NPR recently examined the growing use of overnight tests to diagnose apnea. The number of accredited sleep labs in the U.S. has quadrupled over the past decade, and critics are worried that testing for the condition may be over-prescribed.
Apnea – abnormal pauses in breathing that can lead to snoring, restness sleep and low blood oxygen levels – may increase the risk of heart disease, dementia and other serious illness. The condition has become more common as our population has grown older and more obese.
Traditionally, apnea patients have worked with their family physican to decide on a treatment. A CPAP machine, which helps keep a snorer’s airway open during sleep, is sometimes necessary. In many cases, however, simply losing weight or sleeping on one’s side may help to reduce the condition.
But increasingly, patients are bypassing their doctors entirely and heading straight to the sleep lab – at a cost of upwards of $1,900 a night. And two-night lab stays – one for testing, the second to try the CPAP machine – are not unusual.
As sleep labs have become more lucrative, insurer spending on apnea treatment has jumped accordingly. Medicare payments for sleep testing increased from $62 million in 2001 to $235 million in 2009, according to the Office of the Inspector General.
“We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value,” says Dr. Fred Holt, an expert on fraud and abuse. “This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of the business.”
On the KevinMD.com blog, author Kohar Jones, MD poses two fundamental questions: What should be the stated aim of health care in America? And where would we need to put our money to reach that aim?
Jones finds curious the aims of health care as defined by the Center for Medicare and Medicaid Services: improve the experience of care, better the health of populations, and reduce the per capita costs of health care. As a family doctor, she believes her aims should be to prevent disease, promote health and cure sickness as needed. And the goals aren’t wholly compatible.
So what is the true purpose of a health care system? The answer matters, Jones says:
“How we define ‘health’ and what services we define as part of the ‘health system’ changes the way our society allocates scarce resources. Right now, our society devotes an enormous portion of our budget to the medical system – curing sickness and keeping people from dying. A medical system and a health system, however, are two different things.
“If we redefine a health system as any system within our society that delivers the goods that promote or destroy health, we can restructure our funding priorities to promote population health rather than individual medicine.”
Read the rest of Jones’ thoughts here.
Let’s get this out the way: People who exercise outdoors in cold weather aren’t crazy. They much prefer the term “eccentric".
But seriously, outdoor exercise during the winter is great for those who want to escape the confines of a stuffy gym. The lower temperature can be an effective pick-me-up, expecially for those who tend to get overheated when working out indoors. But prolonged exposure to the cold does require certain steps to stay safe, warns Dr. Cedric X. Bryant, chief science officer at the American Council on Exercise,.
Chief among the risks of winter workouts is hypothermia, an excessive loss of body heat. Symptoms of hypothemia range from shivering to slurred speech, and can cause the victim to drift into unconsciousness.
Bryant offers these safety tips for colder-weather exercise (via HealthDay News):
Only about 1 in 5 American adults have an yearly checkup, according to a study appearing in the upcoming issue of American Journal of Preventive Medicine. And of those who do, just over half receive or are advised of recommended preventive health services.
“The researchers captured audio recordings of 484 office visits by patients between the ages of 50 and 80 by 64 primary care physicians over a 2-year period in southeast Michigan. The goal was to see how often physicians delivered 19 national guideline-recommended preventive services, such as screening tests for cancer and hypertension, counseling on tobacco and alcohol use, and immunizations to patients who were eligible and due.
“Of the 2,662 services due during those visits, 54 percent were delivered. Those most likely to be given were screening tests for colorectal cancer (92.9 percent), hypertension (92 percent), and breast cancer (88.9 percent)… [P]atients were least likely to receive counseling about aspirin use, diet, flu immunization and vision screening.”
MedBen believes that an annual physical is one of the cornerstones of better health. We encourage our clients to visit their family doctors for regular preventive care, and discuss the preventive services that are appropriate for them. Additional information about recommended services is available at HealthCare.gov.
Some medications tolerate food with no problem. Others… well, let’s say if they don’t get along, there’s a good chance you’ll know in no uncertain terms.
Not that the combination of food and certain drugs will necessarily result in a physical reaction. The effectiveness of some medications can get diluted when taken immediately before or after a meal.
The American Academy of Family Physicians offers these tips to avoid negative drug-food interactions (via HealthDay News):
Over half of U.S. states have taken at least preliminary action in establishing a health insurance exchange as mandated by the Affordable Care Act, according to a new report by the Department of Health and Human Services.
Reuters reports that 14 states have enacted legislation or already have the authority in place to set up regulated insurance markets, while an equal number have acted through executive orders or authorized studies aimed at demonstrating their value.
