Health Industry Develops Medical Credit Score

Thursday 03 January 2008 at 1:26 pm The health technology firm Healthcare Analytics is creating a new credit score -- called medFICO -- that would rate an individual's ability to pay medical bills, the McClatchy/Baltimore Sun reports. The score could be introduced as early as this summer in some hospitals. MedFICO would reflect on-time medical bill payments and would include only billing data, not information indicating the reason for treatment. Hospitals would check the score after a patient is discharged to help officials to decide whether a patient can afford to pay bills or whether hospitals should write the debt off as uncollectible.

Development of the score is funded by Fair Isaac, Tenet Healthcare and North Bridge Venture Partners. A sense of the extent of uncollectible bills would help hospitals determine whether to invest in new projects and more accurately balance expenses against gross income, according to McClatchy/Sun.

However, consumer advocates are concerned that the scores might lead lower-income patients with lower scores to receive poorer quality health care than those with higher medFICO scores. Linda Foley, founder of the Identity Theft Resource Center, said, "How much assurance do I have that they're not going to look at this medFICO first, before they decide whether to treat or not?" Consumer advocates also say that given the problems associated with the current Fair Isaac credit score, such as identity theft and inaccurate scoring data, it should not be used as a basis for a medical credit score.

Stephen Farber, chair and CEO of Healthcare Analytics, said, "We only come into play once the patient has been treated and discharged, and the bill already exists," adding, "We help figure out what sort of relief a hospital should grant the patients" (McClatchy/Baltimore Sun, 1/2).

Small Businesses Could Have Major Influence On Next President's Health Care Plan

Thursday 03 January 2008 at 1:23 pm The Los Angeles Times last month examined how the "verdict of small business owners could lift or sink the next president's health care reform plan." Small businesses are "at the core of both the policy problem and the thorniest political challenge" to reducing the number of uninsured U.S. residents, the Times reports.

While most large employers offer coverage, many small companies find the cost prohibitive. Nearly two-thirds of the working uninsured and about 40% of all U.S. workers are employed by companies with fewer than 100 employees, the Times reports. "So in terms of policymaking, it will be almost impossible to reduce the number of uninsured substantially without involving those who work for small firms," according to the Times.

Small businesses traditionally have been "a solid GOP constituency," but they are "being wooed by the Democratic candidates, who are offering to tweak their health care plans to make them more appealing," according to the Times. However, the Times reports that small businesses "are a powerful lobbying force, and winning their support for significant changes may not be easy." Denny Dennis, research director for the National Federation of Independent Businesses, said, "The politicians' problem is coverage. Ours is cost," adding, "If they can't help us with cost, how can we help them with coverage?"

A survey by the federation showed that 9% of its 350,000 members said expanding coverage was the most important issue related to health care, while 74% named health care costs as the most important issue. The survey also found that 57% of federation members said they would support an individual health insurance mandate, while 40% said they would oppose it. An individual coverage mandate "is a cornerstone of universal coverage plans" proposed by Democratic candidates Sen. Hillary Rodham Clinton (N.Y.) and former Sen. John Edwards (N.C.).

Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said, "The individual mandate is attractive in that it sounds like it could get their employees coverage, and it wouldn't require (employers) to contribute very much" (Alonso-Zaldivar, Los Angeles Times, 12/23/07).

Schwarzenegger, Nunez Submit Ballot Initiative For Health Care Reform Proposal

Thursday 03 January 2008 at 1:22 pm California Gov. Arnold Schwarzenegger (R) and state Assembly Speaker Fabian Nunez (D) on Friday submitted to the state attorney general a proposed ballot initiative for the November 2008 elections that would provide the funding mechanism and other changes necessary to enact their plan to overhaul the state's health care system, the Los Angeles Times reports. The submission "sets the stage for what is expected to be a costly and contentious battle pitting the two state leaders and their allies against some powerful opponents," according to the Times (Rothfeld, Los Angeles Times, 12/29/07).

The proposal, approved by the California Assembly last month, would require most state residents to obtain health coverage. Under the bill, residents with incomes up to 250% of the federal poverty level would receive state subsidies for coverage, and residents with incomes up to 400% of the poverty level would receive tax credits to ensure that health care premium costs do not exceed 5.5% of their incomes. Insurers would be prohibited from denying coverage to residents because of pre-existing medical conditions (Kaiser Daily Health Policy Report, 12/21/07).

