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"content": "\u003cp>Most Americans value the prescription products the drug industry produces, but they sure don’t like the prices and want the federal government to take action, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/\">new survey.\u003c/a>\u003c/p>\n\u003cp>Just over half of Americans (54 percent) are currently taking a prescription drug. While most say their drugs are easy to afford, nearly a quarter (24 percent) say it's difficult paying for their medications. But that's overall. Fully a third (33 percent) of people with lower incomes and 43 percent of those in worse health have a difficult time paying for drugs.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\">\u003cimg class=\"aligncenter wp-image-64711 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.21.13 PM\" width=\"608\" height=\"447\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png 608w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM-400x294.png 400w\" sizes=\"(max-width: 608px) 100vw, 608px\">\u003c/a>\u003c/p>\n\u003cp>Consumers in general (72 percent) believe drug costs are unreasonable, according to the poll by the Kaiser Family Foundation.\u003c/p>\n\u003cp>More people (51 percent) think competition would do a better job of controlling prices than federal regulation (40 percent). But large majorities said they would favor allowing Medicare to negotiate with companies on prices and allowing people to buy medicines imported from Canada.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Prescription prices have come under scrutiny as even some people with insurance struggle with the costs, particularly for some drugs for cancer and other hard-to-treat illnesses. The health insurance industry has mounted a major public relations campaign on the issue, countered by pharmaceutical industry claims that drugs can drastically reduce the need for other health spending, like hospital stays.\u003c/p>\n\u003cp>The KFF poll, conducted by phone Aug. 6-11, used a nationally representative sample of 1,200 adults. The margin of error is plus or minus 3 percentage points.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\">\u003cimg class=\"aligncenter size-full wp-image-64712\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.05.48 PM\" width=\"672\" height=\"455\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png 672w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM-400x271.png 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem style=\"line-height: 1.5\">\u003ca style=\"line-height: 1.5\" href=\"http://khn.org\">Kaiser Health News\u003c/a> is \u003c/em>\u003cem style=\"line-height: 1.5\">a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca style=\"line-height: 1.5\" href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem style=\"line-height: 1.5\">.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most Americans value the prescription products the drug industry produces, but they sure don’t like the prices and want the federal government to take action, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/\">new survey.\u003c/a>\u003c/p>\n\u003cp>Just over half of Americans (54 percent) are currently taking a prescription drug. While most say their drugs are easy to afford, nearly a quarter (24 percent) say it's difficult paying for their medications. But that's overall. Fully a third (33 percent) of people with lower incomes and 43 percent of those in worse health have a difficult time paying for drugs.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\">\u003cimg class=\"aligncenter wp-image-64711 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.21.13 PM\" width=\"608\" height=\"447\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM.png 608w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.21.13-PM-400x294.png 400w\" sizes=\"(max-width: 608px) 100vw, 608px\">\u003c/a>\u003c/p>\n\u003cp>Consumers in general (72 percent) believe drug costs are unreasonable, according to the poll by the Kaiser Family Foundation.\u003c/p>\n\u003cp>More people (51 percent) think competition would do a better job of controlling prices than federal regulation (40 percent). But large majorities said they would favor allowing Medicare to negotiate with companies on prices and allowing people to buy medicines imported from Canada.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Prescription prices have come under scrutiny as even some people with insurance struggle with the costs, particularly for some drugs for cancer and other hard-to-treat illnesses. The health insurance industry has mounted a major public relations campaign on the issue, countered by pharmaceutical industry claims that drugs can drastically reduce the need for other health spending, like hospital stays.\u003c/p>\n\u003cp>The KFF poll, conducted by phone Aug. 6-11, used a nationally representative sample of 1,200 adults. The margin of error is plus or minus 3 percentage points.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\">\u003cimg class=\"aligncenter size-full wp-image-64712\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png\" alt=\"Screen Shot 2015-08-20 at 12.05.48 PM\" width=\"672\" height=\"455\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM.png 672w, https://ww2.kqed.org/app/uploads/sites/27/2015/08/Screen-Shot-2015-08-20-at-12.05.48-PM-400x271.png 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem style=\"line-height: 1.5\">\u003ca style=\"line-height: 1.5\" href=\"http://khn.org\">Kaiser Health News\u003c/a> is \u003c/em>\u003cem style=\"line-height: 1.5\">a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca style=\"line-height: 1.5\" href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem style=\"line-height: 1.5\">.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Gov. Brown Says Not So Fast on New Physician-Assisted Suicide Push",
"title": "Gov. Brown Says Not So Fast on New Physician-Assisted Suicide Push",
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"content": "\u003cp>Yesterday came news that supporters of the physician-assisted suicide bill that failed to make it out of the Assembly Health Committee were \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/18/physician-assisted-suicide-bill-revived-in-special-session/\" target=\"_blank\">taking advantage of the special legislative session\u003c/a> called by Gov. Jerry Brown to make an attempt to push a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">similar bill\u003c/a> to the Assembly floor -- a sort of legislative end-around.\u003c/p>\n\u003cp>[contextly_sidebar id=\"YgBUq4rms0V1Zlkalqzkw8dc8SzVP3R4\"]Uh, not so fast, said the governor.\u003c/p>\n\u003cp>Brown said Tuesday through spokeswoman Deborah Hoffman that the session is not the appropriate venue to consider the issue. A better approach would be to reconsider previous legislation next year that is now stalled, she said. Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/23/gov-brown-questions-sustainability-of-health-care-spending-calls-for-special-session/\" target=\"_blank\">called the special session\u003c/a> to address funding for Medi-Cal, which the governor suggested is not sustainable.\u003c/p>\n\u003cp>So would Brown veto the bill if it passed in the special session? Hoffman didn't say.\u003c/p>\n\u003cp>The bill would allow doctors to prescribe lethal medication to terminally ill patients who request it, provided that patients are mentally competent and able to swallow the drugs themselves.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Sen. Bill Monning, D- Carmel and Sen. Lois Wolk, D-Davis, said they decided to make another attempt at passing the legislation after watching two legal efforts — in \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/24/judge-says-he-will-dismiss-right-to-die-lawsuit/\">San Diego\u003c/a> and San Francisco — fail in the courts this summer. The two judges in the lawsuits seeking to protect medically assisted suicide as a constitutional right said it was beyond the jurisdiction of the court to rule on such life and death matters.\u003c/p>\n\u003cp>Susan Eggman, D-Stockton, said in a \u003ca href=\"http://asmdc.org/members/a13/news-room/press-releases/legislators-re-introduce-end-of-life-option-act-following-court-rulings\" target=\"_blank\">press release\u003c/a> announcing the introduction of the bill that time is of the essence:\u003c/p>\n\u003cp>\"We will not wait another year,\" Eggman said. \"We will not wait for a ballot measure. There are people right now who are facing a terminal diagnosis, watching this fight, praying for our success and hoping to be able to take control of their lives through these reforms. They don't have another year to wait; they are counting on this bill, this year.\"\u003c/p>\n\u003cp>Opponents of physician-assisted suicide expressed dismay over the renewed effort.\u003c/p>\n\u003cp>\"We’re shocked that they would use this legislative maneuver to jam through a bill that’s clearly a life and death matter for Californians,” Marilyn Golden, senior policy analyst with the Disability Rights and Education Defense Fund, told KQED's April Dembosky.\u003c/p>\n\u003cp>Tim Rosales, a spokesman for Californians Against Assisted Suicide, said: \"It is particularly troubling that in this rush to judgment, proponents are linking this bill with health care financing. \"That should be truly frightening to those on Medi-Cal and subsidized health care, who quite logically fear a system where prescribing suicide pills could be elevated to a treatment option.\"\u003c/p>\n\u003cp>The earlier bill stalled in the health committee after a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/physician-assisted-suicide-backers-try-to-woo-latinos/\" target=\"_blank\">small, unusual group of holdouts\u003c/a> -- all Southern California Democrats and almost all Latino -- deprived the legislation of the 10 votes needed for passage.\u003c/p>\n\u003cp>The assisted suicide issue isn't the only one getting a second look in the special session. Several Democratic lawmakers have introduced legislation that would define e-cigarettes as tobacco products and bring them under the state’s existing anti-smoking laws.\u003c/p>\n\u003cp>\u003cem>Jon Brooks, April Dembosky, John Myers, Marisa Lagos and the Associated Press contributed to this post.\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Brown says the special legislative session on Medi-Cal funding is not the appropriate venue to consider the issue. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Yesterday came news that supporters of the physician-assisted suicide bill that failed to make it out of the Assembly Health Committee were \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/18/physician-assisted-suicide-bill-revived-in-special-session/\" target=\"_blank\">taking advantage of the special legislative session\u003c/a> called by Gov. Jerry Brown to make an attempt to push a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">similar bill\u003c/a> to the Assembly floor -- a sort of legislative end-around.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Uh, not so fast, said the governor.\u003c/p>\n\u003cp>Brown said Tuesday through spokeswoman Deborah Hoffman that the session is not the appropriate venue to consider the issue. A better approach would be to reconsider previous legislation next year that is now stalled, she said. Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/23/gov-brown-questions-sustainability-of-health-care-spending-calls-for-special-session/\" target=\"_blank\">called the special session\u003c/a> to address funding for Medi-Cal, which the governor suggested is not sustainable.\u003c/p>\n\u003cp>So would Brown veto the bill if it passed in the special session? Hoffman didn't say.\u003c/p>\n\u003cp>The bill would allow doctors to prescribe lethal medication to terminally ill patients who request it, provided that patients are mentally competent and able to swallow the drugs themselves.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sen. Bill Monning, D- Carmel and Sen. Lois Wolk, D-Davis, said they decided to make another attempt at passing the legislation after watching two legal efforts — in \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/24/judge-says-he-will-dismiss-right-to-die-lawsuit/\">San Diego\u003c/a> and San Francisco — fail in the courts this summer. The two judges in the lawsuits seeking to protect medically assisted suicide as a constitutional right said it was beyond the jurisdiction of the court to rule on such life and death matters.\u003c/p>\n\u003cp>Susan Eggman, D-Stockton, said in a \u003ca href=\"http://asmdc.org/members/a13/news-room/press-releases/legislators-re-introduce-end-of-life-option-act-following-court-rulings\" target=\"_blank\">press release\u003c/a> announcing the introduction of the bill that time is of the essence:\u003c/p>\n\u003cp>\"We will not wait another year,\" Eggman said. \"We will not wait for a ballot measure. There are people right now who are facing a terminal diagnosis, watching this fight, praying for our success and hoping to be able to take control of their lives through these reforms. They don't have another year to wait; they are counting on this bill, this year.\"\u003c/p>\n\u003cp>Opponents of physician-assisted suicide expressed dismay over the renewed effort.\u003c/p>\n\u003cp>\"We’re shocked that they would use this legislative maneuver to jam through a bill that’s clearly a life and death matter for Californians,” Marilyn Golden, senior policy analyst with the Disability Rights and Education Defense Fund, told KQED's April Dembosky.\u003c/p>\n\u003cp>Tim Rosales, a spokesman for Californians Against Assisted Suicide, said: \"It is particularly troubling that in this rush to judgment, proponents are linking this bill with health care financing. \"That should be truly frightening to those on Medi-Cal and subsidized health care, who quite logically fear a system where prescribing suicide pills could be elevated to a treatment option.\"\u003c/p>\n\u003cp>The earlier bill stalled in the health committee after a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/physician-assisted-suicide-backers-try-to-woo-latinos/\" target=\"_blank\">small, unusual group of holdouts\u003c/a> -- all Southern California Democrats and almost all Latino -- deprived the legislation of the 10 votes needed for passage.\u003c/p>\n\u003cp>The assisted suicide issue isn't the only one getting a second look in the special session. Several Democratic lawmakers have introduced legislation that would define e-cigarettes as tobacco products and bring them under the state’s existing anti-smoking laws.\u003c/p>\n\u003cp>\u003cem>Jon Brooks, April Dembosky, John Myers, Marisa Lagos and the Associated Press contributed to this post.\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Plan to Absorb Medically Fragile Children Into Managed Care Proves Controversial",
