Thursday, July 30, 2015

Health Care and Black Lung

One of the most serious diseases that exists has been dreaded primarily by coal miners, and by those exposed to mining industries. Coal workers' pneumoconiosis (CWP), also known as black lung disease or black lung, is caused by long exposure to coal dust. It is common in coal miners and others who work with coal.

It is similar to both silicosis from inhaling silica dust, and to the long-term effects of tobacco smoking. Inhaled coal dust progressively builds up in the lungs and is unable to be removed by the body; this leads to inflammation, fibrosis, and in worse cases, necrosis.

Like all occupational diseases, black lung is man-made and can be prevented, according to the United Mine Workers. In fact, the U.S. Congress ordered black lung to be eradicated from the coal industry in 1969. Today, it is estimated that 1500 former coal miners each year die an agonizing death in often isolated rural communities, away from the spotlight of publicity. More details about the legislation to help miners with this disease can be found at this site: http://www.umwa.org/?q=content/black-lung .

According to the American Lung Association (ALA), there is no known treatment for pneumoconiosis, but doctors treat the symptoms and complications of the disease. People who work in jobs where they are exposed to coal dust get pneumoconiosis. This includes working in a coal mine or loading coal for storage, working in a graphite mine or mill, and manufacturing carbon electrodes and carbon black. Carbon electrodes are used in some large furnaces, and carbon black is used in tires and other rubber goods, as well as many other products.

People who inhale coal dust may not have any symptoms for many years, according to the ALA. Over time, however, as the coal dust has settled deep in the lung, it eventually causes the lung to harden. As the lung hardens, breathing becomes more difficult and gets worse over time. Possible complications of pneumoconiosis include:

·         Cor pulmonale (failure of the right side of the heart)
·         Lung cancer
·         Pulmonary tuberculosis
·         Respiratory failure

Pneumoconiosis (Black Lung) is not treatable or curable. How severe each person's disease becomes is the result of the conditions of his or her work during exposure to coal dust. More details can be located at this website: http://www.lung.org/lung-disease/pneumoconiosis/ .

According to the US Department of Labor, the Division of Coal Mine Workers' Compensation, or Federal Black Lung Program, administers claims filed under the Black Lung Benefits Act. The Act provides compensation to coal miners who are totally disabled by pneumoconiosis arising out of coal mine employment, and to survivors of coal miners whose deaths are attributable to the disease. The Act also provides eligible miners with medical coverage for the treatment of lung diseases related to pneumoconiosis.

The Division of Coal Mine Workers' Compensation has published a notice of proposed rulemaking (NPRM) to address several issues that have arisen in administering and adjudicating claims under the Black Lung Benefits Act. The proposed regulations would:

·         Require parties to disclose medical information about the miner developed in connection with a benefits claim.

·         Clarify a liable coal mine operator’s obligation to pay benefits during post-award modification proceedings.

·         Clarify that a supplemental report from an examining physician is a continuation of the physician’s earlier report for purposes of the evidence-limiting rules.

The NPRM was published in the Federal Register on April 29, 2015. The public may submit comments on the proposed rule online at www.regulations.gov (follow the instructions on that web site) or by the other methods set forth in the NPRM. More material about this is located at this site: http://www.dol.gov/owcp/dcmwc/ and at this website: http://www.msha.gov/endblacklung/ .

According to the National Institutes for Health (NIH), your risk of getting coal worker's pneumoconiosis depends on how long you have been around coal dust. Most people with this disease are older than 50. Smoking does not increase your risk of developing this disease, but it may have an additional harmful effect on the lungs. If coal worker's pneumoconiosis occurs with rheumatoid arthritis, it is called Caplan syndrome.

The doctor will do a physical exam and listen to your lungs with a stethoscope. A chest x-ray or chest CT scan will be performed. You may also need lung function tests.  Wear a protective mask when working around coal, graphite, or man-made carbon. Companies should enforce the maximum permitted dust levels. Avoid smoking. You should avoid further exposure to the dust. Details can be sourced at this website: http://www.nlm.nih.gov/medlineplus/ency/article/000130.htm .

Although the overall percentage of Americans are not typically affected with this disease, there are many who are. Follow the recommendations of your health care provider. There are also financial resources available to assist you if you have developed the disease and are permanently disabled as a result. Be careful if you are in this industry.


Until next time.

