News

SPOTLIGHT: Top health insurance company earnings reports for Q3

Anne Zieger — Fri, 20 Nov 2009 12:13:48 -0500

With the Q3 earnings report season upon us--and health plan operations in the spotlight as reform legislation progresses--it's time to take a look at which health plans fared well, and which ones are merely treading water. Our sister publication FierceHealthFinance dug into the earnings reports of some of the largest insurers to find out more. FierceHealthFinance

Proposed cosmetic surgery tax is wrinkling a few brows

Anne Zieger — Fri, 20 Nov 2009 12:06:28 -0500

As the Senate version of the health reform package moves towards a vote this weekend, more than a few hot issues are still hanging fire.

One that hasn't gotten much attention is a 5 percent tax on cosmetic procedures included in the Senate bill, which would take effect in January if passed. The so-called "Botax," which is projected to raise $5 billion over the next ten years, is seen as just one more way to fund the $848 billion healthcare bill's costs. It would affect about 12 million cosmetic procedures and surgeries.

Plastic surgeons, of course, are livid over the proposal. They're arguing that they're still reeling from the damage imposed by the recession, and that if their prices go up even 5 percent to compensate, patients are likely to walk away, particularly given that many clients pay for these services out of pocket. They're also suggesting that if passed, the tax could become the doorway to taxes on other surgeries in the future -- though no one seems likely to be proposing a knee-replacement surgery tax anytime soon.

Supporters of the proposal, meanwhile, say this tax is no different than taxes on luxury goods and services. According to Diane Archer, director of the health care project at Institute for America's Future, cosmetic surgery "is not a medical service. It's the equivalent of a facial or a massage."

It's a bit early for the plastic surgery industry to be alarmed, however. With so many substantial differences between the House and Senate reform bills, it's anybody's guess what will shake out.

To learn more about the bill:
- read this Kaiser Health News piece

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Illinois launches healthcare quality data site

Anne Zieger — Fri, 20 Nov 2009 11:54:37 -0500

Though the evidence continues to be contradictory as to whether report cards and healthcare data have much impact on quality--or whether consumers even use such data--public policymakers continue to take a "build it and they will come" attitude.

The most recent example of such faith comes from Illinois, where the state has launched a new site (www.healthcarereportcard.illinois.gov) offering data on its hospitals and surgery centers. The data listed includes pricing information, procedure volume, how often care meets recommendations and how the facilities rate with consumers. Some of the data on the site comes from Medicare Compare data collected by HHS.

The state site also offers information on how facilities are staffed. For example, it allows consumers to contrast hospitals which use registered nurses heavily with those that lean on nursing assistants more.

Perhaps the most immediate effect of the data may be to help patients get care discounts. A new state law requires hospitals to offer price cuts to patients making up to 600 percent of the federal poverty level in Chicago, and with prices laid out on the Web, patients are more likely to be aware of whether they're getting discounts. The site also highlights big pricing differences between facilities, which can vary by a factor of four from one point to another on some procedures.

To learn more about the new effort:
- read this Chicago Tribune piece

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VA study: Communication is main cause of surgical errors

Anne Zieger — Fri, 20 Nov 2009 11:42:53 -0500

Surgical never-events have attreacted lots of national attention recently, particularly the case of a Rhode Island hospital which saw five wrong-side or wrong-part surgeries over the past two years alone.

Now, researchers at the Veterans' Administration have taken an in-house look at such problems, concluding, as have others, that poor communication is the principal reason for surgical errors.

In 2003, the VA's National Center for Patient Safety put out a directive that all surgeries should follow standard safety protocols, including a "time out" in which medical staff stop and make sure they're operating on the correct patient, the correct body part and the correct side of the patient.

To see how that played out, the NCPS reviewed 342 surgical problems which nonetheless took place at 130 VA hospitals from 2001 through the middle of 2006.

