No bail-out needed for German health IT industry

Demand for health IT in Germany is stable, and the current financial and economic crisis is not expected to have a major impact. These were the conclusions drawn during a media briefing of the VHitG - the German Association of the Healthcare IT Industry - held in Berlin on Feb. 2.

The crisis may even provide an opportunity for "greater leaps forward" - for example for the introduction of the long-awaited Gesundheitskarte, initially planned for Jan. 1, 2006, but yet to make it beyond the testing phase.

"The Gesundheitskarte is technically mature and the industry has made enormous investments in order to proceed with a national health card. However, organizational and political management is delaying implementation," said medatiXX CEO Jens Naumann, currently holding the seat of VHitG. "Perhaps in times of crisis we will see acceptance of this technology increase," he added.

According to Bernhard Calmer, head of IT Sales Germany for SIEMENS Medical Solutions and board member of the VHitG, there are three factors which will drive IT adoption: process optimization, interoperability and medical records solutions.

The anticipated slowdown in hospital mergers and the need to reduce costs could increase the demand for IT, Calmer said, noting that "the fact that European healthcare is still organized on a national level could be beneficial for the German health IT industry," as it is hoped that the economic slowdown in Germany will have less of an impact than in other parts of the world.

 

A dash of Europe, but not too much

National responsibility for healthcare in Europe is also one of the reasons why the VHitG does not feel any urgency to internationalize its scope. "Yes, we are adding a European element to our activities, for example by providing English interpreting services at this year's conhIT," said Andreas Kassner, managing director of VHitG. conhIT is the German health-IT conference and exhibition (Berlin, 21-23 April, 2009).

 

"But at the end of the day, we must tell our customers and conference delegates how to solve their very specific problems - and these problems cannot be solved with a European solution. They require a very local, hands-on answer to regional specifics," Calmer added.

When asked about his views on a European health IT show, Calmer said that conhIT was considering "loose coorperations" with other health IT shows. "However, we will not try to force the European element on our customers," he said.

 

Industry trends

The VHitG also presented the trends from an IT survey carried out among 2,093 German hospitals. Matthias Meierhofer, CIO of the HIS-provider Meierhofer AG and member of the VHitG board, summarized the results:

 

 

Larger hospitals are more likely to implement health IT applications, with a preference for specialized solutions that support medical care rather than administrative systems.Health IT is especially appreciated when it improves workflows, optimizes usability and streamlines communications with stakeholders outside the hospital. Again, larger hospitals are more likely to value these benefits.Integration, interoperability and standardisation are key success factors and the VHitG therefore aims to develop clear recommendations for supporting these factors.

 

"There is greater potential for systems that improve data accessibility, knowledge management and transparacy, as well as technology that supports management decisions," said Meierhofer. "IT has the potential to be worth a lot more than it is today."

Related links:
www.VHitG.de (German)
www.conhit.de (German / English)

Born to run barefoot? Some end up getting injured

LOS ANGELES(AP)�Swept by the barefoot running craze, ultramarathoner Ryan Carter ditched his sneakers for footwear that mimics the experience of striding unshod.

The first time he tried it two years ago, he ran a third of a mile on grass. Within three weeks of switching over, he was clocking six miles on the road.

During a training run with a friend along a picturesque bike path near downtown Minneapolis, Carter suddenly stopped, unable to take another step. His right foot seared in pain.

"It was as though someone had taken a hammer and hit me with it," he recalled.

Carter convinced his friend to run on without him. He hobbled home and rested his foot. When the throbbing became unbearable days later, he went to the doctor. The diagnosis: a stress fracture.

As more avid runners and casual athletes experiment with barefoot running, doctors say they are treating injuries ranging from pulled calf muscles to Achilles tendinitis to metatarsal stress fractures, mainly in people who ramped up too fast. In serious cases, they are laid up for several months.

Many converts were inspired by Christopher McDougall's 2009 best-seller "Born To Run," widely credited with sparking the barefoot running trend in the Western world. The book focuses on an Indian tribe in Mexico whose members run long distances without pain in little more than sandals.

While the ranks of people running barefoot or in "barefoot running shoes" have grown in recent years, they still represent the minority of runners. Some devotees swear they are less prone to injuries after kicking off their athletic shoes though there's no evidence that barefoot runners suffer fewer problems.

In some cases, foot specialists are noticing injuries arising from the switch to barefoot, which uses different muscles. Shod runners tend to have a longer stride and land on their heel compared with barefoot runners, who are more likely to have a shorter stride and land on the midfoot or forefoot. Injuries can occur when people transition too fast and put too much pressure on their calf and foot muscles, or don't shorten their stride and end up landing on their heel with no padding.

Podiatrist Paul Langer used to see one or two barefoot running injuries a month at his Twin Cities Orthopedics practice in Minneapolis. Now he treats between three and four a week.

"Most just jumped in a little too enthusiastically," said Langer, an experienced runner and triathlete who trains in his barefoot running shoes part of the week.

Bob Baravarian, chief of podiatry at the UCLA Medical Center in Santa Monica, Calif., said he's seen "a fair number" of heel injuries and stress fractures among first-timers who are not used to the different forces of a forefoot strike.

"All of a sudden, the strain going through your foot is multiplied manifold" and problems occur when people don't ease into it, he said.

Running injuries are quite common. Between 30 to 70 percent of runners suffer from repetitive stress injuries every year and experts can't agree on how to prevent them. Some runners with chronic problems have seized on barefoot running as an antidote, claiming it's more natural. Others have gone so far as to demonize sneakers for their injuries.

Pre-human ancestors have walked and run in bare feet for millions of years often on rough surfaces, yet researchers surprisingly know very little about the science of barefoot running. The modern running shoe with its cushioned heel and stiff sole was not invented until the 1970s. And in parts of Africa and other places today, running barefoot is still a lifestyle.

The surging interest has researchers racing for answers. Does barefoot running result in fewer injuries? What kinds of runners will benefit most from switching over? What types of injuries do transitioning barefoot runners suffer and how to prevent them?

While some runners completely lose the shoes, others opt for minimal coverage. The oxymoron "barefoot running shoes" is like a glove for the feet designed to protect from glass and other hazards on the ground. Superlight minimalist shoes are a cross between barefoot shoes and traditional sneakers � there's little to no arch support and they're lower profile.

Greg Farris decided to try barefoot running to ease the pain on the outside of his knee, a problem commonly known as runner's knee. He was initially shoeless � running minutes at a time and gently building up. After three months, he switched to barefoot running shoes after developing calluses.

Halfway through a 5K run in January, he felt his right foot go numb, but he pushed on and finished the race. He saw a doctor and got a steroid shot, but the pain would not quit. He went to see another doctor, who took an X-ray and told him he had a stress fracture.

Farris was in a foot cast for three months. He recently started running again � in sneakers.

"I don't think my body is made to do it," he said, referring to barefoot running.

Experts say people can successfully lose the laces. The key is to break in slowly. Start by walking around barefoot. Run no more than a quarter mile to a mile every other day in the first week. Gradually increase the distance. Stop if bones or joints hurt. It can take months to make the change.

"Don't go helter skelter at the beginning," said Dr. Jeffrey Ross, an associate clinical professor of medicine at Baylor College of Medicine and chief of the Diabetic Foot Clinic at Ben Taub General Hospital in Houston.

A year and a half ago, Ross saw a steady stream � between three and six barefoot runners a week � with various aches and pain. It has since leveled off to about one a month.

Ross doesn't know why. It's possible that fewer people are trying it or those baring their feet are doing a better job adapting to the new running style.

There's one group foot experts say should avoid barefoot running: People with decreased sensation in their feet, a problem common among diabetics, since they won't be able to know when they get injured.

Harvard evolutionary biologist Daniel Lieberman runs a lab devoted to studying the effects of running form on injury rates. He thinks form matters more than footwear or lack of � don't overstride, have good posture and land gently.

In a 2010 study examining different running gaits, Lieberman and colleagues found that striking the ground heel first sends a shock up through the body while barefoot runners tend to have a more springy step. Even so, more research is needed into whether barefoot running helps avoid injury.

"The long and the short of it is that we know very little about how to help all runners � barefoot and shod � prevent getting injured. Barefoot running is no panacea. Shoes aren't either," said Lieberman, who runs barefoot except during the New England winters.

Carter, the ultramarathoner, blames himself for his injury. Before he shed his shoes, he never had a problem that kept him off his feet for two months.

In April, he ran his fourth 100-mile race � with shoes. Meanwhile, his pair of barefoot running shoes is collecting dust in the closet.

BMA: Doctors still having problems with Choose And Book

LONDON – Doctors are still struggling with the computer system intended to allow patients to book hospital appointments on the spot, BMA research suggests.

The electronic 'Choose And Book' referral service is intended to give NHS patients in England a choice of place, date and time for their first outpatient appointment. Doctors' views about the system are mixed. Some are very positive and would be unwilling to revert to paper-based referrals. Others find it completely unworkable.

The BMA decided to investigate the disparities in their experiences by interviewing doctors in Hammersmith and Fulham Primary Care Trust - one of many localities across the country where there are large variations in usage.

