Blind movie critic Tommy Edison educates the masses

Tommy Edison knows you've got questions about blind people � because people have been asking him those questions all his life.

Like: Do you see stuff in your dreams?

And: How do you count your paper money?

And: Do you think you could hit a golf ball?

Actually, that last one was a question Edison had and decided to answer, along with the others, in a online video series he calls "The Tommy Edison Experience." The videos are shot and edited by his buddy Ben Churchill, a documentary filmmaker, and share a website with a series called "Blind Film Critic."

Yes, a blind guy reviews movies. In fact, Edison � who works as a traffic reporter for a Connecticut radio station � became mildly famous for his pithy reviews about a year ago. His web traffic spiked after master critic Roger Ebert mentioned him online, Edison says.

With the attention, came the questions �starting with how a blind man can appreciate movies.

"I like strong characters in a good story and I like a few laughs," Edison says in a phone interview. Lots of dialogue helps.

But in between going to movies and reporting on traffic tie-ups (using police scanners and calls from listeners), Edison is just a regular forty-something guy who has been blind since birth. The point of the "experience" videos, he says, is "to show sighted people how I live and how I do things," educate a bit and have some fun.

So Edison has answered questions about his:

�Dreams: "I don't see in my dreams. It's all smell, sound, taste and touch," he says.

�Money: In one video, he buys a beer and has to ask the cashier to name the bills as he takes his change so he can line them up in order. Every blind person needs a system, he explains, because U.S. paper currency is not differentiated in a way blind people can detect (though it soon will be, say advocacy groups for the blind).

�Golf game: It's pretty good - for a blind guy. (He hits a ball after a few lessons).

�Travel style: He's an able-bodied guy, but has to explain to an airport employee (repeatedly, with impressive good humor and politeness) that he doesn't need a wheelchair to get through a terminal.

�Celebrity curiosity: If he could see three celebrities, he'd choose singer Tom Waits ("I've got to see the face that goes with that voice"); actress Angelina Jolie ("I keep hearing how beautiful she is") and Jay Leno ("the devil himself," says the Conan O'Brien fan). He's also curious about the Muppets.

Edison doesn't speak for all blind people. But it's nice to have someone out there answering the kinds of questions many blind people get all the time, says Eric Bridges, director of advocacy at American Council of the Blind. "People are naturally curious," he says. "And humor is the greatest device to sort of cut the tension and put people at ease."

The videos seem "very positive and informative," says Chris Danielsen, director of public relations at the National Federation of the Blind. Social media creates opportunities for many blind people "to get our own stories out," he says.

For Edison, that means sharing his reviews of Cabin in the Woods and The Hunger Games (he didn't love either) and answering the question: "Can you open your eyes?" The answer, as he demonstrates in one video, is yes, he can. "Next time," he promises, "I'm going to show you how I perform surgery."

All Routine PSA Tests For Prostate Cancer Should End, Task Force Says

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Terry Dyroff, at home in Silver Spring, Md., got a PSA blood test that led to a prostate biopsy. The biopsy found no cancer, but it gave him a life-threatening infection.

There they go again � those 17 federally appointed experts at the U.S. Preventive Services Task Force are telling American doctors and patients to stop routinely doing lifesaving tests.

Or at least that's the way some people look at the task force's latest guidelines on prostate cancer screening, which say doctors should stop doing routine PSA tests on men of any age. (The task force earlier recommended an end to testing of men over 75.) You can find the screening guideline in that current issue of Annals of Internal Medicine, along with editorials for and against it.

The American Urological Association pronounced itself "outraged" at the task force edict.

"It really is too extreme for them to say that all PSA testing should stop," fumes Dr. William Catalona, a Northwestern University urologist and PSA testing pioneer. "If all PSA screening were to stop, there would be thousands of men who would unnecessarily suffer and die from prostate cancer."

Catalona insists the evidence suggests routine PSA screening prevents as many as 40 percent of prostate cancer deaths by catching the disease when it's early and curable.

No way, says Dr. Michael LeFevre, a task force member who is professor of family practice at the University of Missouri.

 

"We think the benefit is very small," LeFevre told Shots. "Our range is between zero and one prostate cancer death avoided for every thousand men screened." By comparison, he says, the lifesaving benefit from colorectal cancer screening is two to 10 times higher.

LeFevre doesn't deny PSA screening saves lives. It's just that the benefit is much smaller than screening advocates think, he says. His best case: Widespread PSA testing might avoid between 1,400 and 2,800 prostate cancer deaths among 28,000 US men who now die of the disease. That's 5 to 10 percent.

"I don't want to take lightly any one of those lives," he says. "And if prostate cancer screening was harmless and nobody suffered the consequences on the opposite side, then I'd say, 'Well, why not?' But unfortunately, that's not the case."

Unintended Consequences

The task force says up to 20 percent of men screened every year for 10 years will get a result that sends them to the biopsy suite. When cancer is found, nearly 90 percent will have surgery, radiation or hormone therapy, and up to one-third will end up with urinary incontinence, impotence or bowel problems.

Death from prostate cancer is a worse harm, for sure. But the task force says most of the men treated for cancer found through PSA screening would never have had a problem with the disease if it hadn't been found.

"A goodly proportion of men who have localized prostate cancer actually have a disease that will never kill them if left alone," says Dr. Otis Brawley, the American Cancer Society's chief medical officer. "More than a million men were needlessly cured of their prostate cancer over the last 20 years."

Brawley says this notion � experts call it "overdiagnosis" � is hard for most people to grasp, including cancer doctors (or perhaps especially cancer doctors). "What the Preventive Services Task Force is suggesting is contrary to all our prejudices," he told Shots. "We've all been taught that the way to deal with cancer is to find it early and cut it out."

He especially hopes the new guidelines will put a stop to mass PSA screening by mobile vans at shopping malls and hospital-sponsored "health fairs."

Brawley has been beating that drum since 1997, when an especially candid hospital marketing director bragged to him about the financial advantages of his institution's free PSA screening sessions. He recounts the story in his recently published book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.

"The marketing guy was really proud of his prostate-cancer-screening business plan," Brawley told Shots. "If they screened 1,000 men at the mall ... they got 135 guys coming in [to the hospital's clinics] to figure out why they had an abnormal test. And they would end up collecting an average of $3,000 per guy off of that."

From there, many biopsies would reveal prostate cancer, and nearly all of them would have surgery or radiation, he says. The ones who got radiation, the marketer told Brawley, "reimbursed at almost $80,000 a guy."

"I asked him, 'How many lives will you save if you screen a thousand guys?' " Brawley recalls. "And he took his glasses off and looked at me as if I was a fool and said, 'Don't you know, nobody knows if this stuff saves lives? I can't give you an estimate on that.' "

Brawley says some PSA screening fairs are sponsored by the makers of diapers for incontinent adults, apparently because they know many men with abnormal PSAs will eventually suffer treatment-related urinary problems. "I don't know if screening saves lives, but I sure know it sells diapers."

A Matter Of Semantics?

Brawley is himself an expert in prostate cancer treatment. And as opposed as he is to indiscriminate mass screening, he says he's not against PSA testing if doctors and patients go into it with open eyes, after a frank discussion of potential harms and benefits.

But while he thinks the Preventive Services Task Force "got it right," he says it needs to do a better job of explaining itself. As in the mammography screening controversy of 2009, the task force's analytical language leaves it open to the charge that it's unsympathetic to men's prostate cancer fears and diagnostic dilemma � coldhearted even.

"I wish the task force's wording were a little bit more user-friendly," Brawley says.

Instead of saying that doctors should stop doing PSA "routinely," he says, maybe it should have said they shouldn't do them "automatically."

That leaves the door open to a doctor-patient discussion about the pros and cons. And that's exactly what the task force says it wants to do.

What's Up, Doc? When Your Doctor Rushes Like The Road Runner

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Patients continue to complain that physicians don't spend enough time examining and talking with them.

iStockphoto.com

Patients continue to complain that physicians don't spend enough time examining and talking with them.

To physician Larry Shore of My Health Medical Group in San Francisco, it's no surprise that patients give doctors low marks for time and attention.

"There's some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Shore says. "And that makes you feel like the person is not listening."

A doctor's impatience, though, is often driven more by economics than ego. Reimbursement rates for a primary care visit are notoriously low, and Shore laments the need to hustle patients in and out.

 

"When you have that pressure to see three, four, maybe five patients an hour, you can't wait for the exposition of the patient's story. Which is exactly what you should do. But you can't," he says.

A new poll by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health found about 3 out of 5 patients think their doctors are rushing through exams. That's nearly the exact same number as three decades ago.

NPR's survey asked people the same questions as another poll did back in 1983. We found doctors got better marks on some patient interactions. For example, 64 percent of people said doctors usually explained things well to them, versus 49 percent in 1983. They also are more likely to say doctors are trying to hold down medical costs.

