Amid attendance woes, TEPR names award winners, looks to the future

PALM SPRINGS, CA – Amid perfect weather but less-than-perfect attendance, the Medical records Institute's Towards the Electronic Patient Record (TEPR+) conference kicked off Monday with the announcement of two annual award winners.

Private Access, Inc., an Irvine, Calif.-based provider of Web-based solutions designed to help healthcare consumers access medical information and control who sees their records, was named the winner of TEPR's "Hot Products" competition for its PrivacyLayer, RecruitSource and TrialsFinder products. The runner-up announcement featured a tie between Doctations, a Garden City, N.Y.-based developer of online medical records, and ImageTrend, Inc. of Lakeville, Minn. for its TapChart EMS data collection tool.

The U.S. Department of Veterans Affairs was named TEPR's "Best PHRs" award winner for its MyHealtheVet product. Coming in second place was CapMed, a subsidiary of Milwaukee-based Metavante; while Doctations was named the third-place winner.

The awards were named during Monday's opening session at the Palm Springs Convention Center. Claudia Tessier, MRI's vice president, pointed out prior to the announcement that attendance at this year's 25th annual event is "well over 700," which is well under the 2,000 that MRI officials had hoped to attract.

Tessier said attendance "is not where we've been in the past," and added that the nation's troubled economy may have caused some people to curtail their travel plans. She pointed out, though, that the conference, which is scheduled to run through Wednesday, is "cost-conscious but rich in content."

MRI officials had hoped to rejuvenate the flagging show and conference by focusing on new trends in healthcare IT - namely, the patient-centered medical home, emergency services, confidentiality and privacy concerns and mobile devices. On Sunday, they announced the formation of the mHealth Initiative, a Boston-based, non-profit advocacy group designed to advance the use of health applications through mobile devices, or mDevices.

Speaking before an opening session crowd of about 200 people Monday, MRI CEO C. Peter Waegemann said mobile phones, the so-called "forbidden gadgets of the past few years," would be at the forefront of the healthcare IT movement this year, becoming "the most prized possessions of physicians." He pointed out that more than 120 companies have developed mHealth products, and that number will grow with physician acceptance of such devices.

"It's a very exciting time," he said.

Waegemann also opined that healthcare IT would venture further into the realm of financial services as the healthcare industry struggles to maintain balance in the current economy.

"We cannot focus on electronic medical records without looking at the financial system," he said, listing such uses as real-time transactions, payment incentives and charge capture without codes.

Do you know what you pay for health insurance?

A disturbing survey reveals that most Californians � and likely most Americans � are unwilling to focus on the details of their health coverage. Those who are focused on the details are finding their coverage is increasingly riddled with holes.

Health care consumers say their medical costs are going up and expect them to continue to rise. But people are unlikely to ask about cost before getting care. And many don't even know how much they pay for coverage or what their deductible is.

That's according to a recent survey of Californians, and likely applies to most Americans. It's an odd disconnect that people are aware that costs are going up and likely to continue (73 percent thought so), but that many folks are unwilling to focus on the details of their coverage.

Maybe that's understandable, given how difficult it can be to sort out premiums from deductibles from copays, and how often those change from year to year.

Most Americans still get their insurance coverage from an employer, and we like to think that we're taken care of � that if we have a job and a health plan we're all set. What increasing numbers of people are learning is that there are holes in the system even if we have coverage. In this survey from the California HealthCare Foundation, 39 percent of those whose costs went up in the past year said their benefits got worse at the same time.

Those trends are not news for people buying insurance for themselves on the individual market, where high deductibles and Swiss-cheese coverage are the norm. Of those whose costs had risen, 61 percent were in the individual market.

So, the likelihood that your health plan is getting more expensive and/or less comprehensive is fairly decent, and would seem to provide plenty of incentive to educate yourself about your coverage. And yet just 26 percent of those surveyed tried to get information about the cost of a test, treatment or other type of health service before receiving it. Doing research was more likely among those with a high deductible (the amount of money you pay before insurance kicks in).

More evidence that American consumers are practicing avoidance: Among the half of survey respondents who knew they had a deductible, nearly half didn't know the amount. A third didn't know what their premium was or wouldn't answer the question.

These are troubling statistics given the brave new world of insurance coverage we're living in, one that assumes consumers are shopping for health coverage and medical services just like they do other big-ticket items like cars. But there aren't many people who don't know how much their car payment is.

Report: Wireless medtech market driven more by consumers than telehealth

WELLINGBOROUGH, England – Self-monitoring medical devices utlized by the consumer, rather than those used in a managed telehealth setting, will provide the largest market for wireless health technologies, according to IMS Research. An estimated 50 million wireless health devices will be distributed for consumer monitoring applications over the next five years, with a fewer number of devices being used by telehealth patients.

IMS Research, a market research group recently acquired by IHS Inc., published its latest report, Wireless Opportunities in Health and Wellness Monitoring – 2012 Edition, showing that consumer-purchased medical devices with technologies like Bluetooth low energy and ANT+ that self-monitor health will account for more than 80 percent of all wireless medical devices come 2016.

The demand for self-monitoring one’s health is growing much faster than that for telehealth implementation. Even without healthcare systems that are adapted for this, consumers want the ability to monitor and manage their own health at home. The report projects, however, that the number of wireless devices utilized in managed telehealth programs will increase from 5 percent in 2011, to 20 percent in 2016 as telehealth deployment grows.

[See also: Mobile health app market in growth mode.]

“Due to the relatively slow deployment of managed telehealth systems, which is in part due to a reluctance from health providers to move past trials, issues with reimbursement and stringent regulations related to the use and storage of medical data,” says Lisa Arrowsmith, senior analyst at IMS Research, “medical devices used by the consumer to independently monitor their health will provide the biggest uptake of wireless technology in consumer health devices over the next five years.”

One the main drivers for the inclusion of wireless technology in consumer health monitoring devices is the ability to monitor one’s health using a separate device such as a smartphone to collect and view the information. A wealth of applications on several platforms are currently available that allow users to transfer readings from a medical device that record such things as blood pressure, blood glucose and heart rate -- which can then be stored and displayed on the device -- or uploaded to a cloud-based system.

[See also: Telehealth becomes multi-dimensional.]

“The increase in consumer familiarity with mobile applications as well as an increased awareness of the importance of monitoring health levels is driving the market for connected health devices,” adds Arrowsmith. “Many consumers already utilize smartphone apps to track their own health and fitness results, with devices such as activity monitors and heart-rate monitors. Now, there is increasing availability of health-related peripheral devices such as blood pressure monitors to track and upload information in real time via a wireless or wired connection to devices such as smartphones and tablets.”

Your Stories Of Being Sick Inside The U.S. Health Care System

Enlarge Brittney Lohmiller for NPR

Douglas Harlow Brown, 80, of East Lansing, Mich., watches birds inside a medical rehab facility.

Brittney Lohmiller for NPR

Douglas Harlow Brown, 80, of East Lansing, Mich., watches birds inside a medical rehab facility.

To get a feeling for what being sick in America is really like, and to help us understand the findings of our poll with the Robert Wood Johnson Foundation and the Harvard School of Public Health, NPR did a call-out on Facebook. We asked people to share their experiences of the health care system, and within 24 hours, we were flooded with close to 1,000 responses.

The stories, often lengthy and detailed, echoed what our poll found: Americans with recent firsthand experience of the U.S. medical system are more likely than the general public to say there are serious problems with the cost and quality of care.

From Oregon to Florida and Maine to Mississippi, Facebook respondents told wrenching tales of bankruptcies, missed diagnoses, medical errors, miscommunication and treatment that was delayed or foregone because of its cost.

 

Take Aimee Snyder, a 28-year-old graduate student at the University of Arizona. She got preoccupied with choosing her courses and missed the sign-up deadline for health insurance by one day. Then she started having leg pains and shortness of breath.

Enlarge David Sanders/For NPR

Aimee Snyder, 28, had a blood clot in her leg that could have killed her. She's fine now, but she's had to pay more than $15,000 in medical bills so far.

David Sanders/For NPR

Aimee Snyder, 28, had a blood clot in her leg that could have killed her. She's fine now, but she's had to pay more than $15,000 in medical bills so far.

"My leg swelled up to double the size and turned purple," Snyder says. But she didn't seek care because she couldn't imagine how she'd pay the emergency room bill. After hobbling around in pain for several days, she discovered she could get a discount on her hospital bill and went to the ER.

Doctors found an extensive blood clot in her leg, with pieces breaking off and going to her lungs. She could have died within hours. Luckily, she's fine, but she's had to pay more than $15,000 in bills so far, and she's had to borrow from her family and use student loan funds to pay them.

