? Yes, undoubtedly.

A dozen states file early HIX blueprints

WASHINGTON – The Centers for Medicare and Medicaid Services has already received letters from 12 states declaring their commitment and plans to create a health insurance exchange.

States must provide a summary blueprint by Nov. 16 of how they intend to operate their online insurance marketplace, on their own or within a federal-state partnership.

The states include California, Colorado, Massachusetts and Washington, according to a July 11 blog by Health and Human Services Secretary Kathleen Sebelius.

The Supreme Court upheld most of the Patient Protection and Affordable Care Act, including the creation of the exchanges, where individuals and their families and small businesses may search for, compare and choose affordable health coverage options starting in 2014.

“HHS is committed to flexibility in our support of the states’ progress in whatever route they choose, as well as providing planning and implementation funds to help the states to establish the marketplace that suits their residents’ needs,” wrote Sebelius. States may build their own exchange, work with other states or partner with the federal government.

The governors of New York and Rhode Island, both of whom sent letters of intent, issued executive orders to begin work on their exchanges. Other governors were able to initiate the establishment of exchanges through bi-partisan legislation, such as Washington’s Christine Gregoire.

In particular, the recently awarded $128 million Level II establishment grant will support the staffing and IT infrastructure necessary to complete the remaining design and development work, and the subsequent operation of the Exchange through December 2014,” Gregoire said in her state letter.

Maryland Gov. Martin O’Malley said that his state-based exchange is “well underway, and we continue to make significant progress with strong support from the state’s political leadership and broad-based stakeholder community.”

Other states that have also submitted letters summarizing their plans include Connecticut, Hawaii, Minnesota, Oregon and Vermont.

The 12 states that are moving ahead of schedule are all led by Democratic governors, except Rhode Island, whose Gov. Lincoln Chafee is an Independent.

States that waited until after the Supreme Court ruled to start thinking about their exchanges will find it challenging to complete their blueprint work by November. Information technology systems that are integral for exchange operations require long lead time to arrange contracts, and legislative sessions for the year are over.

As a result, those states, who participated in the lawsuit to strike the health reform law, may have to rely on the federal government for their exchanges.

Medicaid expansion a tough sell to governors of both parties

While the resistance of Republican governors has dominated the debate over the health-care law in the wake of last month�s Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage.

At least seven Democratic governors have been noncommittal about their willingness to go along with expanding their Medicaid programs, the chief means by which the law would extend coverage to millions of Americans with incomes below or near the poverty line.

�Unlike the federal government, Montana can�t just print money,� Gov. Brian Schweitzer (D) said in a statement Wednesday. �We have a budget surplus, and we�re going to keep it that way.�

The law would add an estimated 84,000 people to Montana�s Medicaid program, doubling its size, the governor said. Although the federal government would pay the vast majority of the additional costs, Montana�s health and human services department estimates the state�s share would reach $71 million in 2019. Outside groups say the costs would be far lower than that.

The range of state leaders expressing unease suggests that implementing the law could be rough going, with divisions not always breaking along party lines. The topic is likely to factor prominently in this week�s meeting of the National Governors Association in Williamsburg, Va. And it has been fueled by a long list of unanswered questions about the choice now before states.

In particular, it is unclear how the court�s pronouncement that states cannot be penalized for refusing to adopt the law�s more generous eligibility standards for Medicaid in 2014 changes the rules governing the expansion.

Will states that opt in have the option of scaling back in future years? If a state that opts out decides it wants to participate at some later point, will the federal government still pay nearly the full cost of covering those who become newly eligible for Medicaid? And can a state participate only partially � for instance, by raising the income cutoff for its program to a level lower than the ceiling envisioned in the law, which is set at 133 percent of the federal poverty line?

Asked at a forum Wednesday to describe state reactions to the Supreme Court ruling, Dan Crippen, executive director of the National Governors Association, offered a one word reply: �confusion.�

The association was one of several � along with the Republican Governors Association and the National Association of Medicaid Directors (NAMD) � to send a letter to Secretary of Health and Human Services Kathleen Sebelius this week with a voluminous list of queries.

�The answers to these questions are key,� said NAMD Director Matt Salo. �States need to be making these decisions now, and it�s hard to make them if you don�t have clarity.�

Continue reading…

Americans need to try harder to eat fruits, vegetables

No one said eating enough fruits and vegetables was going to be a piece of cake � even if you're giving it your best shot.

The majority of Americans say they've been trying to eat more fruits and vegetables over the past year, according to a poll of 1,057 adults for the International Food Information Council Foundation.

But most people are consuming less than half of what the government recommends. Kids and adults eat an average of a little more than a cup of vegetables a day and a little more than half a cup of fruit, according to the latest data from the NPD Group, a market research firm. Those numbers don't count french fries but do include other types of potatoes, such as baked and mashed.

How much is enough?

How many cups you should eat is based on your calorie intake, according to the government's dietary guidelines. Anyone who consumes 2,000 calories a day is supposed to eat 2� cups of vegetables and two cups of fruit a day. A person who takes in about 1,400 calories a day should have about 1� cups of fruits and the same amount of vegetables.

"Children 2 through 12 and their parents are inching up in the amount they consume, but unfortunately, teens and the elderly are bringing the averages down," says Elizabeth Pivonka, president and CEO of the Produce for Better Health Foundation, a non-profit nutrition education group.

The Flexitarian Diet

To eat enough fruits and vegetables, Dawn Jackson Blatner, a registered dietitian in Chicago and author of The Flexitarian Diet, recommends trying to incorporate a fruit or vegetable into every meal and snack.

For instance, here�s one way to consume two cups of fruit and 2� cups of vegetables a day.

Breakfast: One cup or one piece of fruit, plus whole-grain toast and cottage cheese with cinnamon

Morning snack: � cup to cup of vegetables such as carrot sticks or broccoli spears with hummus

Lunch: One cup vegetables such as Greek salad stuffed into a whole-grain pita.

Afternoon or evening snack: One piece or cup of fruit with string cheese.

Dinner: One cup of vegetables such as cooked green beans with brown rice and barbecue chicken.

The reason for the push for an increased intake of fruits and vegetables is they are loaded with vitamins, minerals, fiber, antioxidants and other compounds that help fight disease, she says.

But can anyone really eat three to 4� cups from these two food groups each day?

Pivonka says every little bit counts: raisins in cereal, frozen berries in smoothies, vegetables in soup, tomato sauce on spaghetti, beans in chili, veggies on sandwiches, 100% fruit juices.

In general, one cup of raw or cooked vegetables or vegetable juice, or two cups of raw leafy greens, counts as one cup from the vegetable group. One cup (or one piece) of fruit or 100% fruit juice, or half a cup of dried fruit, is considered one cup from the fruit group. So if you eat an apple or banana, that counts as one cup of fruit for the day; a medium side salad could equal about one cup of vegetables.

An easy way to reach the recommended amount is to make half your plate fruits and vegetables at every meal, as suggested by the government's MyPlate icon (choosemy plate.gov), says Rachel Begun, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, formerly the American Dietetic Association: "This is a visual that's easy to remember."

Do the shopping

To eat enough from these two food groups, you need to make sure your fridge and freezer are well-stocked, which may mean grocery shopping one or two times a week, says Dawn Jackson Blatner, a registered dietitian in Chicago.

"I like to buy pre-washed containers of leafy greens, trays of assorted cut veggies and bags of frozen vegetables for later in the week when my fresh produce is gone."

She also likes to have leftover grilled veggies in the refrigerator in the spring and summer and roasted vegetables in the winter and fall.

Cooking vegetables, including grilling or roasting them, often helps bring out natural flavors and sweetness, Blatner says.

Consider the options

When people tell her they don't like vegetables, Pivonka tells them that there are hundreds of different fruits and vegetables that can be prepared in thousands of different ways. "My daughter was 10 years old before I discovered that she liked cooked carrots instead of raw carrots."

She says her group often hears from consumers who are concerned about cost. A government study showed you can eat the recommended daily amount of fruits and vegetables for $2 to $2.50 a day. "It's really a matter of priorities and how you spend your money," she says. "You can skip the soda when you eat out, and you've saved enough money to buy all your fruits and vegetables for the day."

When it comes to both price and taste, it's often best to eat produce that's in season, Begun says:

"There's a world of difference between a tomato from a local farm in late summer vs. one in January that was picked before its time and flown thousands of miles."

Medicaid expansion a tough sell to governors of both parties

While the resistance of Republican governors has dominated the debate over the health-care law in the wake of last month�s Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage.

At least seven Democratic governors have been noncommittal about their willingness to go along with expanding their Medicaid programs, the chief means by which the law would extend coverage to millions of Americans with incomes below or near the poverty line.

