Nurses Union Will Keep Fighting for Medicare for All

Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter�s appeal to single payer advocates to �bury the hatchet,� recently published in The Nation, is both misdirected and shortsighted.

Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.

But there are some gaping holes in this thinking.

First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don�t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.

Second, let�s not have illusions about the history of the ACA.

Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.

So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It’s one reason so many people vote against their own interests.

To get any hearing from Sen. Max Baucus, who was running the Senate side of the debate, nurses, doctors, and single-payer healthcare activists had to get arrested in a Senate Finance Committee hearing. On the House side, Democrats who proposed single payer amendments endured heavy-handed threats from then-White House chief of staff Rahm Emanuel. Meanwhile, then-Press Secretary Robert Gibbs publicly attacked the �professional left� who will only �be satisfied when we have Canadian healthcare and we�ve eliminated the Pentagon.�

It should not come as a surprise that negotiating with your supporters before engaging political opposition, and lecturing, hectoring and seeking to silence healthcare activists who have worked for years for real reform, Obama and the Democrats ended up with a weaker bill. That bill lacked the public option HCAN and other liberals had claimed would be their bottom line, while HCAN and other liberals embraced the individual mandate � the brainchild of the right-wing Heritage Foundation � as high principle.

Even with its positive elements � yes, it does have some � the Affordable Care Act uses public money to pad insurance profits (the subsidies to buy private insurance), prevents the government from using its clout to limit price gouging by the pharmaceutical giants, does little to effectively control rising healthcare costs for individuals and families that have made medical bankruptcies and self-rationing of care a national disgrace, and falls far short of the goal of universal coverage.

We can, as Michael Moore has said, acknowledge that the Supreme Court decision was a defeat for the opponents of any reform of our healthcare system without pretending that our nation�s health care crisis is over.

For three weeks in June and July, the California Nurses Association/National Nurses United sponsored a tour that drew about 1,000 people to free basic health screenings and another 2,000 to town hall meetings in big cities and rural communities across California. We heard a lot of stories like this one, from Carolyn Travao of Fresno:

I worked for Aetna health insurance for 15 years. When I took early retirement, I thought my Cobra would be manageable. Then they sent me a bill in January for $1,300 a month and I couldn�t pay it.

Soon after,

I had a heart attack. I knew I didn�t have health insurance. I have a mortgage. I had a 401(k) that I knew would get wiped out, so I didn�t go to the hospital. I stayed at home for 16 hours, suffering chest pains, praying that I would die because my son would be left homeless and I do have insurance to pay off my mortgage so if I die he would at least have a home. I couldn�t take the pain any longer and I kept passing out, and he kept saying “Mom, you�re going to die.”

�OK,” I said, “take me to emergency.” So we went to emergency. But when I got home, my bill was $135,000. I have $13,000 left in my 401k. I don�t think I can even start [paying]. I never thought I would lay there and want to die. But I would have rather died knowing that my son would be left homeless with no job.

Since the ACA�s cost control mechanisms for insurance companies are so weak � for example permitting insurers to charge far more based on age and where you live � and hospitals will still largely have free reign to impose un-payable bills, will Carolyn and millions like her really have guaranteed healthcare under the ACA?

Sadly, nurses who have seen far too many patients like Carolyn know the answer all too well. That is why nurses and our organization will never stop fighting for guaranteed healthcare based on a single standard of quality care for all that is not based on ability to pay and is not premised on protecting the profits of healthcare corporations that long ago wrote off patients like Carolyn Travao.

Unlike Wendell Potter and many of the liberals, nurses see the ACA as a floor, not a ceiling. It�s time now for those who say they recognize its limitations and believe in genuinely universal healthcare to join us in pushing for an improved and expanded Medicare for all.

Nurses respect the president. But they love their patients far too much not to go the distance for their patients� health and survival.

Health Insurance Prices For Women Set To Drop

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Women pay extra for the coverage, but not for much longer.

Any woman who has bought health insurance on her own probably didn't find herself humming the old show tune, "I Enjoy Being a Girl." That's because more than 90 percent of individual plans charge women higher premiums than men for the same coverage, a practice known as gender rating.

Women spend $1 billion more annually on their health insurance premiums than they would if they were men because of gender rating, according to a recent report by the National Women's Law Center.

Under the health care overhaul, the practice is banned starting in 2014. But according to the Kaiser Family Foundation'sApril health tracking poll, only 35 percent of people are aware of this fact. (Kaiser Health News is an editorially independent program of the foundation.)

