Calcium supplements may raise heart attack risk

Taking a calcium supplement to help prevent bones from thinning puts people at a greater risk for heart attacks, says a report out today in the journal Heart.

The study of approximately 24,000 people between the ages of 35 and 64 found participants who took regular calcium supplements were 86% more likely to have a heart attack than those who didn't take supplements. Those who took only calcium supplements were twice as likely to suffer a heart attack as those who didn't take any vitamin supplements. Calcium supplements have been linked to kidney stones and bloating in other studies, according to the National Institutes of Health.

"Calcium supplements have been widely embraced by doctors and the public, on the grounds that they are a natural and therefore safe way of preventing osteoporatic fractures," the authors write. "We should return to seeing calcium as an important component of a balanced diet."

The study, primarily undertaken to determine if calcium supplements modify cardiovascular risk factors, found no direct link between the supplements and heart attacks, nor did they identify brands of supplements. Participants answered questions about their use of supplements and their diet during an 11-year study of their health.

The study did not look at what caused the heart attacks, but the authors write: "Supplements cause calcium levels to soar above the normal range, and it is this flooding effect which might ultimately be harmful."

"Doctors who work with the elderly and people who are postmenopausal routinely tell them to take a calcium supplement," says Linda Russell, a rheumatologist and osteoporosis specialist at Hospital for Special Surgery in New York. "It's really time to re-examine that philosophy. Other studies about calcium have been suggesting this in recent years, but maybe this study really should get doctors to rethink this approach."

Strategies for preventing bone thinning in postmenopausal women have recently come under review; the Food and Drug Administration warned in the New England Journal of Medicine May 9 about the risks associated with some bisphosphonates and how long patients should take them. Some bisphosphonates, widely prescribed to treat osteoporosis and prevent fractures, have been linked to a rare kind of atypical fracture in the femur.

"It's very important for people to be vigilant, keep track of their medications and to talk with their doctors," says Elizabeth Shane, a professor of medicine at Columbia University's Department of Medicine in New York and spokesperson for the American Society of Bones and Mineral Research. "The knowledge base is continually changing."

Russell says she reevaluates a patient's need for bisphosphonates every year. "The benefits still far outweigh the risks," she says. "They're proven to prevent fractures. But the field is really opening up. Bisphosphonates slow bone loss, while some newer drugs will make bone."

Shane recommends bisphosphonates for patients with osteoporosis. She also advises her patients to get their calcium naturally from their diet in small doses so it is absorbed throughout the day, and to use a supplement only to make up a difference if they fall short of the daily requirement.

For a postmenopausal woman between ages 51 and 70, when developing osteoporosis becomes a greater danger, the recommended range is 1,000 to 1,200 mgs daily. After age 71, the requirement for men and women is 1,200 mgs, according to the NIH.

"Walk into any drugstore and these calcium supplements just jump off the shelves at you," says Russell. "But by taking foods high in calcium four times a day, you should get all that you need."

Be sure, she adds, to make sure most is low in fat, like low- or non-fat yogurt, cheese and milk products. If dairy is a problem, consider kale, Chinese cabbage, broccoli, and juices and grains fortified with calcium.

"For the time being, until it becomes more clear, people should start shifting over to meeting their calcium needs through diet," she says.

Obese teen had to be cut from home in U.K.

LONDON(AP)�Emergency workers who needed to take an obese teenager from her home to a hospital in Wales had to break through a wall of the residence to get her out and into an ambulance, officials said Friday.

The rescue on the second floor of the small house on Thursday used scaffolding as a ramp to lower the woman to the ground level, the local Rhondda Cynon Taf council said.

The unidentified 19-year-old remained hospitalized Friday and her medical condition was not released.

Neighbors said her weight had risen as high as 380 kilos (835 pounds).

The U.K. has one of Europe's fattest populations: more than 60% of adults and one third of children aged 10-11 are overweight or obese, roughly similar to U.S. statistics.

Need A Nurse? You May Have To Wait

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Some fear that with rising medical costs and an aging population, the country's nursing staff will be stretched too thin.

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Some fear that with rising medical costs and an aging population, the country's nursing staff will be stretched too thin.

Nurses are the backbone of the hospital � just ask pretty much any doctor or patient. But a new poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds 34 percent of patients hospitalized for at least one night in the past year said "nurses weren't available when needed or didn't respond quickly to requests for help."

Since nurses provide most of the patient care in hospitals, we were surprised at the findings. We wanted to find out more. We wanted to know what was going on from nurses themselves. So we put a call-out on Facebook.

We received hundreds of responses and read them all: piles of stories about nurses feeling overworked, getting no breaks, no lunches and barely enough time to go to the bathroom. Even worse, many nurses say breaks and lunchtimes are figured into their salaries and deducted, whether they take them or not.

 

When we asked nurses who responded to our call-out if we could interview them for broadcast, most said no. They worried about their employers' reaction. Many would be interviewed only anonymously.

"We're always afraid that something will happen to our patients during the time we're off the floor," one nurse says, "and I personally don't feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I'm off the floor."

This nurse says she rarely stops. Not for 12 hours. She's an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more � often eight, if she's covering for a colleague taking a lunch break. She says there are times when she can't leave patients' bedsides.

"Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn't harm them," she says, "and I can see the call bell going off in the hallway, and there's no way I could respond to that."

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she "missed something."

Another nurse likens her job to "spinning plates," just "praying," she says, that one doesn't fall. "And these are human beings," she says, "not products on conveyor belts."

Stories like this suggest there's a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that's not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can't find jobs.

"There's not an actual nursing shortage," Aiken says. "There's a shortage of nursing care in hospitals and other health care facilities."

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

"In part, it's because our patients are sicker � coming to us with more intense diseases and disorders than they did 25 years ago," she says. "In part, it's because there's so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health."

That is terrific, of course, but it's not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

"Nurses are the surveillance system in hospitals for early detection and intervention [to save patients' lives]," she says.

According to one nurse, little clues from patients are critical.

"I mean, you might walk into a room, and they are breathing and answering your questions," the nurse says, "but if you look at their neck and the jugular vein is slightly distended ... taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast."

In our poll, 51 percent of those who were hospitalized overnight in the past year said they were "very" satisfied with their care. An additional 32 percent said they were "somewhat satisfied" � some things could have been better. Only 16 percent said they were dissatisfied.

It's not all bad news, but with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly. Plus, while our call-out to nurses on Facebook was not scientific, the NPR/RWJ/Harvard poll is, and it does point to significant problems when it comes to the availability of nurses at the hospital bedside.

Report: Wireless medtech market driven more by consumers than telehealth

WELLINGBOROUGH, England – Self-monitoring medical devices utlized by the consumer, rather than those used in a managed telehealth setting, will provide the largest market for wireless health technologies, according to IMS Research. An estimated 50 million wireless health devices will be distributed for consumer monitoring applications over the next five years, with a fewer number of devices being used by telehealth patients.

IMS Research, a market research group recently acquired by IHS Inc., published its latest report, Wireless Opportunities in Health and Wellness Monitoring – 2012 Edition, showing that consumer-purchased medical devices with technologies like Bluetooth low energy and ANT+ that self-monitor health will account for more than 80 percent of all wireless medical devices come 2016.

The demand for self-monitoring one’s health is growing much faster than that for telehealth implementation. Even without healthcare systems that are adapted for this, consumers want the ability to monitor and manage their own health at home. The report projects, however, that the number of wireless devices utilized in managed telehealth programs will increase from 5 percent in 2011, to 20 percent in 2016 as telehealth deployment grows.

[See also: Mobile health app market in growth mode.]

“Due to the relatively slow deployment of managed telehealth systems, which is in part due to a reluctance from health providers to move past trials, issues with reimbursement and stringent regulations related to the use and storage of medical data,” says Lisa Arrowsmith, senior analyst at IMS Research, “medical devices used by the consumer to independently monitor their health will provide the biggest uptake of wireless technology in consumer health devices over the next five years.”

One the main drivers for the inclusion of wireless technology in consumer health monitoring devices is the ability to monitor one’s health using a separate device such as a smartphone to collect and view the information. A wealth of applications on several platforms are currently available that allow users to transfer readings from a medical device that record such things as blood pressure, blood glucose and heart rate -- which can then be stored and displayed on the device -- or uploaded to a cloud-based system.

[See also: Telehealth becomes multi-dimensional.]

