Swedish to open new multiple sclerosis center


Seattle’s Swedish Medical Center opens a new Multiple Sclerosis Center on its Cherry Hill campus today.

The new facility will bring all of Swedish Medical Center’s Neuroscience Institute’s services for patients with multiple sclerosis under one roof.

When fully operational, the facility is expected to serve more than 6,000 patients, making it the largest multiple sclerosis specialty center in the nation.

In most cases, multiple sclerosis is a progressive, disabling neurological disease.But, although there is no cure, patients can live many years and often are able to remain active despite their symptoms.

The goal of the new center will be “to help people live well despite this disease,” said Dr. Jim Bowen, the center’s new medical director.

For reasons that are unclear, the Pacific Northwest appears to have a higher prevalence of MS than other parts of the country, with more than 12,000 patients in Washington state, Montana and Alaska, according to National MS Society’s Northwest Chapters estimates.

Approximately 9,500 of those cases are in Washington state.

The new center’s staff will include two neurologists specializing in multiple sclerosis as well a team of therapists, counsellors and educators who specialize in MS care and services.

A third MS specialist physician will join the team in August, Dr. Bowen said.

The new facility was designed with MS patients in mind: exam tables are low to the floor; doors are wide enough to allow power wheelchairs to pass through easily; and floors are carpet-free and free of grout lines that might trip up some MS patients.

In addition to medical consultation rooms, the new facility features meeting rooms for support groups, a gym for physical therapy, an outdoor deck of rehabilitation, and a “wellness studio” where patients can participate in yoga and other exercise programs.

Services to be provided at the new MS Center include:

• Physical, occupational, speech and mental therapies

• Cognitive rehabilitation and nutritional consultation services

• Ophthalmologic and urologic services

• Individual and family support groups

• Rehabilitation therapy services

• Patient educational resources

• Comprehensive wellness services with a variety of exercise programs

• Gym with equipment to specifically meet the needs of MS patients

• A street-level outdoor deck designed for wellness training

• Yoga classes for patients

The center will also have a clinical research coordinator on site to help patients who want to participate in studies of new treatments and diagnostic technologies.

Swedish projects that the new facility will cost $7.8 million. To date, the Swedish Foundation has received more than $2.1 million toward the cost of the center.

Nine families in the Seattle area contributed, hospital officials said, including Richard and Betty Hedreen and Jim and Gaye Pigott, who have collectively donated $1 million to the new center.

Another set of donors made pledges of $100,000 or more, hospital officials said.

To garner further funding, the new MS Center will be the focus of Celebrate Swedish, the medical center’s annual fund-raising auction, which will be held May 12 this year.

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Virginia Mason launches quality improvement blog


Virginia Mason Medical Center has launched a blog that will focus on quality improvement processes aimed at improving patient safety and cutting costs.

The Seattle hospital established a national reputation for quality improvement by adapting “lean” manufacturing techniques to medicine.

These techniques were first developed by the Japanese car maker Toyota and have been credited for making Toyotas some of the most reliable cars made.

The Toyota approach seeks to eliminate all waste in its production system and to “mistake-proof” its processes, cutting costs and reducing errors.

Virginia Mason started its adaptation of the Toyota approach, developing an approach the hospital calls the Virginia Mason Production System, 12 years ago.

In large part as result of that effort, Virginia Mason was named “Top Hospital of the Decade” by The Leapfrog Group, a national organization of insurers, employers, and other groups dedicated to improving health-care quality.


The new blog will be written by  Charles Kenney. Kenney is a former Boston Globe reporter who has written three books on  improving quality in health care, including a book about the Virginia Mason initiative: Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience.

Kenney says he hopes the blog will provide a forum for anyone who is interested in making health care safer, more efficient and cost-effective.

The site’s first blog post features Kim Pittenger, MD, a family physician at Virginia Mason Kirkland, who discusses on how primary care doctors can organize their work “in flow” to do a better job taking care of more patients in less time, and get home for dinner with no open charts or left over paperwork.

Kenney writes:

Dr. Pittenger and his VM colleagues “have not only reduced the blizzard of paper, email and phone messages, they have created a system that enables more doctors to go home by 6 o’clock more often with no open charts and no left over paper work.

“How have they accomplished this seeming miracle? In a word, flow. They have created flow stations – and a flow production system – where a doctor works in close partnership with a medical assistant who breaks down the indirect care paper, phone calls and email into small lots that can be handled throughout the course of the day rather than in a batch at the end of the day.”

“We will have a lot of these straightforward, things-I-can-do-right-now kinds of posts, and we want our readers to comment, add links, and contribute their knowledge,” says Kenney. “And we’ll post thoughts on books, conferences and articles – anything we think can be helpful to clinicians and administrators working to improve the quality and efficiency of care delivery.’’

To learn more:


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Medicare now covers annual depression screening


Bette Davis in The Little Foxes

By Michelle Andrews

Bette Davis, who had breast cancer and suffered a series of strokes before her death in 1989 at age 81, famously remarked that old age is not for sissies.

Many people assume that as health problems multiply and loved ones die, it’s inevitable that the elderly become depressed.

Not true, say experts. Older people have lower rates of depression than younger groups.

But depression often goes undiagnosed in the elderly, who feel the stigma of mental illness more acutely than younger people and are often less likely to seek help.

At the same time, older people are more likely to have multiple chronic conditions that consume their primary-care provider’s attention in the limited time available during a typical office visit.

The situation may be changing. In October, Medicare began to cover annual depression screening in primary-care settings with no cost sharing for beneficiaries.

Paying doctors to screen for depression — Medicare’s going rate is $17.36 per person — may well increase how often they do it, say experts.

“Doctors are trying to do the right thing, but how do you prioritize what to do in 21 minutes with a complex person?” asks Ken Duckworth, medical director for the National Alliance on Mental Illness, [www.nami.org] an advocacy group. “If they get paid for it, they structure it into their practices.”

Medicare covers 60 percent of the treatment for mental health problems, including depression. (Under a 2008 law, that figure is scheduled to rise to 80 percent in 2014.)