 

Like or loathe the recent Supreme Court decision that the law is constitutional, most people support leveling the premium playing field for women and men. Overall, 6 in 10 people have a favorable view of that provision, according to the poll, including 74 percent of Democrats, 59 percent of independents and 51 percent of Republicans.

Insurers charge women more because they tend to be bigger consumers of health care than men, in part because they're the ones who get pregnant and give birth.

The health law permits insurers to vary premiums based on four factors: individual vs. family enrollment, age, where the insured people live and tobacco use. That formula will be a substantial change over current practice under which, for example, the NWLC report found that more than half of individual plans charged a 40-year-old woman who doesn't smoke more than a 40-year-old man who does.

Texas Gov. Perry Says No To Medicaid Expansion

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Any doubt, and there probably wasn't much, that Texas would reject an expansion of Medicaid under the big federal health law was dispelled today.

The Supreme Court decision on the Patient Protection and Affordable Care Act allows states to opt out of the expansion without losing all federal Medicaid funding. Only the federal money that would have gone toward the expansion is affected.

Texas Republican Gov. Rick Perry wrote in a letter to Health and Human Services Secretary Kathleen Sebelius that he was joining "the growing chorus of governors who reject the PPACA power grab."

The Medicaid expansion "would simply enlarge a broken system that is already financially unsustainable," he wrote. "Expanding it as the PPACA provides would only exacerbate the failure of the current system, and would threaten even Texas with financial ruin."

 

About 1 in 4 Texans has no health insurance. And if Medicaid had been expanded as the federal law originally planned, more than 1.7 million people in the state were expected to get coverage.

As Heard On All Things Considered heard on All Things Considered

July 9, 2012

Texas Rejects Medicaid Expansion In Health Law [4 min 30 sec] Add to Playlist Download  

Under the law, people with an annual income up to 133 percent of the federal poverty line would qualify for Medicaid.

Perry had telegraphed the move. "The cost of this bill to the states is going to be absolutely stunning," Perry said last week on CNBC's Squawk Box. "We don't believe it's right and we know it's going to basically bankrupt the states."

He was on the cable show when Florida Gov. Rick Scott co-hosting. Scott gave a thumbs down to Medicaid expansion and taking part in the insurance exchanges.

Like Florida, Texas also won't come up with its own insurance exchange.

And some states, including Maine, are now looking at whether they can use the Supreme Court's recent decision to roll back some required benefits.

Staph Infections Tied To Misuse Of Drug Vials

Sean Locke/iStockphoto.com

Misuse of a medical vials can spread infections.

Ten people were hospitalized and one was found dead after contracting staph infections from injections received at health clinics in Delaware and Arizona in early spring, according the Center for Disease Control and Prevention.

The infection clusters were described in the latest Morbidity and Mortality Weekly Report.

Seven people were infected at a Delaware orthopedic clinic and four people at a pain management clinic in Arizona after receiving injections from drug vials intended for use with a single patient but that were instead used multiple times, the report and state health officials said.

Patients at the Arizona clinic were infected with methicillin-resistant Staphylococcus aureus, or MRSA, and patients in both outbreaks were hospitalized.

 

One patient was found dead at home six days after receiving treatment at the Arizona clinic, but the report says Arizona officials didn't declare MRSA the official cause of death.

The outbreaks are two of 20 that have been caused by misuse of single-dose vials since safety standards were reinforced in 2007, according to the CDC.

Needles or syringes weren't reused in either clinic, according to Arizona and Delaware state health officials, unlike a high-profile series of hepatitis C infections at a clinic in Las Vegas a few years back. But vials containing drugs intended for one person were used multiple times.

Drugs in single-use vials lack preservatives that prevent the growth of bacteria and subsequent spread of infections between people, CDC spokeswoman Rosa Herrera told Shots.

Health workers sometimes reuse vials when the amount of medicine they contain exceeds the dose needed for a single patient. One factor in the Delaware outbreak was a national shortage of single-dose vials of the anesthetic bupivacaine.

"Medications come in very large vials, but they're often only approved for use in one person," Herrera said. "Health care providers see that as waste. There's a desire to use what you've paid for. And they don't understand that they're putting their patients at risk."

Herrera said CDC is urging clinics dealing with shortages to split doses safely in pharmacies � not where patients receive treatment.

Of the ten patients hospitalized, the stays ranged from three to 41 days. One patient treated in Arizona also needed long-term care, according to the report.

