By MARSHA SHULER
Advocate Capitol
News Bureau
The Jindal administration is preparing to hire a firm that
will be charged with helping Medicaid patients with diabetes, asthma and
congestive heart failure stay out of emergency rooms and hospitals.
The state’s
disease management initiative is hung up in the national debate over how to
reshape health care.
The state health
agency is moving ahead with a program of using $10 million in state and
federal funds appropriated during the 2009 legislative session, state
Department of Health and Hospitals Secretary Alan Levine said.
The idea is to
curb escalating Medicaid costs. Medicaid is the government insurance program
for the poor.
“We made the
decision to move this forward because we cannot afford as a state to wait for
Washington,”
Levine said.
Exactly how it
will fit in or augment a program that LSU’s hospital division has been
operating since the beginning of the decade is unclear.
The LSU program encompasses
six disease conditions and specially trained personnel who monitor and
educate patients that use system hospitals and outpatient clinics, said Dr.
Michael Butler, executive director of LSU’s Center for Health Care
Effectiveness and Quality.
According to LSU
statistics, the program has saved some $20 million over the years as a result
of its work with congestive heart failure, diabetes and HIV/AIDS patients
alone because of fewer emergency room visits and inpatient hospital days.
“It’s money we would have had to come up with somewhere or
those people would have been out of luck,” said Butler.
The program also
covers asthma patients, cancer screening and chronic kidney disease, Butler said.
Levine said his
agency will be seeking proposals from contractors soon to implement the
disease management program that will target Medicaid recipients with chronic
conditions. He said his agency used “various pieces of successful programs in
several different states to develop our program.”
“We will look at what
we are paying out and look at the claims data” to identify high-cost Medicaid
recipients who could benefit from having someone help them do the things
needed to avoid medical crisis, Levine said.
“Ultimately the
consumer decides whether they want to participate,” Levine said.
The most high cost
and frequent hospital or emergency room users because of diabetes, asthma or
congestive heart failure will be targeted first, he said.
Levine said the
state program would expand to other conditions such as hypertension, sickle
cell and HIV/AIDS in the future.
The company will
have representatives that, for instance, can visit with the patient and his
family to educate them about the care plan a physician has ordered, Levine
said. And, he said, the representative can track to see if a patient is
taking their medication.
The contractor
would have access to state health department data on the Medicaid client
under the Chronic Care Management Program, Levine said.
“The care manager
might look to see if, for instance, they have a script for Albuterol (an asthma medication),” he said.
“If they do, and
it was for a 30-day supply, but the care manager notices they hadn’t refilled
it after the 35th day, the care manager would call the patient to make sure
they are taking their meds, and if not, would find out what the patient needs
in order to take their meds,” Levine said.
http://www.2theadvocate.com/news/51830282.html?showAll=y&c=y
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Louisiana Medical News | 07.28.09
TED GRIGGS
LSU Physicians
Worry about Lake Collaboration | LSU, Our Lady of the Lake Regional Medical
Center, Earl K. Long Medical Center, graduate medical education, cooperative
endeavor
The advantages of
a proposed deal to make Our Lady of the Lake
Regional Medical
Center the Baton Rouge teaching hospital for LSU are
obvious, such as better-maintained facilities and newer technology for
patients, medical students and residents. But physicians at Earl K. Long Medical
Center wonder how the Lake will manage to integrate medical training and
treatment of poor patients in a community hospital setting.
Dr. Paul Perkowski, president-elect of the Capital Area Medical
Society, said there are a lot of misgivings and misunderstandings about the
process for physicians at both hospitals. There are lots of issues to
resolve, he said.
For instance, will
the Lake be able to maintain the high
quality of education that medical students and residents now receive at Earl
K. Long?
"That
question hasn't been answered and that really is the biggest concern of
doctors like us who train residents and medical students," said Perkowski, a surgeon with privileges at both Earl K. Long
and the Lake.
There are a number
of other questions, Perkowski said. Will residents
feel as connected to the patients at the Lake
since the patients will ultimately be the responsibility of a community
doctor? Can the Lake's radiology department,
nursing staff, and emergency room – already operating at high capacity –
handle the influx of patients? Whose responsibility are those patients? Will
there be different groups of doctors for LSU patients and the Lake's? How will that affect the LSU patients' care?
Will insured patients take precedent over uninsured patients?
Physicians at both
hospitals are in the dark, Perkowski said.
Meanwhile,
officials at LSU and the Lake have said they
would like to complete a cooperative endeavor agreement by the end of the
year.
Dr. Richard Vath, the Lake's vice
president of medical affairs, said the reason so many questions remain
unanswered is that both sides began by taking "the 50,000-foot
view" to see whether the collaboration could work in theory.
"What you
hear now, I think, is a lot of anxiety about some of the details…and we
haven't actually gotten into any of the details," Vath
said. "We recognize the devil is in the details, but we have really
remained at a very high level conceptually."
Both sides made a
conscious decision not to address the impact on individual physicians,
individual staff, and individual services, Vath
said. The reason people are anxious about the proposal is that they believe
the details have been worked out, when in fact they have not.
Vath said the shift from Earl K. Long to the Lake is such a large-scale endeavor that it could take
two to three years to complete.
While many
elements need to be worked out, the Lake has
some definite ideas about how care will be provided, Vath
said.
The Lake views the move as an opportunity to improve the
access of patients and physicians in training to "best-in-class"
technology and facilities, Vath said. There is no
physician gap; it's just that Earl K. Long doesn't provide some services that
the Lake does.
"As far as
having those patients treated, it was very important to us that we actually
offer the same benefit to those patients that we offer to our current
patients," Vath said.
The LSU patients
will not be segregated from the Lake's other
patients, Vath said. If an LSU patient needs
specialty care from, say, the orthopedic unit he or she will go to the
orthopedic unit.
Vath said having academicians work side-by-side
with community physicians is a great opportunity for both.
The LSU doctors
would enhance the Lake's ability to keep up
to date and push the envelope in terms of the academic knowledge base, he
said. The Lake's physicians will give the
academicians, students and residents the opportunity to learn some of the ins
and outs of day-to-day medical practice.
"We saw it
again as a nice complement that we would bring to each other," Vath said.
He also said
graduate medical education fits well with the community hospital's mission.
