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03/10/11

  03:41:33 pm, by MedBen5   , 266 words,  
Categories: News, Wellness

Palliative Care Eases Suffering While Lowering Costs: Study

Last October on this blog, we noted a study that revealed patients who receive palliative care – which contentrates on relieving the pain and stress of chronic conditions – actually live longer on average than those who get care focused exclusively on extending life. Now another study has determined that palliative care can save money as well.

According to The Wall Street Journal Health Blog, researchers tracked palliative care teams at four New York State hospitals during the years 2004-07. By coordinating the care of seriously ill Medicaid patients, the teams reduced inpatient costs by an average of $6,900 per admission.

While patients suffered from a range of chronic conditions, not every one was at the end of their lives. Palliative care differs from hospice care, which provides physicial comfort and emotional support to the terminally ill. Study co-author R. Sean Morrison says that palliative care “focuses on improving the quality of life for patients living with serious or life-threatening illnesses and their families” while offering “all other disease-directed and life-prolonging treatments.”

The study followed 485 Medicaid patients receiving palliative care. Of those, 296 patients were discharged alive (some to hospice, others to home care) and 189 died in the hospital. Compared to patients who received standard care, the cost difference was $4,098 for the living discharges and $7,563 for those who passed away during their stay. Morrison says that savings came from heeding the wishes of the patients: “Some patients might want to pursue all treatment options, while others want to be comfortable and to minimize symptoms… In the setting of this very complex, very sick population, you’re eliminating misutilization.”

03/08/11

  02:06:26 pm, by MedBen5   , 159 words,  
Categories: News, Health Plan Management

New Website Offers Accessible Approach To Health Reform Law

In an attempt to make the Affordable Care Act (ACA) comprehensible to those of us who don’t speak government-ese, some well-known organizations – AARP, the American Cancer Society, and the American Medical Association among them – have developed the Health Care and You website.

We’ve taken a look around the site and found it to be very user-friendly. In addition to explaining the purpose of the ACA, Health Care and You breaks down the health reform law by state and other factors (i.e., people under age 65, small business owners) so users can see how ACA provisions impact specific populations.

The site also contains a ACA timeline in which the user can select a specific year to learn about future changes, and how the law affects selected groups. All in all, it’s a well-designed resource for anyone looking for intelligble reform information.

The New York Times has a story on the site’s rollout – you can find it here.

  12:13:52 pm, by MedBen5   , 140 words,  
Categories: News

1 in 5 Orthopedic Scans Performed for Defensive Reasons, Study Finds

MedPage Today recently reported on a study in which Pennsylvania orthopedic surgeons acknowledged that nearly 20% of the scans they performed were for purely defensive purposes – representing about 35% of their total imaging cost.

Robert A. Miller, MS, of Temple University in Philadelphia, ran a voluntary audit of members of Pennsylvania’s orthopedics society. The audits were prospective – doctors offered their reasons for the imaging prior to the procedure. A total of 72 orthopedic surgeons participated, and more than 2,000 imaging orders were analyzed.

Of the 19.1% of scans that were performed primarily to avoid potential malpractice suits, 70% were standard X-rays and 25% were MRIs. However, Miller estimated that the MRIs accounted for about 70% of the defensive costs.

The 1-in-5 ratio may not be reflective of defensive medicine in the country as a whole, as Pennsylvania has a high litigation rate compared to other states.

03/07/11

  10:13:07 pm, by MedBen5   , 182 words,  
Categories: Wellness, Health Plan Management

Chronic Condition Costs Highlights Need For Wellness

Spending on Patient-Centered Care Categories, 2007

A paper published in Health Services Research spotlights the cost of chronic medical conditions – and the need for a wellness approach to help control those costs.

As noted on the Healthcare Economist website, health expenditure statistics are commonly broken down by payer (such as Medicare or private insurance) or setting (inpatient or outpatient). The paper’s co-authors instead apply a “patient-centered” grouping to organize health care costs, by focusing on life events of the individual. Using data from the 2007 Medical Expenditure Panel Survey, the co-authors arrange the costs into 7 patient-centered categories.

As the chart shows, chronic conditions account for nearly half of all patient-centered care. When acute illness – which often stems from a chronic condition – is added in, the amount reaches 72.6%.

Improving individual health while managing costs is the essence of MedBen Worksite Wellness. Our program emphasizes early intervention in cancer, diabetes, heart diseases and other chronic conditions, using both primary prevention and specialty care to provide the best results possible.