Upon review, VA researchers found that adverse events occured once in every 18,000 procedures. Among the data they reviewed were 212 adverse events, where wrong procedures were performed, the procedure was performed in the wrong patient, or at the wrong site. Researchers also found 130 "close calls," in which clinical staffers corrected a problem before a procedure took place.

VA research concluded that the in 21 percent of errors, the root of the problem was poor communication between surgical team members. In some of these cases, the "time-out" procedure would not have been enough to address the problems involved.

To find out more about this study:
- read this HealthDay News piece

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CT angiography best for chest pain in ED, study suggests

Anne Zieger — Fri, 20 Nov 2009 11:31:12 -0500

Going straight to CT angiography when patients present at an emergency department with chest pain offers a faster, cheaper and more accurate diagnosis for some patients, a new study concludes.

The study, which reviewed 759 acute chest pain patients at 16 EDs, randomly assigned patients to get either standard screening with myocardial perfusion imaging or computed tomographic angiography.

While both methods appeared to be safe, diagnosis times for patients who had CCTA were 54 percent shorter (3 hours rather than 6.3 hours) and cost of care for CCTA patients was 38.2 lower ($2,137 compared with $3,458 for patients geting standard myocardial perfusion tests).

The CT was particularly effective at speeding things up and improving accuracy for patients with chest pain who have low to moderate enzyme and EKG scores, reported researchers, who presented this week at the American Heart Association's annual meeting.

Get more background on the study:
- read this HealthDay News piece

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Doctors' neckties may transmit illness, AMA says

Anne Zieger — Fri, 20 Nov 2009 11:11:28 -0500

For a while now, U.S. infection control experts have mulled whether such extraneous objects as neckties can cause physicians to spread infections. Until now, most observers have argued that the evidence wasn't clear as to whether ties really did pick up and transmit germs. But now, physicians themselves seem to have decided not to take a chance.

The American Medical Association is now considering a resolution which would recommend a ban on doctors wearing ties while in contact with patients. The same ban could also apply to wearing long sleeves or other excess clothing that could potentially serve as a vector of infection.

The resolution follows a similar move by the British Medical Assocation, which recommended doctors stop wearing what it dubbed "functionless" clothing back in 2006. Meanwhile, some U.S. hospitals have begun to follow the BMA's lead.

The AMA has said that its members are seeking more information on this issue before they take a final vote. However, given existing trends, our guess is that they'll implement this recommendation. Better safe than sorry, after all.

To learn more about this issue:
- read this UPI piece

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SPOTLIGHT: Program uses education, bundled payment to improve kidney patient care

Anne Zieger — Thu, 19 Nov 2009 13:45:36 -0500

Medicare has decided to begin funding a new program educating the public about treatment options for dialysis patients. This comes in the wake of CMS's decision to propose a single bundled payment to facilities covering dialysis and other outpatient care, prescription drugs and lab tests. Article

Senate releases $848 billion health reform bill

Anne Zieger — Thu, 19 Nov 2009 13:39:12 -0500

Senate Majority Leader Harry Reid has released a 10-year, $848 billion health reform bill--featuring a much-lower sticker price than the House's $1.05 trillion bill--which highlights some of the significant differences between the two branches of Congress on the issues.

As expected by most observers, the new bill differs from the House version on key questions like taxation, abortion coverage and the public option. According to the CBO, the Senate version of health reform would cut the federal budget deficit by $130 billion over the first decade after being enacted.

Despite loud outcries against the model from some Senators, the Senate version of the health reform bill would feature a public option plan, though states would be allowed to opt out if they wished. The Senate version of the public plan would negotiate with providers directly to establish rates, rather than tying rates to Medicare.

One controversial section of the bill, added by Reid, would increase the Medicare payroll tax for high-income earners by 0.5 percent to 1.95 percent of adjusted gross income. This new tax, which would raise $54 billion, would affect individuals making more than $200,000 or families earning more than $250,000.

Given the widely varying postures the two chambers have taken on key issues, the process of reconciling the two proposals is likely to be arduous, observers note.

