Posts Tagged ‘Centers for Disease Control and Prevention’

Dying for Coverage

Tuesday, July 10th, 2012

More than 26,000 working-age adults die prematurely in the United States every year because they lack health insurance, according to a study published by Families USA.  The consumer advocacy group study, estimates that a record high of 26,100 people aged 25 to 64 died for lack of health coverage in 2010, up from 20,350 in 2005 and 18,000 in 2000.  That adds up to a rate of approximately 72 deaths per day, or three per hour.

The non-profit group based its report on data from the U.S. Census Bureau, the Centers for Disease Control and Prevention (CDC), and a 2002 Institute of Medicine (IOM) study that showed that Americans who lack insurance face a 25 percent higher risk of death than those with coverage.  The findings are in line with a study by the Urban Institute think tank that estimated 22,000 deaths nationwide in 2006.

“Lives are truly on the line,” said Ron Pollack, Executive Director of Families USA, who supports the Patient Protection and Affordable Care Act (ACA).  “If the Affordable Care Act moves forward and we expand coverage for tens of millions of people, the number of avoidable deaths due to being uninsured will decrease significantly.”  Pollack is not the only healthcare advocate to predict that the number of uninsured will continue to rise without reform as healthcare costs accelerate, employers cut benefits, and the social safety net unravels because of fiscal pressures.

The Affordable Care Act was passed by Congress to address an American tragedy and an American shame,” Pollack said.  “The fact remains that for the millions of Americans without health coverage, only the Affordable Care offers the promise of access to affordable coverage and to a longer and healthier life.”

According to the report, the reasons for being uninsured differ, but many without health insurance were denied coverage because of a pre-existing condition.  Others have been priced out of the market at a time when keeping their homes and feeding their families take priority over holding on to insurance in the face of rising premiums.  Some lost their benefits when employers stopped providing coverage.

Census Bureau data show that 50 million Americans lack healthcare coverage, and experts say that these people do without medical care, physician visits and preventive tests including cancer and blood pressure screenings.  “The uninsured get healthcare about half as often as insured Americans, on average,” said Dr. Arthur Kellermann, director of the think tank RAND Health and co-chairman of the committee that wrote the 2002 IOM study.  “There is an overwhelming body of evidence that they get less preventive care, less chronic disease care and poorer quality hospital in-patient care,” he said.

The $2.6 trillion American healthcare system, which totals nearly 18 percent of the economy, is accessible to a majority of working-age Americans only through private health insurance.  But insurance costs – premiums, deductibles, co-pays and co-insurance – are unaffordable for many.

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the national trade association that represents the insurance industry said the rising cost of care must be addressed.  “Health plans have long supported reforms to give all Americans the peace of mind and financial security that healthcare coverage provides.  The nation must also address the soaring cost of medical care that is adding a financial burden on families and employers and threatening the long-term sustainability of our vital safety net programs.”

Families USA counters that the current delivery system is stacked against Americans who lack insurance.  They pay more for care because they lack the ability to negotiate discounted prices on physician and hospital charges like insurance companies can.

Writing in Forbes, Matthew Herper points out that “This estimate is 19 years old, and this number doesn’t tell us much that’s new about what is wrong with our healthcare system.  If anything, it emphasizes how our total lack of information about what works and what doesn’t is trapping us in an economic and social death spiral around health costs.  If anything, available data seem to point to this estimate being low.  The real story is that we care so little about how much insurance matters to people’s life spans that we haven’t really bothered to find out.  It’s possible that the number is actually higher.  A 2009 article in the American Journal of Public Health actually found a 40 percent increase in the risk of death for those who lack insurance.  The IOM notes this finding, and that using it would have substantially increased the 26,000 number.  So how many people do die from lack of health insurance?  The short answer is that we don’t know, because we don’t look.  We should have data collection systems in place to answer questions about how healthcare is performing.  This should translate into more transparency, so that voters and consumers can find out how well the system is doing.  Instead, we tend not to track data about the healthcare system, and to keep it completely siloed.  And then we wonder why the system doesn’t work.”

