Body Language lips shhh

Body language – F.A.S.T. Stroke Awareness

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Stroke is the No. 4 killer in this country and the leading cause of long-term disability.

Although 4 out of 5 American families will be touched by stroke, more than a third of Americans cannot identify a single warning sign for stroke.

A new ad series sponsored by the American Heart Association, the American Stroke Association and the Ad Council seeks to make the acronym F.A.S.T. an easy-to-remember tool for learning and recognizing the warning signs of a stroke.

F.A.S.T. stands for:

  • Face (face drooping),
  • Arm (arm weakness),
  • Speech (speech difficulty), and
  • Time (time to call 911).

Educating bystanders about the signs of stroke and urging them to call 911 immediately at the onset of symptoms may improve the chances of getting better, but only if you get help right away.

To learn more:

Visit the American Stroke Association’s website: www.strokeassociation.org/STROKEORG/

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Insurance surcharges to fund most online exchanges created under health law

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By Phil Galewitz
KHN Staff Writer

Republican governors in Florida, Virginia, Texas and several other states say they’re reluctant to build the online insurance markets required by the federal health law because they’re worried about getting stuck with the bills.

“That’s not a good value proposition for the people of Virginia or any other state,” Virginia Gov. Bob McDonnell told Fox News last month.

But Democrat-controlled California, which will run the country’s largest insurance market, will do so without taking a cent from the state treasury.

Instead, operations of the market, also called an exchange, will be financed by a surcharge on the billions of dollars in insurance premiums sold in the exchange.

That’s the same way most state-based exchanges will be funded, according to government officials and health consultants working with states.

“When California formed its exchange, we said it will not now or ever be a burden on taxpayers,” said Peter Lee, executive director of the California Health Benefit Exchange.

The insurance markets are a key element of federal health law, also known as Obamacare. They are the way in which millions of consumers and small businesses are expected to buy health coverage beginning in 2014.

Individuals will also be able to find out if they are eligible for subsidies or expanded Medicaid coverage when they shop there.

New Regulations: Fees On Insurance Policies

Concern over operating costs is one reason that fewer than 20 states have committed to building their own exchanges – far fewer than the law’s backers had envisioned.

Supporters of the law say the impact on consumers will be negligible.

Governors have until Dec. 14 to tell federal regulators whether they will set up a state exchange, and until Feb. 15 to decide whether to partner with them to do it. States that do nothing are required by law to have one run by the federal government.

The federally-run exchanges will also be financed with a surcharge — capped at 3.5 percent of monthly premiums in 2014, according to proposed regulations released Friday.

While the Obama administration has compared the new exchanges to travel web sites such as Expedia or Travelocity, selling health insurance is far more complicated than a plane ticket – and more heavily regulated as well.

Officials running the state insurance markets must decide which health plans are offered and what benefits are covered. Their duties include operating toll-free hotlines to help consumers choose a plan, determine eligibility for subsidies or Medicaid, rate plans based on quality and price, and conduct outreach and education.

To encourage participation, the Obama administration has awarded over $2 billion in startup funding. But by law, the markets must be self-sustaining by 2015 —meaning they no longer will get federal funding.

Consumer Impact

State estimates of annual operating costs vary from $15 million to $20 million a year in Rhode Island to $300 million in populous California, with the costs related to the number of people in the state as well as to how much education and outreach, among other functions, are done.

Estimates of annual operating costs vary from $15 million to $20 million a year in Rhode Island to $300 million in populous California.

Financing options include using state treasury funds, charging for advertising on exchange websites and imposing fees on insurance agents or health providers as well as insurers.

California’s approach is typical among the states that have already decided how they will proceed. Oregon, Nevada and Connecticut also plan to raise money with a surcharge on premiums on policies sold in the exchanges that insurers are expected to pass onto consumers.

West Virginia, which hasn’t formally committed committed to building its own exchange, and Washington state are considering a surcharge on individual and small group premiums sold both inside and outside the markets, according to consultant Avalere Health.

Some worry, however, that the added fees, expected to range from 2 percent to 4 percent of premiums, will burden cash-strapped consumers struggling to afford coverage.

“Of course, these expenses would be passed along in the form of fees resulting in higher health premiums for Arizona families and small businesses,” Arizona Gov. Jan Brewer said Nov. 28 when she notified the Obama administration that her state would not build a state exchange.

Supporters of the law say the impact on consumers will be negligible.

“We think that premium assessments are an appropriate mechanism for funding the exchanges,” said Claire McAndrew, senior health policy analyst at Families USA, a consumer advocacy group.

She prefers that states assess all health insurance premiums — not just policies sold inside the exchanges – to reduce the impact on those buying in the exchanges. But even assessing only the exchange plans will have a “negligible effect,” she said.

That’s because consumers shopping there will get a more competitive insurance market which should mean lower prices, she argued.  More than half will also be eligible for federal subsidies in the form of tax credits to purchase policies, according to the Congressional Budget Office.

The insurance industry is more pessimistic.

“Any fees to fund the exchanges are going to be on top of all of these other provisions that already are going to affect the cost of coverage,” said Robert Zirkelbach, spokesman for the trade group America’s Health Insurance Plans.

Massachusetts Relies On State Funding

Massachusetts, whose Health Connector was a model for the federal law, has relied mainly on state funding to cover the cost of running the program.

In 2012, $25 million of its $36 million budget came from the state treasury, and $6.9 million came from a surcharge on insurance policies sold there according to Connector spokeswoman Stephanie Nichols.

Officials are studying whether state funding will be necessary after 2014, she said.

Jonathan Gruber, an MIT economist and Connector board member, said the surcharge on premiums—which ranges from 2.5 percent to 3.5 percent, depending on the type of policy — has been passed onto consumers, but has not prevented people from obtaining coverage.

