More health plan choices at work. What’s the catch?


Steve Heller has worked for Minnesota’s John Henry Foster company for 15 years. He says he likes the greater choice of health plans he now has because of the private exchange. (Photo by Mark Zdechlik/MPR)

By Mark Zdechlik, Minnesota Public Radio

Until recently, John Henry Foster, an equipment distribution firm based in Eagan, Minn., offered its employees only a couple of health plans to choose from. That’s common in companies across America.

“They just presented what we got,” says Steve Heller, a forklift operator who has worked at John Henry Foster for 15 years.

But these days the company’s employees have dozens of choices. And something else is new: Each worker now receives money from the company (from $350 to $1,000 a month, depending on whether Heller and his co-workers are buying insurance for a single person, a couple or a family) to buy a health plan.

Employees are then directed to an online exchange — a private, secure website that offers the selection of plans for side-by-side comparison. Workers can choose high-deductible plans with relatively low monthly premiums or they can pay more each month to have more of their care and medications covered.

Just as before, the company determines the insurance companies listed, and the scope of the treatments and procedures covered by each plan.

Three years after the switch, Heller says he’s happy with his insurance and the exchange. The company’s managers are happy with it, too. Continue reading


You may still qualify to sign up for health insurance


Life change? You may be able to qualify for 2015 coverage.

You may qualify for a Special Enrollment Period

Thinking about moving, getting married, having a baby, or changing jobs?

When you make big decisions in life, you may be eligible to buy or change Health Insurance Marketplace coverage outside the yearly Open Enrollment Period.

If you’ve had a qualifying major life event, you have 60 days from the life event to enroll in coverage. You can apply or change plans online or by phone.

See if you qualify for a Special Enrollment Period. 


Surprise! That urgent care center may send you a big bill (just like the ER)


Sign for an emergency room.By Julie Appleby

Sallyann Johnson considers herself a pretty savvy health care consumer. When she fell and injured her hands and wrists, she didn’t head for an expensive emergency room, choosing an urgent care clinic near her Milwaukee home instead.

Before seeking treatment, she asked the key question: Did the center accept her insurance? Yes, Johnson was assured, both on the phone and then again when she arrived at the clinic.

After X-rays and a visit with a physician assistant, Johnson learned her wrists were sprained, but weeks later, it was her wallet that sustained the most damage.

“I received a bill from a doctor for $356,” said Johnson, 62. “I felt I asked all the right questions. I even re-asked the questions.”

Long seen as a lower-cost alternative to hospital emergency rooms for minor illnesses or injuries, urgent care centers are increasingly popular with consumers – and their insurers.

But like doctors and hospital ERs, urgent care can also present payment headaches if they are not part of a patient’s insurance network. And consumers may need to ask specifically about network participation to find out. Continue reading


Restaurant food not much healthier than fast food | Reuters


burger-and-friesHome cooking is still the best way to control the calories, fat, sugar and other nutrients that families consume, a new U.S. study suggests.

Researchers found that eating food from restaurants – whether from fast food places, or better establishments – led to increases in calories, fat and sodium compared to meals made at home.

Public health interventions targeting dining-out behavior in general, rather than just fast food, may be warranted to improve the way Americans’ eat, says the study’s author.

Source: Restaurant food not much healthier than fast food | Reuters


Health Care Access Improves With Expansion of ‘Obamacare': CDC: MedlinePlus


ACA health reform logoWhile more Americans have health insurance following the expansion of the Affordable Care Act, Hispanic adults have realized some of the biggest gains in access to medical care, a new government report shows.

Approximately 34 percent of Hispanic adults were uninsured in 2014, compared with 41 percent in 2013, according to the U.S. Centers for Disease Control and Prevention report, which was released Wednesday.

Source: Health Care Access Improves With Expansion of ‘Obamacare': CDC: MedlinePlus


Report: ACA plans have a third fewer providers than employer-based plans – The Washington Post


Blue doctorConsumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage, according to an analysis released Wednesday.

The study by consulting firm Avalere Health provides a statistical basis for anecdotal reports from consumers and others about the more limited doctor and hospital choices in plans offered on marketplaces created by the Affordable Care Act. In these “narrow networks,” health plans negotiate contracts with a select number of providers who agree to be reimbursed at lower rates.

That means the insurers can set their premiums lower, at least theoretically. But, depending on the plan’s design, consumers typically pay more, and sometimes much more, if they use a doctor or hospital outside the network.

Source: Report: ACA plans have a third fewer providers than employer-based plans – The Washington Post


Time for those back-to-school shots


Immunization update time for kids is now — beat the back-to-school rush

Boy gets shot vaccine injectionFrom the Washington State Department of Health

While kids across Washington are squeezing every ounce of fun out of summer, many parents are already looking forward to the beginning of the school year and planning for all that must be done before the first day of school.

Now is the time to get kids in to see their health care providers for required immunizations, yearly well-child checks, and sports physicals. Families can cut down on back-to-school stress by getting the right immunizations for their students well before school starts. Students who aren’t in compliance with required vaccines may be kept out of school if a disease epidemic occurs.

Parents can find the immunization requirements to start school and attend child care online. There are new changes to the requirements this year for the chicken pox vaccine. It’s also important that kids are current on their whooping cough shots. The disease is spreading in Washington and everyone can play a part in stopping it. Continue reading


A surgeon with a history of complications, a felony past



Toumbis' booking photo and an excerpt from the police report.

Toumbis’ booking photo and an excerpt from the police report.

by Marshall Allen and Olga Pierce

Officer Richard Walter looked out the window of his patrol car and saw two young men trading punches outside Sutter’s Saloon.

