With PSA Testing, The Power Of Anecdote Often Trumps Statistics

Millions of men and their doctors are trying to understand a federal task force's recommendation against routine use of a prostate cancer test called the PSA.

The guidance, which came out last week, raises basic questions about how to interpret medical evidence. And what role expert panels should play in how doctors practice.

About 70 percent of men over 50 have gotten a PSA blood test. Some are convinced it was a lifesaver.

Tom Fouts of Florida is one of them. He and his doctor had been watching his PSA (prostate-specific antigen) creep up for almost two years. Fouts was losing sleep over it, wondering if it meant a silent killer was incubating in his prostate gland.

 

Finally, he decided to act. After three painful biopsies, doctors discovered a moderate-grade cancer and Fouts had surgery to remove it.

Today he's fine. "I'm a firm believer the PSA test has saved my life," he says. And he doesn't think much of the U.S. Preventive Services Task Force, the government-appointed expert panel that advised against routine PSA testing after analyzing reams of statistics.

"My theory on statistics," Fouts says, "is anybody can look at the same stats and come up with their own opinion. Government does it; each political party does it. Whatever you want it to come up to read, you can fine-tune it and make it come up to that."

Hal Arkes, a psychology professor at Ohio State University, says Fouts' way of thinking is nearly universal. The power of the anecdote almost always overwhelms statistical analysis, he says.

"Statistics are dry and they're boring and they're hard to understand," Arkes tells Shots. "They don't have the impact of someone standing in front of you telling their heart-rending story. I think this is common to just about everybody."

Arkes says anecdotal thinking "contributes to the widespread gross over-estimation of the benefits of PSA screening." He suggests people do a mental exercise to understand what the numbers are saying about PSA:

Imagine an auditorium filled with 1,000 men who had PSA screening tests and another auditorium with 1,000 men who didn't. That represents the kind of studies the federal task force was relying on.

"Take a look at the men in the two auditoriums, the men in the screened and the men in the not-screened auditorium," Arkes says. "There's just as many men who died of prostate cancer in each auditorium, which leads us to think in the aggregate it didn't do any good."

Arkes breaks it down in the journal Psychological Science.

In each auditorium, there would be eight men who died of prostate cancer. But among the thousand who got PSA tests, there would also be 20 men who were treated for prostate cancers that would never have grown and caused symptoms. And five of these needlessly treated men would have lifelong complications, such as impotence and incontinence.

Dr. Ian Thompson of the University of Texas Health Science Center at San Antonio says Arkes "is exactly correct � but only according to the current clinical trials of PSA screening."

"If you leave them the way they are, that article is smack-on correct," says Thompson, a urologist. "But the trials had problems."

Thompson says the chief issue is that men in the best study to date, from Europe, have been followed for a maximum of 13 years � and that's not long enough.

"When you analyze those trials very early, what you pick up on are the harms of testing," Thompson says. "And it really takes many, many years to see the benefits."

He doesn't know how much longer the European men would need to be watched, but thinks it would eventually become clear that PSA testing saved many more from a prostate cancer death. He doesn't think the Preventive Services Task Force should have taken a stand against testing at this time.

Dr. Michael Barry, head of the Informed Medical Decisions Foundation in Boston, thinks Thompson has a point.

"I'm reluctant myself to make a decision for someone else about PSA screening," Barry says. "And as a result, I'm also reluctant for expert panels to take that position of telling men what to do here."

Barry says his way out of the controversy is to take it "one man at a time." That is, doctors need to lay out the evidence as clearly as they can, which he says indicates there's very little, if any, benefit to PSA testing.

"I think many men won't want the test in that circumstance," he says. "But some will, and I'm comfortable with that."

Up to now, Barry says, those discussions haven't been happening nearly enough.

With PSA Testing, The Power Of Anecdote Often Trumps Statistics

Millions of men and their doctors are trying to understand a federal task force's recommendation against routine use of a prostate cancer test called the PSA.

The guidance, which came out last week, raises basic questions about how to interpret medical evidence. And what role expert panels should play in how doctors practice.

About 70 percent of men over 50 have gotten a PSA blood test. Some are convinced it was a lifesaver.

Tom Fouts of Florida is one of them. He and his doctor had been watching his PSA (prostate-specific antigen) creep up for almost two years. Fouts was losing sleep over it, wondering if it meant a silent killer was incubating in his prostate gland.

 

Finally, he decided to act. After three painful biopsies, doctors discovered a moderate-grade cancer and Fouts had surgery to remove it.

Today he's fine. "I'm a firm believer the PSA test has saved my life," he says. And he doesn't think much of the U.S. Preventive Services Task Force, the government-appointed expert panel that advised against routine PSA testing after analyzing reams of statistics.

"My theory on statistics," Fouts says, "is anybody can look at the same stats and come up with their own opinion. Government does it; each political party does it. Whatever you want it to come up to read, you can fine-tune it and make it come up to that."

Hal Arkes, a psychology professor at Ohio State University, says Fouts' way of thinking is nearly universal. The power of the anecdote almost always overwhelms statistical analysis, he says.

"Statistics are dry and they're boring and they're hard to understand," Arkes tells Shots. "They don't have the impact of someone standing in front of you telling their heart-rending story. I think this is common to just about everybody."

Arkes says anecdotal thinking "contributes to the widespread gross over-estimation of the benefits of PSA screening." He suggests people do a mental exercise to understand what the numbers are saying about PSA:

Imagine an auditorium filled with 1,000 men who had PSA screening tests and another auditorium with 1,000 men who didn't. That represents the kind of studies the federal task force was relying on.

"Take a look at the men in the two auditoriums, the men in the screened and the men in the not-screened auditorium," Arkes says. "There's just as many men who died of prostate cancer in each auditorium, which leads us to think in the aggregate it didn't do any good."

Arkes breaks it down in the journal Psychological Science.

In each auditorium, there would be eight men who died of prostate cancer. But among the thousand who got PSA tests, there would also be 20 men who were treated for prostate cancers that would never have grown and caused symptoms. And five of these needlessly treated men would have lifelong complications, such as impotence and incontinence.

Dr. Ian Thompson of the University of Texas Health Science Center at San Antonio says Arkes "is exactly correct � but only according to the current clinical trials of PSA screening."

"If you leave them the way they are, that article is smack-on correct," says Thompson, a urologist. "But the trials had problems."

Thompson says the chief issue is that men in the best study to date, from Europe, have been followed for a maximum of 13 years � and that's not long enough.

"When you analyze those trials very early, what you pick up on are the harms of testing," Thompson says. "And it really takes many, many years to see the benefits."

He doesn't know how much longer the European men would need to be watched, but thinks it would eventually become clear that PSA testing saved many more from a prostate cancer death. He doesn't think the Preventive Services Task Force should have taken a stand against testing at this time.

