How Social Networks Help Chronically Ill

Posted by AMS at 25 MAR 1:45 pm

A former model who is now chronically ill and struggles just to shower says the people she has met online have become her family. A quadriplegic man uses the Web to share tips on which places have the best wheelchair access, and a woman with multiple sclerosis says her regular Friday night online chats are her lifeline.

For many people, social networks are a place for idle chatter about what they made for dinner or sharing cute pictures of their pets. But for people living with chronic diseases or disabilities, they play a more vital role.

“It’s really literally saved my life, just to be able to connect with other people,” said Sean Fogerty, 50, who has multiple sclerosis, is recovering from brain cancer and spends an hour and a half each night talking with other patients online.

People fighting chronic illnesses are less likely than others to have Internet access, but once online they are more likely to blog or participate in online discussions about health problems, according to a report released Wednesday by the Pew Internet and American Life Project and the California HealthCare Foundation.

“If they can break free from the anchors holding them down, people living with chronic disease who go online are finding resources that are more useful than the rest of the population,” said Susannah Fox, associate director of digital strategy at Pew and author of the report.

They are gathering on big patient networking sites like PatientsLikeMe, HealthCentral, Inspire, CureTogether and Alliance Health Networks, and on small sites started by patients on networks like Ning and Wetpaint.

Sherri Connell, 46, modeled and performed in musicals until, at age 27, she learned she had multiple sclerosis and Lyme disease. She began posting her journal entries online for friends and family to read. Soon, people from all over the world were reading her Web site and telling her they had similar health problems.

In 2008, she and her husband started a social network using Ning called My Invisible Disabilities Community. It now has 2,300 members who write about living with lupus, forthcoming operations or medical bills, for example.

“People have good and bad days, and they don’t know a good day’s going to come Wednesday at 5 o’clock when a live support group is meeting,” Ms. Connell said. “The Internet is a great outlet for people to be honest.”

Not surprisingly, according to Pew, Internet users with chronic illnesses are more likely than healthy people to use the Web to look for information on specific diseases, drugs, health insurance, alternative or experimental treatments and depression, anxiety or stress.

But for them, the social aspects of the Web take on heightened importance. Particularly if they are homebound, they also look to the Web for their social lives, discussing topics unrelated to their illnesses. Some schedule times to eat dinner or watch a movie while chatting online.

John Linna, a pastor in Neenah, Wis., did not know what a blog was when his son suggested he start one after discovering he needed to stay home on a ventilator.

“That day my little world began to expand,” he wrote in a post last year about blogging. “Soon I had a little neighborhood. It was like stopping in for coffee every day just to see how things were going.”

When Mr. Linna died earlier this year, people all over the Web who had never met him in person mourned the loss.

Others use the Web to find practical tips about living with their disease or disability that doctors and family members, having not lived with it themselves, cannot provide.

On Diabetic Connect, a diabetes social network with 140,000 members, people share recipes like low-sugar banana pudding, review products like an insulin pump belt and have discussions like a recent one started by a patient with a new diagnosis. “I don’t like to talk to my family and friends about this,” she wrote. “Honestly I feel helpless. I really just need some advice and people to talk to who might have been experiencing the same things.”

Amy Tenderich is the community manager for Diabetic Connect and writes a blog called Diabetes Mine. “There’s no doctor in the world, unless they’ve actually lived with this thing, that can get into that nitty-gritty,” she said. “I’ve walked away from dinner parties with tears in my eyes because people just don’t understand.”

Patients often use social networks to interact with people without worrying about the stigma of physical disabilities, said Susan Smedema, an assistant professor of rehabilitation counseling at Florida State University who studies the psychosocial aspects of disability.

From her home in Maine, Susan Fultz plays online games at Pogo.com and commiserates with people who are frustrated that they do not have a diagnosis for their symptoms.

“There’s no worry of being judged or criticized, and that is something that I know a lot of us don’t get in our daily lives,” said Ms. Fultz, who has Lyme disease and psoriatic arthritis.

Those with chronic diseases or disabilities, like all Internet users, have to be wary about sharing private health information online, particularly with anonymous users.

