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Swedish to stop providing elective abortions if alliance with Providence approved — Seattle Times

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“Out of respect for the affiliation” — Swedish Medical Center will stop performing elective abortions if its pending alliance with Providence Health & Services, a Catholic, not-for-profit organization, goes through, Seattle Times health reporter Carol Ostrom reports.

In the original announcement of the affiliation, both Swedish and Providence said the two organizations would keep their separate names and identities; the announcement said that Swedish would “remain a nonreligious organization”.

. . .  it was not clear why a nonreligious organization would end legal elective abortions, and Swedish officials did not immediately return calls seeking explanation.

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HIV

Tomorrow, Oct. 15, is National Latino AIDS Awareness Day

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National and local health officials are encouraging King County Latinos to be tested for HIV as part of National Latino AIDS Awareness Day, Saturday, October 15th.

It is projected that 1 in 50 Latinos will become infected with HIV in their lifetime, yet fewer than half of Latinos in the U.S. have been tested for the virus.

Among Latino men about 80 percent of infections occur among gay and bisexual men, with the largest number of new infections among gay and bisexual men under the age of 30, according the U.S. Centers for Disease Control and Prevention (CDC).

Of these, 1 in 5 are unaware they carry the virus, the CDC says.

In King County there are more  750 Latinos who have HIV or AIDS. Of these, Public Health – Seattle & King Count officials say, 40 percent received a late diagnosis, meaning they were diagnosed with a immunodeficiency due to the infection shortly after their first positive HIV test result.

Many of these individuals could have been infected for years, unknowingly infecting others and missing the chance for early treatment.

“HIV medications work best when started early,” says said Dr. Matthew Golden, Director of Public Health’s HIV/STD Program. “The earlier we catch infection, the sooner people can get medication that will keep them healthy. And they can consistently use condoms to keep their partners from getting infected.”

In King County, HIV has a disproportionate impact on the Latino community, which makes up 6 percent of the population but 13% of people recently diagnoses with the infection.

To raise awareness in the Latino community Public Health – Seattle & King County and Seattle’s Latino LGBT organization Entre Hermanos have teamed up to launch a new campaign called, All Together: The Latino HIV Testing Campaign, or Todos Juntos: Campaña Latina para la Prueba del VIH.

As part of the initiative the campaign has released a new video, directed by local filmmaker Drew Emery, that features a broad cross-section of Latino and Latina community members speaking about the importance of routine HIV testing.

The CDC recommends that all adolescents and adults age 13 to 64 be tested for HIV, that people in high-risk groups to be tested at least yearly, and that HIV testing be part of standard prenatal and pregnancy testing.

A number of programs provide low-cost options to pay for HIV testing and treatment for people have HIV or AIDS.

Some of local testing locations with Spanish speaking staff include:

To learn more:
  • Go to Public Health’s HIV/STD Program website for more information about these clinics or SabiaUD.org for information in Spanish.
  • Or, to find confidential testing resources near you, visit hivtest.org, a fully English-Spanish bilingual site.
A Spanish version of the press release announcing the campaign is below:

Se pide que más latinos se hagan la prueba del VIH como parte de una nueva campaña y video

Lunes, 10 de octubre de 2011

El 15 de octubre es el Día Nacional Latino para la Concientización del SIDA

CONDADO DE KING, WASHINGTON — Entre Hermanos junto con Salud Pública de Seattle y el condado de King están lanzando una nueva campaña y video para el Día Nacional Latino para la Concientización del SIDA, llamado Todos Juntos: Campaña latina para la prueba del VIH. Dirigido por el cineasta local Drew Emery, el video muestra a un grupo amplio de la comunidad latina resaltando la importancia de la prueba rutinaria del VIH como una norma saludable de la comunidad.

Someterse a la prueba del VIH es vital si queremos reducir las disparidades de salud para los latinos relacionadas con el VIH y el SIDA. En la actualidad, los latinos representan 6% de la población del Condado de King, pero 13% de las personas con recientes diagnósticos del VIH.

“Este proyecto ya ha tenido una tremenda aceptación por parte de la comunidad. Es muy grande la fuerza que ha significado proporcionar un medio para que se escuchen las voces de la comunidad sobre un problema que les es importante”, afirma Marcos Martínez, Director Ejecutivo de Entre Hermanos, la organización latina homosexual, bisexual y transexual de Seattle.

El nuevo video se lanzará el 14 de octubre y estará disponible en los sitios Web de Entre Hermanos y Salud Pública. Estas dos organizaciones solicitarán a los miembros de la comunidad latina y a otras personas que compartan ampliamente el video a través de medios sociales como Facebook, Twitter, blogs, y correos electrónicos, con un mensaje personalizado como, “Yo me someto a la prueba del VIH con regularidad porque me preocupo por mi salud. ¿Te harás tú la prueba?”

“Sabemos que los medicamentos para el VIH actúan mejor cuando se empiezan temprano. Esto representa una oportunidad de hacer saber que las pruebas frecuentes nos ayudarán a diagnosticar el VIH antes”, dijo el Dr. Matthew Golden, Director del programa HIV/STD de Salud Pública. “Cuanto más pronto se descubra la infección, más pronto podrán obtener el medicamento que los mantendrá sanos. Y podrán usar condones constantemente con el fin de evitar que sus parejas adquieran la infección”.

Hay más de 750 personas en el Condado de King que son latinos y tienen VIH o SIDA, y alrededor del 40% de ellos recibieron un diagnóstico tardío, lo que significa que se les diagnosticó SIDA dentro de los 12 meses después del resultado positivo de su primera prueba del VIH.

Aproximadamente el 15% de las personas con VIH en el país no lo saben porque no se han sometido a la prueba recientemente. Cuando las personas no conocen su estado, aún sin ser conscientes de ello, pueden transmitir el virus a otras personas a través de relaciones sexuales sin protección o por compartir agujas. También es vital para las mujeres embarazadas se hagan la prueba, de manera que puedan evitar la transmisión del VIH a sus recién nacidos.

Existen formas económicas de pagar por la prueba y tratamiento de VIH cuando las personas tienen VIH y SIDA. Y existen más opciones de prueba del VIH que nunca antes, incluyendo lugares con personal que habla español como Consejo, Sea Mar, Entre Hermanos, Gay City, clínicas de Salud Pública y varias clínicas de salud de la comunidad. Visiten SabiaUD.org si desean obtener mayor información sobre estas clínicas. Si desea obtener información sobre recursos para someterse a pruebas confidenciales cerca de donde vive, visite hivtest.org.

Para unirse a la campaña o inscribirse para recibir el video de la nueva campaña cuando se publique, vaya a www.surveygizmo.com/s3/665665/All-Together-The-Latino-HIV-Testing-Campaign, o llame 206-205-6105 (ingles) o 206-322-7700 (español).

