A DSS spokeswoman said yesterday that the child protection agency had been involved with the family in the past, but terminated its involvement in 2005. DSS became involved again after MGH stepped in. Fraser said he has no idea why his former wife allegedly decided not to get her son medical care. Dr. Robert Sege, medical director of the child protection team at Boston Medical Center, said there may be many reasons why a parent does not make sure a child gets treatment. The parent may simply not understand how serious the consequences can be, said Sege, who played no role in Jeremy Fraser's case. Also, he said, "people have real issues with the logistics of life - with transportation, with child care. Life doesn't stop just because you have a chronically ill kid." Caring for an ill child is no easy job, he said.
"Families with healthy kids and working parents are stressed out as a baseline, and add to that going to multiple doctors' appointments, keeping track, being on time, making a child take a medication they may not want, and sometimes with chemo, the child is uncomfortable. All the chronic diseases of childhood are really difficult for families." But ultimately, Sege said, "the bottom line is that the child needs to get lifesaving care." . . .
July 3, 2008
Senator Kennedy and Universal Healthcare
The Boston Globe reports on Senator Kennedy's new efforts to prepare for universal healthcare. Lisa Wangass writes,
Senator Edward M. Kennedy's office has begun convening a series of meetings involving a wide array of healthcare specialists to begin laying the groundwork for a new attempt to provide universal healthcare, according to participants. The discussions signal that Kennedy, who instructed aides to begin holding the meetings while he is in Massachusetts undergoing treatment for brain cancer, intends to work vigorously to build bipartisan support for a major healthcare initiative when he returns to Washington in the fall.
Those involved in the discussions said Kennedy believes it is extremely important to move as quickly as possible on overhauling the healthcare system after the next president takes office in January in order to capitalize on the momentum behind a new administration. Kennedy was an early endorser of Senator Barack Obama, the presumptive Democratic presidential nominee who is also a member of the Committee on Health, Education, Labor and Pensions, which Kennedy chairs . . . .
Kennedy played a critical role in helping Massachusetts create a healthcare overhaul proposal in 2006 by aiding the state in obtaining the federal money needed to subsidize it. It appears he is now looking to Massachusetts to help shape the debate in Washington. Earlier this year, Kennedy recruited John McDonough, executive director of Health Care For All in Boston and a major player in the Massachusetts healthcare overhaul debate, to lead the new health initiative.
Aides to Kennedy have also assembled a network of Massachusetts advisers, including healthcare lawyers, economists, nonprofit leaders, doctors, and health insurers who may be asked to work on specific aspects of a national plan. At a recent meeting in Boston, the group discussed how different elements of the Massachusetts approach might work on a national level. . . .
Kennedy is not alone in trying to get a head start on the healthcare debate. Senator Max Baucus, a Democrat from Montana and chairman of the Senate Finance Committee, held a healthcare summit in mid-June, and a bipartisan proposal to make private insurance accessible to all Americans has been put forward by Senator Ron Wyden, a Democrat from Oregon, and Robert Bennett, a Republican from Utah. . . .
Ron Pollack, executive director of Families USA, a healthcare consumer advocacy group, said Kennedy was trying to avoid division by having senior staff members meet with their counterparts on Baucus's committee. "If the two committees are working cooperatively together and developing a common legislative proposal, it means that the process is less likely to get bogged down because of jurisdictional and substantive differences," he said. . . .
Kennedy's committee has held two meetings so far - one with healthcare coalitions, the other with physicians' groups. Eight more will be held by the end of the month. The meetings are attended by aides for committee members of both parties, said Craig Orfield, a spokesman for Senator Mike Enzi of Wyoming, the ranking Republican on the committee.
Whether the two parties and myriad interest groups can overcome their differences over the next year remains to be seen, but several of those participating in the discussions expressed optimism about that possibility. . . .
European Health Care: Germany
National Public Radio has a brief overview of German health care. It is quite an interesting piece and shows the importance of access to health care and also how differently the government role in providing or financing or regulating health care can be. You can listen to the piece here. Here is the write-up:
Mention European health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care. It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies.
German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted. . . .
