Health Care In The States

How One U.S. Hospital Braces For Ebola

This story is part of a partnership that includes WNPR, NPR and Kaiser Health News. It can be republished for free. (details)

Dr. Jack Ross is used to seeing potentially lethal viruses, and he is used to putting patients into isolation. Still, Ebola is different.

Dr. Jack Ross, the director of infection control, gives a tour of Hartford Hospital's isolation unit (Photo by Jeff Cohen/WNPR).

“I think, for any hospital today, Ebola represents one step higher than anything else, if we had to do it,” says Ross, who is the director of infection control for Hartford Healthcare’s five hospitals in Connecticut.

On a tour of one of them, Hartford Hospital, Ross explains how the layout of the building is one of the important factors in his Ebola control plan.

“This would be an area that we would close off with plastic sheeting,” Ross says. His plan  includes the emergency room, intensive care unit and patient floors. “Right here, we’d have a security officer, because you want to restrict visitors. You want to have a log of who goes in, who goes out.”

In Connecticut, the idea of taking care of an Ebola patient is still just theoretical. However, one of the reasons that public health officials in the U.S. are confident that American hospitals could contain an outbreak is because they can accommodate the isolation and sanitation needed to keep the virus from spreading.

The best place to put someone who falls ill, for instance, is ideally at the end of a hall in a room with its own bathroom, anteroom, and entrance. “The rest of the floor is safe,” Ross says. “I limit the amount of traffic. I’m able to do the care there.”

Ross and his team are preparing in other ways, too. With the Centers for Disease Control and Prevention’s help, he’s made a specific list of questions doctors and nurses will ask incoming patients about symptoms and travel. He’s inventoried the supplies they would need to treat an Ebola patient.

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October 8th, 2014, 5:00 AM by Jeff Cohen, WNPR

Short Takes On News & Events

Study: Robotic Surgery More Costly For Ovarian Problems

We’ve heard it before — the robots are coming to save the day. But for certain medical procedures, that day may not be as close as you’d think.

A study published today in the journal Obstetrics & Gynecology suggests that robot-assisted surgeries to remove ovaries or ovarian cysts were more expensive and had more complications than traditional minimally invasive surgeries.

Removing ovaries and cysts with the help of a robot cost about $2,500 and $3,300 more, respectively, than laparoscopic or “keyhole” surgeries. That can add  upward of 80 percent to the cost of a surgery.

What’s more, women whose surgeries had been performed with the help of a robot were slightly more likely to have complications such as a bladder injury, bowel obstruction or excessive bleeding.

The study “really questions the utility of using robotic-assisted surgery,” says Dr. Jason Wright, the chief of gynecologic oncology at Columbia University and the lead author.  “More studies need to be done” he said, “before it’s accepted as the standard of care.”

The data didn’t offer any clue as to why the complications arose. But in the past two months, there have been reports of software glitches, battery malfunctions, and difficulties in seeing through the robotic system’s lens, according to the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience database, which documents issues with medical devices. In some cases, these problems occurred after the patient had been put under anesthesia. Last year, the Associated Press reported “freak incidents” during which robots wouldn’t let go of tissue or accidentally hit patients on the operating table.

Wright’s study looked at nearly 90,000 women 18 years and older who’d gone under the knife between 2009 and 2012 to have ovaries or cysts removed, and compared the cost and safety of robotic surgeries to those which used laparoscopic methods.

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October 7th, 2014, 6:15 PM by Daniela Hernandez

Short Takes On News & Events

Poll: Californians Support Health Coverage For Undocumented Immigrants

This story is part of a partnership that includes KQED, NPR and Kaiser Health News. It can be republished for free. (details)

A majority of the state’s voters support extending current health insurance programs to all low-income Californians, including undocumented immigrants, according to a new statewide poll released today.

The poll was commissioned by The California Endowment, a foundation that has been actively working to expand health insurance access to all people, regardless of immigration status. The Affordable Care Act expressly bars undocumented immigrants from receiving any of its benefits, including subsidies to purchase health insurance. (Note: The California Endowment funds some of KHN’s coverage.)

In the poll, 54 percent of those surveyed said they support covering the undocumented. Support was strongest among younger voters as well as Latino and African-American respondents.

Pollsters drilled down on specific aspects of coverage. Total support for those issues was:

  • 86 percent support important access to preventive care to reduce overall health costs and prevent spread of disease
  • 69 percent support ensuring that working undocumented immigrants can purchase affordable health insurance
  • 56 percent support expanding Medi-Cal, the state’s version of Medicaid, to undocumented residents
  • 54 percent support making subsidies to purchase Covered California plans available to working undocumented immigrants. Covered California is the state’s Obamacare marketplace.

