Maryland / Regional
Tuberculosis
Cases Increase In Maryland
(EmaxHealth)
Maryland receives $1.5 billion in federal funds for health care
initiatives
(Insurance&Financial Advisor – IFAwebnews.com)
Can
‘concierge’ doctors save primary medicine?
(Daily Record)
Working out in an
unhealthy economy
(Daily Record)
Hospitals extend healing hand beyond patients and traditional
medicine (Daily Record)
Hospitals' financial deals turn into liabilities
(Baltimore Sun)
Appeals
court upholds Md. funeral home rules
(Baltimore Sun)
National /
International
Doctors say kidney stones in kids are on the rise
(Washington Post)
Stroke-blocking device shows promise, doctors say
(Washington Post)
Groups find common ground on health care overhaul
(Washington Post)
Opinion
Our Say: Budget proposal passes the misery to the counties
(Annapolis Capital)
Kicking red meat
(Baltimore Sun)
Maryland / Regional
Tuberculosis
Cases Increase In Maryland
By Ruzik_Tuzik
EmaxHealth
Friday, March 27, 2009
Tuberculosis, the infectious lung disease that the American Lung
Association was founded to fight, remains active in Maryland. In
2008, there were a total of 278 cases of TB throughout the
state, up from 270 cases in 2007. While the majority of
localities saw their TB numbers increase or stay the same,
Baltimore City was one of six localities in Maryland where the
number of tuberculosis cases decreased. Baltimore City’s cases
dropped sharply, from 47 in 2007 to 32 in 2008.
“The Baltimore numbers show how we can protect people and defeat
TB with awareness and attention to strategies that work,” said
John M. Colmers, Secretary of the Maryland Department of the
Health and Mental Hygiene (DHMH). “What Dr. Josh Sharfstein and
his department have done to inhibit the spread of TB is an
example for all local health departments, hospitals and
clinics.”
Today, on World TB Day, the American Lung Association in
Maryland commends both Baltimore City and Baltimore County for
their efforts to stop the spread of tuberculosis. Baltimore
County’s TB cases declined as well, from 31 cases in 2007 to 20
cases in 2008.
“Proper detection, diagnosis and treatment of tuberculosis are
important for patient health and public safety,” said Dana Lefko,
Manager of Mission Services and Advocacy for the American Lung
Association in Maryland. “The methods in place in Baltimore City
and Baltimore County are achieving results. That work must
continue and grow in order to keep Marylanders safe from
tuberculosis.”
Tuberculosis is transmitted through the air when someone with
active TB in the lungs coughs or talks, and it is usually spread
in close living quarters. Anyone inhaling air containing TB
bacteria may become infected, which is referred to as latent TB
infection. Only active TB disease causes symptoms and can be
spread to other people; latent TB infection does not cause
symptoms and cannot be transmitted but can lay dormant in the
body for years and become active disease when the body becomes
vulnerable due to other illness, chemotherapy or other
stressors.
In 1919, when the American Lung Association in Maryland was
founded, TB was killing 1 in 4 Americans. That rate has dropped
significantly in the United States, but each year, 9 million
people around the world become sick with TB. An estimated 2
billion people worldwide – one third of the world’s population –
are infected with TB, and more than 2 million of them die
annually of the disease.
“TB is a stubborn disease that has produced illness and early
death for centuries. Though far less common now, TB demands
strong public health protections,” said Frances Phillips, DHMH
Deputy Secretary for Public Health. “Preventing the spread of
this serious disease is the day-today work of public health
investigators, nurses and doctors in every city and county
statewide. With increased international travel and the
development of drug resistant forms of TB, this public health
work becomes even more essential.”
In the United States, there were 12,898 cases of TB reported in
2008, which is a 3.8 percent decline since 2007. The Centers for
Disease Control Advisory Council for the Elimination of
Tuberculosis declared in 1989 that their goal was to eliminate
tuberculosis in the U.S. by 2010. That goal will not be reached.
It will take 96 years to eliminate TB in America if the current
annual rate of decline in TB incidence continues.
“We need to remain vigilant in the fight against TB,” said Lefko
of the American Lung Association. “It is critical to keep this
communicable disease under control so it does not spread. Quick,
accurate diagnoses and consistent, effective treatment are
needed if we are going to eliminate tuberculosis in the United
States.”
Source: Maryland Department Of Health
Copyright 2009 EmaxHealth.
Maryland receives $1.5 billion in federal funds for health care
initiatives
By Keith L. Martin
Insurance&Financial Advisor – IFAwebnews.com
Friday, March 27, 2009
During “Cover the Uninsured Week,” Maryland officials have
announced that the state will receive $1.5 billion in federal
funds to help do just that.
Gov. Martin O’Malley announced that the funds, from the American
Recovery and Reinvestment Act, commonly known as the federal
stimulus package, will help expand health care programs, support
community clinics, address the needs of underserved children and
protect tens of thousands of healthcare jobs.
“More and more people are either having their work hours cut, or
are losing their jobs altogether – and too often are forced to
choose between putting food on the table or seeing a doctor,”
O’Malley said in a statement. “Because of these dollars, and
because of the investments we’ve already made, Maryland’s health
care safety net remains strong and stable – even during this
national economic crisis.”
U.S. Sen. Benjamin L. Cardin (D-Md.), a member of the Senate
Budget Committee, added that families in the state are hurting
given the current economy, but “healthcare should be a right for
all Americans.”
“I am pleased that the economic recovery package includes
funding to help low-income Marylanders continue to receive
health care through Medicaid,” he said. “It also provides a
substantial subsidy for workers who have been laid off so they
can continue to pay for health care coverage.”
During national “Cover the Uninsured Week,” Maryland’s
Department of Health and Mental Hygiene, hospitals, local health
departments and community clinics are promoting healthcare
programs and services as well as enrolling eligible children and
families into existing coverage options.
