Medicare slow to adopt telemedicine due to cost concerns

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telemedicine-5701By Phil Galewitz
KHN

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it.

So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare. Continue reading

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A new focus on family caregivers

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A younger man holds an elderly man's handBy Susan Milligan
Stateline

Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged.

His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely.  A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg.

“They’re sending you home, and you’re thinking, ‘What?’ Nobody instructs you, and says, ‘This is what’s coming home with you and how to use it,’” she said.

The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient.

As many as 42 million Americans take care of a family member at any given time.

Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia and West Virginia) have approved similar laws. In Illinois and New York, legislation is awaiting the governor’s signature.

As many as 42 million Americans take care of a family member at any given time. Traditionally, family caregivers provide assistance with bathing, dressing and eating. They shop for groceries and manage finances.

But as the number of elderly Americans with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes or by home care professionals.

In an AARP survey released in 2012, nearly half of family caregivers said they administered multiple medications, cared for wounds, prepared food for special diets, used monitors or operated specialized medical equipment. Continue reading

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For doctors who take a break from practice, coming back can be tough

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Family practitioner Kate Gibson checks 4-year-old Ashley del Torro’s throat for an infection at the Eisner Pediatric Medical Center in Los Angeles, California, on Friday, June 5, 2015. Gibson completed a re-entry program in order to return to practice medicine after a 10-year break to raise her four children (Photo by Heidi de Marco/KHN)

Family practitioner Kate Gibson checks 4-year-old Ashley del Torro’s throat for an infection at the Eisner Pediatric Medical Center in Los Angeles, California, on Friday, June 5, 2015. Gibson completed a re-entry program in order to return to practice medicine after a 10-year break to raise her four children (Photo by Heidi de Marco/KHN)

By Anna Gorman
KHN

After taking a 10-year break from practicing medicine to raise four sons, Kate Gibson was ready to go back to work.

The family practitioner had been reading about a shortage of primary care doctors and knew she could help. But when Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members or to recover from their own illnesses. Some want to return from retirement or switch from non-clinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Molly Carey, 36, an Ivy-League educated doctor who recently enrolled in a Texas retraining program after four years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is a clearly a dearth of those kind of training programs.”

Policymakers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors. Continue reading

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19 million would become uninsured if health law repealed – CBO

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By Phil Galewitz
KHN

Repealing the federal health law would add an additional 19 million to the ranks of the uninsured in 2016 and increase the federal deficit over the next decade, the Congressional Budget Office said Friday.

cbo repeal 600

The report is the first time CBO has analyzed the costs of the health law using a format favored by congressional Republicans that factors in the effects on the overall economy. It is also the agency’s first analysis on the law under Keith Hall, the new CBO director appointed by Republicans earlier this year.

CBO projected that a repeal would increase the federal deficit by $353 billion over 10 years because of higher direct federal spending on health programs such as Medicare and lower revenues. But when including the broader effects of a repeal on the economy, including slightly higher employment, it estimated that the federal deficit would increase by $137 billion instead.

Both estimates are higher than in 2012, the last time that the CBO scored the cost of a repeal. Continue reading

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NCI funds $3.1M Fred Hutch trial of a smoking-cessation app

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Screen Shot 2015-06-19 at 11.35.43 AMDr. Jonathan Bricker, a behavioral scientist at Fred Hutchinson Cancer Research Center and the University of Washington, has received a $3.1 million, five-year grant from the National Cancer Institute to conduct a randomized, controlled clinical trial of SmartQuit, a smoking-cessation smartphone app.

The new trial follows on the heels of a pilot randomized trial of SmartQuit he conducted in collaboration with UW and 2Morrow Mobile – the first randomized, controlled trial comparing the effectiveness of smoking-cessation programs delivered via mobile apps.

Bricker studies acceptance and commitment therapy, or ACT, to help people quit smoking and other unhealthy behaviors. Unlike traditional quit-smoking approaches, which focus on willpower and avoiding one’s urges to smoke, ACT focuses on increasing one’s willingness to accept the physical, mental and emotional challenges of quitting while also encouraging commitment to engage in values-based behavior change. For more about ACT, see his TEDxRainier talk.

 

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How the CDC responds to outbreaks

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An outbreak of the Ebola virus hits in western Uganda and caused dozens of illnesses or deaths. In this video, a team of investigators from the CDC Special Pathogens Branch travels to Uganda. They work to bring the outbreak under control and learn more about the reservoir hosts for the Ebola and Marburg viruses.

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Most say drug costs ‘unreasonable’

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Most Americans Say Drug Costs Are ‘Unreasonable,’ Although They Can Still Afford To Buy Them

By Phil Galewitz
KHN

Nearly three in four Americans say the costs of prescription drugs are “unreasonable” — and most blame drugmakers for those prices, according to a poll released Tuesday.

The survey by the Kaiser Family Foundation found 74 percent of those taking prescription drugs find the costs unreasonable, as do 72 percent of those not taking such drugs. (KHN is an editorially independent program of the foundation.)

The poll builds on the results of an earlier Kaiser survey in April that identified high drug costs as the public’s top health care priority for Congress and the president.

Drug costs have gained attention in the past year in part as a result of controversies surrounding Sovaldi and other new hepatitis C drugs, which can cure most cases of the deadly liver disease but at a price of $84,000 for a 12-week treatment.