To learn more about the Senate reform bill:
- read this Kaiser Health News item

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Pennsylvania ambulatory surgery centers flourishing despite recession

Anne Zieger — Thu, 19 Nov 2009 13:15:26 -0500

Last time we checked in on the ambulatory surgery center market, it was doing very nicely overall, but that was before the worst of the economic crisis had hit. You could be forgiven if you thought that perhaps the ASC market had since gotten swamped by the recession--but you'd be wrong.

At least in Pennsylvania, ASCs did very well during some of the worst months of the financial crash, actually growing their total margins from 24.31 percent in fiscal '07 to 26.06 percent in fiscal 2008 (June 2008 to May 2009). That's a 15 percent increase in total margin since fiscal 2001, according to the Pennsylvania Health Care Cost Containment Council (PHC3).

Compare that with an average acute-care hospital margin of 4 percent for fiscal 2008, and you begin to get a sense of how successful these entities really are. (Rest assured that hospital leaders in the state are doing so!) The ASCs enjoy a higher proportion of privately insured patients than hospitals (54 percent vs. 47 percent), and only 3.4 percent are covered by Medicaid, vs. 10.4 percent on average for hospitals.

The number of ASCs in the state climbed by 17 during fiscal 2008, though three also closed, reaching a final total of 261 during that period. This number has quadrupled over the past decade.

Learn more about the PA ASC market:
- read this Philadelphia Inquirer article

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Health plans will still pay for under-50 mammograms

Anne Zieger — Thu, 19 Nov 2009 12:52:01 -0500

Recently, a group of independent physicians proposed new guidelines for mammograms that have generated a significant amount of controversy. Rather than getting regular screenings after age 40, the group changed its recommendations to embrace women ages 50 and over, as risks outweigh benefits for younger women, members said.

While health plans are often the first to jump on new guidelines that favor them financially, this time it doesn't seem to be happening. If nothing else, federally-backed plans are not planning to change coverage standards, according to HHS Secretary Kathleen Sebelius.

Commercial health plans have weighed in to reassure women in their 40s, too. For example, Kaiser Permanente, Aetna (AET), CIGNA (CI), Geisinger Health Plan, Group Health Cooperative and WellPoint (WLP) told USA Today that they had no current plans to change mammogram coverage.

Realistically, low reimbursements pose a bigger threat to women's mammogram access than policy debates like these, according to an analysis by The New York Times. With Medicare mammogram reimbursements at around $95, and commercial payers coming in only slightly higher, the number of imaging centers willing to conduct mammograms is falling, the newspaper reports.

Find out more about reactions to the new guidelines:
- read this Kaiser Health News piece

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Hospital report cards may not generate quality improvement

Anne Zieger — Thu, 19 Nov 2009 12:23:49 -0500

It's a common assumption among health planners--nay, an article of faith--that publishing hospital report cards can prompt lagging facilities to improve their quality of care. However, a new study suggests that at minimum, report cards alone aren't enough to spur significant changes.

A new Canadian study concluded that heart patients received the same quality of care from hospitals in the province of Ontario before and after quality report cards were released. These findings were published this week in the online version of the Journal of the American Medical Association.

To conduct their study, researchers looked at medical records from 85 hospitals based in Ontario that admitted patients suffering from heart failure or heart attacks. After examining the process of care, they concluded that in general, the hospitals had not shown improvement since the release of the report cards.

Folks, this finding isn't particularly surprising. After all, making big process changes takes time, money and management commitment, and getting all three in place can be tough to swing. If patients start quoting report cards in detail, it may motivate hospital leaders to take them more seriously, but in the mean time, hospitals are likely to set their own priorities rather than address report card issues.

To get more context on the study:
- read this HealthDay News item

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Doctor bias may affect transplant process

Anne Zieger — Thu, 19 Nov 2009 11:51:15 -0500

Bias by physicians could potentially be keeping Hispanic and African-American patients from receiving organ transplants, according to a newly-published study.

To examine the issue of who gets transplants, Dr. Keith Melancon of Georgetown University Hospital looked at the list of patients ready for the procedure.