For additional information about MedBen Worksite Wellness, contact Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

  04:03:28 pm, by MedBen5   , 217 words,  
Categories: News, Wellness

One-third of Americans Are Pretty Sleepy

Not getting enough shut-eye these days? You’re hardly alone. Two studies by the Centers for Disease Control (CDC) found that over a third of U.S. adults may be getting less than seven hours of sleep per day – and risking bodily harm by doing so.

WedMD reports that of 74,000+ adults in a 2009 CDC study, 35.3% said that they typically got by on less than seven hours of sleep in a 24-hour period, under the 7-9 hours recommended by the National Sleep Foundation. Additionally, respondents who didn’t get enough sleep were more likely to report falling asleep while driving or nodding off unintentionally during the day at least one time per month.

Demographics factored into the results. People 65 and over tend to get more sleep than people 18 to 24, and married people are generally better rested than divorced, widowed, or separated people. One of the greater disparities can be found in race – 48.3% of African-Americans get less than seven hours of sleep, compared to 34.9% of whites and 33% of Hispanics.

The second CDC study examined the relationship between hours of sleep and its effect on concentration, working and other sleep-related issues. Not surprisingly, people who sleep less hours have a more difficult time paying attention – 29.3% of stayer-uppers said they had trouble concentrating, compared to 19.4% of their more alert counterparts.

03/04/11

  02:24:28 pm, by MedBen5   , 225 words,  
Categories: News, Health Plan Management

Florida Judge Grants Stay to Health Reform Law

ABC News reports that Judge Roger Vinson, the Florida federal judge who in January essentially voided the Affordable Care Act (ACA), has granted a stay until March 10 to allow the Obama administration to appeal his ruling.

In his 20-page response to the administration’s request for clarification of his original ruling – a motion filed nearly two weeks after it was handed down – Vinson bordered on the sarcastic: “While I believe that my order was as clear and unambiguous as it could be, it is possible that the defendants may have perhaps been confused or misunderstood its import.”

Elsewhere in the response, the judge expressed in writing his irration with the government lawyers for delaying their stay request: “It was not expected that they would effectively ignore the order and declaratory judgment for two and one-half weeks, continue to implement the Act, and only then file a belated motion to “clarify.” He had expected the request to follow immediately after the ruling.

The question of the health care law’s constitutionality is expected to ultimately be settled in the Supreme… and the sooner it is, “the better off the entire nation will be,” Vinson wrote.

On a related note, if you’re interested on following the various legal goings-on, Kaiser Health News is thoughtfully doing the heavy lifing for you. You can read the ACA Scorecard here.

  11:34:37 am, by MedBen5   , 131 words,  
Categories: News, Wellness

Most Grocery Cart Handles Carry Bacteria, Study Reveals

You know those disinfectant wipe dispensers you see when you enter the grocery store? Snag a sheet before heading for the carts. USA Today reports a study of grocery carts found some rather unpleasant things lurking on the handles.

Checking the handles of 85 carts in four states for bacterial contamination, researchers discovered that 72% of the carts contained fecal bacteria – more than is usually found in a bathroom. The tests also turned up E. coli on half the handles sampled.

Scientists link the study results to prior investigations that found kids who touch the handles increase the risk of infection from salmonella and other bacteria.

In addition to wiping down the handles, the researchers recommend inspecting meats and vegetables before placing them in reusable shopping bags to ensure they’re properly wrapped.

03/03/11

  06:07:15 pm, by MedBen5   , 235 words,  
Categories: News, Health Plan Management

Fraudulent Activity Costs Medicare $48 Billion

On the heels of a major anti-fraud sweep last month, a new report issued by the Government Accountability Office finds that almost 10% of all Medicare payments are fraudulent or otherwise improper, according to Politico.

The Centers for Medicare & Medicaid Services (CMS) estimate that of the $509 billion in fiscal 2010 Medicare expenses, $48 billion went toward fraudulent claims. But the GAO report goes even further, pointing out the CMS failed to take into account improper payments in its Part D prescription drug benefit – so the final amount may be even higher. “CMS needs a plan with clear measures and benchmarks for reducing Medicare’s risk for improper payments, inefficient payment methods and issues in program management and patient care and safety,” the report says.

And speaking of “a plan with clear measures"…

At MedBen, our proactive approach to fighting fraud integrates technology with talent. Our claims auto-adjudication features more than 400 checks to ensure key data is properly recorded, which helps turn around claims quickly and accurately. And all MedBen claims examiners are required to meet daily performance standards and have current accuracy rates of 99.5% procedural and 99.8% financial accuracy.

