Health Care Hoopla: A Primer from the AP

The AP published a pretty good breakdown yesterday of how the proposed health care reform bill in its current incarnation would affect Americans.

It looks to me like the main problems/areas of instability or unease would lie in:
(1) the Employers section, where large employers would be fined if they don't figure out a way to monitor whether employees receive federal assistance -- monitor without violating privacy laws.
(2) the fact that it's going to take three to four years for the exchange and insurers not being allowed to kick people to the curb.
(3) the changes to how medicine is practiced, as PCPs and other general practitioners and surgeons will all have to shift how they treat patients (bc while doctors should already be working to keep patients healthy, the system really is a pay-as-you-go, non-holistic setup). I think this would be viewed as a good change, but a rocky one.

Pennsylvania: Pediatricians and Paperwork

Published on July 27, 2009 in THE PHILADELPHIA INQUIRER.

Summer's no vacation for pediatricians

Pediatricians know it's summer when the health forms start piling up.

For everything from day care and camps to college and driver's license applications, each form asks different questions and often requires handwritten answers.

"It's overwhelming, particularly in the summer" when camps, school, and sports seasons converge, says Jeffrey Bomze, a pediatrician whose Bryn Mawr practice sees around 3,000 patients a year. "It's not just a signature and out the door."

Every year, pediatricians typically see about 95 patients per week, according to the American Academy of Pediatrics. At nearly 5,000 patients per year, four health forms per child, and about eight minutes per form, that means one person could spend 333 workdays a year on health forms alone.

And it's getting worse.

Read the full story here.

Pennsylvania: Insuring the Uninsured

Published on July 1, 2009 in THE PHILADELPHIA INQUIRER.

Bill to expand Pa. health insurance sparks debate

By Michael Vitez and Heather J. Chin
Inquirer Staff Writers

Democratic leaders in Pennsylvania hope to double the number of residents who receive state-sponsored health insurance, known as adultBasic, but Republicans fear the costs may be too high.

The Pennsylvania House on Monday voted, 104-98, in favor of HB 1, to increase the number of individuals receiving adultBasic from 45,000 to 90,000.

Republican leaders in the Senate say they might oppose the effort. Carolyn Scanlan, president and CEO of the Hospital & Healthsystem Association of Pennsylvania, also expressed reservations.

Pennsylvania, like the nation, has seen the numbers of uninsured soar in the last year as the economy has declined, making a bad situation much worse.

AdultBasic is designed for people who earn too much to qualify for poverty programs such as Medicaid but can't afford insurance themselves.

An individual is eligible for adultBasic if he or she earns $21,600 or less; a family of four can earn $44,000 or less.

The program can't begin to meet the rising need. The waiting list, officials say, is growing by 20,000 a month and projects 270,000 as of today.

A year ago, it was at 96,000.

Read the full story here...

AIDS Activists Flunk New York City Health Care Services

D. D-minus. F.

Those are the grades that HIV and AIDS advocates gave to New York City’s health care services.

To mark President Obama’s 50th day in office on Wednesday, March 11, AIDS and HIV prevention advocates from around the country issued a health care report card grading the nation’s progress in finding a cure for the epidemic. The “End AIDS Report Card,” compiled by the activist organization Campaign To End AIDS, failed the city across the board on the services such as housing and medication distribution.

“We need a national strategy to end AIDS,” said Charles King, CEO of Housing Works. “Twenty five years into the epidemic and we still don’t have a coherent national strategy on prevention or on treatment services and care. There has to be a strategy that involves every single state and every single locality doing its fair share.”

New Yorkers gather in Harlem in front of a statue of civil rights advocate, Adam Clayton Powell, Jr., to protest what they call a failing city health care system.

Go to NYC On Deadline to read the rest of the report, view video coverage and listen to interviews.

NATIONAL: School Seeks To Connect Health Policy With Care

(previously published here at www.thebulletin.us)

By Heather J. Chin, The Bulletin

10/06/2008

After a spiritual retreat to Rome in which he met with Vatican leaders in healthcare from around the world, David B. Nash, M.D., M.B.A. returned to Philadelphia, and to Thomas Jefferson University, where he has been named inaugural dean of a new graduate school of health policy.

