Archive for the ‘Health Care Reform’ Category

Jump In The Pool

March 11, 2018

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Health insurance. The topic is enough to make anyone anxious—and rightfully so. The United States’ health care system is the most expensive in the world, averaging $10,348 spent per person per year. With the linkage of health insurance to employment and no publically-financed universal option, Americans are fractured into smaller and smaller coverage pools.

As a result, employee health insurance benefits are a significant portion of health spending. The State of Maryland is no exception. In 2017, the State spent $1.6 billion on state employee health insurance benefits alone. As of 2016, Maryland pays $9,745 for each active state employee’s health insurance benefits.

The State must share the costs and risks. The larger the insurance pool, the greater the spread. Therefore, Maryland should expand its state employee health insurance pool as a means to lower employee benefit costs for public employers.

In fact, statutes already exist in the Maryland Code enabling consortium health insurance purchasing for county, local government, and select non-profit employees who opt into the state pool. However, this legislation has not been maximally leveraged to reduce healthcare costs since few entities have joined in. Furthermore, Maryland’s 100,000 public-school employees are currently in their own independent plans negotiated by the teachers’ unions. Legislation to include them as part of the state-wide insurance pool should be a priority.

By amending the law to include all 501(c)(3) non-profits, Maryland can take advantage of the its unique non-profit landscape. Over 260,000 Marylanders are employed by non-profits representing 11% of the state’s workforce. Of the 32,000 registered Maryland non-profits, half are estimated to employ 50 full-time staff or less. Because of their limited beneficiaries, these non-profits could benefit the most from opting into the state pool.

Maryland should expand its state employee health insurance pool as a means to lower employee benefit costs for public employers. To this end, stakeholders should adopt the following recommendations:

  • The General Assembly should amend Maryland Code to include all 501(c)(3) non-profit organizations
  • County and local governments should take advantage of existing statutes allowing consortium health insurance purchasing by the State
  • With enabling legislation, Maryland public school employees should opt into the State employee insurance pool

 

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Drug Dependence in Pennsylvania: Regulating Opioid Prescribing Practices

March 11, 2018

graphic-drugabuse_xxThe Department of Health and Human Services (HHS) declared opioid addiction a public health emergency within theUnited States during 2017. Opioid-related overdose deaths have steadily climbed over the past decade with more than 40,000 deaths reported in 2016, five times that seen only a decade prior. The problem arose in the late 1990’s when the prescribing rate of opioid pain relievers increased, with little thought to the devastating effects it would have in leaving patients addicted and dependent on opioids, inciting the nationwide opioid epidemic we currently face.

Evidence from 2016 showed that Pennsylvania fell into the top 5 states with the highest rates of death due to drug overdose, with a rate of 37.9 per 100,000. The state should enact policy addressing opioid addiction. To implement rapid change, the length of time that opioid prescriptions are written for should be reduced to decrease potential of dependence. The prescription of opioids for an acute pain may lead to long term use, and the probability of long term use increases with the length of the initial prescription,4 with the probability spiking after the 3rd and 5th days, and then again on the 31st day. Many states have enacted legislation to change the way pain is being treated, to adopt alternate methods for pain control, set dosing limits, and most importantly, limit first time opioid prescriptions to a set number of days. Currently, Pennsylvania is set at 14 days limit of a first-time supply for an acute problem (excluding cancer care, palliative care and long-term use). Policies should focus on a reducing prescription length from 14 to 3- 5 days, to minimize risk of opioid dependence.

 

 

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In order to prevent the crisis in Pennsylvania from getting worse, it is crucial that state policy-makers collaborate with pharmaceutical companies, doctors, and patients to incorporate preventative solutions into drug-related policies and regulations. One way to address this is to reduce the number of days doctors can prescribe opioids to non-cancer and non- palliative patients from 2 weeks to 3-5 days in the coming year.

 

Covering a molecular targeting drug for lung cancer highlighted the problem of continuity of the universal public health insurance in Japan.

March 11, 2018

There has been a continuous discussion about the price of a new molecular targeting drug for lung cancer, which is the leading cause of cancer death in Japan. When the drug was introduced, the price was over $300,000 per person per year.

In Japan, the universal public health insurance has helped people access to good clinical practice without the need of patience. Through the system, people can receive medical examinations by paying thirty percent of the whole expense. Seniors over seventy-five years of age are to pay ten percent with a few exceptions. Furthermore, regardless of the entire cost, when a specific condition is satisfied, the maximum amount of money they should pay per year would be below $20,000 per year at most. The rest of the money is to be paid by insurers. The molecular targeting drug for lung cancer is no exception.