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Clock starts ticking Saturday for Medicare enrollment

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By Christian Torres
KHN Staff Writer

The holiday shopping season seems to start earlier every year.

This year, Medicare’s open enrollment season also begins – and ends – earlier than ever.

The annual enrollment period for Medicare Advantage and prescription drug benefit plans starts Saturday, rather than in mid-November as in recent years.

The deadline for enrollment has also been pushed up, from Dec. 31 to Dec. 7. One in four beneficiaries has a Medicare Advantage plan, and seniors who want to continue in their existing plans don’t have to do anything.

But those who want to switch to a different drug or Medicare Advantage plan need to act by Dec. 7.

The new deadline is a cause for concern, said Medicare Rights Center President Joe Baker, “because people have developed a habit of doing it by the end of the year,” and many tend to procrastinate. “Now, we recommend that people get it done by Thanksgiving, rather than Christmas.”

Operators on MRC’s Medicare helpline, which handles 12,000 calls each year, have asked callers whether they’re aware of the new dates, and most people were not, Baker said.

A survey by Opinion Research Corporation for PlanPrescriber, an online insurance comparison tool and seller, found that 65 percent of 475 seniors enrolled in Medicare’s Part D prescription drug program were unaware of the altered timeline.

“We recommend that people get it done by Thanksgiving.”

That telephone survey was conducted between July 28 and Aug. 29, however, and with the flood of mailings and TV advertisements now under way, “we expect that people will be pretty aware,” said Nicole Duritz, a vice president with AARP.

The change was mandated by the 2010 health law “in order to give people more time to choose a plan and to permit a smoother transition to their new plan,” Tony Salters, a spokesman for the Centers for Medicare and Medicaid Services, said in an email.

Beneficiaries now have seven weeks, rather than six, to decide on plans, and “the new time frame should better ensure that people have their new membership cards in hand at the beginning of the year.” With earlier processing, beneficiaries can start coverage without interruption on Jan. 1.

There is no new leeway, however, for most people who miss the deadline. They will have to wait a full year before they can change their selections.

“The date change was mandated by law, and we are conducting a wide outreach effort to assure that individuals are aware of the timing to make changes to their coverage,” Salters wrote. CMS and the Department of Health and Human Services are coordinating 150 events, complementing publicity efforts by MRC, AARP and the plan providers.

Beneficiaries now have seven weeks, rather than six, to decide on plans

An exception to the new deadlines is that beneficiaries who switch to a five-star Medicare Advantage plan can do so at any time during the year.

The star rating, which is determined by CMS, is based on rates of hospital readmission, complaints and other quality factors. With the star system revamped this year, and price changes expected in many plans, officials encouraged Medicare beneficiaries to thoroughly review their options.

“Whether or not you’re thrilled with your Medicare plan, take the time to evaluate it, given potential changes in your health status, primary doctor and other things,” AARP’s Duritz said, adding that the AARP encourages Medicare beneficiaries to look at coverage, cost and customer service when deciding on plans.

The organization will be holding events across the country during the enrollment period, with an online workshop scheduled for Nov. 17.

More information for consumers, including a description of this year’s deadlines and plan comparisons, are available from CMS at www.medicare.gov.

We want to hear from you: Contact Kaiser Health News

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.

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Open enrollment: How to pick your health benefits plan

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By Andy Miller, Georgia Health News

October brings some scary sights: ghosts, goblins . . . and open enrollment packages.

Not that they’re related. Still, this month kicks off open enrollment season, when many of us dread the annual confrontation with our employer health benefits plan.

Typically during this time, you find that the costs of your health coverage will jump in the upcoming year. And just as typically, the information you are given about your choices is as simple to comprehend as quantum physics.

The good news, though, is that you are being offered health insurance. And during open enrollment, insurance companies are required to accept all applicants of the employer group, no matter what pre-existing health conditions are present.

But there may be some sticker shock on what your premium will be in January.

A recent Kaiser Family Foundation survey found that in 2011, the cost of employer-based family coverage rose 9 percent. Since 2001, premiums for family insurance have increased 113 percent, compared with 34 percent for workers’ wages and 27 percent for inflation, the survey found. (KHN is an editorially-independent program of the foundation.)

With wages generally flat, “health insurance is eating up more and more of people’s money,” says Nancy Metcalf, a health insurance expert for Consumer Reports.

Small businesses and their workers, in particular, wrestle annually with the rising costs of insurance.

Here are some tips — from experts such as Metcalf and from the National Association of Insurance Commissioners — for consumers who are making decisions on employer-sponsored health plans:

  • If you have a choice of health plans, compare them on quality measures. Consumer Reports uses rankings from the National Committee for Quality Assurance to rank health plans’ quality by state, and you may want to consult its list. It’s currently free online, and available in the magazine. The rankings include customer satisfaction and performance on medical measures. Here’s a link.
  • Check to see if your current physicians and hospital are in the network of the plan you’re considering. A good relationship with a primary-care physician “is really important,’’ Metcalf says.
  • Understand the differences between a PPO (preferred provider organization) and an HMO (health maintenance organization). HMOs restrict your choice of doctor and other medical providers, but generally perform better on quality scores, Metcalf says.
  • Read the plan materials thoroughly. Review any pre-existing condition exclusions and prior authorization requirements, NAIC says.
  • Check whether spouses or dependents are covered under your plan.
  • Explore what a plan’s deductible really means. Co-pays and prescription drugs, for example, may or may not count toward meeting a deductible, depending on the health plan. Note that preventive care is free under employer plans that didn’t get ‘’grandfathered’’ status under health care reform.
  • Make cost calculations based on your medical history. Calculate your health spending from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of visits to the doctor, prescriptions and any procedures you may be planning. Also, make a list of the premiums, out-of-pocket expenses and benefits under each plan.
  • You may be able to contribute pre-tax dollars to a flexible spending account (FSA), a health savings account (HSA), or a similar health reimbursement arrangement (HRA). An increasing number of Americans are enrolled in HSAs, which are paired with high-deductible plans. Metcalf says consumers should check to see whether their employer puts money into their savings account. “It’s kind of free money,’’ she says.

HSAs tend not to work as well for people with chronic medical conditions, Metcalf says. They generally work better for people who are younger, healthy, and “who have enough spare money to put into them,’’ she says. They can be used for co-pays, deductibles, co-insurance, and items such as hearing aids.

  • Check to see whether your employer offers a wellness program or incentives for healthy behavior such as exercising regularly or not smoking.
  • Find out what your plan’s annual out-of-pocket spending limit is, and what counts toward it, such as deductibles and co-pays.
  • See whether your medications are on the list of approved drugs in each plan, NAIC says. Your co-pays on drugs can vary among health plans. “You need to look at that carefully,’’ Metcalf says. But don’t go without drug coverage, she says.

The bottom line is that open enrollment is a confusing time for many consumers.

