Sunday, August 9, 2009

News Clipping Archives

 

 

Maryland / Regional

U.S. Health Bill Might Aid Rural Md., Hoyer Says (Washington Post)

Wheat Harvest Hurt by Rainfall (Washington Post)

 

National / International

End-of-life decisions (Baltimore Sun)

Seniors Remain Wary of Health-Care Reform (Washington Post)

28 Illnesses Are Linked to Recalled Ground Beef (New York Times)

 

Opinion

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Maryland / Regional

U.S. Health Bill Might Aid Rural Md., Hoyer Says

Shortage of Doctors Reported in Calvert

 

By Christy Goodman

Washington Post

Sunday, August 9, 2009

 

The health-care legislation being debated in Congress won't solve the problem of the lack of qualified medical professionals in Southern Maryland, but it "tips the hat" to the issue.

 

That is what House Majority Leader Steny H. Hoyer (D-Md.) told doctors and other medical professionals at Calvert Memorial Hospital in Prince Frederick last week during a discussion on the bill.

 

"We do try to provide for a system of reimbursement that will facilitate rural areas' keeping their medical personnel," he said.

 

The bill, which aims to provide affordable health coverage to the nation's more than 47 million uninsured people, would provide funding for pilot programs that would reimburse doctors based on outcomes instead of procedures.

 

Scott Intner, director of business development at Calvert Memorial, said that doctors in the county receive up to 50 percent less in reimbursement funding than those in metropolitan areas and other states.

 

Many medical professionals have large debts after college and go into specialized fields in urban areas, where they will make more money, several professionals told Hoyer.

 

"Losing physicians and nurses and having a higher population [in Southern Maryland], it is a concern," said Mohammad Shahvari, an anesthesiologist.

 

Calvert needs 38 more physicians in 16 specialties over the next three years to meet the growing demands of the community, according to the county's most recent community health assessment. In the next year, 16 additional primary care doctors will be needed, the report says.

 

A report from this year's General Assembly says that there are 34 percent fewer primary care providers in Southern Maryland and other rural areas of the state than compared with the rest of Maryland.

 

Hoyer said the federal legislation should provide better compensation for doctors and "a more rational way of doing it."

 

There are also plenty of changes in the bill for the average person, he said.

 

Hoyer said that the current health-care system "is not sustainable for a long period of time." Most of an average family's premium pays for the uninsured, he said, so "the cost of having [the uninsured] in the system is less than not having them in the system."

 

The bill, which is expected to cost about $1 trillion over 10 years, is being debated in the Senate Finance Committee. Hoyer said that it has provisions to bar insurance companies from excluding people because of preexisting conditions and that it would offer more choices in coverage and care.

 

Margaret Fowler, director of community wellness at Calvert Memorial, asked the congressman whether the bill has incentives for patients to go to wellness centers and "take control and be active in your health care."

 

Hoyer said that co-payments for annual check-ups and preventive care would no longer exist and that deterrents would be applied to certain patients based on behaviors such as smoking.

 

"Everyone is at risk of a medical cost," Hoyer said. "If you don't have insurance, we're all going to pay the bill."

 

Copyright 2009 Washington Post.

 

Wheat Harvest Hurt by Rainfall

Damage From Fungi Diminishes Profits for Md. Farmers

 

By Rick Rojas

Washington Post

Sunday, August 9, 2009

 

The frequent downpours of rain from May into late June -- and the cool and overcast conditions that followed -- drenched the region's grain crops, leaving them susceptible to damaging fungi and farmers with diminished profits, agriculture experts say.

 

The fungi, known as vomitoxins, thrived in the dampness and spread across the region. Grain farmers from Maryland to North Carolina reported crops with too high a fungi count to be sold for flour -- the market in which they could make the most money -- and, in some cases, too high to be used for animal feed, which farmers sell at a heavily discounted rate.

 

For a smaller number of farmers, the fungi count reached a level at which the only option would be to try to use the grain for seed next season, said Maryland Agriculture Secretary Earl F. "Buddy" Hance.

 

Maryland farmers noticed a problem with the crops about a month ago, said Sue DuPont, a department spokeswoman. The state chemist's office then began distributing test kits to farmers across Maryland. Increased vomitoxin counts have been found across the state, with the bulk of them reported in Southern Maryland, according to University of Maryland agriculture extension agents.

 

A multitude of cases has been reported in North Carolina, where farmers were also at risk of losses because of the vomitoxin, Agriculture Commissioner Steve Troxler said in a statement.

 

Hance said the vomitoxin was an unexpected problem that he had never experienced as a wheat farmer.