"title": "California Plan to Absorb Medically Fragile Children Into Managed Care Proves Controversial",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Ever since Nickfredy Gutierrez was born prematurely 12 years ago with hydrocephalus, a tube has drained fluid and relieved pressure from his brain. He has had several surgeries and sees his medical specialists every three months.\u003c/p>\n\u003cp>His mother, Mercedes Maldonado, says her son is alive today because of the medical care he gets at Los Angeles County Harbor-UCLA Medical Center through California Children’s Services, a little-known state program that pays for specialized medical care for children with severe illnesses or birth defects.\u003c/p>\n\u003cp>“For those of us with low incomes, we don’t know how we would do it,” she said. “The care is expensive.”\u003c/p>\n\u003cp>Beginning next year, state officials essentially want to fold the $2 billion program, which serves an estimated 180,000 children younger than 21, into its vast system of Medi-Cal managed care.\u003c/p>\n\u003cp>But families like Maldonado’s, along with children’s advocates and pediatric medical centers, are strenuously opposed. They say Medi-Cal managed care hasn’t worked well for vulnerable populations and is particularly risky for fragile kids whose lives depend on access to highly specialized care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It feels like our children are going to be dumped in to this system that doesn’t even seem to be working for healthier children,” said Kausha King of Concord, Calif., who has a son with cerebral palsy and works as a liaison for families of children with special needs.\u003c/p>\n\u003cp>Under the state’s proposal, about 31,000 children in as many as 25 counties would be moved into Medi-Cal managed care plans in 2017. The rest would follow beginning in 2019.\u003c/p>\n\u003cp>At issue are two separate programs whose beneficiaries overlap. About 90 percent of children served by CCS also qualify for Medi-Cal, the public insurance program for low-income Californians. Medi-Cal covers their general medical care, while CCS covers services related to specific conditions such as spina bifida, cancer, cystic fibrosis and sickle cell disease.\u003c/p>\n\u003cp>CCS pays a fee for each service provided, whereas Medi-Cal increasingly is switching to a managed care approach, in which medical services are coordinated and covered under a single health plan for a fixed monthly payment.\u003c/p>\n\u003cp>State officials say that children who see a variety of doctors, like those in CCS, can benefit from a system in which the “whole child” is treated by one plan. It is not about saving money, said California Department of Health Care Services director Jennifer Kent.\u003c/p>\n\u003cp>“This is an opportunity for us to try something different and to bring improvements to the program,” she said.\u003c/p>\n\u003cp>Kent said the department takes the program seriously and wouldn’t want to jeopardize it. Before transferring any children, she said, the state would make sure the health plans are ready and the department would continue to oversee and monitor the plans.\u003c/p>\n\u003cp>After considering feedback, the department can act on its own, without legislative approval, but officials say they nonetheless will seek to incorporate the changes in state law.\u003c/p>\n\u003cp>Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, said plans are generally supportive of the state’s proposal but need to ensure that the rates are “adequate to cover the high-cost population.” Currently, CCS pays for care at higher rates than Medi-Cal. Evans said she believes the plans are well equipped to work with doctors who are certified by the state as CCS providers.\u003c/p>\n\u003cp>\u003cstrong>Missteps In Managed Care\u003c/strong>\u003c/p>\n\u003cp>Still, many parents and consumer advocates are skeptical. Similar transitions of elderly, disabled and child populations from traditional fee-for-service Medi-Cal into managed care programs have proved controversial.\u003c/p>\n\u003cp>These critics point to a scathing report from the California State Auditor in June, which found that the state could not assure that its Medi-Cal managed care networks were adequate and that thousands of calls to an ombudsman’s office went unanswered every month. They also refer to a lawsuit pending in Los Angeles, alleging disabled people were denied crucial medications, tests and treatment by Medi-Cal managed care plans.\u003c/p>\n\u003cp>Pediatric hospitals are worried about losing the money that undergirds their entire system of expert care.\u003c/p>\n\u003cp>CCS has long provided for a regionalized system that goes beyond county boundaries, so children can see the doctors who are most expert in their child’s condition – regardless of where they are, said Ann-Louise Kuhns, president and CEO of the California Children’s Hospital Association. But if plans don’t allow the children to see those physicians, Kuhns said, it could lead to the “de facto destruction” of the program.\u003c/p>\n\u003cp>“This could potentially destabilize that network that really provides services to everybody,” she said.\u003c/p>\n\u003cp>(Kent of the state health services department says the managed care plans – though they often are set up to serve individual counties – would not restrict access in this way.)\u003c/p>\n\u003cp>At Children’s Hospital Los Angeles, nearly 40 percent of the hospital’s patient services revenue comes from providing services to patients in the CCS program, said Lara Khouri, a vice president at the hospital. The hospital’s bottom line would be significantly affected if their patients had to seek care elsewhere, she said.\u003c/p>\n\u003cp>But children’s hospital officials and doctors say they are less worried about financial consequences than a decline in care.\u003c/p>\n\u003cp>Khouri said the hospital already saw problems when a population of young adults with certain genetic diseases was transferred into managed care. More than a third had to switch doctors and change prescriptions, she said.\u003c/p>\n\u003cp>Kuhns of the children’s hospital association said the state’s proposal threatens children’s access to the pediatric specialists who are most familiar with them and their rare diseases.\u003c/p>\n\u003cp>“These [managed care] plans typically don’t have these specialty providers in their networks,” she said. “You don’t want an adult cardiologist doing open-heart surgery on your special-needs child.”\u003c/p>\n\u003cp>Stuart Siegel, an oncologist who directs the Children’s Center for Cancer & Blood Diseases at Children’s Hospital Los Angeles, said his patients rely on the coordinated care they receive from a team of doctors at state-vetted centers.\u003c/p>\n\u003cp>“Patients with these diseases require decisions made quickly,” Siegel said. “If there are delays … it could literally make a difference between life and death.”\u003c/p>\n\u003cp>\u003cstrong>An Encouraging Experiment\u003c/strong>\u003c/p>\n\u003cp>A pilot project in San Mateo County is testing some elements of the state’s proposal and may offer some insights. Started in 2013, the project involves about 1,500 children covered by the Health Plan of San Mateo, a nonprofit health insurance plan created by county commissioners.\u003c/p>\n\u003cp>The health plan’s CEO, Maya Altman, said the pilot has been successful, particularly in resolving concerns that parents had with traditional CCS, such as getting prescriptions on time.\u003c/p>\n\u003cp>Michael Stevens, the father of a 5-year-old daughter with cerebral palsy and a member of the health plan’s family advisory committee, praised the services his daughter has received in the pilot project.\u003c/p>\n\u003cp>“Everything seems to be faster. There is better communication and we’ve only had to contact the appeals department once, but I was impressed with how they handled it,” said Stevens, whose family lives in San Bruno. “If every county could be like San Mateo County, it would benefit all the (CCS) children statewide.”\u003c/p>\n\u003cp>But the project has never been independently evaluated, and some advocates doubt that the San Mateo model can work elsewhere. San Mateo County is small and relatively affluent, and its residents live within an hour’s drive of three highly rated children’s hospitals, said Dr. Louis Girling, medical director for CCS in Alameda County. And the Health Plan of San Mateo is a nonprofit agency with a public service mission, unlike commercial insurers that contract with the state to provide managed care for Medi-Cal recipients.\u003c/p>\n\u003cp>As the state proceeds with its plans, a bill to slow down the transition is pending in the state Legislature.\u003c/p>\n\u003cp>“It’s quite ironic that we’d talk about dismantling the (CCS) system without any data to suggest that managed care is any better,” Girling said. “Most of us in CCS agree there’s room for improvement – policies have prevented us from serving the ‘whole child.’”\u003c/p>\n\u003cp>But “the state really does not have a good track record in terms of rolling these patients with chronic diseases into managed care. They’re trying to push this through really way too quickly.”\u003c/p>\n\u003cp>\u003cem>Blue Shield of California Foundation helps fund KHN coverage in California.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ever since Nickfredy Gutierrez was born prematurely 12 years ago with hydrocephalus, a tube has drained fluid and relieved pressure from his brain. He has had several surgeries and sees his medical specialists every three months.\u003c/p>\n\u003cp>His mother, Mercedes Maldonado, says her son is alive today because of the medical care he gets at Los Angeles County Harbor-UCLA Medical Center through California Children’s Services, a little-known state program that pays for specialized medical care for children with severe illnesses or birth defects.\u003c/p>\n\u003cp>“For those of us with low incomes, we don’t know how we would do it,” she said. “The care is expensive.”\u003c/p>\n\u003cp>Beginning next year, state officials essentially want to fold the $2 billion program, which serves an estimated 180,000 children younger than 21, into its vast system of Medi-Cal managed care.\u003c/p>\n\u003cp>But families like Maldonado’s, along with children’s advocates and pediatric medical centers, are strenuously opposed. They say Medi-Cal managed care hasn’t worked well for vulnerable populations and is particularly risky for fragile kids whose lives depend on access to highly specialized care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It feels like our children are going to be dumped in to this system that doesn’t even seem to be working for healthier children,” said Kausha King of Concord, Calif., who has a son with cerebral palsy and works as a liaison for families of children with special needs.\u003c/p>\n\u003cp>Under the state’s proposal, about 31,000 children in as many as 25 counties would be moved into Medi-Cal managed care plans in 2017. The rest would follow beginning in 2019.\u003c/p>\n\u003cp>At issue are two separate programs whose beneficiaries overlap. About 90 percent of children served by CCS also qualify for Medi-Cal, the public insurance program for low-income Californians. Medi-Cal covers their general medical care, while CCS covers services related to specific conditions such as spina bifida, cancer, cystic fibrosis and sickle cell disease.\u003c/p>\n\u003cp>CCS pays a fee for each service provided, whereas Medi-Cal increasingly is switching to a managed care approach, in which medical services are coordinated and covered under a single health plan for a fixed monthly payment.\u003c/p>\n\u003cp>State officials say that children who see a variety of doctors, like those in CCS, can benefit from a system in which the “whole child” is treated by one plan. It is not about saving money, said California Department of Health Care Services director Jennifer Kent.\u003c/p>\n\u003cp>“This is an opportunity for us to try something different and to bring improvements to the program,” she said.\u003c/p>\n\u003cp>Kent said the department takes the program seriously and wouldn’t want to jeopardize it. Before transferring any children, she said, the state would make sure the health plans are ready and the department would continue to oversee and monitor the plans.\u003c/p>\n\u003cp>After considering feedback, the department can act on its own, without legislative approval, but officials say they nonetheless will seek to incorporate the changes in state law.\u003c/p>\n\u003cp>Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, said plans are generally supportive of the state’s proposal but need to ensure that the rates are “adequate to cover the high-cost population.” Currently, CCS pays for care at higher rates than Medi-Cal. Evans said she believes the plans are well equipped to work with doctors who are certified by the state as CCS providers.\u003c/p>\n\u003cp>\u003cstrong>Missteps In Managed Care\u003c/strong>\u003c/p>\n\u003cp>Still, many parents and consumer advocates are skeptical. Similar transitions of elderly, disabled and child populations from traditional fee-for-service Medi-Cal into managed care programs have proved controversial.\u003c/p>\n\u003cp>These critics point to a scathing report from the California State Auditor in June, which found that the state could not assure that its Medi-Cal managed care networks were adequate and that thousands of calls to an ombudsman’s office went unanswered every month. They also refer to a lawsuit pending in Los Angeles, alleging disabled people were denied crucial medications, tests and treatment by Medi-Cal managed care plans.\u003c/p>\n\u003cp>Pediatric hospitals are worried about losing the money that undergirds their entire system of expert care.\u003c/p>\n\u003cp>CCS has long provided for a regionalized system that goes beyond county boundaries, so children can see the doctors who are most expert in their child’s condition – regardless of where they are, said Ann-Louise Kuhns, president and CEO of the California Children’s Hospital Association. But if plans don’t allow the children to see those physicians, Kuhns said, it could lead to the “de facto destruction” of the program.\u003c/p>\n\u003cp>“This could potentially destabilize that network that really provides services to everybody,” she said.\u003c/p>\n\u003cp>(Kent of the state health services department says the managed care plans – though they often are set up to serve individual counties – would not restrict access in this way.)\u003c/p>\n\u003cp>At Children’s Hospital Los Angeles, nearly 40 percent of the hospital’s patient services revenue comes from providing services to patients in the CCS program, said Lara Khouri, a vice president at the hospital. The hospital’s bottom line would be significantly affected if their patients had to seek care elsewhere, she said.\u003c/p>\n\u003cp>But children’s hospital officials and doctors say they are less worried about financial consequences than a decline in care.\u003c/p>\n\u003cp>Khouri said the hospital already saw problems when a population of young adults with certain genetic diseases was transferred into managed care. More than a third had to switch doctors and change prescriptions, she said.