May 14, 2013 | 5:06 PM | By

California’s Health Insurance Exchange Builds Critical Outreach Network

Covered California, the state’s health insurance exchange, announced the recipients of $37 million in education and outreach grants on Tuesday. It’s a critical step in the drive toward the full implementation of the federal health law on Jan. 1. “This program now belongs to California … and to Californians, and we have to make it work,” said Dr. Robert Ross, a Covered California board member.

The grants were awarded to 48 lead organizations, which will be supported by 226 community partner groups. They will focus on education and outreach to the 5.3 million Californians the exchange seeks to enroll, with an estimated 2.6 million of those people eligible for subsidies to help them afford insurance. Five of the recipients will target their outreach to small businesses.

Californians will be able to shop for insurance on the new marketplace starting Oct. 1, with coverage going into effect on Jan. 1. Most people must have insurance or pay a penalty. In 2014 the penalty is $95 per person or 1 percent of income (whichever is greater), and the penalty rises to $695 or 2.5 percent of income (again, whichever is greater) by 2016.  Continue reading →

FILED UNDER: KQED blogs, Reform, Affordable Care Act, Covered California, Obamacare
May 14, 2013 | 12:22 PM | By

Why Angelina Jolie’s ‘Medical Choice’ Is Likely Not Yours

(Foreign and Commonwealth Office/Flickr)

(Foreign and Commonwealth Office/Flickr)

Angelina Jolie lit up social media Tuesday morning with her announcement that she recently had a preventive double mastectomy. She took this route, she says, because she carries a specific BRCA1 mutation — putting her at an 87 percent risk of developing breast cancer and a 50 percent risk of ovarian cancer. You can read everything about her history in her New York Times piece, “My Medical Choice.”

But the key here is a specific BRCA1 mutation. There are many different mutations that can occur in the BRCA gene. Jolie is very careful to walk through all her personal decisions stemming from her unusually high risk, but emphasizes that “the risk is different in the case of each woman.”

About 10 percent of all breast cancers are due to those many BRCA mutations. Dr. Otis Brawley, chief medical officer with the American Cancer Society, explains in more detail what individual women should consider, in a response to Jolie’s piece:

This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist. Continue reading →

FILED UNDER: You're the Boss, Angelina Jolie, Breast Cancer, Mastectomy, Science
May 13, 2013 | 8:40 AM | By

Valley Fever Cases Soar in West, Yet ‘Off The Radar’ of East Coast Policymakers

By Rebecca Plevin, NPR

(Daniel Casarez/Vida en el Valle/Reporting on Health Collaborative)

(Daniel Casarez/Vida en el Valle/Reporting on Health Collaborative)

When she was just 6, Emily Gorospe became very tired and sick. The spunky girl, now 8, developed a fever that wouldn’t go away, and red blotches appeared across her body.

“She’s got so much energy usually,” says Emily’s mother, Valerie Gorospe. “Just walking from one part of the house … she was drained.” The little girl was also very pale. “She just didn’t look like herself,” Valerie recalls.

Emily, who lives in the Central Valley town of Delano, was eventually diagnosed with valley fever, also known as coccidioidomycosis. She’s one of an estimated 150,000 people nationwide who get the fungal disease every year. There is no cure and no vaccine.

Valley fever has afflicted about four times more people than West Nile virus, with thousands more going undiagnosed.

Valley fever is well known in the Central Valley and other areas of California and Arizona. Tiny fungal spores live in the soil throughout much of this arid region. When the spores are disturbed, they can be inhaled into the lungs.

James McCarty, the medical director of infectious diseases at Children’s Hospital Central California, says most people feel nothing, or experience symptoms similar to the flu. Common symptoms include fever, night sweats, weight loss, chest pain, cough and sometimes skin rashes.

Valley fever can be a very serious disease for some people, McCarty says. It can spread from the lungs to other parts of the body, like the central nervous system, bones or skin. It can be life-altering or even fatal. Continue reading →

FILED UNDER: Policy, Science, Valley Fever
May 10, 2013 | 1:41 PM | By

Mark Bittman Talks Up Part-Time Veganism (and Delivers 3 Easy Recipes)

(Getty Images)

(Getty Images)

It all started with a prescription from his doctor, but not for a drug.

“You should probably become a vegan,” New York Times food writer Mark Bittman says his doctor told him. That was six years ago. Then 57, Bittman says he was 40 pounds overweight, and his cholesterol and blood sugar which had always been normal, had moved into the “danger zone.”

