House Republicans on Tuesday unveiled their alternative health reform plan to the current bill (HR 3962) making its way to the House floor by the end of the week. Not surprisingly, House Majority Leader Steny Hoyer (D-MD) called the proposal an "effort to protect the status quo while attempting to disguise them as real healthcare reform."
While the full 230 page alternative is still being tweaked, House Minority Leader John Boehner (R-OH) said Tuesday that its focus is on lowering healthcare costs—as opposed to expanding healthcare coverage. "We first released our healthcare plan in June and over the last six months, we have introduced at least eight bills which taken together would implement this blueprint," he said in his weekly Republican address.
Among the elements of the alternative plan are:
Permitting families and businesses to buy health insurance across state lines.
Allowing individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices as large corporations and labor unions currently do.
Allowing states to implement their own reforms in addressing healthcare costs.
End "junk lawsuits" that contribute to healthcare costs by increasing the number of tests and procedures that physicians sometimes order; these laws would be modeled after laws in California and Texas.
Establishing a "universal access program" to guarantee access to care for those with pre existing conditions and reforming high risk pools and reinsurance programs.
Promoting prevention and wellness by giving employers greater flexibility to financially reward employees who adopt healthier lifestyles.
Creating new incentives to save for future and long term care needs by allowing qualified participants to use health savings accounts to pay premiums.
The Centers for Disease Control and Prevention (CDC) said in a final rule issued Monday that it is amending its regulation to remove "human immunodeficiency virus (HIV) infection" from the list of diseases barring immigrants from entering the U.S., effective Jan. 1, 2010.
Prior to this final rule, individuals with HIV infections seeking to immigrate to or reside in the U.S. were considered to have a communicable disease of "public health significance" and thus were inadmissible to the country per the federal Immigration and Nationality Act.
While HIV infection is a serious health condition, it is no longer considered a communicable disease that poses "a significant public health risk for introduction, transmission, and spread" to the American population through casual contact, according to the CDC.
As a result of this final rule, individuals also will not be required to undergo HIV testing as part of the required medical examination that is part of the American immigration process.
While the U.S. has been a leader worldwide when it comes to ending the stigma of HIV/AIDS, it was only one of 12 countries that still "supported the myth that HIV/AIDS is a threat," said Health and Human Secretary Katharine Sebelius, in a statement.
"It's appropriate that the nation is taking the final step to lift the entry ban as President Obama signed [this past Friday] the fourth reauthorization of the Ryan White CARE Act," Sebelius said. Ryan White, who was 13 years old when he contracted HIV/AIDS, fought against the stigma of HIV/AIDS while he was living.
The ability "to travel freely and have access to affordable healthcare" should be available to everyone, she said.
"This change has been a long-time coming, and I am pleased it is happening now," Sebelius said.
Despite concerns about shortages, cost, and practicality of N95 respirators recommended by the CDC to protect healthcare workers against influenza, a new report says surgical masks, which are cheaper and easier to use, work just as well.
"Infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group," the authors wrote. They concluded that the incidence of laboratory-confirmed influenza was similar in nurses wearing the surgical masks and those wearing the N95 respirators.
The study, by Mark Loeb, MD, and colleagues at McMaster University in Ontario, Canada, is based on a trial of 446 nurses at eight Ontario tertiary care hospitals during the 2008-2009 winter influenza season. Roughly half (225) were assigned to wear surgical masks while 221 were to wear fit-tested N95 respirators.
The report was published today in the Journal of the American Medical Association.
The Ontario study does not resolve the issue by any means. The two groups were said to have equal rates of influenza vaccination and comparable numbers of household members had flu-like symptoms during the study period. The investigators did not compare the groups in terms of their hand hygiene practices, triage procedures or cough etiquette, which could have been influential. Only infection as opposed to illness was measured as the outcome.
In mid-October, the Centers for Disease Control and Prevention re-confirmed guidance that healthcare workers should use "respiratory protection that is at least as protective as a fit-tested disposable N95 respirator" when in close contact with patients with suspected or confirmed 2009 H1N1 influenza." As of yesterday, that guideline was still in place, according to a CDC spokesman.
Confusion about what to do has prevailed in the absence of hard data.
In an editorial published Oct. 1 in the online issue of the JAMA, writers noted the differing opinions on the issue. The World Health Organization and the Society for Healthcare Epidemiology of America, "recommend the use of medical masks for most patient care activities," while the CDC recommends N95 respirators, wrote Arjun Srinivasan, MD of the CDC and Trish M. Perl, MD, of Johns Hopkins University in Baltimore.