�Unlike the federal government, Montana can�t just print money,� Gov. Brian Schweitzer (D) said in a statement Wednesday. �We have a budget surplus, and we�re going to keep it that way.�

The law would add an estimated 84,000 people to Montana�s Medicaid program, doubling its size, the governor said. Although the federal government would pay the vast majority of the additional costs, Montana�s health and human services department estimates the state�s share would reach $71 million in 2019. Outside groups say the costs would be far lower than that.

The range of state leaders expressing unease suggests that implementing the law could be rough going, with divisions not always breaking along party lines. The topic is likely to factor prominently in this week�s meeting of the National Governors Association in Williamsburg, Va. And it has been fueled by a long list of unanswered questions about the choice now before states.

In particular, it is unclear how the court�s pronouncement that states cannot be penalized for refusing to adopt the law�s more generous eligibility standards for Medicaid in 2014 changes the rules governing the expansion.

Will states that opt in have the option of scaling back in future years? If a state that opts out decides it wants to participate at some later point, will the federal government still pay nearly the full cost of covering those who become newly eligible for Medicaid? And can a state participate only partially � for instance, by raising the income cutoff for its program to a level lower than the ceiling envisioned in the law, which is set at 133 percent of the federal poverty line?

Asked at a forum Wednesday to describe state reactions to the Supreme Court ruling, Dan Crippen, executive director of the National Governors Association, offered a one word reply: �confusion.�

The association was one of several � along with the Republican Governors Association and the National Association of Medicaid Directors (NAMD) � to send a letter to Secretary of Health and Human Services Kathleen Sebelius this week with a voluminous list of queries.

�The answers to these questions are key,� said NAMD Director Matt Salo. �States need to be making these decisions now, and it�s hard to make them if you don�t have clarity.�

Continue reading…

Clinical Solutions, Fujitsu join forces on improved healthcare access in Spain

MADRID, Spain – Clinical software vendor Clinical Solutions has announced a partnership with Fujitsu Services to help improve access to healthcare and advice for the people of Spain.

With an aging population and chronic conditions on the rise, the escalating cost of healthcare provision is a growing concern for the Spanish Government and regions.

In addition, patient expectations are high, with needs for access to the right healthcare resource, at the right time, and in the right place.

The partnership aims to transform the delivery of quality healthcare through the use of intelligent systems and data analysis - enabling efficient management of resources and appropriate use of emergency, urgent and primary healthcare services. The Clinical Solutions software, branded IntefleCS, has been designed by clinicians and uses flexible, rules-based programmes that provide clinical decision support in either a telephony, in-person or Web environment.

Jose Maria Moyano, director of health at Fujitsu Services, said, "The partnership with Clinical Solutions underpins Fujitsu Services' strategy in Spain, providing innovative healthcare solutions which have already been proven in other countries. The partnership also represents a significant opportunity to improve access to healthcare in Spain, resulting in lower costs, lower risks, higher quality care and ultimately greater patient satisfaction."

Richard Craven, director at Clinical Solutions, said, "This is an exciting opportunity for us to expand our presence in Europe and use our experience, in collaboration with Fujitsu Services, to demonstrate the benefits of technology as a means of improving access to healthcare."

Clinical Solutions's IntefleCS Telephone Triage software is already used in the UK by NHS Direct, the largest telephone triage system in the world, reaching more than 55 million people in England and Wales.

The IntefleCS Health Watch solution is also playing a role in government initiated national services to help prepare planning for pandemic outbreaks and national emergencies.

Adopted by the Department of Health in the UK, the solution is a key component to delivering a multi-channel National Pandemic Flu Line Service to the entire UK population.

In addition to these national services, the IntefleCS Face to Face solution is used by a large number of UK Walk-in Centres, helping to provide the general public with a convenient way to access healthcare services.

Experts: Child hot-car deaths more common than expected

INDIANAPOLIS�The news that two parents in separate central Indiana incidents left their young child in a sweltering vehicle during a record heat wave has stirred outrage, but national child car-safety advocates say that, in reality, it happens more often than people realize and it happens to all kinds of parents.

On Saturday, a 4-month-old girl died in Greenfield and a 16-month-old girl in Fishers suffered a seizure and was in critical condition after being left locked in stifling hot cars.

Right before he left for his parents' home on Saturday afternoon, 18-year-old Joshua Stryzinski helped change his 4-month-old daughter into a one-piece outfit. It left her legs and arms exposed, a way to help keep her cool in the triple-digit heat.

He arrived to a busy home in Greenfield, Ind., his brother outside painting and the family preparing to go on vacation. He chatted with his father, Ronald, about maybe buying a car from him. About a couple of hours later, he realized it was time to pick his baby's mother up from her shift at Arby's.

When he got back to his 2002 Saturn SL1, the doors closed and the windows rolled up, he screamed when he realized what was inside � his daughter. He ripped her out and rushed her inside, still in her car seat.

She wasn't breathing. Joshua's father tried CPR as they rushed her to the hospital, only a block or two away.

But it was too late. Emergency-room doctors pronounced her dead. Her arms and legs had suffered third-degree burns.

These details emerged Monday in a 911 call and police probable-cause affidavit used to charge Stryzinski with neglect of a dependent leading to death. He has pleaded not guilty and was released from Hancock County Jail on Monday afternoon on a $50,000 cash bond.

On the same day Stryzinkski's infant daughter died, 30-year-old Meg Trueblood was shopping at a clothing store while her 16-month-old was in a locked car in the parking lot. That child suffered a seizure and was taken to the hospital but survived. Trueblood also has been charged with neglect of a dependent.

Janette Fennell tracks these cases as the president and founder of KidsAndCars.org. She says that perhaps 90% of the time, the parent is the type to put latches on their doors and padding around the coffee table.

She has met college professors, lawyers and ministers who have done it. Only a small percentage, she said, have drug problems or have had interactions with child protective services. "It's the exact opposite of the stereotype," she said.

Several who knew the Stryzinskis said they left no impression that they were anything but upstanding citizens.

"This is a good family that has lost a child they loved," said 39-year-old next-door neighbor Cherie Sirosky.

The 911 call � made by Stryzinki's brother and with audible screaming and wailing in the background � captures a family overcome with grief, desperation and panic.

Attempts to reach the Stryzinskis at their home Monday were unsuccessful.

Stryzinski had stopped at a friend's home en route to his parents' home to show the baby to the friend's parents, but apparently got confused and thought he had left the baby with the friend.

He told police he could not believe his daughter was in the car.

"The normal routine," Stryzinski told police, "is that someone is always watching my kid."

Statistically, what Stryzinski described fits what typically happens in such cases, according to the organization Safe Kids Worldwide.

The organization has been tallying fatal incidents where children have been left in cars since 1998. They count 550 cases nationwide where a child has died from hyperthermia or heat stroke while in a car. In 2010, at least 51 children died; in 2011, there were 33. The children have ranged in age from 5 days to 14 years old, though more than half of the dead are 2 years old or younger.

Of those cases, 52% of the parents didn't realize they had left the children there; 17% left the kids there knowingly. In 30% of the cases, the child managed to get into the car alone.

But how does it happen? How does a parent forget his or her child?

Kate Carr, president and CEO of Safe Kids Worldwide, said so many factors can contribute to such a scenario � a change in routine, stress, lack of sleep. That might be especially true with a young, new parent.

"We can't rush to judgment," Carr said.

If Stryzinski simply forgot or became confused, less is known about the mother in the Fishers case.

Police detained Trueblood, 30, but records released to the media do not say what she told police as to why she left the child there.

According to police reports, Trueblood was shopping at Simply Chic clothing store in Fishers, leaving her 16-month-old in the back of her silver 2004 Ford Explorer.

A Simply Chic customer had noticed the child in the parking lot and returned inside to tell the store's manager. The customer and manager went outside, noticed the windows were up, tried to open the door � it was locked � and eventually called 911.

A police officer who responded tried to locate the child's mother, then smashed the window in. He carried the child, limp and unconscious, inside the store.

Employees wetted some fabric and started blotting her body with it. The police officer tried unsuccessfully to get her to drink some water. As medics arrived, she began to convulse.

At some point while the officer was caring for the baby, Trueblood identified herself as the girl's mother.

A store employee told police, though, she had arrived at the store about an hour before the police did, saying she wanted to find a dress because she was about to go and meet a guy. The employee said she was sure Trueblood had never left the store.

A Fisher's police spokesman told The Star on Saturday that it didn't appear the woman was coherent, but there was no mention of that in the police report.

