American CEOs get an Israeli medical education
Jerusalem, Israel Arieh O’Sullivan / The Me – Descending the Tower, the imposing new state-of-the-art inpatient hospital at Hadassah’s Ein Kerem Medical Center, Joseph Mapa was impressed. The chief executive officer of Toronto’s Mt. Sinai Hospital said he’s seen innovations he would like to bring back to Canada.
“It’s leading edge. Just the thinking behind it! Healing gardens, patient rooms, square feet, two beds per room, one bed per room, one window per patient…I mean these are huge developments,” Mapa told The Media Line. “It’s not something we wouldn’t do in the States, or in Canada, and it’s something you certainly want to see and showcased,” he adds.
Mapa was part of a first-ever delegation of CEOs from the top hospitals and medical centers across North America that were visiting Israel this week. This was the brainchild of Rafael Harpaz, director of the Economic Department for America and Africa at Israel’s Foreign Ministry.
“We think we have a lot to share with our friends and colleagues from the USA and Canada on medical technologies, cutting-edge technologies, readiness and preparedness and managing medical science through computers. I think these are areas where Israel has good experience,” Harpaz told The Media Line.
Israel’s life expectancy is much higher than the U.S. and its systems of socialized medicine ensures that everyone has access to basic healthcare while Israel spends a smaller percentage of its gross domestic product on health. There still are problems, most recently with doctors striking for higher wages last year. Its major hospitals are equipped with some of the latest medical technologies, which impressed the delegates.
“The American system has many great things, but also many things to learn from this country and I think that the level of medicine here and the level of training is every bit as good as medicine that I see now at the States,” Kevin Tabb, the CEO of Beth Israel Deaconess Medical Center in Boston, told The Media Line.
“In the States, for better or for worse, medicine in many ways is a business,” Tabb said. “It’s about making patients better, but it is also a financial business. But in Israel that really is not the case, and that is very interesting for people, especially for people from the United States, less so for Canada.”
Tabb said they shared data on costs and saw how care similar to that offered in the U.S. was extended with fewer resources in Israel.
“It’s amazing to see the relatively small budgets for an Israeli hospital, doing tremendous amount things, on what would be considered a pittance in the U.S. and that’s fascinating,” Tabb said.
The Tower at Hadassah is slated to be opened later this month and crews are busy scuttling around clearing away scaffolding and supplies. Not all of the floors are finished, but the fifth floor is spectacular with parquet floors and equipment still in plastic.
“This has been a tremendous exchange of North American healthcare leaders with Israeli healthcare leaders,” Amir Dan Rubin, president and CEO of Stanford University Medical Center. “While our political and reimbursement and systems are different, and the organization of our health systems are different, at the core we have common missions; taking care of patients and … research and education.”
“The challenges are similar here,” Rubin said. “We all have issues of how do we provide insurance coverage so there is the payment issue and there is the delivery system, there are access issues, there is improving quality and innovations and while our mechanisms are slightly different those themes are common.”
The group was briefed at Sheba Medical Center and is slated to visit Sourasky Medical Center, Beilinson Hospital — all in Tel Aviv — and Rambam Hospital in Haifa as well as the IDF Medical Forces center in Tzrifin where they will see the emergency unit that deploys at crises around the globe.
“We didn’t anticipate that so many of the CEOs of the big hospitals in North America would come and we are blessed with a delegation which is close to 50 top heads of hospitals and medical centers,” Harpaz said.
“We share the same challenges that we are facing in our medical treatment, and they appreciate that we are doing this, but on the other hand they are really impressed by all which Israel has to offer. And we have a lot to offer when it comes to medical technologies.”
At Sheba, the group observed a simulation of a mass casualty event, something that Israeli hospitals constantly drill for. Catherine Zahn, CEO of Toronto’s Centre for Addiction and Mental Health, found the spirit of Israelis compelling.
“There is a societal receptivity to open mindedness and forward thinkingness,” Zahn told The Media Line. “Like Israel, Canadians believe health care is a basic right of a citizen, a basic human right, rather than a commodity to be bought and sold. There is definitely a kinship there, but I think we have a lot to learn from the perspective of the ‘innovation nation’,” Zahn said.