The ballot initiative submitted by Schwarzenegger and Nunez would ask voters to approve about $9 billion in fees and taxes to partially fund the $14 billion plan. The remaining funding would come from the federal government, consumer premiums and copayments (Chorneau, San Francisco Chronicle, 12/29/07). The initiative would nearly double the state tax on cigarettes to $1.75 per pack, from 87 cents per pack, in mid-2009. The initiative also includes an employer requirement that ranges from 1% to 6.5% of their payrolls, depending on the level of payroll. Funds raised by this fee would go into a new California Health Care Trust Fund to assist state residents who find insurance unaffordable. The initiative specifies that funds directed to the health care trust fund only could be used for the specified purpose.

In addition, the initiative would:

Specify the process by which programs would be suspended if the state encounters insufficient funding;


Levy new fees on hospitals; and


Approve a $25 million loan from the state's general fund to provide funding to families with children who will be dropped from city or county health care programs during the transition to the state program (Los Angeles Times, 12/29/07).
Process
Submitting the measure to the attorney general "is the first step" in qualifying it for the ballot, according to the Chronicle. The attorney general has seven weeks to review the initiative, assign it a formal title and write a summary that can be distributed to voters. Schwarzenegger and Nunez likely will need signatures from more than one million registered voters.

In addition to approval of the ballot measure, supporters of the health care proposal need to pass legislation (AB1X) that would make changes to the state and local government to allow the new health care system to operate. State Senate Pro Tempore Don Perata (D) has delayed a vote on the bill until mid-January, after a financial analysis is completed. If the bill is amended in a "substantial way, a new initiative would have to be drafted and the attorney general would have to begin his review again -- costing backers of the plan precious time," according to the Chronicle. The Chronicle reports that for supporters of the reform proposal, "time is running short to qualify the measure for the ballot and then effectively campaign for its passage" (San Francisco Chronicle, 12/29/07).

Problems With ERISA
The Christian Science Monitor on Monday examined how California leaders "are pushing forward with a health care reform effort ... despite an ominous legal ruling last week" that found that a San Francisco health care program violated the 1974 Employee Retirement Income Security Act by requiring employers to spend a specified amount of money on health programs for their employees. ERISA prevents state and local governments from meddling with employer-provided benefits. The ruling "reiterates the almost Sisyphean nature of health care reform at anything but the national level," and the submission of the ballot initiative by Schwarzenegger and Nunez "signal[s] they are still willing to try to push the boulder back up the hill," the Monitor reports (Arnoldy, Christian Science Monitor, 12/31/07).

Massachusetts Residents Without Health Insurance Face Steep Fines

Wednesday 02 January 2008 at 3:50 pm For residents of Massachusetts without health insurance, the news certainly isn’t happy. They are going to have to spend more towards paying fines for not owning health insurance. With effect from January 1, 2008, new fine amounts come into effect for those lacking health insurance.

The Department of Revenue has come out with a set of guidelines Monday to determine the penalty to be paid by residents of Massachusetts without health insurance. As per these guidelines, an individual would have to pay as much as $912 by 2008-end if he does not have insurance, while the fine for couples is $1824.

This is a steep increase in penalty compared to the earlier one – as of 2007-end, a person without health insurance were subjected to a loss of personal income tax exemption, a one-time loss that was worth $219.

The new fines are part of a new approach that health care officials are adopting. The intent is to push all residents of Massachusetts into buying health insurance. With this new law, which lawmakers approved and former Massachusetts governor Mitt Romney signed in 2006, officials hope almost the entire state would have health insurance cover.

There is no clear indication of the actual number of people in Massachusetts lacking health insurance coverage. The number could be as high as a few hundred thousand people.

The fines are based on half of the plans with the lowest cost that are available to residents through the Health Care Connector. Various factors influence the fine amount, such as age, annual income, etc. Each passing month that a person remains without health insurance, the fine accumulates. The individual will have to pay the fine as part of his tax returns for 2009.

People who cannot afford health insurance have been spared the fines. They are applicable basically only to those Massachusetts residents who are categorized by the Health Insurance Connector Authority as being able to afford health insurance.

Individuals who are more than 27 years old and earn more than three times the federal poverty level of $30,000 a year face the stiffest penalty, of $76 a month or $912 annually. In the case of married couples, the fine would have to be paid individually if both the people in the marriage are uninsured. A couple earning more than $41,076 per annum would have to pay $1824 per year as penalty.

For younger adults, the fines are not that steep. They are lesser for those individuals who earn less than three times the poverty level. A person earning less than $15,325 per annum is not eligible for any penalty.

While there is no way of knowing how many people in Massachusetts actually come under the purview of the fines, the lawmakers’ version is that over 300,000 Massachusetts residents have signed on for health insurance as a result of the law.

Children's insurance extension inadequate

Wednesday 02 January 2008 at 3:48 pm San Antonio Express-News

The State Children's Health Insurance Program, which was hotly debated throughout 2007, is destined to remain a burning issue in the 2008 elections.
Democrats fought to expand the program by $35 billion, but President Bush vetoed two different versions of SCHIP expansion legislation as the Democrats gained Republican support, but not enough to override a presidential veto.


