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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>I remembered the commercial instantly:\u003c/p>\n\u003cp>\u003ciframe src=\"http://www.youtube.com/embed/wAaGbsHBacE\" frameborder=\"0\" width=\"420\" height=\"315\">\u003c/iframe>\u003c/p>\n\u003cp>Debi Austin appeared in the ad in 1996. In a raspy voice, she described starting smoking at age 13. Then declaring, \"They say nicotine isn't addictive,\" she took a drag from her cigarette through a stoma, a hole in her throat which permitted her to breathe. \"How can they say that?\" she concluded.\u003c/p>\n\u003cp>For years, she worked to keep kids from smoking. She died last week after fighting various cancers for more than 20 years.\u003c/p>\n\u003cp>From a release from the California Department of Public Health:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We are saddened by Debi’s death. She exemplified the real toll tobacco takes on a person’s body,” said CDPH Director and State Public Health Officer Dr. Ron Chapman. “Debi was a pioneer in the fight against tobacco and showed tremendous courage by sharing her story to educate Californians on the dangers of smoking. She was an inspiration for Californians to quit smoking and also influenced countless others not to start. We trust she will continue to touch those that hear her story, particularly teens and young adults. She will be greatly missed.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://tobaccofreeca.com/ads/videos/?src=Debi\" target=\"_blank\">Tobacco Free California\u003c/a> says this about Austin on its website (where you can also watch a video about her):\u003c/p>\n\u003cblockquote>\u003cp>Debi Austin started smoking at the age of 13. She continued to smoke through a stoma in her throat even after being diagnosed with cancer and having her larynx removed at the age of 42. But, Debi fought back. She starred in an iconic television ad for the California Tobacco Control Program, quit smoking and has made anti-tobacco education not only her mission in life, but her passion.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Bill for Statewide Soda Tax Introduced",
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"content": "\u003cp>By Mina Kim\u003c/p>\n\u003cfigure id=\"attachment_10794\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/26/10790/poolie_flickr/\" rel=\"attachment wp-att-10794\">\u003cimg class=\"size-medium wp-image-10794\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/poolie_Flickr-300x200.jpg\" alt=\"(poolie/Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(poolie/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Richmond voters may have \u003ca href=\"http://ww2.kqed.org/stateofhealth/jp/quick-read-richmond-soda-tax-unpalatable-to-voters-2/\" target=\"_blank\">crushed an effort\u003c/a> to pass a soda tax last fall, but that’s not stopping one lawmaker from trying to tax sodas statewide.\u003c/p>\n\u003cp>State Senator Bill Monning (D-Carmel) tried to pass a statewide soda tax two years ago that failed, but with Democrats expected to hang on to supermajorities in both houses, Monning thinks this time is different.\u003c/p>\n\u003cp>\"The political train has changed in 2012, but it’s still not going to be automatic by any means,\" Monning says. \"Any tax is going to be an uphill fight.\"\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB622\" target=\"_blank\">Monning’s bill \u003c/a>would slap distributors of sugary drinks with an excise tax of a penny-per-ounce, the same amount that was proposed in Richmond and El Monte, in southern California. The bill would further create a Children's Health Promotion Fund which would then split all revenue between the State Department of Public Health and Superintendent of Public Instruction.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/most-californians-support-soda-tax-if-it-benefits-childrens-health/\" target=\"_blank\">Field Poll \u003c/a>showed support for a tax if the money went to children’s nutrition and physical education.\u003c!--more-->\u003c/p>\n\u003cp>Still, American Beverage Association spokesman Chuck Finnie says the industry isn’t worried. \"Sugar-sweetened beverages are not the major source of added sugar in the American diet,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Finnie says the industry will educate lawmakers on how the drinks are being unfairly targeted.\u003c/p>\n\n",
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"excerpt": "Richmond voters may have crushed an effort to pass a soda tax last fall, but that’s not stopping one lawmaker from trying to tax sodas statewide.\r\n\r\nState Senator Bill Monning tried to pass a statewide soda tax two years ago that failed, but with Democrats expected to hang on to supermajorities in both houses, Monning thinks this time is different.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Mina Kim\u003c/p>\n\u003cfigure id=\"attachment_10794\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/26/10790/poolie_flickr/\" rel=\"attachment wp-att-10794\">\u003cimg class=\"size-medium wp-image-10794\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/poolie_Flickr-300x200.jpg\" alt=\"(poolie/Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(poolie/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Richmond voters may have \u003ca href=\"http://ww2.kqed.org/stateofhealth/jp/quick-read-richmond-soda-tax-unpalatable-to-voters-2/\" target=\"_blank\">crushed an effort\u003c/a> to pass a soda tax last fall, but that’s not stopping one lawmaker from trying to tax sodas statewide.\u003c/p>\n\u003cp>State Senator Bill Monning (D-Carmel) tried to pass a statewide soda tax two years ago that failed, but with Democrats expected to hang on to supermajorities in both houses, Monning thinks this time is different.\u003c/p>\n\u003cp>\"The political train has changed in 2012, but it’s still not going to be automatic by any means,\" Monning says. \"Any tax is going to be an uphill fight.\"\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB622\" target=\"_blank\">Monning’s bill \u003c/a>would slap distributors of sugary drinks with an excise tax of a penny-per-ounce, the same amount that was proposed in Richmond and El Monte, in southern California. The bill would further create a Children's Health Promotion Fund which would then split all revenue between the State Department of Public Health and Superintendent of Public Instruction.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/most-californians-support-soda-tax-if-it-benefits-childrens-health/\" target=\"_blank\">Field Poll \u003c/a>showed support for a tax if the money went to children’s nutrition and physical education.\u003c!--more-->\u003c/p>\n\u003cp>Still, American Beverage Association spokesman Chuck Finnie says the industry isn’t worried. \"Sugar-sweetened beverages are not the major source of added sugar in the American diet,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Finnie says the industry will educate lawmakers on how the drinks are being unfairly targeted.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Approach to Medical Residency May Ease Doctor Shortage in Central Valley",
"title": "New Approach to Medical Residency May Ease Doctor Shortage in Central Valley",
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"content": "\u003cp>By Rebecca Plevin, \u003ca href=\"http://kvpr.org/post/are-teaching-health-centers-cure-valleys-doctor-shortage#.USea0lGUDxU.twitter\" target=\"_blank\">Valley Public Radio\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10770\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/25/new-approach-to-medical-residency-may-ease-doctor-shortage-in-central-valley/plevinphoto/\" rel=\"attachment wp-att-10770\">\u003cimg class=\"size-medium wp-image-10770\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/PlevinPhoto-300x225.jpg\" alt=\"Dr. Peter Broderick examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Peter Broderick examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\u003c/figcaption>\u003c/figure>\n\u003cp>The Central Valley suffers from an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\">acute shortage of doctors\u003c/a> -- especially primary care doctors -- but a new type of residency program aims to bring relief. These new \"teaching health centers\" are funded by the Affordable Care Act.\u003c/p>\n\u003cp>This new approach contrasts with traditional medical residency programs, which are often based at university medical centers in large cities and encourage specialty training.\u003c/p>\n\u003cp>With the recognition that medical residents often stay where they are trained, the idea behind this new approach is to place these young doctors not in large hospitals but in community health centers where they will focus on primary care.\u003c/p>\n\u003cp>“The hope is that more of the graduates from these programs will stay in these underserved settings, will work in these community health clinics, and hopefully address some of the shortages that we have with that population,” said Dr. Peter Broderick, the CEO of Modesto's Valley Consortium of Medical Education.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2010 Broderick's group opened the state's first \"teaching health center\" -- the Valley Family Medical Residency Program. It has trained 12 doctors a year since then.\u003c!--more-->\u003c/p>\n\u003cp>The teaching health center model is gaining traction. This summer, the Sierra Vista Family Medicine Residency Program will welcome its first four residents to Fresno. California's third teaching health center will be located in Redding.\u003c/p>\n\u003cp>Still, traditional programs play a huge role in training the Central Valley's future doctors. UCSF-Fresno remains the largest provider of graduate medical education in the Valley, including 12 family medicine residents each year.\u003c/p>\n\u003cp>Gene Kallsen, the assistant dean of UCSF-Fresno, says the university and the teaching health centers share the goal of increasing the number of primary care doctors in the Valley.\u003c/p>\n\u003cp>But, Kallsen explains, UCSF-Fresno is blocked from growing its residency programs to meet the region’s needs for primary care doctors. A major one, he says, is a convoluted system that ties -- and caps -- the number of medical residents to the number of Medicare patients at a hospital. Once that cap is set, it can’t be changed.\u003c/p>\n\u003cp>“One of the barriers is that programs like ours can’t grow unless we identify new sites,” Kallen said. \"We can only get federal funding for so many residents, and we live up against that cap.”\u003c/p>\n\u003cp>That’s where new programs, like the teaching health centers, come in.\u003c/p>\n\u003cp>“We’re not trying to compete with UCSF at all, and we don’t want to have that perception,” said Norma Forbes, the executive director of Fresno Healthy Community Access Partners. Her organization partnered with Clinica Sierra Vista to launch its Medicine Residency Program.\u003c/p>\n\u003cp>“This is a different model that we hope will grow the number of family medicine doctors,\" she says. \"There is room for both types of training residents here in the Valley and across the country.\"\u003c/p>\n\u003cp>Forbes said the program follows a curriculum similar to more traditional family medicine residency programs. But residents at the teaching health center will gain experience with a variety of patients and procedures, instead of specializing in one specific type of medicine. She drew a distinction between the care offered at a large university hospital's outpatient -- or ambulatory care -- clinics and that of community health center's primary care clinics.\u003c/p>\n\u003cp>“Those primary clinics are free-standing and they are really focused on prevention and wellness -- and working with patients from birth to death,\" Forbes says.\"And when you get into ambulatory clinics associated with more urban environment hospitals, you run into the specialization.”\u003c/p>\n\u003cp>She is confident that the teaching health center model will help train more doctors who are dedicated to serving Valley communities and slowly remedy the region’s primary care doctor shortage. She hopes all of the program’s residents will practice in clinics in rural areas of the Valley after they finish their residencies.\u003c/p>\n\u003cp>“Our goal is to get 100 percent of them, all four of them (each year), staying right here, so we can truly increase the number of doctors through this residency program,” Forbes said.\u003c/p>\n\u003cp>The program currently has a three-year grant from the federal government.\u003c/p>\n\u003cp>Back at the teaching health center in Modesto, Dr. Broderick congratulated medical student Dr. Gewel de los Santos for helping a patient reach a healthy weight. She responded with outright enthusiasm.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valley residents can only hope that more family medicine residents are as excited about practicing in the region.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Rebecca Plevin, \u003ca href=\"http://kvpr.org/post/are-teaching-health-centers-cure-valleys-doctor-shortage#.USea0lGUDxU.twitter\" target=\"_blank\">Valley Public Radio\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10770\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/25/new-approach-to-medical-residency-may-ease-doctor-shortage-in-central-valley/plevinphoto/\" rel=\"attachment wp-att-10770\">\u003cimg class=\"size-medium wp-image-10770\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/PlevinPhoto-300x225.jpg\" alt=\"Dr. Peter Broderick examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Peter Broderick examines a patient's x-ray while family practice medical residents look on. (Rebecca Plevin/KVPR)\u003c/figcaption>\u003c/figure>\n\u003cp>The Central Valley suffers from an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/\" target=\"_blank\">acute shortage of doctors\u003c/a> -- especially primary care doctors -- but a new type of residency program aims to bring relief. These new \"teaching health centers\" are funded by the Affordable Care Act.