Music for Medicine

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Annual Music for Medicine Benefit Concert May 18

Music for Medicine event benefits the Polyclinic Community Health Foundation and the Seattle Young Artists Music Festival.

The Polyclinic Community Health Foundation uses the funds to provide medication to patients who are uninsured, low-income, and suffering from chronic illnesses.

Working with Kelley-Ross Pharmacy and The Polyclinic physicians, the Foundation’s Pharmacy Assistance program assisted more than 160 patients last year, helping to fill more than 3,800 prescriptions.

For every dollar donated, The Foundation is able to provide $4 worth of medication to patients through generous at-cost pricing of drugs from Kelley-Ross and by enrolling patients in pharmaceutical assistance programs.

The event’s Online Auction has already begun but closes soon–1:00 p.m. May 13th.

To see the offerings and place a bid go to HERE.

WHEN:

Wednesday, May 18th, 2011

6:00 – 7:30 p.m. Silent Auction and hors d’ouvres

7:30 – 8:30 p.m. Musical Recital featuring Seattle Young Artists performers.

WHERE:

Seattle Asian Art Museum

1400 East Prospect Street, Seattle

Admission: $25 Adults / $10 Students / Children under 12 free

Tickets and information are available at www.polyclinicfoundation.org


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Violin face and side view

Music for Medicine Benefit — Wed. May 18th

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Annual Music for Medicine Benefit Concert May 18

Music for Medicine event benefits the Polyclinic Community Health Foundation and the Seattle Young Artists Music Festival.

The Polyclinic Community Health Foundation uses the funds to provide medication to patients who are uninsured, low-income, and suffering from chronic illnesses.

Working with Kelley-Ross Pharmacy and The Polyclinic physicians, the Foundation’s Pharmacy Assistance program assisted more than 160 patients last year, helping to fill more than 3,800 prescriptions.

For every dollar donated, The Foundation is able to provide $4 worth of medication to patients through generous at-cost pricing of drugs from Kelley-Ross and by enrolling patients in pharmaceutical assistance programs.

The event’s Online Auction has already begun but closes soon–1:00 p.m. May 13th.

To see the offerings and place a bid go to HERE.

WHEN:

Wednesday, May 18th, 2011

6:00 – 7:30 p.m. Silent Auction and hors d’ouvres

7:30 – 8:30 p.m. Musical Recital featuring Seattle Young Artists performers.

WHERE:

Seattle Asian Art Museum

1400 East Prospect Street, Seattle

Admission: $25 Adults / $10 Students / Children under 12 free

Tickets and information are available at www.polyclinicfoundation.org


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And younger man's hand holds an elderly man's hand

Nursing homes giving powerful antipsychotics to elderly unnecessarily, government report

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By by Marian Wang
ProPublica

Nursing homes are unnecessarily administering powerful antipsychotic drugs to many elderly residents, including residents with dementia, according to a new report by the Health and Human Services inspector general.

The Food and Drug Administration in 2005 mandated that drug makers issue warning labels on atypical antipsychotics, noting that the drugs—which are generally FDA-approved for treating schizophrenia and bipolar disorder—increase the risk of death for elderly patients with dementia.

Yet when the government examined 1.4 million Medicare claims from 2007 for atypical antipsychotics for elderly nursing home residents, the government found that 88 percent of the time, the drugs were prescribed to individuals diagnosed with dementia.

Doctors and nursing homes aren’t the only ones to blame, according to HHS Inspector General Daniel Levinson. The report itself does not specifically examine ties between doctors, pharmacies, and nursing homes, but in a statement accompanying the report, Levinson faulted drug companies for aggressively—and illegally—marketing these products to doctors for treatment of dementia and other off-label uses. (It’s not illegal for doctors to prescribe drugs for off-label uses, but it is for drug companies to promote them as such.)

“Despite the fact that it is potentially lethal to prescribe antipsychotics to patients with dementia, there’s ample evidence that some drug companies aggressively marketed their products towards such populations, putting profits before safety,” Levinson said.

He noted that a number of drug companies have been accused of illegally promoting these drugs off-label to doctors and pharmacies, including those that serve nursing home residents. Some of the lawsuits have settled, but Levin said those settlements alone don’t negate the effects of years of off-label promotion.

“Money can’t make up for years of corporate campaigns that market drugs with questionable benefits and potentially deadly side effects for vulnerable, elderly patients,” according to Levinson.

The report also faulted the Center for Medicare and Medicaid Services (CMS), the agency that oversees Medicare and Medicaid, for failing to hold nursing homes accountable for unnecessary use of antipsychotic drugs.

Unnecessary uses can include inadequate rationale for using the drug as well as excessive doses, excessive duration, and inadequate monitoring of patients to whom the drug was given.

The report notes that the federal government paid more than $116 million more than $116 million for claims that violated its Medicare reimbursement criteria. These claims were only for the first half of 2007.

The inspector general recommends that CMS assess its safeguards for preventing unnecessary antipsychotic drug use in nursing homes. The agency acknowledged that better controls were needed.

In a letter to the inspector general, CMS Administrator Donald Berwick wrote that the agency is “very concerned about the nature of the contractual arrangements” involving nursing homes, the doctors and pharmacies that serve them, and pharmaceutical manufacturers.

We’ve reported on some of those ties in our series, Dollars for Docs. In particular, we highlighted the case of a psychiatrist who served Chicago-area nursing homes and made nearly a half million dollars promoting AstraZeneca’s best-selling antipsychotic.

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Red stethoscope

The old practice of house calls returning to some areas

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By Michelle Andrews

Nobody likes taking time out of a busy day to cool their heels in a doctor’s waiting room. Now you may not have to. Some primary-care practitioners are bringing their black bags directly to home or office, in some cases for as little as $30 to $35 a visit.

Experts agree that house calls are a great convenience, and for seriously ill patients who can’t get to a doctor’s office, they are often invaluable. But unless the practices offering house calls coordinate with patients’ other providers, they may only further splinter an already fragmented health-care system, experts warn.

With 600,000 members in three states —Texas, Massachusetts and Arizona — and plans to enter up to 10 new markets a year, Austin-based WhiteGlove House Call Health is one of the most visible players in the growing field of mobile primary care.

In most cases, the company contracts with businesses and insurers to offer its services to employees or plan members. Companies pay an annual fee of $300 per member; the covered individuals pay up to $35 to have a WhiteGlove nurse practitioner make a house (or office) call. (The service is available from 8 a.m. to 8 p.m. every day of the year.) Individuals can also sign
up with WhiteGlove, for $420 annually and the same $35 fee.

The visit fee also covers any generic prescription medications that are provided. In addition, the nurse practitioner leaves behind a “well kit” with chicken soup, crackers, Tylenol, cough drops, tissues and other incidentals.

Companies like the service because it controls their costs, says Bob Fabbio, WhiteGlove’s chief executive and co-founder. “We’ve turned variable, unpredictable expenses . . . into a capped event,” he says.

Individuals, of course, like the convenience. When Emily and Moody Alexander’s 14-year-old son Hill developed a fever and sore throat on Easter Sunday, they called WhiteGlove.

