News Article | April 21, 2017
GOP Plan To Trim Insurance Benefits Might Not Tame Premiums As House Republicans try to find common cause on a bill to repeal and replace the Affordable Care Act, they may be ready to let states make the ultimate decision about whether to keep a key provision in the federal health law that conservatives believe is raising insurance costs. Conservatives from the House Freedom Caucus and members of a more moderate group of House Republicans, the Tuesday Group, are working on changes to the GOP health overhaul bill that was pulled unceremoniously by party leaders last month when they couldn't get enough votes to pass it. At the heart of those negotiations is the law's requirement that most insurance plans offer 10 specific categories of "essential health benefits." They include hospital care, doctor and outpatient visits and prescription drug coverage, along with things like maternity care, mental health and preventive care services. The Freedom Caucus had been pushing to strip required benefits, arguing that the coverage guarantees were driving up premium prices. "We ultimately will be judged by only one factor: if insurance premiums come down," the Freedom Caucus chairman, Rep. Mark Meadows, R-N.C., told The Heritage Foundation's Daily Signal last month. But moderates, bolstered by complaints from patient groups and constituents, fought back. And a brief synopsis of a proposal outlined by Rep. Tom MacArthur, R-N.J., suggests that the compromise could be letting states decide whether they want a federal waiver to delete essential health benefits. "The insurance mandates are a primary driver of [premium] spikes," Meadows and Sen. Ted Cruz, R-Texas, wrote in March. But health analysts and economists say that eliminating those benefits probably won't bring premiums down — at least not in the way conservatives are hoping. "I don't know what they're thinking they're going to pull out of this pie," says Rebekah Bayram, a principal consulting actuary at the benefits consulting firm Milliman. She is the lead author of a recent study on the cost of various health benefits. Opponents of the required benefits point to coverage for maternity care and mental health and substance abuse treatment as things that drive up premiums for people who will never use such services. But eliminating those benefits wouldn't have much of an impact, Bayram says. Hospital care, doctor visits and prescription drugs "are the three big ones," she says. "Unless they were talking about ditching those, the other ones only have a marginal impact." John Bertko, an actuary who worked in the Obama administration and served on the board of Massachusetts' health exchange, agrees: "You would either have very crappy benefits without drugs or physicians or hospitalization, or you would have roughly the same costs." Maternity care and mental health and substance abuse, he says, "are probably less than 5 percent" of premium costs. Of course, requiring specific coverage does push up premiums to some extent. James Bailey, an assistant professor of health economics at Creighton University in Omaha, has studied the issue at the state level. He estimates that the average state health insurance mandate "raises premiums by about one-half of 1 percent." Those who want to get rid of the required benefits point to the fact that premiums in the individual market jumped dramatically from 2013 to 2014, the first year the benefits were required. "The ACA requires more benefits that every consumer is required to purchase regardless of whether they want them, need them or can afford them," Ohio Insurance Commissioner Mary Taylor said in 2013, when the state's rates were announced. But most of that jump was not due to the broader benefits, Bayram says, but to the fact that for the first time sicker patients were allowed to buy coverage. "The premiums would go down a lot if only very healthy people were covered and people who were higher risk were pulled out of the risk pool," she says. (Some conservatives want to change that requirement, too, and let insurers charge sick people higher premiums.) Meanwhile, most of the research that has been done on required benefits has looked at plans offered to workers by their employers, not policies available to individuals who buy their own coverage because they don't get it through work or the government. That individual market is the focus of the current debate. Analysts warn that individual-market dynamics differ greatly from those of the employer insurance market. Bailey says he "saw this debate coming and wanted to write a paper" about the ACA's essential health benefits. But "I very quickly realized there are all these complicated details that are going to make it very hard to figure out," he says, particularly the way the required benefits work in tandem with other requirements in the law. For example, says Bertko, prescription drugs can represent 20 percent of costs in the individual market. That's far more than in the employer market. Another big complication is that the required benefits do double duty, Bayram says. They not only ensure that consumers have a comprehensive package of benefits, but enable other parts of the health law to work by ensuring that everyone's benefits are comparable. For example, the law adjusts payments to insurers to help compensate plans that enroll sicker-than-average patients. But in order to do that risk adjustment, she says, "all of the plans have to agree on some kind of package. So if you think of essential health benefits as an agreed-upon benchmark, I don't know how they can get rid of that and still have risk adjustment." Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
News Article | April 18, 2017
Saint Francis Hospital is proud to have been named to Healthgrades’ 2017 Patient Safety Excellence Award class, recognized as the top 10 percent of facilities in the nation for patient safety. Saint Francis joins more than 400 hospitals across the nation on the list, but is only one of three Delaware hospitals to receive this honor, having the lowest occurrences of 14 preventable patient safety events. According to Healthgrades, “this distinction places an elite group of hospital recipients within the top 10% of all hospitals evaluated for their superior performance in safeguarding patients from serious, potentially preventable complications during their hospital stays.” The organizations acknowledged are highlighted as being above their peers when it comes to limiting deadly medical errors and other preventable patient harm incidents. “No matter how innovative and progressive a healthcare organization is, without good policies and procedures in place to ensure patient safety, it won’t succeed,” said Dr. Michael Polnerow, Chief Medical Officer of Saint Francis Healthcare. “Patient safety is our number one priority at Saint Francis, and it’s truly gratifying for us to be recognized by Healthgrades.” Saint Francis attributes its high patient safety rating to its mission of excellence and quality patient experience and care. The hospital was acknowledged in December 2016 by Kaiser Health News for having dramatically reduced the number of hospital-acquired conditions over the past year, implementing new practices with its infection prevention team to provide safety to patients and employees. Saint Francis Healthcare, a part of Trinity Health, operates Delaware’s only Catholic hospital serving Wilmington and Northern New Castle County since 1924. Services provided include Partners in CardioVascular Health and Cardiovascular Services, 24-hour Emergency Services, Ambulance Service, Bariatric Surgery Center of Excellence, the da Vinci™ Surgical System, Gastroenterology Services, Hematology-Oncology Services, Minimally Invasive Surgery Center, Advanced Wound Center, Imaging Services, Sleep/Neurodiagnostics Center, Home Care, Outpatient Physical Therapy, Comprehensive Women’s Health Services and three community outreach programs. Saint Francis Healthcare is affiliated with the Saint Francis Foundation and Saint Francis LIFE (Living Independently for Elders), a PACE (Program for All-inclusive Care for the Elderly) model.
