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"content": "\u003cfigure id=\"attachment_19501\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Picture-iHealth-Align-Device-with-iPhone.jpg\">\u003cimg class=\"size-large wp-image-19501\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Picture-iHealth-Align-Device-with-iPhone-640x719.jpg\" alt=\"The iHealth mobile blood glucose monitor. (Courtesy: iHealth Lab)\" width=\"640\" height=\"719\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The iHealth mobile blood glucose monitor. (Courtesy: iHealth Lab)\u003c/figcaption>\u003c/figure>\n\u003cp>iHealth Labs, a Mountain View company focused on mobile, personal, health technology has received FDA approval for what the company says is the world's smallest mobile blood glucose monitor, called iHealth Align.\u003c/p>\n\u003cp>But for people with diabetes, the bigger news is likely to be the cost of the test strips that the device will use. People with diabetes often check their blood sugar one or more times a day. The test strips that users fit into a monitor list at a dollar each, for some of the larger brands. The strips for the new device will run 25 cents each. The device itself is $16.95.\u003c/p>\n\u003cp>\u003cspan style=\"color: #1a1a1a\">“It’s probably more of a known secret in the marketplace that the real margins is within the strips,” Adam Lin, president of iHealth Labs told \u003ca href=\"http://mobihealthnews.com/34056/ihealth-to-launch-smaller-glucometer-drop-test-strip-price/\" target=\"_blank\">MobiHealthNews\u003c/a>. “We (wanted) to pass on all that savings to the end users. It’s got to be simple to understand. You don’t have to go through all these issues for reimbursement. We brought it down to pretty much co-pay.”\u003c/span>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The new glucose monitor is just bigger than a quarter, and it plugs into a phone's headphone jack. It can be used with either Apple or Android phones. It displays and stores readings using iHealth's app.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More from \u003ca href=\"http://mobihealthnews.com/34056/ihealth-to-launch-smaller-glucometer-drop-test-strip-price/\" target=\"_blank\">mobihealthnews\u003c/a>:\u003c/p>\n\u003cblockquote>\n\u003cp style=\"color: #1a1a1a\">Lin thinks the lower cost will bring iHealth more market share, and it will be hard for the bigger players with larger overheads to follow suit. When users take their blood glucose with either of iHealth’s devices, they first scan the QR code on the box of test strips, which allows the app to track how many strips are left. iHealth is developing a feature by which users will be able to auto-reorder their strips based on that data, but right now the app simply reminds the user if strips are running low or about to expire.\u003c/p>\n\u003cp style=\"color: #1a1a1a\">iHealth’s Wireless Smart Gluco-Monitoring System was featured briefly at Apple’s WWDC event as an example of a smartphone-connected glucometer. Lin said that iHealth has plans to integrate all of its devices with HealthKit.\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The product will be available next month, first from \u003ca href=\"http://www.ihealthlabs.com\" target=\"_blank\">iHealth's website \u003c/a>and later from Walgreens.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19501\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Picture-iHealth-Align-Device-with-iPhone.jpg\">\u003cimg class=\"size-large wp-image-19501\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Picture-iHealth-Align-Device-with-iPhone-640x719.jpg\" alt=\"The iHealth mobile blood glucose monitor. (Courtesy: iHealth Lab)\" width=\"640\" height=\"719\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The iHealth mobile blood glucose monitor. (Courtesy: iHealth Lab)\u003c/figcaption>\u003c/figure>\n\u003cp>iHealth Labs, a Mountain View company focused on mobile, personal, health technology has received FDA approval for what the company says is the world's smallest mobile blood glucose monitor, called iHealth Align.\u003c/p>\n\u003cp>But for people with diabetes, the bigger news is likely to be the cost of the test strips that the device will use. People with diabetes often check their blood sugar one or more times a day. The test strips that users fit into a monitor list at a dollar each, for some of the larger brands. The strips for the new device will run 25 cents each. The device itself is $16.95.\u003c/p>\n\u003cp>\u003cspan style=\"color: #1a1a1a\">“It’s probably more of a known secret in the marketplace that the real margins is within the strips,” Adam Lin, president of iHealth Labs told \u003ca href=\"http://mobihealthnews.com/34056/ihealth-to-launch-smaller-glucometer-drop-test-strip-price/\" target=\"_blank\">MobiHealthNews\u003c/a>. “We (wanted) to pass on all that savings to the end users. It’s got to be simple to understand. You don’t have to go through all these issues for reimbursement. We brought it down to pretty much co-pay.”\u003c/span>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The new glucose monitor is just bigger than a quarter, and it plugs into a phone's headphone jack. It can be used with either Apple or Android phones. It displays and stores readings using iHealth's app.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More from \u003ca href=\"http://mobihealthnews.com/34056/ihealth-to-launch-smaller-glucometer-drop-test-strip-price/\" target=\"_blank\">mobihealthnews\u003c/a>:\u003c/p>\n\u003cblockquote>\n\u003cp style=\"color: #1a1a1a\">Lin thinks the lower cost will bring iHealth more market share, and it will be hard for the bigger players with larger overheads to follow suit. When users take their blood glucose with either of iHealth’s devices, they first scan the QR code on the box of test strips, which allows the app to track how many strips are left. iHealth is developing a feature by which users will be able to auto-reorder their strips based on that data, but right now the app simply reminds the user if strips are running low or about to expire.\u003c/p>\n\u003cp style=\"color: #1a1a1a\">iHealth’s Wireless Smart Gluco-Monitoring System was featured briefly at Apple’s WWDC event as an example of a smartphone-connected glucometer. Lin said that iHealth has plans to integrate all of its devices with HealthKit.\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The product will be available next month, first from \u003ca href=\"http://www.ihealthlabs.com\" target=\"_blank\">iHealth's website \u003c/a>and later from Walgreens.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors Say They Would Forego Aggressive Treatment When Near Death",
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"content": "\u003cfigure id=\"attachment_19303\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/468418291.jpg\">\u003cimg class=\"size-large wp-image-19303\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/468418291-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Katherine Hobson\u003c/strong>,\u003ca href=\"http://www.npr.org/blogs/health/2014/05/29/316701155/doctors-say-they-would-shun-aggressive-treatment-when-near-death\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>Everybody dies.\u003c/p>\n\u003cp>But when doctors' time is up, they are different from the rest of us. They \"go gently\" rather than opt for aggressive end-of-life treatments, \u003ca href=\"http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/\" target=\"_blank\">as one physician wrote\u003c/a> a few years ago. They have seen the suffering of their patients at the end of life and want no part of it.\u003c/p>\n\u003cp>In fact, nearly 9 in 10 young physicians just finishing up their residencies or fellowships wouldn't want to receive life-prolonging CPR or cardiac life support if they were terminally ill and their heart or breathing stopped, a Stanford University School of Medicine survey finds.\u003c/p>\n\u003cp>\u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0098246\" target=\"_blank\">The report\u003c/a>, published Wednesday in the journal PLOS ONE, notes the disconnect between the aggressive care the average person receives — an average of \u003ca href=\"http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/06/03/the-cost-and-quality-conundrum-of-american-end-of-life-care\" target=\"_blank\">about $7,000 worth\u003c/a> for Medicare beneficiaries in their last month of life — and what doctors would want for themselves.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>To be sure, nondoctors don't necessarily want that care. According to \u003ca href=\"http://www.chcf.org/publications/2012/02/final-chapter-death-dying\" target=\"_blank\">one survey, from the California HealthCare Foundation\u003c/a>, most people would prefer to die at home and want care to focus on comfort.\u003c/p>\n\u003cp>One of the big barriers that stands in the way is a health care system that defaults to aggressive care, says VJ Periyakoil, the Stanford geriatrician who led the survey of more than a thousand doctors. \"Our system is biased toward overtreatment, not undertreatment,\" both culturally and financially, she says.\u003c/p>\n\u003cp>Local health system culture and doctors' individual practice styles influence the kind of care patients get, she says. In addition, patients may not have given thought to the specifics of what they want, or told family members. So while family members resolve any conflicts between themselves, the patient continues to receive treatments. While everyone is well-intentioned, she says, the end result is care that often exceeds what patients would want.\u003c/p>\n\u003cp>So what's a person who wants a gentle death to do? First, really reflect on what matters to you the most, says Periyakoil. Is it most important that you die at home, with family? What forms of medical care do you really not want to endure?\u003c/p>\n\u003cp>Then you need to talk about your wishes with your family members or anyone else who might be making decisions when you no longer can. (The Conversation Project is an effort to promote these types of \u003ca href=\"http://www.npr.org/2013/12/28/257822206/helping-families-have-the-most-difficult-conversation\" target=\"_blank\">difficult but important discussions\u003c/a>.) Put your preferences in writing, using an \u003ca href=\"http://www.nlm.nih.gov/medlineplus/advancedirectives.html\" target=\"_blank\">advance directive\u003c/a> and, for people who are aware that they soon may die, a \u003ca href=\"http://www.polst.org\" target=\"_blank\">Physician Order for Life-Sustaining Treatment, or POLST\u003c/a>, form. Make your wishes known to your medical team, she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's also important to revisit your advance directive periodically to make sure it's still in line with what you want, and be sure to keep your family members posted on any changes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19303\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/468418291.jpg\">\u003cimg class=\"size-large wp-image-19303\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/468418291-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Katherine Hobson\u003c/strong>,\u003ca href=\"http://www.npr.org/blogs/health/2014/05/29/316701155/doctors-say-they-would-shun-aggressive-treatment-when-near-death\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>Everybody dies.\u003c/p>\n\u003cp>But when doctors' time is up, they are different from the rest of us. They \"go gently\" rather than opt for aggressive end-of-life treatments, \u003ca href=\"http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/\" target=\"_blank\">as one physician wrote\u003c/a> a few years ago. They have seen the suffering of their patients at the end of life and want no part of it.\u003c/p>\n\u003cp>In fact, nearly 9 in 10 young physicians just finishing up their residencies or fellowships wouldn't want to receive life-prolonging CPR or cardiac life support if they were terminally ill and their heart or breathing stopped, a Stanford University School of Medicine survey finds.\u003c/p>\n\u003cp>\u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0098246\" target=\"_blank\">The report\u003c/a>, published Wednesday in the journal PLOS ONE, notes the disconnect between the aggressive care the average person receives — an average of \u003ca href=\"http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/06/03/the-cost-and-quality-conundrum-of-american-end-of-life-care\" target=\"_blank\">about $7,000 worth\u003c/a> for Medicare beneficiaries in their last month of life — and what doctors would want for themselves.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>To be sure, nondoctors don't necessarily want that care. According to \u003ca href=\"http://www.chcf.org/publications/2012/02/final-chapter-death-dying\" target=\"_blank\">one survey, from the California HealthCare Foundation\u003c/a>, most people would prefer to die at home and want care to focus on comfort.\u003c/p>\n\u003cp>One of the big barriers that stands in the way is a health care system that defaults to aggressive care, says VJ Periyakoil, the Stanford geriatrician who led the survey of more than a thousand doctors. \"Our system is biased toward overtreatment, not undertreatment,\" both culturally and financially, she says.\u003c/p>\n\u003cp>Local health system culture and doctors' individual practice styles influence the kind of care patients get, she says. In addition, patients may not have given thought to the specifics of what they want, or told family members. So while family members resolve any conflicts between themselves, the patient continues to receive treatments. While everyone is well-intentioned, she says, the end result is care that often exceeds what patients would want.\u003c/p>\n\u003cp>So what's a person who wants a gentle death to do? First, really reflect on what matters to you the most, says Periyakoil. Is it most important that you die at home, with family? What forms of medical care do you really not want to endure?\u003c/p>\n\u003cp>Then you need to talk about your wishes with your family members or anyone else who might be making decisions when you no longer can. (The Conversation Project is an effort to promote these types of \u003ca href=\"http://www.npr.org/2013/12/28/257822206/helping-families-have-the-most-difficult-conversation\" target=\"_blank\">difficult but important discussions\u003c/a>.) Put your preferences in writing, using an \u003ca href=\"http://www.nlm.nih.gov/medlineplus/advancedirectives.html\" target=\"_blank\">advance directive\u003c/a> and, for people who are aware that they soon may die, a \u003ca href=\"http://www.polst.org\" target=\"_blank\">Physician Order for Life-Sustaining Treatment, or POLST\u003c/a>, form. Make your wishes known to your medical team, she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's also important to revisit your advance directive periodically to make sure it's still in line with what you want, and be sure to keep your family members posted on any changes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Doctors Among Those Charging Medicare the Most for Office Visits",
