Friday, February 13, 2009

News Clipping Archives

 

Maryland / Regional

Increase in hospital financial aid urged (Baltimore Sun)

Who'll be left there to help? (Baltimore Sun)

O'Malley hails federal stimulus package (Baltimore Sun)

Free car seat safety checks offered (Frederick News-Post)

Joint program to offer inmates drug treatment (Baltimore Sun)

State senators weigh domestic violence vs. right to guns (Baltimore Sun)

D.C. Area Stimulus Numbers Cheered (Washington Post)

University of Maryland researchers map genetic codes for cold virus (Baltimore Sun)

O'Malley lauds researchers who sequenced cold virus (Daily Record)

Prince George's residents talk with O'Malley (Prince George’s County Gazette)

Suitland teenager seeks help with continuing costs of prosthesis (Daily Record)

Salisbury dentist indicted in forged Rx case (Salisbury Daily Times)

Bill would pile on work for poultry farms (Salisbury Daily Times)

National / International

Off-label drug use puts patients at risk (Baltimore Sun)

Delay lets military health fraud suspects off hook (Washington Post)

At Wal-Mart, a Health-Care Turnaround (Washington Post)

Retail Medical Clinics Are Poised to Play an Increasingly Important Role in Primary Care (AIS's Health Business Daily )

Sensors Help Keep the Elderly at Home (New York Times)

Medicare Blow to Virtual Colonoscopies (New York Times)

PRUDEN: Prescription for medical malpractice (New York Times)

Survey: Peanut recall known but misunderstood (Hagerstown Herald-Mail)

Opinion

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Maryland / Regional

 

Increase in hospital financial aid urged

Rate-setting agency backs change in state law

 

By James Drew

Baltimore Sun

Friday, February 13, 2009

 

Maryland law should be changed so that hospitals are required to provide charity care to more people and give financial-assistance information to all patients, according to the state agency that sets hospital rates.

 

In a report to Gov. Martin O'Malley that will be released today, the Health Services Cost Review Commission recommends several changes to the state's unique rate-setting system, which was designed in part to guarantee all Marylanders hospital care whether they could afford it or not.

 

The commission also recommended that hospitals be required to provide written notice about the availability of financial assistance to all patients before or as they are discharged, and that hospitals and their collection agencies be barred from adding interest and penalties on bills to uninsured patients for periods before court judgments are entered against them.

 

O'Malley ordered the commission to do an "immediate and thorough review" of hospital debt collection practices in response to a Baltimore Sun investigative series in December. The articles documented how hospitals were aggressively pursuing collection of unpaid bills from patients of limited means even though those debts are supposed to be recovered in the rates they charge.

 

"When we identify there is a problem, it is important that we study it and come up with practical solutions to solve it," said John M. Colmers, secretary of the Department of Health and Mental Hygiene.

 

The 90-page report says hospitals should be required to provide free care to all Maryland residents whose incomes are less than 200 percent of the federal poverty guideline - or $36,620 for a family of three or $44,100 for a family of four.

 

The Maryland Hospital Association has said all of its members, at a minimum, offer free care to patients who have incomes below 150 percent of federal poverty guidelines - $27,465 for a family of three and $33,075 for a family of four - and less than $10,000 in net assets.

 

"The State lacks any standards for Credit and Collection activities and hospitals' articulated policies are ambiguous and vary even more widely," according to the report by Robert B. Murray, executive director of the cost review commission.

 

State officials said yesterday that they could not pinpoint the number of additional Marylanders who could be eligible for charity care if the General Assembly follows the report's recommendations, partly because they are still studying the issue of using assets to determine eligibility. But based on 2007 figures, an estimated 90,000 uninsured, nonelderly citizens could become eligible.

 

The cost review commission had joined the Maryland Hospital Association to oppose moves by the General Assembly in 2005 to define charity care eligibility and to require hospitals to give patients charity care applications.

 

Yesterday, the association said the report and bills being introduced this week "include a number of steps in the right direction to improve the billing and collection process for Marylanders."

 

"Some of the recommendations parallel and strengthen guidelines previously adopted by the Maryland Hospital Association," Carmela Coyle, the trade group's president, said by e-mail.

 

The Sun's series found that in some cases, hospitals sought to add interest at the legal maximum of 12 percent a year on judgments, going back to 60 days after the patient was discharged. The Maryland Constitution sets interest rates at 6 percent for most debt, but hospital debts are exempt.

 

The report to O'Malley also says state regulators should collect more information on how hospitals handle money they recover from unpaid bills. The newspaper'sreport found that state officials cannot be sure hospitals aren't getting paid twice for some of the same bills because they don't check. Hospitals deny they collect bills twice. Commission officials have said that while some hospitals report income from debt collections to them every year voluntarily, others don't.

 

Colmers said state regulators have begun audits of every hospital to determine whether they are deducting money they collect from judgments from the amounts of unpaid bills that they submit for recovery through the rate-setting process.

 

Del. Peter A. Hammen, the Baltimore Democrat who is chairman of the House Health and Government Operations Committee, plans to introduce a bill today that would set the minimum standard for charity care at 150 percent of the federal poverty guideline, as does a bill filed this week by Sen. George Della, a Democrat who represents South Baltimore.

 

Hammen's legislation calls for the commission to set up a "work group" to study several issues, including how the assets of patients should be considered in collection efforts.

 

Also, the attorney general's office would review whether hospitals should continue to be able to obtain liens on patients' homes and charge prejudgment interest. The deadline for presenting findings to the governor would be Oct. 1.

 

Copyright 2009 Baltimore Sun.

 

Who'll be left there to help?

Job cuts may have left Maryland without enough workers to deliver aid from stimulus to the needy

 

By J. Peter Sabonis

Baltimore Sun

Friday, February 13, 2009

 

For a massive infusion of government aid to the needy to stimulate the economy, it is necessary for such aid to actually be delivered. Unfortunately, in Maryland, this is not a given.

 

After the stimulus is approved, federal government transfers such as food stamps, unemployment insurance and health care likely will increase. But it takes state employees to process and deliver that aid. And in this state, recent history shows that human services personnel are expendable.

 

Gov. Martin O'Malley's fiscal 2010 budget pares 1,875 state jobs with a broad sweep that includes all agencies, but the state departments of Human Resources and Health and Mental Hygiene will suffer more than the others. That's because of a seven-year hiring freeze that has hit human services agencies disproportionately hard.

 

The Maryland Budget and Tax Policy Institute examined the change in full-time state positions from the start of the freeze in 2001 until 2008 and found that those two departments lost 1,333 and 1,042 full-time positions respectively - more than twice as many as any other agency. (During the same period, higher education added 2,857 positions.)

 

The institute also reported that 80 percent of the Department of Human Resources vacancies occurred in jobs where state personnel determined eligibility for governmental transfer programs such as food stamps.

 

This is no surprise to us at Maryland Legal Aid. As we represent the unemployed and the working poor during this recession, we've seen the effects of a skeletal state infrastructure. Eligibility documents are lost by local Department of Social Service workers; phone calls are not returned; waiting rooms are crowded; supervisors and managers are unavailable; and mistakes are increasing.

 

Because of untimely retirements and resignations, the Baltimore County DSS has been hit particularly hard. A mother of three who has been regularly receiving food stamps failed to receive her eligibility recertification letter, and her benefits were terminated Dec. 31. Numerous trips to the county's Towson office failed to resolve the problem, and Legal Aid will now bring her matter to an administrative hearing. In the meantime, the family frequents food pantries.

 

At the county's Reisterstown office, another mother with similar difficulties - made worse by a lapse in child support payments - has visited the office four times and has been told that her paperwork is in order, but the office simply doesn't have the staff to process the assistance.

 

Another Legal Aid client, this one with a high-risk pregnancy, visited the Towson office in October 2008 to apply for food stamps and Medicaid. Despite a requirement to act on such applications within 30 days, the county allowed months to pass without any eligibility determination, and acted only when Legal Aid intervened.

 

Missing eligibility deadlines has become so commonplace statewide in Medicaid for the disabled that the state recently proposed emergency rules to extend the application processing deadline from 60 days to 90.

 

Can food stamps put purchasing power into the hands of the working poor if there are no state hands to administer the program? Will expanded health insurance stem the cost-shifting of uncompensated care to the insured if eligibility decisions are delayed or in error? Can government transfer payments stimulate demand if government is in disarray?

 

Just as eyebrows were raised when local governments declared hundreds of public works projects to be "shovel ready" but for federal money, we must also look critically at state governments' ability to deliver federal cash and in-kind assistance. In Maryland, that capacity has been hindered by the false belief that state eligibility workers can always do more with less.

 

J. Peter Sabonis is acting chief counsel of Maryland Legal Aid. His e-mail is psabonis@mdlab.org.

 

Copyright 2009 Baltimore Sun.

 

O'Malley hails federal stimulus package

If it becomes final, state could get $3.3 billion in benefits

 

By Laura Smitherman

Baltimore Sun

Friday, February 13, 2009

 

Gov. Martin O'Malley hailed yesterday the $3.3 billion in federal aid and other benefits Maryland could receive under a stimulus package that congressional leaders hope to pass within days.