The study, which can be found in the American Journal of Transplantation, found that African-Americans were 27 percent less likely than Caucasians to be recommended for a kidney-pancreas transplant, and Hispanics 25 percent less likely. This was true despite the fact that Medicare had increased coverage for people needing the simultaneous transplant of both organs.

Dr. Melancon suggests that physicians might be incorrectly assuming African-Americans have type 2 diabetes, when many met the criteria for Type 1.

To learn more about this trend:
- read this UPI piece

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SPOTLIGHT: Americans support tax on rich to pay for reform

Anne Zieger — Wed, 18 Nov 2009 06:52:47 -0500

Taxing the rich isn't universally popular, and certainly isn't favored by those considered wealthy. But it seems that when it comes to paying for health reform, many Americans see taxes on the well-to-do as a smart way to pay for health reform. A new poll suggests that while Americans aren't big on most other funding sources--including taxes on "Cadillac" plans--they like the idea of surcharges on individuals making $500,000 a year and up (and households making $1 million per year). Article

Retail clinic market should grow through 2014

Anne Zieger — Wed, 18 Nov 2009 06:48:13 -0500

As readers of this publication may know, signs suggested that the retail clinic market had leveled out during the last 12 to 18 months. Several chains got in trouble, and in early 2008, a retail clinic chain affiliated with Wal-Mart suddenly closed down all 23 of its locations.

If a new report is correct, however, the market is likely to open up again over the next few years. Research by the Deloitte Center for Health Solutions is predicting that the retail clinic sector will grow 10 percent between 2010 and 2012, then speed up to a dramatic 30 percent per year in 2013 and 2014.

At present, about one-third of consumers said that they would use a retail clinic, Deloitte researchers found. Another 30 percent would use such clinics if they would cost 50 percent less than seeing their existing physician. The data also suggested that the market for retail clinics was strongest if they were based in retail pharmacies.

Deloitte analysts predict that several factors will add fuel to the retail clinic sector's growth, including higher demand for primary care services thanks to reform; broader acceptance of such clinics by commercial health plans and large employers; increased use by consumers and a rise in the number of services such clinics provide.

Find out more about the research:
- check out Deloitte's report (.pdf)

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Preterm birth rates high in U.S.

Anne Zieger — Wed, 18 Nov 2009 06:15:10 -0500

An advocacy group tracking preterm birth rates has given the U.S. a "D" rating on its current slate of state report cards. Not only did no state receive an "A" grade in the report cards, only Vermont received as high as a "B" grade from the March of Dimes, a non-profit which works to prevent premature births as well as lower the rates of birth defects and infant mortality.

Seven states improved their performance on the March of Dimes report card by one letter grade from the group's last batch of ratings. Two saw lower grades than they had the previous time. Meanwhile, a hefty percentage of states received a grade of "F" from the group, including Texas, Oklahoma, Florida, North Carolina, Ohio and West Virginia.

States were rated by their adherence--or lack thereof--to an objective of 7.6 percent preterm births or less. One of the states getting an "F" rating, Texas, had a rate of 13.6 percent in 2007, and has hovered at this level for years, the report notes.

To lower rates of preterm births, states can institute a wide range of programs, including smoking cessation efforts, consistent care before and during pregnancy, progesterone supplements and wider use of professional guidelines on fertility treatment and early C-sections and induced births, the group says.

To learn more about the ratings:
- read this UPI piece
- examine the March of Dimes report

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Poll: Almost half of high-risk U.S. adults plan to skip H1N1 vaccine

Anne Zieger — Tue, 17 Nov 2009 17:39:35 -0500

Even as things stand, the lines for H1N1 vaccination are likely to be long. Still, it seems likely that many Americans aren't going to bother fighting the crowds, according to a new poll by Zogby International.

The poll concluded that 46 percent of adults identified as high-priority recipients don't plan to get an H1N1 vaccination. Of the group, 38 percent worry that the vaccination isn't safe, and 32 percent contend that they don't really need it.