Enlarge Tom Smart/NPR

Andrew Dasenbrock, 32, was sent to two separate health care facilities owned by the same network and had to submit to, and be billed for, the same tests twice because of their inability to communicate.

Tom Smart/NPR

Andrew Dasenbrock, 32, was sent to two separate health care facilities owned by the same network and had to submit to, and be billed for, the same tests twice because of their inability to communicate.

The new poll finds that 43 percent of people with recent illness ended up with serious financial problems.

Sometimes, medical bills are higher than they need to be. Andrew Dasenbrock of Salt Lake City recently had to pay twice for much of his care. He's 32, a self-employed IT consultant who says he can't afford health insurance.

It started when he woke up one night with alarming stomach pain � "like shards of glass traveling through me," he says. Doctors at a nearby urgent care center ran a bunch of tests but couldn't figure out what was wrong, so they sent him to the hospital.

According to our poll,

Even though the hospital was part of the same system, the doctors there weren't alerted that Dasenbrock was coming and his records weren't transferred. So he had to fill out the same questionnaires and repeat all the same diagnostic tests, as he was doubled over in pain.

A CT scan showed a nonserious ailment that needed only simple treatment � lots of fluids � and Dasenbrock went home. But two days later he got two bills totaling thousands of dollars.

"I laid the two bills next to each other and it was literally word for word, letter for letter and line item by line item the same charges ... for all the tests I had gone through," Dasenbrock says. He ended up having to pay for the duplicate tests.

Just as in the poll, the cost of care was a big problem for many Facebook users who contacted NPR. And often they reported ruinous financial problems.

Marty Clear is one case. He's a 60-year-old freelance writer in Tampa who can't afford health insurance. "If I make $400 a week, it's a really good week," he says.

Enlarge Bill Serne for NPR

Marty Clear, 60, is a freelance writer based in Tampa, Fla., who has no health insurance. Last November, Clear went to an emergency room, and doctors discovered a cancerous tumor on his kidney. He's fine, but he says he'll never be able to pay off the resulting bills.

Bill Serne for NPR

Marty Clear, 60, is a freelance writer based in Tampa, Fla., who has no health insurance. Last November, Clear went to an emergency room, and doctors discovered a cancerous tumor on his kidney. He's fine, but he says he'll never be able to pay off the resulting bills.

He went to the emergency room for a problem and doctors found something unrelated: an enormous tumor on his kidney. It turned out to weigh 8 pounds.

"I was treated at one of the best cancer hospitals in the country, but I know I'll never have any money again," Clear laments. "I'm never going to be out of debt for this."

Clear has sold his car and he skips meals to save money. He feels he'll never be able to pay off medical bills, which may total $200,000. The worst part, he says, is the guilt.

"I feel awful every single day," he says. "You know, people saved my life. And more than that � people fed me and bathed me and changed my socks, you know? And they're not going to get paid � at least they're not going to get paid by me. And I'm going to be ashamed of that for the rest of my life."

There were hundreds of stories raising questions about the quality of care people got. Many were too complicated to recount briefly, and difficult to verify in any objective way. But the level of detail and thoughtfulness of many responses makes it clear things did not go the way they should.

A major theme was miscommunication among caregivers. Jacki Bronicki, a medical librarian at the University of Michigan, tells of the frustration she felt about the treatment received by her father, 80-year-old Douglas Harlow Brown, who has Parkinson's disease.

Enlarge Courtesy of Jacki Bronicki

Douglas Harlow Brown, 80, of East Lansing, Mich., with his daughter Jacki Bronicki. After Brown was hospitalized with broken ribs, Bronicki says, his doctors failed to communicate about his medication.

Courtesy of Jacki Bronicki

Douglas Harlow Brown, 80, of East Lansing, Mich., with his daughter Jacki Bronicki. After Brown was hospitalized with broken ribs, Bronicki says, his doctors failed to communicate about his medication.

Last year he fell and broke three ribs. He was admitted to the hospital, and his mental state began to deteriorate by the second day. "He wasn't even coherent by the third day," Bronicki says.

Brown, a retired engineer who taught physics, was mentally fine before the hospitalization, Bronicki says. So it wasn't normal for him to be so confused.

But she says the parade of doctors who saw him seemed to assume "that was his natural state, given his age and condition. We would have to convince each new doctor that saw him � tell the story of his Parkinson's, explain that this was not his normal, that he was normally functioning, talking, coherent."

Our poll found that among those who've been hospitalized in the past 12 months ...

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

Credit: Alyson Hurt/Nelson Hsu, NPR

A neurologist finally figured out what was wrong. Different doctors had prescribed different pain medications, and the drugs were interfering with Brown's Parkinson's medication. That caused his mental deterioration and made his limbs rigid.

After the medication was straightened out, Brown improved. But Bronicki and her sisters felt they had to maintain a constant vigil at his bedside to prevent another medication error.

And now Bronicki regrets that she ever took her father to the hospital in the first place. After all, there's no specific treatment for broken ribs, which must heal by themselves.

"He has a lot more dementia than he had a year before," she says. "He can't walk anymore. And I'm not sure if it would have normally progressed like this, or if we really sped it up."

Among many stories like this, there were some from people who think the quality of their care is fine.

Liz Gubernatis of Saint Joseph, Mo., says she's been "astonished at the supportive, cohesive care" she has gotten since she was diagnosed recently with diabetes.

"I've been scared, but educated," she writes, "cried, but consoled, and cheered on by a team of amazing doctors, nurses and patient-care folks. Being sick in America isn't all doom and gloom."

According to the new poll, one in four people with recent illness say the quality of care is not a problem for this country. That's not exactly a ringing endorsement.

And even though nearly half of poll respondents say they're very satisfied with the quality of care they get, that leaves lots of room for improvement.

If you want to dive deeper, here's a summary of the poll findings, plus the topline data and charts.

Health information laws made clear on new GWU website

WASHINGTON – A new website, which clarifies federal and state laws pertaining to health information, developed by researchers at The George Washington University's Hirsh Health Law and Policy Program, launched Wednesday.

The website, Health Information and the Law (HealthInfoLaw.org), serves as an online resource where organizations, consumers and healthcare providers alike can find a clear, comprehensible picture of current health information laws, policy changes and legislation.

[See also: RWJF launches new site with quality info on doctors, hospitals]

HealthInfoLaw.org, a Legal Barriers project funded by the Robert Wood Johnson Foundation, offers a lucid list and comparative analysis of regulations and laws relating to health information exchange, the shift to EMRs, confidentiality, HITECH, the ACA and HIPAA, to name a few.

“The laws are very opaque to a lot of people and difficult to navigate, and we wanted to create a resource that would translate laws themselves and complicated issues for people on the ground who are trying navigate them," says Lara Cartwright-Smith, co-director of the Legal Barriers project and assistant research professor in the GW Department of Health Policy.

The project has "a multi-aim," says Jane Hyatt Thorpe, also a co-director of the Legal Barriers project and associate research professor at the GW Department of Health Policy. "We’re hoping to help the activities going on at the local, regional and state level in terms of community organizations and other organizations working to transform care delivery.”

[See also: HIE on the upswing]

Cartwright-Smith adds, “We don’t want to limit the audience.” The audience may consist of “policymakers; it might be individual providers, consumers or organizations trying to implement health reforms and need to know the laws pertaining to them.”

Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy at GWU School of Public Health and Health Services explained in a news release why the website is so significant today:

"Health information law exists at the intersection of many crucial and related fields: law, healthcare, public health, market competition, consumer protection, information technology, and health insurance." she said. "A modest change in any of these fields can trigger a daunting set of issues and challenges. HealthInfoLaw.org offers keys to understanding the laws that govern health information and their implications for health care, consumer rights and population health." 

Doc community stalks Influenza online

CAMBRIDGE. MA – Sermo, Inc., an online physician community, is investigating the ability of 100,000 physicians to track and potentially prevent infectious diseases.

Participating physicians will use technology from Sermo called Sermo FluMonitor to collect and aggregate clinical observations across the country.

Cambridge, Mass.-based Sermo provides U.S. licensed physicians with a free memberships to its community. Adam Sharp, an emergency physician and chief medical officer of Sermo, says its membership is currently more than 100,000.

The Sermo FluMonitor will allow physicians to report geographically-based clinical observations in real time. 

“This endeavor has the potential to be an extremely useful resource in tracking disease and saving lives,” says Sharp. “Sermo’s unique online community already brings physicians together to report bedside data and exchange clinical insights. Until now, this type of tracking mechanism was simply not possible.”