There was a great
deal of concern after Hurricane Katrina that there would not be enough
physicians to treat patients, Vath said. The Lake's primary goal in entering into graduate medical
education was to provide for physician training, to ensure that there would
be a supply of doctors.
The current
proposal calls for spending $129 million to build additional facilities on
the Lake's campus.
Perkowski said LSU physicians would like to know
that other options are being explored, such as expanding the former Vista outpatient surgery facility on Perkins Road or buying the existing
Woman's Hospital when that hospital moves to its new campus.
"I think what
everyone would like to see, at both facilities, is why this is the best plan,
and why this is the only plan for graduate education and indigent care,"
Perkowski said.
http://www.louisianamedicalnews.com/news.php?viewStory=1356
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University Medical
Center Nurses Receive Awards
Louisiana Medical News | 07.28.09
LAFAYETTE – The Louisiana
State Nurses Association, District IV, presented professional achievement
awards to five members of the University
Medical Center
nursing staff during the district’s annual Acadiana
Celebrates Nursing program.
Cameron Foreman,
RN, nurse educator recognized for his leadership skills, role as a mentor,
and unyielding support for students.
Lou Ann Gerard,
RN, UMC director of patient relations, was recognized for her nursing
expertise and patient advocacy.
Dawn Huggins, RN,
BSN, was recognized for her improvement of UMC employee assistance, health
and safety programs.
Lisa Judice, RN, BSN, head of nursing for the Intensive Care
Unit, was recognized for training UMC staff in post-Katrina kidney transplant
services, her service on hospital committees, and development of the ICU Venthilator Care Bundle.
Peggy McCabe, RN,
MSN, nurse educator, was recognized for her comprehensive knowledge and
teaching of pediatric care.
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Leslie Capo
The latest
findings of the North Carolina-Louisiana Prostate Cancer Project reveal
potential new targets for reducing racial disparities in prostate cancer
survival and highlight the importance of the health care delivery system. The study reports differences in physician
trust, access to care, and continuity of care between African American and
Caucasian men which result in advanced prostate cancer at the time of
diagnosis and contribute to the higher death rate among African American men.
The study is published in the early view issue of Cancer online July 27, 2009.
Study nurses
conducted in depth in-home interviews with more than 1,000 North
Carolina and Louisiana
men age 50 and up, newly diagnosed with prostate cancer. Data in this manuscript were obtained from
the interview and from medical record review.
This study
examined health care system factors that may influence outcomes. System
factors include availability of health care facilities, the services offered
at those facilities, the systems in place to trigger appropriate utilization
of those services, and clinician time pressures or encounter characteristics
may impede their ability to fully address patient needs. Other factors such
as provider bias, erroneous stereotypes or lack of understanding of
minorities may also influence patient trust, health behaviors, and
receptivity toward seeking or utilizing health care services.
“The lack of
access to care, lack of a medical home and lack of a relationship with a medical
provider may result in a delayed diagnosis that translates to advanced
disease and higher rates of death from prostate cancer for African
Americans,” notes Elizabeth T. H. Fontham, DrPH, Dean of the School of Public Health at LSU Health
Sciences Center New Orleans, who is the principal investigator of the
Louisiana portion, and co- principal investigator of the entire study.
In this study, the
stage at diagnosis of prostate cancer was similar between African American
and Caucasian men, but African American men had more aggressive cancer as
measured by Gleason score. Compared
with African Americans, Caucasian men exhibited higher physician trust scores
and a greater likelihood of reporting a physician office as their usual
source of care, seeing the same physician at regular medical visits, and
being screened for prostate cancer. African American men were less likely to
report prostate cancer screening prior to diagnosis, and men without a prior
history of screening were more likely to be diagnosed with advanced stage or
high grade prostate cancer than men who reported a history of screening. “Importantly, no differences in
prostate cancer stage at diagnosis were observed between men of either race
when an established relationship with a healthcare provider existed,” notes
Elizabeth T. H. Fontham, DrPH,
Dean of the School of Public Health at LSU Health Sciences Center New
Orleans, who is the principal investigator of the Louisiana portion, and co-
principal investigator of the entire study. “Through an ongoing relationship
with their health care provider, patients’ health status and risks are known,
trust builds over time when consistent, high quality interactions between
patients and providers take place, and patients are more likely to make informed
decisions and receive more timely diagnosis and treatment.”
According to the
American Cancer Society, prostate cancer has the highest incidence of cancers
among US men and is the second most deadly. The prostate cancer incidence
rate among African Americans is 55% greater than among Caucasian men, and the
African American death rate is two and a half times that of Caucasian men.
The researchers
conclude that addressing components of how health care is delivered,
including care continuity, has the potential to meaningfully address the
mortality disparity observed for prostate cancer.
Funded by the
Department of Defense, the North Carolina-Louisiana Prostate Cancer Project
is a population-based study of individuals identified shortly after prostate
cancer diagnosis designed to produce clinical data and identify racial
disparities in prostate cancer, to help determine the best approach to reduce
prostate cancer mortality.
Study authors
include Dr. Fontham, William Carpenter, PhD,
Research Assistant Professor of Health Policy and Management in the
University of North Carolina Gillings School of
Global Public Health, James Mohler, MD, Chair of
the Department of Urology at Roswell Park Cancer Institute, principal
investigator of the Consortium, and other researchers at these institutions.
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Keith Holmes
I appreciate the
letter from Dr. C. Ray Halliburton on his wish list for health-care reform.
I don’t think
there is anyone with any knowledge of health care who doesn’t think we need
reform. The question is how. As they always say, “The devil is in the
details.”
I agree with the
vast majority of Dr. Halliburton’s wish list and would like to add a few
more, if I might.
I think Washington, D.C.,
would do well to listen to the average, on-the-frontlines physicians, which
so far it has not.
First, any reform
must empower the patient to take responsibility for his/her health-care
dollar. We must make the patient part of the decision-making process and tie
the patient financially to the process.
To have this
disconnect, as the current system is, promotes wasteful and unnecessary
spending. No thought is given to, “Do I really need that $2,000 MRI of my
back?” It is just done because neither the patient nor the physician has any
financial negative incentive. The only program I know of that begins to fill
this role is health care spending accounts.
Secondly and
probably even more important, make sure whatever Congress saddles us with,
its members, too, need to be included in the program. No more special perks
and separate insurance programs for themselves. If it is good enough for us,
it must be good enough for them. I suspect if we use this as our litmus test,
Congress will pass something much more prudent and wise.