According to Delaware and Arizona health officials, both clinics remain in operation.

Medicare for all CA Bus tour: In West Covina Tonight SiCKO ‘Sisters’ Reunite

What: SiCKO Reunion on final summer 2012 Medicare for all bus tour in California
When: Thursday, July 12 � health screenings 3-6 pm, and town hall at 6:30 pm
Where: West Covina City Hall, 1444 W Garvey Ave

Today in West Covina, the California Nurses Association summer 2012 Medicare for all bus tour will come to a close. After visiting 18 other California cities since June 19, the nurses will wrap up this run with a bang and with clarity. Three of the subjects of Michael Moore�s 2007 documentary film SiCKO will be on hand to help lead others in sharing their stories of struggle and frustration with the broken healthcare system.

The American SiCKOs reunited in Philadelphia in June. Pictured are Anne Moore, Molly Hardesty-Moore, Reggie Cervantes, Dawnelle Keys, Julie Pierce, Tracy Pierce, Jr., Michael Moore, Adrian Campbell-Montgomery, Eric Weinrib, Larry and Donna Smith, Lee Einer.

9/11 first responder Reggie Cervantes and Dawnelle Keys, the mother whose toddler died because she was denied treatment at an out-of-network hospital, will join me at this final stop where the nurses will perform health screenings from 3 � 6 p.m. and then we�ll have a town hall meeting from 6:30 � 8 p.m. My husband and I lost everything we had worked a lifetime to achieve when we got sick even though we always carried health insurance.

Five years ago, when SiCKO was released, the nurses of CNA went to Sacramento with Michael Moore to call attention to the pain Californians were needlessly suffering at the hands of the dysfunctional system. On this fifth anniversary of the film�s release, this West Covina reunion of some of the American SICKOs will help highlight how far we have yet to go and what these women have to say about the current healthcare law � the Affordable Care Act � just upheld by the Supreme Court and the subject of so much political gamesmanship. These SiCKO patients will share what it means to real people, real Californians. And that�s what this tour has been all about.

Don�t come planning to sit unengaged through a lengthy program. Come ready to become a part of what moves California and the nation to a place where there are no more SiCKOs like me or Reggie or Dawnelle. See you in West Covina. And don�t think because this tour is almost a wrap that the nurses are finished. They won�t be done until every patient is treated under a system that includes a single standard of high quality care for all � a guaranteed, improved Medicare for all system.

A Dozen States Already Showing Leadership on Health Insurance Marketplaces

Because of the Supreme Court�s clear and final decision upholding the Affordable Care Act, middle class families and small businesses have greater security when it comes to health care � they can keep their current coverage or, if they need to or want to, search for new, affordable insurance options. In 2014, we can look forward to new state-based health insurance marketplaces, called Affordable Insurance Exchanges, where consumers can compare health care plans and choose a private health plan that meets their needs. Across the country, a dozen states have committed in recent weeks that they will lead efforts to create these Exchanges.

There is no one-size-fits-all approach, and each state has the opportunity to tailor its Exchange to meet its citizens� needs. States have the flexibility to decide whether to build a state Exchange, work with other states, or partner with the federal government. The Department of Health and Human Services (HHS) is committed to flexibility in our support of the states� progress in whatever route they choose, as well as providing planning and implementation funds to help the states to establish the marketplace that suits their residents� needs.

We have already begun to hear from governors on their states� commitment to establishing these one-stop-shop marketplaces.

As Rhode Island Governor Lincoln D. Chafee noted in his letter, he signed an executive order in September 2011 to begin work on an Exchange, an effort he says �will provide Rhode Island families and small businesses with access to more affordable, high quality health insurance coverage.�

Maryland Governor Martin O�Malley wrote that Maryland�s state-based Exchange is �well underway and we continue to make significant progress with strong support from the state�s political leadership and broad-based stakeholder community.�

Even though the official deadline is November 16, I have already received letters from a dozen states representing nearly one-third of all Americans committing to establishing an exchange. Letters have come from:

California Gov. Edmund G. Brown, Jr.Colorado Gov. John W. HickenlooperConnecticut Gov. Dannel P. MalloyHawaii Gov. Neil Abercrombie.Maryland Gov. Martin O�MalleyMassachusetts Gov. Deval L. PatrickMinnesota Gov. Mark DaytonNew York Gov. Andrew M. CuomoOregon Gov. John A. Kitzhaber, M.D.Rhode Island Gov. Lincoln D. ChafeeVermont Gov. Peter ShumlinWashington Gov. Christine O. Gregoire

I appreciate the hard work many states have engaged in over the past months to begin laying the foundations for the Exchanges, and HHS will be as flexible as possible to help them get over the finish line by 2014. Just late last month, I announced the availability of additional funds to help the states deliver these new health insurance marketplaces, and, as many governors had requested, they will now have until the end of 2014 to apply for the funds. And on January 1, 2014, consumers in every state will have access to an exchange.