That’s partly because there’s currently no standardization among health plans, Metcalf says. “If you’ve seen one health plan, you’ve seen one health plan.’’

Take your time and make careful choices. You can always ask a health plan, your employer or the state insurance commissioner’s office to help clear up any confusion.

Local Resources:


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.

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Social Security expands the number of Compassionate Allowances Conditions

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Social Security will add 13 new conditions to its Compassionate Allowance program that  fast-tracks disability decisions so that Americans with the most serious disabilities receive their benefit decisions within days instead of months or years.

Social Security launched the Compassionate Allowances program in 2008 with a list of 50 diseases and conditions.  The announcement of 13 new conditions, effective in December, will increase the total number of Compassionate Allowances conditions to 113.

The conditions include certain cancers, adult brain disorders, a number of rare genetic disorders of children, early-onset Alzheimer’s disease, idiopathic pulmonary fibrosis, and other disorders.

The newly listed Compassionate Allowance Conditions are:

  • Malignant Multiple Sclerosis
  • Paraneoplastic Pemphigus
  • Multicentric Castleman Disease
  • Pulmonary Kaposi Sarcoma
  • Primary Central Nervous System Lymphoma
  • Primary Effusion Lymphoma
  • Angelman Syndrome
  • Lewy Body Dementia
  • Lowe Syndrome
  • Corticobasal Degeneration
  • Multiple System Atrophy
  • Progressive Supranuclear Palsy
  • The ALS/Parkinsonism Dementia Complex

To learn more:

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Medicaid

Medicaid cuts would hit blacks and Latinos hardest — study

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Blacks and Latinos would be among those hardest hit if Medicaid funding were cut as part of a deficit-reduction package, according to a new report released today by Families USA,  the National Association for the Advancement of Colored People and the National Council of La Raza, among others.

In these communities, more than one in four people rely on Medicaid, the shared federal-state health program for the poor, compared with fewer than one in eight whites.

Blacks and Latinos are not only more likely than whites to suffer from chronic diseases such as diabetes, asthma and certain cancers, but they are also more likely to experience complications, to have poorer outcomes and to die prematurely from those conditions, according to the report.

In black and Latino communities, more than one in four people rely on Medicaid, compared with fewer than one in eight whites.

“Without Medicaid, many of these seriously ill people would not be able to afford the care they need. For them, Medicaid coverage is critical.  Federal or state cuts to the Medicaid program would truly put them at risk,” the study warns.

The report comes as the debt deal’s super committee continues to meet on Capitol Hill, facing a Nov. 23 deadline to vote on recommendations to reduce the federal deficit by at least $1.2 trillion over the next decade.

The document’s findings include:

  • Among blacks with cancer, more than one in five  is covered by Medicaid.
  • More than one-third of blacks with chronic lung disease have Medicaid.
  • Among Latinos with chronic lung disease, nearly two in five have Medicaid coverage.
  • About a quarter of Latinos with diabetes and heart disease or stroke are covered by Medicaid.

According to the report, not having health insurance can contribute to poor health outcomes. In 2010, 20.8 percent of blacks and 30.7 percent of Latinos did not have insurance, compared to 11.7 percent of whites.

If diseases like cancer, diabetes, asthma and heard disease aren’t detected early and managed appropriately, poor outcomes, medical complications and death are harder to prevent, the report states.


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.

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Class helps deaf Bhutanese refugees restart their lives

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Dhan Biswakarma and his wife, Bee Biswakarma, who live in Kent, are among several deaf Bhutanese refugees who have been learning American Sign Language at Highline Community College. Photo Allison Barrett

By Allison Barrett

Nancy Allen, an American Sign Language (ASL) teacher at Highline Community College, goes through a stack of name cards, holding up each one and looking quizzically at the students.

“Whose is this?” she signs.

A short man in his 50s smiles hesitantly and raises his hand slowly as he sees the card with his name.

“What is your name?” Allen signs.

The man points to his chest, crosses his fingers in the sign for “name” and then slowly shapes his stout, weathered fingers to form: “D-H-A-N. My name is Dhan.”

Sitting next to him, his wife laughs out loud as her turn comes. She stumbles over the signing sequence, but she follows Allen’s lead and carefully signs her name.

“My name is B-E-E. Bee.”

For Bee and Dhan Biswakarma, Bhutanese refugees restarting their lives in Kent, the struggles of resettlement are intensified by the fact that the deaf couple has few means of communicating with the speaking world.

The Biswakarmas are among a number of deaf or hard-of-hearing Bhutanese refugees who have been resettled in King County in the past several years. Last spring’s class at Highline represented the Biswakarmas’ first exposure to a developed language.

“They have gone their whole lives with no formal language, getting by without a lot of communication,” said David Van Hofwegen, the couple’s caseworker from the World Relief Organization.

They have a repertoire of gestures to communicate with family members. But when it comes to sharing their thoughts with the hearing world, they are limited to signing the basics: eat, sleep, sick, house, wife, child.

And family.

In class, Bee has difficulty remembering how to sign her name, but she immediately grasped the expression for family. At home, she makes the sign after pointing to each relative seated on the mismatched jumble of couches and wooden chairs.

Sher Pandey (in baseball cap), his wife, Basu Pandey (to his left), and Man Budhathoki (at right) practice signing at Highline's American Sign Language class last spring. Photo Allison Barrett

Bee, 47, and Dhan, 55, met in a refugee camp along Nepal’s eastern border after each fled Bhutan by foot in 1991.

They were driven out of their home country by policies implemented in the mid-1980s to forcefully integrate the ethnic Nepali inhabitants of southern Bhutan into the monarchy’s vision of a unified national identity.

Southern Bhutanese were required to go to impossible ends to prove citizenship, ordered to stop teaching Nepali in schools and to abandon traditional dress and customs.

They protested and the military cracked down.

Homes were raided at night and dissidents were jailed, said Bal Biswa, a relative who helps to take care of Bee and Dhan.

Dhan and his extended family, including his relatives and caretakers Bal and Pabita Biswa, joined 23 other families to walk out of Bhutan, sleeping in the forest by day and traveling at night.

According to the United Nations High Commission on Refugees, since 1990 almost 100,000 southern Bhutanese have fled the tiny Himalayan kingdom that is often hailed as the “happiest country in the world” and celebrated for its measurement of Gross National Happiness.

Sitting in the Kent apartment that he and Bee share with Bal and Pabitra, Dhan points at Pabitra and then brings his hand above the ground in a gesture that looks like he’s placing it on the head of an invisible child. He pantomimes that he is carrying something.

Pabitra explains that Dahn helped her carry her kids out of Bhutan. She and her husband, Bal, lost two of those young children to a fever that broke out in the squalor of the early encampments.

Bhutan. Map by Shahid Parvez under Creative Commons license.