The state funding, which represents .06 percent of the state budget — has been seen as a worthwhile investment to reduce the uninsured rate from 6 percent to less than 2 percent, the lowest in the nation.

“There’s been strong political consensus that this is a good thing,”  said Celia Wcislo, a vice president of  SEIU United Healthcare Workers East and a Connector board member.

But for many recession-battered states, new state funding commitments seem impractical.

Jason Madrak, spokesman for the Connecticut health insurance exchange, said a premium surcharge is the “cleanest and easiest way to go,” because it’s a simple way to collect money and to increase the exchange’s budget along with enrollment.

There was no appetite in Connecticut to use state funds to run the exchange, he said. “We are cognizant of the math and intend to run as lean an organization as we can.”

But for many recession-battered states, new state funding commitments seem impractical.

Florida Gov. Rick Scott, a vehement critic of the law, has worried that building an exchange would lead to higher taxes and health care costs.

But Florida has been building its own online health  insurance exchange, authorized by the state legislature back in 2008, which will be financed with a surcharge on premiums sold in the exchange.

Florida’s market, set to open next year, is a distant cousin to the model in the federal law – it won’t offer subsidies or sell individual policies, at least at the start. However, some state lawmakers are considering expanding it to comply with the law.

KHN correspondent Julie Appleby contributed to this report.

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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Americans die of preventable causes at higher rates than do the British, Germans and the French – info graphic

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Compared with France, Germany, and the United Kingdom, the United States has a higher rate of amenable mortality—that is, deaths that could have been potentially prevented by timely access to appropriate health care.

Infographic from the Commonwealth Fund:

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Hospitals get new grades on safety

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By Jordan Rau

The Leapfrog Group is out with its second round of hospital safety ratings, and what a difference a few months has made.

In the results released Wednesday, 103 hospitals that Leapfrog had given a “C” or lower in its first round of ratings in June got an “A” in the updated Hospital Safety Score, based on more recent data and a slightly tweaked methodology.

Here are the ratings for hospitals in Seattle:

 Northwest Hospital — View the full Score

 Virginia Mason Medical Center — View the full Score

 Swedish/Ballard Campus – View the full Score

 Swedish/First Hill Campus – View the full Score

 UW Medical Center – View the full Score

 Swedish/Cherry HIll – View the full Score

 Harborview Medical Center – View the full Score

For the rankings of all Washington hospitals go here.

These included New York-Presbyterian Hospital, the Hospital of the University of Pennsylvania and Geisinger Medical Center.

Two hospitals awarded an “A” in the first round, Leonard J. Chabert Medical Center in Houma, La., and Lawrence General Hospital in Lawrence, Mass., both slipped to a “D.”

Altogether, 8 percent of the 2,619 hospitals that Leapfrog rated changed by two or more grades, like an “A” to a “C,” according to Leapfrog, a patient safety nonprofit based in Washington, D.C.

Thirty-four percent changed one grade, like a “C” to a “B,” and 58 percent kept the same grade, Leapfrog said.

Leapfrog’s effort to provide a single letter grade based on 26 different measures of safety is part of a burgeoning effort to help consumers evaluate medical providers.

Consumer Reports this year also started boiling down  hospital metrics into its signature circular symbols, known as “Harvey Balls.”

In its first effort, Leapfrog gave a break to hospitals with poor showings, giving them a “Grade Pending.” This time, Leapfrog pulled out its red pen, giving 25 hospitals an “F,” including the Ronald Reagan UCLA Medical Center in Los Angeles.

Another 122 hospitals got a “D.”  Leapfrog gave 790 hospitals an “A,” and 678  received a “B.” Leapfrog gave 1,004 hospitals a “C.”

Leapfrog calculated its grades using publicly-available data, including the frequency of blood line infections, falls in the hospital, bedsores and the consistency that hospitals follow recommended methods of care, such as discontinuing an antibiotic within 24 hours of surgery.

Leapfrog’s effort has earned grumbles from hospitals, which note that much of the data is old, with some of it dating to events from as far back as July 2009.

Hospitals also have complained Leapfrog incorporates its own survey in its evaluations, although the organization says that doesn’t disadvantage hospitals that don’t fill them out.

Dr. Shannon Phillips, patient safety officer at The Cleveland Clinic—which saw its grade slip from a “C” to a “D”—said the Clinic “has seen measurable improvement month after month,” so Leapfrog’s evaluation is now outdated.

Phillips said the grades are of no help to hospitals since they are already aware of the underlying measures, which Medicare calculates and publishes. “It’s repackaging of data the public and we already have,” she said.

Leah Binder, Leapfrog’s chief executive officer, said the ratings will help companies and other health care purchasers as they try to educate their employees to select services with the highest value.

“When a person or employee looks at comparative pricing information, they assume the highest price is the highest quality,” she said. Leapfrog’s grade is “something that can be incorporated pretty easily into pricing transparency,” she said.

The individual hospital scores can be looked up on Leapfrog’s web site. A breakdown of how hospitals in each state did as tabulated by Kaiser Health News is below.

Maryland hospitals are not listed, because Medicare does not collect the same data from that state’s hospitals due to a unique arrangement with the federal government.

