Fred Hutchinson Cancer Research Center announced today that it has named an expert in cancer genetics and precision medicine. D. Gary Gilliland, M.D., Ph.D., a physician-scientist with a background in academic medicine and the pharmaceutical industry, as its new president and director. Gilliland will take the helm as Fred Hutch’s new leader on Jan. 2.
Fred Hutch and SCCA experts weigh in on the good, bad and ugly of the electronic cigarette quandary
By Diane Mapes / Fred Hutch News Service
“Our patients are highly motivated to quit, but they’re confused about the mixed messages of e-cigarettes,” said Donna Manders, a certified tobacco treatment specialist at Seattle Cancer Care Alliance. “A lot of them believe the hype that is out there, that these must be safe because they’re being sold everywhere.”
Unfortunately, there are far more advertisements, celebrity spokesmodels (like anti-vaccine advocate Jenny McCarthy) and new brands of e-cigs than strong, evidence-based studies.
“There’s a lot of excitement but very little data,” said Jonathan Bricker, psychologist and smoking cessation researcher in the Public Health Sciences division of Fred Hutchinson Cancer Research Center. “The FDA has to regulate the device before a researcher can conduct a trial on its efficacy for smoking cessation and the devices aren’t regulated yet. We’re in a Catch-22.” Continue reading
Disease modeling shows virus is spreading ‘without any end in sight’
By JoNel Aleccia / Fred Hutch News Service
The deadly Ebola epidemic raging across West Africa will likely get far worse before it gets better, more than doubling the number of known cases by the end of this month.
That’s the word from disease modelers at Northeastern University and the Fred Hutchinson Cancer Research Center, who predict as many as 10,000 cases of Ebola virus disease could be detected by Sept. 24 – and thousands more after that.
“The epidemic just continues to spread without any end in sight,” said Dr. Ira Longini, a biostatistician at the the University of Florida and an affiliated member of Fred Hutch’s Vaccine and Infectious Disease and Public Health Sciences divisions. “The cat’s already out of the box – way, way out.”
It’s only a matter of time, they add, before the virus could start spreading to other places, including previously unaffected countries in Africa and developed nations like the United Kingdom — and the U.S., according to a paper published Sept. 2 in the journal PLOS Currents Outbreaks. Continue reading
By Carol Ostrom, Seattle Times
APR 23, 2014
Health insurers and hospitals, usually on opposite sides, lined up together Tuesday to give Insurance Commissioner Mike Kreidler an earful about his proposed new rule for insurance-provider networks.
Kreidler proposed the rule after complaints that consumers have been taken by surprise about narrower networks in insurance plans offered in the Affordable Care Act.
Those networks exclude some of the region’s prominent hospitals and medical centers, meaning some consumers don’t have access to providers they expected to use. Continue reading
Seattle’s Fred Hutchinson Cancer Research Institute is conducting a study that offers smokers free access to an online quick-smoking program.
Here’s the announcement from the Center about the study: Continue reading
By Jordan Rau
KHN Staff Writer
More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.
Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates.
Another 1,451 hospitals are being paid less for each Medicare patient they treat.
For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings.
Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.
The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.
“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.
Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms.
Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.
“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”
Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis.
Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.
How A Hospital Is Rated
Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers.
The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.
To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals.
A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement.
It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.
This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.
Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.
The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations.
Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.
Will Penalties Bring Change?
Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.
“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health. Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods.
“The fiscal penalties are nominal, frankly, in the scheme of things,” she said.
Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”
The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates.
“They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”
The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent. Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements.
The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.
The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.
“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”
Many Past Winners Continue To Get Bonuses
Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores.
Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.
A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.
This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money.
Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.
For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent.
As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country.
Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.
Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.
Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.
Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.
Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010.
For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.
The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.
Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.
In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.
Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.
“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”
- Data For Individual Hospitals (interactive chart)
- Downloadable CSV spreadsheet
- State Averages
This article was produced by Kaiser Health News with support from The SCAN Foundation.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
By Kathleen O’Connor
Publisher of the O’Connor Report
This year was the first year that hospitals in Washington State were required to report their executives’ compensation. I did not conduct this research independently.
The figures below are what the hospitals themselves reported to the Department of Health. The complete list of executive pay in not-for-profit hospitals can be found on The Department of Health website here.
For profit hospitals were not required to report their executive compensation, presumably for proprietary reasons. Some hospitals and hospital systems apparently chose not to report. See the list of non-responders at the end of this article.
These salaries raise more questions than answers. The differences between hospitals are staggering and incomprehensible. I offer questions for Boards of Directors and consumers at the end of the article.
We have several millionaires. Some in places I would not have predicted. In order of magnitude:
- Gary Kaplan, MD, Virginia Mason Medical Center, Seattle $3,737,678
- John Evans, Jr., Central Washington Medical Center, Wenatchee $1,766,084
- Rich Roodman, Valley Medical Center, Renton $1,285,860
- Elaine Couture, Providence Sacred Heart, Spokane $1,034,994
- Medrice Caluccio, Providence St. Peter, Olympia $1,010,027
Top Seattle Hospitals
The following is the compensation details only for the top administrator at the four top Seattle hospitals. Swedish has several sites.
