HealthNow selects Benefitfocus for enrollment technology

BUFFALO, NY – HealthNow New York (HNNY), a healthcare company serving Western New York, has announced a partnership with Charleston, S.C.-based Benefitfocus to provide employers healthcare enrollment and e-billing technology.

With the new technology, employers will be able to offer employees a streamlined coverage administration platform that will allow employees to select and enroll in healthcare options provided by the company, officials say. The feature will also double as an administrative tool. Additionally, an e-billing component will be offered to employers that will provide a portal for paying company premiums electronically.

"Personalization at a very granular, employer-centric level is a big part of our design philosophy," said Shawn Jenkins, Benefitfocus president and CEO. "We provide multiple types of support tools to accommodate employer and customer needs.”

"We are continually seeking value-added services that improve satisfaction and engagement," said Kerri Garrison, vice president, Venture Growth for HealthNow. "The personalized plan selection tools and e-billing component in the Benefitfocus Platform takes that commitment to the next level by creating a portal that engages employers and members throughout the enrollment process."

In addition to a full spectrum of individual and employer-sponsored health plans, HNNY also provides members worksite wellness programs, pharmacy benefit management, behavioral health services and personal health concierges who serve as member advocates.

HealthNow joins other insurance companies managing their membership and benefits data in the world's largest benefits cloud. In addition to its plan selection tools, the Platform's data exchange capabilities can manage data for large, complex employers. Synchronized enrollment and billing technology eliminates the time and cost associated with manual invoice reconciliation. HealthNow will be live on the Benefitfocus Platform by November 2012.

With PSA Testing, The Power Of Anecdote Often Trumps Statistics

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

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

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

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

 

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

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

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

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

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

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

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

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

Arkes breaks it down in the journal Psychological Science.

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

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

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

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

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

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

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

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

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

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

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

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.

With new hospitals come new data centers

CHICAGO – Silver Cross Hospital’s recently opened data center puts it at the forefront of an emerging healthcare trend, according to Mortensen Construction, a company with hospital projects across the country. Combining construction of new hospitals with new data centers is becoming more common, according to company executives.

The trend is driven, they say, by the need to accommodate an explosion in applications and patient data – not only documents, but also images and videos.
 
With the February, 2012 opening of its 600,000 square foot, $370 million medical complex with outpatient center, medical service building and hospital, Silver Cross Hospital, a 289-room facility in New Lenox, Ill., needed to update and expand its aging data resources, which were already operating at capacity. So, the project also included a new 2,450 square-foot data center, 50 percent larger than its existing one.
 
Silver Cross also became one of the first hospitals to install patient tracking software so families know where a patient is at all times. New communication equipment supports wireless voice and data networks throughout the hospital, providing access to patients and their families while freeing clinicians to use phones and computers where needed instead of based on location. Also, medical telemetry enables remote monitoring of patient vital signs.

[See also: Chicago health system rolls out $3M virtual data center]

“From day one, the new capabilities have helped us improve care and have helped our medical staff to be more effective,” said Kevin Lane, Silver Cross vice president and CIO.
 
Other hospitals, including OSF HealthCare’s new Children’s Hospital of Illinois in Peoria and the soon-to-open Ann & Robert H. Lurie Children’s Hospital of Chicago, have combined new data centers with new medical facilities. As Mortenson executives see it, the hospitals are establishing a technology foundation for the emerging era in healthcare that will be dominated by electronic health records and new care delivery approaches that require real-time coordination and information exchange among multiple providers, payers, patients and locations.
 
“State-of-the-art data centers will become as essential to new healthcare construction as private patient rooms with flat-screen televisions,” said Greg Werner, Chicago office head for Mortenson Construction. Mortenson has built more than $4.5 billion in healthcare projects in the past 10 years, according to Werner, including Silver Cross and Lurie Children’s, with partner Power Construction. It has also built more than 11 million square feet of data centers – mission-critical space – nationwide, totaling more than $1.1 billion. 
 
Given the escalating IT demands, growth of bigger and better healthcare data centers is only likely to strengthen, Werner said. In a fall, 2011 survey by Mortenson of 90 data center and facilities experts at the 7x24 Exchange Conference, 92 percent of respondents ranked healthcare as the industry with the greatest need for new data centers in the next five years.

[See also: 6 keys to data storage]

HIE market still a little like the 'Wild West'

CAMBRIDGE, MA – Healthcare organizations have been very focused over the last two to four years on rolling out their electronic health record strategy, which has been driven largely by the meaningful use incentives. Today, however, Integrated delivery networks (IDNs) are starting to recognize that their EHRs alone will not solve every problem – especially care coordination issues between IDNs.

“We’ve seen much more of a focus with the IDN this year on what do we do next, what is the platform that enables us to leverage the EMR that we’ve invested in and build a more connected healthcare system,” said Paul Grabscheid, vice president of strategic planning for Cambridge, Mass.-based InterSystems. “We see much more interest than ever before among healthcare providers doing more to connect with their patients through patient portals and community-building capabilities.”