Dr. Michael Barry, head of the Informed Medical Decisions Foundation in Boston, thinks Thompson has a point.

"I'm reluctant myself to make a decision for someone else about PSA screening," Barry says. "And as a result, I'm also reluctant for expert panels to take that position of telling men what to do here."

Barry says his way out of the controversy is to take it "one man at a time." That is, doctors need to lay out the evidence as clearly as they can, which he says indicates there's very little, if any, benefit to PSA testing.

"I think many men won't want the test in that circumstance," he says. "But some will, and I'm comfortable with that."

Up to now, Barry says, those discussions haven't been happening nearly enough.

Colorado taps HMS for insurance buy-in program

DENVER – HMS, which develops coordination of benefits and program integrity technology for payers, has been awarded a contract to administer Colorado's Health Insurance Buy-In (HIBI) Program and its Medicare Buy-In project.

Under the terms of the contract, awarded by Colorado's Department of Health Care Policy and Financing, New York-based HMS will perform outreach and enrollment services for Medicaid beneficiaries who may be eligible for HIBI – a health insurance premium payment (HIPP) program – or Medicare. The contract is renewable for additional one-year periods for a maximum term of five years.

"HIPP programs are designed to save taxpayers money by assisting qualifying Medical Assistance beneficiaries in taking advantage of employer sponsored health insurance, which in many cases may be more cost effective and offer broader benefit coverage than traditional Medicaid agency options," said Maria Perrin, HMS chief business officer. "HIPP furthers states' efforts to help citizens access the most comprehensive healthcare coverage available via flexible enrollment programs."

As states begin to implement health insurance exchanges (HIX) in accordance with the Affordable Care Act, she added, "it will be increasingly important to ensure that the multiple coverage options available to consumers are effectively coordinated between public and private sources and that private insurance coverage options are retained as alternatives for as many individuals as possible."

HMS has provided third party liability and cost avoidance services to Colorado since 2001. During that time, officials say, HMS has recovered more than $230 million on behalf of the state and helped achieve millions more in cost avoidance savings.

73-year-old woman scaling Everest proves you can age well

Swimmer Dara Torres, 45, is still sprinting in the pool; she aims to qualify for her sixth Olympics.

Pitcher Jamie Moyer of the Colorado Rockies, 49, is still dominating batters; he recently became the oldest pitcher to win a game in the majors.

Not bad, right? Now add more than 20 years.

Japanese mountaineer Tamae Watanabe, 73, is still climbing; she set a world record May 19 by becoming the oldest woman to scale Mount Everest, the tallest mountain in the world. She broke her own record set when she was 62.

Exercise experts say we should expect to hear more examples like these � exceptionally healthy adults who are transforming our image of aging.

"My guess is that as more people 'age up' who have been active their whole lives and are really committed, we will see more interesting things from people in the 60 to 80 age range," says Michael Joyner, a Mayo Clinic anesthesiologist and a specialist in exercise science in Rochester, Minn.

And maybe, he adds, they will inspire a nation where many lifestyles are defined by being sedentary or sitting in front of a computer.

Few of us will ever come close to their level of success at any age, but what stops so many of us from staying fit and staying in our games as we grow older? Exercise physiologist Barbara Bushman says 24% of adults over age 65 are totally inactive, and fewer than 40% meet the baseline recommendations for exercise.

"The short answer is that most of society is not pushing themselves hard enough, but there is a subgroup that clearly is," Joyner says.

"What I find interesting about so much of this is that there is a fitness and physical activity/inactivity crisis in the developed world. However, at the same time there is this emerging subgroup or subculture of fit or super fit middle-aged and older people who are redefining things."

When Janet Evans, 40, started her comeback last summer after taking 15 years off from Olympic-level swimming, Joyner said, "This is the whole new normal emerging."

Watanabe is still climbing in the foothills of the Himalayas and hasn't commented on her accomplishments, but Ang Tshering, the sherpa who coached her, shared some insights with the Daily Telegraph.

She lives at the foot of Mount Fuji, Japan's tallest mountain, he said. She led a team of four on the assault on the northern face of Everest, setting out from their last high-altitude camp (27,225 feet) late at night on May 18 and climbed all night. They reached the 29,035-foot summit the next morning.

"She's a very strong climber and has always been very active," Tshering said. "She has always loved the mountains and has been climbing in the Japanese Alps and around the world for many years."

And Watanabe wants to break the Everest record again in her 80s, he said.

"In all of this, motivation and resilience are the key," Joyner says.

But in a society where obesity is an epidemic, what kind of extra motivation do we need?

"Regular physical activity can favorably influence a broad range of body systems and thus may be a lifestyle factor that discriminates between those who experience successful aging and those who do not," says Bushman, a professor in the department of kinesiology at Missouri State University.

Some scientists go so far as to say exercise actually slows aging. A 1990 study comparing masters athletes and sedentary people shows that people who continue to engage in regular vigorous exercise show one-half the rate of decline in maximal aerobic capacity as the sedentary subjects. Recent research even shows aerobic activity is important for healthy cognitive functions. Regular exercise eases the stiffness and pain of arthritis.

Sports doc and triathlete Jordan Metzl knows this firsthand. . He says he has some arthritis, but says exercise helps him. In his new book, The Athlete's Book of Home Remedies, he has a section on strengthening exercises you can do at home to help protect ligaments and joints.

Most of us begin to notice physical decline in our mid-30s, but it doesn't have to be all or nothing, says Bushman. Far from it. Evans, who follows the latest research on training methods, says she has to take better care of herself, including getting more sleep, shedding a few pounds and giving herself more time to recover between workouts compared with when she was younger.

While Evans hasn't suffered any career-threatening injuries, Torres and Moyer haven't been as lucky. Moyer missed the 2011 season afer having ligament replacement surgery, and Torres has had multiple surgeries, including an innovative procedure after the 2008 Olympics on her left knee to regenerate cartilage. Prior to that she couldn't walk without a limp and the muscles in her leg were atrophying.

"There have been isolated examples of exceptional athletic feats by people in their 40s and 50s for many years," says Joyner, who notes that a 38-year-old woman became the oldest woman to win the Olympic marathon in 2008.

"These are now happening more often, and they are more widely noticed. Some of this is probably due to more general interest in aging."

When Bushman heard about Watanabe, she laughed and said, "Now that is successful aging."

And Watanabe is not alone out there on the icy slopes. At the same time she was making her record climb on Mount Everest, a 72-year-old woman was also on the mountain, waiting to make her climb and hoping to become the oldest woman to reach the summit. Watanabe just beat her to it.

"Although not everyone has interest or ability to achieve a feat like climbing Everest, people of all ages can take steps today to develop a complete exercise program," says Bushman, co-author of the American College of Sports Medicine's Complete Guide to Fitness and Health.