Details on other executives’ compensation are included in the compensation data on the DOH website referenced above.
Harborview Medical Center:
Eileen Whalen, base salary $485,000, bonus incentive -0-, other $1,692, retirement/deferred compensation $61,550, non-taxable benefits, $19, 268 Total: $567,599
Swedish Medical Center: First Hill
Todd Strumwasser, base $435,848, bonus incentive $2500, other $71,000, retirement/deferred $76,928, nontaxable benefits $21,928 Total: $607,702
Swedish Medical Center: Cherry Hill
Rayburn Lewis, base $303,584, bonus incentive $24, other $51,875, retire/deferred $51,194, non taxable $17,713 Total: $424,390
Swedish Medical Center: Ballard
Jennifer Graves, base $241,620, other -0-, bonus incentive $37,500 retire/deferred $12,882, nontaxable $11,245 Total: $303,187
University of Washington Medical Center:
Stephen Zieniewicz, base $518,405, bonus -0-, other $1692, retire/deferred $61,793, non taxable $23,942, Total: $605,832
Virginia Mason Medical Center
Gary Kaplan, MD base $1,039,978, bonus incentive $449,871, other $17,788, retire/deferred $2,199,932, non-taxable $30,109 Total: $3,737,678
Other State Hospitals and Medical Centers
Valley Medical Center, Renton, Washington
Rich Roodman, base $706,575, bonus incentive $487,105, other $33,306, retire/deferred $32,201, nontaxable $26,471. Total: $1,285,860
Evergreen Medical Center, Bellevue
Robert Malte, base $592,423, bonus incentive -0-, other $51,581, retire/deferred $194,960, nontaxable $4,272, Total: $843,236
Providence Sacred Heart, Spokane
Elaine Couture, base $360,667, bonus incentive $592,708, other $17,901, retire/deferred $46,618, nontaxable $17,100 Total: $1,034,994
Providence St. Peter, Olympia
Medrice Caluccio base $417, bonus incentive $141,498, other $17,577, retire/deferred $419,464, non taxable $15,710 Total: $1,010,027
Central Washington Medical Center, Wenatchee
John Evans, Jr. base $141,598, bonus incentive -0-, other $1,491,778, retire/deferred $127,110 nontaxable $5,597 Total: $1,766,084
Smaller Hospitals: Top Administrators Total Salaries
Lake Chelan $177,242
Lourdes Medical Center, Pasco $823,668
Skagit County Hospital, Anacortes $378,386
Yakima Valley Memorial Hospital $565,441
Kittitas Valley Hospital, Ellensburg $277,674
Kadlac Medical Center, Richland $879,058
Walla Walla General Hospital $393,221
Shriners’ Hospital for Children $144,910 (Spokane)
Mid-Valley Hospital, Omak $159,972
Hospitals Not Reporting
For profit hospitals were not required to report, presumably for proprietary reasons. Other hospital and health systems apparently chose not to report. All these hospitals accept public money in the form of Medicaid and Medicare money.
There were some health systems that were not abundantly clear about who made what at which hospital, such as Multicare Health System out of Tacoma.
It was not clear what was Multicare, Mary Bridge Children’s Hospital and their other hospitals, so they were not included here. You can check them online at the DOH website.
Overlake Medical Center, Bellevue
Seattle Children’s Hospital
Seattle Cancer Care Alliance
Peace Health Hospitals
Franciscan Health System Hospitals
It’s Time for Accountability
Each of these organizations has a Board of Directors, Trustees or Commissioners. You can go to each hospital website. If you do not easily find the list of their Boards of Directors/Trustees/Commissioners, you can type in “Board of Directors” in the search function on their website and the information will come up.
For example, here is the list of the Board of Trustees for Virginia Mason.https://www.virginiamason.org/BoardMembers
University of Washington Medical Center: http://www.uwmedicine.org/Global/About/Pages/UWMedicineBoard.aspx
Central Washington Medical Center: http://www.cwhs.com/Content.aspx?id=71&terms=board%20of%20directors
Valley Medical Center: https://www.valleymed.org/About-Us/Meet-the-Board/
Providence Health System: This is more difficult since it is a health system, and there is a system board, as well as a local board, but here is Spokane:http://washington.providence.org/donate/providence-health-care-foundation-eastern-wa/board-of-directors/
Mid Valley Medical Center, Omak http://www.mvhealth.org/leadership
Forks Community Hospital, Forks, http://www.forkshospital.org/board-minutes
What We Need to Do
As members of Boards of Trustees, Commissioners, you need to ask the hard questions:
- What value and outcomes are you getting in your community for the salaries you are paying your executives?
- Are they improving patient care?
- What are patient outcomes?
- How many readmissions do you have that may have been avoided?
- How are you doing in managing hospital infections?
