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.

6 points with regard to regulatory threats and mobile health IT

Not long ago, the American Enterprise Institute (AEI) hosted an event titled, "There's a medical app for that – or not: Regulatory threats to mobile health information technologies." It was an extension of a recent Wall Street Journal article, focusing on the FDA, medical apps and the future of mobile health IT.

"All eyes are on the Supreme Court – everyone's starting at the Supreme Court, but that's not the only healthcare news in town," said J.D. Kleinke, resident fellow at AEI and healthcare business strategist. "An attempt has been made by the FDA to expand its mission to one of the more dynamic and important issues happening in healthcare and that's health IT generally, but more specifically, mobile applications."

"For the most part, health IT is a politically neutral zone," he continued. "People from the right and the left agree a computerized healthcare system makes more sense. It's a bipartisan idea, whose time has not just come but is long overdue."

Kleinke and Joel White, executive director of the Health IT Now Coalition, outline five points to consider with regard to regulatory threats to mobile health IT.

1. The FDA has taken an interest in mobile apps. In July of last year, the FDA issued its Draft Guidance on mobile medical applications. "So increasingly, we're seeing that in the market place, as more consumers become comfortable with IT and doctors use apps to treat patients, the FDA is looking at these technologies and have been for some time," said White. "IT is rapidly advancing, and they had to think about the advancements and how that'd fit into a regulatory framework." Essentially, he said, the Draft Guidance for mobile apps does a couple things. For instance, it makes it so apps fall under FDA regulatory authority as medical devices and would be classifies as Class One, Class Two, and so forth, based on what the app does in conjunction with diagnosing the patient. "It would have to go through the regulatory structure for approval," said White. "And if [the app] isn't considered a mobile device, it wouldn't have to go through this process."

2. Issues arise with mobile apps and the 510(k) process. Devices are now classified under the same risk structure as the 510(k) process, which "isn't known as a rapid process," said White. "If you think about the life cycle of apps and software, generally, it is very rapid. So that change in the actual app may trigger some change in the regulatory structure if they go through the 510(k) process." He added that although the FDA does have an "appropriate role to play" in ensuring the safety and effectiveness of these apps, according to the IOM, the 510(k) process has significant issues, most notably, the length of time to get approval. "Most poignantly, the IOM said last year in a report, that the process wasn't working well for the industry or for patients," he said. "So clearly, the process has some challenges."

3. Risk factors do exist when it comes to mobile apps. An IOM report, which was released last November, did confirm three serious issues that exist with regard to mobile apps. "A panel of experts looked at issues of health IT and patient safety, and they concluded serious risk factors," said White. "Errors with how IT operates, errors with how physicians use IT, and information asymmetry issues, or information about a patient or care treatment protocol that wasn't available when using the technology in ways it was intended." What IOM concluded, he said, was there wasn't coordination across agencies, where these issues touch base in jurisdictions. "None of the agencies have resources at their disposal in terms of expertise to address some of the follow-ups in regard to patient safety."

Continued on the next page.

In this week’s Health Wonk Review:

The June 22 edition of Health Wonk Review is posted now at Managed Care Matters, and�features columns from healthinsurance.org bloggers Maggie Mahar, Harold Pollack, and Henry J. Aaron.

They discuss the pending Supreme Court decision on the constitutionality of the Affordable Care Act and its individual mandate, the 2012 elections and what both will mean to the health reform law.

Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog.

ONC targets Rx drug abuse with new data initiative

WASHINGTON – The Office of the National Coordinator for Health IT has launched a pilot program to make existing prescription drug use data available to healthcare providers and pharmacists when they treat patients during office visits and in emergency departments.

The test projects in Indiana and Ohio will measure the effectiveness of expanding and improving access to prescription drug monitoring programs (PDMPs) as part of the administration’s efforts to reduce prescription drug abuse.

The monitoring programs are statewide electronic databases, which are designed as a tool for providers to identify and intervene in cases of potential prescription drug abuse. The databases collect, monitor and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners.

The idea is that by improving real-time access to the information it will encourage providers to use the program more than it is now. So far, 49 states have legislation authorizing prescription drug monitoring programs or have active programs.

“The PDMP pilot projects will help hospital staff identify a patient’s controlled substance history at the point of care to enable better targeting of appropriate treatments and reduce the potential of an overdose or even death,” said Farzad Mostashari, MD, national coordinator for health IT. “We are not creating new systems; we are adding value to those that exist,” he added.

In Indiana, emergency department staff will be able to receive a patient’s controlled substance prescription history directly through the Regenstrief Medical Record System (RMRS), a care management system used by Wishard Health Services, a community health system in Indianapolis, and other hospitals.

The project is a collaboration of ONC, Regenstrief, Wishard, the National Association of Boards of Pharmacy, Appriss Inc., and the State of Indiana. In some states, Emergency departments are responsible for almost 25 percent of all controlled substance prescriptions.