It carried out 16 interviews with GPs, consultants, managers and administrative staff. It found that GPs liked to be able to give patients control of their appointment and administrators liked being able to track the progress of referrals.

"When the system is working well it is amazing. The referral letter and appointment are made while the patient is sitting there," one GP said.

However, even the most enthusiastic GPs said they sometimes struggled with system reliability, reporting for example that it crashed or was slow, or that they were unable to find clinics on the system. Such unreliability was seen as a significant barrier to use of the system. One practice reported that it took as long as 30 minutes to re-boot their systems following a crash.

Most of the consultants interviewed said Choose And Book had little impact on their working practices. The small number who were using it to review appointments were struggling, reporting that it was slow and that there was insufficient time to use it, particularly during a busy clinic.

Dr Chaand Nagpaul, a GP and member of the BMA's Working Party on IT, said, "When Choose And Book works, it helps patients with the referral process, and gives them an idea of the relative waiting times for different clinics. It can also help inform GPs which clinics are available, or most appropriate for their patient.

"When it goes wrong, it is extremely frustrating - to the extent that some doctors find it is not worth using. Trusts and PCTs must ensure that systems are fit for purpose. They cannot expect doctors to be enthusiastic about a system if it is unreliable or slow. For their part, doctors can help improve the systems by recording and reporting problems."

The report's recommendations include:
 

Greater collaboration between primary and secondary care;Clinicians should be integral to any decision to increase the use of Choose And Book;Robust local communications, and an analysis of demand, to address local capacity issues;Local discussions to define how clinics are included on the Directory of Services to suit local needs;Managers should ensure there is appropriate support and resources for Choose And Book users;There should be a named contact at the PCT and Trust so users can seek help, within an agreed timescale when experiencing problems.

Subrogration software a hit

SALT LAKE CITY, UT – SelectHealth brought in house the follow-up reimbursement area of its subrogation processes nearly a year ago.

Since then, the health plan has been able to quickly identify subrogation opportunities and has seen “very big financial improvement over and above” its previous process, said Marc Rueckert, SelectHealth’s senior operations review manager.

Though it varies by state, the industry standard of recovery through subrogation is between 1/2 percent and 1 percent of total claims paid. Prior to using its new process, SelectHealth’s results were lower than the standard, but have since improved 2-3 times over its previous rate, Rueckert said.

Just as important, bringing all subrogation processes in house versus outsourcing has created a stronger ownership of results, better communication and access to all its systems, he said.

SelectHealth implemented SCIOinspire’s technology originally to cover high-dollar case management cases but soon expanded its functionality to identify subrogation opportunities.

Health plans need a good case management platform and an efficient management process, said Krishna Kottapalli, chief sales and marketing officer for SCIOinspire. The more proactive health plans are at tracking and managing, the higher the percentage of capture and recovery, he said.

Control is also important, said Nick Fioravanti, director of client services for SCIOinspire. Having a good grasp of a health plan’s business and member make-up and being able to closely interface with other departments are some of the benefits of having subrogation processes in house.

Although the industry has not done any benchmarking studies, subrogation results in billion-dollar recovery for big insurance carriers, said Michael Carr, executive director of the National Association of Subrogation Professionals.

Carr pointed out that subrogation investment costs one-third less than premium investments. “A small percentage of the claims you pay out are subrogatable if you are good at identifying it,” he said.
 

Subrogration software a hit

SALT LAKE CITY, UT – SelectHealth brought in house the follow-up reimbursement area of its subrogation processes nearly a year ago.

Since then, the health plan has been able to quickly identify subrogation opportunities and has seen “very big financial improvement over and above” its previous process, said Marc Rueckert, SelectHealth’s senior operations review manager.

Though it varies by state, the industry standard of recovery through subrogation is between 1/2 percent and 1 percent of total claims paid. Prior to using its new process, SelectHealth’s results were lower than the standard, but have since improved 2-3 times over its previous rate, Rueckert said.

Just as important, bringing all subrogation processes in house versus outsourcing has created a stronger ownership of results, better communication and access to all its systems, he said.

SelectHealth implemented SCIOinspire’s technology originally to cover high-dollar case management cases but soon expanded its functionality to identify subrogation opportunities.

Health plans need a good case management platform and an efficient management process, said Krishna Kottapalli, chief sales and marketing officer for SCIOinspire. The more proactive health plans are at tracking and managing, the higher the percentage of capture and recovery, he said.

Control is also important, said Nick Fioravanti, director of client services for SCIOinspire. Having a good grasp of a health plan’s business and member make-up and being able to closely interface with other departments are some of the benefits of having subrogation processes in house.

Although the industry has not done any benchmarking studies, subrogation results in billion-dollar recovery for big insurance carriers, said Michael Carr, executive director of the National Association of Subrogation Professionals.

Carr pointed out that subrogation investment costs one-third less than premium investments. “A small percentage of the claims you pay out are subrogatable if you are good at identifying it,” he said.
 

4 keys to creating a common-sense approach to social media

NEW YORK – During one of the first talks at the Connecting Healthcare + Social Media Conference this past week in New York, Ed Bennett, director of Web and communications technology at University of Maryland Medical Center (UMMC), presented on his experiences with social networking, gaining buy-in, and successfully launching a thriving social media presence.

"I come to this as someone who works in a large academic medical center," said Bennett. "The challenges we face with bureaucracy and the themes of my presentation are the things I have learned the past three years using social media."

Bennett spoke on four keys to creating a common-sense approach to social media.

1.Real change comes from the top. According to Bennett, patients are ahead of most organizations in terms of expectations. "And one of the things I've learned is big change comes from the top," he said. "Folks from lower levels may be coming up with ideas, but it takes real leadership to make fundamental change." He added although most view "conservative organizations" as slow to change, when there's buy-in from the top, change happens more quickly and efficiently. "We speak about social media, and I had to find the things that resonated with leadership," said Bennett. "And then it was easy…there are certain types of things you can't make happen unless you convince senior management."

[See also: Social media insights from a digital strategist.]

2.Patient satisfaction is a key driver. During his experiences, Bennett said, patient satisfaction was the number one reason to open access to social media and have a public Wi-Fi network at UMMC. "Patients would go through the hospital and they bring their laptops, and they would be blocked from Facebook," he said. "[They would say], 'You're blocking me from my support network at the very time I need it most.'" Bennett said it was easier to "make the case" to leadership to open access to social media sites because of the growing patient demand, while also pointing out the evolution of the patient-organization relationship. "Some would say, 'Why should we bother with social media? Patients come from the website.'" But he added that such an attitude was all too similar to one 10 years ago, when organizations initially questioned the value of websites. "Those are the drivers I would repeat back: we've been here before, and we realized they weren't as big obstacles as we thought. We moved forward with it."

3.It takes time. UMCC opened access to social media sites in January of 2011. The result? "Nothing happened," said Bennett. "It was a 'no drama' launch; we just let people know and we let staff know, and everything went on like normal. The building didn't set on fire or collapse to the ground. We were just aware of the social media activities in the hospital." However, open access did bring about new opportunities and new services. The organization now has four Facebook pages for patients, each launching three months after opening access. "[Patients] share, and everything is managed in the Com department," said Bennett. From what he found, the biggest hesitation that remained, despite the success, has been the time it takes to implement successful social media efforts. "We think it doesn't take time to put things on Twitter, but it does take time, and physicians have a legitimate question of, 'What's the benefit to me?'" he said.  "It's tangible. Once you get past a certain threshold, patients come because that's the expectation."

[See also: Social media could 'accelerate clinical discovery'.]

4.Social media is more than just the sum of its parts. Throughout his presentation, Bennett maintained a common theme: Social media is more than the sum of its parts. "It wasn't just social media and Twitter and Facebook, but everything else the organization was doing," he said. In summary, there are three takeaways to creating a common-sense approach to social media, said Bennett. "Understand patients are far ahead of anything you want to do," he said. "At a large, transformational level, change has to come from top leadership, so is time best spent to educate and convince about the value of social media. And remember, social media is a tool – anything that comes along, anything an organization wants to do, there's some aspect of social media that can benefit."

Avery Dennison, Preventice partner on wearable sensor technology

PASADENA, CA – Avery Dennison Medical Solutions is partnering with Minneapolis-based Preventice to produce patch­based wearable sensors for clinical monitoring of a patients' unique physiological characteristics.

Preventice develops mobile health applications and patient monitoring systems that deliver continuous care, wherever an individual might be. The apps enable a constant connection and exchange of information between doctors and their patients, officials say, encouraging those patients to stay engaged in managing their health when away from their care providers, while feeding data to clinicians about a patient’s health status without impacting their daily lifestyle.

“Preventice has a unique understanding of clinical care delivery, which when combined with their expertise in mobile device platforms, remote monitoring protocols, algorithms, data management and EMR integration, gives us an advantage in the marketplace,” said Howard Kelly, vice president and general manager, Avery Dennison Medical Solutions.

Through this partnership, Avery Dennison will develop a new version of the Metria patch­based wearable sensor and user interface for the Preventice Care Platform, which creates a real­time, continuous connection between patients and healthcare providers through mobile, cloud­based and sensor technology.