- How much uncompensated care does the hospital provide as compared to other hospitals in the community?
This last question, of course, would not apply to communities such as Omak or Forks where they are the only hospital.
Certainly the choices in Omak and Forks are different than the ones in Tacoma and Seattle, but the question is, how do we hold our health care institutions accountable?
I believe, but I do not know for certain, that many Boards of Trustees are paid to serve on these Boards. If you are paid to serve, who is going to ask the hard questions? Who is going to ask about outcomes, readmission rates, infection control, necessary or unnecessary surgeries?
Certainly the problems in Forks, Omak and other disproportionate share rural hospitals are different from an urban Swedish or Evergreen. But we all need to be smarter about health care.
I offer two sites in Washington State that are dealing with documented health care outcomes as determined voluntarily by community practicing doctors: http://www.qualityhealth.org and its respective programs and the Bree collaborative: http://www.hta.hca.wa.gov/bree.html
As patients and consumers, we need to hold the Boards of Directors/Trustees accountable. Your doctor determines where you go, because of admitting privileges and insurance contracts. Ask him or her why they chose to work with the hospital they use. Talk to the hospital board of director members. Look at the outcomes from facility to facility.
I don’t know how many states require hospitals to report their compensation. But it is time we had community conversations about what we expect from these institutions in return for our community investments.
I am not the only person looking into this.
Here is an article by Kaiser Health News: Hospitals reward CEOs for growth that increase costs.
Kathleen O’Connor, MA: O’Connor, publisher of the O’ConnorReport, has nearly 30 years experience in health care reform publishing and consulting, reform strategies, and consumer advocacy locally and nationally. She is a member of the Association of Health Care Journalists.
By Jim Malewitz
Stateline Staff Writer
Marian Alicea, an engineering student who is slated to graduate from college this spring, needs a doctorate degree to achieve her lofty career goal of becoming a White House environmental adviser with scientific expertise.
But the budget battle in Washington is complicating her plans for getting there.
In normal times Alicea, who attends Southern Polytechnic State University in Marietta, Ga., would likely be a shoo-in for a full research stipend. She is an honors student who has snagged several prestigious internships. And as a Latina she belongs to a minority group that is underrepresented among engineers.
But because of the sequester—the automatic federal budget cuts that went into effect March 1—some of the schools that want Alicea can’t offer her the financial aid she needs.
Federal agencies pour billions each year into university research, largely through grants that allow student researchers to pay their bills as they work.
With less federal money to spend, some Ph.D. programs are delaying admissions decisions, while others have already cut positions amid the uncertainty.
In 2011, federal money accounted for more than $40 billion of the $65 billion universities spent on research. At several large research universities, including Johns Hopkins, the University of Washington, the University of Pennsylvania and Harvard, federal dollars comprised 80 percent of research spending.
Like most other federal agencies, the National Institutes of Health must cut 5 percent of its budget to comply with sequestration. Because NIH funnels about 85 percent of its budget to researchers, it is already scaling back some grants, according to director Francis Collins.
Meanwhile, the National Science Foundation, facing similar cuts, estimates it will give out about 1,000 fewer research grants and awards this year, affecting as many as 3,000 researchers.
Researchers and university officials worry the lost funding will slow or halt research on everything from cancer treatments to contaminated soil and water.
They also fear it will dissuade young scholars from pursuing scientific careers.
“It will be profoundly devastating for this generation of students,” said Michael Reid, head of the physiology department at the University of Kentucky’s College of Medicine.
Alicea was accepted into four of the dozen programs she applied to, but only two —Virginia Tech and Auburn — offered her financial help.
The other universities, Maryland and Illinois, said they could not guarantee her money because the sequester had muddled their budgets.
Enrollment in graduate schools was already lagging amid growing concerns about student debt. Between 2010 and 2011, first-time U.S. enrollment across programs fell by 1.7 percent, following a decade of gains, according to a survey by the Council of Graduate Schools.
“This financial stress on institutions comes at a really tough time,” said Debra Stewart, the council’s president. “It has a chilling effect on what was already a chilly situation.”
For all university students, sequestration will mean higher fees on Stafford Loans and reduced payments from some grants, including federal work study.
Some educators worry that the prospect of amassing higher debt will scare students away, particularly as institutions hike tuition amid eroding state funding.
But the economic forecaster Moody’s expects universities as a whole to face only “minimal” immediate effects from sequestration as they turn to other revenues.
For graduate students in the sciences, the impact will be more dramatic. A lack of federal money prompted the University of Kentucky’s College of Medicine to admit about a third fewer students to its Ph.D. program in physiology, according to department head Reid.
“There were a number of qualified candidates we had to turn away,” he said.
Reid, who oversees a lab studying how chronic disease, such as cancer, speeds up muscle deterioration, said one of his lead doctoral students will lose his grant if sequestration continues, threatening to halt his education and dramatically slowing down the line of work.