Six other states, including Ohio, have shown “no significant activity” toward creating exchanges. And Wisconsin brought the number up to seven yesterday when Gov. Scott Walker declined $37 million from the federal government to help implement that state’s exchange.
The foot-dragging in these states isn’t necessarily due to political posturing, though that likely plays a role. More to the point, health care reform faces an uncertain future in 2012. With a pending Supreme Court ruling on the individual mandate and a November presidential election, some states are waiting to see what shape the ACA will be in when the year is over.
One problem with the strategy: Assuming the reform law makes it through 2012 intact, states would have to scramble to meet a January 1, 2013 deadline to act on an exchange or cede control to the federal government. However, Obama administration officials have said they will work with states who miss the deadline to ensure their participation.
Good news… Americans aren’t getting any bigger!
Bad news… we aren’t getting any smaller, either.
The Wall Street Journal Health Blog reports that adult male waistlines have held steady since 2003, according to a new study based on data from the Centers for Disease Control and Prevention. Women have done even better, with no notable increase in obesity rates since 1999.
But what accounts for the slowdown in growth? Experts aren’t certain. Study author Katherine Flegal, a CDC epidemiologist, and her colleagues cite multiple possibilities, such as an expansion of the food supply, energy imbalance, or the possible effect of environmental endocrine disruptors. Nor do the researchers have any idea if the slowdown is permanent, or if obesity rates could spike again.
Of course, this positive trend doesn’t negate the realty that more than one-third of adult U.S. residents are still overweight. And childhood obesity also remains a crisis – about one in six kids are overweight.
To address the latter problem, the Affordable Care Act now requires health insurers and employers to pay the cost of screening children for obesity and providing them with appropriate counseling. The New York Times recently examined various efforts being made to help kids achieve and maintain a healthier weight.
New federal government initiatives could speed the process of getting generic drugs to consumers, Business Insider reports. Last week, the Food and Drug Administration submitted recommendations to Congress, including a Generic Drug User Fee Agreement.
Under the proposed agreement, the FDA could levy fees on drug manufacturers to help fund generic drug development and review. In exchange, the agency promises to complete inspections of foreign and U.S.-based drugmakers by 2017, which it says will help cut back on review times.
The generic program is similar to the Prescription Drug User Fee Agreement, which collects funds from brand name drugmakers in return for an expedited review process and increased drug and research development.
Allan Coukell of the non-profit Pew Health Group supported the FDA’s recommendations. “Under PDUFA, the FDA has reduced the time it takes to approve new drugs. Now thanks to the first ever agreement with the generic drug makers, industry has made an investment in greater oversight of U.S. medicines made overseas,” Coukell said.
Those little earbuds we pop in to enjoy music not only may be damaging our hearing, they’re putting many people at risk for bodily injury as well. According to NPR, a new study suggests that wearing headphones while walking outside increases the odds of being struck by a car or other vehicle.
Researchers from the University of Maryland School of Medicine reviewed pedestrian accident data from a variety of sources between 2004 and 2011. In 116 instances, the cause of death or injury could be linked to the pedestrian wearing headphone or earbuds. Most of the cases occurred between 2008 and 2011, coinciding with the recent jump in ownership of MP3 players and smartphones that play music.
Perhaps not surprisingly, most of the pedestrians involved in accidents were male (68%) and under 30 (67%) More than half of the pedestrians were struck by a train – and in 29% of the cases, a horn or other warning was sounded before the crash occured.
The researchers cite two reasons for headphone users to become oblivious of their surroundings: inattentive blindness, caused by paying too much attention to the devise and not enough to traffic; and environmental isolation, in which headphone sounds overpower external noises.
The U.S. Centers for Disease Control and Prevention is reminding users of insulin pens not to share them with others. According to HealthDay News (via Yahoo! Health), the agency advises that use of the devices by more than one person raises the risk of hepatitis viruses, HIV and other blood-borne pathogens, even if the pen’s needle is changed.
Insulin pens are injector devices that enable patients to self-inject insulin, which controls the concentration of glucose in the blood. The CDC has repeatedly asked health care professionals to remind users that the pens are meant for use on a single patient, but despite the agency’s best efforts, reports of sharing have increased. One such incident last year required the notification of more than 2,000 potentially exposed patients.
The reminder also warns:
Entrepreneur has compiled a list of mistakes companies should avoid when choosing health care coverage. The entire list is available at the magazine’s website; we summarize several of their suggestions below.
From developing a health care plan that’s right for your employees to advising you on ways to keep your medical costs down, MedBen offers comprehensive health benefits management to employer groups of all sizes. Our services range from fully-insured coverage to third party administration, as well as consumer-driven plans and worksite wellness. And we keep you in the know on regulatory and industry updates.
