Commonhealth Archives

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Firms Drop Insurance, Shifting Cost To State

A number of small businesses are cancelling health insurance plans, nudging their employees onto state-subsidized plans, The Boston Globe reports. While state officials don’t know how widespread the practice is, if the trend continues, it does not bode well for the already cash-strapped state budget.

Kay Lazar reports:

The Massachusetts Division of Health Care Finance and Policy annually surveys employers and found no significant drop in coverage as of the end of 2009, when more than three-quarters of companies offered health insurance.

But insurance brokers say the pace of terminations has picked up considerably since then among small companies, of which there are thousands in Massachusetts. Many of these companies — restaurants, day-care centers, hair salons, and retail shops — typically pay such low wages that their workers qualify for state-subsidized health insurance when their employers drop their plans.

“Those employers are trying to keep their doors open, and to the extent they can cut expenses, they will cut health insurance because they know their people can go to Commonwealth Care,’’ said Mark Gaunya, president of the Massachusetts Association of Health Underwriters, a trade group representing more than 1,000 brokers and other insurance professionals.

The issue is coming to a head as the Patrick administration battles insurers over swiftly escalating rates they have been charging small employers. In February, the governor filed sweeping legislation that proposes to give the Division of Insurance the power to essentially cap health care price increases. That proposal is still pending

Medicaid Docs With A Penchant For Potent Prescriptions

Today, I’m highlighting a must-read story that has nothing to do with health care in Massachusetts.

Emily Ramshaw, writing for the Texas Tribune, by way of Kaiser Health News, reports on Texas doctors who prescribe enormous quantities of antipsychotic drugs to Medicaid patients, many of them children.

Here’s the top of her story:

Houston psychiatrist G.K. Ravichandran practices a “bio-psycho-social-spiritual” approach to mental health treatment, relying heavily on clinically controversial brain scans to detect everything from anxiety to marital discord. He also has a strong penchant for prescribing heavy drugs.

Ravichandran wrote Texas Medicaid patients more than 54,000 prescriptions for costly, potent antipsychotics between 2005 and 2009 — more than any other doctor in the state, and a figure other practicing physicians call borderline impossible. The next highest prescribers of antipsychotics include a North Texas music therapist who believes his Peruvian pan flute tunes have therapeutic benefits, and a Beaumont child psychologist reprimanded for continuing to prescribe to a proven drug abuser. Between them, they doled out more than 89,000 prescriptions for antipsychotics in that time period, according to a Texas Tribune review of state Medicaid data.

Their prescriptions make up just a fraction of the total: Over the last five years, Texas physicians wrote Medicaid patients nearly 3.4 million prescriptions for antipsychotics — mind-altering drugs designed to treat schizophrenia, bipolar disorder and severe psychological distress, but proven to have serious side effects in kids. While a small portion of the state’s 3 million Medicaid patients received the drugs, many of the highest-prescribing doctors predominantly treat children, a strong indication that’s where the bulk of these antipsychotics are going.

Abortion Politics Play Out In Health Reform

Kaiser Health News provides a round-up of news stories analyzing how abortion coverage will be handled once the health reform law is fully implemented.

While President Obama signed an order earlier this year banning federal funds for abortions in insurance exchanges, some anti-abortion groups appear to be worried that individual states may, indeed, have found a way to offer abortion coverage.

According to the Associated Press:

Federal officials say elective abortion is barred under the Pre-Existing Condition Insurance Plan. It offers coverage to people turned down by private insurers because of medical problems, at rates comparable to what the healthy pay. But at least one state — New Mexico — initially listed elective abortion as a covered benefit, reversing course after The Associated Press inquired on Wednesday. National Right to Life and other abortion opponents say rules for the program have not been clearly spelled out, and that could open the way for taxpayer-subsidized coverage of elective abortion. … New Mexico included elective abortion as a covered benefit, following what it was already doing with its own state health programs” (Alonso-Zaldivar, 7/14).

The Doctor Will See You — Now

Imagine calling your doctor in the morning and getting an appointment that very day. Mind-blowing? Maybe. But with an average 63-day wait for an appointment with a family physician in the Boston area, some doctors are beginning to experiment with same day visits, or “open access,” scheduling, according to a story in today’s Boston Globe.