Monday, July 27, 2015

Health Care and Spring Water

Earlier this Summer, companies that bottle spring water were forced to recall millions of plastic bottles of water filled with water collected at a natural spring. According to ABC News, Niagara Bottling said that one of its spring sources has a "positive indication" of E. coli, which the company said indicates that the water may be contaminated with human or animal wastes.

The company said it didn't receive any reports of illness or injury. E. coli microbes can cause diarrhea, cramps, nausea, headaches, or other symptoms, the company said, and may pose a greater risk for infants, young children, some of the elderly and people with severely compromised immune systems. More information about this healthcare issue can be found at this website: http://abcnews.go.com/Business/check-bottled-water-recalled-due-coli/story?id=31963480

The recalled water was sold under the brand names of Acadia, Acme, Big Y, Best Yet, 7-11, Niagara, Nature's Place, Pricerite, Superchill, Morning Fresh, Shaws, Shoprite, Western Beef Blue and Wegmans. ACME Markets, which operates supermarkets in Delaware, Maryland, New Jersey and Pennsylvania, was among the supermarket chains announcing involvement in the recall. Among others were Shaws grocery stores in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont; and Wegmans in Maryland, Massachusetts, New Jersey, New York, Pennsylvania and Virginia.

According to Mother Jones, while many spring water brands started out selling water from a single source, a large portion now draw from multiple springs, even though they don't often tout that fact. The original springs are insufficient in part because demand has grown to the point where the quantity of water available from these natural springs isn't enough. For others, the springs have been over pumped, or the groundwater levels dropped and caused them to dry up.

There are a few rules that bottled-water brands have to follow, however. In order to be called "spring water," according to the EPA, a product has to be either "collected at the point where water flows naturally to the earth's surface or from a borehole that taps into the underground source." Unlike the term "spring water," other terms like "glacier water" or "mountain water" aren't regulated and "may not indicate that the water is necessarily from a pristine area," according to the EPA. 

But, despite spending over $11 billion per year on bottled water, most Americans don't know much about the origins of these beverages. More info can be found at this site: http://www.motherjones.com/environment/2013/03/bottled-water-poland-spring-rubio .

According to the Livestrong Foundation, bottled water is increasingly common, with Americans drinking more than 2 billion gallons of it each year. With the large variety of different types of water on the market, it can be confusing to know the difference between one and the other. Spring water and purified water come from two different sources, and in many cases, are as safe as tap water for drinking, although personal preference often determines they type of water chosen.

Spring water is also sometimes called artesian water, ground water or well water. Spring water may be accessed by a well, and it can be treated or not. In all cases, spring water is collected when it flows or arrives to the surface. Natural springs can form along the sides of hills and in valleys, and some people consider the natural filtration process of spring water to make for better tasting water that is richer in minerals.

Springs for spring water can form where there is any rock, with limestone being a common case in much of the United States. The soft texture of limestone makes it easy for the water to well through. Springs form when an underground aquifer is filled sufficiently high that the excess seeps through to the surface. While water from springs are often clear because they are filtered through rock, the mineral composition of the soil will affect the color.

As well, spring water can be safe to drink without any treatment, however, the quality of the water is not guaranteed. Bottled spring water is required to be tested and filtered for any sediment to meet EPA standards. More material about spring water can be found at this site: http://www.livestrong.com/article/548249-purified-water-vs-spring-water/

Spring water is the subject of many popular misconceptions. Many of those misconceptions are promoted through less than accurate advertising pitches. For example, many people believe that spring water is actually “pure” water. On the contrary, spring waters contain many of the same impurities found in drilled wells or even tap water. In fact, since springs feed rivers, there’s lots of spring water right in your own tap water! On average, the purity of spring water is roughly comparable to that of tap water. Some have lower TDS levels and some are much higher.

But is spring water “100% pure” as many spring water companies advertise? As it turns out, the “100% pure” refers not to the absence of impurities in the water, but to the source of the water itself. That is, 100% of the water in the bottle came from an underground source (i.e. a spring), rather than from a surface water. These cleverly worded phrases may be legally permissible, but many people find them to be misleading, to say the least.  Even more frightening is the fact that most people actually believe them.

Another adjective which frequently pops up in spring water advertising is “natural”. While this term may conjure up images of a pristine wilderness setting, the fact is that “natural” can mean just about anything. This vague term could actually apply to your local tap water since the closest river to your home or office is most certainly a “natural” source. It may be natural, but how many people who would go down to the river and scoop themselves a refreshing glass of “pure and natural” river water!