But when it comes to time, there is a stubborn feeling that doctors are in too big of a hurry. That is troubling � and frustrating � to physicians like Shore who feel that they are already packing more into every workday and are stretched thin by paperwork.

"I think a lot of physicians in smaller practice realized they were becoming both the clerk and the HR and the accounts payable and the accounts receivable and the office manager � things which they may not have an interest in and certainly had no training for," Shore says. But he says many doctors just didn't have the cash flow to hire administrative staff.

Two months ago, Shore opened a new office in which he's trying to break from the day-to-day grind. Appointments are now 20 minutes, instead of 15. And he's hired several other doctors to spread the workload around. But there's also been a shift in his thinking about the way he provides care to his patients: He's trying to treat them more like customers, and focus on making them happy.

"Who are your customers? What do they want? Try to meet those needs," Shore says.

And what his customers want, he believes, is access to him and his staff � how they want it, like over email, and when they want it, like after-hours. To do that, Shore has given up on the model of the doctor as a lonely superhero. Instead, everything is about the team.

Shore hunkers down each morning with his medical assistants for a "care huddle," a rare, quiet moment to strategize about the patients coming in that day. Those assistants now play a bigger role in care, renewing prescriptions and briefing the doctor before he enters the exam room. A check-out assistant guides "customers" out the door.

Shore is trying to make up the financial difference of hiring these additional people by getting the office manager to badger insurance companies to pay more money per patient for better patient health.

That doesn't include patients getting any test or treatment they demand. But Shore's younger colleague Payal Bhandari sounds as much a marketer as family physician when she talks about her hopes for a better assembly line.

"It will actually produce a much better product, where you can actually listen to patients," Bhandari says. "And the physician is a lot happier because they don't feel like, 'Ugh! Another person!' They can actually do their job, but there are others helping them in the process."

Will these improvements be enough to move the stubborn poll number? Shore is optimistic, a belief reflected in a fortune cookie message taped to his office window: It says: "Be not afraid of growing slowly. Be afraid only of standing still."

Varney is a reporter with NPR member station KQED.

Do you know what you pay for health insurance?

A disturbing survey reveals that most Californians � and likely most Americans � are unwilling to focus on the details of their health coverage. Those who are focused on the details are finding their coverage is increasingly riddled with holes.

Health care consumers say their medical costs are going up and expect them to continue to rise. But people are unlikely to ask about cost before getting care. And many don't even know how much they pay for coverage or what their deductible is.

That's according to a recent survey of Californians, and likely applies to most Americans. It's an odd disconnect that people are aware that costs are going up and likely to continue (73 percent thought so), but that many folks are unwilling to focus on the details of their coverage.

Maybe that's understandable, given how difficult it can be to sort out premiums from deductibles from copays, and how often those change from year to year.

Most Americans still get their insurance coverage from an employer, and we like to think that we're taken care of � that if we have a job and a health plan we're all set. What increasing numbers of people are learning is that there are holes in the system even if we have coverage. In this survey from the California HealthCare Foundation, 39 percent of those whose costs went up in the past year said their benefits got worse at the same time.

Those trends are not news for people buying insurance for themselves on the individual market, where high deductibles and Swiss-cheese coverage are the norm. Of those whose costs had risen, 61 percent were in the individual market.

So, the likelihood that your health plan is getting more expensive and/or less comprehensive is fairly decent, and would seem to provide plenty of incentive to educate yourself about your coverage. And yet just 26 percent of those surveyed tried to get information about the cost of a test, treatment or other type of health service before receiving it. Doing research was more likely among those with a high deductible (the amount of money you pay before insurance kicks in).

More evidence that American consumers are practicing avoidance: Among the half of survey respondents who knew they had a deductible, nearly half didn't know the amount. A third didn't know what their premium was or wouldn't answer the question.

These are troubling statistics given the brave new world of insurance coverage we're living in, one that assumes consumers are shopping for health coverage and medical services just like they do other big-ticket items like cars. But there aren't many people who don't know how much their car payment is.

Health Insurance Cutbacks Squeeze The Insured

Hide caption Amber Cooper lives in Modesto, Calif., with her son, Jaden, 5, and her husband, Kevin. She had a liver transplant when she was 10 years old and needs daily medication so her body won't reject her liver. Deanne Fitzmaurice for NPR Hide caption When Amber's employer changed health care plans, she could no longer afford the blood tests that monitor her liver. She also had trouble paying for her medication. A charity, Healthwell Foundation, stepped up to help pay her health care costs. Deanne Fitzmaurice for NPR Hide caption Jaden climbs into a kitchen cabinet, removing the food from the shelves so he can fit. Amber says she can't afford to buy him new shoes or clothes because of her health care expenses. Deanne Fitzmaurice for NPR Hide caption After coming home from his job, Kevin works on a fence he is building around their home. The Coopers have stopped taking trips, eating out and spending money on anything else they don't need. Deanne Fitzmaurice for NPR Hide caption Amber waits for her monthly blood test at a lab in Modesto. For several months she couldn't afford the tests, but then her company changed insurance again and she was able to resume them. Deanne Fitzmaurice for NPR Hide caption The family tries to find entertainment at home � like letting Jaden play in the sprinklers and walking to a neighborhood park � to save money. Deanne Fitzmaurice for NPR

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Amber Cooper and her husband were doing OK. They had jobs, a healthy 5-year-old son, a house in Riverbank, Calif., and health insurance from her job in the accounting department of a small manufacturing company.

Then one day everything changed.

"We were in a conference room ... and I had heard rumors but didn't know if it was true, and I started crying in front of everyone and actually had to excuse myself to gather myself together and go back in. It was devastating for me," Cooper said.

Devastating because the rumors � her worst fears � had come true. She was in that conference room for a meeting about her health insurance.

Cooper had a liver transplant when she was 10. She takes a drug twice a day so her body won't reject her liver.

 

"Every year my company changes the insurance. And instead of giving us three different choices for insurance plans, they were changing to one, which was a high-deductible plan with no prescription coverage," she said.

Cooper was stunned. Her anti-rejection medicine costs way more than she could afford on her own � more than $1,000 a month.

Cooper, 30, started a frantic search for help. Finally, she found the HealthWell Foundation, which was willing to pay for her medication. But she still couldn't afford the $300 blood test she needs every month to make sure she's not rejecting her liver.

"It is scary because the only way to tell if you're going to go into rejection is by the blood work. Your numbers will be a little bit crazy, and then the doctors will be like, 'OK, you need to get in and we need to check you out and make sure you're OK.' So I really took a risk not getting that blood work done. But I couldn't afford to get it done. I really couldn't," she said.

What happened to Cooper is happening more and more these days.

Health insurance has been changing dramatically "beneath the surface," said Drew Altman, president and CEO of the Kaiser Family Foundation, a private, nonprofit, nonpartisan research group. "In plain language, it's becoming skimpier and skimpier and less and less comprehensive."

Paul Fronstin of the Employee Benefit Research Institute says that is the trend nationally.

"Deductibles have gone up. Copays have gone up. You see cost-sharing for out-of-network services have gone up," Fronstin said. "It seems to have accelerated in the last few years. Health care is just continuing to take a bigger bite out of take-home pay."

So even people with insurance are paying thousands of dollars out of pocket before their insurance kicks in. And even when it does, insurance picks up less than it used to � often a lot less.

More than 1 in 5 Americans had a problem getting insurance to pay for a hospital, doctor or other health care in the past year, according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Altman says this comes as many families are struggling to get by.

"This affects not only how people seek health care � they're more reluctant to get it if they can put it off. But it also affects family budgets in a very real way, especially as we're still coming out of recession and families are still crunched by a weak economy," Altman said.

Cooper's family has stopped taking trips, eating out, fixing up their house or spending money on anything else they don't have to. Their son gets by with hand-me-downs, she said.

"He's 5 and growing out of everything. I haven't been able to buy him any clothes and shoes. Those are things I haven't been able to purchase because of the increase in the health care," she said.

And Fronstin says the weak economy is driving more and more companies to cut back on coverage because of simple math: It's the only way they can keep up with rising health care costs.

"Employers are trying to manage those costs. They're trying to keep those cost increases as close to inflation as possible. And they're doing everything they can to get their workers so that they think twice about the health care that they are using," Fronstin said.

Cooper is just grateful she's getting her drugs every month. And she started those monthly blood tests again when her company changed insurance again this year. But it's still not as good as it used to be. So she and her husband don't go to the doctor when they get sick if they can avoid it. The same goes for their son.

"There were a couple of times where he got sick where I just tried to do the best I could with what I had, whether it was children's ibuprofen or cooling him down with cool rags and that sort of thing," she said.

She can't help but worry about the next company meeting about her family's health plan.