"No one is too old, or too young, to invest in their future health."

Obama, Romney On Health Care: So Close, Yet So Far

From now until November, President Obama and GOP presidential candidate Mitt Romney will emphasize their differences. But the two men's lives actually coincide in a striking number of ways. In this installment of NPR's "Parallel Lives" series, a look at one of those similarities: They both signed health care overhaul laws based on an individual mandate.

Health care has become one of the starkest contrasts between President Obama and Republican rival Mitt Romney in the 2012 campaign. And that's surprising, given that once upon a time they both came up with similar plans to fix the system.

Stuart Altman, a professor of health policy at Brandeis University, says the two men once occupied the same political space on health care.

"I would define Obama as a moderate liberal and Romney as a moderate conservative. ... Both of them came to the same conclusion," he says. They decided what was needed was a system "built as much as possible on the existing health insurance system."

Both men embraced what was considered to be mainstream health care policy thinking: maintain the employer-provided system but get everyone covered through an individual mandate � a requirement to buy insurance.

From Victory To Problem

Romney went first. In 2006, as Massachusetts' governor, he talked about the state's mandate in decidedly nonideological terms: "We're going to say, folks, if you can afford health care, then gosh, you'd better go get it; otherwise, you're just passing on your expenses to someone else. That's not Republican; that's not Democratic; that's not libertarian; that's just wrong."

Getting rid of free riders was a moral issue for Romney and many Republicans back then, says Jonathan Gruber, an MIT economist who helped the Romney and Obama administrations design the individual mandate. Gruber says he could tell that health care overhaul had a particular appeal for Romney � a businessman who specialized in turning around troubled companies.

"Mitt Romney was a management consultant. And what management consultants are is they're sort of like engineers. They go in, they see a problem, they solve it," he says. "I saw a lot of excitement, this passion, to say, 'Wow, we can move this piece around, add the mandate, rededicate the money, put it together and we can solve this important problem. Isn't that really neat?' "

Just as passing a national health care law was supposed to be the legacy achievement for Obama, Gruber says that back in 2006, as Romney got ready to run for president, the Massachusetts law also looked like a surefire political winner.

"You can understand his thinking, right? He thought, 'Look, I can run for president by saying I solved this intractable problem by bringing conservative principles to bear � individual responsibility, the health insurance exchange.' I mean, there was a guy from the freaking Heritage Institute on the stage with Romney at the bill-signing," Gruber says. "This was a victory for Republican ideals, a victory for using market forces to solve an intractable problem, and I think that Romney probably thought, 'Isn't this a great thing I can run on as a Republican?' ... I would have thought so, too."

Changing Positions

Over time, Obama and Romney have had a mirror-image relationship with the linchpin of their health care laws: Romney was for the mandate before he was against it. Obama was against the mandate before he was for it.

"The irony is even worse than that," says Altman, the Brandeis professor. "I worked for Obama during the election and he was adamantly opposed to the individual mandate. ... I was on his advisory group, and we said, 'But you know, you really do need an individual mandate to make this all work together.' He said, 'I won't support that because you're asking, you know, not wealthy people to buy expensive insurance. We've got to get the cost down.' "

During the 2008 Democratic primary, the mandate was the single biggest policy divide between Obama and opponent Hillary Clinton.

In a debate, candidate Obama blasted Clinton's plan for an individual mandate by citing the experience in Massachusetts.

"Now, Massachusetts has a mandate right now," he said. "They have exempted 20 percent of the uninsured � because they've concluded that that 20 percent can't afford it. In some cases, there are people who are paying fines and still can't afford it, so now they're worse off than they were. They don't have health insurance and they're paying a fine."

A Shifting Middle

And Romney and Obama have something else in common, Altman says. They were both victims of the same political sea change: The Republican Party got a lot more conservative.

"Obama campaigned that he was going to be a different kind of a president. He was going to get things done; he was going to compromise," Altman says. "And when he got to Washington, he realized that the Washington that he thought was there wasn't there anymore. So the movement of the Republicans to the right ... hurt Obama and really put Romney in a bind."

Romney's bind was apparent in the GOP primaries, when conservatives questioned his ability to attack the president on a plan so similar to his own. But now, with the nomination virtually in hand, Romney is making health care the heart of his argument against the president.

"The president's plan assumes an endless expansion of government, with rising costs and, of course, with the spread of Obamacare," Romney says. "I will halt the expansion of government, and I will repeal Obamacare."

What was once a common bond is now a deep divide.

"I will not go back to the days when insurance companies had unchecked power to cancel your policy, or deny you coverage, or charge women differently from men," Obama says. "We're not going back there. We're going forward."

There is no overlap at all in the two men's current approaches to health care. If Romney is elected, he'll work to get rid of the law that was based on his own plan. If the president wins a second term, he will fight to keep what he can.

Healthcare part of White House mobility mandate

WASHINGTON – The White House on Wednesday unveiled what it called a "sweeping shift to mobile," an initiative aimed at accelerating efforts to make new and useful services available to consumers on their mobile devices.

As part of President Barack Obama's commitment to delivering a 21st century government, he issued a directive requiring that each major federal agency – including the Department of Health and Human Services – make two key government services the American people depend on available on mobile phones within the next 12 months.

In conjunction with the White House initiative, U.S. Chief Technology Officer Todd Park is launching a Presidential Innovation Fellows program. The effort will bring in top innovators from outside government for focused “tours of duty” to work with federal innovators on new projects. Among the projects the fellows will take on are ones to make consumer-friendly government information about health, education, energy, safety, and personal finance more accessible to all Americans.

[See also: Twitter recap: Todd Park talks Big Data Week.]
 
“The release of government weather and GPS data has already led to countless entrepreneurial innovations, which have made life easier for America’s families while also creating multi-billion-dollar industries and generating jobs.” Park said. “The initiatives we’re launching today will make government data resources even more accessible to the public and to entrepreneurs who can turn these data into services that can help Americans find the best doctor for their family, choose the college that offers them the most value for their money, save money on their energy bills through smarter shopping and much more.”
 
The administration is ramping up its efforts to make large amounts of government data more easily accessible to the public to spur entrepreneurs to develop innovative new services and mobile applications that take advantage of this data. The idea is to create new opportunities, businesses and jobs in the process.

The president’s directive is part of a larger digital strategy being implemented by the Administration – a roadmap that will guide the federal government as it makes the most of new sources of digital information.   
 
“Americans deserve a government that works for them anytime, anywhere, and on any device,” said Obama in a news release. “By making important services accessible from your phone and sharing government data with entrepreneurs, we are giving hard-working families and businesses tools that will help them succeed.”  
 
Mobile is rapidly becoming the platform of choice for Americans; it is now anticipated that by 2015 more people will be accessing the Internet via mobile phones than via traditional desktop computers. The Administration announced digital strategies intended to have the government make the mobile shift along with the population.

