Archive for the ‘Healthcare’ Category
Using evidence to determine the fate of legislation! What an innovative and potentially fruitful idea!
Irin Carmon reports at MSNBC:
EUREKA, Calif. – It did not look particularly like a history-making day in the Redwoods. The jars of condoms and the pinned-up primer on the HPV vaccine at the Six Rivers Planned Parenthood were undisturbed, and the waiting room was no more taxed than any other Saturday. The usual lone protester, loosely referred to as “the pastor,” had come early, before the clinic even opened, and gone home.
But inside the employee kitchen, there was proof of something special about this January morning, days after the anniversary of Roe v. Wade. “Well-behaved women rarely make history,” read a note affixed to some irises. “Today we make history!!!” Another card thanked one nurse practitioner by name for “blazing the trail.”
Thanks to a law passed last year, California is actually adding abortion providers – nearly fifty nurse practitioners, nurse midwives, and physicians’ assistants, trained to provide aspiration abortions in the first trimester –with more to come.
The state is bucking a nationwide trend as a wave of new restrictions is forcing abortion providers across the country to shut their doors. In Texas, the second-largest state after California, initial enforcement of a law passed last year initially put a third of the clinics of the state out of commission, and when new regulations go into effect in September, all but a half-dozen clinics are expected to close.
Meanwhile, in California, a Eureka nurse practitioner – who worried about the safety of being named in the press – had just officially become one of the new providers of vaccuum aspiration abortion, the most common procedure.
“I am used to being in a place where we are talking about all the options for birth control and for pregnancy,” she said simply. “It was just a no-brainer, a logical next step.”
The fact that it was an ordinary day – boring, even – was the whole point. The most radical move of all wasn’t just passing a law to expand abortion access. It was treating the termination of a pregnancy like any other medical procedure, and seeing if that changed women’s lives.
“I don’t really see the need for this bill here,” said Assemblyman Don Wagner, an Orange County Republican, at a committee hearing last April for AB154, which would eventually make the nurse practitioner’s day possible. He wondered why there were no women testifying that they had been unable to access an abortion.
“Where is the evidence that there are underserved populations out there?” Wagner asked.
Evidence was something of a magic word to Tracy Weitz, testifying that day in her capacity as a medical sociologist at the University of California, San Francisco. Weitz had overseen a massive peer-reviewed study, published in the American Journal of Public Health, that had trained the Eureka nurse practitioner and dozens of other advanced-practice clinicians on providing aspiration abortions. Armed with a waiver from the state, the study set out to determine whether such clinicians could provide early aspiration abortions as safely as physicians. Eleven thousand abortions later, there was no meaningful difference.
Weitz doesn’t perform abortions, but her colleagues at San Francisco General Hospital do, and they specialize in later ones. And over the years, they’d noticed something.
“We were serving an extraordinarily high number of women later in gestation who were coming from throughout California,” Weitz told Wagner.
The later in pregnancy an abortion occurs, the more expensive it is. And though abortion remains an extremely low-risk procedure – the study had actually shown it was even safer than previously believed – complications rise too. Someone who doesn’t want to be pregnant anymore likely isn’t interested in drawing out the process, either.
“When you talk about, where’s the evidence of lack of access,” Weitz continued, “it’s in the disparity in the number of low-income women geographically located in [remote areas]…who do not access their abortion until later in the second trimester.”
In other words, lifting the barriers would make it easier for women to get abortions earlier in pregnancy. . .
In other news, Michael Meved spoke at the conservative CPAC conference to say, ““There has never been a state in this country that has ever banned gay marriage. That is a liberal lie.”
For the record, this article lists 30 states that have banned same-sex marriage.
I think perhaps Mr. Medved was going for the Big Lie, but picked one a little too big: instead of a size 2 or 3, he went for size 8, and it was just too big to fly (cf. elephants, symbol of the GOP).
Ian Millhiser notes at ThinkProgress:
A company called Marijuana Doctors, which connects medical marijuana patients with doctors who can prescribe the drug, claims that it is airing what it claims is the “first ever marijuana commercial on a ‘Major Network.’” The ad, which “draws a parallel between a ‘shady’ street dealer attempting to push ‘unsafe’ sushi to unsuspecting buyers, and medical marijuana patients being forced to obtain their medication in a similar fashion,” airs in New Jersey on several national networks — including A&E, Fox, CNN, Comedy Central, Food Network and the History Channel. . .
Although medical marijuana is legal in New Jersey — the state started issuing medical marijuana identification cards in 2012 — adult patients currently have greater access to the drug than children. Indeed, one family recently decided to move from New Jersey to Colorado to ensure their daughter would have access to the liquefied marijuana she uses to stave off potentially fatal seizures. Child marijuana patients in New Jersey are technically allowed to access edible marijuana, but marijuana in this form isn’t generally available at New Jersey dispensaries.
Gov. Chris Christie (R-NJ) recently rejected a bill that would have permitted families in a similar situation to buy marijuana in other states and transport it home to New Jersey.
Certainly not the patients. Tara Culp-Pressler writes at ThinkProgress:
Brian and Meghan Wilson don’t want to leave their home state of New Jersey. They would prefer to remain near their families and friends — and they want their two-year-old daughter to be able to keep seeing her nationally renowned neurologist, who’s an expert at treating her rare form of epilepsy.