"It changes every year, so I really have no clue what's going to happen next year and with them making that change, I really don't know what to expect every year," she said.

House To Vote On GOP Bill Framed As Guns Vs. Butter

Republicans who control the House want to block some $55 billion worth of automatic cuts to the Pentagon budget next year. Instead, they want to cut funding for social programs such as food stamps, Medicaid and Meals on Wheels. It's a choice that has been framed as guns versus butter, and this time, guns are expected to win.

The Obama administration has threatened to veto the legislation, which the House votes on Thursday. But the president is willing to leave the Pentagon cuts in place for now, in hopes of bringing Republicans back to the bargaining table.

The Pentagon cuts are the "trigger" that almost nobody wants to pull. Under last year's deficit-cutting agreement, if lawmakers don't agree on how to trim $1.2 trillion in red ink, across-the-board cuts are triggered automatically, with 50 percent coming from the defense budget.

House Republicans are trying to defuse that trigger.

Shifting Costs

Budget Committee Chairman Paul Ryan says instead of military spending, the government should cut social programs that he describes as bloated and inefficient.

"Taxpayers deserve better than to see their money wasted on duplicative programs that never simply end because ending them would take turf away from some bureaucracy," Ryan says.

According to the Congressional Budget Office, the GOP move would leave 1.8 million people without food stamps. Hundreds of thousands of children would lose health insurance and school lunches.

Texas Democrat Lloyd Doggett says there would be less money for vaccinations, prenatal care and quality nursing homes for seniors.

"It's shifting all the cost onto the most vulnerable people that don't have a strong enough lobbyist to stand up for themselves, and I think it is a terrible wrong," Doggett says.

Republicans on the Budget Committee approved the cuts to social programs, setting up Thursday's vote in the full House. Texas Rep. Bill Flores defended the cuts in the name of fiscal responsibility.

"We talk about values. Deficit spending is not a value, ladies and gentlemen. Deficit spending is what's going to bankrupt the future for the children that you say you care so much about," Flores says.

But as Maryland Democrat Chris Van Hollen points out, Thursday's vote isn't really about the size of the deficit. It's just about who bears the cost of government spending cuts: the military or the needy.

"The issue is not whether we should implement a plan to reduce the deficit in a steady, credible and predictable way," Van Hollen says. "We should. The issue is how should we do it?"

Sequestration A 'Crazy Process'

The Obama administration isn't eager to see bigger cuts to either the Pentagon or the safety net. The Defense Department is already scheduled to cut nearly half a trillion dollars in spending over the next decade. And Defense Secretary Leon Panetta warns that another half-trillion in automatic cuts � known as sequestration � would be dangerous.

"Sequestration is a crazy process that would do untold damage to our national defense," Panetta says. "It's a mechanism that would do blindsided cuts across the board and would really hollow out the force."

Obama doesn't like the defense cuts any better. But he says that's the point. He told lawmakers last November that the automatic cuts are designed to be painful, in order to force Congress to come up with a better, more balanced deficit plan. And he's not about to let lawmakers off the hook.

"My message to them is simple: No. I will veto any effort to get rid of those automatic spending cuts to domestic and defense spending. There will be no easy off-ramps on this one," the president said.

Ultimately, Obama wants a deficit plan that includes some additional tax revenue, along with spending cuts. Until then, he's not taking his finger off the trigger, nor allowing Republicans to aim in a different direction.

AMA calls for 2-year extension of ICD-10 deadline

WASHINGTON – The American Medical Association (AMA) has asked the federal government to delay the implementation deadline for ICD-10 from Oct. 1, 2013, until Oct. 1, 2015, "at a minimum."

The AMA asked for this two-year compliance deadline in a May 10 comment letter to the Centers for Medicare & Medicaid Services (CMS). "A two-year delay of the compliance deadline for ICD-10 is a necessary first step," AMA officials wrote to CMS Acting Administrator Marilyn B. Tavenner.

During the delay AMA proposes, officials urge CMS to institute a process to engage all relevant, stakeholders including physicians, to assess whether an alternative code set approach is more appropriate than the full implementation of ICD-10.

Earlier this year, CMS nodded to rolling back the deadline from Oct. 1, 2012, to Oct. 1, 2013, delaying compliance by one year.

In November 2011, AMA’s House of Delegates voted to call for a  repeal of the federal requirement to move to ICD-10 so that physicians and other stakeholders could assess an appropriate alternative.

Physicians will be overwhelmed with the financial and administrative burdens of a transition to ICD-10 while they are also facing implementation of “a number of inadequately aligned” federal programs, AMA officials wrote. The burdens are further compounded by a proposed 31 percent Medicare reimbursement cut proposed for Jan. 1, 2013.

 

Guaranteeing Value for Your Premium Dollars

When we pay for health insurance, we want to know that most of what we are paying for is for health care, not advertising, executive bonuses or overhead. It�s pretty simple: we want to get a good value for our premium dollars.

Thanks to a new rule (the �80/20 rule�) in the Affordable Care Act, you can be sure that insurance companies are spending generally at least 80 cents of every dollar you pay in premiums on your health care or activities that improve health care quality. If the insurance company fails to meet this standard, or the �medical loss ratio�, in any year, they have to pay you a rebate.

Insurance companies that didn�t meet the standard for coverage provided in 2011 are required to provide these rebates no later than August 1st of this year, and to make sure you know what you are owed, insurance companies that owe rebates will also send a letter telling you how much you�ll receive. You can see what that letter will look like here. �According to early estimates from the Kaiser Family Foundation, insurance companies will provide 15.8 million Americans with $1.3 billion in rebates.

Today, we�re also finalizing a notice for insurance companies to send you if they meet or exceed the standard. If your insurance company is providing fair value for your premium dollars, you should know that too. You�ll be able to see your plan�s medical loss ratio on HealthCare.gov starting this summer.�

The 80/20 rule and the rate review program are two ways the Affordable Care Act is protecting you. You can find out more about how the Affordable Care Act increases transparency and protects consumers here: http://www.healthcare.gov/news/factsheets/2012/02/increasing-transparency02162012a.html.

Good Health Begins in Our Own Communities

Good health begins at home and in our own communities. But unfortunately, in too many communities today, healthy choices are neither easy nor affordable. This means that despite her best efforts, a mother is hard pressed to find healthy, affordable food for her children in her city neighborhood. And a father living in a rural community might not have the information and tools to routinely monitor and manage his high blood pressure. These all-too-real situations help explain why seven out of ten deaths among Americans each year are from chronic diseases. And half of all adults have at least one chronic illness.

We can do better. You and your neighbors know what works best in your own community. And often it takes a group of committed, local, hard-working Americans to make some of the biggest changes. By investing in our communities, Americans will be empowered to make better choices and lead longer, healthier lives.

Earlier this week, Community Transformation Grants were distributed to 61 states and communities with more than 120 million residents to help keep people safe from the threats of heart disease, cancer, stroke, diabetes and other leading causes of illness and death. Made possible by the Affordable Care Act, these grants will help communities tackle the root causes of chronic disease such as smoking, poor nutrition, and lack of physical activity. These grants will build on successful programs that have been proven to improve health.

The Community Transformation Grants have been distributed to a wide variety of State and local government agencies, tribes and territories, and non-profit organizations to focus on important contributors to health, including:

Tobacco free living � Some grantees are working to implement tobacco-free and other effective policies to reduce tobacco use � the leading preventable cause of death.Active living and healthy eating � Other grantees are making sure kids get healthier foods and beverages in schools and investing in bike share programs in their communities.Quality clinical and other preventive services � Some grantees are developing monitoring tools based on evidence-based practices. Care teams and patient navigators will use these tools to help patients control their blood pressure.

These are just a few of the innovative and exciting new ways States and communities will use their Community Transformation Grant to make their community a healthier and safer place to live. By targeting these three areas, we can make the places Americans live, work, play, and go to school healthier. Improving health and wellness in communities across our country will help lower costs and reduce health disparities. We look forward to expanding community networks and identifying new and creative community-based solutions to improve the he alth of Americans nationwide.

Faces of the New Health Care Law

Each day this week, you�ve heard stories about what the new health care law means for every day people.� Today, March 23, marks the second anniversary of the Affordable Care Act, and three remarkable women share their stories about how the new health care law is affecting their lives and the lives of their families.� They are truly the faces of the Affordable Care Act, representing the millions of Americans already benefiting from health care reform and looking forward to full implementation of the consumer protections in the health care law in 2014.

Alycia Steinberg�s family was stunned when the pediatrician told them last fall that 2-year-old Avey had leukemia. Her first hospital stay at Johns Hopkins cost $100,000 and she has 2 � more years of chemotherapy ahead of her. �Being uninsured is not an option for my family,� Alycia says.

The Affordable Care Act protects Avey�s health insurance coverage because it bars insurance companies from denying coverage to children for pre-existing conditions.