CDC Wants Baby Boomers Tested for Hepatitis C

Tuesday, May 29th, 2012

A latent legacy of baby boomers’ youthful antics could be hepatitis C. The number of boomers dying from a “silent epidemic” of hepatitis C infections is increasing so quickly that federal officials are planning a nationwide push for widespread testing.  Seventy-five percent of the estimated 3.2 million people who have chronic hepatitis C — and a similar number of those who die from the ailment are baby boomers.  Hepatitis C deaths nearly doubled between 1999 and 2007 to more than 15,000, according to a Centers for Disease Control and Prevention (CDC) study.  Hepatitis C is the primary infectious cause of cirrhosis and liver cancer and is the most common reason for liver transplants, according to the CDC.  In 2007, deaths from the disease surpassed those caused by HIV, and the numbers are expected to increase.

Baby boomers typically became infected in their teens and 20s, either via blood transfusions or with experimental injection drug use. Hepatitis C is often asymptomatic while it damages the liver, according to the CDC.  “It’s a bold action that’s become necessary because there’s a large population that’s unaware of their illness, becoming ill, and dying in an era of effective treatment,” said John W. Ward, director of the division of viral hepatitis at the CDC.

One in 30 baby boomers have hepatitis C, according to the CDC.  A single test of the members of that generation has the potential to identify 800,000 people with hepatitis C, which would prevent liver cancer and perhaps save 120,000 lives.  “We believe this cost-effective public health approach can help protect the health of an entire generation of Americans,” Ward said.  “It’s the fastest-growing cause of death in the U.S. and hepatitis C is the leading cause of liver cancer here.   “Most cancer deaths are going down and this is one of the few that continues to escalate.”

Many baby boomers have a potentially dangerous ‘it’s not me’ mentality about hepatitis C,  and this survey underscores how poorly most people in that generation understand that risk factors do apply to them,” said Ira M. Jacobson, M.D., AGAF, chief, division of gastroenterology and hepatology and professor of medicine, The Joan Sanford I. Weill Medical College of Cornell University, and physician co-advisor to the , American Gastroenterological Association’s (AGA) I.D. Hep C campaign. “Given the potentially deadly consequences of allowing hepatitis C to go undiagnosed, the AGA urges all baby boomers to talk to their doctors about getting tested.”

“The disease can’t be treated if people don’t know they are infected. With treatment, the chance of a cure is greater than ever,” said Michael Ryan, M.D., clinical professor of medicine, Eastern Virginia Medical School, practicing gastroenterologist with Digestive and Liver Disease Specialists of Norfolk, VA, and physician co-advisor to AGA’s I.D. Hep C campaign.  “I see every day the devastation hepatitis C can cause, especially to those who have lived with the disease for years without knowing it.  Baby boomers shouldn’t wait – they should talk to their doctors today about getting this simple test.”

New York Controversy Emerges Over Food Portion Size Campaign

Monday, February 20th, 2012

The New York City Department of Health recently launched a campaign to get New Yorkers to make their waistlines smaller by controlling their portion sizes when ordering food and beverages. “Consuming too many calories can lead to weight gain,” said city Health Commissioner Thomas Farley.  “If New Yorkers cut their portions, they can cut their risk.”  The “Cut your portions. Cut your risk” campaign is billed as “hard-hitting” and has the purpose of making certain that people understand that large meals cause obesity.  Even worse, obesity can cause diseases like diabetes.  In one city poster, a man whose leg has been amputated because of Type 2 diabetes sits behind a graphic showing how soft drink portions have grown over the years.

Over the last 40 years, according to the Health Department, serving sizes for sugary soft drinks have grown four times, and the amount of French fries in a single order has tripled.  As a result, “a single meal could balloon to contain many more calories than the amount an adult needs for an entire day” – roughly 2,000.

Writing on the blog, Spence Cooper takes a more cynical attitude. “The number of New Yorkers motivated to make healthier choices and forgo that next order of large fries because of ad nauseam public service ads is equal to the number of New York smokers who pay attention to the warnings on cigarette packs. You can count them on one hand.”

The new posters, available in both English and Spanish, bear the message “Cut your portions. Cut your risk,” providing New Yorkers with a clear strategy for preventing obesity and its health penalties.  While the City has made strides in combating the nationwide trend of growing obesity, the majority of adult New Yorkers (nearly 57 percent) and two out of every five New York City elementary school children remain overweight or obese and the health consequences are dire, ranging from hypertension to type 2 diabetes.  Nearly 10 percent of New Yorkers have been told they have type 2 diabetes, which can lead to blindness, kidney failure and amputations. In 2006, nearly 3,000 New Yorkers with diabetes were hospitalized for amputations. Obese children and adolescents also are more likely to become obese adults. Even while young, they are more likely to develop obesity-related conditions such as high cholesterol, high blood pressure, and type 2 diabetes.”