The establishment of the Jefferson School of Health Policy and Population Health (JSHPPH) was announced last week by University President Robert L. Barchi, M.D., Ph.D., who described it as building on Jefferson's expertise in health-care quality improvement and chronic care management and providing "a venue for this expertise that is recognized nationally and internationally."

The school, which will be housed in existing facilities, is an expansion of the Jefferson Medical College's Department of Health Policy (DHP). It will feature an interdisciplinary curriculum where medical, nursing and allied health students, as well as recent undergraduates and mid-career professionals, take classes together, both online and in traditional classrooms.

According to Dr. Nash, currently the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and chair of the DHP, this school was months in the making and its purpose is to "address the health-care crisis in the United States - its quality, safety, affordability and accessibility."

"One of the things we're going to teach in our new school is how important it is to take care of the underserved," said Dr. Nash, also a board member of Catholic Healthcare Partners, the non-profit health system that sponsored the Rome retreat. "We're going to pay a lot of attention to the meaning of the word 'mission' in health care."

JSHPPH's stated mission is "to prepare leaders with global vision to develop, implement and evaluate health policies and systems that improve the health of populations and thereby enhance the quality of life."

In Sept. 2009, the school will open for individuals interested in Master's degrees in Public Health and Health Policy, or Chronic Care Management and Healthcare Quality and Safety - two unique programs that are the first of their kind in the nation and region.

The range of programs are aimed at attracting individuals with a variety of interests and career goals. So while the Quality and Safety program may attract mid-career professionals and undergraduates with an interest in social organization and improvement, the Chronic Care program may appeal to people who interact with families - existing nurses, case managers and diabetes educators - and the health policy program students aiming for academia or the governmental process.

As the new school develops further, dual degree programs and two doctoral programs in Health Policy and Population Health Sciences will also be added.

In addition to Philadelphia's resources, JSHPPH is building partnerships with Widener Law School, the University of Delaware and other business schools in the area.

Cooperation will also come from Catholic Healthcare Partners, the American College of Physician Executives, and the American College of Medical Quality.

Key collaborators in the creation of JSHPPH include the Department of Family and Community Medicine, Kimmel Cancer Center and its Division of Population Science in the Department of Medical Oncology, the Center for Applied Research on Aging and Health, and the Jefferson School of Pharmacy.

For Dr. Nash, the opportunity to continue almost two decades of work at Jefferson, developing his interest in health policy and health care, has been rewarding.

"I'm waking up very, very early every day and thinking about the things I have to do," he said.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH: Alzheimer's Patients Resist 'Elderspeak'

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/31/2008

Most parents have experienced a child's resistant behavior at being lectured, then realized their tone often outweighs what they try to say. Now a study published in the American Journal of Alzheimer's Disorders and Other Dementias shows Alzheimer's patients often resist care, become upset and act out when caregivers talk to them like children.

University of Kansas School of Nursing researchers found the tendency of caregivers - whether by family or professional nursing staff - to use infantilizing speech dealing with elderly or infirm patients likely increases a patient's agitation and resistance to care.

The disruptiveness to nursing care contributes to an overall 30-percent increase in costs of such care. These findings were presented Monday at the International Conference on Alzheimer's Disease in Chicago.

Nursing experts describe "Elderspeak" as a type of speech involving an overly caring, yet controlling, tone of voice, shortened sentences, repetition and the use of inappropriately intimate terms of endearment such as "sweetie" or "dear."

"The style of communication that we use with people with Alzheimer's influences how they feel about themselves and how well they respond to those providing care," said Sam Fazio, Ph.D., director of medical and scientific relations at the Alzheimer's Institute.

"People who have dementia are trying to maintain their sense of being a person. And ... if someone is talking to them like they are an infant, that might be distressing," said lead researcher Kristine Williams, R.N., Ph.D., an associate professor at the University of Kansas.

In the study, researchers videotaped the nurses' and nursing assistants' daily interactions with 20 nursing home residents. Ranging between 69 and 97 years of age, the residents had moderate levels of dementia, requiring different levels of care.