When investigators measured the temperature inside the Ford Explorer it was 120 degrees.

Trueblood was charged with neglect resulting in serious bodily injury and taken to Hamilton County Jail, where she was released on bond.

Stryzinski also faces a neglect charge, though if convicted, he perhaps faces a worse sentence. In Indiana, the neglect charges make for a Class B felony if the child is seriously harmed and a Class A felony if the child dies.

More Answers To Your Questions About The Health Care Law

Adam Cole/NPR

The Affordable Care Act remains pretty much intact after its review by the Supreme Court. So what's in it anyway?

Now that the Supreme Court has upheld almost all of the Affordable Care Act, many Americans are scrambling to remember � or learn for the first time � what's in the law and how it works.

We asked for questions from our audiences online and on air. Here's are some, edited for clarity and length, and the answers:

 

Q: Will the penalty for not having health insurance affect people at all income levels, or will low-income people be spared?

A: The short answer is no, if you can't afford insurance you don't have to buy it.

Here is the slightly longer answer.

For starters, if you don't earn enough to have to file a federal tax return, you're exempt. In 2010 that was $9,350 for an individual, or $18,700 for a married couple.

You're also exempt if you would have to pay more than 8 percent of your household's income for health insurance, after whatever help you might get from an employer or subsidies from the federal government.

Q: If someone is only insured for six or seven months a year, will there still be a fine?

A: Possibly, but it would be prorated for only the months you didn't have insurance.

There is one exception. There's no penalty in the law for a single gap of less than three months in a year. That's because many employers impose a waiting period. There's also a separate provision in the health law that forbids employers from imposing waiting periods of longer than three months. So no one will have to pay a penalty specifically because a new employer makes them wait to qualify for coverage.

Q: I understand that businesses above a certain size have to provide a health care insurance option, but do they have to pay for it? Does the law require a certain contribution from the employer, or can the employer make the employees just pay, say, 99 percent of the premiums?

A: This is where the law seems a little bit tricky. It doesn't stipulate how much of the premiums employers have to pay, but it does say that overall, employers with more than 50 workers have to provide a plan that covers 60 percent of the covered expenses for a typical population. And that plan can't cost more than 9.5 percent of family income.

Q: How does the law affect Medicare recipients? I heard it cuts billions of dollars from the program. Does it have other effects?

A: Let's take these one at a time. Yes, the law does reduce Medicare spending by roughly $500 billion less than it would have been without the law. That's over 10 years, by the way, and Medicare will cost a little under $500 billion this year. But none of that comes out of benefits guaranteed under the law.

The biggest single chunk comes from reducing what had been overpayments to private HMOs and other health plans that serve about 20 percent of Medicare patients.

The next biggest chunk comes from hospitals and other providers of health care that hope to get that money back because more people will have insurance.

As to other changes to Medicare, there are actually some new benefits. The doughnut hole, that gap in coverage for prescription drugs, is being gradually closed. And Medicare patients are now getting new preventive screenings, like mammograms, without having to pay a deductible.

Q: My son lives overseas, where he is covered by the national health insurance plan. As an American citizen, would he be required to pay the fee for not being covered under an American plan?

A: No, only residents of the U.S. and its territories are subject to the insurance requirements.

Q: I am a veteran getting my medical care from Veterans Affairs. Am I correct that this counts as having insurance, when it comes to the requirement that everyone be covered or pay a penalty?

A: Yes, the VA counts. So does TRICARE and other military health plans. In fact, just about all government health care program, including Medicare and Medicaid, count as well. That's why the Urban Institute estimates that come 2014, only about 7 million people out of the U.S. population of well over 300 million will have to either purchase insurance or be subject to paying the penalty.

Q: If my current insurance policy does not meet the minimum requirements in the Affordable Care Act, and my insurer must raise the standards of my policy, can my insurer raise the premiums I pay?

A: In a word, yes. That was part of the goal of the law, not just to get people without insurance to have it, but to get people with what was considered substandard insurance up to par. This is controversial, and it's the part that leads to claims that the government is interfering in the private insurance market, which in this case it is. But it's in the law because Congress heard about lots and lots and lots of cases where people who had insurance nevertheless ended up bankrupt because the insurance didn't cover what they thought it did. So will this make healthy people who have to spend more unhappy? Yes. But will it protect people better when they do get sick? Yes, it will do that, too. And will the arguments about it continue? Yes, undoubtedly.

A dozen states file early HIX blueprints

WASHINGTON – The Centers for Medicare and Medicaid Services has already received letters from 12 states declaring their commitment and plans to create a health insurance exchange.

States must provide a summary blueprint by Nov. 16 of how they intend to operate their online insurance marketplace, on their own or within a federal-state partnership.

The states include California, Colorado, Massachusetts and Washington, according to a July 11 blog by Health and Human Services Secretary Kathleen Sebelius.

The Supreme Court upheld most of the Patient Protection and Affordable Care Act, including the creation of the exchanges, where individuals and their families and small businesses may search for, compare and choose affordable health coverage options starting in 2014.

“HHS is committed to flexibility in our support of the states’ progress in whatever route they choose, as well as providing planning and implementation funds to help the states to establish the marketplace that suits their residents’ needs,” wrote Sebelius. States may build their own exchange, work with other states or partner with the federal government.

The governors of New York and Rhode Island, both of whom sent letters of intent, issued executive orders to begin work on their exchanges. Other governors were able to initiate the establishment of exchanges through bi-partisan legislation, such as Washington’s Christine Gregoire.

In particular, the recently awarded $128 million Level II establishment grant will support the staffing and IT infrastructure necessary to complete the remaining design and development work, and the subsequent operation of the Exchange through December 2014,” Gregoire said in her state letter.

Maryland Gov. Martin O’Malley said that his state-based exchange is “well underway, and we continue to make significant progress with strong support from the state’s political leadership and broad-based stakeholder community.”

Other states that have also submitted letters summarizing their plans include Connecticut, Hawaii, Minnesota, Oregon and Vermont.

The 12 states that are moving ahead of schedule are all led by Democratic governors, except Rhode Island, whose Gov. Lincoln Chafee is an Independent.

States that waited until after the Supreme Court ruled to start thinking about their exchanges will find it challenging to complete their blueprint work by November. Information technology systems that are integral for exchange operations require long lead time to arrange contracts, and legislative sessions for the year are over.

As a result, those states, who participated in the lawsuit to strike the health reform law, may have to rely on the federal government for their exchanges.

Dementia Complicates Romance In Nursing Homes

Enlarge iStockphoto.com

Holding hands is the easy part.

iStockphoto.com

Holding hands is the easy part.

Relationships are never easy.

If the partners in love happen to be living in a nursing home, there are even more challenges. And if they're showing signs of dementia, then things get really tricky.

Although no law forbids intimate relationships between people with dementia in nursing homes, staff and family members often discourage residents from expressing their sexuality, says a recent report in the Journal of Medical Ethics.

Sexuality might be an uncomfortable topic for some families to discuss, but sex is a matter of dignity for many older people, says Dr. Laura Tarzia, lead author of the report and a researcher at the Australian Centre for Evidence Based Aged Care.

 

Older people who live on their own continue to enjoy romantic relationships, even if they are in the early stages of dementia; the trouble begins when they move into a facility for care.

"You get couples who have been living together for 50 years and then they move into a residential care facility. Suddenly they have to have separate beds, and that can be quite distressing for them," Tarzia tells Shots. "But I think it's even more difficult for people who form new relationships in a residential care facility, because then staff don't really always know how to deal with it and sometimes families have objections."

Many residents who have been diagnosed with dementia rely on family members with power of attorney to make important decisions. Tarzia says that decisions about intimacy shouldn't rise to that level.

"Sexuality shouldn't be categorized as a high-stakes decision, like, say, a will or a major financial decision where you really need the capacity to consent to things," says Tarzia, "We're saying that sexuality is different and the way to establish consent should be different."

These decisions don't come without risks, and Tarzia says it's important that staff in care facilities be willing to discuss the use of condoms for the prevention of sexually transmitted diseases.

Tarzia and her colleagues are currently working to create a self-assessment tool for residential care facilities to audit their sensitivity to these important issues. "[Facilities] can go through a checklist, and it covers a lot of areas like policies, education for staff, families, and residents, and facilities can kind of monitor how they're going, in terms of addressing sexuality," Tarzia says.

Issues with privacy and sexual freedom exist in American nursing homes too, gerontologist William H. Thomas tells Shots. "There are laws about consent for sexual activity, by state, but there's no top age on those laws," Thomas says.