Germans really hate any hint of unfairness in health care. The fundamental idea is that everybody must be covered and, preferably, everybody should get equal treatment. So the fact that 10 percent or so can buy some perks is an irritant — something Germans complain about but manage to put up with.
But it's unthinkable that 48 million people wouldn't have health insurance at all — the situation in America. As an American, Chris thinks that's shameful. "It's terrible," he says. "It's unbelievable. It shouldn't happen."
Germans, he says, would never tolerate that. And their system has been working pretty well for 125 years.
July 2, 2008
Parents and Health Care Issues
The Boston Globe reports on a tragic case of an austic boy with leukemia whose mother apparently failed to follow a specific treatment regime and now faces jail time. The parents are divorced, their relationship is strained and it is rather difficult to figure out what really happened and what the circumstances were surrounding the mother's ability to comply with the medical treatment doctors had recommended for her child. John R. Ellement and Carey Goldberg write,
Eric J. Fraser wrapped his burly arms yesterday around the slight figure of his 8-year-old son, Jeremy, who doctors say will soon die, . . . Fraser spoke one day after his former wife and Jeremy's mother, Kristen A. LaBrie, was arraigned in Salem District Court on one count of child endangerment. . . .
In a report filed in court, Salem police alleged that LaBrie delayed chemotherapy appointments a dozen times, disrupting a carefully scheduled treatment plan. She also failed to administer home doses of the chemotherapy and to collect prescriptions at the drugstore, police said. "Due to Ms. LaBrie's failure to provide Jeremy with his life-saving cancer medication, his cancer has returned," police wrote. "His cancer has returned quicker and stronger than under ordinary circumstances. He now has been diagnosed with a 10 percent chance of survival."
According to Fraser, police reports, and records in Essex Probate and Family Court, Jeremy Fraser was diagnosed with cancer in 2006 and was to be treated at Massachusetts General Hospital, where doctors told Fraser his son had a good prognosis. The child now has fully developed leukemia . . . .
In mid-February, when LaBrie brought Jeremy to MGH for a routine appointment, doctors determined that he was not getting the care he needed and was in danger if he was allowed to return home with his mother. MGH alerted both Fraser and the Department of Social Services.
The LA Times reports on the California's recent move to prevent PrimeHealth from billing its privately insured patients for unpaid treatment received at PrimeHealth medical facilities. Daniel Costello writes,
The Department of Managed Health Care, in a lawsuit filed Friday in Orange County Superior Court, is seeking to bar Prime Healthcare Services Inc. of Victorville from billing insured patients for unpaid medical bills that the hospital chain contends it is owed from insurers and is seeking from patients as a last resort.
"Prime Healthcare's ongoing practice of putting consumers in the middle of billing disputes between providers and health plans is the largest example of this egregious practice we've seen to date, and it must be stopped," said Cindy Ehnes, director of the state agency. "Consumers who have purchased health coverage in good faith deserve to know that it will cover them in a medical emergency and not result in crushing medical debt," she said. Prime Healthcare said it believed that it was legally allowed to send the bills to patients and that it wouldn't have to do that if insurers paid their portion of the medical bills.
Prime "is disappointed that DMHC . . . has resorted to punitive actions against the very providers, physicians and hospitals alike that are essential to maintaining the healthcare safety net relied on by thousands of patients every day," said Mike Sarrao, Prime's general counsel. Sarrao said the company "does not believe the DMHC has the requisite legal or equitable standing to bring the suit forward." . . .
In response to insurers' partial payments, Prime acknowledges, the hospital chain has been sending as many as thousands of patients in recent months the unpaid portions of their bills -- some as high as $50,000 -- igniting an outcry from patients, insurers and state regulators.
The controversial practice is known as "balance billing" and is increasingly common across the state. But the size and scope of Prime's balance-billing practices appear to be among the largest thus far. Balance billing occurs when doctors and hospitals claim they've been underpaid by insurers and ask patients to pay the balance. Some patients wrongly assume that such bills are cleared by their insurer. For example, a doctor may charge $2,000 for a procedure, but the health plan pays $1,500. Under balance billing, the hospital would ask the patient for $500 -- even though the patient had paid his or her full share of the service. . . .