Bittman had built his career around food, and being a vegan didn’t appeal to him, as he recounted this week on KQED’s Forum. “I wanted … something do-able, something I could stick with,” he said.

He hatched the idea of being vegan until dinner — “you’re only postponing gratitude” until then.

It seems to have worked. Today, he’s 35 pounds lighter and he says his blood sugar and cholesterol are back in the normal range.

Now he has recounted his experience in a new book, “VB6: Eat Vegan Before 6:00 to Restore Your Health and Lose Weight … for Good.” Continue reading →

FILED UNDER: You're the Boss, Diet, Science, Vegan
May 9, 2013 | 11:22 AM | By

Open-Campus Policies Eat Away at School Nutrition

By Katharine Mieszkowski, Center for Investigative Reporting

Scott Sowko, a sophomore at Berkeley High School, leaves Bongo Burger after lunching off-campus. School officials say one-tenth of the students take advantage of the healthy lunch served in the school cafeteria. (Noah Berger/Center for Investigative Reporting)

Berkeley High School students have lunch off-campus at Bongo Burger. School officials say one-tenth of the students take advantage of the healthy lunch served in the school cafeteria. (Noah Berger/Center for Investigative Reporting)

At lunchtime, hundreds of Berkeley High School students rush off campus, leaving behind healthy meals served in the cafeteria. Many of them head to Bongo Burger, Top Dog and other joints selling high-fat, high-sugar alternatives.

Six miles away at Oakland High School, the cafeteria is mobbed. There are not enough seats for everyone, so some students eat lunch outside on picnic tables while others eat in classrooms. No one goes off campus to pick up food from Wingstop or the AMPM convenience store.

The difference? The Oakland High students are no longer allowed to leave campus during lunch.

At Berkeley High, where famed chef Alice Waters’ nonprofit, the Edible Schoolyard Project, has consulted on the menu, school officials say one-tenth of the students take advantage of the healthy lunch on campus.

“Kids could be eating a good meal for free, or they could be running off campus, and in a hurry … they’re going to buy the Flamin’ Hot Cheetos and a Coke.”

In recent years, lawmakers, regulators and school districts have tried to improve students’ health by curbing the sale of junk food and tightening nutritional standards for school food. But those efforts are undermined when students can leave campus to eat whatever they want, as they can at dozens of Bay Area high schools. Based on the experience in Oakland, closing campuses while offering free lunches can be an effective strategy.  

First lady Michelle Obama has made improving what students eat a signature cause. Just this school year, cafeterias nationwide have been implementing new nutritional standards for the lunches they serve. The U.S. Department of Agriculture is working on new regulations for all other foods sold in schools, including from vending machines. But the idea of keeping kids on campus so that they eat healthy lunches is not part of the national debate.

The Oakland Unified School District closed the Oakland High campus last fall to cut down on absenteeism after lunch and reduce break-ins, drug use and trespassing in surrounding neighborhoods, said then-Principal Jeffrey Rogers.

Continue reading →

FILED UNDER: Policy, School Lunches, Science
May 8, 2013 | 6:12 PM | By

How Much Would You Rather Pay For That Procedure? $170,000 or $43,000?

(Getty Images)

(Getty Images)

It’s nearly unbelievable to average consumers, but well known to wonks: health care prices are impossible to come by. Even calling and asking about a specific procedure, as researchers recently reported, led to an “I dunno” from the hospital itself more than half the time.

But now, a little bit of light is being shed on this dark area of health care. Wednesday morning, the federal government released a massive amount of data: the prices that hospitals across the country charge for 100 of the most common inpatient treatments.

Skipping over the wonk for now, let’s dive in to some numbers right here in the Bay Area. They cast a spotlight on how random and wildly variable health care prices are.

I picked one procedure, a hip or knee replacement (“lower extremity major joint replacement”) without major complications.

A joint replacement is generally a procedure you would schedule in advance, not a race-to-the-hospital-life-or-death-spare-no-cost situation. You might think the range of prices would be somewhat narrow.

You would be wrong. Continue reading →

FILED UNDER: Policy, Health Care Costs, Variation
May 7, 2013 | 12:04 PM | By

Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis

By Sandra G. Boodman, Kaiser Health News

(Getty Images)

(Getty Images)

Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn’t think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor  –  the size of a peach pit  –  using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

“I consider myself lucky to be alive,” said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was “really shocked” by his misdiagnosis.