Thomas said that we need to see a shift in our society's understanding of aging. "We need to normalize the idea that older people are human beings," he says. "They have the same needs and same desires they had before. Age changes those needs and desires, but they are still there."

He recommends that adult children talk about the issue of sexuality with their aging parents in nursing homes. "They never thought that Mom would have a boyfriend at the nursing home, but it's true," he says. "As we become an older society, this is something that we need to learn to better address."

13 tips for fighting mobile device threats

As threat risks continue to grow for mobile devices in healthcare — think thumb drives, smartphones, tablets and laptops — the pressure to mitigate these risks is being put on the providers. The folks at ID Experts believe now is the time to assess your mobile strategy and take charge of PHI.

Here are 13 tips for fighting mobile device threats, as compiled by ID Experts and others.

1. Consider USB locks. These can be for your computer, laptop or any other device that may contain PHI or sensitive information, said Christina Thielst, vice president at Tower Consulting Group. A USB lock can help prevent unauthorized data transfer — whether uploads or downloads — through USB ports and thumb drives. "The device easily plugs ports for a low-cost solution and offers an additional layer of security when encryption or other software is installed," she said. "The locks can be removed for authorized USB port use."

2. Try geolocation tracking software or services. Rick Kam, president and cofounder of ID Experts, said this software is a low-cost insurance policy against loss or theft that can immediately track, locate or wipe the device of all data on it. "The majority of healthcare organizations currently lack sufficient resources to prevent or detect unauthorized patient data access, loss, or theft," he said. "And lost or stolen computing or data services are the number on reason for healthcare data breach incidents."

3. Brick the device if it becomes lost or stolen. "In the last year, we have seen greater acceptability among employees of 'remote wipe' processes that 'brick' the entire device when it's lost or stolen, rather than just wiping the encrypted silo of corporate information, for example," said Jon Neiditz, partner at Nelson Mullins Riley & Scarborough LLP. The reason, he continued, that bricking the device is more acceptable is because personal data is now more frequently backed up in cloud storage, "so the bricking of the entire device doesn't result in data loss," he said.

4. Encrypt, encrypt, encrypt. All mobile devices, including often overlooked hardware, such as USB drives, should be encrypted if they are going to be used remotely, said Chris Apgar, president and CEO at Apgar and Associates. "The cost of encryption is modest and is sound insurance against what has been demonstrated to be a significant risk to healthcare organizations," he said. "Most breaches do not occur because of cybercrime – they are associated with people."

5. Forget about 'sleep mode.' According to Winston Krone, managing director at Kivu Consulting, most of the leading encryption products that organizations are "routinely installing" are configured so that once the password is entered, the laptop is unencrypted and therefore, unprotected, until it's booted down. "Simply putting the laptop into 'sleep' mode doesn't cause the encryption protection to kick back in," he said. "A laptop that is stolen while is 'sleep' mode is therefore completely unprotected."

6. Recognize that employees will use personal devices. This is true even if it's contrary to policy, said Adam Greene, partner at Davis Wright Tremaine LLP. "Healthcare organizations should consider documenting this risk in their risk assessments, identifying the safeguards in place to limit the inappropriate use of personal devices," he said. To further reduce this risk, he continued, consider the root cause of the problem. "What benefits are personal devices offering to employees that the organization's systems are lacking?"

Continued on the next page.

EHRs: A legal 'game changer,' privacy experts say

WASHINGTON – A panel of experts gathered at the 2nd International Summit on the Future of Health Privacy in Washington, DC on Wednesday all seemed to agree that the stakes are high when it comes to electronic medical records and privacy.

"Electronic technology is a game changer, legally, because the damage that can be done to someone is perpetual and the damages that can be awarded are incalculable," said James Pyles, co-founder and principal of the law firm of Powers, Pyles, Sutter, & Verville.

Much of the debate centered on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its ability to provide protection.

Pyles said HIPAA only provides a bare minimum of privacy, not a template for best practices.

Members of the panel reminded the some 300 attendees of the conference that when HIPAA was written, it was done to help physicians get reimbursement, not necessarily to keep patients' privacy.

"One would think, if you were approaching healthcare privacy policy, the very first thing, the very top priority would be to ask what do the patients want?," Pyles said. "Unfortunately, we have laws on the books that do not put the patient first."

Pyles said the main problem is technology is moving faster than privacy laws can be written. 

"I approach this in a simplistic way," he said. "I look to see, do you have you a right to privacy for your health information? So far, the courts say you do. The tort laws say you do. Standards of professional ethics of nearly every segment of the medical profession says you do. The HIPAA privacy rule does not say that at all."

HIPAA doesn't address the right to privacy, and it doesn't define the word privacy, Pyles said, both of which need to be addressed today.

Marcy Wilder, currently a partner at Hogan Lovells law firm was the lead lawyer for the Department of Health and Human Services on the development of the HIPAA rules.

She said the beginning premise of HIPAA was designed to let information flow relatively freely to allow treatment, allow physicians to get paid and put fairly strong restrictions on that data once it starts flowing outside the healthcare system.

"It's true HIPAA is the floor," Wilder said. "There is a regime of laws working toward protecting privacy. Health data is some of the most regulated data in the world."

The goal should be to find a balance between providing patients with privacy rights and helping to build quality healthcare, Wilder said.

 [See also: Privacy experts debate patient consent.]

Frank Pasquale, a professor of healthcare regulation and enforcement at Seton Hall University said making new regulations with granularity controls for patients to pick and choose how to share their information would go a long way to helping patients feel safe. If they don't feel safe, they won't willingly share their data.

Even deidentified data poses concerns for many people, Pyles said. "Some people believe you can reidentify anything. Others think we should be more permissible with it," he said. The litmus should be this: if a policy makes people more reticent to share even their deidentifed data, then there is not enough protection there.

Privacy rights encourage disclosure, he added.

Editors note: This story was updated on June 14 to reflect a correction in attribution. Some quotes were originally incorrectly attributed to Joy Pritts, chief privacy officer for the Office of the National Coordinator for Health Information Technology (ONC). They are now correctly attributed to Jim Pyles.  

Blacking Out Single-Payer–And Killing The Auto Industry

By Jonathan Tasini–

When the history of our current economic crisis is written, there will need to be a full chapter devoted to the willful ignorance or stupidity of the traditional media. Right before our eyes stands the solution to a huge chunk of our fiscal nightmare and a lifeline for the auto industry: single-payer health care. And, yet, there is a virtual traditional media blackout on single-payer, witness another example in yesterday’s New York Times.

In The Week In Review, reporter Kevin Sack stumbles through an entirely conventional wisdom article, with this brilliant observation:

Mr. Obama seems to recognize that the recession, with its devastating job losses, affords him the potential to accelerate public opinion. To broaden support for his plan — whatever it ends up being — he insisted last week that systematic improvements in health care would be essential to any lasting economic recovery.

Sacks goes on to chronicle some of the desperation faced by millions of uninsured and under-insured people. And, then, he arrives at the framing of the solutions:

There is a rough consensus, certainly among the Democrats who control both houses, around many key components of the Obama plan — to expand government subsidization of insurance for the poor, to stimulate competition through a new government plan, to require insurers to accept those with pre-existing medical problems and to invest in computerization, prevention and payment incentives for better care.

And…

Less certain, of course, is how to pay for it. During the campaign, Mr. Obama said he would get about half of the necessary total, estimated at more than $100 billion a year, by raising taxes on those making more than $250,000. The rest was to come from savings generated by various efficiencies (their value is a matter of considerable dispute).

Mr. Obama reaffirmed on Thursday that his proposal to roll back the Bush tax cuts might be deferred because of the recession. “We’re probably going to have to, then, find additional dollars to pay for some investments in the short term,” he said, adding that he wants his health plan to pay for itself over a decade.

Some of those dollars may be found by packaging health care initiatives as stimulus measures, a recessionary opportunity presented by the public’s acceptance of deficit spending to spur the economy. What, after all, is $100 billion for health coverage if the government can print $700 billion to bail out the banks?

What is startling–though, perhaps, it should not be by now–is that Sack cannot write the phrase “single-payer” in the entire article, even though it is the only health care plan that would SAVE money and relieve the auto industry–and the rest of the business world–of billions of dollars in health care costs.

Even The Financial Times is starting to get it, though indirectly. In an article today on the auto industry, it acknowledges that wages are pretty much the same between U.S. auto workers and non-union Japanese companies. The big difference is health care, particularly for retirees:

GM and Toyota workers earn similar wages of about $29 an hour.

The big difference is in fringe benefits, such as healthcare insurance and pensions.

The overall labour-cost figures also include retiree benefits. Thousands of GM, Ford and Chrysler workers were on pensions with generous healthcare benefits – foreign carmakers have a fraction of the number of retirees.