A nurse practitioner arrived at their Arlington, Tex., home within two hours, did a rapid strep test and pricked his finger to see if Hill had mononucleosis. The test for strep was positive, so the nurse practitioner gave Hill a generic antibiotic on the spot.

“I think it’s the most genius idea,” says Emily Alexander, who would otherwise have had to get her son into a nearby urgent care clinic with a $100 co-payment that day or get him in to see their regular pediatrician the following morning. The Alexanders’ insurance company covers visits by WhiteGlove.

More From This Series: Insuring Your Health

While the convenience of a house call has undoubted appeal, some experts say nurse practitioners may miss subtle signs of underlying illness in what seems to be a routine cold or other minor ailment.

“They don’t have the same level of academic or hands-on training as a physician,” says Ann O’Malley, a physician and senior researcher at the Center for Studying Health System Change, a think tank based in Washington.

In some states, nurse practitioners can work independently of physicians; other states require varying degrees of oversight by physicians. Texas requires some degree of doctor supervision.

The other area that experts flag as worrisome has to do with the importance of coordinating a patient’s medical care.

Health-policy experts agree that everybody needs a medical home, a primary-care practice that helps ensure that patients get routine and preventive care and that acts as a hub for care coordination with other providers when necessary. This is particularly important for people with such chronic conditions as diabetes who may see a number of specialists in addition to their primary-care provider.

WhiteGlove provides many wellness services, from back-to-school physicals to vaccinations, and it’s moving into chronic disease management as well. “We aim to serve as our members’ primary- and chronic-care provider, for the scope of care we provide,” says Fabbio.

The company doesn’t routinely coordinate members’ care, however, or pass along information to other providers unless requested to do so by a member, he says.

Emily Alexander says she has no plans to use WhiteGlove for regular primary care for her six kids. In fact, if her son got strep again or something else that she thought ought to be followed by a doctor, she would take him to see their regular pediatrician, she says.

One of the challenges for patients is that house-call practices vary widely and patients may not know what to expect, says Constance Row, executive director of the American Academy of Home Care Physicians.

Many providers now doing house calls see only the sickest Medicare beneficiaries, those who are unable to get to a doctor’s office. Medicare pays for these visits because they’re considered medically necessary.

At the other end of the spectrum are “concierge” practices whose doctors are available 24/7 to patients who can afford to pay thousands of dollars a year for services that may include house calls.

The key is to understand what a house-call practice does and doesn’t do, says Row. Since it may not be clear how a service handles important things such as care coordination and follow-up, the crucial advice for consumers is simple: Ask.

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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Illustration of a chromosome

Racial labels may be poor predictor of medical risks

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Racial labels have limited use in personalizing medicine

By Eliza Barclay, NPR News

For all the fanfare around personalized medicine, the idea has been fairly slow to take off.

Boosters have said if doctors had a patient’s DNA information it would be revolutionary: They could look for genetic risk of certain diseases or mutations that determine whether certain drugs are likely to work or not.

The cost of DNA sequencing keeps falling, yet genetic sequencing for medical use isn’t commonplace. In the meantime, doctors can, in theory, consider a patient’s race in anticipating health conditions that could pose a higher risk.

But a study published recently in PLoS One suggests that using race as a stand in for truly personalized genetic information may not work, especially in the most diverse cities (like New York and Los Angeles) that attract immigrants from around the world.

There’s a lot of genetic variability among races. And the genetic risk profiles for many people with mixed ancestry don’t fit neatly into any category.

Researchers at the Mount Sinai Medical Center sequenced the DNA of nearly 1,000 local participants who identified themselves as European American, African-American, or Hispanic to determine their genetic make-up, or genotype.

In part, they wanted to see if the conventional race labels people use to identify themselves would be useful for doctors looking for genetic risk patterns in the community.

Many New Yorkers who self-identify as Hispanic originally came from the Caribbean but genetically are closer to African-Americans than immigrants from Mexico or Central America, the study found. So while both groups might call themselves Hispanic, their risk of disease will be very different.

“The great variability in those populations means the genomic risk of something like Body Mass Index may be valid for certain individuals and not others,” Erwin Bottinger, a study author and director of the Bronfman Institute at Mt. Sinai, told Shots. “That requires much more detailed analysis of genetic background of local communities.”

This means that doctors practicing in places like New York shouldn’t assume anything about disease risk in their community. “It’s ultimately much more important to focus on the individual,” says Bottinger.

Bottinger and others at the Bronfman Institute are now looking at hundreds of genetic markers for major diseases, such as heart disease, kidney disease, liver disease, and diabetes, in the Mt. Sinai patient community.

But the end of the year they plan to have genetic info for 20,000 patients in a Biobank, which they say will help them predict disease risk for the community.

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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Salivary glands: 1) Parotid gland, 2) Submandibular gland, 3) Sublingual gland

Dry mouth? Don’t delay treatment — FDA update

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Almost everyone’s mouth is dry sometimes. But if you feel like you have cotton in your mouth constantly, it may be time for treatment.

Dry mouth, known medically as xerostomia, occurs when you don’t have enough saliva, or spit, in your mouth.

Feeling stressed can trigger dry mouth temporarily. But a persistently dry mouth may signal an underlying disease or condition, so it’s important to see your doctor, says the Food and Drug Administration (FDA), which regulates products that relieve dry mouth.

And because dry mouth can lead to tooth decay, you should see your dentist, too, says John V. Kelsey, D.D.S., of FDA’s Division of Dermatology and Dental Products.

Dry mouth may make it difficult to speak, chew, and swallow, and may alter the taste of your food. It can also cause a sore throat, hoarseness, and bad breath.

Dry mouth can affect people of any age, but older people are especially vulnerable. “It’s not a normal consequence of aging,” says Kelsey. “Older people may take multiple medications that can cause dry mouth.”

According to the Surgeon General’s Report on Oral Health in America, dry mouth is a side effect of more than 400 prescription and over-the-counter drugs, such as antidepressants, antihistamines, muscle relaxants, and high blood pressure medicines.

Other causes of dry mouth include:

  • cancer treatments, such as chemotherapy and radiation of the head or neck
  • hormone changes, such as those that occur during pregnancy or menopause
  • health problems, such as HIV/AIDS, diabetes, and Sjögren’s syndrome, a disease in which a person’s immune system attacks the body’s tissues, including moisture-producing glands
  • snoring or breathing open-mouthed

The Role of Saliva

Saliva is produced by three major glands in the mouth (salivary glands) and plays a key role in

  • chewing, swallowing, and digesting food
  • preventing infection in the mouth by controlling bacteria
  • preventing tooth decay

“Saliva is mostly water, but it also contains enzymes and lubricants,” says Kelsey. “The enzymes help digest food and the lubricants make speaking, chewing, and swallowing more comfortable.”

Salivary glands: 1) Parotid gland, 2) Submandibular gland, 3) Sublingual gland

Saliva helps control bacteria, which cling to the surface of teeth. They feed on sugar in the food we eat and break down and use (metabolize) the sugar to grow.