\u003c/p>\n\u003cp>Kuhns of the children’s hospital association said the state’s proposal threatens children’s access to the pediatric specialists who are most familiar with them and their rare diseases.\u003c/p>\n\u003cp>“These [managed care] plans typically don’t have these specialty providers in their networks,” she said. “You don’t want an adult cardiologist doing open-heart surgery on your special-needs child.”\u003c/p>\n\u003cp>Stuart Siegel, an oncologist who directs the Children’s Center for Cancer & Blood Diseases at Children’s Hospital Los Angeles, said his patients rely on the coordinated care they receive from a team of doctors at state-vetted centers.\u003c/p>\n\u003cp>“Patients with these diseases require decisions made quickly,” Siegel said. “If there are delays … it could literally make a difference between life and death.”\u003c/p>\n\u003cp>\u003cstrong>An Encouraging Experiment\u003c/strong>\u003c/p>\n\u003cp>A pilot project in San Mateo County is testing some elements of the state’s proposal and may offer some insights. Started in 2013, the project involves about 1,500 children covered by the Health Plan of San Mateo, a nonprofit health insurance plan created by county commissioners.\u003c/p>\n\u003cp>The health plan’s CEO, Maya Altman, said the pilot has been successful, particularly in resolving concerns that parents had with traditional CCS, such as getting prescriptions on time.\u003c/p>\n\u003cp>Michael Stevens, the father of a 5-year-old daughter with cerebral palsy and a member of the health plan’s family advisory committee, praised the services his daughter has received in the pilot project.\u003c/p>\n\u003cp>“Everything seems to be faster. There is better communication and we’ve only had to contact the appeals department once, but I was impressed with how they handled it,” said Stevens, whose family lives in San Bruno. “If every county could be like San Mateo County, it would benefit all the (CCS) children statewide.”\u003c/p>\n\u003cp>But the project has never been independently evaluated, and some advocates doubt that the San Mateo model can work elsewhere. San Mateo County is small and relatively affluent, and its residents live within an hour’s drive of three highly rated children’s hospitals, said Dr. Louis Girling, medical director for CCS in Alameda County. And the Health Plan of San Mateo is a nonprofit agency with a public service mission, unlike commercial insurers that contract with the state to provide managed care for Medi-Cal recipients.\u003c/p>\n\u003cp>As the state proceeds with its plans, a bill to slow down the transition is pending in the state Legislature.\u003c/p>\n\u003cp>“It’s quite ironic that we’d talk about dismantling the (CCS) system without any data to suggest that managed care is any better,” Girling said. “Most of us in CCS agree there’s room for improvement – policies have prevented us from serving the ‘whole child.’”\u003c/p>\n\u003cp>But “the state really does not have a good track record in terms of rolling these patients with chronic diseases into managed care. They’re trying to push this through really way too quickly.”\u003c/p>\n\u003cp>\u003cem>Blue Shield of California Foundation helps fund KHN coverage in California.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Remember the so-called death panels?\u003c/p>\n\u003cp>When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.\u003c/p>\n\u003cp>But then Sarah Palin argued that such payments would lead to care being withheld from the elderly and disabled. Her comment ignited a firestorm among conservatives and helped fuel the opposition to the legislation.\u003c/p>\n\u003cp>Her assertions greatly distressed Dr. Pamelyn Close, a palliative care specialist in Los Angeles.\u003c/p>\n\u003cp>“It did terrible damage to the concept of having this conversation,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Amid the ensuing political uproar, Congress deleted the provision. And the lack of payments and concerns about the controversy further discouraged doctors from initiating these talks, according to Close.\u003c/p>\n\u003cp>“We just are not having these conversations often enough and soon enough,” Close said. “Loved ones who are trying to do always the right thing, end up being weighed with tremendous guilt and tremendous uncertainty without having had that conversation.”\u003c/p>\n\u003cp>When done right, according to Close, these counseling sessions often delve into end-of-life treatment options and legal documents, such as advance directives and living wills. The issues to be covered are complex and typically require a series of discussions.\u003c/p>\n\u003cp>Right now, Medicare only pays doctors for this sort of advanced care planning if it happens during the first visit for new Medicare enrollees. But the government recently has again proposed that Medicare reimburse doctors for including these conversations in their practice, whenever they occur.\u003c/p>\n\u003cp>Already, some private insurance companies are starting to do just that.\u003c/p>\n\u003cp>Meanwhile, the Alliance Defending Freedom, a conservative Christian organization, has formally opposed Medicare’s proposal.\u003c/p>\n\u003cp>“By paying doctors for these conversations, what we’re doing is opening the door to directive counseling and coercion,” said Catherine Glenn Foster, an attorney with the group. Foster says her organization supports end-of-life counseling and planning, but not in a doctor’s office.\u003c/p>\n\u003cp>“A doctor is not really the person you’d want to be having it with – particularly not a general practitioner who would not be able to advise on the nuances of end-of-life care in the first place,” she says.\u003c/p>\n\u003cp>But patients seem to want these talks.\u003c/p>\n\u003cp>Many doctors who initiate the discussions often do so on their own dime. More often, they don’t have them at all, said Dr. Daniel Stone, an internist with Cedars-Sinai Medical Center in Los Angeles.\u003c/p>\n\u003cp>“When a doctor has patients scheduled every 15 minutes, it’s difficult to have a face-to-face conversation about values and goals related to the end of life, which is one of the most sensitive topics that you can possibly discuss with a patient,” Stone said.\u003c/p>\n\u003cp>Dr. Susan Tolle, an internist with the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, says the informality with which such conversations are held now means that family members may not be included. Having the discussion as part of a formal doctor’s appointment can change that, she said.\u003c/p>\n\u003cp>“What it does is, it gives this really important conversation dignity and standing,” she said.\u003c/p>\n\u003cp>In Oregon, doctors have been squeezing end-of-life discussions into regular medical appointments for decades, under less-than-ideal circumstances. Over the last five years a quarter of a million Oregonians filed their wishes with a state registry. They use what’s known as a POLST form, which stands for Physician Orders for Life Sustaining Treatment. A version of it has been adopted by some other states, including New York and West Virginia.\u003c/p>\n\u003cp>Jo Ann Farwell, a retired Portland social worker who was recently diagnosed with a brain tumor, completed the form after talking to her doctor.\u003c/p>\n\u003cp>“I had surgery and had a prognosis of four to six months to live,” she said, after she was diagnosed with a brain tumor.\u003c/p>\n\u003cp>She did it, she said, to make sure her last hours are as comfortable as possible.\u003c/p>\n\u003cp>“I wouldn’t want to be on tube-feeding,” she said. “I wouldn’t want to be resuscitated, or have mechanical ventilation, because that would probably prolong my dying, rather than giving me quality of life.”\u003c/p>\n\u003cp>In the 1990s, health care workers all over Oregon recognized that the wishes of patients weren’t being consistently followed. So the health care establishment worked with the state and with ethicists to prioritize end-of-life talks; the result was the POLST form.\u003c/p>\n\u003cp>Rep. Earl Blumenauer, a Democrat from Portland, has introduced the Medicare reimbursement legislation every session since 2009. Until now, he says, the federal government hasn’t placed any value on helping people prepare for death, and he finds that ironic.\u003c/p>\n\u003cp>“The Medicare program will pay for literally thousands of medical procedures, many of them very expensive and complex, even if the person is at the latest stage of life and it may not do any good,” Blumenauer says.\u003c/p>\n\u003cp>From a purely financial point of view, the change could save money. But Blumenauer says that’s not what’s driving him.\u003c/p>\n\u003cp>“I don’t care what people decide,” he says. “If they want to die in an ICU with tubes up their nose, that’s their choice. What we want is that people know what their choices are.”\u003c/p>\n\u003cp>Farwell, the brain tumor patient, well remembers when her sister was dying from cancer.\u003c/p>\n\u003cp>“She never talked about death or dying,” Farwell said, “never talked about what she wanted at the end. It was very, very difficult for me to try to plan and give her care.”\u003c/p>\n\u003cp>Farwell wants her sons to be in a better position when it comes to carrying out her wishes.\u003c/p>\n\u003cp>The federal government is now accepting public comment on the Medicare reimbursement proposal. It’s expected to make a decision in November.\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes \u003ca href=\"http://www.opb.org/news/\" target=\"_blank\">Oregon Public Broadcasting\u003c/a>, \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">Southern California Public Radio\u003c/a>, \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Remember the so-called death panels?\u003c/p>\n\u003cp>When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.\u003c/p>\n\u003cp>But then Sarah Palin argued that such payments would lead to care being withheld from the elderly and disabled. Her comment ignited a firestorm among conservatives and helped fuel the opposition to the legislation.\u003c/p>\n\u003cp>Her assertions greatly distressed Dr. Pamelyn Close, a palliative care specialist in Los Angeles.\u003c/p>\n\u003cp>“It did terrible damage to the concept of having this conversation,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Amid the ensuing political uproar, Congress deleted the provision. And the lack of payments and concerns about the controversy further discouraged doctors from initiating these talks, according to Close.\u003c/p>\n\u003cp>“We just are not having these conversations often enough and soon enough,” Close said. “Loved ones who are trying to do always the right thing, end up being weighed with tremendous guilt and tremendous uncertainty without having had that conversation.”\u003c/p>\n\u003cp>When done right, according to Close, these counseling sessions often delve into end-of-life treatment options and legal documents, such as advance directives and living wills. The issues to be covered are complex and typically require a series of discussions.\u003c/p>\n\u003cp>Right now, Medicare only pays doctors for this sort of advanced care planning if it happens during the first visit for new Medicare enrollees. But the government recently has again proposed that Medicare reimburse doctors for including these conversations in their practice, whenever they occur.\u003c/p>\n\u003cp>Already, some private insurance companies are starting to do just that.\u003c/p>\n\u003cp>Meanwhile, the Alliance Defending Freedom, a conservative Christian organization, has formally opposed Medicare’s proposal.\u003c/p>\n\u003cp>“By paying doctors for these conversations, what we’re doing is opening the door to directive counseling and coercion,” said Catherine Glenn Foster, an attorney with the group. Foster says her organization supports end-of-life counseling and planning, but not in a doctor’s office.\u003c/p>\n\u003cp>“A doctor is not really the person you’d want to be having it with – particularly not a general practitioner who would not be able to advise on the nuances of end-of-life care in the first place,” she says.\u003c/p>\n\u003cp>But patients seem to want these talks.\u003c/p>\n\u003cp>Many doctors who initiate the discussions often do so on their own dime. More often, they don’t have them at all, said Dr. Daniel Stone, an internist with Cedars-Sinai Medical Center in Los Angeles.\u003c/p>\n\u003cp>“When a doctor has patients scheduled every 15 minutes, it’s difficult to have a face-to-face conversation about values and goals related to the end of life, which is one of the most sensitive topics that you can possibly discuss with a patient,” Stone said.\u003c/p>\n\u003cp>Dr. Susan Tolle, an internist with the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, says the informality with which such conversations are held now means that family members may not be included. Having the discussion as part of a formal doctor’s appointment can change that, she said.\u003c/p>\n\u003cp>“What it does is, it gives this really important conversation dignity and standing,” she said.\u003c/p>\n\u003cp>In Oregon, doctors have been squeezing end-of-life discussions into regular medical appointments for decades, under less-than-ideal circumstances. Over the last five years a quarter of a million Oregonians filed their wishes with a state registry. They use what’s known as a POLST form, which stands for Physician Orders for Life Sustaining Treatment. A version of it has been adopted by some other states, including New York and West Virginia.\u003c/p>\n\u003cp>Jo Ann Farwell, a retired Portland social worker who was recently diagnosed with a brain tumor, completed the form after talking to her doctor.\u003c/p>\n\u003cp>“I had surgery and had a prognosis of four to six months to live,” she said, after she was diagnosed with a brain tumor.\u003c/p>\n\u003cp>She did it, she said, to make sure her last hours are as comfortable as possible.\u003c/p>\n\u003cp>“I wouldn’t want to be on tube-feeding,” she said. “I wouldn’t want to be resuscitated, or have mechanical ventilation, because that would probably prolong my dying, rather than giving me quality of life.”\u003c/p>\n\u003cp>In the 1990s, health care workers all over Oregon recognized that the wishes of patients weren’t being consistently followed. So the health care establishment worked with the state and with ethicists to prioritize end-of-life talks; the result was the POLST form.\u003c/p>\n\u003cp>Rep. Earl Blumenauer, a Democrat from Portland, has introduced the Medicare reimbursement legislation every session since 2009. Until now, he says, the federal government hasn’t placed any value on helping people prepare for death, and he finds that ironic.\u003c/p>\n\u003cp>“The Medicare program will pay for literally thousands of medical procedures, many of them very expensive and complex, even if the person is at the latest stage of life and it may not do any good,” Blumenauer says.\u003c/p>\n\u003cp>From a purely financial point of view, the change could save money. But Blumenauer says that’s not what’s driving him.