Number of Hospitals Receiving Each Grade for Patient Safety
State A B C D F
AK 1 2 1 2
AL 12 13 25 4 1
AR 3 5 22
AZ 11 10 14 5
CA 92 56 80 14 4
CO 13 11 15
CT 6 9 13
DC 1 4 2
DE 3 2 1
FL 61 38 49 8
GA 11 27 32 4 1
HI 1 4 4 1
IA 10 8 11 1
ID 1 2 5 1 1
IL 51 31 28 3 5
IN 15 31 16 1
KS 3 11 14 5
KY 12 20 21 1
LA 8 13 29 3 1
MA 50 4 5 1
ME 16 3 1
MI 37 25 22 1
MN 20 14 12 1
MO 18 11 30 3 1
MS 8 8 18
MT 3 4 3
NC 20 29 26 2
ND 3 1 1 1
NE 3 3 11
NH 2 5 6
NJ 23 22 24 1
NM 1 5 7 1
NV 2 5 12 1
NY 33 38 70 16
OH 35 23 45 8
OK 3 12 22 3
OR 4 10 14 2 1
PA 37 29 59 1
RI 2 4 3
SC 14 11 19 1 2
SD 2 1 5 1
TN 25 18 21 3
TX 52 44 91 16 5
UT 3 4 11 1
VA 30 16 21 2 1
VT 3 1 2
WA 13 15 14 1
WI 10 12 24
WV 2 5 17 2
WY 1 3 4
Grand Total 790 678 1004 122 25
Source: Leapfrog Group

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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Blue Pregnant Belly

New prenatal blood tests raise hopes as well as questions

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By Rita Rubin

This story was produced in collaboration with wapo

When Ramona Burton became pregnant with her second child this year, the 37-year-old Upper Marlboro woman knew that her age put her baby at an elevated risk for Down syndrome, even though screening with ultrasound and standard blood tests raised no warning flags.

Burton and her husband didn’t want to risk amniocentesis, the gold standard for prenatal diagnosis, because it carries a small chance of miscarriage.

So when her doctor offered an alternative – a new test that requires only a sample of the mother’s blood – they leapt at it. In less than two weeks, they got the news: no Down syndrome. The baby, a boy, is due next month.

Three versions of this test, which can be performed as early as 10 weeks into a pregnancy, have come onto the market since December.

Tens of thousands of women have used them, according to the companies that sell the tests. But they are not subject to regulation by the Food and Drug Administration, and questions have been raised about a technology whose accuracy and role are still being assessed.

As a result, no major insurance company has yet agreed to cover the tests, whose list prices range up to $1,900.

New medical technologies often challenge a health-care industry grappling with pressures to control costs. It’s not yet clear whether the new tests will cut costs and miscarriages by reducing invasive prenatal diagnostic procedures such as amniocentesis or inflate costs because they’re used by women who probably would never have opted for amnio because of miscarriage fears.

(The established tests are performed about 200,000 times annually in the United States and cost roughly $2,500 in the Washington, D.C. area.)

More is not better

So far, major insurance companies, citing limited studies about the tests’ accuracy and impact on patient care, consider them to be experimental and do not cover them.

With the new tests, fragments of fetal DNA extracted from the mother’s blood sample are checked for increased amounts of material from chromosomes 21, 18 and 13, a sign that the fetus carries three instead of the normal two copies of those chromosomes.

In this case, more is not better. Having an extra copy of 21, a condition called trisomy 21, is the main cause of Down syndrome, while having a third copy of 18, a condition called trisomy 18, causes a less common disorder named Edwards syndrome. Trisomy 13 is also known as Patau syndrome. All three conditions are linked to serious developmental and medical problems.

Standard first-trimester screening for these genetic conditions can be performed as early as 11 weeks’ gestation. It consists of a blood test to check levels of pregnancy-associated proteins and hormones in the mother’s blood and an ultrasound to look for extra fluid under the skin at the back of the fetus’s neck. The results are usually available within a week.

Used together, the standard blood tests and ultrasound can detect about 90 percent of Down syndrome cases and an even greater proportion of trisomies 18 and 13. But there’s a false-positive rate of about 5 percent, and only amniocentesis or the much less commonly used chorionic villus sampling, another invasive test that can cause miscarriage, can provide a definitive answer.

The new blood tests that assess fetal DNA rather than maternal blood perform better than standard screening, says Tufts scientist Diana Bianchi, whose research helped lay the groundwork for them. Bianchi sits on the scientific advisory board of Verinata Health, which launched its test, called Verifi, in March. “The problem is they’re more expensive, so they can’t be a primary screen,” she says.

The tests generally are offered only to women whose age, family history or standard screening put their fetus at a higher risk of having a chromosome abnormality – not to all women, as the standard screening tests are.

So far, major insurance companies, citing limited studies about the tests’ accuracy and impact on patient care, consider them to be experimental and do not cover them.

(Sequenom, the marketer of the MaterniT 21 Plus test, asserted this month that 15 percent of the U.S. population is covered by plans that will pay for the test, though it did not identify those plans.)

A diagram showing the chromosomal rearrangement that causes Down's syndrome.

A diagram showing the chromosomal rearrangement on chromosome 21 that causes Down syndrome.

The American College of Obstetricians and Gynecologists published its first opinion on the tests Nov. 20 and concluded they “should not be part of routine prenatal laboratory assessment.”

However, ACOG said, the tests can be offered to patients at increased risk of having a baby with a trisomy, as long as they are counseled beforehand about the tests’ limitations.

Previously, the National Society of Genetic Counselors and the International Society for Prenatal Diagnosis reached similar conclusions.

Because research has not yet proved that the new tests are as accurate as the standard invasive tests, all three organizations recommend that women with a positive result undergo amniocentesis or chorionic villus sampling to be sure.

“We clearly take ACOG’s opinion into consideration as we evaluate coverage policy,” says Julie Kessel, senior medical director of Cigna’s coverage policy unit.

But, she adds, “it’s not a clear endorsement.”

Cigna typically reviews coverage of technologies annually, unless a “sentinel event,” such as firm new guidelines about their use, suggests the company needs to take another look sooner, Kessel says.

The ACOG opinion is not such an event, she says, so the company likely won’t revisit the blood tests until July.

Aetna spokeswoman Tammy Arnold says her company is awaiting the results of more research into the tests’ accuracy and how testing affects women’s decisions about amniocentesis.

