Archive for the ‘Reporter’s Notebook’ Category

More About Treating Clubfoot

We’ve had a lot of response from readers and listeners to our story on NPR’s Morning Edition on Monday, The Clubfoot Correction: How Parents Pushed For Better Treatment. Readers wrote that they or their children had received casting and boots-and-bars treatment for clubfoot. Some happened many decades ago—some fairly recently. We thought some more explanation is in order.

Dr. Ignacio Ponseti treated his first patient using the Ponseti method in 1948. He published his results 1963, and some physicians began to use it. But the method didn’t gain much traction until 1995, when he published a follow-up study on long-term results. Then, parents of babies born with clubfoot began to connect with each other on the internet, and the treatment spread even more widely, as this study shows.

But casting and boots-and-bars aren’t exclusive to the Ponseti method.  For decades, orthopedic surgeons were starting treatment with some sort of casting. The problem was, it often didn’t work. Many children ended up needing major surgery (sometimes several surgeries). The Ponseti method standardized the treatment in a way that was more effective than other techniques. It includes full-leg casts instead of short-leg casts, for example, and a particular way of manipulating the feet before the casts are applied.

It’s important to also note that individual cases vary, both in terms of the severity of the problem and the response to treatment. There are people who had a great result with non-Ponseti casting and boots-and-bars treatment, and people who a great result with surgery. Even with Ponseti, there is about a 15 percent relapse rate. Most relapses either require another round of casting or minor surgery to move a tendon, as opposed to the major surgeries in the past. And for some of the most extreme cases of clubfoot, surgery may be more appropriate than the Ponseti method in the first place.

In 2010, The British Medical Journal published a summary of how treatment for clubfoot has evolved over the decades.

Our story noted the higher cost of surgery versus the Ponseti method. One reader raised the cost question from another perspective: How low are the reimbursement rates for the less invasive option? Too low to give doctors an incentive to perform it? They are good questions that we don’t know the answer to and important ones to raise in a time of health system change.

We appreciate all the thoughtful responses to our story.

Tuesday, January 28th, 2014

Wyden Plan May Be Vision For Future Medicare Reforms

Key members of both parties and both chambers of Congress stand before the podium to introduce their bipartisan Medicare proposal.  Insurers and health care providers welcome it. Seniors’ groups are on board, too.

Sen. Wyden (Photo by Chip Somodevilla/Getty Images)

If Congress is ever going to overhaul Medicare, it will almost certainly have to happen this way.  Sen. Ron Wyden, the Oregon Democrat widely expected to be the next Senate Finance Committee chairman, last week led a bipartisan group of lawmakers, health care experts and seniors’ advocates backing a plan to better coordinate care given to Medicare beneficiaries.

The proposal is part of the ongoing health policy conversation over shifting Medicare away from paying per service provided to paying for the quality of that care. Sponsors say their measure would modify existing law to make it easier for providers to seek out those patients who have multiple chronic conditions like high blood pressure, high cholesterol, heart disease and diabetes and tailor care to their needs.

Health insurers and providers who want to specialize in chronic care would receive a set amount of money to care for patients and would be responsible for the cost, care and outcomes of their enrolled patients. Doctors and nurses would lead those care teams.

According to the Centers for Medicare and Medicaid Services, 68 percent of Medicare enrollees in 2010 suffered from two or more chronic conditions and accounted for 93 percent of program spending, which was about $487 billion.

(more…)

Tuesday, January 21st, 2014

Alabama Blue Cross Shares Obamacare Tax Woes With Customers

Insurance companies aren’t crazy about their share of the health law’s taxes, but mostly they’ve complained to politicians and regulators.

At least one health plan wants to bring consumers into the loop.

“Affordable Care Act Fees and Taxes” is a separate line item on bills Blue Cross Blue Shield of Alabama is sending to individual customers.

The tax amount is $23.14 a month, or $277.68 annually, on a statement one subscriber shared with Kaiser Health News.  That’s added to the “Current Amount Due for Benefits” of $322.26, for a total monthly premium of $345.40 for one person.

Taxes have been part of health plan costs for decades. Economic theory says business taxes are often borne by consumers in the form of higher prices.

But insurers haven’t typically published taxes on their invoices, says Mark Hall, a law professor at Wake Forest University.

“One thing that bothers me is attributing any amount specifically to the ‘Affordable Care Act,’” he said via email. “There are also state premium taxes, and normal corporate and sales taxes, none of which are itemized the same way.”

He also questioned whether Alabama Blue Cross would have been able to calculate the amount so precisely.

Obamacare backers say the taxes are critical to the health law, which stands to bring insurers billions in new premium revenue. They point out that federal subsidies will help many consumers pay not just the taxes but big portions of the premiums.

(more…)

Monday, December 23rd, 2013

As Lawmakers Roam Their Home Territory, Health Law Arguments Simmer

The battle over the Affordable Care Act shows absolutely no signs of abating, so it’s no surprise that the packets distributed by both parties on Capitol Hill for members heading home for the August recess paint the 2010 health care law in starkly different ways.