But, since progress on New Jersey’s medical marijuana policy has stalled, the family is beingforced to relocate anyway. They’re going to Colorado to seek out treatment for their daughter, Vivian, who needs a liquefied marijuana strain in order to prevent her potentially fatal seizures.
The Wilsons have been fighting for policy reform in New Jersey for the past year. Although the state began issuing medical marijuana cards back in 2012, there were stringent limits for minors that prevented kids like Vivian from being able to take edible marijuana. “Please don’t my daughter die,” Vivian’s dad implored Gov. Chris Christie (R) in August, pressuring the governor to approve legislation that would have expanded access to several strains of marijuana.
Christie ended up approving a weakened form of that legislation. But it wasn’t enough. Although kids with conditions like Vivian’s are now legally allowed to access edible marijuana, the dispensaries in the state aren’t producing those type of products, and the state’s health department has no plans to begin testing them. Christie says he’s “done expanding the medical marijuana law,” and recently rejected a bill that would have allowed families like the Wilsons to buy edible strains in other states and transport them home to New Jersey.
The Wilsons have tried to navigate New Jersey’s restrictive medical marijuana law. But they say the state laws don’t go far enough to help two-year-old Vivian — who must wear an eye patch, avoid direct sunlight, and stick to a special low-carb diet in an attempt to prevent potentially deadly seizures — and they can’t afford to wait it out. Treatment for Vivian’s condition still remains out of reach.
“I’m just ready to start the next chapter. If we get medicine that helps Vivi, that’s great. Who the hell cares we had to move?” Meghan Wilson told the Star-Ledger as her family prepared to board their flight to Colorado.
The Wilsons will join a growing number of “medical refugees” who have moved to Colorado to seek a so-called “miracle strain” of marijuana that can help treat pediatric epilepsy. About 180 other children like Vivian are currently receiving treatment from the same dispensary in Colorado Springs. More than 100 families have moved from 43 states to pursue this optionfor their severely ill children.
The so-called “Charlotte’s Web” strain is named after Charlotte Figi, the first child who tried the treatment after her parents exhausted all of their other medical options. After she started taking this strain of medical marijuana, Charlotte’s seizures immediately stopped, and the seven-year-old is now feeding herself, walking, and riding her bike. Her case helped convince CNN Chief Medical Correspondent Sanjay Gupta to reverse his position on the medical benefits of marijuana, admitting that he was “too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.”
Lois Beckett has a good article in Pacific Standard:
Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings, and other violent injuries.
So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.
They just didn’t know how many: Fully 43 percent of the patients they examined—and more than half of gunshot-wound victims—had signs of PTSD.
“We knew these people were going to have PTSD symptoms,” said Kimberly Joseph, a trauma surgeon at the hospital. “We didn’t know it was going to be as extensive.”
What the work showed, Joseph said, is, “This is a much more urgent problem than you think.”
Joseph proposed spending about $200,000 a year to add staffers to screen all at-risk patients for PTSD and connect them with treatment. The taxpayer-subsidized hospital has an annual budget of roughly $450 million. But Joseph said hospital administrators turned her down and suggested she look for outside funding.
“Right now, we don’t have institutional support,” said Joseph, who is now applying for outside grants.
A hospital spokeswoman would not comment on why the hospital decided not to pay for regular screening. The hospital is part of a pilot program with other area hospitals to help “pediatrics patients identified with PTSD,” said the spokeswoman, Marisa Kollias. “The Cook County Health and Hospitals System is committed to treating all patients with high quality care.”
Right now, social workers try to identify patients with the most severe PTSD symptoms, said Carol Reese, the trauma center’s violence prevention coordinator and an Episcopal priest.
“I’m not going to tell you we have everything we need in place right now, because we don’t,” Reese said. “We have a chaplain and a social worker and a couple of social work interns trying to see 5,000 people. We’re not staffed to do it.”
A growing body of research shows that Americans with traumatic injuries develop PTSD at rates comparable to veterans of war. Just like veterans, civilians can suffer flashbacks, nightmares, paranoia, and social withdrawal. While the United States has been slow to provide adequate treatment to troops affected by post-traumatic stress, the military has made substantial progress in recent years. It now regularly screens for PTSD, works to fight the stigma associated with mental health treatment, and educates military families about potential symptoms.
Few similar efforts exist for civilian trauma victims. Americans wounded in their own neighborhoods are not getting treatment for PTSD. They’re not even getting diagnosed.
Studies show that, overall, about eight percent of Americans suffer from PTSD at some point in their lives. But the rates appear to be much higher in communities—such as poor, largely African-American pockets of Detroit, Atlanta, Chicago and Philadelphia—where high rates of violent crime have persisted despite a national decline.
Researchers in Atlanta interviewed more than 8,000 inner-city residents and found that about two-thirds said they had been violently attacked and that half knew someone who had been murdered. At least one in three of those interviewed experienced symptoms consistent with PTSD at some point in their lives—and that’s a “conservative estimate,” said Dr. Kerry Ressler, the lead investigator on the project.