[See also: HIE as a verb: ONC wants to move quickly on data exchange]

IDNs want to get the most complete, most useful and usable information about patients from different systems to their clinicians when they need it to identify, for example, a population that’s important to them or identify patients who are in that population in order to systematically deliver better quality care, according to Grabscheid.

This business and clinical requirement has made health information exchange (HIE) attractive to IDNs and large providers because the value of HIE is its ability to intelligently aggregate patient data from multiple sources and present a comprehensive view of the patient’s medical status and history.

It comes as no surprise then that the larger market for HIEs is with IDNs and larger providers.

[See also: HIE on the upswing]

“It’s a younger market that is not so well crystallized yet,” Grabscheid observed.

As he sees it, despite the growth in this segment of the market, what’s lacking is a common understanding which software is needed to solve those problems and how best to solve those problems.

“There’s a lot of opportunity for education in the market and a lot of experimentation,” Grabscheid said. “It’s still a little bit of the Wild West.”

Grabscheid pointed out that simply exchanging pieces of data does not leverage the full value HIEs can deliver. He highlighted three IDNs that are looking to take advantage of InterSystem’s HealthShare’s HIE platform. A data model takes all the information accessible through HealthShare and makes it available for analysis via the analytics core technology. Key performance indicators or metrics can then be measured, and those results can be translated into charts and reports and onto dashboards to help clinicians and other users make sense of the data.

One IDN, which comprises 10 hospitals and 20 service sites, and also serves as a payer, is looking to connect its internal and external systems, which include Cerner and Epic EHRs, as well as create comprehensive patient records for provider and patient portals. One of the goals of the IDN is to reduce readmissions for its congestive heart failure patients through the use of analytics. Finally, the IDN wants to link to the regional HIE in its area.

A six-hospital IDN with a large primary/specialty care network is leveraging the HIE platform to streamline multi-payer administrative transactions; enable comprehensive record sharing between acute and primary care providers; alert clinicians of events to ensure safer, more effective care transitions; increase the effectiveness of primary care, specialist, and acute-site referrals; and automate public health reporting to local, state and federal authorities.

A large urban health system, comprising hospitals, clinics, skilled nursing facilities and home health, and serving more than one million patients, has a plan to connect its multiple EMRs, financial systems and more than 500 applications in order to present a consolidated patient record across the enterprise. Once that is accomplished, the IDN will connect to the seven regional health information organizations (RHIOs) in the area.
 
All three are leveraging the HIE platform for multiple initiatives that involve connectivity, interoperability, analytics, and quality measuring and reporting, which will deliver business and clinical benefits that surpass the EMR’s capabilities.

“They’re trying to figure out what they can see right now,” Grabscheid said, of the three IDNs. “But the one thing they know for sure is there’s more change coming,” he added, referring to the upcoming presidential election. “The most important thing in healthcare right now is staying nimble so that as the rules change you can react,” he said. “Trying to guess what is happening and start doing that is too tough. The key is to keep flexible.”

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 Law's Downfall Could Put GOP In Odd Spot

The Supreme Court will rule in the coming weeks on the constitutionality of the Affordable Care Act � the health care law that has been a flashpoint of partisan acrimony and debate since its beginning.

Much of that debate has been philosophical. But now that the law is under review by the country's highest court, politicians have to plan for the real implications of the court's decision. That's proving particularly difficult for congressional Republicans.

They've rallied for repeal of the plan since the day it passed in 2010. And they won a majority in the House later that fall.

But now the GOP has a problem. In the two years since the law passed, several of its parts have become very popular with voters � among them, parents' ability to keep kids on their health plans until age 26 and a ban on denying insurance because of pre-existing conditions.

So it wasn't surprising when news leaked to Politico last week that Republicans were making plans to try to preserve those popular parts of the act if the Supreme Court strikes the law down.

But the political blowback for the GOP was immediate and harsh. Staffers described dozens of calls from angry conservatives. Right-wing think tanks blasted the endorsement of what they called "government meddling in business." And just a few short hours after the news was leaked, House Speaker John Boehner, R-Ohio, sent an email blast to the media, saying, "Our plan remains to repeal the law in its entirety. Anything short of that is unacceptable."

This isn't the first time GOP leaders have hinted at their support for those provisions. Right after Republicans first won the majority, House Majority Leader Eric Cantor, R-Va., spoke at a forum at American University in Washington.

Student Alyssa Franke, who has a chronic medical condition, asked Cantor the question that still stands today: "Will you try to preserve these two provisions as they stand or continue to push for a full repeal of the health care bill?"

At the time, Cantor said: "We too don't want to accept any insurance company's denial of someone because he or she may have a pre-existing condition. And likewise, we want to make sure that someone of your age has the ability to access affordable care, whether it's under your parents' plan or elsewhere."