Metria, which incorporates sensor technology from Proteus Biomedical, will be sold as part of the Preventice Care Platform for remote monitoring applications to hospitals and healthcare systems in the United States.

Kelly said the wearable sensors will "offer clinical remote monitoring applications that address the unmet needs of healthcare providers, while helping improve patients’ quality of life and reducing costs."

Avery Dennison Medical Solutions, a business unit of Avery Dennison Corporation, puts its expertise in advanced skin adhesives and material sciences to work developing technologies for medical apps. The company has licensed proprietary algorithms from Preventice for additional clinical applications of the Metria patch­based wearable sensor, which Avery Dennison will continue to manufacture for both partner companies and their respective customers.

“The potential to improve clinical care through the use of on­-body sensors and remote monitoring is endless,” said Jon Otterstatter, co­founder, president and CEO of Preventice. “We’re confident that the addition of Avery Dennison Medical Solutions to our ecosystem of partners who are focused on healthcare innovation creates a new level of sophistication in monitoring technology. It also supports Preventice’s laser ­focus on providing physicians with new monitoring solutions to significantly improve the patient experience and clinical outcomes.”

Vendor Notebook - Agfa to deliver imaging IT to Ochsner Health System

Agfa Healthcare, with American headquarters in Greenville, S.C., has announced that the Ochsner Health System of New Orleans has deployed the company's IMPAX Data Center to manage diagnostic image access and distribution.

The Informatics Corporation of America, based in Nashville, Tenn., has announced that Lourdes Hospital in Paducah, Ky., has deployed the ICA solution.

The Medsphere Systems Corporation has announced that its Bar Code Medication Administration (BCMA) system has been implemented successfully at all eight facilities of West Virginia's network of acute, psychiatric and long-term care hospitals.

Purkinje, based in St. Louis, has announced that it will offer free training and implementation services to all new EMR customers during the month of February in an effort to accelerate electronic medical records adoption and support the Obama Administration's healthcare transformation initiatives.

DocuSys, Inc., an Atlanta-based provider of anesthesia management, medication management and presurgical care management software, has announced that the VA San Diego Healthcare System has successfully upgraded its DocuSys software to version 7.0 in seven ORs and installed the company's second generation DocuJet point-of-care safety device for monitoring drug deliveries in the OR.

Pharmacy OneSource, Inc., of Bellevue, Wash., has announced that nine Pennsylvania hospitals - Pottstown Memorial Medical Center, Easton Hospital, Phoenixville Hospital, Brandywine Hospital, the Chestnut Hill Health System, Jennersville Regional Hospital, the Berwick Hospital Center, Lock Haven Hospital and Sunbury Community Hospital - have chosen to adopt the Sentri7 infection control and prevention software system.

The Eclipsys Corporation of Atlanta has announced that Madonna Rehabilitation Hospital in Lincoln, Neb., plans to adopt a wide range of the company's clinical solutions.

Unibased Systems Architecture of Chesterfield, Mo., has signed an enterprise-wide agreement with Norton healthcare for pre-visit access management, scheduling, physician portal, healthcare consumer portal and business intelligence software systems and services for Norton's five hospitals in Kentucky.

The Panasonic Computer Solutions Company of Secaucus, N.J., has launched the Toughbook H1 Healthcare Tour, hosted in partnership with Intel's Digital Healthcare Group. The multi-city tour will feature educational seminars on Panasonic's Toughbook H1.

The MedCurrent Corporation, a Los Angeles-based provider of physician practice management solutions, has announced that Pueblo Radiology Medical Group, with 22 radiologists in four centers in Santa Barbara and Ventura, Calif., is among the first imaging centers to use Verify, the company's Web-based insurance eligibility verification tool.

Epocrates, Inc., has introduced the Epocrates Essentials suite for the iPhone and iPod Touch operating systems. The expanded content features disease and diagnostic resources.

Another IT deadline: HIX plans due Nov. 16

WASHINGTON – States must provide details to the federal government by Nov. 16 – just 10 days after the presidential election – on how they will run online insurance marketplaces, according to guidance released May 16.

Those that don’t meet the deadline – or that can’t operate their own marketplaces, called exchanges  – will have it done for them by the federal government, starting in January 2014.

[See also: HHS issues final rule on insurance exchanges]

The marketplaces, which are mandated by the 2010 health law, are designed to increase competition among insurers and to make coverage more affordable. States can choose to run the exchanges, elect to perform only some services or cede control to the federal government, officials said Wednesday. The Department of Health & Human Services “will seek to harmonize … policies with existing state programs and laws wherever possible,” according to a separate report offering a few details on what a federal exchange might look like.

While the guidance does not indicate whether there will be a governing board overseeing the federal exchanges, it does say the federally-overseen marketplaces will accept any insurer that meets the basic requirements.

Some consumer groups, including the American Cancer Society Cancer Action Network wanted the federal government to be more selective, in hopes that it would drive insurers to compete harder on pricing and quality measures.

[See also: Health insurance exchanges mired in political battle]

But Steve Larsen, the federal official overseeing the federal exchange effort, said the initial approach would be an open marketplace, but he told reporters that in future years other options may be explored.  States that run their own exchanges are free to choose whichever model they prefer.

While many states are moving forward  – 34 have received federal grants to pay for planning efforts – others are moving slowly or not at all.  Six states — Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington — received additional grants on Wednesday totaling more than $181 million.

According to news reports, officials in some state say they are holding back pending the Supreme Court’s decision on the constitutionality of the health law, expected at the end of June.  The court could uphold the entire law, strike it down entirely or eliminate some parts of it.

Other state lawmakers have said they want to hold off on creating the marketplaces until after the results of the November election are known.  Larsen reiterated the government’s stance that the court will uphold the law and that the president will be re-elected, and he said “states should turn their attention to moving forward.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

[See also: HHS awards $185M more for insurance exchanges]

HHS aims to help public gauge how healthcare is doing

WASHINGTON – The Department of Health and Human Services  has made available an online tool that makes it easy for the public to monitor and measure how the nation’s healthcare system is performing.

The Health System Measurement Project enables policymakers, providers and the public to develop consistent data-driven charts and views of changes in important health system indicators.

[See also: HHS launches $1B innovation initiative]

The web-based application brings together datasets from across federal agencies that span topical areas, such as access to care, cost and affordability, prevention and health information technology. It presents these indicators by population characteristics, such as age, sex, income level, insurance coverage, and geography.

A user can look at data on a given topical area from multiple sources, compare trends across measures and compare national trends with those at the state and regional level.

For example, an individual could use the tool to examine the percentage of people who have a specific source of ongoing medical care or track avoidable hospitalizations for adults and children by region or ethnic group. Or explore the percentage of non-elderly individuals who have health insurance.

[See also: HHS aims to spur software apps development]

“Ensuring all Americans have access to these data is an important way to make our health care system more open and transparent,” said HHS Secretary Kathleen Sebelius in a May 15 announcement.

The measures are drawn primarily from existing publicly available datasets. The tool contains information on how the measures were calculated and provides users with direct links back to the original data sources.

The HHS Office of the Assistant Secretary for Planning and Evaluation developed and selected the measures in the Health System Measurement Project.
 

Another IT deadline: HIX plans due Nov. 16

WASHINGTON – States must provide details to the federal government by Nov. 16 – just 10 days after the presidential election – on how they will run online insurance marketplaces, according to guidance released May 16.

Those that don’t meet the deadline – or that can’t operate their own marketplaces, called exchanges  – will have it done for them by the federal government, starting in January 2014.

[See also: HHS issues final rule on insurance exchanges]

The marketplaces, which are mandated by the 2010 health law, are designed to increase competition among insurers and to make coverage more affordable. States can choose to run the exchanges, elect to perform only some services or cede control to the federal government, officials said Wednesday. The Department of Health & Human Services “will seek to harmonize … policies with existing state programs and laws wherever possible,” according to a separate report offering a few details on what a federal exchange might look like.

While the guidance does not indicate whether there will be a governing board overseeing the federal exchanges, it does say the federally-overseen marketplaces will accept any insurer that meets the basic requirements.

Some consumer groups, including the American Cancer Society Cancer Action Network wanted the federal government to be more selective, in hopes that it would drive insurers to compete harder on pricing and quality measures.

[See also: Health insurance exchanges mired in political battle]

But Steve Larsen, the federal official overseeing the federal exchange effort, said the initial approach would be an open marketplace, but he told reporters that in future years other options may be explored.  States that run their own exchanges are free to choose whichever model they prefer.

While many states are moving forward  – 34 have received federal grants to pay for planning efforts – others are moving slowly or not at all.  Six states — Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington — received additional grants on Wednesday totaling more than $181 million.

According to news reports, officials in some state say they are holding back pending the Supreme Court’s decision on the constitutionality of the health law, expected at the end of June.  The court could uphold the entire law, strike it down entirely or eliminate some parts of it.