Little preparation

Bee and Dhan arrived in Seattle early this year, part of the more than 1,800 Bhutanese who have been resettled in Washington state since 2008. They came with their son, 12-year-old Golpal, who is able to hear and lives with other relatives.

The couple had little preparation for life here.

Bee and Dhan were both born deaf, leaving limited options for employment or education. Bhutan had no established sign language until 2003, when the monarchy opened its first school for deaf children.

“You are considered backwater in society,” said Mitra Dhital, a Bhutanese refugee who works as a medical social worker for the Asian Counseling and Referral Services.

In many ways, they are even less independent in America.

Bee and Dhan don’t like to walk the five blocks to a grocery store alone, for fear of getting lost. Sometimes they stroll around the perimeter of the building, but never leave the grounds.

At first they were fearful of going to their ASL class. They were daunted by many things, including the bus ride there, until the World Relief organization provided a volunteer-driven van ride.

Among the eight Bhutanese class members, there is a range of hearing impairment, from Bee, who lives in complete silence, to a man in his mid-30s who has no hearing in one ear and is slowly going deaf in the other.

The number of those who are deaf or hard-of-hearing represent only a small percentage of the Bhutanese refugees here. But caseworkers say it is an unusually large number compared to other refugee groups. No one is certain why.

It is unclear whether that is the result of policies that give the deaf resettlement priority because of their lack of opportunities in the camps, or if the number reflects a high occurrence of deafness within Bhutan.

The World Health Organization estimates that of the 278 million people in the world living with moderate to profound hearing loss, 80 percent live in developing countries. And about half of all cases are preventable, caused in part by illnesses like measles, mumps and rubella that have readily available vaccinations in the developed world.

Ear infections, exacerbated by poor sanitation and hygiene, often went untreated in the refugee camps for Bhutanese, said Dhital.

Allen is adamant that even without a formal language, Bee and Dhan understand each other just fine. “All deaf people have a language,” said Allen.

The challenge for Bee, Dhan and the others in the class is finding a way to interact with the hearing world.

Allen, director of interpretive services at Highline, was approached about starting an ASL class for deaf Bhutanese about a year ago. She had never taught a class tailored to refugees.

Around the same time, Allen ran into a Bhutanese couple in the college’s parking lot, a hearing woman with her deaf husband. The wife, enrolled in English classes at Highline, was in search of a class for her husband.

“The light bulbs started going off,” said Allen. “There are other deaf refugees here. There is a need that is not being met.”

She says her deaf co-teacher, Ricardo Velilla, is the key to the class.

Extremely animated, he can model abstract concepts with ease. He acts out a jaunty stroll down the road, a runaway vehicle and narrowly averted catastrophe. He then runs the palm of one hand up the back of the other in a smooth motion. This is the sign for “almost.”

For a short time, Allen and Velilla had a deaf man from Somalia in their class.

“One day he came in very agitated, making all these wild motions,” said Allen. “Ricardo took one look at him and explained to me, ‘He used to have a driver’s license in his home country but he’s frustrated because he can’t get one here.’ ”

Allen knows lots of other deaf refugees and immigrants could benefit from access to ASL. But for now, the class is only offered once a week.

Until Bee and Dhan acquire enough ASL to communicate ideas to the hearing world, their prospects for employment are dismal.

Van Hofwegen is assisting them with the lengthy and very difficult process of qualifying for federal disability benefits.

The program doesn’t accept international evidence. You have to visit a primary physician for a referral and get screened by certified audiologists and other specialists, a procedure that requires Bee and Dhan, accompanied, to run to appointments all over the county.

Evening sets in, and the Kent apartment is filled with the scent of Nepali dumplings. Golpal and some neighbor boys are engaged in a cutthroat game of marbles on the floor. Bal and Pabitra’s sons are using the bulky computer in the corner, browsing Facebook and watching Bollywood videos on YouTube.

Dhan retreats to the bedroom and returns, carrying a sheet of paper. He takes a seat next to Bee on the couch.

They both lean over the manuscript that is covered in a scrawling alphabet, written in Dhan’s shaky hand, and start to shape their fingers into signs, beginning with the letters of their names.

Allison Barrett, a UW senior, wrote this piece for Health Intersections, the UW Communications Department’s class on global health reporting. She can be reached at allisondbarrett@gmail.com

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Medicare Open Enrollment begins Saturday

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Click on image to go to the handbook.

Medicare Open Enrollment Period — which begins earlier this year on Saturday, October 15 – has been expanded to last seven weeks and will end on December 7.

This will give seniors and people with disabilities more time to compare and find the best plan, says the U.S. Department of Health and Human Services.

Beginning today, people with Medicare can begin reviewing the 2012 quality ratings for Medicare Advantage health plans (Part C) and prescription drug plans (Part D) for the upcoming year at: www.medicare.gov/find-a-plan.

Medicare will be highlighting plans that have achieved an overall quality rating of 5 stars with a high performer or “gold star” icon so people with Medicare can easily find high quality plans.

People with Medicare can switch to an available 5-star plan at any time during the year.

Using Medicare’s Plan Finder – available at www.medicare.gov/find-a-plan – people will see the enhanced star ratings for 2012. In addition to the enhanced star ratings for 2012 and new “gold star” icon.

Plan Finder users will also see an icon showing which plans received a low overall quality rating for the past three years.

Due to provisions in the Affordable Care Act, Medicare beneficiaries will have access to lower cost prescription drugs through a 50 percent discount on covered brand name drugs in the coverage gap (also referred to as the “donut hole”).

They will also receive wellness checkups and  certain preventive care with no copayments – a benefit that all Medicare Advantage plans will offer starting in 2012.

Resources for Medicare Beneficiaries

People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:

  • Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder tool has been enhanced for an efficient review of plan choices. Spanish Open Enrollment information is available.
  • Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048. Multilingual counseling is available.

Extra Help:

People with Medicare who have limited incomes and resources may qualify for Extra Help paying for their prescription drug costs. There is no cost to apply for Extra Help, also called the low-income subsidy. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Warning: Protect Yourself Against Fraud and Identity Theft

During this Open Enrollment Period, Medicare recommends that people treat their Medicare number as they do their social security number and credit card information.

People with Medicare should never give their personal information to anyone arriving at their home uninvited or making unsolicited phone calls selling Medicare-related products or services.

Beneficiaries who believe they are a victim of fraud or identity theft should contact Medicare (contact information above). More information is available at www.stopmedicarefraud.gov

 

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Insurers compete for Medicare’s five-star rating

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 Medicare Plans See Dollars In The Stars

Photo by Svilen Milev

By Christopher Weaver

KHN Staff Writer

Three Boston-area health insurers are in a race for a decisive competitive advantage.

They’re not seeking the usual industry plaudits, exclusive deals with high-profile medical providers, or splashy marketing campaigns.