California laws on the issue are vague compared with those in some states. New Jersey and West Virginia require insurers to pay the doctors' bills in such disputes. Connecticut, Colorado and Rhode Island indemnify patients against having to pay such bills.
California has rarely acted against insurers or providers for balance-billing problems. . . . In 2006, Gov. Arnold Schwarzenegger ordered state regulators to ban balance billing. The Department of Managed Health Care spent two years trying unsuccessfully to negotiate a compromise between insurers and providers.
This spring, the agency decided to outlaw the practice and drafted regulations to bar hospitals and their physicians from billing patients for emergency services that are the responsibility of insurers. Because the regulations aren't expected to be in effect until this fall at the earliest, the state sought recourse against Prime Healthcare in court, a department spokeswoman said. "Patients shouldn't be brought into the middle of billing disputes. Period," said department director Ehnes.
July 1, 2008
New Medicare Rules for Hospice
The Washington Post reports on the new Medicare rules for hospice care. Alicia Ault writes,
Twenty-five years after Medicare began paying for hospice care, the federal health program has issued a new rule calling hospice providers to closer account on the quality of care they offer. The rule, which will take effect in December, guarantees hospice patients a say in their treatment plans and requires hospice providers to show they are improving in areas where they have been found deficient.
The move comes at a time when hospice care is growing exponentially but is still vastly underused and under-appreciated, hospice providers and advocates say. About 1.3 million people received hospice services in 2006, more than twice as many as did a decade earlier.
What was once a grass-roots, community-based movement in the late 1960s has become a booming health-care business. . . .
Many in the field say they find it surprising that hospice care isn't more widely used, given the generosity of the Medicare benefit: There are no co-pays, deductibles or out-of-pocket costs for beneficiaries who use hospice. Malene Davis, president and chief executive of Capital Hospice, based in Falls Church, blames widespread misperceptions (the idea, for instance, that hospice is only for cancer patients, or that once someone is in, he can't leave) for holding down the rate of use.
Not all of the 1.3 million people who received hospice services in 2006 died within the next six months, although a life expectancy of six months or less is often a condition for treatment. Some lived into the following year, and about 220,000 were discharged. Predicting the time of death, though, is a notoriously inexact science.
Linda Neighborgall of Falls Church is an enthusiastic supporter, after using hospice for her mother and mother-in-law, both of whom died from cancer. . . . "If there really are angels on Earth, I know where they work: They work at hospice," Neighborgall said.
Some devils may work there, too. In 1995 government investigators issued a "fraud alert" on hospice after they found false claims from providers who improperly diagnosed patients as terminally ill or billed for undelivered care. There's still no central repository of complaints data. "We hear terrible stories about even the most reputable hospices," says Naomi Naierman, president and chief executive of the American Hospice Foundation, a nonprofit consumer advocacy group based in Washington. . . .
The new Medicare rule may not suddenly increase acceptance of hospice, but it will start reducing variations in how care is delivered, and eventually it will help consumers choose high-quality hospice providers, Davis said. . . .
Beginning Dec. 2, hospice organizations will also have to implement a quality assessment and improvement system. Hospices will have to show the Centers for Medicare and Medicaid Services, the agency that administers Medicare, that they are trying to improve in problem areas. Initially, quality data will be available only to each hospice organization and Medicare. Eventually, providers and advocates expect, data will be shared with the public, as the federal government has done with information on nursing homes, hospitals and home health agencies.
Hospice providers are happy with the new rule, Lund Person said. NHPCO members have already been tracking performance voluntarily through its Quality Partners program, she said. Most hospices also use family surveys to measure how well they have handled a case. . . .
Until there are more public data, "there is no way of choosing at this point or differentiating among hospices," Naierman said. That's problematic, she added, because often, "once you make a decision to go into hospice, there's really no recourse; it's a fairly final decision."