Other state lawmakers have said they want to hold off on creating the marketplaces until after the results of the November election are known.  Larsen reiterated the government’s stance that the court will uphold the law and that the president will be re-elected, and he said “states should turn their attention to moving forward.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

[See also: HHS awards $185M more for insurance exchanges]

More than 1 in 10 babies worldwide born prematurely

The first-ever country-by-country estimate of premature births finds that 15 million babies a year are born preterm � more than one in 10 live births.

About 1 million of those babies die shortly after birth, and countless others suffer a significant, life-long physical, neurological or educational disability, says a report, Born Too Soon: The Global Action Report on Preterm Birth, released today.

The findings "dispel the notion that this is a rare problem" and "leave no excuse for preterm births to remain a neglected problem," says Joy Lawn, director of global evidence and policy for Save the Children and co-editor of the report.

Although more than 60% of preterm births are in sub-Saharan Africa and south Asia, they are also a problem for some high-income countries, including the USA and Brazil. Both rank among the 10 countries with the highest number of preterm births.

In the USA, about 12% of all births are preterm, a percentage far higher than in Europe or other developed countries.

Factors driving up the rate in the USA include the number of older women having babies; increased use of fertility drugs, which increase the risk of multiple births; and increased rates of medically unnecessary Cesarean deliveries and inductions "done at the convenience of the doctor or mother," says Christopher Howson, another co-editor of the report and head of Global Programs for the March of Dimes. Other organizations involved in producing the report were the World Health Organization and the Partnership for Maternal, Newborn and Child Health, a global alliance of more than 400 health organizations.

In addition to a notable age gap (the rate for women ages 20-35 was 11% to 12% vs. 15% for women under 17 and over 40), a considerable racial gap also exists in the USA, Howson says.

The preterm birth rate for black Americans in 2009 was as high as 17.5%, compared with 10.9% for white Americans.

"In the United States, our preemies have among the highest survival rates in the world," Howson says. "Where we fall flat is on the prevention side. We need to do a lot more to prevent preterm births, such as improving health care access for all, bringing down rates of smoking and issues of unnecessary C-sections and inductions."

Globally, preterm births are the second leading killer of children younger than 5, and "the numbers haven't come down very much, especially when you compare it to things like pneumonia, diarrhea � where we've really made progress � malaria and HIV, where we've also made significant progress," Lawn says.

"In fact, the numbers have been increasing," she says, adding that "out of 65 countries where reliable trend data is available, only three (Croatia, Euador and Estonia) show a significant reduction" from 1990 to 2010.

For the report, preterm was defined as 37 weeks of completed gestation or less, the standard World Health Organization definition.

A recent March of Dimes analysis shows that, even though numbers are low, the risk of death of babies born at 37 to 39 weeks of gestation is twice as high as full-term babies, or 39 weeks, Howson says: "Only one week increases the risk of adverse outcomes."

An estimated 75% of the world's 1 million preterm deaths could be avoided if a few "proven and inexpensive treatments and preventions" were widely available in low-income countries, according to the report, including teaching "kangaroo care," in which tiny babies are held skin-to-skin on their mother's bare chests for warmth when there are no incubators.

Also, steroid injections for mothers in premature labor, which cost $1 an injection, help develop immature fetal lungs and prevent respiratory problems.

Raising Patient Safety Awareness Across the Country

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) is continuing to work with a wide variety of public and private partners to improve the care and services patients receive in our health system.

We are proud to announce that we have collaborated with nearly 4,500 organizations, including over 2,000 hospitals that have officially committed to improving patient safety by joining the initiative! In fact, HHS is thrilled to recognize the 100% participation rate by Iowa hospitals to promote innovations to improve hospital care and reduce wasteful spending.

Are you a partner? If so, you can add the badge below to your website. All you need to do is click here or on the image below and grab the code provided on the right side of the page where it says �show code.�

Building off the extraordinary work many local hospitals and health systems around the country have already been doing � from Denver Colorado to Richmond Virginia � the Partnership for Patients aims to improve the quality, safety and affordability of health care for all Americans. �

One Denver hospital in particular is setting the bar for Patient Safety. �Last month, HHS Secretary, Kathleen Sebelius, visited Denver Health along with Dr. Don Berwick, Administrator of the Centers for Medicare and Medicaid Services. Denver Health, along with other hospitals and organizations across the country are committed to providing better health care.

Check out this PBS NewsHour program to learn why improving health outcomes and lowering costs go hand in hand.� Seven years ago, Denver Health took a structured approach to improving quality and safety. By focusing on high opportunity clinical circumstances, Denver Health ranks first, with the lowest ratio of deaths according to the 2010 University Health System Consortiums Quality and Aggregate Score. While this success is encouraging, too many Americans go without quality healthcare: which is where the Partnership for Patients comes in.

CMS Administrator Don Berwick meets with VCU pharmacy students.

This partnership is connecting health care providers all across the nation. At a recent visit to Regions Hospital in St. Paul, Secretary Sebelius learned about the �time-out� towel. This towel is used to cover surgical instruments at Regions Hospital to help ensure operations don�t being until safety protocol has been observed. This partnership is fostering innovation and encouraging health care providers to share their own success stories.

HHS Secretary Kathleen Sebelius visiting Regions Hospital in St. Paul.

To kick off this unprecedented partnership, two goals have been identified:

Reduce preventable injuries in hospitals by 40 percentCut hospital re-admissions by 20 percent

By achieving these goals and providing better care, countless Americans will have more healthy years to spend with their loved ones. Together we can build a stronger, safer health care system and he Partnership for Patients helps us do just that, one hospital at a time.

Payers News Briefs

BCBS montana boosts ITs customer service                                       
Blue Cross and Blue Shield of Montana is boosting its customer service with technology from Cambridge, Mass.-based Pegasystems. BCBSMT has selected Pegasystems' Customer Process Manager for Healthcare to optimize its customer service, sales, and process efficiencies. Pegasystems' technology will streamline customer phone inquiries resolving many questions within the first call. The insurer plans to roll out the new technology in early 2009.

Shared Health integrates data, improves workflow
Shared Health, one of the largest public/private health information exchanges (HIE) in the United States, is using technology from Santa Monica Calif.-based Orion Health to integrate data and improve workflow.  Shared Health will implement Orion Health's Concerto Physician Portal to enable an integrated electronic health record system and provide access to patient data from disparate systems. Orion Health North America President Paul Viskovich says Shared Health is the first HIE to leverage Concerto's strengths in integrating health data and workflow applications in a unified, patient-centric view.

UPMC adds medical management technology
UPMC Health Plan, the second-largest health insurer in Western Pennsylvania, has expanded its partnership with Southborough, Mass.-based ikaSystems to improve quality and cost containment. UPMC will add Web-based integrated medical management solutions to its existing ikaEnterprise modules underlying its portal strategy, allowing the plan to enhance healthcare quality for its members while supporting providers with performance information.

FCSO employs new reimbursement system
First Coast Service Options (FCSO), headquartered in Jacksonville, Fla., is working with Alexandria, Va.-based Burgess, a Medicare reimbursement solutions provider, to support a new Medicare contract awarded recently by the Centers for Medicare & Medicaid Services. Under this new contract, FCSO will resolve reimbursement disputes beginning Jan. 1, 2009, between healthcare providers and organizations offering Medicare Private Fee-for-Service plans.  FCSO will license and employ the Burgess Reimbursement System to compute accurate pricing associated with disputed claims.

American Sentinel University adds HSM program

AURORA, CO – American Sentinel University in Aurora, Colo., has added a Bachelor of Science degree program in Health Systems Management (HSM) in response to an increase in the demand for education in healthcare information technology.

The HSM program is designed to provide students with the skills needed to analyze information needs, design solutions and manage information storage, transfer and retrieval in healthcare environments.

It will provide students with a broad knowledge base in computer information systems as they are used in organizational settings and will teach them how to apply this knowledge to the specific needs of the healthcare information environment.

According to the Bureau of Labor Statistics, 18 of the top 20 fastest-growing occupations between 2004 and 2014 will be in healthcare and computer science.

"Job opportunities in health systems management are expected to grow by 36 percent over the next 10 years," said Catherine Garner, dean of Health Professions at American Sentinel University. "We are responding to intense demand for education in healthcare IT by expanding our degree offering to include a Bachelor of Science in Health Systems Management."

American Sentinel University offers more than 20 online degree programs.
The B.S. Health Systems Management courses are open for enrollment twice per month. The university also offers a Master of Science degree in HSM.

"The HSM degree offers an excellent re-training opportunity for individuals with a management or IT background to make the shift from other industries such as finance and manufacturing to healthcare, where there is a projected expansion of employment opportunities," said Garner.
 

Ill. hospital uses InfoLogix to keep employees up to date on technology

NAPERVILLE, IL – Administrators, clinicians and other staff at Edward Hospital don't have much time to learn the latest software applications and hospital procedures. When the choice comes down to taking a training course or doing your job in an ever-busy healthcare environment, healthcare wins out.

The hospital had offered four-hour training sessions at least 10 times a month, but those were hard to fit into a tight schedule, and often clinicians had to postpone or cancel sessions if a medical emergency arose. As a result, the traditional, classroom-based approach was proving unwieldy and expensive.