They’re after the highest mark on Medicare’s quality exam, a one-to-five star rating system that was an afterthought until the 2010 health law tied it to big cash bonuses.

The Medicare Advantage plans’ latest ratings for 2012 will be released Wednesday.

Top scoring plans will also win the ability to enroll new members year-round, rather than a few weeks each autumn.

“It’s a huge game changer in Massachusetts,” said Ken Arruda, executive director of Medicare services for Blue Cross Blue Shield of Massachusetts, which currently has 4.5 stars. Also in the Boston area, Fallon Community Health Plan and Tufts Health Plan are on the cusp of the top score.

Each says their strategy is to reach five stars as soon as possible –a feat only three plans nationwide have achieved so far.

Competition is fiercest in places like Boston, where high-ranking plans are near their goal, but shades of this quality arms race are visible throughout the country. Insurers have rarely competed on quality measures, but as the federal government prepares to unleash an estimated $3 billion to $4 billion next year in bonus payments, the industry is following the money. Star-ratings are bleeding into bottom lines, board meetings, and corporate strategy as the insurers chase top scores.

Top scoring plans will also win the ability to enroll new members year-round, rather than a few weeks each autumn.

Wednesday’s announcement comes just ahead of the open enrollment period which runs from Oct. 15 through Dec. 7. About one quarter of Medicare beneficiaries are now in private plans that contract with the federal government to provide health benefits to seniors and disabled people.

The star ratings have been on the books since 2007 and are the only guide to health plan performance available to consumers. Next year, though, is the first in which there is money at stake for the companies.

“[T]o say that the [private plans] put less than optimal resources toward star quality ratings in the past would be an understatement,” wrote Barclays Capital analyst Joshua Raskin. Now, he said by e-mail, he sees a “clear effort on improving the ratings at most companies.”

The federal health law cut $136 billion in payments to Medicare Advantage plans over 10 years, and health plan accountants increasingly see the new star-rating bonuses as a way to mitigate the losses.

The Obama administration has argued that the private plans, originally devised as a way to reduce Medicare costs, have long been overpaid. They cost the government as much as 114 percent of the cost of traditional Medicare patients, without producing better health outcomes for enrollees.

Photo by Svilen Milev

The federal government announced in November that it would increase the bonuses. The program is part of a push for quality, led by Medicare administrator Dr. Donald Berwick, that is meant to boost results even as the cuts kick in.

Consumer advocates, such as Ilene Stein, the Medicare Rights Center’s federal policy director, are hopeful that the ratings will improve quality for Medicare beneficiaries. However, Stein cautioned, the Medicare agency will need to oversee the bonus system so health plans don’t game the measures.

Beginning in January, plans with three stars – the average rating – or better, will get bonuses of 3 to 5 percent of their total Medicare payments.  The ratings are based on 36 measures, ranging from diabetes care to the volume of consumer complaints. Twenty-two insurers across the country now boast a 4.5 star rating. Of 396 plans that received 2011 scores, only three achieved five stars: one each in Colorado, Florida and Wisconsin.

Attention to the ratings is new even to the top performers. At Marshfield Clinic’s 5-star Security Health Plan in Wisconsin, the plan’s top administrative officer, Steve Youso, described the high score as a natural byproduct of the insurer’s culture of quality.

But, now executives there are paying attention, too, knowing the top rating is worth keeping. “Prior to March 2010″ – when the health law passed – “[ratings were] probably not a topic of discussion,” Youso said. Now, “our senior executive team is talking about this on a weekly basis.”

There’s a similar dynamic at Massachusetts’s Fallon Community Health Plan, which is still gunning for five stars. “The finance department is more interested in our [quality] results than ever before,” said Ann Marie Sciammacco, vice-president of health services. “Basically, the stars equate to dollars.”

In Worcester County, the hub of Fallon’s service area, five-star plans would earn $8 a month more than 4.5 star plans for a typical member, according to Medicare data. For Fallon’s 28,000 members there, it would add up to $2.7 million a year – money that could be used to reduce premiums and attract more customers.

Sometimes boosting ratings is simple work. One measure the government tracks is the rate of colorectal cancer screening for certain patients. Fallon members get a birthday card from their insurance company that reads, “Every nine minutes, someone in the U.S. dies from colorectal cancer.” Eighty-four percent of Fallon patients get the screening.

Fallon – or a rival plan in the Boston-area – could also benefit from the year-round enrollment perk, which would allow a five-star plan to pick off its competitor’s members.  “The primary – but untested in this market – competitive advantage of being five stars… is the ability to enroll year round,” said Richard Burke, Fallon’s president of senior care services, in an e-mail.

Plans that consistently score less than three stars could eventually be booted from the program altogether.

Nationally, lower ranking insurers, such as the publicly traded HealthSpring, which runs mostly three-star plans, view star ratings as a crucial ingredient to boosting revenues and competing more effectively. Jason Feuerman, a top HealthSpring executive, said in an April interview, “We’re putting the resources in place to make sure we can drive those ratings.”

During a visit that month to a HealthSpring-operated clinic in Philadelphia, administrator Nathaniel Decker pointed out equipment, such as a digital retinal camera, that he said was installed to help boost star ratings by allowing doctors to easily perform one of the tasks measured: eye exams for diabetic patients.

In addition to missing out on the bonuses, plans that consistently score less than three stars could eventually be booted from the program altogether under a proposed regulation released early this month by the Medicare agency.

Plans’ interest in boosting ratings is widespread enough to fuel a niche consulting business. The consulting arm of OptumInsight, a subsidiary of UnitedHealth Group, for instance, says it has picked up 35 health plan clients seeking star-related services. “As soon as you start attaching some money to it, it’s amazing,” said Steve Wood, an Optum management consultant.

In some markets, the star ratings could boost underdogs. Houston-based KelseyCare Advantage, a Medicare plan affiliated with the Kelsey-Seybold Clinic, is on the cusp of a five-star rating.

In membership, though, it trails TexanPlus, a Medicare plan operated by the publicly-traded Universal American Corporation, that has 50,000 members – twice as many as KelseyCare. But TexanPlus has only 3.5 stars this year.

KelseyCare President Marnie Matheny is hoping to achieve five stars – and a marketing edge that could level the playing field with a competitor who can do things like rent out the Reliant Center for a Wii bowling tournament to attract customers.

“It will be huge for us,” said Matheny. When patients see “there’s no one else in the market [with five stars], they’ll think there’s something special about KelseyCare.”

Photo by Svilen Milev.

More of Milev’s work can also be seen his website Effective.com and on his Facebook page.

We want to hear from you: Contact Kaiser Health News


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.

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Decorative contact lenses: Is your vision worth it?

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A Consumer Update from the FDA

Wouldn’t it be cool to have Twilight vampire eyes for Halloween?

Or deep violet eyes to match your purple sweater?

How about your favorite sports team’s logo on your eyes just for fun?