 

Although officials here have little experience with vomitoxins brought about by an overabundance of rain, the problem is not unprecedented in the United States. Last year, grain farmers in the Midwest, Kansas especially, faced a fungi plague after heavy rainfall, according to a U.S. Department of Agriculture report.

 

Like the Midwest in 2008, the Washington area in 2009 had a much higher than normal amount of rainfall, according to National Weather Service measurements. In May, 8.05 inches of rain fell, compared with 4.23 inches a year before. In June, 5.86 inches of rain fell; that figure was 2.73 inches for 2008.

 

Jamie Jamison, a wheat farmer in Poolesville in Montgomery County, said the poor conditions this season follow a healthy harvest the previous season.

 

"Last year, they all had perfect wheat. No problem," Jamison said of grain farmers in the region. In 2009, however, "it's just been the most difficult year."

 

Unlike other farmers who will be taking a loss and will depend on crop insurance to make up the difference, Jamison said he took an unusual approach that paid off. He invested in a grain drier and harvested his wheat early. Because of it, he was able to sell his wheat for flour -- the most lucrative market.

 

Many others weren't nearly as successful. Herb Reed of the University of Maryland agriculture extension in Calvert County said the fungus left many crops with a low test weight.

 

The ideal weight for a bushel, which is measured by the density of the kernel, is 60 pounds, he said. Once the pounds per bushel fall below the mid-50s, the wholesalers begin to reduce the price. If that weight falls too low, a crop could be rejected.

 

In order to avoid rejection, many farmers have to mix healthy wheat with a low vomitoxin count in with the other wheat, Reed said. Jamison said the other option would be to pay to have the wheat cleaned. But the alternatives "get fairly expensive," he said.

 

Pamela King, an extension agent in Calvert County, said having a wet season "creates an entirely different set of problems than if we have a dry one."

 

"Will it do them terminal damage?" King said of the vomitoxin. "We hope not. Farming is a very risky business, and that's one of the risks."

 

Hance, a fourth-generation farmer in Port Republic in Calvert, said farmers have to "just roll with the punches." But he has a concern larger than one year's harvest: If farmers cannot make a living in agriculture, they could flee the business.

 

"We hope our farmers are profitable," Hance said. "It's the only way we can maintain the open spaces in Maryland."

 

Copyright 2009 Washington Post.

 

National / International

End-of-life decisions

Health reform: Unfounded fears of government-sponsored 'euthanasia' obscure the real need for planning ahead

 

By Eileen Ambrose

Baltimore Sun

Sunday, August 9, 2009 

 

As an example of how opponents of health care reform have been able to twist facts to scare older Americans, look no further than a comment made to President Barack Obama during a recent town hall meeting.

 

Mary of North Carolina told the president she was worried about rumors she's heard about health care legislation. "I have been told there is a policy in there that everyone that's Medicare age will be visited and told to decide how they wish to die," Mary said. "This bothers me greatly."

 

Who wouldn't be freaked out by that? Or by some of the other wild claims of government-backed euthanasia.

 

But that's not what's proposed at all. Fears are being stoked over a provision that would have Medicare pay for a visit to the doctor if older Americans want to talk to a physician about end-of-life care, including setting up a living will. This is the document that spells out what sort of care you want if your health fails to the point where you can't speak for yourself. It's a document all adults - even healthy ones in their 20s and 30s - should have.

 

Proposed legislation calls for Medicare to foot the bill for a consultation with a doctor once every five years, or more often if a patient's health significantly declines. That's it. No one would be required to talk to a doctor or set up a living will.

 

The president explained this to Mary, noting that he and his wife have a living will as did his late grandmother. But he also added that this is just a proposal, and if it bothers people so much, Congress could drop the provision in the final bill.

 

That would be a shame. It would mean that fearmongers have succeeded in stripping away a small, but valuable perk for older Americans on fixed incomes.

 

Yet no matter what happens with health care reform, adults need documents that address their end-of-life wishes so loved ones aren't left to guess.

 

"It is the responsible thing to do," says Howard Sollins, a health care attorney in Baltimore. "If you care about others, why wouldn't you want to give them some guidance so they aren't completely without information about what you want?"

 

The health care legislation focuses on living wills for Medicare beneficiaries age 65 and older. But it's just as important for young adults to have such documents, says Julie Heffner, a social work supervisor at Gilchrist Hospice Care in Hunt Valley.

 

Young adults are less likely to have had end-of-life care conversations, she says, so families might have to guess the wishes of someone who is incapacitated after an illness or accident.

