Pennsylvania Cuts Medicaid Coverage For Dental Care

Enlarge Erika Beras

Marcia Esters hopes charity will pay for dental work that Medicaid used to cover.

Erika Beras

Marcia Esters hopes charity will pay for dental work that Medicaid used to cover.

Marcia Esters needs crowns fused to six of her bottom teeth and new dentures. But because of changes made to Medicaid in Pennsylvania, she now has to pay for it all herself.

"It's thousands of dollars' worth of work that I cannot afford," she says.

Esters also uses a wheelchair. Because she couldn't get get her teeth fixed, she has spent the last few months eating pureed food and avoiding people.

"I don't go anywhere unless I have to," she says. "If you could look or feel halfway decent, it just helps, it really does."

Medicaid, a program funded jointly by the federal government and the states, covers the poor and disabled. Coverage varies by state.

Most states don't pay for any dental care. Pennsylvania does. But Republican Gov. Tom Corbett has reduced the coverage for 2 million adult Medicaid patients to basic dental care.

 

The changes have eliminated coverage for root canals and periodontal disease work, and limited the number of dentures a patient can receive. The plan now covers little more than cleanings, fillings � and extractions.

The Pennsylvania Department of Public Welfare estimates it is saving $42 million this year. "We can't keep up with the spending that is going on," spokeswoman Anne Bale says. "So we have to limit the number of procedures people have so we can ensure the program for the future."

The state allows people to petition for help. Since last fall the state has received more than 7,500 appeals. Most have been denied, including one filed by Esters.

Surveys show people with disabilities have a harder time seeing a dentist than any other group. Part of the problem is cost: Many dentists don't take Medicaid since it doesn't bring in a lot of money.

And there are other issues. A dentist's office may not be able to easily accommodate someone in a wheelchair. Patients with behavioral issues may require sedation that only an anesthesiologist can provide.

Lynne Taiclet, who runs the Center for Patients with Special Needs at the University of Pittsburgh's Dental School, says these are actually relatively new problems for dentists.

"Patients that live in group homes and in their families' homes now didn't do that 40 and 50 years ago. They were institutionalized at a young age, and the institutional setting took care of their medicine, their dentistry, all of it."

Esters is hoping that a charity will help with her dental expenses or else she'll have to have her remaining bottom teeth removed.

This story is part of a reporting partnership that includes Essential Public Radio, NPR and Kaiser Health News.

HIE markets evolve, shifting priorities to actionable data

FRAMINGHAM, MA – A new report highlighting the evolving nature of health information exchanges (HIEs) found that the HIE market is shifting its priorities from that of connecting the ecosystem with exchange data and meaningful use incentives to turning data into “actionable information.” 

The IDC MarketScape study, "U.S. Health Information Exchange Platform Solutions 2012 Vendor Assessment," evaluated 16 vendors that offer a platform solution – which IDC Health Insight officials define as having development tools, published APIs, education of technical staff, a broad ecosystem of partners and professional services – for HIE and how those platforms have evolved. 

The report shows the market’s priority shift towards transforming data into actionable information will enable emerging accountable care and collaborative care initiatives. This shift has lead to additional market consolidation among HIE vendors.

For example, since the IDC Health Insights report, "Vendor Assessment: Industry Short List for Health Information Exchange Technologies" was published two years ago, seven HIE vendors have been acquired or merged and new, nontraditional players have entered the market, including payers and telecommunication companies.

"The IT requirements for health information organizations and evolving care delivery and reimbursement models are too extensive for any one vendor to satisfy," said Lynne Dunbrack, program director, Connected Health IT Strategies at IDC Health Insights. "To address the business and technical requirements of accountable care, in addition to providing core HIE technologies, vendors are responding by developing, partnering, or acquiring analytics, collaborative care and patient engagement technologies."

Platform-as-a-service, officials say, will play an increasingly important role in delivering HIE capabilities as vendors look to create an ecosystem of strategic partnerships. Platforms will evolve over time to meet the needs of customers and partners in the ecosystem, often through self-development, according to report findings. In contrast, packaged solutions are designed to meet a very specific set of requirements. 

Vendors evaluated for this report include: AT&T, AxSys Technology, Caradigm, Carefx, Certify Data Systems, Covisint, dbMotion, IBM, Infor, InterSystems Corp., Medicity, OptumInsight, Oracle, Orion Health, RelayHealth and Verizon.

Health Care Reform: We’re Not Done Yet

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer � single-payer national health insurance, also known as an improved Medicare for all � would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed �politically impossible.�

�Politically impossible� means that the mere utterance of �single payer� would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world�s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers� tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably � remarkably low for a �uniquely American� solution.

Our politics have robbed us from even discussing a practical, commonsense solution � improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

We dodged a bullet: 4 reactions to today’s decision

I have before me 193 pages of Supreme Court materials � the Roberts decision, along with other judges� concurrences and dissents. Then there are the 1,841 tweets, 75 blog posts, and five screaming people on cable TV � few of whom seem to have carefully read the actual decision. I�ll try not to add to the cacophony. I do want to add some basic points.

1. We all dodged a bullet with this ruling.

Overturning the Affordable Care Act (ACA) would have deeply damaged President Obama�s reelection campaign. As Michael Tomasky noted this morning, a decision overturning the mandate would have been terrible for Obama�s political fortunes:

Part of readying myself for the opposite result included wondering how many times I could go without shooting the television as I watched Mitt Romney say words to this effect: �So now we know. The president, at a time when the economy was in the toilet, when unemployment was rising over 10 percent, devoted all his energy and all his political capital to a cause that we now know was a complete and total waste of the American people�s time.� Never mind the hypocrisy involved in the man who is the original political father of the mandate saying those words. It would have been a powerful argument to swing voters, and it would have hit Obama hard.

Pundits are questioning whether they misjudged Chief Justice John Roberts, who may be a conservative justice, "but apparently not a crudely partisan or insurrectionist one," writes Harold Pollack.

Overturning ACA would have created administrative chaos. Thousands of community health centers, state and local governments, and medical care organizations would have needed to unwind billions of dollars in pending contracts of all sorts.

Such a decision would have damaged the Supreme Court, too. Perhaps this was a key motivation for today�s decision. I confess that I had misjudged Justice Roberts. He showed himself, today, to be a conservative justice, but apparently not a crudely partisan or insurrectionist one. (Steven Teles tells this story well here.) Had Roberts spearheaded a 5-4 partisan decision to overturn the main domestic policy initiative of the Obama administration, this would have greatly damaged his own legacy.

And most important, overturning ACA would have snatched health insurance coverage away from 32 million people � many of whom would never have even known what was done to them. It would have removed health coverage from hundreds of thousands of people who have serious illnesses.

Thus, as I wrote in the New Republic this morning, it�s a huge relief that the court affirmed health reform.