Physicians can monetize their Sermo experience by providing their expertise as a resource for financial services firms, healthcare institutions and government agencies.

The 120 physicians who are participating in the FluMonitor tracking will be paid a nominal fee for their participation, says Sharp.

These Health Law Bets Are No Figure Of Speech

Images_of_Money/Flickr

How much would you wager on the constitutionality of the sweeping federal health law?

The stakes are high in the U.S. Supreme Court's consideration of the 2010 health law, as countless commentators have observed. In some circles, however, the gambling metaphor has been pushed to its logical conclusion.

Bernstein Research stock analyst Ana Gupte laid 50 percent odds recently on chances that the court will strike down the Affordable Care Act's individual mandate along with strict coverage requirements. Over at Intrade, a "prediction market" for current events, the betting Tuesday morning gave chances of about 58 percent that the court will disallow the mandate, which requires people to obtain health coverage or pay a fine.

On the FantasySCOTUS Web site, 54 percent of an audience composed largely of law students and clerks predicted the mandate will be thrown out.

Declaring Vegas-style odds on court rulings isn't the norm for Wall Street analysts such as Gupte. But the Supreme Court decision, expected to be announced at the end of June, is critical for the health-insurance stocks she covers. She puts low probabilities � 15 percent in each case � on chances that the court will uphold the entire law or strike the whole thing down.

 

Predictions about the act's ability to survive whole grew more pessimistic after March's oral arguments from lawyers on each side. Many analysts believed questions from key justices such as Anthony Kennedy and Chief Justice John Roberts betrayed an inclination against the mandate.

At Intrade, bettors raised the odds of the mandate being ruled unconstitutional from less than 40 percent before the arguments to more than 60 percent afterwards. In recent days, however, they've backed off. Intrade deals pay off at $10, and at this morning's prices you could buy a contract on a negative Supreme Court decision for the mandate for $5.76. Buying a chance to win $10 for $5.76 amounts to laying 58 percent odds on your bet.

At FantasySCOTUS no money changes hands. Winners get "bragging rights," said Corey Carpenter, director of analysis for the Harlan Institute, an educational nonprofit affiliated with the site. Predictions on FantasySCOTUS of the mandate's demise saw little increase following the arguments, perhaps because the site's audience pays more attention to legal logic than media coverage, Carpenter said.

The biggest bets on the Supreme Court decision come in the stock market. Insurance companies gained billions of dollars in market value after the oral arguments on expectations of a favorable outcome for the industry. But their prices have drifted back down.

Insurers worry that the court could block the mandate but uphold a separate requirement that they accept all members at a uniform price regardless of pre-existing illnesses. Such an outcome would deprive the companies of billions in new revenue while at the same time assigning them expensive liabilities.

After analyzing the oral arguments, however, Gupte said there's a 50 percent chance that the court will toss the coverage requirements and the mandate at the same time. That's the "most likely" outcome and would raise insurer profits by 7 percent on average, she wrote. Partly as a result, she's bullish on several insurer stocks, including UnitedHealth Group, Cigna and Aetna.

Not all oddsmakers believed the oral arguments occasioned a new betting line. Andrew Cohen, a CBS News legal analyst and contributing editor for The Atlantic, promised to update his odds, set last fall on The Atlantic's site, on how individual justices would vote.

"Having picked [the] wrong horse in last five Kentucky Derbys," he said viaTwitter, "I decided not to chance it."

Poll: Americans Show Support For Compensation Of Organ Donors

AP/Courtesy Giarratano Family

All in the family: Nino Giarratano (left), the head baseball coach at the University of San Francisco, joins hands with his father, Mickey Giarratano, after the transplant of a kidney from son to father at Porter Adventist Hospital in Denver last year.

The shortage of organs for transplant continues to grow, despite years of work to get more donors on board.

Facebook jumped in this month by making organ-donation status something you could add to your profile. And the social media giant made it easy to connect with a registry to sign up as a donor.

Federal law bans payments for organs. But given the need, we wondered what Americans thought about compensation for three kinds of donations that can be made while people are alive: kidneys, bone marrow and a portion of liver big enough to help someone whose liver is failing.

So we asked 3,000 adults across the country as part of the NPR-Thomson Reuters Health Poll, and here's what they told us.

 

If compensation took the form of credits for health care needs, about 60 percent of Americans would support it. Tax credits and tuition reimbursement were viewed favorably by 46 percent and 42 percent, respectively. Cash for organs was seen as OK by 41 percent of respondents.

Among people who said some form of compensation was acceptable, 72 percent said it should come from health insurers, followed by private charities at 62 percent and the federal government at 44 percent.

For all forms of compensation, rates of support tended to fall among older respondents.

There's been longstanding resistance to compensating donors financially in this country. There are concerns about exploitation and also worries that even small amounts of compensation would undercut a system that depends on altruism.

But it may be time to reconsider, Dr. Stuart Youngner, a bioethicist at Case Western Reserve University's med school, told Shots. "I think the market has become such an important guiding principle in so many areas of lives, including health care, that it becomes harder to say why shouldn't a person who donates organs make some money too," he said. "Altruism is very, very important, but in this case the lives of people are very, very important."

After reviewing the results of our poll, Youngner said it would have been stronger if we had asked people whether or not they were registered as organ donors and then investigated how financial incentives might have influenced their decisions.

As it was, we asked about three different donations, and the results came in about the same. About 87 percent of respondents in favor of compensation though it was OK for kidneys. About 85 percent felt that way about livers, and 83 percent for bone marrow.

It seems worth noting that the 9th U.S. Circuit Court of Appeals in March affirmed an earlier decision that compensating people for marrow cells drawn from their blood wouldn't run afoul of the federal law banning payment for organ donations.

OK, so let's say donors could be compensated. How much should it be? Thirty-seven percent of respondents said it should be less than $10,000, and 27 percent said it should be more than $10,000 and less than $25,000.

Finally, we asked if there is a difference between compensating people for organ donations compared with buying them outright. Around 40 percent don't see one. Sixty percent of people said compensation isn't the same thing as a purchase.

"It's clear they're saying there is a difference," Dr. Ray Fabius, chief medical officer for Thomson Reuters' health unit, told Shots. And, overall, the results show that a majority believes "any living donor should be recognized, and it should be handled by insurance companies," he said.

The telephone poll across the country was conducted during the first half of February. The margin for error is plus or minus 1.8 percentage points. Click here to read the questions and complete results. You can find the previous polls here, or by clicking on the NPR-Thomson Reuters Health Poll tag below.

Cost Of Cancer Pills Can Be Hard For Medicare Patients To Swallow

iStockphoto.com

Taking a pill for cancer can cost patients more than getting chemotherapy by IV.

If you've got cancer, chances are you'd rather take a pill to fight the cancer cells than sit for hours hooked up to an IV line as the chemotherapy drips slowly into you.

The difficulty is, many of the new cancer pills, which often target cancer cells for destruction but leave healthy cells intact, are pricey, costing tens of thousands of dollars for a course of treatment. And how some insurers pay for treatments means that pills can wind up costing a patient more than chemotherapy given by IV.

Nineteen states and the District of Columbia now require private health plans to cover cancer-fighting pills, if they're available, to the same degree and without charging patients more than they would for traditional intravenous infusion therapy, according to the National Patient Advocate Foundation.

So, for example, a health plan that has a $1,500 limit on out-of-pocket spending for outpatient services like IV chemotherapy can't charge more than that annually for their treatment pills.

But Medicare beneficiaries don't benefit from these laws.

 

They're tied to whatever coverage they have through their Medicare prescription drug plan, which may or may not provide affordable coverage for their anti-cancer pills, if they're covered at all.

High drug costs are a problem for all patients, but those on fixed incomes can be hit especially hard.

One study by researchers at Avalere Health found that about 46 percent of Medicare beneficiaries faced more than $500 in cost sharing for their initial anti-cancer drug prescription. Sixteen percent of Medicare beneficiaries didn't fill their initial prescriptions for anti-cancer pills, compared with 9 percent of patients with private insurance.

Under the Medicare Part D drug benefit, beneficiaries are responsible for paying 100 percent of their prescription drug costs from the time they reach $2,930 in total drug spending until they hit the $4,700 maximum out-of-pocket limit for the year. Once they're through that so-called doughnut hole in coverage, they're usually responsible for 5 percent of their drug costs.

A new lung cancer drug might cost $10,000 a month. "It's a real problem for people on Social Security who don't have any other income," says Len Lichtenfeld, deputy medical director for the American Cancer Society.

