HEALTH TRAIN EXPRESS
Mission: To promulgate health education across the internet:
Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Health Train Express is usually focused upon matters of physical dimension, illness and wellness. In medicine we are taught early on about the importance of emotions and their effect on our sense of well-being and abilitiy to cope with illnesses.
During a typical clinical encounter with a patient a physician may spend 50-100% of the visit engaging with a patient verbally obtaining history, assessing affect, non-verbal commuinications, and cognitive status. Questions, answers, appropriateness are all features of an examination. The amount of time varies greatly between specialties, with psychiatry or psychology at the tpe and perhaps pathology at the lowest level of mindfulness. Those are extreme on the continuum of neuropsychiatric examination.
Mindfulness is a term that identifies the relationship of thought and the state of physical dimesnsion in humans.
With that thought in mind, I take you to Invisibiliahosted by NPR public radio. Invisibilia is a series about the invisible forces that shape human behavior. The show interweaves personal stories with scientific research that will make you see your own life differently.
We meet a woman with Mirror Touch Synesthesia who can physically feel what she sees others feeling. We also explore the ways in which all of us are connected — more literally than you might realize.
Obamacare Premiums In California May Rise 8 Percent Next Year, State Predicts
California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.
The projected rate increase in California, included in the exchange’s proposed annual budget, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces.
Any increases in California, a closely watched state in the health law rollout, are sure to draw intense scrutiny during a presidential election. Republicans are quick to seize on rate hikes as further proof that President Barack Obama’s signature law isn’t doing enough to hold down health care costs for the average consumer.
Insurers in California have submitted initial rates for 2017, but the final figures won’t be known until July after state officials conduct private negotiations.
Peter Lee, executive director of Covered California, underscored that the estimate was preliminary but said some one-time factors under the Affordable Care Act mean “2017 will be an adjustment year” for rates.
“We shouldn’t put too much focus on this 8 percent number when we will know the reality in two months,” Lee told California Healthline on Tuesday. “There are a number of reasons 2017 will have higher rate increases than the last few years. But we believe in California we won’t see the significant headwinds many other states are experiencing.”
Lee said the expiration this year of two federal programs that have helped health insurers offset expensive medical claims and cover sick patients in general will affect premium rates across the country. In addition, he cited ever-increasing medical costs, particularly for expensive specialty drugs.
The nation’s largest health insurer, UnitedHealth Group, already has said it will exit all but a handful of state exchanges after suffering substantial losses on individual policies.
Lee declined to comment on whether UnitedHealth has submitted a bid to continue selling in Covered California next year.
Health-policy experts said the California rate projection mirrors an upward trend around the country as health insurers reassess their pricing and strategy under Obamacare.
“None of us should be surprised to see average rate increases that are slightly higher than last year,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “It’s still really difficult to discern where we will end up.”
Robert Laszewski, a health care consultant in Alexandria, Virginia, and a frequent critic of Covered California, said Californians will be fortunate if the 8 percent projection holds up.
“That is not a troubling rate increase,” he said. “California is coming back toward the average. A bunch of states would die for just an 8 percent increase in 2017.”
A bigger concern, Laszewski said, is the tepid growth in Covered California’s enrollment and what that may mean for future premiums.
As part of its proposed budget for the next fiscal year, starting July 1, the state exchange expects its annual enrollment to grow by only 2 percent over the next year to 1.34 million. Covered California counts about 1.4 million as currently enrolled but that figure is expected to drop to 1.32 million as of June 30 through normal attrition as people get insurance elsewhere or drop coverage.
Sign-ups are crucial for keeping a diverse mix of enrollees and spreading the insurance costs across a pool of healthy and sick policyholders.
About 3 million Californians remain uninsured, but fewer than 1.4 million of them are eligible for premium subsidies under the Affordable Care Act, according to the exchange’s proposed budget.
Lee said California already boasts one of the healthiest risk pools in the country, which insurers have cited as a main reason for the lower-than-average rate increases the past two years. He said the exchange signs up hundreds of thousands of new enrollees each year, but that’s offset by high turnover as many people leave the marketplace for job-based coverage, Medicare or Medicaid.
The average tenure of a Covered California enrollee is about 25 months, according to exchange data.
Over time, Covered California expects the gradual increases in the state’s minimum wage to $15 an hour could shift more low-income people from Medi-Cal, the state’s Medicaid program, to subsidized exchange policies as their pay increases. By 2020, the exchange expects to reach enrollment of 1.52 million.
“California grew very rapidly in the first few years and now we have reached a cruising altitude after three years. We are projecting modest net growth,” Lee said. “I think any questions about the sustainability [of exchanges] are just pure hot air.”
Covered California’s five-member board will discuss the proposed $308 million budget at a meeting Thursday and vote on it next month.
The proposed budget for 2017 is 8 percent lower than the current year budget, reflecting the slower enrollment growth and the fact that Covered California must operate next year without federal startup funds for the first time.