 

An estimated 66,000 jobs would be saved or created if the bill is enacted, and 242,0000 workers would get $100 more a month in unemployment benefits, O'Malley said. More than 2.2 million Maryland residents would get a tax cut of up to $800 or become eligible for a tax credit to make college more affordable, he said.

 

The federal windfall, parts of which have been attacked by Republicans in Washington and Annapolis as wasteful largesse, is expected to help O'Malley avoid some budget cuts he has proposed, including laying off 700 state workers.

 

The Democratic governor, who must close a $2 billion budget gap in the fiscal year that begins July 1, said he would announce what spending cuts he would be able to retract "as soon as the ink is dry on this."

 

Congressional leaders hope to hold final votes before the week is out and to send a bill to President Barack Obama early next week.

 

The package includes $800 million for road, sewer and other infrastructure projects in Maryland over two years and $1 billion for education. It directs more than $1 billion to the state's Medicaid program and includes more than $100 million in discretionary funding to help plug the budget shortfall.

 

The bill also funds renewable-energy projects and the development of electronic health records, an initiative that is expected to make care more efficient.

 

"This country and our state need this stimulus money to not only help balance budgets here but to keep people working in the private sector," state House Speaker Michael E. Busch said. "So it's been a great boon for us."

 

Copyright 2009 Baltimore Sun.

 

Free car seat safety checks offered

 

By Angela Stanzione

Frederick News-Post

Thursday, February 12, 2009

 

The Frederick County Division of Fire and Rescue Services has developed a "Keep Kids Safe Program" and will provide car seat checks and education at various fire companies to assist the community in keeping children safe in cars.

 

"One of the reasons for having the citizens at the fire stations is that at the very least they will be able to view the FIRE/EMS apparatus and the fire stations," Lt. Troy Grossnickle said. "The department currently has 30 trained technicians in child passenger safety and we want to encourage the citizens to come to the checkpoints."

 

During the car seat checks, several technicians and instructors from county agencies will assist parents. Officials hope to conduct these checks each year at different locations in the county.

 

"There will always be at least one instructor on-site and that person will be in charge of that event," Grossnickle said. "Other counties all have their own ways of doing seat checks and we have done some research to determine that this system will work best for us here in Frederick County."

 

Some of the points technicians will go over are the correct way to face the car seat, the location of the car seat and the installation of the seat.

 

For more information, call the Car Safety Seat Hotline at 301-600-7328. Checks will be held rain or shine but may be delayed or rescheduled depending on technicians' need to respond to emergencies. According to a press release from the organization, not all firefighters and emergency medical services personnel are certified in child passenger safety.

 

E-mail Angela Stanzione at astanzione@gazette.net.

 

In addition to the scheduled checks, appointments can also be made at the following locations.

 

-1-4 p.m., Feb. 22: United/Westview Fire Station, 5525 New Design Road, Frederick. 301-600-3980

 

-1-4 p.m., April 26: Myersville Volunteer Fire Company, 301 Main St., Myersville. 301-293-9817

 

-1-4 p.m., June 28: Urbana Volunteer Fire Company,3602 Urbana Pike, Urbana. 301-663-3822

 

-1-4 p.m., Aug. 30: Walkersville Volunteer Fire Company, 79 W. Frederick St., Walkersville. 301-898-9397

 

-1-4 p.m., Oct. 4: Spring Ridge Fire Station, 6061 Spring Ridge Parkway, Frederick. 301-600-9330

 

Copyright 2009 Frederick News-Post.

 

Joint program to offer inmates drug treatment

 

By Kelly Brewington

Baltimore Sun Brief

Friday, February 13, 2009

 

A new partnership between the Maryland Department of Public Safety and Correctional Services and local nonprofits aims to offer more inmates drug treatment in prison and upon release. The program, known as the Public Safety Compact, is a written agreement between the state agency and community-based programs that offer treatment, case management and other services to inmates and those who have been recently released. Local and national foundations have invested $2 million to launch the program, which is spearheaded by Baltimore's Open Society Institute. The initiative aims to provide up to two years of post-incarceration support for about 250 people.

 

Copyright 2009 Baltimore Sun.

 

State senators weigh domestic violence vs. right to guns

Hearing deals with confications arising from protective orders

 

By Julie Bykowicz

Baltimore Sun

Friday, February 13, 2009

 

Mary Crawford's husband fired a rifle at her chest.

 

Janet Blackburn's sister, niece and two nephews were killed by an abuser.

 

Lt. Gov. Anthony Brown's cousin was shot to death by her estranged boyfriend.

 

The three of them - and a dozen police officers, elected officials and domestic violence specialists - testified yesterday in Annapolis about two initiatives that would take firearms out of the hands of suspected abusers.

 

"These bills do in fact save lives," Brown said. He told lawmakers the story of his cousin, Catherine Brown, a first-grade teacher who was killed last summer at her home days before school was to begin. "Every so often," he said, "our personal lives ... come face to face with the decisions we have to make as elected officials."

 

The measures, part of Gov. Martin O'Malley's legislative package, deal with protective orders, a civil protection meant to put distance between domestic violence victims and their abusers.

 

One bill would give judges the discretion to confiscate guns from the subjects of temporary protective orders, which last seven days and can be issued based on only an alleged victim's version of events. State law now does not permit judges to take guns - even if the person seeking a protective order says the accused has access to guns and has threatened to use them.

 

The other bill would require judges to take guns after a final protective order is granted. Final orders last a year and come after a judge has heard from the accuser and the accused. Under federal law, the subject of such an order cannot possess firearms, but state law leaves it up to judges to order them confiscated. This bill would bring state law in line with the federal regulation, proponents said.

 

Maryland Attorney General Douglas F. Gansler told lawmakers that the federal Violence Against Women Act of 1994 has not been followed as closely as it could be, in part because of the lack of a state law. Gansler is a Democrat, as are O'Malley and Brown.

 

Police officials, including Howard County Chief William J. McMahon and Baltimore County Chief James Johnson, said they support the bills because they would make officers safer, too.

 

"It's well-documented that responding to domestic violence can be the most dangerous thing police officers do," McMahon said.

 

Opponents said the bills do not clearly spell out how people can get their guns back after the protective orders expire. More importantly, they objected to the idea of taking away a person's constitutional right to keep and bear arms after a civil procedure that usually considers only one side.

 

John Josselyn, a vice president of the Associated Gun Clubs of Baltimore, called the legislation "feel-good" measures that amount to "an admission that protective orders don't work."

 

Sen. Alex X. Mooney, a Republican who represents Frederick and Washington counties and sits on the Judicial Proceedings Committee considering the bills, said people intent on harming their partners can use other weapons, such as knives and cars, and that guns shouldn't be singled out.

 

Brown said the bills would not prevent all domestic violence killings. But he said he was certain they would prevent some.

 

Last year, 75 of the 500 or so killings across the state were domestic-related. Brown's cousin was one of the victims.

 

Domestic violence killings, Brown said, "are not the most difficult murders to prevent" because the attacks usually escalate over time. He said about 170 subjects of the state's 7,000 open protective orders are known to have guns.

 

Mary Crawford, a Carroll County woman, said she was convinced that if a judge had taken away her husband's weapons when she received a protective order, he would not have been able to shoot at her and take one of her children hostage during a fight nine years ago.

 

Janet Blackburn said her sister, Gail Pumphrey, a Howard County mother, was so terrified of her estranged husband, David Brockdorff, that she carried a picture of his .22-caliber rifle to every court hearing.

 

Despite a protective order, judges did not take the gun away.

 

On Thanksgiving Day in 2007, at a park in Frederick County, Brockdorff killed his children, David, 12; Megan, 10; and Brandon, 7; his wife, Pumphrey, 43; and himself.

 

Copyright 2009 Baltimore Sun.

 

D.C. Area Stimulus Numbers Cheered

First Figures Find Eager Audiences in Local Governments

 

By Mary Beth Sheridan and Michael Laris

Washington Post

Friday, February 13, 2009; B

 

The economic stimulus bill facing key votes in Congress would provide enough money to modernize more than 300 schools in the District, Maryland and Virginia and would boost unemployment benefits to more than half a million people in those jurisdictions hurt by the recession, according to White House projections released yesterday.

 

The nearly $790 billion measure is expected to provide a windfall for road repairs, energy projects, education and hospitals. Information began to trickle out yesterday about its impact on the Washington area as officials await the release of additional details.

 

The region would benefit not only from new education, transportation, Medicaid and other funds provided to all states, but also from an extra jolt of money for repairing government buildings and helping federal institutions, officials said.

 

The Obama administration predicted that the bill would create or save 66,000 jobs in the next two years in Maryland, 12,000 in the District and 93,000 in Virginia. Some economists said the administration's figures appeared too high, however, and others cautioned that it was difficult to predict exactly how the stimulus package would translate into jobs.

 

"The numbers, as we understand them, are very positive for Maryland," said Shaun Adamec, a spokesman for Gov. Martin O'Malley (D). "There appears to be a good variety of funds that will provide flexibility to shore up shortfalls in our general fund and provide strategic investments in transportation and education."

