By Jay Hancock
KHN Staff Writer
Originally published January 13, 2013
Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.
But consumers may not have as much skin in the game as experts thought, new government figures show.
Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.
"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."
True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.
But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.
The entire article is here.
Saturday, January 26, 2013
Friday, January 25, 2013
Contracts Awarded Despite Inquiry
By Colleen Heild
Journal Investigative Reporter
Originally published on Jan 13, 2013
First of two parts
A Roswell, N.M.-based psychiatric services firm landed state Department of Health contracts that allow charges of up to $2,000 a day, even though it was under investigation for alleged Medicaid fraud at another state agency.
The contracts between the Department of Health and New Mexico Psychiatric Services signed last summer permit the company to bill up to $623,900 to provide on-call or temporary services to state-run health facilities.
They include the Sequoyah Adolescent Treatment Center in Albuquerque, a 36-bed residential treatment center for violent and mentally ill youth.
At the time the contacts were awarded last year, the company was facing allegations of Medicaid billing fraud at the state Human Services Department. Its payments for services for HSD have been suspended pending the outcome of the inquiry.
A top health department official said in an interview last month that he didn’t know New Mexico Psychiatric Services was under investigation at the time he helped evaluate proposals for the so-called “locum tenens” psychiatric services last April.
But in a follow-up response last week, the agency’s spokesman said others in the agency did know and the inquiry by the state Attorney General’s Office wasn’t a “determinative” factor.
DOH spokesman Kenny C. Vigil told the Journal that the president of New Mexico Psychiatric Services, Dr. Babak Mirin, made a “self disclosure” about the investigation before any contracts were signed last year.
Asked whom Mirin had informed at the DOH and when, Vigil responded: “I don’t have that information.”
The Department of Health and the Human Services Department are separate state agencies, albeit with some overlapping missions involving assistance to New Mexicans.
The Human Services Department, which administers behavioral health services, notified New Mexico Psychiatric Services nearly a year ago of the billing fraud inquiry by the AG’s Medicaid Fraud Control Unit.
Mirin’s attorney, David H. Johnson, told the Journal in an email last week that the company has been cooperating with the AG’s investigation “and is committed to the repayment of any overpayments that it may have received.
“At this point there has only been an allegation of billing fraud,” Johnson’s email stated. “Fraud has not been established.”
The entire story is here.
Thursday, January 24, 2013
New Israeli law banning underweight models goes into effect, aims to prevent eating disorders
The Associated Press
Originally published January 11, 2013
When Margaux Stelman began modeling a few months ago, she always had her sister Aline in mind.
Aline was an ex-model who died three years ago after a long battle with anorexia, a common affliction of models trying to look thinner and thinner — and girls trying to look like them.
Now, thanks to a new Israeli law that prohibits the employment of underweight fashion models, Stelman says she feels protected from the traditional pressures of an industry notorious for encouraging extremes in thinness. The law sets weight minimums with the aim of discouraging anorexia and bulimia, eating disorders that affect mostly young women, who go on extreme diets and are unable to eat normally.
"This disease is something that's very close to me," the 21-year-old university student from Belgium said at a recent photo shoot, the country's first since the law took effect last week. "Doing the exact opposite, showing girls that (they) can be healthy and be a model anyway, it's really something I want to show."
The Israeli law, passed by parliament last year, is the first of its kind. The United States and England have guidelines, but their fashion industry is self-regulated. Other governments have taken steps to prevent "size zero" medical problems but have shied away from legislation.
Israel, like other countries, is obsessed by models. International supermodel Bar Refaeli is considered a national hero. Refaeli, an Israeli who has graced the cover of the Sports Illustrated swimsuit edition, among others, is not unnaturally thin.
The entire story is here.
Originally published January 11, 2013
When Margaux Stelman began modeling a few months ago, she always had her sister Aline in mind.
Aline was an ex-model who died three years ago after a long battle with anorexia, a common affliction of models trying to look thinner and thinner — and girls trying to look like them.