“The rates of PTSD we see are as high or higher than Iraq, Afghanistan, or Vietnam veterans,” Ressler said. “We have a whole population who is traumatized.” . . .
If the US is going to continue to make guns freely available to everyone, then it has a responsibility to ameliorate the resulting human damage.
It’s a structural reason, explained well by Paul Krugman.
I continue to believe that, judging by actions, the GOP actively hates lower-income people. Tara Culp-Ressler reports in ThinkProgress:
During a political fight over Medicaid expansion in Arkansas on Tuesday, one Republican lawmaker admitted that he doesn’t want to educate uninsured residents about their new health care options because it’s simply too expensive to provide them with insurance.
State Rep. Nate Bell (R), who offered an amendment to Arkansas’ proposed Medicaid expansion bill that would prevent the state from using federal funds to promote Obamacare, acknowledged that his policy would result in fewer people signing up for health care. He noted that “without active marketing, you probably get declining enrollment.” But in his mind, that’s not a problem — that’s the whole point.
“We’re trying to create a barrier to enrollment,” Bell explained, noting that lower enrollment ultimately translates to lower costs. “In general, as a conservative, if I have the opportunity to reduce government spending in a program from what’s projected… I’m probably going to take that deal.”
Bell’s amendment would prohibit Arkansas from advertising Obamacare plans through television, radio, print, or online ads. It also prevents the state from using federal funds to conduct direct mailing campaigns — which, as the Arkansas Times’ David Ramsey notes, has been critical in getting out the word about the state’s Medicaid expansion. Since Arkansas is pursuing a “private option” for Medicaid, which essentially gives residents a subsidy to purchase private insurance, the process for enrolling in a Medicaid plan is very similar to the process for signing up for a plan on Obamacare’s new state-level exchange.
Preventing Americans from getting all the facts about the health reform law is a popular method of undermining Obamacare, particularly in red states. Republicans have repeatedly targeted “navigators,” the people tasked with helping Americans enroll in new plans, to prevent them from being able to easily do their jobs. And conservative states that are opposed to Obamacare have allocated considerably less money to promote it. It’s no surprise, then, that the people who live in GOP-led states are less likely to understand how to sign up for health care.
Those states are also more likely to have higher populations of low-income people who lack insurance. In Arkansas specifically, the uninsurance rate is among the highest in the nation. Efforts to expand health care in the state are actually projected to save money in the long run because they’ll cut down on the cost of uncompensated care; the Medicaid expansion could save taxpayers as much as $90 million this year.
Nonetheless, Arkansas lawmakers are currently debating whether to kick thousands of low-income people off of their new Medicaid plans. Even though the state began implementing its “private option” last year, and an estimated 83,000 people have already enrolled, the legislature is currently debating whether to approve the policy. And if lawmakers like Bell have their way, even the move to preserve Medicaid expansion may still come at a significant cost.
This sort of facility seems like an excellent idea, and apparently it results in improved happiness and health for its residents. I bet it’s a more pleasant place to work than the usual assisted-living home. With Baby Boomers aging, this would be a good thing to initiate as publicly-owned (taxpayer-supported) facilities. This is exactly the sort of thing you do NOT want to run on a profit motive, which inevitably leads to cuts in quality of service and higher prices over time due to the inexorable drive to grow profits.
What happens when you use a good single-payer healthcare system. Note that the US hospital contrasted is Memorial Sloan Kettering, no slouch of a (US) hospital.
Interesting blog post by Paul Krugman pointing out the deja vu of watching the GOP once again declare that reports are skewed—first, it was polls and reports showing that Obama would win over Mitt Romney, now it’s reports showing that Obamacare is working. The problem with denying reality is that reality is always around and thus, in effect, patient.
Fascinating. Corporate greed seems to have a corrupting effect.
A very good look at Tim Armstrong’s obliviousness by Amy Davidson in the New Yorker:
How does one define “distressed”? Anxious, worried, upset in a slightly old-fashioned way, and somehow ragged. Damsels can be in distress, without being distressed ladies—blithely awaiting rescue, without a ribbon out of place. Fashionably scuffed dressers or jeans are said to be “gently distressed.” When the word is modified that way, it also calls to mind a baby, half woken up and wiggling, darting out a hand to see if someone is there.
When Tim Armstrong, the C.E.O. of AOL, talked about “distressed babies” a few days ago, though, there was nothing gentle added, in either the language or the intent. He was explaining, in a conference call with employees, why the company was making their 401(k) plan worse. “In 2012,” he said, in a transcript that Capital New York got first,
We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs, we made the decision, and I made the decision, to basically change the 401(k) plan.
In other words, don’t blame us for cutting back on retirement benefits; it was two babies we had to keep alive who took your money.
But what did Armstrong mean when he said “we paid a million dollars”? This does not represent an act of charity on the part of a struggling company. AOL is profitable, and just had a very good quarter; it has done well enough to pay Armstrong twelve million dollars, a number that does not seem to distress him. And, as Deanna Fei, the rightly distressed mother of one said baby, wrote in a piece for Slate, she and her husband, who works for AOL, had paid their premiums for the company’s health-insurance plan. This is what they bought, with that money and her husband’s labor: an agreement that, in the event that something bad happened with their health or that of their child, they would be able to go to the doctor, and that they wouldn’t be bankrupted.