Lastly, what I
don’t want is some bureaucrat in Washington
telling us how to practice medicine. Creating more paperwork will not save us
health-care dollars.
Each and every
patient is unique. It is not a perfect science but an art. There is more to
treating patients than just pure science. It involves trust and building
relationships.
Keith Holmes
physician,
internal medicine
Central
http://www.2theadvocate.com/opinion/51946122.html
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Delia Anderson
As a professional
who was prevented from changing jobs because of health insurance concerns, I
am hoping that Sen. Mary Landrieu will reconsider her position on the current
health care reform issue.
I knew that my age
(62) and a "pre-existing" condition would prevent me from getting
affordable health insurance. But this is not even the issue that concerns me
most. It is the 46 million without health care.
I am satisfied
with my current coverage, but it was achieved through twists and turns and
waiting and a complex private bureaucracy that was nearly impossible to
negotiate.
Advertisement
I had to spend
more than six valuable months of my life to reach a just outcome.
For this reason
and many, many others, I support a public option. How can we possibly
continue to allow the medical and insurance lobby to prevent this option?
All we have to do
is look at what they have "managed" to do, or not do, for the 46
million uninsured. I am appalled at them and at the senator's position.
We have a choice:
private insurance companies who deny basic health and care and coverage vs. a
Medicare-like system that is competitive, affordable, managed and much like
what is available to Mary Landrieu as a U.S. senator!
This is not the
time to slow down. We have a chance with President Obama and the younger
generation moving into power.
There could not be
a more important issue, or a more perfect time to take an honorable (not
political) stand for the people of Louisiana!
Both my husband
and I are in our mid-60s and earn an income that is likely to be taxed to
fund health care reform.
And why not us?
We have benefited
from the opportunities in this country and certainly understand that we have
a responsibility to participate in the well being of others.
Delia Anderson
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/124884481373660.xml&coll=1
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Developing a swine
flu vaccine in time for flu season is a challenge that scientists are
struggling to meet, but convincing people that they need to be inoculated is
crucial, too.
Given the short
time frame, there won't be enough doses for everyone to get a swine flu shot
this fall. Health experts are meeting now to figure out who should get the
limited supplies. Children likely will be first in line, along with those who
have health conditions that put them at higher risk.
An Associated
Press poll shows that two-thirds of adults think it's a good idea for their
children to be inoculated against the virus, and that's encouraging.
But only one-third
of those polled say they're likely to be vaccinated themselves. Adults aren't
immune to swine flu, and a sense of complacency could prove to be a public
health problem.
The Centers for
Disease Control and Prevention say that 40 percent of Americans could
contract swine flu this year and next, and hundreds of thousands could die
without a successful vaccination drive and other measures.
Regular seasonal
flu claims about 36,000 lives in the United States each year. So far,
swine flu has killed 300 Americans, even though there have been nearly 1
million cases. That's likely to change once school reopens and colder weather
sets in.
Health experts are
worried about this strain, in part because it has continued to spread during
the summer months, which is unusual.
If all goes well with
testing next month, swine flu inoculations will be available in October.
Those deemed most vulnerable need to take advantage of that protection. And
as the vaccine becomes more available, a broader effort to inoculate
Americans must take place.
http://www.nola.com/news/t-p/editorials/index.ssf?/base/news-5/124884550091340.xml&coll=1
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Senate Majority
Leader Harry Reid's recent announcement that there will be no final vote on a
health care plan before the August recess should be greeted with relief. The
key domestic issue of the time deserves more reflection and debate.
We should all
agree that we pay too much - at least a third more per capita in combined
public and private spending than most other Western industrialized nations -
for much too little in the way of public health outcomes.
Up to 50 million
Americans have no health coverage. We can debate the reasons, but if those
people show up in the emergency room, we're still stuck with the tab.
Even so, the need
for change doesn't translate into a need for reckless speed. We have
questions to answer:
# Louisiana Gov.
Bobby Jindal's administration has proposed
expanding the number of uninsured Louisiana
residents covered by Medicaid while attempting to lower costs by offering
recipients competing private coverage plans. Is there a way here to use the
government's reach to avoid a big new bureaucracy and to cover more people
more cost-effectively?
# We know the United States
tends to have a lower life expectancy and a higher infant mortality rate than
other Western industrialized nations. Yet the outcomes for some specific
medical treatments are better in the United States than elsewhere. How
can these things be? Is our generally lackluster public health performance
the result of factors such as obesity, smoking and violence and not our
health-care system? Or does the better access to care in other nations
translate into better preventive care and healthier populations?
# U.S. Sen. Jim
DeMint, R-S.C., has described health care as a political opportunity to hurt
President Barack Obama, casting the senator's sincerity into doubt. But
DeMint also argues that the government is artificially raising insurance
costs by preventing real interstate competition. Meanwhile, insurers that
compete to administer large group plans - including those that cover
employees in many states - certainly aren't holding the line on costs. Who's
right? We need to know whether government is artificially raising premiums.
# The same forces
that make American health care more profitable also fund medical research and
development, creating the breakthroughs that cure diseases and extend lives
here and abroad. If we reduce those costs, are we risking the advances that
keep us healthy?
We know, as the
president says, that an aging population threatens to drive government
spending far beyond sustainable levels. That's a good argument for doing
health care right, not for undue haste.
http://www.theadvertiser.com/article/20090729/OPINION01/907290324/It-s-good-to-go-slow-on-health-care
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Louisiana ranks 49th in national study of
children's quality of life
by Amber
Sandoval-Griffin
Despite some
incremental improvements over the past few years, Louisiana
children continue to be worse off than their counterparts in every state but Mississippi, according
to various statistical measures analyzed in the 2009 KIDS COUNT Data Book, an
annual study released Tuesday.
More troubling,
analysts see harder times ahead thanks to the still-lurching economy, the
study says.
The data book, the
20th annual report on child well-being compiled by the Annie E. Casey
Foundation of Baltimore, found that Louisiana has among
the nation's highest percentages of low-birthweight
babies, infant mortality, teen death and children with unemployed parents.
Overall, Louisiana ranked 49th of 50 states in the report, which
used data from 2006 and 2007 from the U.S. Census Bureau and the National Center for Health Statistics. The new
data was compared to data from 2000 to measure changes over the past decade.