A Rapid Test

Most primary-care practices that screen for depression use a tool called the patient health questionnaire. The PHQ-9, as it’s called, asks people to describe how frequently during the past two weeks they have felt down or hopeless or taken little interest or pleasure in doing things. It also asks about sleep patterns, appetite and concentration, among other things. Although the test can be taken in just a few minutes, a 2001 study indicated it identifies depression and pinpoints its severity nearly 90 percent of the time.

Nearly 17 percent of people will have a major depressive disorder during their lifetimes, according to 2007 data from the National Comorbidity Survey of mental health disorders. For people 60 and older, however, the lifetime prevalence is much lower, 10.7 percent. “It’s the survivor factor,” says Michael Friedman, an adjunct associate professor at Columbia University’s schools of social work and public health. “You’re more likely to die young if you have depression.”

The lower figures don’t tell the whole story, say experts. Older people are much more likely to suffer from chronic conditions such as diabetes and heart disease, which can complicate diagnosis and treatment of both depression and other medical problems.

“Depression worsens the effect of other illnesses,” says Charles Nemeroff, a geriatric psychiatrist at the University of Miami. “People with depression are more vulnerable to [disease], and once it happens, it’s worse.”

People with depression often don’t take very good care of themselves. They don’t exercise or eat right. They don’t take their medications or get their blood work done to make sure their blood pressure, blood sugar and cholesterol levels are under control. And people with multiple chronic conditions probably take multiple medications that may interact with each other.

In addition, diabetes and heart disease can actually cause a late-life form of depression called vascular depression, which may occur when blood vessels harden, reducing blood flow to the brain.

All of these factors present a challenge for primary-care providers. There’s no point in screening for depression, after all, if you don’t have the resources to help people get the treatment they need.

An Encouraging Trial

Mental health experts point to a model called collaborative care as one that has shown good results. In one trial conducted at 14 primary-care clinics in Washington state, patients who had poorly controlled diabetes and/or heart disease as well as depression received help from a nurse to improve their efforts to control their diseases over a 12-month period.

The nurse worked closely with a psychiatrist, primary-care physician and psychologist to track patient progress and adjust medications as necessary.

Patients who received the intensive team approach showed significantly more improvement in both their depression and other medical conditions compared with patients who received usual care, according to a study published in the New England Journal of Medicine in December 2010 about the trial. Lead author Wayne Katon, a professor of psychiatry at the University of Washington School of Medicine, said the clinics saved an average of $600 per patient over a two-year period.

Most primary-care practices don’t provide that kind of comprehensive, coordinated care, Katon says.

But as policymakers and insurers increasingly offer incentives to primary care physicians to transform their practices into medical homes for their patients and reward providers for better disease control rather than simply running tests and doing procedures, the landscape should change.

Depressed people are more likely to receive diagnoses and be treated in primary-care settings than elsewhere. Research shows that elderly people, in fact, prefer to deal with their primary-care provider on mental health issues. In that context, coverage of depression screening may help more Medicare beneficiaries get the help they need.

Please send questions or ideas for future topics for the Insuring Your Health column toquestions@kaiserhealthnews.org.

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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Weekend reading: Interesting health articles online this week


By Karl Eisenhower

Every week, a KHN reporter selects interesting reading from around the Web.

Rolling Stone: Don Berwick On The Fate Of ‘Obamacare’

Between July 2010 and December 2011, Dr. Donald Berwick was head of the Centers for Medicare and Medicaid Services, the agency that runs the government’s health insurance programs. In a sane world, he would be still. But Senate Republicans refused even to let his confirmation come up for a vote. … A pediatrician by training and a widely respected expert in health care policy, Berwick should have been a lock for the CMS job. But he was a backer of Obamacare; a believer in data and science; a proponent of universal health care. … Rolling Stone got him on the phone to talk about this week’s healthcare hearings at the Supreme Court, the importance of Obamacare, and the future of reform (Julian Brookes, 3/30).

The Economist: Full-Court Press

U.S. Supreme CourtWhen the arguments came to a close at the end of March 28th, Mr Obama faced one hopeful prospect—the court might uphold the mandate—and several nightmares. … The Supreme Court is expected to issue its decision by the end of June. … However the court rules, the political consequences will be huge. Even more important, for the long term, will be the court’s articulation of congressional power. Washington subsists on hyperbole. But this time it is all true (3/31).

The Atlantic: Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up

Blue and white capsules spilling out of a pill bottlePharmaceutical giants, like small-town pizza parlors, have two options for making more money: convince regulars to buy more of what they obviously like, or find ways to persuade more people that they will be happier with this drug or that thin crust with extra cheese. … These “disease mongers” — as science writer Lynne Payer in her 1992 book of that name called the drug industry and the doctors, insurers, and others who comprise its unofficial sales force — spin and toil “to convince essentially well people that they are sick, or slightly sick people that they are very ill.” Changing the metrics for diagnosing a disease is one reliable technique (John-Manuel Andriote, 4/3).

Outside: The Doctor Won’t See You Now

Last year, 13 Americans died during running races, and another eight while competing in triathlons. … the rising participation and the proportional death toll—especially in cases like (Peter) Hass’s—highlight the need for quality medical care at these events. And usually that care comes from volunteer doctors. At least it used to. More and more doctors are refusing to donate their services, and it’s for one frustrating reason: they can’t get medical-malpractice insurance. Most doctors’ insurers typically won’t issue one-day policy riders for sporting events, and race organizers haven’t stepped up to offer alternative coverage (Eric Beresini, 2/28).

Photo courtesy of Griszka Niewiadomski

The New Yorker: Dentists Without Borders

One thing that puzzled me during the American health-care debate was all the talk about socialized medicine and how ineffective it’s supposed to be. … my experiences in France, where I’ve lived off and on for the past thirteen years, have all been good. A house call in Paris will run you around fifty dollars. … most of my needs are within arm’s reach. There’s a pharmacy right around the corner, and two blocks further is the office of my physician, Dr. Médioni. Twice I’ve called on a Saturday morning, and, after answering the phone himself, he has told me to come on over. These visits, too, cost around fifty dollars. … I’ve gone from avoiding dentists and periodontists to practically stalking them, not in some quest for a Hollywood smile but because I enjoy their company (David Sedaris, 4/2).

Paris by McKenna71

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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Health care hiring boom projected to continue, regardless of health law’s fate


By Jay Hancock

Health-care employment will continue to grow much faster than employment generally, with the number of jobs in home care and other ambulatory settings projected to jump more than 40 percent by 2020, a new study suggests.