Once studies of patients prove that the tests add value, Arnold says, “cost savings to the health-care system would be a welcomed bonus.”

Women are asking for the tests right now, however. “I don’t think anybody really anticipated that the consumers would drive this as much as they’re doing,” Bianchi says.

For now at least, the companies that market the new tests appear to be eating much of the cost. For example, the most that women with insurance have to pay out of pocket is $235 for the MaterniT21 Plus test (list price $1,900) and $200 for Verifi (list price $1,200), even if their plan declines to cover the test.

Both companies offer self-pay options for women without insurance: The price is $450 to $500 for MaterniT21 Plus and an “introductory price” of $495 for Verifi.

Jeffrey Spencer, Ramona Burton’s OB-GYN at the Anne Arundel Medical Center in Annapolis, says that although questions remain about how best to use the tests, he needs to make his patients aware of them. “It’s so new we’re not sure the best way to do it. I feel I have an ethical obligation to make patients aware of the option.”

(Spencer says he is a member of the speakers’ bureau of Sequenom, which markets the MaterniT21 Plus test, and is paid a fee when he speaks at the company’s request.)

Burton is one of several hundred higher-risk patients in his practice who have opted for MaterniT 21 Plus, Spencer says.

Mark Evans, a Manhattan OB-GYN, says his patients want to skip the standard screening tests and go right to the new tests.

“My patients are the average New Yorkers,” he says, “who want their answers yesterday.”

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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Access to health care – CityClub event Dec. 3rd

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How will health reform affect the ability of people in Washington state to get access health care?

Hear an expert panel address this and other questions about access to health care at the next CityClub 2012 Health Care Series event, December 3rd.

  • How does the Affordable Care Act change the issues of access for the U.S. and for Washingtonians?
  • Who is going to treat the 32 million new patients covered nationally and 1 million new patients covered in Washington?
  • What reforms are needed to make Medicare and Medicaid sustainable for future generations?
  • Why do we have a shortage of general practitioners and nurses?
  • How can insured populations access their full benefits?
  • What are the disparities in access to care among minority and immigrant populations?

Featuring:

  • Teresita Batayola, CEO, International Community Health Services
  • Jane Beyer, Interim Assistant Secretary, Aging and Disability Services Administration, Washington State
  • Department of Social & Health Services
  • Richard Onizuka, CEO, Washington State Health Benefit Exchange
  • Mark Secord, CEO, Neighborcare Health

Moderated by:

  • Joanne Silberner, Contributor, Public Radio, Artist in Residence, University of Washington

 When:

Monday, December 3, 2012

Where:

Westin Seattle | Fifth Avenue Room | 1900 Fifth Avenue

Details:

Doors Open: 11:30 a.m.

Luncheon & Program: Noon – 1:30 p.m.

Luncheon Prices: CityClub Members – $35 | Guests & Co-Promoters – $40 | General Public – $45

Coffee Only Prices: CityClub Members – $12 | Guests & Co-Promoters – $15 | General Public – $18

Register online or call 206.682.7395.

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Some facts about HIV, AIDS and young Americans — CDC

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All youth should know how HIV is transmitted and prevented, understand what puts them at risk for HIV, and be tested if they are at risk, the U.S. Centers for Disease Control and Prevention warns.

Some facts about HIV, AIDS and young Americans

  • About 50,000 people are infected with HIV each year.
  • 1 in 4 is 13 to 24 years old.
  • Youth make up 7% of the more than 1 million people in the US living with HIV.
  • About 12,000 youth were infected with HIV in 2010.
  • The greatest number of infections occurred among gay and bisexual youth.
  • Nearly half of all new infections among youth occur in African American males.

The risk for HIV for most youth begins when they start having sex or start injecting drugs. HIV causes a serious infection that, without treatment, leads to AIDS and early death.

To learn more and find links to additional resources:

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Photo by Michal Zacharzewski

Medicare cracks down on hospital readmissions

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Photo by Michal Zacharzewski

By Jordan Rau
KHN Staff Writer

This story is produced in collaboration with 

After years of gently prodding hospitals to make sure discharged patients do not need to return, the federal government is now using its financial muscle to discourage readmissions.

Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many readmissions.

Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.

One of those is Barnes-Jewish Hospital in St. Louis, which will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”

The crackdown on readmissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing spending, which reached $556 billion this year.

Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.

The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door.

While some readmissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.

The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries.

“I’ve been doing this for over two decades and talking to hospital leaders about readmissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus  who has devised widely adopted methods to reduce hospitalizations. “Now they’re paying attention.”

With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — readmissions cost the government more than $17 billion annually.

Hospitals’ historic reluctance to tackle readmissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return.

Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind up coming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015.

Medicare also is expanding the list of conditions it will assess in setting punishments.

Right now it only evaluates readmissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization.

The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients.

Researchers say that while some readmissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.

Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid readmissions.

“We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”

Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle.

“One day, we’ll look back and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions.

But those patients can skew his hospital’s readmissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be readmitted to the hospital.”

Dr. Lynch said Barnes-Jewish does set up follow-up appointments for patients who did not have their own doctors to see. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to visit patients at home did not significantly reduce readmission rates either, he said.

“Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients. “For us, it’s not a readmissions penalty,” he said. “It’s a mission penalty.”

Various studies, including one commissioned by Medicare, have found that the hospitals with the most poor and African-American patients tended to have higher readmission rates than hospitals with more affluent and Caucasian patients.

But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat.

In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families.

“Just blaming the patients or saying ‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much, much better.”

Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly.

“It should not be our top priority,” said Dr. Ashish Jha,a professor at the Harvard School of Public Health who has studied readmissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.”

With pressure to avert readmissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success.

A few days after Eda Laurion,  was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August, a nurse showed up at her house.

“She helped explained the medicines I’m taking, the side effects, what they do for you,” said Ms. Laurion, 91, of Sun City West.