Photo by Karl Eisenhower/KHN

Before leaving town for the five-week-long break, House Republicans held their 40th vote to defund all or part of the measure, and supporters and opponents alike have already shown up at town hall meetings during the congressional break to let their lawmakers know how they feel about the law, dubbed Obamacare.

The packets reflect the parties’ philosophies about the law. Republicans see it as a massive job killer that will wreak havoc with the nation’s health care system. Democrats say the law will bring affordable, comprehensive health insurance to millions of Americans who don’t have it and improve coverage for those who do.

The House Republican recess packet offers an array of tips, such as have a conversation with a health care provider, tour a local hospital or clinic to get “the local, real-world detriments” of the law.  GOP members are also advised to meet with “millennials,” young people born between the early 1980s and the early 2000s,  about the health law’s “ongoing and impending consequences.”

(more…)

Tuesday, August 13th, 2013

Schizophrenia, Suicide And One Family’s Anguish

Homer Bell was 54 years old when he committed suicide in April in a very public way — he laid down in front of a bus in his hometown of Hartford, Conn. It was the culmination of three decades of suffering endured by Bell and his family because of his illness, schizophrenia.

The Bell Family, from left: Laura Bell, Regina Bell, Rosalind Scott, and Jack Wilcox (Photo by Jeff Cohen/WNPR).

Harold Schwartz, the psychiatrist-in-chief for Hartford Hospital’s Institute of Living, describes having a family member with the illness. It’s hard to provide services and long-term housing, and, he says, “You frequently are left to observe a deteriorating child sinking into homelessness, perhaps imprisonment. If not imprisonment, at least recurrent revolving-door hospitalizations.”

That describes the Bell family pretty well. His mother, Rosalind Scott, and her daughter, Laura Bell, tell the story of the days before and after Homer Bell took his own life.

He had been to a hospital. He got out and showed up repeatedly on Scott’s porch. One night she let him into the hallway to get warm. But it was hard to let him in further — he could be loud, he could be angry, he could be paranoid. His illness had exhausted her.

One or two nights later, Homer Bell came back. But Scott was tired, and wanting relief, and she couldn’t bring herself to let him in.

Homer’s sister, Laura, jumps in to comfort her mother. “It wasn’t your fault,” she says.

(more…)

Wednesday, July 24th, 2013

Can Humor Sell Health Insurance?

When the Affordable Care Act’s health insurance exchanges open for business in the fall, it will be a new game. Customers will be able to comparison shop in the new online marketplaces, and health insurers will have to sell themselves to the general public in a way they haven’t before.

The law’s requirement that almost everyone buy insurance sounds like a marketer’s dream – captive shoppers directed by the government to buy your product. But when the product is health insurance, there are undoubtedly some pitfalls: Customers may not love your brand. In fact, they may despise you. You doubled, tripled, quadrupled their premiums. You denied them coverage because of a pre-existing condition just when they needed you most.

James Percelay, the co-founder of the viral marketing firm Thinkmodo in New York City, sat down with Kaiser Health News to talk through the advertising challenges insurers will face in the coming months.

“I think it may be too little too late for health insurance companies to now come out, like, ‘Hey! We were just kidding the last 50 years! We’re really not the people that you think we are!’” Percelay says.

(more…)

Friday, July 12th, 2013

Test Driving The Obamacare Software

All the outreach in the world won’t count for much if the Obamacare ticket counter doesn’t work. Behind the campaign to educate the uninsured about the Affordable Care Act is the assumption that software to sell the plans will be ready and user-friendly by Oct. 1, when enrollment is supposed to start. That assumption is not universally shared. Some wonder if systems will be tested and finished on time. Others worry the programs will lead consumers to make dumb insurance choices.

Photo by Ian Barker via Flickr

Kaiser Health News got an early look at Obamacare software that will be deployed in Minnesota, Maryland and the District of Columbia. Connecture is developing the Web interface for consumers under 65 who don’t have employer-based health coverage to shop and sign up for a plan in those states. Connecture isn’t handling the software that qualifies you to buy under the health act or verifies your eligibility for subsidies. Other companies are doing those. Connecture’s piece is the point-of-sale program, the one that steers you through insurance choices and closes the deal.

That process is complex enough by itself. How much coverage do you want? What deductible? Are family members on the plan? Do you need an asthma program? Do you want to keep your current doctor? What about dental?

Health-act proponents liken the signup software to Expedia or Travelocity, where travelers can book flights and hotels. It may be more like TurboTax, escorting you through requirements and choices much more complex than whether you want a flight in the afternoon or the morning.

Like other filtering software, Connecture’s program is a multi-step search engine, screening out inappropriate options (based on your input) to deliver a manageable menu. After getting past the basics (Stripped-down “bronze” plan or high-benefit “platinum”? High deductible or low?), the program asks if it’s important to keep your current doctor.