While this system is thought to contribute to building a society of longevity, some people are worried that it will finally face a crisis of existence in the near future, because of an increase in a burden of treatment cost resulted from an aging population and advance in medicine.

 With the price of the drug mentioned above, a doctor posed a problem that extremely costly medicines would affect the continuity of the universal public health insurance, and the mass media also picked up this issue. Although Pharmaceutical Manufacturers Association took an opposing position, a council of Ministry of Health, Labour and Welfare, which decided the price of medicines declared that drugs which met some criteria should be brought down the price. As a result, the cost of the prescription for lung cancer was reduced by half, and now an additional reduction in price is planned.      

In order to maintain our insurance system and prevent the bankruptcy, this countermeasure should be supported. However, the administration needs to consider not only a first-aid treatment but also how to maintain the insurance system from various angles regarding health continuously. 

PrEP (HIV pre-exposure prophylaxis): reducing the high burden of HIV among young black men who have sex with men

March 11, 2018

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In the United States, the most vulnerable group to acquire HIV is black men who have sex with men (MSM), either gay or bisexual men. There is a concentrated epidemic in this group. Among black men who have sex with men, the age range of 13 to 24 years old is the most affected group. In 2015, 38% of newly diagnosed HIV patients were young black MSM; an increase of 87% between 2005 to 2014. This is mainly attributed to a lack of equitable access to medical care and health education.

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The HIV pre-exposure prophylaxis, best known as PrEP, is a daily pill treatment that is highly effective in preventing the transmission of HIV in groups with high-risk behaviors to contract HIV, such as MSM.

Implementation of PrEP programs for populations with the highest incidence is critical to reducing new infections in the United States. Truvada, the brand name of the PrEP pill, contains two medicines (tenofovir and emtricitabine), and it prevents the establishment of a permanent infection after exposure to HIV through sex.

Now, we have the power to treat HIV-uninfected people and prevent an HIV infection from ever occuring.

There are many challenges of access to PrEP, such as accessibility to healthcare, medication affordability, lack of PrEP information, stigma and discrimination.
According to specialists in Public Health at the Washington University in St. Louis, the access to a health provider who is aware of PrEP treatment and is willing to prescribe it is key for its uptake and adherence. However, this is a huge barrier in Medicaid non-expansion states.

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Although multi-level interventions are needed to increase PrEP access like awareness and affordability, the reduction of the HIV transmission among the most vulnerable group in the US, young black MSM, can be achieved if accessibility to healthcare is increased.

So, the expansion of Medicaid is critical to reaching this goal and it can be accomplished if enough social pressure is applied to convince the governors and state legislators that this is the right path to take. Ultimately, to put an end on the disproportionate burden by HIV that young black MSM are under in the US.

It is time to say NO to this inequality in healthcare and bring the transmission of HIV among young black MSM to ZERO!

How can you give your support?

  1. Contact your state governor and let h/she knows you support the Medicaid expansion!
  2. Contact your state legislator and let h/she knows you support the Medicaid expansion!

Why 21 to Purchase Tobacco Products?

March 11, 2018

The Master Settlement Agreement of 1999 imposed major restrictions on tobacco industries, proved to be a victory for public health workers in the United States and their efforts in tackling the tobacco epidemic.

However, the rise of the use of electronic cigarettes prove to be yet another strategy with tobacco companies in promoting tobacco use. The NIH defines electronic cigarettes, or e-cigs, as battery operated devices that contain aerosol flavorings and other chemicals that mixes with health, producing a vapor.

Due to its’ lack of long term consequences and it’s gateway to adult smoking, I support the bill for increasing tobacco sales from 18 to 21 years old in Washington state.

According to Washington21, 17, 800 Washington kids try smoking for the first time each year, 3, 900 kids become daily smokers with a third of them dying prematurely. The marketing of flavors for electronic cigarettes makes this product more appealing, with majority of teens not knowing exactly what is even in these e-cigs which makes e-cigs all the more dangerous in this population. The IOM Report in 2013 reported that there would be a 25% reduction in 15-17 year olds smoking tobacco and a 10% decrease in smoking related deaths if the age was raised to 21.

Like the effects of increasing the drinking age to 21, I believe that we would see similar effects when raising the age of 21 in purchasing tobacco in Washington, including e-cigs. By supporting the Washington21 campaign we are able to prevent further use of tobacco products among teens and also reduce health related tobacco issues such as cardiovascular/lung diseases, and cancer Participating in advocacy campaigns will also help with providing advocacy tools that can be used at your own state to enact policies to save lives.