New figures from the Labor Department highlight an expected hiring shift away from hospitals, as the system puts greater emphasis on preventive care and reduced admissions, said Jean Moore, director of the Center for Health Workforce Studies at the State University of New York at Albany. The center produced employment forecasts based on the government’s latest projections for occupational and industry growth.

Figures in Thousands

Chart from The Center for Health Workforce Studies

“For a long time, acute-care services tended to trump everything else, and that seems to be changing,” Moore said. “There’s a growing awareness that it’s penny-wise and pound-foolish not to pay attention to preventive and primary care.”

Hospitals are still expected to add jobs — nearly a million between 2010 and 2020, for a growth rate of 17 percent — as baby boomers age and require more inpatient care.

But offices of doctors and other health-care professionals are projected to hire 1.4 million people by 2020, a 36 percent increase. The number of home health care jobs will jump by 872,000, or 81 percent. The total number of jobs related to ambulatory care will grow by 2.7 million between 2010 and 2020, or 44 percent, the report said.  Many of the jobs will be created in low-pay occupations, such as home health aides and personal care aides.

The broader message is that health-care is still projected to be a growth industry, perhaps no matter what happens to the overall economy or  the 2010 Affordable Care Act.

By 2020, nearly one in nine jobs in the U.S. is projected to be in the health sector.

Chart from The Center for Health Workforce Studies

“One of the things I wasn’t expecting was how much growth there was even during the recession,” Moore said. “I would have expected some tempering of the growth.”

Even as total U.S. employment fell by 2 percent from 2000 to 2010, health-care employment increased by a fourth — demonstrating the sector’s increasing share of the economy, the paper said.

By 2020, almost one out of nine American jobs will be in health care, the study projects. Counting 4 million newly created health jobs and people retiring from existing ones, more than 7 million new workers will be needed, including more than 1 million nurses, it said.

The report shows a reduction in adminstrative health-care jobs during the economic slump from 2008 to 2010 even as providers added nursing and other clinical positions.

Recent reports suggest, however, that hospitals are beefing up the hiring of administrative staff to deal with the greater regulation required by the health law.

“They may be rehiring the people they may have had to let go when times were tight,” Moore said.

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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How to find and use health insurance


By David Pittman, Contributing Writer
Health Behavior News Service 

Through both her personal and professional life, DeAnn Friedholm knows all too well how difficult it can be navigating the waters of the health insurance market.

As Director of Health Reform for Consumers Union, the folks behind the popular Consumer Reports publications, DeAnn is familiar with the ins and outs of health insurance and health care delivery in the U.S.

Several years ago, she had to shop for her own health insurance. The prospective insurance company discovered she had had a couple of benign tumors more than a decade before and so denied her coverage because of her preexisting condition.

Just like that, Friedholm had no good option for insurance in case she needed to see a doctor.

Maze by Steve Goodwin of 7rains

Illustration by Steve Goodwin/7rains

Friedholm went without health insurance for a year before landing a job at a large company that provided it. In the meantime, she paid the full doctor’s bill herself and prayed nothing catastrophic would happen.

“We have all kinds of examples of that, where people were denied coverage and couldn’t find anybody to cover them because of something in the past that no longer is a current issue for them,” Friedholm said.

Whether you have a preexisting condition or not, are new to shopping for insurance or trying to figure out what coverage you do have, there are resources to help with this often complicated but important purchase.

First Things First

If you are seeking health insurance, the first thing you should do is figure out what coverage you are eligible for, recommends Cheryl Fish-Parcham, deputy director of health policy at Families USA.

Find out if you can gain coverage through your employer or if you can be placed on your spouse’s or parent’s plan. About 55 percent of Americans have an employer-sponsored plan while another 10 percent buy it on their own, according to the U.S. Department of Health and Human Services (HHS).

Don’t know an HMO from a PPO?

Here are some of the most common terms you will encounter when selecting and using health insurance:

Premium — the amount you and/or your employer pays for health insurance. It can be paid monthly, quarterly or yearly.

Deductible — the amount of money that must be paid out-of-pocket for a health care service before an insurer will start to pay

Co-payment — a fixed amount you pay when receiving a health service, such as a doctor visit or to receive prescription drugs

Co-insurance — the percentage an insured person pays for a service after a deductible is met. Your insurance pays the rest.

Network — the hospitals, physicians and other health care providers your insurance has contracted with to provide health care services.

HMO (health maintenance organizations) — managed care plans that have a closed network of providers you can visit. Most HMOs require you to have a primary care physician who will refer you to a specialist if needed.

PPO (preferred provider organization) –­ managed care plans that allow you to visit any doctor from a preferred network of hospitals and physicians. Under PPOs, you can visit a doctor out-of-network, but you will be charged more.

Out-of-network — health care providers not contracted to provide services to customers on a particular health plan

Out-patient — a person who visits a hospital or clinic for medical services but does not require an overnight stay

Inpatient — a person who is admitted to a hospital for at least one night for ongoing care

Mental Health Care — the diagnosis and treatment of mental illnesses, such as depression

Figure out if your income, age or other factor, such as a disability, makes you eligible for a state or federal health plan. For example, the federal Medicaid program is designated for those with low incomes and children while Medicare covers people over 65 and certain people under 65 with a disability.

Next, consumers should look at how much they will be paying; both for premiums-money paid on a regular basis for health insurance-and through deductibles and co-insurance, which are the amounts insurance companies require you to pay before they cover a portion or the rest. Because everyone has different health needs based on age and health condition, it’s difficult to say overall how much a good plan should cost. “You want to get an idea of what’s available to you in the market,” Fish-Parcham said.

Cost of insurance typically varies from state to state and from region to region as the population by age, race, and sex, the numbers of uninsured and providers, local health care costs, insurance companies and taxes vary.

Additional questions you should ask yourself include: Are prescription drugs covered? Are mental health services included or limited? What is the difference between coverage for out-patient care, like from a doctor’s office, and hospital care or visits to an emergency room?

A common pitfall is choosing the plan that has the lowest deductible without looking at what’s covered under the plan. “That’s a big mistake,” Fish-Parcham said.