\u003c/p>\n\u003cp>“I don’t care what people decide,” he says. “If they want to die in an ICU with tubes up their nose, that’s their choice. What we want is that people know what their choices are.”\u003c/p>\n\u003cp>Farwell, the brain tumor patient, well remembers when her sister was dying from cancer.\u003c/p>\n\u003cp>“She never talked about death or dying,” Farwell said, “never talked about what she wanted at the end. It was very, very difficult for me to try to plan and give her care.”\u003c/p>\n\u003cp>Farwell wants her sons to be in a better position when it comes to carrying out her wishes.\u003c/p>\n\u003cp>The federal government is now accepting public comment on the Medicare reimbursement proposal. It’s expected to make a decision in November.\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes \u003ca href=\"http://www.opb.org/news/\" target=\"_blank\">Oregon Public Broadcasting\u003c/a>, \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">Southern California Public Radio\u003c/a>, \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Authors of a controversial bill that would legalize physician-assisted suicide are trying again. They reintroduced their bill Tuesday as part of the Legislature's extraordinary session, after it stalled earlier this summer in the Assembly Health Committee because they couldn't get enough votes.\u003c/p>\n\u003cp>By pursuing this political pathway, authors can sidestep some of their key opponents from that committee -- at least for now.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/219867816\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Most of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/physician-assisted-suicide-backers-try-to-woo-latinos/\">holdouts, Southern California Democrats\u003c/a> including Lorena Gonzalez and Jimmy Gomez, will not serve on the special session health committee. So authors believe they can get the bill to the Assembly floor more quickly for a full debate and vote.\u003c/p>\n\u003cp>“We've continued our work, and we’re cautiously optimistic that there’s a growing sector of support in the Assembly,” said Sen. Bill Monning, D- Carmel.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new bill, AB X2-15, is the same as the original, SB 128. It would allow doctors to prescribe lethal medication to terminally ill patients who request it. Patients must be mentally competent and able to swallow the drugs themselves.\u003c/p>\n\u003cp>Sen. Monning and Sen. Lois Wolk, D-Davis, say they decided to push the bill again after watching two legal efforts -- in \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/24/judge-says-he-will-dismiss-right-to-die-lawsuit/\">San Diego\u003c/a> and San Francisco -- fail in the courts this summer. The two judges in the lawsuits seeking to protect medically assisted suicide as a constitutional right said it was beyond the jurisdiction of the court to rule on such life and death matters.\u003c/p>\n\u003cp>“The judges have said that this is an issue that needs to be dealt with in the Legislature,” Sen. Wolk said. “We agree with that, and we think the time is now.”\u003c/p>\n\u003cp>Opponents have vowed to continue fighting the bill. Californians Against Assisted Suicide, a coalition of religious and disability groups, recently echoed a concern voiced by the judge in one of the lawsuits: Will patients feel pressured to request lethal drugs for fear of burdening their families with expensive health bills?\u003c/p>\n\u003cp>The Catholic Church, in addition to moral objections, has lobbied lawmakers to oppose the bill for fear that low-income people, in particular, would be subject to such financial pressures, even coercion from family or insurance companies.\u003c/p>\n\u003cp>The opponents criticized the re-introduction of the bill as \"heavy-handed.\"\u003c/p>\n\u003cp>\"We’re shocked that they would use this legislative maneuver to jam through a bill that’s clearly a life and death matter for Californians,\" said Marilyn Golden, senior policy analyst with the Disability Rights and Education Defense Fund.\u003c/p>\n\u003cp>Sen. Monning said the bill has been amended to include strong protections against abuse, including felony provisions for health insurance companies that seek to deny treatment or condition a claim based on whether a patient seeks the lethal drugs or not.\u003c/p>\n\u003cp>The authors said their sense of urgency around the bill has only increased in recent weeks, after two vocal patients who wanted this option to end their suffering on their own timeline died without it.\u003c/p>\n\u003cp>“It is inhumane that we as a society in California cannot give them the relief that they need,” Wolk said. “We're talking about true compassion here.”\u003c/p>\n\u003cp>Jennifer Glass, a lung-cancer patient and outspoken advocate for the bill, died at her home in San Mateo last week, after five days in an induced medical coma. This was not the death she wanted.\u003c/p>\n\u003cp>She spoke with KQED several times about her limited choices at the end of life. She said prohibiting medically assisted suicide would effectively force her to prolong her death.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s nothing that can prepare you for when your doctor looks you in the eye and tells you, you have cancer,” she said last year. “But having choice helps me feel that I have some control over a situation that is uncontrollable.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Authors of a controversial bill that would legalize physician-assisted suicide are trying again. They reintroduced their bill Tuesday as part of the Legislature's extraordinary session, after it stalled earlier this summer in the Assembly Health Committee because they couldn't get enough votes.\u003c/p>\n\u003cp>By pursuing this political pathway, authors can sidestep some of their key opponents from that committee -- at least for now.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/219867816&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/219867816'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Most of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/physician-assisted-suicide-backers-try-to-woo-latinos/\">holdouts, Southern California Democrats\u003c/a> including Lorena Gonzalez and Jimmy Gomez, will not serve on the special session health committee. So authors believe they can get the bill to the Assembly floor more quickly for a full debate and vote.\u003c/p>\n\u003cp>“We've continued our work, and we’re cautiously optimistic that there’s a growing sector of support in the Assembly,” said Sen. Bill Monning, D- Carmel.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new bill, AB X2-15, is the same as the original, SB 128. It would allow doctors to prescribe lethal medication to terminally ill patients who request it. Patients must be mentally competent and able to swallow the drugs themselves.\u003c/p>\n\u003cp>Sen. Monning and Sen. Lois Wolk, D-Davis, say they decided to push the bill again after watching two legal efforts -- in \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/24/judge-says-he-will-dismiss-right-to-die-lawsuit/\">San Diego\u003c/a> and San Francisco -- fail in the courts this summer. The two judges in the lawsuits seeking to protect medically assisted suicide as a constitutional right said it was beyond the jurisdiction of the court to rule on such life and death matters.\u003c/p>\n\u003cp>“The judges have said that this is an issue that needs to be dealt with in the Legislature,” Sen. Wolk said. “We agree with that, and we think the time is now.”\u003c/p>\n\u003cp>Opponents have vowed to continue fighting the bill. Californians Against Assisted Suicide, a coalition of religious and disability groups, recently echoed a concern voiced by the judge in one of the lawsuits: Will patients feel pressured to request lethal drugs for fear of burdening their families with expensive health bills?\u003c/p>\n\u003cp>The Catholic Church, in addition to moral objections, has lobbied lawmakers to oppose the bill for fear that low-income people, in particular, would be subject to such financial pressures, even coercion from family or insurance companies.\u003c/p>\n\u003cp>The opponents criticized the re-introduction of the bill as \"heavy-handed.\"\u003c/p>\n\u003cp>\"We’re shocked that they would use this legislative maneuver to jam through a bill that’s clearly a life and death matter for Californians,\" said Marilyn Golden, senior policy analyst with the Disability Rights and Education Defense Fund.\u003c/p>\n\u003cp>Sen. Monning said the bill has been amended to include strong protections against abuse, including felony provisions for health insurance companies that seek to deny treatment or condition a claim based on whether a patient seeks the lethal drugs or not.\u003c/p>\n\u003cp>The authors said their sense of urgency around the bill has only increased in recent weeks, after two vocal patients who wanted this option to end their suffering on their own timeline died without it.\u003c/p>\n\u003cp>“It is inhumane that we as a society in California cannot give them the relief that they need,” Wolk said. “We're talking about true compassion here.”\u003c/p>\n\u003cp>Jennifer Glass, a lung-cancer patient and outspoken advocate for the bill, died at her home in San Mateo last week, after five days in an induced medical coma. This was not the death she wanted.\u003c/p>\n\u003cp>She spoke with KQED several times about her limited choices at the end of life. She said prohibiting medically assisted suicide would effectively force her to prolong her death.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s nothing that can prepare you for when your doctor looks you in the eye and tells you, you have cancer,” she said last year. “But having choice helps me feel that I have some control over a situation that is uncontrollable.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors Want Physician-Assisted Suicide Now, Before Lawsuit Is Decided",
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"content": "\u003cp>Three doctors who care for terminally ill patients will go to court in San Francisco Friday to ask a judge to allow physician-assisted suicide immediately, while their case seeking to legalize the practice is pending.\u003c/p>\n\u003cp>The doctors, along with four patients, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/11/cancer-patients-doctors-sue-state-to-allow-aid-in-dying/\">filed the lawsuit\u003c/a> in February to challenge California law (Section 401 of the penal code), which makes it a crime to deliberately help someone commit suicide. They argue the law is 140 years old and ambiguous.\u003c/p>\n\u003cp>“Doctors are not providing aid-in-dying because they're afraid to; they're afraid of being prosecuted,” said Nico van Aelstyn, an attorney for the plaintiffs.\u003c/p>\n\u003cp>He requested the preliminary injunction to allow the doctors to begin prescribing lethal medication to terminally ill patients who request it, without interference from law enforcement.\u003c/p>\n\u003cp>The doctors say their patients don’t have time to wait for the lawsuit to work its way through the courts, and that they need relief now.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The lead plaintiff, Angie Bloomquist, suffered from amyotrophic lateral sclerosis, or ALS, and wanted her doctor, Robert Brody, also a plaintiff, to prescribe her the fatal medication, so she could take it when she wanted and control the circumstances of her death. But she died earlier this month before the court could rule.\u003c/p>\n\u003cp>“This is truly an instance where justice delayed was justice denied,” van Aelstyn said. “While we acted as fast as we could, it was not fast enough to provide relief for Angie. Should the next patient of Dr. Brody’s suffer the way Angie did?”\u003c/p>\n\u003cp>Lawyers from the state attorney general’s office, the defendants in the case, argue that the law is clear. Physician-assisted suicide is illegal in California, and these three physicians should not be exempt from the law before a trial is complete.\u003c/p>\n\u003cp>They say that the plaintiffs want to change existing law, a matter they say is better decided by lawmakers in the state Capitol or by voters.\u003c/p>\n\u003cp>“While plaintiffs pose many difficult policy questions worthy of public debate, it is for the Legislature, not this Court, to grapple with these important policy issues,” the defendants wrote in a legal brief.\u003c/p>\n\u003cp>A \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/24/judge-says-he-will-dismiss-right-to-die-lawsuit/\">second lawsuit \u003c/a>challenging the same state law was recently dismissed by a judge in San Diego, on these same grounds. Plaintiffs in that case vowed to file an appeal.\u003c/p>\n\u003cp>Lawmakers did propose a bill (SB 128) to legalize physician-assisted suicide in California, but it was\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/physician-assisted-suicide-backers-try-to-woo-latinos/\"> tabled\u003c/a> earlier this summer.\u003c/p>\n\u003cp>Physician-assisted suicide is legal in four states: The practice was authorized by the courts in Montana, by the legislature in Vermont, and by voters who approved ballot measures in Washington and Oregon.\u003c/p>\n\u003cp>A court authorized physician-assisted suicide in New Mexico in 2014, but a higher court overturned that ruling August 11. The plaintiffs said they plan to appeal to the state Supreme Court.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been corrected to reflect the recent New Mexico Court of Appeals decision. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three doctors who care for terminally ill patients will go to court in San Francisco Friday to ask a judge to allow physician-assisted suicide immediately, while their case seeking to legalize the practice is pending.\u003c/p>\n\u003cp>The doctors, along with four patients, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/11/cancer-patients-doctors-sue-state-to-allow-aid-in-dying/\">filed the lawsuit\u003c/a> in February to challenge California law (Section 401 of the penal code), which makes it a crime to deliberately help someone commit suicide. They argue the law is 140 years old and ambiguous.\u003c/p>\n\u003cp>“Doctors are not providing aid-in-dying because they're afraid to; they're afraid of being prosecuted,” said Nico van Aelstyn, an attorney for the plaintiffs.\u003c/p>\n\u003cp>He requested the preliminary injunction to allow the doctors to begin prescribing lethal medication to terminally ill patients who request it, without interference from law enforcement.\u003c/p>\n\u003cp>The doctors say their patients don’t have time to wait for the lawsuit to work its way through the courts, and that they need relief now.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The lead plaintiff, Angie Bloomquist, suffered from amyotrophic lateral sclerosis, or ALS, and wanted her doctor, Robert Brody, also a plaintiff, to prescribe her the fatal medication, so she could take it when she wanted and control the circumstances of her death. But she died earlier this month before the court could rule.