“This timely investment in health care means Maryland can
continue to serve those who need help most,” said DHMH Secretary
John M. Colmers. “Without these funds provided by our health
care champions in Congress and the White House, over 50,000
people could lose the coverage they now have under our Medicaid
program. The number of people who need our help is likely to
grow as we struggle to recover from the loss of jobs and
healthcare benefits.”
The national stimulus plan is expected to provide funding to
create or save 66,000 Maryland jobs over the next two years,
including doctors, nurses and other health care workers
throughout Maryland, O’Malley said.
© 2008 New Horizon Group, Inc. :: Insurance & Financial
Adivsor | IFAwebnews.com
Can
‘concierge’ doctors save primary medicine?
By Alan Dessoff
Daily Record
Saturday, March 28, 2009
Fed up with health insurance companies, burdensome
record-keeping and low payments for the care they provide to
their patients, more Maryland doctors appear to be following a
national trend and adopting a retainer-based practice that
allows them to avoid insurance hassles, provide quality care to
fewer patients and make more money for themselves.
In the retainer model, doctors charge patients an annual fee,
usually $1,000 or more, which covers a comprehensive range of
services as well as the doctor’s personal attention whenever a
patient needs it. The practice replaces the traditional
fee-for-service arrangement, with patients paying for each
office visit or service they receive.
It also is called “concierge” or “boutique” medicine, with fees
reportedly up to $10,000 or more in some affluent communities in
California and Florida. But Maryland doctors bristle at those
characterizations, which they think suggest that only wealthy
patients can afford their services and that the doctors will
become rich as well.
“It’s not about money. It’s about taking care of patients and
not working for the insurance companies,” says Robert P. Fields,
M.D., who practices internal medicine on a retainer arrangement
in Olney.
“Patients who come to me say they can’t get in to see their
doctor and when they do, they get eight minutes and their
concerns are not addressed adequately. It comes down to a value
decision for patients. Do you value your health and want access
to an unhurried doctor or not?” asks Thomas F. Lansdale III,
M.D., an internist with a retainer-based practice in Baltimore.
Alan Sheff, M.D., a primary care doctor in Bethesda who
converted his practice in 2003, says he wanted to spend more
time focusing on prevention and wellness for his patients.
Before he made the change, he says he was like a fireman. “[I
was] always putting out the fires but never having a chance to
talk to people about how to prevent the next fire from breaking
out. I felt I had moved away from the core values that attracted
me to medicine in the first place,” says Sheff.
“Physicians who are doing this really aren’t trying to make more
money. Because of low reimbursements from the insurance
companies and other problems, they’re just finding it more and
more difficult to practice medicine the way they were taught,”
says Gene M. Ransom III, executive director of MedChi, the
Maryland State Medical Society.
But some Maryland medical authorities see a downside to
retainers. “From the physicians’ point of view, we understand
why it is happening. From the patients’ point of view, our
concern is that it’s going to make a bad situation even worse,”
says Nancy Fiedler, senior vice president of communications for
the Maryland Hospital Association (MHA).
She cites a serious shortage of physicians in Maryland that
already is having an impact on hospitals and consumers in the
state. Maryland is 16 percent below the national average in the
number of physicians in clinical practice, with the shortage
most severe in rural areas, and indications are that the
situation will worsen, according to a study conducted last year
for MHA and MedChi.
According to testimony at a hearing the Maryland Insurance
Administration held in December, Maryland primary care
physicians have 2,500 or more patients and see 20 to 25 a day in
15-minute intervals. As more of these doctors limit themselves
to a few hundred patients who are willing to pay their fees, it
becomes even more difficult for other patients to find new
physicians, Fiedler says.
Maryland has about 25,000 licensed physicians, but approximately
40 percent of them are teachers, researchers or administrators
who do not provide direct patient care. Of those who do, there
is no data on the number who have opted for retainer-based
arrangements, but it is believed to be growing. MDVIP (the VIP
stands for Value in Prevention), a Florida-based company that
helps physicians convert their practices to “personalized and
preventive health care,” lists 26 in Maryland among 280
nationwide. The practice also has its own national professional
organization, the Richmond, Va.-based Society for Innovative
Medical Practice Design.
The prospect of some type of future regulation of retainer-based
practices in Maryland was raised in January in a report issued
by state Insurance Commissioner Ralph S. Tyler following the
hearing the insurance administration held to ascertain if
retainer arrangements “constitute the business of insurance.”
Tyler, acknowledging the impact of retainer practices on primary
care, suggested that the General Assembly “may wish to explore”
requiring them to register with a state agency and also consider
“the broader (non-insurance) public policy implications” of the
practices on health care delivery in Maryland.
Tyler’s look at the retainer model caused at least one Maryland
practice — Charter Internal Medicine, a five-physician office in
Columbia — to step back from its plans to change to a
retainer-based arrangement on Jan. 1. Instead, it told patients
in a letter that it would continue to operate as it was. “We
feel it would be imprudent to proceed with a practice change
until our state government provides clearer direction,” the
letter stated.
Lansdale, who opened his practice in 2005 after nine years as
chairman of the Department of Medicine at the Greater Baltimore
Medical Center, says he has no regrets about it. “I’m very
happy. I can’t tell you how much I love my job,” he says.
He charges an annual fee of $1,500 and has about 250 patients
now and says he will limit his practice to about 350. He
promises to provide complete medical care to his patients,
including laboratory work, and be available to them at all
times, including on his cell phone, which he always carries with
him.
“When I started this,” Lansdale says, “my colleagues said, ‘Tom,
are you out of your mind? You’re going to have people calling
you morning, noon and night.’” But so far, he says, nobody has
called him “inappropriately.” In fact, when he was away for a
weekend recently, a colleague who covered for him “wasn’t up all
day and night” managing his patients.