If the politicians in Washington can craft a budget deal that replaces the sequester, Reid’s lab could immediately resume some of its stalled research, he said. But when it comes to genetically engineering mice, a process that can take years, it would likely have to start from scratch. When that type of research is halted, Reid said, “That’s it. You’re toast.”
A “grim fate”
Alicea has no qualms about taking the offer from Virginia Tech, but she is frustrated by her constricted choices and troubled by what it says about lawmakers’ support for the sciences.
Experts consider investment in those areas to be essential for the country’s economic competitiveness and ability to improve health and technology.
Consider Lucas Arzola, founder and head of Inserogen, a biotechnology startup that uses tobacco leaves to speed up the development of human and animal vaccines. He originally developed the technology as a Ph.D. student at the University of California-Davis, largely supported by federal grants.
If Congress doesn’t act, “how many graduate students will no longer have the support to make that next critical discovery?” Arzola said in a video testimony shortly before sequestration took effect.
Major drug, energy and engineering companies are increasingly relying on universities to build on their research and develop new products, said Robert Duncan, vice chancellor for research at the University of Missouri.
Duncan says sequestration “is terrible for U.S. competitiveness,” pointing to a 2010 National Academies of Sciences studythat showed the U.S. has begun to lag behind other countries in math and the sciences.
“In spite of the efforts of both those in government and the private sector, the outlook for America to compete for quality jobs has further deteriorated,” the authors concluded. They called for more spending on research and education.
Furthermore, many economists argue it is misguided to curb research spending to address the nation’s budget crisis, because several studies have shown such spending spurs economic activity far greater than what is invested.
Last fall, an analysis by the Information Technology and Innovation Foundation, a non-partisan think tank in Washington, estimated cuts to research and development funding under sequestration would reduce GDP by as much as $860 billion over nine years.
“If we want to see our still somewhat lagging economy pick up again, (investing in research) is one of the major ways to achieve it,” said Collins, the NIH head.
At NIH, the cuts follow a decade in which funding stayed static despite inflation, and could result in the elimination of as many as 20,500 U.S. research jobs, according to an analysis by United for Research, a coalition of research institutes and patient advocates.
“It is a paradoxical thing that we are both at a time of remarkable and almost unprecedented scientific opportunity,” Collins said, “and we‘re also at a time in the United States of unprecedented threat to the momentum of scientific progress.”
Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.
By Christine Vestal
Stateline Staff Writer
Hospitals make mistakes, sometimes deadly mistakes. A patient may get the wrong medication or even undergo surgery intended for another person. When errors like these are reported, state and federal officials inspect the hospital in question and file a detailed report.
Now, for the first time, this vital information on the quality and safety of the nation’s hospitals has been made available to the public online.
A new website, www.hospitalinspections.org, includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word.
Previously, these reports were filed with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid (CMS), and released only through a Freedom of Information Act request, an arduous, time-consuming process.
Even then, the reports were provided in paper format only, making them cumbersome to analyze.
Release of this critical electronic information by CMS is the result of years of advocacy by the Association of Health Care Journalists, with funding from the Ethics and Excellence in Journalism Foundation.
The new database makes full inspection reports for acute care hospitals and rural critical access hospitals instantly available to journalists and consumers interested in the quality of their local hospitals.
The database also reveals national trends in hospital errors. For example, key word searches yield the incidence of certain violations across all hospitals. A search on the word “abuse,” for example, yields 862 violations at 204 hospitals since 2011.
Once they receive a complaint, federal and state inspectors attempt to discover the cause of a hospital error or violation. For example, poor safety procedures result in thousands of patients slipping and falling each year in U.S. hospitals, and poor sterilization methods cause thousands more to contract infections. Poor administrative procedures can result in patients receiving wrong treatments.
Once the causes of specific problems are determined, federal and state authorities require hospitals to file a plan to correct them. These plans still remain under wraps, as do inspection reports on psychiatric hospitals and long-term care hospitals.
Also unavailable are the results of complaint-based and routine inspections by the nation’s largest private hospital accreditation organization, The Joint Commission.
Because the commission is a private entity, it is not subject to the Freedom of Information Act. For this reason, the health care journalism association has launched a new effort to gain the release of these reports on hospital quality and safety.
The commission has rejected two previous requests by the journalism group saying disclosure of the information would hamper its efforts to improve hospital quality.
Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.
Dollars for Docs: How to Evaluate Drug Payment Data
by Nicholas Kusnetz
Update: This story has been revised to reflect updated Dollars for Docs data on March 11, 2013.
Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But 15 companies have now made some of that information public.
ProPublica’s Dollars for Docs pulls their disclosures into a single database so patients can easily search for their doctor. We created Dollars for Docs database partly as an educational tool. How can patients use it? Here are some suggestions.
Q. My doctor is on this list. Should I care?
A. If your doctor is listed, it’s because he or she received money from one of the drug companies for promotional activities or consulting.
Payments are legal, so it doesn’t mean your doctor has done anything wrong. But research has shown that drug company marketing can influence what a doctor prescribes, and some experts say it is cause for concern.