\u003c/p>\n\u003cp>“This is truly an instance where justice delayed was justice denied,” van Aelstyn said. “While we acted as fast as we could, it was not fast enough to provide relief for Angie. Should the next patient of Dr. Brody’s suffer the way Angie did?”\u003c/p>\n\u003cp>Lawyers from the state attorney general’s office, the defendants in the case, argue that the law is clear. Physician-assisted suicide is illegal in California, and these three physicians should not be exempt from the law before a trial is complete.\u003c/p>\n\u003cp>They say that the plaintiffs want to change existing law, a matter they say is better decided by lawmakers in the state Capitol or by voters.\u003c/p>\n\u003cp>“While plaintiffs pose many difficult policy questions worthy of public debate, it is for the Legislature, not this Court, to grapple with these important policy issues,” the defendants wrote in a legal brief.\u003c/p>\n\u003cp>A \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/24/judge-says-he-will-dismiss-right-to-die-lawsuit/\">second lawsuit \u003c/a>challenging the same state law was recently dismissed by a judge in San Diego, on these same grounds. Plaintiffs in that case vowed to file an appeal.\u003c/p>\n\u003cp>Lawmakers did propose a bill (SB 128) to legalize physician-assisted suicide in California, but it was\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/02/physician-assisted-suicide-backers-try-to-woo-latinos/\"> tabled\u003c/a> earlier this summer.\u003c/p>\n\u003cp>Physician-assisted suicide is legal in four states: The practice was authorized by the courts in Montana, by the legislature in Vermont, and by voters who approved ballot measures in Washington and Oregon.\u003c/p>\n\u003cp>A court authorized physician-assisted suicide in New Mexico in 2014, but a higher court overturned that ruling August 11. The plaintiffs said they plan to appeal to the state Supreme Court.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been corrected to reflect the recent New Mexico Court of Appeals decision. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Should California Doctors Be Required to Use Drug Monitoring Database?",
"title": "Should California Doctors Be Required to Use Drug Monitoring Database?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>A yearlong study released last month suggests Kentucky's new law requiring physicians and pharmacists to register with and use the state's new electronic prescription drug monitoring system is working.\u003c/p>\n\u003caside class=\"pullquote alignright\">Study shows similar database in Kentucky has reduced prescription drug abuse, but CMA opposes mandate here.\u003c/aside>\n\u003cp>Two weeks ago, New Jersey became the 10th state to establish a \"meaningful mandate\" requiring physicians to check a database before prescribing certain drugs, according to the Brandeis Prescription Drug Monitoring Program Center of Excellence.\u003c/p>\n\u003cp>California is not one of the 10.\u003c/p>\n\u003cp>News from Kentucky and New Jersey along with campaigns in other states have rekindled interest in California efforts to force physicians to use the Controlled Substance Utilization Review and Evaluation System -- California's electronic monitoring system known as CURES.\u003c/p>\n\u003cp>A bill calling for such a mandate stalled in the California Legislature this year after encountering opposition from the California Medical Association.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>SB 482, by state Sen. Ricardo Lara (D-Bell Gardens), would require doctors to check CURES before prescribing controlled substances for the first time to a patient in California, and annually if the course of narcotic treatment continues. The state Senate passed the bill, but it has stalled in the Assembly.\u003c/p>\n\u003cp>CMA, a trade group representing about 40,000 physicians in the state, opposes the bill, saying it \"would create an unnecessary regulatory burden to prescribing and increase the threat of litigation, both of which would have a detrimental impact on patient care.\"\u003c/p>\n\u003cp>CMA officials added another reason to oppose the bill last month when a new version of the electronic system -- CURES 2.0 -- was rolled out. The new version's reliance on the use of up-to-date Web browsers posed a problem for some physicians and physician groups, according to the CMA.\u003c/p>\n\u003cp>\"We support the CURES database, but it needs to be workable before we start mandating the use of it,\" said Molly Weedn, associate vice president of public affairs for CMA.\u003c/p>\n\u003cp>\u003cstrong>CMA Resistance Called 'Troubling'\u003c/strong>\u003c/p>\n\u003cp>Carmen Balber, executive director of Consumer Watchdog, said California policymakers should recognize and join the national trend toward mandatory use of prescription databases.\u003c/p>\n\u003cp>\"More and more states across country are moving in this direction and we're seeing more and more authorities saying it's part of the answer to stemming the epidemic of drug abuse,\" Balber said.\u003c/p>\n\u003cp>\"This isn't just patient or consumer advocates saying this. CDC is strongly pushing in that direction and the American Medical Association has announced a task force to explore the issue,\" Balber said.\u003c/p>\n\u003cp>Balber said the CMA's opposition to Lara's bill is ill advised.\u003c/p>\n\u003cp>\"I find it really troubling that the [California] medical association continues to throw out scare tactics to doctors instead of embracing change that could save lives,\" Balber said.\u003c/p>\n\u003cp>Before CURES 2.0 launched, CMA officials warned physicians about potential connectivity problems, saying that if the California Department of Justice did not change its implementation plan, \"a minimum of thousands of physicians will lose access to CURES.\"\u003c/p>\n\u003cp>DOJ modified its plans and called for a \"soft\" launch, allowing physicians with older browsers to retain access to the older version of the system.\u003c/p>\n\u003cp>\u003cstrong>Kentucky Database Triggered Decline in Drug Abuse\u003c/strong>\u003c/p>\n\u003cp>Research from the University of Kentucky Institute for Pharmaceutical Outcomes and Policy shows a decline in the number of prescriptions for commonly abused medications, a reduction in \"doctor shopping\" and an increase in the number of Kentuckians seeking treatment for prescription medication addiction.\u003c/p>\n\u003cp>The research specifically measured the effect of a law enacted in 2012. Among other things, the new law required all physicians and pharmacists to register with and use the state's recently upgraded electronic system for monitoring prescription drugs. The Kentucky All Schedule Prescription Electronic Reporting, or KASPER, system is similar in scope and intent to CURES.\u003c/p>\n\u003cp>According to the study, the number of patients in Kentucky who \"shop around\" for doctors to obtain prescriptions declined by 52 percent, opioid prescriptions to doctor-shopping individuals dropped by 54 percent and overdose-related deaths declined in 2013 -- the first drop in such deaths in six years.\u003c/p>\n\u003cp>Other states have reported similar results. Earlier this year in a report to the Tennessee General Assembly:\u003c/p>\n\u003cul>\n\u003cli>41 percent of prescribers in Tennessee reported they are less likely to prescribe controlled substances after checking a prescription database;\u003c/li>\n\u003cli>34 percent said they were more likely to refer a patient for substance abuse treatment; and\u003c/li>\n\u003cli>86 percent of prescribers believe the database is useful for decreasing doctor shopping.\u003c/li>\n\u003c/ul>\n\u003cp>\"The study from Kentucky is consistent with the results in every other state that has mandatory use of the electronic system,\" Balber said.\u003c/p>\n\u003cp>Balber discounted the argument that physicians will use the system without being forced to.\u003c/p>\n\u003cp>\"There are some states that have mandates only in name -- saying physicians should check the database 'if they think they need to.' But research has shown that only the truly mandatory requirements have any effect,\" Balber said.\u003c/p>\n\u003cp>The CURES system, used to monitor Schedule II and Schedule III drugs -- such as OxyContin and other opioids -- \"is seldom used in California because checking is voluntary, and that lack of use is costing lives,\" Balber said.\u003c/p>\n\u003cp>Although CMA officials said they support the use of CURES 2.0, they said they wouldn't necessarily support mandatory use -- or Lara's bill -- even if the system is working at 100 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think the most important thing is that we don't know what other problems might arise,\" Weedn said. \"We didn't know until a few days before the rollout that there would be an issue (with browser connectivity) for example,\" Weedn said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A yearlong study released last month suggests Kentucky's new law requiring physicians and pharmacists to register with and use the state's new electronic prescription drug monitoring system is working.\u003c/p>\n\u003caside class=\"pullquote alignright\">Study shows similar database in Kentucky has reduced prescription drug abuse, but CMA opposes mandate here.\u003c/aside>\n\u003cp>Two weeks ago, New Jersey became the 10th state to establish a \"meaningful mandate\" requiring physicians to check a database before prescribing certain drugs, according to the Brandeis Prescription Drug Monitoring Program Center of Excellence.\u003c/p>\n\u003cp>California is not one of the 10.\u003c/p>\n\u003cp>News from Kentucky and New Jersey along with campaigns in other states have rekindled interest in California efforts to force physicians to use the Controlled Substance Utilization Review and Evaluation System -- California's electronic monitoring system known as CURES.\u003c/p>\n\u003cp>A bill calling for such a mandate stalled in the California Legislature this year after encountering opposition from the California Medical Association.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>SB 482, by state Sen. Ricardo Lara (D-Bell Gardens), would require doctors to check CURES before prescribing controlled substances for the first time to a patient in California, and annually if the course of narcotic treatment continues. The state Senate passed the bill, but it has stalled in the Assembly.\u003c/p>\n\u003cp>CMA, a trade group representing about 40,000 physicians in the state, opposes the bill, saying it \"would create an unnecessary regulatory burden to prescribing and increase the threat of litigation, both of which would have a detrimental impact on patient care.\"\u003c/p>\n\u003cp>CMA officials added another reason to oppose the bill last month when a new version of the electronic system -- CURES 2.0 -- was rolled out. The new version's reliance on the use of up-to-date Web browsers posed a problem for some physicians and physician groups, according to the CMA.\u003c/p>\n\u003cp>\"We support the CURES database, but it needs to be workable before we start mandating the use of it,\" said Molly Weedn, associate vice president of public affairs for CMA.\u003c/p>\n\u003cp>\u003cstrong>CMA Resistance Called 'Troubling'\u003c/strong>\u003c/p>\n\u003cp>Carmen Balber, executive director of Consumer Watchdog, said California policymakers should recognize and join the national trend toward mandatory use of prescription databases.\u003c/p>\n\u003cp>\"More and more states across country are moving in this direction and we're seeing more and more authorities saying it's part of the answer to stemming the epidemic of drug abuse,\" Balber said.\u003c/p>\n\u003cp>\"This isn't just patient or consumer advocates saying this. CDC is strongly pushing in that direction and the American Medical Association has announced a task force to explore the issue,\" Balber said.\u003c/p>\n\u003cp>Balber said the CMA's opposition to Lara's bill is ill advised.\u003c/p>\n\u003cp>\"I find it really troubling that the [California] medical association continues to throw out scare tactics to doctors instead of embracing change that could save lives,\" Balber said.\u003c/p>\n\u003cp>Before CURES 2.0 launched, CMA officials warned physicians about potential connectivity problems, saying that if the California Department of Justice did not change its implementation plan, \"a minimum of thousands of physicians will lose access to CURES.\"\u003c/p>\n\u003cp>DOJ modified its plans and called for a \"soft\" launch, allowing physicians with older browsers to retain access to the older version of the system.\u003c/p>\n\u003cp>\u003cstrong>Kentucky Database Triggered Decline in Drug Abuse\u003c/strong>\u003c/p>\n\u003cp>Research from the University of Kentucky Institute for Pharmaceutical Outcomes and Policy shows a decline in the number of prescriptions for commonly abused medications, a reduction in \"doctor shopping\" and an increase in the number of Kentuckians seeking treatment for prescription medication addiction.\u003c/p>\n\u003cp>The research specifically measured the effect of a law enacted in 2012. Among other things, the new law required all physicians and pharmacists to register with and use the state's recently upgraded electronic system for monitoring prescription drugs. The Kentucky All Schedule Prescription Electronic Reporting, or KASPER, system is similar in scope and intent to CURES.\u003c/p>\n\u003cp>According to the study, the number of patients in Kentucky who \"shop around\" for doctors to obtain prescriptions declined by 52 percent, opioid prescriptions to doctor-shopping individuals dropped by 54 percent and overdose-related deaths declined in 2013 -- the first drop in such deaths in six years.\u003c/p>\n\u003cp>Other states have reported similar results. Earlier this year in a report to the Tennessee General Assembly:\u003c/p>\n\u003cul>\n\u003cli>41 percent of prescribers in Tennessee reported they are less likely to prescribe controlled substances after checking a prescription database;\u003c/li>\n\u003cli>34 percent said they were more likely to refer a patient for substance abuse treatment; and\u003c/li>\n\u003cli>86 percent of prescribers believe the database is useful for decreasing doctor shopping.\u003c/li>\n\u003c/ul>\n\u003cp>\"The study from Kentucky is consistent with the results in every other state that has mandatory use of the electronic system,\" Balber said.\u003c/p>\n\u003cp>Balber discounted the argument that physicians will use the system without being forced to.\u003c/p>\n\u003cp>\"There are some states that have mandates only in name -- saying physicians should check the database 'if they think they need to.' But research has shown that only the truly mandatory requirements have any effect,\" Balber said.\u003c/p>\n\u003cp>The CURES system, used to monitor Schedule II and Schedule III drugs -- such as OxyContin and other opioids -- \"is seldom used in California because checking is voluntary, and that lack of use is costing lives,\" Balber said.\u003c/p>\n\u003cp>Although CMA officials said they support the use of CURES 2.0, they said they wouldn't necessarily support mandatory use -- or Lara's bill -- even if the system is working at 100 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think the most important thing is that we don't know what other problems might arise,\" Weedn said. \"We didn't know until a few days before the rollout that there would be an issue (with browser connectivity) for example,\" Weedn said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Strict Limits on Mental Health Care Still Common for California Patients",