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"content": "\u003cfigure id=\"attachment_19133\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516.jpg\">\u003cimg class=\"size-large wp-image-19133\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516-640x426.jpg\" alt=\"Caption will go here. (John Moore/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Aliferis, April Dembosky and Lisa Pickoff-White\u003c/strong>\u003c/p>\n\u003cp>When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor's time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Three California doctors are among the top five nationally in billing for the most complex office visits. \u003c/aside>\n\u003cp>Most doctors' billing patterns to the Medicare program fall in the middle ground between simple and complex.\u003c/p>\n\u003cp>In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine -- and bill -- a large proportion of their office visits as complex.\u003c/p>\n\u003cp>Now an analysis of Medicare billing data -- which was \u003ca href=\"http://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html?emc=edit_tnt_20140409&nlid=58462464&tntemail0=y&_r=0\">made public\u003c/a> for the first time last month -- shows that \u003ca href=\"http://projects.propublica.org/treatment/uniqservices/99215\" target=\"_blank\">three California doctors are among the top five nationally \u003c/a>in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In Orange County, \u003ca href=\"http://projects.propublica.org/treatment/doctors/1568540193\" target=\"_blank\">Dr. Louis VanderMolen\u003c/a>, a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79 percent of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12 percent of their office visits the same way.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>In the Santa Cruz County community of Freedom nearly every one of cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1861484511\" target=\"_blank\">Jeffrey Mace\u003c/a>'s patients received – and was charged for – the highest complexity visit. Mace billed Medicare for these high level visits almost 10 times more often than other cardiologists in California, and the third most in the country.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1932218666\" target=\"_blank\">Jay Schapira\u003c/a> ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared to the one visit typical of other cardiologists in the state.\u003c/li>\n\u003c/ul>\n\u003cp>“That’s unusual for a doctor who’s not seeing patients in the hospital,” said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. “Usually cardiac patients in the hospital are the ones that are about to die.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>KQED conducted this analysis in conjunction with ProPublica, which published its \u003ca href=\"http://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\" target=\"_blank\">national investigation\u003c/a> on Thursday.\u003c/p>\n\u003caside class=\"right\">\n\u003ch4>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\" target=\"_blank\">Look up your Medicare provider\u003c/a>\u003c/h4>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/medicareprovider.jpg\" alt=\"medicareprovider\" width=\"275\">\u003c/a>\u003c/p>\n\u003c/aside>\n\u003cp>These billing patterns raise questions for Medicare as a whole and for individual patients who pay a percentage copay. The higher level visits cost more. “Twenty percent of $200, for example, is obviously more than 20 percent of $100,” said Christina Melnykovych, president of Coding Continuum and an expert in insurance billing. “There's a direct correlation between the service level billed and the paid amount, and thus the copay impacts the patient.”\u003c/p>\n\u003cp>All established patient office visits are coded under a category called \"evaluation and management.\" These visits are billed at one of five levels, with \"5\" being the most complex. Established patients are people the provider has seen at least once before. First-time doctor appointments are coded differently.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment for this story and in a statement said they have not seen the data analysis.\u003c/p>\n\u003cp>\"Some providers have sicker patients, thus are more likely to bill at [evaluation and management] coding levels that carry higher payments. Every day we work with providers to make patient care the priority, and at the same time ensure they use [evaluation and management] codes that reflect the level of service provided,” the agency said. “It’s our assessment that it would be highly unusual for a provider to knowingly use the highest (level) code … for all or nearly all of his or her outpatient visits.”\u003c/p>\n\u003cp>Only one percent of California doctors billed Medicare at the highest level for all of their office visits for their established patients.\u003c/p>\n\u003cp>Coding experts stress that while the numbers cited for the doctors above do not by themselves indicate wrongdoing, they do raise eyebrows.\u003c/p>\n\u003cp>\u003cstrong>‘I’m Not An Average Cardiologist’\u003c/strong>\u003c/p>\n\u003cp>We tried to reach all of the doctors named in this report, with repeated phone calls plus faxes detailing our questions. Drs. VanderMolen and Schapira did not respond to our requests.\u003c/p>\n\u003cp>Dr. Mace sent us a written statement in which he vigorously defended his billing patterns. “I’m not an average cardiologist,” he wrote.\u003cstrong> “\u003c/strong>I spend a great deal of time taking care of patients. I generally spend 12-16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and hopefully, improved quantity of life (longevity).”\u003c/p>\n\u003cp>But billing for an individual visit is not about a physician’s dedication. Experts say it is about the patient’s complaint that day. “What was it about the patient’s clinical presentation and condition that warranted billing a level 5 service?” Melnykovych said.\u003c/p>\n\u003cp>In his statement, Mace said he had been “subject to several audits” over many years in regards to this level 5 billing code. He says that Medicare “has found all of the office visits reviewed to be correctly coded.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">6,340 most-complex visits, at an estimated 40 minutes each, adds up to seeing patients 16 hours a day, every weekday.\u003c/aside>\n\u003cp>While the established office visits are not based on time, per se, as a metric for coding, the American Medical Association assigns average time that would normally go along with different visit levels. For a level 5 visits, it’s 40 minutes, Melnykovych said.\u003c/p>\n\u003cp>If VanderMolen spent the average 40 minutes during all the 6,340 visits which he billed Medicare, that would mean he saw patients 16 hours a day -- presuming he worked every weekday in 2012. Medicare paid VanderMolen nearly $750,000 for these level 5 visits in 2012. He was reimbursed another $1.6 million by Medicare for other services performed.\u003c/p>\n\u003cp>Overpayment can happen for many reasons, including simple error. “But that doesn’t preclude the federal government or any payer from coming to the (doctor) and getting their money back,” Melnykovych said.\u003c/p>\n\u003cp>Sometimes the excuse is legitimate. Blount said if a doctor is affiliated with a teaching hospital – Schapira is a professor at the school of medicine at UCLA – that could explain a higher volume of patients at higher level codes. In his statement, Mace said that he is \"currently on staff at Stanford.\" A spokesman for Stanford Hospital and Clinics said in an email to KQED that Mace is an \"\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">independent community cardiologist who has 'courtesy admitting' privileges at Stanford Hospital & Clinics. Dr. Mace is not on Stanford’s faculty.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">VanderMolen's\u003ca href=\"http://www.ocoh.com/about.html\" target=\"_blank\"> website\u003c/a> says that he \"\u003c/span>\u003cspan style=\"color: #022136\">has had several university, hospital, and other appointments.\" It does not indicate any current affiliations with any academic medical centers. \u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems can also arise from the billing set up at a doctor’s office. Many doctors don’t actually do their own billing, Blount says. They dictate their office notes from a visit or fill out a checklist, and then a clerk in the billing department enters a code.\u003c/p>\n\u003cp>“Many times a physician is not even aware of what their claims are or how their claims are coded,” Blount says.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/149757159&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\">\u003c/iframe>\u003c/p>\n\u003cp>He has also seen a rising trend in unintended coding errors that mirror the rise of the implementation of electronic medical record systems. Many of these systems include an automated coding function. A physician will type in medical observations and treatment protocols, and then an algorithm will determine the code.\u003c/p>\n\u003cp>“Those algorithms are subject to human error,” Blount says. “Some mistakes are being made by the electronic medical record vendors in how they designed the product that they’re selling.”\u003c/p>\n\u003cp>Regardless, according to Medicare rules the ultimate responsibility for billing always rests with the doctor.\u003c/p>\n\u003cp>\u003cstrong>Frequent visits\u003c/strong>\u003c/p>\n\u003cp>It’s not just the total number of visits that could raise red flags among auditors -- repeat complex visits by individual patients could also be a cause for concern.\u003c/p>\n\u003cp>\u003ca href=\"http://projects.propublica.org/treatment/doctors/1205954955\" target=\"_blank\">Dr. Gary Ordog\u003c/a> is listed in Medicare’s billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, non-urgent complaints, like sore throats, to more urgent matters, like a broken wrist.\u003c/p>\n\u003cp>According to KQED's analysis, Ordog's patients received – on average -- 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is 1 complex visit per patient.\u003c/p>\n\u003cp>“That’s a little suspect,” says Patrice Morin-Spatz, a medical coding expert and trainer.\u003c/p>\n\u003cp>This is not the first time questions have arisen around Ordog’s medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.\u003c/p>\n\u003cp>The California Medical Board tried to revoke Ordog’s medical license in 2006 for “repeated negligent acts, incompetence, making false statements, and inadequate record keeping,” according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers' compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.\u003c/p>\n\u003cp>Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.\u003c/p>\n\u003cp>\u003cstrong>How We Did This\u003c/strong>\u003c/p>\n\u003cp>KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare’s Part B program in 2012.\u003c/p>\n\u003cp>KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.\u003c/p>\n\u003cp>We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Matt Levin and Brittany Patterson contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19133\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516.jpg\">\u003cimg class=\"size-large wp-image-19133\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516-640x426.jpg\" alt=\"Caption will go here. (John Moore/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Aliferis, April Dembosky and Lisa Pickoff-White\u003c/strong>\u003c/p>\n\u003cp>When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor's time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Three California doctors are among the top five nationally in billing for the most complex office visits. \u003c/aside>\n\u003cp>Most doctors' billing patterns to the Medicare program fall in the middle ground between simple and complex.\u003c/p>\n\u003cp>In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine -- and bill -- a large proportion of their office visits as complex.\u003c/p>\n\u003cp>Now an analysis of Medicare billing data -- which was \u003ca href=\"http://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html?emc=edit_tnt_20140409&nlid=58462464&tntemail0=y&_r=0\">made public\u003c/a> for the first time last month -- shows that \u003ca href=\"http://projects.propublica.org/treatment/uniqservices/99215\" target=\"_blank\">three California doctors are among the top five nationally \u003c/a>in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In Orange County, \u003ca href=\"http://projects.propublica.org/treatment/doctors/1568540193\" target=\"_blank\">Dr. Louis VanderMolen\u003c/a>, a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79 percent of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12 percent of their office visits the same way.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>In the Santa Cruz County community of Freedom nearly every one of cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1861484511\" target=\"_blank\">Jeffrey Mace\u003c/a>'s patients received – and was charged for – the highest complexity visit. Mace billed Medicare for these high level visits almost 10 times more often than other cardiologists in California, and the third most in the country.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1932218666\" target=\"_blank\">Jay Schapira\u003c/a> ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared to the one visit typical of other cardiologists in the state.\u003c/li>\n\u003c/ul>\n\u003cp>“That’s unusual for a doctor who’s not seeing patients in the hospital,” said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. “Usually cardiac patients in the hospital are the ones that are about to die.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>KQED conducted this analysis in conjunction with ProPublica, which published its \u003ca href=\"http://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\" target=\"_blank\">national investigation\u003c/a> on Thursday.\u003c/p>\n\u003caside class=\"right\">\n\u003ch4>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\" target=\"_blank\">Look up your Medicare provider\u003c/a>\u003c/h4>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/medicareprovider.jpg\" alt=\"medicareprovider\" width=\"275\">\u003c/a>\u003c/p>\n\u003c/aside>\n\u003cp>These billing patterns raise questions for Medicare as a whole and for individual patients who pay a percentage copay. The higher level visits cost more. “Twenty percent of $200, for example, is obviously more than 20 percent of $100,” said Christina Melnykovych, president of Coding Continuum and an expert in insurance billing. “There's a direct correlation between the service level billed and the paid amount, and thus the copay impacts the patient.”\u003c/p>\n\u003cp>All established patient office visits are coded under a category called \"evaluation and management.\" These visits are billed at one of five levels, with \"5\" being the most complex. Established patients are people the provider has seen at least once before. First-time doctor appointments are coded differently.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment for this story and in a statement said they have not seen the data analysis.\u003c/p>\n\u003cp>\"Some providers have sicker patients, thus are more likely to bill at [evaluation and management] coding levels that carry higher payments. Every day we work with providers to make patient care the priority, and at the same time ensure they use [evaluation and management] codes that reflect the level of service provided,” the agency said. “It’s our assessment that it would be highly unusual for a provider to knowingly use the highest (level) code … for all or nearly all of his or her outpatient visits.”\u003c/p>\n\u003cp>Only one percent of California doctors billed Medicare at the highest level for all of their office visits for their established patients.\u003c/p>\n\u003cp>Coding experts stress that while the numbers cited for the doctors above do not by themselves indicate wrongdoing, they do raise eyebrows.\u003c/p>\n\u003cp>\u003cstrong>‘I’m Not An Average Cardiologist’\u003c/strong>\u003c/p>\n\u003cp>We tried to reach all of the doctors named in this report, with repeated phone calls plus faxes detailing our questions. Drs. VanderMolen and Schapira did not respond to our requests.\u003c/p>\n\u003cp>Dr. Mace sent us a written statement in which he vigorously defended his billing patterns. “I’m not an average cardiologist,” he wrote.\u003cstrong> “\u003c/strong>I spend a great deal of time taking care of patients. I generally spend 12-16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and hopefully, improved quantity of life (longevity).”\u003c/p>\n\u003cp>But billing for an individual visit is not about a physician’s dedication. Experts say it is about the patient’s complaint that day. “What was it about the patient’s clinical presentation and condition that warranted billing a level 5 service?” Melnykovych said.\u003c/p>\n\u003cp>In his statement, Mace said he had been “subject to several audits” over many years in regards to this level 5 billing code. He says that Medicare “has found all of the office visits reviewed to be correctly coded.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">6,340 most-complex visits, at an estimated 40 minutes each, adds up to seeing patients 16 hours a day, every weekday.\u003c/aside>\n\u003cp>While the established office visits are not based on time, per se, as a metric for coding, the American Medical Association assigns average time that would normally go along with different visit levels. For a level 5 visits, it’s 40 minutes, Melnykovych said.