“The increase in consumer familiarity with mobile applications as well as an increased awareness of the importance of monitoring health levels is driving the market for connected health devices,” adds Arrowsmith. “Many consumers already utilize smartphone apps to track their own health and fitness results, with devices such as activity monitors and heart-rate monitors. Now, there is increasing availability of health-related peripheral devices such as blood pressure monitors to track and upload information in real time via a wireless or wired connection to devices such as smartphones and tablets.”

Health Law's Downfall Could Put GOP In Odd Spot

The Supreme Court will rule in the coming weeks on the constitutionality of the Affordable Care Act � the health care law that has been a flashpoint of partisan acrimony and debate since its beginning.

Much of that debate has been philosophical. But now that the law is under review by the country's highest court, politicians have to plan for the real implications of the court's decision. That's proving particularly difficult for congressional Republicans.

They've rallied for repeal of the plan since the day it passed in 2010. And they won a majority in the House later that fall.

But now the GOP has a problem. In the two years since the law passed, several of its parts have become very popular with voters � among them, parents' ability to keep kids on their health plans until age 26 and a ban on denying insurance because of pre-existing conditions.

So it wasn't surprising when news leaked to Politico last week that Republicans were making plans to try to preserve those popular parts of the act if the Supreme Court strikes the law down.

But the political blowback for the GOP was immediate and harsh. Staffers described dozens of calls from angry conservatives. Right-wing think tanks blasted the endorsement of what they called "government meddling in business." And just a few short hours after the news was leaked, House Speaker John Boehner, R-Ohio, sent an email blast to the media, saying, "Our plan remains to repeal the law in its entirety. Anything short of that is unacceptable."

This isn't the first time GOP leaders have hinted at their support for those provisions. Right after Republicans first won the majority, House Majority Leader Eric Cantor, R-Va., spoke at a forum at American University in Washington.

Student Alyssa Franke, who has a chronic medical condition, asked Cantor the question that still stands today: "Will you try to preserve these two provisions as they stand or continue to push for a full repeal of the health care bill?"

At the time, Cantor said: "We too don't want to accept any insurance company's denial of someone because he or she may have a pre-existing condition. And likewise, we want to make sure that someone of your age has the ability to access affordable care, whether it's under your parents' plan or elsewhere."

That was more than a year and a half ago, long before last week's firestorm over the same Republican sentiment.

What changed? Well, reality. Back in 2010, the concept of repealing the Affordable Care Act was a long shot. The idea of keeping the popular provisions and dumping the rest was mostly theoretical.

Now, there's a real chance the Supreme Court could strike the whole thing down. And the law is designed so that the ban on pre-existing conditions and the parents' insurance provision are paid for by the thing Republicans hate � the mandate that all Americans buy insurance.

House Democratic Leader Nancy Pelosi of California put the Republicans' quandary this way: "It's all about the guys who brung 'em to the dance. It's about the health insurance industry, and that's the agenda that they will roll out."

Insurance companies, many of which are big Washington political donors, are prepared to fight tooth and claw against any new insurance mandate that doesn't also generate new profits for them.

So Republicans may have to choose who they're going to listen to � the voters or the donors.

Panel advises against PSA cancer screening

Doctors should no longer offer the PSA prostate cancer screening test to healthy men because they're more likely to be harmed by the blood draw � and the chain of medical interventions that often follows � than be helped, according to government advisory panel's final report.

Even after studying more than 250,000 men for more than a decade, researchers have never found the PSA to save lives, according to the U.S. Preventive Services Task Force, a panel of doctors that advises the government on cancer screenings and other ways to avoid disease.

Yet the PSA can cause harm.

That's because the PSA, which measures a protein called prostate-specific antigen, often leads to unnecessary needle biopsies for men who don't actually have cancer. Even worse, those biopsies lead many men to be treated for slow-growing cancers that never needed to be found and that are basically harmless, says task force chairwoman Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston.

Because doctors today often can't tell a harmless tumor from an aggressive one, they end up treating most men with prostate cancer the same, says Otis Brawley, chief medical officer of the American Cancer Society, which takes a neutral stand on the PSA.

Treating harmless prostate tumors can't possibly help men, however. It only increases the odds of making them impotent or incontinent, Moyer says. Treatment can even be deadly: One in 200 men who have prostate surgery die shortly after the procedure, she says.

The recommendation, first released as a draft in October, applies to healthy men of any age, although not for those who already have been diagnosed with prostate cancer.

The panel didn't consider cost in its deliberations, Moyer says. Federal legislation requires that Medicare must continue to pay for the PSA, Brawley says. Private insurers usually follow Medicare's example.

In the future, Moyer hopes doctors will simply stop mentioning the PSA when men come for office visits. If men ask for the test, or if doctors still want to offer the PSA, Moyer says she hopes physicians will discuss both the risks and benefits of screening. Although the task force aims to help doctors by issuing recommendations, physicians aren't obligated to follow its recommendations, Moyer says.

Yet Moyer agrees that men desperately need a better test. More than 28,000 men die of prostate cancer a year.

Unfortunately, there are no other better tests with which to replace the PSA, such as rectal exams, ultrasounds or variations on the PSA, says Ian Thompson, chairman of urology at the University of Texas Health Science Center at San Antonio and a spokesman for the American Urological Association, which recommends the PSA for men over 40. Thompson supports some of the task force's recommendations, such as its call to do away with mass prostate cancer screenings in shopping malls and parking lots.

But Thompson says the task force went too far in rejecting the PSA completely. He notes that death rates from prostate cancer nationwide have dropped 30% to 50% since PSA testing became widespread in the early 1990s. In its recommendations, published in Monday's Annals of Internal Medicine, the task force said it's unlikely that screening alone could have reduced death rates so quickly. Some experts note that treatments also have improved.

Thompson also says he doesn't want to go back to the "bad old days" before screening, when doctors found prostate cancer only after it had become incurable. And because many men are used to getting PSAs, Thompson says, some might not realize their doctors have stopped performing the tests.

"A patient might presume they've had their PSA tested, then come back five or 10 years later with back pain," only to learn they have prostate cancer that's spread to their spine, Thompson says.

Terry Dyroff, 66, says he first realized the risks of prostate screening five years ago. He developed a life-threatening bloodstream infection called sepsis after his PSA results led to a needle biopsy, and he was hospitalized for three days. Though such infections are rare, Dyroff says one such experience was enough; he hasn't had a PSA since. "At my age, if I developed prostate cancer, I'd rather not know," says Dyroff, of Silver Spring, Md. "And if I did know, I probably wouldn't do anything about it."

Doc community stalks Influenza online

CAMBRIDGE. MA – Sermo, Inc., an online physician community, is investigating the ability of 100,000 physicians to track and potentially prevent infectious diseases.

Participating physicians will use technology from Sermo called Sermo FluMonitor to collect and aggregate clinical observations across the country.

Cambridge, Mass.-based Sermo provides U.S. licensed physicians with a free memberships to its community. Adam Sharp, an emergency physician and chief medical officer of Sermo, says its membership is currently more than 100,000.

The Sermo FluMonitor will allow physicians to report geographically-based clinical observations in real time. 

“This endeavor has the potential to be an extremely useful resource in tracking disease and saving lives,” says Sharp. “Sermo’s unique online community already brings physicians together to report bedside data and exchange clinical insights. Until now, this type of tracking mechanism was simply not possible.”

Physicians can monetize their Sermo experience by providing their expertise as a resource for financial services firms, healthcare institutions and government agencies.

The 120 physicians who are participating in the FluMonitor tracking will be paid a nominal fee for their participation, says Sharp.

What's Up, Doc? When Your Doctor Rushes Like The Road Runner

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Patients continue to complain that physicians don't spend enough time examining and talking with them.

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Patients continue to complain that physicians don't spend enough time examining and talking with them.

To physician Larry Shore of My Health Medical Group in San Francisco, it's no surprise that patients give doctors low marks for time and attention.

"There's some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Shore says. "And that makes you feel like the person is not listening."

A doctor's impatience, though, is often driven more by economics than ego. Reimbursement rates for a primary care visit are notoriously low, and Shore laments the need to hustle patients in and out.

 

"When you have that pressure to see three, four, maybe five patients an hour, you can't wait for the exposition of the patient's story. Which is exactly what you should do. But you can't," he says.

A new poll by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health found about 3 out of 5 patients think their doctors are rushing through exams. That's nearly the exact same number as three decades ago.

NPR's survey asked people the same questions as another poll did back in 1983. We found doctors got better marks on some patient interactions. For example, 64 percent of people said doctors usually explained things well to them, versus 49 percent in 1983. They also are more likely to say doctors are trying to hold down medical costs.

But when it comes to time, there is a stubborn feeling that doctors are in too big of a hurry. That is troubling � and frustrating � to physicians like Shore who feel that they are already packing more into every workday and are stretched thin by paperwork.