“It’s also interesting to see how the situation in the Middle East, and the involvement of the military in the country actually probably contributes to that resilience and the attitude that if this doesn’t work out let’s pick up and do something else,” she added. “Picking up on the advances from military science and translating them into health care advances. Those are all very remarkable.”
These sentiments were echoed by her fellow Canadian, Mapa.
“The Israeli system is spectacular — from clinical care to service, to IT in particular, clinical technology, to crisis management,” Mapa said. “It’s state-of-the-art, I mean, its fantastic. We’re excited, but I tell you this not because I am excited, but you see it is evidence based…and that’s what turn us on. Turns me on for sure.”
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U.S. readies for Yemen President Saleh, refuses to divulge details
Washington, D.C., United States (AHN) – The United States on Monday confirmed issuance of visa to ailing Yemeni President Ali Abdullah Saleh for a limited time to undergo medical treatment but refused to divulge time-period for which the visa is issued.
“We have issued a visa for Ali Abdullah Saleh,” said Victoria Nuland, the State Department spokesperson, adding, “It is strictly for medical treatment, and our expectation is that he will leave the United States when his medical treatment is complete.”
Asked to comment on the time period for which this visa is issued, Nuland said, “He’s got a visa for the period that he anticipated the medical treatment would last. If the treatment goes on longer and he needs to apply for an extension, he would do that with Homeland Security.”
Yemeni political players are expecting to utilize President Saleh’s absence to move the country “on a concrete transition plan to a more democratic Yemen,” said Nuland, adding, “We do believe that Saleh’s absence from Yemen at this critical juncture might, in fact, facilitate that dialogue and facilitate the transition process.”
Agreeing that, “it might be helpful to the transition process that he’s out of the country now,” Nuland reiterated, “It (the visa application) was not approved for political purposes. It was approved for medical treatment. The timing, we think, is fortuitous, however, and we hope that the Yemenis will use the time well.”
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The Health Law Goes Graphic
Boston, MA, United States (KaiserHealth) – Nearly two years after the passage of the federal health law, more than 40 percent of people say they know little or nothing about how the law will affect them, according to the Kaiser Family Foundation’s latest monthly health tracking poll, published in December. That figure hasn’t budged since April 2010, just after the law was signed.
Jonathan Gruber, an economist at the Massachusetts Institute of Technology, aims to change that with a book, “Health Care Reform: What It Is, Why It’s Necessary, How It Works,” that explains the ins and outs of the law in an innovative way: an adult comic-strip form similar to graphic novels.
Gruber was one of the architects of the Massachusetts’ health care overhaul, which included many features that appear in the federal law, and he advised the Obama administration and Congress on the Affordable Care Act. I spoke with him about his new book, which he co-authored with HP Newquist. The book is illustrated by Nathan Schreiber.
Q. What made you decide to write a book for consumers about health reform?
A. I think what really inspired me was hearing that when you polled consumers about the Affordable Care Act they were split in their support. But when you polled them about individual pieces of the law, they liked it. As an educator, you didn’t have to do any more than explain what the law did [to gain support]. It needed to be explained in a way that people understood.
Q. Why did you choose a graphic novel format?
A. The publisher approached me about doing it that way. At first I wasn’t that enthusiastic. I didn’t think it would be that effective. But the publisher said they had done a graphic novel about the 9/11 Report. My son likes graphic novels, he’s 17. He said it’s a great opportunity, it’s a great medium. When you’re on a plane and they want to teach you what to do in case of accident, they hand you a graphic. I think it was the right call.
Q. Who’s the primary audience for this book?
A. I wrote it for the person who is confused and open-minded about this bill. The person who doesn’t understand it. The two groups I really hope will read it and benefit from it are the independent voter who was inclined to like Obama and knows it’s a big, transformative bill and wants to learn more, and the disaffected Democratic voter. I’m stunned that many don’t support it.
Q. Do you think it will change any minds? Turn opponents into supporters?
A. I don’t think it’s going to change the minds of anyone who’s convinced it’s a bad piece of legislation. But it could change the minds of those who are wary and concerned.