2. It remains a disgrace that the case got this far.

Yet as I wrote there as well, this case has already done great damage, despite the benign ultimate legal result. As a matter of constitutional law, this case never made much sense. The fact that this dubious case ever reached the Supreme Court indicates how deeply our partisan polarization has penetrated the judiciary.�The prolonged legal battle has slowed the implementation of state health insurance exchanges. It has confused the public. It�s wasted a lot of time and brainpower that both Republicans and Democrats might have better used to make the new law actually work. I�m relieved but hard-pressed to celebrate today�s decision.

3. It�s ‘put up or shut up' time for many red states

Although the Court�s upholding of the mandate receives the most attention, this was not a complete liberal victory. The high court also imposed new limits on the federal government�s ability to withhold Medicaid funds as a bargaining chip to influence the states. The federal government can attach all sorts of strings to new programs tied to health reform. It cannot threaten to withdraw funds from a state�s traditional Medicaid program if that state refuses to implement the pillars of health reform.

No one quite understands the long-term implications here. Right now, though, states such as Texas or Arkansas must actually decide whether they actually want to expand Medicaid as envisioned under the new law. Noting the callousness displayed by some conservative governors towards uninsured or low-income residents of their own states, liberals worry that millions of people will be left uncovered. I am less worried. The federal government will pay essentially the entire tab for newly eligible Medicaid recipients under health reform.

States which choose not to expand Medicaid would leave tens of billions of dollars on the table to make a partisan point. I don�t see conservative politicians being able to say no this money, when thousands of hospitals, nursing homes, and medical providers in their state are desperate for these funds. Indeed today�s court ruling might puncture the hypocrisy of so many red-state politicians who angrily condemn the evils of activist government while quietly accepting huge federal subsidies financed by more-affluent blue states.

4. Wow, the 2012 election is important

Health reform survived on a 5-4 vote in the Supreme Court. President Romney and a Republican congressional majority might well repeal the new law, Nothing in today�s decision prevents them from doing so.

Then there is the court itself. Several contending justices � liberal and conservative � are well over 70 years old. Whoever wins in 2012 may well have the opportunity to appoint three new justices. So the future of health reform � and so much else � remains in the balance.

GOP To Make 31st Attempt To Repeal Obamacare Act

The House Rules Committee takes up a bill Monday called the "Repeal of Obamacare Act." And just like it says, the bill would wipe away the president's Affordable Care Act. A vote of the full House is planned for Wednesday.

It's the first legislative response from House Republicans after the Supreme Court upheld the law. But it is far from the first time the GOP has voted for repeal.

Over the past 18 months, the House has taken 30 floor votes to try to repeal, defund or dismantle the health care law. The first attempt came on Jan. 19, 2011 just two weeks after the GOP took control of the House.

On that day, Rep. Mike Pence,R-Ind., had this to say, "And today, House Republicans are going to stand with the American people and vote to repeal their government takeover of health care lock stock and barrel."

And that's exactly what House Republicans did, all 242 of them. They were joined by just three Democrats. But the measure languished in the Democratic-controlled Senate.

"Even in some bizarre universe where the Senate passed it, President Obama wouldn't sign it into law," says Sara Binder, a senior fellow at the Brookings Institution and an expert in legislative gridlock.

But the House's efforts haven't been necessarily pointless. Binder says votes like the one planned for later this week are all about scoring political points.

"Much of what we see during split party control of Congress, is this message politics, which is the parties taking their chamber and using it to pursue a policy agenda that appeals to their party base," Binder says.

"I think we can agree that this is a vote that the American public has called for and a vote that we owe the American public," said Rep. Rodney Alexander, R-La., speaking in favor of his effort back in April of 2011 to pull funding from the health care law.

It passed the House on an almost purely partisan vote with criticism from Democrats like Connecticut Rep. Rosa DeLauro, "Mr. Speaker instead of working to create jobs, reduce the deficit and do the business of the American people, this majority has been consumed for months now with trying to repeal health care reform."

The measure failed in the Senate. Defunding and repeal efforts large and small have been tucked into everything from defense appropriations to student loans. A handful of smaller items have made it all the way through to a presidential signature. But most have failed or stalled in the Senate.

So, why try again? Why a 31st vote for repeal?

"We want to show people we are resolved to get rid of this," said House Speaker John Boehner, who appeared on CBS's Face the Nation on July 1.

Boehner said the law needs to be ripped out by its roots, and then replaced.

"And while the court upheld it as constitutional," Boehner added, "they certainly didn't say it was a good law."

The only real chance for Boehner and his Republican colleagues to get their way lies with the November election, and possibly an arcane budget procedure known as reconciliation.

For that to work, Mitt Romney would have to win the presidency, Republicans would have to maintain control of the House and win the Senate. When it comes to the Senate, it's virtually impossible for Republicans to get the 60 vote majority needed to overcome a filibuster. And that's where reconciliation comes in. Certain budget bills can go around the filibuster and only need 51 votes to pass.

But Sarah Binder at Brookings says the process would be procedurally challenging.

"It's complicated for Republicans to achieve this, but there is a vehicle if they can carefully calibrate their bill," she says.

That's a whole lot of ifs. And there are questions about if even that could repeal the whole law.

One thing that's not in question, though, is the outcome of Wednesday's expected vote on the Repeal Obamacare Act. Like so many similar efforts in the past, it will pass the House, with overwhelming Republican support.

State Legislatures Stay Busy On Abortion Laws

Enlarge Steve Helber/AP

Virginia Senate Republican Leader Thomas Norment, of James City, (left), and State Sen. Stephen Newman, of Lynchburg, listen to a Feb. debate on a bill requiring an ultrasound before an abortion. The bill was later amended to remove a requirement for transvaginal ultrasound.

Steve Helber/AP

Virginia Senate Republican Leader Thomas Norment, of James City, (left), and State Sen. Stephen Newman, of Lynchburg, listen to a Feb. debate on a bill requiring an ultrasound before an abortion. The bill was later amended to remove a requirement for transvaginal ultrasound.

2011 was a banner year for state laws restricting abortion. And 2012 looks like runner-up.

That's the central finding of the midyear report from the Guttmacher Institute, the reproductive policy research group that keeps track of such things.

There were 39 laws restricting abortion enacted in the first half of 2012. While that's less than half the 80 put in place during the first half of last year, the number of laws already on the books for 2012 is higher than any other year before 2011.

Among the popular targets this year are:

  Restrictions on medication abortions (passed by three states); Banning abortion prior to fetal viability (also passed by three states); and, Limiting coverage of abortion by insurance policies participating in health exchanges that will sell policies under the new health law starting in 2014 (passed by four states).

And while some bills that got a lot of attention didn't pass �- such as ones to ban abortion beginning when a fetal heartbeat can be detected in Ohio, or one requiring a transvaginal ultrasound in Virginia � remarkably similar ones did make it through in other states with far less fanfare.

It seems a new law inLouisiana that requires abortion providers to make the fetal heartbeat audible to women seeking an abortion necessitates a transvaginal ultrasound for many first trimester procedures. One in Oklahoma requires that women be given the opportunity to hear a fetal heartbeat before the procedure.