New lead poisoning guidelines: What parents should know

The Centers for Disease Control and Prevention's decision to redefine the "action level" for lead exposure in kids has renewed some parents' concerns about the best ways to protect their children.

Children will now be considered at risk � and qualify for careful medical monitoring � if they have more than 5 micrograms per deciliter of lead in their blood. That's half the previous threshold.

Public health leaders have applauded the move, noting that the change will allow governments to take broader action to protect children.

Yet parents may feel more confused about when and how to test their children and homes for lead. Even some experts disagree about the best approach.

In its statement on lead poisoning, the American Academy of Pediatrics says, "Most U.S. children are at sufficient risk that they should have their blood lead concentration measured at least once."

Some health departments issue recommendations about how often to test children for lead, based on test results in the area or particular risks, the group says.

Without that kind of specific guidance, however, kids should generally be tested at age 1 and again at 2, when blood lead concentrations peak, it says.

Philip Landrigan, a leading authority on lead poisoning, agrees that all children should be tested.

While most American children are still well below the new action level, with average blood lead levels of 1.8 micrograms, Landrigan notes there is no safe amount of lead, which can cause brain damage and lower IQ.

"I recommend all children be tested, because you never know," says Landrigan, director of the children's Environmental Health Center at the Mount Sinai School of Medicine in New York.

Many insurance plans don't pay for blood lead testing, Landrigan says. And not all pediatricians offer it. Some refer patients to private labs or the health department.

Blood testing is especially important for poor children, although few of the highest-risk kids are ever tested, according to the pediatrics group.

Most lead poisoning cases occur in substandard housing, where window frames are still coated with lead-based paint, which was banned in 1978. About 25% of U.S. kids fall into this category, the group says.

Yet middle-class neighborhoods aren't immune. Tap water in many neighborhoods in the Washington, D.C., area exceeded safety standards for lead in 2003 and 2004, after lead leached from water pipes.

Test the house, not the child

Jerome Paulson, chairman of the pediatrics group's council on environmental health, agrees that families in homes built before 1950 should be "vigilant" about monitoring for lead. And parents should remember that children can also be exposed outside the home, such as at the homes of relatives or a regular babysitter.

But he says some kids can probably skip the needle stick.

"Kids living in homes built after 1978 don't need to be screened," says Paulson, a pediatrician at children's National Medical Center in Washington. "If the health department is saying, 'We don't see kids in this five-block area or this ZIP code with elevated lead levels,' then we don't need to screen kids in that ZIP code.�

"We really need to focus on preventing the kids from coming into contact with lead," Paulson says. "By testing kids, you're sort of identifying the kids after the fact. It really does make more sense to check the home than to check the child. What counts is the home."

Yet testing the home isn't always simple.

While home lead test kits are popular � sold online and at many hardware stores � they're often not reliable, says Scott Wolfson, spokesman for the Consumer Product Safety Commission. It tested home lead test kits in 2007 and found many produced false results, falsely finding lead in some homes and failing to find lead in others where it was present. The agency hasn't tested newer kits.

Professional contractors can get more accurate lead-testing results, but at a higher price.

The most vulnerable

Landrigan notes that testing allows people to identify sources of lead exposure and remove them.

Most often, testing doesn't lead to treatment, Landrigan says. Because treating children for lead poisoning carries its own serious risks, it is performed only when blood lead levels are extremely high. Most children with blood lead levels above the new threshold will be monitored, rather than treated with medication. Once the lead source is removed, children's blood lead levels typically return to a more normal range within weeks, Landrigan says.

About 90% of lead poisoning comes from lead-based paint in windows, Landrigan says. About 10% comes from home renovations, which can pose a particular risk to untrained do-it-yourselfers trying to fix up older houses, he says.

Sometimes, youngsters chew on peeling paint chips.

More often, children take in lead through paint dust, sometimes in microscopic particles, created when windows are closed or doors are slammed, Paulson says.

Children also can be exposed to lead by playing in the dirt, which may contain lead from car exhaust, factory smoke or even paint dust, if the soil is within a few feet of the house, Paulson says.

Most children exposed to lead are poor.

About 80% of kids with high lead exposures are eligible for Medicaid, according to the pediatrics group, which recommends lead tests for all children eligible for Medicaid. Few get them.

Babies and toddlers are exposed to more lead than adults because they spend more time crawling and playing on the floor, transferring dust to their mouths from everything they touch, Paulson says.

Babies' developing brains are especially vulnerable to lead's toxic effects, which can damage the brain and kidneys and, at higher doses, cause behavioral problems and rob kids of IQ points, Paulson says.

Blood lead levels tend to peak at around age 2, according to the pediatrics group's policy statement on lead exposure. Lead levels tend to decline after this age, as children's growing body size dilutes the concentration of lead in their blood.

School-age children, teenagers and adults, however, face little risk, Paulson says.

And doctors note that children today have dramatically lower blood lead levels than a generation ago.

Before 1970, health officials took action only if children had blood lead levels above 60, Landrigan says.

Efforts spread to cut family planning services

AUSTIN�Emily Howell's frequent trips to the Planned Parenthood clinic on East Seventh Street here have less to do with preventing unwanted pregnancies and more about keeping cancer from creeping back into her body.

Eleven years ago, Howell beat a malignant tumor in her stomach. Today, she visits the clinic for free cervical exams, breast screenings, STD testing and birth control pills � none of which she could afford.

"It's a huge burden off me," says Howell, 30, an environmental sciences student at Austin Community College. "Pregnancy and cervical cancer are the last things I need to worry about."

Those services, however, may soon vanish in an ongoing struggle between conservative Texas lawmakers and women's groups here to curtail funding for Planned Parenthood and other clinics affiliated with abortion providers.

Last year, the Republican-controlled Legislature slashed $74 million from the Family Planning Program, resulting in the closings of 155 clinics across the state. The clinics offered services such as cervical exams, breast exams and free birth control but, under state law, could not provide abortions.

In another move, lawmakers passed a law essentially shutting out Planned Parenthood from funding through the state's Medicaid Women's Health Program. Together, the two moves would cut services to more than 300,000 low-income women annually across Texas, according to the Texas Legislative Budget Board.

On Monday, a U.S. District judge ruled that Texas cannot exclude Planned Parenthood from the Women's Health Program. The ruling is a temporary injunction, and a final ruling is expected later.

"The ruling today is great news for Texas women," says Sarah Wheat, interim chief executive officer of Planned Parenthood of the Texas Capital Region. "It's a clear message that politics doesn't belong in women's health care."

Gov. Rick Perry's administration, which supports the cuts, appealed the ruling. "Texas has a long history of protecting life, and we are confident in Attorney General (Greg) Abbott's appeal to defend the will of Texans and our state law, which prohibits taxpayer funds from supporting abortion providers and affiliates in the Women's Health Program," Catherine Frazier, the Republican governor's press secretary, said in a statement.

By Joel Salcido, for USA TODAY

Tewabech Aychiluhem, a clinical assistant, prepares a Depo-Provera injection, a long-term hormonal contraceptive.

'Death by a thousand cuts'

Supporters of the cuts say they are part of a belt-tightening effort to deflate the state's $27 billion deficit � with a special focus on cutting funds for abortion-related groups.

"We went after not just the abortionists but those who did the health checks, screenings and would refer people to the abortionists," says state Rep. Wayne Christian, a Republican, who voted for the cuts. "Citizens in Texas do not want to support abortions with their tax dollars."

Women's rights advocates decry the cuts as an attack on women's reproductive rights. The moves will lead to more unwanted pregnancies and potentially more abortions, especially in a state that ranks third in the USA in teen pregnancies and has the highest percentage of uninsured residents in the country, says Regina Rogoff, chief executive officer of People's Community Clinic, which lost $526,000 of its operating budget to the cuts. "It's a concerted effort to set back the rights of women," she says. "It's death by a thousand cuts."

By Joel Salcido, for USA TODAY

Medical assistant Letty Montelongo performs several pregnancy tests.

The Texas cuts are the latest in a nationwide effort by states to defund family planning services, says Elizabeth Nash of the Guttmacher Institute, a New York-based policy and research center that advocates reproductive health rights for women.

Last year, lawmakers across the USA introduced more than 1,100 reproductive-health and rights-related provisions, up from 950 the year before, Nash says. "We have never seen so many attacks on family planning as we did last year," she says.

Recent examples:

�New Hampshire lawmakers last year voted to cut more than $1 million from the state family planning budget, says Jennifer Frizzell, senior policy adviser with the Planned Parenthood of Northern New England.