News Article | April 19, 2017
It's a fix that hasn't fixed much, but the troubled Veterans Choice program has been extended anyway. On Wednesday, President Donald Trump signed a bill extending the program intended to speed veterans' access to health care beyond its original August end point. Veterans Choice is a $10 billion response to the 2014 scandal in which Veterans Affairs health facilities altered records to hide months-long waits for care in Phoenix and elsewhere. The Choice program pays for private-sector health care for veterans and was set to expire in August, but the VA and some of the program's harshest critics in Congress have agreed to extend it, with a few changes, until January. They said that will give the VA time to propose a more comprehensive package of reforms — fixes for the fix. Sen. Jon Tester, D-Mont., authored the extension bill, which won bipartisan support in the House and Senate. Veterans Choice is designed to allow veterans who have waited more than 30 days for an appointment at a VA facility, or who live more than 40 miles from one, instead to get care from private providers who then bill the VA. But it has been plagued with problems. Many vets complain that Choice actually makes getting care more difficult and time-consuming, and some health care providers have dropped out due to slow payments or administrative hassles. The bigger reforms the VA wants to make following this extension bill will be aimed at fixing more than a half-dozen other systems the VA has for purchasing care from the private sector. "The idea of having seven, eight ways of doing the same thing is part of the problem, because it's confusing to veterans, it's confusing to the community providers," VA Deputy Undersecretary Dr. Baligh Yehia said last year. Yehia says the VA has issued a request for proposals to streamline how it buys care from non-VA providers across the board. It expects to receive those proposals this summer. VA leaders have said a big reason Veterans Choice foundered is because Congress provided only 90 days to set it up. The VA invited 57 companies to bid on running Choice, but only two responded, given the short timeline. Those two companies, Health Net Federal Services and TriWest, have struggled to make it work. Tester, the ranking Democrat on the Senate Veterans' Affairs committee, says he hopes to have draft legislation incorporating private-sector reform proposals ready in the fall. Tester says his goal is to "cut the red tape and make sure it's easy to work with for the providers. And I think we'll get more providers jumping on board, and we'll get more veterans using it, if the time to set up those appointments is reduced dramatically." Tester says he'll defend the VA from those who "don't want the government involved in health care at all." "I think it's idealism versus realism," Tester says. "We have folks that have borne the wounds of battle, and I think the VA is best suited to take care of those folks. So that VA needs to be there, and then we need to have a private sector that fills in the gaps around that VA." That's particularly important in rural states like Tester's Montana, where VA facilities are an important part of a generally understaffed health care landscape. They provide vital services, but rely on partnerships with private-sector doctors, clinics and hospitals to provide specialty care, or appointments that don't require hours of driving. This story is part of a reporting partnership with Montana Public Radio, NPR and Kaiser Health News.