The Open Data Initiatives program will speed and expand the release of government data in machine-readable form in realms ranging from healthcare to education to energy to public safety, and will actively stimulate the creation of new apps and services by entrepreneurs that will improve the lives of Americans in many tangible ways and create jobs of the future at the same time, officials said.   

By next spring, the American people will be able to access dozens of additional government services on their mobile phones for the first time, Obama said.

[See also: Government tools, apps available to help with meaningful use.]
 
He has tasked U.S. Chief Information Officer, Steven VanRoekel with releasing a comprehensive roadmap to help the federal government re-think digital services.
 
“We’re living in an increasingly mobile world and it is critical that the federal government keep up with the way the American people do business,” said VanRoekel. Already, families can use government apps to check the wait time at the airport, get access to critical veteran services, and check the status of their tax return. Today’s directive will accelerate our drive to make key services easily accessible to more Americans than ever.”
 

Katie Beckett Defied The Odds, Helped Other Disabled Kids Live Longer

Hide caption Katie Beckett, 32, inserts a small suction device into her tracheotomy tube to help clear her lungs and throat. Twenty-nine years ago, President Ronald Reagan heard about a little girl who had spent most of her life in a hospital. That little girl was Katie, then just three years old. John Poole/NPR Hide caption Nurse Vicki Hagen comes over to Beckett's apartment in Cedar Rapids, Iowa, to help fit her with a vibrating vest that helps clear mucous from her lungs twice a day. Studies have shown that, almost always, it costs less to care for someone at home than in a nursing home or hospital. John Poole/NPR Hide caption On the wall of her apartment are pictures of Beckett as a child with President Reagan. Reagan created the "Katie Beckett waiver" that changed the Medicaid rules to allow severely disabled children and adults to get government-funded care in their own homes. John Poole/NPR Hide caption Beckett (left) and her mom Julie go to a restaurant in Cedar Rapids, Iowa, once a week to catch up. Beckett is now famous among children's advocates and travels the country with her mom working for laws and programs in favor of homecare. John Poole/NPR

1 of 4

View slideshow i

A few years ago, I asked a 13-year-old girl who was receiving care for cystic fibrosis on a Medicaid program known as the "Katie Beckett waiver" if she knew who Katie Beckett was. "Probably some kind of doctor," the girl said.

It was a logical guess. But Beckett was another child with a significant disability, and she changed health care policy for hundreds of thousands of other children with complex medical needs. On Friday, Beckett, at age 34, died in Cedar Rapids, Iowa, of complications from her disability.

Beckett had spent most of the first three years of her life living in an Iowa hospital because she needed to breathe on a ventilator much of the day. Medicaid would only pay for the expensive treatment if she stayed in the hospital.

In 1981, President Ronald Reagan heard about her situation and changed the rule so she could go home. As Reagan noted, it cost significantly less � about one-sixth as much � for Beckett to receive the care at home, instead of in a hospital.

 

When she was just 5 months old, she contracted viral encephalitis, a brain infection, and went into a coma. After recovering, she had partial paralysis that left her unable to breathe without a ventilator much of the day.

Heard On Weekend Edition Saturday

May 19, 2012

Katie Beckett Leaves Legacy For Kids With Disabilities [2 min 59 sec] Add to Playlist Download  

At the time, federal officials figured there were, at most, one- or two-hundred children like Beckett around the country. Most of them were not expected to live very long. But since then, more than a half-million children have received life-extending medical care at home under the Beckett waiver.

Improved medical technology, and close attention from nurses, aides and parents � all made possible by the funding � have allowed these children to grow up with improved health, despite having severe disabilities.

Now the issue is that the state and federal waiver program ends by age 21, and children are outliving their generous health care.

These disabled children are often leading pretty normal lives. Beckett did. She went to college. She lived in her own apartment, even though she still relied on nurses who, for an hour every night, arrived to give her breathing treatments. She still needed the ventilator to breathe, up to 15 hours a day.

Still, living with complex health care needs is not easy. As Beckett explained in 2010 to a group of health care workers, "Just because you reach a certain age does not mean that you are miraculously cured of all the things you have endured."

Timeline

Milestones In Long-Term Care Policies

Over the past few years, she suffered from a series of illnesses and was forced to put off taking the classes she needed to get the teaching degree she wanted. There were many hospitalizations over the years, and her mother, Julie Beckett, said she often feared for her daughter's life. But Katie's death Friday was unexpected. She died in the same Cedar Rapids hospital where she once made history.

Katie and Julie became known as national advocates for people with disabilities. On Katie's 32nd birthday, she and her mother were in Washington to speak to a meeting of child health workers. Later that morning, Katie, in an interview with me, said she valued being a role model but was happiest back home in Cedar Rapids, where she could lead an anonymous, normal life. "In Cedar Rapids, it's quite different," she said. "I'm the girl that they see drinking a latte at Barnes & Noble. I'm not the girl from the newspaper, from the television station."

Sen. Tom Harkin, the Democrat from Beckett's home state of Iowa and one of the chief authors of the Americans with Disabilities Act, said Katie is a symbol of what the disability civil rights law set out to establish. "It's about making sure that we don't separate out people with disabilities, but make them part of the families, making them part of the communities, part of the schools � just an integral part of society. That's what Katie fought for all of her life."

Joseph Shapiro is a correspondent for NPR News Investigations. Katie Beckett's story was part of the "Home or Nursing Home" series, which explored the struggle for the disabled and elderly to receive care at home.

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.
 

Katie Beckett Defied The Odds, Helped Other Disabled Kids Live Longer

Hide caption Katie Beckett, 32, inserts a small suction device into her tracheotomy tube to help clear her lungs and throat. Twenty-nine years ago, President Ronald Reagan heard about a little girl who had spent most of her life in a hospital. That little girl was Katie, then just three years old. John Poole/NPR Hide caption Nurse Vicki Hagen comes over to Beckett's apartment in Cedar Rapids, Iowa, to help fit her with a vibrating vest that helps clear mucous from her lungs twice a day. Studies have shown that, almost always, it costs less to care for someone at home than in a nursing home or hospital. John Poole/NPR Hide caption On the wall of her apartment are pictures of Beckett as a child with President Reagan. Reagan created the "Katie Beckett waiver" that changed the Medicaid rules to allow severely disabled children and adults to get government-funded care in their own homes. John Poole/NPR Hide caption Beckett (left) and her mom Julie go to a restaurant in Cedar Rapids, Iowa, once a week to catch up. Beckett is now famous among children's advocates and travels the country with her mom working for laws and programs in favor of homecare. John Poole/NPR

1 of 4

View slideshow i

A few years ago, I asked a 13-year-old girl who was receiving care for cystic fibrosis on a Medicaid program known as the "Katie Beckett waiver" if she knew who Katie Beckett was. "Probably some kind of doctor," the girl said.