Despite the low
ranking, Louisiana
bucked a national trend by not seeing an increase in child poverty. While
child poverty in America
has inched up since 2000, the rate has remained steady in Louisiana at 27 percent. For families with
two adults and two children, an income below $21,027 is considered poor.
"What's
surprising is the child poverty rate," said Laura Beavers, National KIDS
COUNT coordinator in Baltimore.
"In almost every other state there was an increase in the child poverty
rate, and this wasn't the case in Louisiana."
Since 2000, Lousiana's teen birth rate has improved, meanwhile,
dropping from 62 births per 1,000 females ages 15 to
19 in 2000 to 54 per 1,000 in 2006. In this area, Louisiana did slightly better, ranking
39th of 50 states and following a national trend toward a lower teen birth
rate.
"This is a
concerning trend because we know . . . as the economy worsens, teen birth
rates do tend to rise," said Teresa Falgoust,
KIDS COUNT coordinator for Agenda for Children.
Falgoust said that some experts theorize that as
the economy has slumped, the incentive to delay child-bearing seems to be
disappearing. But she says they will not understand the shift fully until
more data is released.
Other areas of
improvement for Louisiana:
the number of idle teens, meaning teens not attending school and not working.
That number decreased from 42,000 teens in 2000 to 32,000 teens in 2007.
The child death
rate also improved dramatically, falling from 297 child deaths in 2000 to 219
child deaths in 2007.
But Falgoust is troubled by forecasts for increased child
poverty, which in turn is likely to affect the other indices.
"Almost all
of these indicators are affected by poverty," Falgoust
said. "That's really the one indicator that drives everything else, so
when we see that indicator rising it really concerns
us about the overall well-being of children."
http://www.nola.com/news/index.ssf/2009/07/louisiana_ranks_49th_in_nation.html
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By Karina Donica
The Louisiana
Department of Health and Hospitals has announced a series of local events to
inform parents of uninsured children about resources available to insure
their little ones.
The back-to-school
enrollment drive is designed to provide information on the Louisiana
Children's Health Insurance, known, as LaCHIP. The LaCHIP Affordable Plan and Medicaid programs are
available to children age 19 and younger.
"We certainly
encourage parents, caregivers and grandparents to apply. If there is a need,
your needs can be met with health insurance coverage through these
programs," said Lester Turner of LaCHIP.
Turner said while
many parents have taken advantage of the insurance programs available, there
are still many uninsured children in Central Louisiana.
By the end of
June, there were as many as 24,000 Rapides Parish children under the age of
19 under some type of public insurance program. According to a two-year-old
estimate, as many as 1,800 to 2,000 children are uninsured in Region 6,
Turner said.
Turner said it's
especially important to get the word out due to economic uncertainties of the
times. Many families may have found they are no longer covered due to layoffs
or other situations, he said.
"When those
circumstances occur the Medicaid program and the LaCHIP program is there," to help, Turner said.
Some of the events
will be held starting Saturday and run through Aug. 8 at different locations,
including the Alexandria Zoo, New Haven Baptist Church in Colfax and the Winn
Parish Health Unit.
In order to reach
as many uninsured children as possible, LaCHIP
officials said they are expanding hours of operation for its toll free number
-- 1-877-252-2447 -- from 7 a.m. to 7 p.m., Aug. 3 through Aug. 7.
Region 6
Administrator and Medical Director Dr. David Holcombe, whose office is also
disseminating information about health insurance, said the events are a great
opportunity for local families.
The statistics of
children's health coverage have come a long way in the past few years,
Holcombe said, but there is room for improvement.
"I encourage
(parents) if they have children who are eligible to certainly sign them
up."
Holcombe also
invites parents to vaccinate the children during the upcoming vaccination
drive. Dates for that drive will be forthcoming, he said.
The LaCHIP program is for families with income at or below
200 percent of the federal poverty level -- or about $3,675 per month for a
family of four, officials said in a press release.
With the LaCHIP Affordable Plan, families with income between 200
percent and 250 percent of the federal poverty level -- up to $4,594 for a
family of four -- may purchase health coverage for a $50 monthly premium,
plus co-payments.
Each event will
feature information about various health coverage programs. Applications will
processed on the spot, including for program
renewals. There is no penalty if you don't qualify.
http://www.thetowntalk.com/article/20090729/NEWS01/907290317
[BACK TO TOP]
Meg Farris /
Eyewitness News
NEW ORLEANS – It's a medical condition that can kill
instantly. Often it happens to people who seem healthy, in the prime of their
lives.
Video: Watch the
Story
Most people don't
get a warning of the danger that lies ahead, but one Northshore
mother did.
Becky Winchell,
42, can't believe she is back to her normal active routine, a routine that
involves a regular tennis match. Just two days after Easter, something felt
terribly wrong.
"It is the
worst headache you've ever experienced. I mean it's an incredible amount of
pain," said Rebecca "Becky" Winchell.
"We went from
a nice evening to hell within a minute," said her husband Andy Winchell.
Fluid rushed to
her head, and with a stiff neck, blurred vision and vomiting, she was rushed
to the E.R. But Becky Winchell said in a head scan, using no contrasting dye
running through her vessels, things looked okay. She was sent home.
"Two hours
later I woke up and it was the same feeling and I just told my husband,
'We've got to go back' and that's when they ordered a spinal tap. And when
they did the spinal tap, they realized there was blood in my spinal
fluid," said Becky Winchell.
Becky Winchell was
rushed to West Jefferson
Medical Center
from her home in Covington.
Members of the LSU Health Sciences Center Neurosurgery team knew it was
extremely serious. Dr. Robert Dawson could see the aneurysm deep in her
brain.
"If the
aneurysm ruptures 30 percent of patients do not make the hospital. That's the
bad part. Another 30 percent will succumb to their aneurysm even though they
make the hospital. They will either die or have a very bad outcome,"
said Dawson, an LSU Health Sciences Center Neurosurgeon and Radiologist who
is a member of the Culicchia Neurological Clinic.
Dawson said it wasn’t a very big aneurysm.
"This is
actually a relatively small aneurysm in a terrible place," added Dr.
Dawson while looking at Becky Winchell’s brain scan.
There were two
choices: brain surgery to clip off the protruding bubbled area of the artery
or the less invasive coil method, without ever opening up the skull.
Three-dimensional imaging was crucial to see through all the overlapping and
twisting of vessels and exactly how to get to it.
