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Showing posts with label New York Times. Show all posts
Showing posts with label New York Times. Show all posts

Monday, August 25, 2014

Medicare Star Ratings Allow Nursing Homes to Game the System

Today's post was shared by The New York Times and comes from www.nytimes.com



CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes.
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.
But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.
The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.


The ratings also do not take into account entire sets of...
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Sunday, August 17, 2014

Pharmacies Turn Drugs Into Profits, Pitting Insurers vs. Compounders

Today's post was shared by The New York Times and comes from www.nytimes.com



It may be the biggest thing in diaper rash treatment, a custom-made product to soothe a baby’s bottom at the eye-popping price of $1,600.
This is no Desitin or Balmex, or any other brand found in stores. This cream is blended to order in a pharmacist’s lab.
Does it work better than the common treatments? There is little evidence either way. But the sky-high prices commanded by such compounded medicines are drawing the ire of health insurance companies that must pick up the bill. They say the industry is profiteering at their expense.
Compounded medicines are the Savile Row suits of the pharmacy, made to order when common treatments will not suffice. Pharmacists say it is the doctors who decide what to prescribe. But many pharmacies have standard formulations and some promise six-figure incomes to sales representatives who call on doctors.
Besides the $1,600 ointment to treat diaper rash, there was the $8,500 cream to reduce scarring and the $2,300 salve to relieve pain recently billed to Catamaran, a pharmacy benefits manager. Alarmed that its spending on compounded drugs has quintupled in just two years, Catamaran has begun to review such claims more carefully.


Pharmacy benefit managers owned by UnitedHealth and Blue Cross and Blue Shield plans are also reining in spending on compounded drugs, as are insurers like Harvard Pilgrim and various state workers’ compensation plans.
Express Scripts, the largest pharmacy benefits manager, has said it will stop...
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Monday, July 28, 2014

Inequality Is Not Inevitable

Today's post was shared by Steven Greenhouse and comes from opinionator.blogs.nytimes.com
AN insidious trend has developed over this past third of a century. A country that experienced shared growth after World War II began to tear apart, so much so that when the Great Recession hit in late 2007, one could no longer ignore the fissures that had come to define the American economic landscape. How did this “shining city on a hill” become the advanced country with the greatest level of inequality?
One stream of the extraordinary discussion set in motion by Thomas Piketty’s timely, important book, “Capital in the Twenty-First Century,” has settled on the idea that violent extremes of wealth and income are inherent to capitalism. In this scheme, we should view the decades after World War II — a period of rapidly falling inequality — as an aberration.
This is actually a superficial reading of Mr. Piketty’s work, which provides an institutional context for understanding the deepening of inequality over time. Unfortunately, that part of his analysis received somewhat less attention than the more fatalistic-seeming aspects.
Javier JaƩn
Over the past year and a half, The Great Divide, a series in The New York Times for which I have served as moderator, has also presented a wide range of examples that undermine the notion that there are any truly fundamental laws of capitalism. The dynamics of the imperial capitalism of the 19th century needn’t apply in the democracies of the 21st. We don’t need to have this...
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Monday, July 21, 2014

Part-Time Schedules, Full-Time Headaches

Today's post was shared by Steven Greenhouse and comes from www.nytimes.com

A worker at an apparel store at Woodbury Common, an outlet mall north of New York City, said that even though some part-time employees clamored for more hours, the store had hired more part-timers and cut many workers’ hours to 10 a week from 20.
As soon as a nurse in Illinois arrived for her scheduled 3-to-11 p.m. shift one Christmas Day, hospital officials told her to go home because the patient “census” was low. They also ordered her to remain on call for the next four hours — all unpaid.
An employee at a specialty store in California said his 25-hour-a-week job with wildly fluctuating hours wasn’t enough to live on. But when he asked the store to schedule him between 9 a.m. and 2 p.m. so he could find a second job, the store cut him to 12 hours a week.
These are among the experiences related by New York Times readers in more than 440 responses to an article published in Wednesday’s paper about a fledgling movement in which some states and cities are seeking to limit the harshest effects of increasingly unpredictable and on-call work schedules. Many readers voiced dismay with the volatility of Americans’ work schedules and the inability of many part-timers to cobble together enough hours to support their families.