“Based on our research, the choice of doctor was probably the No. 1 and No. 2 [features] of what people are looking for in a plan,” said Christopher Neuharth, Connecture’s director of user experience.

To try to reduce sticker shock, Connecture shows your net premium price — after the tax credits are applied — early in the shopping process. But perhaps the most important feature is the one estimating the total cost of coverage, including deductibles and co-pays, based on your reported health status. Without that information somebody with a chronic condition requiring lots of care could choose a plan based only on a low premium, not realizing the total expense could be substantially reduced by paying a larger premium up front.

“There’s all sorts of wild ways that carriers can design benefits to meet the actuarial value” required by the health law, Neuharth said. “You have to show the total cost of ownership.”

With three months until the exchanges open, the product isn’t finished. Connecture awaits tryouts by Minnesota, Maryland and DC on specific demographic groups expected to apply for coverage. It could tweak the software based on their responses, Neuharth said.

Your exchange experience may vary. Connecture had a head start, launching work on the code shortly after the health law passed in 2010. Minnesota, Maryland and DC are far ahead of other states in developing their exchanges. At the same time, the best shopping site in the world won’t delight consumers if products are sparse or subpar.

Thanks to the “narrow network” strategy pursued by many insurers, your preferred doctor may not show up in any of the plans on offer. On the other hand, narrow networks are expected to be less expensive because they seek discounts from select doctors and hospitals in return for patient volume. Sorting out such pluses and minuses to help consumers make informed choices is the software’s job.

Thursday, June 27th, 2013

Grassley: Who Approved These Hospital CEO Bonuses?

Sen. Charles Grassley, a longtime member of the Senate Finance Committee and frequent critic of nonprofit hospitals, wants to know whose idea it was to pay hospital CEOs annual bonuses surpassing a million dollars in some cases.

Sen. Grassley finishes speaking during a press conference at the U.S. Capitol in 2011 (Photo by Win McNamee/Getty Images).

“Is the board in control?” he asked in an interview. “Is the board making these decisions and how do they make these decisions? Are they running the show or is the CEO running them?”

The Iowa Republican was responding to a report by Kaiser Health News and ABC News that showed CEOs reaping bonuses for profit, revenue and other financial goals even as policymakers talk about the need to promote efficiency instead of volume. The stories found that boards of nonprofit hospitals are rewarding bosses more for raising prices and increasing the number of procedures than for rigorous quality and cost-cutting goals.

In examining 30 of the biggest public and private nonprofit health systems in the country, KHN listed nine CEOs whose bonuses were at least seven figures.

(more…)

Tuesday, June 25th, 2013

Of ACOs And Proton Beams: Why Hospitals ‘Live In Two Worlds’

For the past several years, hospital CEOs have been talking a big game about accountable care—the latest health care model, which pays doctors and hospitals for quality, rather than the volume of services they provide. ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and to save money by avoiding unnecessary tests and procedures.

But investing in risk-sharing doesn’t mean health systems are giving up on the fee-for-service system, which rewards providers for every test and treatment whether or not it improves the health of a patient.

Just last week, the District of Columbia approved applications from MedStar Health and Johns Hopkins Medicine to build proton therapy centers, a new-fangled radiation treatment for cancer that has not been proven to work better than standard radiation for the vast majority of cancers, but costs twice as much. Both health systems are also pursuing risk-sharing—MedStar is involved in launching an insurance product, and Hopkins has held itself up as a model of how shared savings can work in an academic medical center.

“It doesn’t surprise me at all,” says Chas Roades, chief research officer at the Advisory Board Company in Washington, D.C., which is also helping to launch the MedStar insurance product. “For every CEO who’s considering a risk-based strategy like an ACO or bundled payments, the dilemma they have is that they have to live in two worlds at once.”  A small part of their business might be invested in population health and minimizing utilization of services, Roades explains, but they’re still dependent on the revenues from their fee-for-service contracts. (more…)

Thursday, June 6th, 2013

Boston Couple Faces Amputation Rehab, Together

Only the most seriously injured of the 188 marathon bombing patients remain hospitalized.  Patrick Downes and Jessica Kensky Downes are among them.  The couple was cheering runners near the finish line of the Boston Marathon when the explosions threw them apart. Patrick and Jessica each lost the lower part of their left legs.

Friends are having a hard time reconciling this news with memories of the joyful pair who married just last August.  Smiles in photos of Jessica and Patrick jump off the screen.

“But that’s not just a photograph,” says Leslie Kelly, who watched Jessica grow up just outside Sacramento, Calif.  “Those two are the happiest, most optimistic, wonderful people,” continues Kelly, which provides “a real good foundation for both of them going forward.”

Jessica’s right foot was also badly damaged in the blast, but the family has told friends it looks like it can be saved. And Patrick’s third surgery went well. Family members declined requests for an interview, but a few friends are sharing their story.

“When Patrick came to, he asked if the Red Sox had won,” says Boston College buddy Tom Treacy. “It sounded like they were certainly in good spirits.”

(more…)

Monday, April 22nd, 2013

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