That was more than a year and a half ago, long before last week's firestorm over the same Republican sentiment.

What changed? Well, reality. Back in 2010, the concept of repealing the Affordable Care Act was a long shot. The idea of keeping the popular provisions and dumping the rest was mostly theoretical.

Now, there's a real chance the Supreme Court could strike the whole thing down. And the law is designed so that the ban on pre-existing conditions and the parents' insurance provision are paid for by the thing Republicans hate � the mandate that all Americans buy insurance.

House Democratic Leader Nancy Pelosi of California put the Republicans' quandary this way: "It's all about the guys who brung 'em to the dance. It's about the health insurance industry, and that's the agenda that they will roll out."

Insurance companies, many of which are big Washington political donors, are prepared to fight tooth and claw against any new insurance mandate that doesn't also generate new profits for them.

So Republicans may have to choose who they're going to listen to � the voters or the donors.

Trained Interpreters Can Help Prevent Medical Errors

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When someone arrives at the hospital who doesn't speak English very well, it's common for workers at the hospital who are fluent in that language �doctors, nurses, even administrative staff � to step in and act as the patient's interpreter.

Though they may be well-meaning, not to mention more affordable than trained interpreters, relying on such accidental interpreters during medical treatment is not the best idea, research has found.

Trained interpreters made about half the number of errors with potential clinical significance as so-called ad hoc interpreters, such as hospital staff or family members, in encounters at two large pediatric emergency departments in Massachusetts, according to a recent study published in the Annals of Emergency Medicine.

In order to pass training in medical interpretation at theNorthern Virginia Health Education Center, students must complete at least 40 hours of course work, which includes study in medical terminology, medical privacy issues and ethics, says Dallice Joyner, the program's executive director.

 

In addition, students must score at least 80 percent on a language fluency test to get into the program. "Not everybody passes," she says. "Just because somebody says they're bilingual doesn't mean they're actually fluent."

Under Title VI of the Civil Rights Act of 1964, medical providers that accept federal funds � for treating Medicare or Medicaid recipients, for example � have to provide access to language services for patients who don't speak English well. But funding for such services can be problematic, since many insurers don't reimburse providers for them.

Some hospitals nevertheless have rigorous training programs to ensure that the staffers they use for medical interpreting are up to the task, say experts.

At Inova Health System in Northern Virginia, for example, in addition to several full-time in-house interpreters, more than 300 people on the staff have completed a 40-hour medical interpreting course to prepare them to step in and help patients at the system's five main hospitals, says Alejandro Muzio, language services manager for Inova. They also use outside vendors when needed, he says.

In their service areas, providing such assistance is critical, he says. "In Fairfax County, 1 in 3 households speaks a language that's not English."

But at other hospitals, where staff with no formal training are pressed into providing interpreting services, common errors such as omitting or substituting words, editorializing, or making up words � called "false fluency" � are more likely to occur.

They may occur less often in the future. Starting in July, the Joint Commission, which accredits healthcare providers, will begin to eyeball specifics related to interpreter services more closely in their evaluations, as part of an initiative to promote cultural competence and patient-centered care.

Scared of spiders? You can escape that web

People undone by arachnophobia holding a huge, hairy tarantula in their bare hand? No worries, not after a single brief therapy session changed the brain's fear response in adults with the lifelong, debilitating phobia of spiders.

The "exposure therapy" was small, done on 12 adults, but all of them held or petted the spider afterward, the study from the Northwestern University Feinberg School of Medicine reported Monday. One participant celebrated by getting a spider tattoo after having been unable to even look at photos of spiders.

"A lot of people are afraid of spiders, but in order to meet the criteria (for a phobia), it has to be a clinical diagnosis and interfere with your life," says author Katherina Hauner, a postdoctoral fellow in neurology. "One participant would avoid walking in grass. Another, if he thought the spider was in the room or house, would have to leave the house for days."

Fear of spiders is a subtype of an anxiety disorder called specific phobia, one of the most common anxiety disorders, which afflicts about 7% of the population, the study says. Common specific phobias also include fear of blood, needles, snakes, flying and enclosed spaces.

Tarantulas are "docile," Hauner says, and would rather get away from a human than hunt one.

This is the first study to document the immediate and long-term brain changes after treatment and to illustrate how the brain reorganizes long-term to reduce fear as a result of the therapy, the study says. The findings show the lasting effectiveness of "short exposure therapy" for a phobia and offer new directions for treating other phobias and anxiety disorders.

"Everyone would come in thinking: 'I'm going to be the one who can't do this. There is no way," Hauner says. "They were impressed by the end."

In therapy lasting two to three hours, which is different for each person, the participants were taught that troublesome thoughts about tarantulas were untrue. "They thought the tarantula might be capable of jumping out of the cage and on to them," Hauner said.

Exposure therapy gets its name from exposing a patient to what he fears, says Todd Farchione, research assistant professor at the Boston University Center for Anxiety and Related Disorders. "A lot of it is about dispelling people's beliefs. You can get significant changes in a short period of time."