It was a logical guess. But Beckett was another child with a significant disability, and she changed health care policy for hundreds of thousands of other children with complex medical needs. On Friday, Beckett, at age 34, died in Cedar Rapids, Iowa, of complications from her disability.

Beckett had spent most of the first three years of her life living in an Iowa hospital because she needed to breathe on a ventilator much of the day. Medicaid would only pay for the expensive treatment if she stayed in the hospital.

In 1981, President Ronald Reagan heard about her situation and changed the rule so she could go home. As Reagan noted, it cost significantly less � about one-sixth as much � for Beckett to receive the care at home, instead of in a hospital.

 

When she was just 5 months old, she contracted viral encephalitis, a brain infection, and went into a coma. After recovering, she had partial paralysis that left her unable to breathe without a ventilator much of the day.

Heard On Weekend Edition Saturday

May 19, 2012

Katie Beckett Leaves Legacy For Kids With Disabilities [2 min 59 sec] Add to Playlist Download  

At the time, federal officials figured there were, at most, one- or two-hundred children like Beckett around the country. Most of them were not expected to live very long. But since then, more than a half-million children have received life-extending medical care at home under the Beckett waiver.

Improved medical technology, and close attention from nurses, aides and parents � all made possible by the funding � have allowed these children to grow up with improved health, despite having severe disabilities.

Now the issue is that the state and federal waiver program ends by age 21, and children are outliving their generous health care.

These disabled children are often leading pretty normal lives. Beckett did. She went to college. She lived in her own apartment, even though she still relied on nurses who, for an hour every night, arrived to give her breathing treatments. She still needed the ventilator to breathe, up to 15 hours a day.

Still, living with complex health care needs is not easy. As Beckett explained in 2010 to a group of health care workers, "Just because you reach a certain age does not mean that you are miraculously cured of all the things you have endured."

Timeline

Milestones In Long-Term Care Policies

Over the past few years, she suffered from a series of illnesses and was forced to put off taking the classes she needed to get the teaching degree she wanted. There were many hospitalizations over the years, and her mother, Julie Beckett, said she often feared for her daughter's life. But Katie's death Friday was unexpected. She died in the same Cedar Rapids hospital where she once made history.

Katie and Julie became known as national advocates for people with disabilities. On Katie's 32nd birthday, she and her mother were in Washington to speak to a meeting of child health workers. Later that morning, Katie, in an interview with me, said she valued being a role model but was happiest back home in Cedar Rapids, where she could lead an anonymous, normal life. "In Cedar Rapids, it's quite different," she said. "I'm the girl that they see drinking a latte at Barnes & Noble. I'm not the girl from the newspaper, from the television station."

Sen. Tom Harkin, the Democrat from Beckett's home state of Iowa and one of the chief authors of the Americans with Disabilities Act, said Katie is a symbol of what the disability civil rights law set out to establish. "It's about making sure that we don't separate out people with disabilities, but make them part of the families, making them part of the communities, part of the schools � just an integral part of society. That's what Katie fought for all of her life."

Joseph Shapiro is a correspondent for NPR News Investigations. Katie Beckett's story was part of the "Home or Nursing Home" series, which explored the struggle for the disabled and elderly to receive care at home.

Does your state protect older Baby Boomers?

The Affordable Care Act leaves it to the states to decide whether they will allow insurers to charge older Americans more for coverage. If a state takes no action, a 64-year-old buying his own health insurance in the individual market will pay up to three times more than an 18-year-old.

The Affordable Care Act leaves it to the states to decide whether they want to let insurers charge older Americans more for coverage. If a state takes no action, a 64-year-old buying his own insurance in the individual market will pay up to three times more than an 18-year-old. In the small-group market � if a small business employs an unusually large number of older workers � the same 3:1 ratio applies.

Today, in most states, there are no caps on how much insurers can charge a 60-something forced to purchase his own insurance. In the individual market, only New York State bans age rating altogether, and just three other states limit how much premiums can vary, based on age, to less than 3:1. When insurers sell policies to small businesses, Vermont also prohibits age rating, but only five other states cap increases.

To check whether your state shields older boomers in either of these markets, take a look at these charts. (A checkmark in the right-hand column means that age rating is now unregulated in that state.)

Help from the younger generation?

Under reform, more states could decide to ban age rating, or follow Massachusetts' example, and limit the ratio to 2:1.�But, politically, this would be a third-rail decision.

If older boomers pay less, younger adults would be charged more, and most are vehemently opposed to being asked to support the Pepsi Generation. As one of my younger readers once commented, "I'm willing to help my mother, but not someone else's mother."

Just how much more would a 20-something pay?�According to researchers at the Urban Institute, eliminating age rating would lift average premiums for those 18 to 34 years old by $1,400 (from $3,600 to $5,000). Policy holders ages 35 to 44 would see their premiums rise by $800 (from $4,200 to $5,000). Meanwhile, premiums for those between age 45 and 64 would fall by about $2,400, from $7,500 to $5,100.

In other words, when costs are distributed over a large group, older adults save more than younger adults lose.

Still, many believe that older Boomers can and should pick up the higher tab for their own care. After all, throughout their financial lives, they have been luckier than most: they enjoyed first crack at the employment market when jobs were plentiful, and first dibs on housing when homes were affordable.

A generation hit hard

Yet in recent years, the economy has not been kind to the rock ‘n roll generation. One in six is now unemployed, and from 2000 to 2011, the average (mean) after-tax income of Americans age 45 to 54 (who are now in their 50s and early 60s) plunged by 13.3 percent.

By that measure, the recession has hit them harder than other age groups except Americans aged 15 to 24. Over those years, this cohort should have been enjoying their peak earning years. But as the chart below reveals, they didn't.

Between 2000 and 2011 average after-tax income of Americans age 45 to 54 plunged by 13.3 percent. Graph: Advisor Perspectives, Inc.

Even worse, the Wall Street Journal reports, "at an age when they should be generating peak … savings," many have been raiding their retirement funds and "applying for early Social Security benefits." Among median-income households headed by someone age 55 to 64, total savings and assets stand at just $87,200. In 2014, they will be the 50- to 64-year-olds struggling to scrape together $7,500 to $8,500 to purchase health insurance in the individual market.

Of course, younger middle-class Americans also have watched their incomes slide, but time is on their side. They have many more years to recover. The problem for a jobless 60-year-old is that she won't be able to make up for her losses unless she finds a higher-paying job � and that isn't likely.

In 2014, just how many older Americans will find that they can't afford universal coverage? Writing in Health Affairs in February, the Urban Institute's researchers estimated that under reform, age rating means that roughly 1 million Americans age 45 to 64 will forego insurance.

Abolish age rating?