The high cost has strained Medicaid and Medicare budgets and left private insurers scrambling.

Half the public say they take prescription drugs. More than three quarters of those say they are easy to afford, with only one in five saying they have difficulty paying for them. Continue reading

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Half of athletes at top of game after repeat knee surgery | Reuters

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MRI of the knee

Credit: Wikipedia – Creative Commons License

Researchers examined data on athletes who had one surgery to repair the anterior cruciate ligament (ACL), the connective tissue in the knee that keeps the shin bone from sliding in front of the thigh bone, and then a second procedure to revise the surgery or address a new injury.

After an average of about five years, 84 percent of the athletes still played sports, but only half of them returned to high-level competition, the analysis found.

Source: Half of athletes at top of game after repeat knee surgery | Reuters

 

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Medicare coverage could be even more useful at age 50 | Reuters

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cms-logo-200pxAmericans are living longer, so why not lower the eligibility age for Medicare?

That prescription might sound upside down: rising longevity often is used as an argument for delaying Medicare eligibility past age 65.

However, one of the country’s top experts on geriatric medicine actually thinks Medicare should start covering preventive healthcare when we turn 50.

Source: Medicare coverage could be even more useful at age 50 | Reuters

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Online human breast milk craze has serious health risks: experts | Reuters

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Alert Icon with Exclamation Point!A growing online craze among some fitness communities, fetishists and chronic disease sufferers for buying and drinking human breast milk poses serious health risks, British experts said on Thursday.

Writing in the Journal of the Royal Society of Medicine, specialists said there was little evidence to support claims that the milk – traded via websites in a lucrative market for adult buyers – is some kind of super food that can boost health and fitness and ward off disease.

Claims that it even helps with erectile dysfunction and cancer have no clinical basis, they said.

On the contrary, the experts warned, raw and unpasteurized human breast milk bought online can expose consumers to many serious infectious diseases, including hepatitis, HIV and syphilis.

Source: Online human breast milk craze has serious health risks: experts | Reuters

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US to pay for Agent Orange claims – AP

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veteran-affairs-seal-vaEnding years of wait, the government agreed Thursday to provide millions of dollars in disability benefits to as many as 2,100 Air Force reservists and active-duty forces exposed to Agent Orange residue on airplanes used in the Vietnam War.

The expected cost over 10 years is $47.5 million, with separate health care coverage adding to the price tag.

Source: News from The Associated Press

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Don’t assume your employer’s plan covers care you need

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Sign for an emergency room.By Jay Hancock
KHN

Marlene Allen thought she had decent medical coverage after she fell in December and broke her wrist. She had come in from walking the dogs. It was wet. The fracture needed surgery and screws and a plate.

Weeks later, she learned her employer health plan would cover nothing. Not the initial doctor visit, not the outpatient surgery, not the anesthesiology. She had $19,000 in bills.

Allen’s employer plan covered only vaccines, blood-pressure tests and other preventive care.

“Make sure you find out what kind of plan it is” when employers offer coverage, advises Allen, who lives in northern Minnesota. “I thought health insurance was health insurance.”

A complex health law and bad information helped cause the trouble.

When her employer offered the health plan late last summer she thought she had to sign up.

That was wrong.

Once she was on the employer plan, she thought she had to drop better, comprehensive coverage she had bought through MNsure, the state’s online insurance marketplace.

That was wrong.

After she learned that her work plan covered hardly anything and tried to get back on a marketplace policy, MNsure told her she’s not eligible for subsidies to buy it. Wrong again.

“Horrible situation,” said Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms. It “does make you wonder about the training these call-center folks are getting.” Continue reading

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Connecting released inmates to health care

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9638276289_550f033bb8_nBy Michael Ollove
Stateline

Joe Calderon faced uncomfortably high odds of dying after his release from a California prison in 2010.

According to one study, his chances of dying within two weeks — especially from a drug overdose, heart disease, homicide or suicide — were nearly 13 times greater than for a person who had never been incarcerated.

Despite suffering from hypertension during his 17 years and three days of incarceration, Calderon was lucky. He stumbled onto a city of San Francisco program that paid for health services for ex-offenders, and he was directed to Transitions Clinic, which provides comprehensive primary care for former prisoners with chronic illnesses. The clinic saw to all his health needs in the months after his release.

An increasing number of states are striving to connect released prisoners like Calderon to health care programs on the outside. Frequently, that means enrolling them in Medicaid and scheduling appointments for medical services before they are released.

Some state programs — in Massachusetts and Connecticut, for example — provide help to all outgoing prisoners. Programs in some other states are more targeted. Those in Rhode Island and New York, for instance, focus on ex-offenders with HIV or AIDS.

Elsewhere, probation and parole are being used to encourage ex-offenders to adhere to certain treatments. Utah, for example, passed a measure this year that cuts probation time for former prisoners if they get treatment for mental illness or substance abuse.

The goal of these programs isn’t just to address the health needs of a notoriously unhealthy population, but to improve the likelihood they will succeed in society.

“We want to support them as much as possible to make sure they are productive and do not return to prison,” said Dr. Shira Shavit, executive director of Transitions. Continue reading

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