Something very bad did happen. Fei woke up with sudden pains when she was only five months pregnant with her second child. She was rushed to the hospital, and her baby girl was rescued with an emergency Caesarean section—one pound nine ounces, her skin all purple and blue the way no baby’s should be. (One doctor, Fei said, was “visibly shaken.”) She was put on a ventilator. “That day, we were told that she had roughly a one-third chance of dying before we could bring her home. That she might not survive one month or one week or one day,” Fei wrote.
For longer than I can bear to remember, we were too terrified to name her, to know her, to love her. In my lowest moments—when she suffered a brain hemorrhage, when her right lung collapsed, when she stopped breathing altogether one morning—I found myself wishing that I could simply mourn her loss and go home to take care of my strapping, exuberant, fat-cheeked son.
Except that the baby girl wouldn’t give up: “over the next weeks, she fought for every minute of her young life, as did her doctors and nurses, and we could only strive to do the same.” She was in distress, that baby, but she wasn’t going to wait like some damsel.
Fei doesn’t doubt that all of this—“blood transfusions, head ultrasounds, the insertion of breathing tubes, feeding tubes, and a central line extending nearly to her heart”—could have cost a million dollars. That is the point of insurance. AOL, which is apparently self-insured (while using Cigna as one of its plan administrators) made a bet that it wasn’t going to get the employees it needed without a decent health-care plan, and that this was the way to provide it. (It also, as some commentators have noted, appears not to have opted for a reinsurance policy as a hedge against big claims.) Armstrong also complained about Obamacare, which he said would cost the company millions; as Ezra Klein pointed out in a Bloomberg column, this suggests only that he and AOL haven’t looked closely at the law, and figured out how the company can now join a larger risk pool and protect itself from big swings. Or was his problem with Obamacare that it won’t let insurers tell people like Fei’s daughter that they’ve reached some “lifetime cap” before their first birthday, or keep her father looking for a job with a more sane employer because he’s worried that a “preëxisting condition” will keep her from finding a new insurer?
But wasn’t this about 401(k)s—retirement plans—and not about health care? Armstrong’s rationale is really just a riff on how much higher profits would be if you didn’t have to hire human beings. As Fei wrote, Armstrong “exposed the most searing experience of our lives, one that my husband and I still struggle to discuss with anyone but each other, for no other purpose than an absurd justification for corporate cost-cutting.” (She says she is doing so now because her husband starting getting queries from co-workers minutes after the conference call.) The change to the 401(k) plan was this: instead of matching contributions quarterly, the company would only pay its share for employees who were active on December 31st of a given year. If you were left or passed away or were fired on December 30th, you would get nothing, despite three hundred and sixty-four days as an AOL-er. With the “distressed baby” move, Armstrong removed the presumption that the company wouldn’t use this in bad faith. If someone complains to the entire company about how much trouble it is that a couple of babies were gravely sick, would you put it past him to fire employees who were about to be due a big contribution? Maybe in his next speech he’d be complaining about AOL-ers who had the temerity to die from heart attacks on New Year’s Day, instead of on Christmas.
That speech won’t be given now; Armstrong’s speech was so blatantly oblivious, so cheap in every sense of the word, that he has had to apologize (after a false start, in which he said he’d just been trying to show how much he cared) and also reverse the 401(k) change.
But we’re not done with this. There is more to be distressed about, on behalf of babies, parents, and the people who work with them.
For one thing, Fei pushed back at Armstrong from what was, within the terms of our discussions about parenting, an unassailable position. Armstrong, in his first non-apology, had referred to her pregnancy as “high-risk”:
But there was nothing high-risk about my pregnancy. I never had a single risk factor for a preterm birth, let alone one as extreme as this one. Until the morning I woke up in labor, every exam indicated that our daughter was perfectly healthy.
Her first pregnancy had been “normal”; this one had appeared to be, too. She is absolutely right to remind Armstrong that life itself is riskily uncertain, and of the shallowness of acting as if we make our own luck entirely, picking our circumstances from a store shelf.
But if there had been risk factors—so what? What if she had been older, or had her own health problems or struggles with infertility, or maybe even was single? What if she’d had a wife, rather than a husband? She should have just as much right in any of those circumstances not to be exposed and blamed, and for her baby to not be treated like a beggar.
Armstrong might have assumed there was some such factor at work, and that he had more resentment to play with—including his own. One item that emerged this week was . . .
I think it would be more efficient and save money overall if the mentally ill could go or be taken to a local mental health clinic and get expert treatment by a staff trained in and knowledgeable about mental health illnesses and treatments, thus taking a burdensome and inappropriate responsibility from the police and ERs.
But I don’t think that will happen because, much as with the poor, the controlling powers (Congressional majorities, business interests) simply do not care about people in that category, and so no government money is released to provide the resources. Instead, the problem is to a great degree simply ignored. Somehow we avert our gaze.
But services for this group very much are aligned with promoting the general welfare.