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The expansion would have been financed by new tobacco taxes.

Over the weekend, Bush signed legislation extending the program for the next 15 months, the Assoociated Press reported.

Get ready for the rhetoric casting blame on each side during the fall campaign.

In the words of Reuter's news service, the development leaves "decisions about renewal to the next president and Congress."

Reuters reported that the program covers some 6.6 million children, whose families don't qualify for Medicaid but can't afford insurance.

The situation is more complicated than merely holding down the federal budget.

The program is crucial because it provides health care to children who would otherwise lack preventive care and then, when they get sick, end up in emergency rooms funded by local taxpayers.

The American Medical Association, the American Hospital Association, America's Health Insurance Plans and the Healthcare Leadership, which represents insurers, hospitals, pharmacies and pharmaceutical companies support SCHIP expansion.

The uninsured visit emergency rooms more often, but wait longer before seeking care. The delay increases the severity of their condition and the cost of their treatment.

As we have noted here before, 10 percent of patients consume 80 percent of health care dollars. And those dollars come from the pockets of taxpayers.

Twenty percent of Texas children are uninsured.

Insurance is more cost-effective than emergency room treatment.

Right or wrong, Bush made it clear that he wouldn't budge.

By failing to find a middle ground that would have survived a Bush veto, congressional Democrats and Republicans have kept the nation on a penny-wise and pound-foolish path.

Presidential Candidates Debate Health Care Proposals in Preparation for Iowa Caucuses

Wednesday 02 January 2008 at 3:39 pm Presidential candidates have debated their health care proposals in preparation for the Iowa caucuses on Thursday, the Chicago Tribune reports (Pearson/Chase, Chicago Tribune, 12/31/07).

Democratic presidential candidate Sen. Barack Obama (Ill.) on Monday at a Perry, Iowa, community center defended his proposal against claims made by rival former Sen. John Edwards (D-N.C.). In response to claims by Edwards that Obama should not negotiate with health insurers and pharmaceutical companies, Obama said, "I'd have a big table, and everybody would be invited." He added, "Yes, I'd invite the drug companies and the insurance companies and the HMOs. They'd have seats. They just wouldn't be able to buy every chair." He also said that C-SPAN would televise the negotiations to increase the influence of the public and reduce the influence of special interests. According to Obama, "That's how you get things done, not by shouting" (Eichel, Philadelphia Inquirer, 1/1).

Edwards on Sunday in northern Iowa addressed questions by the Obama campaign about comments he made last year about the role of special interests in health care reform. In comments made in a story on the Web site www.mydd.com, Edwards said that he would "try to bring everybody to the table" on health care reform, although during his campaign he has said that he would not negotiate with special interests. Edwards on Sunday said that he meant health insurers would continue to play a role in the health care system under his proposal. He said, "What I was talking about then was what we needed to do to actually bring about universal health care and the difference between single-payer, government-run health care and what I'm proposing." Edwards added, "I don't eliminate insurance companies from the health care fix. ... People have choice in my health care proposal between a private plan and a government-run plan" (Chicago Tribune, 12/31/07). On Friday during a campaign event in Dubuque, Iowa, Edwards "tried to distinguish himself from his Democratic rivals" on health care and other issues, the New York Times reports (Bosman/Luo, New York Times, 12/29/07).

Drew Altman, president and CEO of the Kaiser Family Foundation, said that health care is "not a wedge issue" and is not "emerging as a pivotal distinguishing issue" in the presidential primaries. However, Altman said, "We're in the early stages of health care re-emerging as a top national issue. It's the next great debate" (Feder Ostrov, San Jose Mercury News, 12/25/07).

Additional Developments


Sen. Hillary Rodham Clinton (D-N.Y.): Clinton on Wednesday plans to launch a television ad in Iowa that will ask voters to "take the first step" in efforts to address health care and other issues through their support for her in the caucuses. In the ad, Clinton says, "As we start this new year, America is at a crossroads," with "47 million people without health care." She adds, "All the men and women across the state who have whispered their health care problems to me -- bills they can't pay, parents they can't afford to care for, insurance companies who refuse to help" have "welcomed me into your hearts and your homes" (Glover, AP/Kansas City Star, 1/2). In related news, Clinton on Dec. 23 during an appearance at the Iowa Veterans Home reiterated her promise to provide adequate health care and other benefits to U.S. troops who return from the wars in Iraq and Afghanistan. Clinton said that "no one has given more to our country than our country's veterans." She added, "I believe that when you sign up to serve our country, our country must serve you with the health care, the compensation and the support that you so richly deserve" (Lorentzen, AP/Lexington Herald-Leader, 12/25/07).