Still, readmissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an undiagnosed kidney problem.

However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic.

Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations.

Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted.

Dr. Krumholz said hospitals should think of readmissions as a challenge to overcome. “One day, we’ll look back,” he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

Photo courtesy of Michal Zacharzewski

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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Doctor inspects mammogram. Photo by Bill Branson/NCI

With routine mammograms, some breast cancers may be overtreated – article and video

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Doctor inspects mammogram. Photo by Bill Branson/NCI

By Richard Knox, NPR News
This story comes from KHN partner NPR‘s Shots blog.

The endless debate over routine mammograms is getting another kick from an analysis that sharply questions whether the test really does what it’s supposed to.

Dr. H. Gilbert Welch, coauthor of the analysis of mammography’s impact, which was just published in the New England Journal of Medicine, tell Shots that the aim was to “get down to a very basic question.”

Welch explains his study in this video:

That is, do annual mammograms among women over 40 discover early-stage breast cancers that can be treated so that they never become deadlier late-stage tumors?

Welch, of Dartmouth Medical School, and coauthor Dr. Archie Bleyer of the Oregon Health and Science University, analyzed 30 years of data on breast cancer incidence.

Over the last three decades, diagnoses of early-stage breast cancers soared, largely due to routine mammogram screening. But the incidence of late-stage cancers declined only slightly. That leads some to question whether mammograms are really doing what they’re supposed to — catching early cancers before they progress.

“And what we see is a dramatic increase — a doubling — in the amount of early-stage cancer,” Welch says. “But we don’t see a corresponding decrease in the amount of late-stage cancer.”

They say this means mammography isn’t catching many advanced breast cancers — even though it’s very good at catching early tumors.

Too good, perhaps. The duo says many of the early tumors revealed by mammography don’t need to be treated at all. Doctors call that “over-diagnosis.”

Welch says more than a million women have been over-diagnosed with breast cancer over the past 30 years. And the problem continues.

“Seventy thousand women a year are over-diagnosed and treated unnecessarily for breast cancer,” Welch says.

This all may come as a shock to many women — and their doctors. No other diagnostic test has been more aggressively promoted than mammography — or, lately, been so controversial, with the possible exception of PSA tests for prostate cancer.

“Whenever I see a paper like this, I say, ‘Oh, boy, here we go again!'” says Dr.Carol Lee, a breast imaging specialist at Memorial Sloan-Kettering Cancer Center in New York City.

Lee is on the communications committee of the American College of Radiology, whose members often do mammograms. The group, in a statement, says the new analysis “is simply wrong.”

The ACR statement’s main criticism is that Welch and Bleyer don’t account for what the radiologists say was a steady increase in the incidence of invasive breast cancer. They say that can explain why mammography didn’t lower the incidence of advanced breast cancer more.

Welch rejects that claim. “Why was breast cancer incidence so stable in the late ’70s, only to shoot up in the 1980s – the very time mammography was introduced?” he writes in an email. “Why didn’t incidence rise dramatically in women under 40 — those not exposed to screening?”

Welch is no newcomer to debates over the benefits and harms of diagnostic screening tests. In fact, he’s a well-known iconoclast, who last year published the popular book Overdiagnosed: Making People Sick in the Pursuit of Health.

Earlier this year, LocalHealthGuide ran an article about Welch’s book “Overdiagnosed: Making People Sick in the Pursuit of Health,” with he wrote with Dartmouth researchers and physicians Lisa Schwartz and Steven Woloshin.The book argues that the medical establishment’s embrace of early diagnosis and treatment as the key to keeping people healthy actually does the opposite. To read the article go here.

“He has a preexisting bias, just as those of us in the breast imaging community have a preexisting bias,” Lee says. “The truth probably lies somewhere in between.”

Still, Lee finds it hard to believe that 70,000 women a year are diagnosed with breast cancer that would not have progressed. And she says the debate isn’t very helpful to most women.

“What my friends in Connecticut want to know is, ‘Should I have a screening mammogram?’ And … this kind of study sometimes raises more questions than it answers,” Lee says.

San Francisco breast surgeon Laura Esserman agrees that women are tortured by these endless debates. But she sees a way out of the dilemma.

“Our concept of cancer has got to change,” she tells Shots. “We now recognize that there isn’t just one pathway — it’s not cancer, yes or no.” And doctors know now that cancer doesn’t always lead to death.

Esserman thinks mammography screening should be done more selectively. Women at lower risk of breast cancer — because they don’t have close relatives who’ve had it or have a genetic predisposition for it — may not need to be screened so often.

Second, she says women and their doctors have to get out of the mind-set that any breast cancer should be treated maximally. For instance, doctors now routinely deploy surgery, hormones and radiation to treat a condition called ductal carcinoma in situ, or DCIS.

“We can watch a lot of those things and most of them turn out to be just fine,” she says.

But this is a long way from how either mammography or breast cancer treatment is practiced right now.

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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The “best” hospital may not be the best place to learn how to be a doctor – study

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By Jenny Gold
KHN

Attention medical students: When selecting your residency program, there’s more than just geography and the hospital’s reputation to consider.

The nation’s 23 top academic medical centers also vary drastically in what researchers are calling “the intensity” of care they provide patients at the end of life, according to a new report from the Dartmouth Atlas Project.

And more intense care can translate into worse and more expensive care at the end of life, according to the authors.

The thinking is that physicians who train at hospitals with better and more efficient care will be better-prepared to become leaders in changing how health care is delivered in this country.

The authors call this phenomenon the “hidden training curriculum.”

“Learning how to use health care resources wisely, provide high-quality care, and incorporate patient preferences into a care plan is just as important as learning to work up a patient,” said Alicia True, report co-author and medical student at the Geisel School of Medicine at Dartmouth.