 

Indeed, Maryland is expected to receive $420 million to fix highways and bridges, $240 million to improve public transit, $27 million for drinking water projects and $96 million for wastewater projects, according to figures from the Senate Appropriations Committee provided by the office of Sen. Barbara A. Mikulski (D-Md.).

 

Maryland will get about $814 million to curb teacher layoffs and other education cutbacks, according to calculations provided yesterday by Mikulski's office.

 

O'Malley submitted a budget proposal to the General Assembly last month that sought to close a $2 billion shortfall in the state's $14 billion general fund through cost-saving measures that include freezing many agency budgets and laying off 700 state workers. Aides said the governor will present a supplemental budget in coming weeks that accounts for the funds from the stimulus package. It is too early to know which cuts will be avoided, however.

 

The stimulus bill would generate enough money to modernize at least 138 schools in Maryland and would provide an additional $100 a month in unemployment insurance benefits to 242,000 people who have lost their jobs in this recession, the White House said.

 

In the District, Chief Financial Officer Natwar M. Gandhi said he hadn't seen the final numbers in the House-Senate compromise reached on the legislation.

 

"However, we know that the stimulus package will likely provide significant budget relief to the District and will be of great assistance to our residents and many of our businesses and institutions," he said.

 

The District is facing a $456 million hole in its budget for fiscal 2010. It would receive enough stimulus funds to modernize at least 34 schools, and about 36,000 District residents who have recently lost jobs would see a $100 bump in their monthly unemployment checks, the White House said.

 

Top Virginia officials were scurrying yesterday to figure out how the plan would translate into dollars in their communities.

 

"We don't know the specifics," said Gordon Hickey, spokesman for Gov. Timothy M. Kaine (D). "We don't know any of the strings, basically. We don't know the rules" on spending the money.

 

Virginia has a budget shortfall of at least $2.9 billion, and Hickey said the state has $3 billion worth of transportation projects that have been put on hold "because we don't have the money." More than $1 billion worth of transportation projects are ready to go within 90 days, he said.

 

The stimulus bill would provide enough funds to refurbish at least 165 schools in Virginia and would increase unemployment benefits to 247,000 people laid off during the recession, officials said.

 

Numerous federal institutions in the D.C. area also would get money from the package, officials said.

 

For example, the bill provides $580 million for the National Institute of Standards and Technology, including $90 million for construction at its Gaithersburg headquarters, Mikulski's office said.

 

The legislation would also award $1 billion to NASA. It was not clear exactly how that would be spent, but the agency has a major facility, the Goddard Space Flight Center, in Prince George's County.

 

Also, $10 billion dollars would go to the National Institutes of Health. Spokesman John Burklow said that, if the money is approved, some would be spent on repairs and construction at the Bethesda campus. However, "the vast majority of the dollars will go out among the more than 3,000 research institutions around the country" that work with NIH, he said.

 

The bill would set aside billions for fixing up federal buildings across the country and making them energy-efficient.

 

"We'll finally catch some advantage out of being a federal city. You have a disproportionate number of federal buildings here, and they're among the oldest" in the country, said Del. Eleanor Holmes Norton (D-D.C.).

 

Norton is seeking to have the bill create apprenticeships for women and minorities to become skilled construction workers.

 

Staff writers John Wagner and David Nakamura contributed to this report.

 

Copyright 2009 Washington Post.

 

University of Maryland researchers map genetic codes for cold virus

Advance could lead to cure, scientists say

 

By Kelly Brewington

Baltimore Sun

Friday, February 13, 2009

 

University of Maryland researchers have mapped the genetic codes for all known strains of the virus that causes the common cold, according to a study published yesterday in the journal Science. Understanding the genetic makeup of the virus could offer scientists clues on how to fight the common cold and possibly discover a cure, scientists said.

 

"There is real promise now, based on full understanding of this virus, that we have never had before," said Dr. Stephen B. Liggett, director of the cardiopulmonary genomics program at the University of Maryland School of Medicine. "My goal is to get at the root cause. Let's get, perhaps, a single pill [that] will kill the virus that day, that moment, and within six hours you are cured. And it is possible."

 

Of course, such a discovery might take time, he said. Until now, fighting the cold was a mystery, because scientists knew little about the genetic makeup of the virus that causes it.

 

Three years ago, Liggett and researchers at the University of Wisconsin-Madison set out to determine why some strains of the cold virus are worse than others, why some cause asthmatics to have attacks and, ultimately, what is needed to create an effective drug that could treat even the harshest colds.

 

"All these questions could not be answered if we did not have the sequence for all recognized strains," Liggett said.

 

When the team began its research three years ago, members knew there were at least 99 strains of the virus, but only eight had been studied.

 

The researchers discovered the details of the strains of the virus, noting the similarities and differences, and mapped them in a family tree to show how they are connected. Understanding the distinctions is important in researching drugs or a vaccine to attack different kinds of colds. Different strains might require different drugs, Liggett said.

 

"It would not surprise us at all that this is not a situation that there is a 'one drug fits all,'" he said. "It may take five drugs. That's OK. Now, we have none."

 

The research is of particular interest for treating asthmatics, the young, the elderly and people with compromised immune systems, all of whom can be debilitated by a common cold. The human rhinovirus is responsible for half of all asthma attacks and plays a role in bronchitis, middle ear infections and pneumonia.

 

Liggett said he plans to go to public health departments nationwide collecting samples from people with colds and study them to get a sense of how the virus can vary in different geographic locations.

 

Meanwhile, in the lab, researchers will study compounds that could work to attack the different strains of the virus. From there, Liggett said, researchers hope to form partnerships with drug companies to test their discoveries on people.

 

Copyright 2009 Baltimore Sun.

 

O'Malley lauds researchers who sequenced cold virus

 

Associated Press

Daily Record

Friday, February 13, 2009

 

Maryland Gov. Martin O'Malley says the sequencing of the common cold virus by researchers in Baltimore shows the importance of funding higher education.

 

Researchers at the University of Maryland School of Medicine in Baltimore were part of a team that announced Thursday that they had sequenced the genomes of all known human rhinoviruses, the viruses that cause the common cold.

 

In addition to causing colds, the researchers say the viruses are a major cause of hospitalization for those with asthma and chronic obstructive pulmonary disease, which cost billions of dollars a year to treat.

 

Researchers from Maryland and the University of Wisconsin, Madison sequenced the viruses at the J. Craig Venter Institute, which has facilities in Rockville, Md., and La Jolla, Calif.

 

Copyright 2009 Daily Record.

 

Prince George's residents talk with O'Malley

Hundreds turn out to Upper Marlboro town hall meeting to discuss education, economy

 

By Greg Holzheimer

Prince George’s County Gazette

Thursday, February 12, 2009

 

Hundreds of residents and government officials squeezed into the auditorium at Dr. Henry A. Wise Jr. High School in Upper Marlboro on Wednesday for a chance to bring their hopes and concerns to Gov. Martin O'Malley and other state officials, who fielded questions on the economy, education and dozens of other issues during a three-hour town hall meeting.

 

Participants came to the event from across the state, and in the end, many of them seemed grateful just to have O'Malley's ear for a moment.

 

"I just love it," said Michael Dozier of Landover. "It makes me feel good on the inside."

 

The event was billed as an open forum on the education system and the economy, but many residents took advantage of the question-and-answer period to ask O'Malley about issues ranging from state regulations that affect small-scale poultry farmers to the legality of the state's domestic violence laws.

 

Maria Loveless, a parent liaison with Avalon Elementary in Fort Washington, said she hoped O'Malley would give some assurance that Prince George's County would not have to cut parent liaison positions to cope with the school system's budget shortfall.

 

"We're standing up for our rights, making sure the budget cuts are not going through," she said before the meeting. "With Prince George's one of the biggest counties, we hope Gov. O'Malley will delegate the majority of the funding to Prince George's County."

 

After the meeting, O'Malley declined to speculate about how much the county or school system would get from the economic stimulus package. The House and Senate agreed Wednesday on a stimulus plan with a cost of about $789 billion.

 

"They have all seen reductions in what we'd like to put in [the budget] this year," he said. "It's our hope that the [stimulus bill] will let us restore some of those cuts - but that remains to be seen."

 

O'Malley touted his record on education during his remarks, pointing to the state school system's recent positive rating by the magazine Education Week and ongoing construction projects at Bowie State University, Prince George's Community College in Largo and other schools.

 

"If we don't have better options for our kids tomorrow, we'd better give them a better education today," O'Malley said.

 

William Thomas, Maryland's 2008 Teacher of the Year, praised the O'Malley administration at the meeting for its support of education but said he was concerned about proposals to shift teacher pensions to local school systems.

 

"There has been some concern in terms of teacher pensions," said Thomas, who said he also wants the state to continue funding small-scale education programs.

 

O'Malley said that debate needs to be settled in the state's legislature.

 

"It's true in every profession - it's the salary and the benefits [that attract qualified employees], and that includes pensions," he said. "It's something for the legislature to debate."