The Ohio pilot will test having a drug risk indicator in the electronic health record (EHR) and how that affects clinical decision making. The Ohio project is a collaboration with the Springfield Center for Family Medicine, Eagle Software Corporation’s NARxCHECK, the State of Ohio, and MITRE.

The hope is that the pilots will improve real-time data sharing among providers, increase interoperability of data among states, and expand the number of people using these tools, according to Gil Kerlikowske, director of National Drug Control Policy.

The Enhancing Access to PDMPs Project stems from joint efforts of public sector and private industry experts that participated in the White House Roundtable on Health IT and Prescription Drug Abuse last year and the subsequent action plan (PDF).

The Centers for Disease Control and Prevention has said that the United States is in the midst of an epidemic of prescription drug overdose deaths, which outnumber deaths from heroin and cocaine combined.

AHIP Gave More Than $100 Million to Chamber’s Efforts to Derail Health Care Reform

The nation’s leading health insurance industry group gave more than $100 million to help fuel the U.S. Chamber of Commerce’s 2009 and 2010 efforts to defeat President Obama’s signature health care reform law, National Journal’s Influence Alley has learned.

During the final push to kill the bill before its March 2010 passage, America’s Health Insurance Plans gave the chamber $16.2 million. With the $86.2 million the insurers funneled to the business lobbying powerhouse in 2009, AHIP sent the chamber a total of $102.4 million during the health care reform debate, a number that has not been reported before now.

The backchannel spending allowed insurers to publicly stake out a pro-reform position while privately funding the leading anti-reform lobbying group in Washington. The chamber spent tens of millions of dollars bankrolling efforts to kill health care reform.

The behind-the-scenes transfers were particularly hard to track because the law does not require groups to publicly disclose where they are sending the money or who they are receiving it from.

For example, in its 2009 IRS filing, AHIP reported giving almost $87 million to unnamed advocacy organizations for “grassroots outreach, education and mobilization, print, online, and broadcast advertising and coalition building efforts” on health care reform. That same year, the chamber reported receiving $86.2 million from an undisclosed group. Bloomberg’s Drew Armstrong first reported the AHIP-chamber link. The $86 million accounted for about 42 percent of the total contributions and grants the chamber received.

The next year followed a similar pattern. In 2010, AHIP reported giving $16.5 million to unnamed advocacy organizations working on health care reform and the chamber reported receiving about $16.2 million from an undisclosed source, which the Alley has learned was AHIP. The $16.2 million accounted for about 8.6 percent of the total contributions and grants the chamber received that year.

Chamber spokeswoman Blair Latoff would not provide the providence of the $16.2 million donation saying only, “We filed our tax returns for calendar year 2010 in November. Schedule B lists all of our contributions, one of which is $16 million dollars from one entity.”

AHIP spokesman Robert Zirkelbach was similarly vague. He referred the Alley to a statement the group put out in 2010 when AHIP’s $86 million transfer to the chamber was first reported.

“We, like other major stakeholders, invested in advocacy. We supported a number of leading health care advocacy organizations and coalitions that shared our views,” the statement said. “While the new law helps millions of people obtain coverage, it fails to bend the health care cost curve. Health plans are committed to working on ways to make coverage more affordable and minimize disruptions for those who are currently insured.”

An AHIP official did say the $16.5 million spent in 2010 was on advocacy efforts prior to health care reform’s passage and had nothing to do with political spending ahead of the 2010 midterm elections.

The news that insurers gave more than $100 million to help fuel the chamber’s efforts to derail health care reform comes as the nation girds for a Supreme Court decision this month that is sure to reignite the health care reform debate on Capitol Hill and the campaign trail.

Elahe Izadi contributed.

Obama sets up formal office for healthcare reform

WASHINGTON (Reuters) – President Barack Obama set up an executive office for healthcare reform at the White House on Wednesday, saying the overhaul was one of the biggest priorities for the first year of his presidency.

Obama issued an executive order that says the U.S. healthcare system “suffers from serious and pervasive problems.”

The White House Office of Health Reform (Health Reform Office) will help the executive branch steer “the federal government’s comprehensive effort to improve access to health care, the quality of such care, and the sustainability of the health care system,” the order reads.

It also says the Secretary of Health and Human Services will create an Office of Health Reform to work with the White House office.

Obama has nominated former Clinton administration health official Nancy-Ann DeParle to lead the White House office. His nominee for Health and Human Services secretary is Kansas Governor Kathleen Sebelius.

The new office will help ensure that policymakers across the executive branch work toward Obama’s healthcare agenda, the order reads.

U.S. government economists predict that public and private health spending will hit $2.5 trillion this year, taking up a 17.6 percent share of gross domestic product.

Yet studies suggest Americans get poorer care than people in other industrialized countries that have national healthcare plans, and 46 million Americans have no health insurance at all.

HHS announces $25M in funding for Aging and Disability Resource Centers

WASHINGTON – Health and Human Services Secretary Kathleen Sebelius on Thursday announced $25 million in funding to enable states to expand their ability to help seniors and people with disabilities access home and community-based long-term support.