As President Obama said after the Supreme Court ruling, it is time to move forward. Since the health care reform law was passed two years ago, we have worked closely with states to begin building these Exchanges where Americans will be able to choose private health insurance plans based on price and quality�and we will continue to work side-by-side with the states to provide the health care quality and security that our citizens need and deserve.

You can read and download the Governors' letters on Exchanges here.

Memphis AFL-CIO Labor Council Endorses HR 676

From UnionsForSinglePayer.org –

Irvin Calliste, President, Memphis AFL-CIO Labor Council, reports that the council has endorsed HR 676, national single payer health care legislation sponsored by Congressman John Conyers (D-MI).

Memphis Congressman Steve Cohen is one of the 76 co-sponsors of this legislation which is also called “Expanded and Improved Medicare for All.”

The Memphis council is the third one in Tennessee to endorse HR 676. The Knoxville-Oak Ridge Area and the Nashville and Middle Tennessee labor councils, as well as the Tennessee AFL-CIO, did so earlier.

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S.

In the current Congress, HR 676 has 76 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 593 union organizations including 142 Central Labor Councils and Area Labor Federations and 40 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV
& MA).

For further information, a list of union endorsers, or a sample endorsement resolution, go to UnionsForSinglePayer.org.

Staph Infections Tied To Misuse Of Drug Vials

Sean Locke/iStockphoto.com

Misuse of a medical vials can spread infections.

Ten people were hospitalized and one was found dead after contracting staph infections from injections received at health clinics in Delaware and Arizona in early spring, according the Center for Disease Control and Prevention.

The infection clusters were described in the latest Morbidity and Mortality Weekly Report.

Seven people were infected at a Delaware orthopedic clinic and four people at a pain management clinic in Arizona after receiving injections from drug vials intended for use with a single patient but that were instead used multiple times, the report and state health officials said.

Patients at the Arizona clinic were infected with methicillin-resistant Staphylococcus aureus, or MRSA, and patients in both outbreaks were hospitalized.

 

One patient was found dead at home six days after receiving treatment at the Arizona clinic, but the report says Arizona officials didn't declare MRSA the official cause of death.

The outbreaks are two of 20 that have been caused by misuse of single-dose vials since safety standards were reinforced in 2007, according to the CDC.

Needles or syringes weren't reused in either clinic, according to Arizona and Delaware state health officials, unlike a high-profile series of hepatitis C infections at a clinic in Las Vegas a few years back. But vials containing drugs intended for one person were used multiple times.

Drugs in single-use vials lack preservatives that prevent the growth of bacteria and subsequent spread of infections between people, CDC spokeswoman Rosa Herrera told Shots.

Health workers sometimes reuse vials when the amount of medicine they contain exceeds the dose needed for a single patient. One factor in the Delaware outbreak was a national shortage of single-dose vials of the anesthetic bupivacaine.

"Medications come in very large vials, but they're often only approved for use in one person," Herrera said. "Health care providers see that as waste. There's a desire to use what you've paid for. And they don't understand that they're putting their patients at risk."

Herrera said CDC is urging clinics dealing with shortages to split doses safely in pharmacies � not where patients receive treatment.

Of the ten patients hospitalized, the stays ranged from three to 41 days. One patient treated in Arizona also needed long-term care, according to the report.

According to Delaware and Arizona health officials, both clinics remain in operation.

From seat belts to drug monitoring, states can cut injuries

Millions of injuries could be prevented every year if states adopted and enforced a set of laws and health policies with proven track records for saving lives, says a report out Tuesday, but many states are reluctant to do so when personal freedoms are at stake and as revenue continues to decline.

Injuries are the leading cause of death for Americans between the ages of 1 and 44, and the third leading cause of death overall. About 50 million Americans get medical treatment for injuries every year. Yet 24 states have enacted five or fewer of 10 injury-prevention measures examined in the report, by the Trust for America's Health and the Robert Wood Johnson Foundation. It's online at healthyamericans.org.

