Posted November 28, 2012 by Megan DiMartino
By Sarah Halzack, The Washington Post
On-site health care clinics are increasingly being set up at large companies that are looking for new ways to reduce health care costs and boost employees’ productivity.
These facilities are being established by firms across all sectors to offer everything from urgent and primary care to biometric screenings to chronic disease management.
A study this year by the Society for Human Resource Management found that only 8 percent of employers across the country currently have such clinics. But among big companies — where large numbers of employees mean a clinic can more easily amass enough patients to justify its cost — these facilities are becoming more common. A recent study by the National Business Group on Health found that 46 percent of large employers offered at least one on-site clinic, up from 37 percent the previous year.
In the Washington region, some workplaces that have established such clinics say they have seen a return on their investment: It has helped them save money and reduce absenteeism.
At Discovery Communications, some 85 percent of the workforce visits its on-site clinic. The center provides an unusually comprehensive range of services, including physicals, pap smears, weight management programs and even travel immunizations and infertility counseling.
By comparing the cost of a visit to the clinic to the cost of a visit to a private doctor, Discovery estimates it will save $2.2 million this year.
The Silver Spring-based firm has also opened its health center to employees’ spouses and children over the age of 12, a move that helps them achieve additional savings since they’d otherwise have to pay for their visits to private doctors.
The clinic at Hughes Network Systems, a Germantown-based satellite company, is smaller. It employs just one nurse, but the company said she had 4,700 visits from employees in 2011.
“If people are using her that much, it’s that much less time that they’re having to spend away from their desk,” said Lynne Rusnak, senior director of human resources.
Other employers are weighing whether such a facility makes sense for their organization.
Montgomery County has an occupational health center to conduct physicals for firefighters and police officers. But its director of human resources, Joe Adler, said the county is seeking proposals from vendors to build a clinic to serve all of its workers.
“There’s an upfront expenditure, and we want to make sure that the expenditure down the road has results,” Adler said.
Some experts say that the implementation of the Affordable Care Act could accelerate or expand interest in employer-sponsored clinics.
With millions of Americans poised to get health insurance, “A lot of our clients are nervous that it’s going to clog an already strained delivery system,” said Bruce Hochstadt, a partner and consultant with human resource consulting firm Mercer.
The heightened interest in on-site health centers has also been advantageous for some local companies that contract with employers to set up and operate such facilities.
Reston-based CHS Health Services specializes in designing, equipping, and managing employer-sponsored on-site clinics. In 2011, the firm received 55 requests for proposals to build such facilities. So far this year, the firm has received 64 requests. CHS also said that its revenue grew 35 percent in 2012 after rising 30 percent the previous year.
Another provider of local on-site clinics, Inova Health System, said it has added staff to deal with demand for these services.
“We’ve put more resources in delivering care and health services to employers. And [on-site clinics] would be one of those areas, and it’s really based on interest,” said Jeffrey Carr, the corporate and consumer growth officer at the Falls Church-based health care provider.
Percentage of large employers (those with more than 100 employees) that had on-site medical clinics last year, according to a National Business Group on Health survey
Posted November 21, 2012 by Megan DiMartino
Safety-standards group wants to simplify confusing language that can lead to dosing mistakes
By Steven Reinberg, HealthDay Reporter
Confusing dosing instructions for prescription drugs cause more than a million medication mix-ups a year in the United States, but experts say proposed labeling changes could slash that number.
The U.S. Pharmacopeial Convention (USP) — a nonprofit group that often sets drug safety standards — is proposing a major reworking and standardizing of the medication labels Americans read every day.
“So many people make mistakes taking their medicines,” said Dr. Joanne Schwartzberg, director of aging and community health at the American Medical Association and a member of the USP’s Nomenclature, Safety and Labeling Expert Committee.
Many mistakes result from dosing directions that simply aren’t clear to patients, she said. For example: “Take two pills twice daily,” to many patients means “take two pills a day,” rather than the intended instruction of taking a daily total of four pills, Schwartzberg explained.
“That’s a mistake that [even] college-educated people make. The words are very simple, but understanding what they mean can be a problem,” Schwartzberg said.
Prescription drug labeling can also differ widely from drugstore to drugstore, she added, and the new labels are an attempt to standardize information for patients.
For example, one drugstore in Chicago printed labels for one patient that offered different instructions for each drug — “PO” (doctor-speak for “take by mouth”); “take by mouth;” “take orally;” “take per oral route.”
“We say use one phrase [consistently], let’s not confuse people,” Schwartzberg said.