Guttmacher researchers suggest a few reasons for the slightly slower pace. "Election year sessions tend to be shorter, and focus more and bread-and butter issues, as opposed to social issues," they wrote. "In addition, mirroring the situation nationally, legislatures in states such as New Hampshire and Indiana appear to be in near-total gridlock, seeming able to tackle only 'essential' issue relating to spending and basic state services."

Europe poised for exponential growth in digitized medical imaging storage space

LONDON – Medical images are increasingly becoming digitized. However, the exponential growth of digitized medical images poses an immense challenge in terms of management, compression and retrieval.

It is essential that image archive storage solution providers, picture archiving and communication system vendors and image modality manufacturers become aware of the growing requirements of storage space.

New analysis from Frost & Sullivan, Strategic Outlook Into Archive Requirements For Image Management In Medical Imaging, finds that the total European storage requirement in 2007 was 106,044 terabytes (TB). In this research, Frost & Sullivan's expert analysts thoroughly examine medical image storage solutions markets in the UK, France, Spain, Germany, Scandinavia, Benelux and Italy.

"There is an increasing demand for digitizing medical images as opposed to the traditional film-based images," said Frost & Sullivan Research Analyst Shriram Shanmugham.

"Unlike film-based images, digital images do not decay over time and can easily be stored for longer periods of time. Digitized images require less inventory space and the same image can be accessed by multiple physicians simultaneously."

Moreover, the turn-around time from the initial meeting with the physician to availing complete diagnosis is reduced. As a result, patients can expect quicker appointments with physicians and they can have permanent access to the images from remote sites.

However, certain images are not DICOM compatible and require a service-oriented approach to be archived. This is primarily because evolving healthcare standards such as DICOM and HL7 are being updated at a much slower pace than image archiving and image modality technology.

Other challenges include ensuring interoperability with hospital-based information systems. Another issue is that diagnostic procedures such as echo and angiogram generate a high resolution, large file-size images, and their long retrieval times pose a concern for hospitals.

"Some PACS vendors provide their own unique solution to archiving images that are not DICOM compatible, while others think it is wise to work around the evolving healthcare standards so that, in the future, systems interoperability is streamlined," said Shanmugham. "This trend of providing solutions to images that are not DICOM compatible will be prevalent over the next five to seven years."

The digitized medical imaging archives market requires complete cooperation among the following three major industry participants: PACS vendors, image modality manufacturers and storage solution providers. Some PACS vendors have indicated that it would be convenient for them if image modality manufacturers provided them with test data before an image modality is released into the market. By having the test data before hand, PACS vendors affirmed that they could easily establish connectivity (interoperability) of their module with the image modality.

"Hospitals cannot afford to experience an image server downtime," said Shanmugham. "It is therefore essential that storage solution providers devise innovative technology that obviates the possibility of such server downtime."

Health Care Reform: We’re Not Done Yet

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer � single-payer national health insurance, also known as an improved Medicare for all � would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed �politically impossible.�

�Politically impossible� means that the mere utterance of �single payer� would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world�s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers� tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably � remarkably low for a �uniquely American� solution.

Our politics have robbed us from even discussing a practical, commonsense solution � improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

Governors Spar Over Medicaid And Health Exchanges

Cliff Owen/AP

Virginia Gov. Bob McDonnell says Medicaid should be overhauled before it's expanded.

The nation's governors � well, many of them, anyway � are gathering in Colonial Williamsburg, Va., for their annual summer meeting this weekend.

It's no easy trick for the National Governors Association to get Republican and Democratic chief executives on the same page, or even the same room.

This year, in the wake of the Supreme Court decision on the Affordable Care Act, it's even harder.

The decision upholding the law means state insurance marketplaces, or exchanges, for individuals and small businesses aren't going away. The exchanges, which can be set up by each state or put together by the federal government, need to be running by the fall of 2013.

 

Governors need to decide soon whether to go ahead with their own exchanges or let the feds do the job.

The high court ruling did make it optional for states to expand Medicaid to cover more low-income people. So governors have to decide whether their states will go ahead with that, or not, too. Quite a few have already said no.

The meeting kicked off Friday with dueling news conferences. On one side, Virginia Republican Gov. Bob McDonnell, host of the meeting, said it would be irresponsible to expand Medicaid, unless it is dramatically overhauled first.

His neighbor Democratic Gov. Martin O'Malley of Maryland said in a separate news briefing that he thinks his state will gain a competitive advantage by being early to expand Medicaid and adopt other aspects of the health care law.

What do the governors have in common? All of them are worried about money.

Unlike the federal government, the governors say they can't print more money. They have to balance their budgets every year. So they're wrestling with how much health care they can afford to provide, even with federal subsidies under the recently upheld law.

Delaware Democratic Gov. Jack Markell told me, "We've taken a hard look, and we have the opportunity to significantly expand the number of people in Delaware who have care. There's sufficient federal resources to pay for it. We think this is a good deal for the people of our state."

Nebraska GOP Gov. Dave Heineman held a different view on a Medicaid expansion. "Until you can prove to me it won't result in cuts to public schools in our state, to the University of Nebraska or state colleges or community colleges, or increases in taxes, then I'm not ready to move in that direction," he said in a scrum after a press conference.

A Dozen States Already Showing Leadership on Health Insurance Marketplaces

Because of the Supreme Court�s clear and final decision upholding the Affordable Care Act, middle class families and small businesses have greater security when it comes to health care � they can keep their current coverage or, if they need to or want to, search for new, affordable insurance options. In 2014, we can look forward to new state-based health insurance marketplaces, called Affordable Insurance Exchanges, where consumers can compare health care plans and choose a private health plan that meets their needs. Across the country, a dozen states have committed in recent weeks that they will lead efforts to create these Exchanges.

There is no one-size-fits-all approach, and each state has the opportunity to tailor its Exchange to meet its citizens� needs. States have the flexibility to decide whether to build a state Exchange, work with other states, or partner with the federal government. The Department of Health and Human Services (HHS) is committed to flexibility in our support of the states� progress in whatever route they choose, as well as providing planning and implementation funds to help the states to establish the marketplace that suits their residents� needs.

We have already begun to hear from governors on their states� commitment to establishing these one-stop-shop marketplaces.