�Childhood cancer is cruel. To have to worry about how your child will get treatment and how you will maintain your family�s most basic financial security is also cruel. ...When discussing health reform, we often talk about our goal of protecting the most vulnerable among us. What we forget is that we are all vulnerable,� Alisha says.

Robyn Martin�s son Jax has serious genetic disorders, including a heart defect.� After he was born, he immediately was placed in the neonatal intensive care unit (NICU) where he spent three weeks.� And Jax has undergone surgery since then.� Before the law, Americans were in danger of having their health insurance coverage max out when the cost of their treatment hit a lifetime limit set by their insurer.� But, the Affordable Care Act now prohibits lifetime dollar limits, which has been a saving grace for Robyn and her family.

�I don�t know how much all of his health care has cost to this point, but in five months, I know it�s got to be a lot. The first day in the NICU was $150,000,� Robin says. �If he in five months used up the lifetime limit for him, my family would be in really dire straits.�

Dr. Sherell Mason received Affordable Care Act assistance to help cover her medical school debt in exchange for working in the National Health Service Corps at a community health center that provides health services to the uninsured and underinsured.

�I feel like the ACA is good because, No. 1, you place the health care workers in place to be able to receive those patients, and also you allow community medicine to happen,� Dr. Mason says.

These women are some of the faces of the Affordable Care Act: two mothers worried about their children�s health and their family�s ability to pay for care, and a doctor who got support for her education so she could serve her community.

Visit www.healthcare.gov/mycare to learn more about the benefits and rights under the law.

Microsoft partners with other groups to keep seniors healthy

LOS ANGELES – Microsoft officials announced Wednesday that the company will partner with the City of Los Angeles Department of Aging, Partners in Care Foundation and St. Barnabas Senior Services to enhance the health of Los Angeles' seniors.

The partnership plans to extend its program to a total of 16 senior centers in Los Angeles, say company officials.

The program, called the Exergamers Wellness Club, combines technology with exercise, overall health monitoring and evidence-based health education from Partners in Care, according to a Microsoft press release. Seniors in the program use Kinect for Xbox 360 to make exercise fun and to supplement other fitness activities such as tai-chi, the announcement said.

[See also: Microsoft Bing, Google compete with health maps.] 

According to Microsoft, participating seniors will also use Microsoft HealthVault to manage and store their personal health information. Participants in the program already report improved fitness and well-being, which has motivated Microsoft and its partners to expand the program to all senior centers in the Los Angeles Department of Aging service area.

Los Angeles Mayor Antonio Villaraigosa said the program "is just one way we can give back to the people who have given our city so much."

According to St. Barnabas CEO Rigo Saborio, some of the Exergamers Wellness Club activities include, flash mobs where seniors erupt into dancing and virtual bowling tournaments. Seniors monitor the health benefits of their activities – including improved blood pressure and blood glucose levels-- with Microsoft Healthvault.

June Simmons, president and CEO of Partners in Care, said the addition of technology to the program was a critical enhancement to the health screenings and health-education programs that her organization delivers to Los Angeles seniors.

The Exergamers Wellness Club kicked off in May 2011 with 22 members, Microsoft officials said. It later expanded and now serves 34 seniors between the ages of 64 and 94. Continued participation is evidence of the club's value to its members, they added.

Follow Diana Manos on Twitter @DManos_IT_News.

Supporting Community Living

After a traumatic brain injury as an infant, Quentin Hammond lived in a nursing home for the first six years of his life. At the nursing home, the caregivers viewed him as blind and vegetative, and not able to engage. However, thanks to a program supporting community living, Quentin�s mother, Teresa, was able to bring him home where he now receives the right mix of services and supports. Quentin has benefited from living with the love and support of his mother and little brother, who calls Quentin his best friend. Much to the contrary of his caregivers� views in the nursing home, today Quentin is can see, engages with others, and attends school. As Teresa said, �it�s been like a 360 turn, he is a different person.�

The Obama Administration has long been committed to helping all Americans, including people with disabilities and seniors, live at home with the supports they need, rather than in nursing homes or other institutions, and participate in communities that value their contributions.�The Affordable Care Act has been critical in those efforts, providing many new resources and supports.

Today, the Department of Health and Human Services (HHS) released the latest step towards expanding community living with the final rule creating the Community First Choice (CFC) Option.�Thanks to the new health care law, CFC gives States additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option.� Under CFC, States can receive a six percentage point increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid.

HHS also announced the first 16 organizations that will participate in the Independence At Home Demonstration program, which encourages primary care practices to provide home-based care to chronically ill Medicare patients.

Here are some other ways the Administration is helping support community living:

The new Administration for Community Living�is bringing together key HHS organizations and offices dedicated to improving the lives of those with functional support needs into one coordinated, focused and stronger entity. This new agency will work on increasing access to community supports and achieving full community participation for people with disabilities and seniors.�The �Money Follows the Person� program � which helped Quentin succeed at home � makes it easier for Americans with a disability to live independently.� In Money Follows the Person, the Medicaid funds that supported the nursing home services �follow� the person and support the long-term services in their home, so they can choose when and what they eat, when to go to bed, and when they visit with their family and friends.�Thanks to the new health care law, the program has expanded to 43 States and helped 12,000 individuals move out of institutions and back into their communities. Already 13 States received $45 million in 2011, and will receive more than $621 million through 2016, to help an expected 13,000 additional people.Thanks to the new health care law, new rules�are making it easier for States to provide home and community based services in the Medicaid program through home-and-community based (HCBS) waivers.� Previously, these waivers required States to serve one target group per waiver, but now States can target multiple groups, including seniors, persons with developmental disabilities or mental illnesses.� This reduces administrative challenges delaying opportunities for persons with disabilities to either remain in or transition to community living situations.Under the Balancing Incentive Program, $3 billion in enhanced Medicaid matching funds are available to States to increase access to long-term services and supports in home and community-based settings rather than institutions. In March 2012, New Hampshire and Maryland were the first States to receive this new funding.�Through a partnership between HHS and the Department of Housing and Urban Development, new housing support is now available to help non-elderly persons with disabilities live productive, independent lives in their communities rather than in institutional settings.� HUD is offering approximately $40 million to public housing authorities across the country to fund approximately 5,300 Housing Choice Vouchers�for non-elderly persons with disabilities, allowing them to live independently.�This includes vouchers to help nearly 1,000 non-elderly Americans with disabilities leave nursing homes or other healthcare facilities to live independently.

Learn more about how the Affordable Care Act is helping Americans living with disabilities here.

Study: Long use of any hormones poses breast cancer risk

CHICAGO(AP)�New research suggests that long-term use of any type of hormones to ease menopause symptoms can raise a woman's risk of breast cancer.

It is already known that taking pills that combine estrogen and progestin � the most common type of hormone therapy � can increase breast cancer risk. But women who no longer have a uterus can take estrogen alone, which was thought to be safe and possibly even slightly beneficial in terms of cancer risk.

The new study suggests otherwise, if the pills are used for many years. It tracked the health of about 60,000 nurses and found that use of any kind of hormones for 10 years or more slightly raised the chances of developing breast cancer.

"There's a continued increase in risk with longer durations of use and there does not appear to be a plateau," said study leader Dr. Wendy Chen of Brigham and Women's Hospital in Boston.

The hormone picture has been confusing, and the absolute risk of breast cancer for any woman taking hormone pills remains small. Doctors say women should use the lowest dose needed for the shortest time possible.

"It's hard to be surprised that if you keep taking it, sooner or later it's going to raise risk," said Dr. Robert Clarke of Georgetown University's Lombardi Comprehensive Cancer Center.

The study was discussed Sunday at a cancer conference in Chicago.

Why calories count: New book goes beyond the numbers

When it comes to calories, some people count them, others are confused by them and some just ignore them. Marion Nestle, a nutrition professor at New York University, and Malden Nesheim, professor emeritus of nutritional sciences at Cornell University, look at the topic in Why Calories Count: From Science to Politics. USA TODAY's Nanci Hellmich talked to them about the new book.

Q: How do people's calorie needs differ?

A: The number of calories anyone needs depends on age, body weight, and activity level. Older people need less. Heavier people need more, and men are bigger than women.

Breaking down the calorie facts

At every age, men generally have higher calorie needs than women. Adult men ages 19-30 expend an average of 3,080 calories a day; adult women the same age, 2,440 calories a day, if moderately active and neither underweight nor overweight. These calorie expenditures were measured, not estimated.

Basal metabolism, the calories burned at rest, accounts for 50% to 70% of total energy expenditure throughout your life. Genetics account for some of the variation in basal metabolism among individual people, but how much fat you have is really the determining factor. The more fat on your body, the lower your basal metabolic rate at any given weight.