In a comment that was the most highly recommended by others — 307 of them — a reader going by “pedigrees” wrote that workers were often reviled for not working hard enough or not being educated...
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Friday, July 18, 2014

Documents Show General Motors Kept Silent on Fatal Crashes

Today's post was shared by Steven Greenhouse and comes from www.nytimes.com

The car crash that killed Gene Erickson caught the attention of federal regulators. Why did the Saturn Ion he was traveling in, along a rural Texas road, suddenly swerve into a tree? Why did the air bags fail? General Motors told federal authorities that it could not provide answers.
But only a month earlier, a G.M. engineer had concluded in an internal evaluation that the Ion had most likely lost power, disabling its air bags, according to a subsequent internal investigation commissioned by G.M.
Now, G.M.'s response, as well as its replies to queries in other crashes obtained by The New York Times from the National Highway Traffic Safety Administration, casts doubt on how forthright the automaker was with regulators over a defective ignition switch that G.M. has linked to at least 13 deaths over the last decade.
They provide details for the first time on the issue at the heart of a criminal investigation by the Justice Department: whether G.M., in its interaction with safety regulators, obscured a deadly defect that would also injure perhaps hundreds of people.


The company repeatedly found a way not to answer the simple question from regulators of what led to a crash. In at least three cases of fatal crashes, including the accident that killed Mr. Erickson, G.M. said that it had not assessed the cause. In another fatal crash, G.M. said that attorney-client privilege may have prevented it from answering. And in other cases, the automaker was more blunt, writing, “G.M....
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Tuesday, July 15, 2014

Why Improving Access to Health Care Does Not Save Money

Today's post was shared by The New York Times and comes from www.nytimes.com

One of the oft-repeated arguments in favor of the Affordable Care Act is that it will reduce people’s need for more intensive care by increasing their access to preventive care. For example, people will use the emergency room less often because they will be able to see primary care physicians. Or, they will not develop as many chronic illnesses because they will be properly screened and treated early on. And they will not require significant and invasive care down the line because they will be better managed ahead of time.
Moreover, it is often asserted that these developments will lead to reductions in health care spending. Unfortunately, a growing body of evidence makes the case that this may not be true.
One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost. You can improve one of these – maybe two – but it will almost always result in some other aspect getting worse.


You can make the health care system achieve better outcomes. But that will usually cost more or require some change in access. You can make it cheaper, but access or quality may take a hit. And you can expand access, but that will increase cost or result in some change in quality.
The A.C.A. was primarily about access: making it easier for people to get insurance and the care it allows. The law also tries to make changes that may bend the curve of spending...
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Monday, April 28, 2014

Missing Ingredient on Minimum Wage: A Motivated G.O.P.

Today's post was shared by The New York Times and comes from www.nytimes.com


Photo
WASHINGTON — Each of the three previous presidents — two Republicans, one Democrat — signed an increase in the federal minimum wage.
Given Mr. Obama’s emphasis on income inequality, and the popularity of an increase in opinion polls, you would think he would. But the story of recent increases underscores the indispensable ingredient he so far lacks: a Republican leader strongly motivated to make a deal over the party’s philosophical objections.
In 1989, it was a new Republican in the White House. President George Bush, while campaigning to succeed Ronald Reagan, had promised “a kinder, gentler America.” The Democrats then controlling both houses of Congress set out to take him up on it.
Mr. Bush drove a hard bargain on the minimum wage. He vetoed the first version Congress sent on grounds that it raised the wage by 30 cents an hour too much. But he eventually accepted a two-stage increase to $4.25 an hour on the condition that lawmakers include a lower “training wage” for teenagers.
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President Bill Clinton and the Republican former Senate leader Trent Lott in 2009, 13 years after they forged agreement on a minimum-wage increase.
In 1996, it was a new Republican Senate leader. Trent Lott took over after Bob Dole, then running for president against the incumbent Democrat, Bill Clinton, resigned his Senate seat.
Mr. Clinton, who had battled fiercely with the House speaker, Newt Gingrich, and Mr. Dole,...
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Saturday, February 15, 2014

Apprehensive, Many Doctors Shift to Jobs With Salaries

Workers' Compensation will soon be impacted by the full economic force and effect of The Affordable Care Act. The economics of the costs of the delivery of medical care will soon be the issue that determines whether workers' compensation continues as a viable program. Today's post that is hared from the NYTimes.com highlights the issue.
Dr. Suzanne Salamon, with a patient at Beth Israel Deaconess Medical Center in Boston, said she has had trouble filling a prestigious fellowship because of relatively low salaries. Katherine Taylor for The New York Times
American physicians, worried about changes in the health care market, are streaming into salaried jobs with hospitals. Though the shift from private practice has been most pronounced in primary care, specialists are following.
Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years.
Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists — such as ophthalmologists and ear, nose and throat surgeons — are employees rather than independent, according to the American Medical Association. “We’re seeing it changing fast,” said Mark E. Smith, president of Merritt Hawkins.
Health economists are nearly unanimous that the...
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Monday, February 3, 2014

Goodbye to the Doctor’s White Coat?