Labels changes the USP would like to see include:
- Keep the drug name, clear patient instructions and dose prominently displayed in clear, large type at the top of the label. Place less important data (pharmacy name, drug quantity) away from dosing instructions.
- Avoid confusing dosing instructions: For example, write, “Take two tablets in the morning and two tablets in the evening” instead of “Take two tablets twice daily.”
- Avoid ambiguous directions, such as “take as directed.”
- If listing the purpose of the drug, use simple terms. For example, “for high blood pressure” instead of “for hypertension.”
- Take the patient’s first language into consideration. If possible, except for the drug’s name, the label should be in the patient’s language of choice.
The proposed changes are “fantastic and long overdue,” said Diane Pinakiewicz, president of the National Patient Safety Foundation. “Will it be perfect and solve everything? No, but it will take us a long way down that path.”
Studies show that 46 percent of patients misunderstand the instructions of prescription drug bottles. The problem is especially acute for patients with poor reading skills. In fact, these patients are 34 times more likely to misunderstand the label direction, one study found. In addition, when a patient is taking several medications — all with different directions — the problem gets even worse.
Even highly literate patients, however, make mistakes because label directions are confusing, Schwartzberg said.
The new label recommendations were undertaken in response to an Institute of Medicine (IOM) effort to improve “health literacy,” which is the ability to get, process and understand basic health information and services needed to make informed decisions about heath.
According to the IOM, 77 million Americans have limited health literacy and most have difficulty understanding and using available health information and services.
Will the new clearer labeling reach your local drugstore? Schwartzberg said that whether or not the USP recommendations are adopted remains up to each state’s board of pharmacy. But she noted that states have typically adopted recommendations from the group before on other pharmaceutical issues.
And Schwartzberg noted that at its 2012 annual meeting, the National Association of Boards of Pharmacy passed a resolution supporting state boards in requiring a standardized prescription labeling.
“It will take time, but I think it will be adopted,” she said.
“We certainly respect USP,” John Norton, a spokesman for the National Community Pharmacists Association (NCPA) said. “Their recommendations for standards are carefully considered by NCPA and the more than 23,000 independent community pharmacies we represent.”
Norton agreed that label changes must occur “in the context of what’s in the patients’ interests in terms of health literacy, visibility and whatever information is necessary to promote adherence.”
However, “from the standpoint of our members, we are concerned with what’s reasonable for a small pharmacy business owner to carry out — for example, the different language translations, font size, label size, etc.” he added. “We want to be as constructive and cooperative as possible balancing all of those concerns and will continue bringing our ideas to the table.”
In the meantime, Schwatrzberg said, doctors and pharmacists can help make sure that each patient understands the medication they are taking, and how they should be taking it.
Posted November 20, 2012 by PHaynes
Consistent with what we’ve known about PPACA, when 2014 arrives, nondiscriminatory wellness programs will have the ability to increase the maximum permissible rewards from 20% to 30% of the cost of coverage. Further, today’s proposed regulations from HHS/IRS/DOL allow for an increase to 50% for wellness programs designed to “prevent or reduce tobacco use.”
As outlined in HIPAA’s 2006 regulations, the following consumer-protection conditions for health-contingent wellness programs remain intact:
- The total reward for such wellness programs offered by a plan sponsor does not exceed 20% of the total cost of coverage under the plan.
- The program is reasonably designed to promote health or prevent disease. For this purpose, it must have a reasonable chance of improving health or preventing disease, not be overly burdensome, not be a subterfuge for discriminating based on a health factor and not be highly suspect in method.
- The program gives eligible individuals an opportunity to qualify for the reward at least once per year.
- The reward is available to all similarly situated individuals. For this purpose, a reasonable alternative standard (or waiver of the otherwise applicable standard) must be made available to any individual for whom it is unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard during that period (or for whom it is medically inadvisable to attempt to satisfy the otherwise applicable standard).
- In all plan materials describing the terms of the program, the availability of a reasonable alternative standard (or the possibility of waiver of the otherwise applicable standard) is disclosed.
Section 120 of The Affordable Care Act (PPACA) amended these nondiscrimination and wellness program provisions (and even extended them to the individual market). Today’s proposed regulations apply to insured and self-insured groups and to both grandfathered and non-grandfathered plans.
Effective for plan years beginning on or after 1/1/2014, the maximum reward can be as high as 30% and as high as 50% for tobacco users (although they are asking for comments on that, especially considering that the 30% differential is based purely upon tiers and plan, whereas the proposed regulations state that a tobacco differential must be prorated by member. We will all eagerly await the final specifics on the 50% tobacco-user-rules).