Now, thanks to a new Israeli law that prohibits the employment of underweight fashion models, Stelman says she feels protected from the traditional pressures of an industry notorious for encouraging extremes in thinness. The law sets weight minimums with the aim of discouraging anorexia and bulimia, eating disorders that affect mostly young women, who go on extreme diets and are unable to eat normally.
"This disease is something that's very close to me," the 21-year-old university student from Belgium said at a recent photo shoot, the country's first since the law took effect last week. "Doing the exact opposite, showing girls that (they) can be healthy and be a model anyway, it's really something I want to show."
The Israeli law, passed by parliament last year, is the first of its kind. The United States and England have guidelines, but their fashion industry is self-regulated. Other governments have taken steps to prevent "size zero" medical problems but have shied away from legislation.
Israel, like other countries, is obsessed by models. International supermodel Bar Refaeli is considered a national hero. Refaeli, an Israeli who has graced the cover of the Sports Illustrated swimsuit edition, among others, is not unnaturally thin.
The entire story is here.
Wednesday, January 23, 2013
Tending to Veterans’ Afflictions of the Soul
By Samuel J. Freedman
The New York Times
Originally published January 13, 2013
Here are some excerpts:
Moral injury might best be defined as an affliction of the soul, as distinct from a specific mental health condition like post-traumatic stress disorder. It arises, to speak in a very broad way, from the way a combatant’s actions in war seem to violate and thus undermine the most deeply held moral beliefs.
Ms. Brock did not formulate the concept of moral injury, which is attributed to the clinical psychiatrist Jonathan Shay. In books like “Achilles in Vietnam,” Dr. Shay has traced moral injury back as far as the Trojan War. But for Ms. Brock and her colleagues, the kind of counterinsurgency wars America has fought in Iraq and Afghanistan has left soldiers uniquely vulnerable to moral injury.
“There’s no good choice,” she said. “If you’re looking at a kid on the side of the road with something in his hand, if it’s a grenade and he throws it and kills someone in your unit, you’ve failed your comrade. But if it’s a rock, you’ve just shot a kid with a rock.
“If you’re praying that your company gets out or that your best friend isn’t shot, and it doesn’t turn out that way, it can collapse your whole moral system. It feels like God abandoned you.”
Her description closely matched that of Michael Yandell, 28, a student at the Brite seminary who worked on a bomb disposal team during the Iraq war. “Most deeply, it’s a loss of confidence in one’s own ability to make a moral judgment with any certainty,” he said. “It’s not that you lose your ability to tell right from wrong, but things don’t seem so clear any more. For me, it’s whether or not what I did, did any good.”
Ms. Brock’s affinity for veterans, and her knowledge of their suffering, has long, deep roots. Her father, Roy Brock, was taken prisoner during World War II and underwent electroshock treatments after liberation for his psychological distress. He later served two tours in Vietnam as a medic, enduring the deaths not only of countless soldiers but the local translator he had befriended.
The entire story is here.
Tuesday, January 22, 2013
Building a Space for Calm
By ROGER S. ULRICH
The New York Times
Published: January 11, 2013
Here are some excerprts:
Efforts to reduce violence in psychiatric hospitals have focused on identifying potentially aggressive patients through clinical histories and improving staff training and care procedures. But these approaches, while worthy, are clearly not enough. While definitive numbers are hard to come by, the incidence of violence in care facilities appears to be going up.
Research suggests, however, that there’s an effective solution that has largely been overlooked: designing hospital spaces that can reduce human aggression — to calm emotionally troubled patients through architecture.
Currently, questions about design at psychiatric care facilities are viewed through the prism of security. How many guard and isolation rooms are needed? Where should we put locked doors and alarms? But architecture can — and should — play a much larger role in patient safety and care.
One prominent goal of facility design, for example, should be to reduce stress, which often leads to aggression.
For patients, the stress of mental illness itself can be intensified by the trauma of being confined for weeks in a locked ward. A care facility that’s also noisy, lacks privacy and hinders communication between staff and patients is sure to increase that trauma. Likewise, architectural designs that minimize noise and crowding, enhance patients’ coping and sense of control, and offer calming distractions can reduce trauma.