You can have all of these looks with decorative contact lenses (also called fashion contact lenses or color contact lenses, among other names). These lenses don’t correct vision—they just change the appearance of the eye.

But before buying decorative lenses, here’s what you should know:

They are not cosmetics or over-the-counter merchandise. They are medical devices regulated by the Food and Drug Administration (FDA). Places that advertise them as cosmetics or sell them without a prescription are breaking the law.

They are not “one size fits all.” An eye doctor (ophthalmologist or optometrist) must measure each eye to properly fit the lenses and evaluate how your eye responds to contact lens wear. A poor fit can cause serious eye damage, including:

    • scratches on the cornea (the top layer of your eyeball)
    • corneal infection (an ulcer on the cornea)
    • conjunctivitis (pink eye)
    • decreased vision
    • blindness

Places that sell decorative lenses without a prescription may give you few or no instructions on how to clean and care for your lenses.

Failure to use the proper solution to keep contact lenses clean and moist can lead to infections, says Bernard Lepri, O.D., M.S., M.Ed., an optometrist at FDA. “Bacterial infections can be extremely rapid, result in corneal ulcers, and cause blindness—sometimes within as little as 24 hours if not diagnosed and treated promptly.”

“The problem isn’t with the decorative contacts themselves,” adds Lepri. “It’s the way people use them improperly—without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care.”

Where NOT to Buy Contact Lenses

FDA is aware that many places illegally sell decorative contact lenses to consumers without valid prescriptions for as little as $20.

You should never buy lenses from:

  • street vendors
  • salons or beauty supply stores
  • boutiques
  • flea markets
  • novelty stores
  • Halloween stores
  • record or video stores
  • convenience stores
  • beach shops
  • Internet (unless the site requires a prescription)

These are not authorized distributors of contact lenses, which are prescription devices by federal law.

How to Buy Decorative Contact Lenses Safely

Get an eye exam from a licensed eye doctor (ophthalmologist or optometrist), even if you feel your vision is perfect.

Get a valid prescription that includes the brand name, lens measurements, and an expiration date. But don’t expect your eye doctor to prescribe anime, or circle, lenses. These bigger-than-normal lenses that give the wearer a wide-eyed, doll-like look have not been approved by FDA.

Whether you go in person or shop online, buy the lenses from a seller that requires you to provide a prescription.

Follow directions for cleaning, disinfecting, and wearing the lenses, and visit your eye doctor for follow-up eye exams.

See your eye doctor right away if you have signs of possible eye infection:

  • redness
  • eye pain that doesn’t go away after a short time
  • decrease in vision

High Price for Fashion

Laura Butler paid $30 for her decorative lenses and $2,000 in medical bills. And she nearly lost an eye.

While at the beach in July 2010, Butler of Parkersburg, W.Va., bought a pair of blue contact lenses at a souvenir shop. The brown-eyed Butler was on vacation and just wanted to try a different eye color for fun, she says.

No instructions came with the lenses and the store didn’t sell contact lens solution. “They felt fine, but they moved around on my eyes and I had to adjust them with my finger,” says Butler.

As she was driving home the next day, Butler felt a sharp pain in her left eye. “It was such excruciating pain, I had to quickly pull over on the side of the road.” It took her 20 minutes to remove the contacts, she says, which had stuck to her eyes like suction cups. She drove home “with pain that was indescribable.”

A trip to the ER and then to an ophthalmologist gave Butler a diagnosis: corneal abrasion. “The doctor said it was as if someone took sandpaper and sanded my cornea,” she says. “He said he wasn’t going to sugar-coat it, that I could lose my eyesight or could lose my eye.”

Butler saw the doctor every day for 10 days and was under his care for seven weeks. “He took really good care of me and I didn’t get an infection,” says Butler. “But the pain was agonizing. I used to lay on the floor and roll back and forth in a fetal position for hours.”

Butler couldn’t see well enough to drive for eight weeks, had a drooping eyelid for five months, and still has decreased vision in her eye, she says. And she found out her optometrist could have ordered two sets of lenses for $50 and charged $60 for an eye exam.

Her advice: Don’t buy fashion lenses. If you do, “Take the time to go to the doctor, pay the extra money, and save yourself the agony.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

October 12, 2011

To learn more:

For related FDA Updates 

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Sidewalks, crime affect women’s physical activity

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By Glenda Fauntleroy, Contributing Writer
Health Behavior News Service

Getting women to meet the U.S. federal government’s recommended level of moderate-to-vigorous physical activity remains a huge challenge.  A large new study shows that where women live affects just how likely they are to exercise.

The study, appearing online and in the November issue American Journal of Preventive Medicine, found that women throughout the United States, in both urban and suburban areas, were more likely to walk where they felt safe and had access to sidewalks and other community resources.

“The results from this study confirm what we know about the health benefits of living in neighborhoods with access to recreation facilities and resources such as shops and stores,” said Keshia Pollack, assistant professor at the Johns Hopkins Bloomberg School of Public Health, who is familiar with the study.

“The bottom line is when people have access to these types of resources, they are more likely to meet physical activity recommendations,” said Pollack, who specializes in formulating policies to create safe and healthy environments.

Green: more walkable. Red: less walkable. Click to view your neighborhood rankings from Walkscore

Researchers from Purdue University evaluated responses from almost 69,000 women between ages 40 and 60 who took part in the Nurses’ Health Study II in 2005.

The survey asked women whether they had shopping and free recreational facilities within walking distance, whether they had sidewalks and about their perception of crime in the area.

Women also responded to items on how much time they spent walking, running or biking outdoors.

Just 24 percent of the women met the recommended activity level – calculated by time spent and pace used for walking, jogging, running or bicycling, or combinations of those – each week.

The study found that an increase in positive environmental characteristics improves the odds that women will be physically active in all regions of the country. Crime had a negative influence on physical activity in most regions.

Having sidewalks made it more likely for women to meet weekly walking guidelines in the Midwest and South, but not in the Northeast and West.

“We need policies that create healthy and safe environments where people live, work, and play,” Pollack said.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Twenty-dollar bill in a pill bottle

Cancer patients often face hefty bills

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By Michelle Andrews

Continuing advances in cancer treatment are a double-edged sword for many patients: New drugs, surgical techniques and other innovations help them battle their disease, but better health and longer lives may come at a hefty cost, even for people with health insurance.

Recent research spells out what patients are facing. A study by the Agency for Healthcare Research and Quality estimated that between 2001 and 2008, 13.4 percent of adults younger than 65 who had cancer spent more than 20 percent of their income on health care, including premiums.

That compared with 9.7 percent of people with other chronic conditions and just 4.4 percent of those with no chronic conditions.

Researchers from the Duke University Medical Center and the Dana-Farber Cancer Institute examined the cancer spending of 216 patients, most with breast cancer, and found their out-of-pocket costs averaged $712 a month.

