Recent news of note:
and a shout out to an excellent source of news and analysis with a focus on Oregon and the broader context:
Posted in Advocacy, Assistance, Children's Health, Community clinics, Economics of Health Care, Health Care Reform, Health Disparities, Health Insurance, Healthcare Inequalities, Medicaid on 6 May 2012 | Leave a Comment »
In these times of intense attention to healthcare from all quarters of the US, a new study by USA Today and Kaiser Health News reporters focused on community clinics. Over the past 2 decades community clinics have developed from origins often as volunteer-run efforts, to become a vital part of what is called the safety-net. Frequently they now are the sole source of care available to over 20 million people, often as the only providers who will accept patients covered by Medicaid, and for the growing ranks of the uninsured. The sorry state of healthcare access would be far worse if it were not for community clinics. These centers will play an important role too in the reforms set to start in 2014. It is expected that many who will become newly insured by Medicaid will be seeking care at community clinics. Long woefully underfunded, clinics will be eligible to receive help from the $10 billion approved by Congress for expanding their service capacity.
The report entitled Community clinics have odds stacked against them looked at almost 1200 community clinics across the country, and ranked them based on the 6 categories of performance quality measures which federally qualified health centers (FQHCs) must report to the federal government. The categories cover care for patients with diabetes and high blood pressure, rates of screening for cervical cancer and childhood immunizations, plus timeliness of prenatal care and rates of low birth-weight babies.
Using 2010 clinic performance data obtained by FOIA request, the reporting team found wide variations in care by center, by region of the country, and between specific centers in the same city. Generally, clinics in the South performed worse that those in New England, the Midwest, and California. Overall, their survey showed community clinics not performing as well as the national averages for the study parameters .
There is more context to understanding the survey results however, that was not part of the report. The National Association of Community Health Centers issued a statement about the report which while recognizing the value of examining clinic performance, expressed concern about the wrong impressions that the media study might give:
The article disregards the better quality care that most health centers achieve when compared to care provided to other low-income patients elsewhere. However, at least the article does reveal what few Americans realize– that every health center reports on the quality of care their patients receive….
…When you compare the federal data that is the focus of the USA Today article with national data from the National Center for Health Statistics, health centers performed better than national averages for entering women into prenatal care during the first trimester, childhood immunization rates, reduced low birth rates and hypertension control…..
NACHC recently published its report Health Wanted – The State of Unmet Need for Primary Health Care in America which takes an in-depth look at the factors behind the consistent and increasing demand for community clinics, the links to social determinants of health and how funding has not kept up to meet population needs. In FY 2011 for example, only 67 out of some 1900 applications for new health center service sites were funded.
Seattle/Local Health Guide extracted localized figures from the report to create a Washington State Comparison Chart. Janna Wilson, Senior External Relations Officer for the Seattle-King County Department of Public Health shared additional concerns with me in a personal communication, about implications and lack of context for specific data used for the local news article:
The data provided for Public Health represents a small subset of the patients we see—our homeless primary care patients. This is because Public Health’s federal health center grant comes under a targeted program called Health Care for the Homeless. Our federal data report, therefore, is specific to our homeless patients per federal reporting requirements. As you know, homeless patients face barriers that often exacerbate medical and behavioral health conditions and complicate treatment plans.
While most community health center grants and programs are for the general low-income population, some — like ours — target special population groups such as homeless people or migrant workers. There is nothing in the USA Today article that provides this important context. That said, quality improvement is a big part of our program for all our patients, whether homeless or housed.
With almost nothing but a steady stream of dire news about public services in 2011 , and the prospect of even more budget cuts facing us as the Washington State Legislature convenes work today, it is heartening to hear some good news. For the third year in a row, Washington has earned bonuses for enrolling children in Apple Health for Kids, our state’s plan for low- and middle-income kids, which includes the Children’s Health Insurance Program. As Crosscut reported:
Tens of thousands more children have health insurance now, despite the state’s having reached the grim milestone of 1 million uninsured residents last year. Washington is also the only Western state to win federal awards in 2011 for both early learning and children’s insurance programs.
Of course, one of the reasons that so many children are now enrolled in Apple Health is because their parents have lost their jobs and/or health insurance. And some 100,000 eligible children are not enrolled in the program, highlighting the need to continue outreach efforts, which lost state funding in 2009. Nevertheless the ceaseless efforts of advocacy groups like the Children’s Alliance are a driving force which led to this performance award, which in turn will help the State do even more for our kids.
Posted in Access to Medicines, Advocacy, Conflicts of Interest, Consumer Protection, Economics of Health Care, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Insurance, Healthcare Inequalities, Prescription drugs, Promotions, Tobacco control on 9 January 2012 | Leave a Comment »
As the new year starts, some ome items of note from near and far:
Posted in Access to Medicines, Advocacy, Assistance, Children's Health, Consumer Protection, Economics of Health Care, Health Insurance, Pharmacists, Prescription drugs, State of Washington on 7 November 2011 | Leave a Comment »
Now more so that ever, learning of positive developments and new efforts of those working to make a difference, helps me to keep going . I share here with you some news of significance at the local, state, and national levels.