\u003c/p>\n\u003cp>This new approach contrasts with traditional medical residency programs, which are often based at university medical centers in large cities and encourage specialty training.\u003c/p>\n\u003cp>With the recognition that medical residents often stay where they are trained, the idea behind this new approach is to place these young doctors not in large hospitals but in community health centers where they will focus on primary care.\u003c/p>\n\u003cp>“The hope is that more of the graduates from these programs will stay in these underserved settings, will work in these community health clinics, and hopefully address some of the shortages that we have with that population,” said Dr. Peter Broderick, the CEO of Modesto's Valley Consortium of Medical Education.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2010 Broderick's group opened the state's first \"teaching health center\" -- the Valley Family Medical Residency Program. It has trained 12 doctors a year since then.\u003c!--more-->\u003c/p>\n\u003cp>The teaching health center model is gaining traction. This summer, the Sierra Vista Family Medicine Residency Program will welcome its first four residents to Fresno. California's third teaching health center will be located in Redding.\u003c/p>\n\u003cp>Still, traditional programs play a huge role in training the Central Valley's future doctors. UCSF-Fresno remains the largest provider of graduate medical education in the Valley, including 12 family medicine residents each year.\u003c/p>\n\u003cp>Gene Kallsen, the assistant dean of UCSF-Fresno, says the university and the teaching health centers share the goal of increasing the number of primary care doctors in the Valley.\u003c/p>\n\u003cp>But, Kallsen explains, UCSF-Fresno is blocked from growing its residency programs to meet the region’s needs for primary care doctors. A major one, he says, is a convoluted system that ties -- and caps -- the number of medical residents to the number of Medicare patients at a hospital. Once that cap is set, it can’t be changed.\u003c/p>\n\u003cp>“One of the barriers is that programs like ours can’t grow unless we identify new sites,” Kallen said. \"We can only get federal funding for so many residents, and we live up against that cap.”\u003c/p>\n\u003cp>That’s where new programs, like the teaching health centers, come in.\u003c/p>\n\u003cp>“We’re not trying to compete with UCSF at all, and we don’t want to have that perception,” said Norma Forbes, the executive director of Fresno Healthy Community Access Partners. Her organization partnered with Clinica Sierra Vista to launch its Medicine Residency Program.\u003c/p>\n\u003cp>“This is a different model that we hope will grow the number of family medicine doctors,\" she says. \"There is room for both types of training residents here in the Valley and across the country.\"\u003c/p>\n\u003cp>Forbes said the program follows a curriculum similar to more traditional family medicine residency programs. But residents at the teaching health center will gain experience with a variety of patients and procedures, instead of specializing in one specific type of medicine. She drew a distinction between the care offered at a large university hospital's outpatient -- or ambulatory care -- clinics and that of community health center's primary care clinics.\u003c/p>\n\u003cp>“Those primary clinics are free-standing and they are really focused on prevention and wellness -- and working with patients from birth to death,\" Forbes says.\"And when you get into ambulatory clinics associated with more urban environment hospitals, you run into the specialization.”\u003c/p>\n\u003cp>She is confident that the teaching health center model will help train more doctors who are dedicated to serving Valley communities and slowly remedy the region’s primary care doctor shortage. She hopes all of the program’s residents will practice in clinics in rural areas of the Valley after they finish their residencies.\u003c/p>\n\u003cp>“Our goal is to get 100 percent of them, all four of them (each year), staying right here, so we can truly increase the number of doctors through this residency program,” Forbes said.\u003c/p>\n\u003cp>The program currently has a three-year grant from the federal government.\u003c/p>\n\u003cp>Back at the teaching health center in Modesto, Dr. Broderick congratulated medical student Dr. Gewel de los Santos for helping a patient reach a healthy weight. She responded with outright enthusiasm.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valley residents can only hope that more family medicine residents are as excited about practicing in the region.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_10715\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/21/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures/ct-scan-13-of-clubs_flickr/\" rel=\"attachment wp-att-10715\">\u003cimg class=\"size-medium wp-image-10715\" title=\"Don't automatically do a CT scan on a child with a minor head injury. (13 of Clubs/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/CT-scan-13-of-Clubs_Flickr-300x225.jpg\" alt=\"CT scan 13 of Clubs_Flickr\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">One new recommendation: Don't automatically do a CT scan to check a child's minor head injury. (13 of Clubs/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\u003c/p>\n\u003cp>On Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit.\u003c/p>\n\u003cp>This \"\u003ca href=\"http://www.choosingwisely.org\" target=\"_blank\">Choosing Wisely\u003c/a>\" campaign is from a coalition of doctors' groups -- ranging from the American Academy of Pediatrics to the Society of Thoracic Surgeons -- in conjunction with Consumer Reports.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/05/please-dont-call-it-rationing/\" target=\"_blank\"> Last year\u003c/a>, the campaign named 45 tests and procedures patients should look at carefully. This year, 17 doctors' organizations representing 350,000 physicians released \u003ca href=\"http://www.choosingwisely.org/wp-content/uploads/2013/02/021513_CW-Phase-II-Press-Release-FINAL.pdf\" target=\"_blank\">90 additional tests and procedures.\u003c!--more-->\u003c/a>\u003c/p>\n\u003cp>The goal is to encourage patients and doctors to consider what care is truly necessary, to understand “that when it comes to health care, more is not necessarily better,” Dr. \u003ca href=\"http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_57.html\">Christine Cassel\u003c/a> of the ABIM Foundation said in a statement.\u003c/p>\n\u003cp>Here are just a few examples of some of their recommendations:\u003c/p>\n\u003cdiv>\n\u003cul>\n\u003cli>Don’t induce labor or schedule a c-section before 39 weeks pregnancy without a valid medical reason. Delivery before 39 weeks is associated with increased risk of learning disabilities and respiratory problems. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)\u003c/li>\n\u003cli>Don’t use feeding tubes in patients with advanced dementia. It does not result in better outcomes. Studies show that helping with eating is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)\u003c/li>\n\u003cli>Don’t automatically do a CT scan to check a child's minor head injury. Roughly half of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may increase future cancer risk. Doctor should observe a child prior to making a decision about needing a CT. (American Academy of Pediatrics)\u003c/li>\n\u003c/ul>\n\u003cp>Fifteen more medical societies are expected to release new or additional lists later this year.\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\r\n\r\nOn Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit. The goal is to encourage patients and doctors to consider what care is truly necessary.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10715\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/21/just-say-no-doctors-groups-define-more-unnecessary-tests-procedures/ct-scan-13-of-clubs_flickr/\" rel=\"attachment wp-att-10715\">\u003cimg class=\"size-medium wp-image-10715\" title=\"Don't automatically do a CT scan on a child with a minor head injury. (13 of Clubs/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/CT-scan-13-of-Clubs_Flickr-300x225.jpg\" alt=\"CT scan 13 of Clubs_Flickr\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">One new recommendation: Don't automatically do a CT scan to check a child's minor head injury. (13 of Clubs/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.\u003c/p>\n\u003cp>On Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit.\u003c/p>\n\u003cp>This \"\u003ca href=\"http://www.choosingwisely.org\" target=\"_blank\">Choosing Wisely\u003c/a>\" campaign is from a coalition of doctors' groups -- ranging from the American Academy of Pediatrics to the Society of Thoracic Surgeons -- in conjunction with Consumer Reports.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/05/please-dont-call-it-rationing/\" target=\"_blank\"> Last year\u003c/a>, the campaign named 45 tests and procedures patients should look at carefully. This year, 17 doctors' organizations representing 350,000 physicians released \u003ca href=\"http://www.choosingwisely.org/wp-content/uploads/2013/02/021513_CW-Phase-II-Press-Release-FINAL.pdf\" target=\"_blank\">90 additional tests and procedures.\u003c!--more-->\u003c/a>\u003c/p>\n\u003cp>The goal is to encourage patients and doctors to consider what care is truly necessary, to understand “that when it comes to health care, more is not necessarily better,” Dr. \u003ca href=\"http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_57.html\">Christine Cassel\u003c/a> of the ABIM Foundation said in a statement.\u003c/p>\n\u003cp>Here are just a few examples of some of their recommendations:\u003c/p>\n\u003cdiv>\n\u003cul>\n\u003cli>Don’t induce labor or schedule a c-section before 39 weeks pregnancy without a valid medical reason. Delivery before 39 weeks is associated with increased risk of learning disabilities and respiratory problems. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)\u003c/li>\n\u003cli>Don’t use feeding tubes in patients with advanced dementia. It does not result in better outcomes. Studies show that helping with eating is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)\u003c/li>\n\u003cli>Don’t automatically do a CT scan to check a child's minor head injury. Roughly half of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may increase future cancer risk. Doctor should observe a child prior to making a decision about needing a CT. (American Academy of Pediatrics)\u003c/li>\n\u003c/ul>\n\u003cp>Fifteen more medical societies are expected to release new or additional lists later this year.\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Rethinking Unprotected Sex for HIV-Positive Men ",
"title": "Rethinking Unprotected Sex for HIV-Positive Men ",
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"content": "\u003cp>By Mina Kim\u003c/p>\n\u003cfigure id=\"attachment_10613\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/permission-to-forego-condoms-for-hiv-men-wanting-children/minasphoto/\" rel=\"attachment wp-att-10613\">\u003cimg class=\"size-medium wp-image-10613\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/MinasPhoto-300x199.jpg\" alt=\"Deon Brimmer, 32, is HIV positive and expecting a daughter. He’s being treated by a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Deon, 32, is HIV positive and expecting a daughter. He’s being treated at a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)\u003c/figcaption>\u003c/figure>\n\u003cp>The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.\u003c/p>\n\u003cp>Now, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies -- the conventional way. The program run by San Francisco General Hospital, called PRO Men, teaches men about a range of reproductive options, from adoption to in vitro fertilization -- where an egg is fertilized in a lab dish -- to carefully timed intercourse.\u003c/p>\n\u003cp>“I would say as an HIV provider community, we have really failed these men,” says UCSF professor Deborah Cohan, who runs the hospital's \u003ca href=\"http://www.sfghf.net/programs/bapac.html\" target=\"_blank\">Bay Area Perinatal AIDS Center\u003c/a> or BAPAC. “We really have not created programs to help them realize those goals and do so safely.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“It is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”\u003c/aside>\n\u003cp>\u003cem>\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>With the discovery of drugs to treat the virus, Cohan said people with HIV are living long, healthy lives. And for those who want to start families, having “safe” sex, Cohan said, can mean foregoing condoms when a female partner is ovulating. Women can also take HIV drugs, which some studies show can protect against the virus. (BAPAC has helped HIV-positive women who adhere to their medications have healthy babies for years.)\u003c/p>\n\u003cp>“We know that if the person who is positive takes antiretrovirals and their viral load is suppressed, meaning the medication is working at killing all the HIV in the blood, that the likelihood of them passing HIV to a sexual partner is essentially zero,” Cohan said.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>“Essentially zero” but not absolutely zero, Cohan says, because there’s some concern the virus can be in genital fluid even when it’s not detected in blood.\u003c/p>\n\u003cp>Despite this concern, couples are forging ahead with their family plans. Deon, 32, who thought his life was over when he tested HIV positive when he was in jail four years ago. Now he is about to welcome a baby girl with his fiancée Caroline. (Both Deon and Caroline preferred to go by their first names only.)\u003c/p>\n\u003cp>The couple became pregnant through unprotected sexual intercourse. Caroline does not have HIV, so the baby does not either. And she said she’s really not too concerned about getting HIV from her partner.\u003c/p>\n\u003cp>“He’s on his meds, and it’s a really, really, really low chance of me getting it,” she said. “And I just, like I love him, it’s not a big issue.”