Fields, who started his practice in 2003, also charges $1,500
annually and is limiting his patient load to 400. Calls to his
office during office hours are answered live and promptly by a
staff member, not a recording. Fields even makes house calls and
claims they save money for patients, Medicare and private
insurance providers alike. “Every house call saves an expensive
trip to the emergency room,” he says.
Sheff, a MDVIP doctor, has limited his practice to 550 patients
who pay $1,650 annually. He says he has a waiting list, but
rarely is able to add new patients because he has a 97 percent
renewal rate. In his earlier, traditional practice, he had more
than 3,000 patients. “I’m as busy as I want to be and I’m doing
just fine financially,” he says. But most important, Sheff
emphasizes, is the time he has to put toward personalized
wellness and prevention for each of his patients.
Although doctors say they will treat adults of any age, Lansdale
says he doesn’t have “a lot of young, healthy people.” Most of
his patients, he says, are in their 40s and older, who “accrue
medical issues they want someone to pay attention to.”
Similarly, he says, retainer-based medicine is not for young
doctors just starting their careers. “Older patients are looking
for experience. You have to establish a reputation,” says
Lansdale, who is 55.
Lansdale, Fields and other doctors reiterate that the hassle
with insurance companies was a key factor in their decisions to
start retainer-based practices. “The hours and hours a day,
literally, that go into bureaucracy and paperwork and trying to
fight for your patients; it was just so disheartening. That’s
what is killing primary care,” Fields says.
“It’s the third party, the insurance company, that drives
doctors crazy,” says Lansdale. “We have a professional, ethical
responsibility to do our best to take care of our patients. In
the old days, patients paid their doctors in chickens, potatoes,
turnips and so forth. There was no such thing as sending a bill
to an insurance company that might or might not decide to pay
it. That’s why doctors are burning out and switching their
practices when they should be in the prime of their careers.
They just can’t stand it anymore.”
As Commissioner Tyler states in his report, “Given the current
economic realities of primary care practice, retainer practice
is likely to remain an attractive alternative to some primary
care physicians.”
Copyright 2009 Daily Record.
Working out in an
unhealthy economy
By Mike Silvestri
Daily Record
Saturday, March 28, 2009
It had been several years since Butch Bowker worked out, and
while he needed to get back in shape, he couldn’t afford to
rejoin the massive gym to which he used to belong.
“I didn’t want to pay the money because they have the pool and
this and that. All you need is the treadmills and the basic
machines to work out,” says Bowker, who is retired and lives in
Bel Air. “If you’re not using all that equipment, why pay for
it?”
So he didn’t. Bowker instead paid about one-third what he used
to pay, joining Anytime Fitness, a small gym open 24 hours every
day with treadmills, stationary bikes and an array of weight
machines. The club in Forest Hill is one of nearly 1,000 in the
country, half of which have opened in the past year.
Many gym-goers view working out as an essential,
stress-relieving part of their lives, but as the ailing economy
continues to struggle, they are trimming costs and adjusting
their exercise routines. The number of people in the country
with a gym membership has held steady recently, according to the
International Health, Racquet & Sportsclub Association, but the
type of customer seems to be changing as more people are leaving
mega gyms and moving to smaller, cheaper clubs, working out at
home or hiring personal trainers.
At Gold’s Gym in downtown Baltimore City, officials said the
economy has caused laid-off workers to cancel their memberships,
and the collapsing economy forced Merritt Athletic Clubs last
year to close its Annapolis gym, a popular workout spot for
state lawmakers.
Meanwhile, the Y of Central Maryland has seen a massive increase
in business. Memberships at the nonprofit centers in the
Baltimore area have increased 20 percent in the past year, says
spokeswoman Sara Milstein. She attributed the jump to the Y’s
family-oriented atmosphere and consistently low prices.
“People are trying to cut back expenses, but they’re also
getting back to basics and reassessing everything in their
lives,” she says.
The nation’s unemployment rate recently reached its highest
level in 25 years, but in tough economic times, many people find
solace at the gym.
Dave Esposito was laid off this past December from his job as an
electrical engineer, but he continues to go to the gym three
times a week. At the gym, the Millersville resident finds a
sense of community and works out frustrations over the way
companies have outsourced jobs in his field.
“It’s my chance to talk to other adults and socialize for a few
hours,” Esposito explains.
Kenneth Reed, who runs a personal training business in Windsor
Mill, says working out is more important in a recession because
it helps people to think positively.
“I’m not in a recession,” he says. “There might be one going on,
but I’m not in it. I think if you just keep thinking about it,
you’ll be in it.”
Personal training offers a more intimate setting than massive
gyms, and trainers often double as therapists, Reed says.
Customers come in to exercise their bodies, but they also talk
about how they lost their job or are afraid they will soon.
Personal trainers often give one-on-one classes, but when the
economy began to tank, Reed began offering more group classes to
make better use of his trainers’ time, and business has remained
steady.
For some, such as Lindsay Hoehn, working out at the gym is too
much a part of life to give up. The 33-year-old Hampden resident
quit her job in August to go to graduate school at the
University of Maryland Baltimore and is saving money by cutting
out some luxuries; refusing, for instance, to buy expensive
lattes and drinking coffee only when she brews it at home.
Working out, however, is “like eating and sleeping.”
“It’s a huge outlet for me,” she says while walking into the
Merritt gym in Canton. “It’s something I don’t really consider a
luxury; it’s a necessity.”
The sagging economy, along with soaring health care costs in the
state, has even prompted a state lawmaker this year to introduce
a bill in the General Assembly that would give Marylanders
working to improve their health a break on their income taxes.
According to the New England Journal of Medicine, Maryland
spends $4.3 billion every year in additional health care costs,
but the added motivation of a tax break would help residents
reduce that cost, says Delegate Jon Cardin, D-Baltimore County.
And in a recession, he adds, people lose their motivation and
fall further out of shape.