Dawson decided to use the coil method. He started
by threading an instrument into a vessel in the groin area going all the way
up to the exact spot in her brain. Once there the bubble is filled up with a
strong platinum-like metal, coiling tightly like a Brillo
Pad.
But now the latest
technology makes the coil method even better. It has a hydrogel
coating that is secreted, soaking up water swelling and filling up the empty
space between the metal wires, making the seal in the bubble even stronger
for the rest of her life.
"At first
people were very skeptical that this was going to work," said Dawson. "People
have been trying to treat aneurysms for a long time and it turns out, we're
quite a bit better than anybody every dreamed we would be."
People are born
with a weak spot in a blood vessel. It usually takes 40-60 years for problems
to show up. High blood pressure and smoking increase the risk. Many don't get
a warning as Becky did.
"I'm more
patient in traffic and if I lose a tennis match I'm like, 'It was fun who cares.' You know, nothing, the line in the grocery
store doesn't bother me as much," said Becky Winchell.
"We don't
take things for granted. Don't sweat the small stuff and we plan on traveling
a lot more," said Andy Winchell.
Now Becky Winchell
is an advocate of trusting your instincts about your health.
"When you
really think something is wrong, you need to say 'Look something is wrong, I
don't want to leave,' " she said.
And she believes
her second trip back to the E.R. is the reason she has a second chance to be
with her seven children.
There are no
routine, inexpensive screenings for aneurysms. If you have two or more
immediate, blood relatives who have had this condition, you are at higher risk.
http://www.wwltv.com/topstories/stories/wwl072709cbanyeurism.82bf6541.html
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Jindal
touts privatizing as solution to La.
woes
By MICHELLE
MILLHOLLON
Advocate Capitol
News Bureau
A week after
rallying around the private health insurance industry, Gov. Bobby Jindal Monday talked up the privatization of unspecified
state services.
Jindal mentioned privatization several times as a
way to cut costs. His audience was a commission that began work this week on
devising ways to streamline state government. The overarching goal is to help
the state grapple with huge budget shortfalls.
The governor asked
the Commission on Streamlining Government to be bold.
“It is absolutely
critical that the commission not just result in a study that sits on a
shelf,” he said.
The commission —
made up of legislators, business leaders and others — must submit
recommendations to the governor and other state officials by Dec. 15.
In a rare visit to
a legislative committee room, Jindal addressed the
commission that he wanted created. The governor made it clear how he thinks
state government can be streamlined: Privatize some state services.
He said Florida saved more
than $550 million through “nearly 140 privatization or managed competition
initiatives.”
The governor said
the state will have to cut costs as revenue shortfalls continue.
The Division of
Administration is projecting a $1 billion to $1.9 billion budget shortfall in
coming years, partly because of an increase in the state’s share of costs for
the Medicaid program for the poor and uninsured.
The budget crunch
already is forcing public colleges and universities to lay off select
employees and furlough many others.
The governor said
he wants state agencies to look for services that can be handled by the
private sector.
His stated
philosophy on the role of private companies in serving the public is
thrusting him into the national spotlight.
Jindal is critical of a proposal before the U.S.
Congress that could pit the federal government against private companies in
providing health-care coverage.
The governor
recently penned a Wall Street Journal opinion piece in which he predicted a
public option plan would drive private plans out of business.
“The government
plan will become so large that it will set, rather than negotiate, prices,” Jindal wrote.
The governor said
he wants his cabinet secretaries to identify programs, functions and
activities that can be privatized or outsourced.
He said he has
also asked his cabinet to:
* Identify a core vision for changes.
* Differentiate between what they are
required to do and what they are doing.
* Define non-core activities.
* Identify outdated activities.
* Identify underperforming programs.
* Identify duplication and overlap with
the private sector.
The commission is
supposed to recommend ways to reduce state government costs as it reviews
agencies.
As an example, Jindal pointed to the Steve Hoyle
Rehabilitation Center in Tallulah, which the state
corrections department used to operate.
The center now is
a female re-entry program operated by Madison Parish Sheriff Larry Cox.
The shift occurred
because the center was proving to be too costly, Jindal
said.
The commission of
nearly a dozen members will split into subcommittees to study various aspects
of state government.
The commission’s
chairman, state Sen. Jack Donahue, said it is not fair to cut every agency by
an equal percentage because there is no strategy in that.
Donahue,
R-Mandeville, said he hopes the commission produces a pile of information on
curtailing costs.
Only some of it is
likely to be palatable, he predicted.
Most of the
meeting focused on compiling a list of questions that commission members want
answered.
State Rep. Jim Fannin, D-Jonesboro, wants to know what other states are
doing to privatize and outsource.
State Treasurer
John Kennedy wants to investigate the layers of management at each state
agency.
Alexandria lumber company executive Roy O. Martin
wants to see state employees’ safety records.
The commission
will meet again Aug. 11.
http://www.2theadvocate.com/news/politics/51830417.html
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Louisiana ranks low in children's healthcare
Reported by
Crystal Price
Lake
Charles, LA (KPLC) - According to a newly released report, the
state of Louisiana
is far behind when it comes to children's well-being.
The Annie E. Casey
Foundation shows Louisiana's
child poverty rate in 2007 was the second highest in the country.
Louisiana is also ranked 49th on two basic measures
of babies' health-infant mortality and low birth weight babies.
Only half of Louisiana's children
are covered by public health insurance.
"People will
put off a lot of visits because they feel like they can't afford it,"
says Anatole Karpovs.
Doctors believe
the greatest concerns for improving child health care in our city are cost
and prohibitive insurance policies.
"A lot of
times there are middle class families who cannot afford to be insured, so
they take a risk," says Karpovs. "Because
if there is a catastrophic injury or illness, they're going to spend a lot of
money out of pocket."
The costs of
immunizations and vaccines can be up to $300 for uninsured patients.
"I really
feel there must be ways to reduce some of those costs or to control
them," says Karpovs.
Karpovs thinks patients might not completely trust
their children's pediatricians when it comes to vaccines.
"They don't
want to believe or they think pediatricians are biased," says Karpovs. "But we're really pushing this for a good
reason, to prevent some serious childhood illnesses."
Doctors say the
main way to prevent long term illnesses is to keep your child immunized and
healthy in their early years.