Lauren Kirchner writes in Pacific Standard:
The last time Virginia state senator Creigh Deeds made national headlines, the occasion was a shocking family tragedy. In November, Deeds’ son Gus, who had been on and off medication for bipolar disorder and crippling paranoia, repeatedly stabbed Deeds, before ending his own life. Now, a recovered but visibly scarred Deeds is back in the news, publicly urging his colleagues in Richmond to help him reform the state’s mental health laws.
On the night before his son attacked him, Deeds told Scott Pelley in a 60 Minutes interview, the family had taken Gus to an emergency room and tried to place him in a psychiatric facility, because they worried that he might hurt himself or someone else. Under Virginia state law, Gus could only be hospitalized against his will for six hours, or until an available bed in a psychiatric facility could be located. But no bed was free, and so Gus went home. Deeds is now working to get Virginia to extend the length of those emergency stays, and to build a state-wide computer database that would make finding open psychiatric beds easier.
Deeds’ story was just one part of the 60 Minutes segment, called “Nowhere to Go: Mentally Ill Youth in Crisis.” Scott Pelley interviewed a number of parents who have had to repeatedly bring their children and teens to the hospital for short-term stays and unsatisfying, piecemeal mental healthcare, for things like bipolar disorder, schizophrenia, and major depression disorder. Long-term psychiatric care is just so much harder to come by. Pelley explains that their experiences today illustrate the result of a half-century-long systemic deinstitutionalization of mental health care in America:
In the decades after the 1960s most large mental institutions were closed. It was thought that patients would get better treatment back in their communities. But adequate local facilities were never built. The number of beds available to psychiatric patients in America dropped from more than half a million to fewer than 100,000. That leaves many kids in crisis today with one option: the emergency room.
But what if those people suffering from mental illness aren’t minors, and they don’t have parents or support systems to bring them in to emergency rooms? If those people are adults, and they’re out in the world, disturbing people with antisocial behavior, then chances are that at some point, they’re going to have a brush with the law.
In a recent NPR report from the nation’s largest jail, Cook County in Illinois, Laura Sullivan described the spare, padded cells that many of the inmates are housed in. At least a third of the 10,000 inmates in Cook County are mentally ill, and the jail’s staff sounded absolutely overwhelmed.
Staff members called the situation they’re facing “staggering” and the policies that caused it “ridiculously stupid.” Sullivan reported that in the past three years, budget shortfalls caused Chicago to cut funding to six of the area’s 12 mental health clinics, and three nearby state hospitals. Those clinics and hospitals had provided mentally ill patients in the community with counseling and medication; without them, many of those patients tend to end up in jail.
Cook County is doing what it can to process the flow, and provide medicine and help to the people who need it—and this help, in turn, attracts more people who need it. Sullivan interviewed one inmate/patient who told her that after his local mental health clinic closed, he started relying on the jail to get regular access to the medication he has been taking for decades to manage his illness. In fact, he regularly commits small crimes just to get sent to jail, where he’ll then stay, until he goes before a judge to receive his sentence. This situation is not only incredibly ineffective in serving the community’s needs, it’s also incredibly expensive, as Sullivan describes: . . .
Rep. Rodgers acted consistently with her earlier performance (of saying that she strongly supported equal pay for women after voting 4 different times against equal pay for women)—that is, she again has taken the path of lying.
Full details here, in a story that develops through several updates.
I doubt that any for-profit hospital can long withstand the constant pressure to grow profits. Julie Creswell and Reed Abelson write in the NY Times:
Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors.
Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.
The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.
This month, the Justice Department said it had joined eight separate whistle-blower lawsuits against H.M.A. in six states. The lawsuits describe a wide-ranging strategy that is said to have relied on a mix of sophisticated software systems, financial incentives and threats in an attempt to inflate the company’s payments from Medicare and Medicaid by admitting patients like an infant whose temperature was a normal 98.7 degrees for a “fever.”
The accusations reach all the way to the former chief executive’s office, whom many of the whistle-blowers point to as driving the strategy.
For H.M.A., the timing could not be worse. Shareholders recently approved the planned$7.6 billion acquisition of the company by Community Health Systems, which will create the nation’s second-largest for-profit hospital chain by revenue, with more than 200 facilities. The deal is expected to be completed by the end of the month.
While the lawsuits against H.M.A. provide a stark look at the pressure being put on doctors and hospital executives to emphasize profits over their patients, similar accusations are being raised at other hospital and medical groups as health care in the United States undergoes sweeping changes.
Federal regulators have multiple investigations into questionable hospital admissions, procedures and billings at many hospital systems, including the country’s largest, HCA. Community Health Systems, the Franklin, Tenn., company from which H.M.A. hired its former chief executive in 2008, faces similar accusations that it inappropriately increased admissions. Community is in discussions with federal regulators over a settlement regarding some of the accusations.
The practice of medicine is moving more rapidly than ever from decision-making by individual doctors toward control by corporate interests. The transformation is being fueled by the emergence of large hospital systems that include groups of physicians employed by hospitals and others, and new technologies that closely monitor care. While the new medicine offers significant benefits, like better coordination of a patient’s treatment and measurements of quality, critics say the same technology, size and power can be used against physicians who do not meet the measures established by companies trying to maximize profits.