By age 9, the total energy expenditure of boys and girls is close to 2,000 a day.

Basal (resting) and total energy expenditures increase throughout childhood, reach a peak between ages 14 and 30, and then decline with increasing age.

Q: Why do women in general need fewer calories than men?

A: Women are smaller and generally have a higher body fat content than men. Fatty tissue needs less energy to maintain than does muscle mass. Pregnancy and breast-feeding increase women's calorie needs.

Q: Why do some people have an easier time maintaining a healthy weight than others? How many calories are used by basal metabolism?

A: Genetics has plenty to do with body weight and some people seem to be able to eat vast amounts of food without gaining weight. About two-thirds the calories we need go for basal metabolism � the amount of energy needed to support basic body functions like breathing, blood circulation, kidney function, etc. The rest primarily supports physical activity. So if you want to lose weight, you have to eat less or move a lot more.

Q: Why does energy expenditure decline as much as 20% by age 50 and 30% by age 71 and older?

A: This, in our opinion, is one of life's great tragedies. Basal metabolism drops with age and so does muscle mass. Lots of people are less physically active when they get older. Staying active does lots of good things for health and one of them is compensating for the decline in calorie needs.

Q: Are all calories created equal when it comes to weight loss?

A: If you lock people in a metabolic ward and feed them the same number of calories in reduced-calorie diets that vary in fat and carbohydrates (all measured), you can show that they lose weight at the same rate regardless of diet composition. The number of calories determines how fast they lose, nothing else.

In the real world, some people lose weight faster on low-carbohydrate, high-fat diets, such as the Atkins diet, especially at the beginning when they excrete so much water. Some people find that low-carbohydrate diets make it easier to reduce calories and stay satiated. And it's always a good idea to cut back on desserts and sodas.

Q: Do excess calories make some people gain weight faster than others?

A: Here's where genetics comes in. In controlled studies of overfeeding, everyone gains weight when they eat more calories than they expend, but at different rates. Some people can overeat and gain only a little weight � growing teenage boys are a good example. They may spontaneously increase their physical activity to burn off excess calories. Other people easily store more of the extra calories as fat.

Q: What is your best advice to people who want to lose weight?

A. Our mantra is: Get organized; eat less; eat better; move more; get political. By get political, we mean work to change the food environment to one that makes it easier to eat healthfully: Support labeling laws and nutrition education; stop advertising to children; support agricultural policies that encourage consumption of fruits and vegetables, local food systems, and environments that encourage physical activity.

Q: What do calories have to do with politics?

A: How much food people eat � and whether they are malnourished or overweight � is affected by income, education, and, therefore, the political system. Many companies and vested-interest groups have a stake in how calories are marketed, perceived, labeled, and promoted, not least because eating less is bad for business.

Efforts to do something about obesity in adults and children focus on eating less or on eating better, meaning more fruits, vegetables, and grains but consuming less of sodas, fast food, snacks, and other highly profitable items.

Such matters as soda taxes, listing calories on food labels or menu boards, or campaigns to promote smaller portions are all political responses to concerns about calorie consumption. For years, consumer groups have pushed for calorie and nutrition labeling on alcoholic beverages, but the Treasury Department (not the FDA) regulates such things and responds to the wishes of the industry.

Allscripts: Debacle or silver lining?

CHICAGO – After what turned out to be a sea-changing Q1 earnings meeting April 26, which saw the ejection of its board chairman and three other board members reportedly quitting in protest, Allscripts on Monday moved quickly to begin to right the ship, with the announcement of a new chairman.

Dennis Chookaszian, who has served on the Allscripts board since September 2010, will take the helm on the board of directors. He was formerly the chief executive and chairman of mPower Inc., a financial advice firm focused on the online management of 401(k) plans.

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

Some Allscripts customers say they are concerned about the recent chaos, but they believe Allscripts CEO Glen Tullman will be able to move the firm forward.

“What I see bodes well for the future," said John Bosco, CIO of North Shore-Long Island Jewish Health System, Allscripts' biggest client. "In the end, it will enable Glen to make the changes that are needed."

“We’re the largest Allscripts customer by orders of magnitude,” said Bosco. “Allscripts is our go-forward partner.”

[See also: Customers have high expectations for Allscripts]

Indeed, North Shore-LIJ has invested $400 million to connect 15 hospitals, 2,500 employed physicians and 8,000 affiliated physicians. Allscripts touted the intiative when it announced the initiative two years ago as “the largest EHR program in the New York metropolitan area and one of the largest in the nation.”

William Spooner, CIO of Sharp Healthcare in San Diego, says Sharp’s user executives are nervous about the recent chaos at Allscripts – and about the lower-than-expected financial results reported for Q1. (Unrelated, Allscripts CFO Bill Davis, is leaving for a post outside the healthcare sector, triggering analysts to downgrade Allscripts stock from “buy” to “neutral.”)

“I am concerned as well," said Spooner, “yet my role is to steady the ship, maintain perspective and consider contingencies. Glen is severely challenged yet a strong leader. Stay tuned for a hot summer.”

Back in June 2010, Allscripts merged with Eclipsys, a deal that gave Allscripts, which had played solely in the ambulatory space, access to the hospital market. At the time, Tullman said, it’s what Allscripts customers were pleading with him to do. Eclipsys, with its Sunrise Enterprise EHR, seemed like a good fit.

Spooner and others said then that the proof would be in execution.

"I think that as these two organizations combine their market strengths, it will translate into new, highly integrated services and products," Michael O'Rourke, CIO of Denver-based Catholic Health Initiatives said at the time of the merger.

Many expressed high expectations then, but the merger does not seem to have turned out as they hoped.

In Bosco’s view, the two companies underestimated the differences in culture between Allscripts and Eclipsys. “They could not have been more different in terms of culture,” he said, adding that the removal of chairman Phil Pead from the board and the stepping down of three other directors might now pave the way for Tullman to put his plans into action.

“All are still pushing hard, and it’s a tough road, but they are focused on long-term success," Bosco said. “I think there’s a silver lining.”

Allscripts also annnounced the board has authorized management to repurchase an additional $200 million of the company's outstanding shares, bringing the total amount authorized for stock buybacks to $400 million.

Helen-Care: Giving Seniors Peace of Mind and More Money in Their Pockets

Helen R. is a senior who likes to keep busy. From helping her grandson with his education, to assisting other seniors at a West Philadelphia senior center, Helen knows there are lots of people counting on her.� That�s why it�s a relief to Helen that she can count on the Affordable Care Act to get the care she needs at an affordable cost.

The law provides free preventive services under Medicare, such as cancer screenings and an annual wellness visit for Helen and other seniors to sit down and talk with their doctor about their concerns and needs. She says that it�s good to know that she and other seniors can access these services �without breaking the bank.�

Helen also falls into the prescription drug coverage gap called the �donut hole�, but because of the law, she receives a 50 percent discount on brand-name drugs.� By 2020, the donut hole will be closed.

�I am a grandmother who is trying to assist a grandson with his education. I take seven different medications. Getting the donut hole closed, that gives me a little more money in my pocket,� Helen explains.

Helen has been working the past six years as a health/wellness coordinator, arranging for health and fitness workshops and activities for seniors older than herself at the senior center. She knows they have the same issues with the costs of staying healthy. �If it weren�t for the health care reform, many of our seniors would not get to a doctor or get mammograms,� Helen says. �It is expensive for us to keep good health.�

Under the Affordable Care Act, over 5.1 million people with Medicare saved more than $3.1 billion on their prescriptions in 2010 and 2011�that�s an average of about $635 per person. The health reform law is also bolstering Medicare by providing new tools to crack down on fraud, waste, and abuse, recovering more than $4 billion taxpayer dollars last year alone.

Helen: �I do have more peace of mind with health care reform.�

See all MyCare stories ?

Making Insurance Plans Easier to Understand

Having affordable, quality health insurance is incredibly important. But how can you pick the plan that is best for you and your family if insurance plans are written in words you cannot understand or in type so small you can barely read it? And how can you take advantage of the health benefits you have if you don�t know what your plan covers?

You�re not alone in your confusion. Too many Americans don�t have access to information in plain language to help them understand the health coverage they have.

Now, thanks to the Affordable Care Act, every American consumer will receive an important new tool to understand their coverage. Under proposed rules announced today, health insurers and employers who offer coverage to their workers must provide you with clear and consistent information about your health plan.

Specifically, you will have access to two important insurance forms:

An easy to understand Summary of Benefits and CoverageA uniform Glossary of terms commonly used in health insurance coverage

This will include basic information that every person should have, including:

What is your annual premium?What is your annual deductible?What services are NOT covered by my policy?What will my costs be if I go to a provider in my network versus one that is not in my network?

