Tuesday, March 3, 2009

News Clipping Archives

 

Maryland / Regional

Hearing to focus on troops' mental health (Washington Post)

Four Podiatrists, One Painful Little Toe (Washington Post)

Doctors Seek Fees at Time Of Service (Washington Post)

Married, With ADHD (Washington Post)

Audit: State overpaid up to $10.8M for drug benefits (Annapolis Capital)

National / International

House calls back in vogue for some doctors (Daily Record)

Opinion

Health Care in the New York State Budget (New York Times)

 

Maryland / Regional

Hearing to focus on troops' mental health

 

Associated Press

By Kimberly Hefling

Washington Post

Tuesday, March 3, 2009

 

WASHINGTON -- A House subcommittee on Tuesday will take a look at military programs targeting mental health.

 

The Army has been investigating an unexplained spike in suicides in January. Last year, the Army had its highest suicide rate on record.

 

Rep. John Murtha, D-Pa., will chair the hearing before the House Appropriations defense subcommittee, which will also examine programs for soldiers with traumatic brain injuries.

 

© 2009 The Associated Press.

 

Four Podiatrists, One Painful Little Toe

 

By Sandra G. Boodman

Washington Post

Tuesday, March 3, 2009; HE01

 

When Karen K. Abrams told her foot doctor the result of a second opinion she'd obtained about the surgery he had been recommending for months, he erupted.

 

"That's the most ridiculous thing I ever heard!" the podiatrist told her, dismissing a specialist's recommendation that she undergo an MRI of her increasingly enlarged and painful toe before any operation. "I told you, you need surgery!"

 

Cowed and unnerved, Abrams slunk out of the office and immediately booked the operation to correct what the podiatrist had diagnosed as a hammertoe, a crooked joint that was causing painful swelling.

 

A clinical psychologist with a busy practice and three children, Abrams, then 47, had been reluctant to undergo hammertoe surgery, which seemed overly aggressive.

 

But three months later, in July 2006, Abrams was forced to consent to a different operation, one she'd never imagined. The painful digit many doctors seemed to regard as trivial had become a serious problem, landing her in the hospital with medical bills that totaled $60,000.

 

"It was a very frightening experience," recalled Abrams, who is called Kay and lives in Montgomery County. For a long time, she said, "everyone seemed to think, well, it was just a little toe."

 

An avid walker, Abrams first noticed the problem in February 2005, when she developed a painful corn on the top of what podiatrists refer to as the "left fifth toe." A foot doctor at a sports medicine clinic near her home took an X-ray and, finding nothing broken, gave her a cortisone shot to ease the pain. The doctor advised her to avoid wearing narrow, tight shoes.

 

"I never wear them," Abrams said, but "that became their mantra. Every podiatrist I saw told me the same thing."

 

A few months later, when the pain, sharper but still intermittent, hadn't gone away, Abrams consulted a second podiatrist. He told her the problem was caused by a hammertoe and recommended surgery.

 

Taken aback by the proposed treatment, Abrams's internist referred her to a third foot doctor, who had a thriving practice and a good reputation. Podiatrist No. 3 agreed with Podiatrist No. 2. Because both baby toes appeared crooked, the third doctor said he could operate on the pair.

 

The timing couldn't have been worse, but there seemed to be no rush. Abrams was about to accompany her 80-year-old father on what she called "the trip of a lifetime" to Vienna and Brussels, where he had grown up. She bought a pair of fleece-lined clogs and padding for her toe, and hoped for the best. To treat periodic flare-ups, she tried smoothing down the corn with a pumice stone.

 

By March 2006, her toe was clearly worse: It was more swollen and hurt constantly, even in the clogs. Abrams went back to Podiatrist No. 3, who reiterated his recommendation of hammertoe surgery.

 

When she told a friend about her upcoming surgery, he suggested that Abrams consult his son, Washington podiatrist M. Joel Morse, for another opinion. "He's not one of those guys who jumps to surgery," Abrams remembers being told.