Mari Edlin of California is a freelance writer who has shopped for and purchased health insurance on her own for 24 years. She advises that people evaluate their lifestyles and medical histories to figure out what they need in terms of routine doctor’s visits and possible specialty care.

As a 59-year-old who expects to have health problems, she admits to paying high monthly premiums in exchange for lower-cost office visits. For example, recent back surgery, which included a hospital stay, only cost her $100.

“I guess I feel a little content paying a slightly high premium knowing everything else I pay is very small,” Edlin said.

Changes Coming 

If navigating the health insurance sea is still a little rocky, there may be some help coming later this year. Starting in September 2012, insurance companies will be required to issue a summary of your insurance benefits in plain, easy-to-understand language. Using uniform standards developed by HHS, the goal is to help customers understand their health insurance coverage and how to use it.

The new benefits summaries will not only tell you what you are paying for and what’s covered but also provide a dictionary for common terms such as “deductible” and “co-payment.”

High-deductible plans

If monthly premiums seem to take a big chunk of your paycheck, Tommy Taylor, managing consultant with the health insurance broker Willis, in Texas, suggests considering a high-deductible plan. Deductibles are the money insurance plans require you to pay first before their coverage kicks in. When employer-sponsored health insurance started to become popular in the 50’s and 60’s, deductibles of $50 or $100 were common.  Now, high-deductible plans often have $1,000 to $5,000 deductibles.

Insurance companies offer lower monthly premiums with these higher deductible plans because the policy holder is willing to pay more of their health costs up front. In some cases, such plans might cover routine office visits and prescription drugs with lower co-pays.  Knowing your health condition and how frequently and likely it is that you will need to see a doctor or receive health care services, will influence the package of health coverage, premium and co-payments that work best for your or your family’s situation.

Taylor drafted an example of a plan for someone living in Austin, Texas. Coverage with a $500 deductible would cost a sample individual $603 a month and a family $2,015. That same person could drop their premiums to $330 per person per month with a $3,500 deductible.

“That’s what a majority of our employers provide,” Taylor said. And added that he believes, “What you should be able to do is buy the plan you are comfortable with.”

Resources, Asking for Help

Fortunately, there are several avenues to guide you along the way if you are lost or need help. And it’s never wrong to ask someone if you are confused or need guidance, DeAnn Friedholm said.

Healthcare.gov is the federal government’s website that provides information on finding and using every kind of insurance, including a guide to selecting insurance. Cheryl Fish-Parcham also noted it has a useful tool to compare small group and individual policies by state.

The Consumers Union, like many other patient advocate groups, has created guides to health insurance designed to help people understand and use their health insurance coverage.

Independent agents can also help. “Be sure that they are licensed in your state before you use them,” Fish-Parcham said. State insurance departments are a good place to check for complaints or compliance charges against plans and agents.

Need help finding and understanding health insurance?

Here are some helpful websites:

Resources from the U.S. Department of Health & Human Services

Resources from Consumers Union

Families USA

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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Whatever the Supreme Court decides, we’re all in this together – Viewpoint


By Dr. Eric B. Larson, MD, MPH
Vice President for Research, Group Health Cooperative
Executive Director & Senior Investigator, Group Health Research Institute

Last week’s U.S. Supreme Court arguments about the Affordable Care Act created uncertainty over health reform’s immediate future. But the debate about the “individual mandate”—the law’s requirement that everyone get health coverage—strengthened my conviction: To solve our health care system’s cost, quality, and access problems, we must ultimately bring all Americans into that system.

Group Health has embraced the idea that “we’re all in this together” since the Cooperative was established in 1947. Our founders understood the basic principle of insurance: No one can predict when illness or injury may strike, so everyone (young, old, sick, or well) needs to participate to ensure that coverage and care are available and affordable for anyone who needs it. They knew that some would need more care than others. But over time, the population would spread the risk, and everyone would get their fair share from the system.

Group Health didn’t even raise rates with age until the 1980s, when the market forced the issue. Without this change, Group Health would have attracted so many old and sick people that everyone’s rates would have become unaffordable.

Group Health has always stood for universal health coverage—not only because it’s the “right thing”, but also because it’s the most cost-efficient way to provide quality care. 

The same dynamic is behind the individual mandate. When healthy people opt out—because they choose to “take their chances” or can’t afford coverage—the system loses resources needed to pay for those who are sick.

The sick may include those few unlucky, uninsured youths who suddenly need treatment for a broken arm, appendicitis, or that rare, unfathomable case of cancer. Or it may be people with existing illnesses who have been denied coverage. The uninsured often get care through emergency rooms, which are required by law to take all comers.

And ultimately, we all pay for their care through higher taxes and increasing insurance premiums. The new law attempts to deal with this problem by expanding coverage through Medicaid and state health-benefit exchanges for individuals and small businesses.

Group Health has always stood for universal health coverage—not only because it’s the “right thing”, but also because it’s the most cost-efficient way to provide quality care. That’s the challenge our country faces today. Ensuring coverage only for subgroups—say, folks over 65, or the employed—just doesn’t work.

As journalist John Cassidy wrote in The New Yorker last week, “Opting out of the health care market is about as realistic as opting out of dying.”

Weeks may pass before the Supreme Court rules. Meanwhile, leading experts continue to call for reforms to the current fee-for-service payment system—a key driver of rising costs.

One is Stanford’s Victor Fuchs, PhD—our country’s most prominent health economist and author of Who Shall Live, a book that has long defined how economics and social choice effect health.

Last week he told the New York Times: “If we solve our health care spending, practically all of our fiscal problems will go away.” And if we don’t, “almost anything else we do will not solve our fiscal problems.”

Dr. Fuchs is not optimistic that health care can change itself. Rather, it will require “revolutionary” changes that unsettle established interest groups, he believes. But “American history is studded with examples of things that were not politically feasible until they were,” like the emancipation of slaves and a trillion-dollar bailout of the financial industry, he said.

“Major changes in health care policy usually occur because of something outside of health policy—large scale civil unrest, a depression,” he added. One catalyst could be a decision by China to stop buying the American bonds that finance Medicare and Medicaid debt, he explained.

But whether change is triggered by forces inside or outside the broken fee-for-service system that dominates our nation’s health care system, we at Group Health must aspire to demonstrate a successful alternative. Ours is a model born 65 years ago from our founders’ desire “to serve the greatest number”—a mantra that fits health reform today.