On March 8, 2018, Washington house has passed SB 6048  raising the age to buy tobacco products to 21.Given this victory, it is promising that Washington state’s bill will hopefully pass the Washington senate! To support this cause and to protect the health of the youth, contact your district legislator and vote for Tobacco 21!

Could Biology Explain Racial Health Inequalities?

March 10, 2018

The consistently greater risk for infections and cancer among men of African ancestry compared to all other ethnic groups in the world suggests fundamental biologic causes that supersede social and geographic influences. One of the most popular arguments for the notion that race is a “social construct” is derived from the point made by the geneticist Richard Lewontin, to the effect that intra-racial genetic similarity among individuals classed within any given “race” typically accounts for only about 7% of genetic similarity. Lewontin concluded from this that racial classification is “meaningless.” While his data concerning intra-racial vs. interracial genetic similarity were correct, the inference from this data that racial classification is meaningless is widely referred to by evolutionary biologists today as “Lewontin’s fallacy.” Indeed, 7% of the genetic material consists of several thousand genetic loci, which is quite an impressive amount of genetic material.

Random studies have found higher Testosterone levels in African American men and higher Testosterone and Estrogen levels among African American women together with low Dehydroepiandrosterone levels (DHEA) compared to their racial counterparts, could explain the health inequality. DHEA levels decrease with old age and low levels are said to reduce body’s immunity against diseases increase the risk for infections and cancer; DHEA levels have been found to be particularly low in African Americans, increasing their vulnerability to diseases. This understanding is key to prioritizing health services to this community. We need policies to address early childhood education including health education; access to healthy food and eating right, and performing work and out of work activities according to your biological capabilities. We need to help people understand their biology and how it affects their health and behaviour and they can take advantage of their differences.racial differences

I advocate for health education and services to reach out to African American communities in their homes, work, schools, and churches. Early screening of African American women, for Breast cancer, Endometrial cancer, and Ovarian cancer and earlier screening of Lung cancer Prostate cancer and other common cancers among African American men; after reaching the age 40.

Featured picture by KANGSTAR

Where Have All the Medicare Doctors Gone – When Will Medicare Ever Learn – When Will They Ever Learn?

March 9, 2018

In 2017, CMS began requiring all eligible clinicians to comply with burdensome quality reporting requirements to receive Medicare reimbursements.  The requirements stemmed from the legislation for merit-based payments  MIPS-MACRA.  Many clinicians complained about the burdens associated with reporting but more importantly clinicians, especially small and specialty practices, complained that the measures that are available for reporting are meaningless and small clinician practices and specialties are considering dropping Medicare patients.

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One doctor’s painful letter about no longer being able to take care of Medicare patients struck a note for many patients and providers My Dear Medicare Patients.

 

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DON’T TURN MY DAD AWAY!

In trying to address the problem, CMS included additional exclusion criteria so that some small practices would not have to report.  However, the answer is not to find ways to eliminate clinicians from the program but rather make it less burdensome and more meaningful so that they can participate – especially since many reports show small practices can provide same or better quality of care to patients National StudyCan Small Physician Practices Survive.  A better solution is for CMS to facilitate and incent collaboration across clinical communities to begin identifying more meaningful measures and remove barriers related to additional measure endorsement requirements NQF.

Medical societies and trade associations are key stakeholders, especially those that represent family practices AAFP.  Some specialty providers are already working with their specialty providers to begin identifying these more meaningful measures American College of Rheumatology.   Patients are also a critical stakeholder who stand to lose access to care, as well as major patient advocacy groups such as AARP and PAF.  However, EHR and Health IT providers stand to gain a lot of money from providers by charging for additional services to support clinician quality reporting.

Actionable Next Steps

If you are a clinician ask your medical society to provide feedback to CMS at QPP urging them to incentivize medical societies and associations to work with their providers to identify meaningful measures.

If you are a patient or caregiver, let your clinician know what is meaningful to you for tracking quality of care.

 

 

Physician Burnout: The Next Public Health Crisis

August 20, 2017

Healthcare reform has led to an alarming prevalence of physician burnout in the United States. The increased workload, productivity demands, reduced autonomy, and overburdening administrative tasks for physicians have led to feelings of emotional exhaustion, depersonalization, reduced personal achievement, and decreased effectiveness. As a result, there are higher rates of job dissatisfaction, cynicism/apathy, absenteeism, depression, suicide, and substance abuse. A recent Mayo Clinic study revealed that 54.4% of physicians, spanning all specialties, reported burnout in 2014, compared with 45.5% in 2011.

Physician burnout has negative impacts on the healthcare system. It leads to reduced quality of care, poor patient satisfaction ratings, increased medical errors, decreased patient safety, decreased productivity, and increased healthcare costs. This decline profoundly impacts the doctor-patient relationship.