Below is an example of a page from the proposed new form:

These common sense rules benefit from a public process led by the National Association of Insurance Commissioners (NAIC) and a working group composed of consumer advocates, employers, insurers, and other people involved in your insurance and care. As with all changes to health care, we are giving the public a chance to review this proposal and send us their comments before we make the rules final.

But starting in March 2012, if you are one of the 180 million Americans with private health insurance, help is on the way to make sure you understand your health insurance.

And this means you and your family will have an easier time accessing the health benefits you currently have--and you will be able to make a more informed decision about purchasing the coverage you need.

For more information about this announcement, please visit: http://www.HealthCare.gov/news/factsheets/2011/08/labels08172011a.html

Payers News Briefs

BCBS montana boosts ITs customer service                                       
Blue Cross and Blue Shield of Montana is boosting its customer service with technology from Cambridge, Mass.-based Pegasystems. BCBSMT has selected Pegasystems' Customer Process Manager for Healthcare to optimize its customer service, sales, and process efficiencies. Pegasystems' technology will streamline customer phone inquiries resolving many questions within the first call. The insurer plans to roll out the new technology in early 2009.

Shared Health integrates data, improves workflow
Shared Health, one of the largest public/private health information exchanges (HIE) in the United States, is using technology from Santa Monica Calif.-based Orion Health to integrate data and improve workflow.  Shared Health will implement Orion Health's Concerto Physician Portal to enable an integrated electronic health record system and provide access to patient data from disparate systems. Orion Health North America President Paul Viskovich says Shared Health is the first HIE to leverage Concerto's strengths in integrating health data and workflow applications in a unified, patient-centric view.

UPMC adds medical management technology
UPMC Health Plan, the second-largest health insurer in Western Pennsylvania, has expanded its partnership with Southborough, Mass.-based ikaSystems to improve quality and cost containment. UPMC will add Web-based integrated medical management solutions to its existing ikaEnterprise modules underlying its portal strategy, allowing the plan to enhance healthcare quality for its members while supporting providers with performance information.

FCSO employs new reimbursement system
First Coast Service Options (FCSO), headquartered in Jacksonville, Fla., is working with Alexandria, Va.-based Burgess, a Medicare reimbursement solutions provider, to support a new Medicare contract awarded recently by the Centers for Medicare & Medicaid Services. Under this new contract, FCSO will resolve reimbursement disputes beginning Jan. 1, 2009, between healthcare providers and organizations offering Medicare Private Fee-for-Service plans.  FCSO will license and employ the Burgess Reimbursement System to compute accurate pricing associated with disputed claims.

Parents today are happier than non-parents, studies suggest

SAN FRANCISCO�Having kids may not make us miserable after all.

The conventional wisdom that's developed over the past few decades � based on early research � has said parents are less happy, more depressed and have less-satisfying marriages than their childless counterparts.

But now, two new studies presented as part of the Population Association of America's annual meeting suggest that earlier findings in several studies weren't so clear-cut and may, in fact, be flawed. The newer analyses presented this week use analytical methods based on data from almost 130,000 adults around the globe � including more than 52,000 parents � and the conclusions aren't so grim. They say that parents today may indeed be happier than non-parents and that parental happiness levels � while they do drop � don't dip below the levels they were before having children.

"We find no evidence that parental well-being decreases after a child is born to levels preceding the children, but we find strong evidence that well-being is elevated when people are planning and waiting for the child, and in the year when the child is born," notes the study presented by co-author Mikko Myrskyl� of the Max Planck Institute for Demographic Research in Rostock, Germany.

The overall net effect of having children is positive, says the research, which analyzes longitudinal data from British and German parents by following the same individuals in the four to five years before the birth up to four years after the birth. The happiness levels of parents are compared to their own happiness levels before becoming parents.

The other study, of some 120,000 adults from two nationally representative surveys between 1972-2008, finds that parents were indeed less happy than non-parents in the decade 1985-95, but parents from 1995 to 2008 were happier. What's happened, suggests co-author Chris Herbst of Arizona State University, is that happiness among non-parents has declined, thus making parents happier in comparison.

He says the evidence isn't clear as to whether the average parent today is less happy than someone without kids. But he says what's "undeniable, however, is that parents have become relatively happier than non-parents over the past few decades."

Herbst, an assistant professor of public affairs at the school's downtown Phoenix campus, says his research identifies "serious problems with previous work that ought to make people skeptical about the earlier conclusions."

Both studies explain a variety of problems with earlier studies on parental happiness, including the fact that they use cross-sectional research methods that don't take into account individual personality differences. They also often use older data that may not apply to today's parents.

Other findings from the European study suggest that parental characteristics, such as age, make a difference in well-being. Those who become parents at younger ages have a downward happiness trend, while postponing parenthood results in a higher happiness level after the birth. However, co-author Rachel Margolis of the University of Western Ontario in London, Ontario, says the risk of involuntary childlessness increases with age.

"The results are not meant to encourage women to wait to very high ages to have a first birth," she says.

Their study also suggests happiness levels change with each child.

"The first child increases happiness quite a lot. The second child a little. The third not at all," says Myrskyl�.

New tenants sign on for Nashville Medical Trade Center

NASHVILLE – The downtown Nashville Medical Trade Center on Friday announced a slate of health information technology companies as tenants.

The Nashville Medical Trade Center is a healthcare marketplace that features permanent showrooms, temporary exhibition space and education and training facilities.

According to the Dallas-based Market Center Management Company, the trade center has secured lease commitments from firms including:

Informatics Corporation of America (ICA), which will showcase interoperability technology that enables health information exchange and will be located in the HIT neighborhoodThe SSI Group (SSI), also located in the HIT neighborhood, will promote its claims management technologyV Alexander will showcase supply chain management tools, such as transportation, customs, compliance, documentation and security, on the services floor.Remind America, a HIPAA-compliant physician reminder service, will also join the services floor and will present customized services geared toward physician practices.Humanscale, will join the furniture neighborhood and offer ergonomic work tools that support healthcare-specific technology.ergoCentric will present a specialized line of medical grade seating, healtHcentric, also in the furniture neighborhood.

"As we move forward on several fronts, this new stage of the project will place an even greater emphasis on innovation and the leading edge of patient care that will draw the industry to Nashville," said Cindy Morris, chief operating officer of Market Center Management Company. "At the same time, we continue work with the first major exhibitor in the trade center, the Health Information and Management Systems Society (HIMSS), to advance our shared vision of a year-round marketplace of ideas, education and innovation. HIMSS has served as a catalyst for attracting a number of important companies to the project."

"HIMSS will serve as the hub of information technology on the top floor of the trade center where we will host technical demonstrations, conferences, workshops and customer demos," said Sandra L. Vance, director of global interoperability showcases for HIMSS. "In addition, HIMSS expects to host more than 100 companies inside an interactive exhibit exploring clinical information systems and infrastructure that provides optimum interoperability."

"We began this project in the midst of uncertainty about the economy and questions about the viability of a global marketplace for healthcare," said Bill Winsor, president and CEO of Market Center Management Company. "But companies have had the time to recognize the cost benefits and business opportunities of a center of innovation attracting visitors from around the world. As the economy continues to warm up we will add a significant number of new companies and organizations as well as announce companies with existing leases."
 

Banner Health earns Stage 7 recognition

PHOENIX – HIMSS Analytics has given Banner Health its Stage 7 Award for 17 of its 23 hospitals, located in Alaska, Arizona, California, Colorado, Nebraska, Nevada and Wyoming. The award recognizes attainment of the highest level on HIMSS' Electronic Medical Records Adoption Model.

Banner Health is one of only 66 facilities in the United States – just 1.2 percent, of the more than 5,000 U.S. hospitals in the HIMSS Analytics Database – to be awarded the HIMSS Analytics Stage 7 Award, officials note.

HIMSS Analytics developed the EMR Adoption Model in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics Database. There are eight stages (0-7) that measure a hospital’s implementation and utilization of IT applications. The final stage, Stage 7, represents an advanced patient record environment. The validation process to confirm a hospital has reached Stage 7 includes a site visit by an executive from HIMSS Analytics and former or current chief information officers to ensure an unbiased evaluation of the Stage 7 environments.

“While achieving HIMSS Stage 7 for 17 of Banner’s 23 hospitals is an important ?organizational achievement, the most important beneficiaries are our patients,” said Banner Health’s executive vice president and chief medical officer, John Hensing, MD. “Our meaningful use of enhanced electronic medical records is integrated into our patient care processes and even targeted to help our clinicians proactively recognize and treat specific and dangerous disorders such as sepsis and delirium."

“Operating as ‘one hospital with 23 locations,’ Banner Health exemplifies a strong culture of change, enabling IT to drive process standardization," said John Hoyt, executive vice president of HIMSS Analytics. "This health system includes the first critical access hospitals at this level of EMR sophistication, with five critical access hospitals among the 17 at Stage 7. With more than 90 percent of all medical orders being directly entered into the system by the medical staff, the quality and safety is significantly enhanced for all Banner patients."