"I think a lot of physicians in smaller practice realized they were becoming both the clerk and the HR and the accounts payable and the accounts receivable and the office manager � things which they may not have an interest in and certainly had no training for," Shore says. But he says many doctors just didn't have the cash flow to hire administrative staff.

Two months ago, Shore opened a new office in which he's trying to break from the day-to-day grind. Appointments are now 20 minutes, instead of 15. And he's hired several other doctors to spread the workload around. But there's also been a shift in his thinking about the way he provides care to his patients: He's trying to treat them more like customers, and focus on making them happy.

"Who are your customers? What do they want? Try to meet those needs," Shore says.

And what his customers want, he believes, is access to him and his staff � how they want it, like over email, and when they want it, like after-hours. To do that, Shore has given up on the model of the doctor as a lonely superhero. Instead, everything is about the team.

Shore hunkers down each morning with his medical assistants for a "care huddle," a rare, quiet moment to strategize about the patients coming in that day. Those assistants now play a bigger role in care, renewing prescriptions and briefing the doctor before he enters the exam room. A check-out assistant guides "customers" out the door.

Shore is trying to make up the financial difference of hiring these additional people by getting the office manager to badger insurance companies to pay more money per patient for better patient health.

That doesn't include patients getting any test or treatment they demand. But Shore's younger colleague Payal Bhandari sounds as much a marketer as family physician when she talks about her hopes for a better assembly line.

"It will actually produce a much better product, where you can actually listen to patients," Bhandari says. "And the physician is a lot happier because they don't feel like, 'Ugh! Another person!' They can actually do their job, but there are others helping them in the process."

Will these improvements be enough to move the stubborn poll number? Shore is optimistic, a belief reflected in a fortune cookie message taped to his office window: It says: "Be not afraid of growing slowly. Be afraid only of standing still."

Varney is a reporter with NPR member station KQED.

Does your state protect older Baby Boomers?

The Affordable Care Act leaves it to the states to decide whether they will allow insurers to charge older Americans more for coverage. If a state takes no action, a 64-year-old buying his own health insurance in the individual market will pay up to three times more than an 18-year-old.

The Affordable Care Act leaves it to the states to decide whether they want to let insurers charge older Americans more for coverage. If a state takes no action, a 64-year-old buying his own insurance in the individual market will pay up to three times more than an 18-year-old. In the small-group market � if a small business employs an unusually large number of older workers � the same 3:1 ratio applies.

Today, in most states, there are no caps on how much insurers can charge a 60-something forced to purchase his own insurance. In the individual market, only New York State bans age rating altogether, and just three other states limit how much premiums can vary, based on age, to less than 3:1. When insurers sell policies to small businesses, Vermont also prohibits age rating, but only five other states cap increases.

To check whether your state shields older boomers in either of these markets, take a look at these charts. (A checkmark in the right-hand column means that age rating is now unregulated in that state.)

Help from the younger generation?

Under reform, more states could decide to ban age rating, or follow Massachusetts' example, and limit the ratio to 2:1.�But, politically, this would be a third-rail decision.

If older boomers pay less, younger adults would be charged more, and most are vehemently opposed to being asked to support the Pepsi Generation. As one of my younger readers once commented, "I'm willing to help my mother, but not someone else's mother."

Just how much more would a 20-something pay?�According to researchers at the Urban Institute, eliminating age rating would lift average premiums for those 18 to 34 years old by $1,400 (from $3,600 to $5,000). Policy holders ages 35 to 44 would see their premiums rise by $800 (from $4,200 to $5,000). Meanwhile, premiums for those between age 45 and 64 would fall by about $2,400, from $7,500 to $5,100.

In other words, when costs are distributed over a large group, older adults save more than younger adults lose.

Still, many believe that older Boomers can and should pick up the higher tab for their own care. After all, throughout their financial lives, they have been luckier than most: they enjoyed first crack at the employment market when jobs were plentiful, and first dibs on housing when homes were affordable.

A generation hit hard

Yet in recent years, the economy has not been kind to the rock ‘n roll generation. One in six is now unemployed, and from 2000 to 2011, the average (mean) after-tax income of Americans age 45 to 54 (who are now in their 50s and early 60s) plunged by 13.3 percent.

By that measure, the recession has hit them harder than other age groups except Americans aged 15 to 24. Over those years, this cohort should have been enjoying their peak earning years. But as the chart below reveals, they didn't.

Between 2000 and 2011 average after-tax income of Americans age 45 to 54 plunged by 13.3 percent. Graph: Advisor Perspectives, Inc.

Even worse, the Wall Street Journal reports, "at an age when they should be generating peak … savings," many have been raiding their retirement funds and "applying for early Social Security benefits." Among median-income households headed by someone age 55 to 64, total savings and assets stand at just $87,200. In 2014, they will be the 50- to 64-year-olds struggling to scrape together $7,500 to $8,500 to purchase health insurance in the individual market.

Of course, younger middle-class Americans also have watched their incomes slide, but time is on their side. They have many more years to recover. The problem for a jobless 60-year-old is that she won't be able to make up for her losses unless she finds a higher-paying job � and that isn't likely.

In 2014, just how many older Americans will find that they can't afford universal coverage? Writing in Health Affairs in February, the Urban Institute's researchers estimated that under reform, age rating means that roughly 1 million Americans age 45 to 64 will forego insurance.

Abolish age rating?

Yet there's a trade off: if age rating were abolished, younger adults would be charged more, and some would decide they can't afford insurance. Bottom line: "the number of uninsured older Americans would be roughly offset by increases in the number of uninsured adults in the two younger age groups�(18-34 and 34-44)."

This worries policymakers for two reasons. First, we need young, healthy Americans in the pool to keep insurance costs down. Secondly, if young families decide to forego insurance, many won't buy separate policies for the children.

How do we choose between children and their grandparents?

If we don't want to ration care, the only rational solution is to bring down the cost by trimming waste in our health care system. This will be difficult. Most of the fat isn't hanging out on the edges of the steak � it's marbled throughout in the form of unnecessary treatments and over-priced products. It needs to be removed carefully, with a scalpel. But it can be done.

Web First: Q&A with Allscripts CEO Glen Tullman

CHICAGO – In real estate, it’s all about location, location, location, they say. In healthcare IT, you might say it’s about integration, integration, integration. Allscripts CEO Glen Tullman is keenly aware of how critical product integration is, he says, and he’s working on it. It’s the difficulties with integration that seem to have led to the EHR company’s recent troubles – at least it’s what Allscripts customers and analysts mention most often. Then came April 25 and the ousting of Allscripts’ board chairman, which triggered three board members to quit in protest, the departure of its CFO (for reasons unrelated, according to the company) and a dismal quarterly report, all of which led to stock price plunging 44 percent.

Allscripts CEO Glen Tullman discusses the challenges that face the company, plans for recovery and its future in the market.

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

Q. Can you make Allscripts whole and thriving again? How? How long will it take? What’s your vision?
A. Yes, I believe we can. Many companies would love to have our positioning, our products, our marketshare and our earnings and cash flow. But to be clear, we can execute better than we have, and we will. We have the right leadership team in place and have made the investments to enable us to lead the industry. And we have the best client base in the industry. Relative to timeline, we are making improvements right now. 
 
Our main areas of focus are product delivery and client experience. We are investing $190 million in 2012 in improving performance, integration and innovation with a number of major releases and improvements in motion. Relative to improving product performance, we have established test labs to eliminate past integration challenges, especially third-party products and the new apps being built for our open platform.

Additionally, Wand, our native iPad app for our Enterprise and Professional EHRs, was recently launched and has been positively received in the market. Our iPad application for our Sunrise Acute offering is already on the market. Wand is another example of the innovation that Allscripts is known for.
 
Over the course of the year, we have added more than 400 frontline support personnel to our team, many of whom are now just coming on line. And, we continue to upgrade our hosting capabilities through a new data center as well as improved monitoring capabilities to better serve our current customers and future prospects. Additionally, at the beginning of the first quarter we launched a major reorganization, bringing together our sales and services teams into a single organization. This is absolutely the right move for our clients, providing them a single point of contact and a team that is not just accountable for selling, but delivering.

Q. Why the so-called poison pill, or shareholders rights approach?
A. This is a common approach when companies believe their stock is undervalued. We are committed to act in the best interests of our stockholders and our clients, which is why we increased the size of our current plan from $200 million to $400 million. We adopted the shareholder rights plan to protect against efforts to obtain control of Allscripts that are inconsistent with the best interests of the company, our clients and our stockholders. As described in a recent article in The Street, “The decision to enact a poison pill by Allscripts, though, also places the company in the camp of target market properties that are deciding to gut it out rather than sell out…”

[See also: Allscripts: Debacle or silver lining?]