Today's post was shared by The New York Times and comes from well.blogs.nytimes.com

A scene from ā€œGreyā€™s Anatomy,ā€ ABC's long-running hospital drama.
A scene from “Grey’s Anatomy,” ABC's long-running hospital drama.
Ron Tom/ABC A scene from “Grey’s Anatomy,” ABC’s long-running hospital drama.
New recommendations on what health care workers should wear may mean an end to the doctor’s white coat.
The Society for Healthcare Epidemiology of America, a professional group whose mission is to prevent and control infections in the medical workplace, has issued guidance on what health care workers should wear outside of the operating room.
The paper, in the February issue of Infection Control and Hospital Epidemiology, suggests that to minimize infection risk, hospitals might want to adopt a “bare below the elbows” policy that includes short sleeves and no wristwatch, jewelry or neckties during contact with patients.
The authors also recommend that if the use of white coats is not entirely abandoned, each doctor should have at least two, worn alternately and laundered frequently. And even if they wear the coat at other times, they should be encouraged to remove it before approaching patients.
The authors emphasize that the recommendations are based more on the biological plausibility of transmitting infection through clothing than on strong scientific evidence, which is limited.
The lead author, Dr. Gonzalo Bearman, a professor of medicine at Virginia Commonwealth University, said that hand washing, bathing patients with antibacterial soap, and checklists for inserting...
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Wednesday, January 29, 2014

In a First, Northwestern Players Seek Unionization

Today's post was shared by The New York Times and comes from www.nytimes.com

The increasingly contentious and complicated relationship between the N.C.A.A. and its top amateur athletes took another step toward a legal showdown on Tuesday when a group of Northwestern football players appealed to the National Labor Relations Board with the first effort by college athletes to join a labor union.

Kain Colter, Northwestern’s starting quarterback last season, was joined by Ramogi Huma, the president of the newly formed College Athletes Players Association, and Leo W. Gerard, the president of United Steelworkers, to announce that a petition had been filed on behalf of Colter and his teammates to seek union representation.

“College athletes need a labor organization that can give them a seat at the table,” Huma said, adding, “This ends a period of 60 years when the N.C.A.A. has knowingly established a pay-for-play system while using terms like ‘student-athlete’ and ‘amateurism’ to skirt labor laws.”

Though payment of players at Football Bowl Subdivision programs and Division I basketball universities has become a thorny issue given the billions of dollars generated by the sports, Colter said medical care, particularly expenses after graduation, was his biggest concern.

“The same medical issues that professional athletes face are...

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Sunday, January 12, 2014

What Do We Know About the Chemical That Just Spilled in West Virginia?

Today's post was shared by Mother Jones and comes from www.motherjones.com

The chemical that leaked yesterday into a West Virginia river "hasn't been studied very well," says Deborah Blum, a New York Times science columnist who specializes in reporting on chemistry.
A state of emergency was declared for nine West Virginia counties yesterday after a chemical called 4-Methylcyclohexane Methanol spilled into the Elk River. The chemical is "used to wash coal of impurities," according to the Times.
The chemical leaked from a holding tank owned by a company called Freedom Industries, according to West Virginia American Water, a water company operating in the region. At present, the nine counties are under a "do not use" advisory from West Virginia American Water, and residents there do not know when they will be able to turn on their taps.
A rush on bottled water subsequently ensued, as documented in this tweet from a local news anchor:
Undoubtedly much more information will emerge on 4-Methylcyclohexane Methanol and how dangerous it is (or isn't) in water. But to start things off we turned to Blum, who was just a guest on our Inquiring Minds podcast.
"We know methanol is toxic, we know that methylcyclohexane is moderately toxic, but I haven't seen a full analysis of the entire formula," says Blum....
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