They learned to approach the tarantula until they could touch the outside of the terrarium. Then they touched the tarantula with a paintbrush, a glove and eventually pet it with their bare hands or held it.

Immediately after, an MRI scan showed the brain regions associated with fear decreased in activity when people encountered spider photos.

When the same people were asked to touch the tarantula six months later, "they freaked out in a good way," Hauner says. "They said they couldn't believe they were doing this."

Ore. company recalls tainted lettuce amidst listeria concern

PORTLAND, Ore.(AP)�A Portland produce distributor announced it is voluntarily recalling bagged lettuce that could be tainted with listeria.

The Pacific Coast Fruit Co. said the lettuce was sold to Fred Meyer stores in the Northwest, and also distributed to a pair of companies that stock vending machines.

Pacific Coast Fruit bought the lettuce from River Ranch Fresh Foods of Salinas, Calif., which issued a nationwide recall on Monday.

No known illnesses have been linked to the recall that has also prompted stores to pull deli sandwiches.

Symptoms of listeria infection include high fever, headache and neck stiffness.

A press release on the U.S. Food and Drug Administration website (http://is.gd/WofHmX ) includes a list of the lettuce products recalled by Pacific Coast Fruit.

Guaranteeing Value for Your Premium Dollars

When we pay for health insurance, we want to know that most of what we are paying for is for health care, not advertising, executive bonuses or overhead. It�s pretty simple: we want to get a good value for our premium dollars.

Thanks to a new rule (the �80/20 rule�) in the Affordable Care Act, you can be sure that insurance companies are spending generally at least 80 cents of every dollar you pay in premiums on your health care or activities that improve health care quality. If the insurance company fails to meet this standard, or the �medical loss ratio�, in any year, they have to pay you a rebate.

Insurance companies that didn�t meet the standard for coverage provided in 2011 are required to provide these rebates no later than August 1st of this year, and to make sure you know what you are owed, insurance companies that owe rebates will also send a letter telling you how much you�ll receive. You can see what that letter will look like here. �According to early estimates from the Kaiser Family Foundation, insurance companies will provide 15.8 million Americans with $1.3 billion in rebates.

Today, we�re also finalizing a notice for insurance companies to send you if they meet or exceed the standard. If your insurance company is providing fair value for your premium dollars, you should know that too. You�ll be able to see your plan�s medical loss ratio on HealthCare.gov starting this summer.�

The 80/20 rule and the rate review program are two ways the Affordable Care Act is protecting you. You can find out more about how the Affordable Care Act increases transparency and protects consumers here: http://www.healthcare.gov/news/factsheets/2012/02/increasing-transparency02162012a.html.

New HL7 program seeks to spur EHR participation

ANN ARBOR, MI – Health Level Seven International (HL7) announced Wednesday the inception of its pilot membership program and launched a website aimed at increasing caregivers’ participation in the development of electronic health record (EHR) standards.

"For several years, the HL7 leadership has voiced its concerns about the typical first encounter with the standards development process,” said Charles Jaffe, MD, CEO of HL7. However, he added, “Now we are in a better position to translate the practical clinical expertise of these caregivers into tangible improvements in the interaction with the health record technology."

Feliciano Yu, MD, a practicing pediatrician and chief medical information officer at St. Louis Children’s Hospital, and co-chair of the HL7 Child Health Work Group, explained that his engagement in HL7 has allowed him “to make a tangible impact on how technology is used in healthcare.” He went on to say, “I reap the benefits in a very practical way as I apply technology within my institution.”

With an HL7 Caregiver Membership, clinicians can:

Help ensure that standards adopted for healthcare IT (HIT) offer real and practical value in supporting the information exchange between health providers essential to coordinating patient care;Improve the quality and usability of the HIT standards developed by HL7 and, ultimately, the EHR products that use them;Network with HL7 members who are nationally recognized experts in HIT;Share knowledge and gain insight on how the use of data standards affects clinical practice in supporting patient care and improving quality and efficiency;Have the information they need to make informed decisions in EHR purchases, and know what to request from vendors.?

“HL7 standards are the most widely used in the industry,” said Don Mon, chair, HL7 board of directors. “Caregiver members will not only gain first-hand exposure to the standards and technology that drive clinical summaries, laboratory results, prescriptions, and public health and quality data, they will have a direct channel to influence the clinical technology requirements that support an increasingly patient-centered healthcare system.”

Standard development projects currently under way that will benefit from caregiver input include HL7:

Electronic Health Records System Functional Model, Release 2Preoperative Domain Analysis Model (DAM)Emergency Medical System DAMNeonatal Functional ProfileCardiovascular DAM

Functional models and profiles describe requirements for EHR system capabilities. DAMs describe workflow and data requirements within specific domains of care.