Not all are in agreement with Farley’s campaign. The New York ads create an “inaccurate picture” of the impact of soft drinks, argues Stefan Friedman, a spokesman for the American Beverage Association.  “Portion control is indeed an important piece of the solution to obesity,” he said. “Instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and new calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families,” he said.

The posters are appearing on subway stops around the city for the next three months. Mayor Bloomberg dismissed his critics who claim that the ads were too graphic and disturbing:  “What do you want to do? Do you want to have people lose their legs or do you want to show them what happens so that they won’t lose their legs? Take your poison. Which do you want?” said Bloomberg.

Many healthcare experts agree with Bloomberg. “Obesity rates in adults rose to 35.7 percent from 30.5 percent between 1999 and 2010, compared with rates that nearly doubled in the two previous decades, the Centers for Disease Control and Prevention (CDC) reported . The rate among boys climbed 29 percent, surpassing girls for the first time, according to the CDC.

More than 78 million American adults — as much as  one third of the population, and about 12.5 million children were considered obese in 2009- 2010, according to a series of studies reported in the Journal of the American Medical Association. The studies are part of a continuing CDC effort to track obesity rates with new numbers every two years.

ACA Is Fixing U.S. Healthcare Delivery: Donald Berwick

Wednesday, January 4th, 2012

Dr. Donald Berwick, who oversaw Medicare and Medicaid until recently said the programs are trapped in a health system that promotes wasteful spending and inefficient care. “Healthcare is broken,” Berwick, who headed the Centers for Medicare and Medicaid Services (CMS), said.  “We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable.  Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”  Berwick said the Patient Protection and Affordable Care Act (ACA) is changing how physicians and hospitals are paid and deliver care through such innovative arrangements as accountable care organizations (ACOs), which improve coordination and lower costs.”

According to Berwick, it is not clear whether these efforts will produce results quickly enough to silence the critics who want to make more radical changes that would shift the majority of the burden onto beneficiaries.  “That is the central question, the nub…whether that will happen fast enough, I just don’t know.”

To read the full transcript of Berwick’s remarks, click this link:

Berwick defended his tenure as CMS administrator. Even though he failed to win Senate confirmation, that did not impact his ability to get things done, though he would have preferred a longer term.  “An agency of this size will do better with longer-term leadership commitment,” he said.  With the knowledge that his tenure was likely to be short, Berwick felt a greater sense of urgency to achieve things.  Berwick’s most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form ACOs, while not making the requirements overly burdensome.

Berwick took exception to state’s efforts to limit hospital coverage for Medicaid recipients, which is presently under review by federal regulators.  Hawaii has proposed a 10-day limit on some enrollees; Arizona has proposed a 25 day limit.  “It’s a nonsensical idea.  If a patient needs 20 days, the patient should get 20 days,” he said.

According to the Bangor Daily News, Berwick’s departure from CMS is “an unnecessary loss.” Berwick’s parting words should help Americans understand how their health system is in the process of being improved.  The article notes that “Waste is a broad term, including needless medical procedures, failure of adequate preventive measures, duplication and inefficiency, as well as outright fraud.  Hospital-acquired infections have caused the deaths of almost 100,000 Americans each year and the illness of millions more, according to the U.S. Centers for Disease Control and Prevention.  Dr. Berwick has reported that these complications have added as much as $45 billion a year to hospital costs borne by taxpayers, insurers and customers.  He said that some hospitals have virtually eliminated some infections that other hospitals still consider inevitable.  Under the Affordable Care Act, sometimes called Obamacare, financial incentives will go to hospitals that excel in fighting these infections starting in 2015.

Unnecessary hospital readmissions add another $12 billion a year, estimates the Medicare Payment Advisory Commission.  It says half or more of these readmissions could be prevented through better coordination and patient education, permitting them to recover at home rather than re-entering the hospital with complications.  ‘Integrated care’ will also reduce costs, said Dr. Berwick, by protecting patients from having to tell their stories over and over to different providers and letting a doctor know what medication they had already been given.  No figure is available for the savings from automated record keeping, but it is becoming substantial.  Preventive medicine is already reducing waste, for example by detecting diseases at early stages for prompt treatment.  The Affordable Care Act makes preventive benefits like cholesterol tests, mammograms and screening for colon and rectal cancer free for everyone with Medicare.”