Over the next one to three years, the funding, made possible by the Affordable Care Act, will support technology-enabled Aging and Disability Resource Centers (ADRCs) in nearly every state.?

Each year, more seniors, people with disabilities and their families are confronted with often challenging decisions about how to obtain the long-term services and support they need. Choices range from care in their home to care in a nursing home, social supports for daily living and transportation to physical therapy.

Sebelius says ADRCs will make it easier for people to learn about and access the services that are available in their communities and best meet their needs.

“We are pleased to make it easier for Americans to get the care and support they need where they need it,” she said. “This opportunity, supported by the new healthcare law, will help states continue to improve their long-term service and support systems.”

The initiative, known as the Aging and Disability Resource Center Program, is established through a partnership between the Administration for Community Living (ACL), the Centers for Medicare & Medicaid Services (CMS) and the Department of Veterans Affairs’ Veterans Health Administration (VHA).

The VHA will make an additional $27 million available over three years in ADRC-funded states through the VA Medical Centers. This funding will increase access to home and community-based services, some enabled by mobile and telehealth technologies, for veterans through ADRC programs.?

"Veterans with disabilities are increasingly looking for services that help them remain in their own homes with their loved ones," said VA Under Secretary for Health Robert A. Petzel. "Today's announcement offers one more opportunity for VA to continue to thank our Veterans by providing them support in a setting of their choice, in this case their own home."

The ADRC Program will help state agencies administer and better coordinate state and federal long-term service and support programs for older adults, people with disabilities, and veterans with disabilities, officials say. Approximately eight states will be competitively selected to accelerate the development over a three-year period of the creation of single entry point models, which provide one-on-one options counseling to streamline the intake and eligibility determination processes for consumers accessing long-term service and support programs.

“Options counseling is an important tool that can provide custom-tailored advice about all the services available in a person’s community, reducing unnecessary time and energy spent searching for answers in a variety of places," said Kathy Greenlee, ACL’s administrator and assistant secretary for aging.

[See also: Home telemonitoring works, study claims.]

“We want these programs to serve as high-performing ‘one-stop shop’ models across the country,” added CMS’ Acting Administrator Marilyn Tavenner.

In addition to accelerating activities in the eight states selected, funding will be provided by ACL to up to 40 states next year to support their current ADRC programs, officials say. This will help them develop a sustainable infrastructure that's critical to ensuring ongoing coordinated access to services.

Ashley-Care: Health Care Coverage Without Stress for a Young Adult

Today, 3.1 million people are newly insured thanks to a provision in the law that enables young adults to stay on their parents� health care plans. Ashley Drew is one of them. Ashley, a young woman from Scarborough, Maine, was born with Cystic Fibrosis, a life-threatening chronic disease. She spends a lot of time in hospitals getting special IV antibiotics, respiratory therapy and physical therapy to clear her lungs and fight infections. One month in the intensive care unit cost her about $144,000; her last stay was for three months.

Ashley was diagnosed with end-stage lung disease and waited on two transplant lists for more than 500 days. She recently successfully underwent a double lung transplant.

Because of the health care law, the Affordable Care Act, young adults under the age of 26 may be able to stay on their parents� health insurance, and for Ashley, this has made all the difference. Staying on her parents� insurance allowed her to pursue her education to become a music teacher and to study instrumental conducting � at a pace she could handle with her health condition � and not worry about how to make sure she had coverage.�

�The fact that the Affordable Care Act is in effect, it�s amazing, because it�s horrible to have to worry and stress about your health and, in my case, something that everyone takes for granted: breathing,� Ashley says. �Everyone deserves to breathe, but unfortunately without health insurance that�s not a reality for some people.�

Without the security that staying on her parents� insurance plan provides, Ashley says she would be spending all her time trying to figure out how to come up with the money for her treatment.

Ashley believes the benefits under the law are important for people who don�t have her immediate health concerns as well. �I think the Affordable Care Act brings peace of mind to people all over this country because you don�t know when something�s going to happen,� she says. �Just to know that you have health insurance � You�re not going to lose your car and you�re not going to end up homeless because you got sick.�

BancTec acquires GTESS claims processing business

IRVING, TX – BancTec, which specializes in financial business process outsourcing, transaction automation and document management, has acquired certain assets of Richardson, Texas-based GTESS, a provider of claims pre-adjudication technology and services for the healthcare industry.

GTESS has served a client base including more than 40 healthcare payers nationwide. BancTec officials say the acquisition – financial terms of which were not disclosed – will enable the firm to strengthen and expand its healthcare claims processing services.

“In this era of healthcare consolidation and reform, health plans and related organizations are under increasing pressure to improve efficiency – but too often are held back by complex, manual pre-adjudication processes,” said Maria L. Allen, senior vice president and president of the Americas at BancTec. “With this addition, BancTec will be able to effectively address this pain point as part of an integrated claims processing offering.”