 

After examining Abrams, Morse thought her primary problem was not a hammertoe but a "sausage toe," a term podiatrists use to describe swelling often due to injury or infection. He asked Abrams if she had injured her toe; she didn't remember doing so. Morse suggested she undergo an MRI to check for an abscess or other problem before any surgery.

 

When Podiatrist No. 3 erupted, mocking Morse's recommendation, Abrams scheduled surgery for June, after her son's high school graduation. But by Memorial Day weekend, her toe had gotten dramatically worse. It felt hot and was so painful she could not stand the pressure of even a bedsheet.

 

"I just wanted to chop it off, it hurt so much," Abrams recalled. A cardiologist friend dropped by, took one look at her toe and told her it was infected and required urgent treatment. In a panic, she reached Morse, who told her to report to Sibley Memorial Hospital the next morning, without eating breakfast in case she needed surgery.

 

"I had no idea what I was about to face," she said. Within hours she underwent an MRI and a procedure that opened the toe to look for an abscess. Afterward several grim-faced doctors filed into her room and told her to forget about any hammertoe operation. She had osteomyelitis, an infection that was eating away at the bone in her toe.

 

There were two treatment options: several weeks of intravenous antibiotics to see if the infection would clear up, or amputation.

 

Osteomyelitis, which affects about two of every 10,000 people, is typically caused by bacteria, often staphylococcus, according to the Cleveland Clinic. It can result from an injury, such as a fracture in which a bone pierces the skin. Sometimes a long-standing infection can penetrate to the surface of the bone. Untreated, osteomyelitis can become chronic and lead to the death of the affected bone. A 2000 article by British physicians in Diabetic Medicine found that sausage toe is a reliable indicator of underlying osteomyelitis.

 

The infection is more common among people with diabetes, those on kidney dialysis, intravenous drug users, the elderly and patients with weakened immune systems. Abrams fit none of those categories.

 

Shocked by the news, Abrams chose to try to save her toe. Doctors implanted an intravenous line in her chest through which she would receive antibiotics; after two days, they sent her home.

 

She remembers the next five weeks as awful. Unable to eat because the antibiotics made her nauseated, she developed an allergy to two of the drugs and had to be rushed back to the hospital twice. Worst of all, the medicines didn't seem to be working.

 

What she wasn't told at the time was that doctors had become concerned that she might have MRSA, methicillin-resistant staphylococcus aureus, the flesh-eating bacteria. While recuperating at home, Abrams called her internist. The physician told her she needed to have the toe amputated and referred her to a prominent orthopedic surgeon in Baltimore who specializes in foot problems. "Come back tomorrow and we can take the toe off," the orthopod told her. "You can live without it, and the antibiotics are doing nothing for you."

 

Abrams said she burst into tears, then called Morse for a second opinion. "He said, 'You're making the right decision,' " she recalled.

 

The next morning she was given a local anesthetic and wheeled into an operating room at Baltimore's Mercy Medical Center, where her baby toe was amputated.

 

Abrams said she still wonders whether it could have been saved. Self-conscious about her missing toe at first, she later developed a shoe obsession. "For a while I couldn't stop buying shoes," she recalled.

 

Although it is clear what was wrong with her toe, the cause of the osteomyelitis remains a mystery.

 

To Morse, Abrams is "a very unfortunate case. Had [the MRI] been ordered earlier, she might not have lost her toe."

 

Abrams said it took her a long time to get over her fear that any injury might conceal a smoldering infection. She remains grateful to Morse, who, she said, "was the first doctor who really listened and was thoughtful."

 

These days when something goes wrong, she does more research and is less easily intimidated. Her attitude toward doctors has also changed.

 

"In your gut if you feel dismissed," she said, "keep looking."

 

Copyright 2009 Washington Post.

 

Doctors Seek Fees at Time Of Service

 

By Francesca Lunzer Kritz

Washington Post

Tuesday, March 3, 2009; HE01

 

When Nicole Atkinson, 29, of Baltimore scheduled the first obstetrics appointment of her pregnancy last year, she knew the experience would come with its share of surprises. But Atkinson wasn't at all prepared for a financial one: a request to pay up her full deductible -- $600 -- before the doctor would see her for the exam.