 

Indeed, patients stricken in their 20s have been at the center of high-profile right-to-die cases where relatives feud in court about whether to stop treatment. That includes Terri Schiavo, Karen Ann Quinlan, Nancy Cruzan and Ronald W. Mack, a Marylander whose case led to state legislation in the early 1990s.

 

State law governs living wills. In Maryland, end-of-life health care documents are rolled into what's called an "advance directive." It has two parts: naming a health care agent and the living will.

 

You don't need a lawyer to set one up. The Maryland's attorney general's office posts forms online at www.oag.state.md.us that you can print out and fill in. You can fill out one or both parts, or add your own supplement.

 

Here are things to consider:

 

Health care agent The directive allows you to name a person to make health care decisions on your behalf when you no longer can. Choose someone you trust, who knows your wishes and will honor them.

 

If you don't name an agent and become incapacitated, a surrogate will be appointed based on state law, starting with a guardian, then spouse or domestic partner, followed by adult children, parents, adult siblings and so on, says Paul Ballard, counsel for health decisions policy with the Maryland attorney general's office.

 

Designating an agent in an advance directive is important if you want someone other than a family member in this role, Heffner says.

 

Name a single agent - not multiple co-agents who might not agree. But make sure you name one or more backups in case your first choice can't serve as your agent.

 

Living will This second part of Maryland's advance directive allows you to express your medical wishes if you are in a persistent vegetative state, a terminal condition where death is imminent or at an end-stage condition where there's no hope for recovery but you can linger for months or years, Ballard says.

 

"It's important to be specific in the advance directive to what you want. Vague language can create problems," he says.

 

Doctors can't override your directive unless the treatment you request is "medically ineffective," Ballard says.

 

Giving guidance Your directive can state when you want it to kick in, such as after the doctor says you have permanently lost the ability to make decisions.

 

You also can state whether you want your agent to follow your wishes to the letter, or to, say, use his or her best judgment after reading the directive.

 

Witnesses In Maryland, you need two people to witness your signing of the advance directive. It can't be just any two people, though. The health care agent can't be a witness. And one of the two witnesses can't knowingly inherit anything from you or financially gain from your death.

 

Your directive won't be legally binding if you fail to get it properly witnessed, Ballard warns.

 

Copies Once the advance directive is completed, give copies to those who need to know your end-of-life wishes, such as your doctor, health care agent and family.

 

An advance directive doesn't expire. Periodically review it and update the document if, say, your choice of a health care agent or your view on end-of-life care has changed.

 

Copyright © 2009, The Baltimore Sun.

 

Seniors Remain Wary of Health-Care Reform

Administration Aims to Reassure Older Americans Fearful of Losing Access to Care

 

By Ceci Connolly

Washington Post

Sunday, August 9, 2009

 

Senior citizens are emerging as a formidable obstacle to President Obama's ambitious health-care reform plans.

 

The discontent in the powerful and highly organized voting bloc has risen to such a level that the administration is scrambling to devise a strategy to woo the elderly.

 

Obama's task will not be easy. Proposals to squeeze more than $500 billion out of the growth of Medicare over the next decade have fueled fears that his effort to expand coverage to millions of younger, uninsured Americans will damage elder care. As a result, barely one-third of seniors support a health-care overhaul, several polls found.

 

"People have gotten more and more worried," said Nancy LeaMond, a vice president at the 50-and-over advocacy group AARP, which will unveil a pro-reform TV and print ad campaign Monday. "They are very concerned about the myths they keep hearing that care will be rationed and they won't have access to doctors."

 

One mailing from the 60 Plus Association, which bills itself as a "conservative alternative to AARP," warns that the proposed Medicare changes will mean "longer wait times at hospitals and doctors offices, less money for new treatments, restrictions on care, prescriptions and what's best for you -- the patient!" Officials at the Virginia-based group did not respond to several messages last week.

 

Conservative talk-radio shows have raised the prospect of euthanasia based on a provision to reimburse doctors through Medicare for counseling sessions about end-of-life directives.

 

And comments posted on former Alaska Republican governor Sarah Palin's Facebook page Friday said that people would have to "stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care."

 

There are no such "death panels" mentioned in any of the House bills.

 

From the raw numbers, it appears seniors are the net losers under bills approved by three House committees last week. The legislation trims $563 billion out of Medicare's growth rate over the next 10 years while pumping in about $320 billion. Without any changes, the program is expected to cost about $6.4 trillion over the same period.

 

But three retiree groups and several independent policy analysts say most of the proposed savings affect providers, rather than beneficiaries, and have the potential to improve quality over the long term. Discounts for prescription drugs, higher reimbursements for many doctors and elimination of co-payments for preventive services are some of the ideas advocates applauded.