"These things
dovetail into adulthood and then you save a lot of money, not only that but
misery in the long term" says Karpovs.
http://www.kplctv.com/Global/story.asp?S=10807489
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Jamie Segura
Re:
"Boundaries set on N.O. tobacco sales," Metro, July 24.
I'm glad to see
efforts to stem the flow of cigarettes into the hands of minors. Perhaps
there should be the same energy put into keeping sodas, candy, chips and fast
foods out of the hands of children as well.
Cigarettes are
harmful, and so are these other items. Louisiana's
children deserve protection on all fronts. Children are eating themselves to
an early grave. Our kids eat so much junk that 36 percent of Louisiana's children
are obese, according to the Centers for Disease Control.
Advertisement
There are already
laws on the books that should prevent a business from selling cigarettes to
minors. That law needs to be enforced.
Let's take action
to further prevent our children from making unhealthy, life-threatening
lifestyle choices. Help our children learn to eat better and we may be able
to save generations from obesity, diabetes, hypertension, and heart disease.
Jamie Segura
Madisonville
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1248758419265450.xml&coll=1
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By Bill Barrow and
Amber
Sandoval-Griffin, Staff writers
A lawsuit seeking
to block the state from closing New
Orleans Adolescent
Hospital must be moved
to East Baton Rouge Parish, an Orleans Parish judge ruled Monday.
Civil District
Court Judge Sidney Cates IV granted the state's request to move the case
after New Orleans
attorney Willie Zanders, who represents NOAH
patients and employees at the Uptown mental health facility, said he did not
oppose the move.
Zanders told the media before the hearing --
originally scheduled to consider plaintiffs' motion for a preliminary
injunction -- that he did not want to get bogged down in a dispute over
venue. "The lack of adequate health care for the mentally ill patients
in this area is far too critical to waste precious time arguing over where
this case should be heard," he said.
Advertisement
--- Denial of
rights claimed ---
The lawsuit, filed
against Gov. Bobby Jindal, state Health Secretary
Alan Levine and other state officials, contends that closing the hospital
would deny several legally protected rights of the facility's patients and
employees.
Lawsuits against
state agencies typically are heard in the 19th Judicial District, based in
the state capital. With Cates' granting of the venue change, the Orleans judge declined
to hear additional arguments on the merits of the case or other procedural
motions. Those matters now must be settled by whatever Baton Rouge judge is assigned the case in
the coming days.
Jindal proposed as part of his February budget
recommendations closing NOAH and moving its inpatient operations to the Southeast Louisiana Hospital
in Mandeville. Lawmakers disagreed, adopting a budget that restored some
financing to NOAH, but Jindal vetoed that language
and proceeded with his original plan. The first patient transfers to
Mandeville began last week.
--- Jindal defends plan ---
Some mental health
advocates in the city have decried the move, though the Jindal
administration cast the plan as a redistribution of resources that does not
cut services to the region. The administration also has said that the money
the Legislature directed to NOAH is not sufficient to keep it in operation,
with the state asserting that the per-day cost of inpatient care is
significantly lower at the Mandeville hospital.
Those claims
figure prominently in the defendants' response to the lawsuit because state
law prohibits a preliminary or permanent injunction against a public office
or agency if the court order would force deficit spending.
Zanders disputes that keeping NOAH open would
force deficit spending, calling it "a political argument, not a legal
argument."
http://nola.live.advance.net/news/t-p/capital/index.ssf?/base/news-7/1248758467265450.xml&coll=1
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Louisiana Medical News | 07.27.09
TED GRIGGS
State Budget Fight
Ends, Federal Battle Begins | Medicaid, Alan Levine, state Department of
Health and Hospitals, Louisiana Hospital Association, John Matessino, disproportionate share dollars.
A bruising state
legislative session ended with private hospitals, physicians and other
providers facing $180 million in Medicaid reimbursement cuts. Now the hard
part begins.
"The
reductions are substantial, and I think it's been a tough year," said
Alan Levine, secretary of the state Department of Health and Hospitals.
"My bigger concern right now is what we're facing next year…. We're
going to have to find $300 million to $500 million to make up for the loss of
the federal match. That's just next year."
The following
fiscal year, Louisiana
will face a Medicaid shortfall of $1.2 billion, Levine said.
The reason is that
the formula used to calculate the state's share of the Medicaid match
involves per-capita income over a three-year period. Louisiana's post-hurricane growth and
economic activity, fueled in large part by federal hurricane recovery funds,
boosted per capita income, which in turn reduced the federal match.
"So we're
sort of continuing to be victimized by Hurricane Katrina," Levine said.
The federal
government now provides 80 percent of the state's $6.75 billion Medicaid
funds. As a result of all the federal hurricane relief funds Louisiana received,
the federal match would be cut to 63 percent from the current 72 percent
level. Under Medicaid regulations, Louisiana
would have to pick up the slack.
John Matessino, president and chief executive officer of the
Louisiana Hospital Association, said he doesn't see how the state can have a
Medicaid program after that kind of cut.
"You will
have to totally eliminate some services. It will be devastating," Matessino said.
And that's before
any of the national healthcare legislation, and the accompanying cuts in
programs required to fund it, kick in, he said.
"People are
very, very nervous about what's going on," Matessino
said. "We're already having major problems funding healthcare in the
state. We don't even know what Medicaid is going to look like in the
future."
One of the options
that politicians have discussed to pay for providing coverage for the
uninsured is a reduction in the disproportionate share dollars,
dollars Louisiana
depends on to fund its rural and charity hospitals, Matessino
said. Louisiana
gets $800 million in disproportionate share funding.
"If suddenly
those dollars are taken away, just think about what we'll do with charity
hospitals. They will close tomorrow," Matessino
said. "If you begin to look at it, some of those things look very much
like doomsday scenarios for healthcare (in Louisiana)."
Matessino said the hospital association is working
with Levine, who traveled to Washington,
D.C. to lobby members of
Congress, to come up with a solution.
Unfortunately, the
rush for some sort of national healthcare reform means that some politicians
are making decisions that they may not be qualified to make, Matessino said.
Levine and Louisiana's Congressional delegation want to pass
legislation that would keep Louisiana's
match at 28 percent. Levine said he does not know what the legislation's
chances are of passing.
On the plus side,
every member of the U.S. House of Representatives and the Senate that Levine
has spoken to understands that Louisiana
cannot absorb $1 billion of additional Medicaid cuts, and the urgency of the
problem, he said.