“A by-product of the metabolized sugar is acid, which starts to eat away at a tooth’s surface,” says Kelsey. Saliva neutralizes the acid and helps wash away food particles. If there is not enough saliva, cavities may occur.

Dry Mouth Treatments

Your doctor or dentist may recommend oral rinses and moisturizers, or prescribe an artificial saliva.

Also called saliva substitutes, artificial salivas are regulated by FDA as medical devices. “Unlike drugs, artificial salivas have no chemical action,” says Susan Runner, D.D.S., chief of FDA’s dental devices branch. “Their action is mechanical. They moisten and lubricate the mouth but do not stimulate the salivary glands to make saliva.”

While not a cure, artificial salivas can provide short-term relief of the symptoms of dry mouth. “They can also help minimize discomfort after an oral procedure,” says Runner.

Artificial salivas come in a variety of forms, including rinses, sprays, swabs, gels, and tablets that dissolve in the mouth. Some are available by prescription only; others can be bought over-the-counter.

FDA has also approved several prescription drugs to relieve dry mouth caused by certain medical treatments or conditions, such as Sjögren’s syndrome and radiation for head or neck cancer.

Advice for Consumers

If you have persistent dry mouth:

  • Talk to your doctor, who may change your medications or adjust the doses.
  • Talk to your dentist and provide a list of the medicines you take as well as any medical conditions or treatments you’ve had. The American Dental Association recommends seeing your dentist at least twice a year.

Tips for Relieving Dry Mouth

  • Sip water or sugarless drinks, or suck on ice chips.
  • Avoid irritants, such as alcohol, tobacco, and caffeine. Remember that caffeine is found in many sodas as well as in coffee and tea.
  • Chew sugar-free gum or suck on sugar-free candy.
  • Avoid salty or spicy foods, which may irritate the mouth.
  • Use a humidifier in your bedroom at night.
  • Consider using saliva substitutes.

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

May 9, 2011

Related Consumer Updates

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Blowing Our Way: Effects of Fukushima on Washington State

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Panel discussion of nuclear energy, the Fukushima nuclear disaster and implications for the state of Washington.

Panelists will give updates on:

  • Health effects of radiation and their impact on Washington State.
  • Status of the situation at the Fukushima reactor; overview of “hot spots” in our state.
  • What citizens need to know that may not be reported fully in the media.

Panelists:

  • Steven G. Gilbert, PhD, DABT, founder and director of the Institute of Neurotoxicology & Neurological Disorders
  • Richard W. Grady, M.D., Children’s Hospital, conducts research concerning the affects of phthalates on infants.
  • Gerry Pollet, J.D., Executive Director, Heart of America Northwest, Hanford clean-up watchdog group, previous WPSR Beeson Peace and 2010 UW School of Public Health

The event is sponsored by Washington Physicians for Social Responsibility (www.wpsr.org) and the Institute of Neurotoxicology & Neurological Disorders (www.toxipedia.org). Both groups are nonprofit organizations based in Seattle.

For more information about the event, contact Tracy Bier, atbier@msn.com or 206-322-8613 or Cherie Eichholz at cherie@wpsr.org or 206-547-2630.

WHEN:

Wednesday, May 11, 2011, 7 – 8:30 p.m.

WHERE:

Seattle Children’s Hospital

Room G1026.

4800 Sand Point Way, NE,

Seattle, WA, 98105.

For directions visit: http://www.seattlechildrens.org/contact/maps-directions/

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Campaign seeks to curb sharp rise in syphilis cases in Seattle and King County

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In response to an explosion of new cases of syphilis, health officials here have launched a media campaign to encourage gay and bisexual men to get tested for the sexually transmitted infection.

In the 1990s, the infection, which is caused by the bacteria Treponema pallidum, had almost been eliminated among gay and bisexual men in the county, but cases have soared recently, nearly doubling from 2009 to 2010, to 289 cases, and this year the number of cases is on track to double yet again.

Number of cases of early syphilis in King County, WA, by year and sexual orientation, 1994-2010

Gay and bisexual men–men who have sex with men or MSM– account for 90 percent of the new cases, according to Public Health – Seattle & King County, the campaign’s sponsor.

The new campaign, called “Syphilis is Back”, emphasizes that syphilis is easy to catch — but also easy to treat.

Syphilis is usually spread when a person comes into contact with syphilis sore, called a chancre, during vaginal, oral and anal sex. Because these sores can be hidden from view, it is often impossible to tell if a sex partner is infected.

In addition, the symptoms of syphilis can be easy to miss. The first symptom is a chancre, a raised, painless sore, which usually goes away in a few weeks.

Treponema pallidum -- CDC Photo

But even though the sore has gone, the infection persists and with time can have devastating effects on the heart, brain and other organs. Untreated infection in pregnant women can also have devastating effects on the fetus.

However, early infections can be easily treated with a single antibiotic injection.

The new campaign encourages sexually active gay and bisexual men to get tested for syphilis regularly and if they have any symptoms of the infection to be tested right away.

To learn more about the campaign, the signs and symptoms of syphilis, and local testing sites:

  • Go to Public Health – Seattle & King County Sexually Transmitted Diseases webpage which has additional information about STDs and information about testing sites.
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Seattle Children's Whale Logo

Children’s moves to improve care of patients in transport — Seattle Times

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In response to an investigation by the U.S. Centers for Medicare & Medicaid Services, Seattle Children’s has taken steps to improve how it provide care to patients while they are bring transported overland, Seattle Times health reporter Carol Ostrom reports in today’s paper.

Ostrom writes:

The CMS report, triggered by a state finding of deficiencies in hospital procedures, said transport nurses appeared to be confused about what they were allowed to do and whether they could administer medications without a doctor’s order. It said the hospital’s review of the cases didn’t pick up that documentation was inaccurate and incomplete or that doctors’ orders — required by law — were missing.

“CMS has accepted the hospital’s plans to correct the deficiencies in the quality improvement process and others noted in that survey, as well as for additional problems cited in a more wide-ranging follow-up survey done in March,” Ostrom reports.

To learn more:

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Jane's expenses on a balance beam with what her plan will pay.

New labels will soon making picking a health plan easier

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By Susan Jaffe

Cars have sticker prices, ketchup bottles have nutrition facts labels and soon health plans will get coverage labels, too.

For the first time, consumers shopping for a health policy will be able to get a good idea of how much of the costs different plans will cover for three medical conditions: maternity care, treatment for diabetes and breast cancer.

And because buying insurance is more complicated than buying a can of soup, the proposed insurance labels are two pages long.

However, the labels will provide pricing based on national averages and not exact numbers that consumers can expect to pay.  And to begin with, only the three medical scenarios will be listed.

“It’s nearly impossible for a consumer to make apple-to-apple comparisons.  It’s the Wild West.”

“Today, there’s really no way for consumers to figure what their premiums are buying,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute in Washington, D.C., who is helping to produce the labels.

The true value of a plan depends on what health problems a beneficiary experiences, but in most cases consumers shopping for plans have no way to compare how much of the costs of treatment the policies will cover. “It’s nearly impossible for a consumer to make apple-to-apple comparisons.  It’s the Wild West,” she said.