The Department of Labor’s Employee Benefits Security Administration updated its website with the following – DOL Wellness Programs Links:
- Proposed regulations
- Market Study
- Fact Sheet – Wellness Programs
- Press Release
- HHS Proposed Regulation – Health Insurance Market Rules
Essential Health Benefits:
- Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation for all non-grandfathered health insurance coverage in the individual plans and small group markets.
Posted November 14, 2012 by Megan DiMartino
By Nick Zieminski
(Reuters) – U.S. corporate executives are more worried about providing healthcare benefits to their employees than about issues like wages, taxes or attracting qualified workers, according to a survey by the world’s No. 1 staffing company, Adecco SA.
In Adecco’s poll of senior executives, 55 percent named healthcare benefits as their biggest current business challenge, and about a third say they are holding back hiring because of healthcare reforms introduced by U.S. President Barack Obama.
Obama’s 2010 healthcare law, upheld this year by the U.S. Supreme Court, is expected to raise insurance costs for employers because it calls for wider coverage of more people, including those with pre-existing medical conditions.
“A lot of firms just don’t know how the (law) is going to impact them financially,” said Senior Vice President Janette Marx. “If it does increase costs, it causes executives to question whether they can hire more.”
Obama is not doing enough to help businesses grow, executives say, and they favor Republican challenger Mitt Romney in the Nov. 6 Presidential election by nearly 3-to-1.
Fewer than half of those polled expect their businesses to grow profits in the next year. Those who run small businesses are more optimistic than those running large ones.
More respondents also reported lower profits over the past year than said their companies grew earnings. They cited government regulation, consumer confidence and commodity prices as the biggest headwinds to growth.
Healthcare’s prominence as an issue has risen since the 2008-2009 recession, Adecco found: in 2007, only 35 percent called healthcare their top worry.
U.S. hiring could pick up after the election, regardless of who wins, because employers will have one less area of uncertainty to keep them on the sidelines. Adecco is seeing pent-up demand for workers among clients in manufacturing, retail, e-commerce and in the car industry.
“Companies have been waiting until after the election to make hires they need to make,” Marx said.
Adecco is the world’s largest staffing company measured by revenues and is the third-largest employer in the United States, behind Wal-Mart Stores Inc and the postal service. Its poll was conducted in early October and included responses from 501 CEOs, owners, managing directors and other senior executives.
Posted November 12, 2012 by PHaynes
By: Ed Waters Jr. News-Post Staff
Three Frederick businesses were honored Wednesday night for their efforts to keep employees well and productive.
The Aircraft Owners and Pilots Association, Legal and General America, and the U.S. Army Garrison at Fort Detrick were presented the honors from Frederick Memorial Hospital.
Ken Coffey, chief development officer and vice president at the hospital, said the awards not only honor the three businesses, but also encourage other companies to start or expand wellness programs.
“Wellness is a personal choice,” said Thomas Kleinhanzl, president and CEO of FMH. He said that choice is based on lifestyle and other factors.
“Leadership is not always at the top,” Kleinhanzl said. “Someone within the organization may have ideas. We need to do this together. We can all learn from others and benefit the 230,000 people in Frederick County. Keeping it a healthy and vibrant community is important.”
Terry O’Malley, vice president of human resources at the hospital, and Angie Blair, health education specialist with the Frederick County Health Department, said programs exist to provide guidelines for business. One of the best is Healthiest Maryland Business at firstname.lastname@example.org, they said.
O’Malley suggested the Frederick County Chamber of Commerce, which jointly sponsored the awards, should have someone working full time to help businesses coordinate wellness programs in the community.
AOPA, which won the small-business award, has an aggressive program for weight loss among employees, an initiative for work-life balance and other health-related programs.
Legal and General America is in its first year of wellness programs. The company has seminars on diet and exercise, how to avoid fad diets and how to maintain one’s health in and out of the office.
The U.S. Army Garrison has joined with local parks and recreation departments to get soldiers and employees active. The garrison also uses the Army’s wellness and exercise programs.
Members of the FMH Corporate Honor Roll, which donate to the health organization’s programs, were thanked for their support in the past year.
Read the original article here.
Posted November 7, 2012 by Megan DiMartino
Viewing medical images on smartphones can be an effective way to evaluate stroke patients during telehealth consultations, according to a study published online in the journal Stroke, Clinical Innovation & Technology reports (Godt, Clinical Innovation & Technology, 10/2).
The study was led by researchers at the Mayo Clinic Telestroke Network in Arizona (Versel, MobiHealthNews, 10/3). According to Mayo Clinic officials, the study is the first to test the effectiveness of smartphone-based teleradiology applications in a telehealth network.