To get the tax cut of several hundred dollars, residents could
join and work out at a gym or quit smoking, Cardin says. Of
course, they would have to be able to document their efforts.
At Anytime Fitness in Forest Hill, the gym’s convenience and
affordability have helped it beat back the recession. The club
opened less than four months ago, but business has been strong.
Memberships cost $43 per month, but other family members can
join for $29 per month. Many of the club’s members live in the
surrounding neighborhoods.
In addition, members use a pass to enter the gym whenever they
want. On a recent Sunday, a day when most gyms are open only a
few hours, Anytime Fitness had its first customer at 6:44 a.m.
The last came at 11 p.m.
Owner Carrie Lang put everything she had into opening the gym,
but she’s confident she made a healthy investment.
“Believe me, I’ve had plenty of nights waking up at 3 in the
morning, going, ‘What am I doing opening a business in this
economy?’” she admits. “But I think this is the right kind of
business.”
Copyright 2009 Daily Record.
Hospitals extend healing hand beyond patients and traditional
medicine
By Mary Medland
Daily Record
Saturday, March 28, 2009
“For years, preventative medicine has been on the backburner,”
says Peter Andrews, director of occupational health for
LifeBridge Health. “It was always an attitude of, ‘Well, it’s
nice, but let’s treat the patients first.’”
But that approach is no longer the case. Hospitals are
increasingly offering patients, employees and those from the
business community the opportunity to partake in acupuncture,
massage therapy, smoking cessation and healthy living programs,
among other offerings. A proactive, often holistic, approach is
becoming increasingly popular both for the improvement in
quality of life, as well as a benefit to the bottom line.
“Franklin Square went completely tobacco-free on July 1, 2008,”
says Ming Tai, Franklin Square Hospital’s public relations
manager. “We had offered smoking cessation courses in the past,
but we had to help the remaining 250 employees who still
smoked,” she says. “We provided classes that focused on
relaxation and behavior modification and also provided everyone
a free, six-week supply of patches.”
For the past 10 years, The Medi-Spa at Mercy Medical Center has
offered acupuncture, massage, reflexology and reiki. “About
one-third of our clients are patients, another one-third are
employees and the rest come from nearby businesses or from the
courthouse,” says Donna Chang, R.N., an aesthetician, reiki
master and owner of The Medi-Spa. “Acupuncture has been accepted
by the World Health Organization and by NIH. It can treat so
many things, such as anxiety, depression, insomnia, stress,
arthritis, tendonitis and asthma.
“Usually the symptom that has presented is superficial and the
disease process initiates on a deeper level and you need to get
to that level. Typically that will take four to six treatments.”
Chang estimates that The Medi-Spa typically treats between 10
and 15 patients a day, many of whom come two to three times a
week.
Reiki enhances the body’s flow of energy, says Chang, and is
directly connected to one’s quality of life. “You use your hands
on or over the body while the patient is fully clothed,” she
says. “This is especially good for people who are afraid of
needles. The calming energy that is transferred from the reiki
master to a student can be transferred to people of all ages,
while reflexology helps rebalance the body by moving the body’s
trigger points to help alleviate symptoms.
“We are seeing more and more people becoming increasingly open
minded about these treatments … I have a woman who is being
treated for cancer and she comes for reiki before every
chemotherapy session. The Medi-Spa at Mercy wants to go beyond
the physical experience of typical therapies and enter deeper
reservoirs of relaxation, healing and well-being.”
In addition, The Medi-Spa offers a number of other services for
the skin, such as micro-dermabrasion sessions, chemical peels
and medical skin care.
One of The Medi-Spa’s regular massage patients is Donna Landers,
R.N., who works in outpatient chemotherapy at Mercy’s Institute
for Cancer Care. “I started doing this about once a month
because it is so relaxing,” she says. “You can be completely
tied up in knots and having a really crazy day. It really makes
a difference and the benefit carries over into other days.”
Increasingly, hospitals are becoming aware of what they are
serving — for better or worse — in their cafeterias. “We have
been adding healthy foods to our cafeteria offerings and listing
calories, what is in the food and pointing out heart healthy
options,” says Andrews. “We looked at non-healthy choices, such
as cheeseburgers and fries, versus healthy offerings, like
salmon and sweet potatoes. To make the salmon more affordable,
we increased the cost of other items.”
Of course, it is not just in the spirit of doing good that
hospitals are offering these changes: Doing so has an impact on
the bottom line. “If our employees are healthy, they are likely
to stay with us longer and to be better workers,” says Andrews,
who adds that LifeBridge has been voted by Baltimore magazine
the best place to work for the past three years. “We gave our
employees, as well as their families and our patients, free flu
shots, which will cut down on employee absenteeism and increase
employee morale.”
Andrews adds that a LifeBridge Health & Fitness center — which
employees can use at a reduced rate — is located just outside
the beltway on Reisterstown Road. In addition, the hospital has
surveyed employees as to what they would like most, whether that
is a walking club, yoga after work or Weight Watchers.
“Our Wellness Committee looks to see what fun things we can do
to get the staff to become more aware of their own health,” says
Andrews. “We are in the process of hiring a wellness
coordinator, which would be a full-time position. This
individual will focus on five key areas — diabetes,
hypertension, asthma, high cholesterol and pregnancy.
“We are also designated as a Pregnancy Friendly Workplace by the
March of Dimes. Our employees who are pregnant can take
advantage of parking that is closer to the building and arrange
for a better choice of shift work. Plus, mothers who return to
work and are breastfeeding can use a private room to pump breast
milk.”
As LifeBridge questioned its employees about what programs they
wanted most, so did Mercy. “We had a meeting with the
administrative offices and did a survey of employees as to what
they wanted to see more of,” says Chang. “They unanimously
requested health and wellness services. Consequently, we offered
our employees a discount for these services.”