"We have a long way to go to get uniform coverage to protect more people across the country," says co-author Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy in Baltimore. "We hope the report moves states and communities to do more. These are common-sense measures that could prevent many injuries and save lives if people were aware of them and supportive of them."

No state has approved all 10 measures, which range from seat belt laws to sports concussion safety laws, drug monitoring, and laws related to teen dating violence. But California and New York scored the highest, with nine each. Montana and Ohio scored lowest, with two each.

"We know injuries are preventable and we'd certainly rather prevent them than deal with the aftermath, which often results in death or long-term disability," says Linda Degutis, director of the Centers for Disease Control and Prevention's Injury Center, which is not associated with the report. "Having certain laws in place helps people follow a safe strategy."

There are impediments. "Some states see requiring people to wear seat belts as a threat to personal liberty," says Jonathan Adkins, spokesman for the Governors Highway Safety Association. "Others see it as a way to allow racial profiling, meaning the police could use it as an excuse to pull anyone over."

But clearly, primary seat belt laws send the strongest signal and are very effective." Primary seat belt laws allow police to issue tickets for not wearing a seat belt without any other traffic offense. Secondary seat belt laws allow police to issue tickets for not wearing a seat belt only if another traffic offense has been committed.

The two groups worked with a committee of top injury-prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Prevention to develop the list of 10 safety measures.

Among the findings of the report, online at healthyamericans.org:

�18 states do not have primary seat belt laws. Seat belts have saved an estimated 69,000 lives from 2006 to 2010. In states that have switched from secondary seat belt laws to primary laws, fatal injuries have declined 9%, Degutis says.

�34 states and Washington, D.C., do not require mandatory ignition interlocks for convicted drunk drivers. Every day about 30 people die in the USA in car crashes that involve an alcohol-impaired driver, according to the Centers for Disease Control and Prevention.

�31 states do not require helmets for all motorcycle riders. Helmets have saved the lives of about 8,000 people from 2005 to 2009.

�29 states do not require bicycle helmets for children. "Not everyone can afford helmets for their children and it's important for children to get exercise in light of all the concern about childhood obesity," Gielen says. "Sometimes communities can help out by raising awareness and taking action. It doesn't all have to be done by the states."

�17 states do not require that children ride in a car seat or booster seat until at least age 8.

The national rate for injury-related deaths is 57.9 per 100,000, says the report. New Mexico has the highest rate of injury-related deaths in the USA, with 97.8 per 100,000 people, while New Jersey has the lowest rate, at 36.1 per 100,000.

The report also notes only 31 states have full-time injury and violence prevention directors, "limiting injury prevention efforts." Also, federal funding for injury prevention dropped 24% from 2006 to 2011.

The report did not study whether all kinds of injuries are increasing or decreasing over time, but it notes that one kind is soaring.

"The number of prescriptions for pain killers has more than tripled in the past three years and we've also seen a tripling in the number of poisonings," says Jeff Levi, executive director of the Trust for America's Health. "To me that was one of the stunning things to jump out from the numbers."

Among the report's recommendations: every state establish a prescription drug monitoring program.

Adopting that measure and nine others would also greatly reduce health care costs, Levi adds. Every year, injuries generate $406 billion in costs for medical care and lost productivity.

MAP offers HHS recommendations on quality reporting programs

WASHINGTON – The Measure Applications Partnership (MAP) has issued two new reports to the Department of Health and Human Services, presenting quality measurement strategies for hospitals that specialize in cancer care and for hospice and palliative care providers.

MAP is a multi-stakeholder public-private group convened in 2011 by the National Quality Forum (NQF) to provide guidance on measures for use in public reporting, performance-based payment and other performance measurement programs. These two reports are the latest in a series of several quality measurement coordination strategies authored by the group, officials say.

The recommendations in both areas are spurred by new legal requirements. With regard to hospice and palliative care, the Patient Protection and Affordable Care Act (ACA) creates the Medicare Hospice Quality Measurement Program, which requires hospice programs to publicly report quality data beginning in 2014 or incur a financial penalty. Hospice care is a Medicare benefit in the last six months of life.

Likewise, the ACA stipulates that 11 hospitals that specialize in cancer care, called PPS-Exempt Cancer Hospitals, must begin to publicly report quality data in 2014, although with no financial penalty or incentive attached to the reporting activity. These specialty cancer hospitals have been exempt from the Medicare Prospective Payment System (PPS) because their narrow focus on cancer care does not lend itself to the payment program as designed. As a result, they have not been required to participate in federal quality reporting programs that now apply to most other hospitals.