To keep its employees up to date on the latest tools and procedures, the 300-bed, full-service hospital in Naperville, Ill., turned to InfoLogix to implement an online training system.

InfoLogix, based in Hatboro, Pa., offers enterprise mobility and wireless asset tracking solutions to a number of healthcare providers, including Kaiser Permanente, the MultiCare Health System and the Stanford School of Medicine. The company created a customized version of its OnTrack Learning Management System for Edward Hospital, developing an online curriculum for more than 150 supervisors and department managers.

The system allowed hospital employees to develop their own individual training schedules. The Web-based program is accessible from any computer and at any time.

"Training administrators and clinicians in a busy healthcare organization involves significant logistical challenges, but InfoLogix studied our requirements and built a Learning Management System that's custom-tailored to how we work, right down to the smallest detail," said Teresa Oliszewicz, the hospital's manager of organization development and learning. "Now we have a fully-automated training system that allows us to train employees quickly and efficiently so they can devote time to what matters most - our patients."  

"Based on our experience working with more than 1,400 hospitals nationwide, we know organizational development and training are ongoing challenges to healthcare organizations," said David Gulian, InfoLogix's president and CEO. "We're excited about the customized Learning Management System we created for Edward Hospital, as we believe that new technology solutions play a vital role in increasing efficiencies, reducing costs and providing better patient care."
 

Supreme Court has the power, but not the social authority, to kill health reform

Oral arguments this week about the constitutionality of the Affordable Care Act make us wonder whether Supreme Court Justices might be too removed from the society they serve.

It's been a tough week for supporters of health reform. Things haven't gone so well at the Supreme Court. The government's chief lawyer, Donald Verrilli, is being blamed for a lackluster performance. He wasn't great, flubbing a basic question on whether the government could make us all buy broccoli, for example.

On the other hand, Verrilli wasn't nearly as bad as many people thought, either. He made some perfectly good arguments that seemed unconvincing for the simple reason that conservative justices simply rejected the reasonable arguments he was making.

The oral argument was especially frustrating because the Supreme Court Justices were so economically misinformed. Watching the proceedings, the New Republic‘s Jonathan Cohn concluded, "The Justices Need Economics 101." The distinguished economist Henry Aaronfound Justice Alito "painfully detached" from basic understanding of how insurance markets work or what the new law is designed to accomplish. Writing in the Journal of the American Medical Association, Harvard's David Cutler concluded: "I can say without hesitation that the Supreme Court failed its oral exam."

The justices had little business debating the policy merits of the health reform bill in the first place. Over decades, Congress debated how to reform our dysfunctional, $2.8 trillion health care system. In 2010, Congress finally enacted a series of fragile political and administrative compromises to cover 30 million people and address other problems. In doing so, Congress drew upon many medical and public health studies exploring whether, when, and how the individual mandate helps to stabilize our national market for health coverage.

A more restrained, indeed conservative Supreme Court might have respected Congress's judgments here. Years ago, conservative economist Thomas Sowell praised the restrained vision of the great Justice Oliver Wendell Holmes, who sought to ensure that "the game is played according to the rules whether I like them or not." "The Constitution," Holmes said, "is not intended to embody a particular economic theory."

Today's conservative, politically activist Court majority holds different views. Salon's Rich Yeselson cites an amazing study of Supreme Court decisions from 1937 to 2006. Four of the five most conservative justices who served over those seventy years � Scalia, Alito, Thomas, and Roberts � are deciding the fate of health reform right now.

Justices' comments jarring

Justices' offhand comments were especially jarring. Justice Scalia earned cheap laughs by asking government lawyers: "You really want us to go through these 2,700 pages?" Yes I do. The final bill devotes about one page for every $1 billion America spends on our health care system. And that's with large fonts and wide margins. If the new law were formatted as a normal book, it wouldn't be much longer than Sarah Palin's memoirs. Justice Scalia might at least check his own script. He made fun of a notorious provision called the "cornhusker kickback" which isn't even part of health reform.

President Obama and Congressional leaders devoted much of his first term to crafting and passing a complex health reform. Health reform was a centerpiece issue of the 2008 campaign. Several justices seemed rather contemptuous of this social insurance project.

Consider the following comments by Justices Alito and Roberts:

(Roberts) "It seems to me that you cannot say that everybody is going to need substance use treatment or pediatric services, and yet that is part of what you require them to purchase."

(Alito) "[A] young, healthy individual targeted by the mandate on average consumes about $854 in health services each year. So the mandate is forcing these people to provide a huge subsidy … It is requiring them to subsidize services that will be received by somebody else."

The Chief Justice is certainly correct that most people don't need substance abuse treatment � though hundreds of thousands of people who do need these services face serious financial barriers. Fewer people require the intensive treatment my brother-in-law requires because he was born with a serious genetic defect. Justice Alito is right that policies such as the individual mandate lead the young and healthy to subsidize others, at least at certain moments in life's trajectory. There is nothing wrong, nothing unconstitutional about requiring those of us who've done well in life's lottery to sometimes subsidize our less-fortunate fellow citizens.

Is the Court deliberating in a bubble?

The Supreme Court seems out of touch with these elemental realities. Its chambers have become conspicuously comfortable, conspicuously insulated places. The Court seems very far from the world of under-insured cancer patients losing their homes, the world of uninsured patients turning to emergency rooms for lack of dental care, the world of diabetes patients who have delayed crucial eye care they could not afford, the world of the jobless person struggling with high COBRA premiums.

Dahlia Lithwick recently chronicled the Supreme Court's evolving stance regarding gay rights. The court has moved in a more liberal direction. Its path to these decisions remained troubling.

[W]e come to the Court, play by its rules, and tell the Justices stories they like to hear about people who remind them of themselves. The Justices don't get out much. All of the current nine attended two law schools; their clerks mainly come from seven law schools; cases are argued by a shrinking number of highly skilled oral advocates … We may well wonder, then, where they get their information about the world outside their chambers, and how they learn … how much they don't know about that world.

I certainly wonder. The Court might damage or destroy the centerpiece of the Obama presidency. This would be an abuse of judicial power. It would also hurt millions of people whose pleas for help seem quite abstract to men in robes who might snatch that help away.

More than 2.5 million grandparents take on role of parent

WILMINGTON, Del. -- These are supposed to be their golden years. They worked hard, earned a decent living and raised their family. Now it's time to relax and reap the benefits of a life well lived.

But not for those who have had to take on the responsibility of raising grandchildren. Their golden years have been put on hold as they have begun another cycle of child-rearing.

Delores and Larry Kling have been parenting their 8-year-old granddaughter, Amber, since she was an infant. The Klings' son and the child's mother abandoned their baby and have yet to remember her on birthdays and holidays.

While Amber is a loving child who does well in school, her grandmother worries how much the situation with her biological parents has affected her and is seeking counseling to help them all cope.

"It's heartbreaking," said Delores Kling. "I'm sure it's on her mind all the time."

The number of grandparents who provide primary care for their grandchildren is growing. Nationwide, more than 2.5 million grandparents are taking on the responsibility of raising grandchildren in what the AARP calls "grandfamilies."

Although grandparents raising grandchildren is not new, the percentage is the largest seen in the past 40 years. "Grandparents are the new safety net and it's not going to change," said Judy Pierson, a licensed clinical psychologist from Rehoboth Beach, Del.

Grandparents are faced with the responsibility of raising their grandchildren for a variety of reasons, including parental death, substance abuse, incarceration, mental health issues, military deployment, teen pregnancy, abandonment, abuse or neglect.

The economy has also played a role. The rate of unemployment among workers ages 22 to 34 is double that of 55- to 64-year-olds.

Grandparents often assume the role of parents to keep the children safe and out of foster homes. Indeed, the 2008 federal Fostering Connections Act says states must first look to kin when a child is removed from a home because of abuse or neglect, allowing grandparents to be considered a replacement when the family has experienced a crisis.

Being called upon to parent on such short notice creates challenges for grandparents. There may be financial constraints as many grandparents live on a fixed income. Moreover, retirement nest eggs have shrunk as a result of the economic downturn.

Behavioral problems can also be an issue. Children may act out because they don't understand why they can't be with their biological parents.

"Psychologists call it 'externalizing problems' where they're going to be resistant and really difficult to deal with," said Pat Tanner Nelson, a professor and certified family life educator at the University of Delaware.

Demands and fears

Grandparent caregivers may feel that they can't keep up with their grandchildren because they are in poor health or because the children are so active. "Kids are hard enough to raise when you're younger but when you're older �," said the 64-year-old Kling, who lives in Dover.

Grandparents raising grandchildren must also deal with a welter of emotions, including anger, resentment and guilt. "For one thing, all of their plans for retirement go out the window," Pierson said.

They may also feel they have been robbed of the traditional grandparenting experience. "If the kids are going to grow up healthy, they have to add that additional layer (of discipline)," Nelson said. "It makes it less fun."

And grandparents may feel that they themselves have failed as parents. "They may feel a sense of shame and worry that it says something about the parenting of that (adult) child," Pierson said.