Former New York City Mayor Rudy Giuliani (R): The New York Times on Friday examined consultant work provided by Giuliani to Purdue Pharma in efforts to defend against federal allegations that the company misled the public about the potential addictiveness of the pain medication OxyContin. According to the Post, Giuliani participated in two meetings between Purdue Pharma officials and the Drug Enforcement Administration acting administrator, and, as a "celebrity, Mr. Giuliani helped the company win several public relations battles." In addition, Giuliani "became the public face" of Rx Action Alliance -- a group of pharmaceutical companies, physicians and law enforcement authorities that seeks to fight prescription drug abuse, the Post reports (Meier/Lipton, New York Times, 12/28/07).


Obama: Obama on Friday launched a television advertisement in Iowa that promotes his health care proposal over those announced by Edwards and Clinton. According to the Washington Post "The Trail" blog, the ad "misrepresents some newspaper assessments" of the Obama proposal. The ad cites a St. Paul Pioneer Press article that said the Obama proposal "guarantees coverage for all Americans" but omits the end of the statement: "but does not require all to have it." The ad also cites an Iowa City Press-Citizen article that praised the Obama proposal as "the best." However, the ad fails to indicate that the article involved a comparison of the proposal to a single-payer health care system, not the plans announced by Clinton and Edwards. In addition, the ad cites a Post article that states the Obama proposal would save "$2,500 for the typical family," although the article attributed the figure to Obama aides without outside verification (Kurtz, "The Trail," Washington Post, 12/29/07). On NBC's "Meet the Press" on Sunday, Obama "sidestepped whether his spot was a stretch" on whether his proposal would expand health insurance to all U.S. residents, the Chicago Sun-Times reports (Sweet, Chicago Sun-Times, 12/31/07). In related news, Obama last week in Mason City, Iowa, promised to not "play politics" on the issue of health care for veterans. Obama said that he would seek to improve health care for veterans and provide them with mental health screenings. According to Obama, "We have to fund all the services that have been promised to our veterans. We can't play politics with it" (AP/Arizona Daily Star, 12/27/07).
Polls
Almost two-thirds of U.S. residents support a health care system "in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers," according to a recent poll commissioned by AP/Yahoo! News. The poll, conducted over the Internet by Knowledge Networks, included telephone contacts with more than 1,800 residents followed by online interviews. The poll also found that 64% of respondents cited concerns about the possibility of unexpected major medical expenses (Kuhnhenn/Tompson, Associated Press, 12/28/07).

In related news, a recent Boston Globe poll of likely voters in the Jan. 8 New Hampshire primary found that 80% of Democratic respondents believe the federal government should provide health insurance, compared with 30% of Republican respondents (Mooney, Boston Globe, 12/26/07).

Opinion Pieces
Summaries of several recent editorials and opinion pieces related to health care in the presidential election appear below.

Edwards, Boston Globe: "I am running for president to make sure that every child can have the same opportunities in life that I've had," and one "thing we need to do is create universal health care in America," Edwards writes in a Globe opinion piece. "Not only are health care costs putting a huge strain on American families and our competitiveness in the global economy, but our broken health care system that leaves 47 million Americans without health care is also a moral disgrace," Edwards writes, adding, "I have proposed a health care plan that calls for shared responsibility among people, businesses, and the government, and will ensure that every man, woman, and child in America has access to affordable, quality coverage" (Edwards, Boston Globe, 12/28/07).


Los Angeles Times: "A sick America can't be a working America," and "changes to the health care system will be necessary to keep us in good health," according to a Times editorial. The editorial states, "The Congressional Budget Office reported this month that rising medical costs, which far outstrip inflation, pose the No. 1 threat to the country's ability to balance federal budgets in the future." The editorial, which recommends a health care "plan that would achieve universal coverage through an individual mandate, requiring every American to buy health insurance," states that most Democratic presidential candidates "line up with our approach" and "seek to expand coverage and to create new purchasing pools to expand choice." However, the "GOP candidates prefer market-based solutions such as health savings accounts, tax refunds for those who buy individual coverage ... and boosting citizens' ability to spend wisely by requiring greater transparency on prices and outcomes from health care providers," all of which are "appealing ideas in theory" but "will not improve care for all Americans," the editorial states (Los Angeles Times, 12/28/07).


Paul Krugman, New York Times: The Democratic presidential candidates are "offering strongly progressive policies on taxes, health care and the environment," Times columnist Krugman writes. However, Republican presidential candidates support "Bushonomics," although the "public is very unhappy with the state of the economy ... with a declining fraction of Americans receiving health insurance from their employers," he writes (Krugman, New York Times, 12/31/07).