For the study, Mayo Clinic neurologists worked with emergency department physicians and radiologists at Arizona’s Yuma Regional Medical Center to compare brain scan images from 53 patients who came to YRMC for stroke treatment (McCann, Healthcare IT News, 10/2).
The physicians compared the quality of medical images when viewed with:
- Desktop computers; and
- An FDA-cleared smartphone application called ResolutionMD.
According to the study, physicians using the two image viewing methods agreed on 92% to 100% of what are considered to be the most important radiological features (MobiHealthNews, 10/3).
Comments on Findings
The study authors wrote that “real-time video-phone neurological examinations and smartphone teleradiology assessments may offer a single mobile health tool with which to expeditiously conduct full telestroke and teleradiology assessments necessary for a complete virtual stroke consultation in a remote environment” (Clinical Innovation & Technology, 10/2).
Bart Demaerschalk — professor of neurology and medical director of Mayo Clinic Telestroke — said, “If we can transmit health information securely and simultaneously use the video conferencing capabilities for clinical assessments, we can have telemedicine anywhere.”
He added that such capabilities are essential in states like Arizona, where more than 40% of residents lack access to immediate neurological care.
Posted November 5, 2012 by Megan DiMartino
By Julie Appleby, KHN Staff Writer
There is no one villain in the battle against rising health care costs. Currently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product. Most years, medical spending rises faster than inflation and the economy as a whole. Many factors — and nearly everyone — contributes to those increases.
Here are seven ways you or your medical providers play a role, based on a recent report from the Bipartisan Policy Center, a think tank in Washington, D.C.
1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.
Most insurers — including traditional Medicare — pay doctors, hospitals and other medical providers under a fee-for-service system that reimburses for each test, procedure or visit. Coupled with a medical system that is not integrated, this encourages overtreatment, including repetitive tests, the report says. New efforts in the federal health law and among some private insurers aim to move payments toward a flat rate for a specific condition, such as a knee replacement, or for a patient’s entire episode of care, in order to streamline costs. Medical systems and doctors are also looking to electronic medical records as a way to improve coordination and reduce unnecessary, repeated tests.
2. We’re growing older, sicker and fatter.
As we get older, we tend to need more medical care. The baby boom generation is heading into retirement, with enrollment in Medicare set to grow by an average of 1.6 million people annually. Additionally, nearly half the U.S. population has one or more chronic conditions, among them asthma, heart disease or diabetes, which drive up costs. And two-thirds of adults are either overweight or obese, which can also lead to chronic illness and additional medical spending.
3. We want new drugs, technologies, services and procedures.
Medical advances can help us get well, avoid disease and delay death, but they also drive up spending. Much new technology comes on the market after being tested only for safety or whether the new treatment is comparable to existing ones or even placebos. Patients and doctors often demand the newest treatments, even if there is little or no evidence that they are better. Prices for newer treatments are often higher than for the products they replace.
4. We get tax breaks on buying health insurance — and the cost to patients of seeking care is often low.
The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care.
5. We don’t have enough information to make decisions on which medical care is best for us.
While medical journals, the Internet and the popular press are awash in health information and studies, professionals and patients find there is no broad standard for evaluating individual treatments, or how specific treatments compare with others. Even when evidence shows a treatment isn’t effective, or is potentially harmful, it can take a long time for that information to actually change how doctors practice or what patients demand, the report says. Additionally, Americans vary widely in how they view end-of- life issues, with some desiring every possible medical intervention to stave off death in every situation, no matter how small the possibility of success.
6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.
While mergers or partnerships among medical providers or insurers may improve efficiency and help drive down prices, consolidation can also have the opposite effect, allowing near-monopolies in some markets and driving up prices, the report says. Increasingly, hospitals are buying up rivals and directly employing physicians, creating larger medical systems.
7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.
Malpractice premiums and jury awards are part of what drives spending. A larger problem, although hard to quantify, is “defensive medicine” — when doctors prescribe unnecessary tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing or unnecessary tests by medical providers seeking to “game the system” are another concern.
Finally, the report notes that state laws sometimes limit the ability of nurse practitioners or other medical professionals, who are paid less than doctors, to fully perform work for which they are trained. The U.S. faces a shortage of primary care doctors, so more advanced practice nurses and others will be needed to help care for patients who gain insurance coverage under the federal health law. Conversely, the U.S. has a higher ratio of specialists than other countries, which can serve to drive up spending. Specialists have more advanced training than primary care doctors, and are paid far more.