\u003c/p>\n\u003cp>\u003cstrong>BREAKING STIGMA\u003c/strong>\u003c/p>\n\u003cp>Though it may not be a big issue for Caroline, being HIV positive and having unprotected sex runs counter to just about every public health message that’s been put out for decades. Both state public health officials and officials with the Centers for Disease Control declined to comment for this story. The \u003ca href=\"http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Ethics_Committee_Reports_and_Statements/hivethics.pdf\" target=\"_blank\">latest ethics report \u003c/a>from the research and advocacy group American Society for Reproductive Medicine called the practice, “unsafe” and “not recommended.”\u003c/p>\n\u003cp>The San Francisco program is thought to be the first of its kind, and David Evans with the AIDS activist group Project Inform said it may stay that way for a while.\u003c/p>\n\u003cp>“I think stigma is still very, very strong in society about HIV in general.”\u003c/p>\n\u003cp>Evans, who has been following HIV medical science for decades and pushes for policy changes, said that in some states, doctors have refused to help those with HIV have kids altogether. Until about two years ago, health officials in Mississippi required people who tested positive for the virus to sign a form saying they would never have children. Evans said a program that affirms the right of people with HIV to have kids, and let go of condoms, could be revolutionary.\u003c/p>\n\u003cp>“I think this really changes things in a quite dramatic way,” Evan said. “And it is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”\u003c/p>\n\u003cp>Case in point, as a typical father-to-be, Deon worries more about raising a daughter than he does about his HIV.\u003c/p>\n\u003cp>“It's like 'Oh my god,’” he said. “I definitely want her to know all kinds of self-defense. I envision her to be a black belt in karate.”\u003c/p>\n\u003cp>Caroline said she's confident they'll be good parents.\u003c/p>\n\u003cp>“We just have a really good relationship, like we really talk about everything,” she said. “He says I can make the decisions, but we make decisions together really, and things are just better when we're together.”\u003c/p>\n\u003cp>The hospital treats about 500 straight men with HIV. The PRO Men program plans to launch a monthly support group in March that will also be open to men living outside San Francisco.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to Mina Kim's story\u003c/strong>:\u003cbr>\n\u003cobject width=\"335\" height=\"85\">\u003cparam name=\"movie\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201302151630b.xml\">\u003cembed src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" type=\"application/x-shockwave-flash\" width=\"335\" height=\"85\" flashvars=\"file=http://www.kqed.org/radio/archives/R201302151630b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.\r\n\r\nNow, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies -- the conventional way.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Mina Kim\u003c/p>\n\u003cfigure id=\"attachment_10613\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/14/permission-to-forego-condoms-for-hiv-men-wanting-children/minasphoto/\" rel=\"attachment wp-att-10613\">\u003cimg class=\"size-medium wp-image-10613\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/MinasPhoto-300x199.jpg\" alt=\"Deon Brimmer, 32, is HIV positive and expecting a daughter. He’s being treated by a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Deon, 32, is HIV positive and expecting a daughter. He’s being treated at a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)\u003c/figcaption>\u003c/figure>\n\u003cp>The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.\u003c/p>\n\u003cp>Now, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies -- the conventional way. The program run by San Francisco General Hospital, called PRO Men, teaches men about a range of reproductive options, from adoption to in vitro fertilization -- where an egg is fertilized in a lab dish -- to carefully timed intercourse.\u003c/p>\n\u003cp>“I would say as an HIV provider community, we have really failed these men,” says UCSF professor Deborah Cohan, who runs the hospital's \u003ca href=\"http://www.sfghf.net/programs/bapac.html\" target=\"_blank\">Bay Area Perinatal AIDS Center\u003c/a> or BAPAC. “We really have not created programs to help them realize those goals and do so safely.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“It is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”\u003c/aside>\n\u003cp>\u003cem>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>With the discovery of drugs to treat the virus, Cohan said people with HIV are living long, healthy lives. And for those who want to start families, having “safe” sex, Cohan said, can mean foregoing condoms when a female partner is ovulating. Women can also take HIV drugs, which some studies show can protect against the virus. (BAPAC has helped HIV-positive women who adhere to their medications have healthy babies for years.)\u003c/p>\n\u003cp>“We know that if the person who is positive takes antiretrovirals and their viral load is suppressed, meaning the medication is working at killing all the HIV in the blood, that the likelihood of them passing HIV to a sexual partner is essentially zero,” Cohan said.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>“Essentially zero” but not absolutely zero, Cohan says, because there’s some concern the virus can be in genital fluid even when it’s not detected in blood.\u003c/p>\n\u003cp>Despite this concern, couples are forging ahead with their family plans. Deon, 32, who thought his life was over when he tested HIV positive when he was in jail four years ago. Now he is about to welcome a baby girl with his fiancée Caroline. (Both Deon and Caroline preferred to go by their first names only.)\u003c/p>\n\u003cp>The couple became pregnant through unprotected sexual intercourse. Caroline does not have HIV, so the baby does not either. And she said she’s really not too concerned about getting HIV from her partner.\u003c/p>\n\u003cp>“He’s on his meds, and it’s a really, really, really low chance of me getting it,” she said. “And I just, like I love him, it’s not a big issue.”\u003c/p>\n\u003cp>\u003cstrong>BREAKING STIGMA\u003c/strong>\u003c/p>\n\u003cp>Though it may not be a big issue for Caroline, being HIV positive and having unprotected sex runs counter to just about every public health message that’s been put out for decades. Both state public health officials and officials with the Centers for Disease Control declined to comment for this story. The \u003ca href=\"http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Ethics_Committee_Reports_and_Statements/hivethics.pdf\" target=\"_blank\">latest ethics report \u003c/a>from the research and advocacy group American Society for Reproductive Medicine called the practice, “unsafe” and “not recommended.”\u003c/p>\n\u003cp>The San Francisco program is thought to be the first of its kind, and David Evans with the AIDS activist group Project Inform said it may stay that way for a while.\u003c/p>\n\u003cp>“I think stigma is still very, very strong in society about HIV in general.”\u003c/p>\n\u003cp>Evans, who has been following HIV medical science for decades and pushes for policy changes, said that in some states, doctors have refused to help those with HIV have kids altogether. Until about two years ago, health officials in Mississippi required people who tested positive for the virus to sign a form saying they would never have children. Evans said a program that affirms the right of people with HIV to have kids, and let go of condoms, could be revolutionary.\u003c/p>\n\u003cp>“I think this really changes things in a quite dramatic way,” Evan said. “And it is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”\u003c/p>\n\u003cp>Case in point, as a typical father-to-be, Deon worries more about raising a daughter than he does about his HIV.\u003c/p>\n\u003cp>“It's like 'Oh my god,’” he said. “I definitely want her to know all kinds of self-defense. I envision her to be a black belt in karate.”\u003c/p>\n\u003cp>Caroline said she's confident they'll be good parents.\u003c/p>\n\u003cp>“We just have a really good relationship, like we really talk about everything,” she said. “He says I can make the decisions, but we make decisions together really, and things are just better when we're together.”\u003c/p>\n\u003cp>The hospital treats about 500 straight men with HIV. The PRO Men program plans to launch a monthly support group in March that will also be open to men living outside San Francisco.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to Mina Kim's story\u003c/strong>:\u003cbr>\n\u003cobject width=\"335\" height=\"85\">\u003cparam name=\"movie\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201302151630b.xml\">\u003cembed src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" type=\"application/x-shockwave-flash\" width=\"335\" height=\"85\" flashvars=\"file=http://www.kqed.org/radio/archives/R201302151630b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Most Californians Support Soda Tax If It Benefits Children's Health",
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"content": "\u003cfigure id=\"attachment_6672\" class=\"wp-caption alignleft\" style=\"max-width: 250px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/21/beverage-companies-blur-the-line-between-philanthropy-marketing/soda/\" rel=\"attachment wp-att-6672\">\u003cimg class=\"size-full wp-image-6672\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/soda.jpg\" alt=\" (La Piazza Pizzeria/Flickr)\" width=\"250\" height=\"250\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda.jpg 250w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-75x75.jpg 75w\" sizes=\"(max-width: 250px) 100vw, 250px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(La Piazza Pizzeria/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Just over three months since voters in two California cities -- Richmond and El Monte -- flatly turned down soda taxes, a new \u003ca href=\"http://field.com/fieldpollonline/subscribers/Rls2436.pdf\" target=\"_blank\">Field Poll released Thursday\u003c/a> found a majority of California voters say they would support a soda tax if the funds raised were devoted to children's health.\u003c/p>\n\u003cp>While only 40 percent of voters said they favor a sugar-sweetened beverage tax, that number jumped to 68 percent if the proceeds will benefit school nutrition and physical activity programs.\u003c/p>\n\u003cp>\"Voters in general don’t trust taxes that aren’t earmarked. They prefer to see taxes linked to something beneficial,\" said Dr. Tony Iton, senior vice president of The California Endowment, which sponsored the poll. \"People that are engaged in constructing policy ... should take heart in this poll and be able to look to it to construct subsequent measures for trying to engage the public support behind obesity prevention.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">Fully 75 percent of voters said they see a link between regular soda consumption and a person's risk of being overweight or obese.\u003c/aside>\n\u003cp>The Field Poll reported that support for such an earmarked tax was especially strong among Latinos (79 percent), Asian Americans (73 percent) and African Americans (70 percent).\u003c/p>\n\u003cp>\"I think this poll shows that a campaign either statewide or locally in cities has an excellent chance,\" Wendel Brunner, Contra Costa County's director of public health, told the \u003ca href=\"http://www.mercurynews.com/science/ci_22586019/new-statewide-field-poll-shows-support-soda-tax\" target=\"_blank\">San Jose Mercury News\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But in the poll voters had the highest support -- more than 80 percent -- for increasing opportunities for being physically active, such as improved school sports fields and playgrounds -- and keeping those facilities open after school and on weekends.\u003c!--more-->\u003c/p>\n\u003cp>Chuck Finnie, with the American Beverage Association, pointed out that soda taxes have failed recently, not just in California, but, he says, in other places across the country. \"Poll after poll shows Americans don't believe taxing sweetened beverages is the way to reduce obesity,\" Finnie said in a statement. \"If we want to get serious about obesity, education -- not taxes and regulation -- is the right approach.\"\u003c/p>\n\u003cp>Still, fully 75 percent of voters said they see a link between regular soda consumption and a person's risk of being overweight or obese. But they don't see the same risk from so-called energy drinks or sports drinks, and Iton finds that troubling.\u003c/p>\n\u003cp>\"It's heartening to see that soda consumption rates are beginning to dip,\" he said, \"but the concern is that people may be substituting with sports drinks, substituting with energy drinks, and those products have -- in many cases -- as much sugar in them. We're concerned that those not be substituted for sodas.\"\u003c/p>\n\u003cp>Californians were also highly supportive (85 percent) of having fresh, clean drinking water available in schools and other public places, such as parks. Availability of clean drinking water can be a significant challenge in some areas, especially rural school districts in the Central Valley. Many homes and buildings rely on well water, which can be contaminated with nitrites and nitrates from pesticide run-off, as well as naturally contaminated with arsenic.\u003c/p>\n\u003cp>Kids in school are \"forced to either drink bottled water, which is expensive,\" Iton says, \"or to substitute fluids, using things like sodas.\"\u003c/p>\n\u003cp>The California Endowment and the Field Poll have been tracking public awareness about sugar-sweetened beverages and obesity for three years. Iton says support for policies to \"improve the environment\" has been increasing.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>These results dovetail with a recent \u003ca href=\"http://www.phi.org/news-events/special-section-california-field-research-release/\" target=\"_blank\">Public Health Institute poll\u003c/a> of rural California counties. In that survey, 94 percent of respondents said that obesity was a serious problem for the country, and 84 percent said it was a problem in their own communities.\u003c/p>\n\n",