Q. You showcase Massachusetts as an example of how health reform can work, noting that it employs some of the same elements that appear in the federal law, like the individual mandate that requires people to have insurance. What should readers be aware of about Massachusetts’ experience with health reform? Has anything surprised you?
A. I would say the point the book tries to make is that Massachusetts was successful in what it tried to do. It reduced the number of uninsured and lowered non-group insurance premiums. Premiums for individual market plans fell by 50 percent relative to national trends. The biggest surprise to me is that employer-sponsored health insurance actually went up after reform when it was falling everywhere else in the country. It speaks to the power of the [individual] mandate. People said, “Give me health insurance,” and they did.
Q. You talk about how health care reform will help Anthony, Betty, Carlos and Dinah, all of whom have different health insurance situations. But you don’t discuss what will happen to Emilio the undocumented worker, who won’t get coverage under the new law. Did you consider talking about who loses out under health reform, including the roughly 11 million illegal immigrants?
A. You hit on a great issue: Who loses out under the law. People don’t lose out. Emilio doesn’t lose out, he just doesn’t gain. A lot of people don’t gain. By design, the bill leaves a lot of people alone, including those with employer-sponsored insurance. They don’t lose but they don’t gain either. As for undocumented immigrants, there was no support to help them. Unfortunately, the law leaves them out in the cold. That was just a political reality.
Q. I know it’s a big piece of legislation and you were trying to cover a lot of ground, but I couldn’t help thinking as I read the book that in some places you oversimplified in such a way that it made the law look better than it is. Can you talk a bit about concerns some may have that you may confuse readers by making sweeping statements about the benefits of this law?
A. Certainly I wrestled a lot with where to simplify and where not to. I think I tried my best to never be misleading. At the end of the book there’s a set of references where people can go to learn more about the law. I think the truth is that most people don’t want that level of detail. It’s for people who just want to know what the heck is this bill.
Q. In the book you discuss the long-term care program created under the law, the CLASS Act, which the administration has decided not to implement, at least not at this time. Obviously, this law is changing and evolving. Depending on what happens in the next election, it could change a lot. What do you think is going to happen? Do you have any plans to update the book?
A. I am fairly confident, I think there’s a better than 50 percent chance, for the Supreme Court not to turn down the mandate, and voters not to kick Obama out of office. If both those things go that way, I think it will be an incredibly positive thing for the Democrats in 2016. It will be good for them because the law will be doing good things by then. States need to move more quickly if we’re going to implement the law smoothly. I can see it starting out roughly and being in great shape in a year or two.
My guess is I wouldn’t want to update [the book]. I haven’t really thought about that.
Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.
– Provided by Kaiser Health News.
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Berwick: Don’t blame Medicare, Medicaid. It’s the delivery system
United States (KaiserHealth) – Dr. Donald Berwick, who oversaw Medicare and Medicaid until earlier this month, defended the programs Monday, but said they are trapped in a U.S. health system that promotes wasteful spending and inefficient care.
“Health care is broken,” Berwick said in an interview with Kaiser Health News. “… We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”
Berwick said the 2010 federal health law is changing how doctors and hospitals are paid and deliver care though such new arrangements as accountable care organizations, which are designed to improve coordination and lower costs.
But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries. “That is the central question, the nub…whether that will happen fast enough, I just don’t know.”
Despite being considered one of the foremost authorities on health quality and safety, Berwick was a controversial pick as administrator of the Centers for Medicare and Medicaid Services after Republicans accused him of supporting rationing care. Berwick denies the charge, but noted both private insurers and government programs impose limits on what they will cover.
After Republicans said they would not confirm his appointment, President Obama appointed him during a congressional recess in July 2010, which meant he could serve only for 18 months. His last day was Dec. 2.
Berwick previously led the Cambridge, Mass.-based Institute for Healthcare Improvement.
On other topics, Berwick told KHN:
- His failure to be confirmed did not affect his ability to get things done, though he would have preferred a longer term. “An agency of this size will do better with longer-term leadership commitment,” he said. Knowing his tenure could be short gave him a greater sense of urgency to achieve things, he said.