Yet there's a trade off: if age rating were abolished, younger adults would be charged more, and some would decide they can't afford insurance. Bottom line: "the number of uninsured older Americans would be roughly offset by increases in the number of uninsured adults in the two younger age groups�(18-34 and 34-44)."

This worries policymakers for two reasons. First, we need young, healthy Americans in the pool to keep insurance costs down. Secondly, if young families decide to forego insurance, many won't buy separate policies for the children.

How do we choose between children and their grandparents?

If we don't want to ration care, the only rational solution is to bring down the cost by trimming waste in our health care system. This will be difficult. Most of the fat isn't hanging out on the edges of the steak � it's marbled throughout in the form of unnecessary treatments and over-priced products. It needs to be removed carefully, with a scalpel. But it can be done.

What's Up, Doc? When Your Doctor Rushes Like The Road Runner

Enlarge iStockphoto.com

Patients continue to complain that physicians don't spend enough time examining and talking with them.

iStockphoto.com

Patients continue to complain that physicians don't spend enough time examining and talking with them.

To physician Larry Shore of My Health Medical Group in San Francisco, it's no surprise that patients give doctors low marks for time and attention.

"There's some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Shore says. "And that makes you feel like the person is not listening."

A doctor's impatience, though, is often driven more by economics than ego. Reimbursement rates for a primary care visit are notoriously low, and Shore laments the need to hustle patients in and out.

 

"When you have that pressure to see three, four, maybe five patients an hour, you can't wait for the exposition of the patient's story. Which is exactly what you should do. But you can't," he says.

A new poll by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health found about 3 out of 5 patients think their doctors are rushing through exams. That's nearly the exact same number as three decades ago.

NPR's survey asked people the same questions as another poll did back in 1983. We found doctors got better marks on some patient interactions. For example, 64 percent of people said doctors usually explained things well to them, versus 49 percent in 1983. They also are more likely to say doctors are trying to hold down medical costs.

But when it comes to time, there is a stubborn feeling that doctors are in too big of a hurry. That is troubling � and frustrating � to physicians like Shore who feel that they are already packing more into every workday and are stretched thin by paperwork.

"I think a lot of physicians in smaller practice realized they were becoming both the clerk and the HR and the accounts payable and the accounts receivable and the office manager � things which they may not have an interest in and certainly had no training for," Shore says. But he says many doctors just didn't have the cash flow to hire administrative staff.

Two months ago, Shore opened a new office in which he's trying to break from the day-to-day grind. Appointments are now 20 minutes, instead of 15. And he's hired several other doctors to spread the workload around. But there's also been a shift in his thinking about the way he provides care to his patients: He's trying to treat them more like customers, and focus on making them happy.

"Who are your customers? What do they want? Try to meet those needs," Shore says.

And what his customers want, he believes, is access to him and his staff � how they want it, like over email, and when they want it, like after-hours. To do that, Shore has given up on the model of the doctor as a lonely superhero. Instead, everything is about the team.

Shore hunkers down each morning with his medical assistants for a "care huddle," a rare, quiet moment to strategize about the patients coming in that day. Those assistants now play a bigger role in care, renewing prescriptions and briefing the doctor before he enters the exam room. A check-out assistant guides "customers" out the door.

Shore is trying to make up the financial difference of hiring these additional people by getting the office manager to badger insurance companies to pay more money per patient for better patient health.

That doesn't include patients getting any test or treatment they demand. But Shore's younger colleague Payal Bhandari sounds as much a marketer as family physician when she talks about her hopes for a better assembly line.

"It will actually produce a much better product, where you can actually listen to patients," Bhandari says. "And the physician is a lot happier because they don't feel like, 'Ugh! Another person!' They can actually do their job, but there are others helping them in the process."

Will these improvements be enough to move the stubborn poll number? Shore is optimistic, a belief reflected in a fortune cookie message taped to his office window: It says: "Be not afraid of growing slowly. Be afraid only of standing still."

Varney is a reporter with NPR member station KQED.

Popular antibiotic linked with rare but deadly heart risk

CHICAGO(AP)�An antibiotic widely used for bronchitis and other common infections seems to increase chances for sudden deadly heart problems, a rare but surprising risk found in a 14-year study.

Zithromax, or azithromycin, is more expensive than other antibiotics, but it's popular because it often can be taken for fewer days. But the results suggest doctors should prescribe other options for people already prone to heart problems, the researchers and other experts said.

Vanderbilt University researchers analyzed health records and data on millions of prescriptions for several antibiotics given to about 540,000 Tennessee Medicaid patients from 1992 to 2006. There were 29 heart-related deaths among those who took Zithromax during five days of treatment. Their risk of death while taking the drug was more than double that of patients on another antibiotic, amoxicillin, or those who took none.

To compare risks, the researchers calculated that the number of deaths per 1 million courses of antibiotics would be about 85 among Zithromax patients versus 32 among amoxicillin patients and 30 among those on no antibiotics. The highest risks were in Zithromax patients with existing heart problems.

Patients in each group started out with comparable risks for heart trouble, the researchers said.

The results suggest there would be 47 extra heart-related deaths per 1 million courses of treatment with Zithromax, compared with amoxicillin. A usual treatment course for Zithromax is about five days, versus about 10 days for amoxicillin and other antibiotics. Zithromax is at least twice as expensive as generic amoxicillin; online prescription drug sellers charge a few dollars per pill for Zithromax.

"People need to recognize that the overall risk is low," said Dr. Harlan Krumholz, a Yale University health outcomes specialist who was not involved in the study. More research is needed to confirm the findings, but still, he said patients with heart disease "should probably be steered away" from Zithromax for now.

The study appears in Thursday's New England Journal of Medicine. The National Heart, Lung and Blood Institute helped pay for the research.

Zithromax, marketed by Pfizer Inc., has been available in the United States for two decades. It's often used to treat bronchitis, sinus infections and pneumonia. Wayne Ray, a Vanderbilt professor of medicine, decided to study the drug's risks because of evidence linking it with potential heart rhythm problems. Also, antibiotics in the same class as Zithromax have been linked with sudden cardiac death.

Zithromax is among top-selling antibiotics. U.S. sales last year totaled $464 million, according to IMS Health, a health care information and services company.

Pfizer issued a statement saying it would thoroughly review the study. "Patient safety is of the utmost importance to Pfizer and we continuously monitor the safety and efficacy of our products to ensure that the benefits and risks are accurately described," the company said.

Patients studied were age 50 on average and not hospitalized. Most had common ailments, including sinus infections and bronchitis. Those on Zithromax were about as healthy as those on other antibiotics, making it unlikely that an underlying condition might explain the increased death risk.

Medicaid patients generally have more disability and lower incomes than other patients, so whether the same results would be found in the general population is uncertain, Ray said.

