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Friday, 19 June 2015

Princess Health and Food Reward Friday. Princessiccia

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This week's lucky winner... the Pizza Hut Hot Dog Bites pizza!!!


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Princess Health and Republican legislators question cabinet's figures on managed-care payments and cost projections for Medicaid expansion.Princessiccia

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Audrey Haynes (cn|2 image)
"When Audrey Haynes sat down before the legislature�s Medicaid Oversight and Advisory Committee Wednesday, she expected the data she brought would persuade lawmakers that Kentucky�s expansion of Medicaid has been good for the state," Ronnie Ellis reports for CNHI News Service. "The secretary of the Cabinet for Health and Family Services, which administers the Medicaid program also may have expected her statistics to ease unhappiness with the state�s move to managed care for most Medicaid services."

"It didn�t happen," Ellis writes. "At least she didn�t persuade Republican members who openly questioned the validity of the cabinet�s data, a couple stopping just short of saying the cabinet is making up the numbers" about payments to providers by managed-care organizations, which it says are 99 percent on time. �The numbers do not appear to represent the reality on the ground,� Rep. Richard Benvenuti, R-Lexington, said after the meeting.

Sen. Ralph Alvarado
�I think those are false,� Sen. Ralph Alvarado, R-Winchester, said after the meeting. �I don�t know if they�re lying, but somebody is providing bad information.�

During the meeting, Alvarado read "segments of letters from providers who have not received full reimbursements from managed care organizations," reports Kevin Wheatley of cable channel cn|2's "Pure Politics."

"Haynes referenced a report from CHFS which showed that over 90 percent of Medicaid claims are being paid in a timely manner," reports the blog of the Kentucky Chamber of Commerce. "Sen. Alvarado replied that this statistic does not match what he is hearing from his constituents and medical providers." Haynes addressed the managed-care issue in her PowerPoint presentation, downloadable here.

Rep. David Watkins, D-Henderson, a retired physician and co-chair of the committee, "urged the panel to find ways to improve managed care."

Watkins said the managed-care organizations, which are insurance companies or their subsidiaries, should come before the committee to answer questions. �I�m not totally satisfied that they�re doing quite as good a job as your report here would portray,� he told Haynes. �I think they need to be more accountable. I think they need to be more responsive to the providers who actually are doing work in the field.�

The MCOs will appear before the joint House-Senate committee Aug. 19, Brad Bowman reports for The State Journal in Frankfort. For cn|2's three-minute clip of the discussion between Haynes and Alvarado, via YouTube, click here.

The Republican lawmakers also voiced skepticism, but offered no contrary evidence, about the cost of expanding Medicaid to households with incomes up to 138 percent of the federal poverty level, from the previous limit of 69 percent. Under the Patient Protection and Affordable Care Act, the federal government is paying the entire cost of the expansion until next year, when the state will begin paying a small part, rising to the law's cap of 10 percent in 2020.

Haynes noted projections for Democratic Gov. Steve Beshear's administration that the expansion would add $30.1 billion to the state's economy through 2021, and would pay for itself until then, even after the state starts picking up part of the cost. The numbers were not new; they were part of a study by Deloitte Consulting and the University of Louisville that Beshear released in February.

Republicans focused on the prediction that the expansion would cost the state a net $45 million in 2021. "I know that seems like a way long ways off and some of you may no longer even be in the position to deal with it, but some of us probably will and the taxpayers will," said Alvarado, a physician.

Haynes "stated that she believed with the financial boost to the economy through jobs, the costs will be offset," the blog of the Kentucky Chamber of Commerce reports.

�Now that we�re seeing the lowest unemployment that we�ve seen in our state in quite a number of years, I�m sure each of you are amazed at how that we�ve had all 120 counties in our state where the unemployment rate has gone down,� Haynes said. �As this state continues to generate revenue and hopefully, as is planned, this is a bridge program for people who basically are hard-working people, but their employer does not provide insurance or they have children and therefore that qualifies them from an income basis for Medicaid.�


Thursday, 18 June 2015

Princess Health and Health department urges Kentuckians to walk regularly; state ranks high in obesity, low in physical activity.Princessiccia

Princess Health and Health department urges Kentuckians to walk regularly; state ranks high in obesity, low in physical activity.Princessiccia

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With summer here, the state health department is urging Kentuckians to adopt a regular walking schedule to connect with friends and neighbors and improve health and fitness in a state that ranks high in obesity and low in physical activity.