 

O'Malley responded to concerns about County Executive Jack B. Johnson's (D) proposal to raise taxes on homeowners to help fix the county's budget deficit. O'Malley said that decision needs to be made on the county level, but said the economy is forcing tough decisions onto every level of government.

 

"Nobody has any money - it's scary," he said. "We've got a lot of bad choices."

 

E-mail Greg Holzheimer at gholzheimer@gazette.net.

 

Copyright  2009 The Gazette.

 

Suitland teenager seeks help with continuing costs of prosthesis

 

Capital News Service

By Erika Woodward

Daily Record

Thursday, February 12, 2009

 

ANNAPOLIS - Lorenzo Smith never thought he'd be penalized for growing taller, but his HMO insurance plan says he has to pay.

 

The 15-year-old was charged more than $20,000 for growing 5 inches in 4 years, and he dares to keep growing.

 

"I'll be 16 (on) Feb. 25," he said. "I'm near 5-foot-8."

 

Because Smith stands tall with the aid of a prosthetic leg, the price of his height is taxing his family, as his insurance restricts coverage for his prosthetic device, including adjustments made for his height.

 

Smith's right leg was amputated from the knee down three years ago after he was struck by a car while walking home from school.

 

"There's several people out here who have lost a limb and they need this certain object just to do their everyday life and it's sad for you to go to your insurance that you've been paying for years and they tell you, `no, you can't get this,'" he said. "I don't understand why they can't help you when you're in need."

 

Smith is taking his fight for affordable prosthetics all the way from his row home in Suitland to legislators in Annapolis, where he is slated to testify Thursday in favor of the Prosthetic Parity Act. This will be the second time he testifies for the bill, which would mandate state-regulated insurance companies provide more comprehensive coverage for prosthetic devices.

 

The bill was held over last session for a Maryland Healthcare Commission report, which analyzed the cost to insurance companies. The commission found the mandate would add zero to 31 cents per policy per month, said Sen. Catherine Pugh, D- Baltimore, who introduced the bill in the Senate.

 

"We just feel that when we talk about prosthetics that those who are in need should be able to have," she said. "We've done our homework. We've done our research and I hope the General Assembly will follow through and pass this bill."

 

But a spokesman for UnitedHealthcare, the parent company for the Smith's insurance policy, said the General Assembly may need to do more homework. While 31 cents sounds cheap, Debora Spano said the real test is to add it to existing mandates and multiply it by the number of people insured.

 

It would be a significant cost to taxpayers, she said.

 

"Maryland is at the top of the list (for states with the highest number of mandates) and that's a cost to everybody who's paying health insurance," she said. "While we see the need for everybody to have a prosthesis, the question becomes how much can we afford?"

 

The Smith family asks the same question.

 

Since being fitted for the artificial leg at age 12, Smith has outgrown two legs and two whole sockets, the part of the prosthesis that helps lock everything in place.

 

Under his mother's insurance plan, only 50 percent of the costs associated with the prosthesis are covered and Smith is limited to 50 doctor visits per year, his mother Albertha Jackson-Smith said.

 

Trips to the doctor add up quickly for an active young man who is a point guard in pick-up basketball games and a wide-receiver in football games.

 

"I'm too good for (wheelchair) basketball," Smith said of his active lifestyle, which helped prompt two doctor's visits in January and one in February.

 

"If my thigh gets too big for the (liner), I have to get that changed. As far as me growing, I have to get an extension," Smith said.

 

"All that takes time to get fixed and it costs money, too," he said.

 

It costs $500 for the liner Smith must replace every five months. The liner is a slip-like sleeve he hand washes daily, which is used to suction his thigh to the prosthesis.

 

It's also one of the many costs that have driven Smith's mother, a government employee, and her husband, a contractor, to get creative with fundraising.

 

They hosted a benefit dinner in 2007 and held the Lorenzo Smith Fund Walk-a-thon that same year and the year after.

 

But they spent more money on the benefit dinner then they made, and while they're proud of the walk-a-thons, last year's only raised enough money for one liner.

 

"It was a good turnout, but not like it was for the first year," said Albertha Jackson-Smith, when people had more money to give.

 

The Smiths are counting on the General Assembly to help them afford the prosthetic that gave their son a new life. He's just not himself without it.

 

"I'm not moving, basically," he said. "I won't do anything outside this house. I still don't understand why I don't like to go anywhere without walking."

 

The Senate Finance Committee with hold the hearing at 1 p.m. Thursday.

 

Copyright 2009 Daily Record.

 

Salisbury dentist indicted in forged Rx case

 

By Sharahn D. Boykin

Salisbury DailyTimes

Friday, February 13, 2009

 

SALISBURY -- David Michael Fisher provided dental services for his stepson and wrote him a prescription for pain medicine.

 

When the stepson went to a Salisbury Superfresh pharmacy to put in his prescription for Amoxil and hydrocodone, he discovered other prescriptions had been filled in his name.

 

Prescriptions that he had never seen before.

 

All 21 prescriptions, from March of last year till August, were allegedly written and filled by Fisher.

 

A Wicomico County Circuit Court judge set bail at $100,000 for the 53-year-old Salisbury dentist indicted on 169 charges related to prescription fraud.

 

The charges filed include multiple counts of obtaining a drug by fraud, possession of forged prescriptions and controlled dangerous substances obtained by forging or altering a prescription. The dentist is accused of writing prescriptions for hydrocodone, diazepam, cephalexin and clindamycin, according to court documents.

 

The bond review Thursday comes less than a month after a Salisbury doctor, Charles Olufemi Folashade, 48, was indicted on 16 charges after allegedly prescribing strong painkillers to undercover police officers.

 

Fisher's stepson contacted police in September after he learned about the prescriptions. That month, the state filed 79 charges against the dentist who was processed and released the same day at the Wicomico County Detention Center on $100,000 bond.

 

Fisher turned himself in to the Salisbury Police Department on Sunday, according to law enforcement officers. Since then, he has been held at the Wicomico County Detention Center.

 

"He wasn't arrested," said Fisher's attorney, Patrick S. Preller. "He walked in and said, 'Here I am. I heard there may be a sealed indictment.' "

 

Preller also told the judge that Fisher is being investigated by the Maryland attorney general and could lose his license.

 

Fisher has worked in Salisbury for about eight years, according to his attorney.

 

A spokesperson for the Maryland Attorney General's Office declined to confirm if Fisher is being investigated.

 

Prosecuting attorney, Patrizia Coletta, told the judge she was not aware of Fisher having a prior criminal history.

 

Not long before Fisher's most recent arrest, Folashade, who worked at Arcadia Medical Center and the Walk-in Clinic, was indicted after being accused of distributing oxycodone, Suboxone and Xanax to undercover police six times between Sept. 24 and Dec. 1.

 

Folashade was released from the Wicomico Detention Center on a $250,000 bond in late January.

 

Staff Writer Greg Latshaw contributed to this report.

 

Copyright 2009 Salisbury Daily Times.

 

Bill would pile on work for poultry farms

Shore lawmakers call ammonia reporting 'ridiculous'; program to cost $81K in 1st year

 

By Greg Latshaw

Salisbury Daily times

Friday, February 13, 2009

 

SALISBURY -- Poultry supporters want to block a proposal by Prince George's County lawmakers that would require most Eastern Shore chickenhouses to report ammonia emissions.

 

Most poultry farmers caught a break in December, when the U.S. Environmental Protection Agency stopped requiring smaller farms to report emissions of ammonia and other noxious pollutants caused by animal waste. That law had been on the books since the 1980s and was meant to give emergency response units data, but livestock lobbyists contended for years that it made smaller farms report harmless emissions levels.

 

Human exposure to ammonia causes respiratory problems, nasal and eye irritation. In large amounts, it can cause death. Studies have found that the concentration of ammonia in contained animal feeding operations, such as chickenhouses, can exceed workplace exposure limits set by the U.S. Occupational Safety and Health Administration.

 

Maryland's House Bill 395 would bring back the reporting standards, telling four times as many farms -- or another 800 -- to report ammonia levels to the Maryland Department of the Environment twice a year, according to a Department of Legislative Services fiscal and policy note on the bill.

 

About 200 large farms, which grow 125,000 birds or more, are still required to report emissions once a year to emergency response planners. They would now have to report twice under the Maryland bill.

 

In the proposal, farms that sell less than $1,000 in poultry products each year would be exempt. Additionally, growers not wanting to measure ammonia levels can opt out by reporting to MDE the average number of birds at their farm twice a year.

 

The bill would also require poultry farmers to furnish "any other information relating to ammonia emissions from poultry animal waste" that the MDE secretary requires.

 

Bill Satterfield, executive director of Delmarva Poultry Industry Inc. in Georgetown, called it a "bad bill" that would accomplish nothing beyond making more work for farmers. Poultry farmers have introduced ways to reduce how much ammonia goes into the air. They have already taken steps to reduce ammonia levels, such as by planting trees near chickenhouses.

 

"What's gained by having poultry growers report twice per year?" he said.

 

The bill was scheduled for a hearing in the environmental matters committee Wednesday.