Health coverage for ex-prisoners: a quiet but important benefit of health reform

"If I'm trying to sell health reform, the smiling waitress with two kids, the laid-off steel worker, and the 7th grader with cancer work better on the campaign posters. Yet for many reasons � some obvious, some not � the health and well-being of ex-prisoners has a disproportionate impact on us all." - Harold Pollack

I began my public health career on a Yale postdoctoral fellowship. One of my formative experiences there was to accompany colleagues on the Community Health Care Van, a needle exchange-based mobile clinic for street drug users. I helped people complete basic paperwork.

A weathered middle-aged guy stepped onto the van. When I asked what brought him there, he pulled back his shirt to reveal a chalky-white oozing crater in his shoulder. That festering infection was my rude introduction to the life realities of injection drug users.

Most of these women and men suffered greatly. Most were uninsured. Facing complex illnesses, addiction, and severe life challenges, many nonetheless consumed enormous health system resources as they cycled through correctional facilities, became emergency department frequent-fliers, and required heavy use of other safety-net services.

We demonstrated that Community Health Care Van services reduced patients' emergency department use. We could have done more for these patients and their loved ones if we could have provided reliable primary care, appropriate drug treatment, and other services requiring insurance coverage.

This won't matter politically, but the Affordable Care Act will quietly improve public health by expanding coverage for hundreds of thousands of ex-prisoners and others under the control of the criminal justice system. Most of these men and women are on parole or probation. A nice Health Affairs paper by Alison Evans Cuellar and Jehanzeb Cheema runs the numbers. Roughly half of the 700,000 people released every year from correctional institutions will gain coverage or improved care under health reform.

Why we should care about ex-cons

Yeah I know. Ex-prisoners aren't the most cute and cuddly people who need insurance coverage. If I'm trying to sell health reform, the smiling waitress with two kids, the laid-off steel worker, and the 7th grader with cancer work better on the campaign posters. Yet for many reasons � some obvious, some not � the health and well-being of ex-prisoners has a disproportionate impact on us all.

For one thing, a large percentage of Americans with HIV/AIDS, tuberculosis, hepatitis C, and other infectious diseases pass through the gates of our jails and prisons every year. Engaging these men and women into care � and keeping them safe and healthy � yields huge public health benefits.

Many ex-prisoners suffer from severe mental illness. As states and localities implement punishing cuts to the medical safety net, frightening numbers of people have limited access to appropriate care, sometimes with tragic results.

There's suggestive evidence that ex-prisoners with health insurance may be less likely to continue prior drug use. They are also less likely to re-offend. Many ex-prisoners have serious drug problems. Absent insurance coverage, many find themselves on long waiting lists for treatment programs. Many women with drug problems require access to reproductive health services to avoid unintended pregnancies.

Nowhere to turn

Right now, many ex-offenders are ineligible for public insurance coverage. The panhandler at the train station with a heroin problem is simply poor. He isn't a vet. He isn't a mom. Addiction and substance abuse are not qualifying conditions for federal disability programs. If he has a history of violent or drug felonies, he may be barred from important aid programs. If he was enrolled in Medicaid prior to incarceration, he might well have been automatically disenrolled upon entry to jail or prison.

The Affordable Care Act improves this situation. Most important, poor people qualify for Medicaid even if they don't match the specific categories of various assistance programs. If your income falls below 133 percent of the federal poverty line, you are eligible. This is a boon for poor people. It is also a boon for mental health and drug treatment centers, and other safety-net providers. These facilities now have a reliable source of payment for their indigent patients. Many ex-prisoners will also benefit from affordability credits and protections provided under the new state health insurance exchanges.

Much practical work remains to be done. Many prisoners serve their time in relative health. They then disappear until they get rearrested or face some crisis that requires costly care. Many offenders lead chaotic lives. Some are homeless or have no fixed address. They aren't always fastidious if they are asked to return three times to the welfare office with different forms. Enrollment and retention procedures for both Medicaid and for the new exchanges must be carefully designed in light of these realities, to ensure that ex-prisoners are actually covered.

I'll bet less than one percent of the American public has thought about this difficult � often thankless � activity on behalf of an easily despised population. It's still important to protect public health and to relieve suffering. It's another reason to support health care reform.

IT pledge has market on pins and needles

WASHINGTON –  President Barack Obama’s pledge to inject $50 billion into the healthcare field over the next five years to develop and support technology has many in the industry wondering how and where that money might be spent.

On Jan. 22, 117 CEOs and business leaders sent a letter to House and Senate leaders supporting federal investment in healthcare information technology, broadband and energy smart grids, saying they “will provide our nation with a near-term stimulus and long-term comparative advantage.”

“Congress and the new Administration face a formidable task, restoring the nation’s confidence and encouraging the innovation, risk-taking and entrepreneurship needed to get our country moving again. The investments in a smarter energy grid, healthcare IT (such as electronic medical records) and accelerating broadband deployment recommended by President Obama will not only stimulate the economy, but will also accelerate long-term growth. They fund the future,” the letter read.