For more information about what MedBen can do for your business or to learn about brokers in your area, please contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
If you didn’t have enough reasons to kick the cigarette habit, you may soon have another – particularly if you find yourself on the medical job market. HealthDay News (via Yahoo! Health) reports that an increasing number of hospitals and other health care employers will not hire job applicants who smoke.
Such actions obviously pique the interest of workers’ rights organizations, some of which believe it to be a form of employment discimination. Health advocates counter that employing smokers cost businesses extra money through higher medical care costs and increased absenteeism. Currently, only 29 states legally prohibit employers from making hiring choices based on smoking or tobacco use.
The HealthDay article highlights Pennsylvania’s Geisinger Health System, which will, beginning in February, require a nicotine screen for all job applicants as part of standard drug testing. Those who fail the screening can reapply in six months, said Marcy Marshall, the organization’s director of clinical enterprise communications.
“Users of nicotine in Pennsylvania are not a legally protected class. We’re well within our rights according to Pennsylvania law to do this,” Marshall said. “We have a responsibility, being a health care organization, to encourage people to take good care of themselves.”
Tobacco users already employed by Geisinger won’t be affected by the new rule.
Without the individual mandate to finance health care reform, expect to see a major spike in individual insurance costs, according to a new analysis from the Robert Wood Johnson Foundation.
The Healthwatch blog reports that premiums could rise as much as 25% if the Supreme Court finds it unconstitutional to require most Americans to purchase health coverage, but other provisions in the Affordable Care Act remain intact. As the mandate was introduced to push young, healthy people into buying insurance, thus offsetting the cost of guaranteeing coverage to people with pre-existing conditions, eliminating it would remove that incentive.
Actual premium increases would vary from state to state depending on the popularity of a given state’s health insurance exchanges. If participation in an exchange is high, the loss of the mandate would raise premiums about 10%. In states where fewer people use the exchange, individual policies would get at least 20% more expensive.
The analysis also finds that fewer people would be insured without the mandate, while Medicaid expansion would be only slightly smaller.
Expect to see significant price increases on brand name drugs in 2012, according to Sector & Sovereign Research. The Pharmalot blog reports that the Wall Street firm believes that after a 11% jump in 2010, we’ll see an even more substantial spike this year, as drugmakers need the higher prices to “generate needed revenue growth.”
SSR’s analysis goes against conventional wisdom. Usually in an election year, the pharmaceutical industry is reluctant to raise prices dramatically – even more so when the preceding year saw a double-digit increase. But the firm predicts that brand-name drugmakers will weigh the need for higher prices to offset declining volume against the risk of getting pilloried on the campaign trail, and ultimately vote for the bottom line.
However large or small pharmaceutical industry increases are in 2012, MedBen has the tools in place to buffer their impact on your group’s health care expenses. Through a combination of superior drug discount rebates, useful reports and formularies, and ongoing plan consultations, we keep your costs well below the average national trend. And we always pass through 100% of negotiated discounts and deliver 100% of paid rebates back to the client.
To learn more about MedBen pharmacy plans, please contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
Will we soon see a revision in recommendations for the early detection of prostate cancer? Hard to say at this point, but those pushing for a rewrite have certainly built up a stack of supporting evidence lately.
On the heels of an advisory by the U.S. Preventive Services Task Force that most men not get tested for prostate cancer, a large trial has concluded that annual screening for the disease doesn’t reduce the risk of dying from it. Reuters recently reported that a comparison of men who received yearly PSA tests to those who just got regular check-ups found more men in the screening group were diagnosed with prostate cancer, but there was no difference in how many died from it.
“Men, if they’re considering screening, should be aware that there’s a possibility that there’s little or no benefit (and) that there certainly are harms to PSA screening,” said study co-author Philip Prorok of the National Cancer Institute. Such harms, he told Reuters, include catching and treating small cancers that never would have been detected or caused men any problems.
Dr. Philipp Dahm, a urologist from the University of Florida (and who wasn’t involved in the report), said that following men who get screened annually limits the effectiveness of the study. But Dr. Scott Eggener, a urologic cancer specialist from the University of Chicago Medical Center (also not involved) calls it a serious flaw: “It ends up being a study of intensive screening versus fairly intensive screening,” he told Reuters Health.
MedBen currently follows the American Cancer Society recommendation that screening should begin at age 50 for men who are at average risk of prostate cancer, but that they should first speak with their doctor about the procedure’s risks as well as its benefits. Men at high risk of getting the disease should start screening at age 45.