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"content": "\u003cp>After the state of California \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">fined her employer $4 million\u003c/a> in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job -- and her patients’ lives -- to get better.\u003c/p>\n\u003cp>Instead, she said, things got worse.\u003c/p>\n\u003cp>Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care. Some patients might not live long enough to make the next available appointment, she said.\u003c/p>\n\u003cp>“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1ebnqoqYgtH13y2uhbXV4An8UIzspTvr\"]In February, two years after assessing the second largest fine in its history, \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\">the California Department of Managed Health Care stepped in again\u003c/a>, finding that Kaiser had improved somewhat but \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">still was short-changing patients\u003c/a> on mental health care. The state is considering another fine against the health maintenance organization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California has taken perhaps the \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\">most proactive stance in the nation\u003c/a> in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But even in this state\u003cstrong>, \u003c/strong>it’s proving difficult to ensure mental patients truly have equal access to treatment.\u003c/p>\n\u003cp>Parity laws, including a sweeping measure passed by the federal government in 2008 and an older California law, require insurers to provide mental health and substance abuse benefits on par with the coverage they offer for other medical care. And a \u003ca href=\"https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx#.VckfjvlVhBd\" target=\"_blank\">separate state law requires\u003c/a> insurers to provide patients with access to mental treatment within a specific timeframe – 48 hours for an urgent visit and 10 business days for a non-urgent one.\u003c/p>\n\u003cp>After the 2013 fine, Kaiser patients continued to face not just ongoing delays – they also faced arbitrary limits on treatment in direct violation of the state’s parity statute, officials found. The law was intended to prevent such things as annual caps on patient visits that would not typically be faced, for instance, by patient with another chronic illness such as diabetes or heart disease. Yet, according to the 2015 report, some Kaiser staffers told mental health patients that they were not entitled to long-term individual therapy -- ever.\u003c/p>\n\u003cp>“No one ever sees a therapist once a week in the Kaiser Health Plan,” according to a 2014 email a Kaiser psychologist sent to a patient, which was cited in the state’s most recent report. “Not a covered benefit for the past 20-something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Dr. Mason Turner, Kaiser Permanente’s Associate Director of Regional Mental Health for Northern California, said that the organization has fixed the problems identified by the state.\u003c/p>\n\u003cp>“Between the time the DMHC made their [initial] findings and now, we've made substantial improvements, hired many more staff, and really put into place a lot of mechanisms to address the initial concerns that were brought up,” Turner said in April.\u003c/p>\n\u003cp>The access problems, he said, were caused by an increase in demand, which rose in part because of the influx of new enrollees under the Affordable Care Act. In response, he said, Kaiser increased the ranks of therapists by 25 percent and arranged to contract with outside therapists when necessary.\u003c/p>\n\u003cp>The actions against Kaiser highlight both how far California has come in ensuring equal treatment for mental health patients and how far it has yet to go.\u003c/p>\n\u003cp>On one hand, after many years of “abysmal” enforcement, “now we have regulators who seem to be enthusiastic,” said Randall Hagar, director of government relations for the California Psychiatric Association.\u003c/p>\n\u003cp>Hagar gives credit to managed health care department director Shelley Rouillard, who spent 20 years in consumer advocacy before joining the department in 2011 and becoming director in 2013. On the other hand, critics say, Rouillard and her staff are making slow progress at best.\u003c/p>\n\u003cp>“This is one of the ‘pace car’ states, and it's still slow going,” said Carol McDaid, who runs the Parity Implementation Coalition, an advocacy group made up of addiction and mental health consumer and provider organizations.\u003c/p>\n\u003cp>\u003cstrong>Holding Insurers Accountable \u003c/strong>\u003c/p>\n\u003cp>Soon after they fined Kaiser in 2013, California officials realized the problems with unequal coverage of mental health were much broader.\u003c/p>\n\u003cp>For years, California, like most states and the federal government, relied on consumers to bring complaints alleging that their rights had been violated under parity laws. State regulators grew concerned that the approach was too passive -- few consumers were complaining, perhaps because of the stigma attached to mental illness.\u003c/p>\n\u003cp>So as a first step, the department of managed health care last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law.\u003c/p>\n\u003cp>The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said.\u003c/p>\n\u003cp>“It is rather shocking,” Rouillard said.\u003c/p>\n\u003cp>Part of the problem, Rouillard said, is that the federal government did not release the final regulations dictating how its parity law should be enforced until November 2013 – five years after the law was passed.\u003c/p>\n\u003cp>In addition to the flawed and incomplete paperwork, her department found insurers trying to control costs in ways that could be discriminatory -- for example, by limiting the number of days a patient could receive inpatient care for a mental health condition.\u003c/p>\n\u003cp>“Mental health services are still sort of a second class benefit as far as the health plans are concerned,” Rouillard said.\u003c/p>\n\u003cp>At this point, Rouillard says the managed care plans she regulates are in varying stages of compliance with the federal parity law. Just one plan, Health Net, has so far been able to prove on paper that its benefits fully comply. Rouillard says she expects the other plans to follow suit by the end of the year, and in 2016, the department plans a more intensive review.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, disputed that insurers see mental health a second-tier benefit. “We're committed to providing this coverage for our enrollees. It's very important, and it's something that we're working hard to do,” he said.\u003c/p>\n\u003cp>But the law poses a huge challenge for health plans, he said, in part because the science underpinning diagnosis and treatment of mental illness is constantly evolving. In addition, health plans are trying to adapt not just to parity law but to the implementation of the Affordable Care Act, which has transformed the national insurance landscape.\u003c/p>\n\u003cp>Even so, he said, “I think by the end of this year, all the plans will have filed the right documents and will have approval from the department, and this will be something that's in the rearview mirror.”\u003c/p>\n\u003cp>\u003cstrong>‘A Societal Problem’\u003c/strong>\u003c/p>\n\u003cp>[contextly_sidebar id=\"ibzkpzZhksO1dURcjHzt07C3hHpl7QzN\"]Finding that her situation did not improve even after the first investigation of Kaiser in 2015, psychologist Ginne made a request of her managers -- copied to Rouillard -- that December. She asked that six of her sickest patients be transferred to other providers who could see them more frequently.\u003c/p>\n\u003cp>One of them, an elderly man with dementia and depression, was hallucinating “fully-formed humans,” Ginne said in an interview. One day, he wandered down the block at 5 am in his pajamas, panicked, and flagged down a truck driver who called the police.\u003c/p>\n\u003cp>“He was a danger to himself,” Ginne said.\u003c/p>\n\u003cp>According to Ginne, the backup in appointments meant she could see him for individual therapy only once every few months. The man had been assigned to regular group therapy for depression, which Ginne felt was inappropriate for his condition.\u003c/p>\n\u003cp>When her supervisors did not transfer the man to another individual therapy provider, Ginne reported the case to Adult Protective Services, because she said she believed him to be imminent danger.\u003c/p>\n\u003cp>“That's such a bad solution,” she said, shaking her head. Ultimately, he and his wife decided to quit therapy entirely.\u003c/p>\n\u003cp>Rouillard said that many managed care plans have a long way to go to ensure fair and equal access to mental health care for Californians. But she also said there’s only so much her department can do.\u003c/p>\n\u003cp>Access to care at companies like Kaiser is also an issue of capacity – and that’s not within the department’s purview, she said.\u003c/p>\n\u003cp>“There just aren't enough therapists to see everyone who needs help,” she said. “It isn't just a plan problem; it's a societal problem. And that is really the crux of the matter. We're trying to address a problem that is beyond our ability to fix, and that is a challenge.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cstrong>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a> \u003c/em>\u003c/strong>\u003cem>and\u003c/em>\u003cem> not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After the state of California \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">fined her employer $4 million\u003c/a> in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job -- and her patients’ lives -- to get better.\u003c/p>\n\u003cp>Instead, she said, things got worse.\u003c/p>\n\u003cp>Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care. Some patients might not live long enough to make the next available appointment, she said.\u003c/p>\n\u003cp>“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In February, two years after assessing the second largest fine in its history, \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\">the California Department of Managed Health Care stepped in again\u003c/a>, finding that Kaiser had improved somewhat but \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">still was short-changing patients\u003c/a> on mental health care. The state is considering another fine against the health maintenance organization.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California has taken perhaps the \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\">most proactive stance in the nation\u003c/a> in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But even in this state\u003cstrong>, \u003c/strong>it’s proving difficult to ensure mental patients truly have equal access to treatment.\u003c/p>\n\u003cp>Parity laws, including a sweeping measure passed by the federal government in 2008 and an older California law, require insurers to provide mental health and substance abuse benefits on par with the coverage they offer for other medical care. And a \u003ca href=\"https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx#.VckfjvlVhBd\" target=\"_blank\">separate state law requires\u003c/a> insurers to provide patients with access to mental treatment within a specific timeframe – 48 hours for an urgent visit and 10 business days for a non-urgent one.\u003c/p>\n\u003cp>After the 2013 fine, Kaiser patients continued to face not just ongoing delays – they also faced arbitrary limits on treatment in direct violation of the state’s parity statute, officials found. The law was intended to prevent such things as annual caps on patient visits that would not typically be faced, for instance, by patient with another chronic illness such as diabetes or heart disease. Yet, according to the 2015 report, some Kaiser staffers told mental health patients that they were not entitled to long-term individual therapy -- ever.\u003c/p>\n\u003cp>“No one ever sees a therapist once a week in the Kaiser Health Plan,” according to a 2014 email a Kaiser psychologist sent to a patient, which was cited in the state’s most recent report. “Not a covered benefit for the past 20-something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Dr. Mason Turner, Kaiser Permanente’s Associate Director of Regional Mental Health for Northern California, said that the organization has fixed the problems identified by the state.\u003c/p>\n\u003cp>“Between the time the DMHC made their [initial] findings and now, we've made substantial improvements, hired many more staff, and really put into place a lot of mechanisms to address the initial concerns that were brought up,” Turner said in April.\u003c/p>\n\u003cp>The access problems, he said, were caused by an increase in demand, which rose in part because of the influx of new enrollees under the Affordable Care Act. In response, he said, Kaiser increased the ranks of therapists by 25 percent and arranged to contract with outside therapists when necessary.\u003c/p>\n\u003cp>The actions against Kaiser highlight both how far California has come in ensuring equal treatment for mental health patients and how far it has yet to go.\u003c/p>\n\u003cp>On one hand, after many years of “abysmal” enforcement, “now we have regulators who seem to be enthusiastic,” said Randall Hagar, director of government relations for the California Psychiatric Association.\u003c/p>\n\u003cp>Hagar gives credit to managed health care department director Shelley Rouillard, who spent 20 years in consumer advocacy before joining the department in 2011 and becoming director in 2013. On the other hand, critics say, Rouillard and her staff are making slow progress at best.\u003c/p>\n\u003cp>“This is one of the ‘pace car’ states, and it's still slow going,” said Carol McDaid, who runs the Parity Implementation Coalition, an advocacy group made up of addiction and mental health consumer and provider organizations.\u003c/p>\n\u003cp>\u003cstrong>Holding Insurers Accountable \u003c/strong>\u003c/p>\n\u003cp>Soon after they fined Kaiser in 2013, California officials realized the problems with unequal coverage of mental health were much broader.