The biggest chunk of that outlay, apart from insurance premiums, went to prescription drugs, at $174.

Long term, cancer treatment costs can have a devastating effect on people’s financial well-being. A study by researchers at Seattle’s Fred Hutchinson Cancer Research Center found that in western Washington state, 0.5 percent of cancer patients declared bankruptcy in the first year after their diagnosis. Five years following diagnosis, the percentage was 1.9. By comparison, just 0.28 percent of the general population declared bankruptcy over a 10-year period.

Most people have job-based insurance, but cancer treatment can take up to a year and employees risk losing coverage if they can’t keep working, says Dr. Scott Ramsey, lead author of the bankruptcy study and a member of the public health sciences division at Hutchinson. “The combination can put a severe financial strain on them,” he says.

More From This Series: Insuring Your Health

Self-employed people have it no easier. In fact, because individual policies often have higher deductibles and cost-sharing than employer-based plans, they may face even tougher financial challenges.

Ellen Jacobs runs an Internet advertising business from her home in Shelbyville, Ky. When she received a diagnosis of breast cancer in May, she had to meet her individual policy’s $3,500 deductible before the plan paid much of anything. Even now, although the policy covers her chemotherapy and pays a portion of her costs for doctor visits and the like, Jacobs, 46, has significant out-of-pocket costs.

Co-payments for specialists whom she must see several times a month are $40. And while many of her medications require only a $15 co-payment, there are some big exceptions.

During her first chemotherapy treatments, for example, she spent $680 on a single anti-nausea drug. (Now she has qualified for assistance from the nonprofit Patient Advocate Foundation’s Co-Pay Relief Program, which has helped cover $600 so far in drug bills.)

After chemotherapy shrinks the tumor in her breast, Jacobs will have surgery. But she is concerned that she might not be able to do so until after the first of the year, when she will face another $3,500 deductible.

Meanwhile, she lives with her mother and her sister, and is gratefully accepting a financial hand from her parents. “Even having insurance, I could never afford this without my mom and dad helping me out,” she says.

“Oncologists are not entirely disinterested parties.”

The American Society of Clinical Oncology encourages oncologists to discuss treatment costs with patients. But that’s easier said than done, say some oncologists. More than half of the income of many oncology practices comes from administering the drugs they prescribe, says Ramsey, so oncologists are not entirely disinterested parties. In addition, the timing is often
tough.

Patients are “already scared and they have cancer,” he says.

But oncologists can routinely do some simple things, according to Dr. Yousuf Zafar, lead author of the Duke study, who says he always asks his patients if they have drug coverage.

Some drugs for breast and colon cancer can be administered either in pill or IV form, and an IV infusion in a doctor’s office might be more affordable for someone without a good policy.  Or he might prescribe a different, less expensive anti-nausea drug if he knows drug coverage is a problem.

Patients are speaking up as well, he says. If they’re traveling to see doctors following an early-stage cancer diagnosis, for example, patients sometimes ask to come in less frequently for checkups, saving travel costs. Depending on the situation, Zafar may agree. “There’s no good evidence that bringing them in more often will help them live longer,” he says.

KHN wants to hear from you: Contact Kaiser Health News


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.

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$100-dollar bill inside a capsule

The five cancers most likely to push you over the financial edge

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By Michelle Andrews

Cancer often takes a heavy toll not only on people’s bodies but on their finances as well. And just as some types of cancer are more deadly than others, some types cause more financial pain, as recent research from Seattle’s Fred Hutchinson Cancer Research Center shows.

When researchers examined bankruptcy rates in Washington state and compared them with a registry of 232,000 cancer patients there between 1995 and 2009, they found that five years after their diagnosis cancer patients were four times more likely to declare bankruptcy than the general population.

Specifically, 1.9 percent of cancer patients declared bankruptcy compared with just 0.28 percent of those without cancer.

When researchers looked further, certain types of cancer were associated with a higher risk of bankruptcy at the 5-year mark than others.

The top five cancers in order of risk for bankruptcy were:

  • Lung
  • Thyroid
  • Leukemia/lymphoma
  • Uterine
  • Colorectal

Although the reasons for the higher bankruptcy rates aren’t known with certainty, study lead author Scott Ramsey, a physician and health economist at Hutchinson, has some ideas.

In the case of lung and thyroid cancers, it may have to do with the populations that are typically affected, says Ramsey.

Lung cancer, for example, is generally diagnosed in smokers who are more likely to be relatively low on the socioeconomic ladder, says Ramsey. Likewise, thyroid cancer is most common in women who are younger than typical cancer patients, and so may have worse or less insurance than older patients.

In the case of leukemia/lymphoma and colorectal cancers, extremely high treatment costs may be the culprit in bankruptcy filings, he says, pointing to bone marrow transplants used to treat blood cancers, and the $300,000 or higher price tag to treat advanced colorectal cancer.

As for uterine cancer, “We’re not quite sure what’s going on with that,” he says.


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.

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Pharmacists jump into the flu shot market

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By Jenny Gold
KHN Staff Writer

Drugstore and supermarket pharmacies across the country have launched a marketing blitz to attract flu shot customers, touting the convenience of stopping at a local drugstore and often offering drop-in vaccinations anytime the pharmacy is open — sometimes even 24 hours a day.

Walgreens Pharmacist Scott Gershman gives a Band-Aid to Drew Troff in Springfield, Va., after injecting him with a flu shot. (Francis Ying/KHN)

“If you decided at 4 o’clock in the morning you wanted to go out and had nothing better to do than get a flu shot, you could walk right in and you could get a flu shot,” says Scott Gershman, pharmacy manager at a Walgreens drugstore in Springfield, Va. The wall outside his store is plastered with a giant sign reading “Walgreens flu shots. Walk in anytime.”

Just after the weather turned cold in late September, Shelley Troff and her 13-year-old son dropped by Gershman’s pharmacy one afternoon to get their annual shots.

Troff says she didn’t even consider going to her doctor’s office. “To be frankly honest, Walgreens is easier,” she explains. “Since this is one mile from my house and the clinic is 20 minutes from my house, this is where I come.”

Pharmacies usually charge between $25 and $32, while a shot at the doctor’s office usually costs at least $48, according to Matthew Davis, a pediatrician and associate professor at the University of Michigan in Ann Arbor. But for most people with insurance, cost is not the issue—convenience is. That’s because the shots are generally paid for by insurance.

For the Troffs, there was no out-of-pocket expense. The pharmacy billed their insurance. That is true for many consumers because under the Affordable Care Act enacted in 2010, most insurers can no longer charge copays for preventive care, including flu shots. Some plans are exempt from that because they were grandfathered under the law.

The majority of Americans still get their flu shot at the doctor’s office, but an increasing number, like the Troffs, are going to their local pharmacy instead.