The Midwest has finally been hit with its first blast of winter weather, and many of us will mark the occasion by breaking out the snow shovel. And with the fluffy white stuff comes the inevitable warnings about shoveling – especially for those who are older, out-of-shape or have a history of heart problems. But are such admonishments legitimate, or just the advice of overprotective worrywarts?
The New York Times recently looked into the claim that shoveling snow raises the risk of a heart attack, and finds there’s some truth to it. An Ontario study of 500 patients who arrived at the hospital with heart problems during two winter seasons found that about 7% of the patients were shoveling snow when symptoms hit. Most were older men with a family history of premature cardiovascular disease.
A smaller study found that the heavy physical exertion of shoveling causes trauma to coronary arteries, resulting in a heart attack. The best way to avoid danger, experts say, is to shovel early, when snow is lighter, and take breaks.
The conclusion reached by the Times: “The exertion involved in shoveling can rupture plaque and cause heart attacks, particularly in those with a family history.” So bottom line, take it easy out there this weekend!
Just 1% of Americans accounted for 22% of health care costs in 2009 – about $90,000 per person – according to a new report by the Agency for Healthcare Research and Quality. A USA Today story on the report says that U.S. residents spent a total of $1.26 trillion that year on health care.
While the finding spotlights how the health status of a small segment of the population can impact overall health care spending, it actually represented a reduced concentration from an earlier report. In 1996, the top 1% of the population accounted for 28% of health care spending.
Most of the top 1% of spenders tended to be white, non-Hispanic women in poor health; the elderly; and users of publicly funded health care. About one in five health care consumers remained in the top 1% for at least two consecutive years.
In the top 10% of health care spending in 2008 and 2009, 80% were white, 60% were women, and 40% were 65 and over. Only 3% in that bracket were ages 18 to 29, and just 2% were Asian.
The report also found that 5% of Americans accounted for 50% of health care costs, or about $36,000 each.
Supporters of a soda tax as a way to discourage the consumption of sugary drinks now have some added ammunition from the scientific community. Medical News Today reports that a new study concluded that a penny-per-ounce tax would result in an approximately 15% reduction in beverage consumption and reduce the risk of of obesity, diabetes, and cardiovascular disease.
Researchers at Columbia University Medical Center and the University of California, San Francisco used data from a national nutrition survey and a questionnaire on food choices to investigate how a decrease in sugary drink cunsumption would impact health. Based on that information, they estimated that, over a ten-year period, the penny-per-ounce tax could reduce new cases of diabetes by 2.6%, as many as 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths.
In pure dollars and cents, the researchers determined that the health benefits from the soda tax would save over $17 billion over a decade in medical costs avoided for adults aged 25, and generate approximately $13 billion in annual tax revenue.
The article states that sugar-sweetened drinks are the largest source of added sugar and excess calories in the American diet, and quite possibly, the single greatest dietary factor in the current obesity epidemic. Many states already impose a soda tax, but experts believe they are too low to influence consumption.
Sometimes, it seems that not a week goes by that common wisdom doesn’t get turned on its head. Repeatedly, we’ve been told that taking aspirin regularly can help healthy people to prevent heart disease. But a new report says such advice is not only groundless, but harmful as well.
Reuters (via Yahoo! Health) reports that researchers reviewed nine previous trials of aspirin use in people who had never shown signs of heart problems. Based on the data, they could find no evidence that aspirin prevented fatal heart attacks. It did apparently cause a small reduction in non-fatal heart attacks, though no more than taking a placebo.
Such minor benefits, however, are more than offset by an increased risk of serious bleeding from stomach ulcers and other conditions – as much as 30%, said Dr. Kausik Ray, who studies heart disease prevention at St. George’s University of London and led the study. “It is actually not net benefit, it is a net harm.”
“What we need to focus on is lifestyle, smoking cessation, and statin and blood pressure medications,” Ray added. “I don’t recommend aspirin.” The article notes, however, that among other teams of scientists who have recently analyzed the same data Ray looked at, one team did interpret the results in favor of aspirin.
Not overeating at a restaurant can be a tricky business. Portions are usually larger than you’d have at home, and the fact that you’re paying for it provides extra incentive to clean your plate. But researchers from University of Texas at Austin think they have a solution for eating healthy when eating out.
Their strategy, called “Mindful Restaurant Eating,” encourages diners to pay close attention to what they’re consuming, favor smaller portions, and heed the signs that they’ve had enough. Eating healthy outside the home, the researchers say, doesn’t mean subsisting on steamed vegetables, but having a plan to avoid excess calories and sticking to it.
Some tips from the research participants, according to HealthDay News (via Yahoo! Health):