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Category Archives: Health Care

$180 million cut could cause 39,000 to lose access to health care – Video

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$180 million cut could cause 39,000 to lose access to health care
New Hampshire House Republicans are taking steps to dismantle one of Gov. Maggie Hassan #39;s signature legislative achievements. Adam Sexton has more Subscribe to WMUR on YouTube now: ...

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$180 million cut could cause 39,000 to lose access to health care - Video

Health care workers taking a new approach to treating sinus infections

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Health care providers are a little bit like that annoying family member who tells the same story from years before at every family function. When a health care provider sees an interesting case, it is often repeated to other professionals, patients and even their own family. Back in 2007, I had a very interesting case when a gentleman presented to the office with a swollen face. It was red and tender and seemed to start without an obvious cause. I started treatment with antibiotics for cellulitis, or a skin infection, of the face. I asked to see him back in 24 hours, because I was worried that it might get worse before it got better. When he returned, the swelling and inflammation in the face was much worse, which prompted me to get a CT scan. This test showed that he had an extensive sinus infection that had actually developed into an abscess. The abscess was moving from the sinus into the eye cavity. He required surgery and recovered without complication.

This case illustrates a complication of sinusitis, or infection of the sinuses. It is fascinating only in that it is very rare. I will likely never see this again, nor will most health care providers. In fact, sinusitis, while annoying, is a generally benign illness that has likely been over managed in the health care industry for years. In 2012, the Infectious Disease Society of America (IDSA) released new guidelines to provide a framework for the treatment of sinusitis. This framework contradicts what was often common practice in the medical community and deserves review so that patients understand how medical practice is evolving.

First off, it is of benefit to look at the sinus anatomy. Humans have eight sinuses in the face. The sinuses are actually cavities, or holes, filled with air and lined with a membrane that makes mucus. In normal day-to-day life, this mucus is made and drained into the nasal passage, where it ends up being swallowed without us even being aware it is happening. This process is part of the filtering capacity of the nasopharyngeal system. Symptoms develop when this normal function is disrupted because of inflammation. The sinuses may become filled with the mucus they normally drain, which is the source of the classic discomfort of a sinus infection.

Health care providers are encouraged to call these situations rhinosinusitis rather than sinusitis. This reflects that it is not just a change in the sinus cavity but also in the tissue of the nose itself. The most common cause of rhinosinusitis is not a bacterial infection, but instead it is the common cold virus. Bacterial infections are felt to be the cause in only 0.5-2.0 percent of cases. This means that although a patient might be diagnosed with rhinosinusitis, the prescribing of antibiotics should not be a foregone conclusion. It is difficult to distinguish which cases are caused by a virus and which are bacterial. The signs of rhinosinusitis are the same whether bacterial or viral. They include nasal congestion, nasal drainage (either clear or discolored), discomfort in the top teeth, and facial pain that worsens when bending forward. To distinguish between a viral and bacterial cause, health care providers are being taught to focus on persistence of symptoms and severity of symptoms. Rhinosinusitis that has been present for greater than 10 days without evidence of improvement may benefit from the addition of antibiotics. In the viral cases, the symptoms might be present for longer than 10 days, but there should be a gradual improvement by the 10-day mark. In terms of severity, health care providers are looking for fever of 102 or greater and severe pain, thick discharge with pain that presents very quickly in the illness.

As always, the reason for making this change in treatment is the avoidance of unnecessary antibiotics. It is the use of unnecessary antibiotics that can lead to severe bacterial infections unresponsive to traditional therapies. A patient should try many home remedies for what they believe to be a sinus infection, if severe symptoms are not present, before consulting their health care provider. Both Tylenol and Ibuprofen products can be of benefit for the discomfort of rhinosinusitis. Nasal irrigation can also help clear thickened mucus and allow the sinuses to drain appropriately. Now that there are options for steroid nasal sprays that are over the counter, those can also be used. The steroid sprays may decrease the inflammation in the nasal passage, also allowing appropriate function.

Whether we are the patient or the health care provider, the goals of treatment of rhinosinusitis should be relief of symptoms and antibiotics only when absolutely necessary. Hopefully, this information will help patients understand the disease process and the best way to assist its resolution.