“It’s not a doctor in there watching those statistics — it’s the finance people,” said Janet Goldstein, a lawyer representing whistle-blowers in one of the suits, of a type known as qui tam litigation, against H.M.A.
What’s more, like their Wall Street bank counterparts, the mega-hospital systems, with billions of dollars in revenue, are more challenging to regulate, according to experts.
Still, when H.M.A. announced the Justice Department’s involvement in the lawsuits, investors and analysts shrugged, and the stocks for both companies involved in the merger barely budged.
Sheryl R. Skolnick, who follows health care for CRT Capital, recently wrote in a note to investors, “Investors seem to think that D.O.J. investigations, qui tam suits and allegations of serious Medicare fraud are simply a cost of doing business.” Many settlements run only into the tens of millions of dollars. That’s a corporate slap on the wrist for companies whose stocks typically soar when executives push the profit envelope. Only if the penalty is at least $500 million, Ms. Skolnick said, are corporations likely to find the cost a deterrent.
H.M.A. also faces shareholder lawsuits and a federal securities investigation. A former executive was indicted late last year on an obstruction charge related to these investigations.
The company said it could not comment on pending litigation, but was cooperating with the Justice Department investigation. In a statement, the company defended the quality of its medical care. “H.M.A. associates and physicians who practice at our facilities are focused on providing the highest-quality patient care in all of our hospitals,” it said.
The architect of the strategy to raise admissions, according to several of the lawsuits, brought by an array of physicians, individual hospital administrators and compliance officers, was the company’s former chief executive, Gary D. Newsome.
“Gary vigorously denies the allegations,” according to an email from his lawyer, Barry Sabin of Latham & Watkins.
Mr. Newsome joined H.M.A. in September 2008 from a high-ranking post at Community Health. He left H.M.A. last summer to head a religious mission in Uruguay. His compensation in the three years before his departure totaled $22 million.
Shortly after joining H.M.A., Mr. Newsome traveled to North Carolina to meet with local hospital officials. He informed them he was putting in place new protocols, using customized software, meant to “drive admissions” at hospitals, according to allegations in a federal suit filed by Michael Cowling, a former division vice president and chief executive of an H.M.A.-owned hospital in Mooresville, N.C.
To reach admission goals, administrators were directed to monitor on a daily basis the percentage of patients being admitted, using a customized software program called Pro-Med. The progress of the physicians in meeting their goals was updated daily on the scorecards.
When Mr. Cowling confronted Mr. Newsome with physician concerns that the new protocols were clinically inappropriate and would result in unnecessary tests and admissions, and said that his doctors “won’t do it,” Mr. Newsome responded: “Do it anyway,” according to the lawsuit.
As a result, according to a former physician who cited multiple examples, patients who did not need inpatient treatment often were admitted, which allowed the hospital to bill Medicare and Medicaid more for the care.
In Georgia, a baby whose temperature was 98.7 degrees was admitted to the hospital with “fever,” according to a lawsuit filed in federal court by Dr. Craig Brummer, a former medical director of emergency departments at two H.M.A. hospitals.
In one case, an 18-year-old Medicaid patient with a right-knee laceration was admitted, though he could have been treated and discharged, Dr. Brummer said in his lawsuit.
Executives who raised questions about H.M.A.’s policies and procedures were often fired.
When Jacqueline Meyer, a regional administrator for EmCare, a company that provided emergency room physicians to a number of H.M.A. hospitals, refused to follow H.M.A.’s directives and fire doctors who admitted fewer patients than H.M.A. wanted, she was fired, according to the lawsuit she filed with Mr. Cowling. The Justice Department has not yet decided whether to join her lawsuit against EmCare, which declined to comment.
Likewise, shortly after Ralph D. Williams, an accountant with 30 years’ experience in hospital management, was hired as the chief financial officer for an H.M.A. hospital in Monroe, Ga., he asked an outside consulting firm to review the hospital’s inpatient admission rate.
When Mr. Williams showed the report, which confirmed a higher admission rate, to a higher-level division executive, he was told to “burn it.” Mr. Williams was soon fired, according to a qui tam lawsuit Mr. Williams filed in federal court in Georgia.
The last year has been particularly tumultuous for H.M.A., starting with . . .
Jaw-dropping: Mitch McConnell is campaigning on his “support” for free preventive healthcare services for Ketuckians
Mitch McConnell seems to lack any shred of integrity. Igor Volsky writes at ThinkProgress:
Sen. Mitch McConnell (R-KY) is out with a new campaign ad touting his success in securing free preventive health care services for Kentuckians. The spot, titled “Cares,” tries to paint the Senate Minority Leader as a compassionate Republican who carries a moral obligation to provide sick people with access to government-sponsored health care.