The new “coverage facts labels” are required under the health overhaul law, which directed the National Association of Insurance Commissioners to draft them. The association gave that job to a working group made up of state insurance regulators, industry representatives and consumer advocates.

On Thursday, the group agreed to seek public comment on the draft labels and conduct consumer focus testing for additional feedback before presenting them to state insurance commissioners.

Once approved, the labels will be sent to federal officials who will consider incorporating them into rules for insurance companies. The labels are part of an effort to demystify insurance terminology and costs so that consumers can better understand what they are purchasing.

The law also requires that consumers receive new, easy-to-understand summary of plan benefits for consumer comparisons. The coverage labels are to be included at the end of the four-page benefits summary.

The federal rules, which were due last March, would instruct insurers to use benefit summaries and labels and are supposed to take effect next year. But developing the model format and language has proved to be complicated and taken more time.

“We want there to be as much information in the hands of consumers as possible,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group that will be conducting consumer focus group testing, as is Consumers Union, later this month. “But we want to make sure that the information is valuable from their perspective.”

Because medical costs vary widely across the country and among providers, and the treatment regimen may also depend on individual providers, the working group opted to use national average prices for the standard treatment regimen on the labels.  The labels then break down how a policy would apportion those costs.

For the breast cancer example, insurers will have to list how much patients would pay – based on the national average price—for office visits, lab tests, surgery, chemotherapy, radiation treatment, prosthesis (wig), prescription drugs and mental health counseling.  If a plan offers no maternity coverage, the label will show that the patient is responsible for paying the entire cost.

At first the working group was going to recommend that each health plan use prices based on their own provider contracts, said Richard Dropski, a group member and senior director for regulatory affairs at Neighborhood Health Plan in Massachusetts.  That turned out to be unwieldy: even within the same plan, two nearby hospitals can charge different prices for the same procedure, he said.

A 2009 study of three California insurance policies found that patients would spend nearly $4,000 for a standard breast cancer treatment under one policy or as much as $38,000 under another even though both policies had similar deductibles and out-of-pocket limits.

The actual costs at a specific hospital may be different from the amounts listed on the coverage label, said Mila Kofman, co-chair of the working group and Maine’s superintendent of insurance. “But you will be able to look at the label and look at two different policies and figure out if you’re a diabetic or if you have baby, under which policy it is likely that more of your costs will be covered,” she said.

The law requires that all carriers selling group or individual health plans provide the benefits summaries and the three treatment labels to shoppers beginning in March 2012.  There is no limit to the number of treatment coverage labels that may eventually be used.

Contact Susan Jaffe at jaffe.khn@gmail.com.

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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EKG tracing

Financial ties bind medical societies to drug and device makers

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by Charles Ornstein and Tracy Weber
ProPublica, May 5, 2011, 9:48 p.m.

SAN FRANCISCO — From the time they arrived to the moment they laid their heads on hotel pillows, the thousands of cardiologists attending this week’s Heart Rhythm Society conference have been bombarded with pitches for drugs and medical devices.

St. Jude Medical adorns every hotel key card. Medtronic ads are splashed on buses, banners and the stairs underfoot. Logos splay across shuttle bus headrests, carpets and cellphone-charging stations.

At night, a drug firm gets the last word: A promo for the heart drug Multaq stood on each doctor’s nightstand Wednesday.

Who arranged this commercial barrage? The society itself, which sold access to its members and their purchasing power.

Last year’s four-day event brought in more than $5 million, including money for exhibit booths the size of mansions and company-sponsored events. This year, there are even more “promotional opportunities,” as the society describes them.

Concerns about the influence of industry money have prompted universities such as Stanford and the University of Colorado-Denver to ban drug sales representatives from the halls of their hospitals and bar doctors from paid promotional speaking.

Yet, one area of medicine still welcomes the largesse: societies that represent specialists. It’s a relationship largely hidden from public view, said David Rothman, who studies conflicts of interest in medicine as director of the Center on Medicine as a Profession at Columbia University.

See also: The Heart Rhythm Society Responds to ProPublica’s Questions — below

Professional groups such as the Heart Rhythm Society are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.

Dozens of such groups nationwide encompass every medical specialty from orthopedics to hypertension.

“What you’re exploring here is the subtle ways in which the companies and professional societies become partners and — wittingly or unwittingly — physicians become agents on behalf of the interests of the sponsoring company,” said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic.

“It has a not very subtle effect on medicine,” said Nissen, an expert on the impact of industry money.

‘This is our business’

Nearly half the $16 million the heart society collected in 2010 came from makers of drugs, catheters and defibrillators used to control abnormal heart rhythms, the group’s website disclosed.

Officials of the Heart Rhythm Society say industry money does not buy influence and is essential to developing new treatments. Still, on Thursday the group unveiled a formal policy that, among other things, requires more detailed disclosure of board members’ industry ties.

“This is our business,” said Dr. Bruce Wilkoff, the incoming society president. “We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.”

The society is one of a handful of groups that make public details about their finances. Most don’t. As non-profits, they must disclose their tax returns but not their specific sources of funding.

Sen. Charles Grassley, R-Iowa, requested the information from the Heart Rhythm Society and 32 other professional associations and groups that promote disease awareness and research.

Their responses and reporting by ProPublica showed wide disparities in money the groups accept from medical companies, what they disclose and how they manage potential conflicts of interest.

With billions of dollars at stake, companies can court entire specialties by helping to bankroll doctors’ groups. The Heart Rhythm Society’s 5,100 members represent a particularly lucrative market.

One implantable cardioverter defibrillator — a device that jolts the heart back to a normal beat — can cost more than $30,000. A single electrophysiologist, a physician specializing in heart-rhythm disorders, can implant dozens a year. World sales of the devices totaled $6.7 billion last year, according to JPMorgan.

All the defibrillator manufacturers are at this week’s conference, including market leaders Medtronic, Boston Scientific and St. Jude Medical, which together gave the society $4 million last year.

These companies and others not only provided financial support to Heart Rhythm but paid many of its board members: Twelve of 18 directors are paid speakers or consultants for the companies, one holds stock, and the outgoing president disclosed research ties, according to the society’s website, which does not specify how much they receive.

Board members at other medical societies have similar arrangements. The American Society of Hypertension does not post disclosures on its website, but records provided to Grassley show that 12 of its 14 board members had financial ties to medical companies.

Grassley, the top Republican on the Senate Judiciary Committee, said these groups commonly say the money doesn’t affect what they do, but he has doubts. “I don’t think it’s believable,” he said. “There are a lot of incestuous relationships that really bother me.”

Big Booths Boost Devices

As competition among cardiac-device makers has intensified, so have questions about whether their products are being used and marketed appropriately.

In January, a study in the Journal of American Medical Association found that more than one in five patients who received cardiac defibrillators did not meet science-based criteria for getting them.

Weeks later, the Heart Rhythm Society disclosed it was assisting a U.S. Justice Department investigation of the issue.

Two of the society’s biggest funders — Boston Scientific and St. Jude Medical — have paid millions since 2009 to settle federal allegations that they improperly paid kickbacks to unidentified physicians to use their cardiac devices. Neither company admitted wrongdoing.