"These measurement strategies are geared toward improving the care of patients grappling with serious and complex healthcare issues," says Elizabeth McGlynn, co-chair of the MAP coordinating committee. "The new public reporting programs, and MAP's reports, are part of a broader effort to ensure that measurement-driven quality improvement and accountability are being applied across the spectrum of the healthcare system."

Both new reports emphasize the importance of measuring components of care that patients and their families find meaningful. This includes surveying patients about their experiences of care, assessing quality of life, evaluating pain and symptom management, and tracking whether each patient has a care plan that signals their preferences, is kept updated, and is being honored. Patients seeking hospice care at the end of life, for example, often choose to avoid unwanted medical procedures and trips to the hospital. Targeted measures can and should assess these dimensions of care, MAP recommends.

The reports also emphasize the importance of measuring how well patients transition from one care setting or type of provider to another – for example, from a hospital to a nursing home or care provided in their own homes. Such "hand-offs" occur frequently for cancer and seriously ill patients and often expose patients and their families to fragmented care from providers who are not communicating – at all or well – with each other. In both new reports, MAP emphasizes that performance measures should evaluate patients' full experiences as they move through the healthcare system, as treatment received in one setting may impact the course of treatment received in another.

"These reports represent an important step toward ensuring that patients who are seriously or terminally ill receive care that addresses all their needs and is being carefully evaluated through standardized measurement programs," says Carol Raphael, chair of the MAP post-acute care/long-term care workgroup.

In each new report, MAP identifies a "core set" of specific quality measures it believes can be applied immediately or quickly adopted to care at PPS-exempt cancer hospitals or to hospice and palliative care services. In addition, the group notes significant areas where no or few measures exist, signaling opportunities for the measure development community to step in to fill important gaps.

In its recommendations for cancer care, for example, MAP stresses the importance of survival data to patients' decision-making on both treatments and providers. It advises that survival data presented to patients and families include information on the specific type and stage of cancer.

"Clear and comparable information on survival rates can be critical to cancer patients and their families making very tough choices at an emotional time," says Frank Opelka, MD, chair of the MAP Hospital Workgroup.

In its report on hospice and palliative care services, MAP notes that many who qualify for the Medicare hospice care benefit either fail to make use of it or do so for a shorter period than the Medicare benefit allows. As a result, MAP advises measuring the degree to which patients have access to, and are well informed about, the alternatives of hospice and palliative care.

"Consistent with its past work, MAP's new reports further expand our thinking about what's important to measure and improve in healthcare in addition to the actual clinical outcomes of care," says George Isham, MD, co-chair of the MAP coordinating committee. "We need to be especially vigilant about how fully and well informed patients are as they move through a complex system, especially if they have life-threatening illnesses or are terminally ill."

The full Performance Measurement Coordination Strategy for PPS-Exempt Cancer Hospitals and Performance Measurement Coordination Strategy for Hospice and Palliative Care reports are available here.

Glen Campbell serenades Congress at Alzheimer's event

WASHINGTON�Ashley Campbell has the dream of any young musician: to belong to a band making a worldwide tour. Yet her dream has a sad twang to it. Her father is singer Glen Campbell, who went public last June with his diagnosis of Alzheimer's disease.

Campbell, 75, has spent the past year trying to raise awareness about the disease, an incurable, brain-wasting illness that affects 5.4 million people in the USA. That number is expected to triple as the Baby Boomers age.

Ashley Campbell, 25, and two of her siblings have joined their dad onstage as his backup band during his Goodbye Tour. The band was back together here Wednesday night at the Library of Congress for a special performance for members of Congress, put on by the Alzheimer's Association to raise awareness about the disease.

"I think music is therapeutic for him," says Ashley, who plays banjo in the band. "He's definitely sharper when he's on tour than if he's sitting home or playing golf. That's when I see him slipping. But if he can put that guitar in his hands and use his fingers to pick music, he's much better.

"Sometimes he'll get confused when he's singing and might forget some lyrics, but that's when the teleprompter helps him out. And he's not the only musician to use one of those. Not by far."

Ashley says her dad loves the crowds at the concerts � and the feeling seems to be mutual.

"The first night of the tour, I couldn't get over it," she says. "He got the rowdiest standing ovation when he came onstage. People were so supportive of him. I thought maybe it was just because it was the first night.

"Until the next night, when it happened again. And the next night, and the next night."