�Two Tennessee Planned Parenthood groups filed a federal lawsuit against the state in February for redirecting more than $150,000 in federal grant money away from the non-profit clinics, according to court documents.

�Arizona lawmakers are considering a bill that would prohibit the state from contracting with any group that performs abortion or runs a facility where abortions are performed, according to the Center for Arizona Policy.

Affects low-income women

In Texas, one of the biggest casualties of the cuts was Planned Parenthood, which had to close 11 of its 76 clinics across the state, mostly in poorer areas, such as the Rio Grande Valley to the south, Wheat says. None of the closed clinics performed abortions.

Clinics in Austin and other large cities were able to stay open through last-minute fundraising, she says. But without new funding streams, the future of the clinics is uncertain. "We're literally in brand-new, uncharted waters," Wheat says.

Community Action Network, a group that serves low-income women in rural areas, had to close two of its four clinics in central Texas � an abrupt loss of services low-income women have relied on for four decades, executive director Carole Belver says.

"It's taken 45 years to build up the infrastructure we have in the state of Texas to provide health care services for low-income women," Belver says. "This is going to unravel all of it."

USDA unveils rules to speed tracking of tainted meat

The government is unveiling new provisions today to keep potentially deadly E. coli from infiltrating summer barbecues and other outings when folks sink their teeth into meat.

The updated rules by the U.S. Department of Agriculture allow inspectors to begin looking for meat contaminated with E. coli O157:H7 as soon as early testing shows a potential problem. The policy is designed to speed up the USDA's ability to track down contaminated hamburger and ground beef � and contain them.

Under the new policy, the USDA will act quicker after the first signs of a potentially deadly spread. The agency previously did not begin investigating possible contaminated meat until several tests were completed, often taking days.

The policy change "buys us 24 to 48 hours in terms of finding the sources," says USDA Under Secretary for Food Safety Elisabeth Hagen.

E. coli O157:H7 is the most commonly identified strain of E. coli. It also causes the most severe cases of illness, says Caroline Smith DeWaal, food safety director at The Center For Science in the Public Interest, a consumer advocacy group.

The ability to quickly track back to the source of contamination "is essential for minimizing the number of illnesses linked to an E. coli outbreak," DeWaal said.

Most people recover from an E. coli infection within five to seven days, according to the Centers for Disease Control and Prevention. But there are instances in which exposure can be deadly. For instance, in 1993 four children died and hundreds of people got ill after eating E.-coli-tainted beef at Jack in the Box restaurants.

The new provisions are part of the USDA's emphasis on "using the data we and industry have in order to get in front of the problems that can harm consumers," Hagen said. "If we get a red flag from a test result, there are all kind of opportunities for us to help prevent harm."

Responding more swiftly to potentially contaminated meat is one part of new approaches by the USDA. Other efforts include an early reporting system that requires companies to notify the USDA's within 24 hours if potentially harmful meat or poultry has been shipped, and adding six new E. coli strains to a government watch list.

The CDC says the six strains sickened 451 people in 2010, hospitalized 69 and killed one.

Biopharmaceutical company expected to merge with MyMedicalRecords.com

SAN DIEGO – Biopharmaceutical company Favrille, Inc. and MyMedicalRecords.com say their merger is now expected to close in the new year.

The two companies signed a definitive merger agreement in November.

"As we had announced earlier this month, two significant conditions for closing the merger, MMR's stockholder vote and settlement with creditors holding more than 85 percent of the dollar value of all of Favrille's known creditor claims, have been accomplished," said John P. Longenecker, president and CEO of Favrille. "We are now pleased to announce that a third significant condition, completion of the audit of MMR's financial statements for the years ended 2005 through 2007, is well underway, with completion expected in early January. We anticipate closing the transaction in January 2009."

Favrille, a San Diego-based company, develops and commercializes patient-specific immunotherapies for the treatment of cancer and other diseases of the immune system.

MMR, headquartered in Los Angeles, offers a consumer-centric personal health record that is available direct to consumers on a free trial basis through its Web site.

"Health information technology and the management of PHRs are at a revolutionary turning point," said Robert H. Lorsch, CEO and president of MyMedicalRecords.com. "Giving consumers the ability to maintain their medical records securely online leads to higher quality care at reduced costs. MMR's proprietary technologies enable consumers and healthcare professionals to create and access a PHR anywhere in the world. We believe this transaction with Favrille will give MMR broader access to the investment community, which is essential to our sales and marketing strategy and continued expansion of our customer base."

The merged company will be focused on continuing to build and develop the MMR brand as the premier online PHR for consumers and healthcare professionals, officials said.

AHRQ: Docs using e-prescribing can improve drug costs for patients

ROCKVILLE, MD – A new study finds that physicians who use an e-prescribing system with formulary decision support can boost drug cost savings.

The report was funded by the Department of Health and Human Services' Agency for Healthcare Research and Quality.

According to the study, physicians can save $845,000 per 100,000 patients per year and possibly more system-wide by using a system that allows them to select lower cost or generic medications.

The study's authors believe this will have important financial implications as e-prescribing systems become more widely available and easier to use.

Complete use of an e-prescribing system with formulary decision support could reduce prescription drug spending by up to $3.9 million per 100,000 patients per year, the authors found.

Many insurers use lists of approved prescription drugs known as formularies. Under these arrangements patients are often charged the lowest co-payment for generic medications (tier 1), a higher sum for preferred brand-name drugs (tier 2) or the highest amount for non preferred brand-name drugs (tier 3).

A challenge to physicians' use of the tiered system is the lack of current data on insurers' prescription drug formularies at the time of prescribing because the information changes so frequently.

Better Medicare Products and Services at Lower Cost

For years, spiraling Medicare costs have threatened Medicare beneficiaries and their providers.� And turning to the competitive marketplace seemed to offer little respite. Until now.

On January 1, 2011, the first phase of the competitive bidding program was successfully implemented for nine product categories in nine areas of the country. This means that suppliers of certain medical supplies, such as oxygen equipment, walkers, and some types of power wheelchairs compete among each other to determine the price Medicare will pay for their services to seniors. This in turn sets new, lower payment rates for these pieces of medical equipment and supplies.

Building on that success, the Centers for Medicare & Medicaid Services (CMS) today announced that they are expanding the competitive bidding program to additional areas of the country and also expanding the list of items included in the first round of bidding. All of the product categories selected for Round Two are high cost, high volume items with large savings potential.

This program reduces Medicare spending and beneficiary cost-sharing, and it forces winners of these contracts to compete on quality and customer service. Ultimately, beneficiaries get better products and services, while paying less out of their own pocket. In fact, the Medicare actuary estimates that this program will save more than $28 billion over the first ten years of the program. The $28 billion savings comes from a combination of savings of more than $17 billion in Medicare expenditures, and savings of over $11 billion for beneficiaries as a result of lower coinsurance payments and the downward effect on monthly premium payments. .

For more information about the Medicare DMEPOS Competitive Bidding Program, please visit CMS� Newsroom or go to �www.medicare.gov/supplier.

Epic Systems wins contract at University Hospital in Dubai

VERONA, WI – Epic Systems, a privately held software company based in Verona, Wis., will roll out clinical technology at the University Hospital at the Mohammed Bin Rashid Al Maktoum Academic Medical Center of Dubai Healthcare City.

Dubai Healthcare City officials announced a seven-year contract with Epic.

The partnership breaks new ground for healthcare in the Middle East, they said, and positions the University Hospital as a leader and innovator of clinical quality through utilizing state-of-the-art healthcare information systems.

The EpicCare system will allow clinicians and patients at the University Hospital to view, share, and act on the latest patient information and clinical intelligence available worldwide.

The University Hospital's healthcare will incorporate the latest medical research, technology and innovation, integrated with Harvard Medical School Dubai Center Institute for Postgraduate Education and Research, the Al Maktoum Harvard Medical Library, and Dubai Healthcare City's own electronic health record.

"The EpicCare Healthcare Information System will help us increase our operational efficiencies, leading to enhanced patient care and satisfaction," said Jim Kingsbury, chief executive officer of University Hospital.

The University Hospital's partnership with Epic Systems covers all aspects of its clinical offerings as part of a comprehensive approach towards building one of the most technologically advanced hospitals in the region, Kingsbury said.

In addition, the integration with Dubai Healthcare City's electronic health record network will allow patient-centric records to be accessed wherever the patient or other healthcare providers require up-to-date health information, including from their own homes.