Founded in 1990, GTESS specializes in automation technologies that drive cost and process improvements in the front-end, or pre-adjudication, portion of healthcare claims processing. This includes the automation of costly, labor-intensive pre-adjudication processes such as provider and member matching and paper claim handling, keying and processing. GTESS has enabled clients to achieve their goals for increased automation, speed and lower costs of claims processing.

“BancTec and GTESS have shared a commitment to superior service and client satisfaction that have stood the test of time,” said Mark King, chairman of GTESS.  “Like GTESS, BancTec provides flexible, focused automation and outsourcing solutions that serve the healthcare industry well. This strategic move gives clients the opportunity to significantly reduce annual expenses by lowering the cost per claim and dramatically improving accuracy, consistency and customer response.”

Dartmouth Board garners $26M innovation grant

With a $26 million government Health Care Innovation Award in hand, the Dartmouth Board of Trustees will  hire Patient Family Activators (PFAs), who will assume roles of patient advocate, assisting the patient with care choices and engaging them in a shared decision-making process.

The project will support and connect 15 High Value Healthcare Collaborative (HVHC) member healthcare systems throughout 16 states, and over the course of three years, will train 5,775 healthcare workers and create 48 new PFA positions.

A portion of the funding will also be used to improve patient data collection via health information technology, as William Weeks, MD, co-creator of the Dartmouth Institute for Health Policy and Clinical Practice, explained.

“Some funds will be used to both facilitate learning and deployment across the HVHC members as well as collecting data (through grant funded tablets that will be integrated into local EHRs), feeding back reports on results, and expanding current IT infrastructure to supplement current HVHC reporting abilities and better integrate such reporting into HVHC member IT systems.”

Health and Human Services (HHS) Secretary Kathleen Sebelius announced on June 15 the second round of recipients for the Health Care Innovation Awards, funded through the Affordable Care Act. The  Dartmouth Board of Trustees was among 81 groups nationwide that walked away with a win.

Three-year cost savings from the Dartmouth project are estimated to be more than $63.7 million, and Weeks explained the majority of savings would result from the overall reduction in Medicare costs of each patient.

Weeks said, “Savings are therefore derived from both improving the efficiency and reducing the costs of each episode of care and using patient shared decision making to help patients make informed decisions, decisions which – according to the literature – are more conservative and less costly than the care that their providers would recommend.”

He continued, “By engaging providers in improving the efficiency and safety of care processes, and by engaging patients in the decision-making process regarding their healthcare choices, we believe that we can reduce this variation and waste, reduce the unrestrained growth in healthcare costs, and concurrently improve patient satisfaction and health outcomes.”

The Dartmouth Board of Trustees-sponsored program was one of 107 total projects nationwide that garnered an Innovation Award out of more than 3,000 applicants nationwide.

The Centers for Medicare & Medicaid Services (CMS) created the Center for Medicare & Medicaid Innovation to improve the health of Medicaid, Medicare and CHIP patients - and by extension all Americans - while combating escalating costs. The $1 Billion Health Care Innovation - carries a triple aim: better health, better healthcare and reduced costs. The Innovation Challenge provides three-year grants of $1 million to $30 million to healthcare providers, payers, local government entities, and public-private partnerships, including collaborative efforts among multiple payers.
 

Technology at forefront of NHS treatment in Scotland

EDINBURGH – Online scanning to allow remote diagnosis for island patients and Scotland's biggest telehealth system are among a raft of hi-tech projects to help more patients be treated quicker and closer to home.

EHealth investment totalling £1.6million - including funding from the NHS's major IT partner - has been announced today by Scottish Health Secretary Nicola Sturgeon.

Speaking at the first annual Scottish Telehealth and Telecare conference, Sturgeon unveiled details of projects extending the use of electronic technology in the NHS, including:

 

Touch screens in the homes of hundreds of patients with chronic conditions in Lothian, allowing them to be monitored from home;

 

 

Online scanning allowing patients in Orkney to be diagnosed remotely, avoiding lengthy trips to hospital;

 

 

New software in Glasgow transmitting patients' records directly to consulting rooms.

 

"Telehealthcare technologies and eHealth have huge potential to benefit patients, by harnessing all that technology can offer to make care quicker, safer and closer to home. It also allows more efficient working and better support for our health and care staff," Sturgeon said.

"In eHealth, our joint investment in 16 pilot projects will help patients in hospital and at home. At the West of Scotland Heart and Lung Centre, for example, they're replacing cardiac databases with the latest systems to improve patient safety.

"Together with NHS Lothian, we're also rolling out Scotland's biggest telehome monitoring system. Four hundred people living with conditions like heart failure or chronic lung disease will have touch screens to monitor their vital signs from home, helping them avoid repeated hospital visits."

The overall eHealth funding announcements made by the Cabinet Secretary totalled £1.6million - £564,000 of which comes from the Atos Origin Alliance, an innovation fund from the NHS's main IT partner.

The Atos Origin Alliance comprises Atos Origin, BT, IBM and Sopra Group.