Reporter Catherine Arnst profiles Worcester doctor Dennis Dimitri, who switched to open access scheduling four years ago. The concept, developed 20 years ago by a California doctor, is “to get today’s work done today,” and not wait for medical problems to fester, she writes.

Patients appear to be happy with the reduced wait time, both for appointments and once they get to the doctor’s office, Arnst reports, although some grumbled that they preferred advanced appointments they could schedule around.

Such results are beginning to catch the attention of wary doctors, said Boston consultant David E. Williams, cofounder of MedPharma Partners LLC. He said the new health law could start nudging physicians toward open access by providing pay-for-performance bonuses.

“One of the things patients hate most are waiting times for appointments and waiting times in the office,’’ said Williams. “When doctors start getting measured on their performance, I think they will become more accepting of open access.’’

GSK Concealed Negative Data On Diabetes Drug

Gardiner Harris, of the New York Times, obtained documents detailing how the pharmaceutical giant, GlaxoSmithKline, concealed negative data about its diabetes medication Avandia that showed patients who took the drug were more likely to suffer from heart problems compared to those taking a competitor’s medication.

The GSK coverup went on for more than a decade, Harris writes.

Quoting from internal company email, he continues:

“This was done for the U.S. business, way under the radar,” Dr. Martin I. Freed, a SmithKline executive, wrote in an e-mail message dated March 29, 2001, about the study results that was obtained by The Times. “Per Sr. Mgmt request, these data should not see the light of day to anyone outside of GSK,” the corporate successor to SmithKline.

The reason for the coverup was clear, Harris writes: disclosure of the drug’s potential heart attack risks could cost GSK hundreds of millions of dollars, at least.

The heart risks from Avandia first became public in May 2007, with a study from a cardiologist at the Cleveland Clinic who used data the company was forced by a lawsuit to post on its own Web site. In the ensuing months, GlaxoSmithKline officials conceded that they had known of the drug’s potential heart attack risks since at least 2005.

But the latest documents demonstrate that the company had data hinting at Avandia’s extensive heart problems almost as soon as the drug was introduced in 1999, and sought intensively to keep those risks from becoming public. In one document, the company sought to quantify the lost sales that would result if Avandia’s cardiovascular safety risk “intensifies.” The cost: $600 million from 2002 to 2004 alone, the document stated.

Why We Can’t Weigh Risk

I hate flying, but I don’t think twice about packing my kids into the car and driving home late at night to avoid traffic. Of course I know there’s a much greater chance of an accident on the road then in the air, but I’d still choose ground transportation anytime. Why?

Well, according to my pal Karen Weintraub’s story in the Boston Globe today, humans are basically pathetic at weighing risk, even if we are intellectually aware of all the relevant facts and statistics.

And when there’s a perceived benefit to a risky activity, it seems to be even harder to avoid, researchers find. Weintraub looks at the example of overexposure to the sun. She writes:

It’s not that we’re stupid: Sunburns have certainly taught most of us the downside of too much sun. It’s just that our emotions and perceptions of the world temper our intellect. The sun feels good on our skin, it’s natural and familiar, so how could it be bad? And we can always go inside — our sun exposure is mostly within our control. So we downplay the warnings from our factual mind and enjoy the warm sensation on our skin.

“It’s about how a risk feels, not what the statistics or the science say,’’ according to David Ropeik, a consultant in risk perception and risk communication, and author of the new book, “How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts.’’

Indeed, the decisions we make about risk are far more complicated than cut and dry calculations about costs versus benefits, Weintraub notes, there’s a powerful emotional component too, which is, of course, why I hate flying.

“Our thinking about risk is influenced by two different processes,’’ said Paul Slovic, a professor of psychology at the University of Oregon. The first is an analytic process that’s based on numbers, fact, and logic. “The other is just intuitive or a gut feeling, and we use both of those mechanisms to evaluate risk.’’

An Advance In AIDS Vaccine Research

Mark Schoofs, writing in The Wall Street Journal today, reports on a breakthrough in AIDS research that could help pave the way for a vaccine against HIV, the virus that causes AIDS.

Schoofs explains the new research, published online in the journal Science:

In the latest development, U.S. government scientists say they have discovered three powerful antibodies, the strongest of which neutralizes 91% of HIV strains, more than any AIDS antibody yet discovered. They are now deploying the technique used to find those antibodies to identify antibodies to influenza viruses.