"Epic Systems and University Hospital share a vision for improving health information systems through an integrated approach," said Judy Faulkner, chief executive officer of Epic Systems. "Our clinical and administrative software solutions offer the flexibility to integrate with clients' existing applications to positively impact the quality of patient care."

The selection of Epic Systems for University Hospital is the result of an 11-month evaluation period, examining almost two dozen worldwide providers of healthcare systems, officials said.

HIMSS to hold webinar on Supreme Court and health IT

CHICAGO – The Healthcare Information and Management Systems Society (HIMSS) will hold a webinar April 11 to discuss how the Supreme Court's ruling on the Affordable Care Act (ACA) will affect health IT.

How the court decides on the ACA and its individual mandate could have a dramatic impact on healthcare in America for years to come, HIMSS officials said.

While the main issue in the ACA case is the individual mandate provision or “shared responsibility requirement,” the law includes a number of provisions dependent on, or related to, health IT – including  electronic health information exchange (HIE); administrative simplification changes and new methods to reimburse expenses based on quality of care such as accountable care organization demonstration projects (ACOs), HIMSS officials added.

Particularly, how the Supreme Court eventually rules on the ACA will determine the near-term future of ACOs and Medicare payment reform, they said.

HIMSS officials said the webinar is expected to: 

define the four major issues before the Supreme Court and how they could be addressed by the justices;explore how the court’s ruling on the several major issues could invalidate other important provisions of the ACA;discuss the short and long term implications of the Supreme Court’s decisions for healthcare reform and health information technology.

The webinar, to be held this Wednesday, April 11, at 1 p.m. ET and is free for HIMSS members ($79 for non-members).

See more information on registration for the seminar on HIMSS' website here.

Follow Diana Manos on Twitter @DManos_IT_News

Sharing Your Prevention Tips

Julia Eisman, HHS New Media Communications Director

Earlier this month, we announced that June is �Prevention and Wellness Month� � a time for us to focus on the steps that we as individuals, and communities, can take to play a more active role in our health and wellness. We recognize that there are a lot of good ideas out there, and there�s a good chance that you have some prevention tips that others may find helpful. �

With this in mind, we asked you to share some of the ways that you proactively stay healthy � by posting your ideas on our Facebook page and twitter accounts. Below are some of the comments you shared with us, that we want to share with others:

Kim says:
I hike, eat well, do yoga and lift weights. I feel that all of these activities are preventive measures.

Roberto says:
Periodic� check-ups are a great way to stay on top of your health.

Sharon� D. says:
Keep my appointments and take my medication.

The American Heart Association says:
We stay heart-healthy by eating right and exercising.

Sharon E. says:
I am so glad to see wellness promoted. That is how we will cut healthcare costs.

Boma says:
A good way to stay healthy is by constantly washing our hands with soap and water to prevent the H1N1 virus.

Jason says:
It�s time we focused on the HEALTH in Health Care!

We hope you continue to give us feedback, and that you keep sharing your great prevention tips!

Arkansas judge fines J&J $1.1B in Risperdal case

LITTLE ROCK, Arkansas�An Arkansas judge on Wednesday fined Johnson & Johnson and a subsidiary more than $1.1 billion after a jury found that the companies downplayed and hid risks associated with taking the antipsychotic drug Risperdal.

Judge Tim Fox determined that Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals Inc., committed nearly 240,000 violations of the state's Medicaid fraud law � or one for each Risperdal prescription issued to state Medicaid patients over a 3�-year period. Each violation carried a $5,000 fine, the state's mandatory minimum amount, bringing the total to more than $1.1 billion.

Fox issued an additional $11 million fine for more than 4,500 violations under the state's deceptive practices act, but he rejected the state's request to levy fines in excess of the $5,000 minimum for the Medicaid violations.

Attorneys for the state declined to immediately comment about the huge award after the hearing.

Janssen issued a statement in which it said, "We are disappointed with the judge's decision on penalties. If our motion for a new trial is denied, we will appeal."

Janssen attorney Ed Posner argued during Wednesday's penalty hearing that there was no evidence that harm had been done and that the penalties were inappropriate.

Arkansas was one of several states to sue over Risperdol. A South Caroline judge upheld a $327 million civil penalty against the J&J and Janssen in December. Meanwhile, Texas reached a $158 million settlement with the companies in January in which the company didn't admit fault.

Shares of New Brunswick, New Jersey-based J&J were trading after the ruling at $64.04, down 16 cents per share.

Jurors in Arkansas were not told about the financial stakes during 10 days of testimony, beyond that Janssen could have seen a $200 million swing in its revenues if it issued alarming warnings that the drug could cause weight gain, diabetes and other health effects. If upheld, the award would go toward the state's Medicaid fund, which is facing a projected $400 million deficit next year.

Risperdal, introduced in 1994, is a "second-generation" antipsychotic drug that earned Johnson & Johnson billions of dollars in sales before generic versions became available several years ago. It is used to treat schizophrenia, bipolar disorder and irritability in autism patients. Risperdal and similar antipsychotic drugs have been linked to increased risk of strokes and death in elderly dementia patients, seizures, weight gain and diabetes.

The 12-person jury deliberated for three hours Tuesday before deciding in favor of the state.

Arkansas Attorney General Dustin McDaniel said Tuesday he pursued the case to protect consumers from "fraud and deceptive trade practices."

Janssen continued to maintain after the verdict that it did not break the law, pointing out that the package insert included with the medication was approved by the U.S. Food and Drug Administration.

Introducing MyCare

Every day, we hear stories of hard-working people struggling with the old health care system, like being denied care when they need it most or making choices between buying groceries and filling their prescription drugs. The good news is that things are changing because of the health care law, the Affordable Care Act.

For Steven, the law helped him get coverage under his parents� health plan, which helped him fight cancer and finish college. And it gave Steven�s mom greater peace of mind that her son was getting the care he needed to be healthy and live the life of an active 23 year-old. Helen, a Senior in the �donut hole� coverage gap, got help with her prescription drug costs and can now get preventive health screenings without breaking the bank.

These are just a few examples of how everyday Americans are no longer at the mercy of insurance companies; these are our friends and neighbors. Thanks to �Steven-Care,� many young adults can get covered under their parents� health plans, and thanks to �Helen-Care,� Seniors are getting help paying for prescription drugs.

To help explain what different parts of the health law mean for people, like Steven and Helen, we are launching �MyCare� � featuring new videos about people from across the country who have been affected by the law.

�

You can find the videos at Healthcare.gov/mycare.

After watching each video, we encourage you to share your story � in your own words or images � about how parts of the law may have helped you. Post your story on twitter with the hashtag #MyCare, or share your story at Facebook.com/HealthCareGov.

Feel free to get creative, and share stories, photos, or even videos.

The health care law is about people like Steven and Helen. It is about your care, and it is about my care.

See all MyCare stories ?

Medicare Open Enrollment: Better Choices, Sooner

Every year, people with Medicare get to explore new choices and pick the plans that work best for them. This year, this Open Enrollment period is starting early � on October 15 � and ending sooner � December 7.

As health plans start their marketing and advertising activities in just a few weeks, we want people to know that the Medicare program is strong and, in 2012, they have a broad array of choices. And, there are lots of new benefits thanks to the Affordable Care Act.

Every person with Medicare will have to choose a �Part D� plan to help them pay for prescription drugs. And people who have chosen to enroll in a �Part C� Medicare Advantage plan for their basic health care services have the option of staying in that plan, choosing a different plan, or going back to the Original Medicare program. These are important choices that should be made with care.

The good news is we have strengthened consumer protections and improved plan choices. We�re making it simpler for people to choose a new health or drug plan by reducing the number of duplicate plans. We�ve also worked with plans to reduce cost sharing on important benefits like inpatient hospitalization and mental health services.

And, thanks to our enhanced bargaining power we can report that average premiums for a Part D plan will be the same in 2012 as in 2011. The average premium for Part C plans is going down by 4 percent. That�s great news for people on Medicare who have a fixed income.

As with last year, people with Medicare will continue to have a variety of Medicare Advantage plan choices. Consumers in every part of the country will have a wide variety of Part D plan choices in 2012, including many plans with zero deductibles and plans with some form of generic gap coverage.

People with Medicare are also enjoying important new benefits. Every person is entitled to an Annual Wellness Visit with their doctor so that they can discuss their health and their health care needs. Prevention services like mammograms and other cancer screenings are now available with no cost-sharing. And people who reach the donut hole in their drug costs will get a 50% discount on covered brand name drugs and a 14 percent discount on generics. That puts money back in your pockets.