\u003c/p>\n\u003cp>If VanderMolen spent the average 40 minutes during all the 6,340 visits which he billed Medicare, that would mean he saw patients 16 hours a day -- presuming he worked every weekday in 2012. Medicare paid VanderMolen nearly $750,000 for these level 5 visits in 2012. He was reimbursed another $1.6 million by Medicare for other services performed.\u003c/p>\n\u003cp>Overpayment can happen for many reasons, including simple error. “But that doesn’t preclude the federal government or any payer from coming to the (doctor) and getting their money back,” Melnykovych said.\u003c/p>\n\u003cp>Sometimes the excuse is legitimate. Blount said if a doctor is affiliated with a teaching hospital – Schapira is a professor at the school of medicine at UCLA – that could explain a higher volume of patients at higher level codes. In his statement, Mace said that he is \"currently on staff at Stanford.\" A spokesman for Stanford Hospital and Clinics said in an email to KQED that Mace is an \"\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">independent community cardiologist who has 'courtesy admitting' privileges at Stanford Hospital & Clinics. Dr. Mace is not on Stanford’s faculty.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">VanderMolen's\u003ca href=\"http://www.ocoh.com/about.html\" target=\"_blank\"> website\u003c/a> says that he \"\u003c/span>\u003cspan style=\"color: #022136\">has had several university, hospital, and other appointments.\" It does not indicate any current affiliations with any academic medical centers. \u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems can also arise from the billing set up at a doctor’s office. Many doctors don’t actually do their own billing, Blount says. They dictate their office notes from a visit or fill out a checklist, and then a clerk in the billing department enters a code.\u003c/p>\n\u003cp>“Many times a physician is not even aware of what their claims are or how their claims are coded,” Blount says.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/149757159&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\">\u003c/iframe>\u003c/p>\n\u003cp>He has also seen a rising trend in unintended coding errors that mirror the rise of the implementation of electronic medical record systems. Many of these systems include an automated coding function. A physician will type in medical observations and treatment protocols, and then an algorithm will determine the code.\u003c/p>\n\u003cp>“Those algorithms are subject to human error,” Blount says. “Some mistakes are being made by the electronic medical record vendors in how they designed the product that they’re selling.”\u003c/p>\n\u003cp>Regardless, according to Medicare rules the ultimate responsibility for billing always rests with the doctor.\u003c/p>\n\u003cp>\u003cstrong>Frequent visits\u003c/strong>\u003c/p>\n\u003cp>It’s not just the total number of visits that could raise red flags among auditors -- repeat complex visits by individual patients could also be a cause for concern.\u003c/p>\n\u003cp>\u003ca href=\"http://projects.propublica.org/treatment/doctors/1205954955\" target=\"_blank\">Dr. Gary Ordog\u003c/a> is listed in Medicare’s billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, non-urgent complaints, like sore throats, to more urgent matters, like a broken wrist.\u003c/p>\n\u003cp>According to KQED's analysis, Ordog's patients received – on average -- 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is 1 complex visit per patient.\u003c/p>\n\u003cp>“That’s a little suspect,” says Patrice Morin-Spatz, a medical coding expert and trainer.\u003c/p>\n\u003cp>This is not the first time questions have arisen around Ordog’s medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.\u003c/p>\n\u003cp>The California Medical Board tried to revoke Ordog’s medical license in 2006 for “repeated negligent acts, incompetence, making false statements, and inadequate record keeping,” according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers' compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.\u003c/p>\n\u003cp>Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.\u003c/p>\n\u003cp>\u003cstrong>How We Did This\u003c/strong>\u003c/p>\n\u003cp>KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare’s Part B program in 2012.\u003c/p>\n\u003cp>KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.\u003c/p>\n\u003cp>We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>In April, Medicare released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. \u003ca href=\"http://projects.propublica.org/treatment/\" target=\"_blank\">ProPublica\u003c/a> created this application to help you find and compare providers.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex/\" target=\"_blank\">Read more\u003c/a> about the three California doctors who are among the top five nationally in billing for the highest number of the most complex office visits. \u003c/p>\n\u003cp>\u003ciframe class=\"alignright\" src=\"http://projects.propublica.org/treatment/widget?layout=embed\" style=\"width:630px;height: 320px;border: 1px solid #ccc\" scrolling=\"no\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In April, Medicare released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. \u003ca href=\"http://projects.propublica.org/treatment/\" target=\"_blank\">ProPublica\u003c/a> created this application to help you find and compare providers.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex/\" target=\"_blank\">Read more\u003c/a> about the three California doctors who are among the top five nationally in billing for the highest number of the most complex office visits. \u003c/p>\n\u003cp>\u003ciframe class=\"alignright\" src=\"http://projects.propublica.org/treatment/widget?layout=embed\" style=\"width:630px;height: 320px;border: 1px solid #ccc\" scrolling=\"no\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_18805\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/470830705.jpg\">\u003cimg class=\"size-large wp-image-18805\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/470830705-640x640.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"640\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>by Rob Stein, \u003ca href=\"http://www.npr.org/blogs/health/2014/04/22/302889772/powerful-narcotic-painkiller-up-for-fda-approval\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>The Food and Drug Administration is trying to decide whether to approve a powerful new prescription painkiller that's designed to relieve severe pain quickly, and with fewer side effects than other opioids.\u003c/p>\n\u003cp>While some pain experts say the medicine could provide a valuable alternative for some patients in intense pain, the drug (called Moxduo) is also prompting concern that it could exacerbate the epidemic of abuse of prescription painkillers and overdoses.\u003c/p>\n\u003cp>An FDA advisory committee is holding a daylong hearing Tuesday to decide whether to recommend that the agency approve the drug.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"This is a product that is very easy to misuse, very easy to crush and snort or crush and inject,\" says addiction specialist Andrew Kolodny. \u003c/aside>\n\u003cp>Moxduo for the first time combines morphine and oxycodone in one capsule. It's designed to provide quick relief to patients suffering severe pain from accidents or surgeries, such as knee replacements, back surgeries or cancer operations, says Ed Rudnic, COO of QRxPharma, the company that makes Moxduo.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The drug allows patients to take lower doses of the two narcotics than they'd need if they took either of the medicines alone, Rudnic says.\u003c/p>\n\u003cp>\"We believe that we've achieved some benefit in reducing the risk of some of the respiratory complications of these strong opioids,\" he says.\u003c/p>\n\u003cp>Suppressed breathing and other respiratory complications are the most serious risks of these drugs — the main reason people die from taking too much.\u003c/p>\n\u003cp>Some pain experts think the idea behind Moxduo is a good one. A lot of patients can't take enough morphine or oxycodone to ease their discomfort because of the risk to breathing and other side effects, such as nausea, vomiting, dizziness and severe itchiness.\u003c/p>\n\u003cp>\u003c!--more-->Patients who could theoretically benefit from such a pill are \"normal people like you and me,\" says Dr. Joseph Audette of Harvard Medical School. \"And then suddenly we get in a terrible accident or have surgery and ... we need something. And the typical agents are used, and suddenly all these terrible side effects come up.\"\u003c/p>\n\u003cp>But Audette is not convinced the company has yet proved that Moxduo has fewer side effects.\u003c/p>\n\u003cp>\"They haven't really done the hard work of absolutely showing ... in humans with real pain problems that synergy is making a big difference,\" Audette says, \"compared to just using the agents that we [already] have available.\"\u003c/p>\n\u003cp>And some experts worry that Moxduo will come with its own problems.\u003c/p>\n\u003cp>\"I have serious concerns about this product,\" says Andrew Kolodny, an addiction specialist at Phoenix House. He also leads the Physicians for Responsible Opioid Prescribing, which is fighting for tighter control of prescription painkillers.\u003c/p>\n\u003cp>Millions of people are addicted to these legal narcotics already, Kolodny says, with thousands dying from overdoses each year. Moxduo, he worries, would only make that worse.\u003c/p>\n\u003cp>\"This is pure morphine and pure oxycodone,\" he says. \"This is a product that is very easy to misuse, very easy to crush and snort or crush and inject. So it's significantly more dangerous than the products that it would be competing with.\" Kolodny cites Vicodin and Percocet as competing drugs that contain multiple other ingredients (in addition to a narcotic) that make them more difficult to abuse in those ways.\u003c/p>\n\u003cp>Patients in severe pain already have plenty of options, he says, and a marketing push to prescribe Moxduo could spell trouble.\u003c/p>\n\u003cp>\"If they get this product put on the market and are able to have a sales force going in and out of doctors' offices encouraging prescribing with the marketing claim that this is somehow a safer product ... I believe that's likely to exacerbate an already severe public health crisis,\" Kolodny tells Shots.\u003c/p>\n\u003cp>For his part, Rudnic argues that the manufacturer already has good evidence that Moxduo is a safer painkiller with fewer side effects. And he disputes the claims that Moxduo is easier to abuse.\u003c/p>\n\u003cp>\"I understand abuse and I understand the anguish that some of these people have that have lost a loved one to a drug overdose,\" says Rudnic. \"I lost a brother to a drug overdose in 2002 and it was really tough.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Rudnic promises his company will set up a system to quickly spot any signs that Moxduo is being misused. QRxPharma is also developing a version of the drug, Rudnic says, that would make it harder to abuse.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18805\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/470830705.jpg\">\u003cimg class=\"size-large wp-image-18805\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/470830705-640x640.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"640\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>by Rob Stein, \u003ca href=\"http://www.npr.org/blogs/health/2014/04/22/302889772/powerful-narcotic-painkiller-up-for-fda-approval\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>The Food and Drug Administration is trying to decide whether to approve a powerful new prescription painkiller that's designed to relieve severe pain quickly, and with fewer side effects than other opioids.\u003c/p>\n\u003cp>While some pain experts say the medicine could provide a valuable alternative for some patients in intense pain, the drug (called Moxduo) is also prompting concern that it could exacerbate the epidemic of abuse of prescription painkillers and overdoses.\u003c/p>\n\u003cp>An FDA advisory committee is holding a daylong hearing Tuesday to decide whether to recommend that the agency approve the drug.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"This is a product that is very easy to misuse, very easy to crush and snort or crush and inject,\" says addiction specialist Andrew Kolodny. \u003c/aside>\n\u003cp>Moxduo for the first time combines morphine and oxycodone in one capsule. It's designed to provide quick relief to patients suffering severe pain from accidents or surgeries, such as knee replacements, back surgeries or cancer operations, says Ed Rudnic, COO of QRxPharma, the company that makes Moxduo.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The drug allows patients to take lower doses of the two narcotics than they'd need if they took either of the medicines alone, Rudnic says.\u003c/p>\n\u003cp>\"We believe that we've achieved some benefit in reducing the risk of some of the respiratory complications of these strong opioids,\" he says.\u003c/p>\n\u003cp>Suppressed breathing and other respiratory complications are the most serious risks of these drugs — the main reason people die from taking too much.\u003c/p>\n\u003cp>Some pain experts think the idea behind Moxduo is a good one. A lot of patients can't take enough morphine or oxycodone to ease their discomfort because of the risk to breathing and other side effects, such as nausea, vomiting, dizziness and severe itchiness.\u003c/p>\n\u003cp>\u003c!--more-->Patients who could theoretically benefit from such a pill are \"normal people like you and me,\" says Dr. Joseph Audette of Harvard Medical School. \"And then suddenly we get in a terrible accident or have surgery and ... we need something. And the typical agents are used, and suddenly all these terrible side effects come up.\"\u003c/p>\n\u003cp>But Audette is not convinced the company has yet proved that Moxduo has fewer side effects.\u003c/p>\n\u003cp>\"They haven't really done the hard work of absolutely showing ... in humans with real pain problems that synergy is making a big difference,\" Audette says, \"compared to just using the agents that we [already] have available.\"\u003c/p>\n\u003cp>And some experts worry that Moxduo will come with its own problems.\u003c/p>\n\u003cp>\"I have serious concerns about this product,\" says Andrew Kolodny, an addiction specialist at Phoenix House. He also leads the Physicians for Responsible Opioid Prescribing, which is fighting for tighter control of prescription painkillers.\u003c/p>\n\u003cp>Millions of people are addicted to these legal narcotics already, Kolodny says, with thousands dying from overdoses each year. Moxduo, he worries, would only make that worse.\u003c/p>\n\u003cp>\"This is pure morphine and pure oxycodone,\" he says. \"This is a product that is very easy to misuse, very easy to crush and snort or crush and inject. So it's significantly more dangerous than the products that it would be competing with.\" Kolodny cites Vicodin and Percocet as competing drugs that contain multiple other ingredients (in addition to a narcotic) that make them more difficult to abuse in those ways.\u003c/p>\n\u003cp>Patients in severe pain already have plenty of options, he says, and a marketing push to prescribe Moxduo could spell trouble.\u003c/p>\n\u003cp>\"If they get this product put on the market and are able to have a sales force going in and out of doctors' offices encouraging prescribing with the marketing claim that this is somehow a safer product ... I believe that's likely to exacerbate an already severe public health crisis,\" Kolodny tells Shots.\u003c/p>\n\u003cp>For his part, Rudnic argues that the manufacturer already has good evidence that Moxduo is a safer painkiller with fewer side effects. And he disputes the claims that Moxduo is easier to abuse.\u003c/p>\n\u003cp>\"I understand abuse and I understand the anguish that some of these people have that have lost a loved one to a drug overdose,\" says Rudnic. \"I lost a brother to a drug overdose in 2002 and it was really tough.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Rudnic promises his company will set up a system to quickly spot any signs that Moxduo is being misused. QRxPharma is also developing a version of the drug, Rudnic says, that would make it harder to abuse.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Despite Obamacare, Big Gap in Substance Abuse Treatment",
