Monthly Archives: December 2012

Should Aging Doctors Be Routinely Evaluated?

By Sandra G. Boodman, Kaiser Health News

This 2009 photo shows the 83-year-old doctor examining the photographers's son. (Laura4Smith:Flickr)

This 2009 photo shows the 83-year-old doctor examining the photographers's son. (Laura4Smith:Flickr)

A distinguished vascular specialist in his 80s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care. An internist who suffered a stroke gets lost going from one exam room to another in his own office. A beloved general surgeon with Alzheimer’s disease continues to assist in operations because hospital officials don’t have the heart to tell him to retire.

These are real-life examples, provided by an expert who evaluates impaired physicians. They exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients.

Norcross estimates that about 8,000 doctors with full-blown dementia are practicing medicine.

About 42 percent of the nation’s one million physicians are older than 55 — and 21 percent are older than 65, according to the American Medical Association, up from 35 percent and 18 percent, respectively, in 2006. Their ranks are expected to increase as many work past the traditional retirement age of 65. Continue reading

To Lose Weight, Less Expensive Approaches Can Work

By Mina Kim, KQED

(Erica Feliciano/Flickr)

(Erica Feliciano/Flickr)

Researchers at the Palo Alto Medical Foundation Research Institute and Stanford University School of Medicine say they have found a cheaper and more practical way to help people lose weight. They’re hoping the findings will help reduce the incidence of Type 2 diabetes.

Researchers have known for a while, that one-on-one coaching is an effective way to help people lose weight and lower their risk for Type 2 diabetes. But that method can be hard to implement in a doctor’s office said Stanford Professor of Medicine Randall Stafford, a researcher who worked on the study.

“Lack of time of the doctor, the difficulties in hiring the appropriate staff,” Stafford said. “And then the fact that the type of services are quite expensive.”

Stafford and others found two, less intensive programs — group coaching or take-home DVDs — led to an average 10 to 15 pounds of weight-loss over a 15-month period. Stafford said that’s enough to have a health impact. Continue reading

Feds to States on Medicaid: Expand Fully or No New Funding

HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)

HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)

The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program.

Because the Supreme Court ruling in June had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear “no” as Secretary of Health and Human Services Kathleen Sebelius explained in a letter to governors.

In a briefing last week, California’s Health and Human Services Secretary Diana Dooley indicated she was waiting for guidance from the feds about the Medicaid expansion and might not expand to the full 138 percent limit.

In an email, a spokesperson for the state’s department of health and human services said staff is currently evaluating the new information and declined to comment further at this time.

Consumer advocates said it was good to have the matter settled. “We thought that it was the case,” Anthony Wright, Executive Director of Health Access told me in a phone call, “but it’s good for the federal government to provide clarity and hopefully this allows the states to move forward with all deliberate speed.”

It’s expected that more than four million Californians will be newly eligible for Medi-Cal. Under the Affordable Care Act, the federal government will pay 100 percent of the cost of those new eligibles from 2014 to 2017. After that, the match will phase down to 90 percent by 2020.

Fiscal Cliffnotes: If Medicare Eligibility Age Goes Up, People of Color Hit Hardest

While we all wait to see if President Obama and House Speaker John Boehner will hash out a deal on the fiscal cliff, one item getting a lot of discussion is raising the Medicare eligibility age, as I wrote about on Friday. Today, I was checking out Sarah Kliff’s twitter feed, and she pointed to UC Berkeley grad student Owen Zidar’s blog. Zidar’s post includes some eye-opening charts from economists David Card, Carlos Dobkin and Nicole Maestas writing in the American Economic Review.

Embedded in these wonky charts is an illustration of disparity:

And that disparity plays out in people not getting health care because of cost. Another snapshot of disparity:

This data was compiled before the Affordable Care Act was passed. We’ll have to wait and see how coverage and access change once the ACA is fully implemented in 2014.


Fiscal Cliffnotes: What Are the Trade-offs in Raising Medicare’s Eligibility Age?



It seems seductively easy: people are living longer, so why not raise the Medicare eligibility age from 65 to 67? This kind of entitlement reform is key to Republican strategies to pull the federal government back from the so-called Fiscal Cliff.

The problem is that while raising the Medicare eligibility age looks great in the short run, longterm it could actually cost money.

First, the short run: the non-partisan Kaiser Family Foundation says the federal government would save an estimated $5.7 billion in 2014 if the eligibility age were raised. Using a slightly different analysis, the nonpartisan Congressional Budget Office says savings could total $113 billion over the next decade.