More good news for consumers is the fact that we�ll be closely monitoring marketplace performance to protect people from misleading information or prohibited tactics by a small minority of unscrupulous plans. Medicare plans are on notice: we�ll move quickly to take action against plans found to be violating marketing rules.

In short, there�ll be a wide range of health and drug plan options available across the country, including Original Medicare. People can turn to www.medicare.gov, call the 1-800-MEDICARE hotline, or consult with a local State Health Insurance Assistance Program (SHIP) for help. We want to make sure people can identify and enroll in the coverage option that suits their needs in 2012.

Lab staff shortages call for better point-of-care diagnostics

LONDON – With a deficit in laboratory workers looming in many countries, point-of-care diagnostics are poised to help alleviate the need for centralized lab testing, says a new report by GlobalData, medical intelligence company.

The study finds that growth in the point-of-care market will be driven by future shortages of medical laboratory personnel, elderly patients’ preference for home monitoring and government initiatives aimed at increasing the adoption of point-of-care testing to cut costs.

The growing elderly population in the United States and elsewhere has increased the need for laboratory services, as elderly individuals are at higher risk of suffering from health problems, GlobalData officials note. This has led to an increase in the demand for medical and clinical laboratory professionals, and according to the Bureau of Labor Statistics, the employment of clinical laboratory workers in the U.S. is expected to grow from 328,100 in 2008 to 373,600 by 2018.

It is predicted that qualified personnel will not be able to meet surging demand due to declining numbers of accredited medical technology programs and increasing numbers of laboratory workers due to retire over the next decade, the study shows. The U.S. will therefore face a drought of qualified staff to man clinical laboratories, threatening patient testing demands and posing a problem for patient welfare. To overcome this concern, the industry may consider the simplification and automation of routine testing procedures to allow patients and physicians to perform tests themselves.

The U.S. is the largest market for point-of-care diagnostics, accounting for 42 percent of the global market during 2011. Growth in this market will be fueled by a strong demand for cardiac markers and coagulation point-of-care diagnostic products, and the launch of compact and small size products offering improved patient comfort and convenience, according to the report, which also notes that significant investments in research and development in the U.S., directed at molecular diagnostics, are also expected to encourage growth in the market.

In addition, with significant investment in electronic medical records by the U.S. government, the study says, the integration of results from point-of-care diagnostics will further enhance flexible patient care.

The global point-of-care diagnostics market was valued at $4.3 billion in 2011 and is forecast to reach $7 billion by 2018, growing at a compound annual growth rate (CAGR) of 7 percent during 2011-2018. The U.S. point-of-care diagnostics alone was valued at $1.8 billion in 2011, and is expected to reach a value of $3 billion by 2018, demonstrating a CAGR of 8 percent.

Read more about the report here. 

Prevention Just Makes Sense

�Prevention� is a word we use a lot in health care � June is �National Prevention and Wellness Month� � but I want to take a minute to think about what it really means.

Intuitively, prevention makes sense: as the saying goes, you can either pay now or you can pay later. But oddly enough, our health care system often doesn�t reflect this fundamental mindset. Most health care focuses on treating disease. Prevention, on the other hand, focuses on health.

Preventive care is also patient-centered care, as people become active participants in maintaining their health and get services customized for their individual needs and preferences.

We know that prevention works. The Affordable Care Act provides new ways to help patients stay healthy and makes access to preventive services easier.

Today, the Centers for Medicare and Medicaid Services (CMS) released a new report showing that more than 5 million Americans with traditional Medicare, or nearly one in six people with Medicare, took advantage of one or more of the recommended preventive benefits now available for free thanks to the Affordable Care Act � most prominently, mammograms, bone density screenings, and screenings for prostate cancer.

These are just a few of the preventive services available to people on Medicare. Earlier this year, Medicare eliminated the Part B deductible and copayments for a host of preventive services, including bone mass measurement, some cancer screenings, diabetes and cholesterol tests, and flu, pneumonia, and hepatitis B shots.

We�ve also eliminated out-of-pocket costs for the �Welcome to Medicare� preventive visit and, for the first time since the Medicare program was created in 1965, Medicare now covers an annual wellness visit with a participating doctor, also at no cost.

We�ve added expanded prescription drug benefits to the preventive arsenal as well. This year, people with Medicare started to benefit from a 50% percent discount on covered brand name drugs bought when they�re in the donut hole, and we�ll continue to chip away at the donut hole until it�s closed in 2020. Making prescription drugs more affordable increases the chance they�ll be taken as needed. Again � prevention just makes sense.

Find out which preventive services are right for you by taking this checklist to your doctor or other health care provider.

Our job now is to ensure that everyone eligible for Medicare uses these benefits. We need to encourage every person with Medicare, every caregiver, every physician to join our nationwide campaign for prevention. We are calling our campaign, Share the News, Share the Health, which will run throughout the summer, with online ads and community events all over the country starting in July.

Focusing on prevention doesn�t just improve care � it�s also an important step in reducing the cost of health care. The financial costs of treating chronic diseases like heart disease, cancer and diabetes are enormous. Add in the intangible costs of pain and suffering, and the very real economic costs of lost productivity, and the opportunity costs of chronic illness are simply unacceptable.

This is why we�re also working closely to incorporate best practices from the Centers for Disease Control, particularly around ways to reduce cardiovascular mortality. This type of collaboration is critical to moving us towards a prevention-based model of care.

Focusing on prevention also makes sense when we value treating the whole patient � not just a condition or disease. When we help people take better care of their health, everyone in the community benefits. If we wait to pay for care as illness progresses, the price of health care for the country will continue to rise.

Prevention just makes sense.

Investing in Our Health Is Investing in Jobs

Did you know that for more than 45 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay? For many Americans, community health centers are the primary source of their care. Everything from prevention to treatment. Today, there are more than 8,100 centers around the country providing high quality care for nearly 20 million people.

In addition to keeping our families healthy, community health centers help keep local economies healthy by creating good-paying jobs. That�s why today we announced the availability of $700 million in new funding made possible by the Affordable Care Act to pay for the renovation and construction of community health centers.

Since the beginning of 2009, health centers have added more than 18,600 new full-time positions in many of the nation�s most economically distressed communities. And the new funds announced today will help continue this trend and create thousands of jobs nationwide. Here are some details.� In 2010, community health centers employed more than 131,000 people including:

9,600 physicians11,400 nurses9,500 dentists and dental staff�6,400 nurse practitioners, physicians� assistants, and certified nurse midwives4,200 mental health care professionalsAnd more than 12,000 case managers and health education, outreach, and transportation staff

All of this is part of the Obama Administration�s ongoing investment in the health of Americans. By improving care and creating jobs we strengthen our communities.

Why We Started the Partnership for Patients: Sorrel King’s Story

Twelve years ago, a study came out estimating that as many as 98,000 Americans die every year from preventable medical errors. Despite many successful efforts, this statistic has not improved much in the following decade.

At any given time,�about one in every 20 patients has an infection related to their hospital care. On average, one in seven Medicare beneficiaries is harmed in the course of their care.

There is a lot of work to be done to prevent unnecessary harm to patients.

A woman who knows this story all too well is Sorrel King.

In 2001 Sorrel lost her daughter Josie King to preventable medical errors. Since the death of her daughter, she has courageously committed herself to shedding light on the role that medical errors play in thousands of preventable deaths every year in the United States. She has also become a valuable partner in our Partnership for Patients initiative.

The goals of the Partnership for Patients are to make hospital care safer, more reliable, and less costly. We want to keep patients from getting sicker, and help patients heal without complications since patients are often at their most vulnerable when leaving the hospital to continue healing at home, in an assisted living facility, or in another care setting.

Watch Sorrel tell her personal story in the video below and share it with people you know. After you�ve watched the video, join the partnership if you haven�t already. Help us raise public awareness and educate patients, families, and consumers about the importance of making care safer and better coordinated.

New program for diabetes patients puts text messaging to work

WASHINGTON – Chartered Health Plan, the oldest Medicaid managed care organization in the District of Columbia, is launching a new text messaging program for 50 of its members to help them better manage diabetes, which requires regular care to avoid costly complications.

The program enables participants to receive brief tips about living with diabetes, as part of a case management program that also includes face-to-face support.

[See also: Diabetes texting program gets a boost]

Research shows that people who actively participate in their care can more effectively manage chronic diseases such as diabetes. In many cases, however, particularly in the neighborhoods Chartered serves, people with diabetes find it difficult to understand and manage the disease, Chartered executives say.
 
"Mobile health is the wave of the future for improved management of chronic disease," said Richard Katz, MD, director of the division of cardiology at the George Washington University Hospital, which previously partnered with Chartered Health Plan on a similar program. "It can be extremely popular with diabetes patients and result in reduced emergency room visits and hospitalizations."