The roll-out of the £700,000 telehealth project for long term-condition patients is funded equally between the Scottish Government and NHS Lothian.

Shocker: Doctors Work When They're Sick

iStockphoto.com

Take a sick day, doc.

How do doctors work around so many ill people without getting sick? Well, they don't.

Even if they scrub their hands like crazy, which certainly helps, they succumb to germs every once in a while, just like the rest of us. And also like lots of the rest of us, they'll go to work sick, a survey of medical residents finds.

A little more than half of the 150 residents surveyed at an Illinois medical meeting in 2010 said they'd worked while having flu-like symptoms in the previous year. And about one-quarter said they'd done so at least three times.

Why? They were just being responsible. More than half � 56 percent � said they felt a responsibility to take care of their patients. Fifty-seven percent said they didn't want to make their colleagues cover for them.

 

The results were published in the latest Archives of Internal Medicine. In a note about them, Dr. Deborah Grady wrote:

"Working while sick may demonstrate an admirable sense of responsibility to patients and colleagues, but clinicians also need to worry about the real danger of infecting vulnerable patients as well as colleagues and staff."

Now, don't you sometimes feel the same way when the cougher in the next cube won't take a sick day? We did our own survey in 2010 and found that almost three-quarters of people had gone to work sick in the past year.

The top reason, cited by 25 percent of people, was that they wouldn't get paid for the absence. That was followed by people saying they weren't sick enough to stay home and "work ethic" came in third at 19 percent.

Roundtable forecasts big changes for state HIEs

WASHINGTON – A new report from the HIMSS State Advisory Roundtable argues that state HIEs will need to adapt to changing approaches to reimbursement, evolving their mission and business models from "information exchange" to "coordination facilitation."
 
Convened about this time last year, the HIMSS State Advisory Roundtable comprises experts and advocates from state and federal governments, regional extension centers, health information exchanges and more. It seeks to target health IT issues that transcend state boundaries, helping enable different states advance their health IT programs.

Its inaugural report, titled "States Will Transform Healthcare through Health IT and HIE Organizations," was published at the HIMSS Government Health IT Conference and Exhibition in Washington, D.C., earlier this week.

Two of the roundtable's members are former Vermont Gov. Jim Douglas and former Wyoming Gov. Jim Geringer. In a blog post on the Government Health IT website, they wrote that, with many states still finding themselves "far behind where they were economically when the recession started 4.5 years ago," a key way "to address the economic challenges of many state budgets is to encourage our states to invest in health information technology."

But there's no shortage of challenges along that road, especially with regard to funding, infrastructure, sustainability, and, most notably, a healthcare industry that's in the throes of reinventing the very basis of its business model – steering away from fee-for-service and toward value-based care.

Other challenges faced by the states include a surge in Medicaid patients – with some states anticipating a more than 50 percent increase in enrollees – and pitfalls with regard to patient engagement. "Putting data in the hands of patients should be a major component in both enabling transparency and driving responsibility of the individual’s and family’s health," according to the report. "This is a challenge due to the complete lack of transparency between the caregiver, the payer and the patient today."

Health information exchanges are another area of concern – but also hold big potential, the report argues.

"Almost all states have large contracts in place for a more extensive build that is just getting underway now," it points out. "Stage 2 Meaningful Use will drive much more rapid development but that is no guarantee of success of state run HIEs. There has always been a concern about state run HIEs being able to compete with private options that are emerging as the market organizes.?

Indeed, there are big questions about many exchanges' sustainability.

"With few exceptions, such as Rhode Island and Vermont, the state-level HIE business model is almost completely void of private investment, leveraging mostly state and federal funds for development and implementation activities," according to the report. "Most models that have found success to date are based on driving efficiencies to providers in a fee-for-service model."

But as that outdated model fades in favor of value-based care, "the sustainability model for HIEs also must change," the report argues.

"This will likely come in the form of leveraging HIEs for care coordination, telehealth visits and quality and payment analytics. Therefore, the business of state HIEs will likely need to shift from 'facilitator of sharing' to 'data aggregator and analyzer' in order to build a sustainable business plan. The challenge will be to provide a basis for comparison across private providers."

[See also: States lead the way on healthcare IT.]

In their blog post, governors Douglas and Geringer offered other advice:

States should leverage their HIEs and other IT infrastructure in "new and innovative ways," such as closer partnerships between state governmental entities, regional extension centers, Beacon Communities and professional trade associations.Health IT "transcends political lines" and should be a top legislative priority, regardless of which part is in power, to maintain its forward momentum.States should "facilitate, engage and educate patients and consumers with the delivery of their healthcare services and promote overall increase in health literacy."Health IT should be foundational to healthcare reform.As that reform drives the shift from "fee-for-service to pay-for-quality models," state-level HIEs, to remain sustainable, will need to rethink their approach, from “health information exchange” to “healthcare coordination facilitation."Better coordination is needed between and among federal and state health agencies to make sure state-level HIEs are aligned with funding sources to ensure success.