\u003c/p>\n\u003cp>For years, California, like most states and the federal government, relied on consumers to bring complaints alleging that their rights had been violated under parity laws. State regulators grew concerned that the approach was too passive -- few consumers were complaining, perhaps because of the stigma attached to mental illness.\u003c/p>\n\u003cp>So as a first step, the department of managed health care last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law.\u003c/p>\n\u003cp>The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said.\u003c/p>\n\u003cp>“It is rather shocking,” Rouillard said.\u003c/p>\n\u003cp>Part of the problem, Rouillard said, is that the federal government did not release the final regulations dictating how its parity law should be enforced until November 2013 – five years after the law was passed.\u003c/p>\n\u003cp>In addition to the flawed and incomplete paperwork, her department found insurers trying to control costs in ways that could be discriminatory -- for example, by limiting the number of days a patient could receive inpatient care for a mental health condition.\u003c/p>\n\u003cp>“Mental health services are still sort of a second class benefit as far as the health plans are concerned,” Rouillard said.\u003c/p>\n\u003cp>At this point, Rouillard says the managed care plans she regulates are in varying stages of compliance with the federal parity law. Just one plan, Health Net, has so far been able to prove on paper that its benefits fully comply. Rouillard says she expects the other plans to follow suit by the end of the year, and in 2016, the department plans a more intensive review.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, disputed that insurers see mental health a second-tier benefit. “We're committed to providing this coverage for our enrollees. It's very important, and it's something that we're working hard to do,” he said.\u003c/p>\n\u003cp>But the law poses a huge challenge for health plans, he said, in part because the science underpinning diagnosis and treatment of mental illness is constantly evolving. In addition, health plans are trying to adapt not just to parity law but to the implementation of the Affordable Care Act, which has transformed the national insurance landscape.\u003c/p>\n\u003cp>Even so, he said, “I think by the end of this year, all the plans will have filed the right documents and will have approval from the department, and this will be something that's in the rearview mirror.”\u003c/p>\n\u003cp>\u003cstrong>‘A Societal Problem’\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Finding that her situation did not improve even after the first investigation of Kaiser in 2015, psychologist Ginne made a request of her managers -- copied to Rouillard -- that December. She asked that six of her sickest patients be transferred to other providers who could see them more frequently.\u003c/p>\n\u003cp>One of them, an elderly man with dementia and depression, was hallucinating “fully-formed humans,” Ginne said in an interview. One day, he wandered down the block at 5 am in his pajamas, panicked, and flagged down a truck driver who called the police.\u003c/p>\n\u003cp>“He was a danger to himself,” Ginne said.\u003c/p>\n\u003cp>According to Ginne, the backup in appointments meant she could see him for individual therapy only once every few months. The man had been assigned to regular group therapy for depression, which Ginne felt was inappropriate for his condition.\u003c/p>\n\u003cp>When her supervisors did not transfer the man to another individual therapy provider, Ginne reported the case to Adult Protective Services, because she said she believed him to be imminent danger.\u003c/p>\n\u003cp>“That's such a bad solution,” she said, shaking her head. Ultimately, he and his wife decided to quit therapy entirely.\u003c/p>\n\u003cp>Rouillard said that many managed care plans have a long way to go to ensure fair and equal access to mental health care for Californians. But she also said there’s only so much her department can do.\u003c/p>\n\u003cp>Access to care at companies like Kaiser is also an issue of capacity – and that’s not within the department’s purview, she said.\u003c/p>\n\u003cp>“There just aren't enough therapists to see everyone who needs help,” she said. “It isn't just a plan problem; it's a societal problem. And that is really the crux of the matter. We're trying to address a problem that is beyond our ability to fix, and that is a challenge.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cstrong>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a> \u003c/em>\u003c/strong>\u003cem>and\u003c/em>\u003cem> not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"5CcxiB3p3cQnSCBTfP2Io8rKbmuM99t7\"]They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ogqQe7sYg9ub49AojFMaeMDBUcoZMN88\"]\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/217606517\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/217606517&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/217606517'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>TORRANCE – The equipment closet for the operating rooms at Los Angeles County Harbor-UCLA Hospital was a mess. Nurses had to maneuver through a maze of wheelchairs, beds, boxes and lights just to find supplies for surgery.\u003c/p>\n\u003cp>“It looked kind of like a dog pile of equipment,” said Dawna Willsey, a clinical director at the hospital. “It was every man for themselves trying to find anything.”\u003c/p>\n\u003cp>As public hospitals like Harbor-UCLA try to cut costs and make patients happier, administrators have turned to an unlikely ally: Toyota. They are adapting the carmaker’s production system to health care, changing longstanding practices such as how to store equipment, schedule surgeries and discharge patients.\u003c/p>\n\u003cp>The philosophy, known as lean, depends on a continuous team effort to pare inefficiency and improve quality.\u003c/p>\n\u003cp>With Toyota’s strategies, the OR staff re-organized the closet. They tossed unnecessary supplies, gave everything a set location and put up easy-to-read signs. The result? Nurses and doctors could find what they needed when they needed it. And that meant the OR team could mobilize more quickly.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It saves time because they don’t go looking for things – they know where they are,” Willsey said.\u003c/p>\n\u003cp>Private hospitals in places like Seattle and Wisconsin started using Toyota’s system a decade or more ago. But the idea is newer to safety net hospitals -- medical centers that historically have served large numbers of poor people. With the Affordable Care Act, these patients are gaining insurance coverage, and safety net hospitals are facing pressure to keep them from going elsewhere for care.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/217030815\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>In California and elsewhere, some medical professionals have expressed skepticism that a process used to build cars can be translated into treating patients. Others doubt whether the changes are sustainable.\u003c/p>\n\u003cp>DeAnn McEwen, a health and safety specialist with National Nurses United, said lean management reduces nursing to a series of standardized tasks.\u003c/p>\n\u003cp>“The problem with that is patients, of course, are not widgets and nurses are not robots,” she said. “And nursing care is not a commodity but a service. It’s a process that requires critical thinking and the application of judgment.”\u003c/p>\n\u003cp>Research and experience from around the country, however, has shown that using Toyota’s techniques in hospitals can improve quality and safety for patients, said Kelly Pfeifer, director of high-value care at the California HealthCare Foundation. The foundation helped fund implementing lean projects at Harbor-UCLA and four San Francisco Bay Area hospitals -- San Francisco General Hospital, Contra Costa Regional Medical Center, San Mateo Medical Center and the Alameda Health System.\u003c/p>\n\u003cp>Toyota provides its consulting services through its nonprofit arm and did not charge a fee to these nonprofit hospitals.\u003c/p>\n\u003cp>Changes inspired by the Toyota process had direct results, including reducing the time patients spent at the hospital and decreasing medication errors, according to the foundation. They also saved money. Just reducing surgery cancellations saved San Mateo Medical Center nearly half million dollars, the foundation said.\u003c/p>\n\u003cp>Susan Black leads the effort at Harbor-UCLA. Her team works closely with administrators, doctors, nurses, clerks and janitors to streamline and standardize everything it can.\u003c/p>\n\u003cp>“This is not a flavor of the month,” she said. “We have a real need to do better, to do more, improve our access and do it for less. That is part of our survival.”\u003c/p>\n\u003cp>Toshi Kitamura, a Toyota advisor, says auto production and patient care aren't as far apart as you think. Organizing the equipment rooms and supply cabinets is the perfect example, he said.\u003c/p>\n\u003cp>“There was a clear translation,” he said. “Just as in the hospital environment, in our environment … we need to make sure we have all the tools and materials we need, and we need to be able to find them quickly.”\u003c/p>\n\u003cp>Unlike in a car plant, however, Kitamura said saving time can spare people pain and even save their lives.\u003c/p>\n\u003cp>At Harbor-UCLA, the effort started with an overhaul of the outpatient eye clinic where the process moved so slowly that some patients were going blind just waiting to get scheduled for surgery. During clinic visits, some had to have their eyes dilated twice because they waited so long to see a doctor.\u003c/p>\n\u003cp>Working with Toyota, staff members picked up the pace: They created a system of color-coded folders so it became clear why patients were there and who they needed to see. They stopped sending patients back and forth to the waiting room during their visits. They put a locked box in each exam room with prescription pads and other medications so doctors could spend more time with patients and less fetching what they needed to treat them.\u003c/p>\n\u003cp>“Before, it was total chaos,” said Tracie Bell, a nursing attendant. “We had piles and piles of paper. With this new color-coded system … it makes it a whole lot easier for us to do our jobs.”\u003c/p>\n\u003cp>Within several months, staffers doubled the average number of new patients seen each day. Patients' time in the clinic dropped from 4 ½ hours to just over two. Surgeries were scheduled faster.\u003c/p>\n\u003cp>Antonio Camargo, 49, a patient at the eye clinic, said he waited months for his first operation, a corneal transplant. But recently, when he needed another operation, he had it within days. “It was a long process before,” he said. “Now it’s better.”\u003c/p>\n\u003cp>Downstairs, doctors and nurses at the primary care clinic are in the early stages of adopting Toyota’s strategies. But Darrell Harrington, an associate medical director for Harbor-UCLA, said one thing is already clear: “There is a lot of waste of movement and waste of time.”\u003c/p>\n\u003cp>On a recent afternoon, Harrington watched as a senior resident came in and out of a patient exam room multiple times. “Walking 50 feet or 100 feet down the hall, and doing that during the patient visit three or four times, is a big waste,” he said.\u003c/p>\n\u003cp>Harrington stopped the resident. “I am just wondering why in and out three different times?” he asked. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It saves time because they don’t go looking for things – they know where they are,” Willsey said.\u003c/p>\n\u003cp>Private hospitals in places like Seattle and Wisconsin started using Toyota’s system a decade or more ago. But the idea is newer to safety net hospitals -- medical centers that historically have served large numbers of poor people. With the Affordable Care Act, these patients are gaining insurance coverage, and safety net hospitals are facing pressure to keep them from going elsewhere for care.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/217030815&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/217030815'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In California and elsewhere, some medical professionals have expressed skepticism that a process used to build cars can be translated into treating patients. Others doubt whether the changes are sustainable.\u003c/p>\n\u003cp>DeAnn McEwen, a health and safety specialist with National Nurses United, said lean management reduces nursing to a series of standardized tasks.\u003c/p>\n\u003cp>“The problem with that is patients, of course, are not widgets and nurses are not robots,” she said. “And nursing care is not a commodity but a service. It’s a process that requires critical thinking and the application of judgment.”\u003c/p>\n\u003cp>Research and experience from around the country, however, has shown that using Toyota’s techniques in hospitals can improve quality and safety for patients, said Kelly Pfeifer, director of high-value care at the California HealthCare Foundation. The foundation helped fund implementing lean projects at Harbor-UCLA and four San Francisco Bay Area hospitals -- San Francisco General Hospital, Contra Costa Regional Medical Center, San Mateo Medical Center and the Alameda Health System.\u003c/p>\n\u003cp>Toyota provides its consulting services through its nonprofit arm and did not charge a fee to these nonprofit hospitals.\u003c/p>\n\u003cp>Changes inspired by the Toyota process had direct results, including reducing the time patients spent at the hospital and decreasing medication errors, according to the foundation. They also saved money. Just reducing surgery cancellations saved San Mateo Medical Center nearly half million dollars, the foundation said.\u003c/p>\n\u003cp>Susan Black leads the effort at Harbor-UCLA. Her team works closely with administrators, doctors, nurses, clerks and janitors to streamline and standardize everything it can.\u003c/p>\n\u003cp>“This is not a flavor of the month,” she said. “We have a real need to do better, to do more, improve our access and do it for less. That is part of our survival.”\u003c/p>\n\u003cp>Toshi Kitamura, a Toyota advisor, says auto production and patient care aren't as far apart as you think. 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"content": "\u003cp>Autism costs to the United States as a whole are expected to reach nearly half a trillion dollars annually in the year 2025, according to an analysis from health economists at UC Davis Medical Center.\u003c/p>\n\u003cp>Researchers looked at medical, non-medical and lost productivity costs. They said costs for 2015 total $268 billion and in 10 years will reach $461 billion. Researchers said their estimates were \"conservative,\" and that it was the first time the economic burden for the U.S. had been calculated.