Raising grandchildren can also cause difficulties with other family members. "The other adult children may resent their parents that are putting out money and resources to take care of the sibling who is not living up to their responsibilities and they may feel that those grandchildren are more important to the grandparents," Pierson said.

Support is essential

Becoming a parent again can be an overwhelming experience, but it can also be a rewarding one with the proper support. Experts agree that grandparents can benefit from sharing their concerns and needs with others in support groups.

Experts also recommend that grandparents take care of their health and make time for themselves.

They should also reach out to family and friends for help. "Even people who live far away can do some things like make phone calls about resources or send a coupon for a massage," Pierson said.

Grandparents who assume the responsibility of raising their grandchildren have a unique opportunity to play an important role in their grandchildren's lives. "We're talking about shaping another human being's life and giving these kids a chance at having a more promising future," Pierson said.

Quick Tips

-- Acknowledge your emotions and find safe ways to express those feelings.

-- Take care of yourself and try to get some "alone" time every day.

-- Make time for your spouse or partner.

-- Consult with an attorney and financial planner.

-- Set limits and rules for your grandchildren and teach them interpersonal skills. Consider counseling to help them cope with their feelings.

-- Ask family and friends for help and utilize existing resources.

Source: Judy Pierson, licensed clinical psychologist

Weight-loss surgery may stem diabetes in some

Diabetes is the seventh-leading cause of death in the United States, and the Centers for Disease Control and Prevention predicts that by 2050, people who have diabetes will comprise a third of the nation's population. Right now, 1 in 12 Americans has the disease.

Several factors impact the sharp rise in diabetes, one of which is the nationwide obesity epidemic, leading more people to develop Type 2 diabetes than ever before.

A new term has been coined: "diabesity," for Type 2 diabetes that develops as a result of obesity. Type 2 diabetes accounts for 90 to 95 percent of all diabetic cases.

Findings published recently in the New England Journal of Medicine and reported inThe Tennessean are giving new hope of decreasing "diabesity" through the use of weight-loss surgery.

Two new clinical trials show that patients who underwent weight-loss procedures were allowed to discontinue diabetes medication within days to only a few weeks, and the rate of remission for those patients after two years was between 75 and 95 percent, according to the findings.

In plain terms, weight-loss surgery currently provides one of the most effective therapies for diabetes, with patients seeing extremely high rates of improvement. Not only that, the surgery can provide similar levels of improvement for patients suffering from other obesity-related conditions, including high blood pressure, sleep apnea, arthritis, asthma, acid reflux, infertility and high cholesterol.

The obesity rate in Tennessee increased more than 90 percent over the past 15 years, and in 2011 we ranked as the fourth most obese state in the United States by the Trust for America's Health and Robert Wood Johnson Foundation.

Despite these encouraging clinical trials, the simultaneous epidemics of diabetes and obesity cannot be cured with weight-loss surgery alone. Surgery is one small component of the overall success for weight management and diabetes remission. Patients who undergo these treatments must make lifestyle changes paired with good nutritional habits following surgery and a commitment to exercise.

That being said, weight-loss surgery can be considered as a treatment option before patients reach a point of last resort. Recently, the Food and Drug Administration approved a lower recommended body-mass index threshold for Lap-Band surgery. The revised recommendations now allow patients who are:

�40-60 pounds overweight to get the procedure, whereas before patients needed to be

�80-100 pounds overweight.

These changes, combined with the encouraging results of the recent clinical trials, ultimately mean more and better options for patients.

If you are eligible for weight-loss surgery and suffer from diabetes, talk with your physician to determine your best course for treatment.

Getting More Value for Your Premium Dollar

The Kaiser Family Foundation released estimates of insurer rebates under the Medical Loss Ratio provision of the new health care law, the Affordable Care Act.� The Medical Loss Ratio provision, also known as the 80/20 rule, requires insurers to spend at least 80% of your premium dollar on medical care and quality improvement, rather than on administrative costs.� If an insurer does not meet the 80/20 standard, it is required to issue rebates to its consumers starting this year.

The Kaiser Family Foundation estimates that rebates will total $1.3 billion in 2012.��Thanks to the health care law, consumers are receiving more value for their premium dollar because insurance companies can no longer spend a substantial portion of consumers� premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.�Some insurance companies are already adjusting to meet this standard by changing their prices to give consumers more value for each dollar they spend on premiums.

Consumers eligible for rebates should expect to see them in their mailboxes by August. Consumers who won�t see rebates can also still feel good knowing that your health plan spent 80% of your premium dollar on health care.

In addition to the 80/20 rule, the Affordable Care Act contains a number of provisions to protect consumers from insurance industry abuses, including reviews of any proposed premium hikes of 10% or more.� Later this year, consumers will begin receiving a four-page, easy-to-understand summary of what their insurance provides so they can compare their coverage options and better understand the value of the coverage they purchase.� And in 2014, insurance companies will be prohibited from charging people higher rates or denying them coverage altogether due to pre-existing conditions or because of their gender. Go to www.HealthCare.gov to learn more about these protections under the law.

AdvantEdge Healthcare Solutions acquires COMPUDATA

WARREN, NJ – AdvantEdge Healthcare Solutions (AHS) a provider of billing, practice management and coding services, announced Thursday its acquisition of Ravenna, Ohio-based medical billing company COMPUDATA.

With this, its  fifth acquisition since 2009, AHS officials say they plan to expand the company’s footprint in Ohio and Pennsylvania and strengthen the company’s anesthesia practice customer base.

COMPUDATA processes thousands of claims each year, representing millions of dollars in physician receivables. Primarily focused on specialty and primary care physician practices, it provides clients a range of medical billing services such as coding, data entry, paper and electronic claims submission, accounts receivable management and follow-up, payment posting and electronic Medicare and Medicaid payment capture. The firm also assists clients with bank deposits, fee schedule and insurance contract tracking, accounting, bookkeeping, payroll and reporting.

“The addition of COMPUDATA to the AHS family not only complements our existing operations in Ohio and Pennsylvania, but enables the COMPUDATA clients to enjoy our advanced technology and other resources that will now be available to them,” said David Langsam, president and CEO of AHS. “Physicians face continuing challenges such as declining reimbursement, increasing regulation and the complexities associated with ICD-10 migration. Our services enable them to navigate these changes and thrive regardless of the environment."

“As billing costs continue to climb and reimbursements decline, outsourcing billing operations can have a dramatic cost and resulting cash flow savings to one’s practice,” said COMPUDATA CEO Ken Lewis. “Ongoing changes to medical regulations have put pressure on small- to mid-size medical billing companies, which are faced with costly technology upgrades to meet new standards."

Lewis will join the AHS management team as vice president, as will current COMPUDATA COO Tyler Lewis. Their addition to the AHS team will help facilitate a seamless client transition to the AHS platform, officials say. AHS will continue operations at the COMPUDATA facility in Ravenna, Ohio.
 

Breaking It Down: The Health Care Law & Women

The President's health law gives hard working, middle-class families the security they deserve.� The Affordable Care Act forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy through annual or lifetime limits, and, soon, discriminating against anyone with a pre-existing condition.

In the past, women often had to pay more for coverage that sometimes didn�t even cover their needs � that�s changing under the health care law. Over 20 million women with private health insurance are receiving expanded preventive services with no cost-sharing, including mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits. What�s more, 1.1 million women between 19 and 25 who would have been uninsured, have coverage under their parent�s health insurance plan. Women are often the ones making health care decisions for the family. The health care law puts them back in charge by shining much-needed light on our health insurance marketplace and cracking down on unjustified premium hikes.

Here are more ways the law helps women:

Soon, being a woman will no longer be a pre-existing condition. Before the Affordable Care Act became law, insurance companies selling individual policies could deny coverage to women due to �pre-existing conditions,� such as having cancer and being pregnant. In 2014, it will be illegal for insurance companies to discriminate against anyone with a pre-existing condition, including women.� Already, insurance companies are banned from denying coverage to children because of a pre-existing condition.Women Have a Choice of Doctor. Thanks to the Affordable Care Act, all Americans in new insurance plans have the freedom to choose from any primary care provider, OB-GYN, or pediatrician in their health plan�s network, or emergency care outside of the plan�s network, without a referral.Women Can Receive Preventive Care Without Copays. Thanks to the Affordable Care Act, all Americans in new health care plans can receive recommended preventive services, like mammograms, new baby care and well-child visits, with no out-of-pocket costs. See a list of preventive services for women.Women Pay Lower Health Care Costs. Before the law, women could be charged more for individual insurance policies simply because of their gender. A 22-year-old woman could be charged 150% the premium that a 22-year-old man paid. In 2014, insurers will not be able to charge women higher premiums than they charge men. In addition, the law takes strong action to control health care costs, including helping States crack down on excessive premium increases and making sure most of your premium dollars go for your health care.

FDA: Stop giving antibiotics to animals

The government wants meat and poultry producers to stop giving antibiotics to their animals to make them grow faster.

The reason: Dangerous bacteria that can kill people have been growing resistant to the drugs, which can leave humans at risk of getting infections that can't be controlled.