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"excerpt": "Just over three months since voters in two California cities -- Richmond and El Monte -- flatly turned down soda taxes on the ba, a new Field Poll released Thursday found a majority of California voters say they would support a soda tax if the funds raised were devoted to children's health. While only 40 percent of voters said they favor a sugar-sweetened beverage tax, that number jumped to 68 percent if the proceeds will benefit school nutrition and physical activity programs.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_6672\" class=\"wp-caption alignleft\" style=\"max-width: 250px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/21/beverage-companies-blur-the-line-between-philanthropy-marketing/soda/\" rel=\"attachment wp-att-6672\">\u003cimg class=\"size-full wp-image-6672\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/soda.jpg\" alt=\" (La Piazza Pizzeria/Flickr)\" width=\"250\" height=\"250\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda.jpg 250w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/27/2012/06/soda-75x75.jpg 75w\" sizes=\"(max-width: 250px) 100vw, 250px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(La Piazza Pizzeria/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Just over three months since voters in two California cities -- Richmond and El Monte -- flatly turned down soda taxes, a new \u003ca href=\"http://field.com/fieldpollonline/subscribers/Rls2436.pdf\" target=\"_blank\">Field Poll released Thursday\u003c/a> found a majority of California voters say they would support a soda tax if the funds raised were devoted to children's health.\u003c/p>\n\u003cp>While only 40 percent of voters said they favor a sugar-sweetened beverage tax, that number jumped to 68 percent if the proceeds will benefit school nutrition and physical activity programs.\u003c/p>\n\u003cp>\"Voters in general don’t trust taxes that aren’t earmarked. They prefer to see taxes linked to something beneficial,\" said Dr. Tony Iton, senior vice president of The California Endowment, which sponsored the poll. \"People that are engaged in constructing policy ... should take heart in this poll and be able to look to it to construct subsequent measures for trying to engage the public support behind obesity prevention.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">Fully 75 percent of voters said they see a link between regular soda consumption and a person's risk of being overweight or obese.\u003c/aside>\n\u003cp>The Field Poll reported that support for such an earmarked tax was especially strong among Latinos (79 percent), Asian Americans (73 percent) and African Americans (70 percent).\u003c/p>\n\u003cp>\"I think this poll shows that a campaign either statewide or locally in cities has an excellent chance,\" Wendel Brunner, Contra Costa County's director of public health, told the \u003ca href=\"http://www.mercurynews.com/science/ci_22586019/new-statewide-field-poll-shows-support-soda-tax\" target=\"_blank\">San Jose Mercury News\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But in the poll voters had the highest support -- more than 80 percent -- for increasing opportunities for being physically active, such as improved school sports fields and playgrounds -- and keeping those facilities open after school and on weekends.\u003c!--more-->\u003c/p>\n\u003cp>Chuck Finnie, with the American Beverage Association, pointed out that soda taxes have failed recently, not just in California, but, he says, in other places across the country. \"Poll after poll shows Americans don't believe taxing sweetened beverages is the way to reduce obesity,\" Finnie said in a statement. \"If we want to get serious about obesity, education -- not taxes and regulation -- is the right approach.\"\u003c/p>\n\u003cp>Still, fully 75 percent of voters said they see a link between regular soda consumption and a person's risk of being overweight or obese. But they don't see the same risk from so-called energy drinks or sports drinks, and Iton finds that troubling.\u003c/p>\n\u003cp>\"It's heartening to see that soda consumption rates are beginning to dip,\" he said, \"but the concern is that people may be substituting with sports drinks, substituting with energy drinks, and those products have -- in many cases -- as much sugar in them. We're concerned that those not be substituted for sodas.\"\u003c/p>\n\u003cp>Californians were also highly supportive (85 percent) of having fresh, clean drinking water available in schools and other public places, such as parks. Availability of clean drinking water can be a significant challenge in some areas, especially rural school districts in the Central Valley. Many homes and buildings rely on well water, which can be contaminated with nitrites and nitrates from pesticide run-off, as well as naturally contaminated with arsenic.\u003c/p>\n\u003cp>Kids in school are \"forced to either drink bottled water, which is expensive,\" Iton says, \"or to substitute fluids, using things like sodas.\"\u003c/p>\n\u003cp>The California Endowment and the Field Poll have been tracking public awareness about sugar-sweetened beverages and obesity for three years. Iton says support for policies to \"improve the environment\" has been increasing.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>These results dovetail with a recent \u003ca href=\"http://www.phi.org/news-events/special-section-california-field-research-release/\" target=\"_blank\">Public Health Institute poll\u003c/a> of rural California counties. In that survey, 94 percent of respondents said that obesity was a serious problem for the country, and 84 percent said it was a problem in their own communities.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The 5 Health Figures on the Guest List at Tonight's State of the Union",
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"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/12/the-5-health-figures-on-the-guest-list-at-tonights-state-of-the-union/screen-shot-2013-02-12-at-1-14-38-pm/\" rel=\"attachment wp-att-10531\">\u003cimg class=\"alignleft size-medium wp-image-10531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/Screen-Shot-2013-02-12-at-1.14.38-PM-300x212.png\" alt=\"The 2012 State of the Union address. (Photo: The White House)\" width=\"300\" height=\"212\">\u003c/a>Five of the 24 people invited to sit near First Lady Michelle Obama at tonight’s State of the Union have strong health care connections. They include a governor, a business owner and a beneficiary of the health law provision that prevents health plans from denying coverage because of pre-existing conditions.\u003c/p>\n\u003cp>Typically, the invited guests at the joint session of Congress help the president highlight a new initiative or show how administration policy is working.\u003c/p>\n\u003cp>Here are the biographies furnished by The White House:\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>Peter Hudson of Evergreen, CO: Co-Founder and CEO, iTriage \u003c/strong>Hudson is a physician and entrepreneur with more than 15 years of experience founding and growing healthcare-related businesses. Using open government data, he launched iTriage in 2009 to help consumers engage in their own healthcare. Through an app, smartphone users can locate nearby providers based on their symptoms, make appointments, store their personal health records, save medication refill reminders, and learn about thousands of medications, diseases and procedures.\u003c!--more-->\u003c/li>\n\u003cli>\u003cstrong>Gov. John Kitzhaber, D-Oregon: \u003c/strong>A former emergency room doctor, Kitzhaber has made major changes to Oregon’s Medicaid program. Now in his third term, he is working with the Obama administration to scale up innovative models that improve health outcomes and achieve greater efficiency.\u003c/li>\n\u003cli>\u003cstrong>Menchu Sanchez, Registered Nurse, NYU Langone Medical Center: \u003c/strong>When Hurricane Sandy cut the power at NYU Langone Medical Center in Manhattan, Sanchez devised a plan to transport 20 at-risk infants to intensive care units around the city. She organized the nurses and doctors to carry the babies down eight flights of stairs with only cell phones to light the way. Menchu was born, raised, and educated in the Philippines and she immigrated to the United States in the 1980s. She has worked as a nurse in New York for more than 25 years and has been at NYU since 2010.\u003c/li>\n\u003cli>\u003cstrong>Abby Schanfield of Minneapolis, MN: \u003c/strong>Prior to passage of the Affordable Care Act, Abby would have lost coverage upon turning 21 and would have been unable to obtain insurance due to several pre-existing conditions. She was born with toxoplasmosis, a parasitic infection that her mother unwittingly passed on during pregnancy and which set the stage for lifelong medical problems. Abby is a member of TakeAction Minnesota’s health care team, a grassroots organization that advocates for progressive policies ranging from health care to economic reform.\u003c/li>\n\u003cli>\u003cstrong>Haile Thomas of Tucson, AZ Youth Advocate: \u003c/strong>Haile Thomas is a 12 year-old co-founder/director of the \u003ca href=\"http://www.dosomething.org/project/happy-organization-inc\" target=\"_blank\">HAPPY Organization\u003c/a>, an Arizona nonprofit dedicated to improving the health and wellness of youth through education, outreach, and advocacy about proper nutrition and healthy lifestyle choices. She hosts an annual H.E.A.L. (healthy eating, active lifestyle) Festival on Global Youth Service Day in Tucson. She created the \u003ca href=\"http://www.hgaclub.com\" target=\"_blank\">Healthy Girl Adventures Club\u003c/a> to inspire girls to embrace healthy habits, and produces online cooking videos aimed at kids.\u003c/li>\n\u003c/ol>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/12/the-5-health-figures-on-the-guest-list-at-tonights-state-of-the-union/screen-shot-2013-02-12-at-1-14-38-pm/\" rel=\"attachment wp-att-10531\">\u003cimg class=\"alignleft size-medium wp-image-10531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/Screen-Shot-2013-02-12-at-1.14.38-PM-300x212.png\" alt=\"The 2012 State of the Union address. (Photo: The White House)\" width=\"300\" height=\"212\">\u003c/a>Five of the 24 people invited to sit near First Lady Michelle Obama at tonight’s State of the Union have strong health care connections. They include a governor, a business owner and a beneficiary of the health law provision that prevents health plans from denying coverage because of pre-existing conditions.\u003c/p>\n\u003cp>Typically, the invited guests at the joint session of Congress help the president highlight a new initiative or show how administration policy is working.\u003c/p>\n\u003cp>Here are the biographies furnished by The White House:\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>Peter Hudson of Evergreen, CO: Co-Founder and CEO, iTriage \u003c/strong>Hudson is a physician and entrepreneur with more than 15 years of experience founding and growing healthcare-related businesses. Using open government data, he launched iTriage in 2009 to help consumers engage in their own healthcare. Through an app, smartphone users can locate nearby providers based on their symptoms, make appointments, store their personal health records, save medication refill reminders, and learn about thousands of medications, diseases and procedures.\u003c!--more-->\u003c/li>\n\u003cli>\u003cstrong>Gov. John Kitzhaber, D-Oregon: \u003c/strong>A former emergency room doctor, Kitzhaber has made major changes to Oregon’s Medicaid program. Now in his third term, he is working with the Obama administration to scale up innovative models that improve health outcomes and achieve greater efficiency.\u003c/li>\n\u003cli>\u003cstrong>Menchu Sanchez, Registered Nurse, NYU Langone Medical Center: \u003c/strong>When Hurricane Sandy cut the power at NYU Langone Medical Center in Manhattan, Sanchez devised a plan to transport 20 at-risk infants to intensive care units around the city. She organized the nurses and doctors to carry the babies down eight flights of stairs with only cell phones to light the way. Menchu was born, raised, and educated in the Philippines and she immigrated to the United States in the 1980s. She has worked as a nurse in New York for more than 25 years and has been at NYU since 2010.\u003c/li>\n\u003cli>\u003cstrong>Abby Schanfield of Minneapolis, MN: \u003c/strong>Prior to passage of the Affordable Care Act, Abby would have lost coverage upon turning 21 and would have been unable to obtain insurance due to several pre-existing conditions. She was born with toxoplasmosis, a parasitic infection that her mother unwittingly passed on during pregnancy and which set the stage for lifelong medical problems. Abby is a member of TakeAction Minnesota’s health care team, a grassroots organization that advocates for progressive policies ranging from health care to economic reform.\u003c/li>\n\u003cli>\u003cstrong>Haile Thomas of Tucson, AZ Youth Advocate: \u003c/strong>Haile Thomas is a 12 year-old co-founder/director of the \u003ca href=\"http://www.dosomething.org/project/happy-organization-inc\" target=\"_blank\">HAPPY Organization\u003c/a>, an Arizona nonprofit dedicated to improving the health and wellness of youth through education, outreach, and advocacy about proper nutrition and healthy lifestyle choices. She hosts an annual H.E.A.L. (healthy eating, active lifestyle) Festival on Global Youth Service Day in Tucson. She created the \u003ca href=\"http://www.hgaclub.com\" target=\"_blank\">Healthy Girl Adventures Club\u003c/a> to inspire girls to embrace healthy habits, and produces online cooking videos aimed at kids.\u003c/li>\n\u003c/ol>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Just What Are 'Habilitative Services'? Hint: Think Health Insurance and Chronically Ill Kids",