Others say the information should carry less weight. They say the amount of money a doctor receives is less important than personal recommendations and the doctor’s training and experience.
One word of caution: Some doctors in our database have the same or similar names, so be sure to confirm with your doctor that he or she is actually the one on the list. Names and addresses on the data are as disclosed by the companies, and they sometimes use variations.
Q. My doctor is not on the list. What does that mean?
A. ProPublica included payments only from the drug companies that have made these relationships public so far. Many doctors do not do promotional work or consulting for drug companies.
Others may receive such payments from companies that haven’t yet disclosed them. So even if your doctor isn’t on the list, experts say it’s worth asking about the issue.
Q. What’s the best way to bring up the issue with my doctor?
A. Although it can feel awkward, some experts say it’s important to ask about potential conflicts of interest. Others say patients should trust their doctors to do what’s right for them.
If you do raise the issue, tell your doctor you want to feel confident the drugs he is prescribing for you are best for the job.
According to a 2010 national survey by Consumer Reports, conducted for this project, 70 percent of adults say doctors should tell their patients about payments they’ve taken from a drug company whose drugs they are about to prescribe.
Ask first if your doctor has any financial relationships with drug companies. If so, ask about what companies are involved, the nature of each relationship and the duration.
Most often, doctors are paid for promotional activities, such as speaking to other doctors about a drug, or for consulting or research.
It’s important to ask whether medications you are taking are made by the companies. If the answer is yes, it’s not necessarily a problem but is worth discussing further.
Q. How can I be sure my doctor is offering unbiased advice about a drug?
A. If your doctor has prescribed you medication made by a company he or she receives payments from, you should ask whether there are any cheaper generic alternatives. How does the drug compare to others in its class? What are the side effects? Are there alternatives with fewer side effects? And importantly, are there non-drug alternatives, such as diet, watchful waiting or physical therapy?
It may be that the drug you are on is the best option. But sometimes a drug company will market a new, more expensive version of an established drug even when the older one is cheaper and effective.
Asking these questions will show your doctor you’re aware of these issues.
Q. Where can I learn more about drugs my doctor prescribes?
A. Searching the Web will bring up a wealth of links and literature. One site that has comprehensive drug and supplement information is MedlinePlus.
Seattle’s Fred Hutchinson Cancer Research Center is seeking smokers to test a quit-smoking iPhone app.
Here’s the announcement from the Hutch:
THERE’S AN APP FOR THAT: ADULT DAILY SMOKERS ARE NEEDED FOR A STUDY OF A QUIT-SMOKING IPHONE APP
Participants in the free Smart Quit study will receive tools to help them quit – and stay quit
Adults who’ve smoked daily for at least the past year who want to quit within the next 30 days are needed for a study of a quit-smoking iPhone app being conducted by Fred Hutchinson Cancer Research Center in collaboration with the University of Washington and 2Morrow Mobile.
Led by Jonathan Bricker, Ph.D., a psychologist based in the Public Health Sciences Division at Fred Hutch, the Smart Quit study will randomly assign participants to one of two iPhone application quit-smoking programs. The goal of the study is to learn which of the two programs is the most useful for people who are quitting smoking.
“This is the first-ever study of any smartphone app for quitting smoking,” said Bricker, an associate member of the Fred Hutch Public Health Sciences Division. “Smartphones are a potentially revolutionary quit-smoking tool because you can carry that support with you anywhere.”
Participants randomly assigned to either program will receive:
- Interactive tools for dealing more effectively with urges to smoke
- A step-by-step guide for quitting smoking
- Personalized plans for quitting and staying quit
Both programs are free. Participants will be asked to complete online questionnaires, including one brief follow-up survey during the next two months. They will receive $25 after completing the two-month follow-up survey. Eligibility criteria include:
- being age 18 or older
- having smoked at least five cigarettes daily for at least the past 12 months
- wanting to quit in the next 30 days
- being interested in learning skills to quit smoking
Bricker and colleagues gratefully acknowledge that support for this work was provided by the Hartwell Innovation Fund.
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A short film about a technology invented by the UW, Fred Hutch, and Children’s Hospital is a semi-finalist at the Sundance Film Festival.
The technology, called Tumor Pain, uses a scorpion toxin to cause cancer cells in the brain light up so that they can be seen and removed during surgery, protecting nearby normal brain tissue.
E. Donnall Thomas, M.D., who won the 1990 Nobel Prize in physiology or medicine for his pioneering work in bone-marrow transplantation to cure leukemias and other blood cancers, died Saturday, the Fred Hutchinson Cancer Research Center has announced.
Here’s the center’s release announcing Dr. Thomas’ death:
‘FATHER OF BONE MARROW TRANSPLANTATION’ DR. E. DONNALL THOMAS DIES
Fred Hutch Nobel laureate established BMT as a life-saving treatment for blood cancers
E. Donnall Thomas, M.D., who won the 1990 Nobel Prize in physiology or medicine for his pioneering work in bone-marrow transplantation to cure leukemias and other blood cancers, died today. He was 92.