We complement these defenses with a powerful claims surveillance system using 80,000 clinical and financial algorithms, plus an Anti-fraud Unit that thoroughly reviews questionable claims. To learn more about steps we take to prevent fraudulent activity, please call Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

  04:54:08 pm, by MedBen5   , 182 words,  
Categories: News, Wellness

Study Finds Exercise Beneficial To Knees

If you’ve been wary about working out because you’re concerned about damage to your knees, a new study may offer some good news for you – or bad news, if you’ve been using a bum knee as an excuse to stick to the sofa.

According to WebMD, researchers in Australia say that exercise is beneficial for knee joint health. Noting that some earlier studies have focused on the overall impact to the knee, a member of the research team said that “none [has] looked at the effect of physical activity on individual parts of the knee.”

Reviewing 28 studies, all of which examined the relationship between physical activity and knee osteoarthritis, the researchers found exercise to have a positive effect on cartilage integrity, with no damage to joint space (where cartilage is housed). Their conclusions challenge long-held thinking that exercise promotes the development of osteophytes, bony spurs in the knee.

Team co-leader Donna Urquhart, PhD said in a statement, “These findings are significant, as they suggest that osteophytes, in the absence of cartilage damage, may just be a functional adaptation to mechanical stimuli.”

  03:47:45 pm, by MedBen5   , 170 words,  
Categories: News, Prescription

FDA Removes Unapproved Cold Medicines From Market

The Food and Drug Administration has ordered that more than 500 prescription cold, cough and allergy medicines be taken off the market, The New York Times reports. While none of the drugs on the list have been found to be unreliable or dangerous, they either predate 1962, the year that the FDA first required drugs to undergo agency review for safety and effectiveness, or contain the same ingredients as drugs marketed before 1962. As the drugs have never been approved, they will need to pass FDA testing before they can return to the market.

The drugs are generally not well known to modern consumers, and even in their absence, many approved prescription medications are still available – so doctors and their cold-suffering patients will still have plenty of remedies available. And the most popular over-the-counter medications are not affected by the FDA’s order.

A listing of the medicines pulled from the market can be found at the FDA website. Pharmaceutical companies have 90 days to stop making the drugs, and 180 to cease their distribution.

03/02/11

  10:52:43 pm, by MedBen5   , 260 words,  
Categories: News, Health Plan Management

Confusion Abounds Regarding Status Of Reform Law

If you’re a regular visitor to this blog, you’re hopefully aware of the fact that the Affordable Care Act is alive and well (well, pretty well, anyway). But a pretty substantial number of Americans – nearly one-quarter, in fact – think that federal health reform is no more.

A Kaiser Family Foundation poll found that 26% were uncertain of the ACA’s current status, while 22% believe it had been repealed altogether. The balance of the 1,001 individuals surveyed correctly responded that the ACA is hanging tough.

Actually, it’s not hard to understand why there’s a bit of befuddlement about the current state of reform. The House bill calling for the law’s repeal did pass, and got a lot of press in the process. When the bill failed in the Senate, the news received comparatively little mention, possibly because it seemed such a foregone conclusion.

Other factors also come into play, as The Wall Street Journal Health Blog notes. The House voted several weeks ago to defund the ACA, and as the Senate hasn’t held a similar vote yet, the issue remains in limbo as the federal budget is hammered out. Also, two federal judges have ruled that the individual mandate provision is unconstitutional – one of whom has gone so far as to declare the entire law null and void. So there’s a good deal of confusion about where health care reform stands at the moment.

Perhaps in part to counter the public disorientation on the matter, the Obama administration has requested that the judge who struck down the ACA clarify his ruling.

  10:04:18 pm, by MedBen5   , 201 words,  
Categories: News, Wellness

Fish Oil May Help Cancer Patients Maintain Weight and Muscle Mass

In previous blog postings, we’ve been pretty rough on fish oil, noting separate studies that concluded that the supplements don’t enhance babies’ IQs, slow Alzheimer’s disease, or prevent heart rhythm problems. But finally there’s a bit a positive news: New research suggests that fish oil supplements may help patients undergoing chemotherapy to avoid the accompanying muscle loss and malnutrition.

According to HealthDay (via MedicineNet.com), a study of 16 lung cancer patients who took supplements containing omega-3 fatty acids throughout their chemotherapy showed greater muscle mass gains compared to 24 patients who didn’t take the supplements. Further, over the 10-week period, the fish oil group lost no weight, while the non-supplement group lost an average of 5 pounds.

Lona Sandon, a registered dietitian who reviewed the findings, was pleased that fish oil appears to aid against malnutrition while preserving lean muscle tissue – both vital to fighting the cancer. But she cautioned that the amount of supplements necessary to affect change is two to three times more than the weekly dietary allowance of fish.

“I would say this is certainly worthy of continuing research and exploration,” Sandon said. “But meanwhile, people should definitely not go out and start consuming huge amounts of fish oil.”