“I expect that the Obama Administration will strongly promote both electronic health records and electronic prescribing, and there is little doubt that this is good news for the country, for patients, for physicians and for Allscripts and other healthcare IT companies,” said Glen Tullman chief executive officer of Allscripts-Misys Healthcare Solutions. “I anticipate these new programs will include both carrots and sticks, similar to the successful CMS e-prescribing program that took effect this month. By encouraging physicians not only to buy the technology but just as importantly to provide incentives for its use, I think we’ll see a significant uptick in adoption and, as a result, better care for patients at lower cost.”

VirtualHealth Technologies, Inc., a Lexington, Ky.-based healthcare IT vendor, issued a press release the day after Obama’s entry into the White House announcing plans to develop new practice management, electronic medical records, secure messaging and patient portal technologies in the coming year.

These Health Law Bets Are No Figure Of Speech

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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."

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

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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.

Embattled Hospital Debt Collector Taps Politicians For Defense

Jim Mone/AP

Minnesota Attorney General Lori Swanson announces a lawsuit against Accretive Health in Jan., saying the company failed to protect the confidentiality of health care records for thousands of Minnesota residents. The charges have widened to include the company's tactics in collecting debts.

So what do you do when you're accused of hitting up sick patients in the hospital to pay their bills � sometimes even before they get treatment?

Well, if you're Chicago-based Accretive Health, under fire by not only the Minnesota Attorney General but key members of Congress and possibly the Obama Administration, you fight fire with fire. You line up your own set of political defenders.

To back up a bit, this story began last year with a stolen laptop, which led to a January lawsuit filed by Minnesota Attorney General Lori Swanson charging Accretive with privacy violations.

The resulting investigation led, in turn, to an April story in The New York Times, that chronicled how Accretive workers allegedly posed as employees in Minnesota hospitals, and included "embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment."

 

Accretive struck back, charging that that Attorney General Swanson's report contained "inaccuracies, innuendo and unfounded speculation." The company also enlisted a formidable political ally � Chicago Mayor and former Obama Chief of Staff Rahm Emanuel. He personally asked Swanson to back off, noting in a letter that the company "does important work for hospitals and good things for our City, particularly for our neediest citizens."

Swanson, however, declined Emanuel's entreaty. "We will continue to interview witnesses and perform our law enforcement responsibilities over charitable hospitals in Minnesota," she said in a statement.

So now Accretive is upping the ante. It has enlisted a veritable who's who in health policy to come up with "national standards for how hospitals and other providers interact with patients regarding their financial obligations." In other words, how aggressive can debt collectors be without running afoul of federal law, various or regulation or good public relations.

The group includes some well-connected heavy-hitters, including former Bush administration Health and Human Services Secretary Mike Leavitt and Medicare chief Mark McClellan, former Senate GOP leader Bill Frist,. There some prominent Democrats too, including former Clinton Administration HHS Secretary Donna Shalala and former Senate Democratic leader Tom Daschle.

For all of Accretive's alleged misdeeds, however, the collection of outstanding bills is a serious one for hospitals, particularly as they await the Supreme Court's decision about the 2010 health law. Hospitals agreed to take significant reductions in Medicare payments with the expectation they would make that money back when currently uninsured patients whose care now goes unpaid would gain coverage.

Should the high court strike down the requirement for most people to obtain insurance, however, that could leave hospitals in a financially difficult spot.

Study: Long use of any hormones poses breast cancer risk

CHICAGO(AP)�New research suggests that long-term use of any type of hormones to ease menopause symptoms can raise a woman's risk of breast cancer.

It is already known that taking pills that combine estrogen and progestin � the most common type of hormone therapy � can increase breast cancer risk. But women who no longer have a uterus can take estrogen alone, which was thought to be safe and possibly even slightly beneficial in terms of cancer risk.

The new study suggests otherwise, if the pills are used for many years. It tracked the health of about 60,000 nurses and found that use of any kind of hormones for 10 years or more slightly raised the chances of developing breast cancer.

"There's a continued increase in risk with longer durations of use and there does not appear to be a plateau," said study leader Dr. Wendy Chen of Brigham and Women's Hospital in Boston.

The hormone picture has been confusing, and the absolute risk of breast cancer for any woman taking hormone pills remains small. Doctors say women should use the lowest dose needed for the shortest time possible.

"It's hard to be surprised that if you keep taking it, sooner or later it's going to raise risk," said Dr. Robert Clarke of Georgetown University's Lombardi Comprehensive Cancer Center.

The study was discussed Sunday at a cancer conference in Chicago.

What People are Saying: Promoting Coordinated Health Care

Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced final rules for a new program designed to encourage primary care doctors, specialists, hospitals, and other health care providers to coordinate their care.� Created by the Affordable Care Act, these rules on Accountable Care Organizations (ACOs) add to the menu of options for providers looking to better coordinate care for patients and will make it easier for providers to deliver high quality care and use health care dollars more wisely.