Top sponsor Medtronic also has disclosed to shareholders that the Department of Justice is investigating the advice it gave purchasers on how to bill Medicare for defibrillators and payments it made to buyers of the devices.

In a statement, Medtronic said societies play an important role in educating physicians about their devices. Boston Scientific declined to comment, and St. Jude did not respond to questions.

At this week’s conference, Medtronic is front and center with a 12,000-square-foot booth to demonstrate its products and allow physicians to examine them.

Medtronic spent $543,000 at last year’s meeting on a similar exhibit, part of $1.6 million it paid to prominently display its name around the conference and fund educational grants. The Minnesota device maker also paid unspecified speaking or consulting fees to eight of the society’s 18 board members.

Labeling the HRS Convention

These slides show “promotional opportunities” – and their asking price – that the Heart Rhythm Society offered to medical industry sponsors at its 2011 conference. Not everything was sold.
Sourcewww.heartrhythmsupport.org/sponsorships.

The spending befits the company’s dominance of the world market for implantable defibrillators. It sold more than $3 billion worth last year.

Next booth down is the 8,100-square-foot spread of rival Boston Scientific, with $1.6 billion in defibrillator sales last year. The company spent $1.5 million on the society in 2010 and paid speaking or consulting fees to seven board members.

Physicians must traverse these and other booths to reach “Poster Town,” where the latest research findings, a big draw of the gathering, are displayed. “It’s very hard to get through there without being accosted,” said Dr. Paul D. Varosy, director of cardiac electrophysiology at the Department of Veterans Affairs’ Eastern Colorado Health Care System.

‘Tag and Release’

Through the years, groups such as the Heart Rhythm Society have expanded the range of sponsorships they offer to drug and device makers. Companies can now fund Wii game rooms or put their names on conference massage stations and on the shirts of the masseuses.

Some deals give companies more than name exposure. Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.

Dr. Westby Fisher, an Evanston, Ill., electrophysiologist, called the practice “Tag and release.” College officials say they’ll do a better job of notifying doctors next year.

Attendees at the Rhythm Society conference also have tracking badges. Society officials say exhibitors are not getting doctors’ personal information.

Two years ago, the American Society of Hypertension teamed with its biggest donor, Daiichi Sankyo, to create a training program for drug company sales reps. The society says about 1,200 Daiichi reps have graduated — at a cost of $1,990 each — allowing them to put the “ASH Accreditation symbol” on business cards.

In fiscal 2009, Daiichi gave the society more than $3.3 million — more than 70% of its total industry funding — according to financial records it provided Grassley. Daiichi makes four hypertension drugs.

“I think it’s an obscenity,” said former ASH president Michael Alderman, professor emeritus at Albert Einstein College of Medicine in New York City. “I can see how it would play out in the doctor’s office: ‘I’m a Daiichi sales rep. But let me tell you something: The American Society of Hypertension is backing me.’”

Alderman and some other prominent members of the group quit after a dispute in 2006 about industry influence.

Current ASH President George Bakris said the training program is science-based and doesn’t focus on specific drugs. The reps “ought to know what they are talking about,” he said.

The 1,900-member group has revised its policies since 2006, he said. Financial conflicts disclosed by board members, however, are available only to members, who must request them in writing and explain why they want them, according to the group’s conflict of interest policy.

Click Here to See How the Heart Society Sells Access

A Question of Influence

Bakris and leaders of several other professional groups say industry funding is essential for much of what they do. It reduces conference registration fees, subsidizes the cost of continuing medical education courses and provides money for disease awareness.

Dr. Jack Lewin, chief executive of the American College of Cardiology, said the money is helping build registries of cardiac procedures that track side effects and flag whether physicians are using devices in the right patients.

The “circus element” of the exhibit booths doesn’t unduly influence attendees, Lewin said. “I don’t buy a soft drink just because of the advertising… I buy it because I like it.”

Researchers say companies are not spending millions solely for altruistic reasons. “If it weren’t influencing the doctors, they wouldn’t be doing it,” said Dr. Gordon Guyatt, a health policy expert at McMaster University in Ontario.

There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.

“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.

Grassley, too, is continuing his efforts to make the groups publicly accountable. In initial responses to his December 2009 request for information, some said they planned to post financial information on their websites. This week, the senator followed up with letters to some groups, asking why they hadn’t done so.

He hopes the political pressure succeeds: “You might conclude that maybe they don’t want to give the information out because it might be embarrassing.”

Follow on Twitter: @charlesornstein@tracyweber

Read a related stories on the ProPublica website: Heart Society’s Tip Sheets Fail To Mention Risks.

The Heart Rhythm Society Responds to ProPublica’s Questions

Reporters Charles Ornstein and Tracy Weber sent the Heart Rhythm Society a set of questions about potential conflicts of interest regarding the group’s acceptance of drug and device industry marketing money. The responses below were provided by the group’s president, Dr. Douglas L. Packer, and president-elect, Dr. Bruce L. Wilkoff.

Q. What is the Heart Rhythm Society’sphilosophy with respect to accepting industry funding?

A. Advances in electrophysiology depend on a collaborative relationship between physicians and industry, who have for decades worked together to develop life-saving devices. The society collaborates with clinicians, scientists, allied professionals, government agencies, other societies and industry to advance electrophysiology/pacing and to accomplish its mission to improve the care of patients by promoting research, education and supportive resources for patients and their families.

The HRS is proactive in examining our policies and procedures on an ongoing basis to avoid conflicts of interest, the potential for misunderstandings or perceptions of bias.

Q. Figures in the financial report on your websiteindicate that half of HRS funding comes from industry sources. That proportion has gone up considerably from 2006. Do you believe the current figure is too low, too high or about right? Please explain.

A. Due to the current policies and procedures we have in place to manage collaborations with industry, the Heart Rhythm Society is seeking new more diverse revenue streams that support our mission. It is important to note that the society has received funding that has helped the public understand heart rhythm disorders through awareness initiatives such as the Apples and Oranges: Sudden Cardiac Arrest Awareness Campaign, which helped to raise government and public awareness of this deadly disease in order to save lives.

Q. Items at your conference—from key cards to newspaper wraps—are available for sponsorships. What is the purpose of these sponsorships? Does the livelihood of the organization depend on them? Do the ads have an impact on what your members buy and use in their practices?

A. The Heart Rhythm Society offers sponsorship opportunities at the annual scientific sessions to provide advertising opportunities for participating exhibitors. Approximately 50 percent of the revenue for the annual scientific sessions is generated by industry in a combination of exhibit space rental (largest), sponsorship/promotional advertising opportunities, unrestricted educational grants and exhibitor office suites. The society does not collect data or ask attendees if sponsorship or advertising impacts their purchase decisions.

Q. Four funders—MedtronicBoston ScientificSt. Jude and Sanofi—account for 30 percent of the group’s annual budget. Is this reliance on a small group cause for concern? Why or why not?