She says that at a concert before they came to Washington, her dad started singing Rhinestone Cowboy, and a man approached the stage from the crowd.

"He shouted, 'You are a hero, Glen. You are a hero, man.' "

Ashley says music was always part of their household when she was growing up. She played piano and guitar until she got to college. Then she discovered the banjo and bluegrass music.

"Banjo is my instrument now," she says. "When I would play at home, my dad would stand up and say, 'Well, look at you. You're really good on that. You are fantastic.' "

He asks her to invite her friends over, and they play bluegrass music together.

Before the Library of Congress performance, she talked about how important it is for her father to keep doing what he enjoys and to help spread the word about the need to find a cure for Alzheimer's.

"People like Glen Campbell and (basketball coach) Pat Summitt, who are using their voices to advocate for the disease, know it's not going to help them," but it may help others, says Angela Geiger, chief strategy officer for the Alzhiemer's Association. "That takes a special kind of courage."

The sound of courage Wednesday night rocked a jammed auditorium that holds several hundred.

The audience stood and cheered when Campbell came out onstage.

"Thank you," he responded. "I appreciate all of you."

Then he broke into one of his famous songs, Gentle on My Mind, and sang about the "rivers of my mind."

A guitar lick he hit to perfection sent the audience into loud applause again.

"It's important for people to know you can keep doing what you want, that life doesn't end right away when you get Alzheimer's," Ashley says.

Backstage, the adulation continued as Campbell signed autographs.

The Goodbye Tour continues through July.

Walmart clinics go live with the cloud

BENTONVILLE, AR – It's about to get a bit cloudy for Walmart retail stores. Instead of bringing rain, however, these clouds are precipitating something much more promising: The retail giant announced it has gone live with cloud-based technology in its health clinics.

Dubbed Smart Care Doc, this technology, provided by BCS Global Networks Limited and Telemed Ventures, will enable remote video consultations between a patient and doctor through a virtual face-to-face video interface, over a secure video network. Users of the service have the ability to conduct telepresence-quality face-to-face interactions over the Internet using existing laptops, smartphones or tablets – making it a very affordable and accessibly solution for patients, doctors and healthcare providers.

“We’ve extended the doctor visits over the internet," said Darrell Jennings, COO of Telemed Ventures. "Many companies have done the video and audio part of it, but not many companies have done the diagnostics, the integration part."

Patients receive all the benefits of a traditional doctor’s visit that they've come to expect: the ability to see a doctor instead of a less experienced practitioner, engaging the doctor in a face-to-face dialogue about medical issues, predictable/transparent pricing options, and the accurate acquisition of vitals and health information.

“My focus has always been to improve quality, enhance access, and lower cost of healthcare delivery by leveraging technology,” said Telemed Ventures founder and CEO, Raj Shah, MD. “The cost of healthcare has been spiraling in the U.S., yet we rank 19th in the world in healthcare outcomes. Our Smart Care Doc retail locations deliver an office visit for 40 to 50 percent less than the fee for traditional office visits by integrating diagnostic medical devices with a world class video network.”

“Getting healthcare to the right people and the right time is key," added Clive Sawkins, CEO of BCS Global. "And technology over the years has been able to help with that. Being able to deliver medical expertise at the right price point and at the right level of comfort for the patient is what we want overall.”

Suffering and Dying for Healthcare in Las Vegas

By Donna Smith–

Happy Easter everyone. Happy season of new life and blooming flowers. It�s the season of rebirth and regeneration. So, if that�s the case, then what the hell is up with letting thousands of people wait and suffer and die because we do not have the money to treat their illnesses anymore? In Las Vegas. It�s Vegas, baby. But it could be Sioux City or Boston or even Missoula. It is the reality of our national healthcare disgrace in America.

If you watched CBS�s �60 Minutes� on Sunday, April 4, then you saw the same horrifying story I did. Budget cuts had to be made at the county hospital in the recession, the hospital CEO said. Outpatient chemotherapy clinic is closed. Letters go out to the patients. Treatment ends. People suffer with growing tumors, broken bones from metastasized cancers; people suffer to breathe. The budget is cut. It�s horrifying stuff this national disgrace. (If you didn�t see it, you can watch it here.)

Want a chocolate Easter egg? How about some jelly beans in a basket?

Meanwhile, a young mom and cancer patient in Las Vegas goes untreated� she worked and had insurance until she got too sick. Then, well, you know the drill by now. She�s dying. She�s suffering. She even had her hospital bed repossessed. She�s one of us. She is me. She is you. She is your child. And she is just one of thousands who got the letters telling them their treatments were ending. Done. No more care.

