Inviting patients to help decide their own treatment


By Anna Gorman

SAN FRANCISCO — Rose Gutierrez has a big decision to make.

Gutierrez, who was diagnosed with breast cancer last spring, had surgery and 10 weeks of chemotherapy. But the cancer is still there.

Now Dr. Jasmine Wong, a surgeon at UC San Francisco, is explaining the choices – Gutierrez can either have another lumpectomy followed by radiation, or she can get a total mastectomy.


Rose Gutierrez (Photo by Heidi de Marco/KHN).


“I think both options are reasonable,” Wong said. “It’s just a matter of how you feel personally about preserving your breast, how you feel about having radiation therapy.”

“I’m kind of scared about that,” said Gutierrez, 52, sitting on an exam table with her daughter on a chair beside her.

“Well if you made it through chemo, radiation is going to be a lot easier,” Wong told Gutierrez, who is from Merced, Calif.

In many hospitals and clinics around the country, oncologists and surgeons simply tell cancer patients what treatments they should have, or at least give them strong recommendations.

But here, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care. Continue reading


New Report: Health law has helped insure 16.4 million


ACA health reform logoBy Julie Rovner

A total of 16.4 million non-elderly adults have gained health insurance coverage since the Affordable Care Act became law five years ago this month – a “historic” reduction in the number of uninsured, the Department of Health and Human Services said Monday.

Those gaining insurance since 2010 include 2.3 million young adults aged 18 to 26 who were able to remain on their parents’ health insurance plus another 14.1 million adults who obtained coverage through expansions of the Medicaid program, new marketplace coverage and other sources, according to HHS’ report .

The percentage of people without coverage has dropped by about a third since 2012: from 20.3% to 13.2%.

Officials say the percentage of people without coverage has dropped by about a third since 2012: from 20.3 percent to 13.2 percent in the first quarter of 2015. Continue reading


Health Coverage In Limbo For Many Washington State Small-Business Employees – Seattle Times


Seal_of_WashingtonFor 20 years, small businesses in the state have relied heavily on associations and trusts to provide coverage for their workers. These groups had cheaper prices than insurance sold on the open market, allowing them to become the dominant players, with roughly half a million of the state’s residents covered by these plans.

Now Insurance Commissioner Mike Kreidler, citing federal changes under the ACA, has rejected the majority of the state’s roughly 64 association and trust plans, saying they don’t comply with the new rules.

via Health Coverage In Limbo For Many Small-Business Employees | Kaiser Health News.


Top five stories of the week

Credit: Dan Shirly

Credit: Dan Shirly


Global health news – March 15, 2015


Globe floating in air


Rating agencies agree to be more flexible about medical debt


Twenty-dollar bill in a pill bottleBy Michelle Andrews

Too many consumers have learned the hard way that their credit rating can be tarnished by medical bills they may not owe or when disputes delay insurer payment.

That should change under a new policy agreed to this week by the three major credit reporting agencies.

The agencies say they will establish a 180-day waiting period before medical debt is added to someone’s credit report. In addition, the agencies agreed that when an insurer pays a bill, the debt will be promptly removed from the consumer’s credit report, unlike certain debts that remain for years.

Agencies say they will establish a 180-day waiting period before medical debt is added to someone’s credit report.

The changes are part of a settlement between the credit rating agencies — Equifax, Experian and TransUnion – and the New York Attorney General’s office that aims to improve accuracy and enhance procedures for disputing credit report errors. The agreement covers consumers across the country.

The three agencies gather information from banks and collection agencies about consumers’ credit — such as payment history and how much someone owes — to create a credit score for about 200 million individuals throughout the country. A person’s credit score is used as a measure of credit-worthiness, and it can influence people’s ability to get loans and the interest rates they’re charged, among other things.

“This is going to help millions of people access more affordable loans,” says Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Mass. “People will no longer be penalized for having a medical bill slip past them and get on their credit report even though the bill gets paid.” Continue reading


Two out of 3 people diagnosed with cancer survive 5 years or more – CDC


A Norwegian study estimates that a many as 25 percent of cases of invasive breast cancers diagnosed by mammography screening are cases of overdiagnosis. (Photo/NCI)Two out of 3 people diagnosed with cancer survive five years or more, according to a study by the US Centers for Disease Control and Prevention published in today’s Morbidity and Mortality Weekly Report.

The report found that the most common cancer sites continue to be prostate, breast, lung, and colorectal cancer.