A. Due to thorough policies and procedures in place for working with industry, the Heart Rhythm Society is comfortable identifying and managing various interactions with industry. Additionally, the society seeks multiple supporters for its educational programs in order to avoid the perception that programs are tied to a specific company. The society has sufficient measures in place to prevent undue influence from industry or introduction of industry bias into HRS-sponsored educational programs, research, scientific documents and policy initiatives.

Q. Sixteen of your 18 board members had relationships with one or more drug or device manufacturers in 2010-11. Are these relationships cause for concern? Why or why not?

A. The Heart Rhythm Society strives to be a transparent entity. HRS leaders are required to disclose their relevant financial, commercial, professional and institutional relationships. Additionally, the society also places restrictions on its president and president-elect, who are prohibited from receiving income from commercial entities that have the potential for conflict of interest during the year(s) in which they hold the position. As charged by its Ethics Committee, the society reviews all disclosures and rules for interactions with industry on an annual basis. We make updates to our policies and procedures as needed.

Q. Most of the experts you appointed to your 2008 device guideline committee had conflicts, including the chair of the panel. Other groups, including the American College of Cardiology, are changing that balance. Will HRS do so as well? Why or why not? What are the potential problems to having guideline writers with conflicts?

A. The Heart Rhythm Society requires that at least one of the chairs of a clinical guidance writing group not have any relationships with industry that would apply to the document.

This policy takes into consideration that relationships with industry do not necessarily bias opinions or recommendations and that experts in the field should not be restricted from full participation in a writing group provided they recuse themselves if there is a conflict of interest. The priority on selection of authors is based on level of expertise, judgment and writing ability.

Q. Some doctors have criticized HRS and ACC for the afibprofessional.org website because they say it promoted Multaq even though the drug has turned out to have serious limitations. Do you believe this is an appropriate criticism? Why weren’t the industry ties of the editor and lecturer initially disclosed on the site? Should industry funding be accepted for non-CME educational material?

A. Afibprofessional.org is a non-CME professional site funded by nonrestricted grants from multiple sponsors. Similar to a journal publication, the site is overseen by an editorial board headed by Dr. Kenneth Ellenbogen. As editor, Dr. Ellenbogen is required to not have any conflicts of interests in companies that contribute to the site. The editorial board has complete control and oversight on how the monies are used and what content will be posted. Industry does not have any review or input into the content of programs.

The Heart Rhythm Society was concerned about the criticisms that were raised and carefully evaluated the circumstances that led to these concerns. The initial complaints about the website were in part due to a production flaw that did not hold the launch of the site until all the content was completed and educational commentary added to ensure balance. The site was updated and all disclosures linked within 72 hours of initial launch. Moreover, the lecturer you note, Dr. Eric Prystowsky, disclosed full details of his relationship with industry during his lecture.

[Editor’s note: Ellenbogen's disclosure form on the afibprofessional.org website, as of earlier this week, listed a financial relationship with Sanofi-Aventis, one of the site's sponsors. ProPublica listened to a recording of the lecture, and Prystowsky, did not mention his relationship with Sanofi. He handed in a disclosure form prior to the lecture, and it was posted later to the website.]

Q. Some members have said that they believe HRS has supported the increased use of implantable cardioverter defibrillators (ICDs) without providing sufficient information on side effects and populations excluded from clinical trials. Is that a fair criticism? Why or why not?

A. The society’s position on the use of ICDs is well-stated in the HRS-endorsed, evidence-based guidance available on our website. This guidance informs the utilization of devices.

Q. HRS officials wrote letters and testified in 2009 in support of Medicare coverage of cardiac ablation for Afib. A Medicare Evidence Development & Coverage Advisory Committee voted that more research needed to be done on senior populations. Why did HRS advocate for broader coverage if the evidence did not yet support it?

A. HRS did not advocate for broader coverage in this situation. In 2009, the Society’s expert insights emphasized that large multicenter prospective trials will be needed to better define the relative benefits and risks of catheter ablation, and until the results of such studies become available, catheter ablation of atrial fibrillation should be considered only in patients who have failed at least one antiarrhythmic medication and have symptomatic AF. There are published studies demonstrating the safety and efficacy of AF ablations in senior patients.

Q. The International Board of Heart Rhythm Examiners, which shares an office and CEO with HRS, offers training for device sales reps, among others. Does this present a conflict for the society, because a sister group receives money to train the reps that will sell devices to HRS members?

A. The International Board of Heart Rhythm Examiners does not provide training of any kind to industry representatives.

Q. Your group is offering exhibitors a novel opportunity this year with theradio frequency identification (RFID) badges. Which exhibitors have signed up for this, and what is the cost to participate? How does the use of these cards square with a study published in HeartRhythm Journal in January 2010 that RFID readers can cause complications to pacemakers and ICDs?

A. At this year’s annual scientific sessions, the Heart Rhythm Society will employ RFID badges. Exhibitors will not be offered an opportunity to purchase nor will they freely receive the information the society gathers from RFID readers. Exhibitors can purchase RFID information from a third-party source regarding the number of visitors to their booth only—contact information will be excluded. They do not obtain this information from the society or pay us any funds for this information.

Furthermore, all attendees were given the option to opt-out and receive a badge without an RFID embedded. This is an acceptable option for attendees with implantable cardioverter defibrillators or pacemakers.

Q. You indicate that RFID technology at the conference was being handled by a third-party company. Does HRS receive any funds or other in-kind contribution from that company for being able to place RFID readers/badges at the conference? You also indicated that contact information is not shared with exhibitors. Will they be told names of attendees at their booths, affiliations of those doctors, their city/states and how long they spent at the booth? This information was recently conveyed as part of the ACC’s meeting.

A. The Heart Rhythm Society does not receive royalties or any other in-kind contributions for RFID technology at our annual Scientific Sessions. The exhibitors will not receive names, contact information or affiliations of attendees, but city and state information will be captured as well as length of time spent at the booth.

Q. Your website includes patient information, including sheets on treatments. In reviewing the sheets on cardiac defibrillators and catheter ablation, they make no mention of risks, limitations or groups for whom these treatments are not recommended. Should these sheets include a more-complete discussion so patients can make informed decisions?
A. The Heart Rhythm Society believes that the most-informed discussion of the risks and limitations of treatments are best conducted between a patient and his/her physician. Please note: We include physician and patient information on our website, but also provide the following:

“Please note: As mentioned, this website is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with questions or who need more information should check with their physician or use the Society’s Find a Specialist tool, which is a publicly searchable directory of the Society’s physician members (e.g., Cardiologists, Electrophysiologists, Interventionalists, etc.) who have requested to have their contact and practice information listed for patient and physician referral purposes.”

Link: http://www.hrsonline.org/PatientInfo/

Q. Some researchers on conflicts of interest say that when a medical society receives half of its funding from industry, it is codependent on them and therefore will—consciously or not—avoid criticizing the products they make. How would you respond?

A. The Heart Rhythm Society’s first and foremost concern is to provide effective and appropriate treatment options to our patients. It is imperative that we interact with industry to develop better therapies and test them thoroughly in rigorous clinical trials. For this reason, we believe that interacting with industry is not inherently wrong with the correct measures in place to mitigate the possibility of conflicts of interest.