- His most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form accountable care organizations to work more closely, while not making the requirements overly burdensome.
- He criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. “It’s a nonsensical idea,” he said. “If a patient needs twenty days, the patient should get twenty days,” he said.
- Managed care done right is the best way to provide care, he said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need. Early in his career, Berwick worked for Harvard Health Plan, a nonprofit HMO based in Boston.
Berwick said he has not yet decided what to do next beyond spending more time with his family in Boston.
– Provided by Kaiser Health News.
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CDC: U.S. teens not eating enough fruits, vegetables
Atlanta, GA, United States (AHN) – U.S. teens are not eating enough fruits and vegetables, according to a new study by the U.S. Centers for Disease Control and Prevention.
The findings, based on data complied from nearly 10,800 students in grades nine through 12 who took part in the National Youth Physical Activity and Nutrition Study 2010, found median consumption was 1.2 times per day for both fruits and vegetables.
Median fruit consumption was much higher among males than females, and much higher among grade nine students than among students in grades 10 and 12.
A little more than 28.5 percent, or one in four, of the high school students ate fruit less than once a day, and 33.2 percent ate vegetables less than once a day.
Only 16.8 percent of students ate fruit at least four times a day, and only 11.2 percent ate vegetables at least four times a day.
Vegetable consumption was lowest among Hispanic and black students, the study found.
Researchers said the findings show that most high school students do not meet the daily fruit and vegetable recommendations, and more needs to be done to see the recommendations are met.
The researchers wrote in the Nov. 25 issue of the CDC’s Morbidity and Mortality Weekly Report, “The infrequent fruit and vegetable consumption by high school student highlights the need for effective strategies to increase consumption.”
Steps have already been taken at schools throughout the country to remove sugary snacks, sodas, high fat, high salt and low nutrient dense foods. New programs such as farm-to-school initiatives, school gardens and salad bars aim to improve access to both fruits and vegetables.
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Analysis: Keys To The Supreme Court’s Health Law Review
Washington, DC, United States (KaiserHealth) – By agreeing today to hear challenges to President Obama’s 2010 health care law, the Supreme Court set the stage for a decision — probably in late June and in the midst of the presidential campaign — that could be among its most important in decades.
The case, which will probably be argued in March on a date still to be announced, is especially momentous because it not only will determine the fate of President Barack Obama’s biggest legislative achievement but also will cast important light on the Supreme Court’s future course under Chief Justice John Roberts on issues of federal government power.
The central issue — but not the only important one — is whether Congress exceeded its constitutional powers to regulate interstate commerce and to levy taxes when it adopted the so-called “individual mandate” at the heart of the health care law.
That provision would require millions of people starting in 2014 to buy commercial health insurance policies or pay financial penalties for failing to do so.
The court also agreed to decide a challenge to the Affordable Care Act’s provision essentially requiring states greatly to expand their Medicaid spending.
The court made clear that if it decides to strike down the individual mandate or Medicaid provision, it will also decide which of the 975-page law’s hundreds of other provisions should go down too, by divining whether Congress would have wanted some or all of them to be effective even without the voided provision or provisions.
Finally, the court agreed to decide whether — as one federal appeals court ruled — the litigation surrounding the individual mandate must be deferred until 2015 because of the 1867 “Anti-Injunction Act,” which bars courts from striking down tax laws before they take effect.
The court allocated an extraordinary five and one-half hours — the most time in many decades for related challenges to a single new law — for argument on all these issues combined.
How The Case Got Here
The court’s announcement Monday centered on a challenge to the law by 26 state governments. The 11th Circuit Court of Appeals in Atlanta voted in August to strike down the individual mandate but to leave standing the rest of the health law, including the Medicaid expansion. All three of the petitions granted today involve that case.
In other action, though, the D.C. Circuit and the 6th Circuit, centered in Cincinnati, have upheld the individual mandate, with opinions supporting the Obama position by two of the nation’s leading conservative judges, the D.C. Circuit’s Laurence Silberman and the 6th Circuit’s Jeffrey Sutton.