The report tracks variations in end of life care and chronic illness management, surgical procedures, and quality and patient experience using data from Medicare and published on the Hospital Compare website.

“Learning how to use health care resources wisely, provide high-quality care, and incorporate patient preferences into a care plan is just as important as learning to work up a patient.”

Take Johns Hopkins Hospital and Mount Sinai Medical Center, for example. They are both prestigious, but around 50 percent of patients at Johns Hopkins were enrolled in hospice in their last six months of life, compared to only 23 percent at Mount Sinai.

Residents at Mount Sinai “may therefore learn a higher threshold for referral of a patient to hospice or may decide to explore more aggressive treatment approaches first,” according to the report, while Hopkins residents “may be better trained in having discussions with patients about their preferences for end-of-life care.”

Patient safety training also varies widely. A patient at NYU Langone Medical Center is 47 times less likely to get an infection from a urinary catheter than a patient at the University of Michigan Health System.

“Medical students should be aware of the practice styles of residency programs they are considering ranking highly in the Residency Match,” report co-author True added.

The report, “What Kind of Physician Will You Be,” is intended as a guide for fourth-year medical students to help them select hospitals with the best practice patterns for training.

The selection is particularly important “for tomorrow’s doctors in order to practice successfully in the new environment created by health care reform,” the authors write.

“These variations in the way care is delivered are not trivial, as they may very well affect the future practice of medicine. During their residency training, young physicians learn by observing faculty, making decisions on how aggressively to treat chronically ill patients at the end of life, and whether to recommend surgery when other treatment options exist,” added Dr. John R. Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, which funds the Dartmouth Atlas Project.

The Dartmouth Atlas has been researching disparities in care using Medicare data to analyze trends about regional and local markets, but this is the first time they have applied the findings to residency training.

Dartmouth is working to get the word out to student medical groups and publications in the hopes that the report will help medical students make informed decisions when selecting their residency program.

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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Online access to docs increases office visits, study finds

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Illustration by Riseli53

This story is part of a reporting partnership that includes Colorado Public RadioNPR and Kaiser Health News.

Uncle Sam wants you to email your doctor. A federal law passed in 2009 says that physicians have to start offering their patients online communication, or Medicare will start docking how much it pays them in the future.

Some patients hope that having online access to their doctors will mean they can cut down on how often they have to go to the doctor’s office.

But new research suggests that patients with online access actually schedule more office visits.

Dr. Ted Palen is an internist at Kaiser Permanente Colorado in Denver. He says it’s pretty common for him to see a patient in his office, and then think, “you know, we could’ve handled this by e-mail.” (Kaiser Health News is not affiliated with Kaiser Permanente.)

Palen, who’s also a researcher, wanted to see if offering patients online access to their doctors would mean they’d need to come in to the office less often. Previous studies found around a 20 percent drop in patient visits once they had online access.

But Palen’s much larger study, just published in the Journal of the American Medical Association, showed that patients with online access actually scheduled more visits.

An estimated 70 million Americans now have some degree of online access to their doctors.

“The finding really did surprise us, this association between online access and an increase in in-person services,” Palen says.

Why the increase? Palen says that it could be that patients who signed up for online access were sicker than those who didn’t, although his study tried to control for that. It could be that doctors who aren’t used to an online give-and-take with patients asked them to come in more often to clear things up.

Or it could be that the new online relationship between doctors and patients means that, together, they’re catching important health indicators that were getting missed in the past, and patients are getting better care.

“In certain cases, with certain diseases, the more frequent visits actually make more sense,” says Judy Murphy, an information technology coordinator at the Department of Health and Human Services, the federal agency that’s requiring doctors to start offering patients online access.

Murphy says that for some, online access to doctors will mean fewer visits, for others, it’ll mean more. It depends on the patient.

And the government’s intent in requiring doctors to offer online access, Murphy says, isn’t to drive the overall number of office visits up or down, but to improve the relationship between doctors and patients by improving communication.

“We have all sorts of individuals right now who actually think their health conditions are the doctor’s problems and not theirs,” Murphy says. “And I think that’s what we’re really trying to focus on, helping the patient see that when they get engaged in their care, and when they become part of the therapy plan, that they can actually have better outcomes.”

There’s no definitive research linking more online access to doctors to better patient outcomes. But many doctors are optimistic.

“It’s a new form of medical care that offers the promise to be able to improve care,” says Dr. Jeff Cain, president of the American Academy of Family Physicians.

Cain says doctors and patients are both still learning what they can accomplish online together, and whether that means more or fewer office visits.

The answer is important both for planning future health system capacity, and because most doctors still get paid based on the number of office visits, not for answering emails.

“This is something that our current health care system doesn’t pay for, so it’s coming out of my spare time,” Cain says.

An estimated 70 million Americans now have some degree of online access to their doctors, a number that’s expected to grow rapidly in the next few years. Whether that means more overtime for doctors, or better health care, or both, is a topic for future studies.

Illustration courtesy of Rizeli53

This story is part of a reporting partnership that includes Colorado Public Radio, NPR and 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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Administration releases new health law rules for insurers, employers

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By Julie ApplebyJay Hancock and Mary Agnes Carey
KHN Staff Writers

Long-awaited details on how insurers can structure health benefits and premiums for policies that will cover tens of millions of Americans starting in 2014 were released by the Obama administration Tuesday.

The three proposed rules reaffirm key elements of the 2010 federal health law, including its requirement that insurers accept all applicants, even those with health conditions, and not charge higher rates based on health, gender or occupation.

But the proposals add additional details on how premiums can vary based on age and tobacco use, including allowing tobacco users who enroll in programs aimed at helping them quit to be exempted from extra premium costs set out in the law.

While insurers and consumer groups were cautious about issuing an immediate assessment of the proposals, a quick review showed that no one group won everything it wanted.