It’s a message you wouldn’t expect from a Republican senate leader who has voted to repeal the Affordable Care Act and continues to oppose its implementation in Kentucky. But the minute-long ad, featuring Robert Pierce, an energy worker and throat cancer survivor, highlights the Republican Senate leader’s effort to secure “cancer screening programs” for Kentuckians and provide them with government compensation. Watch the spot:
The aid is the result of an entitlement McConnell secured for former employees of a plant in Paducah, Kentucky who were exposed to high levels of uranium throughout the 1950s and 1960s, and who now suffer from cancer or other ailments. As the Huffington Post’s Zach Carter and Jason Cherkis catalogue in their exhaustive report on the crisis, McConnell had initially “kept the plant’s doors open” to guarantee jobs for his constitutes, even as “the plant’s toxins had spread through the air and into the ground, slowly killing its own workers and tainting the surrounding area.” Though McConnell had toured the facility, “knew about the contaminated water supply and the mountain of leaking storage containers,” and had been in regular consultation with the Department of Energy about the crisis, he ultimately voted against an amendment that would have held nuclear subcontractors liable for negligence or misconduct at nuclear plants — and didn’t take legislative action to help the plant’s sick workers until 1999.
Almost two decades after employees began dying from cancer, and five years after the Paducah plant was declared a Superfund site by the Environmental Protection Agency, McConnell pushed through a new entitlement “that allowed plant workers over age 50 access to free body scans and free health care.” The program also “provided $150,000 lump sum payments to workers who developed cancers or other illnesses from radiation exposures, and up to $250,000 in compensation for medical problems caused by other toxins.” Once the benefit started flowing in 2001, McConnell and his wife, then-energy secretary Elaine Chao, even “flew to Paducah and awarded the first $150,000 check.”
McConnell has long used his influence to direct federal funds to other health care programs that closely resemble the preventive goals outlined in the Affordable Care Act. The Kentucky senator secured an earmark that ultimately provided pregnant women with sonograms and routine care. He also “directed money to everything from mobile health screenings to lab upgrades for stem cell research into heart failure” and “earmarked close to $3 million to fund heart health classes that would educate residents in the state’s rural areas about how to eat better and exercise.”
Yet ultimately, McConnell’s piecemeal approaches to Kentucky’s health care problems — it’s a state where 17 percent of residents are uninsured, 69.1 percent of adults are overweight or obese, and 30 percent have high blood pressure — won’t solve the state’s public health care crisis. Obamacare, which has provided more than 116,000 Kentuckians with health care coverage, could. But McConnell still opposes the law. Responding to the state’s success in implementing the measure, McConnell said he doesn’t believe in “free” benefits, telling reporters, “That’s free health care. If you want to give out free health care you’re going to have a lot of interest. Just like free anything else.”
Interesting post at Daily Kos by Egberto Willies:
Common knowledge to those who follow the ins and outs of Obamacare is that there is an industry out there to destroy it at all cost. The traditional media has been the major conduit of the lies and misinformation.
It isn’t only the smaller media outlets that are generating the barrage of misinformation. CBS News whose ‘60 Minutes’ has been compromised with Benghazi and NSA misleading stories has been a major culprit. After-all CBS’s Jan Crawford reported a story about a woman losing the insurance she loved and could afford. It turned out had CBS made one telephone call or just checked healthcare.gov they could have informed the woman that she could get much better and reliable insurance for a comparable price.
It is a new day in media. Corporate owned major media that sometimes seem to purposely allow themselves to be a conduit to lies and misinformation are being challenged. Bloggers and other independent media that previously had little reach are now fact checking. They are using the power of the internet to inform with fact based information and not hit pieces that is now endemic in the traditional media.
Maggie Mahar, a prolific blogger at HealthBeat Blog and author of ‘Money-Driven Medicine: The Real Reason Health Care Costs So’ wrote the blog post Anatomy of an Obamacare ‘horror story’ detailing yet another misinforming story. It turns out the story in the Fort Worth Star Telegram was not only biased, it was simply not true. Maher writes.
For months, health reform’s opponents have been feasting on tales of Obamacare’s innocent victims – Americans who lost their insurance because it doesn’t comply with the ACA’s regulations, and now have to shell out more than they can afford – or go without coverage. Trouble is, many of those stories just aren’t true.
Yesterday I posted about a Fort Worth Star Telegram article that leads with the tale of Whitney Johnson, a 26-year-old new mother who suffers from multiple sclerosis (MS). Her insurer just cancelled her policy, and according to Johnson, new insurance would cost her over $1,000 a month.
That claim stopped me in my tracks. Under the ACA, no 26-year-old could be charged $1,000 monthly – even if she has MS.
Obamacare prohibits insurers from charging more because a customer suffers from apre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.
At that point, I knew that something was wrong.
Maggie Mahar did not just read the story, discount it, and go off to something else. She did something about it. She got involved. She checked healthcare.gov and found out that a comparable policy with much better and secure coverage would cost Whitney Johnson $7 more than she was currently paying.
Maggie Mahar went further. She called the Fort Worth Star Telegrram. After calls not being returned, she finally got a callback. She was informed that the newspaper received an email stating Whitney Johnson did find insurance at a similar price. The newspaper would not confirm that they would correct the story. It is evident the newspaper either has an agenda or is scared of revealing the truth for reasons that can be assumed. They came out with a defense of the story as well as a mea culpa for a less than complete story.
Maggie Mahar discovered that Whitney Johnson was a member of the Tea Party. The newspaper did not attempt to do any background checks. She finally reached the reporter of the story. The reporter told her that she had no experience covering healthcare. Moreover her assignment was to find people who were having problems with Obamacare. When she suggested doing a story on people helped by Obamacare she was not given a green light to do so from her editor.