Research has also shown that emotions can be contagious, said Paul Albert, digital services librarian at Weill Cornell Medical Library in New York who has researched how social networks meet the needs of patients with chronic diseases.

“If you hang out on a message board where people are very negative, you can easily adopt a negative attitude about your disease,” he said. “On the other hand, if people are hopeful, you might be better off.”

Some people also worry that patients might exchange erroneous medical information on the Web, he said. Yet most patient social networks make clear that the information on the site should not substitute for medical advice, and the Pew study found that just 2 percent of adults living with chronic diseases report being harmed by following medical advice found on the Internet.

Instead, the sites are used to share information from the front lines, said Lily Vadakin, 45, who has multiple sclerosis and works as a site administrator for Disaboom, a social network for people with disabilities. For instance, she has discussed with other patients how to combat fatigue by working at home and taking vitamin supplements.

“That’s what the community can give you — a real-life perspective,” she said.

Source: By CLAIRE CAIN MILLER

Democrats Taking Aim At Deficit Targets

Posted by AMS at 24 MAR 12:56 pm

Democrats Take Aim At Deficit Targets, Continue To Wait For CBO Numbers On Health Overhaul

18 Mar 2010 Source: Henry J. Kaiser Family Foundation

The Wall Street Journal: “With Congress just days away from an expected vote, Democrats still hadn’t settled on final language of the bill and until they do the Congressional Budget Office can’t release an estimate for how much the complete package would cost.” House Majority Leader Steny Hoyer (D., Md.) said yesterday that “he hoped Democratic leaders would be able to lock down final details soon. He said lawmakers have been working closely with the Congressional Budget Office to ensure the bill is fully paid for and reduces the deficit” (Hitt, 3/17).

Bloomberg/Business Week: “They have been going back and forth with CBO officials for days, (Senate Majority Leader Harry) Reid said. ‘It’s not as if CBO has been over there waiting to crank up their adding machines,’ Reid told reporters. ‘They’ve been giving us numbers all along, trying to come up with a final product. And we expect that soon’” (Rowley and Gaouette, 3/17).

The New York Times: “House Democratic leaders said they still expected the full House to vote on health care by this weekend, even though they are still tinkering with the text of the legislation” and are trying to hold the cost of new insurance coverage provisions to $950 billion over 10 years. “To make the numbers come out right, Democrats said, they are considering bigger cuts in payments to private Medicare Advantage plans, which cover about one-fourth of the 45 million Medicare beneficiaries. And they may ask pharmaceutical companies to pay more to help close a gap in Medicare coverage of prescription drugs” (Herszenhorn and Pear, 3/16).

(Fort Lauderdale, Fla.) Sun Sentinel, with more on the expected cuts to Medicare Advantage plans: “‘We’ve come up with something that we believe is equitable that does phase the payments down but does it in such a way that is not disruptive to beneficiaries who have been getting the extra benefits,’ said Nancy-Ann DeParle, director of the White House Office of Health Reform. DeParle briefed reporters Tuesday about this and other adjustments to health care overhaul legislation that is headed toward conclusive votes in the House this week. … She did not specify those changes, which are expected to be unveiled as early as Wednesday.” Officials say Advantage plans cost an average of 14 percent more than regular Medicare plans (Gibson, 3/16).

The Washington Post: The bill is being held up by “concerns that it would do too little to reduce the nation’s budget deficit.” Democrats hope to unveil the package Wednesday and to vote on the measure Saturday. “‘It is very important to us that this legislation be fiscally sound – that is, save $100 billion in the first 10 years and $1 trillion in the second 10 years. That is our goal,’ (House Speaker Nancy) Pelosi said. ‘We want to come as close to that as possible. In fact, we insist that we will. … The numbers have to add up to drastic deficit reduction as we go forward.’” The bill must reduce the deficit by $2 billion over the next five years because Democrats are using budget reconciliation to pass it to avoid a Republican filibuster. Democrats are trying to raise money by raising Medicare taxes on the wealthy “(b)ut virtually everything House Democrats want to achieve in their package costs money. Meanwhile, House leaders want to dramatically scale back one of the most powerful deficit-reduction tools in the Senate bill: a 40 percent excise tax on high-cost insurance policies” (Montgomery, 3/17).