It was 2 a.m. on what should have been a forgettable night shift in 1989. Sutter’s was near the State University of New York at Buffalo 2013 a student hangout, not a rough dive. Walter, now a seasoned detective, still can’t shake the bizarre and bloody memory of that night.

The men didn’t notice the cop pull into the parking lot. Walter grabbed his baton and approached, then saw a glint of metal. One of the men held a knife, the blade protruding three inches from his clenched fist.

Instantly a geyser of blood spurted from the unarmed man’s neck onto Walter’s uniform 2013 10 feet away. The man collapsed, his neck slashed open “from his ear to his Adam’s apple,” Walter said, recalling what he wrote in the police report. Blood pulsed onto the pavement from his severed carotid artery and jugular vein.

Walter drew his gun and pointed it. The attacker dropped the knife and clasped his hands around his victim’s gashed neck to stanch the bleeding.

“I’m a medical student,” the attacker said. “I know what I’m doing.” Continue reading


How to get the best care for ‘medically complex’ kids


Finding a Formula for ‘Medically Complex’ Kids


Five-year-old Lakota Lockhart, who has a complex medical condition, works on an art project with a volunteer at St. Joseph’s Children’s Hospital in Tampa, Florida. A few hospitals in the U.S. have managed to deliver better care to kids like Lockhart for less money. (St. Joseph’s Children’s Hospital)

By Christine Vestal

TAMPA, Florida — Five-year-old Lakota Lockhart talks about Batman nonstop. When his mom, Krystal, can wedge in a word, she describes what life has been like since Lakota was born with a rare central nervous system disorder that causes his breathing to stop every time he falls asleep.

She says they’re lucky Lakota was born across the street, at Brandon Regional Hospital, or she might never have known about the Chronic Complex Clinic at St. Joseph’s Children’s Hospital.

The brainchild of Dr. Daniel Plasencia, the St. Joseph’s clinic was created 14 years ago to improve care for kids with chronic conditions affecting more than one organ system.

“Their treatment was too complex for most pediatricians . . .”

“Their treatment was too complex for most pediatricians,” Plasencia said. “They needed a medical home and we provided it for them.”

Approximately 3 million children in the U.S. are medically complex, meaning they require intensive treatment from a wide array of specialists. That number is expected to reach nearly 5 million in the next decade as medical advances improve life expectancy for kids with congenital heart defects, sickle cell anemia, cerebral palsy and cystic fibrosis.

Kids like Lakota who have rare conditions, those born extremely prematurely and survivors of near drownings, auto accidents and other catastrophic events are also living longer thanks to new technology.

Research shows that programs like St. Joseph’s save Medicaid and commercial insurers money by reducing emergency room visits and hospital stays. But while a few complex care units in places like Little Rock, Arkansas, Milwaukee and Cleveland have cropped up around the country, the idea has not caught on nationwide. Continue reading


How much does it cost to have a baby? Hospital study finds huge price range


pregnant-money-570By Michelle Andrews

Which hospital parents pick to deliver their baby can have serious cost consequences, according to a new study.

Hospital costs for women who had no maternal or obstetric risk factors to complicate childbirth ranged from less than $2,000 to nearly $12,000, the analysis of discharge data found. The wide variation in cost means that for expectant parents, it can pay to shop around. Continue reading


Medicare rates home health agencies


Star full faceHome Health Agencies Get Medicare’s Star Treatment

By Jordan Rau

The federal government released on Thursday a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings.

The elderly tend to be less familiar with the reputation of home health agencies than they are with hospitals and other institutions.

The star ratings come as home health agencies play an increasingly important role in caring for the elderly.

Last year 3.4 million Medicare beneficiaries received home health services, with nurses, aides, and physical and occupational therapists treating them in the home.

Medicare spends about $18 billion on the home health benefit, which provides skilled services that must be authorized by a doctor, not housekeeping care that some elderly pay for privately. Continue reading


VM tapped to improve UK’s NHS


British Flag UKVirginia Mason Institute announced today it has been selected by England’s National Health Service Trust Development Authority (NHS) to implement Virginia Mason’s quality improvement system as part of a broad effort to improve safety and quality, and control costs in the hospitals.

Virginia Mason Institute team members will train and mentor health care professionals at five NHS acute-care hospital trusts to use the Virginia Mason Production System (VMPS).

The contract awarded Virginia Mason Institute is for five years and approximately $13 million.

VMPS, developed by Virginia Mason in 2002 and inspired by Toyota Production System’s lean principles, engages executives, physicians, nurses and other team members at all levels of the organization to improve safety and quality, and control costs.

The approach uses structured, standardized tools and methods for achieving operational efficiencies, eliminating waste, preventing mistakes and maintaining continuous improvement.



How much acetaminophen a day is safe? Canada may decide it’s less


Badge - Canadian flag canadaBy T. Christian Miller and Jeff Gerth

Canada’s top health agency is considering lowering the maximum recommended daily dose of acetaminophen, the active ingredient in Tylenol and other pain relievers.

Citing the risk of liver damage from overdosing on the popular pain medication, Health Canada announced it will review changes to labels, the creation of an educational awareness campaign and possible revisions to dosage recommendations.

Acetaminophen is considered safe when taken at recommended doses. Tens of millions of people use it weekly with no ill effect. But in larger amounts, especially in combination with alcohol, the drug can damage or even destroy the liver. In severe cases, acetaminophen overdose can cause death.

“Our goal is that we will have fewer effects on liver, less hospitalization, less instances of unintentional overdose, and we have more people that are informing themselves about all the products that they use, not just acetaminophen,” Supriya Sharma, senior medical adviser for Health Canada’s Health Product and Food Branch, told the Toronto Star, in an interview. Continue reading