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October 6th, 2014, 3:47 PM by Lisa Aliferis, KQED

Short Takes On News & Events

Long-Acting Contraceptives Help Reduce Teen Pregnancy Rates, Study Finds

Teenage girls who are given access to long-acting contraceptives such as IUDs or hormonal implants at no cost are less likely to become pregnant, according to a study in the New England Journal of Medicine released Wednesday.

The findings come just two days after the American Academy of Pediatrics recommended that health providers should consider IUDs and implants first when discussing contraception choices with teen girls.

Although there are not as many teenage pregnancies as there once were — rates have been cut by more than half since 1991 — they still pose serious public health issues because of the costs associated with child birth and public assistance for young mothers. These pregnancies can also stunt education and income opportunities for teenage moms.

Each year, 750,000 teenage girls become pregnant, and 80 percent of those pregnancies are unintended. The most common forms of contraception — 52 percent of teenage girls use male condoms and 31 percent use birth control pills — are unfortunately the most susceptible to mistakes. For example, oral contraceptives work best if women remember to take the pills at the same time every day.

An implant is a plastic rod the size of a matchstick inserted into the inside of the upper arm by a health provider, and the IUD is a small, T-shaped plastic device inserted into the uterus. The initial cost for each of these methods is significantly higher than for oral contraceptives, but long-term costs for them even out over time because the devices last from three to 12 years.

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October 1st, 2014, 5:00 PM by Lisa Gillespie

Reporter's Notebook

Deadline Today For 300,000 To Prove They Should Get Subsidies

KHN’s Julie Rovner was on WBUR’s Here and Now Tuesday morning to talk about the 300,000 people who stand to lose their health law subsidies if they don’t prove by today that they are eligible to get them.

Listen to audio of the interview below:

September 30th, 2014, 3:05 PM by KHN Editors

Short Takes On News & Events

California To Launch Medicaid-Funded Teledentistry

California Governor Jerry Brown has signed into law a bill that would require Medi-Cal, the state’s insurance program for the poor, to pay for dental services delivered by teams of hygienists and dentists connected through the Internet.

California is among the first states to launch such teledentistry services, which are intended to increase the options for patients in remote and underserved areas. Other states, like Oregon, Colorado, Hawaii and West Virginia, are interested in creating their own teledentistry programs but are farther behind, advocates for the projects said.

The bill, signed by the governor over the weekend, also expands the types of procedures hygienists and certain assistants can perform without onsite supervision by a dentist — deciding what X-rays to take, for instance, or installing temporary fillings that help prevent decay. The hygienists and other workers will consult with a dentist remotely, sharing records online but will refer a person directly to a dentist if more sophisticated  procedures are needed.

The legislation will take effect on Jan. 1.

Expanding teledentistry statewide will increase Medi-Cal costs minimally in the short-term — by upward of $500,000 a year, according to a State Assembly’s Appropriations Committee fiscal analysis. If teledentistry takes off, the costs could be higher.

Already, the Medi-Cal budget for dental services is slated to grow from $682 million to roughly $940 million by June 2015, thanks to legislation signed in June 2013 that brought back certain dental benefits for adults.

Dr. James Stephens, a Palo Alto dentist and president of the California Dental Association, said that teledentistry could save money down the line, however.

“That’s the real key. It’s a way of getting people who are outside the system into the system,” he said. “Preventive care costs so much less.”

The newly signed law is the culmination of years of work and research by hygienists, dentists and patient advocacy organizations across the state. About five years ago, Dr. Paul Glassman, a dentist at the University of the Pacific in San Francisco, started the pilot Virtual Dental Home Demonstration Project to show that teledentistry could provide a means to improve access at low costs.

“We’re very very excited. It’s a great ending to a long, long adventure here,” Glassman said. “The next challenge is to be able to spread this system.”

According to Glassman, as many as 50 percent of consumers eligible for dental services through Medi-Cal don’t get care. The idea is to deploy hygienists and dental assistants to schools, nursing homes and other community organizations where underserved populations gather. Glassman and other advocates say that will ease transportation, financial, language and cultural barriers that typically keep people from accessing treatment.

Telemedicine in general has been gaining traction, thanks in part to an increasing number of small Internet-enabled medical devices and consumer health trackers as well as growing interest among venture capitalists.  The federal Affordable Care Act has emphasized the use of digital technologies to improve care and cut costs. Recently, a bill was introduced in the U.S. House of Representatives that would allow accountable care organizations to get reimbursed for and use telemedicine more widely.