The Fort Worth Star Telegram has over 200,000 readers. They chose to misinform these users maybe negligently, maybe willfully. What is sure is that so far they have chosen to willfully keep them misinformed.
If this isn’t yet another reason to disregard most of corporate and traditional media, what is? The consequences of misinforming the public are grave. It can even be fatal. The public must be informed constantly that the media that use to be the source of unbiased information that could be depended on is no more.
The conservative wind machine really, really wants Obamacare to be bad, and lately they’ve been harping away at the death spiral: not enough healthy young people sign up, so that the unhealthy and the elderly predominate in the insured population, which raises rates, which drives away more of the young and healthy, leading to more rate increases,… A vicious circle termed the “death spiral.”
Only it’s not happening. Not at all. If you look at the facts (difficult for conservatives), you see that. Ezra Klein lists the ways in which there is no death spiral.
The chart is from a post by Kevin Drum, which you should read in its entirety. Regarding the chart, he states:
Recently a team of authors did just that in JAMA and produced the chart [above]. It shows Years of Potential Life Lost (YPLL) as multiples of the median for other rich countries. A number greater than one means we’re losing more years than the rest of our peers. Here’s the chart.
The dramatic thing about this chart is that the United States does worse than other rich countries in every single area. Sure, it’s possible that there are 16 different reasons that we’re doing worse in 16 different categories, but it doesn’t seem likely, does it? When something is this widespread, the cause is a lot more likely to be something broadly based, like health care delivery. This isn’t smoking gun proof that our Rube Goldberg health care system is responsible for our lousy life expectancy, but it sure ought to make you sit up and take notice. There’s a pretty good chance that you, your friends, and your family are going to live three or four years less than you should, solely because you live in America.
Sarah Kliff has a good comment on the chart in the Washington Post.
David Super is a professor of law at Georgetown University. On Friday, he wrote a New York Times op-ed arguing that, as bad as Obamacare’s launch has been, “food stamp and Medicaid recipients can only look on in envy.” In it, he offered examples of the terrible service the government often offers to the poor, including a Colorado program that “refused food stamps to anyone who did not have a driver’s license from Guam” and a Georgia disaster that failed “to send renewal notices to the homes of some 66,000 food stamp recipients and about half that number of Medicaid beneficiaries: and terminated their coverage on November 1st.”
We spoke by phone on Monday. A lightly edited transcript follows.
Ezra Klein: How does the launch and subsequent trajectory of HealthCare.gov compare to what you typically see in programs for the poor?
David Super: The early months were very typical of what we see whenever a new system is implemented that affects low-income people. But the recovery has been startlingly fast.
EK: So what happens in these programs typically? They launch, fail, and then what?
DS: They just thunder on ahead. The system that’s broken down spectacularly for food stamps and Medicaid in Georgia began as a pilot in a few counties a year-and-a-half ago. It was a miserable failure there. Federal administrators tried calling the toll-free number to get help themselves and couldn’t get through. But they rolled it out anyway.
EK: What’s the decision chain that ends up justifying scaling up a failing pilot?
DS: There’s this idea, “we’ve gone this far, we should keep on going.” You hear people say that this has to be done sooner or later and we might as well do it now. Or they say, “we should take our lumps.” It always makes my blood boil because it’s not the administrators taking the lumps.
EK: There’s an old line that goes, “programs for the poor are poor programs.” When you compare programs that are used by the poor, like food stamps, to programs used by Americans of all income brackets, like the IRS or the DMV, do you think the old adage holds true?
DS: It’s night and day. I hear people complain about the IRS and I’m just astounded. Its level of customer service is radically better than what we see in even fairly well-run poverty programs. There’s all sorts of things the IRS would never dream of doing that are absolutely routine in these other programs. They actually give people a chance to explain things.
EK: These programs are designed with good intentions. The people behind them care. So how do you end up in a situation like Georgia, where many of the people can’t even get through the phone tree? What goes wrong?
DS: There are many reasons. But the reason there are a lot of problems right now is we’ve had so many consecutive years of state budget cuts and hiring freezes. Many states pay very, very low wages for people administering these programs, and so there’s a lot of turnover. So when the state has a hiring freeze, the better-paid agencies don’t shrink very much, but these programs shrink enormously. So they just don’t have enough bodies.
EK: I think someone reading this interview could say, “this is just more evidence that government can’t manage these things well and should stop trying. Give the money to the private sector and let them invest it, or give the programs to private contractors and let them manage them.” Do you agree?
DS: I don’t think that matches up with the evidence. . .
The entire article by Nina Martin at Pacific Standard is interesting and worth reading. It includes an interesting graph:
This is ominous. As has been reported, Catholic hospitals will allow a mother to die rather than take action to abort a fetus, even a non-viable fetus. Moreover, Catholic hospitals require all staff to follow religious dictates, not simply those who are Catholics.
Equally disturbing is the growth in for-profit hospitals. When profits become the goal, the quality of service drops and prices rise (better profits). This has been repeatedly demonstrated.