I wrote as far back as 2005 that single-payer was the solution to the cost issues of the auto industry. But, The New York Times, along with the rest of the traditional media, repeatedly refuses to include single-payer as a legitimate option.

This commentary is from the Huffington Post.

PSA test part of trend: Fewer screenings for well people

Many men were surprised this week when a government advisory panel recommended that doctors stop using the PSA test to screen healthy men for prostate cancer.

Yet health experts say the recommendations by the U.S. Preventive Services Task Force are a part of a broader trend that's been building for years. People are taking a closer look not just at cancer screenings, but at all medical tests and procedures, says Steven Woloshin, co-director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice. Concern about "overtesting" and "overtreating" patients is growing because of a rising recognition that these interventions often have risks and serious side effects.

"There is something going on, not just in cancer," Woloshin says. "There is some sort of shift, and it's encouraging. It feels like this is the beginning of a sea change in attitudes towards testing, treating and overdiagnosis."

Doctors are taking a "less is more" approach on several fronts.

Last month, for example, nine physicians' groups launched the "Choosing Wisely" campaign to discourage 45 frequently overused tests and procedures. The groups, which included the American College of Cardiology, noted many common interventions are unnecessary, including stress tests during routine annual exams.

Many of these overused tests involve trying to "help the well stay well by looking for things to be wrong," says H. Gilbert Welch, a physician and author of Overdiagnosed: Making People Sick in the Pursuit of Health.

The American College of Radiology also is leading campaigns called Image Wisely, to reduce unnecessary radiation exposure in adults, and Image Gently, to reduce exposure in children. The campaigns address growing concerns over the risk of cancers related to medical radiation, which has been estimated to cause up to 29,000 cancers a year. Researchers estimate that one-third of CT scans may be unnecessary, according to a 2009 report in the Archives in Internal Medicine.

And in the past four years, medical groups have voted to restrict several types of cancer screenings. That's partly because science has evolved to help doctors better understand how cancers progress and how best to use screening technology, and also because doctors better understand the risks and limitations of treatment, says Lisa Schwartz, also co-director at the Dartmouth Center.

�In 2008, for example, before the task force voted against the PSA entirely, it recommended offering it only to men under age 75, reasoning that older men would not likely be helped by a test that largely detects slow-growing cancers.

�In 2009, the task force recommended against routine mammograms for women under 50, and suggested women over 50 get screened every other year, instead of annually. That recommendation drew fierce protests from women, radiologists and many politicians.

�In March, in a less controversial move, the American Cancer Society revised its cervical cancer recommendations, suggesting that women get screened every three years, instead of every year, between the ages of 21 and 29. Older women can wait five years between tests, and stop screening at age 65, a change that reflects the slow-growing nature of these tumors.

�Last week , medical groups endorsed using CT scans to screen for lung cancer, but only in a very specific group: smokers and ex-smokers ages 55 to 74 who smoked the equivalent of a pack a day for 30 years, and who still smoke or quit within the past 15 years.

Younger people, or those who smoked less, are not advised to get screened for lung cancer, because the odds of being harmed by the test � which can lead to invasive lung biopsies � is so high, and the chance of being helped is much lower, says Peter Bach, director of Memorial Sloan-Kettering's Center for Health Policy and Outcomes, who wrote an analysis of available evidence published May 20 in the Journal of the American Medical Association.

Bach says it was important to avoid repeating past mistakes. With other screening tests, medical organizations have recommended them broadly for everyone in a particular age category � often before studies showed they did what they were intended to do.

The PSA was approved in 1986 to monitor patients with diagnosed prostate cancer, and in 1994 to screen healthy men � before researchers had determined whether the tests improved survival. For years, many medical groups recommended the PSA for all men over 50.

"The PSA test was unleashed on the male population without any evidence that it provides any benefit and without any quantification of the potential harm," Bach says. "We didn't realize we would cause thousands of men to become impotent."

Yet convincing people that they could be better off with fewer screenings could be a tough sell, says Virginia Moyer, chair of the U.S. Preventive Services Task Force and a pediatrician at the Baylor College of Medicine. Public health groups spent decades persuading reluctant men to give blood samples for PSA tests and frightened women to get their breasts compressed by mammography machines. Today, many people see screening as essential to health, she says.

And the science of screening � and the reasons why it can harm � aren't easily boiled down into a soundbite. "We've been a victim of our own success," Moyer says.

But Welch, the physician and author, agrees the tide is turning.

There's a growing recognition that, "when you are dealing with well people, the balance is really fine: It's hard to make a well person better, but it isn't hard to make them worse," says Welch. "We need to have really high thresholds before we start doing things to well people."

TEPR+ update: Oregon clinic showcases the advantages of patient-centered care

PALM SPRINGS, CA – In Jill Arena's opinion, medical offices can sometimes get too ... medical.

Arena, COO of Greenfield Health in Portland, Ore., sees the nine-physician, two-office practice as an example of patient-centered healthcare. Founded in 2000, the practice is designed - both physically and operationally - with the patient experience in mind.

"What do we think patients really want?" asked Arena. "How do patients experience the physician's office? We need to take apart how we think we're doing business."

Arena was a featured speaker at this past week's Towards the Electronic Patient Record (TEPR+) conference and show in Palm Springs, Calif. The conference, presented by the Boston-based Medical Records Institute, attracted roughly 750 attendees and focused on, among other things, the emerging concept of "participatory medicine."

Arena sees Greenfield Health as a beta test of that concept. The practice, she said, was designed so that the patient can walk right in and see a physician or staff member without having to waste time in a waiting room.

"It's similar to what happens when somebody comes into your home," she said. "It's a lot less clinical. We tend to 'overmedicalize' the experience" of visiting a doctor's office.

Beyond the makeup of the physician's office, Arena said Greenfield Health makes every effort to involve the patient in all aspects of his or her healthcare. The practice has hundreds of thousands of dollars invested in information technology services that connect physicians with patients through electronic medical records, e-mail and phone systems and other services. Among the vendors involved in the 22 "moving parts" of the practice's IT system are GE Healthcare (whose Centricity platform is used) and Kryptiq, which is based in nearby Hillsboro and has been associated with the practice since its inception.

Arena said the practice has been giving patients their personal health records (PHRs) in three-ring binders "because it's their information." They've now developed an electronic PHR, moving those records this past June to Microsoft's HealthVault platform.

In terms of communications, Greenfield Health has set up its telephone system so that if an incoming call isn't picked up by the third ring, every phone in the office rings ("then it's all hands on deck," Arena says). In addition, the practice allows its patients access to the physicians' e-mail addresses.

"We've found that, after eight years (of e-mail contact between patient and physician), the relationships are richer," she said. "People will say more in an e-mail than they might say in person or over the telephone."

Arena said Greenfield Health charges a retainer fee of between $250 and $650 a year for its patients, and makes sure to limit the number of patients each physician sees to ensure that neither the patient nor the provider feels overwhelmed or ignored. This setup, she says, amounts to a roughly 20 percent decrease in the average annual cost of healthcare.

All in all, Arena says, the use of healthcare IT, ranging from EMRs to e-mail, allows about 80 percent of a patient's healthcare needs to be met electronically. That said, there is a concern that a patient might try to have all of his or her healthcare needs handled without ever stepping foot in the doctor's office.

"We have to be mindful of that and say, 'You have to get your body in here,'" Arena said.

GE brings EMRs, analytics to London 2012 Olympics

COLORADO SPRINGS, CO – For the first time ever, the United States Olympic Committee will use electronic medical records rather than paper charts to manage care for more that 700 athletes at the summer games.

The USOC announced Thursday that it will deploy GE’s Centricity Practice Solution, which integrates EMR with practice management technology, to manage the care of more than 700 American athletes competing in the London 2012 Olympic and Paralympic Games, and for 3,000 additional records maintained by USOC staff.

Once upon a time, the USOC relied on pallets of paper records, shipped around the globe, to the the games' host city. Now, at last, EMRs will offer doctors and caregivers faster access to athletes’ medical records and enable more targeted care.

"It's definitely, for the Olympics, the right time to jump on [EMRs] now," Jan De Witte, chief executive officer of GE Healthcare IT and Performance Solutions tells Healthcare IT News. "The EMR has shown its value for healthcare in driving quality, both with completeness of data and speed of decision-making."

Set to go live in June, the London deployment will "be, for us, a record-speed implementation," says De Witte. "We're doing it in less than 90 days." So far, the process has gone well, he reports, especially with the training for the 100 or so people on the USOC medical staff who'll be using the Centricity technology.