LifeBridge has an indoor walking path and three outdoor walking
paths, all of which are marked with distance and number of
steps. “Many people are able to walk the recommended 10,000
steps in about 20 minutes,” says Andrews.
In addition to programs for its employees, Franklin Square is
reaching out to the community. “We just launched ‘Getting It
Right,’ which is a seminar we offer to our female employees and
to women in the community,” says Tai. “’Getting It Right’ offers
education about osteoporosis, menopause and how to take care of
your health.”
Copyright 2009 Daily Record.
Hospitals' financial deals turn into liabilities
Low interest rates turn protective 'swaps' into losses
By Stephanie Desmon
Baltimore Sun
Saturday, March 28, 2009
The complex financial arrangements that recently caused huge
paper losses at Maryland's largest hospitals have been commonly
used for years to protect them against big interest rate
increases when they sell bonds to pay for construction projects
and the like.
But volatile and highly unusual market conditions, including
some of the steepest interest rate declines on record, quickly
turned these supposed hedges into huge liabilities late last
year.
On Thursday, the Maryland Hospital Association said 34 hospitals
had total losses of $466 million in the fourth quarter of 2008.
Many of the losses can be traced to these deals known as
interest rate swaps. Health care operations, while being
squeezed, are still in the black overall.
These reversals came at a time hospitals are suffering major
losses from investments, people are putting off elective
surgeries and others are unable to pay for treatment. "Many
organizations find themselves ill prepared for the sudden drain
on liquidity that swap liabilities can cause," according to a
report by Moody's Investors Service's health care policy team
last month.
"Interest rate swap" is one of many exotic financial terms that
have gone Main Street in recent months as the economic crisis
has spread from Wall Street. Hospitals aren't the only ones
using these arrangements, which are common among not-for-profit
borrowers. For the most part, institutions using them are not
gambling, several experts said.
Simply put, a hospital, in this case, makes a financial contract
with some other party to protect itself in case interest rate
increases drive up the costs on variable-rate bonds it sells to
investors. It promises to pay the other party a fixed rate of
interest in exchange for getting a variable rate back. So if
rates rise, the hospital's increased income from its part of the
swap offsets the higher interest it has to pay on its bonds, and
perhaps generates a gain.
But when interest rates plummeted last year in response to the
recession, the hospitals were left paying far higher fixed rates
on the swap contracts than they were getting back in variable
rates.
In some cases, the contracts lost so much value that the
hospitals were forced to quickly post cash for collateral.
"They're not speculative transactions - these were very
mainstream, well-accepted mechanisms for funding legitimate
capital projects," said Brad E. Spielman, a Moody's senior
analyst. But, he added, "these are very extraordinary times.
Where we are is off the charts in terms of what was expected"
when hospitals signed these deals.
The Johns Hopkins Health System, for example, had $675.2 million
worth of swap contracts outstanding at the end of 2008,
according to its financial statements. Its contracts paid out
fixed rates ranging from 3.3265 percent to 3.946 percent, but
the other parties' interest rate was 67 percent of the one-month
Libor, or London Interbank Offered Rate. On Friday, that rate
was 0.52 percent.
As a result, Hopkins was forced to post $103.3 million in cash
to offset the declining value of the swap agreements and take an
accounting write-down of $152.4 million in the fourth quarter,
leading to a loss of $134.5 million for the period. Hopkins
officials could not be reached for comment.
The University of Maryland Medical System recorded a loss of
$128.7 million in the fourth quarter and had to post $105.7
million in collateral. The system raised the money through a
line of credit, Hank Franey, senior vice president and chief
financial officer, said Friday.
He played down the losses - which led to the University of
Maryland Medical Center losing 77 cents on every dollar of
revenue in the fourth quarter of 2008 - saying, "We're not
troubled by it at all.
"This is a financial instrument," Franey said. "If interest
rates go up - and we are at unbelievably low rates - we in
theory could have a $105 million asset.
"Other investors have used this as a speculative investment,
trying to bet against what is going to happen with interest
rates. We don't do that."
Franey's bigger concern right now is the sharp decline in the
value of the medical system's investments. The system has
counted on pumping $15 million to $20 million in interest income
each year into its operating budgets.
"It's coming at a not-great time," said Ken Kaufman, managing
partner at Kaufman Hall, Chicago-based financial advisers to
hospitals, including some in Maryland. "For years, it worked
fine. Hospitals saved lots and lots of money, not only in
Maryland but around the country.
"You couldn't point to another period and say, 'Watch out for
this,' because it had never happened before."
Copyright 2009 Baltimore Sun.
Appeals
court upholds Md. funeral home rules
Associated Press
Baltimore Sun
Saturday, March 28, 2009
RICHMOND, Va. Maryland's restrictions on funeral home ownership
serve a worthy goal of protecting the public and do not
excessively impair interstate commerce, a federal appeals court
ruled Friday. A three-judge panel of the 4th U.S. Circuit Court
of Appeals reversed a Baltimore judge's ruling that the Maryland
Morticians and Funeral Directors Act violates the commerce
clause of the U.S. Constitution. The panel also affirmed U.S.
District Judge Richard D. Bennett's finding that the law does
not violate the due process and equal protection clauses.
Maryland law limits funeral home ownership to licensed funeral
directors and the holders of 58 corporate licenses that were
issued more than 60 years ago. Four plaintiffs who wanted to get
into the funeral home business contended that the law
unconstitutionally stifles competition.
Copyright 2009 Baltimore Sun.
National / International
Doctors say kidney stones in kids are on the rise
Associated Press
By Lindsey Tanner
Washington Post
Thursday, March 26, 2009
CHICAGO -- Doctors are puzzling over what seems to be an
increase in the number of children with kidney stones, a
condition some blame on kids' love of cheeseburgers, fries and
other salty foods.