CongressDaily: “House Majority Leader Hoyer declined to comment on whether more pay-fors might be needed, including on a question as to whether the excise tax on high-cost ‘Cadillac’ plans would start earlier than 2018. Unions pushed for the 2018 start date and President Obama included it in his proposal for changes that would be made to the Senate-passed overhaul bill.” Pelosi said members will have 72 hours to read the bill before a vote (Edney, 3/17).

Roll Call: Senate Democrats plan to have a special health care caucus meeting Wednesday to discuss the overhaul. “One senior Senate Democratic aide cautioned that the 12:30 p.m. meeting is not intended to provide Senators with an awaited Congressional Budget Office cost estimate of the reconciliation measure, saying it was merely an ‘update’ for Members on where leaders are in the process” (Pierce, 3/16).

EHR Stimulus and Incentives

Posted by AMS at 23 MAR 4:06 pm

On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (Recovery Act), a critical measure to stimulate the economy.  Among other provisions, the new law provides major opportunities for the Department of Health and Human Services (DHHS), its partner agencies, and the States to improve the nation’s health care through health information technology (HIT) by promoting the meaningful use of electronic health records (EHR) via incentives.

Funding

Funding is available to certain eligible professionals (EPs) and hospitals, as described below.  Funds will be distributed through Medicare and Medicaid incentive payments to EPs, physicians, and hospitals who are “meaningful EHR users.” In addition, with regard to the Medicaid program, federal matching funds are also available to States to support their administrative costs associated with these provisions.

Criteria for Qualifying for an Incentive

The qualification criteria for incentives (i.e., meeting specified HIT standards, policies, implementation specifications, timeframes, and certification requirements) are still in development, and will be defined through regulation and additional guidance materials.  However, CMS generally expects that under Medicare, “meaningful EHR users” would demonstrate each of the following: meaningful use of a certified EHR, the electronic exchange of health information to improve the quality of health care, and reporting on clinical quality and other measures using certified EHR technology.  Medicaid programs will determine their own requirements in line with the Medicaid-related provisions of the Recovery Act. Funds will be distributed through Medicare and Medicaid incentive payments to EPs and hospitals who are “meaningful EHR users.”  CMS intends to publish a proposed rule in late 2009 to propose a definition of meaningful use of certified Electronic Health Records (EHR) technology and establish criteria for the incentives programs.  CMS is working extensively with the Office of the National Coordinator for Health Information Technology (ONC) to identify the proposed criteria.

Medicare Payment Incentives for Eligible Professionals

The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users.  Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users. Hospital-based physicians who substantially furnish their services in a hospital setting are not eligible.

Incentive Payments

The incentive payment is equal to 75 percent of Medicare allowable charges for covered services furnished by the EP in a year, subject to a maximum payment in the first, second, third, fourth, and fifth years of $15,000; $12,000; $8,000; $4000; and $2,000, respectively.  For early adopters whose first payment year is 2011, the maximum payment is $18,000 in the first year. There will be no payments for meaningful EHR use after 2016. There would be no payments to EPs who first become meaningful EHR users in 2015 or thereafter.  For EPs who predominantly furnish services in a health professional shortage area (HPSA), incentive payments would be increased by 10 percent.

Payment Adjustments

The Medicare fee schedule amount for professional services provided by an EP who was not a meaningful EHR user for the year would be reduced by 1 percent in 2015, by 2 percent in 2016, by 3 percent for 2017 and by between 3 to 5 percent in subsequent years. For 2018 and thereafter, if the Secretary finds that the proportion of EPs who are meaningful EHR users is less than 75 percent, then the reductions will be increased by 1 percentage point each year, but by not more than 5 percent overall.

Medicaid Payment Incentives

The Recovery Act establishes 100 percent Federal Financial Participation (FFP) for States to provide incentive payments to eligible Medicaid providers to purchase, implement, and operate (including support services and training for staff) certified EHR technology.  It also establishes 90 percent FFP for State administrative expenses related to carrying out this provision.