Meanwhile, Matessino said private providers don't know exactly
what's going to happen under the state's Medicaid reimbursement reductions.
Levine said he was
happy that the state Legislature approved $213 million in hurricane relief
funding, which will help hospitals statewide.
Although the bulk
of the money will go to hospitals in the New Orleans
area – hospitals in Orleans and Jefferson parishes will get $170 million – and in
coastal parishes, Matessino said the funding will
benefit hospitals statewide.
In addition,
lawmakers put $26 million into the Medicaid private provider program, which
could be used to bring in as much as $200 million in federal matching funds.
Providers won't
know what kind of cuts they must absorb until Levine and DHH spell out the
rules, such as what percentage in-patient hospitals or outpatient facilities
will be cut, Matessino said.
"It's one of
those things that has so many moving parts that it's very difficult to
explain what the bottom line's going to be. We really don't know right
now," he said.
The hospital
association's members are anxiously awaiting the DHH formulas, so they can
figure out whether they can absorb the cuts or will be forced to lay off
workers, cut services or consolidate them, he said.
It's also unclear
what the budget cuts will mean for physicians, he added. It was hard enough
before to find physicians who would take on Medicaid patients.
Physicians face
around $29 million in reimbursement cuts, Matessino
said, but DHH will have to decide which specialties will take the hit.
Primary care
physicians will likely be protected because Levine is trying to make sure
that patients have access, Matessino said.
http://acadiana.medicalnewsinc.com/news.php?viewStory=1355
[BACK TO TOP]
Shreveport Times | 07.27.09
Over the past few
weeks, members of Congress and the American people have come to know the
details of the administration's proposed health care plan. Call it whatever
you like, this proposal is nothing more than government-run health care.
As a physician, I
am amazed at the number of bureaucrats in this House who are quick to claim a
government-run health care plan is the reform this country needs. In response
to this, I have offered a resolution, House Resolution 615,
that will offer members of Congress an opportunity to put their
"health" where their mouth is.
My resolution
urges members of Congress who vote for legislation creating a government-run
health care plan to lead by example and enroll themselves
in the same public plan.
Under the current
draft of the Democrat health care legislation, members of Congress are
curiously exempt from the government-run health care option, keeping their
existing health plans and services on Capitol Hill. If members of Congress
believe so strongly that government-run health care is the best solution for
hard-working American families, I think it only fitting that Americans see
them lead the way.
In the week since
we announced this resolution, my office has been flooded with phone calls and
e-mails from around with the country, at one point crashing my Web site with
the large number of simultaneous hits.
Congress has the
bad habit of exempting itself from the problems it inflicts on the American
people. From common workplace protections to transparency and accountability
measures, Congress always seems to place themselves and their staffs just out
of reach of the laws they create. I'll bet most Americans aren't aware that
there is an attending physician on call, exclusively for members, or that
Congress enjoys VIP access and admission to Walter
Reed Army
Medical Center
and Bethesda Naval Medical
Center. It is past time
that we make the men and women making the laws be exposed to the same
consequences as the American public.
There is no doubt
that Americans need and deserve quality health care reform. The system, as it
stands now, does not provide affordable and accessible care for all of our
citizens. We need to do away with pre-existing conditions, increase
portability and increase competition amongst insurers. What we don't need is
to insert the government into the health care system. Government-run health
care will only lead to more taxes, the collapse of private insurance and
DMV-style medicine with long lines. If citizens are going to have to make
sacrifices for a government-run plan to take effect, so should the men and
women who vote to enact it.
Public servants
should always be accountable and responsible for what they are advocating,
and I challenge the American people to demand this from their
representatives. We deserve health care reform that puts a patient's
well-being in the hands of a doctor, not a bureaucrat.
Congressman John
Fleming represents the 4th District of Louisiana and is a physician. He is a
member of the House Armed Services and Natural Resources Committees.
http://shreveporttimes.com/article/20090727/OPINION0106/907250320/1002/NEWS/John-Fleming--Health-care--if-you-approve-it--you-should-use-it
[BACK TO TOP]
by Stephanie
Grace, Columnist, The Times-Picayune
"I know a
little something about health care policy, "
Gov. Bobby Jindal recently told readers of
Politico, a Web site aimed at Washington
insiders and political junkies. It's true; he does.
This is the same
guy who, as an intern, dazzled then-U.S. Rep. Jim McCrery with his analysis
of the complex issues facing the Medicare system. Who, at 24, convinced
incoming Gov. Mike Foster to put him in charge of Louisiana's Department of Health and
Hospitals, and who held several national health care posts before embarking
on his own political career.
Yet the Politico
piece -- part of a series of national television appearances and columns
meant to make Jindal a player on the health care
reform debate -- doesn't read like it was written by that Bobby Jindal.
Which
is a shame, because Jindal the wonk could have
plenty to contribute, if only Jindal the partisan
would be quiet.
Jindal told Fox News that the Democrats are
"trying to tax our way into prosperity, "
a line that reads like a Republican talking point.
He invoked
familiar liberal bogeymen and -women, including Hillary Clinton and Ted
Kennedy, whose stated preference for a single-payer system, he suggested,
hints at a hidden agenda from other Democrats. In the Politico article, he
even veered off point to label a separate bill aimed at curbing greenhouse
gases "the new national energy tax, " and
suggest that "the government now wants to make sure you, and every other
American, pay more in energy costs so former Vice President Al Gore can be
happy."
"This here is
a fine pot of gumbo, " he helpfully added.
And then there was
this, from his column a few days later in The Wall Street Journal:
"The
Democrats disingenuously argue their reforms will not diminish the quality of
our health care even as government involvement in the delivery of health care
increases massively. For all those who have seen the Federal Emergency
Management Agency's response to hurricanes, this contention is laughable on
its face."
Actually, it's the
big-government-is-bad analogy that's laughable on its face. It's also insulting
to Jindal's own constituents, who have every right
to expect a more competent response to hurricanes than they got four years
ago.
On the health care
bill itself, Jindal presented hotly contested
predictions as foregone conclusions.
"Businesses
will, in effect, be forced to send employees into the Democrats'
government-run health care. It's really not something to argue about, it is a
fact, " he wrote. It's also a "fact, " that people happy with their private coverage
wouldn't be able to keep it, as President Barack Obama promises.