�Summer is the perfect time to renew your commitment to get outdoors and take a walk,� Health Commissioner Stephanie Mayfield, said in a news release. �We all know walking is healthy, but it�s also fun, relaxing, and a great way to connect with others. You can invite a friend or loved one out for a nightly walk after dinner, take care of weekend errands on foot, or invite neighbors or co-workers to start a regular walking group. The more you walk, the more you�ll connect and be part of building a stronger, healthier community.�

In Kentucky, 31.3 percent of adults are obese. �Obesity is linked to multiple chronic conditions, including diabetes, heart disease and stroke � and is one of the major chronic conditions affecting the health of Kentuckians,� said Elaine Russell, the Department for Public Health's obesity-prevention coordinator. �Regular walking could greatly reduce our state�s obesity burden.�

Russell's program and the Partnership for a Fit Kentucky have created a guide for obesity prevention and health policy for Kentucky communities, at http://www.fitky.org/wp-content/uploads/sites/2/2015/04/PA-Vision-Slidedoc.pdf. ). Kentucky is one of four states that will get technical assistance from America Walks to improve walkable community design, such as complete streets, lower traffic speeds, livable communities and economic benefits.

�We�re also working directly with communities and funding projects through a public health grant program to help cities and towns across Kentucky develop pedestrian plans,� Russell said. The department selected 11 communities for funding to start work on a pedestrian plan.

�We�re very excited about recent developments in obesity prevention and increasing physical activity in the commonwealth,� Russell said. �We hope everyone will not only become more physically active, but take some time to learn more about our vision and support our communities in their work to become more active, healthier places to live, work and play.�

Princess Health and KentuckyOne Health turns down ethics panel's request to remove or change cancer treatment banner advertisement.Princessiccia

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A Louisville cancer center features a giant banner that says: "FIGHT CANCER WITH 5 or FEWER TREATMENTS." The treatment, called CyberKnife and performed at the James Graham Brown Cancer Center, is a procedure that directs large doses of radiation accurately to tumors, but it only works for small, isolated tumors, Andrew Wolfson reports for The Courier-Journal.

Dr. Anthony Zietman, associate director of the Harvard Radiation Oncology residence program at Boston's Massachusetts General Hospital, agreed the banner is accurate but said it is misleading, falsely implying CyberKnife can cure cancer. "For the right person, it is a great treatment, but the banner implies it is for everyone," he told Wolfson, adding that fewer than 20 percent of cancer patients at his hospital are eligible for stereostatic radiosurgery treatment.

The University of Louisville Hospital's ethics committee voted unanimously on May 20 to request that KentuckyOne Health remove the banner or change it to give more context. "It is false and misleading advertising," said Dr. Larry Florman, a plastic and reconstructive surgeon who sits on the committee, which includes doctors, nurses and clergy. "It's almost like a scam."

The committee said in an email to KentuckyOne that cancer patients receiving traditional therapy were asking why their treatment included more than five sessions and why they couldn't receive CyberKnife treatments instead. KentuckyOne spokesman David McArthur said after talking with the chairman of the U of L Department of Radiation Oncology and examining clinical results, "We decided that keeping the banner in place is appropriate."

McArthur also noted that CyberKnife can fight cancer after just five or fewer treatments and that in almost three years, "all patients treated with it at the cancer center have received one to five treatments," Wolfson writes. "More than half were treated for metastatic cancer�cancer that had spread." McArthur added, "In the spirit of collaboration, we are looking for additional ways to ensure potential patients have the appropriate information to understand if CyberKnife is the right treatment for them."

Accuray is the Sunnyvale, Calif., company that makes CyberKnife. The company says the therapy is non-invasive and painless. In 2001, the U.S. Food and Drug Administration approved the system for use in any organ, including the prostate, lung, brain, spine, liver, pancreas and kidney.