 

"So, I fired her," says Atkinson, who then switched doctors to one who charged only a co-pay for each visit.

 

But if Atkinson decides to have another baby, she may not be able to avoid that balloon payment. More and more physicians are asking for the patient's share of that day's medical fees, including any deductible set by the insurer, at the time of the visit.

 

"It's a paradigm shift from what most consumers are used to at their doctor's office," says Red Gillen, a San Francisco-based analyst with consulting firm Celent, who last month published a report on doctors seeking upfront payment from their patients. Gillen says that until recently, insurers paid so much of the cost of medical care that medical providers, including doctors, labs and hospitals, focused their fee recovery efforts on the companies. But in the past few years, Gillen says, employers and insurers have shifted more costs to consumers in the form of higher co-pays, higher co-insurance and higher deductibles, making those payments an increasingly large share of doctors' incomes. According to Gillen, consumer out-of-pocket spending as a percentage of all health-care spending rose to 12 percent last year, and is expected to continue rising.

 

A survey published by the Kaiser Family Foundation in September, found that 18 percent of people who responded were covered by insurance plans with deductibles of at least $1,000, up from 12 percent the year before. "Until now," Gillen says, "insured patients would see a doctor, leave a co-pay and then watch a series of insurance and physician envelopes come through the mail over weeks to months, until finally one detailed the actual amount, if any, to be paid by the patient." Now, largely through new software programs that assess both a patient's insurance coverage and the day's charges, those weeks to months are often collapsed into just minutes for an estimate, or even a full adjudication of the bill.

 

Owe, say, $90 for a sore throat checkup with at least that amount of a deductible still to be paid, and an increasing number of practices will request $90 that day, plus a co-pay if your insurance includes one.

 

At one doctor's office, just blocks from the White House, a video screen in the waiting area tells patients that if they don't have their insurance card, the practice would be happy to "reschedule your appointment." That practice also asks that the co-pay be coughed up before the patient sees the doctor and calls patients in arrears to a window in full view -- and earshot -- of other waiting patients.

 

Those are more draconian measures than many doctors follow. But few providers let patients head home these days without either some payment or a definitive plan for how to pay their share of the bill.

 

Increasingly, patients get a printout sometimes before but more likely after the medical visit detailing the full cost and the patient's share, including any outstanding deductible. The estimate software has been created by some private firms, but also by a growing number of insurers including some Blue Cross plans, UnitedHealthcare and Humana. In April, Cigna, which has half a million beneficiaries in the Washington area, will be rolling out "The Estimator," software that estimates a patient's financial responsibility, usually by the time he or she has changed into street clothes. Cigna's forms suggest that a doctor ask for no more than half of a patient's estimated bill at the time of care, but every practice can set its own rules.

 

"Most firms rely on estimates, rather than definitive bills, because there could be additional charges related to the visit that can't be anticipated, such as an extra lab test on a biopsy, for example, and there can be a lag in communicating deductible payments between other physicians and the insurer, says Lori Logan, head of new products for Cigna.

 

At Virginia Physicians for Women in Richmond, for example, pregnant patients pay their deductible in six installments. "But during that time we also check to see if they've paid that deductible to other health-care providers and may have to issue some refund checks," says David Knapp, the practice business manager.

 

"The new billings systems are works in progress, with many different practices among health-care systems for now," says Celent's Gillen. At Washington Hospital Center, for example, the financial office uses a care pricing system, says hospital spokeswoman Paula Faria, which determines the co-insurance, but not the deductible. The deductible is still determined in a phone call to the insurer.

 

"This combined information is gathered prior to preregistration and is presented to the patient," says Faria, who adds that "once a patient has a clear idea of what their coverage will cover and what their cost will be, a meeting with our financial counseling office is arranged."

 

Mark Rukavina, executive director of the Access Project, a health-care advocacy group in Boston, says finding out how much patients owe right away, rather than hanging in limbo for weeks to months, is a positive.