Moreover, the Society maintains a neutral position on all products and services offered by industry. The U.S. Food and Drug Administration is our source for information about new products, safety alerts and drug recalls. When new or updated information is disseminated by the FDA relative to electrophysiology, we first determine whether it has an impact on patient care. If so, we disseminate the FDA’s updates whether industry products are cast in a positive or negative light. Again, our priority and concern is to our patients.

A full description of the Society’s safeguards to prevent industry bias can be found in our “Guidance for the Heart Rhythm Society Pertaining to Interactions with Industry,” which will be released on Thursday, May 5, 12:15 p.m. PT at Heart Rhythm 2011, the Society’s 32nd Annual Scientific Sessions. This document is a great example of the introspection that continually occurs at the Society to review and update our safeguards, policies and procedures to appropriately monitor relationships and provide optimal oversight.

Q. You indicate that you intend to diversify your sources of funding. What does diverse mean? Are you seeking non-industry funding and, if so, from where?

A. Diverse means “from multiple sources.” HRS receives revenues from 10+ different categories ranging from industry funding to membership dues, to product sales, to investment income. All current and future sources of revenue align with our mission and strategic goals. Our Form 990 tax return (available on www.guidestar.org, or upon request) details our multiple revenue sources.

Q. You indicate that the society strives for transparency. But is transparency enough when so many board members have relationships with the companies that fund the society and have commercial interests in selling their products?

A. The Heart Rhythm Society believes that transparency, along with the policies and procedures we have in place to safeguard against conflicts of interest, misunderstandings and perceptions of bias, will help to ensure that we remain effective in board considerations and decisions. We believe that collaboration—with appropriate boundaries—is not bad, but is actually required for producing creative solutions for our patients. We know that some risk of perception of bias may be necessary in order for us to continually provide life-saving and life-enhancing solutions to our patients. However, the Society insists on transparency and adherence to multiple safeguards. This is fundamental to the medical endeavor.

Q. Several of your major funders are under investigation by federal prosecutors or have paid millions to settle allegations that they gave kickbacks to electrophysiologists for using their products. Is it appropriate for these companies to exhibit at your conference?

A. The Heart Rhythm Society is not involved in these matters and as a result, can’t really speak to them.

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Kevin Pho

MD blogger faults Children’s for firing nurse linked to patient’s death

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Dr. Pho

Medical blogger Dr. Kevin Pho argues today on his weblog KevinMD.com that Seattle Children’s erred when it fired Kimberly Hiatt, the pediatric critical care nurse whose medication error has been blamed for the death of infant being cared for at the Seattle medical center.

Hiatt, 50, took her own life last month. Friends reported that she had despaired of ever finding a nursing job again.

Dr. Pho writes:

Kimberly Hiatt made a mathematical error that led to the tragic death of an infant patient. Firing her simply absolved the hospital from their share of the blame. Instead, she should have been involved with the subsequent improvement process to prevent future errors.

For more:

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Alert Icon with Exclamation Point!

Grape tomato recall includes products sold in southwest Washington

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A recall of products containing grape tomatoes has been expanded to include fresh kabobs made with grape tomatoes sold in Safeway, Vons, Pavilions and Pak N Save stores in ten states including stores in southwestern Washington, the Safeway Company announced today.

The grape tomatoes, which were supplied by Taylor Farms and the grower Six L’s are being recalled because of concerns that they may be contaminated with the bacteria Salmonella.

A list of the recalled items is below

The recalled kabobs were sold between April 26, 2011 and May 3, 2011 and have a Sell By Date up to and including May 3, 2011, the The kabobs were sold in Safeway, Vons, Pavilions and Pak N Save stores in Arizona, California, Colorado, Wyoming, Nebraska, Nevada, New Mexico, Oregon, South Dakota and Southwest Washington State.

To date, no illnesses have been reported that have been linked to the recalled products, the company said.

Customers are asked to discard these products or return them to their local store for a full refund. Customers who have questions about the recall can contact Safeway at 1-800-SAFEWAY or Taylor Farms at 209-835-6300 between the hours of 8am to 5pm PST, Monday through Friday, or visit the FDA website at www.FDA.gov.

Details about Salmonella from the Safeway press release:

Salmonella is an organism that can cause serious and sometimes fatal infections, particularly in young children, the elderly, and persons with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and/or abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

Salmonella can cause foodborne illness (salmonellosis) through cross- contamination. Consumers are reminded to wash their hands before and after handling eggs. For more information, please visit the Centers for Disease Control and Prevention’s Web site at www.cdc.gov

The list of the recalled items:

The recall effects the following kabobs, including any additional kabobs made with grape tomatoes.