ACA Gives 2.5 Million Young Adults Healthcare Coverage

Tuesday, December 27th, 2011

The number of young adults who have no medical coverage has contracted by 2.5 million since the Patient Protection and Affordable Care Act (ACA) took effect, according to a new analysis by the Obama administration.  That decline is 2½ times larger than earlier government and private estimates, which showed about one million Americans ages 19 – 25 had acquired coverage.

Obama administration officials said they now have more comprehensive data and are slicing the numbers more precisely than the government typically does, in an attempt to identify the impact of a popular provision in the law.  Thanks to the ACA, young adults can remain on their parents’ health insurance plans until their 26th birthdays.  Families have flocked to sign up their offspring, making the transition to work in a challenging economic environment a bit easier.

Thanks to the Affordable Care Act, 2.5 million more young adults don’t have to live with the fear and uncertainty of going without health insurance,” said HHS Secretary Kathleen Sebelius.  “Moms and dads around the country can breathe a little easier knowing their children are covered.”

“This comparison makes it clear that the increase in coverage among 19 to 25 year-olds can be directly attributed to the Affordable Care Act’s new dependent-coverage provision,” according to an Assistant Secretary for Planning and Evaluation (ASPE) brief.  “Furthermore, the coverage gain for young adults was entirely due to an increase in private coverage (from 49 percent to 58 percent), with no change in Medicaid coverage during this period.”

“The increase in coverage among 19- to 25-year-olds can be directly attributed to the Affordable Care Act’s new dependent coverage provision,” according to the Department of Health and Human Services (HHS).  “Initial gains from this policy have continued to grow as…students graduate from high school and college.”

That age group previously recorded the highest uninsured rate. Now, 26- to 35-year-olds have that dubious distinction by a narrow margin, according to the Centers for Disease Control and Prevention.

According to the HHS survey, nearly 36 percent of Americans ages 19 – 25 — more than 10.5 million people — were uninsured in the third quarter of 2010, before the law’s provision took effect.  The majority of employer-based health plans began carrying the provision January 1, 2011.  By the 2nd quarter of 2011, the proportion of uninsured young adults had fallen to slightly more than 27 percent, or about eight million people.

And just who are these young adults?  Some are transitioning from school to work. Others are trying to start their careers by working at low-wage jobs that don’t usually come with healthcare coverage.  Some – known as the “invincibles” – pass up job-based health insurance because they don’t think they’ll need it and prefer some extra money in their paychecks.

Similarly, the National Center for Health Statistics has documented a broadly similar trend, only not nearly as spectacular.  According to administration officials, those statistics do not focus on the change from calendar quarter to calendar quarter, as the new HHS report does.  Instead, they pool data over longer time periods; that tends to dilute the law’s perceived impact.

Time for a Better Flu Shot

Thursday, November 10th, 2011

As the 2011 flu season gets underway, it is reported that  the vaccines given for this dreaded disease may be far less effective than thought, according to a new study.  Michael Osterholm, an infectious disease specialist at the University of Minnesota, found that the most common flu vaccine is effective for just 59 percent of healthy adults, well below the 70 percent to 90 percent level that is generally quoted.  “We’re stuck with a vaccine that has been around for 60 years and not changed much,” Osterholm said.  He stressed the need for an all-new generation of flu shots, especially in case there is a future pandemic.

“Today’s flu shot is like an iPhone 1.0,” according to Osterholm. “What we need is an iPhone 10.0.”  Scientists are presently working on a “universal flu shot” that would be effective for years.  Francis Collins, director of the National Institutes of Health (NIH), said that such a vaccine could be developed within the next five years.

Health officials recommend that all Americans over six months of age get a flu shot.  Nearly 131 million people – just 43 percent of the population — received the flu vaccine in 2010, according to the Centers for Disease Control and Prevention (CDC).

Although Osterholm does not dispute the need for the current vaccines, he said the common perception that they are “good enough” obstructs the development of improved therapies.  In a study published in The Lancet Infectious Diseases, Osterholm and his colleagues examined 5,707 vaccine studies published over the last 40 years.  They focused 31 studies that tested for the presence of flu in laboratory tests rather than counting an increase in flu antibodies — a speedier method that researchers say overestimates the vaccine’s effectiveness.  Additionally, they concentrated on results to those that used randomized controlled trials or other observational methods that did not have “selection bias,” which could lead to sicker people being excluded from the study. 