The announcement Wednesday by the Food and Drug Administration, which asks producers to make the change voluntarily, comes two years after the agency declared that using antibiotics in food-producing animals "is not in the interest of protecting and promoting the public health."

"This is a sea change," says Michael Taylor, the FDA's deputy commissioner for foods. "We're finally ready to put this issue behind us."

Skeptics fear the animal pharmaceutical industry will make only cosmetic changes and the meat producers will continue using feed with antibiotics. "They'll just stop marketing drugs as growth promoters and instead market them for disease prevention at exactly the same doses and same period of use," says Steve Roach with the Food Animal Concerns Trust in Chicago.

Antibiotics have been added to animal feed and water since the 1960s, when it was found that very low, long-term doses not only kept animals from getting sick but also made them grow faster. Concerns about bacteria becoming resistant to those antibiotics � often the same ones used to treat human disease � began in the 1970s. The FDA tried to restrict their use in 1977, but Congress opposed the restrictions. The agency, doctors, farmers and activists have been fighting about the issue ever since.

The new guidance asks, but does not require, that companies stop selling antibiotics medically important in human disease as growth promoters for animals. Two commonly used ones would be penicillin and tetracycline, says William Flynn, deputy director for science policy at the Center for Veterinary Medicine at the FDA.

Antibiotics could still be given to sick animals, but feed containing antibiotics would have to be prescribed by a veterinarian.

Jeff Simmons, president of Elanco, a large animal pharmaceutical company in Greenfield, Ind., agrees with the the FDA's move. Putting antibiotic use "under the oversight of the veterinarian is critical," he says.

The "final rule," in FDA's terminology, is a guideline that does not have the force of law.

There already is a shift away from long-term change the over-use of antibiotics in animal feeds, Taylor says. "Europe no longer allows product that has been treated that way," and McDonald's and Kentucky Fried Chicken don't accept it either, he says.

The FDA will give companies three months to declare their intentions "so we know who's going along with us on this and who isn't," and then will begin a 90-day comment period, Taylor says. After that, companies will have three years to implement the changes. If some companies don't go along, he says, the FDA will "look toward other regulatory options."

Diet drug Qnexa awaits FDA OK amid safety concerns

Some things may indeed look better the second time around, but why would that be the case for a new diet drug that's poised to become the first such drug approved by the Food and Drug Administration in more than a decade?

The proposed prescription medication Qnexa (kyoo-nek-suh) from Vivus Inc. of Mountain View, Calif., helps dieters lose 10% of their weight when used in combination with diet and exercise.

Yet it was rejected on a 10-6 vote the first time it came before a government advisory panel, in 2010, because of safety concerns. But when the medication returned for another review in February, the advisory committee gave it near-unanimous approval (20-2). Because the FDA often follows the advisory panel's advice, Qnexa is likely to get FDA approval, probably by mid-April.

Supporters of Qnexa say that not only does it produce dramatic weight loss, but it helps reduce diabetes and lowers blood pressure and other cardiovascular risk factors.

Cast Your Vote

But critics are charging that too many safety questions remain. Research shows Qnexa caused an increased heart rate in some patients who took a high dose, and it increased the risk of cleft lip in the newborns of expectant mothers who took the drug.

So what led the FDA advisory committee to change its view of the drug between 2010 and 2012?

"We had more data to understand the benefits of the weight loss compared to the health risks in areas of greatest concern: the risk of birth defects and the effects the medicine had on cardiovascular disease," says Abraham Thomas, chairman of the second advisory committee and a member of the first committee. Thomas is head of endocrinology at Henry Ford Hospital in Detroit.

Diet drugs in the past and in the pipeline

Here�s a look at the current diet drugs and the history of some weight-loss medications.

On the market now:
Two prescription drugs used to treat obesity include phentermine, which suppresses appetite; and orlistat (Xenical), which keeps some dietary fat from being absorbed by the intestine. Orlistat is sold in a lower dose over-the-counter as Alli.

Pulled off the market:
In 1997, two diet drugs were pulled from the market � fenfluramine (part of the popular fen-phen combination) and dexfenfluramine (Redux) � because of concern over heart-valve problems.

In 2010, Abbott Laboratories removed sibutramine (Meridia) from the market because of concerns of an increased risk of heart attacks and strokes.

Didn�t get government approval:
In 2007, an FDA advisory panel rejected the experimental diet pill rimonabant (Acomplia) from Sanofi-Aventis, which decreased people�s drive to eat, after hearing testimony that it increased the risk of suicidal thoughts, even in patients without a history of depression.

FDA reviewing now:
In mid April, the FDA is expected to decide whether to approve Qnexa from Vivus. When used in combination with diet and exercise, patients lose about 10% of their weight on the proposed diet medication.

Seeking approval:
In May, an FDA advisory committee will discuss the safety and efficacy of the anti-obesity medication lorcaserin from Arena Pharmaceuticals. It was rejected by an early FDA advisory panel in 2010.

In 2011, the FDA asked for a clinical trial on the cardiovascular safety of Contrave from Orexigen. Contrave combines two drugs now on the market � bupropion, an antidepressant and smoking cessation medication, and naltrexone, currently used for alcohol and opioid addiction. The diet pill works to fight food cravings and improves the ability to control eating. Drug trial will start late in second quarter of 2012.

Source: USA TODAY research

Although heart rate went up slightly in some patients, blood pressure went down, he says. There are health benefits for patients losing 5% to 10% of their weight, which many people can't do by diet and exercise alone, he says.

The committee was reassured that the FDA working with Vivus would have appropriate package labeling and a risk-reduction strategy to prevent pregnant women, or those planning to become pregnant, from taking the medication, Thomas says.

The committee thought the benefits of Qnexa were "great enough" that the medication could go on the market, and then the company could do a larger clinical post-market trial to investigate whether there is more cardiovascular disease when people take the medication for several years, Thomas says.

But Sidney Wolfe, director of the health research group at Public Citizen, a consumer group, says that the risks outweigh the benefits. "We are strongly opposed to approving it. This idea that there is a magic bullet that will knock your hunger out, but not do other kinds of damage, is ridiculous."

He thinks the advisory committee approved the diet drug because members "felt there was a desperate need for a new diet drug even though many other ones had come and gone because of safety concerns."

About two-thirds of people in this country are overweight or obese. Obesity increases the risk of heart disease, type 2 diabetes, some types of cancer and many other health problems.

Most panel members voting for approval of Qnexa said safety concerns about the medication should be thoroughly studied as soon as possible after approval, but Wolfe says all of the potential risks should be investigated before Qnexa is "unleashed on a mass market of hundreds of thousands of people."

The drug 'produces weight loss'

Qnexa is made up of two other older medications: the appetite-suppressant phentermine and the anti-seizure medication topiramate, which is sold under the brand name Topamax. The latter is used to treat epilepsy and migraines. Some physicians already prescribe the two drugs together for weight loss in what is called an off-label use, which is the practice of prescribing medications for an unapproved indication.

Qnexa is designed for people who are obese, which is roughly 30 or more pounds over a healthy weight, or those who are overweight and have other weight-related health issues such as high blood pressure, type 2 diabetes or high cholesterol.

The company's research on Qnexa shows that people lose 10% to 11% of their starting weight in a year. "The efficacy of this drug is not the issue � it produces weight loss," says Tim Church, a researcher at the Pennington Biomedical Research Center in Baton Rouge and an adviser to Vivus.

The studies showed the high dose of the medication increased heart rate by 1.6 beats per minute, Church says, but it also lowered blood pressure, triglycerides (blood fats), C-reactive protein (another heart disease risk factor) and fasting blood sugar. "It dramatically reduces the risk of diabetes."

The two medications that make up Qnexa have been used by millions of people, Church says. "If these are dangerous, why aren't we hearing things about them?"

But Wolfe says that hunger is deeply embedded in the body, and "when you knock out hunger with a drug, you affect many other functions in the body."

He says the studies on Qnexa show that the drug increases heart rate and that five patients on the diet pill had non-fatal heart attacks during the research, while none of those on the placebo had heart attacks.

Wolfe points out that several previous diet drugs have been withdrawn from the market, including sibutramine (Meridia) because of evidence of an increased risk of heart attacks and strokes, fenfluramine and dexfenfluramine (Redux) because of concern over heart-valve problems, and ephedra because of heart attacks and strokes.

Pushing for more trials

Now there's a new wrinkle in the Qnexa story. Last week, the same FDA committee voted 17-6 to require that obesity drugs undergo clinical trials to ensure they don't increase cardiovascular problems, even if there's no suggestion of heart disease risk during the drug's development, Thomas says. Those trials might take place before or after the drug's approval. If the FDA follows the panel's advice, it will add to the cost of getting obesity drugs approved.

Will this latest advice to the FDA affect the agency's decision on Qnexa?

Thomas doesn't think so because Vivus already had an indication of possible heart risk with increased heart rate and is now planning a trial to investigate cardiovascular issues. But it will be up to the FDA to decide whether the trial needs to be conducted before or after Qnexa is approved, he says.

Wolfe says he doesn't know whether the committee's advice will affect the approval.