Part of that preparation involves populating the medical records with the "relevant information for 700 athletes and close to 3,000 staff and volunteers" who will be in the system, says De Witte. From June right through the closing ceremonies, all information related to the athletes' health and performance is going "straight into the EMR."

“The introduction of GE’s EMR technology is a big step forward for the USOC sports medicine program,” Bill Moreau, MD, managing director of sports medicine at USOC, said in a statement. “EMR technology will allow us to better monitor and analyze the health of Team USA athletes, not only when they receive care at our facilities, but also when they are competing and training around the world. Our elite athletes have dedicated themselves to performing at the highest levels in sport and I believe this technology will help us to support them with the highest levels of sports medicine.”

“My extensive training and playing schedule takes me all over the world and the last thing I want to worry about is my medical records," added Alex Morgan, forward for the U.S. Women's' soccer team. "Knowing that not only will my doctors have quick and easy access to my information but that I will as well, no matter where I am, puts my mind at ease. It allows me to not worry about injuries and focus on the task at hand – in this case, winning the gold for Team USA in London.”

Of course, when it comes to athletics, imaging is crucial to diagnosing injuries. In London, De Witte says the GE Centricity Practice Solution will integrate with Centricity PACS-IW technology for medical record image viewing and storage. GE provides a range of diagnostic imaging equipment to the U.S. Olympic Training Centers, including MRI, X-ray and ultrasound.

The EMR deployment is "not a one-time use," De Witte emphasizes. "This is a platform that will stay with the USOC for the years to come."

Indeed, on May 24, GE and the USOC also announced an extension of their sponsorship partnership to the 2014 winter games in Sochi, Russia, to continue through the 2016 summer games in Rio de Janeiro, the 2018 winter games in Pyeongchang, South Korea and the 2020 games. GE’s United States Olympic Committee partnership started in January 2005.

With regard to care delivery, the hope, of course, is to not have to make much use of these EMRs – that all 700 U.S. athletes stay healthy as they quest for gold medals.

"Sure, let's hope you don't have to use it to deal with big injuries," says De Witte. But he also points out that another crucial use of the system is Centricity's analytics capabilities, which can track and monitor performance.

"Over time, the medical record history that will be built into CPS, and the capability to interface with our database will allow the USOC to go into real performance analytics to understand what treatment plans have the best outcome for the athletes," he says. "The real value is going to be having the protocols and the treatment plans and the preparation plans, based on benchmarking data and historical trending of the athletes."

The deployment at the 2012 London game is "a great test case on how to use EMR data to optimize medical care for performance," says De Witte. And by the time the torch is lit for the 2016 games in Rio, that knowledge will only have grown.

As data from more and more elite athletes "further populate the system," he says, "every year, the value of the analytics capabilities will increase."

New lead poisoning guidelines: What parents should know

The Centers for Disease Control and Prevention's decision to redefine the "action level" for lead exposure in kids has renewed some parents' concerns about the best ways to protect their children.

Children will now be considered at risk � and qualify for careful medical monitoring � if they have more than 5 micrograms per deciliter of lead in their blood. That's half the previous threshold.

Public health leaders have applauded the move, noting that the change will allow governments to take broader action to protect children.

Yet parents may feel more confused about when and how to test their children and homes for lead. Even some experts disagree about the best approach.

In its statement on lead poisoning, the American Academy of Pediatrics says, "Most U.S. children are at sufficient risk that they should have their blood lead concentration measured at least once."

Some health departments issue recommendations about how often to test children for lead, based on test results in the area or particular risks, the group says.

Without that kind of specific guidance, however, kids should generally be tested at age 1 and again at 2, when blood lead concentrations peak, it says.

Philip Landrigan, a leading authority on lead poisoning, agrees that all children should be tested.

While most American children are still well below the new action level, with average blood lead levels of 1.8 micrograms, Landrigan notes there is no safe amount of lead, which can cause brain damage and lower IQ.

"I recommend all children be tested, because you never know," says Landrigan, director of the children's Environmental Health Center at the Mount Sinai School of Medicine in New York.

Many insurance plans don't pay for blood lead testing, Landrigan says. And not all pediatricians offer it. Some refer patients to private labs or the health department.

Blood testing is especially important for poor children, although few of the highest-risk kids are ever tested, according to the pediatrics group.

Most lead poisoning cases occur in substandard housing, where window frames are still coated with lead-based paint, which was banned in 1978. About 25% of U.S. kids fall into this category, the group says.

Yet middle-class neighborhoods aren't immune. Tap water in many neighborhoods in the Washington, D.C., area exceeded safety standards for lead in 2003 and 2004, after lead leached from water pipes.

Test the house, not the child

Jerome Paulson, chairman of the pediatrics group's council on environmental health, agrees that families in homes built before 1950 should be "vigilant" about monitoring for lead. And parents should remember that children can also be exposed outside the home, such as at the homes of relatives or a regular babysitter.

But he says some kids can probably skip the needle stick.

"Kids living in homes built after 1978 don't need to be screened," says Paulson, a pediatrician at children's National Medical Center in Washington. "If the health department is saying, 'We don't see kids in this five-block area or this ZIP code with elevated lead levels,' then we don't need to screen kids in that ZIP code.�

"We really need to focus on preventing the kids from coming into contact with lead," Paulson says. "By testing kids, you're sort of identifying the kids after the fact. It really does make more sense to check the home than to check the child. What counts is the home."

Yet testing the home isn't always simple.

While home lead test kits are popular � sold online and at many hardware stores � they're often not reliable, says Scott Wolfson, spokesman for the Consumer Product Safety Commission. It tested home lead test kits in 2007 and found many produced false results, falsely finding lead in some homes and failing to find lead in others where it was present. The agency hasn't tested newer kits.

Professional contractors can get more accurate lead-testing results, but at a higher price.

The most vulnerable

Landrigan notes that testing allows people to identify sources of lead exposure and remove them.

Most often, testing doesn't lead to treatment, Landrigan says. Because treating children for lead poisoning carries its own serious risks, it is performed only when blood lead levels are extremely high. Most children with blood lead levels above the new threshold will be monitored, rather than treated with medication. Once the lead source is removed, children's blood lead levels typically return to a more normal range within weeks, Landrigan says.

About 90% of lead poisoning comes from lead-based paint in windows, Landrigan says. About 10% comes from home renovations, which can pose a particular risk to untrained do-it-yourselfers trying to fix up older houses, he says.

Sometimes, youngsters chew on peeling paint chips.

More often, children take in lead through paint dust, sometimes in microscopic particles, created when windows are closed or doors are slammed, Paulson says.

Children also can be exposed to lead by playing in the dirt, which may contain lead from car exhaust, factory smoke or even paint dust, if the soil is within a few feet of the house, Paulson says.

Most children exposed to lead are poor.

About 80% of kids with high lead exposures are eligible for Medicaid, according to the pediatrics group, which recommends lead tests for all children eligible for Medicaid. Few get them.

Babies and toddlers are exposed to more lead than adults because they spend more time crawling and playing on the floor, transferring dust to their mouths from everything they touch, Paulson says.

Babies' developing brains are especially vulnerable to lead's toxic effects, which can damage the brain and kidneys and, at higher doses, cause behavioral problems and rob kids of IQ points, Paulson says.

Blood lead levels tend to peak at around age 2, according to the pediatrics group's policy statement on lead exposure. Lead levels tend to decline after this age, as children's growing body size dilutes the concentration of lead in their blood.

School-age children, teenagers and adults, however, face little risk, Paulson says.

And doctors note that children today have dramatically lower blood lead levels than a generation ago.

Before 1970, health officials took action only if children had blood lead levels above 60, Landrigan says.

Telemedicine market to reach $2.5B by 2018

LONDON – The thriving telemedicine market hasn't shown signs of abating any time soon, according to a new report by Companies & Markets. The report shows that in 2011, the global telemedicine monitoring market reached a value of $736 million and, according to officials, is poised to increase to $2.5 billion by 2018.

This significant growth in the global market can be attributed to numerous factors as telemedicine monitoring provides ways to improve clinical care delivery to patients while also reducing the need for hospitalizations and visits to the emergency room.

Telemedicine is the use of telecommunication and information technologies in order to provide clinical healthcare at a distance. It helps to eliminate barriers and improve access to medical services that would often not be readily available in rural communities. The technology can also be utilized in critical care and emergency environments.

Having the ability to accurately access patient condition via a combination of advanced testing and telemonitoring creates the opportunity to intervene during a clinical emergency and permits education provisions regarding healthy living in a way that is likely to create compliance with clinician recommendations.