Meanwhile, among the entire U.S. adult population, including those not at higher risk, 32 percent said that they are concerned about H1N1 vaccine safety, and 30 percent said they don't need the shot. A full 62 percent of U.S. adults don't want the vaccine.

Pollsters found there were decided differences between demographic groups. For example, 74 percent of Republicans planned to avoid the shot, compared with only 45 percent of Democrats. And 69 percent of adults tagging themselves as born-again Christians didn't plan to get immunized, compared with 55 percent of those who didn't label themselves in this category.

Get more data from the survey:
- read this Zogby release

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Daschle: Health reform has '60 percent chance' of passing

Anne Zieger — Tue, 17 Nov 2009 17:25:05 -0500

If I were a member of Congress, I'd find Tom Daschle's health reform predictions to be a bit discouraging. A former U.S. Senator and Senate leader who came within a hair's breadth of being HHS Secretary, Daschle certainly knows how things work on Capitol Hill--and that includes the steps it will take to pass a reform bill. And given current forces, he believes that health reforms have no more than a 60 percent chance of passing, he told a healthcare conference audience.

Daschle, who spoke at the Healthcare Capital Conference (HCap) in Washington, D.C., concedes that there are a few broad areas where both branches of Congress--and most of the public--seem to find common ground. These include the need to expand healthcare coverage and access, lower costs and improve care quality, he said. But that's where most people part company, he notes. "There is definitely broad agreement on some issues," Daschle said. "But there are deep philosophical differences on others."

One positive note is that many key stakeholders seem ready to jump on board with at least some portion of proposed reforms, he notes. "Most agree that the status quo is unsustainable, and that staying in the room is in their best interests," Daschle said.

There's also been progress on insurance, payment and delivery reform models, he notes. For example, most legislators seem to agree on creating an insurance exchange for individual and small business coverage, and that provider reimbursement models must be changed to favor models with quality and efficiency incentives built in, such as bundled payment, capitation and episode-based fees.

On the other hand, there's little consensus on how planners should address problems such as addressing lagging quality and medical errors.

As if that wasn't enough confusion, to get a bill through the process reform champions will have to resolve divisive ideological debates over the role of government, settle on appropriate financing mechanisms and have the right strategy to lead the bill through the legislative process, all of which will be a big challenge.

That being said, Daschle ended his talk with a hopeful note, arguing that we're at a uniquely "transformational" time in history where major chances may just occur. He noted that during the civil rights activist's long incarceration, Nelson Mandela was challenged by a fellow prisoner who argued that apartheid would never end. Mandela's response, Daschle says? "Many things seem impossible until they're already done."

Study: Direct-to-consumer drug ads can be misleading

Anne Zieger — Mon, 16 Nov 2009 23:09:40 -0500

Drugmakers have taken a lot of flack over direct-to-consumer drug advertising, but to date, Congress hasn't imposed any major limitations on the practice. Critics have argued that such ads encourage the use of costly new drugs over equally-effective generics. And those critics aren't going away anytime soon, it seems, especially if studies like these keep coming.

The latest challenge to DTC drug ads comes from researchers with the University of California, Los Angeles. The research team, led by clinical psychologist Dominick L. Frosch, concluded that American TV viewers see as many as 16 hours of prescription drug advertisements every years.

The study found that DTC drug advertisements aren't doing much to help consumers make better health decisions, either. With commercials featuring emotional portrayals of drug benefits, and risk messages obscured by happy imagery, consumers can easily be mislead, suggests the study.

Moreover, most ads don't provide enough information to help consumers determine whether the drug would help them, according to the study, which is published in the American Journal of Public Health.

To learn more about the study:
- read this UPI piece

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Geriatrics group urges more focus on physician care for seniors

Anne Zieger — Mon, 16 Nov 2009 22:01:03 -0500

With 78 million baby boomers headed for retirement, the need for specialists in geriatric medicine will be great. Unfortunately, geriatricians still are a rare species, and unless something changes, they're likely to stay that way.