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"content": "\u003cfigure id=\"attachment_18660\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/impact-house-1000px-e1397234248515.jpg\">\u003cimg class=\"size-large wp-image-18660\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/impact-house-1000px-640x426.jpg\" alt=\"Jessica Schabel, 19, is under treatment at the Impact Drug and Alcohol Treatment Center in Pasadena for heroin and methamphetamine addiction. Her insurance benefits only allowed for 30 days, but the facility paid for her to stay an additional 30 days to continue treatment. (Heidi de Marco/KHN)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jessica Schabel, 19, is under treatment at the Impact Drug and Alcohol Treatment Center in Pasadena for heroin and methamphetamine addiction. Her insurance benefits only allowed for 30 days, but the facility paid for her to stay an additional 30 days to continue treatment. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/stories/2014/april/10/substance-abuse-treatment-access-health-law.aspx?referrer=search\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>The nation’s health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many unable to afford services in the past now can receive them without first landing in jail or an emergency room, health officials say.\u003c/p>\n\u003caside class=\"pullquote alignleft\">An old law bars many residential drug treatment centers from billing Medicaid. \u003c/aside>\n\u003cp>\"There is no illness that will be more favorably affected [by the Affordable Care Act] than substance abuse,\" said A. Thomas McLellan, former U.S. deputy drug czar who now heads Treatment Research Institute in Philadelphia. \"This is the beginning of substance abuse disorders being part of mainstream health care.\"\u003c/p>\n\u003cp>The law requires that substance abuse treatment be offered to people newly insured through the insurance exchanges or Medicaid, the government health plan for the poor and disabled.\u003c/p>\n\u003cp>But serious impediments remain to widespread access, including a shortage of substance abuse providers and available beds nationwide, say treatment experts and government officials.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We don't have enough capacity right now,\" said Becky Vaughn, executive director of State Associations of Addiction Services in Washington, D.C.\u003c/p>\n\u003cp>More than 23 million Americans needed treatment for an alcohol or drug problem in 2012 but only about 11 percent received it, according to estimates from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).\u003c/p>\n\u003cp id=\"yui_3_13_0_ym1_1_1396032296675_18810\">One significant barrier to access is that drug treatment centers with more than 16 beds can't bill Medicaid for residential services provided to low-income adults. The restriction steams from a decades-old federal law designed to prevent Medicaid dollars from funding private mental institutions. The purpose was to avoid warehousing of mental patients, treatment providers said.\u003c/p>\n\u003cp>As a result of the limitation, drug rehabilitation centers across the nation are turning away new Medicaid beneficiaries who need residential treatment and now are entitled to receive it under Obamacare.\u003c/p>\n\u003cp>\"The unintended consequence is that you are discriminating against an adult who needs help,\" said Elizabeth Stanley-Salazar, a vice president at the Phoenix House, which offers drug treatment in a dozen states, including California, Florida and Virgina. \"We don't do that for any other illness or disease. … Everyone recognizes that it needs to be fixed.\"\u003c/p>\n\u003cp>\u003cstrong>\"Dumb\" Restriction Doesn't Work Economically or Patients\u003c/strong>\u003c/p>\n\u003cp>Health officials and treatment centers have raised concerns about the restriction.\u003c/p>\n\u003cp>Toby Douglas heads California's Department of Health Care Services. In a letter to the Centers for Medicare & Medicaid Services last month, he said that just 10 percent of the available inpatient beds in the state are in facilities that meet the federal government’s size restrictions. He asked the federal government to give the state some flexibility in counting beds.\u003c/p>\n\u003cp>Similarly, the vast majority of the substance abuse treatment in Colorado is located in centers with more than 16 beds, said Arthur Schut, chief executive officer of Denver-based Arapahoe House. There are ongoing conversations among treatment providers statewide about how to legally get around the restriction so they can offer the newly available benefits to more people, he said.\u003c/p>\n\u003cp>\"Everyone is in agreement about how dumb this is,\" he said. \"It doesn't work economically and it doesn't work for the people seeking treatment.\u003c/p>\n\u003cp>There are no plans to change the law, said Suzanne Fields, a SAMHSA senior advisor on health care financing. The federal government is working with states on other options, including treating patients under programs paid for with other federal money.\u003c/p>\n\u003cp>Fields said federal health officials are also meeting with insurance plans and trade groups to provide information and help them ease the transition to the new system of expanded benefits.\u003c/p>\n\u003cp>In the past, many people didn't have access to substance abuse treatment because they were uninsured or their policies didn't cover it. The majority of states also did not include substance abuse benefits or only offered bare-bones coverage through Medicaid.\u003c/p>\n\u003cp>\"These are services that have not been covered or haven't been covered very well,\" said Dan Belnap, senior health policy analyst at Legal Action Center, a nonprofit advocacy group based in New York. \"There is a lot of ground to make up.\"\u003c/p>\n\u003cp>In addition to the protections under the Affordable Care Act, long-awaited rules for another federal law -- the Mental Health Parity and Addiction Equity Act -- were released late last year requiring that coverage for substance abuse and mental health treatment not be more restrictive than other medical coverage. For example, insurance companies can't have different rules for co-payments or visit limits for substance abuse or other behavioral issues than for medical issues.\u003c/p>\n\u003cp>The expansion of coverage and services is also expected to lower health care spending. Illicit drug use in the U.S. costs more than $190 billion, including from lost productivity and on health care expenditures, according to estimates from the federal government.\u003c/p>\n\u003cp>Still, some of the reforms have sometimes been slow to take root.\u003c/p>\n\u003cp>For example, despite the new coverage and protections, treatment centers said they are continuing to fight with insurance plans over how long they can keep patients in care. The law does not specify length or intensity of treatment.\u003c/p>\n\u003cp>\"This is disease in which continued treatment is essential,\" said David Rosenbloom, a professor at Boston University School of Public Health. \"If the new law is implemented by managed care companies with short leashes, they will undo its potential efficacy.\"\u003c/p>\n\u003cp>Les Sperling, chief executive officer of the Central Kansas Foundation, said there is significant pressure by insurance companies to shorten the length of time people are in residential care. \"There is that natural tension between a payer and a provider that continues,\" he said.\u003c/p>\n\u003cp>At the Impact Drug and Alcohol Treatment Center in Pasadena, Calif., administrators said they constantly are trying to persuade insurance plans to pay for longer stays. \"We have to paint a picture for the insurance companies of this sick person who needs a lot more help,\" said Mark Paquet, admissions director.\u003c/p>\n\u003cp>\u003cstrong>Recovery from Addiction \"Takes a Long Time\"\u003c/strong>\u003c/p>\n\u003cp>Take 19-year-old Jessica Schabel from Yucaipa, Calif., who is covered through her parents' plan. Her insurance benefits ran out after 30 days but administrators could not get the treatment extended. The facility paid for her to stay an additional 30 days.\u003c/p>\n\u003cp>Outside in the garden, where she sat down to eat a hamburger, Schabel explained that she dropped out of high school and has been arrested numerous times. She started using heroin and methamphetamine when she was 15, a habit Schabel said she supported by selling drugs.\u003c/p>\n\u003cp>\"For people who have used for years, it takes a long time to break that habit,\" she said.\u003c/p>\n\u003cp>Providing care for patients dealing with substance abuse has long been a priority, but plans are now doing what's necessary to meet the new requirements, said Clare Krusing, spokeswoman for America's Health Insurance Plans. Plans are basing their coverage decisions on what the evidence shows is \"proven to be safe and effective for a particular patient given a particular condition,\" she said.\u003c/p>\n\u003cp>Even with all of the unanswered questions and obstacles, the new benefits are a relief for those covered under Obamacare, said Tom Delegatto, executive director of business development for Gateway Foundation in Illinois.\u003c/p>\n\u003cp>\"Nobody is jumping for joy when they have to go into substance abuse treatment,\" he said. \"But they are grateful to have the ability to pay for it. ... They have an opportunity they did not have before.\"\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"DWtxiJ5y7LUnWUj9Azjujxpa4z2EmjL5\"]\u003c/p>\n\n",
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"excerpt": "While the ACA is intended to cover substance abuse treatment, an older law bars many residential drug treatment centers from billing Medicaid. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18660\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/impact-house-1000px-e1397234248515.jpg\">\u003cimg class=\"size-large wp-image-18660\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/impact-house-1000px-640x426.jpg\" alt=\"Jessica Schabel, 19, is under treatment at the Impact Drug and Alcohol Treatment Center in Pasadena for heroin and methamphetamine addiction. Her insurance benefits only allowed for 30 days, but the facility paid for her to stay an additional 30 days to continue treatment. (Heidi de Marco/KHN)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jessica Schabel, 19, is under treatment at the Impact Drug and Alcohol Treatment Center in Pasadena for heroin and methamphetamine addiction. Her insurance benefits only allowed for 30 days, but the facility paid for her to stay an additional 30 days to continue treatment. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/stories/2014/april/10/substance-abuse-treatment-access-health-law.aspx?referrer=search\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>The nation’s health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many unable to afford services in the past now can receive them without first landing in jail or an emergency room, health officials say.\u003c/p>\n\u003caside class=\"pullquote alignleft\">An old law bars many residential drug treatment centers from billing Medicaid. \u003c/aside>\n\u003cp>\"There is no illness that will be more favorably affected [by the Affordable Care Act] than substance abuse,\" said A. Thomas McLellan, former U.S. deputy drug czar who now heads Treatment Research Institute in Philadelphia. \"This is the beginning of substance abuse disorders being part of mainstream health care.\"\u003c/p>\n\u003cp>The law requires that substance abuse treatment be offered to people newly insured through the insurance exchanges or Medicaid, the government health plan for the poor and disabled.\u003c/p>\n\u003cp>But serious impediments remain to widespread access, including a shortage of substance abuse providers and available beds nationwide, say treatment experts and government officials.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We don't have enough capacity right now,\" said Becky Vaughn, executive director of State Associations of Addiction Services in Washington, D.C.\u003c/p>\n\u003cp>More than 23 million Americans needed treatment for an alcohol or drug problem in 2012 but only about 11 percent received it, according to estimates from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).\u003c/p>\n\u003cp id=\"yui_3_13_0_ym1_1_1396032296675_18810\">One significant barrier to access is that drug treatment centers with more than 16 beds can't bill Medicaid for residential services provided to low-income adults. The restriction steams from a decades-old federal law designed to prevent Medicaid dollars from funding private mental institutions. The purpose was to avoid warehousing of mental patients, treatment providers said.\u003c/p>\n\u003cp>As a result of the limitation, drug rehabilitation centers across the nation are turning away new Medicaid beneficiaries who need residential treatment and now are entitled to receive it under Obamacare.\u003c/p>\n\u003cp>\"The unintended consequence is that you are discriminating against an adult who needs help,\" said Elizabeth Stanley-Salazar, a vice president at the Phoenix House, which offers drug treatment in a dozen states, including California, Florida and Virgina. \"We don't do that for any other illness or disease. … Everyone recognizes that it needs to be fixed.\"\u003c/p>\n\u003cp>\u003cstrong>\"Dumb\" Restriction Doesn't Work Economically or Patients\u003c/strong>\u003c/p>\n\u003cp>Health officials and treatment centers have raised concerns about the restriction.\u003c/p>\n\u003cp>Toby Douglas heads California's Department of Health Care Services. In a letter to the Centers for Medicare & Medicaid Services last month, he said that just 10 percent of the available inpatient beds in the state are in facilities that meet the federal government’s size restrictions. He asked the federal government to give the state some flexibility in counting beds.\u003c/p>\n\u003cp>Similarly, the vast majority of the substance abuse treatment in Colorado is located in centers with more than 16 beds, said Arthur Schut, chief executive officer of Denver-based Arapahoe House. There are ongoing conversations among treatment providers statewide about how to legally get around the restriction so they can offer the newly available benefits to more people, he said.\u003c/p>\n\u003cp>\"Everyone is in agreement about how dumb this is,\" he said. \"It doesn't work economically and it doesn't work for the people seeking treatment.\u003c/p>\n\u003cp>There are no plans to change the law, said Suzanne Fields, a SAMHSA senior advisor on health care financing. The federal government is working with states on other options, including treating patients under programs paid for with other federal money.\u003c/p>\n\u003cp>Fields said federal health officials are also meeting with insurance plans and trade groups to provide information and help them ease the transition to the new system of expanded benefits.\u003c/p>\n\u003cp>In the past, many people didn't have access to substance abuse treatment because they were uninsured or their policies didn't cover it. The majority of states also did not include substance abuse benefits or only offered bare-bones coverage through Medicaid.\u003c/p>\n\u003cp>\"These are services that have not been covered or haven't been covered very well,\" said Dan Belnap, senior health policy analyst at Legal Action Center, a nonprofit advocacy group based in New York. \"There is a lot of ground to make up.\"\u003c/p>\n\u003cp>In addition to the protections under the Affordable Care Act, long-awaited rules for another federal law -- the Mental Health Parity and Addiction Equity Act -- were released late last year requiring that coverage for substance abuse and mental health treatment not be more restrictive than other medical coverage. For example, insurance companies can't have different rules for co-payments or visit limits for substance abuse or other behavioral issues than for medical issues.\u003c/p>\n\u003cp>The expansion of coverage and services is also expected to lower health care spending. Illicit drug use in the U.S. costs more than $190 billion, including from lost productivity and on health care expenditures, according to estimates from the federal government.\u003c/p>\n\u003cp>Still, some of the reforms have sometimes been slow to take root.\u003c/p>\n\u003cp>For example, despite the new coverage and protections, treatment centers said they are continuing to fight with insurance plans over how long they can keep patients in care. The law does not specify length or intensity of treatment.