As citizens and patients, as health care professionals and researchers, we each have a stake in health care’s future; our place at Group Health gives us a front-row seat to history in the making. More importantly, we have an opportunity to work for positive transformation. Let’s not be spectators, but doers.

Attend 2012 Birnbaum Endowed Lecture on April 30. Dr. Don Berwick, senior fellow at Center for American Progress, and former administrator of Centers for Medicare & Medicaid Services, will describe the important role health professionals play in health care reform. Then Group Health, Geisinger Health System, and HealthPartners leaders will discuss the development of integrated health organizations as learning health care systems.

To learn more:

  • Read Center for American Progress on why establishing insurance coverage for people with pre-existing conditions requires enacting an individual mandate.
This article first appeared in the Group Health Research Insitute’s online Research News webpage.
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U.S. cancer deaths continue steady decline


By Sharon Reynolds
NCI Cancer Bulletin Staff Writer 

According to the latest data on nationwide death rates from cancer, overall mortality from cancer declined from 1999 to 2008, maintaining a trend seen since the early 1990s.

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lungcolorectalbreast, and prostate), although the rate of decline varied by cancer type and across racial and ethnic groups.

The complete Annual Report to the Nation on the Status of Cancer, 1975–2008 appeared March 28 in Cancer.

The declines in cancer death rates (mortality) averaged 1.7 percent per year for men and 1.3 percent per year for women from 1999 through 2008.

Among men, the overall rate of new cancer cases (incidence) fell by an average of 0.6 percent annually from 1999 to 2008.

Among women, incidence dropped by an average of 0.5 percent annually from 1999 to 2006 but held steady from 2006 to 2008.

Cancer incidence in children ages 0 to 14 rose from 1999 to 2008 (by 0.5 percent a year), continuing a trend seen in previous Annual Reports to the Nation.

However, advances in treatment contributed to a steady decline in mortality rates for children with cancer in the last 5 years (an average of 2.8 percent per year).

“Steady progress, as measured by declines in cancer death rates for many cancers, is good because we have an aging, growing population,” said Dr. Brenda K. Edwards, NCI’s senior advisor for surveillance.

“While the number of people diagnosed with cancer or who die of the disease may be increasing, the decline in cancer death rates for more than a decade is the best indicator of progress due to prevention, screening, diagnosis, and treatment,” she added.

NCI, the American Cancer Society, the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the report. Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and from the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Not All Good News

There were some notable exceptions to the overall decreases in incidence and mortality. From 1999 to 2008, death rates rose for pancreatic cancer in men and women, for liver cancer and melanoma in men, and for endometrial cancer in women.

The cervical cancer death rate, which had been falling for decades, showed no further decrease over the last 5 years.

And, although incidence rates fell overall for men and women from 1999 to 2008, the decline was not distributed evenly across racial and ethnic groups.

Cancer incidence rates did not decrease significantly among American Indian/Alaska Native men and women combined or among black, Asian and Pacific Islander, and American Indian/Alaska Native women.

Although incidence rates in black men did decline, this group still had the highest cancer incidence rate of any racial and ethnic group, 15 percent higher than that of white men and nearly double that of Asian and Pacific Islander men.

Major Modifiable Risk Factors

Each Annual Report to the Nation includes a special feature that focuses on a topic of importance to the cancer research community and the public.

This year’s report featured an analysis on the contribution of excess weight (overweight and obesity) and insufficient physical activity to the nation’s cancer burden.

More than 60 percent of the U.S. adult population is estimated to be overweight or obese, and a similar percentage of adults do not get the recommended amount of physical activity.

The rates of insufficient physical activity are even worse for children; for example, up to 90 percent of high school girls do not engage in recommended levels of physical activity.

Excess weight “is a major modifiable risk factor for cancer and other diseases—probably second only to tobacco use in terms of its impact on cancer incidence and mortality,” said Dr. Edwards. “The risk may be modest but it’s so pervasive that we felt this was the time to look at [cancer] incidence in this context.” Physical inactivity not only contributes to excess weight but is itself a risk factor for several cancer types.

The report was not designed to quantitatively link the trends in excess weight and lack of physical activity to the national trends for cancer, explained Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in NCI’s Division of Cancer Control and Population Sciences.

Many other studies have shown convincing links between excess weight and several cancer types, including endometrial, postmenopausal breast, colorectal, kidneyesophageal, and pancreatic cancer.

The point of the special feature, she noted, “is to highlight specific types of cancer that are related to [excess weight and lack of sufficient physical activity], show how these behaviors relate to these cancers in terms of their relative risks, and briefly describe some of the mechanisms by which they relate.”

The special feature also highlights national- and state-level prevention strategies in policy and environmental change that are intended to help people achieve recommended changes in their diets and physical activity levels.

As the nation’s weight has risen, so has the incidence of some, although not all, types of cancer related to excess weight and lack of sufficient physical activity. From 1999 to 2008, incidence rates of kidney cancer and of adenocarcinoma of the esophagus each rose about 3 percent per year for men and women, while incidence of pancreatic cancer rose 1.2 percent per year among men and women.

In addition, incidence rates of endometrial cancer rose significantly among black, Asian and Pacific Islander, and Hispanic women. Incidence of postmenopausal breast cancer stabilized from 2005 to 2008, after a period of decline.

“Although all of these cancers are influenced by multiple factors, the high prevalence of excess weight and insufficient physical activity likely contributed to these observed increases and to the lack of decline in breast cancer,” the authors wrote. “Continued progress in reducing cancer incidence and mortality rates will be difficult without success in promoting healthy weight and physical activity, particularly among youth.”

Excess weight and lack of physical activity also influence cancer survivorship, explained Dr. Ballard-Barbash, as both can negatively affect outcomes after a cancer diagnosis, further increasing the need for these risk factors to be addressed on a personal and societal level.

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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2010 insurance rebates would have hit $2 billion, study says


By Jay Hancock

Consumers would have received rebates of nearly $2 billion — in some cases as much as $300 member – if the health-law cap on insurance profits and overhead had been in place in 2010, estimates a new study.