David Leonhardt, New York Times: The only difference between Clinton and Obama "on any domestic policy that has received much attention" is the issue of a health insurance mandate, which Clinton has included in her health care proposal but Obama has not included in his plan, Times columnist Leonhardt writes. "Outside of health care, the campaigns -- and we in the media -- have focused on more exalted concepts, like experience, change and judgment," but "there really are some other important differences between the candidate," such as "policies as a whole" and "competing economic philosophies," Leonhardt writes, adding, "The fight over health insurance is just one part of their disagreement." According to Leonhardt, "Mrs. Clinton and Mr. Edwards favor a mandate because -- as they point out -- there will never be universal health care without one," and "skepticism about government tinkering" raised by Obama "helps explains his stance on a health care mandate." He adds, "Obama is right that some people would ignore a health care mandate. But some wouldn't. As any good behavioral economist knows, there really are people who can afford health insurance and who would like to have it -- but who haven't gotten around to getting it. A mandate would nudge some of them to do so, and the whole health care system would be better off as a result" (Leonhardt, New York Times, 1/2).


Jacob Sunshine, Seattle Post-Intelligencer: "There are many reasons physicians and people in health care are lukewarm about John Edwards' presidential candidacy," and none "is bigger probably than his professional past," Sunshine, a student at the University of Washington School of Medicine, writes in a Post-Intelligencer opinion piece. Sunshine writes, "In the '80s and '90s, he amassed a fortune as a trial attorney, in no small part through malpractice cases against OB/GYNS in North Carolina," and "this makes some people in health care uneasy." However, "no matter how you feel about Edwards' past, of all the candidates seeking the presidency, he is the one most committed to improving the public's health, in addition to health care," based in part on his "having the most progressive universal health plan" and his focus on poverty, Sunshine writes. He adds, "Make no mistake; those measures will not be easy. But by focusing on poverty, in addition to his health plan, Edwards is in a position to do a tremendous amount to improve our country's collective health" (Sunshine, Seattle Post-Intelligencer, 1/2).


Washington Post: "When it comes to health care, the way policy makers define the problem determines the answer they produce," as "Democratic presidential candidates tend to focus on the uninsured" and Republicans candidates tend to focus on "rising costs," a Post editorial states. According to the editorial, "Both are important: The unaffordability of health insurance won't be addressed without tackling health-care costs, but reducing cost growth alone won't solve the insurance problem." A health care proposal announced by presidential candidate Sen. John McCain (R-Ariz.) is the "most detailed and thoughtful of the Republican proposals" but "does not put enough emphasis on dealing with the uninsured," the editorial states. In addition, McCain "puts too much emphasis on the ability of consumers, once they are aware of and responsible for health-care costs, to drive down prices," and his "plan is weakest on the underlying problem with the health-insurance market, in which insurers have every incentive to cherry-pick the healthiest purchasers," the editorial states. However, according to the editorial, "his suggestions for constraining costs and reforming the irrational tax treatment of health insurance merit serious consideration by whoever is elected." The editorial states, "The McCain plan represents an important improvement on a dead-on-arrival proposal from President Bush earlier this year," adding, "Getting rid of the tax preference would be a good step toward achieving a more rational system, one that does not favor some purchasers of health insurance over others and does not encourage spending on gold-plated health care plans" (Washington Post, 12/22).
Broadcast Coverage
"Meet the Press" on Sunday included a discussion with Obama about his health care proposal and other issues (Russert, "Meet the Press," NBC, 12/30). Video of the complete program is available online. A transcript of the complete program also is available online.

Forum
PBS's "NewsHour with Jim Lehrer" last week reported on the latest in a series of health policy forums in Washington, D.C., organized by Families USA and the Federation of American Hospitals. Democratic presidential candidates Sen. Joe Biden (Del.); Clinton; Edwards; Rep. Dennis Kucinich (Ohio); and New Mexico Gov. Bill Richardson participated in the forum (Dentzer, "NewsHour with Jim Lehrer," PBS, 12/25/2007). Republican candidate Sen. John McCain also has participated in the forum.

The Kaiser Family Foundation hosts the forums in its Barbara Jordan Conference Center in Washington, D.C. Kaiser is webcasting the forums live through kaisernetwork.org, its health policy news and information service. Susan Dentzer of "NewsHour" will moderate the forums, and additional panelists will include journalists from NPR, Wall Street Journal and ABC News. Live and archived webcasts of the six forums held to date, as well as additional information about them, are available on a dedicated Web site, http://presidentialforums.health08.org. The forums are being funded by The California Endowment and the Ewing Marion Kauffman Foundation (Kaiser Daily Health Policy Report, 11/20).