Incentive Payments to Providers

Certain classes of Medicaid professionals and hospitals are eligible for incentive payments to encourage the adoption and use of certified EHR technology.  Eligible professionals include physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants who are practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant.
Eligible professionals must meet minimum Medicaid patient volume percentages, and must waive rights to duplicative Medicare EHR incentive payments.  Eligible professionals may receive up to 85 percent of the net average allowable costs for certified EHR technology, including support and training (determined on the basis of studies that the Secretary will undertake), up to a maximum level, and incentive payments are available for no more than a 6-year period.
Acute care hospitals with at least 10 percent Medicaid patient volume would also be eligible for payments, as would children’s hospitals of any patient volume. Entities that promote the adoption of certified EHR technology, as designated by the State, are also eligible to receive incentive payments through arrangements with eligible professionals under certain conditions.

Medicaid Incentive Program Qualifications

To be eligible for incentive payments not associated with the initial adoption/implementation/upgrade of EHR technology, the provider must demonstrate meaningful use of the EHR technology through a means approved by the State and acceptable to the Secretary.  In determining what is “meaningful use,” a State must ensure that populations with unique needs, such as children, are addressed.  A State may also require providers to report clinical quality measures as part of the meaningful use demonstration.  In addition, to the extent specified by the Secretary, the EHR technology must be compatible with State or Federal administrative management systems.

EPs may not receive an incentive under both Medicare and Medicaid in a given year.  CMS and the States will develop means to prevent such duplicate payments.  CMS expects that the prevention of duplicative payments will be addressed more fully through notice and comment rulemaking.

Department of Health & Human Services Recovery Information

Posted by AMS at 23 MAR 1:31 pm

The American Recovery and Reinvestment Act of 2009 (PDF – 1.07 MB) was signed into law by President Obama on February 17th, 2009. It is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century. The Act is an extraordinary response to a crisis unlike any since the Great Depression, and includes measures to modernize our nation’s infrastructure, enhance energy independence, expand educational opportunities, preserve and improve affordable health care, provide tax relief, and protect those in greatest need.

HHS Marks the first Anniversary of the Recovery and Reinvestment Act

On February 16, 2010, President Obama marks the first Anniversary of the American Recovery and Reinvestment Act. The US Department of Health and Human Services has led several initiatives to help spur new economic growth in direct response to the worst economic crisis since the great depression.

The Recovery Act is a combination of tax relief, financial assistance and infrastructure projects designed to cushion the impact of the downturn and lay a foundation for economic recovery. Public and private forecasters estimate the program is already responsible for about 2 million jobs – putting it on-target to support more than 3.5 million jobs by the end of 2010.

• See HHS Recovery Act Accomplishments

Successful Commitment to Increasing Access to Health Care for People across the Country

Goal: Enable 1,129 Health Centers in 50 States and Eight Territories to Provide Expanded Service to Approximately 300,000 Patients

Why? As the cost of health care goes up and more people are losing coverage or even worse, losing their jobs, a growing number of people are turning to government sponsored health care for themselves and their families.

Results: 500,000 patients served!

Learn more about how this commitment was accomplished.

200-Days Milestone Report

HHS exceeds its 200-Day 300,000 patient goal, serving 500,000 patients in Community Health Centers!

Read the Vice President’s remarks on the 200 Days of the Recovery Act

Learn how Recovery Act funding successfully increased access to health care.

Implementation

HHS is committed to a timely implementation. Plans for spending, reporting, auditing, and investigation of fraud and abuse of Recovery funds are being developed and will be made available here.

Total Obligated HHS Funds: $71.4 Billion (as of 3/5/10)

Total Gross Outlays: $53.5 Billion (as of 3/5/10)

List of Programs for Which Funding Has Been Announced:

• Adoption Assistance and Foster Care Programs
• American Indians and Alaska Natives (AI/AN) Health Care Construction and Information Technology Funding
• Child Care and Development Fund
• Child Support Incentives
• Community Health Center Program
• Community Services Block Grant Program
• Comparative Effectiveness Research Funding
• Early Head Start and Head Start Expansion
• Immunization Grants Program
• Medicaid and Prescription Drug Funding
• National Health Service Corps
• NIH Medical Research and Construction Funding
• Senior Nutrition Programs
• State Health Information Technology Grants
• Strengthening Communities Fund
• Temporary Assistance for Needy Families (TANF) Programs