More of the interview on the next pages.

Pennsylvania Doctors Worry Over Fracking 'Gag Rule'

From WHYY

A new law in Pennsylvania has doctors nervous.

The law grants physicians access to information about trade-secret chemicals used in natural gas drilling. Doctors say they need to know what's in those formulas in order to treat patients who may have been exposed to the chemicals.

But the new law also says that doctors can't tell anyone else � not even other doctors � what's in those formulas. It's being called the "doctor gag rule."

'I Don't Know If It's Due To Exposure'

Plastic surgeon Amy Pare practices in suburban Pittsburgh where she does reconstructive surgeries and deals with a lot of skin issues. She tells me about one case, a family who brought in a boy with strange skin lesions.

"Their son is quite ill � has had lethargy, nosebleeds," Pare says. "He's had liver damage. I don't know if it's due to exposure."

The family lived near natural gas drilling activity, and there was some concern that the boy may have been exposed to some of the chemicals being used. Producing natural gas is a pretty industrial process and gives off a lot of fumes. It uses a lot of chemicals to open wells to get the gas flowing.

Pare's first step was to figure out what chemicals the drillers were using. But that information isn't easy to get. In this case, Pare says, the patient's family had a good lawyer who helped them find out what kind of chemicals the gas company was using.

"If I don't know what [patients] have been exposed to, how do I find the antidote? We're definitely not clairvoyant," she says.

Revealing Trade Secrets ... Sort Of

Enlarge Susan Philips/WHYY

Plastic surgeon Amy Pare says it's important for doctors to know what kind of substances patients she's treating might have been exposed to.

Susan Philips/WHYY

Plastic surgeon Amy Pare says it's important for doctors to know what kind of substances patients she's treating might have been exposed to.

Pennsylvania's new law was supposed to make things easier for doctors and patients. The law, which is similar to those in Texas and Colorado, requires drillers to list the chemicals used to produce oil or gas on a public website that doctors like Pare can access.

But the website doesn't list all the chemicals used; it leaves off those considered to be trade secrets. These are ingredients that a company says it has to keep secret in order to maintain an edge over its competitors. Before the law, doctors couldn't find out what those trade-secret chemicals were. Now, they can.

But there's a catch: Doctors can get the chemical names only if they sign a confidentiality agreement and agree not to share that information. That's a move that makes doctors like Pare nervous.

"As I understand it, it's legally binding, so if 20 years from now I hiccup that someone was exposed to zippity doo dah, I'm legally liable for that," she says.

It's not even clear whether the doctor can share the trade-secret ingredient with the patient or the patient's neighbors, co-workers or primary care doctor.

'A Mountain Out Of A Molehill'?

state impact

Shale Play: Natural Gas Drilling in Pennsylvania

Ever since the law was signed earlier this year, doctors have been asking lots of questions. But authors of the law say doctors are overreacting.

"It's not to discredit those who are sincerely looking out for the health of others, but I think a mountain has been made out of a molehill," says Drew Crompton, a legislative staffer and one of the primary drafters of the law. "It's important to have disclosure, and that's what we tried to do. And I think this is coming from people who oppose the industry."

The law was modeled after a Colorado initiative, which was modeled after a federal Occupational Safety and Health Administration regulation. At a recent talk for local officials, Michael Krancer, the head of Pennsylvania's Department of Environmental Protection, defended what some are calling the "doctor gag rule."

"The 'gag order on physicians' � nothing could be further from the truth or more nonsensical than this," Krancer said. "The provisions of Act 13 are exactly like what we have already and had had in the federal system since the '70s. There's nothing new there."

But there are some differences. The federal law was designed for workers, while the new state laws cover everyone. And critics say some important parts of the federal law are missing in these state laws.

Balancing Trade Secrets And Public Health

Barry Furrow, the director of the health law program at Drexel University in Philadelphia, says writers of Pennsylvania's law made it vague.

"They've lacked definition. They haven't defined the boundaries of disclosure, so doctors are properly nervous," Furrow says. "What can they disclose to the state? What can they disclose to the community? It's just the patient and the doctor only. And this is a public health problem with toxic chemicals. It's much larger than one patient. It's going to be a community."

Explore Shale: Go deep inside the natural gas drilling process � and how it's regulated � in this interactive from Penn State Public Broadcasting.

Pennsylvania's Department of Public Health recently issued a statement assuring doctors that they would be able to share information with their patients and public health officials. But Furrow wonders how well that statement would hold up in court.

"If Halliburton decides to sue a doctor, that's quite terrifying," he says. "You have a very large, probably rather aggressive company, given its history."

Howard Frumkin, dean of the School of Public Health at the University of Washington, is an expert in treating workers who have been exposed to chemicals on the job.

"In more than two decades of practicing occupational medicine, I'll tell you how often I was able to make the right diagnosis and plan the right treatment when I didn't know what the patients were exposed to � zero times," he says.

Frumkin says companies have a legitimate right to protect trade secrets. But he says there is also a legitimate public need to know about what they may have been exposed to.

"You need to balance off those two rights," he says. "In this case, it seems the law tried to make the balance but didn't quite get it right. There are very chilling statements there that would inhibit physicians and public health officials from getting information that they need."

Some Pennsylvania lawmakers are responding to doctors' confusion. A bill has been introduced to remove the need for doctors to agree to a confidentiality agreement.

This story comes from StateImpact, a collaboration between NPR and member stations, exploring how state issues affect people's lives.

Study: 96% of restaurant entrees exceed USDA limits

If you plan to chow down tonight at a big chain restaurant, there's a better than nine-in-10 chance that your entree will fail to meet federal nutrition recommendations for both adults and kids, according to a provocative new study.

A whopping 96% of main entrees sold at top U.S. chain eateries exceed daily limits for calories, sodium, fat and saturated fat recommended by the U.S. Department of Agriculture, reports the 18-month study conducted by the Rand Corp. and funded by the Robert Wood Johnson Foundation.

"If you're eating out tonight, your chances of finding an entree that's truly healthy are painfully low," says Helen Wu, assistant policy analyst at Rand who oversaw the study. It examined the nutritional content of 30,923 menu items from 245 restaurant brands across the USA. "The restaurant industry needs to make big changes to be part of the solution," she says.

The restaurant industry is "employing a wide range" of healthier-living strategies, says Joan McGlockton, vice president of food policy at the National Restaurant Association. Among them: putting nutritional information on menus, adding more healthful items and launching a 2011 program at nearly 100 brands in more than 25,000 locations that offers children's meals in line with 2010 dietary guidelines.

How much is too much? These USDA recommended limits were used to measure against main entrees:

No more than . . .

667 calories
35% of calories from fat
10% of calories from saturated fat
767 mg sodium

Source: USDA

Even then, the restaurant industry-supported "Healthy Dining" seal of approval is too generous on sodium, Wu says. It allows up to 2,000 milligrams of sodium for one main entree, while the USDA's daily recommended limit for most adults is 2,300 milligrams, she says.

Other highlights of the study, which is posted on Public Health Nutrition:

�Appetizers can be calorie bombs. Appetizers � while often shared � averaged 813 calories, compared with main entrees, which averaged 674 calories per serving, Wu says.

�Family restaurants fared worse than fast-food. Entrees at family-style restaurants on average have more calories, fat and sodium than fast-food restaurants. Entrees at family-style eateries posted 271 more calories, 435 more milligrams of sodium and 16 more grams of fat than fast-food restaurants, Wu says.

�Kid "specialty" drinks often aren't healthy. Many drinks offered on kids' menus have more fat and saturated fat on average than regular drinks. While regular menu drinks had a median of 360 calories, the median number of calories in kid specialty drinks, such as shakes and floats, was 430. The message to parents, Wu says: "It's the little extras you order that add up."

National report shows surge in e-prescribing among health practitioners

ARLINGTON, VA – By the end of 2011, 58 percent of office-based physicians were using e-prescribing, with solo practitioners contributing the most significant growth, according to Surescripts, which released today “The National Progress Report on E-Prescribing and Interoperable Healthcare Year 2011.”

Included in the report is data analysis that documents the prevalence of e-prescribing adoption and use in the United States from 2008 through 2011.

The report is the only one of its kind in the U.S. that tracks adoption and frequency of e-prescribing nationwide. Two studies also included in the report measure both the effects of e-prescribing on medication adherence and examine e-prescribing use to determine the attainability for the e-prescribing measure in both Stage 1 and Stage 2 of meaningful use.