But, those 65 and 66-year-olds are the youngest and presumably healthiest people in the Medicare program — meaning that if they leave Medicare, they would then be the oldest and presumably sickest people in any other insurance pool.

What would happen to those people? Continue reading

Quick Read: Off-Label Drug Marketing is Free Speech, Court Rules

It’s a federal appeals court decision that is either a victory for free speech or a significant threat to public health. While doctors can prescribe an approved drug for any purpose, FDA regulations have long held that companies may only market a drug for its approved use. This decision could open the door to television advertising for off-label uses of drugs. Caveat emptor!

A decision by a federal appeals court this week could have a dramatic impact on the marketing of prescription drugs in America, potentially affecting patient care and everything from TV advertising to future government prosecutions which, in the past, had yielded billions of dollars in settlements, doctors and attorneys said Tuesday.

Read more at:

How Many Dentists Accept Children on Medi-Cal? Depends on Who You Ask

New report says one in four dentists accept state’s Denti-Cal insurance; older reports say closer to two-thirds

By Emily Bazar, CHCF Center for Health Reporting

(Paul Goyette/Flickr)

(Paul Goyette/Flickr)

I’ve spent many months reporting on dental care for poor California children, looking into what kind of access they have to treatment.

(About half of kids in the Medi-Cal dental program see a dentist annually, although figures vary wildly by county.)

But I haven’t focused as much on the dentists who participate in the program, called Denti-Cal.

A new report by health care consultant Barbara Aved does just that. Based on her research, Aved concludes that 25 percent of California’s general dentists participate in the program.

Why not more? Here are some of Aved’s primary conclusions, based in part on a survey of dentists in five counties that she says reflect California as a whole. Out of about 2,000 general and pediatric dentists invited to participate, 322 responded.

  • Of dentists who do not participate, 97 percent cited the state’s low reimbursement rates as the No. 1 reason. California’s rates, Aved said, are among the lowest in the nation.

“Unlike physician practices, dental practices are in large part solo or two-person practices,” she said. “It’s really like a small business. Economically, it just doesn’t make sense to do business where you’re not going to be fully reimbursed.” Continue reading

California Spends Less Than 4 Cents of Every Tobacco Dollar to Reduce Tobacco Use

By Joshua Johnson and Lisa Aliferis

(Raul Lieberwirth/Flickr)

Tobacco prevention advocates are calling on California to spend more on anti-smoking programs — especially since the state already has the money for it.

A new report published Thursday titled Broken Promises to Our Children looked nationwide at how states are spending the money from the 1998 master settlement agreement with cigarette companies and from states’ tobacco taxes.

Campaign for Tobacco-Free Kids, which published the analysis, says states spend only a “minuscule portion” or tobacco revenue on cessation and prevention programs. The group estimates California will get $1.6 billion this year in tobacco revenue, but will spend just $62 million on smoking prevention and cessation efforts. Nationwide, states spend just two percent of their total tobacco revenue on prevention and cessation.

“California and other states have shown that these tobacco prevention/cessation programs more than pay for themselves,” said Danny McGoldrick, vice-president for research with the Campaign for Tobacco Free Kids. “When we cut them and reverse our progress in reducing smoking, we’re actually costing the state money, because we’re going to have more costs related to treating tobacco-caused disease.” His group estimates health care costs to treat tobacco-caused diseases total $9 billion in California. Continue reading

Quick Read: Treat Nutrition and Cancer Research Cautiously

This analysis comes from the Stanford Prevention Research Center and Dr. John Ioannidis — who brought us the news that there’s no silver bullet. Now, it looks like no single food will prevent — or cause — cancer.

Researchers created a list of 50 random food items, then found studies from the last 35 years that claimed risks or benefits for the majority them. But most of the claims were based on weak evidence.

Read more at:

Fiscal Cliffnotes: 6 Health Care Questions, Answered

By Mary Agnes Carey, Kaiser Health News

(Graphic: Kaiser Health News)

(Graphic: Kaiser Health News)

The so-called “fiscal cliff” is a package of automatic spending cuts and tax hikes set to kick in next month unless President Obama and Capitol Hill agree on a way to stop them.

Negotiations to avert the cuts are ongoing and both sides have exchanged offers. On one side, the president and congressional Democrats have said they will reduce spending on entitlements, including Medicare, if Republicans will agree to increase tax rates on the highest earners.

And on the other side, Republicans have agreed to more revenue — but by closing loopholes and eliminating some deductions. They oppose raising tax rates.

Here are answers to six questions about what could happen in health care before the end-of-year deadline.

Q: If no deal is struck, how would that affect Medicare patients as well as the hospitals and physicians and other providers who care for them? Continue reading