Questions and or comments regarding this weeks health column please contact Kathleen Harder-Brouwer, MD at Ravalli Family Medicine 411 West Main Street, Hamilton, MT 59840. Working together to build a healthier community!

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Health care workers taking a new approach to treating sinus infections

Health care plan enrollments steady despite reform law

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The health care reform law has so far had little effect on the percentage of employees enrolled in employer-sponsored health care plans, according to a survey.

The Mercer L.L.C. survey of nearly 600 employers found that on average 83% of employees eligible for coverage enrolled in plans this year, down from 84% in 2014.

In addition, the percentage of employees both eligible and ineligible for coverage who enrolled in plans was unchanged at 74% in both 2014 and 2015, according to the survey, which was released Tuesday.

That lack of enrollment growth is somewhat of a surprise given the stiff penalties that employers and employees face under the health care reform law if they do not, respectively, offer coverage or enroll in a plan.

Employers with at least 100 employees that do not offer coverage in 2015 to at least 70% of full-time employees those working an average of 30 hours or more a week are liable for a $2,000 per employee penalty. In 2016, the penalty applies to employers with at least 50 employees and coverage has to be offered to at least 95% of employees.

Employees not enrolled in a health care plan are liable in 2015 for a penalty of $325 or 2% of income, whichever is greater.

Employers that had to offer coverage to more employees were braced for a bump in enrollment this year, Tracy Watts, a senior partner and national leader for health reform in Mercers Washington office said in a statement.

One reason, Mercer believes, that employers did not see enrollment growth is that some employees opted out of coverage from their employers and instead enrolled in Medicaid.

The health care reform law gave states funds to expand Medicaid to more lower-income individuals, and about two dozen states took advantage of that offer.

According to the Mercer survey, 14% of respondents with 5,000 or more employees said they believe some employees who previously opted for coverage now waived it and instead enrolled in Medicaid.

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Health care plan enrollments steady despite reform law

At the front line of health care

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At the front line of health care

Becoming a nurse has been a life changing decision for Uputaua Suniula, as she battles not only to help patients, but also to prevent health problems from developing in the first place.

One of the problems we face is that teenagers and children dont come in to see a doctor till theyre really sick, Uputaua says.

What couldve been addressed in the clinic instead becomes complex, at which point they become an inpatient in the hospital.

Uputaua has worked on the front line of healthcare at both Waitangirua and Poriruas Community Health Service, two of the most challenging areas within Capital & Coasts District Health Board region.

She says that she has found the experience empowering.

The positive impact I can make within the community has been mind blowing, especially working as the first point of contact for people in need, Uputaua says.

My focus is to work with Poriruas young population to help develop prevention strategies that can stop acute presentations of preventable things like asthma and skin infections, reduce the strain on hospital services, as well as lower our overall healthcare costs.

One campaign Uputaua works closely on is the rheumatic fever prevention program in Porirua.

As Uputaua explains, a sore throat is an early indicator of the disease, which can cause a lifetime of heart issues, its all about treating the patient early, before they develop a serious problem.

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At the front line of health care

Khmer, Health Care [TURMERIC INGREDIENTS BRONZE ALMIGHTY PREVENT CANCER] – Video

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Khmer, Health Care [TURMERIC INGREDIENTS BRONZE ALMIGHTY PREVENT CANCER]
Welcome to S.V.P Khmer Comedy channel You would like to funny watching in my channel in Cambodia Language such as [Comedy Funny] [Concert] [Health and Fitness] [Non Music] [RFA...

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Khmer, Health Care [TURMERIC INGREDIENTS BRONZE ALMIGHTY PREVENT CANCER] - Video

Obama launches new effort for veteran’s administration reform – Video

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Obama launches new effort for veteran #39;s administration reform
President Obama is back at the White House after visiting the VA Medical Center in Phoenix yesterday. It was at that medical center that the scandal erupted last spring, over long delays for...

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Obama launches new effort for veteran's administration reform - Video

Meet Dr. Sandhya Nagubadi, Internal Medicine – Advocate Health Care – Video

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Meet Dr. Sandhya Nagubadi, Internal Medicine - Advocate Health Care
Learn how Dr. Sandhya Nagubadi and her practice provide convenient and quality care to their patients. https://www.advocatehealth.com/body_full.cfm?id=13 action=detail ref=1298118.