  09:19:07 pm, by MedBen5   , 240 words,  
Categories: Wellness

Doctor Supports Internet Research by Patients

A few weeks, back, we highlighted a Consumer Reports study of physician attitudes toward their patients. One of the noteworthy findings was that doctors don’t care much for patient who do self-diagnoses online – nearly half felt that it served no useful purpose. But one doctor in the minority argues why Internet research can be a good thing, in an ABC News opinion piece.

Dr. Roni Zeiger shares a colleague’s personal story: When his infant daughter was acting strangely, the colleague and his wife sought a doctor’s diagnosis, only to be told to let the illness run its course. But when the odd behavior continued unabated, the parents took to the Internet to seek a potential cause for her lethargy and drooped head. And they found it – infant botulism, a sometimes fatal disease. ER doctors agreed with the diagnosis and brought in a specialist for treatment.

Dr. Zeiger notes that infant botulism is so rare – only about 100 cases are reported in the US every year – that most physicians will never encounter it. So in this case, the parents’ legwork had a critical impact and, moreover, the doctors were grateful for the diagnosis. He does admit that self-diagnoses can sometimes do more harm than good, as when an individual mistakes the symptoms of a common cold for something more serious. But Dr. Zeiger feels strongly that anything that forges a partnership between patient and doctor should be encouraged.

03/01/11

  10:37:14 pm, by MedBen5   , 235 words,  
Categories: News, Health Plan Management

President Obama Says He'll Approve Earlier State Opt-Out Date

Barack Obama appears ready to make a huge concession to critics of the Affordable Care Act (ACA). Speaking to a group of governors Monday, the President said he would support letting states opt out of the health care reform law years earlier than initially planned, The Washington Post reports.

At the winter meeting of the National Governors Association (NGA), Obama said he would approve moving up the opt-out date from 2017 to 2014, provided that the states could cover as many people as would be covered under the ACA without increasing the deficit. “It will give you more flexibility more quickly, while still guaranteeing the American people reform,” he said.

To implement the provision, state would need the approval of Republicans in Congress, who last month attempted to appeal the ACA. House Majority Leader Eric Cantor (R-Va.) said, “[The opt-out provision] is just making our point that not only have we seen a variety of exceptions and waivers issued for the private sector under the act, but now we’re seeing how that act is troubling states in a real way as far as their trying to figure out the fiscal answer.”

Meanwhile, governors are looking to get even more state control of health care reform."Give me as a state the opportunity to determine more about the eligibility and benefits, and we’ll be glad to run that program,” said Gov. Dave Heineman (R-Neb.), the NGA vice chair.

  09:33:03 pm, by MedBen5   , 174 words,  
Categories: News, Wellness

Daily Consumption Of Sugary Drinks May Increase Blood Pressure Risk

Perhaps it should come as no surprise that soda, for all it carbonated tastiness, isn’t a particularly healthy option (though ironic, when one knows that some of the oldest soft drinks were initially marketed as miracle elixirs). Earlier this month, researchers found that diet sodas may increase the risk of stroke and heart disease. Now, another study suggests that people who drink sugar-sweetened sodas daily are at greater risk for high blood pressure.

According to WedMD, the researchers concluded “every extra sugar-sweetened beverage drank per day was associated with a 1.6 point rise in systolic blood pressure (the upper number) and a 1 point rise in diastolic pressure (the lower number).” High salt consumption brought the numbers up further still.

An important caveat about the study is that data was gathered from questioning participants about their soda consumption habits rather than comparing a sugary-beverage drinking group with a non-sugary-beverage drinking group. A spokesperson for the American Beverage Association said the study is flawed and the blood pressure changes were “inconsequential” and within the standard measurement error.

  05:08:45 pm, by MedBen5   , 147 words,  
Categories: News, Prescription

Ohio Legislation Would Require Drugmakers to Report Doc Gifts

A bill has been introduced in the Ohio Senate that would require pharmaceutical manufacturers to report gifts they give to doctors who are authorized to prescribe drugs, the MedCity website reports. If passed, drugmakers would have to submit an annual report to the state of any gift valued at $25 or more, and must detail “the value, nature and purpose” of the gift.

The legislation comes as something of a surprise, as the Affordable Care Act already contains similar language requiring drugmakers to report physician payments, though the federal law also applies to medical device makers. That provision is scheduled to take effect in 2013.

Ohio State Medical Association spokesman Jason Koma said that the doctors’ trade group “supports transparency in this area as long as the responsibility for providing this transparency falls on the pharmaceutical industry — not physicians who are already burdened with far too many administrative hassles.”