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"content": "\u003cp>You're likely familiar with rehabilitation -- physical therapy after an injury would fall into this category. But parents with chronically ill children are all too familiar with a different type of service -- habilitation service -- as Elaine Korry detailed Monday morning for \u003cem>The California Report. \u003c/em> From her story:\u003c/p>\n\u003cblockquote>\u003cp>\"Habilitative services are really just making sure that a child can thrive in the world that they’re living in, so, for example, hearing aids are a habilitative service,\" says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. ...\u003c/p>\n\u003cp>Dr. Thomas Long, a health financing expert with the American Academy of Pediatrics, says it helps young patients, like deaf kids, attain health in the first place.\u003c/p>\n\u003cp>\"Habilitation implies skills that have not yet been developed,\" Long says. \"For example, speech therapy. It’s terribly important for children to learn to speak well.\u003c/p>\n\u003cp>Habilitation is also important for kids with a chronic disease, such as asthma or diabetes.\u003c/p>\u003c/blockquote>\n\u003cp>California's implementation of the Affordable Care Act is in full swing. It takes effect next Jan. 1. The federal health bill left it to states to determine their own benchmark health insurance plan that would be offered in the health benefit exchange -- as long as that plan offered benefits across the \u003ca href=\"http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html\" target=\"_blank\">10 categories\u003c/a> required by the ACA.\u003c/p>\n\u003cp>[\u003cstrong>Related:\u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/13/people-with-disabilities-who-need-habilitative-services-face-complex-choices-under-obamacare/\" target=\"_blank\"> People with Disabilities Who Need Habilitative Services Face Complex Choices Under Obamacare\u003c/a>]\u003c/p>\n\u003cp>One hitch is that the federal government did not define exactly what was meant by \"habilitative services,\" so California legislators stepped in when they passed \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/asm/ab_1451-1500/ab_1453_bill_20120930_chaptered.pdf\" target=\"_blank\">AB 1453\u003c/a> last fall. That bill defined the benchmark plan in California, and legislators defined 'habilitative services' this way:\u003c/p>\n\u003cblockquote>\u003cp>“Habilitative services” means medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills and functioning and that are necessary to address a health condition, to the maximum extent practical.\u003c/p>\n\u003cp>These services address the skills and abilities needed for functioning in interaction with an individual’s environment.\u003c/p>\n\u003cp>Examples of health care services that are not habilitative services include, but are not limited to, respite care, day care, recreational care, residential treatment, social services, custodial care, or education services of any kind, including, but not limited to, vocational training. Habilitative services shall be covered under the same terms and conditions applied to rehabilitative services under the plan contract.\u003c/p>\u003c/blockquote>\n\u003cp>Did you catch that? The passage lists not only what\u003cem> is\u003c/em> included and but also what's \u003cem>not\u003c/em> included. In Korry's piece, she interviewed the family of a teenage girl who has Type 1 diabetes. The entire family has learned a lot about managing the disease in a diabetes camp, a retreat sponsored by the Diabetic Youth Foundation. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>It’s a place where kids with a life-threatening disease, like 15-year-old Taylor Gaydon, can have fun while learning to manage their disease.\u003c/p>\n\u003cp>\"I usually check my sugar 8 to 10 times a day,\" Gaydon says, \"and I don’t think I’d be as good taking care of my diabetes without camp. It really helped. ...\u003c/p>\n\u003cp>Fun activities such as zipline plunges and scavenger hunts are just a small part of the weekend’s events. Program director Janet Kramchuster says most of the time is devoted to education.\u003c/p>\n\u003cp>\"We talk about carbohydrate counting, we talk about insulin adjustments,\" Kramchuster says. \"We talk about how the family is functioning as a unit. We really delve into intensive education that cannot be covered in a 15-minute doctor’s appointment.\"\u003c/p>\n\u003cp>The Diabetic Youth Foundation subsidizes most of the cost of running this camp. Families pay the remainder, usually out of pocket. Those with chronically ill children often face expenses for vital services their insurers don’t cover. But children’s advocates say that under the Affordable Care Act, support services must be covered by insurance, if they fall into habilitative services category.\u003c/p>\u003c/blockquote>\n\u003cp>So, is a diabetes camp a habilitative service? Maybe, maybe not. It depends how individual health plans are written. Charles Bacchi with the California Association of Health Plans says the challenge will be in finding a balance. The more generous a benefit package, the higher the premiums. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>\"We’ve got to look at things that are medical,\" Bacchi says, \"provided by licensed providers -- and not try and shift social and educational costs into the health care premium dollar, because that will inordinately increase premiums and make health care unaffordable for millions of Californians.\"\u003c/p>\n\u003cp>That’s one argument. On the other side, advocates for kids with chronic illnesses say a broad array of service, including social supports and education, arm patients with vital knowledge. Again, Diabetic Youth Foundation’s Janet Kramchuster.\u003c/p>\n\u003cp>\"That knowledge prevents the ER visits, and it helps reduce complications down the road,\" says the Diabetic Youth Foundation's Kramchuster. \"Talk about a savings for insurance companies.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cem>Support for Elaine Korry's reporting comes from \u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars/lucile-packard-foundation-childrens-health-journalism-fund\" target=\"_blank\">Lucile Packard Foundation for Children's Health Journalism Fund\u003c/a> at USC Annenberg School for Communication and Journalism.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "You're likely familiar with rehabilitation -- physical therapy after an injury would fall into this category. But parents with chronically ill children are all too familiar with 'habilitation' services, as Elaine Korry detailed Monday morning on The California Report. From her story:\r\n\r\n\"Habilitative services are really just making sure that a child can thrive in the world that they’re living in, so, for example, hearing aids are a habilitative service,\" says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You're likely familiar with rehabilitation -- physical therapy after an injury would fall into this category. But parents with chronically ill children are all too familiar with a different type of service -- habilitation service -- as Elaine Korry detailed Monday morning for \u003cem>The California Report. \u003c/em> From her story:\u003c/p>\n\u003cblockquote>\u003cp>\"Habilitative services are really just making sure that a child can thrive in the world that they’re living in, so, for example, hearing aids are a habilitative service,\" says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. ...\u003c/p>\n\u003cp>Dr. Thomas Long, a health financing expert with the American Academy of Pediatrics, says it helps young patients, like deaf kids, attain health in the first place.\u003c/p>\n\u003cp>\"Habilitation implies skills that have not yet been developed,\" Long says. \"For example, speech therapy. It’s terribly important for children to learn to speak well.\u003c/p>\n\u003cp>Habilitation is also important for kids with a chronic disease, such as asthma or diabetes.\u003c/p>\u003c/blockquote>\n\u003cp>California's implementation of the Affordable Care Act is in full swing. It takes effect next Jan. 1. The federal health bill left it to states to determine their own benchmark health insurance plan that would be offered in the health benefit exchange -- as long as that plan offered benefits across the \u003ca href=\"http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html\" target=\"_blank\">10 categories\u003c/a> required by the ACA.\u003c/p>\n\u003cp>[\u003cstrong>Related:\u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/13/people-with-disabilities-who-need-habilitative-services-face-complex-choices-under-obamacare/\" target=\"_blank\"> People with Disabilities Who Need Habilitative Services Face Complex Choices Under Obamacare\u003c/a>]\u003c/p>\n\u003cp>One hitch is that the federal government did not define exactly what was meant by \"habilitative services,\" so California legislators stepped in when they passed \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/asm/ab_1451-1500/ab_1453_bill_20120930_chaptered.pdf\" target=\"_blank\">AB 1453\u003c/a> last fall. That bill defined the benchmark plan in California, and legislators defined 'habilitative services' this way:\u003c/p>\n\u003cblockquote>\u003cp>“Habilitative services” means medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills and functioning and that are necessary to address a health condition, to the maximum extent practical.\u003c/p>\n\u003cp>These services address the skills and abilities needed for functioning in interaction with an individual’s environment.\u003c/p>\n\u003cp>Examples of health care services that are not habilitative services include, but are not limited to, respite care, day care, recreational care, residential treatment, social services, custodial care, or education services of any kind, including, but not limited to, vocational training. Habilitative services shall be covered under the same terms and conditions applied to rehabilitative services under the plan contract.\u003c/p>\u003c/blockquote>\n\u003cp>Did you catch that? The passage lists not only what\u003cem> is\u003c/em> included and but also what's \u003cem>not\u003c/em> included. In Korry's piece, she interviewed the family of a teenage girl who has Type 1 diabetes. The entire family has learned a lot about managing the disease in a diabetes camp, a retreat sponsored by the Diabetic Youth Foundation. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>It’s a place where kids with a life-threatening disease, like 15-year-old Taylor Gaydon, can have fun while learning to manage their disease.\u003c/p>\n\u003cp>\"I usually check my sugar 8 to 10 times a day,\" Gaydon says, \"and I don’t think I’d be as good taking care of my diabetes without camp. It really helped. ...\u003c/p>\n\u003cp>Fun activities such as zipline plunges and scavenger hunts are just a small part of the weekend’s events. Program director Janet Kramchuster says most of the time is devoted to education.\u003c/p>\n\u003cp>\"We talk about carbohydrate counting, we talk about insulin adjustments,\" Kramchuster says. \"We talk about how the family is functioning as a unit. We really delve into intensive education that cannot be covered in a 15-minute doctor’s appointment.\"\u003c/p>\n\u003cp>The Diabetic Youth Foundation subsidizes most of the cost of running this camp. Families pay the remainder, usually out of pocket. Those with chronically ill children often face expenses for vital services their insurers don’t cover. But children’s advocates say that under the Affordable Care Act, support services must be covered by insurance, if they fall into habilitative services category.\u003c/p>\u003c/blockquote>\n\u003cp>So, is a diabetes camp a habilitative service? Maybe, maybe not. It depends how individual health plans are written. Charles Bacchi with the California Association of Health Plans says the challenge will be in finding a balance. The more generous a benefit package, the higher the premiums. From Korry's report:\u003c/p>\n\u003cblockquote>\u003cp>\"We’ve got to look at things that are medical,\" Bacchi says, \"provided by licensed providers -- and not try and shift social and educational costs into the health care premium dollar, because that will inordinately increase premiums and make health care unaffordable for millions of Californians.\"\u003c/p>\n\u003cp>That’s one argument. On the other side, advocates for kids with chronic illnesses say a broad array of service, including social supports and education, arm patients with vital knowledge. Again, Diabetic Youth Foundation’s Janet Kramchuster.\u003c/p>\n\u003cp>\"That knowledge prevents the ER visits, and it helps reduce complications down the road,\" says the Diabetic Youth Foundation's Kramchuster. \"Talk about a savings for insurance companies.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cem>Support for Elaine Korry's reporting comes from \u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars/lucile-packard-foundation-childrens-health-journalism-fund\" target=\"_blank\">Lucile Packard Foundation for Children's Health Journalism Fund\u003c/a> at USC Annenberg School for Communication and Journalism.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "At Life's End, Aggressive Care Still the Norm",
"title": "At Life's End, Aggressive Care Still the Norm",