Spring water advertising is all about images – images of the mountains, streams and wildlife. What really happens to get that bottle of water to you is actually quite different from those images. Many, if not most, spring waters are not bottled at their source. Instead, the water is pumped into large tanker trucks for transportation to a bottling facility at a different location.

Remember, those “pristine” springs are being visited many times each day by large diesel tanker trucks – not exactly a “pristine” image. Health regulations dictate that the water in those tanker trucks be either chlorinated or ozonated at all times to protect against bacterial contamination. Additional info about this topic is found at this site: http://www.drinkmorewater.com/types-of-water .

At the end of the day, much of what is consumed in the bottled water industry comes down to personal preference and taste. Is spring water better than tap water? Maybe, or maybe not. That is for you to decide, and how much you are willing to spend on your next drink of cold, clear water on the go. If you’re like most Americans, you prefer convenience over cost.


Until next time.

Monday, July 13, 2015

Health Care and UV Safety

The sun can be brutal to your skin, especially during the warmer months of the year. Additionally, protection against its rays is often neglected by most people. According to the US Department of Health and Human Services (HHS), the need to protect your skin from the sun has become very clear over the years, supported by several studies linking overexposure to the sun with skin cancer.

The harmful ultraviolet rays from both the sun and indoor tanning “sunlamps” can cause many other complications besides skin cancer - such as eye problems, a weakened immune system, age spots, wrinkles, and leathery skin. UV rays are their strongest from 10 am to 4 pm Seek shade during those times to ensure the least amount of harmful UV radiation exposure.

When applying sunscreen be sure to reapply to all exposed skin at least 20 minutes before going outside. Reapply sunscreen every two hours, even on cloudy days, and after swimming or sweating, according to the HHS. A significant amount of info can be found at this website: http://www.foh.hhs.gov/calendar/july.html .

As well, according to the University of Washington, UV or ultraviolet lamps are used in biological safety cabinets, light boxes, and cross linkers in many university laboratories and in some patient care rooms. One of the problems in working with UV radiation is that the symptoms of overexposure are not immediately felt so that persons exposed do not realize the hazard until after the damage is done.

The health effects of exposure to UV light are familiar to anyone who has had a sunburn. However, the UV light levels around some UV equipment greatly exceeds the levels found in nature. Acute (short-term) effects include redness or ulceration of the skin. At high levels of exposure, these burns can be serious. For chronic exposures, there is also a cumulative risk of harm. This risk depends upon the amount of exposure during your lifetime. The long-term risk for large cumulative exposure includes premature aging of the skin and even skin cancer.

The eyes are also susceptible to UV damage. Like the skin, the covering of the eye or the cornea, is epithelial tissue, too. The danger to the eye is enhanced by the fact that light can enter from all angles around the eye and not only in the direction you are looking. The lens can also be damaged, but since the cornea acts as a filter, the chances are reduced, according to the University of Washington.

This should not lessen the concern over lens damage however, because cataracts are the direct result of lens damage. Burns to the eyes are usually more painful and serious than a burn to the skin. Make sure your eye protection is appropriate for this work. More info on this type of UV exposure can be found at this site: http://www.ehs.washington.edu/rsononion/uvlight.shtm.

According to the Centers for Disease Control (CDC) protection from ultraviolet (UV) radiation is important all year round, not just during the summer or at the beach. UV rays from the sun can reach you on cloudy and hazy days, as well as bright and sunny days. UV rays also reflect off of surfaces like water, cement, sand, and snow. More details about UV protection can be found at this site: http://www.cdc.gov/cancer/skin/basic_info/prevention.htm .

People who get a lot of exposure to ultraviolet (UV) rays are at greater risk for skin cancer. Sunlight is the main source of UV rays, but you don’t have to avoid the sun completely, according to the American Cancer Society. And it would be unwise to stay inside if it would keep you from being active, because physical activity is important for good health. But getting too much sun can be harmful. There are some steps you can take to limit your exposure to UV rays.

Some people think about sun protection only when they spend a day at the lake, beach, or pool. But sun exposure adds up day after day, and it happens every time you are in the sun. Simply staying in the shade is one of the best ways to limit your UV exposure. If you are going to be in the sun, “Slip! Slop! Slap!® and Wrap” is a catchphrase that can help you remember some of the key steps you can take to protect yourself from UV rays:

·         Slip on a shirt.
·         Slop on sunscreen.
·         Slap on a hat.
·         Wrap on sunglasses to protect the eyes and skin around them.