The exchange is planning to draw on $58 million in reserves for operations, and it wants to raise its surcharge on customer policies to 4 percent of premiums, up from 3.4 percent now, or $13.95 per member per month.
Covered California doesn’t receive money from the state’s general fund and relies on policyholder assessments to pay for marketing, service center operations and other expenses.
Health insurers have urged the exchange not to pass on any unnecessary costs to consumers.
“Price is the number one factor impacting consumers when they enroll, so we must always keep an eye toward affordability,” said Charles Bacchi, chief executive of the California Association of Health Plans. “We urge Covered California to move cautiously before increasing this fee and look for cost savings.”
The exchange is proposing to spend $2 million to establish an ombudsman program to help resolve customer service problems.
Consumer groups have criticized Covered California for failing to fix long-standing enrollment and tax-related errors that have blocked people from getting coverage and left some with unforeseen bills.
Last month, federal lawmakers called on Covered California to resolve a problem that has caused some pregnant women to be dropped from their health plans and enrolled in Medi-Cal without notice or consent.
“Absolutely, some consumers have had problems with customer service,” Lee said. “We are making significant investments to do better.”
Microcephaly caused by Zika infection in pregant women
Quest Diagnostics Inc said it has received emergency authorization from the U.S. Food and Drug Administration to sell the first commercially developed diagnostic test for Zika in the United States, a step that may help expand testing capacity and speed diagnosis of the virus.
Previously, the only Zika blood tests that had Emergency Use Authorization, or EUA, were available from the U.S. Centers for Disease Control and Prevention and were only to be used in qualified laboratories designated by the CDC.
Quest, in its announcement on Thursday, said it plans to make the new test broadly available to doctors for patient testing, including in Puerto Rico, by early next week.
Currently, the only laboratory that will use the new Zika test is at Quest's reference laboratory in San Juan Capistrano, California, where the test was developed and validated. But the Emergency Use Authorization may allow for testing at other qualified laboratories, including one in Puerto Rico, Quest said in a statement.
Quest's molecular test for Zika can only detect the virus when it is still present in the blood. A negative test does not completely rule out Zika infection. Further serological tests that look for antibodies made in response to the virus can help confirm infection. Quest said it is exploring options to make serological tests for Zika available as well.
The FDA's authorization is for emergency use, and does not constitute FDA approval.
What does "The Donald" recommend for health reform ? It is all rather vague.....like the Affordable Care Act. You won't know what is in it until it is passed.
Donald Trump released details of his health plan. No surprise - he wants to repeal Obamacare. NPR's Alison Kodjak reports that the other proposals on Trump's website include many Republican favorites and some that both liberals and conservatives find troubling.
ALISON KODJAK, BYLINE: When Trump was asked about his health care proposal in the debate last week broadcast on CNN, this is mostly what he talked about.
(SOUNDBITE OF ARCHIVED RECORDING)
DONALD TRUMP: We have to get rid of the lines around the states so that there's serious, serious competition.
UNIDENTIFIED MODERATOR: But Mr...
KODJAK: What he meant was that he wants to allow insurance companies to sell policies across state lines. It's a popular idea among Republicans, but beyond that, Trump was criticized because he had little more to offer. Now that's changed. The Trump campaign has posted a seven-point health plan on his website. It includes getting rid of those lines around the states, and it adds a handful of other provisions that are mainstays in conservative health care circles. Joe Antos is a scholar at the right-leaning American Enterprise Institute.
JOE ANTOS: He mentions things that, depending on how you interpret them, could really fit well within traditional Republican views.
KODJAK: Among those items, Trump calls for people to deduct their health insurance premiums from their taxes and use tax-free health savings accounts to pay for out-of-pocket costs. He proposes changes to Medicaid, the government health insurance for the poor and disabled. He'd give a fixed amount of money to each state rather than using today's cost-sharing formulas. Trump's plan leaves a lot up to interpretation. Antos likes the tax provision because he's assuming Trump would ensure they be structured to benefit low-income people, but other conservatives see it differently. Jeffrey Anderson is a senior fellow at the Hudson Institute. He looks at the proposals for deducting premiums and health savings accounts and sees a huge giveaway.
JEFFREY ANDERSON: It creates a new tax loophole by providing an open-ended tax break on the individual side.
KODJAK: Anderson agrees with Trump's goal to repeal the Affordable Care Act, but her worries about Medicaid. Trump's plan says, quote, "we must review basic options for Medicaid and work with the states to ensure that those who want health care coverage can have it." Anderson says that sounds to him like a huge Medicaid expansion. That's the conservative discussion. Liberals are interpreting Trump in yet another way. Igor Volsky is deputy director of the American Progress Action Fund. He says Trump wants to simply ditch Obamacare.