By the end of 2011, 58 percent of office-based physicians were using e-prescribing. Adoption rates were shown to be the highest – at 55 percent – among smaller practices with six to 10 physicians, and practices with two to five physicians totaled to 53 percent.

Solo practitioners contributed the most significant growth to physician adoption – from 31 percent in 2010 up to 46 percent in 2011.

Among specialty groups, e-prescribing adoption rates were highest among internists at 81 percent, endocrinologists at 78 percent, cardiologists at 76 percent and 75 percent for family practitioners.

Other highlights from the report include:

The number of electronic prescriptions in 2011 increased to 570 million, up from 326 million e-prescriptions in 2010. By the end of 2011, an estimated 36 percent of prescriptions dispensed were routed electronically, up from 22 percent at the end of 2010.A recently completed analysis shows that of the physicians who adopted and began using e-prescribing in 2008, up to 60 percent have successfully met the Stage 1 meaningful use e-prescribing measure and 38 percent of these early users would meet the proposed Stage 2 meaningful use e-prescribing measure if it were now in effect. Also observed in the results was the increase in e-prescriptions per active e-prescriber over time. In first quarter 2008, there was an average of 49 per month. By fourth quarter 2011, the study group averaged 213 per month.In 2011, Surescripts partnered with PBMs and retail pharmacies to compare the effectiveness of e-prescriptions and paper prescriptions on first-fill medication adherence. The data showed a consistent 10 percent increase in patient first-fill medication adherence (i.e., new prescriptions that were picked up by the patient) among physicians who adopted e-prescribing technology. The analysis suggests the increase in first-fill medication adherence combined with other e-prescribing benefits could lead to between $140 billion and $240 billion in healthcare cost savings and improved health outcomes over the next 10 years.

In addition to tracking numerous measures of health IT adoption and use, the report also discusses the future of e-prescribing, the value of prescription benefit information and how industry collaboration is driving continuous improvements in electronic prescription quality. For a downloadable copy of "The National Progress Report on E-Prescribing and Interoperable Healthcare, Year 2011" go to www.surescripts.com/report.

Pennsylvania Doctors Worry Over Fracking 'Gag Rule'

From WHYY

A new law in Pennsylvania has doctors nervous.

The law grants physicians access to information about trade-secret chemicals used in natural gas drilling. Doctors say they need to know what's in those formulas in order to treat patients who may have been exposed to the chemicals.

But the new law also says that doctors can't tell anyone else � not even other doctors � what's in those formulas. It's being called the "doctor gag rule."

'I Don't Know If It's Due To Exposure'

Plastic surgeon Amy Pare practices in suburban Pittsburgh where she does reconstructive surgeries and deals with a lot of skin issues. She tells me about one case, a family who brought in a boy with strange skin lesions.

"Their son is quite ill � has had lethargy, nosebleeds," Pare says. "He's had liver damage. I don't know if it's due to exposure."

The family lived near natural gas drilling activity, and there was some concern that the boy may have been exposed to some of the chemicals being used. Producing natural gas is a pretty industrial process and gives off a lot of fumes. It uses a lot of chemicals to open wells to get the gas flowing.

Pare's first step was to figure out what chemicals the drillers were using. But that information isn't easy to get. In this case, Pare says, the patient's family had a good lawyer who helped them find out what kind of chemicals the gas company was using.

"If I don't know what [patients] have been exposed to, how do I find the antidote? We're definitely not clairvoyant," she says.

Revealing Trade Secrets ... Sort Of

Enlarge Susan Philips/WHYY

Plastic surgeon Amy Pare says it's important for doctors to know what kind of substances patients she's treating might have been exposed to.

Susan Philips/WHYY

Plastic surgeon Amy Pare says it's important for doctors to know what kind of substances patients she's treating might have been exposed to.

Pennsylvania's new law was supposed to make things easier for doctors and patients. The law, which is similar to those in Texas and Colorado, requires drillers to list the chemicals used to produce oil or gas on a public website that doctors like Pare can access.

But the website doesn't list all the chemicals used; it leaves off those considered to be trade secrets. These are ingredients that a company says it has to keep secret in order to maintain an edge over its competitors. Before the law, doctors couldn't find out what those trade-secret chemicals were. Now, they can.

But there's a catch: Doctors can get the chemical names only if they sign a confidentiality agreement and agree not to share that information. That's a move that makes doctors like Pare nervous.

"As I understand it, it's legally binding, so if 20 years from now I hiccup that someone was exposed to zippity doo dah, I'm legally liable for that," she says.

It's not even clear whether the doctor can share the trade-secret ingredient with the patient or the patient's neighbors, co-workers or primary care doctor.

'A Mountain Out Of A Molehill'?

state impact

Shale Play: Natural Gas Drilling in Pennsylvania

Ever since the law was signed earlier this year, doctors have been asking lots of questions. But authors of the law say doctors are overreacting.

"It's not to discredit those who are sincerely looking out for the health of others, but I think a mountain has been made out of a molehill," says Drew Crompton, a legislative staffer and one of the primary drafters of the law. "It's important to have disclosure, and that's what we tried to do. And I think this is coming from people who oppose the industry."

The law was modeled after a Colorado initiative, which was modeled after a federal Occupational Safety and Health Administration regulation. At a recent talk for local officials, Michael Krancer, the head of Pennsylvania's Department of Environmental Protection, defended what some are calling the "doctor gag rule."

"The 'gag order on physicians' � nothing could be further from the truth or more nonsensical than this," Krancer said. "The provisions of Act 13 are exactly like what we have already and had had in the federal system since the '70s. There's nothing new there."

But there are some differences. The federal law was designed for workers, while the new state laws cover everyone. And critics say some important parts of the federal law are missing in these state laws.

Balancing Trade Secrets And Public Health

Barry Furrow, the director of the health law program at Drexel University in Philadelphia, says writers of Pennsylvania's law made it vague.

"They've lacked definition. They haven't defined the boundaries of disclosure, so doctors are properly nervous," Furrow says. "What can they disclose to the state? What can they disclose to the community? It's just the patient and the doctor only. And this is a public health problem with toxic chemicals. It's much larger than one patient. It's going to be a community."

Explore Shale: Go deep inside the natural gas drilling process � and how it's regulated � in this interactive from Penn State Public Broadcasting.

Pennsylvania's Department of Public Health recently issued a statement assuring doctors that they would be able to share information with their patients and public health officials. But Furrow wonders how well that statement would hold up in court.

"If Halliburton decides to sue a doctor, that's quite terrifying," he says. "You have a very large, probably rather aggressive company, given its history."

Howard Frumkin, dean of the School of Public Health at the University of Washington, is an expert in treating workers who have been exposed to chemicals on the job.

"In more than two decades of practicing occupational medicine, I'll tell you how often I was able to make the right diagnosis and plan the right treatment when I didn't know what the patients were exposed to � zero times," he says.

Frumkin says companies have a legitimate right to protect trade secrets. But he says there is also a legitimate public need to know about what they may have been exposed to.

"You need to balance off those two rights," he says. "In this case, it seems the law tried to make the balance but didn't quite get it right. There are very chilling statements there that would inhibit physicians and public health officials from getting information that they need."

Some Pennsylvania lawmakers are responding to doctors' confusion. A bill has been introduced to remove the need for doctors to agree to a confidentiality agreement.

This story comes from StateImpact, a collaboration between NPR and member stations, exploring how state issues affect people's lives.

New Report: Health Care Law Saves Money for Consumers

Today, 11 million Americans buy health insurance on their own, without the help of an employer, Medicare or Medicaid. Too often, these people pay more money but get fewer benefits than people who have insurance through their employer. What�s more, people in the individual market have higher out-of-pocket costs, including larger deductibles and copays, and a lower likelihood of having prescription drug coverage.

And yet, these individuals are the ones who have been lucky enough not to have been turned away because insurance companies have denied them coverage because of health status or a pre-existing condition. The new health care law has already prohibited discriminating against children because of a pre-existing condition and prohibits the practice with respect to all Americans beginning in 2014.

A new study released today shows that the Affordable Care Act will help people in the individual health insurance market even more. In 2014, individual health insurance is likely to be more generous and more similar to employer-based coverage. And this means Americans will save money. The study compared how much people in the individual market would have saved in out-of-pocket spending alone, had the Affordable Care Act already been implemented.