Thomas joined the faculty of Fred Hutchinson Cancer Research Center in 1974 as its first director of medical oncology. He later became associate director and eventually director of the Center’s Clinical Research Division. He stepped down from that position at age 70 in 1990 and officially retired from the Hutchinson Center in 2002.
Thomas, along with his wife and research partner, Dottie – a trained medical technologist – and a small team of fellow researchers stubbornly pursued transplantation throughout the 1960s and 1970s despite doubts by many prominent physicians of the day.
“To the world, Don Thomas will forever be known as the father of bone marrow transplantation, but to his colleagues at Fred Hutch he will be remembered as a friend, colleague, mentor and pioneer,” said Larry Corey, M.D., president and director of Fred Hutchinson Cancer Research Center. “The work Don Thomas did to establish marrow transplantation as a successful treatment for leukemia and other otherwise fatal diseases of the blood is responsible for saving the lives hundreds of thousands of people around the globe.”
His groundbreaking work is among the greatest success stories in cancer treatment. Bone marrow transplantation and its sister therapy, blood stem cell transplantation, have had worldwide impact, boosting survival rates from nearly zero to up to 90 percent for some blood cancers. This year, approximately 60,000 transplants will be performed worldwide.
Thomas edited the first two editions of the seminal bone marrow transplantation reference book, “Hematopoietic Cell Transplantation,” in 1994 and 1999, which became recognized as the “bible in the field.” He also contributed a chapter to the third edition, published in 2004, at which time the book’s title was changed to “Thomas’ Hematopoietic Cell Transplantation.”
“Don quite literally wrote the book on marrow transplantation,” said Fred Appelbaum, M.D., director of the Hutchinson Center’s Clinical Research Division, a friend of Thomas’ and an editor of the book. “Don was a hero. He was, by far, the most influential person in my career, and I know that many others would say the same thing.”
Thomas was a member of 15 medical societies, including the National Academy of Sciences. He also received more than 35 major honors and awards, including the Gairdner Foundation International Award and the Presidential Medal of Science. He was past president of the American Society of Hematology and served on the editorial boards of eight medical journals.
Thomas came to Seattle in 1963 to be the first head of the Division of Oncology at the University of Washington School of Medicine. Continuing work begun in Cooperstown, N.Y., Thomas led a small team that labored in the basement of temporary facilities at the former U.S. Public Health Hospital.
They sought to do what others were convinced would never work: to cure leukemia and other cancers of the blood by destroying a patient’s diseased bone marrow with near-lethal doses of radiation and chemotherapy and then rescuing the patient by transplanting healthy marrow.
The goal was to establish a fully functioning and cancer-free blood and immune system.
“We moved to Seattle … at a time when it seemed that marrow transplantation would never be successful,” Thomas recalled in a 2000 interview. “So we focused our attention on laboratory experiments.” As chief of medicine at the Mary Imogene Bassett Hospital in Cooperstown, N.Y., Thomas began studies of marrow grafts, treating relatively few human patients.
After moving to Seattle, Thomas and his colleagues worked almost exclusively in the laboratory well into 1967, postponing work on patients until treatment complications could be resolved.
It took almost 20 years after Thomas’s seminal paper on bone-marrow transplantation was published in The New England Journal of Medicine in September 1957 for the procedure to become an accepted therapy. During that time most medical professionals dismissed the idea.
“In the 1960s in particular and even into the 1970s, there were very responsible physicians who said this would never work,” Thomas said. “Some suggested it shouldn’t go on as an experimental thing.”
The early success was enough to convince Seattle surgeon William Hutchinson, M.D., to support Thomas and his team and build the group a permanent home. In 1972, ground broke for the construction of the original Fred Hutchinson Cancer Research Center building in Seattle’s First Hill neighborhood, and its doors opened in 1975.
Thomas and his team persisted because they believed transplantation was the key to saving the lives of people with leukemia, lymphoma, multiple myeloma and other fatal blood diseases.
“I’ve said in the past that I have two attributes: one is I’m stubborn to keep doing it and other is I attracted some good people to work with me,” Thomas told an interviewer in 2006.
Today, bone marrow transplants are a proven success for treating leukemia and other cancers as well as blood disorders such as aplastic anemia.
Thomas is survived by his wife, Dottie, two sons and a daughter.
To mark National Breast Cancer Awareness Month Seattle’s Fred Hutchinson Cancer Research Center and its clinical care partner, the Seattle Cancer Care Alliance have published a “baker’s dozen” of top beast health tips gleaned from four previously published tip sheets.
TOP TIPS FOR BREAST CANCER PREVENTION from Anne McTiernan, M.D., Ph.D., a member of the Center’s Public Health Sciences Division and author of “Breast Fitness” (St. Martin’s Press):
1) For all women: Follow a healthy lifestyle, including keeping your weight in normal range (body mass index under 25), being physically active (at least 30 minutes a day of moderate-intensity exercise), minimizing alcohol intake (one drink a day or less), and don’t smoke.