In Washington State:
In New York State:
Medicaid team passes four sets of reform proposals, including Safe Rx to “Promote Language Accessible Prescriptions”
Posted in Advocacy, Conflicts of Interest, Consumer Protection, Economics of Health Care, Ethics, Global Health, Health Care Marketing, Health Insurance, Military medicine, Promotions, State of Washington, Tobacco control on 17 August 2011 | 1 Comment »
[Washington] State Insurance Commissioner Mike Kreidler has fined Regence BlueShield $100,000 for denying contraceptive coverage to 984 women.
Regence had covered the women’s use of an IUD, or intrauterine contraceptive device, but not the removal of it. When the women wanted to remove the device because it was outdated, or because they wanted to get pregnant, the insurance giant did not consider those reasons as “medically necessary,” state officials said Monday.
“There’s an important lesson here,” Kreidler said in a statement.
“If you believe you’ve been unjustly denied coverage, don’t just accept it, call us. Of the 984 women who were denied contraceptive coverage by Regence, only three appealed the decision – and all the denials were upheld.”
He said one woman’s call to his office resulted in coverage for nearly a thousand other women who were denied coverage over the span of eight years.
Five tobacco companies have filed suit against the U.S. government claiming that government-ordered graphic warning labels on cigarette packs violate their First Amendment rights.
Starting on Sept. 22, 2012, cigarettes sold in the U.S. will have to carry graphic images warning of the dangers of smoking. These images include a tracheotomy hole, rotting teeth, diseased lungs, and a body on an autopsy table.
The images will be accompanied by dissuasive wording on cigarettes and smoking, including “cigarettes are addictive,” “cigarettes cause cancer,” and “smoking can kill you.” They must be displayed on at least half of the front and back of cigarette packs, and 20% of the top of the pack.
The lawsuit was filed by four of the nation’s largest tobacco companies — including R.J. Reynolds Tobacco and Lorillard, and one smaller company (Sante Fe Natural Tobacco Company) — against the FDA and the Department of Health and Human Services.
The companies are seeking to prevent enforcement of the images, arguing that the government cannot legally force them to espouse an anti-smoking advocacy message….
This is yet another area of health promotion in which the US has long fallen short. Graphic warning labels on cigarette packs have been used in Canada since 2001, and dozens of other countries have followed suit.
A bit of both, local news that is national :
Madigan Army Medical Center surgeon Michael Eisenhauer says his military career foundered as he exposed cozy dealings between an Army doctor and a medical-equipment manufacturer. His whistle-blowing helped lead to the criminal conviction of one doctor; but Eisenhauer is still fighting to clear his own name.
Eisenhauer detailed a cozy relationship between the medical-equipment manufacturer Boston Scientific and two Madigan cardiologists, who insisted on sole-source purchases of that company’s implant devices.
The long-standing practice of drug companies and medical-equipment manufacturers offering doctors free trips, speaking honorariums and other payments is controversial. Critics say the money may often represent kickbacks for favoring a company’s drugs or devices.
Still, in civilian practices such payments are generally considered legal. In the military, however, doctors are prohibited from taking such payments.
“Military doctors must owe their allegiance to the soldiers and families they treat — not to drug companies or makers of medical devices,” said U.S. Attorney Jenny Durkan in a statement announcing the plea deal reached with Davis.
“That is why we have a bright line rule: doctors employed by the government cannot accept payments or gratuities from an outside source — especially one that is seeking government business.”
Kudos to Insurance Commissioner Mike Kreidler, who took action on behalf of consumers! From the OIC blog:
Individual and small employer health insurance rate requests are now public. See the complete filings received since July 1, as well as a summary for each request.
Several health insurers filed rate requests prior to July 1, but have voluntarily made their filings public. They include: Asuris Northwest Health, Kaiser Foundation Health Plan, and Regence BlueShield.
Insurance Commissioner Mike Kreidler proposed the legislation (HB 1220) making health rates public on behalf of the consumers who contact his office, demanding to know what’s driving their higher premiums. State law prevented him from sharing the information that insurers use to justify rate requests – even after the rate was approved.
The new law makes most individual and small employer health insurance rate filings public shortly after they’re received. This includes how much of the requested rate will be spent on medical claims, administrative costs and profit. Also, the public will see if their rate change includes any benefit changes.
Kreidler’s office is building an interactive web tool where the public can search rate requests, post comments, and sign-up to get an e-mail when their health plan requests a change and a decision is made. The new tool is scheduled to go live early this fall.