\u003c/p>\n\u003cp>\"This is disease in which continued treatment is essential,\" said David Rosenbloom, a professor at Boston University School of Public Health. \"If the new law is implemented by managed care companies with short leashes, they will undo its potential efficacy.\"\u003c/p>\n\u003cp>Les Sperling, chief executive officer of the Central Kansas Foundation, said there is significant pressure by insurance companies to shorten the length of time people are in residential care. \"There is that natural tension between a payer and a provider that continues,\" he said.\u003c/p>\n\u003cp>At the Impact Drug and Alcohol Treatment Center in Pasadena, Calif., administrators said they constantly are trying to persuade insurance plans to pay for longer stays. \"We have to paint a picture for the insurance companies of this sick person who needs a lot more help,\" said Mark Paquet, admissions director.\u003c/p>\n\u003cp>\u003cstrong>Recovery from Addiction \"Takes a Long Time\"\u003c/strong>\u003c/p>\n\u003cp>Take 19-year-old Jessica Schabel from Yucaipa, Calif., who is covered through her parents' plan. Her insurance benefits ran out after 30 days but administrators could not get the treatment extended. The facility paid for her to stay an additional 30 days.\u003c/p>\n\u003cp>Outside in the garden, where she sat down to eat a hamburger, Schabel explained that she dropped out of high school and has been arrested numerous times. She started using heroin and methamphetamine when she was 15, a habit Schabel said she supported by selling drugs.\u003c/p>\n\u003cp>\"For people who have used for years, it takes a long time to break that habit,\" she said.\u003c/p>\n\u003cp>Providing care for patients dealing with substance abuse has long been a priority, but plans are now doing what's necessary to meet the new requirements, said Clare Krusing, spokeswoman for America's Health Insurance Plans. Plans are basing their coverage decisions on what the evidence shows is \"proven to be safe and effective for a particular patient given a particular condition,\" she said.\u003c/p>\n\u003cp>Even with all of the unanswered questions and obstacles, the new benefits are a relief for those covered under Obamacare, said Tom Delegatto, executive director of business development for Gateway Foundation in Illinois.\u003c/p>\n\u003cp>\"Nobody is jumping for joy when they have to go into substance abuse treatment,\" he said. \"But they are grateful to have the ability to pay for it. ... They have an opportunity they did not have before.\"\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Your Doctor's Skill at Colonoscopy May Reduce Your Later Colon Cancer Risk",
"title": "Your Doctor's Skill at Colonoscopy May Reduce Your Later Colon Cancer Risk",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/136237601-e1396647760530.jpg\">\u003cimg class=\"size-large wp-image-18548\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/136237601-640x437.jpg\" alt=\"136237601\" width=\"640\" height=\"437\">\u003c/a>\u003cbr>\nIf you're going to go to the trouble of having a colonoscopy, you'd probably prefer that you get as much as you can out of the screening test. A new study this week shows that a doctor's rate of finding and removing adenomas -- these are pre-cancerous growths -- is linked to the patient's lower risk of developing colon cancer later.\u003c/p>\n\u003caside class=\"pullquote alignleft\">For every 1 percent increase in adenoma detection there was a 3 percent decrease a person's colon cancer risk. \u003c/aside>\n\u003cp>Colonoscopy is one of the \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations\" target=\"_blank\">recommended screening tests\u003c/a> for colon cancer. Yet doctors have differing rates at how often they find these adenomas. This is the first study in the U.S. to look at the association between finding adenomas and later cancer risk, as part of a national review funded by the National Cancer Institute. It was published in the\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1309086\" target=\"_blank\"> New England Journal of Medicine.\u003c/a>\u003c/p>\n\u003cp>In the study, researchers at Kaiser Permanente Northern California reviewed more than 300,000 colonoscopies performed by 136 gastroenterologists between 1998 and 2010.\u003c!--more-->\u003c/p>\n\u003cp>The doctors' detection rates for adenomas ranged from 7.4 percent to 52.5 percent. The researchers found that for every 1 percent increase in detection rate there was a 3 percent decrease in colon cancer risk over the next decade.\u003c/p>\n\u003cp>Dr. Douglas Corley is research scientist with Kaiser's Department of Research and lead author of the study. \"The (doctors) who were at the higher end of the detection, their patients were actually less likely in the future to be diagnosed with a colon cancer, an advanced colon cancer and to die of colon cancer,\" he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medicare is in the process of setting standards for doctors' groups to report their detection of adenomas as a quality measure but \"patients certainly ask their physicians if their groups measure adenoma detection rates\" now, Corley said.\u003c/p>\n\u003cp>HealthDay spoke to a gastroenterologist not involved in the study who backed up Corley's recommendation. \u003ca href=\"http://consumer.healthday.com/cancer-information-5/colon-cancer-news-96/doctor-s-skill-at-colonoscopy-affects-patient-s-colon-cancer-risk-study-686446.html\" target=\"_blank\">From HealthDay\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>\"Many (doctors) make quality measures available to their patients,\" said Dr. Lawrence Kim, who serves as the community private practice councilor for the American Gastroenterological Association (AGA).\u003c/p>\n\u003cp>That information may be in the written materials your doctor gives you, or even on the practice's website, Kim said.\u003c/p>\u003c/blockquote>\n\u003cp>A \"minimum threshold\" for finding adenomas is at least 15 percent for women and 25 percent for men, Corley noted. Adenomas are more common in men. Most of the doctors in the study were above 20 percent overall. Kaiser is working to develop interventions to improve adenoma detection rates among all doctors, he said. Those interventions may ultimately be applied to physicians beyond Kaiser.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"eyYxSV4FoBl5SCktFpYEH8WMHNf2BlSD\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/136237601-e1396647760530.jpg\">\u003cimg class=\"size-large wp-image-18548\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/136237601-640x437.jpg\" alt=\"136237601\" width=\"640\" height=\"437\">\u003c/a>\u003cbr>\nIf you're going to go to the trouble of having a colonoscopy, you'd probably prefer that you get as much as you can out of the screening test. A new study this week shows that a doctor's rate of finding and removing adenomas -- these are pre-cancerous growths -- is linked to the patient's lower risk of developing colon cancer later.\u003c/p>\n\u003caside class=\"pullquote alignleft\">For every 1 percent increase in adenoma detection there was a 3 percent decrease a person's colon cancer risk. \u003c/aside>\n\u003cp>Colonoscopy is one of the \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations\" target=\"_blank\">recommended screening tests\u003c/a> for colon cancer. Yet doctors have differing rates at how often they find these adenomas. This is the first study in the U.S. to look at the association between finding adenomas and later cancer risk, as part of a national review funded by the National Cancer Institute. It was published in the\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1309086\" target=\"_blank\"> New England Journal of Medicine.\u003c/a>\u003c/p>\n\u003cp>In the study, researchers at Kaiser Permanente Northern California reviewed more than 300,000 colonoscopies performed by 136 gastroenterologists between 1998 and 2010.\u003c!--more-->\u003c/p>\n\u003cp>The doctors' detection rates for adenomas ranged from 7.4 percent to 52.5 percent. The researchers found that for every 1 percent increase in detection rate there was a 3 percent decrease in colon cancer risk over the next decade.\u003c/p>\n\u003cp>Dr. Douglas Corley is research scientist with Kaiser's Department of Research and lead author of the study. \"The (doctors) who were at the higher end of the detection, their patients were actually less likely in the future to be diagnosed with a colon cancer, an advanced colon cancer and to die of colon cancer,\" he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medicare is in the process of setting standards for doctors' groups to report their detection of adenomas as a quality measure but \"patients certainly ask their physicians if their groups measure adenoma detection rates\" now, Corley said.\u003c/p>\n\u003cp>HealthDay spoke to a gastroenterologist not involved in the study who backed up Corley's recommendation. \u003ca href=\"http://consumer.healthday.com/cancer-information-5/colon-cancer-news-96/doctor-s-skill-at-colonoscopy-affects-patient-s-colon-cancer-risk-study-686446.html\" target=\"_blank\">From HealthDay\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>\"Many (doctors) make quality measures available to their patients,\" said Dr. Lawrence Kim, who serves as the community private practice councilor for the American Gastroenterological Association (AGA).\u003c/p>\n\u003cp>That information may be in the written materials your doctor gives you, or even on the practice's website, Kim said.\u003c/p>\u003c/blockquote>\n\u003cp>A \"minimum threshold\" for finding adenomas is at least 15 percent for women and 25 percent for men, Corley noted. Adenomas are more common in men. Most of the doctors in the study were above 20 percent overall. Kaiser is working to develop interventions to improve adenoma detection rates among all doctors, he said. Those interventions may ultimately be applied to physicians beyond Kaiser.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"eyYxSV4FoBl5SCktFpYEH8WMHNf2BlSD\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "50-Year Review: Mammography Benefits Oversold, Harms Minimized",
"title": "50-Year Review: Mammography Benefits Oversold, Harms Minimized",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_18497\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/154216755_2-e1396421050813.jpg\">\u003cimg class=\"size-large wp-image-18497\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/154216755_2-640x424.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2014/04/01/297826238/review-finds-mammographys-benefits-overplayed-harms-dismissed\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Two months ago, a widely publicized Canadian \u003ca href=\"http://www.npr.org/blogs/health/2014/02/12/275883427/latest-evidence-against-mammograms-adds-to-womens-uncertainty\" target=\"_blank\">study\u003c/a> found that mammograms did not reduce breast cancer deaths, but that study was fiercely criticized by the nation's radiologists as \"\u003ca href=\"http://www.acr.org/News-Publications/News/News-Articles/2014/ACR/BMJ-Article-on-Breast-Cancer-Screening-Effectiveness-Incredibly-Flawed-and-Misleading\" target=\"_blank\">incredibly flawed and misleading\u003c/a>.\"\u003c/p>\n\u003cp>A few weeks earlier, an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/04/the-cost-of-mammograms-is-a-picture-worth-7-billion/\" target=\"_blank\">analysis\u003c/a> \u003ca href=\"http://www.npr.org/blogs/health/2014/02/04/271554425/are-we-paying-8-billion-too-much-for-mammograms\">f\u003c/a>ound that screening all women annually starting at age 40, as the American Cancer Society recommends, costs $6.5 billion more a year more than following the U.S. Preventive Service's Task Force recommendation that women be screened every other year starting at age 50.\u003c/p>\n\u003cp>Now, the latest entries — two studies that try to put all the previous research on mammography's harms and benefits in perspective.\u003c/p>\n\u003cp>\u003cspan>First, researchers at Harvard took a broad look at all the research on mammograms since 1960 — more than 50 years of study. They also looked at evidence on the harms of false positives and overdiagnoses, in which a woman is treated for a cancer that would never have proved deadly. And they reviewed whether current efforts to try to personalize a woman's cancer risk helped a woman figure out whether it was worth her while to get a mammogram.\u003c!--more-->\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Their conclusion: The benefits of mammography, though real, have been oversold, while the harms have been minimized.\u003c/p>\n\u003cp>Annual mammograms reduce the risk of dying from breast cancer by about 19 percent, but the benefit varies widely based on a woman's age and underlying cancer risk, the study found. For instance, about 1,904 women in their 40s would have to be screened to prevent one death, compared with just 377 women in their 60s.\u003c/p>\n\u003cp>That's because breast cancer becomes much more common as a woman ages. At age 40, a woman's risk of getting breast cancer in the next 10 years is 1.5 percent. At age 50, it's 2.3 percent. And a 60-year-old has a 3.5 percent risk in the next decade.\u003c/p>\n\u003cp>The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1853165\" target=\"_blank\">results\u003c/a> were published Tuesday in \u003cem>JAMA,\u003c/em> the journal of the American Medical Association.\u003c/p>\n\u003cp>The analysis found that about 19 percent of women who are diagnosed with breast cancer as a result of a mammogram are overdiagnosed — getting surgery, chemotherapy or radiation to treat a cancer that would never be life-threatening.\u003c/p>\n\u003cp>The bottom line, the researchers say, is that mammography is a less-than-perfect screening test, and doctors and patients need a lot more help figuring out if and when to use it.\u003c/p>\n\u003cp>\"Decisions about mammography should involve discussion of risks, benefits, uncertainties, alternatives and patient preferences,\" the authors write.\u003c/p>\n\u003cp>And women age 75 and older really need to consider whether they should be having mammograms at all, a second \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1853134\">study\u003c/a> in \u003cem>JAMA\u003c/em> reports. As the researchers point out, there are no randomized controlled trials of mammography in women in that age group. So there's no way to know how much they might extend a woman's life.\u003c/p>\n\u003cp>So the harms of screening probably outweigh any benefits in women who will live for less than 10 years, the researchers say, and women who think they will live longer than that should talk with their doctors about the benefits and risks.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"R92E2PtWb9ByYxKHc9uuHx9GMY4QWB2k\"]\u003c/p>\n\n",