 

In a time when most poultry farms are struggling to survive, Sen. Richard Colburn, R-37-Dorchester, said the bill is "ridiculous." Instead of helping one of the state's top agricultural industries, the bill would add to the workload of practically every farm.

 

"This is what you call 'Piling it on,' " he said. "Many farmers say the next straw could be the one that breaks the chicken's back."

 

Delegate Page Elmore, R-38A-Somerset, dismissed the bill as another one by "extreme, left-wing" environmental lawmakers. A bill that would more realistically measure pollution in the bay or respiratory harm to individuals would be one asking motorists in Maryland's most populous areas to calculate their automobile exhaust emissions, he said.

 

"This brings it on to the littlest farmer," he said. "Fortunately, I don't think it'll pass as written."

 

The bill's lead sponsor, Delegate James W. Hubbard, D-23A-Prince George's County, could not be reached for comment at his Annapolis office on Tuesday and Wednesday.

 

The bill is also sponsored by Barbara Frush, D-2-Anne Arundel, and Justin D. Ross, D-22-Prince George's.

 

According to the Department of Legislative Services, implementing House Bill 395 would cost the MDE $81,200 in the program's first year, and an average of $68,000 through 2014. MDE would need to hire another employee to process, maintain and track the reports.

 

The Chesapeake Bay Foundation, based in Annapolis, does not have a position on the bill, and may not in the future, spokesman Tom Zolper wrote in an e-mail.

 

A spokeswoman for Perdue Farms Inc., which has contracts with farmers to grow their poultry, declined to state the company's position on the bill.

 

"Because the producers are not employees, they are independent growers, we won't speak on their behalf," Julie DeYoung said.

 

Copyright 2009 Salisbury Daily Times.

 

National / International

 

Off-label drug use puts patients at risk

 

Baltimore Sun

Friday, February 13, 2009

 

The Baltimore Sun's article "Bush, FDA changed rules to benefit off-label drugs" (Feb. 1) discussed rule changes approved by former President George W. Bush that will benefit drug manufactures by making it easier for them to promote "off-label" uses for prescription drugs.

 

The use of drugs for purposes that have not been tested and approved by the Food and Drug Administration has long been a practice of doctors and drug companies.

 

But the studies that support the use of those drugs for purposes other than the ones for which they were approved by the FDA are usually sponsored by the very same drug company that will benefit from the additional profits generated by those uses of the drug. This poses an obvious conflict of interest.

 

I don't understand why the drug company can't go through the FDA approval process for these additional uses.

 

At the very least, the patient should be informed that the drug he or she is being prescribed has not been tested and approved by the FDA for that purpose and of the additional risks associated with this additional use.Henry L. BelskyBaltimore

 

The writer is a plaintiff's attorney who is conducting a lawsuit over off-label pharmaceutical use.

 

Copyright 2009 Baltimore Sun.

 

Delay lets military health fraud suspects off hook

 

Associated Press

By Ryan J. Foley

Washington Post

Thursday, February 12, 2009

 

MADISON, Wis. -- A dozen defendants who allegedly swindled the military's health care program out of hundreds of thousands of dollars in the Philippines won't face justice or pay any restitution after authorities failed to arrest them.

 

The U.S. Attorney's Office in Madison, Wis., has dismissed indictments against the suspects _ Philippine doctors, spouses of military retirees and one Navy veteran _ because of lengthy pretrial delays.

 

Several of them had confessed to their roles in schemes in the 1990s and early 2000s in which they filed fraudulent claims to the military's Tricare program, which paid out money to cover health services never provided, court records show. They were indicted between 1999 and 2003 as part of an investigation into widespread Tricare fraud.

 

But U.S. authorities failed to bring them to justice. They decided to wait for the suspects to step foot on U.S. soil so they could be arrested but they either never did or weren't caught. In 2006, prosecutors finally asked the Philippines government to arrest and extradite five of the suspects but those attempts failed.

 

The 12 cases were dismissed last month after U.S. District Judge Barbara Crabb in November threw out an indictment against a Filipino doctor accused of submitting $2 million in fraudulent claims. Crabb said his right to a speedy trial was violated because investigators waited until 2008 to arrest him when he set foot in Guam, four years after he was indicted.

 

Crabb said the delay made it difficult for the doctor to prepare a defense because the passage of time meant the memories of witnesses had faded. She said prosecutors' "decision to do nothing for more than four years" wasn't justified.

 

Based on that ruling, Assistant U.S. Attorney Peter Jarosz said it was clear he had to dismiss cases against the others. He said it is difficult to quantify the exact amount they were accused of obtaining fraudulently. Court documents suggest it was at least $400,000 but likely more since prosecutors did not file charges for every suspect claim.

 

Among those getting off the hook is a doctor who told investigators how she would make false claims on behalf of military retirees and their dependents and then give them a portion of the money.

 

She gave investigators two log books filled with the names of patients her clinic had falsely claimed to treat. "I know it was fraudulent but I just took the risk," she told investigators.

 

Also getting off:

 

_ A U.S. Navy retiree, who was accused of working with a doctor to submit 21 false claims for him and his dependents totaling $133,000.

 

_ The wife of a retired Marine who submitted false claims totaling $49,000 for her and her child.

 

_ The wife of a retired U.S. Air Force serviceman who said she used her windfall to pay for her children's education. "I know what I am doing is wrong," the woman told investigators.

 

The defendants never appeared in U.S. court or even had defense attorneys since the cases never got off the ground.

 

Prosecutors have defended their decision not to seek extradition in some cases, arguing the Philippines government would likely fail to execute the request or botch it. They cited one example in which a suspect learned of his warrant through a newspaper and went underground.

 

In November's ruling, Crabb wrote the decision to wait for suspects to step on U.S. soil might have been reasonable initially "but as time wore on, it became all the more pressing for the government to do something."

 

The ruling and dismissals were a setback for an investigation that has otherwise won praise. More than a dozen people have been convicted of Tricare fraud in recent years, including U.S. military retirees. The probe is handled by Wisconsin-based federal prosecutors because WPS Health Insurance in Madison holds the contract to process many of the claims.

 

In the biggest case, Health Visions Corp. submitted fraudulent and inflated claims to bilk the U.S. government of $100 million between 1998 and 2004. The company and a former executive have been ordered to pay back the full amount and the government is in the process of trying to recoup some money from the sale of its assets.

 

A string of internal audits have faulted the Pentagon's management of Tricare, warning that lax controls make the program vulnerable to fraud overseas. Its managers say they are taking steps to tighten them but note the complexity of a program that provides benefits all over the globe.

 

© 2009 The Associated Press.

 

At Wal-Mart, a Health-Care Turnaround

Once Criticized, Company Is Now an Innovator in Employee Coverage

 

By Ceci Connolly

Washington Post

Friday, February 13, 2009; A01

 

Washington policymakers contemplating a fundamental overhaul of the nation's troubled health-care system may want to study the saga of Wal-Mart.

 

Once vilified for its stingy health benefits, the world's largest company has become an unlikely leader in the effort to provide affordable care without bankrupting employers, their workers or taxpayers in the process. From its headquarters in Bentonville, Ark., the retailer is doing in the real world what many in Washington are only beginning to talk about.

 

At a time when other firms are scaling back or eliminating health coverage, Wal-Mart has made a serious dent in the problem of the uninsured. New figures being released today show that 5.5 percent of its employees now lack health insurance, compared with a nationwide rate of 18 percent.

 

The company has also put into practice many of the innovations that experts say will lead to higher-quality, more efficient care. Using its high-tech marketing savvy, Wal-Mart has introduced digital records, partnered with prestigious organizations such as the Mayo Clinic, and begun targeting costly health problems such as obesity and premature births.

 

Yet for all of Wal-Mart's achievements, the story of its immersion in the world of health policy is also a warning about the depth and breadth of one of the thorniest challenges facing the country today.

 

In attempting to strike a balance between healthy profits and healthy workers, Wal-Mart, like many businesses, still falls short of the comprehensive care that President Obama says he wants for Americans.

 

To reach near-universal coverage, the largest private employer in the nation relies heavily on the government and other employers to play a role. Of the company's 1.4 million workers, 52 percent are in a Wal-Mart health plan. Despite revenue that is expected to exceed $400 billion for 2008, the company charges its low-wage workers a substantial portion of their income for medical coverage.

 

Though proud of what it sees as dramatic progress, Wal-Mart itself warns that in a global market with a weakened economy, it cannot -- or will not be able to -- accept annual health-care increases of about 8 percent indefinitely.

 

"It starts to impact us competitively," said Linda Dillman, the company vice president tapped to oversee the health plan.

 

To Andrew Stern, president of the Service Employees International Union and a frequent Wal-Mart critic, the company's health contributions are not commensurate with its financial success. The moral, he said, is that "volunteerism has its limits."

 

But to Mark Smith, head of the California HealthCare Foundation, an independent nonprofit focused on health-care quality and efficiency, Wal-Mart's experience provides a different lesson.

 

"Even a company as big and successful as Wal-Mart cannot possibly solve this problem on its own," he said. "There are limits to what one company can do."