Telemedicine table devices typically cost $350 in 2011, with the average price of the software at $75 per unit. Officials say this indicates a growing services business that will pay for the devices over time.

Moreover, telemedicine has been seen to be beneficial for individuals living in isolated communities and rural regions. Telemedicine technology allows patients who live in these rural areas to be seen by a doctor or specialist, who can provide an accurate and complete examination, without the patient to traveling away from their families to far-off medical centers.

To access the Companies & Markets telemedicine report, click here.

Patches for pain relief are gaining in popularity

Sometimes the pain from her fibromyalgia gets so bad that Kimberly Smalling can't lift her arms.

She peels open a painkilling patch, puts half on each shoulder, and then crawls into bed. The next morning she can get back to work cutting men's hair.

"It's kind of like a Band-Aid, I guess, but it works," says Smalling, 59, a stylist in Dallas.

She says her prescription lidocaine patch supplements her regular painkiller enough that, 20 years into a disease characterized by chronic pain, she hasn't had to resort to narcotics.

Europeans already get roughly one-quarter of their pain relief from topical treatments, such as patches and creams; the Chinese relieve about half their pain that way, an industry analysis finds. In the USA, where 88% of pain relief comes in a pill, Americans are slowly getting used to the idea of patches, says Patrick Carroll of Hisamitsu America, maker of Salonpas over-the-counter pain patches. The active ingredients are 10% methyl salicylate, a topical analgesic, 3% menthol.

"I think it's just a cultural thing that we've been bred on popping pills," Carroll says.

Baby Boomers are leading the trend, hobbled by the aches of middle age and concerned about the risks of pills.

While patches aren't danger-free � every medication carries some risk � the most common complaint is minor skin irritation around the site. Patches also need to be placed in areas where they'll stick � not a bending elbow or hairy forearm.

The main downside is cost. A five-pack of Salonpas arthritis pain patches is about $9, the same as nearly 100 Advil pills.

Manufacturing a patch is more complicated and therefore more expensive than making a pill, says Phil Nixon of Pfizer's Pharmaceutical Sciences Technology & Innovation division in Groton, Conn.

Patches also must be disposed of out of the reach of pets and children, because they still have medication on them, says Smalling's doctor, Scott Zashin, a clinical professor of medicine at the University of Texas-Southwestern Medical School.

There are two basic types of patches: The first provides a drug locally � for example, over-the-counter pain relievers such as Salonpas. In the second, the medication seeps through the skin into the bloodstream. Nicotine patches, for quitting smoking, work this way, as do patches for attention deficit hyperactivity disorder, menopause symptoms and Alzheimer's.

A few types of medications are particularly well-suited to patches, Nixon and others say. By entering the body through the skin, medications bypass the liver, where they could do damage, or be broken down and made less effective. Robert Shmerling, a rheumatologist at Beth Israel Deaconess Medical Center in Boston, says he occasionally tries patches for arthritis patients who have stomach problems that can be a side effect of over-the-counter pain medications.

Some patients also prefer a patch to a pill because the drug enters the bloodstream slowly and continuously, rather than in a large dose, Nixon says. And for older people with memory problems, a once-a-week patch may be easier to manage than a daily regimen of pills.

For smokers who want to quit or make it through a day of travel or meetings, a patch is more discreet than nicotine gum or lozenges, says Jonathan Winickoff, a pediatrician and tobacco control expert at Massachusetts General Hospital and Harvard Medical School. Nicotine patches deliver the drug 24 hours a day, he says, so people wake up without the intense urge to smoke. Patches double your chance of success vs. going cold-turkey, he adds.

Though patches are used to deliver a wide range of medications to the bloodstream, a lot of newer drugs, called biologics, are too big to pass through the pores of the skin.

Researchers are working on patches that will solve that problem using either ultrasound to open the pores or dozens of "microneedles" so tiny their pricks cannot even be felt. They'll be painless, so they won't carry the fear factor of "real" shots, promises MIT professor Robert Langer, who is working to advance microneedle technology.

Health care increasingly out of reach for millions of Americans

Having trouble finding a doctor?

You�re not alone.

Tens of millions of adults under age 65 � both those with insurance and those without � saw their access to health care worsen dramatically over the past decade, according to a study abstract released Monday.

The findings suggest that more privately insured Americans are delaying treatment because of rising out-of-pocket costs, while safety-net programs for the poor and uninsured are failing to keep up with demand for care, say Urban Institute researchers who wrote the report.

Overall, the study published in the journal Health Affairs found that one in five American adults under 65 had an �unmet medical need� because of costs in 2010, compared with one in eight in 2000. They also had a harder time accessing dental care, according to the analysis based on data from annual federal surveys of adults.

�For decades, Americans have been facing costs rising well above wage levels,� said Lynn Quincy, senior policy analyst for Consumers Union, a nonpartisan group. �These are real families. . . . It�s very concerning.�

The 2010 health care law, which will expand health coverage to 30 million people starting in 2014, won�t necessarily solve all those access problems, the study said. That�s because the law, which is under review by the Supreme Court, may not alter the trend toward private insurance policies with larger deductibles and higher co-payments or address some of the barriers within public coverage. While the law does increase payments temporarily to primary care doctors who see people covered by Medicaid, it will not force more doctors into the program, or require states to provide dental coverage to adults.

Quincy noted that the law does offer several new strategies, such as new payment methods to control rising costs, which could help improve access, but there�s no guarantee they will work.

Read more here: http://www.mcclatchydc.com/2012/05/07/147985/health-care-increasingly-out-of.html#storylink=cpy#storylink=cpy

BancTec acquires GTESS claims processing business

IRVING, TX – BancTec, which specializes in financial business process outsourcing, transaction automation and document management, has acquired certain assets of Richardson, Texas-based GTESS, a provider of claims pre-adjudication technology and services for the healthcare industry.

GTESS has served a client base including more than 40 healthcare payers nationwide. BancTec officials say the acquisition – financial terms of which were not disclosed – will enable the firm to strengthen and expand its healthcare claims processing services.

“In this era of healthcare consolidation and reform, health plans and related organizations are under increasing pressure to improve efficiency – but too often are held back by complex, manual pre-adjudication processes,” said Maria L. Allen, senior vice president and president of the Americas at BancTec. “With this addition, BancTec will be able to effectively address this pain point as part of an integrated claims processing offering.”

Founded in 1990, GTESS specializes in automation technologies that drive cost and process improvements in the front-end, or pre-adjudication, portion of healthcare claims processing. This includes the automation of costly, labor-intensive pre-adjudication processes such as provider and member matching and paper claim handling, keying and processing. GTESS has enabled clients to achieve their goals for increased automation, speed and lower costs of claims processing.

“BancTec and GTESS have shared a commitment to superior service and client satisfaction that have stood the test of time,” said Mark King, chairman of GTESS.  “Like GTESS, BancTec provides flexible, focused automation and outsourcing solutions that serve the healthcare industry well. This strategic move gives clients the opportunity to significantly reduce annual expenses by lowering the cost per claim and dramatically improving accuracy, consistency and customer response.”

HealthNow selects Benefitfocus for enrollment technology

BUFFALO, NY – HealthNow New York (HNNY), a healthcare company serving Western New York, has announced a partnership with Charleston, S.C.-based Benefitfocus to provide employers healthcare enrollment and e-billing technology.

With the new technology, employers will be able to offer employees a streamlined coverage administration platform that will allow employees to select and enroll in healthcare options provided by the company, officials say. The feature will also double as an administrative tool. Additionally, an e-billing component will be offered to employers that will provide a portal for paying company premiums electronically.

"Personalization at a very granular, employer-centric level is a big part of our design philosophy," said Shawn Jenkins, Benefitfocus president and CEO. "We provide multiple types of support tools to accommodate employer and customer needs.”

"We are continually seeking value-added services that improve satisfaction and engagement," said Kerri Garrison, vice president, Venture Growth for HealthNow. "The personalized plan selection tools and e-billing component in the Benefitfocus Platform takes that commitment to the next level by creating a portal that engages employers and members throughout the enrollment process."

In addition to a full spectrum of individual and employer-sponsored health plans, HNNY also provides members worksite wellness programs, pharmacy benefit management, behavioral health services and personal health concierges who serve as member advocates.

HealthNow joins other insurance companies managing their membership and benefits data in the world's largest benefits cloud. In addition to its plan selection tools, the Platform's data exchange capabilities can manage data for large, complex employers. Synchronized enrollment and billing technology eliminates the time and cost associated with manual invoice reconciliation. HealthNow will be live on the Benefitfocus Platform by November 2012.