And now there is no bail-out for her or for any of us if we�re in her shoes. Where�s her bail-out? No one is even talking that way or thinking that way. Healthcare reform is on their radar, they say. We�ll get it done this year, they proudly exclaim. Meanwhile, this woman suffers. Another person dies. What is there to be proud of?

Could this Congress act now on our behalf, please? There is a war against humanity going on in these United States. My Congress and my President are to be keeping me safe and secure in my home. But so long as they know of these lethal abuses within the healthcare system, they are not honoring their commitments to me. Or to you.

This isn�t Iraq or Afghanistan. It�s Las Vegas.

We could see swift action, if we had lawmakers who saw this as an attack on our citizens. For instance, there could be a moratorium on any patient having cancer treatment discontinued due to budget cuts or insurance company bottom lines. Clean and clear. No more letters cutting off treatment. While they dance their political dances on the long-term policy, could they please act as if we�re under attack? Because we are. People are being put to death through budget cuts and profit-margins, and many are getting less care than is guaranteed a prisoner under our set of laws protecting those who are incarcerated.

Yet we sit in calm meetings in Washington, DC, — and we argue about who sits in the White House forums and who does not — and in other venues around the nation trying to decide if the political impact of health reform plans will harm re-election chances for our favorite elected friends or make the insurance or big corporate hospital interests upset with our lawmakers. Blah, blah, blah� while another dozen or score or more die. Cancer doesn�t wait for anyone to decide who is in and who is out.

Happy Easter. The season celebrating the risen prince of peace isn�t so damn peaceful for people on the wrong side of the recession. Especially people with cancer.

I just want that young woman and the thousands of others in her same inexcusable situation in these United States to know we�re fighting for what is just� healthcare is indeed a human right. Health insurance will not get us there � it can be lost, it can be changed, it can be inadequate, it can be denied and it can be dishonored.

But healthcare is a human right. It is not a political football. I pray we have the strength to do what is right and just, publicly funded and privately delivered healthcare � and do it now � because doing less would not be what we are all about as people. We are better than this.

During Easter and every season, we are better people than this. I know we are because we still have the ability to be horrified when a young mother in Las Vegas suffers needlessly. I hope she takes her place in heaven knowing we cared. Happy Easter, Yolanda Coleman. May God somehow make your pain a little less severe today. I am sorry you have hurt so badly during this time. You deserved better.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Fewer antibiotics prescribed for children

The number of antibiotic prescriptions for kids declined 14% from 2002 to 2010, but antibiotics remain the most frequently prescribed drugs for pediatric patients, a federal analysis finds.

Antibiotics accounted for about a quarter of all pediatric prescriptions; amoxicillin leads the list.

Overall, 263.6 million prescriptions were written for patients 17 and under in 2010, down 7% from 2002, finds the analysis of prescription claims databases by Food and Drug Administration researchers, published today in the journal Pediatrics. By comparison, 3.3 billion were dispensed for ages 18 and up, 22% more than in 2002.

The medical community has made "an enormous effort to decrease antibiotic use" for kids in the past decade "by educating parents about the futility of treating viral infections with antibiotics" and about antibiotic resistance, the FDA study says.

Those efforts "are succeeding to some extent," but this study and others show antibiotic overuse "is still a big problem," says Adam Hersh, assistant professor of pediatric infectious diseases at the University of Utah. He says overuse of azithromycin and other broad-spectrum antibiotics "is contributing to the epidemic of antibiotic-resistant infections."

Other drug categories down from 2002-2010 were allergy medications (61%); pain (14%); and cough/cold without expectorant (42%). But prescriptions increasing include corticosteroids for asthma (14%); contraceptives (up 93%, possibly because of secondary uses, such as acne) and attention deficit hyperactivity disorder (46%).

"It's good news that cough and cold prescriptions are down, given that they don't work and can have serious side effects," says Danny Benjamin, a professor of pediatric medicine at Duke University. In 2008, the FDA advised against them for the youngest children. But he says the rise in prescriptions for ADHD and off-label use of proton pump inhibitors for certain gastrointestinal disorders is worrisome. Safety of long-term ADHD drugs is unknown, he says. The study cites 358,000 outpatient prescriptions for lansoprazole (Prevacid) for infants, despite labeling that it is not effective in babies under 1 year.