 

What's bad, he says, is that not all providers have let their patients know that payment, or payment arrangements, are expected at the time of care. "That's usually not a pleasant surprise in this economy," says Rukavina, who worries that subtle intimidation could push some people to put bills on an already weighed-down credit card or even avoid care altogether.

 

Last week a Kaiser Family Foundation tracking poll of more than 1,200 adults, completed in mid-February, found that 53 percent surveyed had put off some form of medical care, including physician visits, because of cost concerns.

 

William Dolan, a trustee of the American Medical Association, and an orthopedic surgeon in Rochester, N.Y., says the AMA has no policy on patients being asked for payment at the time of care but suggests that doctors give patients warning weeks before implementing a new payment policy and that providers be "fair and reasonable" in helping patients make payment arrangements.

 

One payment option will be a credit card. "It's a myth that people only use their credit cards for flat-screen TVs," says Tim Westrich, a research associate who specializes in credit issues at the Center for American Progress, a D.C. think tank. "If you're already financially stressed, a credit card could be your only pressure valve," Westrich says.

 

But some guidance on use of the cards for medical expenses, especially unexpectedly higher ones, could help prevent extra charges and higher interest rates. Rukavina advises patients to never use a credit card that must be paid up monthly unless they are prepared to do so. If they don't pay on time, a $30 flu shot can cost an extra $30 or so for the late fee, plus trigger higher interest rates.

 

Celent's Gillen says that as consumer share of medical expenses increases, he expects banks to issue interest-free health-care-specific credit that might be linked to payrolls for deductions and even offer discounts for users. (Some health-care-only cards exist now but are generally intended for elective health expenses such as Lasik and plastic surgery. They generally start with 0 percent interest but trigger a percentage increase if payment is late or missed.)

 

One bright note for people who use credit cards to pay their medical expenses: The Federal Reserve has issued rules prohibiting excessive fees or interest rates on credit cards, effective next year. Similar legislation is to be introduced in Congress within the next few months and, if passed, could take effect before the Federal Reserve's rules.

 

The AMA's Dolan suggests asking about payment practices when you make your appointment, so that you know what to expect. Increasingly, though, billing staff won't be waiting for you to bring up the subject.

 

Copyright 2009 Washington Post.

 

Married, With ADHD

Relationships Suffer Under Stress of Raising Child With Disorder, Study Finds

 

By Shankar Vedantam

Washington Post

Tuesday, March 3, 2009; HE01

 

For many years, scientists have explored how parental conflicts and other marital problems can affect the well-being of children. Far less attention has been paid to the opposite question: How do children, especially difficult children, influence the quality of married life?

 

Couples who have a child with attention deficit hyperactivity disorder are nearly twice as likely to divorce or separate as couples who do not have children with the psychiatric disorder, according to a definitive new study that is the first to explicitly explore the question. The reason appears simple: Having a child who is inattentive or hyperactive can be extremely stressful for caregivers and can exacerbate conflicts, tensions and arguments between parents.

 

The research topic is sensitive because it can be easily misinterpreted to mean that scientists are blaming kids for the marital woes of their parents; that may be one reason researchers have generally avoided the topic and limited their investigations to how parental conflicts affect children. But increasingly, the evidence suggests that the lines of influence run in both directions.

 

The study, led by psychologists Brian Wymbs and William Pelham and published last year in the Journal of Consulting and Clinical Psychology, longitudinally tracked a large number of families with and without children diagnosed with ADHD, a disorder characterized by inattention and hyperactivity and often accompanied by conduct problems and oppositional behavior.

 

While 12.6 percent of the parents of children without ADHD were divorced by the time the children were 8 years old, the figure was 22.7 percent for parents of kids with ADHD. Couples with ADHD kids also tended to reach the point of divorce or separation faster.

 

"We have known for a long time that kids can be stressful for their parents. What we show is they can be really stressful and can lead to marital dissatisfaction and divorce," said Pelham, who works at the State University of New York at Buffalo. "What it means is ADHD should not be treated without involving the parents in the treatment."