Another appeals court, the 4th Circuit, said courts have no power to decide the individual mandate issue until 2015, when the first monetary penalties will be due for failing to comply with the individual mandate to buy health insurance. This decision held that the penalty provision is a “tax” within the meaning of the Anti-Injunction Act, as described above.
If the justices agree that the Anti-Injunction Act applies, this year’s case will be perhaps the greatest anticlimax in Supreme Court history. And, the justices’ assignment of a full hour of oral argument to this question suggests that some take this issue very seriously.
Meanwhile, the purpose of the individual mandate is to force millions of Americans to obtain health insurance — whether they want to or not — in order to offset the costs that health insurers would bear under the health care law’s requirement that they sell insurance to everyone without charging those with especially costly health problems more than healthy people.
The lower court judges who have struck down the mandate have cited as their reasoning the lack of any precedent for Congress to require people to buy a commercial product they don’t want and the government’s failure to show how — if the individual mandate is upheld — a limit enforceable by the courts could be applied to this exercise of congressional power.
As background, the two Supreme Court decisions since’37 that have struck down acts of Congress as exceeding the commerce power, one in’95 and one in 2000, stressed that Congress’ commerce power must be restrained by some principle that could be enforced by the judicial branch of government.
Defenders of the individual mandate stress other Supreme Court precedents suggesting that even economic decisions that have a tiny direct effect on interstate commerce — such as a person’s decision not to buy health insurance — cumulatively have major effects on interstate commerce and thus can be regulated by Congress.
With the court’s announcement today, none of the justices recused themselves from hearing the case. Some conservative opponents of the health care law have suggested that Justice Elena Kagan should recuse herself because of her prior work as President Obama’s Solicitor General. And some liberals have suggested that Justice Clarence Thomas should recuse himself because of his wife Virginia Thomas’s political activities opposing the health care law. But the decision on recusal is left to each individual justice and it would have been announced with today’s order.
Meanwhile, as is customary, the Court announced the grants of review with no comment or indication of the vote. Any four justices can agree to review a case. And, given the importance of the issues, with federal appeals courts divided, today’s announcement was widely expected.
Most but not all Supreme Court experts predict — some very confidently, some cautiously — that the Court will uphold the law. The Supreme Court’s four liberals are certain to uphold the law. They would need only one more vote to prevail. While Justice Clarence Thomas seems a sure vote to strike the law down, Chief Justice John Roberts and Justices Anthony Kennedy, Antonin Scalia and Samuel Alito are harder to call.
A decision in June — or before — would help make the future of health care law a central issue in the 2012 presidential campaign.
Taylor, an author and journalist, is a nonresident fellow at the Brookings Institution.
– Provided by Kaiser Health News.
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Some cases of Alzheimer’s may be transmitted
Houston, TX, United States (AHN) – Some cases of Alzheimer’s disease may be transmitted similar to other infectious illnesses, according to a new study.
Researchers with the University of Texas Health Science Center at Houston said that the brain damage associated with Alzheimer’s may originate in a way similar to that of what are known as infectious prion diseases such as mad cow disease, or bovine spongiform.
“Our findings open the possibility that some of the sporadic Alzheimer’s cases may arise from an infectious process, which occurs with other neurological diseases such as mad cow and its human form, Creutzfeldt-Jakob disease,” researcher Claudio Soto said in a statement.
Soto said the underlying mechanism of Alzheimer’s disease is “very similar” to the prion diseases.
“It involves a normal protein that becomes misshapen and is able to spread by transforming good proteins to bad ones. The bad proteins accumulate in the brain, forming plaque deposits that are believed to kill neuron cells in Alzheimer’s,” Soto said.
Soto and his colleagues injected the brain tissue of a confirmed Alzheimer’s patient into mice and compared the results with a group of mice injected with the tissue of someone without the disease. None of the mice injected with the control showed signs of Alzheimer’s, but all of the rodents injected with Alzheimer’s brain extracts developed plaques and other alterations associated with the disease.
“The mouse developed Alzheimer’s over time and it spread to other portions of the brain. We are currently working on whether disease transmission can happen in real life under more natural routes of exposure,” Soto said in a statement.
A full report on the study appears in the Oct. 4 online issue of the journal Molecular Psychiatry.