The "NewsHour" segment includes comments from Biden; Clinton; Edwards; Kucinich; Richardson; Laura Meckler, a reporter for the Journal; David Muir, a correspondent for ABC News; and Julie Rovner, a correspondent for NPR ("NewsHour with Jim Lehrer," PBS, 12/25/2007).

Audio and a transcript of the segment are available online.

Treating Oft Ignored Non Cancer Health Issues After Cancer Diagnosis Prolongs Survival

Friday 28 December 2007 at 4:22 pm Receiving treatment for non cancer health issues while being treated by specialists for cancer improves cancer survival rates according to a study published in the December 20 issue of the Journal of Clinical Oncology.

The study, by researchers from the Indiana University School of Medicine, the Regenstrief Institute and the Roudebush Veterans Administration Medical Center, is the first to look at the effect of primary care on health outcomes in cancer patients.

Receiving care from a primary care physician (a general internist or family practice doctor) during cancer treatment from an oncologist appears to improve cancer survival rates, likely due to the comprehensiveness of care that is received in primary care, according to study authors Caroline Carney Doebbeling, M.D., M.Sc. and Laura Jones, Ph.D. The researchers focused on lung cancer because of the low one-year lung cancer survival rate in these patients.

"We cannot afford to ignore the chronic medical conditions that most cancer patients have because treating these conditions may bring increased longevity as well as improved quality of life. Lung cancer patients are often faced with many additional health issues, such as high blood pressure, emphysema and other respiratory conditions, all of which can and should be treated," said Dr. Carney Doebbeling, associate professor of medicine and of psychiatry at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

"When doctors think their patients have a higher risk of mortality, as they do with lung cancer, chronic disease management may be not as big a focus," said Dr. Jones, who is with the Roudebush VA Medical Center's Center of Excellence on Implementing Evidence-Based Practice and is a health services researcher.

Lack of primary care utilization in the first six months following lung cancer diagnosis had a marked effect on survival even when controlling for extent of the disease. The researchers looked at electronic medical record data of 323 male veterans diagnosed with lung cancer. The median survival rate was only 3.68 months for those without primary care utilization, but increased by a factor of more than four if the patient had at least 3 primary care visits during the first 6 months following cancer diagnosis.

"Further investigation is needed to gain a better understanding of how and why primary care utilization improved outcomes in lung cancer patients. What we do know is that over 80 percent of lung cancer patients have at least one additional serious medical condition. The take home message to cancer patients is to not stop seeing your primary care doctor even if you have cancer," said Dr. Carney Doebbeling. "The importance of managing the health of the whole person, not just one disease at a time, cannot be overstated."

The study was funded by the Veterans Health Administration.

Federally Funded Study Shows More Women Can Avoid Hysterectomy For Common Problem

Friday 28 December 2007 at 4:21 pm A minimally invasive procedure called endometrial ablation is as effective as hysterectomy in solving a common female complaint called "dysfunctional uterine bleeding" or DUB, according to a new federally-funded study published in the Journal of Obstetrics and Gynecology.

DUB (dysfunctional uterine bleeding) can be described as abnormal bleeding which cannot be attributed to abnormalities of the female reproductive system, pharmacological interaction, intrauterine contraception, or bleeding disorders. It is also referred to menometrorrhagia.

The condition affects up to a third of all women at some point during their reproductive years, usually women over age 30. It is characterized by extremely heavy, erratic menstrual bleeding and is often accompanied by fatigue, pelvic pain and decreased quality of life. The excessive blood loss in DUB can provoke iron deficiency anemia.

"This is a very important study, proving that a minimally invasive procedure -- endometrial ablation -- can solve the problem of excessive bleeding as well as hysterectomy," commented Franklin D. Loffer, M.D., Executive Vice President/Medical Director of AAGL, the professional organization dedicated to the advancement of minimally-invasive gynecologic surgery. "Women should always be offered the least invasive, effective approach to solving her medical problems."

While hysterectomy (the removal of the uterus and in some cases the ovaries and cervix) has a long history of use to cure DUB, newer, less invasive procedures have become available in recent years. These have stirred controversy over whether hysterectomy is overused, particularly for conditions such as DUB for which more conservative approaches may be just as effective and cause fewer complications.

The new study, bearing the acronym of StopDUB for "Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding," was a multi-center, randomized, controlled trial in the U.S. and Canada involving 237 women at 25 treatment centers. The primary complaint causing women to seek surgery was excessive bleeding that had not been mitigated by medical therapy. These women were randomly assigned to receive either hysterectomy or endometrial ablation, a minimally invasive technique that removes only the lining of the uterus (the lining cells are responsible for the bleeding), not the entire organ.

The primary measure of success in the study was women's satisfaction with their treatment, rather than just a clinical endpoint. After three years of follow-up, the vast majority of patients in both groups (93-95%) reported that their problem was solved. The secondary endpoints of pain and fatigue were also similar between the hysterectomy group and the endometrial ablation group.