As Rhode Island Governor Lincoln D. Chafee noted in his letter, he signed an executive order in September 2011 to begin work on an Exchange, an effort he says �will provide Rhode Island families and small businesses with access to more affordable, high quality health insurance coverage.�

Maryland Governor Martin O�Malley wrote that Maryland�s state-based Exchange is �well underway and we continue to make significant progress with strong support from the state�s political leadership and broad-based stakeholder community.�

Even though the official deadline is November 16, I have already received letters from a dozen states representing nearly one-third of all Americans committing to establishing an exchange. Letters have come from:

California Gov. Edmund G. Brown, Jr.Colorado Gov. John W. HickenlooperConnecticut Gov. Dannel P. MalloyHawaii Gov. Neil Abercrombie.Maryland Gov. Martin O�MalleyMassachusetts Gov. Deval L. PatrickMinnesota Gov. Mark DaytonNew York Gov. Andrew M. CuomoOregon Gov. John A. Kitzhaber, M.D.Rhode Island Gov. Lincoln D. ChafeeVermont Gov. Peter ShumlinWashington Gov. Christine O. Gregoire

I appreciate the hard work many states have engaged in over the past months to begin laying the foundations for the Exchanges, and HHS will be as flexible as possible to help them get over the finish line by 2014. Just late last month, I announced the availability of additional funds to help the states deliver these new health insurance marketplaces, and, as many governors had requested, they will now have until the end of 2014 to apply for the funds. And on January 1, 2014, consumers in every state will have access to an exchange.

As President Obama said after the Supreme Court ruling, it is time to move forward. Since the health care reform law was passed two years ago, we have worked closely with states to begin building these Exchanges where Americans will be able to choose private health insurance plans based on price and quality�and we will continue to work side-by-side with the states to provide the health care quality and security that our citizens need and deserve.

You can read and download the Governors' letters on Exchanges here.

Web First: Q&A with Allscripts CEO Glen Tullman

CHICAGO – In real estate, it’s all about location, location, location, they say. In healthcare IT, you might say it’s about integration, integration, integration. Allscripts CEO Glen Tullman is keenly aware of how critical product integration is, he says, and he’s working on it. It’s the difficulties with integration that seem to have led to the EHR company’s recent troubles – at least it’s what Allscripts customers and analysts mention most often. Then came April 25 and the ousting of Allscripts’ board chairman, which triggered three board members to quit in protest, the departure of its CFO (for reasons unrelated, according to the company) and a dismal quarterly report, all of which led to stock price plunging 44 percent.

Allscripts CEO Glen Tullman discusses the challenges that face the company, plans for recovery and its future in the market.

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

Q. Can you make Allscripts whole and thriving again? How? How long will it take? What’s your vision?
A. Yes, I believe we can. Many companies would love to have our positioning, our products, our marketshare and our earnings and cash flow. But to be clear, we can execute better than we have, and we will. We have the right leadership team in place and have made the investments to enable us to lead the industry. And we have the best client base in the industry. Relative to timeline, we are making improvements right now. 
 
Our main areas of focus are product delivery and client experience. We are investing $190 million in 2012 in improving performance, integration and innovation with a number of major releases and improvements in motion. Relative to improving product performance, we have established test labs to eliminate past integration challenges, especially third-party products and the new apps being built for our open platform.

Additionally, Wand, our native iPad app for our Enterprise and Professional EHRs, was recently launched and has been positively received in the market. Our iPad application for our Sunrise Acute offering is already on the market. Wand is another example of the innovation that Allscripts is known for.
 
Over the course of the year, we have added more than 400 frontline support personnel to our team, many of whom are now just coming on line. And, we continue to upgrade our hosting capabilities through a new data center as well as improved monitoring capabilities to better serve our current customers and future prospects. Additionally, at the beginning of the first quarter we launched a major reorganization, bringing together our sales and services teams into a single organization. This is absolutely the right move for our clients, providing them a single point of contact and a team that is not just accountable for selling, but delivering.

Q. Why the so-called poison pill, or shareholders rights approach?
A. This is a common approach when companies believe their stock is undervalued. We are committed to act in the best interests of our stockholders and our clients, which is why we increased the size of our current plan from $200 million to $400 million. We adopted the shareholder rights plan to protect against efforts to obtain control of Allscripts that are inconsistent with the best interests of the company, our clients and our stockholders. As described in a recent article in The Street, “The decision to enact a poison pill by Allscripts, though, also places the company in the camp of target market properties that are deciding to gut it out rather than sell out…”

[See also: Allscripts: Debacle or silver lining?]

More of the interview on the next pages.

Passing on Single-Payer Health Care

The following article was printed in the October/November issue of Dollars and Sense magazine.

Passing On Single-Payer Health Care
Union leadership is out of touch with the rank and file�and the public�on health care.

By Jeffrey Muckensturm

A coalition of major labor unions and liberal organizations has recently created what it calls �a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all.�

Health Care for America Now (HCAN) is a project of three major unions, the American Federation of State, County, and Municipal Employees (AFSCME), the Service Employees International Union (SEIU), and the United Food and Commercial Workers (UFCW), along with MoveOn and the Association of Community Organizations for Reform Now (ACORN). Elizabeth Edwards is a spokesperson for the new coalition.

With its $40 million budget, HCAN could put a lot of muscle into the fight for a universal, single-payer system that would make the government the sole insurer (the �single payer� to doctors and hospitals). Unfortunately, instead HCAN favors a mixed public/private system that would allow Americans to �keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.�

While HCAN�s �health care for all� slogan will resonate with labor and the left, the group�s actual proposal has met with a skeptical response from, among others, the California Nurses Association and Physicians for a National Health Program. Both fault HCAN for failing to support the United States National Health Insurance Act (H.R. 676), aka �Medicare for All,� introduced in February by Rep. John Conyers (D-Mich.). The bill now has over 91 co-sponsors.

So why doesn�t HCAN support single-payer? According to Richard Kirsch, HCAN�s national campaign director, �One point of this approach [giving people the choice of private insurance or Medicare] was not to scare people away from reform or to make it easier for the opponents of reform to panic the public.� HCAN apparently thinks single-payer is not popular enough among labor, elected officials, or the public to be politically feasible�but they�re wrong.

H.R. 676 has significant labor support. To date, over 445 labor organizations, including 36 state AFL-CIO chapters, 110 Central Labor Councils, the United Steel Workers, the United Auto Workers, and at least 14 AFSCME and SEIU locals have passed resolutions supporting the bill. Interestingly, both SEIU and AFSCME have passed resolutions supporting H.R. 676 at national conventions, showing that there is strong rank-and-file support for single-payer.

Why? Because H.R. 676 takes health benefits off the bargaining table, allowing labor to focus on other key issues. A position paper from the New Jersey State Industrial Union Council explains: �H.R. 676 can create a real opportunity for white- and blue-collar workers. When negotiating a contract the final two issues always are wages and medical benefits. The benefits will always affect wages, and the employer will cry that their health insurance costs limit their ability to give raises.� With health care a non-issue, unions can concentrate on wages, safety, and organizing more workplaces.

And given the budget crisis states and municipalities across the country are facing, the support of AFSCME�s leadership for HCAN rather than single-payer is particularly questionable. According to the National Conference of State Legislatures, more than 30 states face deficits totaling a projected $40 billion this year. The U.S. Conference of Mayors, representing over 1,000 cities with populations over 30,000, unanimously adopted a resolution supporting H.R. 676, which, in their view, will save municipalities millions. According to Healthcare-NOW!, a national organization founded five years ago (not to be confused with HCAN), even a small city could save millions of dollars.