Major Activities

As of February 12, 2010:

• Cumulative Recovery Act Medicaid FMAP State draw downs total about $ 48.5 billion.
• Secretary Sebelius announced the availability of $10 million in cooperative agreements for national public or private nonprofit organizations to help communities decrease smoking and obesity, increase physical activity and improve nutrition. The funding opportunity, under the Communities Putting Prevention to Work, will be for national organizations to provide expert guidance to communities and foster a national movement toward prevention. This part of the initiative is being lead by the Office of Public Health and Science in partnership with the Centers for Disease Control and Prevention. (March 5)

Source: http://www.hhs.gov/about/

House’s Approval to Revamp Health Care

Posted by AMS at 22 MAR 9:12 pm

NEW YORK (CNNMoney.com) — The House’s approval of a measure to reform and revamp the nation’s health care system was praised Monday by consumer groups, given mixed reviews by doctors and got a thumbs down from insurers.

Here’s how all sides in the health care system responded to the vote:

Consumer groups: Consumer advocacy groups were generally pleased with the measure.

“This is an enormous achievement that will provide huge benefits to families across the country,” said Ron Pollack, executive director of consumer advocacy group Families USA, who said his organization has been “flooded with e-mails and phone calls about this historic victory.”

Pollack said the legislation makes sure health care is affordable and that people won’t lose their coverage if they get sick or have a pre-existing condition.

“This legislation will curb insurance company abuses that have plagued too many families,” he said. “When you look back at history, the only events that rival this success are the Social Security Act of 1935 and the Medicare and Medicaid Act of 1965.”

Medicare tax hikes: What the rich will pay

Doctors weigh in: Some of the nation’s leading physician groups called the new health care legislation a step in the right direction, but said that it still does not address all of their concerns.

The American Medical Association (AMA), the largest physician group, applauded new measures to increase payments for primary care physicians caring for Medicaid patients and give bonus payments to physicians who work in underserved areas.

“Those who have insurance will see improvements right away: lifetime caps on coverage end, children can stay on parents’ policies until age 26, and insurance companies can’t cancel coverage except in the case of fraud,” AMA president Dr. James Rohack, said in a statement Monday.

At the same time, he lamented that the legislation does not repeal the Medicare physician payment formula that threatens to cut what doctors receive from the program.
0:00 /1:44Health care bill and small business

Dr. Lori Heim, president of the American Academy of Family Physicians, said she was mostly pleased with the legislation.

“Our health care system has so many significant problems that no one legislation will rectify then in one fell swoop,” Heim said.

She particularly liked a 10% increase in Medicare payments to all primary care physicians for certain services, including preventive visits, management of new diagnoses and related follow-up visits and management of acute medical problems.

However, Heim pointed out flaws not addressed, including malpractice reform, controlling costs and shifting the system to be more focused on patient outcome and not the number of procedures performed.

The American Academy of Pediatrics (AAP) said the legislation addressed most of its concerns.

From a coverage standpoint, the group said the measure comes closer to providing health care to every child in America, although families without legal documentation will still be barred from coverage unless its emergency care.

Under the new measure, insurers can no longer charge customers a co-payment for preventive visits, which include routine check ups and vaccination visits, until the age of 21.

However, one of the biggest concerns for the AAP is that Medicaid payments to providers typically are lower than what Medicare pays providers for services that are comparable. The AAP hopes the Senate will later this week pass a fix in a reconciliation bill that would put Medicaid payments on par with Medicare for comparable services.

Insurers react: America’s Health Insurance Plans, the group representing nearly 1,300 member companies, said the legislation doesn’t go far enough in addressing escalating health care costs and improving the quality of care.

“Last summer there was a dramatic shift. It went from health care reform to health insurance reform,” said Robert Zirkelbach, spokesman for AHIP. “Overall, the legislation takes an important step in getting more people covered but it is off base in bringing [health care] costs under control.

Zirkelbach said the new measures will raise costs for families and small businesses.

He said the measure imposes “tens of billions of dollars in new taxes on insurance providers, pharmaceutical companies and medical device makers.”

“All this will increase the cost of coverage. At the same time, very little in the legislation changes the problems with how care is delivered,” he said. To top of page