“Technology has really allowed things that weren’t possible before,” said Shelly Gehshan, the director of the children’s dental policy team at the Pew Charitable Trust. “But it’s not like flipping a switch.”

Before the promise of teledentistry can be borne out, the state still has to figure out the billing mechanism and payment structure for telemedicine-enabled services. Glassman acknowledged this could be a topic of debate: Providers will want to bill at the same rates as for in-person consultations, while Medi-Cal might opt for lower rates to control costs.

Professional organizations still need to build programs to train hygienists and dental assistants on taking X-rays by themselves, applying temporary fillings, and working as part of a teledentistry team. The bill spells out the type of training that will be necessary.

September 29th, 2014, 4:01 PM by Daniela Hernandez

Health Care In The States

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal

This story is part of a partnership that includes Capital Public Radio, NPR and Kaiser Health News. It can be republished for free. (details)

With the stroke of a pen, Gov. Jerry Brown rejected an effort to protect the estates of Medicaid beneficiaries in California, the San Jose Mercury News reported Friday. The bill, which the Democratic governor vetoed on Thursday, would have shielded the assets of people who receive Medicaid, known as Medi-Cal in California, from being recouped by the state after their deaths.

In a three-paragraph letter to the state senate, Brown advised legislators to consider the issue during the budget process. Brown wrote: “Allowing more estate protection for the next generation may be a worthy policy goal. The cost of this change, however, needs to be considered alongside other worthwhile policy changes in the budget process next year.”

The issue is important to people like Anne-Louise Vernon, who recently signed up for Medi-Cal under the Affordable Care Act’s expansion of the program. Vernon told Pauline Bartolone of Capitol Public Radio that she fears using her new coverage.  “I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor,” she said.

The law has been on California’s books for two decades, but with the expansion of Medi-Cal it now has the potential to affect many more people.

More from Pauline Bartolone’s story for Kaiser Health News and Capitol Public Radio:

Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it’s modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries,” said Landsberg.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

September 26th, 2014, 2:29 PM by Diane Webber and Pauline Bartolone

Short Takes On News & Events

After Glitch, CVS Gives 11,000 Birth Control Refunds

CVS Health will pay refunds to about 11,000 women whom it accidentally charged co-payments for generic prescription birth control – a violation of the federal health law – due to a price coding glitch affecting Maryland, Virginia and the District of Columbia.

The company found that the charges resulted from an error that affected people covered by a single plan, CVS spokeswoman Carolyn Castel said in an email.

That plan was offered through CareFirst BlueCross BlueShield, which operates in Maryland, Virginia and Washington, D.C., according to California Democratic Rep. Jackie Speier’s office.

Speier was contacted by CVS in response to concerns she had raised earlier this month, when a congressional staffer purchased generic prescription birth control and was charged a $20 copay.

The coding error was in effect for less than two months, according to the letter, which noted that the problem should be fixed by Sept. 26. The 11,000 affected customers are expected to receive refunds by the start of October.

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September 26th, 2014, 8:19 AM by Shefali Luthra

Short Takes On News & Events

California Program Trains Young Men To Change Their Lives By Saving Others

On Thursday’s PBS NewsHour, KHN’s Sarah Varney reported on an innovative program in Oakland, Calif., that trains at risk youths to be emergency medical technicians. Watch the video below and read more on the NewsHour website.

September 26th, 2014, 8:10 AM by KHN Editors

Short Takes On News & Events

For Gay Men, Gaps In HIV Knowledge And Treatment Persist

This KHN story can be republished for free. (details)

Saturday is National Gay Men’s HIV/AIDS Awareness Day, but the news about knowledge and treatment of HIV in the gay community is dispiriting.

(Photo by Mario Tama/Getty Images)

Just 30 percent of gay and bisexual men say they were tested for HIV within the last year as recommended; another 30 percent say they have never been tested.

And even when they are tested, only half of those who have been diagnosed with HIV are receiving care and treatment for their infection.

Those statistics come from two reports released Thursday, the first a survey of gay and bisexual men from the Kaiser Family Foundation and the second, an analysis of men diagnosed with HIV in 2010 from the Centers for Disease Control and Prevention. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

“It’s unacceptable that treatment, one of our most powerful tools for protecting people’s health and preventing new HIV infections, is reaching only a fraction of gay men who need it,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention in a statement. “A top prevention priority at CDC is making sure every gay man with HIV knows his status and receives ongoing medical care – otherwise, we will never tackle the HIV epidemic in the country.”

At least part of the problem may be a lack of education about the disease.

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September 25th, 2014, 1:02 PM by Jenny Gold