Children need special attention. They tend to spend more time outdoors, can burn more easily, and may not be aware of the dangers. Parents and other caregivers should protect children from excess sun exposure by using the steps above. It’s important, particularly in sunnier parts of the world, to cover your children as fully as is reasonable. You should develop the habit of using sunscreen on exposed skin for yourself and your children whenever you go outdoors and may be exposed to large amounts of sunlight.

Children need to be taught about the dangers of too much sun exposure as they become more independent. If you or your child burns easily, be extra careful to cover up, limit exposure, and apply sunscreen. Many more details about UV safety can also be located at this site: http://www.cancer.org/cancer/cancercauses/sunanduvexposure/skincancerpreventionandearlydetection/skin-cancer-prevention-and-early-detection-u-v-protection .

According to the American Academy of Opthalmology, growths on the eye, such as pterygium, can show up in your teens or twenties, especially in surfers, skiers, fishermen, farmers, or anyone who spends long hours under the mid-day sun or in the UV-intense conditions found near rivers, oceans, and mountains. Diseases like cataract and eye cancers can take many years to develop, but each time you are out in the sun without protection you could be adding damage that adds to your risks for these serious disorders.

Additionally, as you sleep, your eyes enjoy continuous lubrication. During sleep the eyes also clear out irritants such as dust, allergens or smoke that may have accumulated during the day. Some research suggests that light sensitive cells in the eye are important in your ability to regulate wake-sleep cycles.

This may be more critical as you age, when more people have problems with insomnia. While it's important that you protect your eyes from overexposure to UV light, your eyes also need minimal exposure to natural light every day to help maintain normal sleep-wake cycles. More information on this topic can be found at this website: http://www.geteyesmart.org/eyesmart/living/sun.cfm .

July, which is UV Safety Month, and August are a great time to spread the message about sun, fun, and UV safety to the community. Be careful.


Until next time. 

Monday, June 29, 2015

Health Care and Poison Control

As Summer starts, one key element of health care during these months is poison control. In 2013, America’s 55 poison centers received over 3.1 million calls, and about 2.2 million of those were for poison exposures including carbon monoxide, food poisoning, snake bites, and many more. The remainder of those calls consisted of people asking general information about poison, according to the AAPCC.  

The American Association of Poison Control Centers supports the nation’s 55 poison centers in their efforts  to prevent and treat poison exposures. These locations offer free and confidential medical advice 24/7 through the toll free poison help line at 800-222-1222. This service provides a primary source for information about poisoning and helps reduce costly emergency room visits through in-home treatment in non-emergency situations.

According to the Texas Poison Center Network, in years past, if your child swallowed some type of poison, you wouldn't think twice about using Ipecac to induce vomiting. Today, Poison Centers would never recommend Ipecac. However, many online sources still vouch for its effectiveness. In a panic, people often click on the first seemingly reputable option online.

Every second counts when it comes to poisoning. The longer it takes to look through pages of search results online, the greater the danger of negative health effects. A mistreated poison exposure can escalate an easy in-home treatment into a trip to the hospital. 

Because factors like weight, height, medical history, and in some cases even geography can drastically change the outcome of a poison exposure, it's vital that poisonings are handled on a case-by- case basis. Poison Center experts are the only reliable source for accurate medical recommendations regarding poisons.  

Calling a Poison Center is like calling a really smart, caring family member, minus the judgment and gossip-spreading. The voice on the other end of the line is a medical professional who has undergone years of training and rigorous testing just to qualify to answer your questions. In fact, 20 percent of calls are from doctors, nurses and other health care professionals who are seeking specialized treatment advice. More info can be found at this site: http://www.poisoncontrol.org/ .

However, there are a great number of poisonings that happen that never result in an initial call to a poison control center. In 2010 there were 42,917 deaths attributed to poison, yet poison centers were consulted in 1,730 poisoning fatalities (only 4%).  The CDC estimated that there were 1,098,880 poisoning injuries in 2010 that resulted in a visit to an emergency department. 

Yet, poison centers were involved in only 601,197 cases that involved treatment at a health care facility, indicating that poison centers are not consulted for many poisoning-related ED visits.  Poisonings also go unreported when people do not realize they have been exposed, choose not to seek medical treatment or advice, do not have access to medical care, or do not know about poison center services.