“We found a number of differences in how influenza vaccine has performed in different populations of people,” Osterholm said. Because 3,000 to 49,000 Americans die of flu every year – the number varies because the disease is not easily predictable, seasonal and pandemic – its severity differs.  In other words, flu is a unique public health problem.  Because of those variations, each year’s vaccine has some differences.  “It’s clear that what we really need is to develop new and better vaccines,” according to Osterholm.  The holy grail would be a vaccine that is effective against all varieties of flu.

The H1N1 vaccine performs slightly better than seasonal flu shots, preventing infection in 69% of adults under 65.  Nasal sprays do even better, preventing infections in 83 percent of children aged seven or less, according to The Lancet.  One study found that flu shots reduce hospitalizations by eight percent.  That is significant, however, because the flu sends about 200,000 Americans to the hospital every year.  The results should not deter people from getting vaccinated, Osterholm said.  “We have an obligation to tell the public what we know.  We know we need better vaccines.  But 59 percent protection is still better than zero.  To me, that still very much recommends getting vaccinated.”

“There isn’t any doubt that influenza vaccine is a pretty good vaccine, but it’s not an excellent vaccine, like polio or measles,” says William Schaffner, a professor at Vanderbilt University School of Medicine.  “Even in the best of times, it’s not capable of completely eliminating infections.”

By comparison, just two measles vaccines prevent about 95 percent of infections, and polio vaccines have eliminated polio in most countries.

The bottom line, is that most years, it will prevent illness, it will prevent hospitalizations, and it will prevent deaths.” But, he added, “it won’t prevent them all and it cannot eradicate influenza,” as vaccines have done for certain other diseases such as polio and measles.

The American examination could help public health planners determine how to get the most our of the vaccine while better vaccines are developed, said Dr. Scott Halperin, director of the Canadian Centre for Vaccinology in Halifax.  “A lot of research is going on in the flu vaccine field to get a better vaccine,” Halperin said.  “But having said that, you know 59 or 60 percent is still far better than zero percent.”

Andrew Pavia, M.D., who chairs the Pandemic Influenza Task Force of the Infectious Diseases Society of America, said the study confirms what is already understood about the current flu vaccine.  “Everyone agrees that we need better vaccines and we are making progress in that direction.  We have known for years that the vaccine we have does not provide a first-rate level of protection in the elderly and the very young, but it does provide protection.  It would be terrible if the message to the public was that getting vaccinated isn’t important.”  In fact, the less effective a vaccine is, the more important it is that as many people as possible are vaccinated so that those who are most vulnerable are protected.  “With a vaccine that is less than perfect, which is most of our vaccines, much of the protection comes from having widespread coverage within a community,” Pavia concluded.

ER Visits on the Rise, Thanks to Quick Treatment

Monday, October 24th, 2011

Visits to hospital emergency rooms soared to an all-time high of 136 million in 2009, according to new estimates provided by the Centers for Disease Control and Prevention (CDC).  This represents an approximately 10 percent increase from the 2008 statistic of 123.8 million.  The CDC study is one of three examinations of ER use being released at the American College of Emergency Physicians meeting.  

According to the CDC, patients under the age of 15 accounted for 21 percent of ER visits in 2009; patients between 15 and 24 made up 15 percent; patients between 25 and 44 accounted for 28 percent; patients between 45 and 64, 21 percent; and patients 65 and older, 15 percent.  Breaking visits down by gender, the CDC noted that women visited the ER at a rate of 48 visits per 100, while men had a rate of 42.   

The expected sources of payments for ER visits were private insurance, 39 percent; Medicaid or State Children’s Health Insurance Program, 29 percent; Medicare, 17 percent; other and unknown, five percent each.  Nineteen percent of ER visitors reported that they had no insurance.  The most typical reasons for visiting the ER were stomach and abdominal pain, 9.6 million; fever, 7.4 million; chest pain, 7.2 million; cough, 4.7 million; headache, four million; and shortness of breath and back symptoms, 3.7 million each.  