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Meet Dr. Sandhya Nagubadi, Internal Medicine - Advocate Health Care - Video

Health care files a rich trove for identity thieves

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The 80 million-person Anthem Inc. data breach jeopardized the identities of more than 750,000 Pennsylvanians, including 51,867 Highmark customers notified by letter last week.

It also reminded the information security world that health records subject to strict privacy requirements are a rich target for hackers.

The value of personal financial and health records is two or three times [the value of financial information alone], because theres so many more opportunities for fraud, said David Dimond, chief technology officer of EMC Healthcare, a Massachusetts-based technology provider. Combine a Social Security number, birth date and some health history, and a thief can open credit accounts plus bill insurers or the government for fictitious medical care, he noted.

Hackers also can comb through clinical information, looking for material to blackmail wealthy or powerful patients, added John Christiansen, a Seattle-based health care technology attorney.

While Pittsburgh hasnt seen a massive breach of health information, technologists for area hospitals and insurers arent feeling smug as the data maze becomes more byzantine.

The data is in a lot of different places, said John Houston, UPMCs vice president of privacy and information security. Its very complicated.

Breaches up

Even before hackers took data held by Indianapolis-based Anthem including some referencing customers of other Blue Cross Blue Shield affiliates treated in Anthems territory health care data breaches involving 500 or more patients were trending up.

In 2011 and 2012, combined, there were 458 big breaches involving a total of 14.7 million people, according to the federal Department of Health and Human Services. In 2013 and 2014, there were 528 involving 19 million people. Around 10 percent of breaches stem from hacking, while around half are physical thefts of records or computers. The rest are inadvertent losses, unauthorized disclosures or improper disposals of health information.

In April 2014, a Highmark employee wrongly mailed out names, addresses, phone numbers, dates of birth, genders, medications and health information of 2,589 people. The root cause was failure of a human being to follow policy, and the solution was more training, Highmark chief privacy officer Lisa Martinelli said.

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Health care files a rich trove for identity thieves

New sign-up under health care law gets lukewarm reception

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WASHINGTON (AP) - Several million people hit with new federal fines for going without health insurance are getting a second chance to sign up, and that could ease the sting of rising penalties for being uninsured.

But after the enrollment window reopened Sunday, its unclear how many know about the time-limited opportunity, let alone are taking advantage of it.

Fines payable to the IRS are the stick behind the offer of taxpayer-subsidized private insurance under President Barack Obamas health care law. Virtually everyone in the country is now required to have coverage through an employer or a government program, or by buying individual policies.

This is the first year fines are being collected from uninsured people the government deems able to afford coverage. Tax preparation company H&R; Block says the penalty averages about $170 among its affected customers. It usually is deducted from a persons tax refund.

Those penalized are mainly the kind of people the law was intended to help: low- and middle-income workers who do not have coverage on the job or are self-employed. Roughly 4 million people are expected to pay fines, according to congressional estimates. Many more will qualify for exemptions.

Travel agent Charles Baxter of Phoenix said his tax refund was reduced by $247 for being uninsured in 2014. He had not heard about the second chance to sign up for 2015 coverage.

Baxter says he will take another look now, but is not sure whether he will opt to buy insurance. Much of his income goes to help take care of his mother, who has health problems.

I may have to see if any of the health care costs have changed, to where I might be able to squeeze it in, he said. But so far, its not looking like it.

Baxter supports the overall goals of the health law, but says the government should also look at someones expenses - not just income - before assessing the fine.

Penalties for being uninsured are going up this year, to a minimum of $325 for the full 12 months. Thats a significant increase from the $95 minimum in 2014.

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New sign-up under health care law gets lukewarm reception

House, Senate health-care funding disagreement shapes budget talks

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TALLAHASSEE | A disagreement between the Florida House and Senate over health-care funding and Medicaid expansion could foreshadow a budget showdown that leaves hospitals and health clinics vulnerable.

The Senate is including in its budget a plan to use federal Medicaid expansion dollars to provide health coverage to roughly 1 million poor Floridians. The conservative House has blocked similar proposals for the past two years.