In 2013, the National Capital Poison Center provided consultations for 54,534 callers from the DC metro area.  Sixty-nine percent (38,197) were about people exposed to a poison. Other consultations involved pet poisonings (1,566) and information requests (14,771).  Some interesting facts include: 
·         Most poison exposures (77%) were unintentional.  The Center also received calls about other types of poisonings: medication side effects, substance abuse, malicious poisonings, and suicide attempts. 
·         14,771 people (27%) called for poison-related information. Their questions were about possible problems with medication interactions, pesticide use, workplace chemicals, the safety of specific medications while breast-feeding, and many more topics.
·         44% of poison exposures involved children younger than six, but the most serious cases occurred in adolescents and adults.
·         55% of poison exposures involved medications; other exposures were to household or automotive products, plants, mushrooms, pesticides, animal bites and stings.
·         75% of poison exposures involved people who swallowed a drug or poison. People were also poisoned by inhalation and through exposures to the skin or eyes.
·         65% of poison exposures were safely managed over the phone and did not need medical treatment in a health care facility. However, 82% of those who called a poison center first, before going to a health care facility were safety treated at home. This number increases to 90% for pediatric poisonings when the Poison Center is consulted first, before other medical intervention is sought.

Although these specific stats are for the Metro DC area, they are indicative of the general types of poisonings that happen nationwide. More info about this topic and other associated details can be found at this site: http://www.poison.org/ .

What should you do in an event regarding a poisoning?  REMAIN CALM. For UNCONSCIOUS patients, CONVULSIONS, or any DIFFICULTY BREATHING, call 9-1-1. Otherwise call the Poison Control Center TOLL FREE NUMBER.

Information the Poison Center Specialist Will Need:
·         AGE and WEIGHT of the person.
·         WHAT was ingested. Have the bottle or container with you.
·         HOW MUCH was taken. This will help the Poison Center Specialist determine the severity of the incident.
·         HOW the victim is feeling or acting right now.
·         Your NAME and PHONE number.

Here are some safety tips:

·         EYE - Flood the eye with lukewarm water Repeat for 15 minutes. Encourage patient to blink while flushing the eye. Do not force the eyelid open.
·         SWALLOWED MEDICINE - Do not give anything by mouth until calling for advice
·         CHEMICAL OR HOUSEHOLD PRODUCTS - Unless patient is unconscious, having convulsions, or cannot swallow - give a small amount of water. Then call for professional advice to find out if patient should be made to vomit. Do NOT induce vomiting unless recommended by your physician or the Poison Center.
·         INHALED - Immediately get patient to fresh air. Avoid breathing fumes. Open doors and windows. If victim is not breathing, call for help and start assisted (mouth-to-mouth) breathing.
·         SKIN - Remove contaminated clothing and flood skin with water for 15 minutes. Then wash gently with soap and water and rinse. 

Here are some preventive safety tips, according to www.calpoison.org :
How Can You Prevent Poisonings?
Medicines
·         Use only child resistant covers.
·         Keep in locked cabinets.
·         Return to safe storage immediately after use.
·         Always measure dose - don't guess.
·         Never tell children that medicine is candy.
·         Never take medicine in front of children. They often imitate adults.
·         Keep all purses out of your child's reach. They may contain medicines or other items that could harm a child.

Disposal of Medicines
·         Old, unused and expired prescription and over the counter medication should not be kept
·         Always be careful to remove and/or destroy all personal information on the medication container
·         Wrap medication containers in a thick paper bag or plastic bag that can be closed and place in the trash
·         Place medicines in the trash just before pick-up so that children and animals don’t get to it
·         Tablets and capsules can be crushed or melted in water and mixed with kitty litter, coffee grounds, sand or other kitchen garbage, put in a plastic bag and thrown away
·         Some cities and counties in California have drop-off sites that you can take your medication to, call your county's hazardous waste collection center to find out
·         Flushing medication down the toilet is discouraged and it is better to try one of the other ways listed above, but keeping the home safe by removing old and unused medication is most important

Household Products:
·         Select products with child resistant covers.
·         Keep in locked cabinets.
·         Return to safe storage immediately after use.
·         Store products and food in separate areas.
·         Keep products in original containers. Never put them into food or beverage containers.
·         Don't turn your back on a child when a product is within reach. If the phone or doorbell rings, take the child with you.

Plants:
·         Know the names of all your plants and which ones are poisonous.
·         Keep all plants out of the reach of small children.
·         Teach children not to put any part of plants in their mouths.