The paper, published Thursday by the Commonwealth Fund, makes no predictions about the rebates that insurers will be required to pay this year for the first time. But the study shows that insurers have been spending more on administrative costs than what the health law will allow, said Sara Collins, a Commonwealth Fund economist.

“The United States has insurer administrative costs that exceed those of private insurance companies in other industrialized countries,” she said.  “It’s an indication that there is waste in the system that can be reduced.”

The 2010 Affordable Care Act allows insurers to devote no more than 15 to 20 percent of their revenue, in most cases, to overhead, profits, executive pay and the like. (This is the mirror of the requirement that they spend at least 80 to 85 percent of their revenue on medical care and quality improvements.)

Anything over the cap must be returned to the plan members and employers who pay the premiums. The rules for what’s known as the medical loss ratio took effect for 2011, with rebate checks of an undetermined amount scheduled to be sent out in August.

If the cap had been in place for 2010, nearly a fourth of privately insured consumers would have received rebates, the study said. More than half of those with individual coverage would have pocketed refunds. Rebates would typically have been $100 to $300 per member, the study said.

In Washington, total rebates to individual coverage would have run more than $6.5 million or about $62 per member.

Texas insurance customers collectively would have received the most in rebates — $255 million — followed by those in Florida, who would have gotten $202 million. One fifth of nonprofit insurers would have owed rebates.

Among for-profit plans, 70 percent would have been required to send rebate checks, said the study, which was conducted by Mark Hall of Wake Forest University and Michael McCue of Virginia Commonwealth University.

While 2011 insurer profits were substantial, some have suggested that moves by the industry to lower premiums last year will reduce rebates owed this year.

“Given the unpredictable nature of health care costs, it’s not surprising that some health care plans expect to pay rebates to consumers in some markets,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry lobby. “But the amount — and to whom and in what markets — we’ll find out when they’re filed in June.”

Even though the study doesn’t predict how much in rebates will be paid, it gives an idea of the administrative dollars that would henceforth be devoted to reduced premiums, rebates or medical spending in order for the industry to comply with the law, Collins said.

“What you would hope to see over time is a reduction in the premium dollar that goes to profits and administrative costs and more of that premium dollar going to medical care,” she said.

AHIP’s Zirkelbach, on the other hand, said administrative spending ratios have declined. And he portrayed profits and administrative costs as minor factors in the big picture of health expense.

“This arbitrary cap on health care administrative costs does nothing to affect the real drivers of premium increases,” he said. “It doesn’t get at the underlying medical costs that are contributing to those increases.”

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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Twenty-dollar bill in a pill bottle

CityClub’s 2012 Health Care Series begins April 17th


CityClub’s 2012 Health Care Series

Seattle’s City Club begins a series of talks on the cost of health care April 17.

The series will feature four expert panels which will talk about why U.S. health care costs so much and what we can do to bring those costs down.

The series will be moderated by Joanne Silberner, NPR’s Health Policy Correspondent for 18 years and Artist in Residence at University of Washington.

Tuesday, April 17, 2012 : Delivery Systems and the Cost of Care

How do we discover the true costs of health care, and how do we gain more transparency in the system? How much do services and procedures really cost? How do uncompensated care and other hidden expenses also drive cost?  How can consumers assess relative costs and quality among different providers? What are the barriers to transparency in the system? What role can hospitals, physicians, insurance companies, health systems and the consumer play in breaking those barriers down? How can understanding the true cost of care ultimately help us reduce it?


  • Scott Bond, President and Chief Executive Officer, Washington State Hospital Association  
  • Rich Maturi, Senior Vice President for Health Care Delivery Systems, Premera 
  • Robert O’Brien, Executive Vice President Health Plan Division, Group Health Cooperative
  • Rick Cooper, Chief Executive Officer, The Everett Clinic 


Washington Athletic Club | 1325 Sixth Avenue, Seattle, WA 98101


Registration: 11:30 a.m. – noon

Luncheon & Program: noon – 1:30 p.m.

Luncheon Prices:

  • CityClub Members: $35
  • Guests & Co-Promoters: $40
  • General Public: $45
  • Coffee & Dessert Prices -
  • CityClub Members: $12
  • Guests & Co-Promoters: $15
  • General Public: $18
To learn more and register go to CityClub.

June/July 2012 : Appropriate Use of Care

When does cost containment sacrifice quality? How much do testing and technology advance the standard of care, and how much is too much for us to afford? Why are hospitals and medical centers building new stand-alone emergency facilities when that is the most expensive care to provide? Is there an overuse of care for end-of-life patients and, if there is, how can we address it?

August/September 2012 : Health Care Payment Reform

Who actually pays for healthcare – how much of the burden do government, employers, insurance companies and consumers bear, and how has that shifted over the last decade? How do we increase productivity and accountability in the provision of health care? How can we switch from paying for procedures to paying for outcomes? How can we invest more healthcare dollars in prevention?

November/ December 2012 : Access to Affordable Health Care

Why do we have a shortage of general practitioners and nurses? What do we do to cover the growing number of uninsured Americans? Should we use a carrot or a stick to drive down healthcare costs, e.g. should we provide less care for patients who don’t take care of themselves? What reforms are needed to make Medicare and Medicaid sustainable for future generations? What countries are doing this better and what can we learn from them?


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Schematic drawing of an EKG of a normal heart beat

Physician groups list 45 tests and treatments that are often unnecessary


Schematic drawing of an EKG of a normal heart beatPhysicians Wade Into Efforts To Curb Unnecessary Treatments

By Julie Appleby
KHN Staff Writer

Nine prominent physician groups today released lists of 45 common tests and treatments they say are often unnecessary and may even harm patients.

The move represents a high-profile effort by physicians to help reduce the extraordinary amount of unnecessary treatment, said to account for as much as a third of the $2.6 trillion Americans spend on health care each year.

Each of the societies, representing both primary care doctors and specialists, picked five procedures that medical evidence shows have little or no value for certain conditions, and which they say should be questioned by patients and their doctors.

Illustration: Agateller via Wikipedia

Choosing Wisely List – American Academy of Family Physicians

Don’t do imaging for low back pain within the first six weeks, unless red flags are present.

Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits.

Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.

Symptoms must include discolored nasal secretions and facial or dental tenderness when touched. Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80 percent of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs.

Don’t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.