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Exercise shown to help combat brain fatigue
Charleston, SC, United States (AHN) – Those suffering from brain fatigue may want to consider starting an exercise regimen.
Researchers at the University of South Carolina said a new study confirms that exercise increases the brain cells responsible for generating energy.
An increase in these brain cells, called mitochondria, is thought to be behind many of the positive physical effects of exercise, including increased strength and endurance.
The researchers conducted their work on lab mice, which were assigned to either an exercise group that ran on a treadmill six days a week for an hour, or to a sedentary group. After eight weeks, the scientists examined the brain and muscle tissue from some of the mice in each group to test for signs of increased mitochondria.
The exercise group experienced in increase in mitochondria in their muscles, and they increased their run to fatigue time from about 74 minutes to about 126 minutes. No change was seen for the sedentary mice.
A full report on the study appears in the American Journal of Physiology – Regulatory, Integrative, and Comparative Physiology.
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FDA to review safety of bone drugs
Washington, D.C., United States (AHN) – Two U.S. Food and Drug Administration advisory panels will meet on Friday to review popular bone drugs. Included in the panels’ agenda is to discuss a possible recommendation for women to rest first from taking the medication due to concerns over side effects on long-term use.
The comprehensive safety review to determine if it is safe for females to use the bone drugs beyond three to five years comes 16 years after the drugs such as Fosamax were launched into the market.
The FDA recommendation is expected to affect about four million women in the U.S. who take biphosphonates, which inhibit the bone renewal process by adding bone mass. However, its possible side effects include causing the bones to become brittle.
The FDA review will cover at least four branded bisphosphonates and generic counterparts, used for the treatment and prevention of osteoporosis. It includes:
- Fosamax (alendronate sodium) tablets and solution and Fosamax Plus D made by Merck
- Actonel (risedronate) and Actonel with calcium made by Warner Chilcott
- Bonivia (ibandronate sodium) tablets and injection made by Roche, and
- Reclast (zoledronic acid) made by Novartis.
Among the reported risks to long-term use of the osteoporosis drugs are jawbone death, unusual broken thigh bones and esophageal cancer. Due to those risks, the FDA ordered in October the manufacturer of the drugs to add a warning of the higher risks for atypical femur fractures and in 2005 a warning for osteonecrosis.
Because of the side effects, Merck has 1,115 lawsuits over jaw damage and another 535 over unusual femur fractures and other bone injuries.
After the patent of Fosamax, which was launched in 1995, expired in 2008, generic versions of the medication came out in the market.
In 2010, global sales of bone drugs reached $7.6 billion, which went down from a peak of $8.8 billion in 2007.
The FDA is expected to issue a report on the results of the Friday discussion on Wednesday, Sept. 14.
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Readers Face Multiple Dilemmas About Insurance Coverage, Costs
Washington, DC, United States (KaiserHealth) – This week, we address readers’ questions about health insurance coverage and costs.
My son was denied coverage on the basis that he had been drinking before going to the ER with a broken shoulder. Is drinking a legitimate reason for denial of coverage? John Johnson, Tucson, Ariz.
More From This Series Insuring Your Health
As of 2008, 36 states allowed insurers to exclude coverage for injuries related to alcohol and/or drug consumption, according to research from George Washington University’s Department of Health Policy at the School of Public Health and Health Services.
The practice dates to’47 when, as a way to discourage drinking, the National Association of Insurance Commissioners adopted a model statute that excluded coverage of alcohol-related health claims. More than 40 states and the District subsequently passed such laws.
But as the benefits of drug and alcohol treatment programs became apparent, these laws were recognized as counterproductive, since they discouraged emergency department and other medical personnel from screening people for and counseling them about drug and alcohol abuse. In 2001, the NAIC reversed course and recommended that such laws be scrapped.
My husband had a stroke in December, and the insurance reps refused to discuss his account with me because they didn’t have his signature on a form, and he couldn’t tell them over the phone it was okay to talk to me. And it is MY insurance! They said they had to follow HIPAA [the Health Insurance Portability and Accountability Act, which protects patients' medical privacy]. Is this true? Name withheld, Lawrenceville, Ga.