Poisonings are going to happen. Some are life threatening, but all of them are dangerous. Take time to review your house and other areas you frequent. Practice safety wherever you are regarding poison control. Remember to teach everyone in your household and office good prevention for poison control. Keep your doctor’s phone number handy, and always call 911 if you have an emergency.


Until next time. 

Tuesday, May 26, 2015

Health Care and Medicaid

One of the most difficult health care issues facing America today is Medicaid, the state run public healthcare assistance program for people who are poor. The technical description of Medicaid is that is a federal program that provides health coverage to nearly 60 million children, families, pregnant women, the elderly, and people with disabilities, and it is administered at the state level. Medicaid covers US citizens and eligible immigrants.

All States provide Medicaid to infants and children under age 6 with family incomes up to 133% of the federal poverty level, or FPL. Medicaid is available in every state for children under age 19 with family incomes up to 100% of the FPL. For a family or household of 4 persons living in one of the 48 contiguous states or the District of Columbia, the poverty guideline for 2015 is $33,465 if your state is expanding Medicaid. Separate poverty guideline figures are developed for Alaska and Hawaii, and different guidelines may apply to the Territories.

Medicaid pays for a full set of services for children, including preventive care, immunizations, screening and treatment of health conditions, doctor and hospital visits, and vision and dental care. In most cases, these services are provided at no cost to families.

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program, according to CMS, the Centers for Medicare and Medicaid Services.

States are not required to participate in the program, although all currently do. Medicaid recipients must be U.S. citizens or legal permanent residents, and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.

The Patient Protection and Affordable Care Act significantly expanded both eligibility for and federal funding of Medicaid. Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program.

However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius that states do not have to agree to this expansion in order to continue to receive previously established levels of Medicaid funding, and many states have chosen to continue with pre-ACA funding levels and eligibility standards.

According to the Kaiser Family Foundation (KFF), Medicaid is the nation’s main public health insurance program for people with low income and the single largest source of public health coverage in the U.S. covering nearly 70 million Americans. States design and administer their own Medicaid programs within federal requirements, and states and the federal government finance the program jointly. Medicaid plays many roles in our health care system.

Medicaid coverage facilitates access to care for beneficiaries, covering a wide range of benefits and tightly limiting out-of-pocket costs for care. As a major payer, Medicaid is a core source of financing for safety-net hospitals and health centers that serve low-income communities, including many of the uninsured. It is also the main source of coverage and financing for both nursing home and community-based long-term care. Altogether, Medicaid finances 16% of total personal health spending in the U.S.

There are, of course, a number of arguments against expanding Medicaid, according to the Atlantic Magazine. While the federal government would pick up much of the immediate cost of the new enrollees, it sticks states with 10 percent of the tab after 2020. A 2014 study found that people use emergency rooms more, not less, once they enroll in Medicaid, somewhat undermining the argument that the expansion would funnel more people toward cheaper primary-care doctors. (Though it’s worth noting that people tend to use all sorts of healthcare more — not just ERs —once they get insured.) And physicians are indeed reluctant to accept Medicaid: Its lower reimbursement rates mean that more than a third of doctors won’t see new Medicaid patients, a shortage that is especially acute among specialists.

Studies on Medicaid’s health benefits show mixed results. One Urban Institute paper found that Medicaid provides its beneficiaries with similar access to care as employer-sponsored insurance, except at a lower cost for the individual. For example, patients would spend more than four times as much on out-of-pocket medical expenses if they were uninsured, and three times as much if they had employer insurance, as they do with Medicaid.

Meanwhile, another New England Journal of Medicine (NEJM) study that looked at Oregon residents who won a Medicaid lottery found that getting coverage generated no significant improvements in cholesterol or hypertension in the first two years. It did, however, encourage people to go to the doctor more, raised their rates of diabetes detection and management, lowered rates of depression, and reduced financial strain. A NEJM study also found that states that had previously expanded Medicaid saw a 6.1 percent reduction in the death rate among adults younger than 65. While critics of Medicaid point out the program’s spotty record of saving money or alleviating certain health conditions, its proponents say that many of its shortcomings apply to Medicare and private insurance as well.

According to KFF, as of March 2015, 22 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2015 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible.

Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits.

Nationally, nearly four million poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would have been newly-eligible for Medicaid had their state chosen to expand coverage. Nationally, 43% of uninsured adults in the coverage gap are White non-Hispanics, 24% are Hispanic, and 27% are Black.