DEXA is not cost effective in younger, low-risk patients, but is cost effective in older patients.

Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.

There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Potential harms of this routine annual screening exceed the potential benefit.

Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.

Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety, additional testing and cost. Pap smears are not helpful in women after hysterectomy (for non-cancer disease) and there is little evidence for improved outcomes.

The list includes such common practices as routine electrocardiograms for patients at low risk for heart disease, and antibiotics for mild sinus infections.  It is meant as a set of guidelines.

Dr. Donald Berwick, the former head of Medicare and a longtime quality researcher, called the campaign “a game changer.” Part of the reason is that patients generally trust doctors more than insurers, employers or others who attempt to influence what gets covered and what doesn’t.

“This could be a turning point if it’s approached with energy,” Berwick says. “Here you have scientifically grounded guidance from a number of major specialty societies addressing a very important problem, which is the overuse of ineffective care.”

Choose Wisely Lists Online:

For the most part, the list is non-controversial, avoiding such hot-button issues as prostate-specific antigen testing for prostate cancer, or how often to perform mammography screenings for breast cancer.

But the items on the list include a broad range of interventions that can be revenue-generating for doctors, clinics and hospitals — and costly for insurers and patients. Some also pose health risks to patients, because they may lead to additional radiation exposure, side effects from medications or unneeded surgeries.

“We need to use this opportunity to raise awareness that sometimes overtreatment or testing can be harmful,” says Glen Stream, president of the American Academy of Family Physicians, one of the nine specialty groups participating.

The campaign comes amid a variety of efforts – some called for in the federal health law – to compare the effectiveness of treatments and to change payment incentives to doctors and hospitals to reward quality and penalize inefficiency

But efforts to slow medical spending growth often become political, spurring fears of rationing or “death panels.”

“Anytime you are recommending against a test or treatment, people wonder ‘is it for some economic interest?'” notes Stream, who says the evidence-based recommendations are designed to counter those concerns.

Among the items the groups recommend doctors and patients question: X-rays or other scans for uncomplicated headaches or early evaluation of low back pain, exercise electrocardiograms, often called “stress tests” or “treadmill tests” for low-risk patients with no symptoms of heart disease, and chemotherapy for patients with advanced solid-tumor cancers who are unlikely to benefit.

Some of the recommendations go against financial self-interest of the societies or their members because they are likely to result in fewer tests or procedures, Berwick notes. Because of that, some policy experts question whether physician groups will tackle the problem enthusiastically.

2011 study in the British Medical Journal, for example, found financial conflicts of interest among many of the doctors charged with drawing up clinical guidelines for diabetes and cholesterol treatments in the U.S. and Canada.

Nonetheless, physicians are becoming more involved in efforts to spread the message that more care is not always better. Other recent efforts to identify medically unnecessary treatments include 37 listed by the American College of Physicians in the Annals of Internal Medicine in January.

And in 2008, the National Priorities Partnership – a collaboration of 28 national health care organizations released its own analysis of overused services, including Caesarean-section deliveries and chemotherapy given to patients in the last two weeks of their lives.

The new campaign, called “Choosing Wisely,” is funded by the ABIM Foundation, an arm of the American Board of Internal Medicine. The recommendations will be featured on the website of Consumer Reports magazine, which partnered with the foundation.

Educational materials will be distributed to physicians. The specialty societies in the campaign include those representing family physicians, cancer doctors, cardiologists, radiologists, gastroenterologists, allergists and kidney specialists. Another eight specialty groups – representing rheumatologists, pathologists, head and neck surgeons and others – are expected to release their own lists in the fall.

While calling the campaign “magnificent and long overdue,” another quality expert noted that most physicians are already aware that most listed procedures are overused.

“This is important, but obviously a first step … classic low-hanging fruit,” says Steve Pearson, president of the Institute for Clinical and Economic Review, which evaluates medical treatments and is affiliated with Harvard Medical School.

He adds that many would find it remarkable that “it’s still required to tell physicians not to do these things.”

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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Seattle Children’s names Lisa Brandenburg hospital president


Seattle Children’s has named Lisa Brandenburg hospital president.

Brandenburg, who has served as the hospital’s administrative officer (CAO) for five years, will assume the position immediately.

Brandenburg replaces former hospital president and chief operating officer Pat Hagan who after more than 15 years at Children’s resigned  last January to serve as a continuous performance improvement consultant.

Brandenburg talks about her new position:

In addition to CAO, Brandenburg has been serving as interim president since Hagan’s departure.

Brandenburg has 21 years experience leading complex service organizations, including the University of Washington Medical Center.

As CAO of Children’s, she has been involved in all aspects of the hospital including patient care, physician practice management, the Building Hope expansion, transportation initiatives, human resources, and supply chain management.

Brandenburg’s CAO duties will now be distributed to other leaders across the organization so she can focus on her new responsibilities.

Brandenburg will report to Dr. Hansen and will become one of three current Children’s presidents joining: James Hendricks, PhD, president of Seattle Children’s Research Institute; and Douglas Picha, president of Seattle Children’s Hospital Foundation.

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Virginia Mason launches web portal for patients


Virginia Mason has launched online portal for anyone who is receiving outpatient care at Virginia Mason facilities.

Users will be able to:

  • Request, review or cancel appointments
  • Renew established prescriptions
  • Review lab results
  • Send and receive secure messages from their care team
  • Review a summary of their health record

To ensure privacy, the site is password protected and encrypted secure, and patients wanting to use the new portal must enroll in person at any Virginia Mason location.

To learn more about MyVirginiaMason and to review frequently asked questions, visit www.myvirginiamason.org

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April 4th: “National Start Walking Day”


April 4th is National Start Walking day. The idea is to get everyone out and get a little exercise.

Local events are sponsored by Seattle Parks and Recreation and the American Heart Association.