 

Pelham said his interest in the topic was piqued after he conducted a study that looked into how children's behavior influenced the propensity of their parents to consume alcohol. Pelham had a large number of parents interact with children who were not their own. Some of the kids were trained to act cooperatively, while others were trained to act as though they had ADHD. The parents were given a break midway through the session, when they could consume alcohol, and then sent back in for a second period with the same child.

 

The parents thought the experiment was measuring how parent-child interactions changed depending on alcohol use; in reality, Pelham wanted to know how dealing with easy and difficult children influenced the propensity of caregivers to drink. The psychologist found that parents randomly assigned to interact with the difficult children drank a whopping 40 percent more alcohol during the break than parents who were assigned manageable kids.

 

Several previous studies have hinted at connections between marital health and children's behavior.

 

"Parents of children with ADHD report less marital satisfaction, fight more often, and use fewer positive and more negative verbalizations during child-rearing discussions than do parents of children without ADHD especially if the child also has conduct or oppositional problems," Pelham and Wymbs noted in their paper.

 

Many other factors influence whether couples stay together. Communication problems, substance abuse, financial difficulties and mental health problems among partners all play a role in the health of intimate relationships. The difference between those other factors and the role that children play is that the other factors have been widely documented and discussed.

 

Wymbs said that in a separate study, he brought parents with and without ADHD kids into a laboratory. As before, he assigned them to interact with children who were not their own; some had been trained to act cooperatively, and others had been trained to act difficult. (The "difficult" kids in the study were nowhere as difficult as many kids with ADHD in real life; ethical guidelines forbade researchers from training child actors to hit or scream.)

 

Wymbs had the parents and kids perform four exercises: The first involved playing the game Jenga, which requires strategic thinking and planning. Kids trained to be helpful worked cooperatively with the parents; the kids trained to act difficult undermined the parents at every turn.

 

A second exercise called for parents to monitor the kids solving math problems while they themselves had to fill out a checkbook, the kind of parallel processing that induces stress. The easy kids attended to their homework; the difficult kids refused to do their homework, scribbling on their papers or erasing their answers and blowing the shavings on the parents.

 

In the third task, the kids directed play. The child actors always chose to play mini-bowling and mini-basketball. The cooperative children took turns and helped set up the games, and the difficult children played out of turn and were disruptive.

 

The fourth task involved cleanup where, as you might imagine, the children were trained to be either helpful or unhelpful.

 

Wymbs videotaped the interactions. What he was on the lookout for was not how the parents interacted with the children, but how the children's behavior affected the way the parents worked with each other. Regardless of whether they had children with ADHD, Wymbs found, the parents asked to work with difficult children were four times as likely to exchange negative criticism and questions, or to ignore each other and trade nonverbal barbs, than the parents in the other group.

 

And regardless of whether they were dealing with easy or difficult children, parents who had ADHD children at home were three times as likely to be negative toward each other as parents who did not. Put another way, the parents of children with ADHD simply had less ability to respond to challenges with equanimity; they appeared to be psychologically worn thin.

 

Pelham said that although medications are effective in addressing ADHD symptoms, they often prove unhelpful when it comes to parent-child interactions because ADHD drugs are stimulants, usually given to the kids in the morning before they head to school. The medication is wearing off by the time kids get home and have most of their interactions with their parents. It isn't advisable to give children more medication because it would keep them up at night.

 

Several researchers said parents need to develop behavioral techniques to improve coping skills.

 

"When you sit back, you can laugh at it, but in the moment it is phenomenally stressful for the family," said Charlotte Johnston, a psychology professor at the University of British Columbia, referring to the daily challenges that parents of kids with ADHD face. "Often the parents have different tolerances for tantrums. One wants to stand firm, but the other is willing to give in. Now the parents are set up to fight, [saying,] 'You let him do that?' or 'You are too strict with him!' "

 

Johnston teaches parents to get on the same page and follow three rules: The first is to pare down their expectations and to focus on only one or two problem behaviors in their ADHD child. The second rule is the familiar parental technique of rewarding all positive behavior and discouraging negative behavior, often by ignoring it. The third rule is to consistently stick with the technique long enough to see it work.

