Flu plan includes withholding ventilators
Filed under: Government, Health policy, Hot Health Headline
Sheri Fink, M.D., of ProPublica, is reporting that state and federal officials are drawing up guidelines on who would get ventilators should there be a severe flu outbreak, including “procedures under which patients who weren’t improving would be removed from life support with or without permission of their families.”
On Thursday morning, the Institute of Medicine is expected to release guidelines to help planners create standards of care in extreme emergencies, according to Fink.
Many of the draft guidelines, including those drawn up by the Veterans Health Administration, are based in part on a draft plan New York officials posted on a state web site two years ago and subsequently published in an academic journal. The New York protocol, which is still being finalized, also calls for hospitals to withhold ventilators from patients with serious chronic conditions such as kidney failure, cancers that have spread and have a poor prognosis, or “severe, irreversible neurological” conditions that are likely to be deadly.
Update
The IOM has released its report on “Standards of Care During Disaster Situations.”
Equal treatment for mental health in peril
Phyllis Vine of MIWatch.org, a site about mental illness, writes that last year’s mental health parity legislation has run into problems. According to Vine, if federal rules for implementing the Wellstone-Domenici Mental Health Parity and Addiction Equity Act are not in place by the Oct. 3 deadline, treatment for many could be delayed or stopped.
The act requires insurers to treat mental illness the same way they do physical ailments, eliminating higher co-pays, deductibles and limits on hospital stays. Vine provides some background:
We should recall that parity was hotly debated before two bills (HR 1424 in the House, S 558 in the Senate) were folded into last year’s stimulus package. It was an initiative supported by a unique collaboration between advocates in the mental health community and those in the addiction community, with coverage extending to the self-insured and to those in Medicaid managed care. The House initiative, led by Reps. Patrick Kennedy and Jim Ramstad, wanted to base treatment criteria on the American Psychiatric Association’s Diagnostic and Statistical Manual. Insurance and business were able to determine that the Senate’s bill allow them to define “medical need.”
Vine writes that insurance companies are now trying to sabotage the law in an attempt to preserve profits. Letters from the American Benefits Council and Wellpoint Inc., sent during the public comment period, ask for exclusions of some conditions, treatments, providers and limits on the number of visits patients can make.
OIG: Are we ready for a flu pandemic?
The Department of Health and Human Services’ Office of Inspector General has released two reports assessing just how prepared Americans are for a flu pandemic. Their findings? Communities are on the right track when it comes to preparing for a surge in patient numbers, but they’re not as ready as they could be. Likewise, there’s still more to be done before local organizations will be ready to distribute vaccines and antiviral drugs.
A surge of flu victims
In the Southern Hemisphere, where the flu season has already struck, the biggest systemic issue was lack of space in intensive care units overwhelmed by H1N1 victims. Are American communities doomed to more of the same? After reviewing the coordination, volunteer recruitment/organization, medical equipment, alternate care and triage and admission guidelines of 10 localities as of late summer 2008, the OIG’s answer is a resounding “not quite.” (Get the full 37-page report here.)
The OIG’s to-do list for the assistant secretary for preparedness and response?
- Keep emphasizing those five areas that we evaluated
- Make sure that, when states and localities do medical surge preparedness exercises, they then document and address the lessons they learned from those activities.
- Those lessons everyone just documented? Make sure they share them with everyone else too. Preferably through the CDC. Then the feds can work to address specific local issues.
- Consider working with states (or even the federal government) to “develop appropriate legal protections for medical professionals and volunteers who respond to public health emergencies and who may need to alter standards of care.”
Getting vaccines/antivirals to the right place, at the right time
According to HHS, “even a mild pandemic could cause between 2 million and 7.4 million deaths worldwide” and H1N1 looks to be a “moderate” one. Vaccination is a key component of the prevention plan, which is why the OIG evaluated the pandemic flu plans of 10 communities in the categories of “Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.” In general, they found that the communities need to practice more, plan for all eight categories and make those plans “actionable.” In general, folks were best at planning for receiving/staging and dispensing and worst at planning for security, storage and transportation.(Read the whole 57-page report here.)
Based on those findings, the OIG recommended that the CDC:
- Work with states to figure out why folks are still in the “early stages” of planning and help them make some progress
- Prioritize which of the eight areas states should focus on in order to improve local readiness as quickly as possible.
- Emphasize “actionable” plans that “identify the organizations or individuals responsible for carrying out specific actions and the sources that would be necessary to staff distribution and dispensing positions” that are “supported by valid, detailed formal agreements with partnering agencies.”
- Again, make sure locals keep track of what they’ve learned in preparedness exercises and that they make plans to correct any deficiencies. Also, make sure they share plans and “emerging promising practices.”
Blogger: Flu reporters got it right this time
Bloggers at Effect Measure have some praise for “flu reporters” and their coverage of a recent NIH press release about the H1N1 vaccine in children.
The writer points out that the reporters he praises took the time to recognize that the real news was buried in the press release: that younger children will need two doses of the H1N1 vaccine.
The writer (the editors of Effect Measure sign their posts “Revere” to recognize Paul Revere, a member of the first local board of health in the United States) does call out one report for being just a rewrite of a press release but notes:
I’ve spent a lot of time here complaining how so much science reporting I see everyday is barely massaged press releases regurgitated by reporters acting as stenographers.
Walking school bus hopes to cut traffic, obesity
Just in time for International Walk to School Day (Oct. 7), Bobbie O’Brien of public radio station WUSF-Tampa reports on a county health department in Florida that’s become the latest local group to join the walking school bus movement.
The idea behind the program is to “Have children, with one or more adult along for safety’s sake, walk to school in organized groups,” NPR’s Mark Memmot writes. “They get exercise, traffic around the schools gets better and everybody benefits.”