IGOR VOLSKY: It gets rid of Obamacare but doesn't talk about coverage expansion, doesn't talk about cost controls. And so we're left in the world where a lot of people are losing the coverage they currently have under Obamacare and they don't actually get anything in return.
KODJAK: We asked the Trump campaign to clarify some of these provisions. A spokeswoman said via email, quote, "the plan speaks for itself." Alison Kodjak, NPR News.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
Like most of the campaign rhetoric this year the discusisons disguise real issues, creating angst for most people, and not being able to filter the important goals of elections.
“In the future we want to conduct research in partnership with people — not as subjects, but as our partners,” said Joanne Waldstreicher, MD, Chief Medical Officer of Johnson & Johnson. “Hugo holds the promise to empower people with their data and will create innumerable opportunities for them to participate in programs and projects that are customized to their interests and needs — and provides opportunities to be part of communities that contribute to knowledge that will help us all.”
The benefits of enabling data to flow more easily extend beyond research. Patients face the same hurdles as researchers in accessing their health information from different health systems. Hugo is designed to enable patients to acquire their data in a single platform for their own use, for example when seeking a second opinion, and increase transparency in health care. It will also allow them to be the carriers of their longitudinal health records.
Researchers at the Yale School of Medicine are launching a novel approach to research that engages people as true partners in science. Using an innovative health information technology platform called Hugo, which was developed in partnership with Yale New Haven Health System, people will be able to acquire their health-related data and use it to participate in studies.
Hugo is a highly secure cloud-based personal health platform that enables people to access their electronic health records (EHRs) from multiple health care systems and synchronize them with a research database. Designed to be user-friendly, it also allows people to contribute information from wearable devices and questionnaires.
“This could be a game changer. Hugo harnesses the very latest in digital health technology and puts patients in the center, making them true research partners,” said Dr. Harlan Krumholz, the Harold H. Hines Jr. Professor of Medicine, director of the Center for Outcomes Research and Evaluation (CORE) at Yale-New Haven Hospital, and a developer of Hugo.
Is common sense being overruled by Evidence Based Medicine ? That is the core argument in this article in The Health Care Blog written by clinicians, they can lead to clinical errors. MICHAEL L. MILLENSON summons Nortin M, Handler M.D. as his muse, stating the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious rors.
No slouch at his own erudite ambivalence about edicts from the National Academy of Medicine, Millenson comes out as highly suspicious and pessimistic about the evidence based medicine cult which appears to have the upper hand, becoming embedded in institutional cement. Some of his reticence results from the seemingly lack of effect of evidence based medicine in parts of North Carolina Perhaps this is a local cultural resistance to centralized federal government edicts and perhaps the exception that proves the rule. The United States is such a large country and has a heterogeneous diverse population both genetically, in socioeconomic strata as well as culturally that one should not be surprised by regional variations.
“The current medical culture is obsessed with perfect replication and avoidance of error. This stemmed from the 1999 alarmist report of the National Academy of Medicine [formerly the Institute of Medicine], entitled “To Err is Human,” in which the absurd conclusion was propagated that more patients died from medical errors than from breast cancer, heart disease and stroke combined; now updated by The National Academy of Medicine’s (formerly the IOM) new white paper on the epidemic of diagnostic error.
Not long after the National Academies published “To Err is Human. Building a safer health system”, a study from the US Veteran’s Administration demonstrated that the preventable hospital deaths due to medical errors was very much “in the eye of the reviewer.”[1]
In a recent post, the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious clinicians, they can lead to clinical errors. That post was followed by another by Paul Levy, a former CEO of a Boston hospital,arguing that the errors can be diminished and the anxieties assuaged if institutions adhered to an efficient, salutary systems approach. Both Dr. Samuels and Mr. Levy anchor their perspective in the 1999 report of Institute of Medicine Report,
Dr. Samuel's post on THCB is similarly worthy for championing the role of the physician in confronting the challenge of doing well by one patient at a time. Mr. Levy and his fellow travelers are convinced they can create settings and algorithms that compensate for the idiosyncrasies of clinical care. I will argue that there is nobility in Dr. Samuels’ quest for clinical excellence. I will further argue that Mr Levy is misled by systems theories that are more appropriate for rendering manufacturing industries profitable than for rendering patient care effective.
Physicians must not be coerced by government guidelines. These metrics are ruled by the least common denominator, and filtered by ta hierarchy of committees.
America has made a tremendous investment in intensive care units. We have many times the ICU beds per capita as any other resource advantaged country, 25 per 100,000 people as compared to 5 per 100,000 in the United Kingdom. Not surprisingly, when we build them we also build the demand, so-called demand elasticity.[2] The indications for admission in America result in a very different case-mix than anywhere else. We need ICU beds for patients with acute or potentially reversible conditions, but do we need them for the frail elderly or the terminally ill? Maybe the error is not so much in their medical treatments as in the lack of appreciation of their humanity.