It’s a common misperception by health-care providers and insurers that HIPAA prohibits them from discussing patients’ medical information with family members, says Deven McGraw, director of the health privacy project at the Center for Democracy and Technology, a civil liberties group that promotes health privacy. “It’s not true; it has never been true,” she says. Unless the patient objects, such information can be shared with family members.
Advance planning documents can help avoid confusion and heartache, say experts. A living will spells out what if any measures you wish to have taken to prolong your life — being put on a breathing machine or on dialysis, for example. A health care proxy names the person you choose to make medical decisions for you in the event that you can’t do so yourself.
In addition, most states have surrogacy laws that assign decision-making responsibility to family members based on their relationship to the patient. Typically, if someone is incapacitated, state law would assign decision-making to the patient’s spouse, says Jay Horton, clinical program manager at the Lilian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York. If there is no spouse, the laws spell out who would be assigned to make decisions instead, based on their relationship to the patient.
Our doctor recommended that my husband get a preventive colonoscopy since it had been five years since his last one. The doctor found two benign polyps and removed them. Our [health] plan was to cover 100 percent for a preventive colonoscopy. Because the doctor removed the polyps during the procedure, it is now not covered. We have to pay the deductible, and the balance owed. I can assure you that many, many people will not have this procedure done (as I will not) when they are made aware of the additional costs involved. Pam Nevin, Rutherfordton, N.C.
Under the new federal health law, Medicare beneficiaries and members of new private health plans starting this year can generally receive free colonoscopies to screen for colon cancer if they meet age and other criteria.
Unfortunately, like you, others have been hit with sometimes substantial charges if a growth or mass called a polyp is discovered during a routine screening colonoscopy they thought would be free. Once a preventive procedure turns into a diagnostic procedure or other type of treatment, providers can charge you for it under the new law. According to the interim final rules: “A plan or issuer may impose cost-sharing requirements for a treatment that is not a recommended preventive service, even if the treatment
results from a recommended preventive service.”
Some experts have expressed concern that colonoscopy charges raise questions about what other newly free preventive services might incur similar hidden costs. Fortunately, it doesn’t appear that it will be a widespread problem, says Stephen Finan, senior director of policy for the American Cancer Society’s Cancer Action Network. The reason: Colonoscopies appear to be the only procedure covered under the new guidelines for free preventive care where both prevention and diagnosis happen during
the same procedure. Usually they’re separate, as when something suspicious turns up on a woman’s mammogram. In that case, a separate procedure such as a biopsy would be scheduled to diagnose the problem, says Finan. “Colonoscopy is a very unique scenario,” he says.
Got a question for Michelle Andrews to answer in a future column? khnquestions@kff.org
– Provided by Kaiser Health News.
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- Florida university tests Cuba travel ban before Supreme Court
- Los Angeles area school district bans flavored milk
- Government strips Arroyo scholars of aid, forces ex-leader to shoulder tuition of student
- Government strips Arroyo scholars of aid, forces ex-leader to shoulder tuition of student
- Free Homeowner Help Workshop in Temecula, California on June 23rd
- U of I wants $100 million for scholarships
- Loans
- Clock ticking for Egypt’s finances
- Payroll-tax cut pact passes Congress
- Employers added 243,000 jobs in January
- Mass. Governor Patrick disappointed in Bruins goalie’s snub of Obama
- Nation’s Mayors Support Gay Marriage But Complain About Unemployment
- U.S. unemployment claims drop to 372,000
- Myanmar president Sein uses Independence Day to reaffirm army role
- No. 1 worry among Americans is the economy
- Moody’s downgrades top three French banks
- German exports fall more than expected
- Loans
- SEC Warns Top Banker of Charges Over Magnetar Deal
- World Bank president plans to leave in June
- Congress considers new foreign guest worker program
- Greek political leaders reach deal on austerity measures
- Roseanne Barr running for president
- Home prices continue to fall
- U.S. stocks fall as GDP trails forecast
- Wall Street opens mixed Friday on GE, Google earnings
- ‘Expat Unfriendly’: Fighting words for the UAE
- Atlanta’s tallest building heading for foreclosure
- Personal Loans