HCAN seems to be out of touch with the American public as well. People aren�t scared of a national health program�quite the opposite. USA Today reported the results of a December 2007 Associated Press/Yahoo! poll: �Sixty-five percent of those polled said the United States should adopt universal health insurance that covers everyone under a program such as Medicare that is run by the government and financed by taxpayers.�

While mixed public/private plans like Massachusetts� are beset by problems and have left many uninsured and over-charged, single-payer has become increasingly popular. With HCAN�s full support, H.R. 676 could be even closer to becoming reality. It�s our only hope if we truly want quality �health care for all.�

Jeffrey Muckensturm is a freelance writer and activist living in Philadelphia. �He can be reached through www.CityInvincible.org.

Resources: Health Care for America Now, www.healthcareforamericanow.org; Jim Kuhnhenn and Trevor Tompson, �Poll: Economy, Health Care Top Issues,� USA Today, December 28, 2007; Richard Kirsch, �Why Not Single-Payer?,� the Now! Blog, blog.healthcareforamericanow.org, July 15, 2008; New Jersey State Industrial Union Council, �For HR 676 One Plan, One Nation Campaign And Regarding Health Care for America Now The Trojan Horse,� www.healthcare-now.org.

Despite doubts about finances, hospitals moving forward with EHRs

NEW YORK – A new study from KPMG finds nearly half of business leaders at hospitals and health systems are more than halfway through full EHR deployments, even as many harbor doubts about how much funding their organizations have planned to support the initiatives.
 
Some 49 percent of hospital and health system business administrators who participated in the poll said they were more than 50 percent of the way to completing EHR deployment.

Only 25 percent said they were "very comfortable."
 
"There is a level of uneasiness as to whether there is adequate funding to complete these projects," said Gary Anthony, principal with KPMG Healthcare. "In most organizations, EHR deployment will most likely be one of the most transformational projects that they've ever undertaken, as well as one of the largest investments outside of the construction of a new hospital they've ever made."

Nonetheless, he added, many hospitals still look at EHR deployments as "just an IT project, and that may be why we are seeing multiple extensions to scope, timeline and budget."

In terms of resource strategies used to complete EHR deployment, 46 percent of hospital and health system execs said they're using a multiple-resource strategy. This was followed by leveraging existing staff (16 percent), hiring new or additional staff (13 percent) and securing third party assistance (10 percent). Fifteen percent said they didn't know.
 
When asked whether their organization had a mobility access strategy that provides clinicians and patients with "anywhere" access to EHRs, roughly half of the administrators said they didn't know.
 
"EHR deployment isn't an end point," said Jerry Howell, principal with KPMG Healthcare. "It's an important step in an organization's journey to automate the clinical functions within the hospital or health system and improvement to quality and patient safety. There needs to be continued focus on resourcing and having the correct sponsorship and commitment to deploy an EHR and to continue to support and use it."

Survey aims to 'amplify the conversation' on aging

There's no cure for growing old, but your attitude about what's important and how you feel about aging can depend in part on how old you are, a new survey finds.

The survey of 1,017 people over 18 finds, for instance, that 24% admit they have lied about their age. But of those 50-64, it's just 21%, and for those over 65, it's 18%.

The survey, out today, was commissioned by the drug company Pfizer in conjunction with about a dozen health advocacy organizations to help encourage dialogue about aging in America. In addition to the survey, the group plans to launch a website, GetOld.com, which invites users to share perspectives on aging.

Asked how they feel about getting old, the top choice was "optimistic" (39%). But not far behind was "uneasy" (36%). About 42% of those 50 to 64 are optimistic, the highest percentage of any age group.

Experts say findings are not surprising. Many adults spend more years in good health, says Nancy Perry Graham, editor in chief of AARP The Magazine.

People also enjoy more freedom as they age and stop having to prove themselves at work or in relationships, Graham says.

The survey also aimed to shed light on people's fears. Only 7% over 65 said their biggest fear was dying; 64% said they were most afraid of losing independence or living in pain.

More than half (51%) of those 18 to 65 would accept having a parent live with them, but just 25% over 65 would want to live with a younger relative if unable to care for themselves.

Freda Lewis-Hall, Pfizer's chief medical officer, says the company and partners did the survey to "shake things up."

"We think a good way to do that is to start by listening and then amplifying the conversation and learning how Americans are really tackling aging � and that's Americans of all ages."

The findings suggest that adults' priorities shift as they age: presented with a list of lifetime achievements, 45% of 18- to 34-year-olds most aspire to have $1 million, but 48% of those over 65 say they would rather see their grandchild graduate.

Linda Fried of the International Longevity Center at Columbia University says it's crucial that people deal with the realities of aging, not just the downsides. "We have such a human aversion to getting old; it's associated with death, and death is scary. But as a society, we have not had the conversations we need to have. There's huge opportunities there."

64%

over age 65 say their biggest fear is losing independence or living in pain

AxSys provides NHS with enhanced clinical IT platform

AxSys Technology has unveiled its enhanced Excelicare clinical IT platform to provide NHS Trusts and primary care providers with a cost-effective way to build patient records electronically.

Excelicare has the functionality of a portal and also works as a health information exchange. It enables multi-disciplinary care coordination, supporting disease management and delivering clinical applications through its platform. The platform also includes a patient portal complete with personal health record and an advanced clinical explorer that allows enterprise-wide viewing of integrated patient information.

The Salisbury NHS Foundation Trust is using Excelicare to replace departmental systems with custom clinical solutions created using the clinical care process modeler. This allows one clinical platform to support many different clinical specialties.

“Today’s NHS needs clinical software more than ever before," said Pradeep Ramayya, MD, CEO of AxSys. "With Excelicare you don’t need a big budget, or have to rip out and replace existing systems, as is often the case with a new electronic patient record. With the drive towards integrated and coordinated care, the new Excelicare platform allows healthcare organisations to further raise their ability to share relevant clinical information and coordinate care across boundaries."

Remote monitoring technology improves pacemaker performance

NEW YORK – A new pacemaker with advanced remote patient management capabilities is being used to treat patients with bradycardia, a condition in which the heart can’t beat fast enough, resulting in oxygen deprivation throughout the body.

St. Luke’s and Roosevelt Hospital Center of New York are two of the first hospitals in the U.S. to utilize the new INGENIO pacemaker technology, developed by Boston Scientific.

"The INGENIO device enables physicians to treat pacemaker patients with an advanced and comprehensive set of therapies," said Emad Aziz, DO, attending in the Department of Medicine and Cardiology at St. Luke’s and Roosevelt Hospitals. "The INGENIO pacemaker’s MV sensor is easy to optimize and will provide needed therapy for CI patients to help them feel less fatigued during physical activity."

INGENIO pacemakers feature RightRate technology, which uses a minute ventilation (MV) sensor and adds programming options that promote ease-of-use and overall in-clinic time savings. Officials say the MV sensor is the only sensor clinically proven to restore chronotropic competence. Chronotropic Incompetence (CI) is the inability of the heart to regulate its rate appropriately in response to physical activity, which may cause patients to feel tired or short of breath during daily activities such as walking or carrying groceries. CI affects up to 42 percent of pacemaker patients.