The HIV antibodies were discovered in the cells of a 60-year-old African-American gay man, known in the scientific literature as Donor 45, whose body made the antibodies naturally. The trick for scientists now is to develop a vaccine or other methods to make anyone’s body produce them as well…

Donor 45’s antibodies didn’t protect him from contracting HIV. That is likely because the virus had already taken hold before his body produced the antibodies. He is still alive, and when his blood was drawn, he had been living with HIV for 20 years.

While he has produced the most powerful HIV antibody yet discovered, researchers say they don’t know of anything special about his genes that would make him unique. They expect that most people would be capable of producing the antibodies, if scientists could find the right way to stimulate their production.

Mass. Hospitals Outperform Others In U.S.

A new federal ranking from the Centers for Medicare and Medicaid Services found that when it comes to the quality of outpatient care, and other measures, Massachusetts hospitals outperform others in the U.S.

The Boston Globe’s Liz Kowalczyk reports on the just-released CMS study of quality measures:

Massachusetts hospitals as a whole outperform hospitals across the country on the quality of outpatient care, including providing fast treatment to emergency room patients with chest pain and protecting surgery patients from infections, according to new federal data.

She says that the state also did better, on average, when it came to whether hospitals conducted too many MRI’s or other imaging tests, which can signal a culture in which overtreatment is encouraged.

For example, the agency tracked the percentage of patients with low back pain at a hospital that had an MRI without trying physical therapy or other recommended treatments first. If a number is too high, it may mean a hospital is doing unnecessary imaging tests. In Massachusetts as a whole, 30 percent of patients had an MRI first, compared with nearly 33 percent of patients nationally.

Berwick’s Recess Appointment Avoids A Nasty Confirmation Fight

Don Berwick, the Harvard pediatrician and advocate of quality health care, will be appointed by President Obama to oversee the federal agency that runs Medicare and Medicaid in a recess break, as a way to avoid a nasty confirmation battle with GOP lawmakers, reports the Boston Globe.

Berwick, who runs the Cambridge-based Institute For Healthcare Improvement, which backs novel approaches to making medical care both better and more affordable, has been attacked by Republicans for comments he’s made about his fondness for Britain’s national health system and about “rationing” health care. Democrats, and health policy experts in general say the attacks are completely without merit and that Berwick is uniquely qualified to run the U.S. Centers for Medicare and Medicaid Services, or CMS.

Still, by appointing Berwick during a Congressional recess, Obama can avoid a prickly fight, writes The Globe’s Susan Mulligan:

The recess appointment to the Centers for Medicare and Medicaid Services means Obama won’t have to subject his nominee to promised Republican grilling of Berwick in nomination hearings, because appointments made during official congressional breaks do not require a vote. The agency has not had a permanent director since 2006.

“Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points. But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing,’’ Dan Pfeiffer, White House communications director, wrote on his blog last night…

But Republican foes, who had been planning for months to wage an attack on Berwick and, by extension, the health care overhaul, were outraged. Seizing on some of Berwick’s writings, they were preparing to question him on what they called his support for “rationing’’ health care and his admiration of Britain’s National Institute for Health and Clinical Excellence, which Republicans deride as overly bureaucratic.

For more information, read Kaiser Health News’ Resource Guide to Berwick.

For An Immune Boost, Get Into Nature

I am lucky to have spent the long weekend in Wellfleet, in a cottage in the woods with my children. So I was overjoyed to read Anahad O’Connor’s “Really” column yesterday detailing the immune boost researchers have identified in people who have spent time outdoors around trees and nature.

In a series of studies, scientists found that when people swap their concrete confines for a few hours in more natural surroundings — forests, parks and other places with plenty of trees — they experience increased immune function.

Stress reduction is one factor. But scientists also chalk it up to phytoncides, the airborne chemicals that plants emit to protect them from rotting and insects and which also seem to benefit humans.

In Japan, the popular practice of visiting a nature park for its therapeutic effect is called “forest bathing,” O’Connor says, noting that one Japanese study found that “being among plants produced lower concentrations of cortisol, lower pulse rate, and lower blood pressure.”

A number of other studies have shown that visiting parks and forests seems to raise levels of white blood cells, including one in 2007 in which men who took two-hour walks in a forest over two days had a 50-percent spike in levels of natural killer cells. And another found an increase in white blood cells that lasted a week in women exposed to phytoncides in forest air.