News Article | April 22, 2017
Peter Uribe left Chile at 21 with his wife and 2-year-old daughter, landing in Baltimore and finding steady work in construction. His social life revolved around futbol, playing "six or seven nights a week in soccer tournaments," he says. A couple of years after his arrival, he broke his foot during a game and afraid of the cost, didn't seek medical care. "Some of my family warned me that if I went to the hospital and couldn't pay the bill, I'd get a bad credit record," says Uribe, 41, who made about $300 a week and had no health insurance. "I wanted to buy a car or a house someday." Instead, he hobbled through workdays and stayed off the field for three years; the residual pain is sometimes disabling, even two decades later. For reasons both economic and cultural, Hispanic men are loath to interact with the health system. Women across all races are more likely to seek care than men. But the gender gap in the Hispanic community is especially troubling to health care providers. Studies show that Latino men are much less likely than Latinas to get treatment. That is true even though Hispanic men are more likely than non-Hispanic whites to be obese, have diabetes or have high blood pressure. Those who drink tend to do so heavily, contributing to the group's higher rates of alcoholic cirrhosis and deaths from chronic liver disease. Many take risky jobs such as construction workers and laborers, and are more likely to die from on-the-job injuries than other workers, government data show. Hispanics' share of the population is expected to widen from nearly a fifth now to a quarter by 2045. As that number grows, researchers worry that the nation could face costly consequences as long-ignored conditions lead to serious illness and disability. "It could literally break the health care system," says José Arévalo, board chairman of Latino Physicians of California, which represents Hispanic doctors and others who treat Latinos. And now, some medical professionals fear the effects of President Donald Trump's crackdown on illegal immigrants. "When the community faces this kind of stress, I worry that people will do unhealthy things, like abuse alcohol, to deal with it," says Kathleen Page, co-director of Centro SOL, a health center at Johns Hopkins Bayview Medical Center, and founder of the city's Latino HIV Outreach Program. "That means they may not work as much," she adds. "They'll have less money, which means they're less likely to seek care." Welcomed by Baltimore officials, immigrants have driven the city's Hispanic population, tripling it to 30,000 since 2000. Here, as elsewhere, evidence suggests that for many Hispanic men, seeking health care is an extraordinary event. Hospital data show they are more likely than Hispanic women, white women and white men to go to the emergency room as their primary source of treatment – a sign that they wait until they've no choice but to get help. Some care providers say medical institutions haven't done enough to keep Hispanic men healthy, or to persuade them to get regular exams. "There's been an ongoing need for institutions to become more culturally attuned and aware of bias," says Elena Rios, president of the National Hispanic Medical Association, which represents the nation's 50,000 Latino physicians. There are some significant differences in health risk and illness rates among Hispanic subgroups – Puerto Ricans are more likely to be smokers, for example. Compared with Hispanics born in the U.S., those born elsewhere have much lower rates of cancer, heart disease and high blood pressure. Overall, Hispanics live longer than whites. But these advantages may be dissipating as Latinos become Americanized and adopt unhealthy habits such as smoking and diets high in fatty, processed foods. "I tell people we live longer and suffer," says Jane Delgado, a clinical psychologist and Cuban-American who serves as president of the National Alliance for Hispanic Health. Researchers who investigate gaps in cancer testing have found that all ethnic groups and genders have seen a decrease in late-stage colon cancer diagnoses and deaths in recent years — except Hispanic men, who get screened at the lowest rates of any race or ethnic group. Often, health problems arise after immigrants come up against an insurance barrier. A few years after Jose Cedillo came to Baltimore from Honduras, the 41-year-old cook noticed his legs were often numb or painful. Worried about finances, he eschewed treatment and continued to work, before finally going to a clinic where he was diagnosed with diabetes. In the seven years since, his health has so deteriorated he can't work, is frequently homeless and spends long stints in the hospital. As an immigrant who came to the U.S. illegally, he is not eligible for government-paid insurance or disability payments. And he can't afford medicine. Instead, he says, "I'll drink alcohol to numb the pain." Part of the problem is that Spanish speakers are underrepresented among medical professionals. After arriving here, Uribe's family members frequently brought along an English-speaking nephew or niece when they could afford to see doctors. Otherwise, "we'd travel a long ways to find a doctor who spoke Spanish," he says. Hospitals frequently lack cultural understanding and bilingual staffing, administrators admit. Though Latinos make up nearly 20 percent of the population, only 5 percent of physicians and 7 percent of registered nurses are Hispanic. That gap has widened as more Hispanics have come to this country during the past three decades, according to a UCLA study released in 2015. "Too often, people don't understand what you're saying, they don't know what you're going to charge them, what dietary restrictions you might place upon them," says James Page, vice president for diversity at Johns Hopkins Medicine. "It creates a trust issue for Hispanics. We've got to get better at serving them." That is particularly true in mental health. Only 1 percent of psychologists in the U.S. are Hispanic, meaning that Spanish-speaking men who do seek therapy will probably struggle to find it. In Baltimore, there is only one Spanish-language support group for men who suffer from anxiety and depression, local psychologists and Latino advocates say. The city employs one Spanish-speaking substance abuse counselor. A small handful of bilingual social workers citywide offer reduced-rate counseling sessions, and only three psychiatrists offer therapy sessions conducted in Spanish. For Peter Uribe, the key to maintaining his family's health is getting help paying for care. His wife and brother both suffer from epileptic seizures, and his brother's despondency caused Uribe to become depressed, he says. In 2015, he obtained insurance for his family through a charity program. With the help of now-affordable medicines, his wife's seizures waned, and he sought help for chronic depression. Since he now speaks English, finding counseling help is easier. In January, after intervention from a Latino advocacy group, the charity renewed the Uribes' policy for two years. Peter Uribe calls it a godsend: "I honestly have no idea what we'd do without it." Michael Anft is a Baltimore-based journalist and writer whose work regularly appears in AARP: The Magazine, The Chronicle of Higher Education and other publications. Daniel Trielli, a data journalist at Capital News Service at the Philip Merrill College of Journalism, contributed to this report. Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. The Annie E. Casey Foundation supports KHN's coverage of health disparities in East Baltimore.