For example, insurers did not succeed in getting the government to phase-in a requirement that limits their ability to charge older applicants more than younger ones.

And consumer groups, which wanted specific details on the benefits required in 10 broad categories, instead saw continued discretion given to state regulators to pick “benchmark” plans and benefits.

“It looks like the Obama administration is continuing to be pragmatic in their approach to the regulations,” said Robert Laszewski, a consultant and former health insurance executive.

Insurers, consumer groups and the public have 30 days to weigh in with comments on two of the proposed rules and will have until Jan. 25 for the third, which outlines how employers can structure wellness programs that offer discounts to workers who participate.

Based on documents posted on HealthCare.gov, here’s a quick look at the new regulations:

The benefits are required to cover 10 categories, among them emergency services, hospitalization and pediatric services, including oral and vision care

.Essential Health Benefits

Insurance plans sold to individuals who buy their own coverage and to employers – except those that self-insure —  must include a core package of items and services known as “essential health benefits.”

The benefits are required to cover 10 categories, among them emergency services, hospitalization and pediatric services, including oral and vision care.

The proposed rules reaffirm earlier directions from the administration that states can choose the exact package of benefits that insurers must provide, based largely on what is already offered in the most popular plans currently sold in their states.

Insurers and state regulators wanted states to have that leeway, but consumer groups wanted more prescriptive details.

“Ultimately, the goal is to establish a clear package of essential benefits,” said Stephen Finan, senior director of policy American Cancer Society/Cancer Action Network. “Patients should have same set of evidence-based benefits no matter  where they live.”

But his group and other consumer advocates are cautiously optimistic about one of the changes in the proposed rules, a move that may expand earlier guidance from the administration on prescription drug coverage.

That information, released in a bulletin last December, would have set a minimum standard of only one drug per category in a policy’s “formulary.”

The consumer groups feared such a rule would have led to only one type of drug being covered for large categories of problems, such as depression or asthma or cancer.

The new proposed rule says that the minimum standard should be the number of drugs per category in the state’s chosen benchmark plan or one drug, whichever is greater.

Most of the plans being chosen as benchmarks by the states cover more than one drug per category, so the proposed rule sets “a significantly higher standard” that insurers will have to meet, said Caroline Pearson, a director at Avalere Health, a consulting group in Washington.

“It really ensures robust coverage, but you will have state-to-state variation,” Pearson said.

Premiums And Other Cost Issues

Insurers can vary their rates based on age, tobacco use and where an applicant lives, but they cannot charge sick people higher rates than the healthy or charge women more than men.

The proposed rules say that insurers can charge tobacco users 50 percent more than non-users, but offers an exemption to those who try to quit.

They also offer more definition of how insurers can increase rates as a person ages. The health law says older people cannot be charged more than three times what younger people are charged.

In most states, this could result in lower rates for older residents than under current practices but higher rates for younger people.

The new rules say premium rates cannot vary by age for individuals under age 21.

But, above that age, insurers could charge slightly more for each birthday until a person hits age 63. Everyone over 63 would pay the same rate. The proposal differs from the most common way insurers now set such “age bands,” which are generally in five or 10-year increments.

Karen Ignagni, the head of the industry’s trade group, said the proposed rules need to insure that health coverage remains affordable.

While welcoming the state flexibility, she said, “We remain concerned that many families and small businesses will be required to purchase coverage that is more costly than they have today.  It also is important to recognize that the new EHB requirements will coincide with the new restrictions in age rating rules that also go into effect on January 1, 2014.  Both of these provisions may incentivize young, healthy people to wait to purchase insurance until they are sick or injured, driving up costs for everyone with insurance.”

The proposal also gives more flexibility to states and insurers to vary annual deductibles, co-pays and other elements of the policies — so long as the policies’ overall coverage meets a requirement known as minimum actuarial value, or the average percentage the plan pays toward a typical consumer’s estimated annual medical costs.

Employers will be able to provide discounts on health insurance to workers who achieve certain medical or fitness goals, including such things as weight, cholesterol level or blood pressure.

Wellness Programs

The health law allows employers to provide discounts on health insurance to workers who achieve certain medical or fitness goals, including such things as weight, cholesterol level or blood pressure.

The proposed rule raises the maximum permissible reward, discount or penalty from 20 percent to 30 percent of the cost of the health coverage, and further increases the maximum reward to 50 percent for programs to reduce tobacco use.

But the proposed rules also say  the programs must offer alternatives for employees whose health conditions  make it “unreasonably difficult” or for whom “it is medically inadvisable” to meet the specified health-related standard.

In addition, the discounts or other rewards must be available to workers annually.

While Tuesday’s announcement was significant, the administration still has yet to issue regulations on other parts of the health law. Those areas include how new taxes on premiums and medical devices will work, and how the federal government will set up insurance markets in states that refuse to do it on their own.

The administration also has to determine how to handle the Supreme Court’s decision that states can opt out of the expanded Medicaid program created by the law, and how the government will allot a reduced amount of money targeted for hospitals that care for uninsured people. Also outstanding is a final rule on how birth-control coverage will be provided to employees of religious universities and hospitals that object to it.

Staff writers Jordan Rau and Phil Galewitz contributed to this article.

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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Managing diabetes – Tips from the CDC

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From the U.S. Centers for Disease Control and Prevention

Unless we make changes in how we live and eat, forty years from now we may have two or three times as many people with diabetes as we do now.

That means somewhere between one out of three and one out of five adults would have diabetes.

Right now, about one out of nine adults has diabetes.

Diabetes is a serious disease that affects almost every part of your body and can shorten your life. Some complications you can get because of diabetes are kidney disease, heart disease, stroke, eye disease, and having to have a leg or foot amputated.

If you already have diabetes, you can still do a lot to keep from getting complications from diabetes.