Item Description UPC

————————————————– ———–

SALMON ATLANTIC KABOB 23037000000

————————————————– ———–

SALMON ATLANTIC KABOB MESQUITE 23037100000

————————————————– ———–

SCALLOP SEA KABOB W/VEGETABLES 23040600000

————————————————– ———–

SHRIMP KABOB WITH VEGETABLES 23040700000

————————————————– ———–

TUNA KABOBS FRESH 23040900000

————————————————– ———–

HALIBUT KABOB W/VEG 23040500000

————————————————– ———–

SALMON KABOB W/VEGETABLES FRESH 23363900000

————————————————– ———–

SALMON ATLANTIC KABOB MESQUITE 23364000000

————————————————– ———–

SALMON ATLANTIC KABOB MARINATED 23364000000

————————————————– ———–

SALMON KABOB W/VEGETABLES FRESH 23363900000

————————————————– ———–

SALMON KABOB W/VEGETABLES FRESH 23363900000

————————————————– ———–

HALIBUT KABOB FRESH WITH VEGETABLES 23180700000

————————————————– ———–

TUNA KABOBS FRESH 23513400000

————————————————– ———–

SHRIMP KABOB WITH VEGETABLES 23875100000

————————————————– ———–

SCALLOP SEA KABOB WITH VEGETABLES 23700400000

————————————————– ———–

SALMON ATLANTIC KABOB MARINATED 23364000000

————————————————– ———–

BEEF KABOBS WITH VEGETABLES 20173200000

————————————————– ———–

BEEF KABOBS WITH VEGETABLES 20725100000

————————————————– ———–

BEEF KABOBS WITH VEGETABLES 20888800000

————————————————– ———–

CHICKEN KABOBS WITH VEGETABLES 20746000000

————————————————– ———–

CHICKEN KABOB TERIYAKI WITH VEGETABLES 20746100000

————————————————– ———–

TURKEY KABOB WITH VEGETABLES 20747500000

————————————————– ———–

PORK KABOB WITH VEGETABLES 20948200000

————————————————– ———–

MILD ITALIAN SAUSAGE KABOB WITH VEGETABLES 25014400000

————————————————– ———–

BEEF KABOBS TERIYAKI WITH VEGETABLES 20944000000

————————————————– ———–

SAUSAGE SMOKED KABOB WITH VEGETABLES 20948400000

————————————————– ———–

GOURMET CHICKEN KABOB WITH ZUCCHINI & TOMATO 20974700000

————————————————– ———–

MARINATED CHICKEN KABOB WITH ZUCCHINI & TOMATO 20974800000

————————————————– ———–

GOURMET BRATWURST KABOB WITH MUSHROOMS AND TOMATO 20974900000

————————————————– ———–

SAUSAGE KABOB GOURMET 20975800000

————————————————– ———–

CHICKEN KABOB GOURMET ZUCCHINI TOMATO 20894300000

————————————————– ———–

CHICKEN KABOB MARINATED ZUCCHINI TOMATO 20894400000

————————————————– ———–

BRATWURST KABOB GOURMET MUSHROOM TOMATO 20894500000

————————————————– ———–

SAUSAGE KABOB GOURMET 20895300000

————————————————– ———–

PORK KABOB WITH VEGETABLES 20347300000

————————————————– ———–

SAUSAGE ITALIAN MILD WITH VEGETABLES 20430200000

————————————————– ———–

CHICKEN KABOB W/VEGETABLES 20923300000

————————————————– ———–

TURKEY KABOB WITH VEGETABLES 20599000000

————————————————– ———–

SAUSAGE SMOKED KABOB WITH VEGETABLES 20442700000

————————————————– ———–

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per capita

U.S. health costs, already highest, rising faster as well

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While health spending is rising faster than incomes in most developed countries, it is rising fastest in the United States, which already spends far more per person than any other country, according to a report prepared by the Kaiser Family Foundation.

 

Total Health Expenditure per Capita, U.S. and Selected Countries, 2008

Total Health Expenditure per Capita, U.S. and Selected Countries, 2008

“Since 1980, the U.S. also has had among the highest average annual growth rates in per capita spending on health care,” the report notes. “Despite this relatively high level of spending, the U.S. does not appear to provide substantially greater health resources to its citizens or achieve substantially better health benchmarks, compared to other developed countries.”

Growth in Total Health Expenditure Per Capita, U.S. and Selected Countries, 1970-2008

The report concludes:

Faced with expanding public deficits, and growing health care costs, American policy makers may elect to examine the tools employed by other countries to rein in costs. The growing difference between America’s spending and other developed countries may encourage an examination of what people in the U.S. are getting for their healthcare dollar.

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Photo by Brainloc

Remaking Medicare: Saving money or shifting costs?

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By Julie Rovner, NPR News
This story comes from KaiserHealthNews partner NPR

Photo by Brainloc

There’s no debating that the budget blueprint passed by the U.S. House of Representatives last month would make major changes to the Medicare program for the elderly and disabled.

What Republicans and Democrats don’t agree on, however, is whether those changes would actually save money or just shift costs now paid by the government to Medicare patients.

Rep. Paul Ryan (R-WI), who as chairman of the House Budget Committee wrote the plan that passed that chamber, says his plan would help bring down costs.

“We say, let 40 million seniors have choice, have power, and have those providers compete against each other for their business so they’re in charge of their Medicare,” he said during the House debate.

But Democrats — led by President Obama — say the GOP plan would merely let the government pay less by making Medicare patients pay more.

“I mean, it’s not hard to save the government money if you’re willing to just say, ‘Here, you pay for it,’ ” the president said at a town hall meeting in northern Virginia two weeks ago. “That’s not a solution.”

At the heart of Ryan’s plan for Medicare is a proposal to give everybody in the program a limited pot of money every year instead of the government-run health insurance they get now. But it’s not really a pot of money. Technically, it would be a subsidy they could only use to buy private health insurance.

Ryan says the plan would make Medicare work just like the health insurance he gets as a member of Congress.

“Look at all these plans we get to choose from,” he said, reading from the federal employees health plan handbook on the House floor during the debate. “Kaiser, Aetna, Blue Cross/Blue Shield, Coventry — pages and pages of choices and options. This is what we’re talking about for people [ages] 54 and below.”

Or not.

Rising Costs, Inflation

“It’s not at all what you’ll have,” says Austin Frakt, a health economist at Boston University who co-authors a health blog called The Incidental Economist.

Frakt says one key advantage of the health plans available to members of Congress is that the subsidy they get to pay their health insurance premiums keeps up with rising health care costs.

“It keeps pace, it doesn’t erode over time,” he says.

That wouldn’t be the case with Ryan’s Medicare plan. It’s designed so that the amount seniors get to buy insurance would only go up as fast as inflation in the rest of the economy. Frakt says that could be a big problem. Health costs tend to rise much faster, sometimes twice as fast, as overall inflation.

“That difference means that the subsidy is kind of riding along, going up at a slow rate, and health care costs are going way up, and premiums reflect health care costs, so the entire difference is shifted to beneficiaries,” Frakt says.

In other words, Ryan’s plan allows the government to spend less on Medicare by making patients pay more — potentially a lot more.

To see exactly how much more, we did a little math experiment.

The most popular federal worker health plan is the standard option Blue Cross/Blue Shield Plan. Its total annual premium this year is just under $7,000.

The government (the employer in this case) pays just under 70 percent of that amount, and the workers (including members of Congress) pay 30 percent.

This year, those amounts would be roughly $4,900 and $2,100.

Say next year the plan’s total premium rises to $7,500; that would be a fairly modest increase of about 7 percent. Under the federal plan, the government still pays that 70 percent. So, Frakt says, using the new total, “70 percent of that is $5,250, and the difference would be what enrollees pay … $2,250.”

That’s a total annual premium increase for federal workers of $150.

Now let’s try the same exercise under the Ryan Medicare plan.

Assume, just for comparison’s sake, the first year the government provided the same $7,000 for an individual. (The subsidy would likely be considerably higher, since seniors tend to have more health problems, and their health care costs more). And assume that the first year that subsidy would be enough to cover the full cost of a low-cost insurance plan.

What happens to the subsidy, then, when that plan’s cost rises to $7,500 the next year?

“It depends on the inflation rate,” Frakt says. “But say inflation was essentially zero, the subsidy would stay the same. So that increase in $500 in the premium would be entirely paid by the beneficiary.”

In other words, the increase for the Medicare patient would be more than three times higher than the one for the federal employee. And each year, the Medicare enrollee would be responsible for that difference between overall inflation and health inflation.

‘Cost-Conscious Consumers’

Now, Ryan and his supporters dispute that exercise. They say their plan has elements that actually would reduce health care spending.

For example, Michael Cannon of the libertarian Cato Institute says having people spend their own money, rather than the government’s, helps.

“They’ll be cost-conscious consumers, they’ll choose economical health plans, they’ll put downward pressure on prices, because they will get to see the savings,” he says.

At the same time, Cannon adds, more competition within the health care industry will also help hold down prices.

“Because in order to capture the business of those cost-conscious consumers, health plans, providers, will have to find ways to cut costs while improving quality,” he says.

So far the Ryan plan is barely more than an outline. And it’s going nowhere in the Democratic-led Senate. But it’s an important marker in the emerging Medicare debate.

And that debate comes with more than a few political perils. Medicare clearly needs some kind of fix to withstand the onslaught of 78 million baby boomers.

But so far, public opinion polls show that neither Republican nor Democratic voters favor any big changes to the program.

PHOTO by Brainloc

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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