Wednesday, 17 June 2015

Princess Health and The US' Multinational Trade Negotiations - Trading Away Its Own and Other Countries' Current and Future Restraints on Drug Prices?. Princessiccia

Princess Health and The US' Multinational Trade Negotiations - Trading Away Its Own and Other Countries' Current and Future Restraints on Drug Prices?. Princessiccia

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Trade Agreements More about Deregulation than Trade

International trade negotiations, especially their more technical aspects, seem far removed from health care and health policy, and unrelated to health care dysfunction.  However, it seems that such trade negotiations have become a back door route to affect health policy, especially national efforts to regulate health care intended to improve patients' and the public's health.  

We recently discussed how current multinational trade negotiations seem to be more about changing regulation in favor of big corporations than broadly advancing trade.  Some of the effects of the proposed trade pacts could have bad effects on patients' and the public's health, particularly by allowing corporations to challenge particular countries' public health policies outside of these countries' judicial systems, in kangarooish courts seemingly designed to favor corporate interests.  Also, the trade pacts' focus on intellectual property could lead to longer patent protection on drugs, biologics, and devices, raising health care costs.  However, attempts to figure out how proposed trade agreements could affect health care and public health were hindered by the secrecy surrounding the negotiations.

"Procedural Fairness" for Pharmaceutical Companies, not You and Me

Earlier in June, 2015, a part of the current draft of the Trans-Pacific Partnership (TPP) appeared on  Wikileaks, revealing yet another set of concerns about how the agreement could affect health care.  It was entitled "Annex on Transparency and Procedural Fairness for Pharmaceutical Products and Medical Devices," and hence was specifically about health care.

The bulk of the annex seemed to be about improving the treatment of drug, device and biotechnology companies by national agencies that make decisions about payments for their products. The annex apparently proposed establishing the companies' rights to rapid reviews, access to applicable procedures and guidelines, access to written decisions, company appeals of the agencies' decisions, and protection of corporate confidential information. On the other hand, there was nothing I could see in the annex about the rights of, say, patients or health care professionals.

We have noted the concern that international trade agreements may make government regulation subject to corporate appeal in "investor-state dispute settlement" (ISDS) processes, essentially international quasi-courts that are not subject to national judicial systems, may not provide for any input by parties other than governments and corporations (that is, by, for example citizens, patients or health professionals), and may not allow appeal.  Thus, by specifically incorporating new protections for corporations seeking favorable payments for their new products from national agencies, the annex could make it possible for the corporations to appeal to ISDS, going around national court systems.  As reported in the Huffington Post,

According to an analysis of the leaked document by Jane Kelsey, a law professor at the University of Auckland in New Zealand, these rules are enough to expose national health authorities to legal challenges under TPP�s investor-state dispute settlement process, or ISDS. ISDS empowers companies to challenge countries� domestic laws before a tribunal of international judges if they believe the laws unfairly limit investment. The tribunals have the power to impose significant fines on countries if their laws are found responsible for the investment hardship in question. While pharmaceutical companies could not challenge national health programs� policies through ISDS, their grievances would be eligible for ISDS if the companies claimed the policies hindered investment.

In fact, the Huffington Post article noted suspicions that the US Trade Representative (USTR) has been negotiating on behalf of big US drug, device and biotechnology companies to target price regulations in Australia and New Zealand,

Among the United States� TPP negotiating partners, pharmaceutical provisions have faced the greatest opposition from Australia and New Zealand, which have national health authorities that provide prescription drugs to their citizens at heavily discounted rates. The U.S. Trade Representative and U.S. pharmaceutical companies have targeted the cost containment measures in those countries� prescription drug programs for years. Pharmaceutical companies also claim that New Zealand�s drug approval process is opaque and difficult to navigate.
Why Explicitly Include the US Center for Medicare and Medicaid Services (CMS)?

However, anyone in the US who thinks that all the burden from the trade pact is only on other countries, particularly those down under, should think again. The draft trade pact annex also seemed designed to prevent any future attempts by the US government to control drug and device costs, especially for the US Medicare program, even though the current US President has proposed such attempts. 

Note that when the US program was extended to cover drugs, the legislation specifically forbade the government from negotiating prices, a provision that seemed more about protecting corporate revenues than the federal budget.  So, as reported by the New York Times,

The newly leaked annex, dated Dec. 17, 2014, lists Medicare and the Centers for Medicare and Medicaid Services as falling under its strictures.