 

"I don't see anything that will affect beneficiaries' access to care, though some of it will depend on implementation," said Joseph Baker, president of the Medicare Rights Center, a nonprofit group focused on older Americans.

 

Senior citizens have long had doubts about Obama. Voters 65 and older were the only age group to choose Sen. John McCain (R-Ariz.) in last year's presidential election, according to exit polling that looks at four common age groups. Those polls show McCain won seniors 53 percent to 45 percent.

 

"They are more risk averse; they wanted more experience and less change," said Democratic pollster Celinda Lake, who tracks retiree attitudes. In health-care reform, seniors see "very rapid change and in an area they don't want change."

 

The overhaul Obama envisioned would expand insurance coverage to about 46 million people. But the elderly have comprehensive coverage through the federal Medicare program, which cost $453 billion this year. For seniors, health reform represents a threat to care they like, said Lake.

 

"They only want to hear one thing: that their Medicare benefits won't be affected," she said. It is a message, she added, that has not been conveyed adequately by Obama, congressional Democrats and "third-party validators."

 

Administration officials said Saturday that they are considering several options for reaching out to skeptical seniors, including a "myth-busting" Web site and public appearances by the president.

 

Diane Rowland, executive vice president of the nonprofit Kaiser Family Foundation, said the House legislation does not "address all of the issues in Medicare that seniors would like to see addressed," including money for long-term care. But discounts on prescription drugs and provisions that would extend the Medicare Trust Fund for at least five years are "an attempt to reassure the Medicare population."

 

Under the bills, insurance companies that sell managed-care plans known as Medicare Advantage would take the largest hit. The independent Medicare Payment Advisory Commission has recommended reducing payments under Medicare Advantage, noting that insurance plans that were touted as being more efficient should not cost 14 percent more than the traditional fee-for-service Medicare policy.

 

Insurers say the extra money provides benefits such as eye care, dental and gym memberships -- benefits that could be eliminated if the 10-year, $156 billion reduction occurs. Though the industry's lobbyists have spoken against the change, the criticism has been muted in the hopes that health-care reform will deliver millions of new customers.

 

Hospitals would also receive smaller-than-anticipated payments under the House plans. One provision would slash payments to hospitals that have high readmission rates. Medicare estimates that 19 percent of the unpleasant, costly readmissions are "preventable." Another proposed change would "bundle" fees for packages of care such as knee replacement to encourage medical teams to coordinate care from an initial assessment through surgery and rehabilitation.

 

The hospital industry has pledged to make $155 billion in reductions over the next decade as part of health reform and AARP has endorsed the changes.

 

But the organization, which has a separate business unit that sells insurance, has objected to some proposals, including an Obama-backed plan to empower an independent advisory board to decide Medicare coverage and payment policies.

 

Rep. Eric Massa (D-N.Y.) said tightening provider payments could lead to access problems for patients.

 

"We will force doctors to decline Medicare patients," he said after a raucous town-hall meeting in Upstate New York. "If we believe these savings are there, let's test the concept. But we can't hinge the entire funding of this bill on these not-yet-seen savings."

 

Copyright 2009 Washington Post.

 

28 Illnesses Are Linked to Recalled Ground Beef

 

Associated Press

New York Times

Sunday, August 9, 2009

 

SAN FRANCISCO (AP) — Health officials in three Western states said Friday that at least 28 people had reported illnesses tied to recalled ground beef that might be tainted with salmonella.

 

On Thursday, Beef Packers Inc. of Fresno recalled nearly 826,000 pounds of ground beef produced from June 5 to 23.

 

The Food Safety and Inspection Service of the Agriculture Department said the beef was sent to retail distribution centers in Arizona, California, Colorado and Utah, with some sold at Safeway Inc. and Sam’s Club.

 

On Friday, the department confirmed that California, Colorado and Wyoming had reported illness linked to the recalled beef.

 

Colorado health officials said 21 people there had been sickened, and all were recovering. California officials said five people had reported feeling sick. Wyoming health officials reported that two people had fallen ill.

 

Officials are investigating other reported illnesses in Arizona, Idaho, Illinois, Nebraska, New Mexico, Nevada, South Dakota and Texas that may be linked to the same strain of salmonella, the Agriculture Department said.

 

Federal officials do not yet know if those cases are associated with the beef recalled Thursday.

 

Because the beef was repackaged under different retail names, the department recommends consumers check with the store where they bought the beef to determine whether what they bought has been recalled.

 

Salmonella can result in abdominal cramps, diarrhea and fever. Most people recover without treatment, but some require hospitalization. In rare cases the organism can get into the blood and produce more severe illnesses.

 

Copyright 2009 New York Times.

 

Opinion

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