Misdiagnosis “happens all the time … This is an enormous problem.”

But patient safety experts say Brook’s experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. To cite just two examples: Continue reading →

FILED UNDER: Policy, Medical Error, Patient Safety, Science
May 6, 2013 | 11:14 AM | By

New Factors in Play for Legislators Considering Statewide Soda Tax

(Getty Images)

(Getty Images)

A soda tax failed at the ballot at two California cities last November. Before that, a statewide soda tax failed two years ago. But advocates and legislators are trying again. A bill that would require a penny-per-ounce tax on any sugary beverage is back in front of legislators and, so far, has passed out of two Senate committees.

The bill by Sen. Bill Monning (D-Carmel) has two explicit goals: to “discourage excessive consumption” by increasing the price of sugary drinks and to create a Children’s Health Promotion Fund.

“We’re in the midst of a public health crisis fueled by childhood obesity,” CaliforniaHealthline reports Monning said to the Senate Committee on Health last week. “This legislation sets an alternative path toward health and wellness.”

The health committee approved the bill. Next stop is the Senate appropriations committee.

While the soda industry is expected to be back in force for this bill, as it was for the other soda-tax efforts, this time there are new forces in play. Continue reading →

FILED UNDER: Policy, Science, Soda Tax, Sugar-Sweetend Beverages
May 3, 2013 | 3:26 PM | By

Oregonian Describes Life — and Health — After Winning Medicaid Lottery

(Fred/Flickr)

(Fred/Flickr)

For you wonks out there, Kaiser Health News has a fascinating Friday afternoon read for you.

In a piece titled “Bloggers See Own Reflections in Oregon Medicaid Study,” reporter Jordan Rau describes how this week’s news about Oregon’s Medicaid Experiment quickly became “a Rorschach test for how partisans and health policy wonks view the health care law.”

With no money for better food, no money for good shoes to go on walks, no rain gear, no walkman for listening to music as a distraction while walking, change is harder.

To quickly recap, in a New England Journal of Medicine study researchers analyzed how 10,000 people who won Medicaid coverage have fared since they gained insurance. The highlights were: no apparent affect on physical health; rates of depression 30 percent lower than those without coverage; catastrophic out-of-pocket medical expenses essentially eliminated.

In his piece, Rau publishes excerpts from seven blogs, each with a different take on the study’s highly nuanced results. But he closes with something I hadn’t seen elsewhere: a view of the experiment by someone who says he was one of the winners of the Medicaid coverage. Rau found the post on the blog Robert’s Stochastic thoughts.

Here’s the post in its entirety:

I am one of the winners in the Oregon lottery [winners could get Medicaid]. Going from no insurance to insurance is very confusing. When you have no money every health question starts with “would I rather live with this problem and have electricity, or treat this problem and keep my milk in a cooler for a month or so?” Stepping back into healthcare was like Continue reading →

FILED UNDER: Policy, Affordable Care Act, Medicaid, Obamacare, Science
May 3, 2013 | 10:18 AM | By

How Nurses and Other ‘Mid-Level Providers’ Fill Growing Gap in Primary Care

By Jose Martinez, KPCC

(Keith Brofsky/Getty Images)

(Keith Brofsky/Getty Images)

Simmi Gandhi — a family nurse practitioner at South LA’s UMMA Community Clinic — is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.

In Urdu, she tells the patient her mammogram shows the mass in the woman’s breast isn’t cancer. After Gandhi hangs up, she doesn’t miss a beat: She starts debriefing for her next patient, who’s been missing appointment for months.

“Looks like he has diabetes,” she says. “I had asked for him to be able to get an appointment six weeks thereafter, so that was back in September. That was cancelled, and then he didn’t come for two appointments that were rescheduled. And now he’s finally back.”

Simmi Gandhi is what’s called a midlevel provider — which includes registered nurses, physician assistants and nurse practitioners. These are medical professionals who are in-between physicians and lower skilled medical technicians and nurses. At the UMMA clinic, she provides a wide range of primary care people in need.

“A community like this has less resources,” she says. “A lot of the folks that live here have less education as I’m sure everybody’s aware, our educational system is stressed so the basic education people get around their bodies … is low.” Continue reading →

FILED UNDER: KQED blogs, Place Matters, Midlevel Providers, Primary Care