 

'It Had to Do Something'

It began with an internal memo, union agitators and some awfully bad press.

 

In fall 2005, the union-sponsored Wal-Mart Watch got its hands on a company memo outlining ways to clamp down on soaring health-care bills. Among the suggestions: Stop hiring unhealthy people.

 

Frustration with Wal-Mart had been building. Main Streets across the country chafed at the big-box store's arrival; labor activists complained that workers had to wait up to two years to qualify for the company health plan, which in many cases cost nearly 10 percent of the typical $20,000-a-year salary.

 

Yes, some U.S. companies did not provide any health insurance. But the skimpy Wal-Mart coverage seemed particularly galling compared with the billions in personal wealth amassed by the company's founding family, the Waltons.

 

The retailer symbolized by a bright-yellow smiley face was suddenly tagged with a red bull's-eye. Unions underwrote two aggressive anti-Wal-Mart campaigns, staffed primarily with Democratic political operatives. Teachers boycotted the back-to-school shopping season.

 

Several states, including Maryland, considered legislation in 2006 requiring that large employers commit a certain portion of their revenue to employee health care. Though the bills never said so, they were aimed at just one company.

 

The criticism stung, but more important, it began to affect the bottom line. Between 2000 and late 2005, Wal-Mart's stock fell 27 percent.

 

"It was hurting them when they tried to open a new store," Smith said. "For normal competitive reasons and its corporate image, it had to do something."

 

In 2006, then-chief executive Lee Scott appointed Dillman, his technology guru at the time, to take over health care. Though she maintains that Wal-Mart's program was never as bad as opponents suggested, Dillman moved quickly to make changes.

 

First, the wait to enroll in the health plan was reduced from two years to one for part-time employees and to six months for full-time workers. By the following year, an additional 50,000 workers were eligible.

 

Next, Wal-Mart put its marketing genius to work, doing sophisticated research on its own personnel.

 

"Any retailer will tell you that's what they do with their customers," Dillman said in a recent interview. "There are very sophisticated methods of doing this. If you want people to sign up, go find out what they need."

 

Employees said they wanted more choices, especially low-cost emergency coverage options. Wal-Mart responded with a menu of deductibles, co-payments and maximum out-of-pocket costs. It teamed up with the Internet site WebMD to simplify enrollment, created electronic health records and expanded its $4 generic drug plan from the 350 medications available to customers to more than 2,000 for employees.

 

Many workers have chosen low-premium, high-deductible plans that analysts say provide less coverage for preventive and primary care. The company tries to mitigate that with an upfront credit of between $100 and $500 that can be used on any medical expense.

 

"We're seeing utilization on types of care you would hope," such as checkups and the generic drugs, Dillman said. "And they're managing costs at the same time."

 

From 2007 to 2008, the retailer saw a 78 percent increase in 16-to-24-year-old workers who opted for the high-deductible plans. "It's better to have them in that than to have nothing, which is where most of them were," Dillman said.

 

Others, such as Cynthia Murray of Hyattsville, say a $180 premium out of a biweekly paycheck that averages $489 after taxes is too steep. Murray and her husband have been without health coverage for the nine years she has worked at Wal-Mart. "I just pray a whole lot I don't get sick," she said.

 

Seeking the Best Value

At the opposite end of the spectrum, Wal-Mart contracted with the Mayo Clinic for all transplant services, calculating that it could save money by using a single provider with a sterling performance record.

 

Whether purchasing toasters or transplants, "Wal-Mart looks for value," said Brooks Edwards, director of Mayo's transplant center in Rochester, Minn., one of several Mayo centers around the nation. "One of the most cost-effective things we do is weed out the patients that don't need a transplant."

 

Where other medical centers might recommend a heart transplant, for example, Mayo might opt for a simpler valve surgery. The strategy of evaluating various treatments, known as comparative effectiveness research, is gaining currency in policy circles. The economic stimulus bill sets aside $1 billion to pursue it.

 

Wal-Mart's newest initiative, "Life With Baby," is aimed at reducing the rate of premature births among employees, which is double the national average, Dillman said. Mothers-to-be are matched with a registered nurse who counsels them on issues such as diet, stress and smoking. The support continues with lactation instruction and vaccinations for the child's first year.

 

"Wow, it was really good. It helped me so much," said Cristina Majano, a 23-year-old new mother who works at a Wal-Mart in Northern Virginia.

 

For her first four years on the job, Majano did not purchase health insurance. "I was younger and didn't think I needed it," she said.

 

The coverage, even with a $1,000 deductible, is worth it for her and her daughter, Majano said. But she and her husband decided they could not afford to add him to the plan.

 

Wal-Mart, taking a cue from leading policy analysts, hopes to continue to focus on major cost drivers, moving next to back pain and diabetes.

 

"This is like the national discussion," Dillman said. "First you've got to get them in the plan, then figure out how to help them take care of themselves, stay healthy and get the care they need."

 

Research editor Lucy Shackelford contributed to this report.

 

Copyright 2009 Washington Post.

 

Retail Medical Clinics Are Poised to Play an Increasingly Important Role in Primary Care

 

By Michael E. Carbine, Managing Editor

AIS's Health Business Daily

Thursday, February 5, 2009

 

The big news for 2008 in the retail medical clinic industry was the slowdown in clinic growth rates as operators scaled back their expansion plans, closed clinics and left the field. But for 2009, the big news could be the gradual move of hospitals into the retail clinic space and a gradual move by clinics to broaden their traditional scope of services within the primary care delivery system.

 

One development to watch: Walgreen Co.'s move to integrate its drug stores, retail clinics and employer work-site clinics into what could become a primary care delivery powerhouse.

 

According to Tom Charland, CEO of Medical Merchant, a research and consulting firm, "2008 will go down as the year that logic and reason overtook the retail clinic market." His U.S. Retail Clinic Market Report, published in the Jan. 1, 2009, issue of Merchant Medicine News, finds that 2008 ended with 1,175 retail clinics in 37 states, a net increase of only 274 from the 901 clinics operating at the end of 2007. With some clinic operators curtailing their expansion plans, a handful of closed clinics and a few operators leaving the field, the industry will not come anywhere near the 6,000-clinic figure many analysts originally projected for 2011. Charland expects about 320 new clinics to be opened during 2009 at a rate of about 26 per month. Should that projection hold, there would be just over 2,100 clinics operating by the end of 2011, roughly one-third the original projection.

 

MinuteClinic, owned by CVS Caremark Corp., and Take Care Health Systems, owned by Walgreen Co., continue to dominate the market with 74% of all clinics under their control. Add four other smaller operators with more than 10 clinics each, and you have 88% of the market.

 

Is there room for growth? Charland says yes, pointing to the low number of retail clinics operating in many of the nation's top 50 metropolitan markets.

 

It's No Country for Private Investors

Private investors, meanwhile, are leaving the field given the relatively long time it takes a clinic to turn a profit, a critical factor in the current economic climate. This leaves the field to the major drugstore chains, a handful of other retail operators and hospitals. According to Merchant Medicine News, hospitals typically operate anywhere from one to five clinics.

 

But hospitals are eyeing the field and could become major players, especially with Wal-Mart's new strategy of partnering with regional hospitals, health systems and even physician groups to operate its in-store clinics. Wal-Mart benefits because the clinics are branded by recognized and trusted local providers, broadening their customer appeal. Hospitals benefit because they can tap into new referral sources.

 

An important development for hospitals (and other operators) to consider, Charland says, is the impending primary care physician shortage and how it could change the way primary care services are delivered. In this new landscape, clinics could become a "new world of caring for chronic disease patients," given the use of EHRs (electronic health records) and a clinic's ties to the local provider network "It won't be the 'be all and end all' model," Charland adds. "But these clinics could play an important role as the primary care delivery system is reconfigured."

 

Charland cautions hospitals to think carefully before making a move. "If you see a retail clinic as a stand-alone entity, the strategy won't work. If you see it as part of a larger rethinking of your primary care delivery strategy, it will." The hospital's physicians also must be on board. "If they [physicians] see it as part of the strategy for addressing what primary care will look like in the future, then it will succeed," he says.

 

Of particular interest to the industry are several developments that could move retail clinics beyond a scope of practice that focuses on treating common illnesses and providing basic preventive care.

 

"Over the past year or so, we've seen clinics offer more in the way of preventive services, health screenings, immunizations, sports physicals and other services," Tine Hansen-Turton, director of the Convenient Care Association, tells ICDC. The association is the trade group for retail clinics. To date, this has been done within the basic retail-clinic business model of typically treating 10 common illnesses using a single staff person (nurse practitioner or physician assistant) within a 15-minute time frame. "This fills a primary care niche where there's a tremendous need," she adds.

 

But Hansen-Turton says that nothing precludes a clinic from providing more in the way of primary care services. "Local market needs will determine the scope of services provided by a clinic, so we've seen discussions around chronic disease management, more health screenings and wellness services." She says that clinics could contract with local providers to meet identified needs in the community, just as they are contracting with employers for certain services. But when a clinic expands its scope of services, it could mean changing its business model and looking more like a medical provider office or urgent care center.