"Using women's satisfaction as the study goal, rather than clinical endpoints alone, was very astute from our perspective, because the most important outcome is the woman's opinion, not the doctor's," said Dr. Loffer. "Our view at AAGL is always patient-focused: how much pain will there be, how much trauma, how much time lost, what impact on the quality of life? These are the measures that count."

Advantages of the less invasive procedure include shorter hospital stays (hours instead of days), less blood loss, fewer complications and quicker recovery. In many cases endometrial ablation causes menstrual periods to become much lighter and more regular, rather than eliminating them altogether. Many women consider this to be a satisfactory outcome and would prefer to have normal periods rather than lose their uterus.

"Both endometrial ablation and hysterectomy are effective treatments in women with dysfunctional uterine bleeding. However, hysterectomy was associated with about four times more adverse events and six times as many postoperative infections," said Malcolm Munro, MD, an investigator in the StopDUB Research Group at the David Geffen School of Medicine, University of California Los Angeles. Dr. Munro is also an advisor to the AAGL.

The American College of Obstetricians and Gynecologists (ACOG) recommends that treatment for menorrhagia begin with the least invasive therapy. But, for some women, endometrial ablation may not solve their problem.

"In this study about two thirds of women were able to avoid hysterectomy by having an endometrial ablation procedure while about a third of the patients who had received endometrial ablation ended up having a hysterectomy several years later. This rate is comparable to that seen in other studies," said Munro.

About 600,000 hysterectomies are performed annually in the U.S., making it the second most common major surgery performed on women of reproductive age. There is controversy about how many of these hysterectomies are really necessary. Clearly, 120,000 hysterectomies performed each year for DUB (without uterine pathology) are amenable to endometrial ablation. Moreover, many patients with uterine fibroids and abnormal bleeding can be treated via endometrial ablation. Fibroids account for 40% of hysterectomies each year.

While some doctors may look for anemia as a diagnostic indicator for DUB, in the StopDUB study women's perception of their problem was the main criterion, supported by clinical measures of excess duration, amount, or unpredictability of flow. "We felt that women should not have to be anemic in order to seek help and have their problem taken seriously," said Munro.

"Based on our results, it is reasonable to recommend that women should select the type of surgery they want for DUB, based on their preferences and situations," concluded Munro.

About AAGL

The AAGL is the first and largest organization in the world dedicated to gynecologic endoscopic surgery. Founded in 1971, AAGL works to advance the safest and most efficacious diagnostic and therapeutic techniques that afford less invasive treatments for gynecologic conditions through the integration of clinical practice, research, innovation, and dialogue. For the past 36 years, the organization has educated the world's finest surgeons while improving the lives of women everywhere. This global commitment to women's health care is embodied in their continuing medical education of physicians and professionals to further promote the well-documented high standards of minimally invasive gynecologic surgery. For more information visit http://www.aagl.org.

Flirting Can Help Your Relationship

Friday 28 December 2007 at 3:26 pm I know that flirting can be a huge source of contempt in relationships. Some guys see their partners flirting with other men and go ballistic. Some women see guys flirting with other women and think he's trying to score.

And while I know that flirting can be a dangerous game if you're playing with the wrong people, I also believe that flirting can be healthy - as long as you're taking the energy you're building and putting it back into your relationship.

So, what can innocent flirting with a co-worker, stranger, or random bartender do to help your relationship? More than you may think.

Flirting Gives You Confidence

A relationship progresses after some time, and both sides fall into the same rut of Friday pizza, Saturday out, and sleepy Sunday. Same old, same old. The message: We're stuck together, we're comfortable together, and we may be perfectly content together.

All well and good, but that does as much for your romantic confidence as having spinach in your teeth. What flirting allows you to do is feel like you're impressing another person and being attractive to another person - without the baggage, stigma, and pressures of the next step. Bringing that sexual and romantic confidence back to your relationship helps you - and strengthens the relationship across the board.

Flirting Keeps You Sharp

Being wanted is one of our most basic needs. Sometimes, when we're in relationships, we don't always get that positive vibe - that we're wanted, needed, and desired.

Every once in a while, flirting can reinforce that primitive need of feeling valued. And that little innocent dialogue with some stranger in a bookstore may be all the kick-start you need to lose a little weight or change up your hair or whatever it is that you want to do to make yourself feel better about yourself. Which has benefits for everyone involved.

Flirting Lets You Build Up Sexual Energy

Some shrinks say it's OK to fantasize about anyone you want and build up a head of steam - as long as you, well, go ahead then and release that pent up energy with your partner.