 

Other experts said it is also important to teach parents to take time to pamper themselves and put themselves back together psychologically.

 

"Many parents do not take care of themselves. We encourage them to do that even though they may feel they have no time because of all their commitments to their families," said Andrea Chronis-Tuscano, a psychologist who directs the University of Maryland's ADHD Program. "One of our mantras is, 'If you don't take care of yourself, you can't do your best as a parent.' "

 

Copyright 2009 Washington Post.

 

Audit: State overpaid up to $10.8M for drug benefits

 

Associated Press

By Kathleen Miller

Annapolis Capital

Tuesday, March 3, 2009

 

ANNAPOLIS — Maryland benefit officials missed out on as much as $10.8 million in contractually guaranteed prescription drug rebates and discounts in 2005 and 2006, according to an audit released Monday.

 

The report by the state's Office of Legislative Audits faults employees charged with administering contracts for the mistakes and urges the state to recover overpayments. In 2005, the state received a 46.7 percent discount from the average wholesale prices on generic drugs, although a contract stipulated they were to receive discounts of 56 percent. In 2006, the state received discounts of 48.7 percent instead of the 50 percent discount required by the contract. The audit said the state is estimated to have spent up to $10.1 million in overpayments for drugs during this time.

 

"Our audit disclosed a number of deficiencies in the administration of the contract with the pharmacy benefit manager for the state's prescription drug benefit program," the report from the Office of Legislative Audits said.

 

State officials told auditors they would attempt to recoup the money after the audit report was final. In addition, the state also did not receive an estimated $700,000 in drug manufacturer rebates during 2006, according to the audit. Office of Personnel Services and Benefits officials are actively pursuing recovery of the rebate money.

 

"While the overpayments occurred under the prior administration, we are aggressively pursuing any amounts due the state and Maryland taxpayers," Gov. Martin O'Malley's spokesman Shaun Adamec said.

 

Department officials say they have implemented a new quarterly review process to ensure prescription drug pricing guarantees are obtained and manufacturer drug rebates are received.

 

"There's a lot of pockets of dollars here," legislative auditor Bruce Myers said Monday. "We're pretty satisfied with their response, hopefully it will correlate into action."

 

The report also finds that department leaders did not always review and report potential cases of prescription narcotic drug abuse by plan participants in a timely manner. Department officials say they have now reported any all suspected abuse cases to the Governor's Chief Counsel.

 

Copyright 2009 Annapolis Capital.

 

National / International

 

House calls back in vogue for some doctors

 

Associated Press

Daily Record

Saturday, February 28, 2009

 

ST. LOUIS — Pediatrician Natalie Hodge spent seven years in a hectic doctor's office. Some days, she'd see 40 sick kids, 10 minutes at a time. Moms calling for advice about sore throats or ear aches had to wait. Hodge could only find time to return those calls as she drove home.

 

Finally, she had enough.

 

"I kind of threw up my hands and said, 'There's got to be a better way to do this,'" Hodge said. "I said, 'I'm going to get a laptop and a Treo and make house calls.'"

 

For much of America's history, that was the norm. Home visits died when medical insurance replaced pay-as-you-go, and administrative costs and malpractice insurance fees forced doctors to abandon individual practices and join together in groups. By the early 1970s, fewer than 1 percent of doctors made house calls.

 

Now, doctors visiting the sick in their homes seems to be in vogue again. The doctor still carries a little black bag, but a laptop bag, too, and perhaps a portable X-ray machine.

 

Experts say the number of doctors checking patients at home, while still a very small percentage of all doctors, has risen sharply since a Medicare policy change a decade ago that increased reimbursement for home visits. But that change mostly involved house calls to the homebound.

 

The American Academy of Home Care Physicians doesn't track how many doctors make house calls, executive director Constance Row said. Neither does the American Medical Association.

 

Private and public medical insurance typically doesn't pay for "concierge" services like Hodge's — that is, house calls borne out of convenience, not necessity. In fact, Hodge's clients typically pay a $1,500 annual out-of-pocket fee plus a charge for every visit.