The pacemaker will also have the capacity to transmit implantable cardiac device data from the device to physicians and other healthcare providers. Boston Scientific’s new remote patient management system, currently under review by the FDA, will allow physicians to conduct remote follow-ups of these device patients to monitor specific device information and heart health status. The system will also detect clinical events between scheduled visits and send relevant data directly to a secure website, which can be accessed by physicians. This wireless technology will allow patients to transmit data to physicians from most locations in North America without the need for landline-based technology.

Obese teen had to be cut from home in U.K.

LONDON(AP)�Emergency workers who needed to take an obese teenager from her home to a hospital in Wales had to break through a wall of the residence to get her out and into an ambulance, officials said Friday.

The rescue on the second floor of the small house on Thursday used scaffolding as a ramp to lower the woman to the ground level, the local Rhondda Cynon Taf council said.

The unidentified 19-year-old remained hospitalized Friday and her medical condition was not released.

Neighbors said her weight had risen as high as 380 kilos (835 pounds).

The U.K. has one of Europe's fattest populations: more than 60% of adults and one third of children aged 10-11 are overweight or obese, roughly similar to U.S. statistics.

Long commute time linked with poor health, new study shows

New evidence shows that a long commute by car not only takes hours out of your day, but could take years off your life.

A study published this month in the American Journal of Preventive Medicine found that the longer people drive to work, the more likely they are to have poor cardiovascular health.

"This is the first study to show that people who commute long distances to work were less fit, weighed more, were less physically active and had higher blood pressure," said Christine M. Hoehner, a public health professor at Washington University School of Medicine in St. Louis and the study's lead author. "All those are strong predictors of heart disease, diabetes, and some cancers."

The study monitored the health of 4,297 adults from 12 counties in Texas, a metropolitan region where 90 percent of people commute to work by car, Hoehner said.

The New York area has the longest average commuting time -- almost 35 minutes -- of any metropolitan area, according to the Census Bureau in its analysis of the 2009 American Community Survey. But the other nine metro areas in the top 10 also averaged a half hour or more. And even the area with the shortest average commute, Great Falls, Mont., still clocked in at 14 minutes.

That's important because those who commuted by car 10 miles or more each way were more likely to have high blood pressure than people who drove shorter distances. And those who traveled 15 or more miles each way were more likely to have bigger waistlines and less likely to be physically active, according to Hoehner's study.

Tom Ricci, 53, drives 130 miles round trip each day from his home in Mahopac, N.Y., to his job at a music record company in Lyndhurst, N.J.

He gets up at 4:30 a.m. almost every day to hit the gym before work.

"I'd go crazy and lose my mind" without a workout routine, Ricci said. "You need a release from that grind."

Diet, exercise and sleep habits were not looked at in the study, Hoehner said. They also can also contribute to obesity and high blood pressure.

Christine Bruno of Garrison, N.Y., feels the difference. Her commute used to be 7 minutes. Now since she moved in with her fiance it take up to 90 minutes each way to make the 40-mile trek to New Rochelle, N.Y.

"By the time you finish your final meal of the day, there is no time to do much else," said Bruno, 40. "There is no time to exercise. And there is no time to go to the gym, and it's a huge issue, because I used to be a gym rat."

Danielle Mahoney, 36, lives in Patterson, N.Y., works in Suffern, N.Y., and commutes 126 miles round trip a day. Her company offers fitness classes to employees several times a week so they can exercise during the day. Without them, Mahoney said, she wouldn't have time for the gym, especially with twin toddlers at home.

The hours she spends in her car are "definitely draining," she said.

"If it's a longer day or you didn't get enough sleep, you can doze when you are driving," she said. "Numerous times I catch myself."

Dr. Franklin Zimmerman, a cardiologist and director of critical care at Phelps Memorial Hospital in Sleepy Hollow, N.Y., said what makes long commutes by car even worse is that many people are also sitting at work.

He tells patients to get 30 minutes of moderate to vigorous exercise each day. If people can't get to the gym, he suggests they park their cars farther from their offices and then walk. People can also sneak in exercise by getting off the elevator and taking the stairs.

"It's OK to split it up into increments," he said. "It's hard to find 30 minutes, but it's not hard to find five minutes, and all of that still counts."

(Contributing: Tim Henderson, The (Westchester, N.Y.) Journal News)

7 critical success factors for ACOs

To date, 32 organizations across the country are participating in the Pioneer ACO initiative, hoping to inspire others in their regions to follow suit. As the benefits of adopting this model become clear, more organizations are looking to explore the possibility of becoming anACO. 

Ron Parton, MD, chief medial officer at health IT firm Symphony Corporation, outlines seven critical success factors for ACOs. 

1.Align the payment model with value. The key for organizations to be successful in these types of new payment arrangements, said Parton, is to make sure they have the payment arrangements in place as they change their care delivery models. "There are organizations and integrated systems around the country that have introduced their quality improvement programs before entering into a shared risk arrangements, and [they] have improved quality significantly but have lost revenue because they reduced fee for service business," he said. "So one of the keys is to try to make sure you're matching your payment model with your quality improvement efforts so you don't get ahead of yourself." And once you've created that type of payment model, Parton added – whether it's participating in a Medicare shared risk arrangement, or a local or national insurance company that's creating a pay-for-performance or a shared risk opportunity – it becomes a question of investing in the right type of infrastructure. 

2. Pay attention to leadership and cultural change. According to Parton, one of the most pressing things to understand when changing payment models is that specialty physicians, in particular, may struggle with understand the importance of these new arrangements, since most have depended on fee-for-service to be successful through their careers. "So, it's important to pick leaders who are forward-thinking and who will support the new care payment arrangements," said Parton. These selected individuals can help lead initiatives across the medical staff. "Once you get some of the medical staff bought in, it's important to invest in infrastructure that helps them be successful in the new model," he said. 

[See also: ACOs dominate early discussion at MGMA conference.]

3.Hire experienced health professionals, especially nurses and health coaches. Part of driving cultural change, said Parton, is to hire staff to help make these new initiatives successful. "One of the key factors of all this work is to identify complex patients who have difficulty navigating the system, managing their own illness, taking medications, etc.," he said. "The professionals who have skill sets to change that behavior may be different than what current integrated systems have hired." Identifying nurses who understand how to implement specific techniques and help patient manage their illness can drive the transition more quickly, said Parton, therefore making it essential to have these types of staff members on board. 

4.Take the time to gain buy in from the primary care practitioners and their staff. Naturally, there will be practices that are resistant to change, said Parton, so make sure you touch base with every practice and have a contact and leader in each to help educate and lead their group. "This is extremely important, otherwise, people will give lip service but they won't change their workflow of how they're managing their practice day to day," he said.  He added that a lot of the work doesn't need to be done by physicians, but by associated in their offices, like nurses, medical assistants, nutritionists, etc. "Getting that buy-in across the entire staff of a practice is important," he said. "It's not just the practitioners." Keep in mind the role EHRs will play in the transition, Patron added, especially when it comes to adding more work to learning the new IT system. "Doing this work for an ACO is additional stress," he said. "So helping them understand some techniques, some new tools they can use to improve their work is part of the issue."