The ACA Medicaid expansion was designed to address the high uninsured rates among adults living below poverty, providing a coverage option for people who had limited access to employer coverage and limited income to purchase coverage on their own. However, with many states opting not to implement the Medicaid expansion, millions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage: they are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own. A significant amount of info on Medicaid can be found at this site: http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/ .

Medicaid is a very expensive program to maintain and administer. And, at some future date, there is a tipping point where it won’t be sustainable or a viable option for states or the federal government. Not to mention, physician drop out in Medicaid is increasing at a greater rate since the Affordable Care Act negotiated reimbursements in the past few years.

What are the options? Charitable organizations are one option, and they are going to need to increase their work in communities affected by the lack of income based families who can afford insurance. Another option would be to engage individuals in financial counseling and income opportunities. States should develop programs to assist those adults capable of working to find better employment options, and educational programs should be developed in partnership with community organizations to provide job skills and training.

Although Medicaid is a way to help families and individuals receive a limited form of health care, it is not the end all answer. More work needs to be done by all stakeholders to improve the financial wellness of those with limited incomes to move beyond the FPL, and to encourage the health care community to lessen access the restrictions to all types of medical care. Certainly, Medicaid should be seen more as a stop gap measure versus the lifestyle it perpetuates.


Until next time. 

Thursday, May 14, 2015

Healthcare and Prescription Adherence

Individuals who take medications, especially seniors or those with chronic health issues, are supposed to be taking their prescriptions on regularly scheduled intervals. One of the most critical issues that health plans and medical providers face is the lack of prescription adherence. 

Taking your medications as prescribed is very important to your overall health regimen. Doctors are constantly dealing with patients who either refuse or forget to stay on track. As a consequence, many people suffer from problems related to the lack of consistency with their medications.

Prescription adherence is especially severe with anyone who has a maintenance medication, and does not maintain their adherence due to various reasons—cost, memory, fear, and other excuses. Medication adherence usually refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication.

Medication non-adherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care, according to the American Heart Association. It’s very important in cardiovascular care. For more details, read material at this website: http://circ.ahajournals.org/content/119/23/3028.full .

People do not realize the real damage or consequences of non-adherence, according to the American Heart Association. When patients with chronic conditions such as cardiovascular disease do not take medication as directed, the repercussions can be severe. For instance, not keeping blood pressure in check can lead to heart disease, stroke, and kidney failure.

In sum, poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations. There are many reasons why people are not able to take their medication as directed.
·         They may forget.
·         They may not be convinced of the medication’s effectiveness or be unsure that it is working.
·         They may fear the side effects or have difficulty taking the medication (especially with injections or inhalers).

And we all know that the rising cost of prescription medications is a barrier for many.
Some may face a combination of these reasons for not taking their medications. One person may face different barriers at different times as he or she manages his or her condition. Whatever the reason, you could miss out on potential benefits, quality of life improvements, and could lose protection against future illness or serious health complications. Much more detailed material on this subject can be located at this site: http://www.heart.org/HEARTORG/Conditions/More/ConsumerHealthCare/Medication-Adherence---Taking-Your-Meds-as-Directed_UCM_453329_Article.jsp

According to the American College of Preventive Medicine (ACPM), poor adherence to prescribed medication is associated with reduced treatment benefits and can obscure the clinician’s assessment of therapeutic effectiveness. Non-adherence is thought to account for 30% to 50% of treatment failures. Non-adherence leads to worse medical treatment outcomes, higher and avoidable hospitalization rates, institutionalization for the frail elderly, and increased healthcare costs.

Physicians play an integral role in medication adherence. Patients who trust their physicians have better two-way communication with their physician. Trust and communication are two elements critical in optimizing adherence. Numerous studies show that physician trust is more important than treatment satisfaction in predicting adherence to prescribed therapy and overall satisfaction with care. Physician trust correlates positively with acceptance of new medications, intention to follow physician instructions, perceived effectiveness of care, and improvements in self-reported health status.