Overweight, inactivity and alcohol all increase risk for breast cancer, and smoking increases risk in some women.
2) For young women: Breast-feed your babies for as long as possible. Women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer.
3) For postmenopausal women: Avoid hormone replacement therapy.
Menopausal hormone therapy increases risk for breast cancer.
If you must take hormones to manage menopausal symptoms, avoid those that contain progesterone and limit their use to less than three years.
“Bioidentical” hormones and hormonal creams and gels are no safer than prescription hormones and should also be avoided.
4) For high-risk women: Consider taking an estrogen-blocking drug.
Women with a family history of breast cancer or who have had breast biopsies or are over 60 should talk to their doctor about the pros and cons of estrogen-blocking drugs such as tamoxifen, raloxifene, and aromatase inhibitors.
TOP TIPS FOR BREAST CANCER SCREENING AND EARLY DETECTION from Constance Lehman, M.D., Ph.D., director of Radiology at Seattle Cancer Care Alliance:
5) If you are over 40, get a mammogram. Early detection of breast cancer offers the best chance for a cure. SCCA supports the American Cancer Society’s recommendation that women begin annual mammography screening at age 40.
6) Know your risk. Tell your doctor if you have family members who have had breast cancer, especially a mother or sister, and if they had breast cancer before reaching menopause because your own risk of cancer may be higher than average.
Some women at high risk may be recommended for annual MRI in addition to a screening mammogram.
7) Don’t put off screening because of discomfort or fear of the results: A mammogram should never be painful.
To reduce discomfort, try to schedule the exam after your monthly period, when breast tissue is less sensitive.
You may benefit by taking an over-the-counter anti-inflammatory such as ibuprofen or acetaminophen before your mammogram. Above all, tell the mammography technologist about any discomfort you may be experiencing.
Most abnormalities found after a mammogram are not cancer.
However, in some cases you may be called back for more tests, such as additional mammography or ultrasound screening, to confirm that the area on the screening mammogram is normal.
TOP TIPS FOR BREAST CANCER PATIENTS DURING TREATMENT from Julie Gralow, M.D., director of Breast Medical Oncology at Seattle Cancer Care Alliance and co-author of “Breast Fitness” (St. Martin’s Press):
8) Choose your doctor wisely. Breast cancer specialists who work at dedicated cancer centers offer specific expertise as well as access to the latest treatments that are part of clinical studies.
Such centers can provide other specialty services, usually under one roof, such as physical therapy, nutrition and social work.
9) Get specifics on your diagnosis and treatment. To maximize your time with your providers, bring your questions with you in writing to your appointments.
Ask for copies of your test results and keep a notebook of all these results. Keep a list of questions that arise between visits so you don’t forget, and take notes of the answers.
Above all, make informed decisions; learn as much as you can about your diagnosis and treatment.
10) Get good nutrition and bone up on bone health. Cancer treatment may influence taste and smell, and it may alter your digestion. Foods that you normally enjoy may not taste good during treatment while, paradoxically, foods that normally don’t appeal to you might taste better.
You may have more energy and less nausea if you eat smaller amounts of foods more frequently rather than eating three big meals per day.
Eat more vegetables, fruits, whole grains, nuts, seeds and legumes such as black beans and lentils.
Choose a rainbow of colorful whole foods (like deep greens of spinach, deep blues of blueberries, white for onions, and so on) to ensure that you get a variety of anti-cancer nutrients.
Alcohol is usually not preferred or recommended during treatment. Keeping your bones healthy throughout your life is important; however, if you’re a woman who’s been diagnosed with breast cancer, bone health is especially important.
Research shows that some breast cancer treatments can lead to bone loss. Plus, women are about twice as likely as men to develop osteoporosis after age 50.
Talk to your health care team about specific recommendations for keeping bones healthy, taking calcium and vitamin D, and appropriate weight-bearing exercises to help keep bones strong.
TOP TIPS FOR BREAST CANCER SURVIVORS from Karen Syrjala, Ph.D., director of Biobehavioral Sciences in the Hutchinson Center’s Clinical Research Division and co-director of the Hutchinson Center Survivorship Program
11) Get a summary of your treatments. Have a list of what surgery, radiation and chemotherapy doses you received so that you can communicate these to your primary care providers. This will help you plan for the next tip on the list.
12) Make a plan for monitoring the long-term effects of your cancer treatment. Talk to your doctor about the potential long-term effects of your cancer treatment and what to watch out for. For example, some cancer treatments can increase the risk of cardiovascular problems or second cancers; others can impact your bones.
13) Learn how to manage the fear of cancer coming back. First, find out your risk of recurrence from your health care provider. Second, remember that risk is an estimate based on averages and does not always apply to you as an individual. Third, consider counseling or other assistance to help you face your fears and move forward.
To learn more read the full tip sheets:
- Tips for breast cancer prevention.
- Tips for breast cancer screening and early detection.
- Tips for breast cancer treatment.