These rules followed months of comment and soliciting feedback from stakeholders across the health care industry.� Here�s what people are saying about the new rules:

AARP: "The programs announced today can benefit people in Medicare by encouraging providers to work together to better coordinate patient care"

American Medical Association: "We are pleased that the final rule on Medicare Accountable Care Organizations (ACOs) includes many of the important changes recommended by the AMA to allow all interested physicians to lead and participate in these new models of care."

American Hospital Association: "We believe today�s menu of ACO options allows America�s hospitals to create new models of accountable care organizations on which the transformation of health care delivery is so dependent."

Association of American Medical Colleges: "Medical schools and teaching hospitals� institutions that often treat the sickest and most vulnerable patients�have a better opportunity to participate in the ACO initiative."

American Medical Group Association: �CMS has listened to what other people said and proposed a different approach�I�m hoping lots of ACOs form because of the potential this model has for transforming our health system for the better.�

National Association of Public Hospitals and Health Systems: "By listening and responding to provider concerns, the administration has taken positive steps toward developing a program that will provide more integrated care to patients in a framework feasible for providers... These changes will allow hospitals and other providers to more easily participate in the program, and should add to the success of this initiative and future innovations in health care delivery system reform."

Campaign For Better Care: �As advocates for consumers, particularly for our oldest and sickest patients who urgently need better-coordinated care, we applaud this effort to incentivize better primary care, increase coordination, and share accountability across providers. We are very pleased that this final rule will require ACOs to adhere to strong patient-centered criteria, use beneficiary experience of care measures to evaluate performance, and ensure full transparency, notification and choice for beneficiaries.�

Quality Health Care is More than What Happens in the Doctor’s Office

What does high quality health care mean to you�as a patient, a family member, a taxpayer, and an American?

High quality care is about more than getting better when you are sick.�It means getting an appointment with your doctor when you need one, and getting to spend enough time with them to discuss the decisions that affect your care.�

It means all of your doctors talking to each other, so that you don�t have to do the same test over again or be on your own to figure out if prescriptions from two different doctors are safe to take together.�

It means never having to worry that going to the hospital to treat one illness will expose you to catching another one.�

It means knowing how to stay healthy and keeping small health problems from becoming bigger ones.

And it means that we have a health care system that uses our dollars wisely so that care is affordable.

Making sure that every American receives this kind of high-quality health care all the time takes a lot of people working together.� The United States has the most highly-skilled doctors and nurses in the world, but they can�t do this alone.� It takes patients, insurance companies, employers, communities, and health care providers all being on the same page.

That�s why the new health care law, the Affordable Care Act, called for a National Quality Strategy so that we�re all focused on the same goals.� Last March, after talking to patients, providers and stakeholders from around the country, we released the first-ever National Quality Strategy and focused the nation�s attention on 6 priorities for improving health care quality.�

And we�re building on that work.�� Today, we announced our progress on the National Quality Strategy. For each of our shared priorities, we have nationwide initiatives � happening in all 50 states � to improve health care quality.�We�ve picked key measures to hold the system accountable for truly improving quality, not just talking about it.����

And there�s more to come. The National Quality Strategy isn�t just a piece of paper that�s going to sit on the shelf and collect dust. It represents just some of the actions we�re taking to ensure that Americans have access to affordable health coverage and high-quality health care that they need and deserve.

To read more about the National Quality Strategy and what we�re doing to improve health care quality, visit this page.

EHR Association weighs in on Stage 2

CHICAGO – The HIMSS Electronic Health Records Association logged its comments on Stage 2 meaningful use with CMS and ONC this past Friday. Members of the vendor group praised the decision to delay Stage 2 by a year, allowing more time for development and testing.

The association responded to notices of proposed rulemaking (NPRMs) from both the Centers for Medicare and Medicaid Services, related to meaningful use objectives and measures for providers' use of certified EHRs, and the Office of the National Coordinator for Health IT, regarding EHR certification criteria and standards related to Stage 2.

The group offered recommendations on proposed certification criteria and standards, as well as on Stage 2 meaningful use requirements for providers. It praised CMS’ confirmation of a one-year delay in the start of Stage 2 in order to allow more time for testing and implementation of EHRs updated for Stage 2 – something that had been requested by a wide variety of stakeholder organizations.

"This was truly a collaborative effort that engaged more of our members than any of the previous public comment opportunities," said Leigh Burchell, vice president of government affairs for Allscripts and chair of the association’s Public Policy Leadership Workgroup. “Seven of our eight standing workgroups focused on specific sections of the NPRMs, ultimately collecting feedback from 138 individuals representing 25 member companies. We’re delighted with the level of participation, which represents the majority of operational EHRs in the U.S. and, most importantly, their users, lending credibility and weight to these comments.”