02/28/11

  10:32:31 pm, by MedBen5   , 178 words,  
Categories: News, Health Plan Management

What Constitutes "Essential" Care?

The Wall Street Journal examines an aspect of health care reform that promises to provoke a great deal of debate: the question of what constitutes “essential” care.

When health care exchanges are launched in 2014, regulators are expected to have come up with a detailed list of basic medical services that must be covered. The Department of Health and Human Services has assigned The Institute of Medicine the task of defining criteria for essential benefits that will fall under 10 categories of care… and undoubtedly, they’ll be no shortage of opinionated people ready to assist them in their work.

This week, the Institute of Medicine will host a meeting at which insurers and patient groups will be well-represented. Insurers want broad categories to allow flexibility in plan design, while patient advocacy groups are pushing for greater specificity and no coverage limits.

As the article notes, habilitative services – one of the 10 care categories – will be an especially contentious issue, as the open-ended nature of treatments to the disabled could push up the cost of policies sold through the exchanges.

  05:08:25 pm, by MedBen5   , 182 words,  
Categories: News, Wellness

Moderate Alcohol Consumption Good For The Heart, Researchers Find

Drinking alcohol in moderation – and we’ll stress those words again, in moderation – may decrease your risk of developing heart disease, USA Today reports. Two separate studies, both by research teams at the University of Calgary, reached similar judgments about the positive effects of moderate imbibing on heart health.

In the first study, researchers reviewed 84 studies that explored the link between alcohol consumption and heart disease, and concluded that people who have one drink a day or less are 14-25% less likely to develop heart disease as those who don’t drink alcohol. A second research team also analyzed multiple studes and found that moderate alcohol intake (one drink a day for women, 1-2 drinks daily for men) significantly increases levels of “good” cholesterol, a protective defense against heart disease.

The authors of the second research paper emphasized that the choice of alcohol, be it beer, wine or spirits, has no bearing on its healthful benefits – only the alcoholic content matters.

And did we mention it’s all about moderation? Because seriously, it is. Drinking in excess serves no healthy purpose whatsoever.

02/27/11

  08:06:44 pm, by MedBen5   , 352 words,  
Categories: News, Health Plan Management

MedBen Cost Containment Partner Recognized By National Cancer Network

AWAC, a leading provider of cost containment and medical consulting solutions to third party administrators and insurance plans, has been recognized by the National Comprehensive Cancer Network® (NCCN®) as an organization that supports the appropriate and efficient use of oncology agents and care of patients based upon recommendations in the NCCN Drugs & Biologics Compendium (NCCN Compendium).

MedBen partnered with AWAC in 2007 to provide physician-directed, information technology-driven claims surveillance services. The proprietary surveillance system, which uses over 80,000 physician-produced algorithms to locate cost reduction opportunities, saves MedBen clients an average of 46% on selected claims.

“By participating in the NCCN Recognition Program, AWAC has demonstrated its commitment to helping ensure that individuals with cancer have access to high quality, evidence-based care and to clinical trials,” said Liz Danielson, Director of Payor Relations for NCCN. The NCCN Recognition Program recognizes non-payor organizations that provide case management, patient management, disease management, utilization review and other services that make good faith efforts to educate their clients about these issues.

Full story »

02/25/11

  05:09:51 pm, by MedBen5   , 244 words,  
Categories: Wellness

Gastric Bypass Isn't A Cure-All For Obesity

In the “quick fix” culture we live in, gastric bypass, or GIB, surgery is viewed by some as a cure-all solution to being overweight. No more yo-yo diets or failed exercise campaigns… a few hours under the knife and the problem is permanently solved.

Not so, writes Michael Kirsh, MD on the KevinMD.com blog. He chronicles a recent office visit by a overweight patient who informed him that she intended to have the GIB procedure performed, even though she actually weighed less than many patients are after undergoing the surgery. When Dr. Kirsh suggested she join Weight Watchers instead, the patient replied that she didn’t have time for the weekly meetings – apparently unaware that the commitment to GIB far exceeds any demands that would be made by a weight-loss group.

Dr. Kirsh continues:

“I explained to her that gastric bypass is major surgery with all of the risks of any abdominal surgery. More importantly, I emphasized to her that even when the operation is successful, it changes your life every single day forever. The dining experience, one of society’s most important social and familial forums, would be irrevocably altered.”

Additionally, Dr. Kirsh notes, a can patient undergo a bypass and still gain weight – there are no guarantees. And nutritional deficiencies can arise if the remaining intestines are inadequate to absorb vital nutrients. For a handful of patients, GIB may be “the right choice” – but only as a last resort.

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