[See also: ACO program is asking too much, says expert.]

5.Develop the data model, IT infrastructure, and tools to support reporting and analytics. One key piece for larger organizations, said Parton, is getting all organizations involved in the transition on the same page. "There are multiple organizations involved, and they come together to do the shares risk arrangement," he said. "So they may be on multiple systems and multiple data sources, and one of the challenges upfront is integrating and taking data from all those sources into one common data warehouse." The first step, he added, is to identify who's participating in the ACO and what the differences are in their data infrastructures. The next step is to create interfaces with each separate data source to do mapping. "That's where the data model comes in," he said. "You need to make sure you understand the differences in data from one entity to the next … all that detail is extremely important." The last step, said Parton, is pulling the data and integrating it into a common platform, "so if you invest in that, you have the data to do any of the programs, projects, or measurements, and it makes your life so much easier if you do all that upfront."

6. Invest in a population health and care management system, and integrate with the EHR. A population care management system allows you to take data from all your sources and use it specifically to track and manage subpopulations, said Parton. "You want to target and allow care teams to do follow-up work with care plans, " he said. "The population care management system can be the common care plan platform that allows professionals to track and manage patients across the system... care is coordinated in a way that helps people stay out of the ER and out of the hospital." In turn, the system takes nightly feed of EHR data and makes it available to care teams, allowing them to determine gaps in care by seeing the care across an entire population. "Whether they're following evidence-based guidelines and are looking for patterns of someone not taking medication, or they have multiple doctors managing care and it's uncoordinated, they can look for that pattern," said Parton. "They can target the right patient and give them the care they need."

7.Match the organizational readiness for change. "All the things an ACO needs to do simultaneously, it's a lot of work and a lot of change for an organization," said Parton. "It's important for the organization to continuously monitor how well these initiatives are going on a daily or weekly basis and make sure you're not getting ahead of yourself." Constant communication and listening, Parton continued, in terms of feedback from physicians is key. "At some point, you may find you have to step on the brakes for a bit because you have to wait for your IT team to catch up," he said. "Or, from a payment model perspective, you have the model in place and need to accelerate those results-oriented projects because you need results from the bottom line sooner. It's about stepping on the brake or the gas to make sure things are moving."

Genetic testing: Does Kristen Powers have mom's fatal gene?

CHAPEL HILL, N.C.�Just a little while ago, Kristen Powers was being a rowdy teenager, singing loudly and swaying to an upbeat Katy Perry song in the back seat of her family's car on the way to a long-awaited appointment.

But now, her face and eyes are still, void of any expression. She is sitting in a hospital examination room, bracing herself to come to terms with the most important news of her young life. After turning 18, she decided to get tested for Huntington's disease, an incurable neurodegenerative illness that claimed her mother's life last year at age 45. It is considered a death sentence by many because it can begin debilitating people in their mid-30s, the prime of life.

"We have good news for you today," says Debbie Keelean-Fuller, genetic counselor at children's outpatient clinic at University of North Carolina.

"You tested negative."

The results, Keelean-Fuller adds, mean neither Kristen nor her children will get Huntington's. In a nanosecond, a smile bursts onto Kristen's face, her eyes light up and her father folds her in his arms.

Genetic testing and disease: Would you want to know?

This behind-the-scenes look at a young woman�s decision to test for Huntington�s disease, an incurable hereditary disease, is the second in a series.

Part 1: Kristen's story

"These are the same tears (of joy) I cried the day you were born," Ed Powers says to his firstborn child.

Kristen's stepmother, Betsy Banks Saul, and best friend, Daniel Woldorff, quickly join in the group hug.

"Oh. My. God." Kristen says softly with both hands pressing the sides of her face.

Children have a 50-50 chance of inheriting the rare disease from their parents. Kristen Powers told USA TODAY in April she had decided to get genetic testing for two reasons: for herself � "I always craved getting information" � and for the larger Huntington's disease community.

She said before she got her test results that she would want to be honest about her diagnosis with future partners, and would not have children for fear of passing on the gene. She also said she wants to raise awareness about an illness many families try to hide.

One way she's doing that is by making a documentary. She has raised more than $18,000 on crowd-funding website Indiegogo to hire a video crew to document her experiences with genetic testing.

"She is going to empower an entire generation at risk of developing Huntington's disease," says Mary Edmondson, a psychiatrist at Duke University's specialty Huntington's disease clinic. "The more you can do to empower people, the more they can master the skills required to deal with the disease."

Kristen grew up surrounded by fear and uncertainty. Her parents divorced, and her mother had custody for several years. But when Nicola Powers' disease progressed and she could no longer care for Kristen and her younger brother, Nate, their father gained custody. Kristen was 9. She recalls her mother stumbling, and walking "like a drunk person at times. That's before we knew what was wrong with her. It was really scary."

By the time she was 11, Kristen says, she understood that she was also at risk. She feels she's waited a lifetime to learn the truth about her genetic heritage. Nate has also decided to test for Huntington's when he turns 18.

Not everyone wants to know

Genetic testing isn't for everyone, though, and is not conclusive at diagnosing every disease.

"Some people don't test for Huntington's because other family members don't want to know," says Kristen, adding that one reason a young person might not test is because a positive result would mean a parent would also have the disease. The parent just might not be displaying symptoms yet.

Many people say they wouldn't want to know whether they have the disease, according to James Evans, a medical geneticist and director at the University of North Carolina's Bryson Program for Human Genetics.

"After I give talks, I ask audiences if they'd want to be tested" for various conditions, he says. "And about half of the audience will raise their hands."

Keelean-Fuller says one reason some people don't want to test is insurance-related. Though the federal health care law prevents insurance companies from discriminating against people because of pre-existing conditions, the entire law � or parts of it � could be ruled unconstitutional when the Supreme Court issues a ruling later this month.

"Also, it can be hard for people to get disability insurance, long-term care insurance and life insurance with some conditions," she says. "Those are very important concerns to families."

Accepting responsibility

Knowing whether you have the Huntington's gene, Kristen says, means accepting responsibility for your life. She was prepared to become the face of the disease. She still plans to push for a cure.

"People with positive tests and negative tests go through a year of adjustment," says Edmondson. "There is an opportunity for tremendous personal growth."

Kristen graduates from high school on Saturdayand will begin college at Stanford University in California in September.

Before leaving the hospital, her step-mom asks Kristen if she thinks she'll finetune her identity now, since so much of hers has been branded by being at genetic risk.

"I don't know," she says, taking a few seconds to think. "I guess so."

Then she beams again. When asked whether she has started making plans for the future, she draws a blank again. Her head is still back in the exam room.