News Article | April 28, 2017
For Some, Pre-Hospice Care Can Be A Good Alternative To Hospitals Gerald Chinchar, a Navy veteran who loves TV Westerns, isn't quite at the end of his life, but the end is probably not far away. The 77-year-old's medications fill a dresser drawer, and congestive heart failure puts him at high risk of emergency room visits and long hospital stays. He fell twice last year, shattering his hip and femur, and now gets around his San Diego home in a wheelchair. Above all, Chinchar hopes to avoid another long stint in the hospital. He still likes to go watch his grandchildren's sporting events and play blackjack at the casino. "If they told me I had six months to live, or [could instead] go to the hospital and last two years, I'd say leave me home," he said. "That ain't no trade for me." Most aging people would choose to stay home in their last years of life. But for many, it doesn't work out: They go in and out of hospitals, getting treated for flare-ups of various chronic illnesses. It's a massive problem that costs the health care system billions of dollars and has galvanized health providers, hospital administrators and policymakers to search for solutions. Sharp HealthCare, the San Diego health system where Chinchar receives care, has devised a way to fulfill his wishes and reduce costs at the same time. It's a pre-hospice program called Transitions, designed to give elderly patients the care they want at home and keep them out of the hospital. Social workers and nurses from Sharp regularly visit patients in their homes to explain what they can expect in their final years, help them make end-of-life plans and teach them how to better manage their diseases. Physicians track their health and scrap unnecessary medications. Unlike hospice care, patients in this program don't need to have a prognosis of six months or less to live, and they can continue getting treatment that is aimed at curing their illnesses, not just treating symptoms. Before the Transitions program started, the only option for many patients in a health crisis was to call 911 and be rushed to the emergency room. Now, they can get round-the-clock access to nurses, one phone call away. "Transitions is for just that point where people are starting to realize they can see the end of the road," said Dr. Dan Hoefer, a San Diego palliative care and family practice physician, and one of the creators of the program. "We are trying to help them through that process," he said, "so it's not filled with chaos." The importance of programs like Transitions is likely to grow in coming years as 10,000 baby boomers — many with multiple chronic diseases — turn 65 every day. Transitions was among the first of its kind, but several such programs, formally known as home-based palliative care, have since opened around the country. They are part of a broader push to improve people's health and reduce spending through better coordination of care and more treatment outside hospital walls. But a huge barrier stands in the way of pre-hospice programs: There is no clear way to pay for them. Health providers typically get paid for office visits and procedures, and hospitals still get reimbursed for patients in their beds. The services provided by home-based palliative care don't fit that model. In recent years, however, pressure has mounted to continue moving away from traditional payment systems. The Affordable Care Act has established new rules and pilot programs that reward the quality of care, rather than the quantity. Those changes are helping to make home-based palliative care a more viable option. In San Diego, Sharp's palliative care program has a strong incentive to reduce the cost of caring for its patients, who are all in Medicare managed care. The nonprofit health organization receives a fixed amount of money per member each month, so it can pocket what it doesn't spend on hospital stays and other costly medical interventions. Palliative care focuses on relieving patients' stress, pain and other symptoms as their health declines, and it helps them maintain their quality of life. It's for people with serious illnesses, such as cancer, dementia and heart failure. The idea is for patients to get palliative care and then move into hospice care, but they don't always make that transition. The 2014 report "Dying in America," by the Institute of Medicine, recommended that all people with serious advanced illness have access to palliative care. Many hospitals now have palliative care programs, delivered by teams of social workers, chaplains, doctors and nurses, for patients who aren't yet ready for hospice. But until recently, few such efforts had opened beyond the confines of hospitals. Kaiser Permanente set out to address this gap nearly 20 years ago, creating a home-based palliative care program that it tested in California and later in Hawaii and Colorado. Two studies by Kaiser and others found that participants were far more likely to be satisfied with their care and more likely to die at home than those not in the program. (Kaiser Health News is not affiliated with Kaiser Permanente.) One of the studies, published in 2007, found that 36 percent of people receiving palliative care at home were hospitalized in their final months, compared with 59 percent of those getting standard care. The overall cost of care for those who participated in the program was a third less than for those who didn't. "We thought, 'Wow. We have something that works,'" said Susan Enguidanos, an associate professor of gerontology at the University of Southern California's Leonard Davis School of Gerontology, who worked on both studies. "Immediately we wanted to go and change the world." But Enguidanos knew that Kaiser Permanente was unlike most health organizations. It was responsible for both insuring and treating its patients, so it had a clear financial motivation to improve care and control costs. Enguidanos said she talked to medical providers around the nation about this type of palliative care, but the concept didn't take off at the time. Providers kept asking the same question: How do you pay for it without charging patients or insurers? "I liken it to paddling out too soon for the wave," she said. "We were out there too soon. ... But we didn't have the right environment, the right incentive." Hoefer is a former hospice and home health medical director and has spent years treating elderly patients. He learned an important lesson when seeing patients in his office: Despite the medical care they received, "they were far more likely to be admitted to the hospital than make it back to see me." When his patients were hospitalized, many would decline quickly. Even if their immediate symptoms were treated successfully, they would sometimes leave the hospital less