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"content": "\u003cp>By Alvin Tran, \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2013/02/aggressive-care-still-the-norm-for-dying-seniors/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10438\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/06/at-lifes-end-aggressive-care-still-the-norm/medical-monitors/\" rel=\"attachment wp-att-10438\">\u003cimg class=\"size-full wp-image-10438\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/ICU_machine_KaiserHealthNews.jpg\" alt=\"(Photo/Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo/Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>While fewer older Americans are dying in hospitals, \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1568250\">new research\u003c/a> suggests that doesn’t mean they’re getting less aggressive care in their final days.\u003c/p>\n\u003cp>Even as deaths in acute hospitals declined between 2000 and 2009, the use of intensive care units in the final 30 days of life increased, as did short-term hospice use, according to a study of Medicare beneficiaries published Tuesday in the Journal of the American Medical Association. The rate of changes to care for these patients, such as transitions within the last three days of life, also increased.\u003c/p>\n\u003cp>\u003ca href=\"http://research.brown.edu/research/profile.php?id=1100925316\" target=\"_blank\">Dr. Joan Teno\u003c/a> at Brown University's medical school led the study. She says the increased use of hospice is encouraging, but worries about when seniors are referred to hospice.\u003c/p>\n\u003cp>“While there is greater access to hospice services, there’s also more ICU, more repeat hospitalizations, and more late transitions in the last three days of life,” Teno said during an interview. “The good news is that we are referring to hospice. The bad news is we’re referring to hospice in the last hours of life.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Teno and her team analyzed findings of Medicare claims data from more than 800,000 seniors 66 years and older, who died in 2000, 2005, and 2009. While a 2010 report by the federal Centers for Disease Control and Prevention has looked at the patient’s location at death, researchers in this study examined beneficiaries’ medical claims for the last 180 days of life.\u003c/p>\n\u003cp>Hospice use at the time of death increased from nearly 22 percent in 2000 to 42 percent in 2009, the authors reported, but short stays of three days or less went from 22 to 28 percent. And 40 percent of those short stays came after time in a hospital ICU.\u003c/p>\n\u003cp>According to Teno, the study’s findings, particularly the increase in the number of short hospice stays following hospitalizations, suggest that aggressive care at the end of life is growing. “We really need to improve our referral patterns to make sure that people are receiving the appropriate and timely access to palliative care services at the end of the life,” she said.\u003c/p>\n\u003cp>Jon Radulovic, the vice president of communications of the nonprofit \u003ca href=\"http://www.nhpco.org/templates/1/homepage.cfm\">National Hospice and Palliative Care Organization,\u003c/a> says the study adds to concerns about end-of-life care. “With the number of patients (in hospice) who die under seven days or less, it’s questionable whether the patient and family caregivers are able to fully benefit from the unique services that hospice offers,” he said.\u003c/p>\n\u003cp>With some provisions of the federal health law set to take effect in 2014, Teno sees an opportunity to hold institutions more accountable.\u003c/p>\n\u003cp>“The opportunity under health care reform is to really pay for quality and not pay for another day in the ICU,” she said. “Our fee-for-service system has probably resulted in overutilization of care and really, what we want to do is get the right care at the right time, for the right person, at the right location. And we want to respect the patient’s right to choose.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "While fewer Medicare beneficiaries are dying in hospitals, new research suggests that doesn’t mean they’re getting less aggressive care in their final days.\r\n\r\nEven as deaths in acute hospitals declined between 2000 and 2009, the use of intensive care units in the final 30 days of life increased, as did short-term hospice use, according to a study published Tuesday in the Journal of the American Medical Association. The rate of changes to care for these patients, such as transitions within the last three days of life, also increased.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Alvin Tran, \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2013/02/aggressive-care-still-the-norm-for-dying-seniors/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_10438\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/06/at-lifes-end-aggressive-care-still-the-norm/medical-monitors/\" rel=\"attachment wp-att-10438\">\u003cimg class=\"size-full wp-image-10438\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/02/ICU_machine_KaiserHealthNews.jpg\" alt=\"(Photo/Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo/Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>While fewer older Americans are dying in hospitals, \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1568250\">new research\u003c/a> suggests that doesn’t mean they’re getting less aggressive care in their final days.\u003c/p>\n\u003cp>Even as deaths in acute hospitals declined between 2000 and 2009, the use of intensive care units in the final 30 days of life increased, as did short-term hospice use, according to a study of Medicare beneficiaries published Tuesday in the Journal of the American Medical Association. The rate of changes to care for these patients, such as transitions within the last three days of life, also increased.\u003c/p>\n\u003cp>\u003ca href=\"http://research.brown.edu/research/profile.php?id=1100925316\" target=\"_blank\">Dr. Joan Teno\u003c/a> at Brown University's medical school led the study. She says the increased use of hospice is encouraging, but worries about when seniors are referred to hospice.\u003c/p>\n\u003cp>“While there is greater access to hospice services, there’s also more ICU, more repeat hospitalizations, and more late transitions in the last three days of life,” Teno said during an interview. “The good news is that we are referring to hospice. The bad news is we’re referring to hospice in the last hours of life.”\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Teno and her team analyzed findings of Medicare claims data from more than 800,000 seniors 66 years and older, who died in 2000, 2005, and 2009. While a 2010 report by the federal Centers for Disease Control and Prevention has looked at the patient’s location at death, researchers in this study examined beneficiaries’ medical claims for the last 180 days of life.\u003c/p>\n\u003cp>Hospice use at the time of death increased from nearly 22 percent in 2000 to 42 percent in 2009, the authors reported, but short stays of three days or less went from 22 to 28 percent. And 40 percent of those short stays came after time in a hospital ICU.\u003c/p>\n\u003cp>According to Teno, the study’s findings, particularly the increase in the number of short hospice stays following hospitalizations, suggest that aggressive care at the end of life is growing. “We really need to improve our referral patterns to make sure that people are receiving the appropriate and timely access to palliative care services at the end of the life,” she said.\u003c/p>\n\u003cp>Jon Radulovic, the vice president of communications of the nonprofit \u003ca href=\"http://www.nhpco.org/templates/1/homepage.cfm\">National Hospice and Palliative Care Organization,\u003c/a> says the study adds to concerns about end-of-life care. “With the number of patients (in hospice) who die under seven days or less, it’s questionable whether the patient and family caregivers are able to fully benefit from the unique services that hospice offers,” he said.\u003c/p>\n\u003cp>With some provisions of the federal health law set to take effect in 2014, Teno sees an opportunity to hold institutions more accountable.\u003c/p>\n\u003cp>“The opportunity under health care reform is to really pay for quality and not pay for another day in the ICU,” she said. “Our fee-for-service system has probably resulted in overutilization of care and really, what we want to do is get the right care at the right time, for the right person, at the right location. And we want to respect the patient’s right to choose.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Are Medicare Advantage Plans Skimming Off Healthiest Patients?",
"title": "Are Medicare Advantage Plans Skimming Off Healthiest Patients?",
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"content": "\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/February/04/Medicare-Advantage-disenrollment.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9340\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/07/fiscal-cliffnotes-what-are-the-trade-offs-in-raising-medicares-eligibility-age/aging_healthy_patrick_flickr_02212012-2/\" rel=\"attachment wp-att-9340\">\u003cimg class=\"size-medium wp-image-9340\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Aging_Healthy_Patrick_Flickr_02212012-300x240.jpg\" alt=\"(Patrick/Flickr)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Patrick/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems, fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don’t provide the most attractive care for the very ill.\u003c/p>\n\u003cp>More than \u003ca href=\"http://www.kff.org/medicare/8323.cfm\" target=\"_blank\">13 million people\u003c/a>, a quarter of all Medicare beneficiaries, are enrolled in these private plans. Enrollment has been growing, in part because the plans often offer lower premiums than does traditional Medicare, as well as special perks such as \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2012/01/gym-memberships-in-medicare-advantage-plans-cater-to-healthy-seniors/\" target=\"_blank\">free gym memberships\u003c/a>. Many Republicans want to build on them while capping the amount of money each Medicare beneficiary gets toward insurance. Democrats are disturbed the plans are more expensive than traditional Medicare and cut payments in the 2010 health law.\u003c/p>\n\u003cp>The federal government pays the plans a set fee for each enrollee. That has drawn concerns from some senior advocates that the plans have incentives to skim off the lowest-maintenance customers and leave the expensive patients to traditional Medicare.\u003c!--more-->\u003c/p>\n\u003cp>A \u003ca href=\"http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MMRR/Downloads/MMRR2012_002_04_A08.pdf\" target=\"_blank\">study\u003c/a> released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Another \u003ca href=\"http://content.healthaffairs.org/content/31/12/2630.abstract\" target=\"_blank\">study\u003c/a> in the December issue of the journal Health Affairs found that people \"disenrolling were much more likely than other beneficiaries to report health declines.\" Those researchers, led by J. Michael McWilliams, a Harvard Medical School professor, surmised that beneficiaries who developed serious ailments might leave the plans to get unfettered access to physicians and treatments through traditional Medicare, but neither that study nor Riley’s determined what motivated the changes.\u003c/p>\n\u003cp>\"It may just be a benign motivation, that patients, when they're sick, want the freedom to go where they want,\" said Robert Berenson, a senior fellow at the Urban Institute.\u003c/p>\n\u003cp>McWilliams' study, along with other analyses in the same issue of Health Affairs, found that generally, Medicare has succeeded in reducing cherry-picking by Medicare Advantage plans by changes in how the program worked, including restrictions in the time periods that people could switch from a private plan back to traditional Medicare. In 2006, Medicare tried to crack down on switches by limiting them to once a year rather than monthly.\u003c/p>\n\u003cp>Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group, said the government has protections in place to ensure these plans provide satisfactory care for the sick. \"CMS reviews these plans every single year specifically to make sure they are not discriminating against any kind of beneficiaries,\" he said.\u003c/p>\n\u003cp>He also noted that other independent studies have found Medicare Advantage plans do a superior job in caring for enrollees. For instance, another \u003ca href=\"http://content.healthaffairs.org/content/31/12/2609.abstract\" target=\"_blank\">study\u003c/a> in the December Health Affairs found that people in the private plans were less likely to end up in the emergency room and get elective surgeries, and more likely to get certain recommended types of care.\u003c/p>\n\u003cp>Also, \u003ca href=\"https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MMRR/Downloads/MMRR2012_002_01_A02.pdf\" target=\"_blank\">an analysis \u003c/a>of patients in three big states—California, New York and Florida — by researchers at the federal Agency for Healthcare Research and Quality determined people in private managed care plans were less likely to end up in the hospital.\u003c/p>\n\u003cp>Riley's study noted the health law’s reduction in payments to Medicare Advantage plans. \"This may intensify pressure on plans to encourage selective disenrollment,\" he wrote. \"Chronically ill enrollees may be more inclined to disenroll if access to care deteriorates or if plans cover a smaller portion of the costs of their care.\"\u003c/p>\n\u003cp>Judith Stein, executive director of the Center for Medicare Advocacy, a watchdog group based in Connecticut, said the conclusions echo anecdotal experiences her group has seen as it assists the elderly trying to obtain services.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Private Medicare Advantage plans work for people when they are relatively well, but fall short of traditional Medicare when they are sick or disabled,\" she said. \"This is particularly true for our clients with long-term and chronic conditions, many of whom also have low incomes. They are often denied coverage for necessary skilled care, or it is terminated before it should be, while the same coverage would be available in traditional Medicare.\"\u003c/p>\n\n",