"All I can hear is, 'We have good news,' and the rest is a blur," she says.

Then Kristen gets in her dad's car, and the Huntington's-free teen heads to school to tell her friends the good news and rejoice.

AARP, Microsoft partner on PHR aimed at seniors

WASHINGTON – AARP on Tuesday announced the launch of AARP Health Record. By connecting with Microsoft HealthVault, it enables people over 50 to store their personal health information in a secure, central location and share it selectively with caregivers and family members.
 
Officials say Health Record, which is offered free to AARP members, makes it easy to create and maintain security-enhanced, up-to-date electronic records that can be accessed from an Internet connection. By storing all of their health information in one location, members can partner more effectively with their doctors and other healthcare providers, be better prepared for emergencies and reduce wasteful and redundant paperwork.

HealthVault account holders can select among hundreds of connected health and wellness applications to monitor chronic conditions and share data with their doctors, or track progress against wellness or fitness goals.  For example, AARP members will be able to import prescription history from a HealthVault-connected pharmacy – such as CVS Caremark or Walgreens – into their AARP Health Record, or choose to enter prescriptions manually.

It would not be the end of health reform, just a chance to get it right

If President Obama is now confiding to Democratic donors that he may have to “revisit” health care in a second term if the Supreme Court throws out his first attempt, as Bloomberg News reported June 1, maybe this time we can get it right.

Instead of trying to dress up our broken private insurance-based system, or resuscitating elements of a convoluted plan the court may overturn, it’s time to try something different.

Fortunately, we have a well established, uniquely American model in place, one that meets the legal test. A program that already takes care of the 40 million Americans over 65. That has the added benefits of being universal in coverage and far more cost efficient than our present system.

Nurses rally for Medicare for all and a tax on Wall Street to help pay for it in Chicago May 18

It’s called Medicare. And it’s been working well for nearly 50 years, and remains wildly popular, even among those hate “Obamacare.”

How do we fix our health care system? Easy, and we don’t need 2,700 pages either. Just open up Medicare to cover everyone, regardless of age.

It’s a step we should take, no matter how the court rules.

Even if the law is upheld, some 27 million Americans would remain uninsured by 2016, according to the Congressional Budget Office, families will continue to struggle with rising out-of-pocket health costs and un-payable medical bills and more employers will drop coverage or shift more costs to employees.

Can our nation stand another fight over health care reform? The better question is, can we afford not to?

Over the past year, nurses have seen an alarming nexus between the economic decline and broad erosions in health status, such as stress-induced heart ailments, anxiety and “gut” disorders, health woes associated with poor nutrition, and illnesses traditionally seen in adults increasingly found in children. Nurses now routinely see patients skipping or delaying not just routine medical visits, but even cancer treatment and other life-saving or life prolonging care due to cost.

A library of surveys and studies document these worrisome trends.

A Centers for Disease Control analysis found a quarter of children age 17 and under were in families struggling to pay medical bills.

In 2010, 30 million Americans were contacted by debt collection companies chasing them to pay medical bills, a jump of 5 million people in just half a decade, the Commonwealth Fund reported. Unpaid bills as small as $250 were ruining credit records for many. Medical bills account for 62 percent of personal bankruptcies, and nearly 80 percent who went broke from health care had insurance.

Fifty million Americans still have no health coverage. Another 29 million are under insured with massive holes in their health plans, an increase of 80 percent since 2003, according to the journal Health Affairs.

What do they do for care? They suffer in silence, until it hurts so bad they go to where it is most expensive, the emergency room. AFebruary report by the Pew Center on the States recorded a 16 percent in the number of people going to the ER for dental care.

A Kaiser Family Foundation survey last December found a majority of those uninsured or with poor coverage delaying needed care, and 75 percent of the unemployed or under employed skipping dental checkups or recommended medical treatment or tests or not filling prescriptions.

Those boasts about how we have the best medical system in the world need a re-write, the best perhaps based on ability to pay. As a nation, we spend twice per person as much as many countries for health care, but get far less. We’re falling farther behind other countries in life expectancy, infant mortality, waits for care, costs for doctor visits, surgeries, and prescription drugs, and health care well-being for our children.

If you want to stew over just one sobering statistic, consider this: According to the World Health Organization, the U.S. ranks behind more than 40 other countries in death rates for child-bearing women.

What distinguishes us is that virtually all those other countries havesome form of coordinated national health care system, like our Medicare. We have private insurance companies whose prime directive is earning profits for their investors, not guaranteeing patients get the care they need when they need it.

Let’s take that mulligan on health care reform and do a make over. Just as we fought to provide retirement security, including health care for everyone over 65, we can make the same effort for the rest of our nation. There’s no time to lose.

Scared of spiders? You can escape that web

People undone by arachnophobia holding a huge, hairy tarantula in their bare hand? No worries, not after a single brief therapy session changed the brain's fear response in adults with the lifelong, debilitating phobia of spiders.

The "exposure therapy" was small, done on 12 adults, but all of them held or petted the spider afterward, the study from the Northwestern University Feinberg School of Medicine reported Monday. One participant celebrated by getting a spider tattoo after having been unable to even look at photos of spiders.

"A lot of people are afraid of spiders, but in order to meet the criteria (for a phobia), it has to be a clinical diagnosis and interfere with your life," says author Katherina Hauner, a postdoctoral fellow in neurology. "One participant would avoid walking in grass. Another, if he thought the spider was in the room or house, would have to leave the house for days."

Fear of spiders is a subtype of an anxiety disorder called specific phobia, one of the most common anxiety disorders, which afflicts about 7% of the population, the study says. Common specific phobias also include fear of blood, needles, snakes, flying and enclosed spaces.

Tarantulas are "docile," Hauner says, and would rather get away from a human than hunt one.

This is the first study to document the immediate and long-term brain changes after treatment and to illustrate how the brain reorganizes long-term to reduce fear as a result of the therapy, the study says. The findings show the lasting effectiveness of "short exposure therapy" for a phobia and offer new directions for treating other phobias and anxiety disorders.

"Everyone would come in thinking: 'I'm going to be the one who can't do this. There is no way," Hauner says. "They were impressed by the end."

In therapy lasting two to three hours, which is different for each person, the participants were taught that troublesome thoughts about tarantulas were untrue. "They thought the tarantula might be capable of jumping out of the cage and on to them," Hauner said.

Exposure therapy gets its name from exposing a patient to what he fears, says Todd Farchione, research assistant professor at the Boston University Center for Anxiety and Related Disorders. "A lot of it is about dispelling people's beliefs. You can get significant changes in a short period of time."

They learned to approach the tarantula until they could touch the outside of the terrarium. Then they touched the tarantula with a paintbrush, a glove and eventually pet it with their bare hands or held it.

Immediately after, an MRI scan showed the brain regions associated with fear decreased in activity when people encountered spider photos.

When the same people were asked to touch the tarantula six months later, "they freaked out in a good way," Hauner says. "They said they couldn't believe they were doing this."