able to take care of themselves. They would get infections or suffer from delirium. Some would fall. Hoefer's colleague, Suzi Johnson, a nurse and administrator in Sharp's hospice program, saw the opposite side of the equation. Patients admitted into hospice care would make surprising turnarounds once they stopped going to the hospital and started getting medical and social support at home, instead. Some lived longer than doctors had expected. In 2005, the pair hatched a bold idea: What if they could design a home-based program for patients before they were eligible for hospice? Thus, Transitions was born. They modeled their new program in part on the Kaiser experiment, then set out to persuade doctors, medical directors and financial officers to try it. But they met resistance from physicians and hospital administrators who were used to getting paid for seeing patients. "We were doing something that was really revolutionary, that really went against the culture of health care at the time," Johnson said. "We were inspired by the broken system and the opportunity we saw to fix something." Despite the concerns, Sharp's foundation board gave the pair a $180,000 grant to test out Transitions. And in 2007, they started with heart failure patients and later expanded the program to those with advanced cancer, dementia, chronic obstructive pulmonary disease and other progressive illnesses. They started to win over some doctors who appreciated having additional eyes on their patients, but they still encountered "some skepticism about whether it was really going to do any good for our patients," said Dr. Jeremy Hogan, a neurologist with Sharp. "It wasn't really clear to the group ... what the purpose of providing a service like this was." Nevertheless, Hogan referred some of his dementia patients to the program and quickly realized that the extra support for them and their families meant fewer panicked calls and emergency room trips. Hoefer said doctors started realizing home-based care made sense for these patients — many of whom were too frail to get to a doctor's office regularly. "At this point in the patient's life, we should be bringing health care to the patient, not the other way around," he said. Across the country, more doctors, hospitals and insurers are starting to see the value of home-based palliative care, said Kathleen Kerr, a health care consultant who researches palliative care. "It is picking up steam," she said. "You know you are going to take better care of this population, and you are absolutely going to have lower health care costs." Providers are motivated in part by a growing body of research. Two studies of Transitions in 2013 and 2016 reaffirmed that such programs save money. The second study, led by outside evaluators, showed it saved more than $4,200 per month on cancer patients and nearly $3,500 on those with heart failure. The biggest differences occurred in the final two months of life, said one of the researchers, Brian Cassel, who is palliative care research director at the Virginia Commonwealth University School of Medicine in Richmond. Nurse Sheri Juan and social worker Mike Velasco, who both work for Sharp, walked up a wooden ramp to the Chinchars' front door one recent January morning. Juan rolled a small suitcase behind her containing a blood pressure cuff, a stethoscope, books, a laptop computer and a printer. Late last year, Gerald Chinchar's doctor recommended he enroll in Transitions, explaining that his health was in a "tenuous position." Chinchar has nine grandchildren and four great-grandchildren. He has had breathing problems much of his life, suffering from asthma and chronic obstructive pulmonary disease — ailments he partly attributes to the four decades he spent painting and sandblasting fuel tanks for work. Chinchar also recently learned he had heart failure. "I never knew I had any heart trouble," he said. "That was the only good thing I had going for me." Now he's trying to figure out how to keep it from getting worse: How much should he drink? What is he supposed to eat? That's where Juan comes in. Her job is to make sure the Chinchars understand Gerald's disease so he doesn't have a flare-up that could send him to the emergency room. She sat beside the couple in their living room and asked a series of questions: Any pain today? How is your breathing? Juan checked his blood pressure and examined his feet and legs for signs of more swelling. She looked through his medications and told him which ones the doctor wanted him to stop taking. "What we like to do as a palliative care program is streamline your medication list," she told him. "They may be doing more harm than good." His wife, Mary Jo Chinchar, said she appreciates the visits, especially the advice about what Gerald should eat and drink. Her husband doesn't always listen to her, she said. "It's better to come from somebody else." Outpatient palliative care programs are cropping up in various forms. Some new ones are run by insurers, others by health systems or hospice organizations. Others are for-profit, including Aspire Health, which was started by former senator Bill Frist in 2013. Sutter Health operates a project called Advanced Illness Management to help patients manage symptoms and medications and plan for the future. The University of Southern California and Blue Shield of California recently received a $5 million grant to provide and study outpatient care. "The climate has changed for palliative care," said Enguidanos, the lead investigator on the USC-Blue Shield project. Ritchie said she expects even more home-based programs in the years to come. "My expectation is that much of what is being done in the hospital won't need to be done in the hospital anymore and it can be done in people's homes," she said. Challenges remain, however. Some doctors are unfamiliar with the approach, and patients may be reluctant, especially those who haven't clearly been told they have a terminal diagnosis. Now, some palliative care providers and researchers worry about the impact of President Donald Trump's plans to repeal the Affordable Care Act and revamp Medicare — efforts that seem to be back in play. Gerald Chinchar, who grew up in Connecticut, said he never expected to live into old age. In his family, Chinchar said, "you're an old-timer if you make 60." Chinchar said he gave up drinking and is trying to eat less of his favorite foods — steak sandwiches and fish and chips. He just turned 77, a milestone he credits partly to the pre-hospice program. "If I make 80, I figured I did pretty good," he said. "And if I make 80, I'll shoot for 85." This story is part of NPR's partnership with Kaiser Health News. KHN is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can follow Anna Gorman on Twitter: @annagorman.