A recent meta-analysis of physician communication and patient adherence to treatment found that there is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well, according to the ACPM. Statistically, the odds of patient adherence are 2.26 times higher if a physician communicates well. This translates into more than 183 million medical visits that need not take place if strong interpersonal physician/patient communication occurs.
Communication contributes to a patient’s understanding of illness and the risks and benefits of treatment. Hence, the major challenge is to improve:
  • Verbal and nonverbal communication (patient-centered care)
  • Interviewing skills (improved competency)
  • Discussions and provide greater transmission of information (task-oriented behavior)
  • Continuous expressions of empathy and concern (psychosocial behavior)
  • Partnerships and participatory decision-making (patient-centered care)
Among significantly more detailed information and additional statistics located at this website:  http://www.acpm.org/?MedAdherTT_ClinRef , a challenge to improve adherence is clearly stated. Poor adherence to medical treatment is widespread and well recognized, as are its consequences of poor health outcomes and increased healthcare costs. Lack of prescription adherence is estimated to annually cause 125,000 deaths. Consider these other statistics:
  • Overall, about 20% to 50% of patients are non-adherent to medical therapy.
  • People with chronic conditions only take about half of their prescribed medicine. 
  • Adherence to treatment regimens for high blood pressures is estimated to be between 50 and 70 percent. 
  • 1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year.
    • Underuse of anticoagulant therapy for prevention of thromboembolism is attributed to the risk factors of younger age, male gender, low overall stroke risk, poor cognitive function, homelessness, higher educational attainment, employment and reluctant receptivity of medical information.
  • Rates of adherence have not changed much in the last 3 decades, despite WHO and Institute of Medicine (IOM) improvement goals.
  • Overall satisfaction of care is not typically a determining factor in medication adherence
  • Adherence drops when there are long waiting times at clinics or long time lapses between appointments.
  • Patients with psychiatric disabilities are less likely to be compliant.
According to a new national poll by Greenberg Quinlan Rosner Research and Public Opinion Strategies, 40 percent of American adults suffer from some form of chronic illness, ranging from diabetes and cancer to heart disease and high blood pressure. In recent years, however, lack of regular adherence to medications has resulted in higher health care costs and an increase in the prevalence of chronic conditions that directly impact patient health. In fact, nine out of ten patients who adhere to their prescription medications describe their health as “good” or “excellent,” while two thirds of patients with poor adherence report the same.

A growing body of evidence suggests that medication adherence programs have the potential to reduce health spending and, in the process, generate significant savings for taxpayers. Policies to promote medication adherence have the potential to improve health and significantly reduce health spending, according to this organization: http://adhereforhealth.org/who-we-are/medication-adherence/ .

There are some tools that can help remind people to take prescriptions. This particular website includes ways to keep track of your medicines, how-to videos about taking your medicine, and tips to help you talk with your doctor or pharmacist about your health problem and your medicine. For more information, go to this site: http://www.scriptyourfuture.org/tools/ .

The average adherence rate (the degree to which patients correctly follow prescription instructions) for medicines taken only once daily is nearly 80%, compared to about 50% for treatments that must be taken 4 times a day. As many as 75% of patients and 50% of chronically ill patients fail to adhere to or comply with physician prescribed treatment regimens.

In a poll (Med Ad News 02/2010) of U.S. individuals 65 years old and older who use medications, researchers found that 51% take at least five different prescription drugs regularly, and one in four take between 10 and 19 pills each day. 57% of those polled admit that they forget to take their medications. Among those using five or more medications, 63% say they forget doses, compared to 51% among those who take fewer medicines. This website offers solutions for products to assist with prescription adherence: http://www.epill.com/statistics.html .

Remembering to take your medicine is the key to compliance. Medicine will be effective only when taken as prescribed by your physician. If you are a caregiver for someone who needs prescriptions taken on a daily basis, your responsibility to help them follow their regimen is especially important. According to the Rosalynn Carter Institute of Georgia Southwestern College, there are 25 million non-professional caregivers in the U.S., and 80% of those are women. Between 80% and 90% of people taking medications receive them from a family member. That’s why it is critical to be adherent to medication therapies.

Prescription adherence is such a huge health care issue in America that Congress is considering ways to mandate options to make it happen better. Organizations that promote adherence are all about education and awareness for the public to know how important the issue is relative to the population at large and the overwhelming costs to the economy. All stakeholders in the medical community--doctors, clinics, hospitals, health plans, pharmacists, etc--are in full stress mode to monitor and maintain the highest degrees of medication adherence.

If you are on regular prescriptions for maintenance medications, keep your schedule intact as much as possible and follow the instructions of your doctor and pharmacist. Even if your medication need is temporary, such as an antibiotic or other short term prescription, follow the directions.  Not only does this help you, but it provides safety and comfort to those around you. Plus, it reduces the possibility of a recurring illness or relapse.


Until next time.