Here are some important steps you can take to control diabetes:

  • Talk to your doctor about how to manage your blood sugar level, your blood pressure, and your cholesterol levels.
  • Stop or don’t start smoking or using any kind of tobacco.
  • Do what you can to keep from getting sick. If you have diabetes, you are more likely to get sick and you may get sicker than a person without diabetes. Also, when you’re sick, it’s hard to keep your blood sugar under control. Here are some things you can do to improve your chances of staying well. Click here.
  • Get a flu shot. A person with diabetes is more likely to get really sick or even die from pneumonia or the flu (influenza) than a person who doesn’t have diabetes. If you or someone in your family has type 1 or type 2 diabetes, it is very important to get a flu shot. Make sure you ask for the flu shot—not the nose spray, which doesn’t help as much. CDC recommends that every person six months old and older get a flu shot. Also, ask your doctor if you should get a pneumonia shot. The shot is not appropriate for everyone.
  • Don’t ever use someone else’s insulin pen or any other device that draws blood. You can get a virus from the other person if you do. Click here to visit the One and Only Campaign website. It has more information on being safe and also has buttons and badges you can share with friends.
  • Stay at a weight that’s healthy for you.
  • Make sure you are physically active. Physical activity can help you control your weight, blood sugar, and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol.
  • Do something like walking quickly, gardening, dancing, jogging, or jumping rope at least 150 minutes a week to get yourself moving.
  • At least two days a week, also do other kinds of activity to make your muscles stronger.

Things to Do to Help Keep Yourself from Getting Type 2 Diabetes

If you have prediabetes, there’s good chance you will have type 2 diabetes within three to six years. A person with prediabetes has a blood sugar level that is higher than normal, but not high enough to be diagnosed as diabetes.

CDC estimates that 79 million people in the United States—one out of three adults—has prediabetes.

There is hope, though. If you have prediabetes, research shows that you can slow down or keep from getting type 2 diabetes by losing weight and becoming active. For example, a person who weighs 200 pounds needs to lose about 10 to 14 pounds. (If you weigh more than that, you need to lose more weight. If you weigh less, you need to lose less weight.)

You also need to become physically active for at least 150 minutes per week. Just doing these things can slow down or keep you from getting type 2 diabetes by nearly 60%.

You don’t have to make these changes on your own, you can get help (free written and electronic resources) through the National Diabetes Education Program, which is led by CDC and the National Institutes of Health. Also, CDC leads the National Diabetes Prevention Program.

To find a class in your area click here.

Free! Tools to Educate and Help Yourself

More Information

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Turkey Time: Holiday food preparation tips from the CDC.

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Food safety tips from the U.S. Centers for Disease Control and Prevention

Holidays are times we share the kitchen with family and friends. Make it a goal this year to also share good food safety practices. CDC is a partner with the United States Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS), which is responsible for the safety of meat and poultry.

Here are simple tips that all cooks in the kitchen can follow this holiday season for cooking a delicious and safely prepared turkey.

Uncooked turkey in a pot

Turkey Basics: Safely Thaw, Prepare, Stuff, and Cook

When preparing a turkey, be aware of the four main safety issues: thawing, preparing, stuffing, and cooking to adequate temperature.

Safe Thawing

Food Thermometer Truths

  • Always use a food thermometer to guarantee that foods are cooked to a safe-to-eat temperature.
  • Some food thermometers must be calibrated to ensure that they read food temperature accurately. Find out if your thermometer can be calibrated by reading the USDA fact sheet on kitchen thermometers.
  1. Fill a pot of water with distilled water and bring to a rolling boil.
  1. Hold the thermometer probe in the boiling water for one minute. Do not let the probe touch the pot.
  1. After one minute, the thermometer should read between 210° and 214° F. If it does not read between these temperatures adjust the thermometer manually to 212° F. If the thermometer cannot be adjusted manually do not use it until it is serviced by a professional.

Thawing turkeys must be kept at a safe temperature. The “danger zone” is between 40 and 140°F — the temperature range where foodborne bacteria multiply rapidly.

While frozen, a turkey is safe indefinitely, but as soon as it begins to thaw, bacteria that may have been present before freezing can begin to grow again, if it is in the “danger zone.”

There are three safe ways to thaw food: in the refrigerator, in cold water, and in a microwave oven. For instructions, see “Safe Methods for Thawing;” instructions are also available in Spanish.

Safe Preparation

Bacteria present on raw poultry can contaminate your hands, utensils, and work surfaces as you prepare the turkey.

If these areas are not cleaned thoroughly before working with other foods, bacteria from the raw poultry can then be transferred to other foods.

After working with raw poultry, always wash your hands, utensils, and work surfaces before they touch other foods.

Safe Stuffing

For optimal safety and uniform doneness, cook the stuffing outside the turkey in a casserole dish. However, if you place stuffing inside the turkey, do so just before cooking, and use a food thermometer.

Make sure the center of the stuffing reaches a safe minimum internal temperature of 165°F.

Bacteria can survive in stuffing that has not reached 165°F, possibly resulting in foodborne illness.

Follow the FSIS’ steps to safely prepare, cook, remove, and refrigerate stuffingSpanish language instructions are available.

Safe Cooking

Set the oven temperature no lower than 325°F and be sure the turkey is completely thawed. Place turkey breast-side up on a flat wire rack in a shallow roasting pan 2 to 2-1/2 inches deep.

Check the internal temperature at the center of the stuffing and meaty portion of the breast, thigh, and wing joint using a food thermometer. Cooking times will vary.

The food thermometer must reach a safe minimum internal temperature of 165°F. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat.

For more information on safe internal temperatures, visit FoodSafety.gov’s Safe Minimum Cooking Temperatures.

Following these cooking guidelines can help you prepare
a safe holiday dinner that everyone will enjoy.

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