Thanks to decades of study on the design of apartments, prisons, cardiac intensive care units and offices, environmental psychologists now have a clear understanding of the architectural features that can achieve the latter — and few of these elements, if incorporated into a hospital design from the outset, significantly raise the cost of construction.
Providing day rooms and other shared spaces with movable seating, for example, gives patients the ability to control their personal space and interactions with others. Sound-absorbing surfaces reduce noise (and stress), as do designs that offer more natural light.
Some features, like single-patient bedrooms with private toilets, do increase the building cost — but that is arguably offset by the reduced trauma for patients and hospital workers. Violence, after all, isn’t just a danger to well-being, its effects — from medical care to lawsuits — are frequently expensive, too.
The entire story is here.
Thanks to Gary Schoener for this story.
There is more to end-of-life practices than euthanasia — Authors' reply
The Lancet
Volume 381, Issue 9862, Pages 202-203
Bregje Onwuteaka-Philipsen, Arianne Brinkman-Stoppelenburg, Hans van Delden, Anges van der Heide
We agree with Jan Schildmann and Eva Schildmann that the debate on end-of-life practices should not be limited to euthanasia. We also agree that increased attention to palliative care does not necessarily result in good quality end-of-life care. Our study gives an insight into end-of-life decision making and end-of-life acts, but not into the quality of end-of-life care. Additionally, what good quality end-of-life care consists of is not that straightforward. This is certainly true for palliative sedation. Although there is an increasing body of published studies on this subject, there are controversies on terminology and ethical acceptability of the practice. Guidelines are a way to try to overcome this and to improve quality of care. Yet there are many different guidelines—eg, at the institutional level and in different countries—and the premises of national guidelines can be the subject of debate. In our opinion, the role of empirical studies such as ours is to underpin the ongoing debate with information about what occurs in practice.
We declare that we have no conflicts of interest.
doi:10.1016/S0140-6736(13)60087-2
Volume 381, Issue 9862, Pages 202-203
Bregje Onwuteaka-Philipsen, Arianne Brinkman-Stoppelenburg, Hans van Delden, Anges van der Heide
We agree with Jan Schildmann and Eva Schildmann that the debate on end-of-life practices should not be limited to euthanasia. We also agree that increased attention to palliative care does not necessarily result in good quality end-of-life care. Our study gives an insight into end-of-life decision making and end-of-life acts, but not into the quality of end-of-life care. Additionally, what good quality end-of-life care consists of is not that straightforward. This is certainly true for palliative sedation. Although there is an increasing body of published studies on this subject, there are controversies on terminology and ethical acceptability of the practice. Guidelines are a way to try to overcome this and to improve quality of care. Yet there are many different guidelines—eg, at the institutional level and in different countries—and the premises of national guidelines can be the subject of debate. In our opinion, the role of empirical studies such as ours is to underpin the ongoing debate with information about what occurs in practice.
We declare that we have no conflicts of interest.
doi:10.1016/S0140-6736(13)60087-2
Monday, January 21, 2013
U.S. could save $2 trillion on health costs - study
By David Morgan
Reuters
Originally published January 10, 2012
The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.
Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.
Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.
But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.
"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.
The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.
The entire article is here.
Reuters
Originally published January 10, 2012
The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.
Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.
Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.
But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.
"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.
The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.
The entire article is here.
Wealth but not health in the USA
The Lancet
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Sunday, January 20, 2013
Suspect in Killings Is Deemed Not Fit
By THE ASSOCIATED PRESS
Published: January 7, 2013
A judge ruled on Monday that a man accused of killing seven people at a small Christian college in Oakland is not mentally fit for trial.
Judge Carrie Panetta of Alameda County Superior Court temporarily suspended the case against One L. Goh after two psychiatric evaluations concluded that he had paranoid schizophrenia.
David Klaus, an Alameda County assistant public defender, said after Monday’s hearing that Mr. Goh’s condition causes him to have hallucinations and delusions and to distrust people, including those trying to help him. Mr. Goh’s lawyers have trouble talking to him, Mr. Klaus said.
The rest of the story is here.
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