Access the HIMSS State Adivsory Roundtable's report here.

 

U.S. ranks near last in value-based healthcare, report says

BOSTON – A report released Wednesday from Boston Consulting Group shows the United States trailing behind eight countries with regards to value-based care adoption, suggesting criticism of the U.S. healthcare system may be merited.

The Boston Consulting Group (BCG) study examined the progress of 12 industrialized countries in adopting value-based healthcare – an approach experts say would improve health outcomes while also reducing the industry’s expenditures. 

The report, title, "Progress Toward Value-Based Health Care: Lessons from 12 Countries," evaluates national health systems along two dimensions. 

The first is the degree to which key supports of value-based healthcare are in place at the national level – for example, common national standards and IT infrastructure, national legal and consent frameworks, the ability to link health outcomes with costs and high engagement on the part of clinicians and policymakers. 

The second is the quality of a country’s existing disease registries – institutions that track selected health outcomes in a population of patients with the same diagnosis or who have undergone the same medical procedure – both in terms of the richness of the data and the sophistication of the medical community’s use of the data.

“When it comes to implementing value-based healthcare, Sweden is the most advanced country of the 12 we studied, followed by Singapore, Canada and the U.K.,” said Neil Soderlund, a BCG partner and coauthor of the report. “By contrast, Germany and Hungary have the furthest to go.”

The U.S. health system, which has the highest per capita costs of the 12 nations studied and spends 17.6 percent of GDP on health care, is also one of the laggards in the group. 

Some experts say the fragmented nature of the U.S. healthcare system has limited the collection and use of national health-outcome data. “Reporting standards and clinical outcome metrics differ substantially across the system, even within the same specialty,” said Peter Lawyer, a BCG senior partner and coauthor of the report. “There currently exists no national mechanism for compelling providers to report outcomes to disease registries. Nor is there a unique patient identifier in place that would enable research to combine data across different disease states to examine the effect of complex comorbidities.” 

“We learned that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some are significantly farther along the learning curve than others,” said Stefan Larsson, MD, a BCG senior partner and coauthor of the report. 

The challenge for U.S. healthcare executives and regulators is how to close the gap with the rest of the world. “Notwithstanding the politics of health care reform, reimbursement is moving from a volume basis to outcomes,” noted Martin B. Silverstein, MD, a senior partner and former global leader of BCG’s Health Care practice.

For more widespread and systematic use of disease registries to take hold, key stakeholders will need to champion them, he added. “National medical societies, in particular, have a leadership role to play,” said Silverstein, “both in creating uniform standards for data collection and in securing broad support and participation of practicing clinicians.”

The federal government can also support registries, he said, “by creating a legislative and regulatory framework that facilitates their establishment and by providing seed funding to get them up and running.”

Military to employ IT to improve traumatic brain injury care

WASHINGTON – The Military Health System will spend $14.1 million to enhance the collection of traumatic brain injury and associated behavioral health information for military service members throughout the entire continuum of care.

The program is managed from MHS' Defense Health Information Management System program office in support of the Department of Defense and Department of Veterans Affairs overarching response to the President's Commission on Care for America's Returning Wounded Warriors.

The Military Health System tapped Vagent, Inc. to do the job. Vangent will develop a clinical information technology solution to improve the workflow of patients' behavioral health information and integrate with the military's electronic health record.

When deployed, the technology will make behavioral health patients' information more quickly available for diagnosis, treatment and ultimately positive clinical outcomes, officials said.

Vangent's subcontractors include Akimeka, LLC; Guident, Inc.; Enterprise Information Management, Inc.; Forgentum, Inc. and n-tieractive, Inc.

"The Traumatic Brain Injury and Behavioral Health Clinical Data Documentation solutions are imperative to providing clinicians a tool to improve the treatment of our Wounded Warriors," said Mac Curtis, president and CEO of Vangent, Inc. "With Vangent's broad experience in healthcare, we are leveraging our experience to rethink the technologies and solutions utilized by our front-line clinicians providing care to their patients."

The award represents a major win for Vangent, which has grown its portfolio of military health business to more than $140 million over the past year providing mission critical services and support for health initiatives within the Department of Defense.

Other major contracts include the common user database for the Force Health Protection & Readiness Program, e-commerce operational system support for the TRICARE Management Activity and executive information and decision support for the Military Health System.

More docs questioning benefits of ACA, EHRs

WATERTOWN, MA – Physicians remain concerned over the future of U.S. healthcare, a new survey reveals. Among the survey’s findings, most physicians think EHRs and the ACA will adversely affect the quality of patient care, and nearly two-thirds anticipate that quality of healthcare will worsen over the next five years. 

The Physician Sentiment Index (PSI), conducted by Watertown, Mass.-based athenahealth and Cambridge, Mass.-based Sermo, collected responses from 500 physicians who represented a diverse range of specialties and practices sizes. 