It found that if adults in the individual market during 2001-08 had benefits similar to those provided under the Affordable Care Act, they would have seen:

An average annual savings of $280 in annual out-of-pocket spending for medical care and drugs,Average out-of-pocket savings of $589 for those 55-64 and $535 for those 26-64 with low incomes, respectively, andNear elimination of out-of-pocket expenses over $6,000 for all adults and a reduced likelihood of those expenses over $4,000.

This study highlights just one way the Affordable Care Act will save Americans money, and ensure they get high-quality health care.

How will this happen? Under the Affordable Care Act, there will be a new marketplace�known as Affordable Insurance Exchanges�for individuals to buy health insurance. Exchanges allow consumers to easily compare and purchase affordable, high quality health insurance and require insurance plans to compete on a level playing field. That kind of competition drives costs down for consumers. Additionally, eligible Americans purchasing coverage through Exchanges will have essential health benefits, an annual out-of-pocket limit on coverage, and access to premium tax credits � a benefit not taken into account under this study.

The Affordable Care Act makes other important changes to make the health insurance market work better for Americans. Changes include:

Getting rid of lifetime limits and phasing out annual dollar limits on most benefits,Setting a minimum medical loss ratio or 80/20 rule for insurers, generally requiring rebates if less than 80 percent of premiums are spent on health care and quality, andLowering out-of-pocket spending limits even further for low-income Americans.

For other ways the Affordable Care Act benefits Americans, visit this page.

The article, �Individual Insurance Benefits to be Available under Health Reform Would Have Cut Out-Of-Pocket Spending in 2001 - 08� is available at: http://content.healthaffairs.org/content/early/2012/05/11/hlthaff.2011.1206

Black Madam to stand trial for illegal butt injections

PHILADELPHIA(AP)�A Philadelphia woman dubbed "the Black Madam" used silicone from Thailand and Krazy Glue to perform at-home cosmetic surgery that left an exotic dancer with a plump derriere � and potentially deadly complications, the dancer testified Wednesday.

Padge Windslowe charged $1,000 to perform injections on a dining room table at "pumping parties," 23-year-old Shurkia King testified. But King suffered severe respiratory problems afterward and spent two weeks in the hospital. A doctor testified that he found silicone particles on her lungs that could have killed her.

A judge Wednesday order Windslowe, 42, to stand trial on charges that include aggravated assault, practicing medicine without a license and theft by deception.

Police believe Windslowe also injected 20-year-old London tourist Claudia Aderotimi, who died last year after a pumping party at a Philadelphia airport hotel. Aderotimi complained of chest pain and difficulty breathing following the procedure. No charges have been filed in that case as detectives await extensive autopsy test results.

King heard about the London woman's death on the news and asked Windslowe about it, King said.

"She said she didn't kill the girl, (that) she was high," King said.

Windslowe, who wore a sleek black outfit to court, did not testify at the hearing and showed little outward reaction to the testimony. She remains in jail on $750,000 bail.

Philadelphia police believe she has performed at least 14 cosmetic surgeries, moving locations to avoid detection.

King, slender and modestly dressed, described the defendant's technique in her hour-long testimony. She said she learned about Windslowe through fellow dancers. She said she thought Windslowe was a nurse.

King first had the procedure done at a friend's house on New Year's Eve. All went well, so she went back for more in February, she said. She and four others waited upstairs, while one-by-one the women went down for the five-minute injections, King testified.

King said the needles looked clean, although she found it odd that the silicone was in a water bottle. As before, she got four injections that added a cup of silicone to her buttocks. But one of the injections seemed to go in wrong, and left her leg shaking, she said.

"She (Windslowe) said, 'Just breathe. It's OK. It's OK,'" King said.

King's oxygen level was "dangerously low" when she arrived at a hospital two days later, a doctor testified. She spent about a week in intensive care and used an oxygen tank to breathe until two weeks ago, when she returned to work, the doctor and King both testified.

The silicone particles attached to her lungs are diffuse and too small to remove surgically, Dr. Arka Banerjee of Lankenau Medical Center testified.

On cross-examination, the doctor acknowledged that medical records show King to be a daily smoker and marijuana user.

A prosecutor asked if she could live a normal life.

"It's possible. If she gets an illness, maybe not," Banerjee said.

MedAptus, Intelligent Medical Objects partner for ICD-10 search

BOSTON – MedAptus, which develops charge capture technologies, has partnered with  Northbrook, Ill.-based Intelligent Medical Objects to help bring increased search capabilities to ICD-10 users.

Intelligent Medical Objects' IMO Problem (IT) search engine will be integrated in MedAptus' Professional Charge Capture solution. Offering an advanced search capability, officials say it will provide clinical users with a faster diagnosis search experience and a higher degree of accuracy when completing charge documentation using ICD-10 codes.

Intelligent Medical Objects (IMO) develops, manages and licenses medical vocabularies and software applications. As an integrated component of MedAptus, the IMO Problem (IT) offering will provide end-users with a way to search for billing diagnoses in a clinically advantageous way, MedAptus officials say. The search utilizes more than 260,000 terms expressing clinical intent while at the same time providing the correct coding for that intent.

MedAptus' Professional Charge Capture is used by provider organizations ranging from single-specialty practices to large academic medical centers. Officials say the improved ICD-10 clinical keyword brought by IMO will help enable a more simple, effective and timely charge capture process for physicians, end-users and administrative support staff.

"We've been preparing for the ICD-10 transition for several years now with particular focus on how to enhance physician usability of our product given the massive coding changes that the larger vocabulary will demand," said Ryan Secan, MD, chief medical officer of MedAptus. "We evaluated several different keyword search solutions and determined that what IMO has to offer is the best in the marketplace, the best for our end-users."

The IMO search is one of several usability enhancements that MedAptus is making to ease physician adoption of ICD-10 within Professional Charge Capture, Secan added, noting that, "customer feedback indicates that our multi-pronged approach to diagnosis code selection will provide physicians with the necessary tools for managing patient workloads and care demands while adjusting to the new coding requirements."

Choose Health Coverage Like An Economist

Enlarge ryasick/iStockphoto.com

Picking an insurance plan can be a little like this.

ryasick/iStockphoto.com

Picking an insurance plan can be a little like this.

If you want to eat well, find out where the chefs go after they clock out.

If you're wondering how to deal with a health problem, ask your doctor what she'd do for her mom.

And if you're puzzling over which insurance plan to pick, take a look at how some health economists size them up.

Clever journalist Dinah Wisenberg Brin got some big names in the world of health economics to reveal details about their insurance status. And you might learn a thing or two from their thinking.

She rounds it up in a piece for The LDI Health Economist, an online health policy magazine from Penn's Leonard Davis Institute.

 

University of Minnesota's Stephen Parente has a high-deductible plan, which left him on the hook for $400 a month to cover a brand-name drug. He found a generic at Costco for $21. Lesson: Spend some of the money you're saving on premiums with a high-deductible plan on a warehouse club.

University of Pennsylvania's Mark Pauly, a senior fellow at the Leonard Davis Institute of Health Economics, has a traditional insurance plan with the most benefits. It's the most expensive one Penn offers. He's 70 and could go with Medicare, but the private plan gives him more options and he spends pretax money on it.

Harvard's Micheal Chernew went with an HMO that has a "typical benefit structure." He figured there was no reason not to. "It was really based on our perception of the available providers," Chernew told Brin.

There's a great sidebar with useful links to sites that can help you navigate the lingo and choices of health insurance.

Health Insurers Set To Pay $1.3 Billion In Rebates

JS Callahan/tropicalpix/iStockphoto.com

Come summer, mailboxes of 1 in 3 buyers of individual health insurance buyers could get rebate checks.

If you buy your own health insurance, there's nearly a 1 in 3 chance that come this summer you'll get a nice little surprise in the mail: money back from your health insurance company.

At least that's the prediction from an analysis by the Kaiser Family Foundation.

The checks are rebates. And they're the result of a provision of the 2010 Affordable Care Act (assuming it doesn't get struck down before then by the Supreme Court).

It's called the medical loss ratio." In English, that means health insurers have to spend either 80 or 85 cents of each dollar they collect in premiums on actual medical care. That leaves, at most, 15 or 20 cents for administrative costs, marketing and profit.

 

Plans that fail to meet that standard have to return the excess to policyholders by August of the following year. The MLR rules first went into effect for calendar 2011, so the first rebates are due this summer.

When the Department of Health and Human Services issued rules for all this last November, it predicted that rebates would amount to as much as $1.4 billion. Not a bad estimate.

The Kaiser analysis, based on preliminary data from the insurance companies themselves, estimates total rebates to be around $1.3 billion. A separate survey by Goldman Sachs, reported by Bloomberg News, pegged the total at $1.2 billion.