So says a study Jindal and other Republicans frequently quote, which was
conducted by a subsidiary of the insurance giant UnitedHealth Group, although
the group says it maintains editorial independence. Yet an analysis by the
Congressional Budget Office released Monday argues that private insurance
would be able to coexist with a government plan.
This is an
important point, worthy of less fear-mongering and more substantial
consideration than the governor offered last week.
Jindal should be well positioned to participate
in that discussion. In fact, in an interview last week, he downplayed the
rhetoric and delved into the actual nuances of the proposed reform. He said
he would prefer to see policies that push private sector competition rather
than a public option. He backed purchasing pools for those who now only
qualify for expensive individual policies, an idea that is also reflected in
the Democratic bill, although he said he finds the version as written more
government-driven.
He questioned the
proposal to devise a benefit package, arguing instead for a system in which
people could choose their coverage and deductibles. "People may be
willing to make those trade-offs, " he said.
He opposed a
mandate that most individuals get health insurance, a key part of the plan.
He said he believes "that we should fix the marketplace so health
insurance is more affordable and attractive, instead of assuming people would
not make the right choice to have health insurance."
Most importantly,
he said he thinks change is urgently needed. Unlike some Republicans, he
points out, he considers health care a basic human
right, not a privilege.
This was Jindal the wonk speaking -- the guy who has a different
philosophy from the president and his supporters, but who takes the issues
seriously.
There's room for
someone like that in the national debate, and Jindal
can fill that role, if he leaves the talking points at home.
http://www.nola.com/news/index.ssf/2009/07/stephanie_grace_jindal_should.html
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The New York Times | 07.28.09
By ASHLEY SOUTHALL
Silver dental
fillings containing mercury are safe for use by adults and children ages 6
and above, the Food and Drug Administration said Tuesday. Only people who are
allergic to mercury should avoid that type of filling, the agency said.
After reviewing
more than 200 scientific studies, the agency concluded that mercury vapor
released by the filling was not enough to cause brain damage. Still, the
agency for the first time classified the fillings as a Class II, or “moderate
risk,” medical device.
The move
acknowledges the risk for patients and allows the agency to impose tighter
safety controls.
The decision is
somewhat of a change of heart for the F.D.A., which settled a lawsuit last
year with groups opposed to mercury use by posting a warning on its Web site
about the filling’s potential risks for fetuses, breast-feeding infants and
children younger than 6. The agency said the findings showed that the
fillings do not expose those groups to mercury levels considered unsafe by
the Environmental Protection Agency, but added that there were few studies on
the effects of mercury in fillings on children under 6.
The filling, known
in the scientific community as dental amalgam, is a mixture of liquid mercury
and a powdered alloy. The mercury and the alloy had previously been
classified separately. The mercury component was considered a Class I “low
risk.”
“While elemental
mercury has been associated with adverse health effects at high exposures,
the levels released by dental amalgam fillings are not high enough to cause
harm in patients,” the agency said in a statement.
The regulator
advised manufacturers to include labels recommending that dentists use
adequate ventilation when handling the material for the fillings and discuss
the scientific evidence on the benefits and risks of mercury fillings with
patients.
Silver dental filling
is the least expensive type of filling, used in roughly a third of procedures
to replace tooth decay.
http://www.nytimes.com/2009/07/29/health/29fda.html?ref=health
[BACK TO TOP]
By LAURAN
NEERGAARD, AP Medical Writer
WASHINGTON – Obesity's not just dangerous, it's
expensive. New research shows medical spending averages $1,400 more a year
for an obese person than for someone who's normal weight. Overall
obesity-related health spending reaches $147 billion, double what it was
nearly a decade ago, says the study published Monday by the journal Health
Affairs.
The higher expense
reflects the costs of treating diabetes, heart disease and other ailments far
more common for the overweight, concluded the study by government scientists
and the nonprofit research group RTI International.
RTI health
economist Eric Finkelstein offers a blunt message for lawmakers trying to
revamp the health care system: "Unless you address obesity, you're never
going to address rising health care costs."
Two-thirds of
Americans are either overweight or obese, and the average American today is
23 pounds overweight, said Dr. Thomas Frieden,
director of the Centers for Disease Control and Prevention.
"Obesity and
with it diabetes are the only major health problems that are getting worse in
this country, and they're getting worse rapidly," Frieden
said Monday at the CDC's first major conference on the obesity crisis.
It's not an
individual problem but a societal problem — as the nation's health bill
illustrates — that will take society-wide efforts to reverse, Frieden stressed. His agency last week released a list of
strategies it wants communities to try. They include: increasing healthy
foods and drinks in schools and other public venues; building more
supermarkets in poor neighborhoods; encouraging more mothers to breast-feed,
which protects against childhood obesity; and discouraging consumption of
sodas and other sweetened beverages.
The average
American consumes 250 more daily calories today than two or three decades
ago, 120 of them from those kinds of drinks, Frieden
said. Science suggests that while eating a candy bar before dinner will spoil
your appetite, liquid calories don't — you won't cut back on dinner if you
have a sugary soda first.
He said there's
some evidence that adding a tax to those drinks might help curb consumption,
although he stressed that wasn't a view of the Obama administration.
The new Health
Affairs study found obesity-related conditions now account for 9.1 percent of
all medical spending, up from 6.5 percent in 1998. During that time, the
obesity rate rose 37 percent.
On average, health
bills for a normal-weight person are about $3,400 a year, but that rises to $4,870 for someone who's obese, Finkelstein said.
Prescription drugs are the biggest driver of those costs: Medicare spends
about $600 more per year on medications for an obese beneficiary than a
normal-weight one.
Health economists
have long warned that obesity is a driving force behind the rise in health
spending. For example, diabetes costs the nation $190 billion a year to
treat, and excess weight is the single biggest risk factor for developing
diabetes. Moreover, obese diabetics are the hardest to treat, with higher
rates of foot ulcers and amputations, among other things.
The new study's
look at per-capita spending may offer a shock to the wallets of people who
haven't yet heeded health warnings.
"Health care
costs are dramatically higher for people who are obese and it doesn't have to
be that way," said Jeff Levi of the nonprofit Trust for America's
Health, who wasn't involved in the new research.
"We have ways
of changing behavior and changing those health outcomes so that we don't have
to deal with the medical consequences of obesity," added Levi, who
advocates community-based programs that promote physical activity and better
nutrition.
http://yahoo.twi.bz/Vc
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