So in a way, you can use flirting as a kind of foreplay. Build a little frisky tension with the barista, get warmed up, then bring home the dividends. And when you're at home, leave a copy of this list around the house. Think of it as a kind of flirting with your partner - and a fun to-do list.

Flirting Reminds You How Good You Have It

The fun of flirting is that there are no strings attached. Just some good ole banter with jokes, laughs, and some well-timed sexual innuendo. Fun at first. But when you think of the long process that comes after, it makes you realize that what you've got at home is exactly what you want.

I can hear you now: too much flirting can lead to real temptation. Here's what we told Men's Health readers to do when faced with a home-wrecking temptress.

Have some thoughts on flirting? Share them here.

Kids Of Abused Moms Have Greater Health Needs

Thursday 27 December 2007 at 12:02 pm Children whose mothers have a history of abuse by intimate partners have higher health care needs than children whose mothers have no history of abuse, according to a study conducted at Group Health, a Seattle-based health plan.

These needs - expressed in terms of the cost of providing care and use of health services - were higher even if the abuse occurred before the children were born, the research team found. Scientists from Group Health Center for Health Studies, Harborview Injury Prevention and Research Center (HIPRC), and Seattle Children's Hospital Research Institute conducted the study, which appears in the December 2007 issue of the journal Pediatrics.

"Children are the other victims when intimate partner violence (IPV) occurs in the home," said lead author Frederick P. Rivara, MD, MPH. "This study shows that children require more health care--especially for mental health--when their mothers are victims of such violence."

Rivara is a researcher with HIPRC and Children's. The principal investigator for the study is Robert S. Thompson, MD, senior investigator at Group Health Center for Health Studies.

The study compared medical records and utilization data from 631 children of mothers with a history of IPV with those of 760 children whose mothers had not experienced IPV. The mothers - who participated in a randomly sampled telephone survey of Group Health female members aged 18 to 64 - provided the information regarding their lifetime history with IPV. The study defines IPV as both physical abuse (slapping, hitting, forced sex) and nonphysical abuse (threats, and chronic disparaging remarks or controlling behavior.) The researchers looked at 11 years of data.

Among the mothers in the study, 46.6 percent reported experiencing IPV since age 18. Among the children of mothers with IPV, the violence stopped before they were born for 21.8 percent. For 23.6 percent, the violence happened during the children's lifetime.

Previous studies have shown that children exposed to IPV in the home have increased risk for many problems, including also being abused at home; school problems; poor health; risk-taking behavior; and becoming perpetrators of violence.

In 2006, the Group Health study team published evidence that IPV resulted in significantly higher health utilization and costs for women. This current study is the largest ever to examine the link between mother's exposure to IPV and their children's health utilization and costs. The study is also unique in that it examined a large middle-class population and one that is very representative of Seattle, said Rivara.

"Intimate partner violence harms everyone in our society, and it must be viewed as not acceptable either for women or their children," he added.

The researchers found:

* Health care utilization and health care costs were higher in most categories of care for children whose mother had a history of IPV, with significantly higher levels of mental health costs and services, primary care visits, primary care costs, and laboratory costs. Overall, the annual costs of health care were 11 percent higher than those for children of mothers without IPV.

* Children of mothers with a history of IPV that ended before the child was born had significantly greater utilization of mental health, primary care, specialty care, and pharmacy services. Health care costs were 24 percent higher for children in this group compared to children whose mothers had experienced no IPV in their lifetime.

* Children exposed directly to IPV after birth had greater emergency department and primary care use during the IPV and were three times as likely to use mental health services after the intimate partner violence ended. They had 16 percent higher primary care costs than did children of mothers without IPV.

The authors recommend that health care providers routinely screen women for IPV and provide appropriate referrals to community agencies and mental health care both for mothers and children affected.

They also state that interventions for women and their children are needed to minimize the effects of IPV in the family. "Such interventions are unlikely to be cost effective in the short term," they write, because the victims' increased health care utilization seems to be higher for years after IPV stops. "Nonetheless, such services are necessary to attend appropriately and responsibly to the long-term consequences of violence," the authors conclude.

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Article adapted by Medical News Today from original press release.
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The research was funded by the Agency for Healthcare Research and Quality, the Health Services arm of the U.S. Department of Health and Human Services.

In addition to Rivara, authors of the paper include researchers from Group Health Center for Health Studies: Melissa L. Anderson, MS; Paul Fishman, PhD; Robert J. Reid, MD, PhD; David Carrell, PhD; Robert S. Thompson, MD; and Amy Bonomi, now at Ohio State University.

About Group Health Center for Health Studies

Founded in 1947, Group Health is a Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. It is funded primarily through government and private research grants.

Source: Joan DeClaire
Group Health Cooperative Center for Health Studies