 

Dr. Steven Landers, medical director for home health care at Cleveland Clinic, said house calls can mean better patient care.

 

"The real benefit is the access," said Landers, who makes about 20 house calls per week to geriatric and chronically ill patients. "You get to see people in their own environment. You learn things you wouldn't normally know."

 

Row said too many frail and elderly people skip seeing the doctor simply because it is too difficult to make the trip to the office. For them, she said, home visits are essential.

 

"This is one of these areas where the need has outstripped the capacity," Row said. "There are more people who need the service than there are physicians who provide it."

 

House calls today are made easier by advances in technology. Hodge said that for most visits, she needs little more than her iPhone, a laptop and a high-tech cooling system for medicine. Landers checks a patient's chart and schedules the next appointment on the laptop he carries with him.

 

Mobile technology means doctors can perform blood tests and X-rays inside a patient's home. Digital photos can be e-mailed to specialists. New data storage systems keep all the information safe.

 

Hodge, 39, was a University of Kentucky medical student doing a stint in Hazard, Ky., when she got her first taste of house calls. "I would drive up into little hollers, taking care of guys who wouldn't come into the clinic, coal miners," she said.

 

She did her pediatrics residency at Washington University in St. Louis, then began working in a multi-specialty office here. By 2005, she grew weary of what she found to be impersonal, inadequate care.

 

So she launched her house call practice, Personal Pediatrics. She started a Web site and the business took off. It was so successful she plans to expand nationally. And as the business expands, Hodge hopes to partner with a charitable foundation that could offset the annual fee, making the service available to a broader audience.

 

The benefit is convenience. No more phone tag with the doctor's office, no more dragging a sick kid out of bed. When parents have a question, they call or e-mail Hodge directly.

 

On a recent chilly morning, Hodge visited 7-year-old Elizabeth Cupini, who stayed home from school with a sore throat, sneezing and coughing.

 

Snug in a pink bed decorated with Teddy bears, Elizabeth opened wide as Hodge used a small flashlight to examine her throat.

 

"Well, you have a pulse so I think you're going to live," the doctor said as the girl giggled. Nothing worse than a bad cold, the doctor told Elizabeth and her mom.

 

The bottom line, Hodge said, is that house calls make for better care.

 

"If they have asthma, you can say, 'get rid of this carpet or these drapes.' If they're overweight or diabetic, you can see what's in the fridge or the candy jar," she said.

 

It's that sort of connection that Landers said is simply lacking in the current health care system.

 

"The real power is the basic things that made the house call useful 50 years ago," he said. "The patients and families find it to be a very caring gesture. Sometimes just showing that you care is the most important thing."

 

Copyright 2009 Daily Record.

 

Opinion

 

Health Care in the New York State Budget

 

New York Times Letter to the Editor

Tuesday, March 3, 2009

 

To the Editor:

 

Your Feb. 21 editorial “Albany, Don’t Bank on the Feds” calls for health care reform to encourage more cost-effective care. Unfortunately, when it comes to long-term care, Gov. David A. Paterson’s recommendations merely continue a failed strategy of cutting reimbursement without supporting new concepts in services to frail elderly and chronically disabled individuals.

 

A result could be genuine harm to our most vulnerable and needy citizens. What we need is a budget that will reconcile the state’s financial imperatives and essential moral obligations.

 

Years ago, after the Willowbrook consent decree, New York found a way to transform care for mentally retarded and developmentally disabled individuals from an institutionally based system to one that provided community-based care. At that time, Gov. Hugh L. Carey had his own fiscal crisis to deal with, but he never let that be a reason for neglecting the state’s obligation to care for those most in need.

 

Jim Introne

New York, Feb. 22, 2009

 

The writer, the president of the Catholic Health System, Archdiocese of New York, was the commissioner of the New York State Office of Mental Retardation and Developmental Disabilities under Governor Carey.

 

Copyright 2009 New York Times.

---

BACK TO TOP