Kidney stones are usually an adult malady, one that is notorious
for causing excruciating pain _ pain worse than childbirth. But
while the number of affected children isn't huge, kids with
kidney stones have been turning up in rising numbers at
hospitals around the country.
At Children's Hospital of Philadelphia, the number of children
treated for kidney stones since 2005 has climbed from about 10 a
year to five patients a week now, said Dr. Pasquale Casale.
Johns Hopkins Children Center in Baltimore, a referral center
for children with stones, used to treat one or two youngsters a
year 15 or so years ago. Now it gets calls about new cases every
week, said kidney specialist Dr. Alicia Neu.
In a 2007 study in the Journal of Urology, doctors at North
Shore-Long Island Jewish Medical Center reported a nearly
fivefold increase in children brought in with kidney stones
between 1994 and 2005. In 2005, 61 youngsters were treated there
for stones.
Dr. David Hatch at Loyola University Medical Center in Maywood,
Ill., near Chicago, also has seen an increase. His youngest
patient was a cranky 8-month-old girl whose mother found a
pea-size kidney stone in her diaper.
Kids' stones have been the talk of recent pediatric kidney
specialists' conferences, said Dr. Uri Alon, director of the
bone and mineral disorders clinic at Children's Mercy Hospital
in Kansas City.
So far, the only evidence is anecdotal. But Alon is involved in
research trying to determine if the increase is real and not
just the result of greater awareness and better ways of
detecting stones. Alon also is studying whether improved
nutrition can prevent kids' kidney stones.
Eating too much salt can result in excess calcium in the urine.
In children, most stones are calcium-based, and Alon said their
eating habits, plus drinking too little water, puts them at
risk. Plenty of water is generally recommended to help prevent
kidney stones.
Matty Billemeyer is just 8 years old but already has had four
bouts with stones, the first in 2007, the last a year ago in
April. He was first stricken in his first-grade class; the
school nurse, his parents and even the emergency room doctors
all thought it was his appendix.
"It felt really painful and intense," the Doylestown, Pa., boy
recalled. "I was really scared because it was hurting a lot."
Darryl Billemeyer said it was frightening seeing his son
writhing and screaming in pain. The boy was transferred from a
local hospital to Children's Hospital of Philadelphia, where
ultrasound tests showed kidney stones.
"We really didn't know what to make of it," Billemeyer said. "I
definitely thought they were more of an adult thing."
The first time, Matty needed surgery; the other times the stones
passed during urination.
Now he takes diuretic pills to increase urination, brings a
water bottle to school everyday, and has given up favorite
foods, including sausages, pickles and packaged ramen noodles _
all high in salt.
His parents are both busy teachers, and with four other sons,
family meals used to include quick processed foods like canned
spaghetti or chicken nuggets. Until Matty's diagnosis, salt
"wasn't something we really thought about," Billemeyer said.
The main problem associated with kidney stones is extreme pain.
It is caused by stones blocking urine flow, which, if untreated,
could lead to kidney damage.
The preferred treatment is observation _ giving kids pain
medicine but nothing else to see if the stones will pass on
their own. Stones can be as small as a sugar granule or as large
as a pearl. Bigger ones have been reported but are rare; most
are less than 1/4 inch in diameter, which can usually pass on
their own. But even small ones can mean incredible pain.
When that doesn't happen, the patient is anesthetized and
doctors may thread a slender scope through the urinary tract to
break up and remove the stone. Other treatment may involve
noninvasive shock-wave therapy that uses sound waves to break up
the stone, or minimally invasive surgery.
Dr. Barry Duel, a pediatric urologist at Cedars-Sinai Medical
Center in Los Angeles, said kidney stones can be a sign of
underlying metabolic problems that result in too much calcium in
the urine. But he said in most cases children have no underlying
disorder and are otherwise healthy.
Still, because some metabolic problems can slow growth if
untreated or lead to repeated bouts with kidney stones, the
American Academy of Pediatrics recommends metabolic testing for
all children with kidney stones.
Hatch, the Loyola urologist, said the best prevention is plenty
of water, so that the minerals in urine stay dissolved.
How much water depends on a child's size, but for an
average-size 10-year-old it would be about four cups a day, on
top of whatever else they are drinking. That is far more than
most kids drink.
"What I like to tell kids is that they should drink enough water
to keep their pee almost clear," Hatch said.
For children who have had one kidney stone, doctors sometimes
recommend fresh-squeezed lemonade or other citrus juice, which
can help keep the urine from forming stones.
On the Net:
National Institutes of Health:http://www.nlm.nih.gov/medlineplus/kidneystones.html
© 2009 The Associated Press.
Stroke-blocking device shows promise, doctors say
By Marilynn Marchione
Washington Post
Saturday, March 28, 2009
ORLANDO, Fla. -- A novel device to treat a common heart problem
that can lead to stroke showed promise in testing, but not
without risk, new research shows.
The experimental device, called the Watchman, is the first to
try to permanently fix atrial fibrillation, a heartbeat problem
afflicting more than 2 million Americans. A federal Food and
Drug Administration panel will consider it next month.
In the study, the Watchman was at least as good at preventing
strokes as warfarin, sold as Coumadin and other brands. The
drugs pose hazards of their own, so doctors and their patients
are anxious for a better option.
But the procedure to implant the Watchman led to strokes in some
patients, study results showed. Complications and side effects
were twice as common with the device as with warfarin.
Despite those drawbacks, doctors who saw the results Saturday at
the American College of Cardiology Conference were impressed.
"Wow. At first blush, this is very encouraging," and could help
as many as two-thirds of those who have the heartbeat problem,
said Dr. Richard Page, cardiology chief at the University of
Washington in Seattle and an American Heart Association
spokesman.
Atrial fibrillation occurs when the upper chambers of the heart
quiver instead of beating properly. That lets blood pool in a
pouch-like appendage. Clots can form and travel to the brain,
causing a stroke.