Hoyt added that Banner's "world-class simulation center for clinician training and creative tools used to build specific views of patient health data" also support the health system's Stage 7 achievement.

Better Health and Lower Costs for Medicare Beneficiaries

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services

It�s been a big summer for the millions of Americans who are benefitting from improved Medicare coverage thanks to the Affordable Care Act. The benefits are clear: More people are getting preventive services to keep them healthy and people with high prescription drug costs are seeing the donut hole coverage gap starting to close � lowering the cost of drugs so that people don�t have to worry about being able to afford the care they need. Take a look at the past few months:

June: Through the end of June, 899,000 Americans with Medicare have benefited from the discount on brand name drugs in the Medicare Part D "donut hole" coverage gap -- an increase of over 420,000 individuals in the month of June alone.These discounts have saved seniors and people with disabilities a total of�$461 million, including $200 million in June alone!July: Through the end of July, 17.3 million people with traditional Medicare, or 51.5 percent, have received one of more free preventive services.�During the same time period, over 1 million Americans with traditional Medicare have taken advantage of Medicare�s new free Annual Wellness Visit, up from 780,000 in mid-June;

To learn more about these new benefits, check out the Medicare campaign, �Share the News, Share the Health�, to learn about the importance of prevention for people with Medicare.

But the good news doesn�t stop here. Over the coming years, provisions of the Affordable Care Act will help close the donut hole coverage gap completely. Here is a sense of what Medicare beneficiaries can look forward to:

2013: You will pay less and less for your brand-name Part D prescription drugs in the donut hole.2020: The coverage gap will be closed, meaning there will be no more �donut hole,� and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit.

The chart below shows Medicare prescription drug savings over time:

�Medicare prescription drug savings over time�You Will Pay This Percentage for Brand-name Drugs in the Coverage GapYou Will Pay This Percentage for Generic Drugs in the Coverage Gap2011

50%

93%

2012

50%

86%

2013

47.5%

79%

2014

47.5%

72%

2015

45%

65%

2016

45%

58%

2017

40%

51%

2018

35%

44%

2019

30%

37%

2020

25%

25%

Source: Centers for Medicare and Medicaid Services

This all amounts to even more examples of how the Affordable Care Act is providing better health care for people covered by Medicare and making a difference in the lives of millions of Americans.

Emageon demands HSS close on buyout by Tuesday

BIRMINGHAM, AL – Emageon executives have formally demanded a closing of the company's pending merger with Health Systems Solutions, Inc. by Tuesday, accusing New York-based HSS of "stalling."

The deal was first announced Oct. 14, pending approvals, and Emageon shareholders approved the proposed sale on Dec. 18. HSS officials said then that they would use Emageon as a platform for growth.

HSS was to pay $62 million, or $2.85 a share, for Emageon, which provides information technology systems for hospitals, healthcare networks and imaging facilities.

"We believe we have an obligation to consummate our merger in an expeditious manner in accordance with the requirements of both parties under the merger agreement," said Chuck Jett, chief executive officer of Emageon, in a news release. "We also believe our stockholders, who have resoundingly supported this transaction, desire us to move forward without delay. Health Systems has not agreed to set a closing date, instead making additional due diligence requests. This news was especially surprising given Health Systems' recent public and private support of the transaction."

"There is no due diligence condition in the merger agreement and the time for due diligence ended when the parties signed the merger agreement," Jett said. "Health Systems has also asserted purported breaches of our representations, warranties and covenants under the merger agreement, which we categorically deny and reject as immaterial.

"Health Systems is clearly stalling for reasons that are not apparent to us and unrelated to any purported breaches of the merger agreement," Jett continued.  "We believe we have satisfied our conditions to closing and that it is time for Health Systems to comply with its obligations and close the merger."

If the closing does not occur by Tuesday, Jett said, "we intend to pursue our rights and remedies under the merger agreement."

Supreme Court ruling will set the course for healthcare

WASHINGTON – Now that the Supreme Court justices have heard the arguments for both sides of the health reform law, will the conservative majority fall back on their political leanings to strike down the law and maintain the unsustainable healthcare patchwork, or move the nation a giant step toward the future in healthcare?

The fact that a 5-4 majority of justices were named by Republican presidents does not bode well for the health reform law. It is widely believed that Justice Anthony Kennedy could be the pivotal vote that could uphold the individual mandate and the remainder of the law.

[See also: All or nothing? Health reform law now up to justices to decide]

However the justices rule, they will have a place in history either in enabling the transformative process of healthcare to gain steam or miring the nation in more political quicksand as tens of millions of uninsured continue to weigh down a system with uncompensated and unnecessary costs.

As flawed as the Patient Protection and Affordable Care Act (ACA) is, it is a means to include the overwhelming majority of Americans in healthcare instead of fending for themselves and leaving the taxpayers and the insured to pick up the costlier tab, according to Solicitor General Donald Verrilli Jr.

Once the health reform provisions are in practice, the voters can decide where it needs polishing to work more effectively, he said.

[See also: Day 2: High court delves into heart of health reform]

At the conclusion of his arguments March 28, Verrilli said Congress struggled with the issue of how to deal with the acute problem of 40 million people without healthcare for many years, and it made a judgment, one that conformed to what lots of experts thought was the best set of options to handle this problem, he said.

“Maybe they were right; maybe they weren’t. But this is something about which the people of the United States can deliberate and vote, and if they think it needs to be changed, they can change it,” Verrilli said. But he called on the justices to make sure that the federal government maintains these “enumerated powers.”

“This was a judgment of policy that democratically accountable branches of government made by their best lights,” Verrilli said, urging the court to “respect that judgment" and uphold the ACA "in its entirety."

The justices will rule in June.

The 26 states led by Florida and the National Federation of Independent Business that challenged the health reform law view the mandate as the federal government encroaching on individual freedom because it forces those who are healthy or do not want insurance to obtain it.

Politics, of course, has been a part of health reform all along and is a foundation of the lawsuit. Even Justice Antonin Scalia pointed out during the March 28 session, “Is there any chance at all that 26 states opposing it have Republican governors and all of the states supporting it have Democratic governors?”

While the justices intensely grilled Verrilli and his deputy Solicitor General, Edwin Kneedler, and often interrupted and cut off their answers, the federal government technically has a much higher bar to prove their point since the ACA expands on traditional views of federal reach, much as Medicare and Social Security did decades earlier.

Justice Anthony Kennedy suggested that the individual mandate changes the relationship between the government and individuals and so it would have “a heavy burden of justification to show authorization under the Constitution.”

Chief Justice John Roberts Jr. was troubled by the extent of power that Congress could exert in the future to compel people to do all kinds of things. “Once we say there is a market and Congress can require people to participate in it, as some would say, or as you would say, that people are already participating in it ... all bets are off, and you could regulate that market in any rational way,” he said.

Paul Clement, attorney for the states and former Solicitor General under President George W. Bush, argued for limiting the federal government’s reach and finding alternatives for a solution to the nation’s uninsured.

Justice Sonia Sotomayor countered, however, “My greatest fear is that we’re going to say to the federal government, ‘The bigger the problem, the less your powers are.’”

While the justices will be deciding constitutional questions, let’s hope they also weigh what health     care has the possibility of looking like in the long term if the difficult changes start now.

Helping More Medical Students Repay their Loans

Thousands of primary care providers have a passion for helping those in need, and the National Health Service Corps Loan Repayment Program, strengthened by the Affordable Care Act, helps doctors, nurses, dentists and other health care providers do just that.

Today marks the opening of the 2012 application cycle for the National Health Service Corps Loan Repayment Program. Primary care medical, dental, and mental/behavioral health clinicians are able to pay down their educational debt, and earn a competitive salary, while providing comprehensive care in underserved communities.

Access to primary care services remains a major challenge in the United States.� About one in five people (21 percent) live in a primary care shortage area. This often means that entire families � from infants to grandparents � must travel far distances to receive care, can�t find a provider, or they simply go without.

With more than 10,000 clinicians working at one of 17,000 National Health Service Corps-approved health care sites in urban and rural communities, the program helps train Americans who work in organizations that provide primary care services to approximately 10 million people � regardless of where they live or their ability to pay. From Oakland, California to Altamont, Tennessee to Glassboro, New Jersey, Corps members make an impact in their communities for the long-term.

Dr. Katherine Culp says the National Health Service Corps provided her exactly what she was looking for � an opportunity to be debt free, stay in her state and be close to family. Dr. Culp is a dentist who has remained at her NHSC site for the past 8 years and has risen to the position of Dental Director. �I got here and saw how we provide access to so many people, especially children and that it is a perfect match for me.�

Since 1972, the National Health Service Corps has supported some 40,000 primary care providers as they�ve worked in communities with limited access to care.� Many changes have happened over the years, but the central goal of the Corps has remained the same: to connect dedicated primary care providers with the communities that need them most.