It depends on how serious the FDA is about following the panel's advice, which hasn't been implemented into guidelines yet, he says. On one hand, these standards were not in place when Vivus started its drug trials for Qnexa, Wolfe says. On the other hand, the FDA's job is to make sure that when a drug "comes out the door, the benefits exceed the risks," he says.

Vivus has declined to comment, saying it's in a "quiet period" before the FDA makes its decision on the drug.

A need for diet medications

Vivus has been having discussions with the FDA on doing a large-scale follow-up study on the pill's effect on cardiovascular risk factors.

Cardiologist Michael Lincoff, vice chairman of cardiovascular medicine at Cleveland Clinic, is helping Vivus design a post-marketing drug trial. He says a study of 11,000 people is designed to investigate cardiovascular outcomes. "We feel that a drug that reduces weight, blood pressure, triglycerides and the severity of diabetes will address the unmet needs in the treatment of cardiovascular disease."

He says the drug's effect on heart rate "was very mild" and that heart attacks among people taking Qnexa in the drug's earlier studies were a "tiny number and probably a result of chance."

The new study will take two to three years, he says. It'll be expensive, "and the reality of the marketplace is they will need an income stream to fund a trial like this."

Lincoff says there is a need for diet medications such as Qnexa. "We know that, on average, a person who follows a diet and exercise plan will lose 3% of their body weight, and there is no good medical therapy to help them lose more."

Qnexa suppresses appetite so people are more likely to reduce their calorie intake and lose 10% to 15% of their weight, Lincoff says. "For a 200-pound person, that's 20 to 30 pounds. That's no trivial thing."

Costly Heart Procedures Thrive In Some Places, Despite Cheaper Alternatives

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Build a cardiac catheterization lab and doctors will tend to use it, even if treatment with drugs alone would suffice.

iStockphoto.com

Build a cardiac catheterization lab and doctors will tend to use it, even if treatment with drugs alone would suffice.

Why do some doctors keep performing expensive medical procedures after it becomes apparent there are cheaper and equally safe ways to treat patients? A study of cardiac procedures in Michigan takes a crack at this question, and while it comes up short on definitive answers, it has some provocative findings.

The Center for Healthcare Research and Transformation, a nonprofit partnership between the University of Michigan and the insurer Blue Cross Blue Shield of Michigan, examined rates of heart bypass surgery and angioplasty among the insurers' patients under 65.

Between 1997 and 2008, the rate of these procedures in Michigan dropped by 19 percent, as many doctors and patients opted for using drugs to treat patients � an approach that costs about $10,000 less than the $35,000 for surgical interventions, according to the analysis.

 

In 14 regions of the state, the combined rates of bypass surgeries and angioplasties decreased, with the Dearborn hospital market leading the way with a 43 percent drop, the researchers found. But the rate of cardiac interventions rose by 11 percent in one hospital region, St. Joseph, which is located on the southwestern side of the state along the Lake Michigan shore.

In 1997, 38 of every 10,000 Blue Cross Blue Shield members in the St. Joseph region received a coronary intervention; in 2008, 43 received one. Notably, the report categorized 55 percent of the angioplasties in St. Joseph as elective, meaning the procedure had been performed on patients who had not had a previous heart attack and had stable cardiac disease. That rate is more than in any other region of the state.

The differences between the parts of the state with the largest and smallest numbers of coronary interventions actually got wider as the number of procedures dropped overall. By 2008, nearly twice as many interventions were being performed in Saginaw as in Grand Rapids, according to the report.

The findings suggest that areas with more cardiac catheterization labs � places where patients are diagnosed for heart problems � tended to have more interventions.

Marianne Udow-Phillips, director of the research center, said that many of these labs are in facilities that also perform angioplasties. "What happens is when they're on the table, people are anesthesized, the doctors come out and say to the spouse 'there's an indication of a need and we can do it right now,'" she said. "So in many cases, they're done right then in the cath lab without the benefit of the patients having the opportunity to reflect on the risks and opportunity."

Angioplasty usually involves the placement of a stent, a tiny metal scaffold, to prop open a narrowed artery. Doctors' quick decision to put stents in whenever they see tight spots in coronary arteries has been dubbed the "oculo-stento" reflex by some critics.

Nationwide, it's not clear whether the country has more in common with St. Joseph or the rest of Michigan. From 1997 to 2007, the rate of inpatient cardiac procedures increased by 10 percent, but it dropped by 11 percent in that last year, according to the report. Even in Michigan, the rate of bypasses and angioplasties increased among Medicare patients.

Community clinics have odds stacked against them

STONE MOUNTAIN, Ga.�At Oakhurst Medical Center here, just 20% of children have received all their recommended immunizations by age 2.

Adults don't fare much better at this community health center, which provides primary care to 14,000 mostly poor people in a town famous for its granite monolith and "Confederate Mount Rushmore," just east of Atlanta.

Fewer than half of its diabetics and a little more than a third of those with high blood pressure had their conditions under control in 2010 � far below national averages for the U.S. population, according to a Kaiser Health News-USA TODAY analysis of the latest federal data.

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But 65 miles east of here in Greensboro in rural central Georgia, it's a different story. At TenderCare Clinic, almost all children get the appropriate immunizations, and eight out 10 diabetics have normal blood sugar levels.

The marked differences between Oakhurst and TenderCare underscore the wide variability in how well community health centers are caring for millions of people nationwide.

"There is tremendous performance variation within community health centers and also tremendous variation among any health providers, hospitals, nursing homes, doctors," says Deborah Gurewich, a Brandeis University researcher. "That's the American health system."

Lower-performing centers typically have a higher proportion of uninsured patients and more staff turnover, she says. Most also lack electronic record systems, which makes it harder to track patients.

Oakhurst has many of those challenges. It is one of eight community health centers nationwide whose patients fell below the U.S. average for all six quality care indicators in 2010 � diabetes and blood pressure control, cervical cancer screening, childhood vaccinations, timely prenatal care and low birth-weight babies.

"We can do better," says Oakhurst Chief Executive Officer Jeffrey Taylor.

The difficulties he faces include high rates of obese patients; many African immigrants are unaccustomed to seeking preventive care such as vaccinations; and 40% of patients don't have health insurance.

Another issue: Patients who don't follow recommendations. Candy Armstead, 36, who has been coming to Oakhurst for three years, illustrates the challenge. Despite her doctor's urgings, she refuses to take blood pressure medicine after having a bad experience with one drug. "It caused my hair to shed, so I stopped taking it," says Armstead, who is on Medicaid like almost half the center's patients.

Taylor says the center is doing a number of things to boost care. Staff members now routinely ask parents about getting their children immunized, no matter why they came in. The same goes for women who are due for a Pap test. And an electronic health records system is being installed, which will help monitor patients.

But it is an uphill battle. Last year, Oakhurst identified more than 300 patients as high-risk because they are obese, diabetic or have high blood pressure and asked them to enroll in a free nutrition class. Only 18 signed up.

In rural Georgia, some of those same issues bedevil TenderCare � no-show rates top 30% overall and 70% for Medicaid clients because of transportation difficulties, says CEO Lisa Brown.

But TenderCare uses case managers and counselors to make reminder calls, do in-house counseling and troubleshoot other issues that might interfere with patients' care � efforts that have helped the center achieve some of the best quality scores in Georgia.

Medical assistant Jackie Davis plays a starring role. Using a phone in a corner of the room reserved for minor surgical procedures, Davis calls parents who are late bringing in kids for immunizations, women behind on getting their annual Pap tests and the diabetics who have neglected their monthly checkups.

In a nearby office, Health Education Coordinator Pamela Luke intercepts patients after they meet with doctors to advise them about nutrition, set exercise goals and put them through "diabetes school."

Still, says Dave Ringer, a family doctor, it's not unusual for patients to tell him they cannot keep appointments because they couldn't pay a family member for a ride.

The center also has trouble finding specialists and hospitals willing to provide surgery to its uninsured patients. While many health centers have trouble finding specialists and hospitals to do surgery on patients without insurance, TenderCare is in a more precarious spot because it is outside the areas covered by Grady Memorial, the large public hospital in Atlanta, and Medical College of Georgia in Athens.

In the past year, an uninsured man waited more than eight months to find a neurosurgeon to operate on a brain tumor, Ringer says. An uninsured woman died of cervical cancer after waiting a year to find a surgeon.

The clinic's remote location also has some pluses, though. As one of the few health providers in town, TenderCare has been able to attract patients with Medicare and private insurance that pay higher rates than Medicaid. That helped the center privately finance a new $3 million building in 2009.

TenderCare is also more advanced than most rural health centers with its computerized pharmacy dispensing system to reduce errors.

Some patients still struggle. Josiette Ellison, 39, a heavyset woman from nearby Eatonville, Ga., is uninsured. On a recent visit her blood sugar was 456, almost three times normal. Her blood pressure is also high, and her vision has started to blur because of her decade-long struggle with diabetes.

"I can't avoid the sugars and sweets," she says. "I see the chocolate cake, and it's hard to resist."

Brown pats Ellison's leg and tells her the staff will help her get healthier. Ellison says she's grateful. "It's my bad decisions that are to blame," she says.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.