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"excerpt": "New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems, fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don’t provide the most attractive care for the very ill.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/February/04/Medicare-Advantage-disenrollment.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9340\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/07/fiscal-cliffnotes-what-are-the-trade-offs-in-raising-medicares-eligibility-age/aging_healthy_patrick_flickr_02212012-2/\" rel=\"attachment wp-att-9340\">\u003cimg class=\"size-medium wp-image-9340\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Aging_Healthy_Patrick_Flickr_02212012-300x240.jpg\" alt=\"(Patrick/Flickr)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Patrick/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems, fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don’t provide the most attractive care for the very ill.\u003c/p>\n\u003cp>More than \u003ca href=\"http://www.kff.org/medicare/8323.cfm\" target=\"_blank\">13 million people\u003c/a>, a quarter of all Medicare beneficiaries, are enrolled in these private plans. Enrollment has been growing, in part because the plans often offer lower premiums than does traditional Medicare, as well as special perks such as \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2012/01/gym-memberships-in-medicare-advantage-plans-cater-to-healthy-seniors/\" target=\"_blank\">free gym memberships\u003c/a>. Many Republicans want to build on them while capping the amount of money each Medicare beneficiary gets toward insurance. Democrats are disturbed the plans are more expensive than traditional Medicare and cut payments in the 2010 health law.\u003c/p>\n\u003cp>The federal government pays the plans a set fee for each enrollee. That has drawn concerns from some senior advocates that the plans have incentives to skim off the lowest-maintenance customers and leave the expensive patients to traditional Medicare.\u003c!--more-->\u003c/p>\n\u003cp>A \u003ca href=\"http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MMRR/Downloads/MMRR2012_002_04_A08.pdf\" target=\"_blank\">study\u003c/a> released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Another \u003ca href=\"http://content.healthaffairs.org/content/31/12/2630.abstract\" target=\"_blank\">study\u003c/a> in the December issue of the journal Health Affairs found that people \"disenrolling were much more likely than other beneficiaries to report health declines.\" Those researchers, led by J. Michael McWilliams, a Harvard Medical School professor, surmised that beneficiaries who developed serious ailments might leave the plans to get unfettered access to physicians and treatments through traditional Medicare, but neither that study nor Riley’s determined what motivated the changes.\u003c/p>\n\u003cp>\"It may just be a benign motivation, that patients, when they're sick, want the freedom to go where they want,\" said Robert Berenson, a senior fellow at the Urban Institute.\u003c/p>\n\u003cp>McWilliams' study, along with other analyses in the same issue of Health Affairs, found that generally, Medicare has succeeded in reducing cherry-picking by Medicare Advantage plans by changes in how the program worked, including restrictions in the time periods that people could switch from a private plan back to traditional Medicare. In 2006, Medicare tried to crack down on switches by limiting them to once a year rather than monthly.\u003c/p>\n\u003cp>Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group, said the government has protections in place to ensure these plans provide satisfactory care for the sick. \"CMS reviews these plans every single year specifically to make sure they are not discriminating against any kind of beneficiaries,\" he said.\u003c/p>\n\u003cp>He also noted that other independent studies have found Medicare Advantage plans do a superior job in caring for enrollees. For instance, another \u003ca href=\"http://content.healthaffairs.org/content/31/12/2609.abstract\" target=\"_blank\">study\u003c/a> in the December Health Affairs found that people in the private plans were less likely to end up in the emergency room and get elective surgeries, and more likely to get certain recommended types of care.\u003c/p>\n\u003cp>Also, \u003ca href=\"https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MMRR/Downloads/MMRR2012_002_01_A02.pdf\" target=\"_blank\">an analysis \u003c/a>of patients in three big states—California, New York and Florida — by researchers at the federal Agency for Healthcare Research and Quality determined people in private managed care plans were less likely to end up in the hospital.\u003c/p>\n\u003cp>Riley's study noted the health law’s reduction in payments to Medicare Advantage plans. \"This may intensify pressure on plans to encourage selective disenrollment,\" he wrote. \"Chronically ill enrollees may be more inclined to disenroll if access to care deteriorates or if plans cover a smaller portion of the costs of their care.\"\u003c/p>\n\u003cp>Judith Stein, executive director of the Center for Medicare Advocacy, a watchdog group based in Connecticut, said the conclusions echo anecdotal experiences her group has seen as it assists the elderly trying to obtain services.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Private Medicare Advantage plans work for people when they are relatively well, but fall short of traditional Medicare when they are sick or disabled,\" she said. \"This is particularly true for our clients with long-term and chronic conditions, many of whom also have low incomes. They are often denied coverage for necessary skilled care, or it is terminated before it should be, while the same coverage would be available in traditional Medicare.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Economist Rekindles Debate over Geographic Differences in Health Spending ",
"title": "Economist Rekindles Debate over Geographic Differences in Health Spending ",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/January/31/disputing-dartmouth-medicare-federal-reserve.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health overhaul.\u003c/p>\n\u003cp>The Obama administration and many prominent economists believe that as much as a third of the $2.7 trillion spent on health care may be due to wasteful practices of physicians and hospitals that could be eliminated without hurting patients. This is based on decades of research, principally by the \u003ca href=\"http://www.tdi.dartmouth.edu/\">Dartmouth Institute for Health Policy & Clinical Practice\u003c/a> in New Hampshire, showing that Medicare spending in some regions of the country is significantly higher than others.\u003c/p>\n\u003cp>This geographic variation in spending, which the government has also \u003ca href=\"http://www.medpac.gov/documents/Dec09_RegionalVariation_report.pdf\">examined\u003c/a>, was a motivating force behind a number of government initiatives including changes in Medicare payment to \u003ca href=\"http://www.kaiserhealthnews.org/stories/2012/december/21/medicare-hospitals-value-based-purchasing.aspx\">reward hospitals\u003c/a> and \u003ca href=\"http://www.kaiserhealthnews.org/stories/2012/april/15/medicare-doctor-pay.aspx\">doctors\u003c/a> who provide good care efficiently.\u003c!--more-->\u003c/p>\n\u003cp>The Institute of Medicine has been \u003ca href=\"http://www8.nationalacademies.org/cp/projectview.aspx?key=IOM-HCS-09-08\">studying\u003c/a> the causes of regional variation, and its conclusions could influence more policies as the government seeks to clamp down on health spending. The policy implications are significant, because if these variations do help identify ways to economize, the government and private insurers might be able to cut large amounts from Medicare in some areas of the country without harming patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the thesis has sparked passionate opposition by medical professionals and facilities and their lobbies in Washington.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.federalreserve.gov/pubs/feds/2013/201304/201304pap.pdf\">new paper\u003c/a> by \u003ca href=\"http://www.federalreserve.gov/econresdata/louise-m-sheiner.htm\">Louise Sheiner\u003c/a>, an economist at the Federal Reserve, provides them with additional fodder. Sheiner examines health spending differences among states and the health of people in those states. She concludes health and socioeconomic factors — things like the prevalence of smoking, obesity and diabetes — best explain why health spending in some regions of the country is higher. That view has been argued for years by researchers such as Dr. \u003ca href=\"http://www.kaiserhealthnews.org/stories/2009/november/16/cooper-debate.aspx\">Richard “Buz” Cooper\u003c/a> of the University of Pennsylvania.\u003c/p>\n\u003cp>Sheiner writes:\u003c/p>\n\u003cblockquote>\u003cp>[T]he variation in Medicare spending across states is attributable to factors that affect health and health behaviors, rather than practice styles. … It is not surprising that states in the South spend more on Medicare and have worse outcomes. These states perform significantly worse in numerous areas, including high school graduation rates, test scores, insurance, unemployment, violent crime, and teenage pregnancy. There are many ways that such differences can affect health utilization and outcomes, including differences in underlying health, social supports and social stressors, patient self-care and advocacy, ease of access to services, capabilities and quality of hospital and physician nurses and technicians, and cultural differences in attitudes toward care. A comparison of health spending in Mississippi with health spending in Minnesota is not likely to provide a usual metric of the ‘inefficiencies’ of the health system, nor is likely to provide a useful guide to improve the quality of care in places where it is lacking.\u003c/p>\u003c/blockquote>\n\u003cp>Sheiner’s analysis was issued as a working paper, which the Fed calls “preliminary materials circulated to stimulate discussion and critical comment,” not representations of the views of the central bank.\u003c/p>\n\u003cp>Nonetheless, the paper has circulated widely enough in health policy circles that the Dartmouth Institute this week rebutted it in a statement from \u003ca href=\"http://www.dartmouth.edu/~jskinner/\">Jonathan Skinner\u003c/a> and Dr.\u003ca href=\"http://geiselmed.dartmouth.edu/faculty/facultydb/view.php?uid=61\">Elliott Fisher\u003c/a>, two senior Dartmouth researchers. \u003ca href=\"http://tdi.dartmouth.edu/press/press-releases/response-of-the-dartmouth-institute-for-health-policy--clinical-practice-to-sheiner-on-variation\" target=\"_blank\">They wrote\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The focus on states … ignores much of the variation within states, or … the greater than 1.5 fold differences in overall utilization rates across providers in the care of patients with health conditions (such as hip fracture or heart attack) that could not be accounted for by individual patient characteristics, nor, of course, by state level differences in population health. Most of the variations in spending are due to greater use of discretionary services, such as avoidable hospital readmissions or differences in the use of post-acute care, largely ignored in Sheiner’s analysis. … To argue that the geographic variations found in hundreds of studies are pure statistical artifacts seems farfetched.\u003c/p>\u003c/blockquote>\n\u003cp>The dustup is quickly spreading around health policy circles. On the \u003ca href=\"http://blog.academyhealth.org/geographic-variation-in-health-care-spending-and-the-ecological-fallacy/\" target=\"_blank\">Academy Health blog\u003c/a> Thursday, economist \u003ca href=\"http://theincidentaleconomist.com/wordpress/about/about-austin/\" target=\"_blank\">Austin Frakt \u003c/a>of the Incidental Economist rebutted Sheiner. He agrees with Dartmouth that Sheiner erred in focusing on differences between states rather than the individual level as Dartmouth does. Frakt writes:\u003c/p>\n\u003cblockquote>\u003cp>I wish Sheiner's conclusions could be believed. It would really simplify things if the vast majority of health spending variation was due to obesity, sedentary lifestyles, lack of insurance, and a few other things. Were that true, we'd know better how to shape policy. However, based on the body of evidence, it's far more likely the story is more complex and also includes the efficiency with which care is delivered.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's note: The 1973 paper \u003ca href=\"http://www.dartmouthatlas.org/downloads/papers/Science_1973.pdf\" target=\"_blank\">Small Area Variations in Health Care Delivery\u003c/a> essentially launched the field of study of geographic variation in health care. That study looked at regional variation within the state of Vermont. In the study, researchers found the rate of tonsillectomy, to take one example, ranged from 13 percent in one area of Vermont to 66 percent in another.\u003c/em>\u003c/p>\n\n",