 

One important player to watch as the market evolves is Take Care, the retail clinic chain operated by Walgreens. Last year, Take Care informed the American Academy of Family Practice (AAFP) that it would not renew its commitment to the association's "Attributes of Retail Health Clinics," which limits clinics to a well-defined and limited scope of clinical services.

 

Dan Zacchei, a Take Care Health Systems spokesperson, tells ICDC that "after treating over 1 million patients, Take Care determined that there's a real demand for extended services in this space." He notes that Take Care has always maintained a good relationship with AAFP. "But our company is dedicated to the patient, and as we see a demand from our patients [for other services], we will be meeting these needs."

 

Walgreens Goes for Depth of Offerings

Zacchei says that Take Care is moving to "elevate the level of available health care services" in order to provide multiple options for customers. "We will be providing multiple points of care with a depth of offering," he says. "Through Walgreen's Health and Wellness Division, of which Take Care is the primary entity, the company will be able to extend its core business into the broader health care space and will expand health care access beyond the retail pharmacy." He adds that Walgreens is scanning the horizon to identify the next generation of services consumers want and need, "and we'll consider the best way to meet those needs."

 

One move in this direction: On Jan. 14, Walgreens said that it is marketing its network of pharmacies, in-store clinics and work-site health centers to employers as a seamless and fully price-transparent health care resource. The new Complete Care and Well-Being program, being offered through Take Care, will integrate pharmacy, health and wellness services into a single health care delivery solution. Walgreens says that the program will provide services ranging from acute through primary care as well as occupational health, infusion services, disease management and specialty pharmacy services through its network of work-site pharmacies and health centers, Take Care's in-store retail clinics and Walgreens pharmacies across the U.S. Retirees and employee family members also are eligible.

 

In announcing the program, Walgreens said that the program is also available to health insurers and managed care organizations as a single-source offering. The program can incorporate Walgreens' existing pharmacy administration capabilities or be integrated into an existing capability.

 

Copyright 2009 AIS's Health Business Daily.

 

Sensors Help Keep the Elderly at Home

 

By John Leland

New York Times

Friday, February 13, 2009

 

Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.

 

Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.

 

A wireless sensor under Ms. Branch’s bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.

 

Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.

 

But the devices, which can be expensive, remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.

 

Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.

 

“I lost a very close friend recently,” she said. “She was also diabetic and she fell during the night. She didn’t have the sensors. She went into a coma.”

 

Without the sensors, Ms. Branch said, “I would probably be dead.”

 

Stories like Ms. Branch’s show the potential of relatively simple devices to provide comfort and independence to an aging population that is quickly outgrowing the resources of doctors, nurses, hospitals and health care dollars available to it.

 

The cost for Ms. Branch’s basic system, supplied by a health care provider called New Courtland as part of a publicly financed program, is about $100 a month, far less than a nursing home, where the costs to taxpayers can exceed $200 a day. In the two years Mrs. Branch has had the system, she has fallen three times and been stuck once in the bathtub, each time unable to call for help without it.

 

“On an individual basis, we’ve demonstrated that they can be very effective,” said Brent Ridge, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York. “But until they’re launched on a wide-scale basis, you just don’t know. Physicians might say, ‘I’m already overstretched, I don’t have time for all this data.’ ”

 

At a white ranch-style house in Middletown, N.J., Joseph Hayduk, 86, a retired Air Force lieutenant colonel, is greeted by a voice from a small box: “Good morning. It is now time to record your vital signs.” Mr. Hayduk has been using the device since 2006, after his second heart attack, through a program run by Meridian Health.

 

He stepped on a scale. “Are you experiencing more difficulty breathing today, compared to a usual day?” the voice asked. Mr. Hayduk pressed yes.

 

“That’s normal for me,” he said.

 

“Are your ankles more swollen than usual?” the machine asked. In patients with chronic heart failure, swelling or weight gain can indicate that they are retaining fluid. Mr. Hayduk pressed no. After a blood pressure reading, the device signaled that it had relayed the information to Meridian Health.

 

There, a nurse calls all 18 patients in the program daily, starting with the ones whose data call for urgent attention. One morning, Mr. Hayduk left the house before the nurse’s call. As he sat on his neighbor’s porch, he watched a police car pull up to his house to check on him.

 

Mr. Hayduk chuckled at the memory, but said that the system had allowed him to stay in his home of 37 years.

 

“This system’s invaluable to me, not only physically, but psychologically,” he said. “I don’t want to be in assisted living. That’s for people in wheelchairs and walkers.”

 

Philip Marshall, 85, another Meridian Health patient, uses a system tied to his cellphone to help him remember his medications. Mr. Marshall has high blood pressure and macular degeneration, and takes 10 pills a day. He cannot see a clock or work the buttons on most phones, so he uses a Jitterbug, a phone with big buttons and limited functions.

 

Drug compliance is one of the biggest problems for the elderly, especially those with memory loss. Until Mr. Marshall got Meridian’s Jitterbug system, his daughter Melanie, 55, said she had to leave work several times a month to help him with his drugs. “I’m answering the phone in meetings,” she said. “He’d forget whether he took a pill or whether he was supposed to take a pill.”

 

The system, which costs $20 a month, calls him after he is scheduled to take a pill and asks if he has taken it; if not, it asks him why not and sends automated alerts to his daughters.

 

“I worry a lot,” Mr. Marshall said. “All my life. So this gives me peace of mind.”

 

He added that knowing that a call was coming had helped him remember to take his medications before the phone rang.

 

This is the ultimate goal of personal health monitoring — that people who know they are being watched may modify their behavior to better their health. Jeffrey Kaye, director of the aging and Alzheimer’s and memory assessment clinics at Oregon Health and Science University, said one of the most useful health technologies was a cheap pedometer, because carrying one motivated people to walk more.

 

But Stuti Dang, who directs dementia care for the Miami Veterans Affairs Healthcare System and uses monitoring systems to track the vital signs of 400 patients, said one unforeseen consequence of the system was that “it somehow absolves their kin of the responsibility.”

 

“The daughter doesn’t have to call every day because she knows if something was wrong with her father, she would receive an alert,” Dr. Dang said, adding: “It’s good for the patient, but there needs to be personal responsibility. As a provider, I don’t want to be responsible for my patient 24 hours a day.”

 

Raymond Carroll, 59, a retired school administrator, said he went online every day to check on his mother, Viola Carroll, 85, who lives in a building in Queens run by Selfhelp, a nonprofit organization that assists Holocaust survivors. Mr. Carroll checks the temperature of her apartment and calls if it is too hot. Since a system of motion detectors called Quiet Care was installed three years ago, on a grant from Selfhelp, he said he probably called more often but visited less.

 

Marvin Joss, whose mother, Ray, 89, is also in a Selfhelp building, said the system had helped improve their conversations. “In the past, I tried to spend more time on, ‘How are you feeling?’ ” Mr. Joss said. “I still ask those questions, but now it’s more to an idea of having a conversation, not trying to listen for clues about whether she’s O.K. ”

 

The future of these technologies, and the terabytes they gather, can involve unprecedented information about the whereabouts and well-being of older people. In a program with Intel, Dr. Kaye is combing motion data for patterns that indicate the onset of dementia, years before the decline shows up on cognitive tests.

 

But until there is more research — and reimbursement — the technologies’ ultimate impact remains unknown.

 

“It’s not that we need new technologies,” Dr. Kaye said. “We need to use what we have more creatively. It’s all cool — but is it going to be helpful?”

 

Copyright 2009 New York Times.

 

Medicare Blow to Virtual Colonoscopies

 

By Andrew Pollack

New York Times

Friday, February 13, 2009

 

Medicare has tentatively decided not to pay for virtual colonoscopies, dealing a setback to a technique that some medical experts recommend as a more tolerable alternative to conventional colonoscopy in screening for colon cancer.

 

The Centers for Medicare and Medicaid Services said in a decision posted on its Web site that there was “insufficient evidence” to conclude that virtual colonoscopy “improves outcomes in Medicare beneficiaries.”

 

The agency is taking public comments for 30 days before issuing a final decision.

 

Dr. Sean Tunis, a former chief medical officer for Medicare, said that there had been cases where a tentative coverage determination had been changed but that this one seemed to be “pretty carefully and fully considered.”

 

“I personally would be a little surprised if the final decision were different,” Dr. Tunis said.

 

Virtual colonoscopy, formally known as CT colonography, uses noninvasive CT scans, which depend on X-rays to get images of the inside of the colon for abnormal growths called polyps. Controversy has swirled for years over whether the CT scans were as effective as conventional colonoscopy, in which a probe with a camera on its end is snaked through the rectum and colon.

 

Supporters of CT scans denounced the decision.

 

“It seems to defy logic,” said Dr. Perry J. Pickhardt, associate professor of radiology at the University of Wisconsin, who has consulted for some makers of software used to analyze the CT scans.

 

Dr. Pickhardt said the virtual colonoscopy was “better, safer, faster, cheaper” than conventional colonoscopy.

 

Dr. Durado Brooks, director for colorectal and prostate cancer at the American Cancer Society, said the decision would reduce the choices available. “There are certainly some patients who may opt not to be screened because they don’t want to have a colonoscopy,” Dr. Brooks said.