According to Kaiser, 3.4 million people in the individual market are expected to get a rebate check, which will average $127 each. That's about 31 percent of all people who purchase their own policies. Consumers in Texas, Oklahoma, and South Carolina are most likely to get rebates.

In the small group market, about $377 million in rebates are expected to go out covering just under five million enrollees, or about 28 percent of that market. Those rebates are projected to average $76 per enrollee.

The large group market includes the smallest percentage of enrollees who can expect to share in the rebate rush � just 19 percent. But because most people are in large group plans, they account for the most money that will be rebated to the most enrollees. An estimated $541 million covering 7.5 million people. Rebates will go to the employers that purchase the policies, but they're to share them with workers. They should average $72 per enrollee.

Analysts for both the Kaiser Family Foundation (which is not affiliated with the insurance plan Kaiser Permanente) and Goldman Sachs said one reason the rebates are a bit smaller than originally projected is that insurers held down premiums to make sure they didn't have to refund money. That, of course, was the intent of the including the provision in the law in the first place.

Still, insurance industry consultant Robert Laszewski isn't impressed. "Does a $200 rebate on a $13,000 premium make health insurance any more affordable?" he asked in a blog post.

And it didn't stop Republicans from using the news to hammer on the fact that premiums have continued to climb in spite of then-candidate Obama's vow to reduce them by as much as $2,500. Obama campaign chief David Axelrod tweeted the news of the rebates earlier today with a link to a report from The Wall Street Journal no less. And the Republican National Committee tweeted in response: "Obama promised $2,500 premium savings, just another broken promise?"

Unusual Alliances Form In Nebraska's Prenatal Care Debate

Enlarge Nati Harnik/AP

Nebraska Gov. Dave Heineman vetoed a bill that would spend government funds on prenatal care to illegal immigrants. He has that service for illegal immigrants should be provided by churches and private organizations, not with taxpayer money.

Nati Harnik/AP

Nebraska Gov. Dave Heineman vetoed a bill that would spend government funds on prenatal care to illegal immigrants. He has that service for illegal immigrants should be provided by churches and private organizations, not with taxpayer money.

In Republican-dominated Nebraska, government leaders often line up together, but lately a political tornado has ripped through this orderly scene.

A political showdown over taxpayer funding of prenatal care for illegal immigrants has produced some unusual political splits and alliances in the statehouse of the Cornhusker State.

"I am extraordinarily disappointed in your support of taxpayer-funded benefits for illegal aliens," said Republican Gov. Dave Heineman as he read a letter he wrote to fellow Republican Mike Flood, speaker of Nebraska's officially nonpartisan Legislature.

Heineman was referring to a bill he subsequently vetoed that would restore publicly funded prenatal care for women in the country illegally. Until two years ago, Nebraska was one of about 15 states providing that benefit.

 

Nebraska dropped the coverage when the federal government said the state couldn't use Medicaid funds, though it offered to continue funding under another program. Heineman frames the issue as one of the benefits to illegal immigrants.

Flood, a leading abortion opponent, says pregnant illegal immigrants will ultimately give birth to babies who will be U.S. citizens. He says providing them with prenatal care is consistent with his opposition to abortion.

"If I'm going to stand up in the Legislature and protect babies at 20 weeks from abortion, and hordes of senators and citizens are going to stand behind me, and that's pro-life, then I'm going to be pro-life when it's tough, too," Flood said.

The issue has exposed a fault line between anti-illegal-immigrant sentiment and anti-abortion groups, but it's also brought together an unusual coalition. Among those supporting the bill is the politically influential Nebraska Right to Life organization.

"We don't want to distinguish that because ... of a baby's circumstances or in whose womb that baby resides that dictates whether that baby receives care or not," said Julie Schmit-Albin, the group's executive director.

Another supporter is the Nebraska Appleseed Center for Law in the Public Interest, which advocates for immigration reform and access to universal health care. Jennifer Carter, the center's public policy director, says the immigrants are our "neighbors" and should be helped.

"They're in our communities and they're helping contribute to our communities," Carter said. "So we believe providing this kind of prenatal care coverage to their children is appropriate."

Still, Heineman, backed by what Republican Party polls say is a clear majority of voters, remains adamant in his opposition, though he calls himself strongly anti-abortion.

"Most Nebraskans and I agree, we support prenatal care, but in the case of illegal immigrants, it should be done by churches, private organizations, charities, private individuals � not the use of taxpayer funds," he said.

Supporters of the bill, on both sides of the abortion debate, cite their own polls in support and say the savings from avoiding intensive care for babies born without prenatal care would outweigh the costs of the program.

With the governor turning up the political heat, the question now is whether enough legislators will vote to override the veto. That vote is scheduled for Wednesday.

White House launches 'big data' initiative

WASHINGTON – Healthcare stands to reap big rewards from the government's $200 million "big data" project, launched March 29 by the Obama Administration.

Aiming to make the most of the fast-growing volume of digital data, the Obama Administration announced a “Big Data Research and Development Initiative,” pledging to “extract knowledge and insights from large and complex collections of digital data,” to help address the nation’s most pressing challenges.

[See also: Farzad Mostashari: Man on a digital mission]

“In the same way that past federal investments in information-technology R&D led to dramatic advances in supercomputing and the creation of the Internet, the initiative we are launching today promises to transform our ability to use big data for scientific discovery, environmental and biomedical research, education and national security,” said John P. Holdren, assistant to the president and director of the White House Office of Science and Technology Policy.

To launch the initiative, six federal departments and agencies announced more than $200 million in new commitments that, together, promise to improve the tools and techniques needed to access, organize, and glean discoveries from huge volumes of digital data, officials said.

The initiative aims to:Advance state-of-the-art core technologies needed to collect, store, preserve, manage, analyze and share huge quantities of data.Harness these technologies to accelerate the pace of discovery in science and engineering, strengthen our national security, and transform teaching and learning; andExpand the workforce needed to develop and use big data technologies.

[See also: Gartner looks beyond 2012, sees big changes for payers, providers]

Holdren said the initiative is in response to the President’s Council of Advisors on Science and Technology, which last year concluded that the federal government is under-investing in technologies related to big data. In response, OSTP launched a senior steering group on big data to coordinate and expand the government’s investments in this area.

The first wave of agency commitments to support the initiative include:National Science Foundation and the National Institutes of Health – "Core Techniques and Technologies for Advancing Big Data Science & Engineering." NIH is particularly interested in imaging, molecular, cellular, electrophysiological, chemical, behavioral, epidemiological, clinical and other data sets related to health and disease.National Science Foundation – In addition to funding the big data solicitation, and keeping with its focus on basic research, NSF is implementing a comprehensive, long-term strategy that includes new methods to derive knowledge from data; infrastructure to manage, curate and serve data to communities; and new approaches to education and workforce development.National Institutes of Health – "1000 Genomes Project Data Available on Cloud." The world’s largest set of data on human genetic variation – produced by the international 1000 Genomes Project – is now freely available on the Amazon Web Services (AWS) cloud. At 200 terabytes – the equivalent of 16 million file cabinets filled with text, or more than 30,000 standard DVDs – the current 1000 Genomes Project data set is a prime example of big data, where data sets become so massive that few researchers have the computing power to make best use of them. AWS is storing the 1000 Genomes Project as a publically available data set for free and researchers only will pay for the computing services that they use.Department of Defense – "Data to Decisions." The Department of Defense is investing approximately $250 million annually (with $60 million available for new research projects) across the military departments to harness and utilize massive data in new ways and bring together sensing, perception and decision support to make truly autonomous systems that can maneuver and make decisions on their own.Department of Energy – "Scientific Discovery Through Advanced Computing." The Department of Energy will provide $25 million in funding to establish the Scalable Data Management, Analysis and Visualization (SDAV) Institute.US Geological Survey – "Big Data for Earth System Science." USGS is announcing the latest awardees for grants it issues through its John Wesley Powell Center for Analysis and Synthesis. The Center catalyzes innovative thinking in Earth system science by providing scientists a place and time for in-depth analysis, state-of-the-art computing capabilities, and collaborative tools for making sense of huge data sets.

Obama makes Daschle nomination official

CHICAGO – At a news conference Thursday, President-elect Barack Obama formally nominated former Senator Tom Daschle to be the next Secretary of the Department of Health and Human Services. He also announced that the South Dakota Democrat will lead a White House healthcare reform team.

Obama had unofficially floated Daschle's nomination on Nov. 19.