Hoping to turn this trend around, members of the American Geriatrics Society are beginning to lobby medical schools to turn out more geriatric graduates. Leaders of the AGS say that even well-trained physicians from other specialties may not be as aware of the impact aging has, such as changing the way medications are metabolized.

Just 7,128 doctors nationwide are certified geriatricians, meaning there's only one per 2,556 seniors, according to the Institute of Medicine. And as things stand, that supply is unlikely to increase on its own, as geriatrics doesn't pay as well as other specialties. Moreover, it doesn't have a prestigious reputation within the medical community.

The group would like to see elder care added to a list of six core areas that are standard foci for medical school training. If it succeeds, medical schools would add a geriatrics rotation to the training students already receive in family medicine, internal medicine, pediatrics, psychiatry, surgery and obstetrics/gynecology.

Get up to date on the AGS's efforts:
- read this piece from The Boston Globe

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Will health reform disappoint the public?

Anne Zieger — Mon, 16 Nov 2009 17:28:49 -0500

In theory, President Obama will look like a hero to health reform supporters if the final bill satisfies supporters. In practice, however, the public may end up being disappointed by the realities of health reform, suggests a new article in insider Capitol Hill newspaper Politico.

For example, few in the public understand that the much-bruited public option will only be available to those who don't get health coverage from their employer. Even for those people, the plan doesn't begin until 2013, a wait that can seem like an eternity to those needing medical care now.

Americans who expect their insurance premiums to go down are likely to be unsatisfied, too, as reform efforts are aimed only at slowing down the rate of healthcare cost increases.

Then, there's the very risky $400 billion Obama proposes to cut out of the Medicare budget, which he says can be covered painlessly if leaders cut down fraud and waste. But if Medicare cuts lower reimbursement too much, it will gut the ranks of providers willing to participate in the program, which should mobilize the powerful senior bloc to vote against the current administration.

Finally, there's the matter of how the various reform measures handle the gap between premiums for young people and seniors. While both the House and the Senate are proposing to limit the differences--lowering premiums for seniors--observers suggest that such rules could dramatically raise premiums for the young as insurers spread out costs.

To learn more about political "gotchas" in reform:
- read this Politico piece

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Report: Inpatient satisfaction continues to rise

Anne Zieger — Mon, 16 Nov 2009 17:10:28 -0500

Despite a tough economy that forced many hospitals to cut staff and reduce services, hospital patient satisfaction levels jumped substantially last year, according to a new report from research firm Press Ganey Associates.

Press Ganey, which surveyed almost 3 million patients seen at more than 2,000 hospitals, noted that patient satisfaction with U.S. hospitals has grown steadily since 2003. Last year, hospitals saw a previously unheard-of 1.5 percent jump in overall inpatient satisfaction, and a 2 percent increase in the willingness to recommend their hospital to family and friends. Overall, these patients rated their overall care between "good" and "very good," the research firm said.

Still, patients feel that communication within hospitals could be improved. In particular, patients who rated "response to concerns and complaints made during your stay" as inadequate didn't tend to recommend their hospitals to others.

Patients also were sensitive about the extent to which hospital staffers addressed their emotional needs, the effort staff made in including patients in decisions about treatment, how well nurses kept them informed and how promptly they responded to the call button.

Other findings included OB/GYN services receiving the highest satisfaction ratings, and the state of Maine earning the highest-ratings for satisfaction.

To get more data from Press Ganey:
- read this report (.pdf)

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SPOTLIGHT: Provision in House bill could allot $23.5 billion to Medicaid funding

Anne Zieger — Mon, 16 Nov 2009 11:30:01 -0500

Though it's gotten little attention, a provision in House health reform bill could offer a big boost to state Medicaid programs. If passed, the bill would allot $23.5 billion to Medicaid funding, offering relief to states struggling with the rapidly-growing costs of the program. The stimulus has already pushed up the federal share of the program's costs from an average of 57 percent to 66 percent, and the new provision would keep funding at post-stimulus levels for an additional six months. This would wipe out most of the projected state budget shortfalls for next year. Article

Price hikes could raise $10 billion in additional income for pharmas

Anne Zieger — Mon, 16 Nov 2009 11:18:02 -0500

Pharmaceutical companies have been asked to help fund health reform by cutting drug costs $8 billion per year over the next 10 years. But while this sounds good, drugmakers may be taking steps to soften or even nullify the financial effect of their agreement with the Obama Administration.