Diabetes affects D.C. residents at substantially higher rates than in other areas of the country. In 2010, 10.9 percent of D.C. adults received a diabetes diagnosis, compared with 8.7 percent nationwide, and death rates associated with the disease are also disproportionately higher. Poorly managed diabetes can lead to complications such as blindness and foot problems, often leading to costly emergency room visits that could be avoided.

"This program connects our diabetic members to the real-time support they need," said Karen Dale, an executive at Chartered Health Plan. "Through this and other innovations, we're opening doors to good health for those who need it most in our community."

[See also: HHS Text4Health, mHealth initiatives focus on smoking cessation]

Bridging the gap
For years, Chartered has sought to keep members with diabetes engaged in their care through regular telephone calls and mailings, as well as face-to-face interaction with members. By adding a text-messaging element, Chartered executives say, the plan is expanding the impact of this effort and enabling members to play a more active role in the management of their disease.

The program encourages members to avoid unnecessary emergency room visits and instead to schedule annual appointments with their primary care providers as well as get annual eye and foot exams. It also helps people take their diabetes medicines appropriately and make lifestyle changes to better support their health.

Participants receive tips and messages on various topics, including when to contact a doctor, nutrition tips and diabetes-related information. The text messages also include interactive quizzes and announce community events to keep participants involved.

Future plans
The program will be evaluated later this year with an eye toward potential expansion. It is part of Chartered's commitment to transform healthcare in the District, officials say. Building on its secure cell phone technology platform, Chartered ultimately hopes to create support groups for various diseases and send other disease-specific messages and personalized messages, such as appointment reminders, to its members.

"Our goal is to leverage mobile technologies and smart networks to improve the well-being of our community," said Dale. "We've been committed to improving the quality of care, reducing costs and creating a healthier community for the past 25 years, and will continue to take advantage of new opportunities to solve Washington's most critical health and social challenges."

Senate panel explores healthcare IT issues for stimulus package

WASHINGTON – Panelists at a Thursday hearing on healthcare funding in an economic stimulus package agreed that IT won't be the silver bullet that everyone hopes for, but could be an effective tool if used properly.

Sen. Barbara Mikulski (D-Maryland) called a hearing to explore what policy measures, if any, should be included with healthcare IT funding as part of the economic stimulus package.

Mikulski admitted she has been skeptical about handing over immediate healthcare IT funding, for fear of acting in haste and producing a "techno-boondogle."

However, she said, she supports President-elect Barack Obama's commitment to healthcare IT as part of an economic stimulus package and healthcare reform plan. She held the hearing to allow for debate in advance of the vote on a stimulus bill, now being negotiated in Congress.

The way things are passed, she said, is with polite debate. Hearings are included in that process.

Panelists, which included representatives of private industry, government oversight agencies and non-profits, unanimously said that healthcare IT is merely a tool that, if used properly, can reduce healthcare costs and save lives.

Without the ability to study the data and measure performance, healthcare IT's potential will be wasted, they said. Most panelists encouraged incentives to providers who use healthcare IT data to provide better care, not just incentives for adopting HIT.

Jack Cochran, MD, executive director of the Oakland, Calif.-based Permanente Federation, which represents the national interests of Kaiser Permanente's eight medical groups, said implementing the technology is the first step.

"It is much harder to translate the data. It's not just about digitizing the technology," he said. "You have to use it to give better care. For that you need physician buy-in and leadership."

The second theme expressed by panelists was concern about privacy. Physicians and patients will not support the transition unless privacy is ensured, they said.

Peter Neupert, vice president of Microsoft Health Solutions, endorsed a solution that puts the patient as the main custodian of his or her health data. He said healthcare data stored by Microsoft HealthVault - or some other data storage provider - can ensure that privacy is maintained and the patient can chose where to allow access to that data.

Neupert said advancing healthcare IT need not be difficult at first. "We already have the data needed to get going," he said. Lab work, images and electronic prescriptions provide a good place to start.

Valerie Melvin, Director of Information Technology at the Government Accounting Office, recommended federal requirements to measure progress on healthcare IT advancement.

Warren Buffett diagnosed with early stage prostate cancer

NEW YORK�Billionaire investor Warren Buffett told shareholders of Berkshire Hathaway on Tuesday that he has prostate cancer but "feels great" and will continue to run the conglomerate during treatments.

In a letter to Berkshire (BRK.B) investors, Buffett, 81, the chairman and CEO, said he has been diagnosed with early stage prostate cancer and that he will commence daily radiation treatment in mid-July. Buffett, nicknamed the Oracle of Omaha for his investment prowess, stressed that his condition is treatable and is "not remotely life-threatening or even debilitating in any meaningful way."

The five-year survival rate for the type of cancer Buffett has � a stage 1 tumor, in which the cancer hasn't spread outside the prostate gland � is 100%, according to the American Cancer Society. Even after 15 years, the survival rate for all stages of prostate cancer combined is 91%.

Buffett's letter suggests he will continue to run Berkshire as he has for almost 50 years. His upcoming treatment would restrict Buffett's travel but would not otherwise change his normal work schedule. Still, the statement got investors talking about the succession plan at Berkshire. At the annual meeting in February, Buffett said the board had identified the person to succeed him as CEO, but the person was not identified.

"When a transfer of responsibility is required, it will be seamless, and Berkshire's prospects will remain bright," Buffett wrote in February in his letter to shareholders. Buffett also said there were two backup candidates.

Jeff Matthews, a Berkshire investor and author of Secrets In Plain Sight: Business & Investing Secrets of Warren Buffett, says the news "tells us that he is mortal and also reinforces the idea that the succession planning he has been working on will be needed."

Survival Chances

More than 200,000 men are diagnosed annually with prostate cancer and about 30,000 will die from the disease. Five-year survival rates:

*About four of five prostate cancers are found in this early stage.

Source: American Cancer Society

Credits: Kevin A. Kepple, Anne Carey and Liz Szabo

While Buffett is irreplaceable, investors say he has stitched together a strong group of companies, ranging from railroads to retail, that will prosper long after he is gone.

"It's a shock to everybody," says Andy Kilpatrick, author of Of Permanent Value: The Story of Warren Buffett. "But his life will go on, and Berkshire will go on. There's no need for any emergency alarm. But it's something to watch over the next three to five years."

Most prostate tumors grow very slowly, especially in older men, in whom the disease is extremely common. Autopsy studies, in fact, have found that most men will die with cancer in their prostate cancer, although most never knew it.

Because prostate cancer is so slow-growing, the medical community has been hotly debating how just aggressively to screen for it and treat it. That's because the treatments � which can lead to impotence, incontinence, and even death � can cause more harm than the actual cancers, says Otis Brawley, the cancer society's chief medical officer, in his recent book, How We Do Harm.

In December, an expert panel from the National Institutes of Health said that about 100,000 of the 240,000 men diagnosed with prostate cancer annually don't need immediate treatment, and instead could safely opt for "active surveillance" � monitoring the disease with tests and scans to see if it grows, rather than going straight to surgery or radiation.

In October, the U.S. Preventive Services Task Force, an independent expert panel that advises the government on health care, announced that healthy men should no longer be screened with the Prostate-Specific Antigen (PSA) blood test for prostate cancer. The risk of causing harm outweighed the uncertain benefits, the task force said.

Studies have failed to clearly show that getting a PSA test saves many lives, if any, Brawley says.

Contributing: Liz Szabo

AHRQ: Docs using e-prescribing can improve drug costs for patients

ROCKVILLE, MD – A new study finds that physicians who use an e-prescribing system with formulary decision support can boost drug cost savings.

The report was funded by the Department of Health and Human Services' Agency for Healthcare Research and Quality.

According to the study, physicians can save $845,000 per 100,000 patients per year and possibly more system-wide by using a system that allows them to select lower cost or generic medications.

The study's authors believe this will have important financial implications as e-prescribing systems become more widely available and easier to use.

Complete use of an e-prescribing system with formulary decision support could reduce prescription drug spending by up to $3.9 million per 100,000 patients per year, the authors found.

Many insurers use lists of approved prescription drugs known as formularies. Under these arrangements patients are often charged the lowest co-payment for generic medications (tier 1), a higher sum for preferred brand-name drugs (tier 2) or the highest amount for non preferred brand-name drugs (tier 3).

A challenge to physicians' use of the tiered system is the lack of current data on insurers' prescription drug formularies at the time of prescribing because the information changes so frequently.