News Article | April 17, 2017
What Happens To A Congressman's Health Insurance If Obamacare Goes Down? As members of Congress debate the future of the health law and its implications for consumers, how are they personally affected by the outcome? And how will the law that phases out the popular Medigap Plan F – popular supplemental Medicare insurance — affect beneficiaries? We've got answers to these and other recent questions from readers. What type of insurance do our elected representatives in Washington, D.C., have? Is it true that they're insured on the ACA exchanges now and that any repeal and replacement will affect them too? Under the Affordable Care Act, members of the U.S. House of Representatives, the Senate and their office staffs who want employer coverage generally have to buy it on the health insurance exchange. Before the ACA passed in 2010, they were eligible to be covered under the Federal Employees Health Benefits Program. (People working for congressional committees who are not on a member's office staff may still be covered under FEHBP.) The members of Congress and their staffs choose from among 57 gold plans from four insurers sold on the DC Health Link's small business marketplace this year. Approximately 11,000 are enrolled, according to Adam Hudson, a spokesperson for the exchange. The government pays about three-quarters of the cost of the premium, and workers pay the rest. They aren't eligible for federal tax credits that reduce the size of insurance premiums. For some other members of Congress, declining exchange coverage was a political statement. "There are several who, because of animus to Obamacare, rejected the offer of coverage, and either buy on their own or get it through a spouse," said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. Proposed bills to replace the ACA don't affect this provision of the law, said Timothy Jost, a professor emeritus of law at Washington and Lee University School of Law in Lexington, Va., who has written widely on the regulation of health care and its reform. I am told by our insurance broker that in 2020 Medicare is eliminating Medigap Plan F. Having to switch to a new plan may be difficult for many seniors whose health has deteriorated. Should seniors act early, if needed, to switch Medigap plans while they still have good health? You needn't worry. As long as you continue to pay your Medigap Plan F premium you won't lose that coverage. "This guy can hang onto his F plan forever," said Bonnie Burns, a training and policy specialist at California Health Advocates, a Medicare advocacy and education group."All Medigaps are guaranteed renewable as long as the premiums are paid," she said. There are 10 standard Medigap plans, sold by a variety of private insurers, that pay for expenses that Medicare doesn't include. These supplemental plans are identified by letter from A through N. They cover – to varying degrees — beneficiaries' out-of-pocket Medicare costs, including deductibles and coinsurance. All the plans with the same letter offer the same basic benefit. When seniors first enroll in Medicare, insurers must sell them a Medigap plan without taking their health into account. But if those who are eligible wait, or want to switch plans later, they can be turned down. Medigap plans F and C cover all the Medicare costs that the program doesn't pay for, including the deductible for Medicare Part B (which covers outpatient care, such as doctor visits). Generally, that Part B deductible in 2017 is $183. Plans F and C are the only two Medigap plans that cover it. As part of the 2015 Medicare Access and CHIP Reauthorization Act, Congress decided that, starting in 2020, newly eligible Medicare beneficiaries will no longer be allowed to buy plans that pay the deductibles for Medicare Part B. "Congress decided that people should have more 'skin in the game,'" said Burns, referring to the idea that patients will make more prudent health care decisions if they're on the hook for at least part of the cost. But the change doesn't affect anyone who is enrolled in those plans before 2020 or who will be eligible for Medicare by then even if they aren't yet using it. And even though Plans C and F will no longer be available to new beneficiaries, Medigap plans D and G will be good substitutes. They provide similarly comprehensive coverage — except for the Part B deductible. Can my spouse continue to cover me under her health insurance after we are divorced? Once you're divorced, it's unlikely you'll be able to remain covered as a dependent on your ex-wife's plan, said J.D. Piro, who leads the health and law group at benefits consultant Aon Hewitt. A few states may allow it, and that could work in your favor if the plan is subject to state law. But many large employers pay their employees' claims directly rather than buy insurance, and they're generally not subject to state insurance rules. However, you may be able to keep your ex-wife's coverage for up to three years under the federal law known as COBRA. That law applies to companies with 20 or more workers, and several states have similar laws that apply to smaller companies. The catch: You'll have to pay the insurance policy's full premium. Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. Email questions for future columns: KHNHelp@KFF.org. Michelle Andrews is on Twitter: @mandrews110
News Article | May 25, 2017