Over the last year, pharmas have raised wholesale prices on brand-name meds by about 9 percent, the fastest rate since 1992, according to an analysis published in The New York Times. The price increases have pushed the average annual cost for brand name drugs to now more than $2,000 per year, according to Stephen W. Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota, who has analyzed drug pricing for the AARP.

These price hikes should raise about $10 billion in addition income for pharma, putting it $2 billion in the black even after making the promised concessions.

Drugmakers contend that they are raising prices to compensate for the impact of patent expirations over the next few years, as well as to fund R&D for new drugs. Critics, on the other hand, say that pharmas are working to cancel out the effect of the price-cutting agreements they've made.

To get more details on pharma pricing strategies:
- read this piece in The New York Times

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Religion impacts parents' health decisions for seriously ill children

Anne Zieger — Mon, 16 Nov 2009 10:52:31 -0500

Religion pays a significant role in shaping the medical decisions parents make regarding seriously ill children, especially when those parents must make hard choices, according to a new survey by U.S. sociologists.

Researchers from Waltham, Mass.-based Brandeis University interviewed 30 doctors from high-prestige U.S. medical centers, asking them about their views of religion and spirituality, and how those impacted their practices.

According to researchers, most physicians saw religion and spirituality as most important when parents were struggling with difficult medical choices, especially where end-of-life care was concerned. Pediatric oncologists were more likely than pediatricians to see dealing with such issues as part of their job.

Some physicians noted that religion and spirituality could prove to be both helpful and a hindrance. In cases where religious traditions impact the nature of care for children--such as when families are Jehova's Witnesses or Christian Scientists--doctors said they sometimes felt some tensions with families.

To learn more about this issue:
- read this UPI piece

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One in eight men over 40 likely to suffer from sudden heart attack

Anne Zieger — Sun, 15 Nov 2009 23:07:53 -0500

Men seem to be at a relatively high risk of sudden cardiac death, particularly black men, according to new academic research. Authors say that that these are the first lifetime estimates for cardiac death, as others focused on the next 10 years.

Researchers examined sudden cardiac death data for about 5,000 U.S. adults who were involved in a major heart study. To examine risk, the team followed data from ages 40 through 95. The study concluded that the lifetime risk of sudden heart attack for men ages 40 and over is 12.3 percent--roughly one in eight men. Meanwhile, only 4 percent of women--or one in 24--are likely to face sudden cardiac death after age 40.

African-American men faced about twice the risk of sudden cardiac death as white men at any points in their lives, though white women and African-American women experienced essentially equal risk throughout the years.

Traditional risk factors for disease, such as diabetes, smoking and high cholesterol, substantially upped the risk for everyone studied.

To learn more about the study:
- read this HealthDay News article

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Americans see disease prevention as key to reform

Anne Zieger — Sat, 14 Nov 2009 17:45:31 -0500

It seems the American public understands healthcare delivery better than we thought. A new poll by the Trust for America's Health and the Robert Wood Johnson Foundation has concluded that 71 percent of U.S. residents support making larger investments in disease prevention.

The poll, which found that 44 percent strongly favor a jump in prevention spending, concluded that Americans weren't even daunted by the $34 billion in costs budgeted for prevention in health reform legislation. Seventy percent of people supported this investment, as opposed to only 24 percent against.

In fact, disease prevention was the second most popular reform strategy identified by the researchers, after banning health plans from excluding people due to age, medical problems or pre-existing conditions.