Physicians attributed the sharp increase to both greater demand for services and improvements that allow ERs to treat patients faster.   “With the economy, people have lost their coverage and, given the fact the emergency department is the safety net, they come to us,” said Dr. Jay Kaplan, an emergency physician at Marin General Hospital who serves on the board of the emergency physicians’ organization.  The physicians contend that it is counterproductive to discourage patients from going to the ER to save money in healthcare costs because they say it doesn’t.  “We’re efficient.  We take care of acute patients and that’s what we do well,” said Dr. Paul Kivela, managing partner of Napa Valley Emergency Medical Group, and a board member of the American College of Emergency Physicians.  

According to Dr. Michael Gerardi, an ACEP board member, he and his colleagues want comprehensive medical liability reform that includes indemnification based on recognized guidelines, caps on non-economic damages and medical courts where providers are judged by medical peers.  “In America, we sue far too often for bad outcomes and not deviations from standard of care,” Gerardi said.  “The overall anxiety of patients and the lack of acceptance that bad outcomes happen are driving costs.”  Because ERs are safety-net providers, they have become increasingly overcrowded.  One factor is the passage in 1986 of the Emergency Medical Treatment and Labor Act, which requires hospitals to provide people with emergency services, despite their inability to pay.  

It has been estimated that 13.7 percent of all emergency room visits could be treated in retail medical clinics, which are typically based in pharmacies or grocery stores.  These facilities are equipped to treat a limited number of minor conditions, such as throat infections or urinary tract infections.  An additional 13.4 percent of emergency room visits could be handled by urgent-care clinics — an independent medical facility that can handle a broader scope of problems, such as minor fractures and more serious injuries.  Urgent-care clinics typically are open on evenings and weekends, fulfilling the need for patients with occurring before or after typical physician office hours.

HHS Provides Funding to Improve Rural Healthcare IT

Thursday, September 8th, 2011

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius awarded as much as $137 million, to the states funded in part by the Affordable Care Act (ACA), with the goal of strengthening the public health infrastructure and provide jobs in core areas of public health.  Awarded in almost all 50 states, the grants enhance state, tribal, local and territorial efforts to provide tobacco cessation services, reinforce public health laboratory and immunization services, prevent healthcare-associated infections, and provide comprehensive substance abuse prevention and treatment programs.  “More than ever, it is important to help states fight disease and protect public health,” Sebelius said.  “These awards are an important investment and will enable states and communities to help Americans quit smoking, get immunized and prevent disease and illness before they start.”

The grants will fund vital state and local public health programs supported through the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA).  The majority of grant dollars come from the Prevention and Public Health Fund section of the Patient Protection and Affordable Care Act (ACA).  SAMHSA dollars add to this investment.  “CDC supports state and local public health departments which are key to keeping America safe from threats to health, safety, and security from this country or anywhere in the world,” said CDC director Dr. Thomas Frieden.  “With these funds, CDC is strengthening our ability to prevent and combat diseases and keep Americans safe against expensive and dangerous health threats.”

“These funds will allow us to bolster public health services to communities and build on successful programs that have helped people lead healthier lives.  Today’s investments will help us prevent future healthcare costs from problems such as tobacco-related illness and substance abuse,” said Pamela Hyde, SAMHSA administrator.

According to Rene Letourneau, Managing Editor of Healthcare Finance News, “The grants include $1 million to further enhance the nations’ public health laboratories by hiring and preparing scientists for careers in public health laboratories, providing training for scientists and supporting public health initiatives related to infectious disease research; nearly $5 million to help states and territories enhance and expand the national network of tobacco cessation toll-free quit lines to increase the number of tobacco users who quit; More than $42 million to support improvements to the Immunization Information Systems (registries) and other immunization information technologies; development of systems to improve billing for immunization services; planning and implementation of adult immunization programs; enhancement of vaccination capacity located in schools; and evaluations of the impact on disease of recent vaccine recommendations for children and adolescents; and $2.6 million to the Emerging Infections Programs around the country to continue improvement in disease monitoring, professional development and training, information technology development and laboratory capacity,” to name a few.

In a related initiative, President Obama recently announced that new healthcare IT jobs are part of his Jobs Initiatives for Rural America at the recent White House Rural Economic Forum held in Peosta, IA.  The plan includes making HHS loans available to assist more than 1,300 Critical Access Hospitals recruit supplementary staff, and help rural hospitals purchase software and hardware to implement healthcare IT.

“These are tough times for a lot of Americans – including those who live in our rural communities,” Obama said.  “That’s why my administration has put a special focus on helping rural families find jobs, grow their businesses, and regain a sense of economic security.”