The usual treatment is the anti-clotting drug warfarin, but
getting the right dose is tricky _ too little means a risk of
stroke, and too much can cause fatal bleeding. The right amount
varies by 10 times from one person to another, and even certain
foods can throw it off. Patients must go to the doctor often for
blood tests to monitor the dose.
The Watchman device is a fabric-covered metal cage that plugs
the pouch. Doctors pass a hollow tube through a leg vein into
the heart's right atrium, puncture the wall separating it from
the left atrium, and implant the device through the tube.
Dr. David Holmes Jr. of the Mayo Clinic in Rochester, Minn., led
a study of it in 707 patients in the United States and Europe.
After an average of 16 months of followup, there were 15 strokes
and 17 deaths (from all causes) in the 463 who got the device
and 11 strokes and 15 deaths in the 244 treated with warfarin,
Holmes said.
The balance tipped in favor of the device. Just over 3 percent
of Watchman patients suffered the main problems doctors were
measuring in the trial (a composite of strokes, heart-related
deaths and certain blood clots) versus 5 percent of those
treated with warfarin.
About 90 percent of device patients were able to go off
warfarin.
However, complications were twice as common _ 8 percent in the
device group and 4 percent on warfarin. Five strokes were
triggered by implanting the device, and about 5 percent of
device patients developed serious fluid buildup around the
heart. Doctors were unable to implant the Watchman in 41 people
assigned to get it.
These problems declined as the study went on, Holmes said.
Any new technology has "a learning curve" that improves with
experience, said Dr. Ralph Brindis, a heart specialist at the
California-based Kaiser Permanente health plan and spokesman for
the college of cardiology.
The device's maker, Atritech Inc. of Plymouth, Minn., paid for
the study, and Mayo may potentially receive future royalties
from the device. Medicare paid $9,500 for the procedure,
including $6,000 for the device itself, a company spokeswoman
said. Hospitals typically charge two to three times the Medicare
rate, she said.
Dr. Tristram Bahnson of Duke University said that if the device
is approved, "patients and their physicians will have to decide
whether assuming some increased risk up front is preferred to
ongoing therapy with Coumadin, where there's a small risk of
complications and the risk is cumulative."
For Kenneth Giunchedi, that was an easy choice. Giunchedi, 75,
of suburban Chicago, had the device implanted last March by Dr.
Bradley Knight of the University of Chicago Medical Center as
part of the study. He had been on Coumadin for about two years.
Taking the drug was "a horrible experience for me," he said. "I
was never easy to regulate _ I was always in trouble. They were
constantly adjusting the dosage and I would go in for a blood
draw sometimes as often as three times a week. I would have done
anything to get off of the Coumadin."
© 2009 The Associated Press.
Groups find common ground on health care overhaul
By Ricardo Alonso-Zaldivar
Washington Post
Friday, March 27, 2009
WASHINGTON -- Groups often at odds over health care reform _
consumers, insurers, doctors, employers _ reached a broad
agreement Friday that could serve as a starting point for
lawmakers trying to overhaul the system.
Although the long-awaited report of the Health Reform Dialogue
avoided some of the most contentious issues, the agreement does
have the kind of far-reaching support lawmakers will need to
meet their goal of passing legislation this year.
"You can bet I'll be working closely with these groups," said
Senate Finance Committee Chairman Max Baucus, D-Mont., who is
trying to find consensus on Capitol Hill.
In their report, the groups said the uninsured should be covered
through a mix of expanded government programs and subsidies to
purchase private health coverage. They called for savings from
making the health care system less wasteful and urged that
prevention become the foundation for medical care. Many of their
ideas are shared by President Barack Obama and influential
lawmakers such as Baucus.
But the five-page proposal was thin on details, starting with
how to pay for the plan. And the groups avoided such divisive
issues as whether insurers should be forced to compete with a
new government-sponsored insurance plan, as Obama has proposed.
Critics minimized the result. "They've moved the health care
debate forward a few inches," said Richard Kirsch, director of
Health Care for America Now, a grassroots campaign backed by
labor.
The 18 groups met for six months. Along the way, two major
unions pulled away, but other groups representing seniors,
businesses, nurses, drug makers and patients kept talking.
"What the agreement tries to do is achieve a balance for
coverage expansion through the two key pillars of health care
today," said Ron Pollack, executive director of Families USA, a
liberal advocacy group that stayed in the talks. "One is
employer-sponsored private coverage and the other is safety-net
coverage."
Other participants included the National Federation of
Independent Business and the health insurance industry, who were
instrumental in sinking the last attempt at a health care
overhaul in the 1990s. Also in the talks were staunch supporters
of guaranteed coverage for all, such as AARP and the American
Cancer Society Cancer Action Network.
The Service Employees International Union and the American
Federation of State, County and Municipal Employees took part
but didn't sign on to the agreement because some of their
concerns could not be satisfied. That underscored the difficulty
of getting a health care compromise.
The groups all but endorsed a requirement that every American
obtain health insurance. While their agreement avoided the
politically loaded term "individual mandate," it said Congress
should "enact reforms necessary so that all individuals will
purchase or obtain quality, affordable health insurance." They
avoided the issue of requiring employers to help pay premiums.
The agreement called for a two-prong strategy to cover the
estimated 48 million uninsured. First, the Medicaid program
should be expanded to cover all adults earning up to the federal
poverty level, about $22,000 for a family of four. Then,
subsidies or tax credits should be offered to help the middle
class.
"I think what this document represents are some tough choices
and some very tough consensus," said Mary Grealy, president of
the Healthcare Leadership Council, which represents the medical
industry. "It tells Congress: here are some very important
components for health care reform that you can now be assured
have widespread agreement."
The groups decided to sidestep the issue of whether to create a
government insurance plan to compete with private companies.