The survey also found that 82 percent of respondents favored better training for public health workers, up-to-date laboratories and an adequate communications infrastructure to deal with broader health threats.

To get data from the survey:
- read this report

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SPOTLIGHT: Maryland launches hospital hand-washing study

Anne Zieger — Fri, 13 Nov 2009 13:04:55 -0500

Working with local healthcare groups, the state of Maryland has launched a program that will track how often doctors and nurses working in hospitals wash their hands. The Maryland Hospital Hand Hygiene Collaborative, which is funded by $100,000 in stimulus money, won't penalize clinicians who don't wash up; instead, the idea is to raise awareness, officials say. Article

Reform bill would require pharma disclosures of CME funding

Anne Zieger — Fri, 13 Nov 2009 13:01:04 -0500

While it's gotten relatively little attention from pundits, provisions within reform bills passing through Congress would demand that pharmaceutical companies disclose how they're spending on continuing medical education.

The reform bill passed by the House last week requires drug and medical-device companies to disclose payments to both doctors and third parties, including medical-education firms. Senate versions of the bill include similar provisions, though they don't require the disclosure of third-party payments.

Since doctors can't get CME credit for attending courses run directly by drugmakers, CME companies hold the classes. Many have suggested that these courses, which are directly sponsored by the pharmas, are more infomercial than education.

Congressional investigations of physician ties to industry have already hit CME companies hard, many of which have seen their revenue fall by double digits, according to the Wall Street Journal. Industry payments to for-profit firms dropped 22 percent during 2008, to $463 million, from $594 million a year earlier, according to the Accreditation Council for Continuing Medical Education.

Imposing such restrictions would not be a new idea for Congress, which has been mulling over the related Physician Payments Sunshine Act since 2007. The current version of the PPSA hasn't yet come out of the Senate Finance Committee, however, while the Senate is all but guaranteed to pass some reform bill very shortly.

To learn more about this issue:
- read this Wall Street Journal piece (sub. req.)

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Health reforms get qualified business support

Anne Zieger — Fri, 13 Nov 2009 12:40:36 -0500

As might be expected, business groups continue to be cautious about supporting health reforms, though some CEOs of major companies have developed data that argues in favor of some current reforms.

Among the more optimistic supporters is the Business Roundtable, a group representing the CEOs of large companies. The group, which commissioned an analysis by consulting firm Hewitt Associates, concluded that current reforms could save up to $3,000 per employee by 2019 if reform elements strike the right balance.

On the other hand, small business leaders continue to argue that reform efforts are likely to hurt their bottom line. They worry that they won't be able to afford even low-cost insurance for their employees, according to groups like the U.S. Chamber of Commerce and the National Federation of Independent Business.

The small business groups are particularly opposed to the public option, arguing that it's likely to pay less than cost-level reimbursements. If that happens, hospitals and doctors are likely to make up the difference by charging private insurers higher rates, which will in turn get shifted to employers, the groups suggest.

To get more detail on businesses' reform issues:
- read this Kaiser Health News piece

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U.S. spends almost $1B annually on blood thinners

Anne Zieger — Fri, 13 Nov 2009 11:57:15 -0500

New research suggests that the U.S. spent $900 million on anticoagulant (blood thinner) drugs in 2007, most of which went to senior patients with heart-related conditions. The study, which was developed by the Agency for Healthcare Research and Quality, concluded that about 4.2 million Americans ages 18 and older used an anticoagulant that year.

According to the study, less than 1 percent of U.S. residents younger than 65 were prescribed an anticoagulant in 2007, compared with 6 percent of patients ages 65 to 74, and about 10 percent of patients ages 75 and older.

Seventy-four percent of patients with heart-related conditions--40 percent of those who had surgery that year, and 30 percent of those with cancer or diabetes--had been given those drugs.

Generic prescriptions were far more common than brand-name scripts. With 28 million prescriptions filled by pharmacists in 2007, 19.3 million were for generic medications and 8.5 million for brand-name drugs.

To learn more about this report:
- read this HealthDay News piece

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