A measure called the Resistiveness to Care Scale (RTCS) was used to gauge the type and degree of disruptive behaviors. Actions termed "resistive" included grabbing onto persons or objects; turning away; pulling the limbs tightly to the body; saying 'no' or crying out; and hitting or kicking.

When these behaviors occurred, the researchers rewound the tape seven seconds to see whether any particular type of communication led up to it.

"[We found] they were more likely to be resistive to care if the nurses were using the 'Elderspeak' communication compared to the normal adult-to-adult kind of talk," said Dr. Williams.

"They also tend to alter the pronouns, [perhaps saying] 'Are we ready for our bath?' ... instead of 'Are you ready for me to help you with your bath?'"

Combined, these alterations in communication and speech patterns have the effect of enforcing the sense the patient receiving treatment stands helpless or highly dependent on the caregiver. Furthermore, the caregiver tends to use "Elderspeak" more often according to how much infirmity they perceive in the patient.

"What, theoretically, we think is going on is that younger people have stereotypes of older adults as being less able to communicate, less competent in a lot of different areas," Dr. Williams said

For family members who witness "Elderspeak" in a nursing home or assisted-care environment, Dr. Williams does not recommend hostile criticisms. Instead, "try and tell them a little bit about your loved one, that they were a high-functioning adults. To get them thinking more of the person in terms of that competent adult framework."

"[Caregivers] really have to know who that person's been their whole life, and not just define them in terms of their disease or their symptoms," said Dr. Fazio, of the Alzheimer's Institute.

"People are always saying, 'Oh, I can't do that because it's going to take more time and I have too many people to take care of.' But this showed us that the other way of doing things was causing even more time and care."

The number of people with Alzheimer's likely will increase to over 106 million people worldwide by 2050.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

LOCAL: PCVB Seeks More Health Care Conferences, Sporting Events

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin
07/24/2008

"America's life sciences meetings destination" may become the newest Philadelphia marketing slogan, according to officials from the Philadelphia Convention & Visitors Bureau. They unveiled their business strategy on Tuesday, aimed at drawing more visitors with a variety of programming - including more health care conventions.

Forty percent of all meetings held at the Philadelphia Convention Center are devoted to health care and life sciences, while 55 percent are held in Philadelphia-area hotels. PCVB hopes increased marketing and cooperation with economic-development groups to recruit related students and businesses to the region, the city will become a global destination for meetings.

The greater Philadelphia area hosts many health care; pharmaceutical and biomedical research; manufacturing; and marketing facilities, including U.S. branches of international corporations.

"Not only do we have the community to hold those conventions, but also the connections in the life sciences to make these things happen," said Mr. Jack Ferguson, executive director of PCVB. From being within driving distance from 85 percent of "big pharma" in the country and [institutions] of higher education, "we've got the infrastructure to do it and an expanding convention center to host."

Philadelphia is the 12th most-visited U.S. city for international visitors, and tourism rose by 27 percent last year, to around 550,000 visitors, according to U.S. Department of Commerce figures, due in part to the strength of foreign currency against the dollar. This increase was valued at $1.2 billion in economic impact for the region, PCVB President Tom Muldoon told a regional business news publication.

The convention center, at 15 years old, is set to expand from the current 440,000 square feet of exhibit-hall space to 700,000 square feet. Construction could finish in January 2011, at an expected cost of between $700 million and $800 million.

In addition to more life-science conventions, PCVB's business plan for the upcoming fiscal year aims to attract individual and group tourism, multicultural groups and sporting events. The Philadelphia Sports Congress, a division of PCVB, has already hosted the U.S. Olympic Team Trials in Table Tennis and Gymnastics, generating over $20 million in economic impact.

The PCVB and the Sports Congress, also continue to build on the Philadelphia 2016 Olympic bid, further branding the city as an international and Olympic sports destination city.

"If our city is to compete in a global marketplace, we need to continue to tell the Philadelphia story to people around the world so they choose to travel to America's birthplace," said Mayor Michael Nutter.


Heather J. Chin can be reached at hchin@thebulletin.us


©The Evening Bulletin 2008