The president-elect also announced his choice of Jean Lambrew to be deputy director of HHS. A senior fellow at the Center for American Progress and an associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs at the University of Texas, Lambrew co-authored a book with Daschle titled "Critical: What We Can Do About the Health-Care Crisis."

Obama said Daschle has fresh ideas and is one of foremost healthcare experts today, bringing expertise and the ability to work across the aisle.

"He has trust from folks on every angle on this issue," Obama said. "Tom is a no drama guy" who will lead with decency, graciousness and pragmatism.

Obama said the nation faces "a time when there is so much at stake," yet fixing healthcare is one of his top priorities. "It's hard to overstate the importance of this work," he said.

The CLASS Program

There is a critical and growing need to provide long-term services and supports for people with chronic illnesses and disabilities. Help with everyday activities like dressing, bathing or taking medication can make the difference between staying in the community and going into a nursing home. Long-term care helps people remain as independent as possible, for as long as possible. It can be a literal lifeline for millions of Americans.

But long-term care is expensive and it can be difficult for people to buy insurance that will cover these costs. This means increasing numbers of Americans will be faced with leaving the workforce and spending down their life savings in order to qualify for Medicaid. The Community Living Assistance Services and Supports (CLASS) program was included in the Affordable Care Act in an effort to help Americans forced to choose between assistance and poverty gain access to affordable insurance assistance.

Some policymakers have questioned whether the CLASS program is the right way to make long-term care affordable and sustainable. The challenge of assuring the solvency of CLASS has been the subject of reports and analyses since before it became law.

Recognizing these concerns, Congress included an important safeguard in the law, written by then-Senator Judd Gregg (R-NH), that conditions implementation of the CLASS program on a determination by the Secretary of Health & Human Services (HHS) that it will be solvent over a 75-year period.

The Secretary has repeatedly said she takes this responsibility seriously and has firmly stated that she will not go forward with the CLASS program unless it is financially solvent, sustainable and consistent with the statute. Our commitment to financial solvency has driven our work on CLASS over the past 18 months.

During this time we have examined the long-term care market, conducted consumer research, modeled possible plan designs, consulted actuaries inside and outside of government, and analyzed the requirements of the CLASS statute.� We are looking at the CLASS program from every angle. We are doing our due diligence.

We recently received a report from the actuary retained by CLASS which provides the actuarial analysis of a number of potential CLASS benefit plans. This report will be included in its entirety in a comprehensive review of our work on CLASS over the last 18 months.

We are now reviewing the findings of the actuarial report in combination with the legal and policy analyses that we have undertaken as part of our careful exploration of the many aspects of operationalizing the CLASS program. Once this work is complete, HHS will issue a report along with recommendations about how to proceed. We are on target to release our comprehensive report by mid-October.

GE Healthcare given FDA clearance for new lung imaging system

NEW YORK – GE Healthcare, in partnership with Deep Breeze Ltd, which provides vibration response imaging technology, has announced that the U.S. Food and Drug Administration has granted marketing clearance for the VRIxv, a non-invasive, radiation-free lung imaging system.

Responding to the market need for bedside monitoring of lung sounds, GE Healthcare and Israel-based Deep Breeze have designed the VRIxv to display comprehensive information during the respiratory process on ventilated patients.

The VRIxv records lung sounds by using acoustic sensors brought in contact with the patient's back while lying in bed. Sophisticated software converts signals into dynamic images of the lungs with regional distribution maps, numerical representation and breathing graphs.

Each recording samples 20 seconds of lung sounds, typically covering several breath cycles. Monitoring capabilities are enhanced by synchronization of the VRIxv image and vibration energy graph with the pressure and flow waveforms sampled from the ventilator. This synchronization helps to rapidly and objectively assess the recorded image, officials said.

"GE Healthcare is helping to facilitate the next era in patient care by providing to the clinical community not only a wide range of ventilation solutions, but also advanced respiratory monitoring tools - such as the VRIxv, which provides a clinician with a window into what is happening inside the lungs in real time," said Pam Hall, general manager for the critical care segment of the respiratory and sleep business at GE Healthcare. "Our goal is to help clinicians efficiently monitor their patients' respiratory conditions and help clinicians tailor therapy to improve the outlook for every respiratory patient."

"The availability of the VRIxv device in the U.S. will allow the critical care community to effectively record and monitor the overall and regional distribution of lung sounds during the respiratory process," said R.Phillip Dellinger, MD, professor of medicine at Robert Wood Johnson Medical School and director of the critical care division at Cooper University Hospital. "The VRIxv provides the physician with measurements that reveal changes in lung sounds, including changes due to therapeutic treatment, changes due to ventilator settings or changes due to the clinical conditions in mechanically ventilated patients."

"The FDA clearance of VRIxv advances our efforts to create a new clinical paradigm in which our VRI technology will be the standard application in a broad line of clinical applications, such as monitoring the impact of ventilator settings or managing risk associated with mechanically ventilated patients." said Miki Nagler, CEO of Deep Breeze.
 

Freeing Doctors to Focus on Patients, Not Paperwork

Did you know your doctor has to spend 12 cents of every dollar she makes to hire staff just to fill out insurance forms and other paperwork?� Wouldn�t you rather she spend that time with you?

Today, the Department of Health and Human Services issued rules to simplify the mounds of paperwork that doctors, nurses, and other caregivers have to complete in order to get paid for treating you. We estimate that these changes will save our health care system $12 billion over the next 10 years.� More important, it will free caregivers to spend more time with you. We estimate these changes will give doctors back four hours a week and another five hours to their staff.

This common-sense streamlining means fewer phone calls between physicians and health plans, lower postage and paperwork cots, and fewer denied claims.� All in all, this means physicians can cut through the red tape and spend more time and money administering quality care to their patients.

Under these rules, called for by the Affordable Care Act, doctors and other health care professionals will be able to use a simple, streamlined form to ask your insurance company if you are eligible for benefits.� And a second form will be used for doctors� offices to check to the status of insurance claims they have filed. And insurers have agreed to accept these forms rather than use multiple systems.

This is only the beginning of our efforts to cut out waste and inefficiency in our health care system and free dedicated doctors, nurses, and caregivers to focus their time and efforts on keeping patients healthy, treating illness, and restoring health.� Stay tuned.

Medicare Open Enrollment: 4 Places to Look for Medicare Information

Whether it�s apple picking or Sunday afternoon football, there�s a comfort in things that happen every fall. Shorter days and cooler nights also mark the start of Medicare Open Enrollment. Between now and December 7, you can expect to hear about the choices, benefits, and lower overall costs you have when it comes to Medicare - many of them thanks to the health care law.� �

Open Enrollment is your chance to review your health care coverage and see if you need to make any changes, or if you are happy sticking with the plan you have.� The health care law extended the Open Enrollment period and made it earlier � giving you more time to make choices and giving Medicare time to process everything so your coverage starts without a hitch on January 1st.This year, you can make any changes as early as October 15.

Over the next few months, look around � you�ll find a wealth of information about your Medicare benefits .� Our Medicare Open Enrollment calendar tells you what to look for this fall, especially in these 4 everyday places:

1. �Your mailbox

Look through your mail carefully � you may get important notices from your current plan, Medicare, or Social Security about changes to your coverage or any extra help you may get paying for prescription drugs.

Also look for your Medicare & You handbook.� Like an old friend, it shows up around the same time every year. This year, it may be in your email inbox instead � if you decide to �go green� and asked to get it electronically. But whether it�s on your computer or on your bookshelf, now is the time to take it out and find out what�s new in Medicare.

You�ll also start to see brochures from companies that offer Medicare health and drug plans. Just remember, be smart about protecting your personal information and your identity � plans aren�t allowed to call or come to your home without an invitation from you.

2. �On your computer

Comparing your plan choices is important �and our Medicare Plan Finder makes it as simple as possible. Soon, you�ll be able to watch a video about how the Plan Finder works. Enter the drugs you take to find out how you can lower your costs, review a the plan�s star ratings to compare plans based on quality, and join a plan right online if you find one that meets your needs.

3. �In newspaper, newsletters, and magazines

Take a moment as you enjoy that morning coffee to read the Medicare information that�s out there.� You may find a local event � somewhere right around the corner with counselors to help you, like your State Health Insurance Assistance Program. Don�t miss the chance to get personalized help if you need it.

4. �On television and radio

At the end of one of those shorter days, as you relax in front of the television, you may see some advertisements or programming about Medicare plans and your new choices. You might also hear some advertisements on your way to or from work as you listen to the radio.

Now is the time to enjoy the choice and control you have over your health care coverage. Just like fall, Medicare Open Enrollment only comes once a year.

Note: This blog also appeared on The Medicare Blog.