There is a cause of greenhouse gas (GHG) emissions that nobody likes to talk about, and it is cow farts. In a single day, a lone cow can fill a 55-gallon bag with methane-laden gas–methane being a GHG as much as 30 times more damaging than carbon dioxide–and at least 1.5 billion cows roam the planet. The meat and dairy industry accounts for as much as 15% of global emissions. Various solutions have been proposed to rein in cattle-fueled methane: A scientist at Texas A&M University is developing a closed-loop dairy concept to trap emissions from manure and convert it into fertilizer; a group of farmers in Argentina has gone down a less sophisticated route and begun to harvest cow farts in giant bags. But a team of American researchers, led by Helen Harwatt at Loma Linda University, are suggesting that the key might be people switching up their diets–and swapping out beef for beans. Before we get sidetracked by the myriad “one gas for another” jokes to be made, let’s first get through the science of it all. This one change, the researchers found, would lead to the United States immediately hitting 50% to 75% of its GHG reduction targets for the year 2020. Beef is the most emissions-intensive food to produce, but–despite the fact that we, as a nation, have collectively reduced our consumption of it by 19% since 2005–it’s among the most popular proteins of choice in the country. Beans and legumes don’t carry the same all-American cache as a burger, but the researchers found that their production results in one-fortieth of the emissions produced by the livestock industry. A number of dietary adjustments have been floated as potential alternatives to our emissions-heavy consumption habits. The Reducetarian Solution, a new book, advocates for collectively reducing the societal consumption of animal products by stating to cut back small amounts of meat, and plant-based food startups like Impossible Burger are finding new ways to recreate the experience of eating meat without harming the planet. But the gimmicky nature of examining the effect of one dietary swap, Harwatt told Loma Linda University Health News, is the point. “Given the novelty, we would expect that the study will be useful in demonstrating just how much of an impact changes in food production can make and increase the utility of such options in climate-change policy,” Harwatt said. Through her research, Harwatt also discovered that shifting to beans and legumes would free up a good deal of land currently monopolized by the inefficient livestock industry. Around 42% of cropland, or 400 million square miles, currently used for beef production, would be liberated for other uses, which could go a long way toward supporting new, sustainable ways to feed our growing population. While in the study, the researchers are careful to note that “beans for beef” is not yet being weighed as a climate policy option, Harwatt indicated that it could be. “Given the scale of greenhouse gas reductions needed to avoid the worst impacts of climate change, are we prepared to eat beef analogs that look and taste like beef, but have a much lower climate impact?” she said in Loma Linda University Health News. “It looks like we’ll need to do this. The scale of the reductions in greenhouse gas emissions needed doesn’t allow us the luxury of ‘business as usual’ eating patterns.” Now, joke away.
News Article | May 10, 2017
GOP lawmakers condemn ‘potentially illegal’ requirement that health department workers must check with bosses before communicating with Hill A federal health department memo telling employees they must consult with management before “any communications with members of Congress” was called “potentially illegal and unconstitutional” by two Republican congressmen, who said it could deter whistleblowers from coming forward. Chuck Grassley and Jason Chaffetz “obtained” a copy from the health and human services department (HHS) and sent it on to the health and human services (HHS) secretary, Tom Price. “Federal employees will most certainly read this instruction as a prohibition against direct communications with Congress without permission,” Grassley and Chaffetz wrote to Price, requesting more information about the policy. “As such, it is potentially illegal and unconstitutional, and will likely chill protected disclosures of waste, fraud, and abuse.” Grassley is chairman of the Senate judiciary committee and Chaffetz of the House committee on oversight and government reform. The 3 May memo was sent from Price’s chief of staff, Lance Leggitt, to the heads of staff and operating divisions at HHS. Because health department employees would be required “to expose their communications with Congress to agency management, necessarily subjecting them to a significantly increased risk of reprisal”, the memo could violate several laws that protect whistleblowers, the Republican congressmen said. “The effect will be to substantially chill those communications.” The memo said any requests from Congress for “calls, meetings, briefings, technical assistance, policy development, hearings, oversight, detailees, etc”, should be coordinated with the assistant secretary for legislation. The Trump administration recently nominated a Tennessee businessman to fill that role. Price’s chief of staff, in the memo, said the department was only attempting to reiterate “the department’s longstanding policy regarding congressional relations”. An HHS spokesperson said: “This type of memorandum is nothing new. It reflects consistent agency policy which has been in place for decades as has been confirmed by the HHS Office of the General Counsel.” She added: “There is no prohibition in the memorandum on direct communications ... If an HHS employee has concerns about waste, fraud or abuse at the agency, we want them to contact the appropriate officials so it can be stopped.” The letter was published by Kaiser Health News the same day a reporter was arrested for attempting to shout questions at Price. Daniel Ralph Heyman, a 54-year-old journalist for Public News Service, was arrested after asking Price whether being the victim of domestic violence would exclude someone from health insurance under the new Republican health bill. “I asked him the question repeatedly and he did not answer,” said Heyman at a news conference shown on the American Civil Liberties Union of West Virginia’s Facebook page. “I think they decided I was just too persistent in asking this question and trying to do my job, so they arrested me.”