In 2010, 18.4 percent of adults who were immunized received the flu vaccine at a supermarket or drugstore, just edging out workplace vaccinations for the second most popular venue, according the Centers for Disease Control and Prevention.

The H1N1 epidemic in 2009, which showcased a particulary deadly strain of flu, helped propel the trend; the panic sent customers running to drugstores, which often had vaccines available after physicians’ offices had run out.

“It became clear to the government and Americans that pharmacies can provide easy access to vaccines,” says Edith Rosato, senior vice president of the National Association of Chain Drug Stores.

But while more people are going to the pharmacy, the number of Americans who get the flu vaccine each year has remained fairly constant at about 40 percent of all adults.

Walgreens Pharmacists Adel Jaber and Scott Gershman stand at their registers in Springfield, Va. The pair give flu shots regularly to customers. (Francis Ying/KHN)

Drugstores and supermarket pharmacies are eager to stake out a bigger piece of that market.

Gershman spent his first seven years at the Walgreens behind the pharmacy counter, filling prescriptions and dispensing advice.

Three years ago, he entered a training program on delivering vaccines. Now, he spends a good part of his fall and winter workdays vaccinating customers. He says “being able to step out behind the counter and talk one-on-one with patients” is among the most rewarding parts of his job.

 Nationwide, the number of pharmacists trained to deliver vaccines has nearly quadrupled since 2007, from 40,000 to 150,000. The stores hope to market their growing vaccine business, even offering incentives to customers. At Safeway, the flu shot brings a 10 percent discount on groceries. CVS offers a $5 gift card. Rite Aid gives away a coupon book worth $100 in potential savings.

Nonetheless, it is not clear how profitable the flu shot is to pharmacies, and experts’ views differ. Revenue figures are proprietary, but Katherine Harris, a senior economist at the Rand Group who studies the vaccine market, says flu shots are not usually a big money-maker.  They often involve taking time away from other duties to educate patients and bill insurers, she explains. Other analysts believe drugstores earn profits of 30 to 50 percent on the procedures, according to The Wall Street Journal.

The number of pharmacists trained to deliver vaccines has nearly quadrupled since 2007, from 40,000 to 150,000.

Rosato explains that flu shots are an important public service as well as an effective way to gain customer business. “Everyone is trying to drive customers into the store to get their flu vaccine and then hopefully build customer loyalty” so they will buy other products as well, she says.

Vaccine campaigns are part of a broader effort to expand the role of pharmacists in health care delivery, says Rosato. “With the shortage of primary care and other professionals in the future,” she explains, pharmacists see an opportunity to work closely with doctors and nurses to advise patients with chronic illnesses, offering blood pressure and diabetes screenings and medication management. “Immunization is just one piece of it.”

Thus far, doctors have not pushed back against the efforts. Vince Hartzell, who with his father owns a pharmacy in Catasauqua, Pa., says 10 of the local physician practices actually refer their patients to his pharmacy, grateful to give up a service that is not particularly lucrative.

But some experts warn that getting the flu vaccine at a pharmacy is not right for everyone, particularly patients with chronic illnesses or those who are uninsured.

“If you’re uninsured, go shopping,” says Davis. He says the uninsured can often find a cheaper option at their local health department, where the vaccine may even be free.

Davis recommends that anyone with a chronic illness stick with their primary care doctor for the flu vaccine as part of an effort to “track vaccinations and manage effort to vaccinate high risk population in more efficient way.”

He adds that while it’s good for private retailers to join the vaccination army, he also worries that some patients might skip the annual doctor’s visit altogether.  “The main concern about pharmacy-based vaccination is that it might somehow discourage patients from otherwise following up with their doctors.”

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.

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Webwatch: Best of the Web on health

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KHN reporter Jessica Marcy selects interesting reading from around the Web.

The Daily Beast: Bart Stupak On Life After Health Care

Former Democratic congressman Bart Stupak is relishing the good life. After nine terms in the House of Representatives, the once obscure, pro-life, conservative legislator who became the flash point in last year’s historic health care debate gave up his seat to become a gilded Washington operative — a partner in the Government and Legislative Affairs Group of Venable LLP. … Even before he negotiated a last-minute deal with President Obama to ban federal funding for abortion and provided the defining vote, he called his life “a living hell.” “I was the face of health care. Whatever you thought about it, I was it,” he says calmly. “I’m surprised I never got shot.” (One enraged constituent, Russell Hesch, recently pleaded guilty to threatening to kill Stupak, his wife, Laurie, and his son Ken, and to paint the Mackinac Bridge with their blood. His trial is scheduled for mid-December.) (Sandra McElwaine, 10/2).

Mother Jones: Is Susan G. Komen Denying the BPA-Breast Cancer Link?

If you’ve ever bought something pink to support breast cancer research, there’s a good chance a portion of the money went to Susan G. Komen for the Cure, the largest nonprofit in the world solely dedicated to eradicating the disease. Famous for its fundraising races and pink gear, the foundation has been fighting breast cancer for three decades. So it may come as a surprise that Komen has posted statements on its website that dismiss links between the common chemical bisphenol A (BPA) and breast cancer, even while funding research that explores that possible connection. … And yet, it’s hard to ignore mounting scientific evidence that strongly suggests a link between BPA and cancer (Amy Silverstein, 10/3).

Governing: Freeing Up Space (And Money) In The Emergency Room

Sign for an emergency room.Over the past few years, a number of states, cities and counties have come to the same conclusion: identifying those who use the emergency room the most and steering them to less costly care elsewhere saves money for everyone. … Kelly Harder, now the director of Dakota County Community Services in Minnesota, had an “aha moment” five years ago when he was director of human services in rural Steele County, south of the Twin Cities. He heard about the financial pressure the community hospital faced caring for uninsured and underinsured patients in the ER and, adhering to the 80/20 rule, knew that a few people likely accounted for most of the cost. A quick glance at those patients revealed they were often the same folks Harder dealt with in other human services programs. … At the time, Harder had just established a program to reduce recidivism in local jails, in which a social worker helped parolees find housing and jobs. “We had success with that,” he says, “[so] why wouldn’t that work in the ER?” (David Levine, October 2011).

American Medical News: Bracing For Medicaid Expansion

More than two years remain before millions of low-income Americans gain Medicaid eligibility through an expansion authorized by the health system reform law, but it’s already clear the overhaul will affect some states much more than others. Certain states in the Northeast and Midwest already cover most or all of their poorest residents. So the health reform law’s Medicaid expansion to 133 percent of the federal poverty level should pose relatively little strain to their safety nets. But other states — particularly in the South and Mountain West — are bracing for a bigger impact. … Challenged states — such as Texas, Oklahoma, Mississippi and Idaho — have limited numbers of physicians, but they already pay relatively high Medicaid fees to doctors in an effort to retain them (Doug Trapp, 10/3).


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.

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