Since demand for physicians is outpacing supply, AMA estimates a shortage of up to 90,000 physicians by 2025. The viability of the healthcare system is at stake when physicians retire early, reduce clinical work, or leave the profession, thereby further reducing the workforce. The cost to replace a physician leaving clinical practice is up to $1 million, depending on specialty.

In pursuing improved population health, enhanced patient care experiences and reduced costs, institutions neglected the front-line people who bear these burdens. Despite being crucial to the health care industry, physicians are the forgotten patients. Physician burnout is becoming a public health crisis. Given the scope of the problem, national, state, and local healthcare organization leaders must focus on addressing this problem now, before it’s too late. Physician burnout equates to physician abuse. It is imperative that the healthcare industry culture change to value physician well-being over profits. To achieve high quality and affordable health care, a symbiotic relationship must exist between those who provide and those who seek care. Everyone must help to stop this impending train wreck from becoming a national health crisis.

 

We’re Doing it Wrong: Chronic Care in America

August 20, 2017

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Americans are chronically ill.  The prevalence of chronic conditions in America is trending to be 1 in every 2 persons by 2030. We all know people with chronic conditions and it is safe to say that they suffer from worse quality of life. Unfortunately, our healthcare system is ill-equipped to meet the needs of those with chronic diseases. But there are ways to change that.

The majority of Americans on Medicare are chronically ill and they have to pay a co-pay every time they interact with their physician. Every. Single. Time. It’s annoying enough to pay for that yearly physical (which we should all do and by the way; Medicare pays for it). How about paying every month for hypertension management? Or being required to schedule a timely face-to-face visit with your provider to discuss the blood pressures you’ve been checking yourself? Still have to pay. And the reality is many of us can’t.

Is it all down to the greedy physicians? Unfortunately, it’s not that simple. Providing care to medically complex, chronically ill adults is burdensome and time-consuming. Primary care providers are already under-compensated for the work they do – and the lack of incentive for a team based approach is causing physician burn-out.

So what’s the solution? One might be to invest in Comprehensive Primary Care programs that promote chronic care management. These programs can provide special services to patients that give them more access to their provider’s health team. By eliminating patient co-pays, CPC programs actually improve patient satisfaction and lower the cost of healthcare.

For providers, funding for these programs allows for investment in the infrastructure needed to provide a team based approach to chronic care. Oh yeah – and the fee schedule adjustments allow them to be fairly compensated for all their labors.

Here’s the kicker – the CPC models actually costs Medicare less than traditional fee-for-service models. So you know the drill – call your congressperson and tell him/her that you support funding for Comprehensive Primary Care programs.

Regulation by Florida of Cancer Treatment Costs for Medicare Beneficiaries

August 20, 2017

Cancer comes with one of the costliest medical expenses. Doctors often diagnose individuals 65+ years old with new cancers, so Medicare and its beneficiaries must pay for the high treatment costs. Medicare requires high-cost sharing among its beneficiaries, which leads to financial distress for example bankruptcy. Florida has one of the largest populations of senior citizens (19.9%), two million of which are Medicare beneficiaries. The high out-of-pocket burden from cancer treatment costs leads Medicare beneficiaries towards decreased medication adherence or medical care postponement. Overall, beneficiaries have poorer cancer treatment outcomes compared to privately insured individuals.

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Photo from: NCI Visuals Online

The Florida Department of Health, along with Gov. Rick Scott, should negotiate cancer treatment costs at quality cancer centers in Florida, such as Moffitt Cancer Center, and with pharmaceutical companies like Bristol-Myers Squibb to reduce out-of-pocket expenses for Medicare beneficiaries. The Florida Department of Health should place caps on cancer treatment costs to maintain them at reasonable prices. This political action would test whether cancer treatment cost negotiations at the state level are more effective than federal level negotiations. Biomedical companies can flexibly negotiate cancer treatment prices based on prevalences and morbidities in distinct states.

Florida’s House will not expand Medicaid health insurance coverage, and pharmaceutical companies refuse to negotiate drug prices for Medicare beneficiaries. Placing treatment cost negotiations and caps in the state’s health department’s hands may reduce Medicare beneficiaries’ substantial out-of-pocket cancer treatment expenses. Cancer incidence and morbidity has declined. However, cancer treatment costs and Medicare spending have only risen and are expected to continue growing.

Besides other factors that affect cancer treatment like transportation costs, psychosocial stressors, and reduced quality of life, add stress to a patient’s cancer care experience despite the financial resources provided by organizations like the American Cancer Society.