The EHR Association represents a community of software developers with many decades of experience creating successful electronic health records and related modules. Members noted that comments and suggestions sent to ONC and CMS represent companies ranging from developers of small ambulatory systems to large enterprise systems, software-as-a service models to traditional software, and software module suppliers.

“Through our comments, we try to highlight many of the initiatives from ONC and CMS that we agree with and offer our comments on how to fine-tune other areas for best adoption by our users,” said Carl Dvorak, vice president at Epic and chair of the EHR Association.

“We are honored to carry the message from our customers to ONC and CMS in support of appropriate timelines for not only software development and deployment, but most importantly for safe adoption by clinicians," he added. "In this regard, we strongly support and appreciate CMS’ proposed one-year extension of Stage 1 of meaningful use. We also recommend that CMS and ONC consider the additional ideas shared previously by the EHR Association and again in our comments this week that would build upon the one-year extension and assist in holistically resolving the challenge of appropriately timing Stage 2 for all stakeholders.”

Association members also noted that many elements of both the CMS and ONC proposed rules are aimed at substantially increasing the use and benefit of standards-based interoperability and exchange, which has been one of the EHR Association’s areas of advocacy and support since its inception in 2004.

“Overall, we congratulate ONC and CMS on the tremendous effort that went into the development of the proposed rules, as well as the progress we’ve made as an industry in accelerating the adoption of EHRs and other health IT," said Burchell. "We are ready to work with ONC and CMS to add clarification to the final rules as quickly as possible after they are published to ensure that our companies are ready to support the work our customers will need to do to upgrade their systems and implement many new features prior to the rapidly approaching start of Stage 2.”

Read the EHR Association's letters to National Coordinator for Health IT Farzad Mostashari, MD, and Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner, with their respective comments on the Stage 2 NPRMs, here and here.

Doctor Pay: Where The Specialists Are All Above Average

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Making a living practicing medicine is more complicated and frustrating than ever. But it still pays. And pretty well.

A survey of more than 24,000 doctors conducted online for Medscape, a doctor-oriented information service of WebMD, finds that their average annual pay ranges from $156,000 for pediatricians, the lowest-paid specialty, to $315,000 for the top earners.

Who makes the most? Specialists who do things to you. Orthopedic surgeons and radiologists top the earnings chart at an average income of $315,000 a year. Right behind them are the cardiologists and anesthesiologists at $314,000 and $309,000, respectively.

Medscape says the order of the top earners is the same as the last survey, though annual compensation fell 10 percent for both radiologists and orthopedic surgeons. General surgeons saw their pay drop the most � by 12 percent since 2010. Ophthalmologists saw the biggest increase � 9 percent.

Who makes the least? After the pediatricians, it's family practitioners and internists at $158,000 and $165,000, respectively. Other doctors who do a lot of talking rather than performing procedures, are on the lower end of the pay scale, such as psychiatrists at $170,000.

Kaiser Health News points to other groups' findings on doctors' pay with slightly different results. A Medical Group Management Association report based on 2010 data, found the median compensation for radiologists was $471,253 and $192,148 for pediatricians.

The Medscape survey asked doctors if they consider themselves rich. Overall, just 11 percent said yes. High debts may be one factor.

But Americans generally take a different view, according to a 2011 Gallup poll. Most people say anyone with an annual income of $150,000 or more is rich. And the U.S. Census Bureau pegs the median household income at just shy of $50,000 in 2010. So even the pediatricians are looking pretty prosperous.

Compare International Medical Bills

Countries with governments and economies similar to the United States have come up with a variety of methods to make sure that all of their citizens receive health care. While residents in Europe and Japan may pay higher insurance premiums or taxes than Americans, in the end, when all costs are added up, Americans spend more money on health care per person with fewer people covered. (Data most recent available as of July 2008.)

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Your doctors try hard to give you the best care possible, but it can be a challenge to get all the information they need to protect your health.� For people with Medicare, this is particularly important because a significant number of people over age 65 and those with disabilities live with one or more chronic conditions. That is why I�m so pleased with the work we are doing with doctors and hospitals to find ways to improve care and reduce costs.

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When doctors, hospitals, and other health care providers are able to work together they provide better, more coordinated health care. Thanks to the Affordable Care Act, they can do that by becoming an Accountable Care Organization (ACO).

By taking this step, providers will be able to communicate closely with each other about your health with the goal of delivering better and more coordinated care while meeting your needs and preferences. Doctors will be able to spend more time with patients. And specialists and primary care doctors will communicate more to ensure that you get the care you need.

Medicare will help doctors and hospitals that choose to participate ensure you are getting the right care, in the right place, at the right time.� And if that care coordination lowers costs, doctors and hospitals as well as Medicare can share in the savings � shifting payments toward value rather than volume of care.

Your Medicare benefits will stay the same. You can see still see any doctor or healthcare provider who accepts Medicare � even if your doctor chooses to participate in this program. Nobody � not your doctor, not anyone � can limit your choice on who you see.