Related
For a thorough primer on covering obesity, AHCJ members should check out “Covering Obesity: A Guide for Reporters” slim guide.
Bloomberg explains all five House, Senate plans
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Bloomberg’s Kristin Jensen and Nicole Gaouette have perused all five proposed health care reform plans, each originating from a different committee in either the U.S. Senate or House of Representatives, and were kind enough to explain exactly what they have in common and what they don’t.
In case you’re wondering, they all come with an individual mandate, expanded coverage, comparative effectiveness, increased regulation of insurers and cost-cutting measures. They differ in terms of budget, funding, a public option and an employer mandate.
Baucus plan takes on ’secret pricing’
Filed under: Health care reform, Hospitals, Hot Health Headline
The Associated Press’ Carla K. Johnson reports that a provision of Sen. Max Baucus’ health reform plan has brought attention to the “secret pricing” model that dominates in the health care system. According to Johnson, the Baucus bill would not only require hospitals to list standard charges for each procedure up front, it would also “require health plans to report how much of each dollar paid in premiums goes to items other than medical care.”
Maine and New Hampshire already provide online cost-comparison tools, and Johnson quotes a scientist at the Agency for Healthcare Research and Quality as saying such information “ought to be available on a more widespread basis.”
Related
- Primer on reform draws from AHCJ presentation
- Princeton economist Uwe Reinhardt’s Health Journalism 2009 presentation on the economics of health care
- Reinhardt calls for price research/transparency
Calif. malpractice cap: Model or cautionary tale?
Filed under: Health care reform, Health policy, Hot Health Headline
The San Francisco Chronicle’s Victoria Colliver reports on how a discussion of a health reform-related push for medical malpractice reform can learn from California’s 34-year old law capping malpractice awards at $250,000.
First, the case against the cap: It’s too small (1975’s $250,000 is equal to about a million of today’s dollars) to make malpractice suits worth a lawyer’s while.
Critics object to the fact the $250,000 cap hasn’t been adjusted for inflation in 34 years . They also argue that because the law allows unlimited awards for economic losses, such as lost wages and ongoing medical costs, it discriminates against children and seniors, who have limited earnings if any, as well as against the families of those who died and did not have high medical costs.
“It’s economic suicide for a medical malpractice lawyer in the state of California to undertake too many or any cases that are capped at just 250,000,” said Erik Peterson, a San Francisco medical malpractice attorney who agreed to take on the Volkmuth’s case, even at a loss.
Cap proponents say the law helps keep costs down and to attract physicians to the state.
Supporters say the law has resulted in improved access to care for patients because it has persuaded doctors to stay in California without fear of skyrocketing insurance premiums.
Lisa Maas, executive director of Californians Allied for Patient Protection, pointed to her group’s research, which shows the average annual premium for a specialist in obstetrics and gynecology in Los Angeles was about $90,000 last year, compared to nearly $195,000 a year for the same specialist in Nassau and Suffolk counties of New York, a state without medical malpractice reforms.
NYT’s Toxic Waters series takes on ag polluters
Filed under: Hot Health Headline, Public health, Public records
In the latest installment of the Toxic Waters series, The New York Times‘ Charles Duhigg turns his investigative spotlight toward agricultural runoff and the havoc it has wrought upon water supplies around the country.
According to Duhigg, “runoff from all but the largest farms is essentially unregulated by many of the federal laws intended to prevent pollution and protect drinking water sources” and regulation and enforcement are instead left up to local authorities, who often lack the necessary resources.
Duhigg makes the scope of the contamination clear:
“Agricultural runoff is the single largest source of water pollution in the nation’s rivers and streams, according to the E.P.A. An estimated 19.5 million Americans fall ill each year from waterborne parasites, viruses or bacteria, including those stemming from human and animal waste, according to a study published last year in the scientific journal Reviews of Environmental Contamination and Toxicology.”
In the end, Duhigg seems to indicate that the only real hope of reigning in this contamination lies in overcoming powerful, entrenched ag interests and giving the E.P.A. broader powers to regulate agriculture.
Related
- Leah Beth Ward of the Yakima Herald-Republic explains how she reported the “Hidden wells, dirty water” series.
- Greg Barnes of the Fayetteville Observer gives a behind-the-scenes look at the award-winning “What lies beneath” series that revealed contaminated drinking water in the Fayetteville area.
- NYT investigates Clean Water Act violations
- Herbicide levels high in many water supplies
Bloggers try to connect Baucus plan, WellPoint
Filed under: Conflicts of interest, Health policy, Hot Health Headline
An analysis by blogger Kevin Conner over at LittleSis seems to point to connections between Montana Sen. Max Baucus’ plan for health reform and insurance heavyweight WellPoint. While nothing has been set in stone, they are the sort of sprawling connections that should be explored and accounted for as the Baucus plan is evaluated, especially in light of the Senator’s well-documented financial connections to the health industry (Hat tip to NPR Health Blog’s Scott Hensley).
Sen. Max Baucus
A glance at the proposal’s Microsoft Word Metadata shows the name of Liz Fowler, a former WellPoint VP who now works for Baucus on the Senate Finance Committee. Furthermore, Wyoming Republican Sen. Mike Enzi’s former chief health adviser, Stephen Northrup, is now WellPoint’s top reform lobbyist. Enzi is a member of Baucus’ bipartisan “Gang of Six,” a group that helped shape the Healthy Future Act. It’s also interesting that, according to Conner, “key provisions in the Baucus plan apparently draw on industry-inspired legislation first introduced by Enzi in 2006, while Northrup was still his chief health aide.”
According to their Web site, “LittleSis is a project of Public Accountability Initiative, a nonprofit nonpartisan research and educational organization focused on government and corporate accountability.”
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Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