“Creating jobs and economic opportunity in rural America is a priority for the Obama Administration, and the White House Rural Council has used an ‘all hands on deck’ approach to leverage resources across the federal government to achieve that goal,” said Agriculture Secretary Tom Vilsack. “By bringing new capital, job training, and additional investments to our rural communities, we are working to ensure the people who live in these towns have a better, brighter future.”

“The Small Business Administration (SBA) is pleased to announce that we will be doubling the capital going to rural businesses through the Small Business Investment Company program, with no cost to taxpayers,” said Administrator Karen Mills.  “Small businesses of all kinds are thriving in rural areas where they are creating jobs of the future and helping ensure the economic stability of the middle class.  Half the people who work in America either own or work for a small business, and two out of three new private sector jobs are created by small businesses.  The Obama Administration and SBA have been committed to supporting rural businesses, which drive economic growth across the country and will continue to do so through these programs.”

“Creating jobs and economic opportunity in rural America is a priority for the Obama Administration, and the White House Rural Council has used an ‘all hands on deck’ approach to leverage resources across the federal government to achieve that goal,” said Agriculture Secretary Tom Vilsack. “By bringing new capital, job training, and additional investments to our rural communities, we are working to ensure the people who live in these towns have a better, brighter future.”

“The Small Business Administration (SBA) is pleased to announce that we will be doubling the capital going to rural businesses through the Small Business Investment Company program, with no cost to taxpayers,” said Administrator Karen Mills. “Small businesses of all kinds are thriving in rural areas where they are creating jobs of the future and helping ensure the economic stability of the middle class.  Half the people who work in America either own or work for a small business, and two out of three new private sector jobs are created by small businesses. The Obama Administration and SBA have been committed to supporting rural businesses, which drive economic growth across the country and will continue to do so through these programs.”

HHS Issues Guidance for State Healthcare Exchanges

Wednesday, July 27th, 2011

The Department of Health and Human Services (HHS) has proposed a structure for health insurance exchanges that gives states significant flexibility in how and when they set up open marketplaces designed to boost competition.  HHS announced a sliding deadline for states to create the exchanges, allowing them to receive conditional approval if they are in advanced preparation by 2013.

Additionally, states that are not ready by the final 2014 deadline can delay opening the exchanges until 2015 or later.  States that are still deciding whether to establish health insurance exchanges have sought clarity on how these insurance marketplaces will function.  The federal government previously had provided few details on this key part of the Patient Protection and Affordable Care Act (ACA).

The rationale for the exchanges is to create convenient access to an open marketplace of insurance plans that lets uninsured people and small businesses join together to negotiate affordable rates.  States had faced a January 1, 2013, deadline to decide if they would participate in the program.  Those opting to participate are expected to create governance and information technology structures virtually from scratch to have the exchanges in full operation by 2014.

“If we don’t have significant progress made by the end of the year, the IT experts tell us it’s going to be really hard to meet the deadline,” Kansas Insurance Commissioner Sandy Praeger said.  She is working to establish an exchange despite a lack of legislation in her state to move forward with it, not to mention a conservative governor who strongly opposes the health law.  “The health insurance market is often broken, especially for small businesses,” said HHS Secretary Kathleen Sebelius.  Sebelius said the exchanges would share three key features: They will serve as one-stop shops for comprehensive insurance needs; create competition between insurers based on price and quality; and provide basic coverage to all Americans.  “This is how members of Congress get their health insurance today,” she said.  “And once these reforms are fully in place, buying insurance will become much more like buying a home appliance or an airline ticket.”

Meanwhile, HHS announced three new initiatives to help states improve the quality and cut the cost of care for “dual eligible” – the approximately nine million Americans who qualify for both Medicare and Medicaid.  The programs include a demonstration program to try out two new financial models to better coordinate care for people who are eligible for both government programs; a demonstration program to help states upgrade the quality of care for people in nursing homes that focuses on cutting hospitalizations; and setting up a technical resource center to help states improve care for high-need high-cost beneficiaries.  “By improving care to the most vulnerable of our citizens, we can improve the quality of their lives and prevent wasteful spending,” Sebelius said.  “Governors and their staff have been looking for tools to help them accomplish these important goals.  I am pleased that we can continue our strong partnership with the states to do this.”