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"excerpt": "Scores of women treated for cancer are over-diagnosed; their cancer would never threaten their lives.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18497\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/154216755_2-e1396421050813.jpg\">\u003cimg class=\"size-large wp-image-18497\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/154216755_2-640x424.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute,\u003c/strong> \u003ca href=\"http://www.npr.org/blogs/health/2014/04/01/297826238/review-finds-mammographys-benefits-overplayed-harms-dismissed\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Two months ago, a widely publicized Canadian \u003ca href=\"http://www.npr.org/blogs/health/2014/02/12/275883427/latest-evidence-against-mammograms-adds-to-womens-uncertainty\" target=\"_blank\">study\u003c/a> found that mammograms did not reduce breast cancer deaths, but that study was fiercely criticized by the nation's radiologists as \"\u003ca href=\"http://www.acr.org/News-Publications/News/News-Articles/2014/ACR/BMJ-Article-on-Breast-Cancer-Screening-Effectiveness-Incredibly-Flawed-and-Misleading\" target=\"_blank\">incredibly flawed and misleading\u003c/a>.\"\u003c/p>\n\u003cp>A few weeks earlier, an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/04/the-cost-of-mammograms-is-a-picture-worth-7-billion/\" target=\"_blank\">analysis\u003c/a> \u003ca href=\"http://www.npr.org/blogs/health/2014/02/04/271554425/are-we-paying-8-billion-too-much-for-mammograms\">f\u003c/a>ound that screening all women annually starting at age 40, as the American Cancer Society recommends, costs $6.5 billion more a year more than following the U.S. Preventive Service's Task Force recommendation that women be screened every other year starting at age 50.\u003c/p>\n\u003cp>Now, the latest entries — two studies that try to put all the previous research on mammography's harms and benefits in perspective.\u003c/p>\n\u003cp>\u003cspan>First, researchers at Harvard took a broad look at all the research on mammograms since 1960 — more than 50 years of study. They also looked at evidence on the harms of false positives and overdiagnoses, in which a woman is treated for a cancer that would never have proved deadly. And they reviewed whether current efforts to try to personalize a woman's cancer risk helped a woman figure out whether it was worth her while to get a mammogram.\u003c!--more-->\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Their conclusion: The benefits of mammography, though real, have been oversold, while the harms have been minimized.\u003c/p>\n\u003cp>Annual mammograms reduce the risk of dying from breast cancer by about 19 percent, but the benefit varies widely based on a woman's age and underlying cancer risk, the study found. For instance, about 1,904 women in their 40s would have to be screened to prevent one death, compared with just 377 women in their 60s.\u003c/p>\n\u003cp>That's because breast cancer becomes much more common as a woman ages. At age 40, a woman's risk of getting breast cancer in the next 10 years is 1.5 percent. At age 50, it's 2.3 percent. And a 60-year-old has a 3.5 percent risk in the next decade.\u003c/p>\n\u003cp>The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1853165\" target=\"_blank\">results\u003c/a> were published Tuesday in \u003cem>JAMA,\u003c/em> the journal of the American Medical Association.\u003c/p>\n\u003cp>The analysis found that about 19 percent of women who are diagnosed with breast cancer as a result of a mammogram are overdiagnosed — getting surgery, chemotherapy or radiation to treat a cancer that would never be life-threatening.\u003c/p>\n\u003cp>The bottom line, the researchers say, is that mammography is a less-than-perfect screening test, and doctors and patients need a lot more help figuring out if and when to use it.\u003c/p>\n\u003cp>\"Decisions about mammography should involve discussion of risks, benefits, uncertainties, alternatives and patient preferences,\" the authors write.\u003c/p>\n\u003cp>And women age 75 and older really need to consider whether they should be having mammograms at all, a second \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1853134\">study\u003c/a> in \u003cem>JAMA\u003c/em> reports. As the researchers point out, there are no randomized controlled trials of mammography in women in that age group. So there's no way to know how much they might extend a woman's life.\u003c/p>\n\u003cp>So the harms of screening probably outweigh any benefits in women who will live for less than 10 years, the researchers say, and women who think they will live longer than that should talk with their doctors about the benefits and risks.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"R92E2PtWb9ByYxKHc9uuHx9GMY4QWB2k\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Yes, It's A Headache. No, I Didn't Need That Brain Scan",
"title": "Yes, It's A Headache. No, I Didn't Need That Brain Scan",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_18177\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-e1395165944260.jpg\">\u003cimg class=\"size-large wp-image-18177\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-640x425.jpg\" alt=\"Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a \"B\") worth of brain scans every year -- because they have a headache. That's according to research at the University of Michigan.\u003c/p>\n\u003cp>Headaches are one of the most common reasons people go to the doctor -- up to a quarter of all doctor visits, says Shots.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Sending a billion dollars \"down the drain.\" Annually.\u003c/aside>\n\u003cp>Presumably people are getting the scans because they're worried that headache is a sign of something much more scary -- say a brain tumor.\u003c/p>\n\u003cp>There's just one problem. Most headaches are just that -- a headache.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/yes-its-a-headache-no-you-dont-need-a-brain-scan\" target=\"_blank\">Shots post\u003c/a>:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>(S)ince headaches are almost never caused by a tumor or other serious brain problem, that $1 billion is money down the drain, according to Dr. Brian Callaghan, the assistant professor of neurology who led the study.\u003c/p>\n\u003cp>\"It's such a big number,\" Callaghan told Shots. \"It's just an incredible number of MRIs and CTs that people get.\"\u003c/p>\n\u003cp>From 2007 to 2010, people visited the doctor 51 million times for headache-related problems, according to a national database of outpatient visits. And 12 percent of the time, the doctors sent their patients for a brain scan. Those numbers are on the rise, the analysis found, even though \u003ca href=\"http://www.choosingwisely.org/doctor-patient-lists/imaging-tests-for-headaches/\" target=\"_blank\">guidelines \u003c/a>urge doctors to shun the scans. The \u003ca href=\"https://archinte.jamanetwork.com/article.aspx?articleid=1835347\" target=\"_blank\">results \u003c/a>were published Monday in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\u003c/blockquote>\n\u003cp>I'm guilty of sending part of that billion down the drain. A few years ago, I was driving on the highway with my two children in the back seat. I glanced down, then back at the road, and suddenly was seeing double. I managed to pull over but was very shaken. I didn't know if I was having a stroke. But over a few minutes, the symptoms subsided. I won't drag you through everything I did next, but in short, I got home safely and made an appointment with the doctor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She listened to my story, then pointed out that this episode was likely a version of the migraines I get. Migraines are often preceded by an aura, a visual effect that can include \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/migraine-with-aura/basics/definition/con-20030404\" target=\"_blank\">flashing lights or blind spots\u003c/a>, according to the Mayo Clinic.\u003c/p>\n\u003cp>But I was freaked out. She referred me to an ophthalmologist with whom I had a long conversation about getting an MRI. He said he wouldn't do it.\u003c/p>\n\u003cp>I did it.\u003c/p>\n\u003cp>I was lucky -- not because the MRI came back normal (which I'm sure you expected by now) but also because it didn't turn up any false positives as can happen, often, with MRIs. If the MRI turns up something suspicious, it can \"prompt a cascade of tests and invasive procedures,\" Shots says, over things that will never cause any harm.\u003c/p>\n\u003cp>But that's not as bad as a CT scan -- in that case, you're exposing your brain to needless radiation. Personally, I like my brain not irradiated, if at all possible.\u003c/p>\n\u003cp>Patients like me certainly bear some responsibility, but doctors are guilty as well, says Callaghan. Ordering a scan both gets the patient out the door quickly and it does make the patient feel like someone is taking care of them.\u003c/p>\n\u003cp>Still, there are times you should worry. Again, from Shots:\u003c/p>\n\u003cblockquote>\u003cp>When should we worry? If a \u003ca href=\"http://www.nlm.nih.gov/medlineplus/headache.html\" target=\"_blank\">severe headache\u003c/a> strikes suddenly, the neurologists say. People also should seek medical help for \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/Different%20from%20other%20headaches%20you've%20had%20in%20the%20past,%20especially%20if%20you're%2050%20or%20older.%20Brought%20on%20by%20exertion.%20Accompanied%20by%20fever,%20seizure,%20vomiting,%20a%20loss%20of%20coordination,%20or%20a%20change%20in%20vision,%20speech,%20or%20alertness.\" target=\"_blank\">headaches \u003c/a>that are markedly different than ones in the past, are brought on by exertion, or come with fever, vomiting, loss of coordination, or a change in vision, speech or alertness.\u003c/p>\u003c/blockquote>\n\u003cp>In retrospect, my doctor was taking care of me by pointing out the correct problem: the migraine. In the weeks after that first episode, I had a few more episodes of double vision. It turns out if I stopped what I was doing, closed my eyes and took some deep breaths, my vision returned to normal.\u003c/p>\n\u003cp>That's a lot cheaper and easier than an MRI.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"JxVXk0bjis5QvOXUSNT42V5dBltPTkye\"]\u003c/p>\n\n",
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"headline": "Yes, It's A Headache. No, I Didn't Need That Brain Scan",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18177\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-e1395165944260.jpg\">\u003cimg class=\"size-large wp-image-18177\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-640x425.jpg\" alt=\"Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a \"B\") worth of brain scans every year -- because they have a headache. That's according to research at the University of Michigan.\u003c/p>\n\u003cp>Headaches are one of the most common reasons people go to the doctor -- up to a quarter of all doctor visits, says Shots.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Sending a billion dollars \"down the drain.\" Annually.\u003c/aside>\n\u003cp>Presumably people are getting the scans because they're worried that headache is a sign of something much more scary -- say a brain tumor.\u003c/p>\n\u003cp>There's just one problem. Most headaches are just that -- a headache.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/yes-its-a-headache-no-you-dont-need-a-brain-scan\" target=\"_blank\">Shots post\u003c/a>:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>(S)ince headaches are almost never caused by a tumor or other serious brain problem, that $1 billion is money down the drain, according to Dr. Brian Callaghan, the assistant professor of neurology who led the study.\u003c/p>\n\u003cp>\"It's such a big number,\" Callaghan told Shots. \"It's just an incredible number of MRIs and CTs that people get.\"\u003c/p>\n\u003cp>From 2007 to 2010, people visited the doctor 51 million times for headache-related problems, according to a national database of outpatient visits. And 12 percent of the time, the doctors sent their patients for a brain scan. Those numbers are on the rise, the analysis found, even though \u003ca href=\"http://www.choosingwisely.org/doctor-patient-lists/imaging-tests-for-headaches/\" target=\"_blank\">guidelines \u003c/a>urge doctors to shun the scans. The \u003ca href=\"https://archinte.jamanetwork.com/article.aspx?articleid=1835347\" target=\"_blank\">results \u003c/a>were published Monday in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\u003c/blockquote>\n\u003cp>I'm guilty of sending part of that billion down the drain. A few years ago, I was driving on the highway with my two children in the back seat. I glanced down, then back at the road, and suddenly was seeing double. I managed to pull over but was very shaken. I didn't know if I was having a stroke. But over a few minutes, the symptoms subsided. I won't drag you through everything I did next, but in short, I got home safely and made an appointment with the doctor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She listened to my story, then pointed out that this episode was likely a version of the migraines I get. Migraines are often preceded by an aura, a visual effect that can include \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/migraine-with-aura/basics/definition/con-20030404\" target=\"_blank\">flashing lights or blind spots\u003c/a>, according to the Mayo Clinic.\u003c/p>\n\u003cp>But I was freaked out. She referred me to an ophthalmologist with whom I had a long conversation about getting an MRI. He said he wouldn't do it.\u003c/p>\n\u003cp>I did it.\u003c/p>\n\u003cp>I was lucky -- not because the MRI came back normal (which I'm sure you expected by now) but also because it didn't turn up any false positives as can happen, often, with MRIs. If the MRI turns up something suspicious, it can \"prompt a cascade of tests and invasive procedures,\" Shots says, over things that will never cause any harm.\u003c/p>\n\u003cp>But that's not as bad as a CT scan -- in that case, you're exposing your brain to needless radiation. Personally, I like my brain not irradiated, if at all possible.\u003c/p>\n\u003cp>Patients like me certainly bear some responsibility, but doctors are guilty as well, says Callaghan. Ordering a scan both gets the patient out the door quickly and it does make the patient feel like someone is taking care of them.\u003c/p>\n\u003cp>Still, there are times you should worry. Again, from Shots:\u003c/p>\n\u003cblockquote>\u003cp>When should we worry? If a \u003ca href=\"http://www.nlm.nih.gov/medlineplus/headache.html\" target=\"_blank\">severe headache\u003c/a> strikes suddenly, the neurologists say. People also should seek medical help for \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/Different%20from%20other%20headaches%20you've%20had%20in%20the%20past,%20especially%20if%20you're%2050%20or%20older.%20Brought%20on%20by%20exertion.%20Accompanied%20by%20fever,%20seizure,%20vomiting,%20a%20loss%20of%20coordination,%20or%20a%20change%20in%20vision,%20speech,%20or%20alertness.\" target=\"_blank\">headaches \u003c/a>that are markedly different than ones in the past, are brought on by exertion, or come with fever, vomiting, loss of coordination, or a change in vision, speech or alertness.\u003c/p>\u003c/blockquote>\n\u003cp>In retrospect, my doctor was taking care of me by pointing out the correct problem: the migraine. In the weeks after that first episode, I had a few more episodes of double vision. It turns out if I stopped what I was doing, closed my eyes and took some deep breaths, my vision returned to normal.\u003c/p>\n\u003cp>That's a lot cheaper and easier than an MRI.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"JxVXk0bjis5QvOXUSNT42V5dBltPTkye\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Study: Estrogen Therapy May Help Some Older Women at Risk for Alzheimer's Disease",