News Article | May 9, 2017
One-Third Of New Drugs Had Safety Problems After FDA Approval The Food and Drug Administration is under pressure from the Trump administration to approve drugs faster, but researchers at the Yale School of Medicine found that nearly a third of those approved from 2001 through 2010 had major safety issues years after the medications were made widely available to patients. Seventy-one of the 222 drugs approved in the first decade of the millennium were withdrawn, required a "black box" warning on side effects or warranted a safety announcement about new risks, Dr. Joseph Ross, an associate professor of medicine at Yale School of Medicine, and colleagues reported in JAMA on Tuesday. The study included safety actions through Feb. 28. "While the administration pushes for less regulation and faster approvals, those decisions have consequences," Ross says. The Yale researchers' previous studies concluded that the FDA approves drugs faster than its counterpart agency in Europe does and that the majority of pivotal trials in drug approvals involved fewer than 1,000 patients and lasted six months or less. It took a median of 4.2 years after the drugs were approved for these safety concerns to come to light, the study found, and issues were more common among psychiatric drugs, biologic drugs, drugs that were granted "accelerated approval" and drugs that were approved near the regulatory deadline for approval. Drugs ushered through the FDA's accelerated approval process were among those that had higher rates of safety interventions. These approvals typically rely on surrogate endpoints, meaning that researchers measured something other than survival, such as tumor size, to determine whether the drugs worked. "This [finding on surrogate endpoints] has the greatest relationship to policy today," Ross says. "In the 21st Century Cures Act, there's a push to have the FDA move to further support the use of surrogate markers ... [but] they're more likely to have concerns in the post-market setting." President Barack Obama signed the 21st Century Cures Act into law on Dec. 13. It offers ways to speed drug approval by pushing the FDA to consider evidence beyond the three phases of traditional clinical trials. The new process has made some researchers worry that it will open the door for approvals of drugs that haven't been adequately tested. "I'm actually sympathetic to the idea that there are ways in which the FDA can be more streamlined and do a quicker job," says Dr. Vinay Prasad, a hematologist-oncologist and professor at Oregon Health and Sciences University who did not work on the study. "The one place you don't want to cut a corner is safety and efficacy prior to coming to market." The FDA's system for reporting drug- and device-related health problems is voluntary. The reports are not verified, and critics say this system is underutilized and filled with incomplete and late information. The FDA also monitors other available studies and reports to determine whether it needs to take action on a particular drug. FDA spokeswoman Angela Hoague said the agency is reviewing Ross' findings. "In general, the FDA does not comment on specific studies but evaluates them as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health," she said. Surprisingly, drugs approved in under 200 days were less likely to have safety issues, which the authors speculate could be because "some approval packages provide clearer evidence of safety, allowing for more rapid regulatory approval." The study included market withdrawals of three drugs: the anti-inflammatory drug Bextra; Zelnorm, which was used to treat irritable bowel syndrome; and the psoriasis drug Raptiva. Bextra and Zelnorm were withdrawn because of cardiovascular risk, and Raptiva was withdrawn because of increased risk of a rare and fatal infection that causes brain damage. Still, it's important to keep in mind that the post-approval safety issues cover the spectrum from relatively minor to serious, says Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness who did not work on the study. Good next steps would be to dig into the most serious safety problems, determine whether the FDA could have flagged them sooner and examine how they might have been missed, he says. Alexander commended the researchers, saying their study "underscores the importance of surveillance" after a drug has been launched. He says this helps researchers find new problems — and new benefits — associated with a drug. "All too often, patients and clinicians mistakenly view FDA approval as [an] indication that a product is fully safe and effective," he says. "Nothing could be further from the truth. We learn tremendous amounts about a product only once it's on the market and only after use among a broad population." Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. KHN's coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
Shiffman M.L.,Health News
Current Opinion in Gastroenterology | Year: 2014
Purpose of Review The evolution of treatment for patients with chronic hepatitis C virus (HCV) is evolving at a rapid pace. Two new oral antiviral agents, simeprevir and sofosbuvir, have already been approved and are now available for treatment of patients with chronic HCV. Other antiviral agents will be available during 2014. Recent Findings The protease inhibitor simeprevir was recently approved for use with peginterferon (PEGINF) and ribavirin (RBV) in patients with chronic genotype 1. About 80% of patients achieve a rapid virologic response and can be treated for 24 weeks the sustained virologic response (SVR) in treatment-naive patients is about 80%. Sofosbuvir, the first polymerase inhibitor, is effective in all HCV genotypes. When utilized with peginterferon and RBV for 12 weeks in treatment-naive patients with genotypes 1, 4, 5 and 6, an SVR of 90% is observed. Sofosbuvir and RBV have also been studied without interferon and represent the first interferon-free therapy for chronic HCV. Summary: It is now possible to cure chronic HCV in the vast majority of patients with chronic HCV and in many patients without interferon.