However, the House does hope to include about $2 billion in its budget to continue the Low-Income Pool, or LIP, a separate Medicaid program that is set to expire in June. State and federal officials are in discussion about how to keep LIP money flowing for another year or longer, but nothing has been agreed upon.

UF Health Jacksonville, a hospital perpetually on shaky financial ground, receives nearly $95 million from the program each year in addition to $26 million directly from the city budget that would also be in jeopardy if LIP goes away because of the lost incentive of a federal match. It and other safety net hospitals around the state are main beneficiaries of the program.

The Florida Senate has said the uncertainty around LIP makes it even more important to fight for Medicaid expansion and the roughly $50 billion in federal dollars that would come with it over the next decade.

These are Florida dollars; they dont come out of the ground in Washington, D.C., they come out of our pockets in the state of Florida, and we deserve to have them back here, Sen. Bill Galvano, R-Bradenton, said Tuesday when the Health Policy Committee unanimously approved the Medicaid expansion plan. And I assure you and I assure the Florida House that this will be the cornerstone of our 15-16 budget.

While the business and health-care industries are in support of the Senates health care proposal, conservative organizations like Americans for Prosperity and the James Madison Institute are opposed. These groups have singled out the simultaneous debate about LIP as reason why the federal government cant be trusted to keep its long-term promise to shoulder the majority of the costs of Medicaid expansion.

The U.S. Department of Health and Human Services has said that LIP cannot continue in its current form, causing some conservatives to interpret it is a veiled threat that the program would be allowed to expire and leave safety net hospitals that depend on the money in a lurch.

Our concern is anytime you take $50 billion from the federal government, youre asking for trouble, and we see that illustratively with the LIP funding, JMI President and chief executive Bob McClure said during the committee meeting.

Because of time constraints, the public comment period was abbreviated, and McClure wasnt able to read his entire prepared remarks. That statement gives even more insight to the connections he makes between the LIP extension and Medicaid expansion debates.

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House, Senate health-care funding disagreement shapes budget talks

Research calls for new policies to support women veterans' health care needs

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Special issue of Medical Care presents findings from VA's women's health researchers

March 16, 2015 - As more women veterans seek health care in the Veterans Administration (VA) system, effective approaches are needed to ensure that their unique needs are recognized and met. A special April supplement to Medical Care collects new studies from an ongoing research initiative to inform health care policy for women veterans. The journal is published by Wolters Kluwer.

"The goal of this supplement is to disseminate new research findings related to the planning, organization, financing, provision, evaluation and improvement of health services and/or outcomes for women veterans and women actively serving in the military," according to an introductory editorial. Guest Editors for the special issue were drawn from the VA Women's Health Research Network, led by Lori A. Bastian, MD, MPH, of the VA Connecticut Healthcare System, West Haven. The supplement was sponsored by the VA Health Services Research & Development (HSR&D) Service in the Office of Research and Development.

Research to Guide Policy on Health Care for Women Veterans

The number of women veterans receiving care in the VA system has more than doubled, making it essential to understand and introduce system-wide policies to meet their health care needs. The 21 studies in the special issue provide new data to guide policy in areas identified by the VA HSR&D Service's Women's Health Research agenda, including:

A final section on using research evidence to transform women veterans' health and health care identifies "top priority recommendations" for providing gender-sensitive care in each area of comprehensive women's health care. These recommendations can help to guide quality improvement efforts, but will require "multi-level engagement of a broad array of key stakeholders."

In an editorial, David Atkins, MD, MPH, and Linda Lipson, MA, of the HSR&D Service highlight important issues for further research in the wake of the 2014 Veterans Choice Act, which broadens veterans' access to health care services. Kristin Mattocks, PhD, of VA Central Western Massachusetts, Leeds, discusses the policy challenges of coordinating care for women veterans using dual health care systems--both inside and outside the VA.

Elizabeth M. Yano, PhD, MSPH, of the VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy reports on the Women's Health Collaborative Research to Advance Transformation and Excellence (CREATE)--a new "partnered research initiative" seeking to accelerate the implementation of comprehensive care for women veterans. The guest editors conclude, "Researchers should continue to engage in effective partnerships with clinical and administrative leaders within the VA to ensure that research is fully capable of informing improvements in clinical care and advancing evidence-based policy," the editors conclude.

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Research calls for new policies to support women veterans' health care needs


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