And in September, the Institute of Medicine also "supported" the use of N95 respirators."
"A single study will not end the debate over influenza respiratory protection for" healthcare providers, Srinivasan and Perl wrote. "Unfortunately, this intense discussion over respiratory protection has distracted attention from the critical importance of implementing other strategies known to prevent the transmission of influenza in healthcare settings" including vaccination.
Among healthcare providers, influenza vaccination rates remain low at about 45%, the authors wrote.
They closed by writing, "That this study is, to our knowledge, the first and only published randomized trial assessing respiratory protection for preventing influenza transmission is a sad commentary on the state of research in this area."
Guidelines to help the public determine whether or not their H1N1 symptoms warrant a trip to the emergency room were released today by the American College of Emergency Physicians.
The guidelines are a joint effort by ACEP and the Office of the Assistant Secretary for Preparedness and Response and the Emergency Care Coordination Center, which are divisions of HHS.
"Emergency physicians are on the frontlines of this national emergency," said Angela Gardner, MD, president of the 28,000-member ACEP. "People are understandably concerned about contracting the H1N1 virus and confused about when to seek emergency care and when to stay home. That is why we developed a set of guidelines based on symptoms and the patient's overall state of health to help them make that decision."
People who go to the Web site are first asked, "Do you have a fever or feel feverish and have a cough and/or sore throat?" If the answer is "no," then emergency medical care is probably unwarranted.
If the answer is "yes," the guidelines offer a list of symptoms that indicate severe illness that does warrant a visit to the emergency department, such as difficulty breathing, inability to keep liquids down, and changes in behavior.
The guidelines list conditions—pregnancy, chronic heart disease, etc.—that might require a visit to the emergency department if accompanied by fever, cough, and/or sore throat.
"Ultimately, you are probably the best judge of whether to seek emergency care," Gardner says. "If you think you are having an emergency, come see us. We are specialists in diagnosing and treating all kinds of emergencies, including flu. Our doors are open 24 hours a day, every day of the year."
To cut healthcare costs, the Obama administration has advocated moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better. Under that vision, providers would be given a few years to move to performance-based medicine, in which fees and results are published, money is directed to evidence-based therapies, and harmful errors such as preventable infections are reduced. But many are worried that the president's hopes to constrain costs could result in tepid half-measures on Capitol Hill, the Washington Post reports.
Time is running short for Congress to deliver a health bill to President Barack Obama before the end of the year, prompting lawmakers to prepare for the debate to carry into 2010. Senate Majority Leader Harry Reid indicated that the chamber may not meet its goal of passing a bill in the next several weeks, the Wall Street Journal reports.
As part of the healthcare overhaul under consideration by Congress, lawmakers have included provisions intended to shed light on the financial relationships between the medical industry and doctors. The targets are common business practices like drug company payments to doctors for speeches and consulting services, which have the potential to influence patient care and increase medical bills. But if previous attempts by state legislatures, federal agencies, and academic hospitals are any indication, such efforts are all too vulnerable, the New York Times reports.
Moderate lawmakers are exerting their influence in the divided Senate to secure changes to healthcare reform legislation, potentially adding more delays to the bill, the Washington Post reports. Moderates have raised numerous concerns about aspects of the bill, including the public insurance option that included an "opt out" provision for states that don't want to participate. Many moderate Democrats prefer a "trigger" mechanism that would allow government-backed coverage only in states where private insurers fail to offer broadly affordable plans.
Children's Hospital Boston has agreed to limit increases in fees it charges Massachusetts' major health insurers next year as part of a larger push to control the rise in pediatric healthcare costs. In exchange, the three health plans—Blue Cross-Blue Shield, Harvard Pilgrim Health Care, and Tufts Health Plan—along with the state's Medicaid program, will contribute a portion of their savings, about $10 million in total, to a fund that will enable Children's Hospital to accelerate pilot programs aimed at providing better care at lower costs.
Leaders of the University of Miami are complaining strongly about the overall direction of the Jackson Health System and the doctors it is hiring. Phillip George, a plastic surgeon who is chairman of the UM board of trustees, said he was upset about the quality of Jackson's new doctors. "I wouldn't send my family to many of them," he said. The comment came during a summit of leaders of two major South Florida institutions at a time when Miami-Dade County's public health system is struggling with mounting losses—and growing concerns about UM's ambitions since it purchased Cedars Medical Center, reports the Miami Herald.