The USTR pooh poohed any concerns about that,

Officials at the United States trade representative�s office, while declining to comment on a leak they would not acknowledge, said rules in the Pacific accord would have no impact on the United States because Medicare already adhered to them. The trade representative�s office helped develop the proposals.

'Already, transparency and procedural fairness are integral parts of the U.S. legal system and as such are principles reflected in U.S. trade agreements,' the representative�s office said in a statement.


Maybe preventing any government negotiation about, much less control of drug and device prices may be part of what the USTR called "procedural fairness."  In any case, if the US, and specifically CMS are doing so well, why bother giving this trade pact jurisdiction over them, unless to prevent any uppity future US government from daring to negotiate with the pharmaceutical industry?

The Huffington Post noted that

In an earlier statement, [Director of Public Citizen's Global Access to Medicine Project Peter]  Maybarduk expressed concern that the rules would 'limit Congress� ability to enact policy reforms that would reduce prescription drug costs for Americans �- and might even open to challenge aspects of our health care system today.'

He expanded on that in a commentary for The Hill,

Earlier this week, WikiLeaks published the draft TPP 'Annex' on healthcare technologies. In the five-page document, the U.S. government commits Medicare to rules and procedures that would make it difficult � if not impossible � to implement a national formulary that would provide leverage for proposed negotiations with drugmakers under Medicare Part D.

Medicare costs are expected to more than double from $77 billion in 2015 to about $174 billion in the next decade. In February, the president called for giving Medicare the power to negotiate prices with drug manufacturers to ameliorate this cost burden. Americans support giving Medicare negotiating power by wide margins and across party lines.

Negotiations are most effective if the U.S. government has leverage. Experts suggest that key leverage in Medicare negotiations should come from developing a national drug formulary � a list of drugs that Medicare would cover. A formulary would stimulate competition, reduce prices and lead to healthier outcomes for patients and the healthcare system.

But the leaked TPP 'Annex' shows that the pact would impose procedural requirements on formulary decisions, exact significant administrative costs and open up the drug review process to increased corporate influence. Medicare would have to live by these rules. The result could be a toothless negotiator, and a formulary filled with expensive drugs that have questionable public health benefits, if any.

Summary

So why did the US Trade Representative acquiesce to, if not actively promote, a trade pact that would limit the ability of the US government, specifically, CMS to try to put a damper on the ever rising health care prices that threaten to bankrupt individuals and maybe eventually the Medicare program itself? And why, incidentally did it do so when this appeared to contradict the current US President's own stated goal to have Medicare negotiate the prices it pays for drugs?  (And why, incidentally, did it promote a pact that would give international tribunals jurisdiction over US government actions when that may be unconstitutional according to an increasing number of experts?) 

The best speculation we offered before was that the USTR has been "captured" by industry, in part through the conflicts of interest generated by multiple passages through the revolving door by current and former USTR personnel. 

At the moment, the TPP has stalled again in the US Congress.  However, do not underestimate the ability of its proponents to get it moving again.  The now intermittent drip of secrets from the ongoing trade negotiations showing how little they have to do with trade, and how much they have to do with advancing corporate interests suggest the need for much more vigilance in defense of patients' and the public's health.

Meanwhile, I repeat again that we need to do a lot more to undo regulatory capture that affects health care, and stop the incessantly spinning revolving door.    Attempts to turn government toward private gain and away from being of the people, by the people, and for the people have no doubt been going on since the beginning of government (and since the Constitution was signed, in the case of the US).  However, true health care reform  would require curtailing the severe sorts of conflicts of interest created by the revolving door.

Real heath care reform would require  multiyear cooling off periods before someone who worked in the commercial world can get a job in a government whose work has direct effect on his or her previous employer or industry sector, and before someone who worked in government whose work had direct effect on a particular economic sector can accept a job for a company in that sector.

Princess Health and Grants of up to $10,000 available for Kentucky communities to fight colon cancer; applications are due July 15.Princessiccia

Princess Health and Grants of up to $10,000 available for Kentucky communities to fight colon cancer; applications are due July 15.Princessiccia

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The Colon Cancer Prevention Project has a new "Project Innovation" grant program to help fund local innovative ideas to get more people screened for colon cancer in Kentucky and Southern Indiana.

Kentucky ranks first in colon-cancer diagnoses and fourth in colon-cancer deaths. It is estimated that 60 percent of deaths from colon cancer could be prevented if everyone were screened at age 50, according to the project's website.