- Tips for breast cancer survivorship.
Six Myths about prostate cancer
When it comes to prostate cancer, there’s a lot of confusion about how to prevent it, find it early and the best way – or even whether – to treat it. Below are six common prostate cancer myths along with research-based information from scientists at Fred Hutchinson Cancer Research Center to help men separate fact from fiction.
Myth 1 – Eating tomato-based products such as ketchup and red pasta sauce prevents prostate cancer.
“The vastmajority of studies show no association,” said Alan Kristal, Dr.P.H., associate director of the Hutchinson Center’s Cancer Prevention Program and a national expert in prostate cancer prevention.
Kristal and colleagues last year published results of the largest study to date that aimed to determine whether foods that contain lycopene – the nutrient that puts the red in tomatoes – actually protect against prostate cancer.
After examining blood levels of lycopene in nearly 3,500 men nationwide they found no association. “Scientists and the public should understand that early studies supporting an association of dietary lycopene with reduced prostate cancer risk have not been replicated in studies using serum biomarkers of lycopene intake,” the authors reported in Cancer Epidemiology, Biomarkers & Prevention. “Recommendations of professional societies to the public should be modified to reflect the likelihood that increasing lycopene intake will not affect prostate cancer risk.”
Myth 2 – High testosterone levels increase the risk of prostate cancer.
“This is a hypothesis based on a very simplistic understanding of testosterone metabolism and its effect on prostate cancer. It is simply wrong,” Kristal said.
Unlike estrogen and breast cancer, where there is a very strong relationship, testosterone levels have no association with prostate cancer risk, he said.
A study published in 2008 in the Journal of the National Cancer Institute, which combined data from 18 large studies, found no association between blood testosterone concentration and prostate cancer risk, and more recent studies have confirmed this conclusion.
Myth 3 – Fish oil (omega-3 fatty acids) decreases prostate cancer risk.
“This sounds reasonable, based on an association of inflammation with prostate cancer and the anti-inflammatory effects of omega-3 fatty acids,” Kristal said.
However, two large, well-designed studies – including one led by Kristal that was published last year in the American Journal of Epidemiology – have shown that high blood levels of omega-3 fatty acids increase the odds of developing high-risk prostate cancer.
Analyzing data from a nationwide study of nearly 3,500 men, they found that those with the highest blood percentages of docosahexaenoic acid, or DHA, an inflammation-lowering omega-3 fatty acid commonly found in fatty fish, have two-and-a-half times the risk of developing aggressive, high-grade prostate cancer compared to men with the lowest DHA levels.
“This very sobering finding suggests that our understanding of the effects of omega-3 fatty acids is incomplete,” Kristal said.
Myth 4 – Vitamins and dietary supplements can prevent prostate cancer.
Several large, randomized trials that have looked at the impact of dietary supplements on the risk of various cancers, including prostate, have shown either no effect or, much more troubling, they have shown significantly increased risk.
“The more we look at the effects of taking supplements, the more hazardous they appear when it comes to cancer risk,” Kristal said. For example, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest prostate cancer prevention study to date, was stopped early because it found neither selenium nor vitamin E supplements alone or combined reduced the risk of prostate cancer.
The Hutchinson Center oversaw statistical analysis for the study, which involved nearly 35,000 men in the U.S., Canada and Puerto Rico.
Myth 5 – We don’t know which prostate cancers detected by PSA (prostate-specific antigen) screening need to be treated and which ones can be left alone.
“Actually, we have a very good sense of which cancers have a very low risk of progression and which ones are highly likely to spread if left untreated,” said biostatistician Ruth Etzioni, Ph.D., a member of the Hutchinson Center’s Public Health Sciences Division.
“For the majority of newly diagnosed cases of prostate cancer, by taking into account initial clinical and biopsy information we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment.”
“Men with a low PSA level, a biopsy Gleason score of 6 or lower and very few biopsy samples with cancer are generally considered to be very low risk,” Etzioni said.
Such newly diagnosed men increasingly are being offered active surveillance – a watchful waiting approach – rather than therapy for their disease, particularly if they are older or have a short life expectancy.
“The chance that these men will die of their disease if they are not treated is very low, around 3 percent,” she said. Similarly, such men who opt for treatment have a mortality rate of about 2 percent. “For the majority of newly diagnosed cases of prostate cancer, by taking into account initial clinical and biopsy information we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment.”
Myth 6 – Only one in 50 men diagnosed with PSA screening benefits from treatment.
“This number, which was released as a preliminary result from the European Randomized Study of Prostate Cancer Screening, is simply incorrect,” Etzioni said. “It suggests a very unfavorable harm-benefit ratio for PSA screening. It implies that for every man whose life is saved by PSA screening, almost 50 are overdiagnosed and overtreated.”
“The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one.”
The 50-to-one ratio, which is based on short-term follow-up data, “grossly underestimates” the lives likely to be saved by screening over the long term and overestimates the number of men who are overdiagnosed, Etzioni said. “The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one.”