CMS pays $5.58B in EHR incentives to date

WASHINGTON – Another milestone: The Medicare and Medicaid electronic health record program has paid out $5.58 billion to 110,650 physicians and hospitals in total program estimates through May 2012.

Final figures will be available later this month once the Centers for Medicare and Medicaid Services completes its May monthly data collection.

In May, CMS paid $346 million to Medicare physicians and hospitals and $205 million to Medicaid providers for a total of $551 million to 16,400 providers in preliminary estimates, said Robert Anthony, specialist in CMS’ Office of eHealth Standards and Services.

“We are reaching an even keel as to how much we are paying each month in incentive payments,” he said in his program status report at the June 6 meeting of the Health IT Policy Committee, which advises the Office of the National Coordinator for Health IT.

Through April, CMS paid $5.03 billion to 94,097 Medicare and Medicaid physicians and hospitals in incentive payments since the program’s inception. In April alone, 12,205 Medicare providers received $276 million, while 3,977 Medicaid providers received $195.5 million for adoption, implementation and update of EHRs and 37 Medicaid providers got $3.17 million for demonstrating meaningful use.

It was the first month that Medicaid professionals could be paid as meaningful users, but not all of the states have their systems up and running yet for meaningful use attestations, he said.

Most states have initiated their Medicaid EHR incentive programs, but Hawaii, Minnesota, New Hampshire, Nevada and Virginia are preparing to start within the next few months. Nebraska was the latest state to launch its Medicaid EHR program in May.

Registration among providers for the program is “consistently high,” with 12,374 in April and a total of 238,139 Medicare and Medicaid registrants as of the end of April.

“About 71 percent of hospitals that are eligible to participate in the program have registered, and we are fast closing in on 50 percent of eligible professionals being registered at this point,” Anthony said.

While provider registrations show they have reached a plateau, there were predictable bumps in January and February so those providers could be included in the count for 2011 meaningful use.

The preliminary estimates for May show “a little downtick” for the number of Medicare providers receiving payments. Many came in at the end of the year.

“We won’t see people coming back for 2012 until 2013 because they will have to do meaningful use for an entire year,” he said. But May also included payments for eligible physicians in Medicare Advantage organizations.

A snapshot from 2011 meaningful use data is beginning to emerge. “It does appear that those coming in at the end were performing significantly lower in a way from those who came in the beginning. We’re unsure whether that means that once you’re a meaningful user, you’re a meaningful user, or whether these are the folks in 2011 who were most situated to come in and incorporate it in the workflow. We’ll want to look at whether the folks who came in 2012 differ in any significant way,” Anthony said.

As of April, about 45 percent of all eligible hospitals have received an incentive payment, while 1 of every 7 eligible Medicare physicians is a meaningful user of EHRs, moving steadily higher from the previous month’s 1 in every 9 Medicare physicians, he said.

And nearly 1 of every 5 Medicare and Medicaid eligible provider have received payment whether it’s for meaningful use or to adopt, implement or update EHR systems.

Healthcare petition urges: Everybody In, Nobody Out

For more than five years, medical students from the University of Kansas Medical Center have put in long hours serving uninsured patients at their Jay Doc Free Clinic.

Last year, a number of students and physicians involved in such efforts started a new group, Heartland Healthcare for All. Their aim is to push universal health care beyond the walls of their free clinics and into federal legislation that would leave no patient behind.

With a new president preparing to take office, they’re not wasting any time sending their ideas to Washington, D.C.

Elizabeth Stephens, a medical student at KU Med and a member of Heartland Healthcare for All, says the organization started with a viewing of Michael Moore’s 2007 documentary, Sicko, which criticizes the current model of private health care as ineffective and unjust.

“They left the movie outraged by what they had seen,” Stephens says of a group of students and professionals at the screening. “They started talking in the lobby and decided to form a group of concerned citizens.”

Since then, the HHFA has organized vigils and protests to advance a more equitable system. They’ve thrown their weight behind a publicly financed, single-payer system, like the one proposed by Michigan Congressman John Conyers and co-sponsored by Missouri U.S. Rep. Emanuel Cleaver. “We really believe the most equitable and most cost-effective way to truly have a system where everybody’s in and nobody’s left out is a single-payer system,” Stephens says.

Now the group is trying to get more citizens on board.

After Barack Obama became the Democratic nominee for president, his campaign called for citizens to hold meetings in their homes and to discuss the changes they’d like to see in Washington, D.C. About 40 people showed up to an HHFA-sponsored gathering to talk about health care, Stephens says. The group came up with a unanimous vision. They put that wording down on paper. Now they’ve turned that session into an online petition that demands: “Everybody In, Nobody Out.”

In the two weeks since it went live, the effort has gained more than 100 signatures. Stephens says the hope is to get as many names as possible and then send the message to the new president once he takes office.

“He’s asked for input from the people who elected him,” Stephens says of Obama. “We thought this would be a great time to show the president-elect and local representatives and senators there is strong support for this and people want it. Politicians aren’t ever going to go out on their own and do something radical. They have to know the people who voted for them want that change first. We want to demonstrate wide support for this so they can get behind it, as well.”

This weekend, the Obama camp is once again calling on citizens to throw house parties to jump-start political discussions. Before then, though, the members of HHFA will gather at the same free clinic that hosts the Jay Docs tonight to keep pushing for a system that’s open to everyone.

This article is from pitch.com.

New book debunks myths of green living

Food grown locally, rather than far away, supports area farmers and is often fresher, but it makes little difference in the fight against climate change.

How about e-readers vs. print books? Or opening a new car's windows rather than running its air conditioner? The answer's the same in each case: There's no big difference in which consumes less energy overall, so don't sweat it.

Those are the findings of a new eco-myth-busting guide to green living that quantifies the climate impact or carbon footprint of hundreds of consumer decisions. It tallies the energy and resources involved in making and using a product as well as the heat-trapping emissions that ensue. It challenges Americans to cut their fossil-fuel energy use 20% in the coming year.

"You can get there faster by sweating the right stuff," says climate scientist Brenda Ekwurzel, co-author of Cooler Smarter, a two-year study by The Union of Concerned Scientists, a science-based environmental group.

The book makes a plaintive call to action, arguing that climate change has reached a dire point because of human use of heat-trapping fossil fuels. "Our failure to address this problem will imperil us all," it says.

"I don't think that's true. There's not a consensus we're heading toward catastrophe," says David Kreutzer, a research fellow in energy economics and climate change at the Heritage Foundation, a self-described "conservative" think tank. He says Americans should cut their carbon footprint "if it makes them feel good," but not because they fear for the future.

In touting the most effective eco-steps, Cooler Smarter takes on four common myths:

�Buylocally grown food. Many consumers may think this has climate benefits, but as it turns out, transporting food from the farm to the supermarket accounts for only about 4% of the emissions involved in food production. Most of the emissions occur at the farm itself, where it typically takes a long time and lots of grain to raise cattle.

That's why red meat has 18 times the carbon footprint as an equal amount of pasta. So a more efficacious climate approach, rather than buying meat locally, is simply buying less of it, the book says.

"But don't give up on the farmers' market," Ekwurzel says. She says fruits and vegetables have a much smaller overall carbon footprint and transportation accounts for a higher share of their emissions than it does for meat, poultry or seafood.

"What matters more than local or not local (for the environment) is the production method used," says Chris Hunt, a senior policy adviser at Sustainable Table, a non-profit that advocates for healthy, eco-friendly food. He says fewer emissions result from grass-fed beef on pasture farms compared with grain-fed beef on factory farms. Ekwurzel agrees.

�Keep the old stuff. This is not always best for the environment when the products are energy guzzlers. Ekwurzel says many refrigerators and cars have become so much more efficient that replacing old ones will cause fewer emissions in the long run.

If a refrigerator was made before 2003, she says, consumers will recoup � in lower utility bills � the cost of replacing it with an average new Energy Star unit within a few years. If you are buying a new or used car, she says, look for fuel efficiency. Compared with a car that gets 20 miles per gallon, a 40- mpg car will save 4,500 gallons of gasoline if driven 12,000 miles a year over 15 years.

�Drive a hybrid. Not all hybrids are created equal. Some use hybrid technology to boost power, not lower fuel use, and get fewer miles per gallon than 100% gasoline-fueled compacts.

�You need to sacrifice comfort to cut emissions. Not so. Ekwurzel says Americans enjoy lifestyles similar to those of Germans and Japanese but use more than twice as much energy per capita. She says more efficient appliances and heating/cooling equipment can help close the gap. For example, she says, new-car air conditioners are more efficient than older versions, so consumers won't save gas by choosing instead to roll down the windows, which creates air resistance that lowers fuel mileage.