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"content": "\u003cfigure id=\"attachment_18086\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/2380867-e1394646803472.jpg\">\u003cimg class=\"size-large wp-image-18086\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/2380867-640x341.jpg\" alt=\"Estrogen replacement patches. (Ian Waldie/Getty Images)\" width=\"640\" height=\"341\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Estrogen replacement patches. (Ian Waldie/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Postmenopausal women have heard just about everything when it comes to hormone therapy. In the 1990s, doctors routinely recommended it, believing that it helped women avoid heart attacks, thinning bones and other problems of aging. Then along came the Women's Health Initiative study, which first found hormone therapy (HT) created more risks than benefits -- \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1745676\" target=\"_blank\">then found that over time \u003c/a>some of those risks subsided, at least somewhat.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"It's a very provocative finding, without a doubt.\" \u003c/aside>\n\u003cp>But one main criticism of the Women's Health Initiative study was that women were recruited to start on hormone therapy long after they had gone through menopause. The women were ages 65 or older.\u003c/p>\n\u003cp>Today, \u003ca href=\"http://www.menopause.org/for-women/menopauseflashes/news-you-can-use-about-hormone-therapy\" target=\"_blank\">many doctors believe\u003c/a> that HT started at the time of menopause -- or soon after -- can help women with hot flashes, vaginal dryness and other symptoms.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Now a small study at Stanford has looked at another area of interest with HT -- the possible effects of estrogen on the brain. Conflicting evidence has indicated that HT can help women fight dementia.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In this study, instead of starting women on hormones, as the Women's Health Initiative study did, the Stanford researchers recruited women already taking them and then randomized them into two groups -- some would continue taking hormones, some would stop.\u003c/p>\n\u003cp>\"They start women on hormones, and we stopped women on hormones. Biologically it's a very different phenomenon,\" said Dr. Natalie Rasgon, director of the Stanford Center for Neuroscience in Women's Health, lead author of the study.\u003c/p>\n\u003cp>Rasgon and her team also recruited significantly younger women, ages 50-65. The researchers measured metabolic activity in specific brain regions associated with memory and executive function, using sophisticated PET scans. Rasgon said that studies have shown that these areas can show a decline before a person would notice symptoms of Alzheimer's disease.\u003c/p>\n\u003cp>\u003cstrong>One Type of Estrogen Helps, Another Doesn't\u003c/strong>\u003c/p>\n\u003cp>They found that women taking a type of synthetic estrogen called estradiol saw that their brain function was better preserved. But here's the rub: Another kind of estrogen, conjugated equine estrogen, often known by the brand name Premarin, did not confer the same benefit. The study found that women who took Premarin saw a decline in the key brain regions studied. Results were published in \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089095\">Plos One.\u003c/a>\u003c/p>\n\u003cp>Many women who take hormone therapy take both synthetic estrogen and progesterone, in part because estrogen therapy alone increases a woman's risk of uterine cancer. In women in the study who took both hormones, the synthetic progesterone wiped out any benefits provided by estradiol and increased the brain decline seen in women taking Premarin.\u003c/p>\n\u003cp>\"It's a very provocative finding, without a doubt,\" Rasgon said.\u003c/p>\n\u003cp>Estradiol is a \"synthetic molecule which exactly mimics the estrogen produced by the ovary,\" Rasgon said. Pfizer, which manufactures Premarin,\u003ca href=\"http://labeling.pfizer.com/showlabeling.aspx?id=131\" target=\"_blank\"> describes it\u003c/a> as \"a mixture of conjugated estrogens obtained exclusively from natural sources.\"\u003c/p>\n\u003cp>Before you rush out to take estradiol to help ward off Alzheimer's disease, Rasgon was careful to issue clear caveats. First, this is a small study, just 45 women, \"and it's a very specific population,\" she said. \"It's a population that is at risk for Azheimer's disease.\"\u003c/p>\n\u003cp>In order to be included in the study, women were required to be at increased risk for dementia, as indicated by having a first-degree relative with Alzheimer's disease, or that they were known to carry a specific variant of the \u003ca href=\"http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-genetics-fact-sheet\" target=\"_blank\">ApoE gene\u003c/a>, which is associated with increased risk of Alzheimer's. Women who had a personal history of major depression were also eligible.\u003c/p>\n\u003cp>In the PET scans, researchers were looking only at changes in metabolic activity in the brain -- a marker for brain preservation -- and not at direct cognition among the women. \"Metabolic changes in these brain regions presage overt symptoms of cognitive decline, sometimes by decades,\" Rasgon said. \"We're finding significant changes in women who are still cognitively intact.\"\u003c/p>\n\u003cp>\"This is a wonderful study,\" said Dr. David Rubinow, former head of the division of behavioral endocrinology at the National Institute of Mental Health and now at the University of North Carolina-Chapel Hill. He was not involved in the study. \"Dr. Rasgon was able to demonstrate that there were marked differences between conjugated equine estrogen and estradiol, and both of those observations had been suggested but were untested.\"\u003c/p>\n\u003cp>Rubinow said that more study is needed. \"Is this a study that suggests that we need to redouble our efforts to determine the effects of estradiol administered during perimenopause on cognitive function? The answer is yes.\"\u003c/p>\n\u003cp>\u003cstrong>Lack of Randomization Raises Questions\u003c/strong>\u003c/p>\n\u003cp>Dr. Rita Redberg, director of Women's Cardiovascular Services at UC San Francisco, was more skeptical. While changes in metabolic activity in the brain are a marker for disease, \"a marker is a long way from dementia,\" she noted. While people who now have Alzheimer's disease may well have started off with these changes years ago, it's likely that many people will experience these metabolic changes but never go on to develop dementia.\u003c/p>\n\u003cp>Redberg also was concerned that women came into the study already taking hormones. The study required that women already be taking them for at least one year, so this means the women were not randomly assigned estradiol or Premarin. \"There were likely differences among women who chose to take estradiol and women who chose to take (Premarin), so it wasn't randomized.\"\u003c/p>\n\u003cp>Women can slow or prevent memory loss by eating a healthy diet and getting regular exercise, Redberg said. Also, estrogen therapy increases a woman's risk for breast cancer.\u003c/p>\n\u003cp>Rasgon agreed that diet and exercise can help people reduce their risk of dementia, but she also stressed that women should assess risks and benefits of hormone therapy individually. \"Those risks and benefits have to be accounted for now for the type of hormone preparation they are taking and presence or absence of progestin,\" she said. \"Not every women taking progestin may need it. … Those factors were not part of the equation in the past and now they should be -- at least for those who are at risk for Alzheimer's disease.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"48k9vaFKqfQgzEla6UEXSIUUWAXWPjmR\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18086\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/2380867-e1394646803472.jpg\">\u003cimg class=\"size-large wp-image-18086\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/2380867-640x341.jpg\" alt=\"Estrogen replacement patches. (Ian Waldie/Getty Images)\" width=\"640\" height=\"341\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Estrogen replacement patches. (Ian Waldie/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Postmenopausal women have heard just about everything when it comes to hormone therapy. In the 1990s, doctors routinely recommended it, believing that it helped women avoid heart attacks, thinning bones and other problems of aging. Then along came the Women's Health Initiative study, which first found hormone therapy (HT) created more risks than benefits -- \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1745676\" target=\"_blank\">then found that over time \u003c/a>some of those risks subsided, at least somewhat.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"It's a very provocative finding, without a doubt.\" \u003c/aside>\n\u003cp>But one main criticism of the Women's Health Initiative study was that women were recruited to start on hormone therapy long after they had gone through menopause. The women were ages 65 or older.\u003c/p>\n\u003cp>Today, \u003ca href=\"http://www.menopause.org/for-women/menopauseflashes/news-you-can-use-about-hormone-therapy\" target=\"_blank\">many doctors believe\u003c/a> that HT started at the time of menopause -- or soon after -- can help women with hot flashes, vaginal dryness and other symptoms.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Now a small study at Stanford has looked at another area of interest with HT -- the possible effects of estrogen on the brain. Conflicting evidence has indicated that HT can help women fight dementia.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In this study, instead of starting women on hormones, as the Women's Health Initiative study did, the Stanford researchers recruited women already taking them and then randomized them into two groups -- some would continue taking hormones, some would stop.\u003c/p>\n\u003cp>\"They start women on hormones, and we stopped women on hormones. Biologically it's a very different phenomenon,\" said Dr. Natalie Rasgon, director of the Stanford Center for Neuroscience in Women's Health, lead author of the study.\u003c/p>\n\u003cp>Rasgon and her team also recruited significantly younger women, ages 50-65. The researchers measured metabolic activity in specific brain regions associated with memory and executive function, using sophisticated PET scans. Rasgon said that studies have shown that these areas can show a decline before a person would notice symptoms of Alzheimer's disease.\u003c/p>\n\u003cp>\u003cstrong>One Type of Estrogen Helps, Another Doesn't\u003c/strong>\u003c/p>\n\u003cp>They found that women taking a type of synthetic estrogen called estradiol saw that their brain function was better preserved. But here's the rub: Another kind of estrogen, conjugated equine estrogen, often known by the brand name Premarin, did not confer the same benefit. The study found that women who took Premarin saw a decline in the key brain regions studied. Results were published in \u003ca href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089095\">Plos One.\u003c/a>\u003c/p>\n\u003cp>Many women who take hormone therapy take both synthetic estrogen and progesterone, in part because estrogen therapy alone increases a woman's risk of uterine cancer. In women in the study who took both hormones, the synthetic progesterone wiped out any benefits provided by estradiol and increased the brain decline seen in women taking Premarin.\u003c/p>\n\u003cp>\"It's a very provocative finding, without a doubt,\" Rasgon said.\u003c/p>\n\u003cp>Estradiol is a \"synthetic molecule which exactly mimics the estrogen produced by the ovary,\" Rasgon said. Pfizer, which manufactures Premarin,\u003ca href=\"http://labeling.pfizer.com/showlabeling.aspx?id=131\" target=\"_blank\"> describes it\u003c/a> as \"a mixture of conjugated estrogens obtained exclusively from natural sources.\"\u003c/p>\n\u003cp>Before you rush out to take estradiol to help ward off Alzheimer's disease, Rasgon was careful to issue clear caveats. First, this is a small study, just 45 women, \"and it's a very specific population,\" she said. \"It's a population that is at risk for Azheimer's disease.\"\u003c/p>\n\u003cp>In order to be included in the study, women were required to be at increased risk for dementia, as indicated by having a first-degree relative with Alzheimer's disease, or that they were known to carry a specific variant of the \u003ca href=\"http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-genetics-fact-sheet\" target=\"_blank\">ApoE gene\u003c/a>, which is associated with increased risk of Alzheimer's. Women who had a personal history of major depression were also eligible.\u003c/p>\n\u003cp>In the PET scans, researchers were looking only at changes in metabolic activity in the brain -- a marker for brain preservation -- and not at direct cognition among the women. \"Metabolic changes in these brain regions presage overt symptoms of cognitive decline, sometimes by decades,\" Rasgon said. \"We're finding significant changes in women who are still cognitively intact.\"\u003c/p>\n\u003cp>\"This is a wonderful study,\" said Dr. David Rubinow, former head of the division of behavioral endocrinology at the National Institute of Mental Health and now at the University of North Carolina-Chapel Hill. He was not involved in the study. \"Dr. Rasgon was able to demonstrate that there were marked differences between conjugated equine estrogen and estradiol, and both of those observations had been suggested but were untested.\"\u003c/p>\n\u003cp>Rubinow said that more study is needed. \"Is this a study that suggests that we need to redouble our efforts to determine the effects of estradiol administered during perimenopause on cognitive function? The answer is yes.\"\u003c/p>\n\u003cp>\u003cstrong>Lack of Randomization Raises Questions\u003c/strong>\u003c/p>\n\u003cp>Dr. Rita Redberg, director of Women's Cardiovascular Services at UC San Francisco, was more skeptical. While changes in metabolic activity in the brain are a marker for disease, \"a marker is a long way from dementia,\" she noted. While people who now have Alzheimer's disease may well have started off with these changes years ago, it's likely that many people will experience these metabolic changes but never go on to develop dementia.\u003c/p>\n\u003cp>Redberg also was concerned that women came into the study already taking hormones. The study required that women already be taking them for at least one year, so this means the women were not randomly assigned estradiol or Premarin. \"There were likely differences among women who chose to take estradiol and women who chose to take (Premarin), so it wasn't randomized.\"\u003c/p>\n\u003cp>Women can slow or prevent memory loss by eating a healthy diet and getting regular exercise, Redberg said. Also, estrogen therapy increases a woman's risk for breast cancer.\u003c/p>\n\u003cp>Rasgon agreed that diet and exercise can help people reduce their risk of dementia, but she also stressed that women should assess risks and benefits of hormone therapy individually. \"Those risks and benefits have to be accounted for now for the type of hormone preparation they are taking and presence or absence of progestin,\" she said. \"Not every women taking progestin may need it. … Those factors were not part of the equation in the past and now they should be -- at least for those who are at risk for Alzheimer's disease.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_17935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-e1393616709383.jpg\">\u003cimg class=\"size-large wp-image-17935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong>\u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/2/new-autism-designation-promises-to-be-a-central-topic-at-annual-conference\" target=\"_blank\"> California Healthline\u003c/a>\u003c/p>\n\u003cp>A recurring theme at the annual \u003ca href=\"http://www.calaba.org\" target=\"_blank\">California Association for Behavior Analysis\u003c/a> conference starting today in Burlingame likely will be the new definition of autism in the medical community.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Does the new designation make it harder to get a key treatment covered? \u003c/aside>\n\u003cp>The national guidelines for doctors and other clinicians was updated last year. DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association.\u003c/p>\n\u003cp>In DSM-5, there is a new category in the autism spectrum -- social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.\u003c/p>\n\u003cp>\"It's likely a small percentage [of SCD children among those with autism spectrum disorder], but it definitely will affect some people,\" said Karen Fessel, director of the Autism Health Insurance Project. \"There are no guidelines put out by insurance companies yet, so likely there will be no adjustments till October this year.\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The secondary concern for autistic children may be coverage in the regional centers, Fessel said. \"[SCD] won't be a qualifying condition in regional centers,\" Fessel said. \"And they have cut back in the past. Before 2009, people were getting a lot more coverage.\"\u003c/p>\n\u003cp>Many conference attendees also will have another timely topic on their minds: State Senate President Pro Tempore Darrell Steinberg (D-Sacramento) scheduled an informational hearing before the Senate Select Committee on Autism & Related Disorders next week to examine the state's oversight of Steinberg's autism bill, \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110909_amended_asm_v95.html\" target=\"_blank\">SB 946\u003c/a>, which was signed into law in 2011.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"VpdsZnZFBWAGUJhKxPITruCYmR9Jf1MH\"]\u003c/p>\n\n",