Dr. Bruce Psaty, a professor of medicine at the University of Washington, said doctors and patients need to know about the potential risks. He said the results also raise concerns about long-term use of Zithromax, which other research suggests could benefit people with severe lung disease. Additional research is needed to determine if that kind of use could be dangerous, he said.

���

AP Medical Writer Lindsey tanner can be reached at http://www.twitter.com/LindseyTanner

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]

Poll: What It's Like To Be Sick In America

Compared to the not sick people in our poll, Americans who've been sick in the past 12 months ...

Source: NPR/Robert Wood Johnson Foundation/Harvard School of Public Health Poll

Credit: Alyson Hurt/Nelson Hsu, NPR

In the lull between the Supreme Court arguments over the federal health overhaul law and the decision expected in June, we thought we'd ask Americans who actually use the health system quite a bit how they view the quality of care and its cost.

Most surveys don't break it down this way.

When the results came back, we found that people who have a serious medical condition or who've been in the hospital in the past year tended to have more concerns about costs and quality than people who aren't sick. No big surprise there.

But what was notable: 3 of 4 people who were sick said cost is a very serious problem, and half said quality is a very serious problem.

Nearly half of those with recent serious illness say they felt burdened by what they had to pay out of their own pocket for care.

The recently ill are more likely to say the cost and quality of care have worsened over the past five years, compared to people who weren't sick.

Among people who've recently required a lot of care, significant proportions say their treatment was poorly managed, with nearly a third complaining of poor communication among their caregivers. One in eight believe they got the wrong diagnosis, treatment or test.

Those findings led us to investigate the problems people are having, both in our poll and in a series of stories on the radio and the Web we're calling "Sick in America."

The poll, a joint venture of NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health, is one of very few focusing on people who've actually been seriously ill, injured or hospitalized in the past year.

"This poll listens to the voices of the sick," says Robert Blendon of Harvard. "That provides a good barometer of what's happening in health care in America."

The poll randomly surveyed 1,508 adults across the nation. A little more than a quarter of them had a serious illness, injury or disability requiring "a lot of medical care," or overnight hospitalization within the past 12 months.

If you want to dive deeper, here's a summary of the poll findings, plus the topline data and charts. And you can meet some of the real people who shared their experiences of being sick in America with NPR in this post.

No 'bubble' for healthcare IT, analysts say

NASHVILLE, TN – Leading financial analysts scoffed at the notion of a healthcare IT “bubble” that could slow the pace of mergers and acquisitions this year. Speaking on a panel called “Financing The Deal” at the Nashville Health Care Council, they predicted that 2012 M&A activity would be brisk, though not superheated.

In the health IT sector, there’s currently a glut of buyers and not enough companies to acquire. There are many non-healthcare players like Lockheed-Martin wanting to buy healthcare IT companies – and many suitors for a limited number of clinical decision support companies. “There are still a lot of great opportunities for technology-enabled healthcare companies with a demonstrable ROI,” said David Jahns, managing partner at Galen Partners.

[See also: All in a week's work]

The analysts agreed that deal-making this year won’t be dampened by uncertainty surrounding the future of healthcare reform. If anything, there’s greater pressure to make deals this year in advance of possible post-election efforts at tax reform.

“There’s still a stable financing environment despite the upcoming election and the events in Europe,” said Jon Santemma, global co-head of healthcare investment banking at Jefferies & Company. “Valuations are down in some sectors like nursing homes and home health, which makes them good deal-making opportunities this year. And we anticipate a lot of deals this year involving private-pay companies.”

There’s still about $350 billion in private equity “overhang”, which sets the stage for some rapid-fire M&A this year. “I look for a lot of activity in the mid-market private equity arena, with a lot of possible deals in the $200 million to $800 million range,” added Santemma.

[See also: Health IT M&A activity down in 2011, value up]

According to Irving Levin & Associates, hospital M&A reached a 10-year high last year, when 86 deals were completed. “I look for hospital transactions to increase,” said Ravi Sachdev, managing director at J.P. Morgan. “The attitude we’re now seeing is, ‘If I can’t be No. 1 or No., 2 in my service area, I want out’.”

Panelists were reluctant to make long-range forecasts. “Five years ago, who would have predicted that you’d have payers acquiring HIEs?” said Jahns. “But that’s exactly what’s happening now.” The panel members agreed that one long-term trend is rock-solid: a lot of money will continue to flow through America’s healthcare system – enough money to allay dealmakers’ concerns about declining state and federal reimbursements.

As for overseas deals, look for increased activity in telemedicine in 2012. China and India have been quick to harness the potential of telemedicine. And as one panelist quipped, “It’s easier for U.S. telemedicine companies to operate in China than across state lines.”

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.

HHS tackles stubborn HAIs with updated plan

WASHINGTON – Even as it reports progress on efforts to eliminate healthcare acquired infections, known as HAIs, the Department of Health and Human Services is calling for comment on an updated plan to strengthen its work. The initiative, which calls for the use of health information technology to detect and monitor infections and to aid in reporting, could save tens of thousands of lives billions of dollars each year, according to HHS.

The news is not all good. The rates of one type of infection remain at historic highs. Clostridium difficile (C. difficile) is a germ that causes serious diarrhea, kills 14,000 Americans each year and adds an estimated $1 billion in extra costs to the healthcare system. While many HAIs declined in the 2000s, data from the Agency for Healthcare Research and Quality show that the number of hospital stays associated with C. difficile tripled before leveling off at historic high rates.  In addition, a recent CDC report showed that C. difficile infections have moved beyond hospitals and that 75 percent of these infections now begin in medical settings outside hospitals, such as nursing homes and outpatient clinics.

[See also: HHS awards $137M to states for health IT, prevention]

The updated National Action Plan is posted on the HHS site and an announcement of the request for public comments on the National Action Plan will be published in the Federal Register the week of April 23. The HHS Office of Healthcare Quality (OHQ) is soliciting public comments on the revised action plan through June 22, 2012.

“Today, we celebrate the rapid progress achieved through concerted efforts to reduce preventable infections in hospitals,” said Howard Koh, assistant secretary for health. “Already we are saving lives and reducing unnecessary healthcare expenditures. Through dedicated and conscientious partnerships, we are well-positioned to make hospitals safer and extend the same gains to all places of care.”

A new state-by-state breakdown by the Centers for Disease Control and Prevention (CDC) demonstrates that HAIs in hospitals have been declining since HHS first introduced its National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination in 2009. The CDC report also pinpoints specific medical procedures that require stronger infection prevention efforts to maximize patient safety.

[See also: CDC goes on the offensive with HAIs]

According to data submitted to CDC’s National Healthcare Safety Network and reported in the HAI Action Plan, central line-associated bloodstream infections have declined by 33 percent, surgical site infections (SSIs) have declined by 10 percent, and catheter-associated urinary tract infections have declined by 7 percent since the baselines were set.