Start Walking events will be held at 17 area locations:

Start Walking Locations:

  • Parks Administration, 100 Dexter Avenue North , Seattle WA 98109 – 12 noon, 30 minutes to Lake Union Park and back.
  • Alki Community Center at Alki Bathhouse, 2701 Alki Ave. SW, Seattle WA 98116- 5:30 p.m., walk along the beach sidewalk
  • Ballard Community Center , 6020 28th Ave NW, Seattle WA 98107 – 10 a.m., 30 minute walk around the neighborhood
  • Bitter Lake Community Center, 13035 Linden Ave N, Seattle WA 98133 – 12 Noon, 30 minute walk around the neighborhood
  • Green Lake Community Center, 7201 E Green Lake Dr N, Seattle WA 98115 – 12 Noon, 45 minute walk around Green Lake
  • Loyal Heights Community Center, 2101 NW 77th St, Seattle WA 98117 – 12 Noon, 30 minute walk around the neighborhood
  • Helene Madison Pool, 13401 Meridian Ave N, Seattle WA 98133 – 2:30 p.m., “Walking in Water”, admission required
  • Magnolia Community Center, 2550 34th Ave W, Seattle WA 98199 – 9:30 a.m., 30 minute walk around the neighborhood
  • Magnuson Community Center & Life Long Recreation , 6344 NE 74th Street, Seattle WA 98115 – leaving from the Magnuson Brig – 12 Noon, walk through the wetlands
  • Meadowbrook Pool & Center, 10517 35th Ave NE, Seattle WA 98125 – Walking in Water” event – 12 Noon at Meadowbrook Pool (People not wanting to get wet will be able to walk the pool deck while cheering on those in the water). Admission required
  • Medgar Evers Pool, 500 23rd Ave, Seattle WA 98122 – water walking on Wednesday, April 4th from 1:30 – 2:00 P.M. in the shallow end Admission required
  • Miller Community Center, 330 19th Ave E, Seattle WA 98112 2:30 p.m., Teens walk with NOVA and One World Schools
  • Rainier Community Center , 4600 38th Ave S, Seattle WA 98118 – meet at 11:45 a.m., start walking at 12 Noon, community center to Mt. Baker Rowing & Sailing and back
  • Sound Steps : Rainier Indoor Walkers, Rainier Community Center 4600 38th Ave S, Seattle WA 98118 (group meets every Wednesday) at Rainier CC at 10 a.m.
  • Southwest Teen Life Center, 2600 SW Thistle St, Seattle WA 98106: for teens “Walk and Mile, Talk a Mile” – starting at 4 p.m.
  • West Seattle Life Long Recreation – Alki Beach, approximately 2726 Alki Ave. SW, Seattle WA 98116 10 a.m. meet at the Statue of Liberty
  • South Park Community Center, 8319 8th Ave S, Seattle WA 98108 4 p.m., teens and adults at the playfield
Screen Shot 2012-04-03 at 12.28.53 PM-2

Whooping cough reaches epidemic levels in much of Washington


Whooping cough has reached epidemic levels in Washington state, Washington State Secretary of Health Mary Selecky announced Tuesday.

Since the beginning of the year, 640 cases of whooping cough have been reported and confirmed in 23 of the state’s 39 counties. At this time last year, only 94 cases had been reported, Sec. Selecky said.

Red represents cases so far this year; blue cases from last year;

The actual number of cases may be far higher, Selecky said, because only about 10 percent to 12 percent of cases are reported. “This is the tip of the iceberg,” she said.

Infants are most vulnerable to the disease, and there have been at four infant deaths in the state due to whooping cough over the past years.

“We’re very concerned about the continued rapid increase in reported cases,” said Secretary of Health Mary Selecky. “This disease can be very serious for young babies, who often get whooping cough from adults and other family members. We want all teens and adults who haven’t had Tdap [a pertussis vaccine] to be vaccinated to help protect babies that are too young for the vaccine.”

In the epidemic continues at its current rate, the state is on track to see the most cases it has seen since 1942, Sec. Selecky said.


Photomicrograph of the bacteria that causes whooping cough

Pertussis, the whooping cough bacteria -- CDC photo

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

It is caused by a bacteria called Bordetella pertussis. The name, pertussis, comes from Latin, from per-‘away, extremely’ + Latin tussis ‘a cough.’

According to the U.S. Centers for Disease Control and Preventing, in the 20th century,  pertussis was one of the most common childhood diseases and a major cause of child death in the United States.

Initially, an infection may seem like just a cold. However, during this phase of the infection, which can last several weeks, a person can spread the disease to others.

Patients typically then go on to develop a severe, persistent–often wracking–cough that can last for several more weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants and it wears off with time.

Related article: Vaccine Hesitancy

Seattle’s Child’s lead article this month is a piece by Laura Hirshfield on “Vaccine Hesitancy”. She writes:

“While there is a small, but vocal, minority of parents who outright refuse all vaccines, much more common are parents who choose to skip or delay their children’s vaccines. In a recent Seattle Children’s Research Institute survey, 77 percent of Washington pediatricians reported regularly seeing parents who ask to vary the recommended vaccine schedule.

“Health officials call these parents “vaccine hesitant” and link the statewide rise in outbreaks of whooping cough, a highly contagious, airborne disease, to the rising number of under-vaccinated kids.”

Read the full article on the Seattle’s Child website.

Health officials therefore recommend that anyone who has contact with newborns and infants be vaccinated or, if they have been vaccinated, to make sure their vaccination is up-to-date.

Sec. Selecky urged parents to make sure their children are fully vaccinated and up-to-date and that teens and adults to check to see whether they need a booster.

Because newborns cannot be vaccinated, pregnant women should make sure they are vaccinated because they can transfer some of their immunity to their newborn that will confer some protection during the first months of life.

In addition, being vaccinated will reduce the risk that they will contract the infection and spread it to their child.

“Many adults don’t realize they need to be vaccinated, or they assume they have been,” said State Health Officer Dr. Maxine Hayes. “We’re asking everyone to verify with their health care provider that they’re up-to-date on vaccines. We’re also asking everyone to use good health manners — like cover your cough and stay home when you’re sick — that will also help prevent spreading whooping cough.”

For full information about pertussis vaccines and about who should get vaccinated go to the Department of Health’s pertussis information page: http://www.doh.wa.gov/cfh/Immunize/diseases/pertussis/

Free vaccine available

  • All recommended vaccines are offered at no cost to all kids under 19 through health care provider offices participating in the state’s Childhood Vaccine Program.
  • Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee.
  • People who cannot afford the administration fee can ask their regular health care provider if they’ll waive that cost.
  • Most health insurance carriers will cover the whooping cough vaccine; adults should double-check with their health plan.

To learn more:

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