Many Democrats see that as an essential element of any final
compromise. The insurance industry considers it a deal breaker.
The agreement also failed to spell out how to pay for expanded
coverage in what is already the world's costliest health care
system. The options lawmakers are considering include taxing
some health insurance benefits and limiting tax deductions for
high earners, both seen as highly controversial. Independent
estimates of the costs range as high as $1.5 trillion over 10
years.
But the agreement did acknowledge that hospitals, doctors, drug
companies, insurers and other major elements of the health care
system must become more efficient and less wasteful.
The groups will continue to meet as Congress moves ahead on
legislation. Their support could prove decisive if a viable
compromise does emerge, much as AARP's backing helped ensure
passage of the Medicare prescription drug benefit.
© 2009 The Associated Press.
Opinion
Our Say: Budget proposal passes the misery to the counties
Annapolis Capital Editorial
Thursday, March 26, 2009
Scant attention is paid when a business, beset by declining
revenues, has to draw up a budget smaller than ones in prior
years. When a government has to do so, it is big news. The idea
that government spending simply must grow, and that the only
debate will be on how fast it grows, is deeply ingrained.
But plunging tax revenues have forced Maryland lawmakers to do
the unthinkable. The House Appropriations Committee last week
passed a budget about $300 million below the last one of
then-Gov. Robert L. Ehrlich Jr.'s administration in fiscal 2007.
The proposed budget doesn't raise taxes or fees (which is merely
common sense in a deep recession) and is great news if you
happen to be a state employee. If you happen to work in local
government, the outlook isn't as cheery.
The committee avoided cutting local aid earmarked for the police
or the more than $120 million in disparity grants that go to
poorer jurisdictions. But aid to local governments as a whole
would be slashed.
Anne Arundel County - once you throw in reductions in highway
user and income tax revenue - would lose nearly $13 million.
That's on top of a local budget shortfall already approaching
$150 million.
Meanwhile, under the House committee's budget, state employees
won't have to worry about hundreds of layoffs or a 1 percent pay
cut - cutbacks that were at least fleetingly discussed, but
which Gov. Martin O'Malley has treated as a fate worse than
death.
O'Malley's commitment to protecting the state work force seems
not just intense but emotional. When unionized state employees
held a rally at Lawyers Mall Monday - their chants indicating
that the very idea of layoffs and pay cuts in the middle of a
deep recession is a crime against nature - the governor was
there. He pledged: "So long as there is breath in my body, and I
have the trust of the people of Maryland to do this job … I will
be doing it for you."
With an attitude like that, what do the employees need union
representatives for?
We don't blame O'Malley for not enjoying the idea of state
layoffs. No one likes layoffs, and we wouldn't want to work for
a CEO who yearned to impose them. But most CEOs don't have tax
revenue to draw on, or the sort of flexible bookkeeping
strategies available in drawing up a state budget. They must do
what the bottom line dictates.
Also, most CEOs don't have the option of exporting much of the
red ink to other CEOs. The state's moves seem likely to move
this county from $150 million in the red to more than $160
million. Do you think the county will be able to avoid pay cuts
or layoffs for its dedicated employees?
The state should do more to share the pain with the local
jurisdictions, rather than just shunt it in their direction.
Copyright 2009 Annapolis Capital.
Kicking red meat
By Larry Williams
Baltimore Sun Commentary
Saturday, March 28, 2009
I am a 64-year-old office worker, overweight, a recent veteran
of a triple bypass operation and a recovering red meat addict.
Every day I crave the stuff - sausages, Big Macs, New York strip
steaks, cheese steaks, bologna, hot dogs, chili - you name it
and if it's red meat, I love it. My doctors have warned me, my
wife has pleaded and still I yearn for red meat. Each time I
slip and eat the stuff, I tell myself that it's not that bad,
that my normal diet is generally healthy - oatmeal for
breakfast, a salad for lunch and chicken or fish with veggies
for dinner.
But this week I stopped trying to kid myself. A study published
in the Archives of Internal Medicine offered compelling evidence
that my red meat habit could and will kill me if I don't back
off. The analysis of more than 500,000 Americans between the
ages of 50 and 71 found that men who ate about 5 ounces of red
meat a day had a 31 percent higher risk of death over a 10-year
period than men who ate less than 1 ounce a day. These men had a
22 percent higher risk of dying of cancer and a 27 percent
higher risk of dying of heart disease. The danger is even
greater for women.
The National Cancer Institute study laid it out pretty well: Red
meat eaters face an earlier death from cancer and heart disease
but also from Alzheimer's, stomach ulcers and an array of other
conditions. The folks at Perdue must be cheering.
Statistics show that I am not alone in my struggle. The average
American eats 200 pounds of meat a year, and a growing
proportion of the population is obese, an epidemic caused in
part by those filet mignons, lamb chops and Sunday roasts. And
the habit is spreading around the world. In India, meat and
dairy consumption more than doubled between 2000 and 2005, and
China has shown a similar trend.
If the study didn't appeal to my desire to live a long and happy
life, it got to my concern for the planet. Yes, eating all that
red meat also has considerable environmental consequences.
Livestock account for 18 percent of global greenhouse gas
emissions, more than cars, buses, taxis and other four-wheel
vehicles, a recent United Nations study found. In America, we
carnivores are tempted daily. Millions of fast food outlets
offer red meat as an accessible and affordable meal. It tastes
good and satisfies hunger more compellingly than other more
healthful foods.
As tough as it will be for me to walk away from red meat, it
seems doubtful that millions of others will be able to do the
same. Then again, I was a heavy smoker in my 20s but found a way
to quit and now can't stand the smell of tobacco. Some day soon,
I hope the heady odor of a fresh-cooked burger will turn my
stomach. Until then, I'll be starting my own support group - see
ya at the Chick-fil-a.
Copyright 2009 Baltimore Sun.
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