In addition, invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections have declined by 18 percent, and the use of measures known to prevent SSIs, as reported by the Centers for Medicare & Medicaid Services' Surgical Care Improvement Project, have steadily increased since the baseline was established.  These reductions are in line with the prevention targets detailed in the HAI Action Plan and the HHS Partnership for Patients initiative.

The HAI Action Plan has nine goals:50 percent reduction in bloodstream infections100 percent adherence to central line insertion practices30 percent reduction in Clostridium difficile infections30 percent reduction in Clostridium difficile hospitalizations25 percent reduction in urinary tract infections50 percent reduction in MRSA invasive infections (in the general population)25 percent reduction in MRSA bacteremia25 percent reduction in surgical site infections95 percent adherence to surgical SCIP measures.

Since 2009, the HAI Action Plan has marshaled resources across HHS, several other federal agencies, and numerous stakeholders in a concerted effort to substantially reduce HAIs by 2013.  Phase 1 of the effort focuses on combating HAIs in hospitals, while Phase 2 focuses on ambulatory surgical settings, end-stage renal disease facilities, and the influenza vaccination of healthcare personnel. A new third phase, to initiate next summer, will focus on long-term care facilities.
 
The HHS Partnership for Patients works to accelerate progress against HAIs through highly structured learning collaboratives to support hospitals nationwide in adopting and helping to spread proven interventions so that they become the standard of care. The Partnership for Patients is a nationwide public-private collaboration focused on keeping patients from getting injured or sicker in the hospital, and helping patients heal without complication once they are discharged. 

Other Partnerships for Patients partners, including state and national associations, consumer groups, unions, employers, researchers, community-based organizations, patients and others also are collaborating to help to accelerate progress against HAIs and other preventable conditions. HHS welcomes additional partners in these efforts to build the healthcare system that Americans need, desire and deserve.

[See also: IT is key to preventing HAIs]

Important Information for Small Businesses Owners

If you�re a small business owner, there are a few deadlines approaching that you won�t want to miss in order to help provide health coverage for your employees.

As you might know, if you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will bring down the cost of providing insurance.

In order to take advantage of these tax credits, you must file by a certain date. Here are two important tax filing deadlines in coming weeks that you should be aware of:

September 15. Corporations that file on a calendar year basis and requested an extension to file to September 15 can calculate the small employer health care credit on Form 8941 and claim it as part of the general business credit on Form 3800, which they would include with their corporate income tax return.October 17. Sole proprietors who file Form 1040 and partners and S-corporation shareholders who report their income on Form 1040 have until October 17 to complete their returns. They would also use Form 8941 to calculate the small employer health care credit and claim it as a general business credit on Form 3800, reflected on line 53 of Form 1040.

The Department of Health and Human Services (HHS), along with the IRS, wants to make sure that businesses who qualify take advantage of the credit. In order to get the word out, there is a big outreach effort that will include IRS YouTube videos in English, Spanish and American Sign Language. Targeted e-mails and tweets will be sent to the small business community and tax preparers. The goal is to remind employers about the upcoming extension deadlines and also provide details on other important information about the credit, including:

Businesses who have already filed can still claim the credit: For small businesses that have already filed and later determine they are eligible for the credit, they can always file an amended 2010 tax return. Corporations use Form 1120X and individual sole proprietors use Form 1040XBusinesses without tax liability this year can still benefit: The Small Business Jobs Act of 2010 provided that for Tax Year 2010, eligible small businesses may carry back unused general business credits (including the small employer health care tax credit) five years. Previously these credits could only be carried back one year. Small businesses that did not have tax liability to offset in 2010 should still evaluate eligibility for the small business health care tax credit in light of this expanded carry back opportunity.Business that couldn�t use the credit in 2010 can claim it in future years: Some businesses that already locked into health insurance plan structures and contributions for 2010 may not have had the opportunity to make any needed adjustments to qualify for the credit for 2010. So these businesses may be eligible to claim the credit on 2011 returns or in years beyond. Small employers can claim the credit for 2010 through 2013 and for two additional years beginning in 2014.

The Administration will also continue to work with and encourage private-sector outreach. For example, a number of Blue Cross Blue Shield plans implemented a wide variety of innovative outreach initiatives to promote the program and encourage small employers to offer insurance coverage to their workers. Blue Cross Blue Shield of Kansas City is a leading innovator with a promotion campaign built around the H&R Block tax calculator and the small business tax credit on its site www.BlueKCTaxcredit.com.� Since April 2010, they have enrolled over 9,000 new members covered in over 400 new employers.� Thirty-eight percent of these employers previously did not offer insurance.

Additional information about eligibility requirements and calculating the credit can be found on the Small Business Health Care Tax Credit for Small Employers page of IRS.gov.

Protecting Physicians and People with Medicare

One of the most important relationships people have is with their doctor.� They rely on them for treatment when they are sick, counseling on ways to stay well, and for help navigating our complex health care system.� But, unfortunately, a problem in Medicare�s payment system for doctors threatens that relationship and seniors and people with disabilities� regular access to their doctor.

In 1997, Congress passed a law that was intended to slow the growth in Medicare spending so that the program would remain financially solvent. There were many good things in that law but one piece of it has proved to be problematic. A new formula � known as the Sustainable Growth Rate or SGR � was supposed to make sure we didn�t overpay for doctors� services.� Instead, it has resulted in the potential for huge cuts in Medicare fees that would not be good for doctors or patients.�

For nine years in a row, Congress has enacted legislation to override large payment cuts to physicians. But lawmakers haven�t acted to get rid of the SGR and replace it with a formula that works. Since he took office, President Obama has called for a �permanent fix� to the SGR that would avoid this annual exercise. While we stopped the cuts scheduled for 2010 and 2011, we are now faced with the prospect of a 29.5 percent cut in 2012.

Today, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules that spell out how this cut is calculated and warned that if Congress does not act in time, doctor fees will be slashed come January 1. We cannot � and will not � let this happen.

In his proposed budget for fiscal 2012, the President again called for getting rid of the SGR and he identified savings to pay for that change for the next two years.� In his fiscal framework, the President identified additional savings that would pay for a 10-year fix.

For too long, we�ve been putting a Band-Aid on a wound that needs a permanent fix to heal.�And we are committed to fixing this problem, once and for all. �

At CMS, we are working every day to make Medicare a system focused on three major aims � better care, better health, and lower costs through improvement.� To achieve this, physicians need to know what Medicare will pay and patients need to know that they can continue to see their doctors. �This is the system 48 million people with Medicare need and the system we want to preserve for years to come.�

Today happens to be the 45th anniversary of the implementation of Medicare. There couldn�t be a better time to begin renewing our commitment to the people it serves and the physicians who care for them.

Read the press release here.

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."