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"excerpt": "An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health law.\r\n\r\nThe Obama administration and many prominent economists believe that as much as a third of the $2.7 trillion spent on health care may be due to wasteful practices of physicians and hospitals that could be eliminated without hurting patients. This is based on decades of research, principally by the Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, showing that Medicare spending in some regions of the country is significantly higher than others.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/January/31/disputing-dartmouth-medicare-federal-reserve.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health overhaul.\u003c/p>\n\u003cp>The Obama administration and many prominent economists believe that as much as a third of the $2.7 trillion spent on health care may be due to wasteful practices of physicians and hospitals that could be eliminated without hurting patients. This is based on decades of research, principally by the \u003ca href=\"http://www.tdi.dartmouth.edu/\">Dartmouth Institute for Health Policy & Clinical Practice\u003c/a> in New Hampshire, showing that Medicare spending in some regions of the country is significantly higher than others.\u003c/p>\n\u003cp>This geographic variation in spending, which the government has also \u003ca href=\"http://www.medpac.gov/documents/Dec09_RegionalVariation_report.pdf\">examined\u003c/a>, was a motivating force behind a number of government initiatives including changes in Medicare payment to \u003ca href=\"http://www.kaiserhealthnews.org/stories/2012/december/21/medicare-hospitals-value-based-purchasing.aspx\">reward hospitals\u003c/a> and \u003ca href=\"http://www.kaiserhealthnews.org/stories/2012/april/15/medicare-doctor-pay.aspx\">doctors\u003c/a> who provide good care efficiently.\u003c!--more-->\u003c/p>\n\u003cp>The Institute of Medicine has been \u003ca href=\"http://www8.nationalacademies.org/cp/projectview.aspx?key=IOM-HCS-09-08\">studying\u003c/a> the causes of regional variation, and its conclusions could influence more policies as the government seeks to clamp down on health spending. The policy implications are significant, because if these variations do help identify ways to economize, the government and private insurers might be able to cut large amounts from Medicare in some areas of the country without harming patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the thesis has sparked passionate opposition by medical professionals and facilities and their lobbies in Washington.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.federalreserve.gov/pubs/feds/2013/201304/201304pap.pdf\">new paper\u003c/a> by \u003ca href=\"http://www.federalreserve.gov/econresdata/louise-m-sheiner.htm\">Louise Sheiner\u003c/a>, an economist at the Federal Reserve, provides them with additional fodder. Sheiner examines health spending differences among states and the health of people in those states. She concludes health and socioeconomic factors — things like the prevalence of smoking, obesity and diabetes — best explain why health spending in some regions of the country is higher. That view has been argued for years by researchers such as Dr. \u003ca href=\"http://www.kaiserhealthnews.org/stories/2009/november/16/cooper-debate.aspx\">Richard “Buz” Cooper\u003c/a> of the University of Pennsylvania.\u003c/p>\n\u003cp>Sheiner writes:\u003c/p>\n\u003cblockquote>\u003cp>[T]he variation in Medicare spending across states is attributable to factors that affect health and health behaviors, rather than practice styles. … It is not surprising that states in the South spend more on Medicare and have worse outcomes. These states perform significantly worse in numerous areas, including high school graduation rates, test scores, insurance, unemployment, violent crime, and teenage pregnancy. There are many ways that such differences can affect health utilization and outcomes, including differences in underlying health, social supports and social stressors, patient self-care and advocacy, ease of access to services, capabilities and quality of hospital and physician nurses and technicians, and cultural differences in attitudes toward care. A comparison of health spending in Mississippi with health spending in Minnesota is not likely to provide a usual metric of the ‘inefficiencies’ of the health system, nor is likely to provide a useful guide to improve the quality of care in places where it is lacking.\u003c/p>\u003c/blockquote>\n\u003cp>Sheiner’s analysis was issued as a working paper, which the Fed calls “preliminary materials circulated to stimulate discussion and critical comment,” not representations of the views of the central bank.\u003c/p>\n\u003cp>Nonetheless, the paper has circulated widely enough in health policy circles that the Dartmouth Institute this week rebutted it in a statement from \u003ca href=\"http://www.dartmouth.edu/~jskinner/\">Jonathan Skinner\u003c/a> and Dr.\u003ca href=\"http://geiselmed.dartmouth.edu/faculty/facultydb/view.php?uid=61\">Elliott Fisher\u003c/a>, two senior Dartmouth researchers. \u003ca href=\"http://tdi.dartmouth.edu/press/press-releases/response-of-the-dartmouth-institute-for-health-policy--clinical-practice-to-sheiner-on-variation\" target=\"_blank\">They wrote\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The focus on states … ignores much of the variation within states, or … the greater than 1.5 fold differences in overall utilization rates across providers in the care of patients with health conditions (such as hip fracture or heart attack) that could not be accounted for by individual patient characteristics, nor, of course, by state level differences in population health. Most of the variations in spending are due to greater use of discretionary services, such as avoidable hospital readmissions or differences in the use of post-acute care, largely ignored in Sheiner’s analysis. … To argue that the geographic variations found in hundreds of studies are pure statistical artifacts seems farfetched.\u003c/p>\u003c/blockquote>\n\u003cp>The dustup is quickly spreading around health policy circles. On the \u003ca href=\"http://blog.academyhealth.org/geographic-variation-in-health-care-spending-and-the-ecological-fallacy/\" target=\"_blank\">Academy Health blog\u003c/a> Thursday, economist \u003ca href=\"http://theincidentaleconomist.com/wordpress/about/about-austin/\" target=\"_blank\">Austin Frakt \u003c/a>of the Incidental Economist rebutted Sheiner. He agrees with Dartmouth that Sheiner erred in focusing on differences between states rather than the individual level as Dartmouth does. Frakt writes:\u003c/p>\n\u003cblockquote>\u003cp>I wish Sheiner's conclusions could be believed. It would really simplify things if the vast majority of health spending variation was due to obesity, sedentary lifestyles, lack of insurance, and a few other things. Were that true, we'd know better how to shape policy. However, based on the body of evidence, it's far more likely the story is more complex and also includes the efficiency with which care is delivered.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's note: The 1973 paper \u003ca href=\"http://www.dartmouthatlas.org/downloads/papers/Science_1973.pdf\" target=\"_blank\">Small Area Variations in Health Care Delivery\u003c/a> essentially launched the field of study of geographic variation in health care. That study looked at regional variation within the state of Vermont. In the study, researchers found the rate of tonsillectomy, to take one example, ranged from 13 percent in one area of Vermont to 66 percent in another.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Young Mother, Immigration Program Puts American Dream Within Reach",
"title": "For Young Mother, Immigration Program Puts American Dream Within Reach",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_10279\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/30/for-young-mother-immigration-program-puts-american-dream-within-reach/img_1101/\" rel=\"attachment wp-att-10279\">\u003cimg class=\"size-medium wp-image-10279\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/IMG_1101-300x225.jpg\" alt=\"Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Jose resident Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Last year the Obama administration passed a law allowing some undocumented immigrants to apply for work permits. As part of our occasional series called \"\u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">What's Your Story?\u003c/a>\" San Jose resident Ayary Diaz talks about how \u003ca href=\"http://www.dhs.gov/deferred-action-childhood-arrivals\" target=\"_blank\">Deferred Action for Childhood Arrivals\u003c/a> is opening doors to opportunities she says she never thought she'd have. We post it here, since there is an intersection between Diaz' immigration status and her health. The following is a transcript of her first-person radio story.\u003c/em>\u003c/p>\n\u003cp>For 24 years I've been forced to live in the shadows because of a choice that was never mine.\u003c/p>\n\u003cp>I’m an ‘illegal.’ My parents brought me here from Mexico when I was five, and I have been living -- undocumented -- in the United States ever since. I have two amazing children and a loving fiance but my road has been hard.\u003c/p>\n\u003caside class=\"pullquote alignleft\">I can finally come out of the shadows, stop hiding who I am, and shine in a country that I've always considered my home.\u003c/aside>\n\u003cp>When I graduated from high school, I hoped to go to college like my peers. But I needed a Social Security number to apply and, most importantly, to get financial aid. I didn't have one and began to think that I would have the same poor and unproductive life I’d seen my parents live.\u003c/p>\n\u003cp>But in 2001, a new California law changed things. Undocumented students could apply to college as California residents if they had graduated high school and had been continuously living in the States for several years. So I went to Foothill Community College and then San Francisco State. It took me eight years, working countless hours as a minimum wage server while going to school fulltime to pay for my tuition in cash. But I had my degree, in international business, the first in my family.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>It gave me the greatest sense of accomplishment. Education was the way out of poverty. But I couldn't have been further from the truth because now I had a new problem. I’m still undocumented, so most people don’t want to hire me.\u003c/p>\n\u003cp>\u003cstrong>After college, dreams deferred indefinitely\u003c/strong>\u003c/p>\n\u003cp>Graduating from college was my greatest achievement educationally. But it also has been a source of distress and sorrow. It has been extremely difficult to see my former classmates succeed professionally, while I can’t. Being unable to reach my full potential professionally has driven me to depression. Discontent and failure dominate my thoughts. I often fantasize about what I could have accomplished if I had the same opportunities as my successful classmates.\u003c/p>\n\u003cp>Almost four years after graduation, my diploma continues to sadly hang and accumulate dust in my room, a constant reminder of how far my determination, perseverance and hard work have come -- but also a bigger reminder of how much further I still need to go.\u003c/p>\n\u003cp>\u003cstrong>\"Deferred Action\" brings opportunity to shine\u003c/strong>\u003c/p>\n\u003cp>But now another law has changed my life, known as Deferred Action. It means I can get a Social Security number and a work permit for two years that will allow me to work legally. This is a vindication of everything I've worked hard for. I can finally come out of the shadows, stop hiding who I am, and shine in a country that I've always considered my home. I will no longer be punished for a decision I did not make.\u003c/p>\n\u003cp>I now have this huge sense of relief and hope. The stress I've been living with for 24 years has lifted because I will now be able to drive without the fear of being stopped and having my vehicle confiscated. My fiance won’t have to be the sole provider for our family. I will be able to live my life to the fullest. I can now proudly display who I am: A qualified professional.\u003c/p>\n\u003cp>But most importantly I can proudly say, \"My name is Ayary Diaz, and it's now my turn to live the American Dream.\"\u003c/p>\n\u003cp>\u003cstrong>Listen to Ayary Diaz' story:\u003c/strong>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201301300850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201301300850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Do you have a health-related story to share? Visit KQED's \"\u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">What's Your Story?\u003c/a>\" to learn more\u003c/em>.\u003c/p>\n\n",
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"excerpt": "For 24 years I've been forced to live in the shadows because of a choice that was never mine.\r\n\r\nI’m an ‘illegal.’ My parents brought me here from Mexico when I was five, and I have been living -- undocumented -- in the United States ever since. I have two amazing children and a loving fiance but my road has been hard.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10279\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/30/for-young-mother-immigration-program-puts-american-dream-within-reach/img_1101/\" rel=\"attachment wp-att-10279\">\u003cimg class=\"size-medium wp-image-10279\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/IMG_1101-300x225.jpg\" alt=\"Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Jose resident Ayary Diaz (L) says she can finally work to help support her family because of the Deferred Action for Childhood Arrivals program.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Last year the Obama administration passed a law allowing some undocumented immigrants to apply for work permits. As part of our occasional series called \"\u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">What's Your Story?\u003c/a>\" San Jose resident Ayary Diaz talks about how \u003ca href=\"http://www.dhs.gov/deferred-action-childhood-arrivals\" target=\"_blank\">Deferred Action for Childhood Arrivals\u003c/a> is opening doors to opportunities she says she never thought she'd have. We post it here, since there is an intersection between Diaz' immigration status and her health. The following is a transcript of her first-person radio story.\u003c/em>\u003c/p>\n\u003cp>For 24 years I've been forced to live in the shadows because of a choice that was never mine.\u003c/p>\n\u003cp>I’m an ‘illegal.’ My parents brought me here from Mexico when I was five, and I have been living -- undocumented -- in the United States ever since. I have two amazing children and a loving fiance but my road has been hard.\u003c/p>\n\u003caside class=\"pullquote alignleft\">I can finally come out of the shadows, stop hiding who I am, and shine in a country that I've always considered my home.\u003c/aside>\n\u003cp>When I graduated from high school, I hoped to go to college like my peers. But I needed a Social Security number to apply and, most importantly, to get financial aid. I didn't have one and began to think that I would have the same poor and unproductive life I’d seen my parents live.\u003c/p>\n\u003cp>But in 2001, a new California law changed things. Undocumented students could apply to college as California residents if they had graduated high school and had been continuously living in the States for several years. So I went to Foothill Community College and then San Francisco State. It took me eight years, working countless hours as a minimum wage server while going to school fulltime to pay for my tuition in cash. But I had my degree, in international business, the first in my family.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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