Among these common cancer sites 5-year relative survival was:

  • 97 percent for prostate cancer,
  • 88 percent for breast cancer,
  • 63 percent for colorectal cancer, and
  • 18 percent for lung cancer.

The authors noted that disparities in cancer incidence still persist, with greater rates among men than women and the highest rates among blacks.

Additionally, 5-year relative survival after any cancer diagnosis was lower for blacks (60 percent) than for whites (65 percent).

Data by state show incidence rates for all cancer sites ranged from 374 cases per 100,000 persons in New Mexico to 509 cases per 100,000 persons in the District of Columbia.

“These data are an important reminder that a key to surviving with cancer is making sure everyone has access to care from early diagnosis to treatment,” said Lisa Richardson, M.D., director of CDC’s Division of Cancer Prevention and Control.  “We know, for example, that early detection of colorectal cancer has had the largest impact on long-term survival rates.”’

Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services, including screening for some cancers, that may be covered with no additional costs.

Visit or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.

The full report, “Invasive Cancer Incidence and Survival – United States, 2011,” can be found at For more information about CDC’s efforts in cancer prevention and control, visit


Three Kansas patients die after eating tainted ice cream | Reuters


Alert IconThree Kansas hospital patients have died and two have been sickened by listeriosis linked to single-serve Blue Bell Creameries ice cream products since last year, health officials said on Friday.

The five adults became ill from January 2014 to January of this year with one of four rare strains of Listeria monocytogenes bacteria while hospitalized with unrelated illnesses, Kansas health officials said in a news release.

via Three Kansas patients die after eating tainted ice cream | Reuters.


Couch Potatoes Rejoice: Strenuous Exercise May Be Unhealthy – WSJ


potatoA recent study in Circulation, a journal of the American Heart Association, found that exercising strenuously four to seven days a week conferred an increased risk of vascular disease, compared with two to three days a week of strenuous exercise.

Accompanying the study, published in Circulation’s Feb. 24 edition, is an editorial entitled, “Physical Activity: Can There Be Too Much of a Good Thing?”

Photo: Courtesy of Sanja Gjenero

via Couch Potatoes Rejoice: Strenuous Exercise May Be Unhealthy – WSJ.


At Phoenix VA, Obama says more work to do for veterans


veteran-affairs-seal-vaAmid persistent complaints about veterans’ health care, President Barack Obama acknowledged lingering weaknesses Friday in the federal government’s response to the chronic delays and false waiting lists that triggered a national outcry over the Veterans Affairs health system last year.

Obama said that while VA Secretary Robert McDonald is “chipping away” at the problem, it was clear there was still more work to do.

via News from The Associated Press.


American Indians and Alaska Natives: How to use your new health insurance


ACA health reform logoYvette Roubideaux, M.D., M.P.H.
Senior Advisor to the Secretary for American Indians and Alaska Natives

Since many American Indians and Alaska Natives have used the Indian Health Service all their lives for health care, using health insurance can be an unfamiliar challenge.

You can still use it when you visit IHS, and you can use it to access health services with other providers and facilities.

If you now have access to health insurance, through the Affordable Care Act, your job or your Tribe, using your coverage for the first time can be confusing.

The Centers for Medicare and Medicaid Services in the Department of Health and Human Services has developed a great brochure entitled “From Coverage to Care” and has even developed a Tribal version of this document that:

  • Contains information and tips on how to understand and use your health insurance
  • Serves as a very helpful roadmap with suggestions on how to choose providers and how to prepare for your health care appointment
  • And is also tailored to provide you information on special benefits and resources for American Indians and Alaska Natives

For more information, go to or


Prediabetes: Are you at risk?


From the US Centers for Disease Control and Prevention:

1 in 3 U.S. adults has prediabetes

Most don’t know it. Are you at risk?

You may have prediabetes and be at risk for type 2 diabetes if you:

  • Are 45 years of age or older
  • Are overweight
  • Have a family history of type 2 diabetes
  • Have high blood pressure
  • Are physically active fewer than three times per week
  • Ever had diabetes while pregnant (gestational diabetes) or gave birth to a baby that weighed more than 9 pounds


What is prediabetes?

Having prediabetes means your blood glucose (sugar) level is higher than normal, but not high enough to be diagnosed as diabetes. But, nearly 90 percent of adults who have prediabetes don’t know they have it.

Prediabetes can lead to serious health problems

If you have prediabetes and don’t lose weight or increase your physical activity, you could develop type 2 diabetes within five years.

Type 2 diabetes is a serious condition that can lead to health issues such as Continue reading