This year's PSI tells a story of over-burdened physicians who are deeply concerned about where the healthcare industry is headed. The data suggests the leading distractions affecting physicians' ability to provide the optimum care for patients center on government intervention, increased utilization of and frustration with EHRs and administrative burdens. All told, these distractions have diminished physicians' optimism around their ability to deliver quality care and remain viable, profitable practices. 

"There is a lot of ‘stuff’ going on in healthcare that is making the noble pursuit of the MD degree a lot less attractive," said Jonathan Bush, athenahealth CEO and chairman. "Government involvement, ill-designed EHRs and administrative complexities are encroaching on the sacred relationship between the physician and the patient and the ability for that doctor to be fully present at the point of care."

"U.S. healthcare is changing rapidly, but time and again policymakers aren't listening to the physician perspective," said Jon Michaeli, VP of membership for Sermo. "As a result physicians feel disempowered to influence change, and hence they are more disenchanted with their profession and less connected to patients than ever.”

More specifics of the survey’s findings are listed below: 

Doctors skeptical of regulation

Over half (in 2012 and 2011) say that government involvement in regulation will not yield lower costs and better outcomes, with slightly more pessimism on display this year.A growing number concerned about the ACA’s impact on the quality of care:  Nearly one-third (29 percent) say they still do not understand the details and implications, compared to 22 percent in 2011.16 percent said they'd like to see the ACA remain 'as is' (versus 11 percent in 2011).53 percent report the ACA will have a detrimental effect on their ability to provide high quality care, versus 50 percent in 2011 – 43 percent more believe the ACA will be very detrimental to the delivery of quality of care (from 14 percent in 2011 to 20 percent in 2012).26 percent want to see the entire ACA repealed (versus 21 percent in 2011).Three-quarters report that the meaningful use process is at least somewhat difficult and/or cumbersome.The ACO model draws concerns: More indicated ACOs as having a negative impact on quality of care (39 percent in 2012 versus 26 percent in 2011) and profitability (63 percent in 2012 versus 48 percent in 2011).

EHRs – more purchased, more in use, but what do docs think?

73 percent said EHRs are a distraction to doctor-patient interaction, up 12 percentage points from 2011.The number who purchased an EHR jumped 10 percentage points between 2011 and 2012 (from 70 percent to 80 percent). – Yet, very favorable opinions did not move in line –18 percent fewer voiced a very favorable opinion of EHRs (from 39 percent in 2011 to 32 percent in 2012).36 percent more say they believe EHRs somewhat or significantly worsen patient care (from 11 percent in 2011 to 15 percent in 2012). The majority (44 percent) says that the EHR was not designed with physicians in mind versus 32 percent in 2011.

Administration woes

89 percent said payers have become more intrusive on the patient-physician relationship versus 87 percent in 2011.74 percent said payers inhibit the care they would like to provide their patients (76 percent in 2011).59 percent more physicians see pay-for-performance as negatively impacting quality of care; 30 percent more believe it will negatively impact their bottom line.However, 42 percent are very/somewhat confident their transition to ICD-10 will be smooth.

[See also: Docs believe EHRs safer than paper, but patients still ambivalent.]

Independent physicians – fretting about the future of medicine, their viability

81 percent do not see the future of independent practice as viable, representing 19 percent more doctors in 2012 than 2011.This year, 50 percent more view the current healthcare climate as very detrimental to quality care delivery.Unchanged from 2011, about two-thirds anticipate that the quality of medicine in the U.S. will decline over the next five years.

 

Healthcare IT stimulus funding: Show me where to put the money

NASHVILLE – Now that the $787 billion American Recovery and Reinvestment Act has been signed into law, what does it mean for the healthcare industry, particularly for healthcare IT?

Providers and other healthcare IT stakeholders should focus on five areas that will likely be targeted by healthcare IT funding, said John Tempesco, vice president of Client Services and Marketing for Informatics Corp. of America, or ICA.

Ready-to-go healthcare IT projects that prevent medical mistakes, provide better patient care, promote preventative care, evaluate the most cost-effective healthcare treatments and drive cost-savings efficiencies will not only provide ROI but create jobs as well, he said.

Vendors should encourage their customers to expand healthcare IT projects and get them in place to be "shovel ready" for when the funding becomes available, he said.

"Because the focus is shifting away from automating the business of medicine to the clinical practice of medicine, the emphasis is now on informatics," Tempesco said.

Congress and demonstration projects by the Centers for Medicare and Medicaid Services, or CMS, have been focusing on clinical results and how physicians use information in healthcare IT platforms to reduce errors, make better-informed clinical decisions and deliver workflow efficiencies, he pointed out.

As a result, clinical informatics will be an area of job creation, he said. With increased physician involvement in the selection and deployment of solutions, hospitals should strengthen the relationship between their clinical and IT staffs. That will require clinical application specialists and medical technicians to help train staff.

What's missing in the healthcare industry is the actual teaching and translation of how providers use healthcare IT solutions in their daily workflow to make incremental changes in their businesses, he said. "There are not enough clinical application specialists in most hospitals," he said.