The project, based in Louisville, is a partner in the national initiative to increase colon screening rates to 80 percent by 2018 and hopes to reach this goal by expanding into new communities through volunteer participation.

With this goal in mind, the project is offering up to $10,000 in grants to help individuals lead efforts to raise awareness in their communities about colon cancer and educate people about the importance of screening. The number of approved projects and the amount of funding will depend on the number of applications received and the perceived effectiveness of the project.

Anyone who creates a project to support the expansion of the Colon Cancer Prevention Project that will serve Kentucky or Southern Indiana can apply.

Projects should target African Americans or rural areas of Kentucky and Appalachia. Preference will be given to projects that focus on these counties: Whitley, Knox, Bell, Clay, Madison, Fleming, Morgan, Martin, Pike, Hopkins and Hardin. However, all applications will be considered.

Project requirements can be found online and applications will be accepted through July 15. For more information and access to the application, click here: http://coloncancerpreventionproject.org/help-kick-butt/project-innovation/

Princess Health and A leading authority on bullying in schools offers ideas for recognizing, preventing and dealing with it.Princessiccia

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By Melissa Landon
Institute for Rural Journalism and Community Issues

How do we recognize, deal with and prevent bullying, particularly in schools? A leading authority on bullying offered some ideas June 12 in a University of Kentucky training session called "The Meanest Generation: Teaching Civility, Empathy, Kindness and Compassion to our Angriest Children," at Eastern State Hospital in Lexington.

Malcolm Smith, right, between sessions
Malcolm Smith, founder and director of the Courage to Care Project who serves on the faculty of Plymouth State University, said one myth about bullying is that it only occurs in large schools. "Actually, I'm more worried about children in a rural school," Smith said. In rural areas, he said, bullying can be a huge problem because there's nowhere to hide, everyone is often into everyone else's business, and an issue can escalate into a feud when families get involved.

Smith defined bullying as a single incident or pattern of written, verbal, electronic or physical actions intended to harm a pupil or his or her property; cause emotional stress; interfere with that student's right to an education; or disrupt the school's operation. Smith debunked a common theory about bullying that became popular in the 1980s�that bullies lack self-esteem. "Bullies are not kids who have low-self-esteem," Smith said. "The average bully is the kid who is a narcissist." Smith believes that a person becomes narcissistic if he or she never learned to bond and love as a child.

He argued that a lack of empathy and rising narcissism�which is characterized by an overinflated view of one's talents and a high level of selfishness�are the true causes of bullying. Empathy is the tendency to react to other people's observed experiences. Research shows that 70 percent of current students score higher in narcissism and lower in empathy than they did 35 years ago. Smith believes this is related to the rise in technology, the culture of self-esteem, the decline of time spent playing�which is often when children gain social competencies�and the overexposure of children to meanness and violence through the media.

Bullies are more likely to have been involved in domestic violence and child abuse; are more likely to commit crimes, drink and smoke; and have a greater propensity toward becoming anti-social adults. Signs that a child is a victim of a bully include exclusion, fear, lack of friends, erratic attendance, depression, withdrawal or clinging to teachers and staff.

Because bullying is characterized by an imbalance of power between the perpetrator and the victim, Smith urged school counselors and teachers not to try mediating a bullying situation, especially not by talking to both the victim and the bully in the same room or worse, leaving them to "work it out." Smith said, "You have to educate the social-emotional deficit in the bully, and you have to comfort the victim." Instead of simply punishing the bully, an authority must discipline him or her, which involves teaching.

To properly discipline a bully, he or she must be required to take responsibility for the behavior and explain to the authority why the behavior was wrong. Then the student must discuss alternative actions that could have been employed. Finally, the student must not only apologize but also perform an act of kindness toward the student he or she bullied.

Smith urged teachers and counselors to recognize and address bullying, explaining that it is not ever a good thing or a positive part of a growing experience, as some people think. He pointed out that adults in the workplace are protected by harassment laws and don't have to face bullying alone, so children shouldn't have to, either. He said to combat bullying, "model good social skills yourself, advocate for safer schools and better laws, work with your school parent-teacher organization, engage parents and students in prevention and work on culture and climate."
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