These moves couldn’t come at a better time.  It is estimated that the growth in the uninsured adult population continued in 2010 — particularly among the number of long-term uninsured and poorer uninsured.  Americans of all ages who were uninsured during the last year reached 60.3 million in 2010, an increase of nearly two million when compared with 2009, according to a report by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

Private health coverage continued to decline while public coverage increased, especially for children.  Among non-elderly adults, 61.1 percent had private coverage in 2010, a 1.7 percent decline.  The rate of privately insured children fell 1.9 percent to 53.8 percent.  While greater numbers of adults became uninsured, fewer children on the whole lost coverage.  That’s largely because the percentage of kids with public coverage — Medicaid and the Children’s Health Insurance Program (CHIP) — increased to 39.8 percent, up nearly two percent.  “Medicaid and CHIP have been a real success story,” said Tom Buchmueller, PhD, a University of Michigan health economist.  State expansion of children’s health programs began increasing the percentage of publicly covered children beginning in 2008.

Sebelius was joined by Washington State Governor Christine Gregoire,  who said the 135,000 dual eligible residents of her state cost $1 billion annually in healthcare costs.  Though they represent only 12 percent of the Medicaid caseload, they total more than one-third of the spending, she said.  “If we could just reduce the cost of two percent a year by investing in community-based solutions rather than nursing homes, which is what our patients want anyway, by helping them avoid psychiatric hospitalizations, we believe we could save at least $10 million a year just with that small segment – that high-risk segment of our dual eligible population.  This is our costliest population, with the greatest need, yet we’re not able to focus on what’s right for them,” Gregoire said.  “The opportunities you’ve provided us will make this possible now.”

HHS Acts to End Healthcare Disparities Among Minorities

Wednesday, May 18th, 2011

The Department of Health and Human Services (HHS) has issued guidelines to reduce disparities in healthcare for racial and ethnic minorities.  “We need to make sure we eliminate disparities in America,” said Senator Benjamin Cardin (D-MD).  For too many years, racial and ethnic minorities “have had less access, less treatment and less research.”

The HHS Action Plan to Reduce Health Disparities relies heavily on provisions of the Patient Protection and Affordable Care Act (ACA).  The plan’s five major goals are: to transform healthcare; strengthen the national health and human services workforce; advance the public’s health and well-being; implement a new health data collection and analysis strategy; and increase efficiency, transparency and accountability so that assessments of policies and programs on health disparities will become a part of all HHS decision-making.

Minorities still trail other Americans in many health outcome measures.  They are less likely to get preventive care, more likely to suffer from serious illnesses — such as diabetes or heart disease — and when they do get sick, they are less likely to have access to quality healthcare.  The Affordable Care Act can potentially address the needs of racial and ethnic minorities, by cutting healthcare costs, investing in prevention and wellness, supporting primary-care improvements, and creating links between the traditional realms of health and social services.  “For the first time, the United States has a coordinated road map designed to give everyone the chance to live a healthy life,” said HHS Secretary Kathleen Sebelius.  “We all need to work together to combat this persistent problem so that we can build healthier communities and a stronger nation.”

According to the Centers for Disease Control and Prevention, two of five Latinos and one of five African-Americans lack insurance. The Agency for Healthcare Research and Quality has found that about 30 percent of Hispanics and 20 percent of African-Americans have no regular source of healthcare, compared with 16 percent of whites.  In treatments for serious illnesses, minorities constantly lag behind whites.  Blacks are one-third less likely to have bypass surgery than whites and significantly less likely to receive children’s medications for asthma.  Additionally, they are more likely to be uninsured.  The minority population currently represents the fastest growing segment of the American population, according to Census Bureau data.

“Health disparities have burdened our country for too long,” said Assistant Secretary for Health Howard K. Koh, MD, MPH.  “This plan reaffirms and revitalizes a national commitment to helping all persons reach their full health potential.”  Communities can use the National Stakeholder Strategy to identify the goals that are most imperative and adopt effective strategies and action steps to reach them.

The plans ask that federal agencies and their partners to cooperate on the social, economic and environmental factors that contribute to health disparities.  “Where people live, learn, work and play affects their health as much as their access to healthcare,” said Garth Graham, MD, MPH, deputy assistant secretary for minority health and director of the HHS Office of Minority Health.  “We have to confront the social, economic and environmental factors that contribute to health disparities if we are to fulfill the President’s goal of ‘winning the future.”