For more information about the NHSC and the Loan Repayment Program, please visit NHSC.hrsa.gov.

CMS awards $111M contract for health IT app

INDIANAPOLIS – Centers for Medicare & Medicaid Services has awarded a $111 million contract to Indianapolis-based National Government Services, Inc. to support the Next Generation Desktop (NGD) over the next five years.

National Government Services is a subsidiary of WellPoint, a Fortune 50 company, and one of the largest health benefits companies in the nation. NGS has held the contract since the application was put in place.

[See also: Verizon, Northrop Grumman, NGS help CMS battle fraud]

The NGD is the desktop application used by all Medicare Contact Center Customer Service Representatives (CSRs) to answer millions of calls from Medicare beneficiaries. The application reduces the amount of time required to help Medicare beneficiaries and improves the CSRs ability to provide more timely and accurate service for inquiries, company executives said.

One key function of the application is to allow CSRs to access information the beneficiary may have previously entered into the Medicare Website, MyMedicare.gov. For example, if someone had been in the process of choosing a Medicare Prescription Drug Plan, but needed assistance, that individual could simply call 1-800-Medicare and the CSR would have the information previously entered at their fingertips.

"Data integration is a critical innovation in the healthcare IT arena," said Tim Masheck, vice president of health information technology at National Government Services. "Such technology enables those on the front lines to provide better patient care and a more pleasant experience overall. National Government Services is proud that we were called upon yet again to ensure the integrity of this critical application."

[See also: NGS will have chance to bid on VA technology contracts]

1-800-Medicare received 26 million calls last year with approximately 3,500 CSRs at the call center using the NGD desktop tool to assist callers with their Medicare inquiries.

"This award is an important signal of CMS's continuing confidence in National Government Services and a key step in our efforts to further grow our business," said National Government Services President Sandra Miller. "We look forward to helping CMS continue to innovate and provide better service to all of its 46 million Medicare beneficiaries."

CMS to develop eligibility tools for insurance exchanges

WASHINGTON – The Centers for Medicare and Medicaid Services plans to develop verification data and services to support coverage and eligibility infrastructure for health insurance exchanges and seeks industry information about applications that are available.

A solution that verifies eligibility for qualifying coverage in an employer-sponsored plan is part of the process for determining whether an individual qualifies for advance payment of the premium tax credit that is available to support the purchase of health plans through the exchanges.

[See also: Exchange deadline creeps closer]

CMS wants to identify authoritative data sources that can be used or adapted to meet the verification requirement and also how to develop new data sources that could fulfill that condition, according to an April 30 announcement for request for information in Federal Business Opportunities. Responses are due May 21.

Among solutions that the Health and Human Services Department has proposed in a rule describing health insurance exchanges is development of a database that contains authoritative data to assure employer-sponsored coverage.

The Patient Protection and Affordable Care Act did not require this data, so population of a potential database would be voluntary. And no data sources currently exist that contain comprehensive information about access to employer-sponsored coverage or the affordability and minimum value of such coverage, according to the notice.

[See also: Insurance exchange rule unveiled]

Under the health reform law, states must have operational capability of their online marketplace to compare and purchase health coverage by October 2013.

One example of how verification might work is that an exchange could use a database to check applicant attestations about access to employer-sponsored coverage. A business service request generated by the exchange would check private and public data sources through a CMS data services hub to confirm the accuracy of the data that was submitted. These data sources could include the state Directory of New Hires or state quarterly wage databases. 

CMS also seeks information about technology or business process applications that can verify the current income of individuals and households seeking insurance through the qualified health plans offered through the exchange, according to an April 23 request for information. The process is similar to that for verification for employer-sponsored coverage and the use of a CMS data services hub to confirm data. Responses are due May 14.

Exchanges must be able to determine also whether individuals are eligible to receive advance payments of the premium tax credit, cost-sharing reductions and exemptions from the individual responsibility requirement. Income levels are available from individual confirmation and data from federal, state and commercial sources.

Processes for eligibility and income verification need to be streamlined and coordinated across HHS, the exchanges, state Medicaid and Children’s Health Insurance Program agencies. Yet the information required from an applicant must be the minimally necessary to support eligibility and enrollment procedures across those programs.

[See also: Health insurance exchanges mired in political battle]

Breast cancer is rare in men, but they fare worse

CHICAGO�Men rarely get breast cancer, but those who do often don't survive as long as women, largely because they don't even realize they can get it and are slow to recognize the warning signs, researchers say.

On average, women with breast cancer lived two years longer than men in the biggest study yet of the disease in males.

The study found that men's breast tumors were larger at diagnosis, more advanced and more likely to have spread to other parts of the body. Men were also diagnosed later in life; in the study, they were 63 on average, versus 59 for women.

Many men have no idea that they can get breast cancer, and some doctors are in the dark, too, dismissing symptoms that would be an automatic red flag in women, said study leader Dr. Jon Greif, a breast cancer surgeon in Oakland, Calif.

The American Cancer Society estimates 1 in 1,000 men will get breast cancer, versus 1 in 8 women. By comparison, 1 in 6 men will get prostate cancer, the most common cancer in men.

"It's not really been on the radar screen to think about breast cancer in men," said Dr. David Winchester, a breast cancer surgeon in NorthShore University HealthSystem in suburban Chicago who was not involved in the study. Winchester treats only a few men with breast cancer each year, compared with at least 100 women.

The researchers analyzed 10 years of national data on breast cancer cases, from 1998 to 2007. A total of 13,457 male patients diagnosed during those years were included, versus 1.4 million women. The database contains about 75 percent of all U.S. breast cancer cases.

The men who were studied lived an average of about eight years after being diagnosed, compared with more than 10 years for women. The study doesn't indicate whether patients died of breast cancer or something else.

Greif prepared a summary of his study for presentation Friday at a meeting of American Society of Breast Surgeons in Phoenix.

Dr. Akkamma Ravi, a breast cancer specialist at Weill Cornell Medical College in New York, said the research bolsters results in smaller studies and may help raise awareness. Because the disease is so rare in men, research is pretty scant, and doctors are left to treat it the same way they manage the disease in women, she said.

Some doctors said one finding in the study suggests men's breast tumors might be biologically different from women's: Men with early-stage disease had worse survival rates than women with early-stage cancer. But men's older age at diagnosis also might explain that result, Greif said.

The causes of breast cancer in men are not well-studied, but some of the same things that increase women's chances for developing it also affect men, including older age, cancer-linked gene mutations, a family history of the disease, and heavy drinking.

There are no formal guidelines for detecting breast cancer in men. The American Cancer Society says routine, across-the-board screening of men is unlikely to be beneficial because the disease is so rare.

For men at high risk because of a strong family history or genetic mutations, mammograms and breast exams may be helpful, but men should discuss this with their doctors, the group says.

Men's breast cancer usually shows up as a lump under or near a nipple. Nipple discharge and breasts that are misshapen or don't match are also possible signs that should be checked out.

Tom More, 67, of Custer, Wash., was showering when he felt a pea-size lump last year near his right nipple. Because a golfing buddy had breast cancer, More didn't put off seeing his doctor. The doctor told More that he was his first male breast cancer patient.

Robert Kaitz, a computer business owner in Severna Park, Md., thought the small growth under his left nipple was just a harmless cyst, like ones that had been removed from his back. By the time he had it checked out in 2006, almost two years later, the lump had started to hurt.

The diagnosis was a shock.

"I had no idea in the world that men could even get breast cancer," Kaitz said. He had a mastectomy, and 25 nearby lymph nodes were removed, some with cancer. Chemotherapy and radiation followed.

Tests showed Kaitz, 52, had a BRCA genetic mutation that has been linked to breast and ovarian cancer in women. He may have gotten the mutation from his mother, who is also a breast cancer survivor. It has also been linked to prostate cancer, which Kaitz was treated for in 2009.

A powerboater and motorcycle buff, Kaitz jokes about being a man with a woman's disease but said he is not embarrassed and doesn't mind showing his breast surgery scar.

The one thing he couldn't tolerate was tamoxifen, a hormone treatment commonly used to help prevent breast cancer from returning in women. It can cause menopausal symptoms, so he stopped taking it.

"It killed me. I tell you what � night sweats, hot flashes, mood swings, depression. I'd be sitting in front of the TV watching a drama and the tears wouldn't stop pouring," he said.

Doctors sometimes prescribe antidepressants or other medication to control those symptoms.

Now Kaitz gets mammograms every year. Men need to know that "we're not immune," he said. "We have the same plumbing."

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Online:

Male breast cancer: http://bit.ly/ayq2S6

Support group: http://www.malebreastcancer.org