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iC6D3rqatMOXaW6SyV76Bbh1tVGG1xMm\"]\"The economic burden of autism is more than double the economic burden for stroke and hypertension -- combined,\" said lead author Paul Leigh, a health economist at UC Davis Medical Center.\u003c/p>\n\u003cp>And while these costs are very high, research funding lags, he said.\u003c/p>\n\u003cp>\"The economic burden of autism is on par with the costs of diabetes,\" Leigh said. \"And yet the federal government is funding diabetes [research] at about five times the rate that it is funding research into autism.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study was published online in the \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/26183723\" target=\"_blank\">Journal of Autism and Developmental Disorders\u003c/a>.\u003c/p>\n\u003cp>Leigh says more intensive services that can help people with autism to have jobs and live independently can reduce societal costs later.\u003c/p>\n\u003cp>\"There are definitely cost-effective interventions for children and adults,\" Leigh said, \"and these can yield big dividends in a few years ... when people with autism become functional and compete in the workforce.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"EJWRnp2pQbcXu9jpCWywxGE6g6IdQUS7\"]Costs associated with autism have been calculated in other studies, the authors noted, but those have primarily focused on per-person lifetime costs. Because universal costs were not tallied until now, it made comparison with other diseases difficult.\u003c/p>\n\u003cp>Kristin Jacobson, executive director of Autism Deserves Equal Coverage, an advocacy group, said the study's findings validate what the autism community had long known.\u003c/p>\n\u003cp>\"Autism is one of the largest and the fastest growing health crises in the United States and the world,\" she said by email. \"Unfortunately it still remains dramatically underresearched and underfunded. If California and the U.S. continue to underinvest in research and therapy, the financial and social costs will be catastrophic.\"\u003c/p>\n\u003cp>She noted that her own organization had previously calculated that California could save $46 billion to $64 billion over 10 years by providing behavior health treatment to individuals with autism.\u003c/p>\n\u003cp>\"If the state and federal government does not wake up and significantly invest in understanding ASD [Autism Spectrum Disorder] and making ASD treatment accessible, the societal and financial burden will be devastating,\" she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the study, Leigh and co-author Juan Du called for research into possible \"modifiable causes\" of ASD at a level \"as great as other major diseases,\" as well as new research into the cost effectiveness of different therapies.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study was published online in the \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/26183723\" target=\"_blank\">Journal of Autism and Developmental Disorders\u003c/a>.\u003c/p>\n\u003cp>Leigh says more intensive services that can help people with autism to have jobs and live independently can reduce societal costs later.\u003c/p>\n\u003cp>\"There are definitely cost-effective interventions for children and adults,\" Leigh said, \"and these can yield big dividends in a few years ... when people with autism become functional and compete in the workforce.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Costs associated with autism have been calculated in other studies, the authors noted, but those have primarily focused on per-person lifetime costs. Because universal costs were not tallied until now, it made comparison with other diseases difficult.\u003c/p>\n\u003cp>Kristin Jacobson, executive director of Autism Deserves Equal Coverage, an advocacy group, said the study's findings validate what the autism community had long known.\u003c/p>\n\u003cp>\"Autism is one of the largest and the fastest growing health crises in the United States and the world,\" she said by email. \"Unfortunately it still remains dramatically underresearched and underfunded. If California and the U.S. continue to underinvest in research and therapy, the financial and social costs will be catastrophic.\"\u003c/p>\n\u003cp>She noted that her own organization had previously calculated that California could save $46 billion to $64 billion over 10 years by providing behavior health treatment to individuals with autism.\u003c/p>\n\u003cp>\"If the state and federal government does not wake up and significantly invest in understanding ASD [Autism Spectrum Disorder] and making ASD treatment accessible, the societal and financial burden will be devastating,\" she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the study, Leigh and co-author Juan Du called for research into possible \"modifiable causes\" of ASD at a level \"as great as other major diseases,\" as well as new research into the cost effectiveness of different therapies.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Happy 50th Birthday, Medicare. Your Patients Are Getting Healthier",
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"content": "\u003cp>Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a\u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8035\" target=\"_blank\"> study\u003c/a> in the \u003cem>Journal of the American Medical Association\u003c/em>.\u003c/p>\n\u003cp>Doctors, hospitals and government administrators have put a lot of effort into making Medicare more efficient in the past 15 years. \u003ca href=\"https://medicine.yale.edu/intmed/people/harlan_krumholz.profile\" target=\"_blank\">Dr. Harlan Krumholz\u003c/a> and colleagues at Yale University took on a study to see whether that effort has paid off.\u003c/p>\n\u003cp>[contextly_sidebar id=\"d6fBr9xMRQXiy0cpNzqihfUmFxAiuvKG\"]\"The results were rather remarkable,\" says Krumholz, a cardiologist and leading health care researcher. \"We found jaw-dropping improvements in almost every area that we looked at.\"\u003c/p>\n\u003cp>The researchers looked at the experience of 60 million older Americans covered by traditional Medicare between 1999 and 2013. They found that mortality rates dropped steadily during that time, and people were much less likely to end up in the hospital.\u003c/p>\n\u003cp>\"If the rates had stayed the same in 2013 as they had been in 1999, we would have seen almost 3.5 million more hospitalizations in 2013,\" Krumholz says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"People who were being hospitalized were having much better outcomes after the hospitalization,\" he says. \"They had a much better chance of survival.\"\u003c/p>\n\u003cp>And the average cost of a hospital stay dropped too, he says, from $3,290 to $2,801 in inflation-adjusted dollars over the 15-year-period for patients in the traditional Medicare program. (Researchers couldn't quantify the experience in Medicare Advantage, the managed-care alternative to Medicare).\u003c/p>\n\u003cp>Krumholz attributes the improvement to a wide variety of measures designed to boost patients' health, from prevention programs to advances in medical care. He says some of the savings also came about because medical care shifted from hospitals to less expensive outpatient clinics.\u003c/p>\n\u003cp>\"They're pointing out a very good thing in the medical system,\" says economist \u003ca href=\"https://www.kellogg.northwestern.edu/faculty/directory/garthwaite_craig.aspx\" target=\"_blank\">Craig Garthwaite\u003c/a> at the Kellogg School of Management at Northwestern University. He says the recession, which helped slow rising health care costs overall, apparently played a minor role in this story of Medicare.\u003c/p>\n\u003cp>Costs really are being contained, Garthwaite says. One other reason that's happening is that the federal government is reimbursing hospitals and doctors less for treating Medicare patients.\u003c/p>\n\u003cp>\"That's an easy way to get control of medical spending in Medicare,\" Garthwaite says, but \"it's just not something we can do in the private market, and we have to worry about how sustainable it is for the Medicare program overall.\"\u003c/p>\n\u003cp>With the post-World War II baby boom now reaching retirement age, more and more people are turning 65 and becoming eligible for Medicare. That growth continues to drive up the overall cost of the program, even as that average cost per illness or hospitalization comes down. And as older Americans live longer lives, they use Medicare for more years than previous generations did.\u003c/p>\n\u003cp>Medicare is still running a bit of a deficit, but the situation is improving. The program's trustees say its trust fund will be solvent through 2030. Some adjustments would be needed to keep the program in good financial health beyond that date.\u003c/p>\n\u003cp>Garthwaite says other recent trends could make matters worse, with one especially worrisome example being sharply rising drug prices.\u003c/p>\n\u003cp>\"Some of these [new cancer] products are providing only a few months of life for several hundred thousand dollars,\" he says. And the system doesn't do a good job of making difficult judgments in situations like that.\u003c/p>\n\u003cp>\u003ca href=\"https://www.aei.org/scholar/joseph-antos/\" target=\"_blank\">Joseph Antos\u003c/a>, an economist in health policy at the American Enterprise Institute, agrees that the good news from the Yale study doesn't assure a rosy future. He's concerned about the financial health of Medicare if, for example, an effective drug for Alzheimer's disease is developed.\u003c/p>\n\u003cp>\"I would argue that if anybody came up with an effective treatment for Alzheimer's today, that treatment would be hailed as a major breakthrough and we wouldn't be looking at the cost.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And that would almost certainly break the pattern that's been documented over the past 15 years, where improving health has actually helped drive down the cost of medical care.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Happy+50th+Birthday%2C+Medicare.+Your+Patients+Are+Getting+Healthier&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a\u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8035\" target=\"_blank\"> study\u003c/a> in the \u003cem>Journal of the American Medical Association\u003c/em>.\u003c/p>\n\u003cp>Doctors, hospitals and government administrators have put a lot of effort into making Medicare more efficient in the past 15 years. \u003ca href=\"https://medicine.yale.edu/intmed/people/harlan_krumholz.profile\" target=\"_blank\">Dr. Harlan Krumholz\u003c/a> and colleagues at Yale University took on a study to see whether that effort has paid off.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The results were rather remarkable,\" says Krumholz, a cardiologist and leading health care researcher. \"We found jaw-dropping improvements in almost every area that we looked at.\"\u003c/p>\n\u003cp>The researchers looked at the experience of 60 million older Americans covered by traditional Medicare between 1999 and 2013. They found that mortality rates dropped steadily during that time, and people were much less likely to end up in the hospital.\u003c/p>\n\u003cp>\"If the rates had stayed the same in 2013 as they had been in 1999, we would have seen almost 3.5 million more hospitalizations in 2013,\" Krumholz says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"People who were being hospitalized were having much better outcomes after the hospitalization,\" he says. \"They had a much better chance of survival.\"\u003c/p>\n\u003cp>And the average cost of a hospital stay dropped too, he says, from $3,290 to $2,801 in inflation-adjusted dollars over the 15-year-period for patients in the traditional Medicare program. (Researchers couldn't quantify the experience in Medicare Advantage, the managed-care alternative to Medicare).\u003c/p>\n\u003cp>Krumholz attributes the improvement to a wide variety of measures designed to boost patients' health, from prevention programs to advances in medical care. He says some of the savings also came about because medical care shifted from hospitals to less expensive outpatient clinics.\u003c/p>\n\u003cp>\"They're pointing out a very good thing in the medical system,\" says economist \u003ca href=\"https://www.kellogg.northwestern.edu/faculty/directory/garthwaite_craig.aspx\" target=\"_blank\">Craig Garthwaite\u003c/a> at the Kellogg School of Management at Northwestern University. He says the recession, which helped slow rising health care costs overall, apparently played a minor role in this story of Medicare.\u003c/p>\n\u003cp>Costs really are being contained, Garthwaite says. One other reason that's happening is that the federal government is reimbursing hospitals and doctors less for treating Medicare patients.\u003c/p>\n\u003cp>\"That's an easy way to get control of medical spending in Medicare,\" Garthwaite says, but \"it's just not something we can do in the private market, and we have to worry about how sustainable it is for the Medicare program overall.\"\u003c/p>\n\u003cp>With the post-World War II baby boom now reaching retirement age, more and more people are turning 65 and becoming eligible for Medicare. That growth continues to drive up the overall cost of the program, even as that average cost per illness or hospitalization comes down. And as older Americans live longer lives, they use Medicare for more years than previous generations did.\u003c/p>\n\u003cp>Medicare is still running a bit of a deficit, but the situation is improving. The program's trustees say its trust fund will be solvent through 2030. Some adjustments would be needed to keep the program in good financial health beyond that date.\u003c/p>\n\u003cp>Garthwaite says other recent trends could make matters worse, with one especially worrisome example being sharply rising drug prices.\u003c/p>\n\u003cp>\"Some of these [new cancer] products are providing only a few months of life for several hundred thousand dollars,\" he says. And the system doesn't do a good job of making difficult judgments in situations like that.\u003c/p>\n\u003cp>\u003ca href=\"https://www.aei.org/scholar/joseph-antos/\" target=\"_blank\">Joseph Antos\u003c/a>, an economist in health policy at the American Enterprise Institute, agrees that the good news from the Yale study doesn't assure a rosy future. He's concerned about the financial health of Medicare if, for example, an effective drug for Alzheimer's disease is developed.\u003c/p>\n\u003cp>\"I would argue that if anybody came up with an effective treatment for Alzheimer's today, that treatment would be hailed as a major breakthrough and we wouldn't be looking at the cost.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And that would almost certainly break the pattern that's been documented over the past 15 years, where improving health has actually helped drive down the cost of medical care.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Happy+50th+Birthday%2C+Medicare.+Your+Patients+Are+Getting+Healthier&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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