 

The cancer society, in partnership with other groups, last year began recommending virtual colonoscopy as one option for colon cancer screening. But the United States Preventive Services Task Force, which advises the government on prevention, said last year that there was insufficient evidence to assess the benefits and harms of the CT technique. Some private insurers pay for the tests; others do not.

 

CT scans detect larger polyps about as well as colonoscopy, according to Medicare’s analysis. They are not as good at detecting smaller polyps, although there is debate over whether such smaller growths are dangerous.

 

The CT scans do not require the sedation often used for colonoscopies, and they have a lower risk of bowel perforations. But they still require unpleasant bowel preparation, and they do expose patients to radiation. If polyps are detected, a patient would typically undergo a regular colonoscopy to have them removed.

 

“Why do a test that will pretty much require another test to be done?” said Dr. John Petrini, president of the American Society for Gastrointestinal Endoscopy. The society, whose members perform conventional colonoscopies, supported Medicare’s decision.

 

In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare’s older population.

 

For instance, older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater. That would make the CT scan less cost-effective.

 

Copyright 2009 New York Times.

 

PRUDEN: Prescription for medical malpractice

 

By Wesley Pruden

New York Times

Friday, February 13, 2009

 

ANALYSIS/OPINION:

 

Nasty surprises are always nasty. We can expect to see a lot of them as the details of Barack Obama's Big Bopper Bailout unfold over the next several months. Joe Biden reckons the chances of the bailout working, despite the hype and hysteria, to be no better than 30 percent "even if we do everything right, if we do it with absolute certainty."

 

We've already had a few nasty surprises, enlivening the front pages from the moment President Obama took the oath. Sen. Judd Gregg's deciding that he doesn't have the stomach to be the secretary of Commerce is only the latest of the misfires. But the nastiest surprises are not likely to be the failure of the bailout legislation to work, but the way some of it will work only too well. The surprises won't be the Bridges to Nowhere, but the bridges to places no one wants to go.

 

Nastiest of all will be the health care catastrophe hidden in the thousands of pages of this legislation, the work of Tom Daschle, who was almost secretary of Health and Human Services before he was sent back to K Street to work on his tax returns.

 

The health rules set out in the bailout legislation will, as the bill boasts, affect "every individual in the United States." There will be no escaping the consequences of turning life-and-death health care decisions over to officious bureaucrats. (Members of Congress will get their usual special privileges.) If you think dealing with insurances companies is as awful as it can get, you'll be surprised.

 

A vast bureaucracy called the National Coordinator for Health Information Technology, soon to be vaster, will carefully monitor what your doctor prescribes for you, not to protect and restore your health, but to make sure your doctor does what the government deems "appropriate" and "cost-effective."

 

These provisions are identical to the prescriptions set out by Mr. Daschle last year in his book about what to do about "the health care crisis." Doctors, he wrote, have to forgo their own judgment and "learn to operate less like solo practitioners." Deference will not be required to, say, distinguished professors from the Harvard Medical School, but to narrow-minded little men armed not with learning but with a lot of attitude, trained not in the medical arts and sciences but in government paperwork.

 

"Hospitals and doctors that are not 'meaningful users' of the new system will face penalties," Betsy McCaughey, a former lieutenant governor New York who is an analyst of health care issues at Hudson Institute, writes for Bloomberg News. " 'Meaningful' user isn't defined in the bill. That will be left to the HHS secretary, who will be empowered to impose 'more stringent measures of meaningful use over time.' "

 

How doctors will be penalized for putting the health of their parents above all else is not specifically set out in the bailout bill. But Mr. Daschle offers a hint or two in his book, language borrowed by the authors of the bailout bill's health care passages. The goal is to slow up the development of new medications and treatments that are driving up costs. He praises Europeans - whose health care is rarely praised for its quality or efficiency - as being more willing to accept "hopeless diagnoses."

 

Americans expect miracles; Europeans are resigned to mediocrity. (Does anybody go to London or Paris for advanced surgery?) The government bureaucrats would work from a formula dividing the cost of the treatment by the number of years a codger could expect to live. The elderly are expected to understand they're supposed to get sick when they get old, and hear something like: "Here, take this aspirin and if you don't feel better tomorrow don't call me, call the undertaker."

 

He cites as an example of what to expect from the decree of a British health board, which told elderly patients with macular degeneration that they must wait until they go blind in one eye before they could get expensive drugs to prevent losing sight in the other. Only after years of angry protests was the grotesque regulation rescinded.

 

But where are the angry protests here from Congress, or from the American Association of Retired Persons (AARP), which worked to elect Barack Obama. Where is the coverage from our robust mainstream media? Where is the follow-up to Miss McCaughey's revealing account in Bloomberg?

 

President Obama and his partisan allies in Congress are determined to get this bailout legislation to his desk for a signature before all its gory details are discovered. He calls it "inexcusable and irresponsible" to delay. Why the rush? He remembers what happened to Hillary Rodham Clinton's health care plan, and he's determined that this one gets no scrutiny, or, as Mr. Daschle warns, is "stalled by Senate protocol."

 

The nasty surprise is saved for later.

 

Wesley Pruden is editor emeritus of The Washington Times.

 

Copyright 2009 New York Times.

 

Survey: Peanut recall known but misunderstood

 

By Mike Stobbe

Hagerstown Herald-Mail

Friday, February 13, 2009

 

ATLANTA (AP) -- Most Americans know about a peanut-based national salmonella outbreak but many are wrong about what products are involved and few have confidence in food safeguards, according to a Harvard survey released Friday.

 

About 1 in 4 of those polled mistakenly think that national peanut butter brands are involved in the product recalls, but fewer than half are worrying about recalled snack bars, baked goods, ice cream and dry-roasted peanuts.

 

The recall of 1,900 products includes mainly minor-label peanut butter and a range of other items, but not major brand names of jarred peanut butter.

 

"A lot of people have taken some precautions but they're not looking at the ingredients in products not related to peanut butter," said Robert Blendon, the Harvard health policy professor who directed the survey.

 

About 93 percent know about the outbreak and recall, and most of them understood it was caused by salmonella bacteria - an unusually high level of awareness for a public health issue, Blendon noted.

 

The poll also indicated little faith in corporations and the government. Only 1 in 3 Americans said they have a good or great amount of confidence in food manufacturers or government inspectors to keep food safe, the survey found.

 

Federal health officials are tracking a salmonella outbreak that has caused at least 636 illnesses in 44 states and has been linked to 9 deaths. The outbreak has been traced to a Virginia-based company, Peanut Corporation of America, that makes some minor-label peanut butter, peanut paste and other products.

 

Nearly 200 food makers who used or sold Peanut Corporation products are listed in a recall of more than 1,900 different items, making this one of the nation's largest recalls.

 

The telephone survey, which dialed both landline and cell phone numbers, included nearly 1,300 U.S. adults. The interviews were done last week.

 

Of those that knew about the outbreak, 70 percent knew that peanut butter crackers were part of the recall.

 

There was not a question about all brands of peanut butter. But a question about major national brands indicated 25 percent mistakenly thought they were involved and had been recalled.

 

Only about half correctly identified some snack bars containing peanut paste as part of the recall. Just a little more than a third understood that some candy and prepackaged meals were involved, and only about a quarter identified some types of ice cream as a risk.

 

Fewer than 1 in 5 people have gone to the U.S. Food and Drug Administration's online list of foods involved or sought other information about recalled products.

 

The survey also indicated extremes of concern and apathy: About 31 percent contacted friends or relatives to make sure they know about the recall, and about 15 percent stopped eating any foods containing peanuts. But 69 percent didn't contact loved ones, and 45 percent continued to eat all peanut-containing foods.

 

The survey also found that 33 percent of all survey respondents were very worried or somewhat worried about getting food poisoning, which was down a bit from the 38 percent who expressed such concern in a similar poll last June.

 

"We don't know why the level of overall worry about food safety did not increase," Blendon said. One possible factor: "About the peanut thing, some people say they are not worried because they're taking precautions," he said.

 

The poll also found that 37 percent had a good or great amount of confidence in government food inspections, down from 47 percent a year ago. About 48 percent had significant faith in grocery stores to safeguard food, down from 58 percent a year ago.

 

Only 32 percent had significant confidence in food manufacturers. There was no similar question on last year's poll to compare that result to.

 

The negative reviews may be due in part to increasing success in tracking food problems, said Glen Nowak, a spokesman for the Atlanta-based U.S. Centers for Disease Control and Prevention.

 

Although the number of confirmed food poisonings has held about steady in recent years, more advanced testing allows investigators to better link cases and identify national outbreaks.

 

"The system is going to look less safe," Nowak said.

 

Harvard is funded by the CDC to do a series of surveys on public health topics. The Harvard poll was conducted by ICR of Media, Pa., and had a margin of error of plus or minus 3.5 percentage points.

 

On the Net:

Harvard School of Public Health: http://www.hsph.harvard.edu/

 

© 2009 The Associated Press. All rights reserved.

 

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