Emergency Room Malfunction - Again
Wasn't fairly recently that we read about person dying in the emergency room after she fell to the floor and displayed symptoms of severe distress. It seemed too terrible to repeat - but yet today we read about an emergency room full of people who ignore the plight of a very ill individual. This time it is the Kings County Hospital in New York. The Associated Press report is here and contains the video of the woman falling off her chair and everyone - fellow patients, hospital security, nurses, and doctors, ignoring her as she convulses on the floor. She had been waiting for 24-hours. Truly terrible.
June 30, 2008
Women and Health Insurance
Ezra Klein reports on the findings of Jon Cohn regarding the health insurance industry and women He writes,
Jon Cohn peers into insurance price differentials and comes back with a depressing, but unsurprising, finding: Insurers charge women more than they charge men. I'd add to this that studies show the effect is all the more pronounced when you're dealing with health savings accounts and other forms of high-deductible coverage. A Harvard study from a year or so back ran the numbers and found that men under 45 racked up about $500 in yearly, out-of-pocket costs, while women spent closer to $1,200. Dr. Steffie Woolhandler, the lead author of the study, summed up the findings starkly. "When an employer switches all his employees into a consumer-driven health plan, it's the same as giving all the women a $1,000 pay cut, on average, because women on average have $1,000 more in health costs than men."
Here's why: For most of their lives, men and women use health care very differently. Men seek episodic care: I sawed off my thumb, fell off a mountain, tried to stop an SUV with my Civic. . . . Conversely, women seek a lot of routine care. Check-ups, pap-smears, reproductive health care, etc. The expenses are small, but they're regular. So when you move towards health coverage where small, regular expenses come out of pocket, you're erecting financial barriers to the type of care sought by women. . . .
FDA - More Bad Produce?
The Washington Post reports that it may be more than just tomatoes that contain the salmonella that has sickened more than 810 across the United States. Annys Shin reports,
Tomatoes carrying a rare form of salmonella that has sickened more than 800 people may still be on the market, federal officials said yesterday, two weeks after they first warned consumers about the risk. Investigators are considering the possibility that other produce may be spreading the bacteria.
"We continue to see a strong association with tomatoes, but we are keeping an open mind about other ingredients," said Patricia Griffin, a top epidemiologist with the Centers for Disease Control and Prevention.
The FDA has not changed its guidelines that it is safe to eat Roma, red plum and red round tomatoes not attached to a vine that were grown in certain areas. All cherry tomatoes, grape tomatoes and tomatoes attached to the vine are also okay. (For a list of safe areas, go to http:/
/ www.fda.gov.) . . .
With reports of more recent cases coming in daily, investigators are questioning some of their working assumptions about the likely source of the outbreak. "We have to re-examine the whole thing," David Acheson, a top food safety official with the Food and Drug Administration said. "We are concerned there is something out there still exposing people to this salmonella saintpaul strain.". . . .
June 29, 2008
CT Scans and New Health Technologies: A Cost/Benefit Analysis
The New York Times has a long front page article today on the value of CT scans and other new technologies that doctors feel they need to use for patient health without much proof that they promote and health. There is also that little problem of the financial incentives involved with the use of such technologies. Alex Berenson and Reed Abelson report,
A group of cardiologists recently had a proposition for Dr. Andrew Rosenblatt, who runs a busy heart clinic in San Francisco: Would he join them in buying a CT scanner, a $1 million machine that produces detailed images of the heart? The scanner would give Dr. Rosenblatt a new way to look inside patients’ arteries, enable his clinic to market itself as having the latest medical technology and provide extra revenue. Although tempted, Dr. Rosenblatt was reluctant. CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.
Dr. Rosenblatt worried that he and other doctors in his clinic would feel pressure to give scans to people who might not need them in order to pay for the equipment, which uses a series of X-rays to produce a composite picture of a beating heart. “If you have ownership of the machine,” he later recalled, “you’re going to want to utilize the machine.” He said no to the offer.
And yet, more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients. . . .
No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments. At a time when Americans are being forced to pay a growing share of their medical bills and when access to medical care has become a major political issue for states, Congress and the presidential candidates, health care experts say it will be far harder to hold down premiums and expand insurance coverage unless money is spent more wisely.
The problem is not that newer treatments never work. It is that once they become available, they are often used indiscriminately, in the absence of studies to determine which patients they will benefit. . . .