Tempesco expects stimulus funding to flow to community projects. ICA is already seeing a lot of Requests for Proposals from states, including Kentucky, Mississippi and Louisiana, for statewide health information exchanges, or HIEs. "Any time you talk about HIEs, it requires vendors producing data inputs and outputs, and hospital staff doing integration, implementation and training," he said.

Tempesco has a word of caution for those giddy with the forthcoming healthcare IT funding. "My biggest fear is that we dump money into projects that don't have sustainability plans," he said, referring to the community health information networks, or CHINs, that received government funding but failed in the 1990s.

If initiatives stick to the five key areas, Tempesco said, those projects would glean value.
 

First lady walks fine line on NYC drink proposal

WASHINGTON(AP)�First lady Michelle Obama says banning big servings of sugary drinks isn't anything she'd want to do at the federal level, but she offered some kind words Tuesday for New York Mayor Michael Bloomberg's effort to do just that. She later issued a statement backing away from taking a stand on New York's controversial proposed ban.

It was a telling example of the fine line the first lady walks as she tries to improve Americans' health and eating habits without provoking complaints that she's part of any "nanny state" telling people how to eat or raise their children.

Asked about Bloomberg's proposal during an interview with The Associated Press, Mrs. Obama said there's no "one-size-fits-all" solution for the country's health challenges. But she said, "We applaud anyone who's stepping up to think about what changes work in their communities. New York is one example."

And asked whether the nation's obesity epidemic warrants taking a more aggressive approach, such as Bloomberg's, she said: "There are people like Mayor Bloomberg who are, and that is perfectly fine."

Mrs. Obama later issued a statement saying that she hadn't intended to weigh in on the Bloomberg plan "one way or the other."

"I was trying to make the point that every community is different and every solution is different and that I applaud local leaders including mayors, business leaders, parents, etc., who are taking this issue seriously and working towards solving this problem."

"But this is not something the administration is pursuing at a federal level and not something I'm specifically endorsing or condemning."

In the interview, Mrs. Obama said she's "trying to create a big tent for people. Our motto is everyone has a role to play in this and I think it's up to communities and families to figure out what role they can play, what role they should play."

Last week, Bloomberg proposed limiting portion sizes of sugary drinks to 16 ounces at the city's restaurants, delis, food trucks, movie theaters and sporting arenas. Regular soda and sports drinks would be affected but not diet sodas.

The proposal is unpopular with most New Yorkers, according to a NY1-Marist poll conducted Sunday. A majority of New York City residents said the proposal was a bad idea and 53 percent said it was more government going too far than good health policy to fight the problem of obesity. The ban is expected to win the approval of the Bloomberg-appointed Board of Health and take effect as early as March.

Mrs. Obama spoke about the Bloomberg plan during an interview promoting her new book, "American Grown: The Story of the White House Kitchen Garden and Gardens Across America." The $30 book, which came out last week, traces the story of the garden on the South Lawn and of gardens around the country as the starting point for a national conversation "about the food we eat, the lives we lead, and how all of that affects our children," as Mrs. Obama puts it.

The first lady, wearing a print dress and periwinkle cardigan, enthused over green peppers coming into their own and a fig plant that's finally standing tall after a perilous infancy as she offered a walking tour of the garden. She ducked under some evergreens to point out a row of logs nailed to a post that will soon be sprouting shitake mushrooms.

Then, seated at a picnic table dressed up with a yellow checkered tablecloth, the first lady spoke of the progress that's been made in offering people healthier food choices and better nutrition information.

Mrs. Obama had just come from an appearance with Disney executives, where the company announced it would become the first major media company to ban junk food ads from its TV channels, radio stations and websites intended for children, starting in 2015.

Later in the day, she was scheduled to present a garden-related Top 10 list on CBS' "Late Show With David Letterman."

An example from her list, according to a CBS preview: "No. 7: In his lifetime, the average American will eat half a radish," she said, speaking from the White House Map Room.

And next Tuesday, she'll do a book signing at a Barnes & Noble in Washington � for a limited number of customers who buy a book this week and get a special wristband.

It's all part of the first lady's all-out effort to combat childhood obesity without provoking a backlash by pushing too hard. Mrs. Obama's high favorability ratings show she's largely been able to strike the right tone, a boon to her husband's re-election effort. But there is still sniping from some on the right who say they don't need a government lecture � or more intrusive steps � on what they eat or how they exercise.

Asked if she ever has to bite her tongue at Obama critics � legion in an election year � the first lady batted away the idea, saying she stays away from "all the chatter and the noise."

"It's not a difficult thing for me to do because we've got so much good stuff to talk about � like this book and the garden and getting our kids healthy and active," she said.

Mrs. Obama spoke of the enthusiastic response the garden has elicited from kids all over the country � but not so much from her own daughters.

"You know, they are not interested in gardening," she said. "I think it has a lot to do with the fact that I'm their mother and this is my interest, and they go in the opposite direction."