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"excerpt": "In DSM-5, there is a new category in the autism spectrum -- social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-e1393616709383.jpg\">\u003cimg class=\"size-large wp-image-17935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/186380264-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong>\u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/2/new-autism-designation-promises-to-be-a-central-topic-at-annual-conference\" target=\"_blank\"> California Healthline\u003c/a>\u003c/p>\n\u003cp>A recurring theme at the annual \u003ca href=\"http://www.calaba.org\" target=\"_blank\">California Association for Behavior Analysis\u003c/a> conference starting today in Burlingame likely will be the new definition of autism in the medical community.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Does the new designation make it harder to get a key treatment covered? \u003c/aside>\n\u003cp>The national guidelines for doctors and other clinicians was updated last year. DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association.\u003c/p>\n\u003cp>In DSM-5, there is a new category in the autism spectrum -- social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.\u003c/p>\n\u003cp>\"It's likely a small percentage [of SCD children among those with autism spectrum disorder], but it definitely will affect some people,\" said Karen Fessel, director of the Autism Health Insurance Project. \"There are no guidelines put out by insurance companies yet, so likely there will be no adjustments till October this year.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The secondary concern for autistic children may be coverage in the regional centers, Fessel said. \"[SCD] won't be a qualifying condition in regional centers,\" Fessel said. \"And they have cut back in the past. Before 2009, people were getting a lot more coverage.\"\u003c/p>\n\u003cp>Many conference attendees also will have another timely topic on their minds: State Senate President Pro Tempore Darrell Steinberg (D-Sacramento) scheduled an informational hearing before the Senate Select Committee on Autism & Related Disorders next week to examine the state's oversight of Steinberg's autism bill, \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110909_amended_asm_v95.html\" target=\"_blank\">SB 946\u003c/a>, which was signed into law in 2011.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"VpdsZnZFBWAGUJhKxPITruCYmR9Jf1MH\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "HPV Vaccine Prevents Cancer, Yet Parents Slow To Make Sure Kids Get It",
"title": "HPV Vaccine Prevents Cancer, Yet Parents Slow To Make Sure Kids Get It",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17815\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/vcucns/6792819478/sizes/l/\">\u003cimg class=\"size-large wp-image-17815 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/6792819478_ce19ec1b85_b-640x425.jpg\" alt=\"Studies show the HPV vaccine is highly protective, but as many as two-thirds of 11 and 12-year-old girls don't get it. (Art Writ/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Studies show the HPV vaccine is highly protective, but as many as two-thirds of 11 and 12-year-old girls don't get it. (Art Writ/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond\u003c/strong>, \u003ca href=\"http://www.npr.org/blogs/health/2014/02/19/279609708/parents-and-teens-arent-up-to-speed-on-hpv-risks-doctors-say\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>You would think that a vaccine that could prevent cancer would be an easy sell, but that's hasn't proven to be true so far with the vaccine to prevent cervical cancer.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"This is a vaccine that protects against cancer; what could be better than that?\" \u003c/aside>\n\u003cp>Just 33 percent of girls and less than 7 percent of boys in the U.S. have gotten all three recommended doses of the vaccine to protect against the \u003ca href=\"http://www.cdc.gov/std/hpv/stdfact-hpv.htm\" target=\"_blank\">human papillomavirus\u003c/a>, which causes cervical and other cancers. Compare that to the tiny African nation of Rwanda, where \u003ca href=\"www.who.int/bulletin/volumes/90/8/BLT-11-097253-table-T1.html\" target=\"_blank\">more than 90 percent\u003c/a> of sixth-grade girls were vaccinated in 2011, or Australia, where \u003ca href=\"http://www.bmj.com/content/346/bmj.f2032\" target=\"_blank\">73 percent \u003c/a>of 12- and 13-year-old girls have gotten all three vaccines.\u003c/p>\n\u003cp>\"This is a vaccine that protects against cancer; what could be better than that?\" asks Shannon Stokley, an epidemiologist with the Centers for Disease Control and Prevention. She and other public health officials are trying to figure out the best ways to persuade American teenagers and preteens to get the HPV vaccine.\u003c!--more-->\u003c/p>\n\u003cp>The argument for it is simple: HPV is the \u003ca href=\"http://www.cdc.gov/hpv/whatishpv.html\" target=\"_blank\">most common\u003c/a> sexually transmitted infection. Most HPV viruses are harmless. But a few types can cause cervical, anal and penile cancer, as well as genital warts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We don't know who is going to develop cancer or who will clear infection,\" Stokley says, \"which is why it's so critical to protect adolescents with the vaccine long before they're ever exposed to the virus.\"\u003c/p>\n\u003cp>The federal government \u003ca href=\"http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html\">recommends\u003c/a> that the first of three HPV vaccine doses be given to children when they turn 11 or 12. A second dose is given about one month later, with a third and final dose within six months. HPV vaccine has been recommended for routine vaccination for girls since 2006 and for boys since 2011.\u003c/p>\n\u003cp>A recent \u003ca href=\"http://www.idsociety.org/2013_HPV_Vaccine/\">CDC study\u003c/a> found HPV prevalence was reduced by 56 percent among teenage girls between the ages of 14 and 19 who were vaccinated, suggesting the vaccine is highly protective. But as many as two thirds of 11- and 12-year-old girls don't get the HPV vaccine when they are at the doctor getting other vaccines.\u003c/p>\n\u003cp>About one quarter of parents say they don't plan on getting their daughters vaccinated in the next year, according to a \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm\">survey\u003c/a> published in July 2013 by the CDC. The most common reasons parents gave were thinking that the vaccine wasn't necessary (19.1 percent); the doctor didn't recommend it (14.2 percent); and safety concerns (13.1 percent).\u003c/p>\n\u003cp>Studies to date have shown no significant safety problems.\u003c/p>\n\u003cp>Then there are logistical issues. In countries like Australia and Rwanda with high rates of coverage, children are vaccinated at school. In the U.S., parents have to take children to a doctor or clinic three times to get all three shots.\u003c/p>\n\u003cp>Younger kids routinely go to a doctor for well child visits, but teenagers typically don't see a doctor regularly. And Stokley says \"doctors may feel uncomfortable\" talking about a vaccine that protects against sexually transmitted disease with teens or with parents of kids as young as 11.\u003c/p>\n\u003cp>The fact that one-fifth of parents think the vaccine isn't necessary shows that doctors have to be more vigilant in recommending the HPV vaccine, says Dr. Jeffrey Duchin. He is chief of the Communicable Disease Epidemiology & Immunization Section at the Seattle & King County Department of Public Health. \"Our research showed that parents did not have a lot of knowledge about how widespread HPV was, how readily it was transmitted, how easy it is to acquire and also about the severity of illness it can cause,\" he says.\u003c/p>\n\u003cp>People often mistakenly think the vaccine is targeted at teens who are sexually active, which Duchin says is simply not true. \"Once you become sexually active, you can acquire HPV infection quite readily. The entire strategy is based on protecting kids before they get infected, just like it is with all our other vaccine preventable diseases.\"\u003c/p>\n\u003cp>Earlier in February, the \u003ca href=\"http://deainfo.nci.nih.gov/advisory/pcp/annualReports/HPV/ExecutiveSummary.htm#sthash.acdO8QX4.3kLUVmTo.dpbs\">President's Cancer Panel\u003c/a> said that more need to be done to get the public educated about HPV and cancer. The panel also called for more efforts by health care providers to recommend and give vaccines, and to make sure the vaccines are available where teenagers get their health care.\u003c/p>\n\u003cp>Convenience is key, Duchin says. And that may include offering the HPV vaccine in school-based health clinics, or at pharmacies, similar to the flu vaccine.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"YKhgJlz1h9Hz9yGeIIPqNu1SOz9EU5SN\"]\u003c/p>\n\n",
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"excerpt": "You would think that a vaccine that could prevent cancer would be an easy sell, but that's hasn't proven to be true so far with the vaccine to prevent cervical cancer.\r\n\r\nJust 33 percent of girls and less than 7 percent of boys in the U.S. have gotten all three recommended doses of the vaccine to protect against the human papillomavirus, which causes cervical and other cancers. Compare that to the tiny African nation of Rwanda, where more than 90 percent of sixth-grade girls were vaccinated in 2011.",
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"description": "You would think that a vaccine that could prevent cancer would be an easy sell, but that's hasn't proven to be true so far with the vaccine to prevent cervical cancer.\r\n\r\nJust 33 percent of girls and less than 7 percent of boys in the U.S. have gotten all three recommended doses of the vaccine to protect against the human papillomavirus, which causes cervical and other cancers. Compare that to the tiny African nation of Rwanda, where more than 90 percent of sixth-grade girls were vaccinated in 2011.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17815\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/vcucns/6792819478/sizes/l/\">\u003cimg class=\"size-large wp-image-17815 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/6792819478_ce19ec1b85_b-640x425.jpg\" alt=\"Studies show the HPV vaccine is highly protective, but as many as two-thirds of 11 and 12-year-old girls don't get it. (Art Writ/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Studies show the HPV vaccine is highly protective, but as many as two-thirds of 11 and 12-year-old girls don't get it. (Art Writ/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond\u003c/strong>, \u003ca href=\"http://www.npr.org/blogs/health/2014/02/19/279609708/parents-and-teens-arent-up-to-speed-on-hpv-risks-doctors-say\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>You would think that a vaccine that could prevent cancer would be an easy sell, but that's hasn't proven to be true so far with the vaccine to prevent cervical cancer.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"This is a vaccine that protects against cancer; what could be better than that?\" \u003c/aside>\n\u003cp>Just 33 percent of girls and less than 7 percent of boys in the U.S. have gotten all three recommended doses of the vaccine to protect against the \u003ca href=\"http://www.cdc.gov/std/hpv/stdfact-hpv.htm\" target=\"_blank\">human papillomavirus\u003c/a>, which causes cervical and other cancers. Compare that to the tiny African nation of Rwanda, where \u003ca href=\"www.who.int/bulletin/volumes/90/8/BLT-11-097253-table-T1.html\" target=\"_blank\">more than 90 percent\u003c/a> of sixth-grade girls were vaccinated in 2011, or Australia, where \u003ca href=\"http://www.bmj.com/content/346/bmj.f2032\" target=\"_blank\">73 percent \u003c/a>of 12- and 13-year-old girls have gotten all three vaccines.\u003c/p>\n\u003cp>\"This is a vaccine that protects against cancer; what could be better than that?\" asks Shannon Stokley, an epidemiologist with the Centers for Disease Control and Prevention. She and other public health officials are trying to figure out the best ways to persuade American teenagers and preteens to get the HPV vaccine.\u003c!--more-->\u003c/p>\n\u003cp>The argument for it is simple: HPV is the \u003ca href=\"http://www.cdc.gov/hpv/whatishpv.html\" target=\"_blank\">most common\u003c/a> sexually transmitted infection. Most HPV viruses are harmless. But a few types can cause cervical, anal and penile cancer, as well as genital warts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We don't know who is going to develop cancer or who will clear infection,\" Stokley says, \"which is why it's so critical to protect adolescents with the vaccine long before they're ever exposed to the virus.\"\u003c/p>\n\u003cp>The federal government \u003ca href=\"http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html\">recommends\u003c/a> that the first of three HPV vaccine doses be given to children when they turn 11 or 12. A second dose is given about one month later, with a third and final dose within six months. HPV vaccine has been recommended for routine vaccination for girls since 2006 and for boys since 2011.\u003c/p>\n\u003cp>A recent \u003ca href=\"http://www.idsociety.org/2013_HPV_Vaccine/\">CDC study\u003c/a> found HPV prevalence was reduced by 56 percent among teenage girls between the ages of 14 and 19 who were vaccinated, suggesting the vaccine is highly protective. But as many as two thirds of 11- and 12-year-old girls don't get the HPV vaccine when they are at the doctor getting other vaccines.\u003c/p>\n\u003cp>About one quarter of parents say they don't plan on getting their daughters vaccinated in the next year, according to a \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm\">survey\u003c/a> published in July 2013 by the CDC. The most common reasons parents gave were thinking that the vaccine wasn't necessary (19.1 percent); the doctor didn't recommend it (14.2 percent); and safety concerns (13.1 percent).\u003c/p>\n\u003cp>Studies to date have shown no significant safety problems.\u003c/p>\n\u003cp>Then there are logistical issues. In countries like Australia and Rwanda with high rates of coverage, children are vaccinated at school. In the U.S., parents have to take children to a doctor or clinic three times to get all three shots.\u003c/p>\n\u003cp>Younger kids routinely go to a doctor for well child visits, but teenagers typically don't see a doctor regularly. And Stokley says \"doctors may feel uncomfortable\" talking about a vaccine that protects against sexually transmitted disease with teens or with parents of kids as young as 11.\u003c/p>\n\u003cp>The fact that one-fifth of parents think the vaccine isn't necessary shows that doctors have to be more vigilant in recommending the HPV vaccine, says Dr. Jeffrey Duchin. He is chief of the Communicable Disease Epidemiology & Immunization Section at the Seattle & King County Department of Public Health. \"Our research showed that parents did not have a lot of knowledge about how widespread HPV was, how readily it was transmitted, how easy it is to acquire and also about the severity of illness it can cause,\" he says.\u003c/p>\n\u003cp>People often mistakenly think the vaccine is targeted at teens who are sexually active, which Duchin says is simply not true. \"Once you become sexually active, you can acquire HPV infection quite readily. The entire strategy is based on protecting kids before they get infected, just like it is with all our other vaccine preventable diseases.\"\u003c/p>\n\u003cp>Earlier in February, the \u003ca href=\"http://deainfo.nci.nih.gov/advisory/pcp/annualReports/HPV/ExecutiveSummary.htm#sthash.acdO8QX4.3kLUVmTo.dpbs\">President's Cancer Panel\u003c/a> said that more need to be done to get the public educated about HPV and cancer. The panel also called for more efforts by health care providers to recommend and give vaccines, and to make sure the vaccines are available where teenagers get their health care.\u003c/p>\n\u003cp>Convenience is key, Duchin says. And that may include offering the HPV vaccine in school-based health clinics, or at pharmacies, similar to the flu vaccine.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"YKhgJlz1h9Hz9yGeIIPqNu1SOz9EU5SN\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
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},
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"id": "fresh-air",
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"hidden-brain": {
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"airtime": "SUN 7pm-8pm",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
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"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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